“THE CANE AS A STATUS SYMBOL”

February 8, 1972

      “Men sowed the seeds of their future reputations, perhaps, at a much earlier period than is usually supposed, and the later years of life are occupied merely in digesting and arranging what was in earlier years impressed.”  Matthew Baillie made his entire contribution to medical science before his 40^th year.  The remainder of his life (and he died at age 63) was spent accumulating a fortune in the practice of medicine and gaining an enviable reputation as a consultant to commoners and kings alike.  He attended George III in his last illness, and in addition to being  physician extraordinaire to the king, was physician ordinaire to the Prince of Wales.  Born in 1761, Baillie was to become the last holder of the gold headed cane, which was presented to the Royal College of Physicians by Mrs. Baillie upon his death in 1823.  The cane has successively been carried by Drs. Radcliffe, Meade, Askew, and Pitcairn.

     Anthony Askew was most noted as a collector of books.  He lived in Queen’s Square, London, and his main claim to fame, apparently, was his rare book collection and as a possessor of the gold headed cane.  His statuette in unbaked clay is one of the prized possessions at the Royal College of Physicians.

     Askew got the cane from Richard Meade (1673 – 1754), who was physician to St. Thomas’ Hospital and a fellow of the Royal Society.  His collection of books, statues, medals and incidentals was housed in a gallery in Great Ormond Street.  The printed catalog of his library contained 6,592 separate entries.  They included many oriental, Greek, and Latin manuscripts.  It was Meade who persuaded the wealthy citizen, Thomas Guy, to bequeath his fortune to found the hospital which bears his name.

     Meade got the cane from Dr. Radcliffe, but that is a later story.  Meade moved into Radcliffe’s house on Bloomsberry Square in 1715.  He acquired much of Radcliffe’s practice and on the accession of George II, became the physician in-ordinary, and in practice he was said to be without rival.  His average income for several years amounted to between 600 and 700 pounds, an enormous sum for that time.  His charity was exceeded only by his hospitality, and apparently this is the reason he had access to so many men of wealth.

     John Radcliffe (1652-1714) was a Yorksman noted for his generosity and obesity.  In addition to leaving a large sum to University College Oxford and St. Bartholomew’s Hospital, the Radcliffe library, observatory, and infirmary were established in Oxford, and 2,000 pounds was provided towards the college building on Pall Mall.  He was said to have been capricious and outspoken.  He attended King William many times and Queen Mary’s death from smallpox in 1694 was blamed on Radcliffe.  Many of the anecdotes recorded about Radcliffe showed his nature.  In 1699 when King William showed him his ankles, which were swollen although the rest of his body was emaciated, and asked “What do you think of these?”  “Why truly” replied Radcliffe, “I would not have your majesty’s two legs for your three kingdoms”.  This finally and irretrievably lost him the King’s favor.  He was often at issue with the college authorities, chiefly over his nonattendance.  He was threatened with assassination for refusing to attend Queen Anne in her last illness.  After coming to London from Yorkshire, he was said to have earned an enormous income and his practice included many highly distinguished people including the Bishop of London and Princess Anne of Denmark.  He was the fellow who started the succession of the gold headed cane.  The possessor of the cane between Askew and Baillie was William Pitcairn (1711 – 1791).  Also a wealthy practitioner, he reigned as president of the College for ten successive years.

     Matthew Baillie was almost assured success from the start.  First, he was the nephew of John and William Hunter, and at age 22 received 5,000 pounds and William Hunter’s Scottish estate, Long Calderwood, which incidentally, he decided would be more properly handed over to Uncle John.  His second insurance policy was his marriage to the daughter of Dr. Denman, a wealthy and successful practitioner.

     His prime contribution was the first textbook of pathology published in the English language.  Morbid Anatomy of Some of the Most Important Parts of the Human, published in 1793, was supplemented by a beautifully engraved atlas in 1802.  His Morbid Anatomy, according to Desmond Long, was not only the first in English, but the first book in any language treating the subject of pathology as an independent science capable of cultivation apart from its immediate application to the practice of medicine.  It proved to be totally lacking in depth, but this I suppose reflects the knowledge of the breast, skin, joints, spinal cord and other major areas of the body.  In many respects it seems as though he were a better observer than he was in obtaining clinical-pathologic correlation.  For instance, he is quite dogmatic in assuring us that the symptoms attending inflammation of the pericardium cannot be distinguished in practice from lesions affecting the myocardium.

     According to most of the Biographers, his success was largely due to his clarity of thought and to his plain, precise method of speaking.  He was always brief.  He could explain disease processes with equal clarity to the referring physician and family.  One point that is continually emphasized is the fact that he never stole patients from the referring physician.  For this they loved him.  He never revealed the truth if misdiagnosis or mistreatment had been administered and for this they worshiped him.  His attention to morbid anatomy enabled him to make nice discriminations between diseases which resembled each other.  This was not done by his colleagues.  In the words of Sir Henry Halford, “It gave him confidence in propounding opinions which our conjectural art does not readily admit.”  Upon his demise his professional friends erected a monument consisting of a fine bust by Chantry in the Westminster Abbey at the expense of 800 guineas.  A copy of an oil by John Hoppner still hangs at St. George’s Hospital.

     Dr. William MacMichael published The Gold Headed Cane in 1827.  This was later revised by Munk.  The original of the gold headed cane, which belonged in succession to Radcliffe, Meade, Askew, Pitcairn and Baillie, is preserved in the College.

     MacMichael incidentally was the first Baillie fellow at Oxford and probably did more than anyone else to immortalize his benefactor.

 After studying the performance of these individuals who have been immortalized, at least in the Archives of the Royal College of Physicians, it is most difficult to single out great contributions for some.  Baillie, of course, did publish important works that were to change the concepts of medical practice and thus should be given full credit.  After the age of 30, his contribution was to the art of practice.  It is also true that Radcliffe in his own way contributed.  Thomas Hearne who was Radcliffe’s biographer had this to say “He had little or no learning, but had a strange sagacity and was so wonderfully successful at his practice of physic he never had his equal by means of which he got such a vast sum of money.”  Bill Bean says both Oxford and English medicine still profit from his generosity and thus his memory is kept green in continuing good work which are considerably more than most physicians, or most people for that matter, leave in trust for those who follow them.  He contributed the original cane which now adorns the Royal College, thru the generosity of Baillie.  He contributed considerable wealth, which was to grow rapidly due to his selection of astute trustees.  The others all contributed in that.  They were the fine physicians of their day and were the link between Radcliffe and Baillie.