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William Heberden

Born 1710
Died 1801-05-17

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English physician, born 1710, London; died May 17, 1801.

Biography of William Heberden

"the last of the learned physicians"
Samuel Johnson

William Heberden was born in London in 1710 and commenced his studies in that town, but at the age of 14 years entered St. John's College, University of Cambridge. Following a brilliant scholastic career he was six years later elected to the fellowship of his College and then commenced medical studies in Cambridge and London. After qualification - Doctor of Physic - he spent a decade working as a physician and lecturing on materia medica before moving to London to commence clinical practice in 1748.

Heberden was the outstanding clinician of his era and his intellectual brilliance was recognised by his election to fellowship of the Royal College of Physicians in 1746, at the age of 36, and the Royal Society of London thirteen years later, in 1759. He developed a large and successful practice which occupied the next 30 years of his life.

In 1761 he was appointed to the court of George III as personal physician to the queen, a position he was initially inclined to turn down, fearing that it might restrict his daily work, visiting and treating the sick.

Through his whole life he maintained his habit of taking down notes in Latin of anamnesis and status findings in connection with the examination of patients, regardless of where. He then went through them at the end of each month trying to draw more general conclusions from his observations. These meticulously recorded clinical observations, taken down during a long practice, made a unique contribution to the development of medical science.

He spent the last twenty years of his life putting his notes in order and editing them for his Commentaries on the History and Cure of Diseases, been called the last important medical treatise written in Latin, and perhaps an indication of the disuse into which Latin had fallen may be seen in the fact that the work was immediately translated and published in English in the same year as this first edition. The book was enthusiastically received, and the author was compared to Hippocrates.

Heberden wrote this major work at an age where most people have long been members of the Ground Council, or, if still alive, retire from work. In his foreword he reminds of Plutarch's description of the Vestalin virgin, whose life was separated into three periods. The first one devoted to the acquiring of knowledge of the duties of her position, the second devoted to exercising these duties, and the third, to teach them to others. He looked upon his authoring work as the third period of his life, emphasising that Plutarch's description might well serve as an example to the career of physicians.

His most important contributions are his delineations of several disorders which are well recognised today, including angina pectoris and night blindness His descriptions of angina pectoris starts with the words "There is a peculiar disease of the chest." Heberden's description of the symptoms of ischaemia heart disease was first recorded in 1772, but also appeared in his Commentaries on the History and Cure of Diseases published by his son, also William, in 1802, one year after his father's death.

He also differentiated chicken-pox from smallpox, stressing how the former, a mild and unimportant disease, should be distinguished from the latter. He stressed that the person who has had chicken-pox remained immune from further attacks of that disease, but did not comment on cross-immunity from cowpox, which seemed to render some farmhands who had had vaccinia less liable to contract smallpox.

Heberden noted that tuberculosis often improved during pregnancy but not post partum. In 1766 he suggested the establishment of Medical Transactions to the College of Physicians, in which observations on cures and disease could be recorded. His special interest in joint disease is commemorated by the Heberden Society, a group based in Britain and dedicated to the furtherance of rheumatological research.

In 1768 the Royal College of Physicians commenced publishing its transactions under the title of "medical transactions", to a large degree inspired by Heberden. Several of his writings, spanning a broad field of everything from the cleaning of water to philosophy and medicine, may be found in the three first volumes, 1768, 1772 and 1785.

Heberden was a virtuous, religious man with compassion for mankind and he was universally held in great esteem. He had a happy old age and his son, William Heberden the younger (1767-1845) in his biographical notes, commented that "after passing an active life with uniform testimony of good conscience, he became an eminent example of its influence in the cheerfulness and serenity of his latest age." Heberden spent the last years of his life in Windsor, where he died in 1801 at the age of 91 years.

Heberden was called to the bed of Samuel Johnson, the diarist, after he had suffered a stroke. The famous patient then commented on the choice of physician with the words: "Dr. Heberden ultimus Romanorum - the last of our learned physicians". Heberden was a very religious man and a leading Latin and Hebrew scholar.

His son translated his commentaries on the history and cure of diseases from the original Latin into English and both versions were published in 1802, one year after his death. William Heberden Jr. wrote an Epitome of paediatrics.

In chapter 28 of Commentaries on the History and Cure of Diseases, William Heberden gave the following account of "digitorum nodi" which are now known as Heberden's nodes:

    "What are those little hard knobs, about the size of a small pea, which are frequently seen upon the fingers, particularly a little below the top, near the joint? They have no connection with the gout, being found in persons who never had it; they continue for life; and being hardly ever attended with pain, or disposed to become sores, are rather unsightly, than inconvenient, though they must be some little hindrance to the free use of the fingers."
It is evident that Heberden had recognised that the nodes differed from gout tophi. Thereafter his name was attached to them and they became regarded as a component of a form of osteo arthritis. Dominant inheritance in females, with recessive inheritance in males, was proposed by Stecher (1955) but this remains a matter for speculation.

    «There is a disorder of the breast marked with strong and peculiar symptoms, considerable for the kind of danger belonging to it, and not extremely rare, which deserves to be mentioned more at length. The seat of it, and sense of strangling, and anxiety with which it is attended, may make it not improperly be called angina pectoris.
    They who are afflicted with it, are seized while they are walking, (more especially if it be up hill, and soon after eating) with a painful and most disagreeable sensation in the breast, which seems as if it would extinguish life, if it were to increase or to continue; but the moment they stand still, all this uneasiness vanishes.»
    [On the syndrome he named without knowledge of the coronary mechanisms]
    Commentaries on the History and Cure of Diseases. Chapter 70.

    «Cancers of the tongue and mouth begin with a small hard lump, and sometimes with a little sore; both of which are attended with pricking pains, and they spread in the same manner with cancerous sores in other parts. This is so great an evil, that the slightest suspicion of it occasions very great uneasiness.»
    Commentaries on the History and Cure of Diseases. Chapter 56.

    «Swellings of the ankles or legs towards evening, which vanish, or are greatly lessened in the morning, are very common in women while they are breeding, and in hot weather.»
    Commentaries on the History and Cure of Diseases. Chapter 48.

    «Where persons after having laboured for some time under complaints of the lungs, or of the bowels, begin to find a swelling in the legs, it is a sign of some deep mischief in the breast or abdomen, the swelling will most probably increase to a just dropsy, and the case end fatally.»
    Commentaries on the History and Cure of Diseases. Chapter 48.

    «The Dysentery is common in camps.
    Commentaries on the History and Cure of Diseases. Chapter 31.

    «There has lately been established in several of the London hospitals, a plan of courses of lectures in all the branches of knowledge useful to a student of physic. Such plans, if rightly executed, as I have no reason to doubt they will be, must make London a school of physic superior to most in Europe. The experience afforded in an hospital will keep down the luxuriance of plausible theories. Many such have been delivered in lectures, by celebrated teachers, with great applause; but the students, though perfectly masters of them with what nature exhibits in an hospital, have found themselves more at a loss in the cure of a patient than an elder apprentice of an apothecary.»
    Letter to Dr. Thomas Percival, October 15, 1794.

    «Lord Verulam* blames physicians for not making euthanasia a part of their studies: and surely though the recovery of the patient be the grand aim of their profession, yet where that cannot be attained, they should try to disarm death of some of its terrors, and if they cannot make him quit his prey, and the life must be lost, they may still prevail to have it taken away in the most merciful manner.»
    Commentaries on the History and Cure of Diseases. Chapter 51.
    * Sir Francis Bacon (1561-1626).

    «A bad state of health is often joined with a fistula ´ani, and the mischief, after the cure of the ulcer, has many times fallen upon other parts, and particularly the lungs, and has brought on asthmas, spittings of blood, and consumption.»
    Commentaries on the History and Cure of Diseases. Chapter 40.

    «Various distempers in certain ages and countries have had the fashion on their side, and have been thought reputable and desirable: other, on the contrary, have been reckoned scandalous and dreadful. . . . Some maladies have been esteemed honourable, they have accidentally attacked the great, or because they usually belong to the wealthy, who live in plenty and ease. We have all hear of the courtiers who mimicked the wry neck of Alexander the Great; and when Lewis XIV happened to have a fistula, the French surgeons of that time complain of their being incessantly teased by people, who pretended, whatever their complaints were, that they proceeded from a fistula: and if there had been in France a mineral water reputed capable of giving it them, they would perhaps have flocked thither as eagerly as Englishmen resort to Bath in order to get the gout. For this seems to be the favourite disease of the present age in England; wished for by those who have it not, and boasted of by those who fancy they have it, though very sincerely lamented by most who in reality suffer its tyranny. Hence, by a peculiar fate, more pain seems to be taken at present to breed or produce the gout, than to find out its remedy.»
    Commentaries on the History and Cure of Diseases. Chapter 9.

    «The gout most usually begins with a pain in the first joint of the great toe, which soon looks very red, and after a little while begins to swell. The violence of the first pain seldom lasts twenty-four hours; but before it has quite ceased, another begins in the same, or some other part, where it continues as long. A succession of similar pains makes up a whole fit of the gout.»
    Commentaries on the History and Cure of Diseases. Chapter 9.

    «There will a first be an interval of two or three years, or more, between the fits; but after some time they will be repeated once or twice every year. The attacks of an old gout are less painful, but of longer continuance, and are attended with a greater and more lasting weakness. Most gouts continue to return to the end of life. I never knew a certain instance of their beginning before the years of puberty.»
    Commentaries on the History and Cure of Diseases. Chapter 9.

    «The gout affords a striking proof of the long experience and war attention necessary to find out the nature of diseases and their remedies. For though this distemper be older than any medical records, and in all ages so common; and besides, according to Sydenham, chiefly attack men of sense and reflexion, who would be able, as well as willing, to improve every hint which reason or accident might throw in their way; yet we are still greatly in the dark about its causes and effects, and the right method in which it should be treated.»
    Commentaries on the History and Cure of Diseases. Chapter 9.

    «The pains . . . are for the most part transmitted to the descendants of those who have suffered in any considerable degree.»
    Commentaries on the History and Cure of Diseases. Chapter 9.

    «This state [which] I call the hypochondriac affection in men, and the hysteric in women, . . . is a sort of waking dream, which, though a person to be otherwise in sound health, makes him feel symptoms of every disease; and, though innocent, yet fills his mind with the blackest horrors of guilt. Commentaries on the History and Cure of Diseases. Chapter 49.

    «Hypochondriac complaints resemble the gout, and madness, and consumptions, in their not appearing before the age of puberty.»
    Commentaries on the History and Cure of Diseases. Chapter 49.

    «Great anxiety of mind, whatever may have been its origin, is a principal cause of insanity, that is, a disordered understanding with a quite pulse and without any acute illness. It has been the consequence of some diseases, particularly of worms, and epileptic fits, and of many affections of the head, as dropsies of the ventricles of the brain, and scirrhous tumours, and also of blows.»
    Commentaries on the History and Cure of Diseases. Chapter 53.

    «A violent itching of the skin without any eruption is familiar to the jaundice, and adds sometimes to the discomforts of old age.»
    Commentaries on the History and Cure of Diseases. Chapter 23.

    «The most dangerous ischuria is that, in which the kidneys secrete no urine from the blood.»
    Commentaries on the History and Cure of Diseases. Chapter 55.

    «On affections of the liver, haemorrhoidal bleedings are very common.
    Commentaries on the History and Cure of Diseases. Chapter 44.

    «Men are more commonly affected with scirrhous livers than women, because they are more given to intemperate drinking, which is the principal cause of this disorder.»
    Commentaries on the History and Cure of Diseases. Chapter 50.

    «The power of moving in every part of the body by means of the muscles which obey the will, or by means of others the actions of which are involuntary; the various perceptions by the five external senses; and lastly those mental powers named memory, imagination, attention, and judgement, together with the passions of the mind; all these seem to be exercised by the ministry of the nerves; and are impaired, disturbed, or destroyed, in proportion to an injury done to the brain, the spinal marrow, and nerves, not only by their peculiar diseases, of which we know little, but by contusions, wounds, ulcers, and distortions, and by many poisons of the intoxicating kind.
    Commentaries on the History and Cure of Diseases. Chapter 69.

    «The hysteric globe in the throat is scarcely ever heard among men, but is one of the most familiar symptoms with hysteric women.»
    Commentaries on the History and Cure of Diseases. Chapter 49.

    «The love of life, or fear of death, makes most men unwilling to allow that their constitution is breaking; and for this reason they are ready to impute to any other cause what in reality are the signs of approaching and unavoidable decay.»
    Commentaries on the History and Cure of Diseases. Chapter 9.

    «Women during the state of pregnancy, and just after the menses have finally left them, are peculiarly subject to the piles.»
    Commentaries on the History and Cure of Diseases. Chapter 44.

    «Plutarch says that the life of a vestal virgin was divided into three portions; in the first she learned the duties of her profession, in the second she practiced them, and in the third she taught them to others. This is no bad model for the life of a physician: and as I have now passed through the two first of these times, I am willing to employ the remainder of my days in teaching what I know to any of my sons who may choose the profession of physic.»
    Commentaries on the History and Cure of Diseases. Preface.

    «I please myself in thinking that the method of teaching the art of healing os becoming every day more conformable to what reason and nature require; that the errors introduced by superstition and false philosophy are gradually retreating; and that medical knowledge, as well as all other dependent upon observation and experience, is continually increasing in the world. The present race of physicians is possessed of several most important rules of practice, utterly unknown to the ablest in former ages, not excepting Hippocrates himself, or even Aesculapius.»
    Letter to Dr. Thomas Percival, October 15, 1794.

    «I have entered my eighty-fifth year; and when I retired a few years ago from the practice of physic, I trust it was not a wish to be idle, which no man capable of being usefully employed has a right to be; but because I was willing to give over before my presence of thought, judgment and recollection was so impaired that I could not do justice to my patients. It is more desirable for a man to do this a little too soon, than a little too late; for the chief danger is on the side of not doing it soon enough.» Letter, 1794.

    «The rheumatism is a common name for many aches and pains, which have yet got no peculiar appellation, though owing to very different causes.»
    Letter to his son, November 28, 1765.

    «The epilepsy may be called the reproach of physicians as well as the gout, for it was well known before the writing of the most ancient medical books, and yet no certain method of cure has been discovered.»
    Commentaries on the History and Cure of Diseases. Chapter 33.

    «The fit makes the patient fall down senseless; and without his will or consciousness presently every muscle is put in action, as is all the powers of the body were exerted to free itself from some great violence. In these strong and universal convulsions, the urine excrements, and seed, are sometimes forced away, and the mouth is covered with foam, which will be bloody, when the tongue has been bitten, as it often is in the agony.»
    Commentaries on the History and Cure of Diseases. Chapter 33.

    «The inability to speak is owing sometimes not to the paralytic state of the organs of speech only, but to the utter loss of the knowledge of language and letters; which some have quickly regained, and others have recovered by slow degrees, getting the use of the smaller words first, and being frequently unable to find the word they want, and using another for it of a quite different meaning, as if it wee a language which they had once known, but by long disuse had almost forgotten.»
    Commentaries on the History and Cure of Diseases. Chapter 69.

    «Lastly, where there is no room for anything else, there is the duty of a physician to exert himself as much as possible in supporting the powers of life, by strengthening the appetite and digestion, and by providing that the stools, and sleep, and every other article of health, shall approach as nearly as may be to its natural state.»
    Commentaries on the History and Cure of Diseases. Chapter 2.

    «New medicines, and new methods of cure, always work miracles for a while.
    Commentaries on the History and Cure of Diseases. Chapter 2.

    «No aphorism of Hippocrates holds truer to this day, than that in which he laments the length of time necessary to establish medical truths, and the danger, unless the utmost caution be used, of our being misled even by experience.»
    Commentaries on the History and Cure of Diseases. Chapter 13.

    «Consumptive women readily conceive, and during their pregnancy the progress of the consumption seems to be suspended; but as soon as they are delivered, it begins to attack them with redoubled strength; the usual symptoms come on, or increase with great rapidity, and they very soon sink under their distemper.»
    Commentaries on the History and Cure of Diseases. Chapter 43.

    «Dissections of those who have died of pulmonary consumptions, have acquainted med, that their lungs are full of little glandular swellings, many of which are in a state of suppuration.»
    Commentaries on the History and Cure of Diseases. Chapter 72.

    «In England we have very little apprehensions of the contagious nature of consumptions; of which in other countries they are fully persuaded. I have not seen proof enough to say, that the breath of a consumptive person is infectious; and yet I have seen to much appearance of it, to be sure that it is not; for I have observed several die of consumptions, in whom infection seemed to be the most probable origin of their illness, from their having been the constant companions, or bed-fellows, of consumptive persons.»
    Commentaries on the History and Cure of Diseases. Chapter 72.

    «The phthisis pulmonum usually begins with a dry cough, so slight and inconsiderable, that little or no notice is taken of it, till its continuance, and gradual increase, begin to make it regarded. Such a cough has lasted for a few years without bringing on other complaints... It has sometimes wholly ceased, and after a truce of a very uncertain length it has returned, and after frequent recoveries and relapses the patient begins at last to find an accession of other symptoms, which in bad cases will very soon follow the appearance of the first cough. These are shortness of breadth, hoarseness, loss of appetite, wasting of the flesh and strength, pains in the breast, profuse sweats during sleep, spitting of blood and matter, shiverings succeeded by hot fits, with flushings of the face, and burning of the hands and feet, and a pulse constantly above ninety, a swelling of the legs, and an obstruction of the menstrua in women; a very small stone has sometimes been coughed up, and in the last stages of this illness a diarrhoea helps to waste the little remainder of flesh and strength.
    Commentaries on the History and Cure of Diseases. Chapter 72.

    «The signs of a stone in the bladder are, great and frequent irritations to make water, a stoppage in the middle of making it, and a pain with heat just after it is made; a tenesmus, pain in the extremity of the urethra, incontinence or suppression of urine, together with a quiet pulse, and the health in no bad state.»
    Commentaries on the History and Cure of Diseases. Chapter 16.

    «Very pale urine, unless the patient have drunk a great quantity of small liquors, is a bad sign of fevers, and it is very desirable to see it become thick, and deposit a sediment.»
    Commentaries on the History and Cure of Diseases. Chapter 37.

    «A total suppression has lasted seven days, and yet the patient has recovered. It has been fatal so early as on the fourth day. But in general those patients, who could not be cured, have sunk under their malady on the sixth or seventh day.»
    Commentaries on the History and Cure of Diseases. Chapter 55.

    «Whatever probability there may be, that the bladder is empty, and that the disease is in the kidneys, it will still be advisable in every suppression to make the matter certain by the introduction of a catheter.»
    Commentaries on the History and Cure of Diseases. Chapter 55.

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