Feature Christmas 2012: Yesterday’s World

John Collins Warren (1778-1856): An American surgeon in London

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8251 (Published 17 December 2012) Cite this as: BMJ 2012;345:e8251
  1. David K C Cooper, professor of surgery
  1. 1University of Pittsburgh, Thomas E Starzl Transplantation Institute, Pittsburgh, PA 15261, USA
  1. Correspondence to: D K C Cooper cooperdk{at}upmc.edu
  • Accepted 5 November 2012

David K C Cooper finds that the writings of American surgeon John Collins Warren provide an insight into medical practice in early 19th century London

John Collins Warren was born in Boston, Massachusetts, in 1778, into a family noted for its many eminent medical practitioners (web appendix).1 These included Warren’s uncle, a doctor killed in the early stages of the War of American Independence, and father, one of the founders of Harvard Medical School. Although professionally successful and respected (box), Warren was a reserved and disciplined man, and few in Boston had much affection for him.

John Collins Warren’s medical career

  • 1778: Born 1 August 1778, in Boston, Massachusetts

  • 1797: Graduated from Harvard College

  • 1799-1802: Continued medical studies in London, Edinburgh, and Paris

  • 1802: Entered surgical practice in Boston

  • 1806: Adjunct professor in anatomy and surgery at Harvard College

  • 1810: Lobbied for Harvard Medical School to move from the “college town” of Cambridge over the river to Boston, which had a much larger population of potential patients

  • 1815: Promoted to full professor, on the death of his father. Also gave lectures on physiology and midwifery

  • 1816-19: First dean of Harvard Medical School

  • 1812: A founder (and an editor) of the New England Medical Journal

  • 1819: Honorary medical degree bestowed on him by Harvard University, his only medical qualification

  • 1821: A founder of the Massachusetts General Hospital, serving as its first surgeon

  • 1837: Second visit to London

  • 1845: On 20 January, performed operation under unsuccessful nitrous oxide anaesthesia (administered by Horace Wells)

  • 1846: On 16 October, performed the first operation under successful ether anaesthesia (administered by William Morton)

  • 1847: Presented his collection of anatomical and pathological specimens to Harvard University, forming the basis of the Warren Anatomical Museum

  • 1851: Third visit to London

  • 1856: Died 4 May, in Boston, Massachusetts

Warren began to study medicine under his father. In 1799, with no hospital or official medical school in Boston at that time, Warren (figure) chose to continue his studies in Europe, beginning in London. In the US, surgery remained fairly basic, but because of the recent studies of John Hunter, surgery in London was becoming an established branch of scientific medicine.

Figure1

John Collins Warren, as a young man

Impressions of London

Of London, Warren wrote to his father: “You have no idea sir, what a shocking place this is in winter. No cold weather, for the grass is perfectly green; but a constant drizzling, that keeps the town dirty as a kennel . . . The air is thickened with smoke and vapors, so that it is scarcely respirable; and as for the sun, no one can tell you when he was seen. The days are five hours long; or, more strictly speaking, there are five hours of twilight: . . . I have, within this week, been obliged to stop almost every day, at some part of it, so totally dark was it.”2 There were, however, “plenty of amusements here: in truth, there is amusement at every step through the streets of London. I constantly meet something new and interesting in this wonderful place.”2

Surgical training in London

Warren spent his most important formative period in surgery at Guy’s Hospital, of which he considered himself an alumnus. Warren wrote: “There are two kinds of students in the hospitals . . . the one called ‘dressers’, and the other ‘walkers’. The first have the advantage of practicing on all the simple surgical cases, and dressing all wounds themselves [that is, receive a hands-on experience]: the others merely see what is done [that is, act as mere observers]. Of course, the former have vastly the greatest opportunities: but the expense is likewise double; as the walker pays £25, the dresser £50. Though I do not like to pay so much money for one object, I believe I shall enter as a dresser; for, as I intend to become a surgeon, I think the acquiring [of] a facility and steadiness in manual operation of the utmost importance.”2

He was clearly a serious student: “It will be necessary . . . to give up every idea of amusement and company; for a student who is tolerably disposed to be industrious will find every moment of his time fully occupied.”2 Indeed, dining out at the weekend and an occasional visit to a London theatre were the only breaks Warren allowed himself.

Warren was appointed as dresser to William Cooper (circa 1724-1800), who Warren described as one of the best of men and most eminent surgeons in London. Warren was “immediately put in charge of about forty patients, comprising as interesting a collection of surgical accidents and diseases as could be desired. A large number of these patients required daily dressing, which I practiced for a year faithfully. During my week [on call], I slept in the hospital . . . I am pitched into a surgeon. Obliged to do things of which I never saw a case, nor had an idea of, and I think I do very well.”2

On his living conditions, Warren wrote: “My residence, while at Guy’s Hospital, was in St. Thomas Street, close to the hospital. I lived at a cork-cutter’s, and had two small rooms on the third story . . . I lived in the usual manner of medical students; that is, entirely by myself. Food being provided by the landlady, I took it in my room. We breakfasted at nine, dined at three, and drank tea irregularly.”2 (Presumably, he returned to work after dining.)

William Cooper left patients largely in the care of his assistants, which suited Warren, who was keen to gain as much experience as possible. Twice a week, Cooper “walked round with his dresser in a very quiet way, making amusing and instructive remarks. He had no great respect for America, considering her as having separated from the British Empire before maturity . . . He was a very pleasant man, however, and occasionally asked me to dine with him.”2

Within a few months, William Cooper retired and was succeeded by his nephew, Astley Cooper (1768-1841), who Warren described as “one of the handsomest men I ever saw . . . a young man of the greatest natural abilities, and almost adored at the hospitals. The obligations I am under to Mr. Cooper are infinite. He has always treated me with the most particular attention, and suffered no opportunity of instructing me to pass by. I wish it were possible to return, in the smallest degree, the favors with which he has loaded me.”2

Warren wrote to his father: “There are operations almost every day . . . the stone, hydrocele, cataract, and amputations innumerable; but Mr. Cline’s operations (at St. Thomas’s) for aneurism and hernia are grand. It is a pleasure to see him take up or turn his knife. The lectures have gratified me very much; they have such immense advantages from these (anatomical) preparations. Not a part but is elegantly prepared; some injected with quicksilver, some with wax, dried and wet. Every morbid appearance is here preserved . . . You well know how much clearer an idea is conveyed by these specimens than can be done by a dead, flaccid body. If I had time, I should make many [specimens] myself; but I despair of doing a quarter of what I wish, here. Dissection is carried on in style: twelve or fifteen bodies in a room; the young men at work on them in different ways . . . The people called resurrection-men [that is, body snatchers] supply us abundantly . . . The surgeons here, considering themselves at the head of their profession, dare to differ from everybody else, if they think they have truth with them.”2

In late 1800, after more than a year at Guy’s Hospital, Warren left London for Edinburgh and, six months later, continued his studies in Paris. He returned to Boston in 1802, where he joined his father in practice.

Surgical practice in Boston

In 1837, Warren published Surgical Observations on Tumors, an illustrated volume of over 600 pages. The British and Foreign Medical Review remarked in the book’s review that “the author proves himself to be a worthy disciple of the school in which he received his early instruction [Guy’s Hospital]; and which, connected as it is with the names and celebrity of Cooper, Bright, and others of hardly less eminence, he seems proud to acknowledge as his alma mater. And surely that school need be no less proud to claim him as a pupil.”3

London, 1837

Arriving in Liverpool, accompanied by his wife and a daughter, Warren soon moved on to London. “As we came within the ten miles, and witnessed the bustling of carriages, the continuous line of houses, and saw the black smoke rising at a distance—although I had been formerly a resident, I was in some measure oppressed by the idea of entering this world with my family.”2

One of the first things Warren did was call on Astley Cooper, now knighted, who had written: “My old friend Dr. Warren carries in his excellent head all the knowledge of the Old and New World. I shall be delighted to see him.”2 Warren presented Cooper with a copy of his book on tumours. Warren noted that, at this late stage of Cooper’s career, “having acquired an ample fortune, he has no occasion to submit to the laborious and responsible duties of the profession; but he is ready at stated hours to give advice to those who apply, both at his own house and in the town. He rises early, and employs two or three hours in anatomical and surgical investigations before breakfast; afterwards he receives patients at his house till two; then visits till six or seven—the common hour of dinner . . . He does not regularly attend any hospital; though, as consulting surgeon of Guy’s he is ready to visit when he can be useful; and his attendance is hailed with pleasure by the surgeons, as a gratifying occurrence.”2

One evening, Warren dined with a group of physicians whose conversation related to the standing of the medical profession in the UK, which was considered not as high as law. “Mr. Key [probably Charles Aston Key (1793-1849) of Guy’s Hospital4] complained of their being unable to attain the highest honors. Lawyers have precedence.”1

Warren and anaesthesia

In his later career in Boston, Warren participated as surgeon in two pioneering efforts of anaesthesia at Massachusetts General Hospital, both initiated by dentists (box).5 The first effort, using nitrous oxide, was unsuccessful. But on 16 October 1846, Warren performed an operation for a neck tumour under successful ether anaesthesia. Warren became an enthusiastic advocate of this major innovation.

London, 1851

In September, Warren revisited Guy’s Hospital with a student. They examined the museum, dissecting room, library (which he noted to contain some of his books, but none of those on ether), and the room where he used to sleep. They also found, in what was described as the “accident ward,” the sister or nurse—the only surviving person who was at the hospital when he was a dresser.

Describing the experience in his diary, Warren also wrote: “Finally, I visited what I never did when there—the chapel of the hospital, and the splendid monument of Guy, who founded it . . . It was very interesting to me to go over the ground I trod more than fifty years ago, and to compare the feelings of the period with those of the present; but, though no doubt the balance would be in favor of the first, it was very fascinating, from the uncertainty of success, and the predominant feeling that my life would be short.”2

John Collins Warren—a “Guy’s man”—died in Boston, aged 77.

Notes

Cite this as: BMJ 2012;345:e8251

Footnotes

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review: Not commissioned; not externally peer reviewed.

References