J R Soc Med 2005;98:281-286
doi:10.1258/jrsm.98.6.281
© 2005 Royal Society of Medicine
The curious case of Dr Alabone—heterodoxy in 19th century medicine
Michael Vaile FRCP 1
Sally Gilbert MA 2
1 63 Joy Lane, Whitstable, Kent CT5 4DD
2 Archivist, Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE,
UK
Correspondence to: Dr Michael Vaile E-mail:
c-mvaile{at}lineone.net
 |
INTRODUCTION
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The year 1910 saw publication of a book entitled
Poly-cycloepicycloidal
and other Geometric
Curves,1
written by Dr E W Alabone, ex-
MRCS but with
MDs from two
American institutions. Previous works
of the author included
The Cure of
Consumption2
and
Infamous
Conduct.
3 The
story of Alabone illustrates the struggle to regulate doctors
and eliminate
professional quackery that was underway a century
ago.
|
THE CURE OF CONSUMPTION
|
|---|
The RSM Library holds just one copy of Alabone's book
The Cure of
Consumption dated 1898, 34th edition. Even at that time the
author was
describing himself as ex-
MRCS. The text is a melange
of medical
history, science (or pseudoscience) and self-justification;
and the flyleaf
bears a remarkable diatribe in an unknown hand,
presumably that of a reader
acquainted with Alabone. Denouncing
him as 'an Utter Failure in the
Medical Profession' the writer
warns anybody attending his public
performances not to leave
'any Silver Spoons or Valuables about'. So
who was the author
who occasioned such an indictment?
|
BACKGROUND
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Edwin William Alabone was born in Newport Isle of Wight in 1849.
His family
moved to Islington in North London where he lived
and worked all his life. He
was always interested in biology
and became a dresser at Guy's Hospital;
his books frequently
reprint the favourable references he obtained there. He
was
admitted a member of the Royal College of Surgeons (
MRCS) in
1870
and was registered under the Medical Act (1858) by the Council
of Medical
Education and Registration, also known as the General
Medical Council or
GMC.
The new doctor acquired various part-time appointments including those of
casualty surgeon to the Home for Reclaimed Females and surgeon to the Lower
Clapton Orphan Home. Alabone was a keen microscopist, and his wide interests
extended to cancer. One of his earliest written works was Cancer and
External Tumours; Their Successful Removal by a New Process without the
Knife.4
However, it was his work and writing on the scourge and cure of consumption
that was to bring him fame, a modest fortune and vilification.
|
VILIFICATION
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Alabone first came to the attention of the Royal College of
Surgeons (RCS)
in 1885 for publishing 'objectionable material'
(Council Minutes
June 1885). The objection alludes to a 'secret
remedy' described in
an early edition of his
The Cure of Consumption.
Alabone wrote to the
College apologizing; and, when he offered
to have all copies withdrawn, he was
told that any new edition
must be submitted to the Council of the RCS for
inspection.
He produced a new edition later and the RCS rejected it because
it
failed to specify the composition of lachnanthes, the basis
of his remedy. Sir
Joseph Lister, Bt, moved that 'in the opinion
of the Council Mr Alabone
still publicly professes a secret
method or process of cure relating to his
practice as a surgeon
and that he be removed from being a member of the
College' (Minutes
October 1885).
After further apologies from Alabone the Council effectively gave him
another chance, even though its attention had been drawn to an advertisement
for The Cure of Consumption in the Evening News. This did
not end matters. In June 1886 a letter from a Dr Goddard was read to the
Council pointing out to the President of the RCS a notice relating to Alabone
that had appeared in a journal called Moonshine. The letter suggested
that such notices ought to be stopped. The RCS Council minutes note:
'moved by Sir James Paget Bt, seconded by Sir T Spencer Wells that... Mr
Alabone must be held responsible and that such notices were in the opinion of
the Council prejudicial to the interest and derogatory to the honour of the
College and disgraceful to the profession of surgery' (Minutes 10 June
1886).
|
MOONSHINE
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Moonshine was a curious London publication that appeared weekly
between
1879 and 1902, edited by Charles Harrison and costing one penny.
With
its content of advertisements, quotations, campaigns, sharp
political comment,
poems and jokes, it read like a cross between
Punch and
Private
Eye. It was the 5 June 1886 edition of
Moonshine with its
cartoon of Alabone that offended the College
(
Figure 1).
Cartoons of other
medical men had appeared over the years,
so it was probably the lengthy
accompanying article that upset
the College. Some brief extracts are
sufficient to show why:
'... a successful specific treatment of consumption has at last been
discovered... the discoverer, Dr Alabone whose distinguished abilities and
eminent position in his profession are well known... there can be no doubt he
has effected a real revolution in the treatment of pulmonary consumption, and
no one can lay a more just claim to the title of a restorer of medical
science.'
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EX-MRCS
|
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Alabone was called to appear before the Council to show why
he should not
be removed from the College. On 24 June 1886 he
'solemnly asserted that
the notices in
Moonshine and other journals
had not been furnished by
him' (Minutes 24 June and 5 August
1886). He followed his appearance with
a letter attesting the
laudatory articles in
Moonshine and
Christian World had been
placed by patients of his and assured the
Council that 'nothing
shall be wanting on my part to prevent any such
articles appearing
as those objected to'. The Council's solicitor
was asked to
inquire further into announcements of Alabone's treatments
in
Pictorial World and
St Stephen's Review. It was
revealed at
a meeting of Council in July that the advertisements had been
paid
for, and while the editors of the respective journals were
not prepared to
disclose who had paid for them, the information
on which they were based had
admittedly been supplied by Alabone.
The inevitable result was that the motion
to expel Alabone was
carried 'nem con'. It was also resolved that,
under the Medical
Act, the Registrar of the GMC be informed of the removal of
Alabone's
membership.
The decision was to have profound consequences because, as the minutes of
the GMC's meeting of 1 November 1886 state, 'as Mr Alabone's
only registered qualification had been that of a member of the RCS, the
Medical Council finding him to be deprived of that qualification under the
circumstances stated, has ordered his name to be erased from the
Register'.
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PROTESTATIONS OF INNOCENCE
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Alabone became an embittered man, as he made plain in every
edition of
every book or pamphlet he published subsequently.
In vain he protested that
other medical men (Sir Henry Thompson
and Sir Morell Mackenzie amongst them)
had been the subjects
of cartoons in
Moonshine—the difference,
as he put it,
being that they had 'Baronet' after their names. (He
did not
add that references to these medical men had not always been
laudatory,
especially in the case of Mackenzie.)
Although Dr Alabone, as he continued to call himself and be known, appealed
for an explanation or reconsideration, the RCS minutes are silent until 1901.
That year the Bishop of Gloucester, whose wife had been treated by Alabone,
visited the College to plead for his reinstatement. Later the same year
another patient, Colonel the Hon le Poer Trench, wrote to the College
requesting it to rescind its resolution of 1886. The RCS declined. The Colonel
tried again, asking permission to 'inspect the accounts of the
proceedings of the Council and to make extracts therefrom'. On a movement
by Sir Frederick Treves the Council declined to do so (Minutes October
1901).
Alabone had run into implacable opposition, but he was not alone in his
plight. The College minutes mention many other cases of blatant advertising,
with application of similar sanctions. The College was much concerned about
advertising of medical services and especially sought to eradicate
'medical quackery'. The profession of secret or undisclosed remedies
exercised the Colleges, the British Medical Association, the newly formed
medical defence associations and the GMC alike. The library of the Royal
College of Physicians holds more than twenty reports or documents dated 1875
to 1900 on advertising, or related matters, concerning cures or institutions
recommended by medical men.
Despite his erasure from the Register, Alabone continued his work, building
up a considerable practice based at his home in London. He claimed to have
treated more than 200 000 patients from all over the UK and the near
Continent. Several of his patients were happy to tell the world and a
sceptical medical establishment how their lives had been saved. Some went so
far as to campaign against what they saw as unfair lack of recognition and
spiteful behaviour by the profession. There were flurries of reports, letters
and articles in papers as varied as The Times, 1900, and The
Englishman (a Calcutta journal), 1906.
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ALLEGED CURE FOR TUBERCULOSIS
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What was it that Alabone discovered, developed and promoted
which led to
such polarization? In the early 1870s Alabone learned
of the reputed
properties of the herb lachnanthes (
Lachnanthes tinctoria) indigenous
to North America and esteemed by Native
Americans for its effects on fluency
of speech, cough and pneumonia.
Over the next 30 years Alabone perfected his
methods of inhalation
of the syrup of lachnanthes with the addition of oxygen
and
camphor (among other ingredients). The delivery methods required
the
building of complex machinery (
Figure
2).
View larger version (66K):
[in this window]
[in a new window]
|
Figure 2. Illustration from Alabone's Testimonies of patients
demonstrating the Curability of Consumption, Asthma and other Diseases of the
Chest, 1900 [Reproduced by permission of the Wellcome Library,
London]
|
|
Alabone preferred to treat patients at his surgery but he also travelled
widely in the UK and corresponded with patients overseas, and for the distant
patients he invented a hand-held inhaler. Examples of his pocket inhalers may
still be found.5
Alabone advocated a holistic approach, recommending cod liver oil, a
nourishing diet, and light airy clothes. He was in no doubt about the
importance of avoiding occupations requiring bent or cramped postures. He was
not modest about his success but did not claim the treatment to be infallible:
'Some cases do not recover, but it will I think, be conceded that it is
an unprecedented success, hundreds of lives in the last extremity having been
saved....'6 He
was rightly appalled by the nihilistic attitude of much of the medical
establishment to tuberculosis. That attitude, of course, left the field wide
open to academics, inventors and charlatans alike. The story of tuberculosis
and the debates about its causes, from innate susceptibility to the final
acceptance of communicability, is well told by
Porter.7 Alabone was
not alone in being scathing about 'germ theory' and Koch's
discoveries regarding the infectious nature of TB. He called it all
'Kochspiel', and he would have noted that Koch himself later went
consistently and 'imperiously' wrong in claiming curative properties
for his extract 'Tuberculin'. Alabone was not good, however, at
picking winners: 'In a short time Pasteurism, Listerism and Kochism will
be burned in a common grave', he claimed in the 47th edition of The
Cure of Consumption. He was ultimately prepared to accept that there was
a tubercle bacillus but not that it caused consumption. It should be added
that Alabone made repeated requests to orthodox medical bodies and hospitals
to put his methods to the test. There is no record that this ever
happened.
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APPEARANCE IN COURT
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Alabone was eventually to stand accused in court. The event
attracted
widespread comment in national papers and a withering
leading article in
The Lancet (1900; i: 715).
In 1900 he was summoned under Section 40 of the Medical Act for
'wilfully and falsely pretending to be a doctor of medicine and taking
certain letters which implied recognition by the law as a practitioner of
medicine' (Daily News 1 March). The prosecution was initiated by
the GMC and was in effect a common 'sting' operation. An undercover
informer wrote to Alabone saying that he had heard of Alabone's treatment
of consumption and, having a sick relative, requested a copy of his pamphlet.
According to the Daily News report of the trial, a reply was sent by
the defendant stating terms, with a copy of his book. The defendant described
himself as MD Philadelphia, and other letters, as well as
ex-MRCS.
Defence counsel, Mr Schultess-Young, carefully separated the case from that
of others where there had been no qualification, where mala-fides existed and
where a conviction was obtained. In this case the 'ignorant
practitioner' did not apply. Dr Alabone was qualified, if not registered,
and it did not follow that a man lost his brains when his name was struck from
the Register (Stoke Newington Recorder, 2 March). He went on to say
that 'there is not the slightest pretence that there is anything false
about his titles as there would be if he had called himself MD
solely'. Alabone attested that he had obtained the MD
Philadelphia in 1875, long before he was removed from the Medical List, by
answering certain questions and writing a thesis on consumption.
The magistrate in summing up said he could not accept the prosecuting
counsel's arguments that the description of diplomas was calculated to
lead people to suppose that Dr Alabone was entitled to be registered in
England. There was nothing to suggest that the diplomas were bogus: Dr Alabone
had carefully inserted ex-before MRCS. The summons was dismissed
with 10 guineas costs against the GMC; leave to appeal was refused. According
to the Stoke Newington Recorder, the decision was greeted with
applause in court.
The GMC had damaged its image and the Islington Gazette reported
on 5 March that Alabone 'appeared to glory in his quarrel with the
Council and possibly did better as a satirist of their absurd etiquette than
he would have done if they had left him alone'. The Lancet also
pointed to the failure of the GMC in its editorial of 10 March '... the
friends of sheer quackery, as well as those persons who, in a desire to be
open minded, favour the claims of irregular medicine, will point with triumph
to the failure of the GMC to get a judgement in North London Police
Court'.
The Lancet's argument was that, on the evidence presented,
the judgment in Alabone's favour was correct. However, it points out that
both institutions from which Alabone obtained a qualification (Philadelphia
and Bellevue) were fraudulent, closed by the State Board of Health in 1880.
The Lancet argued that the court, had they considered this, should
have judged the degrees, and therefore Dr Alabone, bogus. It concluded that
'it was not a vexatious prosecution but does not appear to have been a
very well presented one'. Into this murky pool strode the weighty figure
of Sir Victor Horsley.
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SIR VICTOR HORSLEY
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Horsley (1857-1916), one of the most distinguished medical figures
of his
age, created the specialty of neurosurgery and was famed
nationally and
internationally for his research, teaching and
operating skills. He was
energetic in attempting to protect
the public by the suppression of
unqualified practice and of
quack advertisement. Horsley was active in medical
politics
too: he is acknowledged as founder of the modern British Medical
Association,
and he reformed the Medical Defence Union when it was threatened
with
failure. He was less successful with the GMC, which was offended
by his
vehemence. Although his lifelong philosophy could be
described as radicalism
tempered by belief in constitutional
methods, he was exasperated by 'the
old men of the GMC... they
must be crushed or driven to do the right
thing' he
wrote.
8 He was
elected a member of the GMC but failed in his historic
attempt to make
medicine a closed shop (i.e. attendance on the
sick should be restricted to
qualified practitioners).
Horsley may have thought that the ridicule heaped on the GMC over its
prosecution of Alabone was an opportunity to attack on several fronts.
The Lancet on 5 May 1900 reported that, at a conference on medical
organization, Horsley was scathing about the incompetence of the GMC and its
lawyers, using the Alabone case as an example. The remarks raised a storm of
indignation. Alabone's supporters were outraged and his enemies were
concerned that vilification of such a nature could rebound to his advantage.
On 26 May The Lancet printed a letter from Alabone's solicitors
stating the true position that there never had been any implication of
infamous conduct in his erasure from the Register. To this Horsley replied on
2 June, insisting on his interpretation of the Medical Act—namely, that
an offence against the ethics of the profession sufficient to demand expulsion
from a College amounted to infamous conduct. Alabone and his supporters were
incensed and The Lancet stood firm in its own (correct)
interpretation of the Act.
Weathering a flurry of correspondence from Alabone's solicitors,
supporters and patients, Horsley now kept his silence, neither apologizing nor
justifying. Alabone had his own views on the silence, believing it to be
wicked and unscrupulous, and the matter was still unresolved when nearly a
year later Alabone wrote to Horsley himself 'purposing to publish the
correspondence and desire now to offer you any explanation you may like to
make...'. The silence must have continued and Alabone duly published a
booklet 29 pages long. He gave his reasons in the preface, explaining why,
'being a man of peace', he had not taken out a libel action. Perhaps
the most significant point though was this: 'In these days, when every
one should be labouring to find means of preventing Consumption and other
forms of Tuberculosis, one would have expected men holding high positions in
the profession to co-operate with others who have devoted their lives to this
end'.9
Alabone's sense of injury was deep, and he believed the falsehood was
deliberate, aimed at damaging his practice 'as a fellow professional
man'. For the remainder of his life he believed he had been 'subject
to the greatest persecution and mordacity that had befallen any medical man of
the present
century.'10
Every subsequent edition of his professional books, including the last (47th)
edition of The Cure of Consumption published in 1912, contained
further testimony to the hurt and the wrongness of it all. Each edition made
renewed appeals for understanding, while setting the record straight, as he
saw it, by laying out the particulars of the trials he had suffered at the
hands of the RCS and the GMC.
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SUPPORT FOR ALABONE
|
|---|
Alabone had eloquent independent supporters who took up his
cause in
public, mainly from a libertarian standpoint. Perhaps
the most formidable was
Labouchère, the radical journalist
and politician, who published the
weekly journal
Truth. Truth took the line that a technical offence
did not or should not
remove a person's qualifications, much less his
experience.
It went on to suggest that covering up for bungling colleagues
was
a much worse fault. It pointed to blatant advertising by
senior medical
figures and concluded that Alabone had been unjustly
dealt with.
Truth's final comment on the issue resonates to
more recent
times. The GMC is a 'tribunal which has deadly power
against which there
is no appeal. It is in no sense an independent
judicial body but the master of
the rules it administers and
directly interested in every decision it
gives'.
11
Another crusading organ to take up the fight was The Free Lance.
This journal fired at 'the modern Trades-Unionism, in its worst
sense' of the GMC. In November 1900 The Free Lance printed this
comment: 'In an ordinary court of justice all evidence is given openly
and no vulgar informers are allowed to shelter themselves under the cloak of
secrecy, but the Medical Council seems to be a renovation of the old Star
Chamber or the Inquisition'. In the case of Dr Alabone the persecutors
appeared to have been 'actuated by pure jealousy. A great good will have
been accomplished if the veil of secrecy surrounding the [G]MC were to be
removed'.
Alabone's practice in the early years of the 20th century, having been
badly damaged by controversy and bad publicity, recovered and prospered up to
his last years. His treatments were unchanged although he invented various new
ways of delivering them. His books and their content of theory and
self-justification likewise remained untouched by scientific and clinical
advance, in particular the universal acceptance of the infectious origin of
tuberculosis.
|
OBITUARIES
|
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Misfortune pressed hard in Alabone's last year; his wife died
aged 52,
and a fire at his publishers robbed him of valuable
editions of his works (the
book of curves alone was priced at
two guineas), and ill health was creeping
upon him. Alabone
died in 1913 of bowel cancer at the age of 65, leaving an
estate
worth £25 000.
Sympathetic obituaries described him as a kindly and original man. They
referred to his humanity and generosity and his refusal to accept payments
from poor patients, and to the grief he felt at the separation from his
colleagues and the solitary application of his own researches. The body of
work on poly-cyclo-epicycloidal curves was mentioned as giving Alabone great
pleasure and not a little solace as he corresponded with other enthusiasts, in
contrast to his bruising encounters with the medical establishment.
|
CONCLUSION
|
|---|
Alabone should be judged by the standards and knowledge of his
time. There
were many and various contemporary treatments for
tuberculosis and some seem a
good deal more bizarre than his.
Alabone's misfortune was to have run
into a medical establishment
trying to clean up quackery within the profession
while at the
same time protecting the interest of its members. The traditional
Punch image of doctors as a tribe steeped in snobbery and devoted
to
self-advancement was giving way slowly to the aspirations
of reformers. This
meant regulation and standards, or restrictive
practices, depending on your
viewpoint. The battle was long
and bitterly fought. Regulation of practice and
the setting
of standards may have reduced flagrant competition within the
profession,
but professionalization required limitation of some lucrative
sidelines
such as the advertising of practice and of novel cures.
Last year the BMJ, in its series 'one hundred years
ago', reprinted an apposite piece on professional jealousy from 1904. The
article tells of the Italian philosopher Ferriani, who had created a scale of
jealousy in various
professions.12
Doctors were listed as among the most jealous (exceeded only by actors), and
Ferriani suggested that they displayed the vice by affecting to regard each
other as quacks. The article goes on: 'But it is to be feared that in a
profession in which men are necessarily brought into such close personal
rivalry as is the case in medicine, jealousy, with its unhappy and often
degrading consequences, is inevitable.' Alabone may well have fallen foul
of such jealousy.
|
Acknowledgments
|
|---|
We gratefully acknowledge the help of the British Library, the
National
Library of Medicine, Bethesda, MD, USA, the General
Medical Council, the Royal
College of Physicians, the Royal
College of Surgeons of England, and the Royal
Society of Medicine.
|
REFERENCES
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|---|
- Alabone EW. Poly-cyclo-epicycloidal and other Geometric
Curves. London: John Swain & Son,1910
- Alabone EW. The Cure of Consumption, Asthma, Bronchitis,
and other Diseases of the Chest with chapters on laryngitis, tabes
mesenterica, post nasal catarrh and hayfever, 34th edn. London:
John Kemp and Co, 1898
- Alabone EW. Infamous Conduct: Edwin W. Alabone versus
Victor Horsley. London, 1901
- Alabone EW. Cancer and External Tumours; their
Successful Removal by a New Process without the Knife. London:
Stacy Bros, 1876
- Sanders M. Inhalatorium—vintage inhalers and asthma
remedies
[info{at}inhalatorium.com]
- Alabone EW. Testimonies of Patients Demonstrating the
Curability of Consumption, Asthma and other Diseases of the
Chest. London: Apsley Guise: Powage Press,1900
- Porter R. The Greatest Benefit to Mankind. A Medical
History of Humanity from Antiquity to the Present. London:
Harper-Collins, 1997
- Paget S. Sir Victor Horsley: A Study of his Life and
Work. London: Constable, 1919
- Alabone EW. Infamous Conduct; Edwin W Alabone versus
Victor Horsley. London, 1901
- Alabone EW. Testimonies of Patients Demonstrating the
Durability of Consumption, Asthma and other Diseases of the
Chest. London: Apsley Guise: The Powage Press,1900
- Truth 1900; No.1501
, p. 803
- Anonymous. Professional jealousy. BMJ2004; 328:887[Free Full Text]
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INTRODUCTION
THE CURE OF CONSUMPTION
