JMS Pearce
Hull, England

Virtuous and faithful HEBERDEN, whose skill
Attempts no task it cannot well fulfil,
Gives Melancholy up to nature’s care,
And sends the patient into purer air.
—William Cowper in his poem “Retirement”

It is difficult to avoid eulogies of the outstanding humane compassion and clinical accomplishments, which are the hallmarks of William Heberden the elder (1710–1801). He was educated at a Southwark grammar school.¹ Aged only fourteen, he studied at St. John’s College, Cambridge, where he was elected a Fellow in 1730. He proceeded to Bachelor of Arts in 1728, and MD in 1739. He practiced and lectured in Cambridge for a decade before settling at Cecil Street behind the Strand in London. He voluntarily relinquished his fellowship at St. John’s College for the benefit of some poorer scholar to whom it might be of use. He was elected a Fellow of the Royal College of Physicians in June 1746, and was in turn Goulstonian lecturer, Harveian orator, Croonian lecturer, and censor. He was elected FRS in February 1749. In 1763, he was a founder of the Medical Transaction of the Royal College, a forum where members presented their clinical cases.²

Of many contributions, perhaps his most important was his original description of angina pectoris, which he named in Some account of a disorder of the breast to the Royal College of Physicians, London, in July 1768,³ and detailed in his Commentaries.⁴

The excellence of his observations and clinical skills, outstanding in his time, is evident in his many articles. In a 1759 pamphlet, Heberden first identified chickenpox as a disease distinct from smallpox⁵ and gave specific instructions on smallpox inoculation. He gave one of the first accounts of seasonal catarrh or hay fever. He also made accurate observations on gout,⁶ bladder stones, and the olfactory aura of epilepsy.^7,8 He described aphasia in apoplexy,⁹ and depicted all the essentials of migraine and its visual aura:

There is a dimness of sight in which dark spots float before the eyes, or only half, or some part of all objects appear, which continues for twenty or thirty minutes, and then is succeeded by a headache lasting for several hours, and joined sometimes with sickness.¹⁰

His Purpureae Maculae (1802) described a boy aged five with joint and abdominal pains, petechiae, and hematuria.⁴ Many years later it was redescribed eponymously by Schönlein and Henoch.

Neither did mental illnesses escape his attention. He clearly described manic-depressive (bipolar) illness:

…madness and reason. Such as never return to the use of their senses, are alternatively under the dominion of spirits either too drooping, or too elevated; and in each of which states it is not uncommon to have them pass several months together…

Heberden succinctly described De nodis digitorum, the osteoarthritic bony swellings that develop in the distal interphalangeal joints, named Heberden’s nodes.^{4(ch. 28)} They are distinguished from Bouchard’s similar proximal interphalangeal nodes. In 1936, the Heberden Society for the advancement of the study of rheumatology was founded to celebrate Heberden’s writings on osteoarthritis, gout, and (before it was named by Archibald Garrod in 1859) rheumatoid arthritis.

Many men of distinction sought his kindness and clinical skills. Heberden’s patients included: the poet William Cowper; the celebrated novelist Samuel Richardson; Horace Walpole (1717–1797), politician, and art historian who suffered from gout; and David Garrick (1717–1779), the illustrious actor who succumbed during his final illness, allegedly with kidney stones. Dr. Samuel Johnson suffered not only from gout, but also from Tourette’s syndrome and cardiac failure. Towards the end of his life, Boswell tells us: “Dr. Johnson being asked which physician he had sent for replied he, ‘Dr. Heberden, ultimus romanorum, the last of our learned physicians.’”

Lord Cohen of Birkenhead’s eloquent, scholarly Heberden oration considered him among “the outstanding clinical observers of the 18th century…who touched so many topics in clinical medicine.”¹⁰

Heberden was an accomplished scholar of Greek and Latin but above all a great clinician. A fervently pious man, amongst many kindnesses, he paid the widow of the clergyman Conyers Middleton the money required by a publisher for a manuscript left her by her husband on the “Inefficacy of Prayer.” Though Heberden thought it unedifying; after paying the cost he burned it. George III invited Heberden to become physician to Queen Charlotte, but he refused because he was apprehensive: “lest it might interfere with those connections of life which he had now formed.”¹¹ He retired aged seventy-three: “before my presence of thought, judgment and recollection was so impaired, that I could not do justice to my patients.”

He married Elizabeth Martin in 1752, but she died in childbirth two years later. In 1760 he married Mary Wollaston. Of their seven children, three died in infancy. Their son, William (1767–1845), MD, FRCP, FRS was similarly pious, and a successful physician who attended King George III in his famous illness. Heberden senior died aged ninety-one at Pall Mall and was buried in the parish church at Windsor.

Munk’s Roll recounted:

From his early youth Dr. William Heberden had entertained a deep sense of religion, a consummate love of virtue, an ardent thirst for knowledge, and an earnest desire to promote the welfare and happiness of all mankind. By these qualities, accompanied with great sweetness of manners, he acquired the love and esteem of all good men, in a degree which perhaps very few have experienced…

Let the final encomium be that of William Charles Wells MD FRS, who in a letter to Lord Kenyon, said of him:

No other person, I believe…has ever exercised the art of medicine with the same dignity or has contributed so much to raise it in the estimation of mankind.¹²

Addendum: Heberden’s nodes

The eminent physician William Heberden (1710–1801) made original clinical advances in: angina pectoris, shingles, arthritic disorders, chickenpox, smallpox, and gout. Heberden’s nodes are perhaps the least clinically important part of his legacy. They are hard or bony swellings that develop in the distal interphalangeal joints, often of the second and third fingers, caused by localized osteoarthritis. Heberden’s brief account is not often reproduced; it is original and provides a fine description of a common condition, which is seldom of more than of nuisance value.^a Distinct from gout and inflammatory arthropathies, repeated minor injuries and a familial tendency^b are common associated factors. There is controversy about a putative correlation between Heberden’s nodes and generalized osteoarthritis.

• a. Heberden W. De nodis digitorum. Commentaries on the History and Cure of Diseases. London: T. Payne, Newsgate [Published posthumously in 1802].
• b. Irlenbusch U, Schäller Th. Investigations in generalized osteoarthritis. Part 1: Genetic study of Heberden’s nodes. Osteoarthritis and Cartilage 2006;14, (5): 423-427.

 

References

1. Heberden E. William Heberden the elder (1710-1801): aspects of his London practice. Medical History, 1986, 30: 303-321.
2. Payne JF. William Heberden the Elder. In: Dictionary of National Biography. London, Smith, Elder1891;25:359. https://www.oxforddnb.com/display/10.1093/odnb/9780192683120.001.0001/odnb-9780192683120-e-12855
3. Heberden W. Some account of a disorder of the breast. In: Transactions of the Royal College of Physicians of London, 1772;2: 59-67.
4. Heberden W. Commentaries on the History and Cure of Diseases. London, T. Payne, News-gate, [published posthumously in 1802].
5. Heberden W. Of the Chickenpox. Transactions of the Royal College of Physicians of London 1767;1:117–122.
6. Heberden W. On the Nature and Cure of Gout. Medical Observations and Inquiries 1770;2:3-7.
7. Heberden W. A Case of Epilepsy. Medical Observations and Inquiries, 1776;5: 8-12.
8. Heberden, W. Observations on Epilepsy. Medical Transactions of the Royal College of Physicians of London 1782; 3:95-110.
9. Heberden, W. On the Loss of Speech in Some Cases of Apoplexy. Medical Transactions of the Royal College of Physicians of London 1778;2:85-92.
10. The Rt Hon Lord Cohen Of Birkenhead. Heberden Oration, 1961: William Heberden. Ann Rheum Dis. 1962 Mar;21(1):1-10.
11. Munk W. In: Munk’s roll, Royal College of Physicians 1710-1801;Vol II:159.
12. Wells, William Charles. A letter to the Right Hon. Lloyd Lord Kenyon: Relative to some conduct of the College of Physicians of London, posterior to the decision of the Court of King’s Bench in the case of Dr. Stanger; July 1799, quoted in T J Pettigrew, A biographical memoir of Dr W Heberden, Medical portrait gallery, London, 1839. Wellcome Collection. https://wellcomecollection.org/works/cznw9rxb

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