It seems somewhat sad that John Fothergill would be recalled today only as Benjamin Franklin’s doctor, rather than as the observational innovator that he was, and man who determined early in life that regardless of the obstacles placed before him, he would acquire a medical education.
He was six years Franklin’s junior, born at Carr End, Yorkshire, 8 March 1712 (NS). His father, also John, was a Quaker preacher and farmer, a man of modest means. Young John was educated nearby at Sedbergh School, Cumbria, and then apprenticed to an apothecary of Yorkshire. Here he developed a love for medicine and sought further education in the field. Unfortunately, as a member of a dissenting sect, his clear path from Sedbergh to Cambridge was legally barred, and he sought permission to read for medicine at the University of Edinburgh. He would complete his education there in 1736 and relocate to London for resident training at St. Thomas Hospital.
He launched his London practice then in 1740, and from the outset made it clear that, as a devout Quaker, he would see any and all in need of his services. Among the poor children of London, he found outbreaks of an illness of the throat, manifest as sloughing of the surface tissue with underlying ulcer, and in many cases persisting unrelentingly to inability to breathe or to uncontrolled bleeding in the throat. His description of this “Putrid throat”, which the French, two generations later would label “diphtheria,” was one of the first in the English medical literature.
In 1744, based on patients for whom he had provided care for chest pain related to activity or stress, and who subsequently succumbed to a cardiac incident, he realized that there was an association between the development of “hardening of the arteries” due to calcium buildup in the vessels of the heart, and the symptoms of chest pain. He described this association before the Royal Society and was acclaimed for this contribution for decades.
Over the course of his busy London practice, Fothergill had come into contact with fourteen patients who had developed episodes of severe pain, always on only one side of the face, sometimes due to stress, or talking, or chewing food, but on occasion by very light touch, such as an insect or a handkerchief. He raised the concern as to whether this were tumor-related and felt strongly that it was not related to seizure disorders. His clinical description became the standard for the ensuing 100 years in medicine and was known as “Fothergill’s disease.” What the French referred to as “tic doloureux” we now know as “trigeminal neuralgia,” not tumor-related, but debilitating and challenging to treat. In the 1770’s, Fothergill described for the Society of Physicians what he called “sick headaches,” episodes of severe head pain often brought on by consumption of alcohol or cheeses, often associated with nausea and sensitivity to light; we now know these attacks as “migraine headache.”
By the 1760’s, Fothergill was renowned throughout the environs of London as a skilled and caring physician and carried one of the largest and most time-demanding practices in the area. As a result, he came into significant wealth and connections in all corners of the city. His home in Harpur Street was considered a showpiece in Bloomsbury, the neighborhood two generations later of Robert Browning and Elizabeth Barrett. It is small wonder that Benjamin Franklin was drawn to John Fothergill; Franklin was, after all, no longer a “healthy specimen” and would be plagued in his later years by gout manifesting as kidney stones and debilitating arthritis. At the same time, Franklin appreciated the many doors that Fothergill could open for him in the political and financial world of London. Throughout the 1760’s and 1770’s, Fothergill’s steady hand and stern demeanor at non-compliance would nurse Franklin through physical debility and keep him well enough to carry out his goals for the American colonies.
For this, the United States owes a true debt of gratitude to John Fothergill for his care of the “grandfather of America.” John Fothergill was not only one of the preeminent British physicians of the 18th century but was an American patriot in the best sense of the term.