The first English medical journal

Introduction

This essay attempts a study of the oldest medical journals published in England. As with us, journals are born, grow and die. It is, at times, difficult to offer a definitive account. I have restricted my study to monthly and weekly journals that remain in publication.

This study has been rewarding in that I unearthed hitherto unknown gems. I have provided a few illustrative examples.

The student of history of medicine would do well to spend time referring to papers published in the early volumes of these pioneering publications. Long-forgotten, classic contributions by individuals whose names are now the stuff of medical legend will be encountered and the reader will marvel at their clinical skills, perspicacity and innovative genius. Those were times when papers were descriptive, often illustrated by woodcut plates and autopsies were essential to the understanding of disease and the efficacy of therapy. Dr Macdonald Critchley, discussing Sir William Gowers’ A manual of diseases of the nervous system, had stated, ‘…anyone who thinks he has stumbled upon something new or obscure should not neglect to search the Manual before claiming originality’.^[1] The same statement can be made about these venerable old tomes.

Considerable merit awaits individuals who mine these journals as Dr Ruth Richardson has done with The Lancet (2006).^[2]

The Early English Journals

The anonymous editors of the first issue of The British Medical Directory (1853), list medical journals being published that year [Figure - 1].^[3]

Figure 1: From The British Medical Directory (1853)

Figure 2: Title page of Medico-Chirurgical Transactions, Volume 1

They state that the oldest medical periodical is Medical and Chirurgical Society's Transactions, published annually from 1812.

Medico-Chirurgical Transactions

In this list, under Monthly, there is no reference to Medico-Chirurgical Transactions published since 1809. This journal deserves attention as it was the progenitor of the Journal of the Royal Society of Medicine. The National Library of Medicine, Bethesda provides the following archival information:^[4]

• J R Soc Med: Vols. 71 to 113; 1978 to 2020
• Proc R Soc Med: Vols. 1 to 70; 1908 to 1977
• Med Chir Trans: Vols. 1 to 90; 1809 to 1907

Let us study the first volume of Medico-Chirurgical Transactions. It was published in 1809. (The third edition of Volume 1 was accessible to me. It was published in 1815.)

In the Preface to this volume, published by the Royal Medical and Chirurgical Society of London, we learn that ‘The want of a Society, founded upon liberal and independent principles, and conducted with the propriety and dignity which are worthy of the medical profession, had been long acknowledged: and a few physicians and surgeons in the year 1805, held a meeting for the purpose of considering the best means by which it might be obviated. They invited many gentlemen of eminence to join them, and thus a Society was formed, which, they soon had the satisfaction to see, comprised a very respectable portion of the professional rank and talent of the metropolis.

‘The present volume is composed of papers which have been communicated to this Society, and read at its meetings. The President and Council submit it to the consideration of the medical public, not without the hope, that it will support the claim of respectability and usefulness, which they are desirous that it should possess.’

The society was realistic in its approach.

‘The papers which come before the Society have necessarily various degrees of value; and in considering their merits with a view to publication, it is wished equally to avoid the extremes of fastidiousness, and want of discrimination. Brilliant discoveries in medicine and surgery, or the branches connected with them, are seldom made; but the observing practitioner has various opportunities of improving the profession, by attention to the facts which come daily within his view, and by the management of the materials which are already in his possession… Cases having a fatal issue, however, are often not less instructive than such as terminate favourably. They frequently tend to point out more accurately the plan to be pursued in the treatment of similar complaints; they afford valuable information relative to the probable causes of failure; and when dissection is permitted, they throw light on the more intimate nature and modification of the disease.’ (‘Dissection’ was the term then used to represent post-mortem examination.)

There was initial uncertainty on the frequency of publication. ‘The particular periods at which the Medical and Chirurgical Society may publish its Transactions, must depend entirely on the quantity of valuable materials in its possession. As it is important, however, not to delay too long the publication of the communications with which the Society may be favoured, it is deemed advisable, rather to publish, within a moderate period, a small volume, than to wait till there is sufficient matter to form a large one…’

Among the founders of the Society were John Abernethy, William Babington, Matthew Baillie, Sir Joseph Banks, Astley Cooper (he was knighted in 1820), Humphrey Davy, John Hunter, Edward Jenner, James Parkinson and Peter Mark Roget. The papers published in the first volume included:

• Two papers on ‘aneurism of the carotid artery’ by Astley Cooper

In the first patient (pp. 1–14), ‘…The tumour (on the right carotid) at this time reached from near the chin beyond the angle of the jaw, and extended downward to within 2 inches of the clavicle…’ Ligation of the artery proximal to the aneurysm was carried out on 1 November 1805. On 8 November, her left limbs, hitherto showing no abnormality, were weak and she was restless and irritable. She was in good spirits the next day and moved her left arm better than on the previous day. ‘The ligatures were drawn from the wound’ on 12 November. The power continued to improve and the aneurism was much smaller. From 17 November onwards, she was irritable, slept poorly, the aneurism was larger and ‘there is great soreness upon the neck’. She was unable to swallow and showed a rapid pulse rate. She died on 21 November. Dissection showed an inflamed aneurysm sac with pus and blood within. The trachea was inflamed. ‘As I could not obtain permission to open the head, the cause of paralysis remains unknown…'

He concluded that earlier surgery, when the aneurism was smaller might have resulted in better results and that as with other arteries, the carotid artery could be safely tied. In a post-script to the report, he noted the subsequent successful ligation of the carotid artery by Mr Travers.

In his second case report (pp. 224–35), he described his experiments in dogs and experiences that justified the ligation of a carotid artery. His second patient had an aneurism ‘the size of a pullet's egg’ on the left carotid artery. The left carotid artery was ligated in the neck and the patient was discharged cured. Eight months later, ‘the tumour has disappeared’ and ‘he has returned to his former employment without any diminution of his mental or corporeal powers…’

• ‘On a diminution, in consequence of Disease, of the Area of the Aperture, by which the left Auricle of the Heart communicates with the Ventricle of the same side’ by John Abernethy
• ‘A case of Hydrophobia; with an Account of the Appearances after Death’

Alexander Marcet, physician to Guy's Hospital, describing this patient, referred to him by Astley Cooper, noted that ‘The pathology of this malady, however, still continues enveloped in the greatest obscurity…’ He prepared this paper as he had the opportunity of ‘inspecting the body after death’. The admirable description of the patient's progress and the therapy offered is provided on a day-to-day basis.

The autopsy findings are detailed. ‘The vessels on the surface of the brain were turgid with blood. Between the pia mater and tunica arachnoides of the left side there was a slight degree of effusion similar to that which is found in cases in which death has been preceded by delirium, but in a less degree. Some of the vessels of the pia mater contained small bubbles of air; but it was doubtful whether this air had not entered the vessels, in consequence of the sawing of the scull [sic]. The ventricles of the brain did not contain more than the usual quantity of serum, nor were there any other morbid appearances of the brain than those above described.'

Given the understanding of the disease at that time, his analysis of clinical and autopsy findings make especially interesting reading. (It is salutary to note that Louis Pasteur was born in 1822 and Dmitri Ivanovsky coined the term virus when studying diseased tobacco plants in 1892.)

• ‘A case of Tumour in the Brain, with remarks on the Propagation of Nervous Influence’ by John Yelloly

  This is a clinical and autopsy report of what may have been a tuberculum meningioma. Diagnosis, treatment, autopsy findings and interpretations and analysis are of considerable historical significance.

• ‘Case of a Fœtus found in the Abdomen of a Boy’ by George William Young

  There is, of course, much, much more to marvel at but we must now turn to another—weekly—journal.

The Lancet

Of the weekly publications, The Lancet, first published on 5 October 1823, appears to be the oldest [Figure - 3]. In 1937, Mr W.R. Lefanu, librarian at the Royal College of Surgeons of England called it ‘…the oldest English medical journal still running in unbroken series…’.^[5]

Figure 3: Title page of The Lancet, Volume 1

Thomas Wakley

This journal was the creation of Dr Thomas Wakley (1795–1862), a general practitioner and a surgeon in London, then 28 years old [Figure - 4].

Figure 4: Portrait of Dr Thomas Wakley

Wakley's biography deserves study. The works by Sprigge (1897),^[6] Jones (2009)^[7] and Richardson (2006)^[2] provide details. The attempt to murder him and the destruction of his home by arson in 1820 and difficulties in obtaining compensation from the Hope Fire Assurance Company must have left deep scars on his mind. William Cobbett (1763–1835) undoubtedly influenced the direction in which Wakley steered his own journal. They were kindred spirits—combative, outspoken, critics of the status quo and willing to stand up to authority.

Under the section Wakley himself in Dr Richardson's book, we learn that Wakley had been a pugilist in his youth. As he matured, he developed ‘a resolute sense of justice and a genial sense of humour’.

‘At the age of 10 he had already worked his way to India and back.' He had obtained his father's reluctant permission. He travelled to Calcutta in an East Indiaman captained by a personal friend of his father. On his return 17 months later, he attended school once again. The floggings and deaths witnessed during the voyages by sea to and fro appear to have proved important in his decision to study medicine and later endeavours for reform. Wakley campaigned in his journal against flogging as a punishment for many years. (See Paul [2017]^[8] for details on this visit to India.)

Jones (2009) recreates in words the setting in which the journal was set up: ‘Early 19th century medicine…was primitive and unregulated. Poorly-trained doctors grappled with diseases of which they knew almost nothing and for which there were no effective treatments. Surgery was barbaric and there were no anaesthetics. Infection was everywhere and standards of hygiene were abysmal. Louis Pasteur was not born until 1822 and Joseph Lister in 1827. Nepotism and patronage were the norm. Body-snatching was rife. Wakley came to London in 1815 and, in 10 years, had begun to change the face of English medicine.‘^[7]

Jones (2009) points out that the journal was unusual from the outset in that it did not represent the interests of a particular group or report the transactions of a medical society.

The first issue of the journal

Presaging the counsel offered by countless subsequent editors, Wakley stated: ‘…we shall exclude from our pages the semibarbarous phraseology of the [medical] Schools, and adopt as its substitute, plain English diction… We hope the age of “Mental Delusion” has passed, and that mystery and concealment will no longer be encouraged.’

Wakley started verbatim reproduction of lectures by such eminent clinicians as Sir Astley Cooper. The report on Sir Astley Cooper's lecture four days earlier (pp. 3–10) was almost conversational [Figure - 5].

Figure 5: Preface to The Lancet, Volume 1, Number 1.

The report ended: ‘At the conclusion of the Lecture, the applause was as enthusiastic as at the beginning.'

The next report in this issue was on Politics and included terms such as ‘the pestilential effluvia of the misnamed Holy Alliance’, ‘staunch partisans of tyranny’, ‘continental despots and their insects in power’ and ‘the official coxcomb, running after wild, impractical schemes regardless of everything but the gratification of his own senseless, remorseless and petty ambition’.

On pages 12–14 are to be found notes on the Drury Lane theatre and the performance of Richard Sheridan's The Rivals and performances at Covent Garden Theatre [Figure - 6].

Figure 6: Extract from the report on Sir Astley Cooper's lecture

Papers such as ‘Case of anasarca successfully treated by acupuncturation’, ‘Case of Hydrocephalus Chronicus (Chronic Water of the Brain) in which pressure proved most beneficial’ and ‘Case in which Hydatids were discharged in considerable quantities from the Intestines’ follow and would command attention even today! Many will also be fascinated by the case report and autopsy findings in ‘Fatal Effects of Fear’ during surgery for a ‘moderate sized aneurism of the femoral artery’ (pp. 28–29).

‘Compositions of quack medicines’ were discussed on page 30. The section entitled ‘Table Talk’ (pp. 30–32) has interesting tidbits including a report on ‘a noted body-searcher (at the time of the plague) whose name was Snacks’ along with an explanation of this unusual name.

An essay on the laureate Robert Southey and a short notice to correspondents brings this issue to a close.

Vintage papers from this journal

We are fortunate in having Dr Ruth Richardson's collection of vintage papers from this journal.^[2] She points out that The Lancet was never intended to serve only as a medical journal but also espoused social ideas and innovation and was boldly independent. At a time when few periodicals survived more than a few months, The Lancet has prevailed.

Dr Richardson tells us that Wakley chose the title for his journal carefully in the hope that ‘…using the quill for purposes similar to those for which surgeons used the lancet, he might, in the body medical, get rid of much that was harmful.’

Wakley ensured that his journal was within the reach of everyone interested in matters concerning health—urban and rural practitioners of medicine, medical students and the public at large. He kept the price at six pence an issue. His provocations for reform in several areas provoked hostility and admiration. At the same time, ‘Wakley always observed the law, even when he knew it to be an ass.’

The Lancet laid ‘the foundations of evidence-based medicine, medical audit and the regulation of the medical profession’ (Jones 2009).^[7]

Coverage of ‘every subject connected with the progress of medical and surgical science, both in this country and on the continent’ ensured that no advance in France, especially Paris, which had gained prominence in medicine, was ignored. The breadth of interest evident in the contents of the journal gained ever increasing numbers of readers. Dr Richardson points out that it was the first periodical in the world to carry chess problems and their solutions!

Wakley was soon able to state that ‘our success has exceeded our most sanguine expectations…’

He was elected Member of Parliament for Finsbury and worked towards the passage of the Medical Act of 1858, which was followed by the foundation of the General Council of Medical Education and Registration.

Wakley remained the editor of The Lancet until his death. He was succeeded by William, his youngest son.

Pulmonary tuberculosis prompted a move to Madeira. Characteristically, while there, Wakley discovered and exposed the export of fake Madeira wine. He planned to return to London but, as is not uncommon in extensive tuberculosis with the consequent development of arteriovenous fistulae in the lungs, he sustained a massive and fatal pulmonary haemorrhage on 16 May 1862.

Wakley's personal honesty, fearlessness and willingness to fight for causes he believed in and his journal helped reform medicine in mid-19th century England. He set an example in medical journalism that remains unique to this day.

British Medical Journal (now BMJ)

Its popularity and accessibility prompted this note on its origins although its first issue saw the light of day only in 1840.

The website of this journal tells us that ‘The BMJ is one of the world's oldest general medical journals. It published its first weekly edition on 3 October 1840 as the Provincial Medical and Surgical Journal (PMSJ) before uniting with the London Journal of Medicine and publishing from January 1853 as the Associated Medical Journal. Four years later in January 1857, this merged journal became the British Medical Journal. The title was shortened to BMJ in 1988, and then changed to The BMJ in 2014.‘^[9]

In the ‘Introductory Address’ on page 1 of the first issue [Figure - 7], we learn that the main objects for which this journal was established were ‘…the maintenance of the honour and respectability of the medical profession…the affording a special means of communication for the several medical and surgical branch associations which have been formed in various parts of the kingdom…the collecting and recording of the numerous facts observed…and… the working out of the rich mines of information and medical instruction—the County Hospitals, Infirmaries and Dispensaries…' The essay concluded, ‘Unaccustomed, as we are, to public speaking, we have to crave indulgence for the manifold imperfections of this our “maiden” effort. We trust, however, that our voice, though it be the voice of an infant, affords some indications of vitality—some prospect of a hale and vigorous manhood. To the kindness of our numerous friends in the provinces we owe much, if not all, of the strength with which we find ourselves thus suddenly clothed…'

Figure 7: Title page of the Provincial Medical & Surgical Journal

The paper in this premier issue of the journal that caught my eye was that entitled ‘On the ligament of the candia equina’ on page 7 [Figure - 8].

Figure 8

Several classic papers first saw the light of day in the pages of this journal and those of its successor. Sir James Young Simpson announced chloroform as an anaesthetic agent. (Provincial Medical and Surgical Journal 1847;s1–11:656); [Figure - 9].

Figure 9

Joseph (later Lord) Lister published his pioneering papers on antisepsis in the British Medical Journal (1867–79); [Figure - 10].

Figure 10

The work of Ronald Ross on the mosquito as the vector for malaria was reported here in 1897 [Figure - 11].

Figure 11: From The British Medical Directory (p. 95)

The randomized controlled trial on streptomycin in the treatment of tuberculosis (1948) and Richard Doll's papers on the correlation between smoking and lung cancer (1950 and 1954) are other examples.

As yet we have no compilation of classic papers from this journal as we have from The Lancet.

Conclusion

I hope I have stirred your curiosity. I promise you long hours of satisfaction and considerable learning as you travel to these times past.