John Coakley Lettsome (1744-1815) Philanthropologist and physician

Though they were not contemporary medical students at Leiden, John Lettsome from the Antilles and James Sims from Ireland became firm friends and collaborators when they settled into practice in London. John Coakley Lettsome was born in 1744 in the British Virgin Islands.

John and his brother were the only surviving pair of seven sets of twins born on Little Jost Van Dyke to Edward and Mary Lettsom (variant spelling was common). At the age of six, John was sent alone to England to be educated, and at school in Lancashire he came to the attention of the Quaker, Samuel Fothergill. Fothergill recommended him to his brother John, physician to St Thomas's Hospital in London, after the youth had completed an apprenticeship to a Yorkshire apothecary in 1766. However, John returned to the West Indies when his father died; he freed the family's slaves, worked hard himself and made £2,000, half of which he gave to his mother before returning to Europe to complete his medical training.

A thesis on the natural history of the tea-tree won him his MD from Leiden in 1769 and he repaired to London, took the LRCP and in 1770 founded the General Dispensary for the Sick Poor of the City in Aldergate Street. It is doubtful if many of his dispensary patients agreed with his view that long-term tea drinking was pernicious to health, causing a multitude of new diseases, leading to enervation and debility.¹

Satellite dispensaries soon followed in the city, and members of the staff met to confer on patient care. While living laborious days, Lettsome was happy in his work, aware of the growing recognition he received from his colleagues, and in 1773 conceived the idea that a Medical Society was best suited for that purpose. Lettsome's “The Medical Society of London” has survived and continues today.²

James Sims, a key member of the Society, was born in county Down in 1741, graduated at Leiden in 1764, and settled in London. Some of his papers were translated into French, German and Italian. For 22 years he was president of the Medical Society of London, to which he presented his library in 1802. In 1810 he retired to Bath where he died in 1820.³

Originally made up of 30 physicians, 30 surgeons and 30 apothecaries, the membership of the Society was widened, to cater for a broader range of interests. Outbreaks of infectious diseases (fevers) were reported by members, case histories were analysed, instruments and new medicines were considered and medical intelligence from the provinces and from abroad was encouraged.

William Withering's (1741-1799) claim for the foxglove, digitalis in treatment of dropsy, received a stormy reception in 1785, and Lettsome was less than circumspect when commenting that his own trials of the drug ‘in pulmonary consumption never cured anyone, and that its indiscriminate use had killed many’ – an addendum not to be ignored [in the light of later experience].²

Figure.

The meeting of the Medical Society of London when John Coakley Lettsome presented the deeds of 3 Bolt Court to the Society. The President, en chapeau, is James Sims. Reproduced from Trent's paper (p 135)¹ by kind permission of Elsevier.

The eighteenth century, in the history of culture and of science, is looked upon as the age of Enlightenment, which included (particularly by the Germans) the cultivation of the history of medicine, although it was marred by the hankering after systems tending to explain the motives or philosophy of the healing art. (pp 589, 657)⁴

Medical practice was regarded in all circles as a matter of conscientious vocation, and not as one of the higher classes of business. Most members of the medical profession – certainly the better class, at least – also possessed, or at least strove to attain, a universal humanistic education, quite in contrast with [later] one-sided education of special branches. Hence the physicians of the eighteenth century also universally strove, with a consummate love of science, to gain for themselves an acquaintance with all the special medical and medicotechnical branches of knowledge.

Upon these facts depended not only the high self-esteem of the physicians themselves, but also the general esteem which met them everywhere. (p 731)⁴

That century is widely regarded as the golden age of the medical profession, and in England, physicians far surpassed continental (especially German) counterparts in mercenary acquisition – often used, it is only fair to add, in philanthropic ways. (p 730)⁴

John Fothergill (1712-1780) bequeathed £200,000 to the poor in his will (p 764)⁴, Richard Mead's (1673-1754) largest annual income was £7,000, his house with its famous museum and library at 49 Great Ormond Street became the Hospital for Sick Children⁵; and Astley Pastin Cooper (1768-1841), surgeon at Guy's Hospital, for many years earned £15,000; the highest was £21,000 (p 764)⁴.

It is chastening that these huge incomes arose from ‘the most profound faith in drugs’ in the case of the physicians; drugs, according to the wits, were ‘substances about which the physicians knew nothing, but they administered them to patients about whom they knew even less’.

Lettsome was the busiest, most philanthropic, and most successful physician of his day, earning as much as £12,000 a year, even though a large part of his practice was gratuitous, and he gave away immense sums in charitable contributions (p 652)3. He is said to be the author of When patients sick to me apply I physics, bleeds and sweats ‘em Sometimes they live, sometimes they die; What's that to me? I Lettsome (p 652)⁴

The Medical Society met fortnightly to discuss current medical topics. Edward Jenner (1749-1823), who practised in his native Berkeley in Gloucestershire, became a corresponding member of Lettsome's Society in 1789. In 1800 he informed the members that in 1796, James Phipps had been protected from smallpox by inoculation of cow-pox material taken from the vesicles on the finger of a dairymaid, Sarah Nelmes; the members were suitably impressed when Jenner, in person, presented the Society with a copy of An inquiry into the causes and effects of the Variola Vaccine (July 1798). Lettsome and his fellows adopted the cause enthusiastically, spread the word widely, and struck a medal and awarded a testimonial to Jenner in March 1802.²

The Society was not just a talking shop. When an epidemic of influenza hit London in March 1803, a postal investigation was begun, and the Post Master General granted free postage for the 200 circulars sent to members at home and abroad.²

In September 1878 Lettsome presented a freehold property, 3 Bolt Court, Fleet Street, London to the Society, for meetings and space for a library; the society moved more than once over the years. The Medical Society of London, the oldest medical society in the United Kingdom, now serves the community from Chandos Street, near Cavendish Square.²

Lettsome disposed of his country estate at Grove Hill some time before his death, and part of his library was too large for his London residence. A philanthropist and generous patron of his many literary friends as well as learned institutions, he was forced to continue working hard late into his life, even until his death in 1815.¹