John Haygarth. 1827. US National Library of Medicine.

In one of his Table Talk essays, William Hazlitt wrote that “posterity is by no means as disinterested  as they might be supposed to be,  and that they give the gratitude and admiration in return for benefits received.” In this spirit we remember both the physician John Haygarth of the Enlightenment and his more recent biographer, Sir Christopher Booth, a clinician and medical historian, described  as “one of the great characters of British medicine”. ^1,2

In his writings, Sir Christopher points out that in Britain many advances  were made by physicians working not in London but in the “provinces.” ³ One such person was John Haygarth, born in 1740 in the northwest of England in Garsdale, “in the beautiful valley of the River Clough”. ^4,5 He was educated at the Sedbergh, a school founded in 1525 ⁴, where he received an early education in the classics and was also tutored by a local surgeon, “a remarkable rural genius” in mathematics, who inspired and advised him in his later epidemiological work. ⁴

From Sedbergh, John Haygarth proceeded to St. John’s  College in Cambridge, where he was exposed to mathematics, classics, philosophy, and theology. He then spent three years in medical  school in Edinburgh, at the time the most prestigious medical school in Great Britain, where he would have been taught by such famous people as the Monros and William Cullen. After graduating and briefly continuing his medical education in  Leiden and London, he was appointed in 1767 physician to the local infirmary in Chester, a relatively prosperous city on the left bank of the River Mersey opposite the port of Liverpool.

During his thirty-year long career in Chester, he developed a large and successful medical practice and became known as one of the best physicians in Britain. He would have seen private patients as well as the ones whom he cared for at the Infirmary, including those suffering from asthma, tuberculosis, jaundice, dropsy, scrofula, scurvy, worms, and leprosy. ³  He also saw many patients with acute inflammatory diseases of the joints, probably acute rheumatic fever or rheumatoid arthritis , perhaps also lupus, such as in the young woman where the breath  became shorter, with a cough and spitting of blood, which soon terminated fatally, and where “the rheumatick inflammation seems here to have been translated from the joints to the lungs.” ⁵

He became particularly interested in smallpox and the other infectious diseases that occurred in regular epidemics at that time. Recognizing the value of Edward Jenner’s newly developed smallpox vaccine, he became a vocal supporter of its widespread use, publishing several influential articles promoting it, raising public awareness, dispelling prevalent misconceptions, and forming in 1778 a “ Smallpox Society” to that effect.

In 1783 he prevented the spread of epidemic smallpox by setting up at the hospital special fever wards dedicated to affected patients and isolating them there. He insisted on strict cleanliness and rules that  “ no patient, after the pocks have appeared, must be suffered to go into the street or other frequented place.” “No patient must be allowed to approach any patient liable to the distemper till every scab is dropt off,  till all the cloths, furniture, food, and all other things touched by the patient during the distemper, till the floor of the sick chamber, and till his hair, face, and hands have been carefully washed.” By this and other measures, he effectively stopped the spread of smallpox. ^5,6 His expertise led to the setting up of similar wards in Liverpool, Leeds, and later in Manchester and London. His provision of isolating patients also effectively stopped the spread of an epidemic of typhus in 1784; and in that year he published a book titled, An Inquiry how to prevent the Smallpox; and he later applied the same principles to prevent the spread of epidemic influenza and even of infectious diseases in farm animals. His efforts would later lead to the establishment of specialized fever hospitals on the model of the lazarettos of Italy and the Mediterranean. Haygarth was also active in promoting the education of the children of the poor and having government-supported free schools. He set up criteria for the treatment of canine rabies and proposed a national scheme to exterminate smallpox from the entire country. ⁵

In 1799 Haygarth retired from Chester and moved to Bath. There in 1801 he performed what may have been the first study of the effect of placebos on  symptoms, a remarkable trial for its time. In America, a certain Dr. Elisha Perkins of Connecticut had achieved great renown by promoting the use of pieces of metal that he called ‘Tractors’ for the treatment of various disorders. Their composition was kept a secret, but they achieved popularity on both sides of the Atlantic and were used by several renowned people. In Bath,  Haygarth set up in collaboration with several other physicians a study to determine the value of these Tractors. Five patients were given either real Tractors or false ones indistinguishable from them, and both proved equally successful for their effects.

As a result of this study, Haygarth published a treatise Of the Imagination as a Cause and as a Cure of Disorders of the Body. (1800) . This was followed by  Letter to Dr Percival on the prevention of infectious fevers (1803); and Clinical History of Diseases  (1805 – mainly about rheumatic diseases). As a leading authority on infectious fevers,  he continued to write and comment on medical matters. He even advised on the prevention of yellow fever in Philadelphia with the methods he had used in Chester. In his later years he continued his philanthropic and scientific interests, and he died in 1827 at age  87. His work qualifies him as being called one of the earliest British epidemiologists,⁵ planting  the seed for the later work by John Snow and William Budd.

 

References

1. Wikipedia: Christopher Booth.
2. Lock, S. Christopher Booth. BMJ 2012:345:35
3. Christopher Booth: John Haygarth FRS (1740-1827). A Physician of the Enlightenment. American Philosophical Society, Philadelphia. https://www.google.com/books/edition/John_Haygarth_FRS_1740_1827/iXS07n2njQYC?hl=en&gbpv=1&dq=John+Haygarth&pg=PR9&printsec=frontcover
4. 4   Booth, C.: John Haygarth FRS (1740-1827). J.R.Soc Med 2014;107(12):490.
5. Elliott, J.: A Medical Pioneer: John Haygarth of Chester , Brit Med J  1913, 1:235-242  (Feb 1) .
6. 6.Editorial: John Haygarth (1740-1827) – Epidemiologist and  Rheumatologist. JAMA 1964;190(6):542.
7. Perkins metallic tractors – Connecticut’s cure for everything that ails you. https://www.google.com/search?q=perkins+metallic+tractors&oq=&aqs=chrome.0.69i59i450l8.1126903372j0j15&sourceid=chrome&ie=UTF-8
8. Miller,WS. Elisha Perkins and His Metallic Tractors. Yale J Biol Med 1935 ; 8(1): 41.

 

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GEORGE DUNEA, MD, Editor-in-Chief

 

Spring 2023  |  Sections  |  Infectious Diseases