ohn Pattison's experience in 1866-1867 was eerily similar that of Dr. Fell in 1857, even to the point of public scandal. Case #4134, The Queen v. Pattison, led to the revocation of his license to practice medicine in England. According to clinical notes, Mrs. Charles Hay Frewen, age 54, accompanied by her husband, had consulted Pattison, on 21 September 1866, regarding a mass in the left breast. Pattison determined that the disease was stage II cancer, involving the axillary port of the breast. To manage her asthma, Mrs. Frewen had spent the previous winter in the warmer climate of Cannes. Pattison recommended that, after receiving cancer therapy from him, she and her husband should revisit the south of France for the coming winter; the warmer temperatures would ease her respiratory condition and allow her to recuperate fully from the escharotic treatment that was about to begin. Mr. and Mrs. Frewen, however, unwisely delayed the anticancer treatment until the middle of November (Cancer: Its Nature , 41-8).
The remainder of Dr. Pattison's 1866 account covered events transpiring from 19 November 1866 to 9 February 1867. Two factors incited a conflict between Pattison and the Frewens: one was their refusal to heed the doctor's medical advice, leading to the patient's death; and another was Mr. Frewen's refusal to pay for Pattison's services. On 19 November, after the risky seven-week delay, Pattison began to treat Mrs. Frewen, beginning with an application of nitric acid to remove cutaneous skin for better absorbency (, 41). By 16 December, the H. canadensis-ZnCl2 paste that Pattison used had successfully destroyed the tumor; and, in January 1867, the devitalized mass was reported to have detached itself from the chest wall. In the short term, Dr. Pattison's escharotic therapy was successful. Unfortunately, the chronic asthma flared up near the end of the cancer therapy. To manage the respiratory condition and to help Mrs. Frewen to recuperate fully, Pattison urged Mr. Frewen, without further delay, to take his wife to southern France, as he had in the previous winter. For reasons that can only be inferred, Mr. Frewen refused to comply and "could not be persuaded from his own pre-conceived opinion" (, 43). Pattison remarked, on record, that Mr. Frewen had been contemptibly stubborn. Having rejected Dr. Pattison's advice on the advisability of the warmer climate, the couple sought a second opinion from Pattison’s colleague, Dr. Wilkinson. On 31 January 1867, after Dr. Wilkinson confirmed Pattison's diagnosis and reaffirmed his colleague's advice, Mr. Frewen appeared to relent; but instead of travelling to the south of France, the couple embarked on a less expensive trip to the coast of Hastings, 50-miles south of London.
Before the Frewens left for Hastings, Pattison who had not yet been paid approached Mrs. Frewen to settle the bill. She expressed satisfaction with the treatment rendered to date and promised to speak to her husband about the amount owed. On 6 February 1867—just one week later-- Dr. Pattison was summoned to Hastings because Mrs. Frewen was acutely ill. The Frewens, it appears, had occupied a house "exposed to the sea." Pattison contended that the inclement and colder environment had aggravated her respiratory condition. On the scene, Pattison "again urged her immediate removal [but] without effect." Mrs. Frewen passed away on 9 February 1867 (, 43).
Dr. Pattison was not charged with medical malpractice, for the attending physician at Hastings had testified that the cause of death had been "fatty degeneration of the heart" and "bronchial irritation" (, 43). Furthermore, the Hastings physician's post-mortem of Mrs. Frewen found "no trace of cancer" (43). In view of the medical evidence, what exactly provoked a lawsuit? It turned out to be Pattison’s assertion that the cause of Mrs. Frewen's death was her husband's refusal to heed his medical advice about recuperation. Pattison contended that, had Mr. Frewen acceded to his directions and brought his wife early in January to the south of France, "she would to this day have been quite well" (43). From a clinical standpoint, the doctor was understandably frustrated. Although the cancer treatment had worked in the short term, his patient had succumbed, needlessly in his view, to a pre-existing but manageable condition. The moral responsibility was Mr. Frewen's
The delay in remittance worsened the acrimony. Pattison maintained that, over a five-month period, he had made 138 visits to the Frewens' Devonshire Place residence, but he had not been fully remunerated. Had Pattison presented documentation that Mr. Frewen was in arrears, the case might have been quietly resolved; instead, it spiraled out of control. Instead of presenting documentation to the authorities, Pattison sent hate mail to Mr. Frewen. Nothing could be gained from this behavior and more was lost, as Mr. Frewen was socially prominent: an influential landowner, one of Her Majesty’s sheriffs, and a grieving widower. On the other hand, although Dr. Pattison was a licensed allopath and although he deserved payment, to those who would adjudicate the case, he was an insensitive and dishonest.
Publicly humiliated and seeking redress, Mr. Frewen filed a complaint with the Branch Council which summoned Dr. Pattison to appear before the Medical Council on a misconduct charge. According to chapter 90, section xxiv, of the Medical Act of 1858, practitioners convicted of a felony or misdemeanor could be struck from the Register—that is, lose their license to practice in Great Britain. The language of section xxix was intentionally ambiguous: aside from a legal conviction of any kind, if a medical practitioner, "after due Inquiry be judged by the General Council to have been guilty of infamous conduct in any professional Respect, the General Council may, if they see fit, direct the Registrar to erase the Name of such Medical Practitioner from the Register" (Medical Act of 1858).
According to the "Minutes of the General Council of Medical Education & Registration," Pattison had been summoned to appear on a charge of misconduct under section 24 of the Act. The Council recognized that, at the outset, he had desired to be represented by counsel, but his request was denied (47-8). Having been denied legal representation, Pattison then forwarded a statement to the Council. The charge and misconduct proceedings then proceeded on the basis of an affidavit, submitted by Charles Frewen, Esq., who was represented by an attorney. Mr. Frewen maintained that Dr. Pattison had treated his wife, but during his opening statement, said nothing about her pre-existing condition, about the short-term, palliative effect of the escharotic, or about the professional advice of Drs. Pattison and Wilkinson on behalf of Mrs. Frewen. Clearly, the issue had nothing to do with health care. In regard to the delinquency in payment, Frewen had absolutely no excuse; so, probably on the advice of an attorney, he withdrew the misconduct charge against Pattison and admitted being in arrears to the sum of £168. Pattison alleged, however, that this was only part of the fee and that Frewen had reneged on an additional £105. The General Medical Council was clearly trying to find a compromise, but at Pattison's expense. In what sounds like a scripted reaction, Mr. Frewen refused to pay the balance, then threatened, but did not pursue, further legal action against Pattison.
Dr. Pattison could not control his anger, even though it was likely that, had he accepted the unfair decision, he could have moved on. Instead, he harassed Mr. Frewen with "irritating correspondence." Frewen claimed to have asked Pattison to desist but was ignored. This led Frewen to resubmit the misconduct grievance. This incensed Pattison who then threatened to expose the unseemly facts in a forthcoming book on cancer which would report the details of Mrs. Frewen’s treatment, including his professional recommendation about recuperating in southern France and Frewen's noncompliance with the sound advice of two licensed physicians. Ironically, publishing the narrative would have publicly cleared Pattison of medical malpractice, because it proved that the tumor, which was outside the scope of ablation, had been destroyed chemically, and that (as the attending doctor at Hastings had corroborated) the patient had been rendered cancer-free in the short-term. The allegation that forced Frewen's hand was Pattison's charge that, possibly to save money, the former had been indifferent to his wife’s medical needs. The Council had little patience with Pattison’s animus: "The case was described in the coarsest way, and in a manner calculated to wound the feelings of a man of honour . . . The judges of the Court of Queen’s Bench were angered by Pattison’s persistence despite Frewen’s consenting to a compromise (he would pay only half of what was owed)" (em>The Queen v. Pattison, 35-7; and "Medical Trial" [30 January 1869], 175-76). Pattison's name was summarily expunged from the Register. His medical career was cut short, not because of malpractice, but because he had said the wrong things to the wrong person.
An article in The Lancet, of 30 January 1869, provided further details. Mr. Frewen was portrayed as a grieving victim; and Dr. Pattison, as a rude calumniator. In one of Pattison’s objectionable letters to Frewen, as noted above, the former is said to have "hinted" at exposing the details of the case in a professional journal ("Medical Trial," [30 January 1869], 175-76). Mr. Frewen testified that he had received a number of letters from Pattison which he subsequently returned through the dead-letter office and that he had his attorneys order Pattison to desist. Intending to expose how miserly Frewen had been, Pattison threatened to communicate the matter on postcards and then mail them to the members of the former's private club. Pattison's character-assassination campaign had the anticipated effect. The Court's judgment was that the "defendant" had imputed to Frewen the shabbiest conduct "in disputing [the] demand" to stop annoying Frewen.(175).
The Lancet reported, on 6 February 1869, that, in the case of The Queen v. Pattison, "The rule was discharged on condition of payment by the defendant of all the expenses incurred" ("Medical Trial" [6 February 1869], 213). Not only had the "defendant" been forced to pay the accuser’s legal fees, but a transcript of the hearing, published in The Medical Times and Gazette of 10 July 1869, depicted Dr. Pattison, not as one unjustly accused and denied representation, but as one who stood in contempt of Court and was legally indefensible: "Mr. Pattison was neither in attendance in compliance with the order of the Council, nor had his solicitor appeared on his behalf" ("Mr. Pattison's Case," 37). A later account has it that Frewen, sick of the pressure and publicity, actually paid in full, and apologized to Mr. Pattison.
Temperament & Opportunity
A Table of One Hundred cases of Cancer of the Breast from Pattison’s Cancer: Its Nature, Treatment, & Cure (1856). Click on image to enlarge it.
John Pattison was an interesting figure. On the one hand, this NYU graduate was a learned physician, an innovator, and a tireless worker. On the other hand, we find a self-aggrandizing person who was willing to skew valuable data to further his career goals. Unethical in this respect, he was, however, sympathetic and dedicated to his patients. He despised close-minded traditionalists who refused to test the merits of an alternative system, especially if the standard treatment was woefully inadequate. The intemperate passage below resulted when Pattison learned that, in Kent, the family physician of a young man suffering from cancer of the face and jawbone had warned him not to visit Pattison for chemical treatment. The physician who was partial to radical surgery claimed that Pattison had lately been fired and confined in the Queen's Bench, "'for torturing to death the son of a clergyman of the city of York'" (, 84n.). The improbability of the story and the anti-homeopathic sentiment behind it were obvious to the patient. Pattison learned of the defamatory comments and reacted predictably:
YES, I FEEL PROUD OF THE NAME OF QUACK, IF IT MEANS ONE WHO IS WILLING AND WHO IS ABLE TO RELIEVE SUFFERING; AND I WOULD RATHER A THOUSAND TIMES BE SUCH A QUACK, THAN ONE OF THOSE PROFESSIONAL DOGS IN THE MANGER WHO, BEING UNABLE TO RELIEVE THEIR PATIENTS THEMSELVES, PREVENT THEM BY FALSEHOOD AND MISREPRESENTATION, FROM GOING TO THOSE WHO CAN. [(1856), 84]Hospital Board rejections and slanderous comments left him embittered, and his inability to control his temper destroyed his career a decade later.
Pattison's 1856 compilation of case studies demonstrated the undeveloped potential of his work. On the one hand, although the case studies he included were substantive, the corpus represented only a fragment of the patients whom Pattison treated. It seems that he only selected those cases that conformed to his pro-escharotic viewpoint and might have omitted failures that would have had the opposite effect. Only 35 treatable cases (from December 1851 to September 1855) were cited in the 1856 text out of total of 281 or more possibilities--a meager 12% of cases treated from 1842 to 1852; all of them reflected positively on his method. Compounding the problem of selectivity was textual disorganization and digressiveness. Case studies of oral, skin, breast, and cervical cancers, which comprised nearly one half of the book, seemed to have been randomly compiled. Neither chronological nor numerical order was observed.
Pattison deserved credit for tabulating the breast-cancer data, even though he failed to extrapolate from the results. In "A Table of 100 Cases of Cancer of the Breast," the image of which is reproduced here, he presented his findings under six headings: (1) the category of possible causes: bodily injury (54%) and heredity (30%); (2) the site of the tumor: 54% in the left breast, 29% in the right, and 16% had lymph-node involvement; (3) distribution by age of onset: a bell curve inclining from 10-20 years (6%), to 20-30 years (3%), to the mean of 30-40 (28%) and 40-50 years (36%); the curve declining precipitously from 50-60 (10%) to 70-80 years (2%); (4) how the disease was diagnosed: as a small tumor (51% of cases) and as an indurated nipple (39%); (5) the three treatment options (knife, caustic, or none): a bimodal distribution curve of 31% (ablation group), declining to 12% (escharotic group), and re-inclining to 57% (no treatment); and (6) the average time elapsed between therapy and recurrence: 43 of the 100 women had operations (31 [ablation] and 12 [caustics] and 57 [no treatment]) (, 4).
The distribution scale for post-surgical recurrences, the sixth category, contained invaluable information for breast-cancer research in the mid-Victorian period. Twenty-six of the 31 recurrences in the sampling happened within 24 months of treatment. The chances of recurrence for all treated women up to 11 years was 77%; but the odds of recurrence decreased significantly after 24 months (, 4). Pattison who was preoccupied with promoting his expertise failed to explore these data. Nevertheless, the Table suggested that heredity and physical trauma were risk factors; that women in the 30-60-years distribution were most at risk; that careful palpation for breast tumors was diagnostically essential; that regular post-surgical follow-ups were mandatory in the 24 months after surgery; and that surgical techniques had to be improved. Had Pattison developed these lines of investigation, he might have been recognized, in some respect, as a forerunner of William Stewart Halsted, M. D. (1852-1922).
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Last modified 6 May 2021