Robin Agnew, MA, MD (Dubl), FRCP(Irl)
Emeritus Consultant Chest Physician of Liverpool, United Kingdom (Summer 2014)
|Portrait of John Forbes MD as a physician in Chichester
Courtesy of the Postgraduate Medical Centre
St. Richard’s Hospital, Chichester, West Sussex
Sir John Forbes, the remarkable Scottish royal physician and medical journalist, died on 13 November 1861.
He was not an innovator like the great French physician René Laȅnnec (1781-1826), who invented the monaural stethoscope in 1816. This consisted of a crude cylinder that could be applied directly to the chest in order to listen to the sounds of the heart and lungs. Forbes wrote an English translation of Laȅnnec’s classical work on auscultation first published in 1819.1 This was written when Forbes was practising at the Public Dispensary in Penzance in Cornwall and appeared in 1821.2
Forbes was criticised for altering the terminology of Laȅnnec’s original description of the lung sounds but his translation was a great success, inspiring three further editions in 1827, 1829, and 1834. The latter were published after he moved to Chichester, West Sussex, in 1822. The translations helped to spread Laȅnnec’s teaching on stethoscopy to the English-speaking world.
In 1824 Forbes published the results of his further experience with auscultation, as well with percussion of the chest.3 He described thirty-nine patients treated by himself in Chichester, in many of whom the vital physical signs were verified at autopsy. This was a major innovative publication, which echoed the pioneer methodology of the Irish physician Robert Graves (1796-1853) at the Meath Hospital in Dublin. This interrelationship of physical signs and symptoms in life with pathological findings at autopsy was a major diagnostic advance.
The first section of fifty-nine pages is a translation of Auenbrugger’s original treatise on percussion of the chest into English. There follows a Selection of the more important Commentaries of Corvisart on that work, the first published in 1761 and the latter in 1808. The technique of percussion is described in detail, including a patient with a pleural effusion whose symptoms included orthopnoea and with signs of dullness on percussion on the affected side.4
On mediate ausculation
The early model of Laennec’s stethoscope is illustrated on the back pages of Original Cases…in which the printer has transposed Plates II and III. Forbes describes the wooden cylinder used for mediate auscultation “called the Stethoscope.”5 He points out the correct method for the applying the cylinder to the chest wall and differentiates the models to be used for listening to the heart as opposed to the breath sounds: “On all occasions, the cylinder should be held in the manner of a pen and the hand of the observer should be placed very close to the body of the patient, to insure [sic] the correct application of the instrument.”6
Cases with dissection and remarks
This is the principal part of the book: it contains descriptions of the case histories and physical signs of thirty-nine patients seen personally by Forbes between 1821 and 1824. In fifteen fatal cases, the stethoscopic signs were verified at autopsy, usually performed by himself. This was a new approach.
There were thirty male and nine female patients, mostly aged 30-50. Case IV was first seen at Penzance Dispensary on 21 September 1821 when she was aged 30. She was one of the first patients in whom Forbes used the stethoscope for diagnosis.7
The APPENDIX to Original Cases is an essay on the physical signs in the diagnosis of diseases of the chest by a young Parisian physician named Victor Collin. (Born in 1796 and thought to have died in the early 1830s.)8 Forbes believed it might be useful in teaching medical students.
John Forbes was elected to the Fellowship of the Royal Society in 1829. He continued as a physician in Chichester, where he commenced a second career in medical journalism in 1832. After leaving Sussex in 1840 he extended this in London. In 1841 he was appointed Physician to the Royal Household. He became sole editor of the British & Foreign Medical Review until its demise in 1848. His editorship enhanced the reputation of British medicine in Europe and in America.9 In 1846, he was appointed Consultant Physician to the Brompton Hospital and was considered to be “one of the first authorities in England on consumptive cases.”10 His services as Court Physician were rewarded by a knighthood in 1853.
In 1859, after suffering several minor strokes, he retired to live at the home of his only son, Alexander Clark Forbes (1824-1901) at Whitchurch-on-Thames in Oxfordshire.11 He died peacefully just before his seventy-fourth birthday on 13 November 1861 and is buried in the local churchyard.12
I am grateful to Simon Riley for help in inserting the image of John Forbes into the text.
- Laënnec RTH. De L’Auscultation Médiate; ou Traité du diagnostic des maladies des poumons et du coeur, fondé principalement sur ce moyen d’exploration. 2 vols. Paris: Brosson et Chaudé, 1819.
- Forbes J. A Treatise on the Diseases of the Chest in which they are described according to their Anatomical Characters, and their Diagnosis established on a new principle by means of Acoustic Instruments. London: T & G Underwood, 1821.
- Forbes J. Original Cases with Dissections and Observations illustrating the use of the Stethoscope and Percussion in the Diagnosis of Diseases of the Chest; also commentaries on the same subjects selected and translated from AVENBRUGGER [sic], CORVISART, LAENNEC and others. London: T & G Underwood, 1824.
- Ibid. p. 47.
- Ibid. p.68.
- Ibid. p. 68.
- Agnew RAL. Heart Failure in Penzance: A Cornish enigma. Vesalius 2001; xvii (1): 35.
- Personal communication Bernadette Molitor. Service d’histoire de la médicine, Bibliothèque Interuniversitaire de Médicine, Paris.
- Agnew RAL. The Life of Sir John Forbes (1787-1861). Bramber, West Sussex: Bernard Durnford Publishing, 2009, p.38.
- Barker J. The Brontës. London: Abacus. An imprint of Little, Brown Book Group, 2010, p. 690.
- Agnew RAL. John Forbes FRS (1787-1861). James Lind Library Library, 2009, p.4.
- Agnew RAL. Forbes, Sir John (1787-1861). Oxford Dictionary of National Biography: Oxford University Press, 2012, p. 3.
The above is an abridged version of A memoir of Sir John Forbes (1787-1861), Journal of Medical Biography in the press and is submitted by kind permission of Sage Publications, UK.
ROBIN AGNEW, MA, MD (Dubl), FRCP(Irl), is Emeritus Consultant Chest Physician of Liverpool. He is a member of the British and International Societies for the History of Medicine, the Liverpool and Welsh Medical History Societies, and a Retired Fellow of the Royal Society of Medicine of London. His books, The Life of Sir John Forbes (1787-1861) and Lightfoot Winds (on the naval career of Forbes) were first published in 2002 and 2005 respectively; both were reprinted in 2009. His books with peer reviews, etc., may be viewed at http://www.sirjohnforbesbooks.webeden.co.uk.Follow Hektoen International via social media to see more featured content.