Bleeding, Blisters and Opium by Michael Sydney

Joshua Dixon and the Whitehaven Dispensary

An amazing thing happened to the little Cumberland fishing village of Whitehaven between the middle of the 17th century and the end of 18th century.  From being a tiny coastal community of about 24 households, it grew  to become the second most important port in England after London, with a population of some 16,000.  Coal, tobacco and the entrepreneurial Lowther family were the prime factors in its growth, but the rapidly expanding population – mostly crammed into inadequate, insanitary housing – inevitably fell prey to smallpox, typhus, enteric fevers, dysentery and TB.  The average life expectancy was 40 and child mortality was running at over 30%.  The town was thriving;  its population was not.

Public healthcare in the north west of England in the early 18th century was rudimentary and haphazard.  There was no formal system of education or medical registration and people – the poor in particular – had to rely on a floating population of wise women, barber surgeons  and travelling practitioners, many of whom were out-and-out quacks.  When formally qualified regular pracitioners did start to appear mid century, their assistance was not readily accessible by the poor (generally those most in need) until the appearance of, first, the voluntary hospitals and then the Dispensaries.

The first voluntary hospital – established and maintained entirely by charitable donations – was the Westminster in London, which opened in 1720.  It would be another 30 years before provincial hospitals appeared in  Liverpool, Newcastle and Manchester.  The Dispensaries grew from the voluntary hospitals, providing out-patient care to those in need.  Like the hospitals, they depended on public subscriptions to keep them afloat.  The subscribers referred appropriate cases for treatment, via ‘letters of recommendation’, to the Dispensaries.  The resident Apothecary (who was paid an annual salary) received the letters and presented the cases to the medical practitioners – who held only honorary posts and relied on their private practices for income.

Whitehaven Dispensary was established in 1783 and the remarkable Dr Joshua Dixon – a native of the town – was the driving force in its creation.  The son of a Whitehaven mariner, he first became an Apothecary’s Assistant in Liverpool and then studied medicine in Edinburgh.  Returning home as a qualified Physician in 1775 he dedicated the rest of his life to relieving the sufferings of the poor and needy of  Whitehaven and was the Physician to the Dispensary for 40 years until his retirement in 1823 at the extraordinary age of 78.

He was at the forefront of preventitive medicine – essentially one of the country’s very  first Public Health Physicians and he very  nearly succeeded in wiping out smallpox in the town, by being amongst the first to introduce the controversial vaccinations.  In fact in the final three years of his tenure, there were no cases at all.

Every year he produced meticulous Dispensary reports  – detailing its accounts, number of cases treated, nature of the conditions, number of subscribers  … all carefully listed and enumerated.  The 1821 report – just two years before his retirement – is reproduced in full in the book and makes astounding reading, listing the total patient statistics for the 38 years of the Dispensary’s life to that date:

Cured                                                                      60625
Relieved                                                                   2276
Incurable                                                                 1027
Dead                                                                         1490

Some of Dr Dixon’s prophylactics – measures to prevent disease – are a little eyebrow raising to modern eyes (like the exploding of gunpowder to purify the air), but most of them still hold good today – fresh air, frequent changes of bed clothes and linen, moderate labour, warm clothing, generous diet and the avoidance of distressing passions – along with the positively cutting edge observation:

Tranquility, Cheerfulness and Fortitude of Mind being the best Preservatives from the Power of Contagion.

The story of Dr Dixon and his Dispensary could have ended up as a very worthy but thoroughly dull tale, but Michael Sydney – a modern-day Whitehaven GP – tells it with such enthusiasm, understanding and  humour that his obvious love of his subject is infectious.  We’re treated to a detailed – and frankly jaw-dropping – explanation of the history of smallpox vaccination.  Much time is also spent on the equipment for the ‘Recovery of Persons Apparently Drowned’ which included a pair of bellows (and if you’re eating anything – I suggest you stop for a moment) to pump burning tobacco smoke into the bowels via a rubber tube inserted into the anus.  This was apparently due to the observation that after death the lower intestine retained its irritability long after the other organs had failed;  and you can quite see why – if someone was hovering in the twilight zone – that particular approach might cause a sharp intake of breath.

Interspersed with the the facts and anecdotes are extracts from the local newspaper;  advertisements for purging elixirs and Baume de Vie (good for purifying the blood juices, apparently), stories about the citizens of Whitehaven being harassed by marauding pigs (I really shouldn’t have laughed at the tale of the little girl being pursued by a sow, which snatched a piece of bread and butter en route) and my personal favourite – the advertisement placed by one  Dr James Graham.  He announced that he was coming to Whitehaven for two months, at urgent and repeated public request, to deal with all the diseases “that have baffled other Doctors and resisted the Power of the most celebrated Medicines”.  Three weeks later, a small announcement appeared to the effect that, “Yesterday morning, Dr James Graham was set off to Edinburgh in the custody of two constables.  This unfortunate man had, for some days past, discovered such marks of insanity as made it advisable to secure him.”

People who jump into stormy seas and run into burning buildings to save lives are hailed as heroes.  Men like Joshua Dixon go unsung;  and yet in the 40 years of his tenure he must have saved literally thousands of lives.  In his time he was loved by the people of Whitehaven and lauded by the medical establishment throughout the country, and then – unaccountably – he was virtually forgotten.

Happily, thanks to this delightful and thoroughly accessible book he’s forgotten no more – but when I’d finished reading it, George Eliot’s famous closing words to Middlemarch were echoing in my brain:

“… for the growing good of the world is partly dependent on unhistoric acts; and that things are not so ill with you and me as they might have been, is half owing to the number who lived faithfully a hidden life, and rest in unvisited tombs.”

Stainburn Publications.  2009.  ISBN: 978-0-9563881-0-0.  197pp.

(Bleeding, Blisters and Opium achieved a  ‘Highly Commended’ in the ‘Popular Medicine’ section of the 2010 BMA Medical Books Awards.)

Available from all good bookshops or  direct from the publisher.  And if you mention Vulpes Libris, Dr Sydney might even sign your copy for you …

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