The legacy of William Heberden the Elder (1710–1801)

Heberden Historical Series/Series Editor: M. I. V. Jayson

T. Y. Lian1 and K. K. T. Lim2

1Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308 433, Singapore and 2Subang Jaya Medical Centre, Subang Jaya, Selayar, 47500, Malaysia.

Attending always, but attending more Where sorrow ask’d his presence than before Tender and ardent, with a kindest air

A handsome tribute by George Crabbe [1], a physician poet of William Heberden a man of ‘ardent’ compassion for his patients.

Born in 1710 in an era that preceded the stethoscope and other medical innovations, William Heberden was a man of brilliant intellect with an outstanding ability for clinical observation. To many, he is best known for his description of the nodular swellings in osteoarthritis, the Heberden's nodes. However, his contributions are far more reaching and he is regarded as both the father of clinical observation of the eighteenth century and also the founder of rheumatology [2]. Today, the official organization of the British rheumatologists is the Heberden Society.

The son of an innkeeper, he attended the parish grammar school of St Saviour in Southwark, an Elizabethan foundation providing free education. He so impressed the faculty that the headmaster prevailed on his mother to send him to Cambridge and at the age of 14 years, Heberden was admitted to St John's college. In 1731, 3 years after obtaining his BA, he was elected fellow of his college and at the age of 29 in 1739, he was awarded his MD. For the next 10 years, Heberden followed the placid career of a bachelor don in Cambridge. During this period, he made his name as an able and sympathetic practitioner, attending patients at the university, in Scarborough during his long vacations and also making the occasional trips to London, where he acted as an unpaid physician at St Bartholomew's Hospital. In 1746, he was admitted as a fellow of the Royal College of Physicians. His invitation to deliver the prestigious Goulstonian lecture in 1749 and to be the Harvenian orator in 1750 is a testament to the recognition of both his talent and genius by the Royal College of Physicians [2, 3]. He quickly rose through the ranks to ‘elect’, one of the senior fellows who picked the president of the college.

Although Heberden’s name is eponymous with the ‘digitorum nodi’ of osteoarthritis and, specifically, the differentiation between gout and osteoarthritis, his contribution to medical knowledge is exhaustive. In 1740, he delivered the first of his annual series of public lectures on materia medica. His arguments all directed to the same conclusion: the physician must always be guided by his own direct observation and his accumulating exposure. In 1763, he was one of the leading forces behind the publication of the Medical Transactions of the Royal College, a forum whereby members could report their observations on patients. It was in these publications that he made many of his lasting contributions to medicine, including his monumental medical contribution, the original and masterful clinical description of angina pectoris in ‘Some Account of a Disorder of the Breast’ [4]. He also had great interest in preventive medicine and an example of this was illustrated in his ‘Remarks on the pump-water of London’ where he warned against the dangers of contamination, recommending either distilling or filtering water before it could be consumed. He made many other formidable contributions, including his recognition of chicken pox and small pox as two distinct entities and he collaborated with Benjamin Franklin in preparing a pamphlet on inoculation for use of the colonies in 1759. Heberden was versatile in his interests and talents and also ventured into non-medical fields like botany, and he even has a plant species named after him called Herbenia [2].

Heberden had a holistic approach to medicine. When he knew no cure for a symptom like melancholy, he prescribed ‘cool air; quiet; a sparing mild nourishment, administered in small quantities at a time’. He frequently advised his wealthy patients to make a visit to a spa, preferably Bath, and although his belief of the alleged medicinal virtues of spa water was rather ambivalent, he thought the most important factor in visiting the spa was the change of routine and respite from work, domestic worries and overindulgence [5].

Heberden’s contribution to the medical world was even more valuable in his retirement at the age of 72. The result was his ‘Commentaries’, which was a compilation of his lifelong habit ‘of making notes in a pocket-book at the bedside of his patients’, his observations of a lifetime. This was originally written in Latin and later translated by his son, William Heberden the Younger. Heberden died in his 91st year at his home in Pall Mall in 1801, bequeathing upon us his legacy of the essential ingredients of medicine: the art of observation, critical assessments of observations and, importantly, compassion for his patients. Indeed, William Heberden is justly regarded as one of the most illustrious physicians of the eighteenth century.


    References
 Top
 References
 

  1. Paulshock BZ. William Heberden and opium—some relief to all. N Engl J Med 1983;308:53–5.[ISI][Medline]
  2. Bendiner E. William Heberden: father of observation. Hosp Pract (Off Ed). 1991;26,103–106,109,113–6.
  3. Jay V. The legacy of William Heberden. Arch Pathol Lab Med 2000;24:1750–1.
  4. Kligfield P. The frustrated benevolence of ‘Dr Anonymous’. Am J Cardiol 1981;47:185–7.[ISI][Medline]
  5. Heberden E. William Heberden the elder (1710–801): aspects of his London practice. Med Hist 1986;30:303–21.[ISI][Medline]




This Article
Full Text (PDF)
Alert me when this article is cited
Alert me if a correction is posted
Services
Email this article to a friend
Similar articles in this journal
Similar articles in PubMed
Alert me to new issues of the journal
Add to My Personal Archive
Download to citation manager
Disclaimer
Request Permissions
Google Scholar
Articles by Lian, T. Y.
Articles by Lim, K. K. T.
PubMed
PubMed Citation
Articles by Lian, T. Y.
Articles by Lim, K. K. T.
Related Collections
Historical Medicine