JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 92 June 1 999

Robert Willan MD FRS (1757-1812): Dermatologist of theMillenniumChristopher C Booth MD FRCP

J R Soc Med 1999;92:313-318

On 25 February 1999, the Sections ofDermatology and the History of Medicine held a joint meeting at The Royal Society of Medicine toselect a Dermatologist of the Millennium. Robert Willan was the winning candidate and this paper is the presentation made on his behalf.

Robert Willan (Figure 1) was born in 1757 at a stone-built farmhouse near Sedbergh, then in Yorkshire, calledThe Hill. It had belonged to the family for sixgenerations1. The Willans were Quakers who attendedMeeting nearby in the lovely meeting house at Briggflatts,which dates from 1675. In many of the records-theDictionary of National Biography, Munk's Roll of the College ofPhysicans and regrettably some of my own publications2'3-Robert Willan's father has been supposed to have been anMD of Edinburgh who wrote a book on the king's evil4. This,however, is not true, for the Robert Willan who wrote thatbook can be positively identified as a bachelor who workedfirst as a physician in Scarborough (where he wrote his book),then became a schoolmaster in Philadelphia and ultimatelydied there in 17701.

Robert Willan's lineage shows that his father was indeedanother of the many Robert Willans in his familyl. Soonafter his marriage to Ann Weatherald in 1745 his father puta datestone on a building at The Hill, with the initials ofhimself and his wife-R and A W 1748. He was not, assupposed, an MD but a local medical practitioner who whenhe died was described by the Friends as a 'man-midwife'. Heis said to have enjoyed an extensive practice; his character,however, was apparently not flawless for in 1758 his MonthlyMeeting drew up a paper on their disunity with him onaccount of his 'drinking to excess and breaking word'1.

His son and youngest child, Robert the futuredermatologist, was educated at nearby Sedbergh School,an ancient foundation that dates from 1525. The oldschoolhouse where Willan studied is now the school library.At Sedbergh, Willan is said to have become anaccomplished classical scholar, even exceeding his master,Dr Bateman, in Latin and Greek.

EDINBURGH

As a Quaker, Willan was barred from the universities ofOxford or Cambridge and therefore, like so many other

dissenters, he went to the medical school of the Universityof Edinburgh, where he matriculated in 1777. There hecame under the influence of several important teachers5.The first was Professor John Hope, who held the chair ofbotany. A pupil of Bernard de Jussieu in Paris, it was hewho introduced the new classification of Linnaeus toEdinburgh. Willan would also have been influenced by thegreatest Edinburgh teacher of medicine of that era, WilliamCullen. Cullen had attempted to arrange human diseases bythe method that Linnaeus had successfully employed in theclassification of plants and the animal kingdom. It wasLinnaeus who introduced the binomial system, in which thefirst name was the genus, the second the species. Thus wehave Digitalis purpurea, Homo sapiens, Salmo truttus (orthymalis for a grayling, since it smells of thyme when freshlycaught). Following Linnaeus, Cullen described classes,orders, genera, species and varieties. It was an attempt that

Figure 1 Robert Willan. Portrait at the Royal College of Physicians ofLondon, on permanent loan from the Governors of Sedbergh School

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Wellcome Institute for the History of Medicine, 183 Euston Road, London NW12BE, UK

Correspondence to: Sir Christopher Booth 313

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equalled in complexity the nosology of Boissier de Sauvagesin Montpellier6. At that time, however, knowledge ofhuman disease was insufficiently developed to permit such aclassification and Cullen's nosology, although used untilwell into the nineteenth century, did not endure.

A further influence on the young Willan as a medicalstudent may have been Andrew Duncan, who worked at thePublic Dispensary in Edinburgh. In his records of hismedical cases, published in 1777, Duncan complained thatthere was no satisfactory distinction of cutaneous diseasesand he considered it would be of great consequence if'distinct genera could be formed, especially if proper markscould be discovered according to the causes from whichthey proceed .

LONDON

Willan graduated MD in June 1780 with a thesis entitled DeJecinoris Inflammatione which was published in Edinburgh.Aged 23, he then went down to London to seek the help ofDr John Fothergill, family friend, fellow Quaker andalumnus of Sedbergh School and Edinburgh graduate.Fothergill urged him to settle in the capital but sadly he diedof prostatic obstruction at Christmas that year7. Willan,hearing of the death of an elderly relative in Darlington,decided instead to start practice in the north in 1781. Herehe became interested in the waters of a small spa at Croft,near Darlington, and he wrote a book to extol its virtues8.He recommended the waters, as was the custom of thetime, for all manner of diseases but he seems, even at thisearly stage of his career, to have evinced a particularinterest in skin diseases, 'Why are the nations of the north',

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0 l l l l l1769 1770 1774 1777 1779 1780 1781

he asked, 'and especially this kingdom, more liable tocutaneous affections?'.

By early 1783, however, Willan had decided once moreto seek his fortune in the capital. On this occasion, he wasmuch helped by John Fothergill's formidable sister Ann,who had been the doctor's housekeeper9, and by JohnCoakley Lettsom, an adopted member of the Fothergillfamily. Through Lettsom's influence he was at onceappointed physician to the newly established Carey StreetDispensary, of which Lettsom was a governor.

During the first half of the eighteenth century, in therapidly expanding city of London, philanthropic endeavourswere directed towards the necessary task of founding newhospitals Guy's, St George's, Westminster and theLondon all dating from that time. The hospitals, however,did little for the majority of the sick poor of the metropolis.In particular, those with fever, a common disorder in theapalling slums of the eastern parishes, were not accepted aspatients. In 1770, deeply concerned with the afflictions ofthe poor, the young Lettsom (he was only 26), hisphilanthropy nurtured by his Quaker background andparticularly by his upbringing with the Fothergills, hadfounded the first General Dispensary at Aldersgate'0"1.There a physician, surgeon and apothecary attended to theneeds of the poor on an outpatient basis. More importantly,they also undertook to see patients in their own oftenmiserable homes. It was a courageous philanthropic venturethat could cost the physicians their lives. Lettsom's ownmuch-loved son later succumbed to a fever contractedduring his work as a dispensary doctor.

The dispensaries attracted the benevolent support of thegreat and the good from their first foundation. They werealso highly successful (Figure 2). The first President of

1782 1785 1786 1789 1792 1793 1802 1805

YearFigure 2 Growth of dispensaries in London314

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Lettsom's Aldersgate Dispensary, where Lettsom himselfworked after 1773, was the Earl of Dartmouth, half brotherof the Prime Minister Lord North, Secretary of State forthe American Colonies during the American War, andpatient and friend of Dr John Fothergill. The Earl ofSandwich occupied the same position at Carey Street. Hehad been a tolerably incompetent First Lord of theAdmiralty in Lord North's administration until its fall in1782. Popularly known as Jemmy Twitcher, afterMacheath's Judas in the Beggar's Opera'2, one can onlyhope that he did better for Willan's Dispensary than hehad for the Royal Navy.

It has been said of Willan's era, 'The rich physician,pampering the imagined ills of the wealthy, has been takenas typical of the age, but he is common to all ages; the herofigure was the dispensary doctor risking his life daily in thedisease-ridden hovels of the poor'13.

Willan in 1783 joined this band of heroes. He was toserve the Carey Street Dispensary for 20 years. His practicethere must have provided him with a dermatologicalgoldmine-proximity, filth, squalor and the lack of baths orbathing leading to all manner of conditions beyond the ever-present itch. Willan, through his work at the Dispensary,was familiar with the grinding poverty of his patients. Hewrote:

'It is perfectly true that persons of the lowest classes donot put clean sheets on their beds three times a year; thateven when no sheets are used they never wash nor scourtheir coverlets, nor renew them until they are no longertenable; their curtains, if unfortunately there should beany, are never cleaned but suffered to continue in thesame state till they fall to pieces; lastly, from three toeight individuals of different ages and different sexesoften sleep in the same bed-at the same time-therebeing in general but one room and one bed for eachfamily 14

WILLAN'S CLASSIFICATION

By 1790, after 7 years at the Dispensary, it seems thatWillan, who by now would clearly have had considerableexperience of cutaneous diseases, decided to attempt aLinnaean-based classification. It was an idea that no doubtowed much to his mentors in Edinburgh, but Willanrecognized that cutaneous disease, being entirely visible,lent itself particularly to an arrangement similar to that ofLinnaeus for plants, which were classified according to theappearance of their parts. He was now encouraged,probably by Lettsom, to submit his work to the MedicalSociety of London. The Society had been founded byLettsom in 1773, the year of his FRS, and it served toprovide an intellectual forum for the increasing number ofLondon doctors who were dissidents, often graduates of the

University of Edinburgh, and who were debarred frombastions of privilege such as the Royal College ofPhysiciansl0"1. It was they, like Lettsom and Willan, whostaffed the increasing number of London dispensaries. Theyoccupied a lowly position in the medical hierarchy of theday. Unlike the distinguished French dermatologist, BaronAlibert, senior physician at the Hopital Saint Louis in Parisand royal physician5, Willan never served on the staff of afamed hospital. Nor as a Quaker would be ever haveaccepted a national honour or have been among the greatwho might have been considered as candidates for the postof royal physician.

Lettsom, devoted to encouraging the scientific study ofhuman disease, had also founded a gold medal of the societyin honour of his patron and mentor, Dr John Fothergill'6. Itwas to be awarded for an essay on a matter of contemporarymedical importance. In 1790 the medal was bestowed onRobert Willan for his studies of cutaneous disease. Themedal was awarded only six times, the last recipient beingEdward Jenner in 1803. The Society was so impressed byWillan's presentation that they encouraged him to publishhis work. It was not easy, however, to find a publisher andWillan wrote later that 'The publication has been delayedmuch beyond the Author's intention, in consequence of the

ON

CUTANEOUS DISEASES.

ORD. I. PAPULIE.

ORD. II. SQUAKIE.

VOL. I.

CONTAINING T I N

ORD. III. EXANTHEMATA.

ORD. IV. BULLE.

BY

ROBERT WILLAN, M.D. F.A.S.

LONDON:

PRINTED FOR J. JOHNSON, ST. PAULS CHURCH-YARD.

1808.

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Figure 3 Frontispiece of Willan's Cutaneous Diseases 3 15

JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 92 June 1 999

Difficulties experienced in a subject entirely new'17. Heclearly recognized the novelty of what he was doing.

By 1797, living in Red Lion Square, Willan had definedseven different orders of skin disease. He now published hiswork in three parts, in paper covers17. Unfortunately, fewof these volumes survive to this day. Part I, dated 1798,dealt with his first order, the papulae. It also included a listof Willan's seven different orders. It was at once translatedinto German and published at Breslau. Part II appeared in1801 and was concerned with scaly diseases. Part IIIfollowed in the year of Trafalgar and comprised Willan'sthird order, the rashes.

By now Willan, responding to criticism, had increased hisorders to eight, the papulae and the bullae being separated. Asan example of Willan's different genera, the squamaeincluded four-Lepra, Psoriasis, Pityriasis and Ichthyosis.These were subdivided into different species. Pityriasis thegenus (following Linnaeus' binomial system) included threespecies-capitis, rubra and versicolor. Willan's arrangementwas a remarkably complete classification of cutaneous diseasesthat in many ways we recognize today.

Clearly the paper-covered tracts were not entirelysatisfactory as separate publications and Willan in 1808published his Cutaneous Diseases, Vol I (Figure 3)18, anauthoritative account of the first four of his orders the

A

PRACTICAL SYNOPSIS

OF

CUTAN.VEOUS DISEASES

ACCORDIXO' TO THE ARtANGEMENT OF

DRl. WILLAN,

EXHISITING A CONCISE VISW OF THE DOAGWOUTIOSYMPTOMS AND 111 ETMIOD Oi TSETMENT.

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Bt THOMAS BATEMAN, M.D. FBM.S. KPIIYSICIAN TO THE PUBLIC DISPEISART, AND

YEVER INSTITUTION.

LONDON:

FRINTED FOA J.ONOMAN1 HVUES, LENS, OROE AND LEOWN)?ATE9XOITER-EOW.

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Figure 4 Frontispiece of Bateman's first edition

papulae, squamae, exanthemata and bullae. This was a noblequarto volume, liberally illustrated with plates made fromwater-colour drawings.

There is limited evidence on Willan's method ofpractice. A letter from Willan to Lettsom, however, dated12 January 1810, and written from his home in BloomsburySquare, is preserved in the Wellcome collections. It showsthat he might be sent a drawing of a particular skincondition and he would reply giving his opinion: 'As far as Ican judge by your drawing which is on a reduced scale',wrote Willan, 'the complaint is the Lichenose eruptionsucceeding in some persons to the use of Mercury eitherinternally or externally'.

POSTHUMOUS PUBLICATIONS

Willan had always intended to publish a second volume ofhis Cutaneous Diseases dealing with the remaining four of hisorders, the pustulae, vesiculae, tubercula and maculae.Unfortunately, the work was not completed in his lifetime.In late 1811, he had a haemoptysis while attending apatient. Thought to have tuberculosis, he went to Madeirain search of a milder climate but died at Funchal on 7 April,1812, at the age of 55. His tombstone is preserved to thisday against the wall of the churchyard19.

After Willan's death, his casebooks, notes and manu-scripts passed into the hands of his future son-in-law, AshbySmith, who had been present at his death in Madeira. AshbySmith edited and published in 1814 A Practical Treatise onPorrigo or Scalded Head, and on Impetigo, by the late RobertWillan20. This was the only work ready for the press thatWillan left.

It was, however, to be Thomas Bateman who ensuredWillan's dermatological immortality. Bateman, a fellowYorkshireman who had been born in Whitby in 1778,graduated in Edinburgh in 1801. He became a pupil ofWillan at the Carey Street Dispensary when he removed toLondon in the same year. He went on to succeed Willan asPhysician to the Dispensary in 1804.

Bateman was, as Beswick has put it, almost fanaticallydevoted to Robert Willan. After his death he at once boughtthe copyright of the books as well as purchasing all thedrawings and engravings that Willan had amassed. In 1813he published his Synopsis of Cutaneous Disease according to thearrangement of Dr Willan with coloured plates (Figure 4)21.The book was a comfortable octavo that might fit into anearly nineteenth century pocket, but it lacked the quality ofthe plates in Willan's Part I of 1808. The book's onlyillustration was a conglomerate of different skin lesions.Nevertheless, it was to achieve remarkable success, goingthrough five editions before Bateman's premature death in1821 and achieving an eleventh edition as late as 1850.316

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In addition to his own work, which throughout all itseditions acknowledged its indebtedness to Willan, Batemansucceeded in completing Willan's Cutaneous Diseases. In1817 he brought out Willan's promised Part II, in ahandsome quarto edition that matched Part I of 180822. Thework dealt with the four orders that Willan had been unablehimself to complete-the pustulae, vesiculae, tubercula andmaculae. It included plates made from Willan's owncollection of water-colour drawings; many of the originalsare now preserved in a splendidly bound volume in theLibrary of the Royal College of Physicians. In someinstances they are inscribed with comments made inWillan's characteristically crabbed hand.

POSTERITY'S VIEW

Willan's posthumous reputation is attested by the manyeditions of Bateman's work and the translations in at leastfive different languages, all of which gave credit to Willan'sclassification. In France, Baron Alibert had his own systembut Willan's classification was introduced to Paris by a Swissphysican, Dr Biett, who was medicin adjoint at the Hopital StLouis, a position he owed to his chief, the influentialProfessor Alibert. Biett made a visit to England some timeafter Waterloo and returned entie'rement converti au syste'me dume'dicin anglais Willan which he considered plus claire, plusfacile et plus nouvelle. He went on to abandon theclassification of his teacher Alibert and developed a newsystem qui etait celle de Willan conjuge'e et augmentedels. Thiswas to be widely accepted in France.

As to his personal life, Willan married Mary, the widowof a Dr Scott, in 1800, and they lived in Bloomsbury Square,where there is a plaque to his memory on the house, now theBloomsbury Hotel. He was a man of many interests. Hewrote on vaccination, smallpox and its history; he recordedunusual and informative cases of all sorts; he was interestedin hygiene and the public health, the design of chimneys andgarden stoves, the cure of alcoholism and chlorosis; and hejoined Lettsom and other eminent London physicians inplanning a Fever Hospital, following the precepts laid downin Chester by his fellow Dalesman, Dr John Haygarth, whohad also been a pupil at Sedbergh School. He published aHistory of the Ministry ofJesus Christ and wrote on the ancientwords used in 'The mountaneous district of the West Ridingof Yorkshire'. Some of these, such as brant, cowp, mappen,roggle or wrydden will be lost on all but the mostaccomplished scholars of north country dialect2. He retainedthroughout his life his love of the classical tongues and calledhis horses after the heroes of the distant past. He wrote in1803 to his elder brother Richard, a life-long bachelor livingat the family home at The Hill, 'My old horse Achilles is wellnigh demolished and young Telamachus seems very thin andtottering'2.

At his death, the Gentleman's Magazine recorded that

'In addition to his great merits as a physician, and as anaccurate and classical writer, he was one of the mostamiable of men, a sincere friend, a good husband and anaffectionate father. He was in truth a model of the perfecthuman character; a benevolent and skilful Physician, acorrect and sound philosopher, and a truly virtuous man'23.

That modest Quaker, Robert Willan, would no doubthave been embarrassed by such eulogies; nor would he haveever imagined that he might be nominated for the title of'Dermatologist of the Millennium'. But as the individualwho first brought order into what had been a clinical subjectof extraordinary confusion and uncertainty, whose influencewas to be felt far beyond his native land and whose work hasendured, he fully merits that distinction. Dermatology inhis native land has, until recently, recognized hiscontribution by printing his portrait on the cover page ofthe British Journal of Dermatology each month. The membersof the Dermatology Section of the Royal Society ofMedicine have erected a glass screen with an engravedportrait in the Library. At the Royal College of Physicians,where because he was not a graduate of Oxford orCambridge he was never more than a licentiate, there is aWillan Room. The Willans are also remembered in thatremote area of the north from which he hailed. Thetombstone of his elder brother Richard, with whom fromLondon he maintained a lively correspondence, standsagainst the wall of Sedbergh Church, he having left theFriends on amicable terms some years before his death in1820. He was the last Willan to live at The Hill. And on awall of that ancient farmhouse near Sedbergh, whereRobert Willan was born two years before the capture ofQuebec, there is another memorial plaque placed by hisgreatest admirers, the dermatologists of today.

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1 Booth C C. Robert Willan and his kinsmen. Med History 1981;25:181-96

2 Booth C C. Robert Willan, M.D., F.R.S., F.S.A. BrJ Dermatol 1968;80:459-67

3 Corner B C, Booth C C. Chain of Friendship. Selected letters of Dr JohnFothergill of London, 1735-1786. Cambridge, Mass: Bellknap Press ofHarvard University Press, 1971:126, 149, 339

4 Willan R. An Essay on the King's Evil. London: J & P Knapton, 1746

5 Hare P J. A note on Robert Willan's Edinburgh days. Br J Dermatol1973;88:615-17

6 Boissier de Sauvages F. Nosologica methodica sistens morborum classes, juxtaSydenhami mentem et Botanicorum Ordinem. Amsterdam: Fratrum deTourne, 1768

7 Fox R H. DrJohn Fothergill and his Friends. London: Macmillan, 19198 Willan R. Experiments and Observations on the Sulphurous Waters of Croft and

Harrowgate. London: J Johnson, 1786 317

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9 Booth C C. Ann Fothergill. The Mistress of Harpur Street. Proc Am PhilSoc 1978;122:340-54

10 Kilpatrick R. 'Living in the Light'; dispensaries, philanthropy, andmedical reform in late eighteenth century London. In: Cunningham A,French R, eds. The Medical Enlightenment of the Eighteenth Century.Cambridge: Cambridge University Press, 1990:254-80

11 Booth C C. '1773'. Annual oration, Medical Society of London, 1998.Proc Med Soc Lond (in press).

12 Martelli G. Jemmy Twitcher. A lIfe ofJohn Montagu, 4th Earl of Sandwich1718-1782. London: Jonathan Cape, 1962

13 Loudon I S L. The origins and growth of the dispensary movement inEngland. Bull Hist Med 1981;55:322-42

14 George M D. London Lfe in the XVIIIth Century. London: Kegan Paul,Trench, Turner, 1930:86-7

15 Balteau J, Barroux M, Prevost M, eds. Alibert, Jean-Louis-Marie.Dictionnaire de Biographie Fran,aise, Vol 1. Paris: Librarie de Letouzey etAne, 1933:1510-15

16 Booth C C. The Fothergillian Medals of the Medical Society ofLondon. J R Coll Physicians Lond 1981; 15:254-8

17 Beswick T S L. The solution of a ninety-year-old mystery. J Hist MedAllied Sci 1957;12:349-65

18 Willan R. On Cutaneous Diseases. London: J Johnson, 1808

19 MacCormac H. At the Public Dispensary with Willan and Bateman. BrJ Dermatol 1933;45:35-8

20 Smith A, ed. A Practical Treatise on Porrigo or Scalded Head, and on theImpetigo, the Humid or Running Tetter, by the late Robert Willan. London:E Cox & Son, 1814

21 Bateman T. A Practical Synopsis of Cutaneous Diseases, According to theArrangement of Robert Willan. London: Longmans, 1813

22 Bateman T. Delineations of Cutaneous Disease, Exhibiting the CharacteristicAppearances of the Principal Genera and Species, Comprised in theClassification of the late Dr Willan. London: Longmans, 1817

23 Gentleman's Magazine 1812;82, part 1:595

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