Doctor's Review: Medicine on the Move

August 17, 2017
Bookmark and Share

Piercing The Lancet

The famous medical journal was the brainchild of a radical reformist

The Lancet is arguably the world’s most storied – and perhaps even most influential – medical journal. Though it ranks just behind The New England Journal of Medicine in terms of impact factor, physicians around the world have been turning to The Lancet for the reporting of research and the dissemination of crucial medical information since its founding in 1823 by English surgeon Thomas Wakley.

When Canadian medical schools began to emerge during the first half of the 19th century, they were founded mostly by physicians who emigrated from Great Britain and the United States, who surely brought with them their own tattered copies of The Lancet. Wakley introduced our first generations of homegrown physicians to the latest breakthroughs in medicine as well as the beginnings of evidence-based research. Through the simple act of printing the transcriptions of lectures, he disseminated the ideas of London’s brightest minds to the medical world.

Although “new” copies of the weekly journal would have actually been quite old by the time they made their way across the Atlantic, The Lancet brought with it from the drawing rooms of the Old World to the classrooms of the New World revolutionary ideas of medical reform. Indeed, it was the ardent desire for change and improvement in the practice of medicine everywhere that was the primary goal of its founding editor, himself a controversial figure in British medicine and politics.

BORN TO MAKE TROUBLE

Born in Devon on July 11, 1795, Thomas Wakley was the youngest boy of his parents’ 11 children. His father was a wealthy farmer, horse breeder and landowner, and so lucky Thomas was afforded the chance to pursue an education in London. He set his sights on medicine – having apprenticed with an apothecary as a teen – and graduated from the United Hospitals of Guy’s and St. Thomas’s.

By the tender age of 22, he was a member of The Royal College of Surgeons, had a rich young bride on his arm, a powerful father-in-law and a practice in tony Argyll Street. Though somewhat of a hot-head, Wakley was well on his way to a life of privilege until a disastrous case of mistaken identity set him on an entirely different path.

One the night of August 27, 1820, some men came to Wakley’s door, claiming to have a message for him. When he turned his back to get them a drink, they stabbed him, beat him and set his house on fire. Though Wakley escaped, his house was destroyed. Though never proven, it seems the men believed they were avenging the executions of the so-called Cato Street Conspirators – a group of five who’d recently been tried, hanged and then publicly decapitated for their attempt to assassinate the Prime Minister and his entire Cabinet. A newspaper report wrongly stated that the skilled head-hacker who had impressed the blood-thirsty crowd with his near-medical precision was “a young surgeon of Argyll Street.”

To add insult to injury, Wakley’s insurer refused to pay for the damages, claiming that he has burned his own house down as evidenced by the fact that he had (coincidentally) upped his coverage not long before. Not one to back down, Wakley took the matter to court. During the trial, while his reputation was up in the air, he worked in a poorer part of London, encountering for the first time the medical and social issues of the working classes. Eventually, he won a large settlement against the insurance company.

LOVING THE LAW

The experience opened Wakley’s eyes to the world of injustice as well as the power of the law to correct it. He felt that one man could make a difference if he was willing to put himself out there, and from that point on, he committed himself to the pursuit of justice. Throughout his life, he campaigned tirelessly not only for medical improvements, but also for the rights of the working classes and all types of humanitarian reform.

In 1821, he met a politically minded journalist and budding politician named William Cobbett. After hanging around Cobbett and his radical friends for awhile, Wakley became convinced that a new sort of publication would be just the thing to reform the medical profession and give him a platform to share his views and enlighten the world.

Wakley founded the medical journal for which he would become famous in 1823. As for the unusual name he chose for his new publication, Wakley offered the following as explanation: “A lancet can be an arched window to let in the light or it can be a sharp surgical instrument to cut out the dross and I intend to use it in both senses." From the first printing of a few hundred copies, circulation quickly grew to 4000 copies a week by 1830.

Right off the bat, Wakley began to criticize the Royal College of Surgeons, calling for new professional standards, higher qualification requirements for physicians, and a centralized management of doctors, surgeons and pharmacists. Not surprisingly, he piled up plenty of enemies along the way, especially considering his zeal for publishing vivid accounts of botched surgeries and outing those who committed the most egregious of medical mistakes. Fortunately, Wakley had a libel lawyer on call from day one... and it wasn’t too long before his services were required.

A BOTCHED BLADDER

In 1825, Wakley ran a scandalous article describing an ill-conceived and woefully executed surgery gone dreadfully wrong. The case was that of Dr Bransby Cooper – famously incompetent nephew of the great Dr Astley Cooper, one of London’s leading surgeon and medical professors – who thought it would be a good idea to remove his patient’s bladder stones via a large incision in his scrotum.

As the surgery went from bad to worse, Cooper panicked and things devolved from there. It took the unlucky patient a while to die, and Cooper tried to cover the whole thing up. Wakley interviewed his operating-room team and brought the whole mess to light. When Cooper sued, Wakley’s lawyers made short work of him, marking The Lancet and its editor as a serious force to be reckoned with.

From that point on, Wakley pretty much spent his life in litigation, both as plaintiff and defendant. The case opened his eyes to the potential dangers of nepotism within the profession and renewed his passion to fight for higher standards in the hopes of safeguarding the rights of patients and improving their access to quality medical care, especially for those who could afford it the least. He consistently called attention to the fact that the “poor” hospitals had yet to adopt the sanitary standards known to reduce mortality and disease, while the wealthy enjoyed the benefits of the most modern medical thinking. Despite Wakley’s earnestness, the fight against medical and humanitarian abuses was a slow process.

Impassioned by his beliefs – and frustrated by the pace at which his efforts to shake up the College of Surgeons were moving – Wakley set his sights on politics. He ran as a radical and was elected Member of Parliament for Finsbury, a seat he held until 1852. He fought for medical coronerships, and especially advocated inquests into the deaths of those who died in police custody. In 1839 he became Coroner for Middlesex County, and encountered a cause of death that spurred him to action once again: flogging. Still used by the British Army as a punishment, flogging was proven by Wakley to be the cause of death in a case involving a young soldier named James White. The subsequent inquest turned the tide of public opinion against the cruel practice, though flogging was not officially abolished until the Army Act of 1881.

ADULTERATION OF FOODSTUFFS

Among Wakley’s other notable campaigns for social reform was his successful attempt to expose the dangers of the adulteration of foodstuffs. He developed a council to test at the microscopic level many of the foods and drinks available in London at the time. Coffee, for example, was being cut with chicory, flour and beans. Investigations into sugar, tobacco, bread and others soon followed. Crooked merchants and distributors guilty of repeat offenses found their names published in The Lancet. Wakley’s Adulteration Act of 1860 was eventually passed into law, guaranteeing the purity of foodstuffs.

Wakley was also an outspoken opponent of slavery, a supporter of suffrage and, though a devout Anglican, he campaigned against Lord’s Day Observance. With the six-day workweek, he argued, working men were unable to visit merchants, stores, museums and zoos if they were closed in Sundays – yet another form of economic and cultural discrimination against the poor.

He despised the Newspaper Stamp Act, too, which made newspapers prohibitively expensive and therefore available only to the upper classes. Repealing the notorious Poor Law Amendment Act of 1834 – which created deliberately deplorable and dangerous workhouse conditions as an ill-conceived attempt to encourage the poor to seek gainful employment elsewhere – was also on the top of Wakley’s to-do list. Through it all, he used his editorship at The Lancet as a platform from which to spread his views and incite debates into social and medical reform at every level of society.

NOTABLE FIRSTS

Among some of the most significant moments in the journal’s nearly two-century history have been the publication of the first successful blood transfusion by Blundell (1829); Lister’s theory of antisepsis (1867); Rivers’s description of shell shock, the precursor of PTSD (1918); the link between thalidomide and birth defects (1961); the first description of foetal alcohol syndrome (1973); the announcement of the first “test tube baby” (1978); the identification of Creutzfeldt-Jakob syndrome (1996); and the causative agent of SARS (2003).

Along the way, some somewhat less-than-proud moments have occurred as well. The most significant of these was perhaps last year’s retraction of Andrew Wakefield’s fraudulent research into the links between autism and the MMR vaccine.

Dr Thomas Wakley died from what were probably complications of tuberculosis on May 16, 1862, after falling during his retirement in Madeira, Portugal. The helm of The Lancet was subsequently passed on to his younger son James, then his older son Thomas, and, eventually, his grandson “Young Tom” Wakley. When he died in 1909, the Wakleys’ editorial run finally came to an end, although their legacy proudly lives on.

This article was accurate when it was published. Please confirm rates and details directly with the companies in question.

Comments

Post a comment