Thomas Wakley

The Lancet is one of the world's most important peer-reviewed medical journals. The name of the journal refers not only to the medical blade for cutting out diseased tissue, but for the tall, narrow lancet windows that admit light. From its earliest issues in 1823, The Lancet has been not only a publication about new developments in medical practice, but also a voice for reform. In recent years, the journal has used the context of Bill Clinton's impeachment to raise the question of what young people believe does or does not constitute "sex," and examined the implications for public health. The Lancet also published the controversial statistical survey that attributed hundreds of thousands of Iraqi deaths to the 2003 invasion of that country. The journal is at the forefront of combatting medical practices, such as homeopathy, with a poor record of clinical validation.

But The Lancet might not have existed at all if not for the attempted murder of its founder.

Thomas Wakley (1795-1862) was the youngest son of Henry and Mary Wakley, prosperous farmers in Devon. He moved to London in 1815, qualified as a surgeon in 1817, and set up a private practice. With the help of his future father-in-law, a wealthy merchant, Wakley was able to purchase and take over a thriving established practice in the West End, along with a 15-room house near Oxford Circus. Wakley married Elizabeth Goodchild at St. James's, Piccadilly. Still in his early twenties, Wakley was positioned for a comfortable and conventional career in medicine.

To understand what happened to Wakley to alter the direction of his life, one must remember that Europe at this time was still smouldering with revolutions and revolutionary ideals. Among the revolutionaries was Arthur Thistlewood, whose travels to the United States and France had exposed him to revolutionary societies and convinced him that Britain, too, needed to be shaken from its ancient foundations. There was a lot that was rotten in British government at the time. Parliament was hardly representative of the populace, thanks to suffrage limited to large landholders and geographic constituencies that hadn't changed with shifts of population. For example, the county of Lancashire with a combined population of nearly one million in half a dozen cities sent two representatives to Parliament, whereas Old Sarum in Wilshire, home of just one eligible voter, also sent two representatives. But the real driver of unrest was probably the economic depression in the aftermath of the Napoleonic wars. Wages fell by as much as two thirds, while new taxes drove up the price of food. Revolutionaries found sympathy among many ordinary people.

Arthur Thistlewood and his compatriots were furious over two recent events. One was the Peterloo Massacre. In 1819, some 60,000 residents of Lancashire gathered at St. Peter's Fields in Manchester to protest their under-representation in Parliament and to elect an unauthorized MP. On the orders of the local officials, soldiers moved to arrest the leaders of the protest, and the culmination of the ensuing confrontation was a cavalry charge into the crowd. Fifteen people were killed, and hundreds, including women and children, were injured. The government's response to an outraged press and populace gave rise to Thistlewood's second grievance: the Six Acts. I think of it as the Patriot Act of 1819. The Acts said that any meeting advocating radical reform constituted "an overt act of treasonable conspiracy." The Acts limited many civil rights, exerted pressure on the press, and made seditious writing punishable by transportation out of Britain for a period of fourteen years.

Not content with organizing meetings, which would be illegal now anyway, Thistlewood endorsed a plot to assassinate government ministers at a dinner party. What he didn't know was that the dinner party was a sham concocted by a police informant, a double-agent in Thistlewood's group. The police went so far as to place newspaper notices about the dinner to convince Thistlewood and his conspirators to proceed with the plan, which had all been the idea of the informant to begin with.

The first attempt to arrest Thistlewood and the radicals in his group was botched. Thistlewood killed a policeman with a sword before making his escape. Soon after, he was hunted down and jailed. Those conspirators who did not cooperate with the prosecution were hung, and reportedly their heads were removed from their corpses by an anonymous "surgeon." In fact, this mutilation was probably performed by a hospital porter cum body snatcher named Parker, not a surgeon at all.

However, "surgeon" was the operative word for some of Thistlewood's escaped compatriots, and rumors pointed them in the direction of a young doctor living in the West End as the man who had decapitated Arthur Thistlewood. They intended to have their revenge upon the establishment.

On 27 August 1820, the young Dr. Wakley had a headache. He treated it by applying leeches to his temples and tying a tourniquet around his head. A stranger called at Wakley's door, asking to confer about one of Wakley's patients. The stranger then asked if he might have a glass of cider, and when Wakley obligingly went to the cellar to fetch some, the stranger admitted a group of masked men. The assailants knocked Wakley unconscious with a blow to the head --- the tourniquet may have prevented the blow from killing him. They kicked him and stabbed him. When Wakley came to, his house was ablaze. He escaped, but the house and its contents, including the Wakleys' wedding presents, were a total loss.

Wakley was heavily insured, but the insurance company accused him of staging the assault and setting the fire himself. Wakley took them to court, but in the meantime he and his wife had to seek much more modest lodgings. The Wakleys moved to the poorer neighborhood of Newport Street, off the Strand, where Wakley tried to establish himself again as a doctor. However, he had a hard time making ends meet. The residents of his new neighborhood could hardly afford his services, and on top of this he was distracted by his legal fight with the insurer and was still recovering from his injuries.

Several factors may have combined to motivate Wakley to try his hand at medical publishing. Elizabeth Wakley had expected to live in rather better circumstances and urged him to find an alternative to medicine. While living on Newport Street, Wakley had befriended William Cobbett, a radical journalist and reformer. Finally, in 1823, Wakley met Dr. Walter Channing, one of the founders of the New England Journal of Medicine and Surgery, who seems to have encouraged Wakley in his scheme of starting a new medical journal in London. Channing may even have bankrolled the effort.

The Lancet published its first weekly issue on 5 October 1823. The journal was the only medical weekly in Britain, and it was successful almost immediately.

Wakley's battle with his insurance company ended in victory for Wakley. He was awarded full compensation and costs, but the move to Newport Street had already changed the direction of his life.

Wakley went on to have a remarkable career, building on his publishing reputation to get himself elected to Parliament as a reformer. In Parliament, he made an impression with his impassioned speech in defense of six laborers, the Tolpuddle Martyrs, who had been sentenced to transportation for organizing to resist a reduction in their wages. He pushed through legislation that required government to pay for expert medical consultants to assist coroners, who at that time had legal training but no expertise in medicine. While still serving in Parliament, Wakley was elected coroner himself, the first medical man to take the post. He ran on a reform platform that promised to investigate all suspicious deaths, and in office he earned the enmity of workhouse managers when his investigations into accidental deaths exposed the terrible conditions at these institutions. Among Wakley's admirers were Charles Dickens and William Makepeace Thackery.

Wakley is not buried at Kensal Green, though his corpse is deposited there. That is, his coffin rests, along with those of his wife and daughter, in one of the niches of Kensal Green's catacombs under the Anglican chapel.