Sir Thomas Lauder Brunton Bt FRCP FRS (1844–1916)

‘I need your most kind help’⁹

Thus Miss Florence Nightingale wrote to Dr Thomas Lauder Brunton in December 1887. She had been ill intermittently since her return from the Crimea in 1856, infected with what was described as Crimean fever (since diagnosed as chronic brucellosis). At the age of 67, Nightingale was suffering from back pain, nervous irritability and palpitations, prompting her to consult Brunton (she may have been introduced to him by their mutual friends Sir James Paget or Sir Henry Acland or met him through Alice Stopford Green who was Brunton’s sister-in-law, see below). By the 1880s, Brunton and Nightingale were on the best of terms: his letters express concern, apologies for failing to call on her at the most convenient time, 5 p.m., and while at Hyderabad he promised to make enquiries about the nursing of British troops in India on her behalf. For her part, Nightingale was grateful for Brunton’s kindness and his recommendation of a masseuse, but she found that the medicines he prescribed did not suit her.

Nightingale cultivated intelligent gentlemen, namely Sidney Herbert, first Baron Herbert of Lea (1810–1861), who as Secretary of State at War invited her to lead a group of nurses to Scutari in 1854. She was close to Benjamin Jowett (1787–1861), Master of Balliol College, University of Oxford, (it was rumoured they might marry), and to her neighbour, Sir John Forbes FRS (1787–1861), physician to the royal household. Dr Thomas Lauder Brunton FRCP FRS was another admirer.

The somewhat plaintive letter Nightingale addressed to Brunton in December 1887 began ‘You have been very kind to me. I have just had my first séance from your Swedish masseuse, Miss Brinck. I arranged with her, thank you, to come down to me every evening at Pine Acres, Sunnydale [Nightingale’s nephew, Frederick Verney, lived at Pine Acre, Sunningdale]… And I hope you will allow me to send for you when I come back. I need your most kind help’. In addition to recommending regular massage, Brunton had prescribed bromide and chloroform for Miss Nightingale, neither of which had the desired effect. ‘Do you know’, she wrote, ‘I feel doubtful of being able to take the Bromide. I took yesterday the dose in the morning. I was so cold and my brains so mixed after it that I could hardly do anything. I took one dose of the Comp. Spirit chloroform in the afternoon because I had a heavy appointment. I could scarcely get thro’ it. It has never had that effect on me before. It may be fancy, of course, that it was the medicine. My eyes are very bad. Pray believe me, With many, many thanks, Most faithfully yours, Florence Nightingale’. ¹⁰ Brunton prescribed potassium bromide as a sedative (his textbook claimed it allayed excitability and irritability) and he claimed that diluted spirit of chloroform acted on the nervous system ‘somewhat the same way as alcohol’, having a stimulating effect and reducing pain and spasm. ¹¹

The letter from Nightingale to Brunton came up for auction in 1996, inspiring a headline in the Daily Mail – ‘The Dark Truth About the Lady with the Lamp’. ¹² The article declared that Nightingale’s public image was now ‘darkened’ by the revelation that she attended séances and took drugs. The journalist ignored the meaning of séance as a session or appointment (in this case with a masseuse for the relief of back pain), the use of bromide to steady the heart and the popularity of chloroform as a sedative, particularly after Queen Victoria praised its soothing effect in childbirth. ¹³

Whether or not Nightingale continued to take the chloroform and bromide prescribed for her by Brunton, her health and spirits improved so that by the end of December 1887 she was enjoying walks and playing with the cats at Pine Acre. The following May she received a pensive note from Brunton, addressed to ‘My Dear Miss Nightingale’: he had ‘been feeling lately how very true your remark is that it is not what we do but what we leave undone that wears us out. I dare say you have been thinking me sadly neglectful but I can assure you it is not for lack of thinking about you’. Having arranged to call on her the next day, the missive concludes ‘With kind regards, Believe me, Very sincerely Yours, T. Lauder Brunton’. ¹⁴ Writing again in June, Brunton’s tone was apologetic: his schedule had left no time for him to call on Miss Nightingale. As he explained, he had been summoned to Dorking by telegram in the middle of a dinner, returning to St Barts to lecture and thence to examinations in Oxford, causing him to neglect his private practice in London, where he was esteemed as a specialist in heart disease and circulation. ‘On Sundays I say I have left undone the things that I ought to have done’ he confessed, ‘but every day in the week I think it many times over…I feel all the more vexed with myself when I think of your kind letters’. He vowed to visit her shortly. ¹⁵

Florence Nightingale was of course concerned about nursing arrangements for the British Army in India and, knowing that Brunton was at Hyderabad in 1889 she asked him to make enquiries. On his return to England, Brunton forwarded a report from the inspector of nursing at the Bangalore and Secunderabad military hospitals where the nurses were treating severe cases of tetanus and typhoid. The report concluded ‘We are too few to do much good’, underlined in red, presumably by Nightingale. In his covering note, Brunton wrote ‘I was very sorry indeed to be absent from home when you wanted me, but I trust you are now feeling strong again’. ¹⁶

Sir Thomas Lauder Brunton would have been among the mourners at Nightingale’s memorial service at St Paul’s Cathedral in 1910. A year after her death, Nightingale’s pamphlet on Health Visiting in Rural Districts (1892) was reprinted with a preface by Brunton confirming that he had enjoyed the honour and pleasure of knowing the author personally. He paid tribute to her ‘clearness of intellect’ and praised her glorious work during the Crimean war, continuing ‘after the war was over, Miss Nightingale, exhausted in mind and body by the tremendous strain she had undergone, never regained the health which she devoted to her country’s cause. And yet from her couch this woman of loving heart and gracious presence originated and developed with marvellous organising power a system of sick nursing which has lessened the pains and smoothed the weariness of millions of sufferers and has even robbed deathbeds of much of their terror’. Nightingale’s scheme centred on health visitors throughout the country ‘who could visit homes and give the mothers the instruction they needed in order to prevent the death of their children or their disablement by disease’. ¹⁷

The Second Hyderabad Commission, 1889

Kind, sociable, hardworking and with an international reputation, Brunton was in demand as a lecturer at medical congresses and as a member of commissions. With Sir James Paget, Lord Lister (1827–1912), Sir Richard Quain Bt (1816–1898) and other medical luminaries, Brunton was appointed to report on Louis Pasteur’s treatment of hydrophobia (rabies) in 1886. Three years later he was selected by The Lancet to investigate the effects of chloroform anaesthesia. Since its introduction in 1831, the safety of chloroform was a major medical issue. The matter had been investigated by the chloroform committee of the Royal Medical and Chirurgical Society in 1864 and by the Glasgow committee, which in 1880 re-affirmed that chloroform could have a dangerous effect on the heart. The first Hyderabad Commission, dominated by Surgeon-Major Edward Lawrie (1846–1915) of the Bengal Army Medical Service, contradicted the received wisdom: Lawrie asserted that in 40–50,000 experiments he had never witnessed the heart injured or dangerously affected by chloroform. This statement stirred a hornet’s nest. The Lancet dismissed Lawrie’s findings as scanty experiments performed on dogs, whereupon the Nizam, the hereditary ruler of Hyderabad, called for a second commission of enquiry, donating £1000 to fund an independent physician of repute to organise further investigations. Dr Thomas Lauder Brunton was chosen to fulfil this role.

Appropriately, Brunton travelled to Bombay aboard the P&O liner The Empress of India, taking with him the necessary apparatus. Thence to the residency at Hyderabad where he was lavishly entertained by the Nizam. From mid-October until mid-December 1889 Brunton, Lawrie and their team worked rigorously, researching the action of chloroform on respiration and on the heart. In early December, The Lancet received a telegram from Brunton reporting that ‘Four hundred and ninety dogs, horses, monkeys, goats, cats and rabbits used…Results most instructive. Danger from chloroform is asphyxia or overdose; none whatever heart direct’. The influence of Lawrie and/or their recent experiments had changed Brunton’s views on chloroform. He now backed Lawrie, declaring that chloroform did not cause heart failure. The editors of The Lancet and a significant proportion of its readers were incredulous. More evidence was demanded, and Brunton’s reputation was damaged: ‘In the episode of his career known as the Hyderabad Commission (1889) Brunton was less successful. The whole affair was too brief, too hurried’. ¹⁸

When the Report of the Second Hyderabad Commission was published in 1890 it stated categorically that sudden death from stoppage of the heart was not a risk of chloroform itself. In the ensuing commotion Brunton was invited to address the Medical Society of London and he chose to elaborate on shock under chloroform sedation. The lecture conjured up images of female monkeys encased in plaster of Paris jackets to imitate stays, with tight bandages round their abdomens resembling bands of petticoats – ‘the animals seemed to die very quickly indeed’. ¹⁹ Many years later, when reviewing the work of the Commission in an obituary to his colleague Lawrie, Brunton admitted that the physiological effects of chloroform inhalation still needed to be fully investigated and his tone was measured: ‘even yet the causation of deaths during chloroform anaesthesia has not, I think, been completely ascertained and I am still disposed to think that shock plays a much greater part than is usually believed’. ²⁰ Due to the risks associated with it, chloroform lost favour in the twentieth century although it continued to be used in childbirth, and for field operations during the Second World War. As for the debate about its effects on the heart or respiration, this ceased once it was realised that it affected both. Chloroform still has its uses but has been superseded as an anaesthetic by sophisticated new drugs.

The Lancet had lost confidence in Sir Thomas Lauder Brunton and his views on chloroform, as reflected in the journal’s negative reaction to Brunton’s proposal that mitral stenosis might be treated by surgery (1902). Seeking to alleviate ‘one of the most distressing forms of cardiac disease’, Brunton’s proposition showed foresight but it was unacceptable. An editorial criticised him for sparking a contentious debate without adequate experimentation: ‘we gather that he has proceeded no further than the table of the dead-house in making his investigation’ and Brunton’s suggestion that ‘one could divide the constriction as easily during life as one can after death’ was dismissed as too risky. Contrary to the spirit of discovery that sparks advances in medical science, Brunton’s proposal was criticised on two fronts: the difficulty of the operation and its doubtful outcome. Furthermore, the author was warned against inciting others ‘to pursue a path into the unknown which must be beset with very grave difficulties and responsibilities’. ²¹ This attitude prevailed; surgeons were discouraged and it was not until 1923 that a girl in Boston, Massachusetts, was operated on for mitral stenosis and lived for 4 years. In London, the courageous Sir Henry Souttar (1875–1964) performed a successful mitral valvotomy using an innovative technique in 1925 and by the time of his death the procedure was routine. ²²

To war

Sir Thomas Lauder Brunton’s capacity for forward thinking was demonstrated further by his efforts to prepare the British for military conflict. His familiarity with the Continent, particularly his knowledge of the German nation, convinced him that war between England and Germany was inevitable, especially after a series of international incidents dating from 1899. Shifting political alliances, Germany’s territorial ambitions and military strength were among the factors that led to the invasion of Belgium in August 1914: ‘not only an outrage on Belgium, a country which the Huns had pledged themselves to respect; it was a crime against humanity’ Brunton fumed. ²³ He had been alerting this country, North America and South Africa to the likelihood of war since 1902, travelling abroad to lecture on the importance of physical training for young men. He launched a scheme for physical training in schools (1902) and from 1903 campaigned for compulsory physical training, drill and shooting practice for all British schoolboys. He inaugurated the National League for Physical Training and Improvement (1905) and published a paper on Physical Education and Training in Relation to National Defence (1908). He served on the Council of the Boy Scouts and supported the London Cadet Brigade as part of his mission to prepare the nation’s young men for war.

General Douglas Haig, first Earl Haig (1861–1928) and another son of Roxburghshire, shared Brunton’s sense of foreboding. As Director of Military Training from 1906 to 1909 he prepared British troops and the War Office for the future conflict. Recalled from India to Aldershot in 1911, Haig organised intensive training and an expeditionary force of regular soldiers with a back-up of territorial reservists. As he wrote to Brunton in August 1915, ‘You and I have often talked about the certainty of this war, and have done (each of us) our best to prepare in our own spheres for it’. ²⁴ On the mobilisation of the British Expeditionary Force in August 1914 Haig led the troops at Mons, Marne, Aisne and Ypres and from 1915 to 1918 he was Commander-in-Chief of the British forces on the western front.

In what proved to be the last year of his life, 1916, Brunton took up the cudgel in defence of the diplomat and Irish rebel, Sir Roger Casement CMG (1864–1916). Lady Brunton’s family, the Stopfords, had been prominent in Irish academic and ecclesiastical circles since the eighteenth century and Alice Stopford Green (1847–1929), Brunton’s sister-in-law, was a passionate Irish nationalist, a historian and an active supporter of Casement’s efforts to obtain Home Rule for Ireland, to the extent that she helped organise gun-running from Hamburg to Howth harbour, Dublin Bay, in July 1914. Alice Stopford Green’s zeal, and possibly a genuine sympathy for Casement drew Sir Thomas Lauder Brunton into the fray.

Casement had served with the Foreign Office in East Africa, Brazil and the Congo with distinction, as recognised by the award of the CMG and a knighthood (1911). Soon thereafter his thoughts turned to his Irish roots and the desirability of Irish Home Rule; he became involved with the Irish Volunteer Force and began to canvass support in North America and Germany at a particularly sensitive time. Three months after war was declared in 1914, British intelligence tracked down Casement in Berlin where he was arranging for armaments to be transported from Lübeck to Ireland. The venture failed, Casement was arrested and when his diaries were scoured they revealed his treasonable activities and homosexuality. He was found guilty of high treason and as he awaited execution, several well-known figures argued for a reprieve, WB Yeats, GB Shaw, John Galsworthy, Alice Stopford Green and Lauder Brunton among them. The latter wrote to The Times, describing Casement as ‘a criminal lunatic’ and proposing that he should be confined to Broadmoor asylum for life rather than executed. Brunton’s testimony that Casement’s health had broken down in 1912 as the result of malaria and the strain of his duties in Brazil, hinted that Casement had been his patient. The editor of The Times declined to publish Brunton’s letter. Casement was ‘hanged as a traitor’ on 3 August 1916 and later that day Brunton sent a copy of his letter to the librarian at the British Museum as a record for posterity. ²⁵

‘Father in thy gracious keeping, Leave we now thy servants sleeping’. ²⁶

Brunton retired as physician to St Bartholomew’s Hospital in 1904 due to illness. His long career at Bart’s was celebrated by a dinner at the Café Royale hosted by 14 former housemen who presented him with a silver loving-cup, to which Brunton responded with an eloquent and touching speech. He was appointed a Governor of the Hospital and given the position of honorary consultant. Despite declining health, he accepted the position of President of the Medical Society of London in 1905 and he was a force to be reckoned with at Macmillan and Co, inundating George and Maurice Macmillan with papers, and urging the publication of a book that would show ‘the real character of Germany’s arms and actions’ (1914). ²⁷

At the outbreak of war, the widowed Lauder Brunton was living at 1 De Walden Court, New Cavendish Street, Marylebone. His wife, Louisa Stopford (1848–1909), daughter of the Archdeacon of Meath, had died in 1909 after 30 years of marriage. Lady Brunton, ‘the beloved wife of Sir Lauder Brunton MD FRS’ was buried in Highgate Cemetery where the headstone also commemorates ‘Sir Lauder Brunton Bt MD FRS’ and their sons (Figure 2). Their eldest son, Major James Stopford Lauder Brunton (1884–1943) had attended the Royal Military Academy, Woolwich, and was briefly in the Royal Engineers before emigrating to Canada to enrol in the Department of Mining Engineering at McGill University, Montreal, leading to his employment by the Geological Survey of Canada (1912–1913). He served with the Canadian Artillery in France during the First World War which may have accounted for his subsequent ill health. In his forties he was influenced by the Woking Muslim Mission, culminating in his conversion to Islam at Lahore in 1931 when he took the name Jalal-ud-Din. ²⁸ His younger brother, Edward HP Brunton MRCS (1890–1915), was a surgeon at Bart’s until 1914 when he joined the RAMC and was despatched to France; he was killed at Loos while attached to the Grenadier Guards in 1915, which came as a severe shock to his doting father. OPEN IN VIEWER

Thomas and Louisa Lauder Brunton’s two daughters were Alice (Elsie, 1881–1956), who married Professor Augustine Henry of the Royal College of Science, Dublin. She wrote an account of her wartime experiences in Ireland, The World Upturning (eventually published in 2013), and was awarded the OBE for organising the production of sphagnum moss for dressing war wounds. Her younger sister, Anne (b. 1888) was a gardener and the recipient of a gold medal from the Horticultural Society for her work at Sudeley Castle. At the conclusion of the war, she was active in war reparations work with the Society of Friends in Europe. She married Adolf Kruming of Kiev.

On the death of the second baronet, James Stopford Brunton, the title was inherited by his son, Edward Francis Lauder Brunton MD (1916–2007), who served with the Royal Canadian Army Medical Corps during the Second World War and was later Associate Professor of Medicine at McGill University. His son, James Lauder Brunton (b. 1947), followed his ancestors into the medical profession and was Professor of Medicine at the University of Toronto until his recent retirement.

Sir Thomas Lauder Brunton’s death in the autumn of 1916 was expected, as he wrote in August, ‘I am suffering from severe cardiac disease and probably shall be dead in October’. ²⁹ Some 3 weeks before his death he was pursuing plans for physical education to be taught at universities. And just 1 week before his death on 16 September, he founded the Lauder Brunton Prize in Pharmacology and Therapeutics for senior medical students and recent graduates at the University of Edinburgh. Lastly, on his death-bed he addressed a few touching words to D’Arcy Power, ‘I am going to join Ted’, he wrote, referring to his younger son (Figure 2). ³⁰

Obituaries tell of ‘an entirely lovable and faithful friend’ (Dr John Mitchell Bruce); ³¹ ‘a man of extraordinary parts, earnest, far-seeing, ingenious and full of resource. Personally a man of charming disposition, simple, sympathetic, most generous and hospitable, he had no enemies’ (Sir Dyce Duckworth); ³² ‘his mind was a treasure house of knowledge and experience’ (Dr Thomas Bodley Scott); ³³ ‘a dear and trusted friend’ (Sir David Ferrier). ³⁴ Contemporaries stressed Brunton’s researches into digitalis and amyl nitrate as his chief contributions to medicine, especially the use of amyl nitrate for angina, which led to further developments in the treatment of cardiac pain. D’Arcy Power considered Brunton’s work on digestion and secretion ‘epoch making’; ³⁵ others claimed his Text-book of Pharmacology and Therapeutics and Materia Medica was a milestone because it established pharmacology as a scientific subject. Arguably, Lauder Brunton’s founding of the National League for Physical Education and Improvement, which aimed to nurture generations of healthy, vigorous and high-spirited children was his ‘most signal memorial’. ³⁶ It was indeed a personal triumph and a laudable cause that was of lasting benefit to the nation, as recognised by the baronetcy awarded to Sir Thomas Lauder Brunton of Marylebone for services to his country.