William Stokes

William Stokes was the leading representative of the Irish, or Dublin, school of anatomical diagnosis, which emphasized clinical examination of patients in forming a diagnosis.

Stokes received no formal education. His grandfather was a professor of mathematics and his father was Whitley Stokes (1763-1845), a respected physician and Regius professor of medicine at Dublin University. However, he left the established church to follow the teachings of the reverend John Walker, the so-called Walkerite sect. As a result his father resigned from his fellowship of Trinity College and would not expose his son to a society which he believed did not follow the scriptures accurately. So although born in Dublin he spent most of his early life at his father’s country house in Ballinteer in the Dublin hills and learnt the ballads of Sir Walter Scott (1771-1832) by heart. Scott latter remained one of his favourite authors.

As he grew older he helped his father in the laboratory and rambled with him through the countryside and saw patients with him. His father had initiated teaching in the natural sciences at Trinity College and lectured on these subjects there from 1806 onwards. Furthermore, his father’s Dublin household was visited by numerous intellectuals such as George Petrie, an artist, archaeologist and musician, whose biography he was to write. Henry Grattan (1746-1820), leader of the movement that forced Great Britain to grant legislative independence to Ireland in 1782; James Martineau (1805-190), the Unitarian pastor and scholar; and O’Connor, the Irish landscape painter. The reverend John Walker acted as a private tutor and from him he learned the classics and mathematics.

Stokes enrolled in the College of Surgeons School in Ireland in 1821, in a course of anatomy where his father had succeeded John Cheyne as professor of medicine. Initially he was interested in chemistry, and went to Glasgow University to study this under the professor of chemistry there, Thomas Thompson. After two years, however, he decided to switch to medicine and went to Edinburgh where he made friends with professor William Pulteney Alison (1790-1859) and Dominic John Corrigan (1802-1880). Stokes graduated M.D. in 1825 with the dissertation De ascite.

In 1825 Stokes also became a Licentiate of the King and Queen’s College of Physicians, and a clinical instructor. When his father resigned from Meath Hospital in Dublin in 1826 he was elected in his place, and also became physician to the Dublin County Infirmary. A close friend and colleague of his at Meath Hospital was Robert James Graves (1797-1853).

He continued the educational reforms introduced at Meath by Robert Graves a few years earlier. Stokes encouraged students to gain clinical experience by working, under faculty supervision, in hospital wards; he also urged them to acquire a general as well as a medical education to provide a basis for independent judgment.

Stokes was a pioneer in the new methods of clinical diagnosis popularised by the Parisian school of anatomical diagnosis and was leader of the movement in Dublin. He introduced the stethoscope to the medical school and this innovation caused much comment, often sarcastic, rather than laudatory. His book, An introduction to the use of the stethoscope, was the first on this topic in English.

During the Dublin epidemic of typhus in 1826 he worked amongst the poor, and in fact developed the disease himself in 1827.

In 1832 Stokes had the opportunity of ascertaining the first cholera case in Ireland. In 1843 he succeeded in his efforts to occasion an amendment of the Sir James Graham’s (1792-1861) Medical Charities Bill, as well as the founding of a chair in public medicine and state pharmacology at the Trinity College.

Although he was by this time a well established and well-liked physician, the College of Physicians could not make him a fellow because he had not graduated in arts, and his medical degree had been obtained in Edinburgh and not Dublin. This was finally circumvented by Trinity College awarding him an honorary M.D. and Stokes was admitted to fellowship. Upon the death of his father in 1845, he was confirmed as Regius professor of medicine at Dublin University.

Stokes was president of the King and Queen’s College from 1849-1850, 1858-1877 represented Ireland in the General Medical Council, 1867 president of the British Medical Association, 1874 of the Royal Irish Academy. He was also the founder of the famous Pathological Society in Dublin (1838) and its life-long secretary.

Stokes was one of the first physicians who ever received the Prussian Order Pour le Mérite, which had been established by Frederick II of Prussia, at whose court French was the only accepted language.

Stokes is said to have commented “my father left me but one legacy, the blessed gift of rising early.”

His son, Sir William Stokes (1839-1900) became a distinguished physician and was knighted 1886. His great-grandson was the distinguished bacteriologist and pathologist Adrian Stokes (1887-1927).

Stokes published more than a hundred scientific works, but the two most important were A Treatise on the Diagnosis and Treatment of Diseases of the Chest, published in 1837, and The Diseases of the Heart and Aorta, published in 1854.

• De ascite. Doctoral dissertation. Edinburgh, 1825.
• A Treatise on the Diagnosis and Treatment of Diseases of the Chest. Part 1. Diseases of the lung and windpipe.
  Dublin, Hodges and Smith, 1837, 1839. Philadelphia, A. Waldie, 1837, 1844.
  German translation by Gerhard von dem Busch (1791-1868), Bremen, 1838; Leipzig, 1844.
• The Diseases of the Heart and Aorta.
  Dublin, Hodges & Smith, 1854. Philadelphia, 1854, 1855. Italian, Torino, 1857.
  Cheyne-Stokes respiration is described on pages 320-327.
  The first description of paroxysmal tachycardia is on page 161.
  French translation, by Sénac, Paris, 1864.
  German by Joseph von Lindwurm (1824-1874): Handbuch der Krankheiten des Herzens und der Aorta. Würzburg, 1855 (54?).
• Lectures on fever. London, 1874; Philadelphia, 1876.
• An Introduction to the Use of the Stethoscope, with its application to the Diagnosis in Diseases of Thoracic Viscera.
  The Lancet, London, 1825: 471-475.
  Edinburgh, Maclachlan & Stewart, 1825.
  London, Baldwin & Co., 1825.
• Clinical Reports of the Medical Cases in the Meath Hospital.
  With Robert J. Graves. Edinburgh, 1827.
• Lectures on the Theory and Practice of Physic. Philadelphia, 1837.
  American edition of a paper first published in the Dublin Journal of Medical and Chemical Sciences. 2nd edition, Edinburgh, 1838. New American edition with numerous remarks and 12 new lectures by John Bell, Philadelphia, 1840; German translation, Leipzig, 1835, 1839.
• Researches on the State of the Aorta and the Use of Wine in Typhus Fever.
  Dublin, 1839; Philadelphia, 1839.