This is the story of our practice as it has evolved with the development of medicine over the past two centuries. Although it has been produced primarily for our patients and local residents, we feel it may also be of interest to other general practices and medical historians.
We were surprised at the variety and depth of our own history which includes:
- The first description of a rare form of epilepsy.
- A Victorian polymath whose research interests included the weights of human teeth and the study of shells.
- A campaign which lead to the first council houses in England being built.
In 1815, the year of the battle of Waterloo, Tonbridge was a small market town. A long narrow High Street, lined by slum dwellings, led to the Big Bridge over the Medway, which was overlooked by the Norman Castle. This had been built to guard the bridge, which carried the main road running from the eastern Channel Ports across the Weald of Kent, to London.
On February 3rd that year William James West from St. Albans qualified as a member of the Royal College of Surgeons (MRCS). He came to live and practice from a house by the river, near the castle. Why he came to Tonbridge, we do not know. He was the first in the uninterrupted line of doctors that we can trace to what is now Warders Medical Centre. John Morris, who came from Tonbridge, soon joined him. He had qualified MRCS and LSA (Licentiate of the Society of Apothecaries) in 1816. These two qualifications were the usual ones for the surgeon apothecary, who was the forerunner of our general practitioner. Nothing else is known about Morris, and by 1832 he no longer appeared in the medical registers. West took as an apprentice, a local boy, John Gorham. In 1832 Gorham went to Guy’s hospital to complete his medical training. By 1841 he was back in Tonbridge, in partnership with West.
They both became deeply involved in town matters as well as medicine. This was very important to the practice for getting to know local worthies who hopefully might become patients. Thus West became a manager of the Tonbridge Savings Bank, was a vice-president of the Tonbridge Literary Society, and was on the committee of the National School. In 1845 they were jointly asked to advise on the best way of dealing with the potato crop, which had been hit with blight. Their results were printed in a handbill, which was circulated in the town. West’s death from dropsy in 1848 was a tragedy for the town.
Gorham took over the practice, which he ran single-handed with the help of numerous assistants until 1873. We know as little of the day-to-day work of Gorham as we do of other practitioners, for such work leaves little documentation.
Excitements appeared in the local newspapers from time to time. In 1868 a lady took an overdose of chloroform and Dr. Gorham assured the jury that they could not view the corpse, which was in a soldered coffin as the body was too decomposed. The same year his prompt assistance to a young man returning from a meeting of The Young Man’s Christian Association who fell down with “a very severe attack of spasms” “stopped the probability of a fatal outcome.” In 1872 he assisted at the birth of a baby in a railway carriage. Judging by the size of the houses in which he lived, the practice must have flourished. This good publicity, for there was none that was bad, must have helped.
Dr William West
In June 1828 West married Mary Halsey Dashwood and their first daughter, Julia, was born soon afterwards. A son, William Robert was born in 1834, and their last child, James Edwin followed in 1840. James was a fine baby until he was four months. He then started having attacks in which he bobbed his head up and down. These increased in frequency and power until his head was forcibly drawn down to his knees followed immediately by relaxation to the upright position. This happened between twenty and thirty times in the space of a few minutes. He had two to three episodes of these attacks a day, each of which was preceded by a ‘strange noise.’
Initially he was unwell and lost weight, but after a few months he recovered to look fit. Unfortunately it was soon noticed that he was developing neither physically nor mentally as he should. By the age of a year he could not even hold his head upright. It was ascribed to some irritation of the nervous system associated with teething. His father treated him in the contemporary way. He was purged, had leeches applied and had his gums lanced. All to no effect.
West took him to London to the foremost specialists, Sir Charles Clarke and Dr. Locock, both of whom had seen a few cases previously and called it a ‘salaam convulsion’. They had no treatment to offer. West took further advice from physicians in Dublin. Neither could they help. Sadly West wrote to The Lancet (Lancet 1 1841 p724) describing the condition most accurately and suggesting that it was a condition in its own right that had previously escaped the attention of the medical profession.
At a conference in Marseille in 1964 the condition was called ‘syndrome de West’. Otherwise it is now known as ‘infantile spasms’ or ‘infantile myoclonic encephalopathy’. In 1989 damages of £441 527 were awarded against a general practitioner who failed to diagnose the syndrome in a baby.
The attacks continued, and by 1842 James had developed definite epileptic fits as well. By the time he was three he could just get himself up into a chair and he started to walk. At the age of seven when he could understand what was said to him but could neither feed himself nor talk, Aston Key, a surgeon at Guy’s Hospital and later surgeon to Prince Albert, suggested that he would benefit from the society of other children. The poor boy was sent to school, which did not last long. Neither did his attempt to live in a nursery. This was not surprising as James had frequent fits of idiotic laughter and rollings of the head. Unfortunately for James, his father died in 1848 and in the same year James was admitted to Park House in Highgate, a home for the mentally subnormal.
In 1854 all the patients were transferred to Earlswood Hospital and James came under the care of John Langdon Down. He died from tuberculosis 1860 and was buried with his father in Tonbridge.
In 1833 West had been asked to the delivery of a lady aged 45. On ante-natal examination he found an ovarian cyst in the pelvis which he was able to push upwards into the abdominal cavity. She had a normal labour. By 1837 the cyst had grown so large that life was becoming very difficult as she had difficulty in breathing. She had previously tried other treatments, so, after much discussion, she agreed to operation. West, assisted by two local practitioners, opened the abdomen, drew more than twenty pints of fluid from the cyst which he then removed. The abdomen was closed with four sutures and adhesive plaster. The cyst was sent to Guy’s Hospital where it was exhibited in the museum. This operation had only been successfully performed for the first time the previous year. Two surgeon apothecaries in Suffolk, Jeafferson of Framlingham and King of Saxmundham, had each had good results. West’s published series of three cures in four operations was remarkable before the days of anaesthesia and antisepsis. His pioneering work helped to make the operation acceptable, as it was not done at Guy’s until 1839.
During the course of the century the size of the town had trebled, from about 4000 in 1840 to almost 12,000 in 1900. Clearly there was need for other medical aid. Throughout this time there had always been one other practice of comparable size in Tonbridge and other practitioners came and went. We know little of their practice, but they were clearly successful. However none of them had the continuing fame of West with his eponymous syndrome, nor published prolifically as Gorham did.
Dr John Gorham
After qualifying with the MRCS LSA in 1835, he stayed at Guy’s and worked as a practitioner in Southwark, for further experience. This included taking Thomas Addison’s outpatient clinics when Addison was away. Gorham gave several papers to Guy’s Medical and Physical Society, and in 1838 published the first of many papers on medical and other subjects. The subjects included, Intussusception in Children (1838), A Case of Fungoid Disease of the Kidney (1838), and a case of Extraordinary Development of the Mammae in a Male (1839). Gorham joined the controversy in the medical journals about the propriety of removing ovarian cysts with Observations on the Propriety of Extirpating the Cyst in Some Cases of Ovarian Dropsy (1839).
In 1841, Gorham was appointed Medical Attendant to the Poor Law Union. It would have been difficult not to appoint him, as he had glowing testimonials from thirteen distinguished doctors from Guy’s, including Richard Bright, Thomas Addison, Aston Key, and John Hilton.
Whilst at Guy’s a microscopical department was founded and it could have been this that fired Gorham’s interest. He joined the Royal Microscopical Society and contributed several publications to its journal. These included papers on compound eyes in insects, venation in the leaves of umbelliferae and on the composite structure of simple leaves. He was a practical man, as in other papers he suggested ways of making casts of insect eyes and other objects in collodion for microscopic study and improving ways of preparing microscopic slides. His botanical interests were furthered by membership of The Royal Botanical Society.
By 1869 his interest had turned to teeth. He wrote a booklet on “The proper method of extracting teeth.” It was full of common sense and advice, and pointed out that if the doctor learnt early on his career how to do it, “the practitioner might vie with the professional dentist in this department of surgery.” This would have added to the doctor’s income considerably and it is not surprising that the booklet ran to five editions. His interest in teeth lead him to study some thousands of them supplied by a local dentist and Charles Fox at the London Dental Hospital. He published his findings in The Medical Times and Gazette and they were reprinted in The British Journal of Dental Science. Each was carefully measured and the average weight of each tooth calculated. All the lower teeth were lighter than their complementary upper ones. By measuring the distance from each tooth to the mid point of the jaw, he worked out the ‘lever power’ for each tooth. After many calculations he came to the conclusion that if the lower teeth were as heavy as the upper, an extra 200 grains of work would be necessary at each bite. The inescapable conclusion was that The Divine Artificer has designed the body perfectly and that the arrangement of the teeth was ‘the best and wisest that could be devised’.
This fundamentalist view accorded well with his Free Church views. He never really got involved with the Parish Church. Gorham kept a very high profile in the town. He gave courses of lectures in the Public Hall on mineralogy, colour and conchology. That on colour was ‘not very well attended, but the company was select’. He gave penny readings at the Mechanics Institute, which he had helped to found and played his flute in trios with his wife and daughter in concerts at The Public Hall. He became President of The Aesthetic Society and later, The Choral Society.
In 1894 he retired and died of influenza in 1899, by which time the young man who had worked with Addison and Bright in the advances of the early nineteenth century was described as ‘a doctor of the old school’.
|Late Nineteenth Century||Early Twentieth Century|
|History of the Penshurst Practice||Tonbridge Cottage Hospital|
|The Warders Garden||After the NHS Was Formed|
|Hanover House||The 21st Century and Other Recent Developments|