Cheshire Antiquities
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In the late 18th century and until the middle of the 19th there were three medical professions in England. The Physicians were founded by Henry VIII in 1518 to regulate teaching in London. By the end of the 18th century they had restricted membership to those with a degree from Oxford or Cambridge, the only two English universities, partly as a protection against the Scottish trained men. This in effect restricted access to the profession to Anglicans as Nonconformists could not graduate from Oxbridge. The Scottish universities admitted all religions. Neither Oxford nor Cambridge had a medical school as currently understood. This did not matter as students were not required to have contact with patients. Students learned the works of the ancient Greek, Hippocrates ( c. 460 – c. 370 BCE) and Galen (129 – c. AD 216), the Greek physician to the Roman Emperor, Marcus Aurelius. There were no written examinations for students but they were required to quote the works of Hippocrates and Galen in oral examinations when asked how they would have treated a disorder. There were relatively few physicians and they practised almost exclusively in London, where they could make a good living by attending the rich. They were largely life-style adviser and drew on the services of the other two medical professions - surgeons and apothecaries. If they thought a patient needed bleeding they sent for a surgeon and if they thought a purge was necessary they would send for an apothecary. Surgeons and apothecaries qualified by apprenticeship and some people qualified in both. They provided most of the medical treatment outside London. The Surgeons had formerly been part of the Guild of Barbers Surgeons set up Henry VIII in 1540. They split from the barbers in 1745 to form the Corporation of Surgeion and 55 years later, became the Royal College of Surgeons in 1800.
The Apothecaries' Act of 1815 empowered the Society of Apothecaries to examine and to grant licences to successful candidates to practise as an Apothecary in England and Wales. It also gave the Society the duty of regulating such practice. The title of the original qualification was Licentiate of the Society of Apothecaries (LSA). Following the establishment of the General Medical Council in 1858 the LSA became a registerable qualification. There was also the higher qualification of FSA (Fellow of the Society of Apothecaries). The apothecary was, in effect, the forerunner of the modern general practitioner and indeed many had the double qualification of apothecary and surgeon. It was a fourth profession, the Chemists and Druggists who were the forerunners of the modern profession of pharmacy. In 1858, the Medical Registration Act brought together the physicians, surgeons and apothecaries into a unified profession with approved education and a registration system.
Two of the common sources of information on the are at slight variance on William Withering's background. According to Wikipedia, Withering was born in Wellington, Shropshire, the son of a surgeon. He studied medicine at the University of Edinburgh Medical School. Later He worked at Birmingham General Hospital from 1779. Encyclopaedia Britannica on the other hand tells us that William was influenced by his father, Edmund, who worked as an apothecary, and by his uncle, Brooke Hector, who worked as a physician in Lichfield. Withering enrolled at the University of Edinburgh in 1762, following four years of medical apprenticeship but we are not told where or in what field.. In 1766, having shown little interest in botany, which formed a large part of the medical curriculum at the time, he prepared his thesis on malignant sore throat, titled De Angina Gangraenosa. While in Edinburgh, William Withering converted from atheism to Christianity. This may explain why he went to Edinburgh rather than Oxford or Cambridge where he would need to agree to the Thirty-nine Articles of Anglican Faith.
Encyclopaedia Britannica tells us that after qualifying in Edinburgh he moved to Stafford, where he attended private patients and served as a founding physician of the Stafford General Infirmary. He began to enjoy botany and met Helena Cookes, who sketched the plants he collected. They were married on Sept. 12, 1772, and had three children. Seeking a more substantial income, Withering decided to move to Birmingham to fill a vacancy created by the death of physician and Lunar Society cofounder William Small in 1775. The move to Birmingham was suggested to Withering by Lichfield physician Erasmus Darwin, the grandfather of Charles Darwin. Together with fellow physician John Ash, Withering served as a founder of the Birmingham General Hospital, which opened in 1779. There he treated several thousand patients each year, many of whom were impoverished and received their care free of charge.
Withering's main claim to fame is is An Account of the Foxglove, and Some of Its Medical Uses (1785). Though foxglove (Digitalis purpurea) had been used in folk medicine for centuries, Withering drew upon 156 of his own cases to demonstrate its value in treating dropsy, the bodily swelling that typically accompanies heart failure. In particular, he noted that foxglove leaf preparations were effective in small, nontoxic doses and that their action varied according to the plant’s stage of bloom. Withering’s publication created considerable furor with fellow Lunar Society member Erasmus Darwin, who claimed priority in having published on foxglove’s therapeutic use in managing dropsy. This was not the first conflict between Withering and Darwin. The previous year, Darwin, together with fellow members of the Lichfield Botanical Society, had published the first English translation of Swedish naturalist and explorer Carolus Linnaeus’s Genera et Species Plantarum (the translated text was published in 1784) without acknowledging Withering’s contributions.
What Withering would not have known, as there were not the analytical techniques available for measurement, was that the concentration of various metabolites in plants varies not only with the season but also the time of day. During daylight hours, plants use photosynthesis to make sugars which are the raw materials for all their metabolites and cellular structure, whereas as the light fades this process stops and metabolism is mainly respiration. Moreover, without chemical analysis, Withering would not have known that the method of drying and storage of the leaves could affect the concentration of the plant metabolites. Similarly the duration of action would not be known accurately without modern analytical techniques. It is for these reasons that there were many cases of overdosing of digitalis, some with serious consequences. Digitalis derived drugs are used in patients with congestive heart failure. The drugs are also used to slow the rate of ventricular contraction in patients with atrial fibrillation or flutter. Digitalis directly increases the contractile power of the heart muscle. Other effects of digitalis include a slowing of the heartbeat, an increase in the heart’s output, and a decrease in the size of the heart. However, careful monitoring is required to avoid adverse effects (e.g., heart palpitations, anorexia, vomiting, and diarrhea) that may result from accumulation of the drugs in the body. In fiction, the homicidal use of digitalis has appeared in the writings of Mary Webb, Dorothy Sayers and Agatha Christie.
Withering gained renown for his botanical writings, the first of which, following in the tradition of English naturalist John Ray, was A Botanical Arrangement of All the Vegetables Growing Naturally in G. Britain (1776). Withering’s later work, An Arrangement of British Plants (1787–92), was designed to show amateur botanists, many of whom were young women, the utility of the Linnaean classification system. In addition, this work introduced his specially designed field microscope, which subsequently became known as the Withering botanical microscope.
William Withering also made a contribution to chemistry. He studied Terra Ponderosa (heavy earth) an ore from Cumberland. He deduced that it contained a hitherto undescribed element which he was unable to characterise. It was later shown to be barium carbonate and in 1789 the German geologist Abraham Gottlob Werner named the mineral Witherite in his honour. The Matthew Boulton mineral collection of Birmingham Museum and Art Gallery may contain one of the earliest known specimens of witherite. A label in Boulton's handwriting records; "No.2 Terra Ponderosa Aerata, given me by Dr. Withering"
Encyclopaedia Britannica
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