‘Neither a borrower nor a lender be’: Letters from the anaesthetist Joseph Thomas Clover to the Birmingham surgeon Joseph Sampson Gamgee

The Apothecary at University College Hospital

On 7 January 1850, Joseph Clover climbed onto the icy roof of University College Hospital (UCH) with a bucket of water. A fire was smouldering in the chimney of the student’s room below but as he poured the water down the chimney, it snaked mysteriously into another room, failing to reach its target. Eventually, he stuffed the chimney with pieces of carpet and bedclothes, depriving the fire of oxygen and completing one of the many tasks required of the hospital Apothecary in 1850. ⁶

Clover had taken the position as Apothecary in 1848 while he studied for the fellowship examination at the Royal College of Surgeons, the FRCS. ⁷ Clover obtained his basic medical qualifications, the Membership of the Royal College of Surgeons (MRCS) and Licentiate of the Society of Apothecaries (LSA) in 1847 at UCH after three years of study there. While still studying, he was appointed as House Physician to Dr Charles JB Williams in November 1846. Then, when James Syme arrived at UCH as head of surgery in early 1848, Clover became his House Surgeon.^7,8 Syme moved back to Edinburgh five months later, offering Clover a job in his new department. After much deliberation, Clover decided not to leave London and accepted the position of Apothecary in August. ⁹

Apart from the odd dangerous foray onto the roof, the job seemed to suit him. He had been plagued with ill-health but this period at UCH appears to have been relatively free from illness, despite a gruelling work load and a cholera epidemic, which stretched hospital resources in 1849. ¹⁰ His responsibilities included ensuring the cleanliness and ventilation of the wards, reporting on the state of the patients to their caring physician or surgeon, accounting for all medication, looking after emergencies, recording the admissions and superintending ‘generally the conduct of the Pupils, Patients, Nurses and Servants; and inform Committee of whatever may require attention in his department’. ⁷ The diversity of duties led to the position being renamed ‘Resident Medical Officer’ on 10 January 1851.

The first public anaesthetic given in London was on 21 December 1846 at UCH. ¹¹ Joseph Clover was present on that occasion^12,13 and, since the Apothecary was responsible for all medication in the hospital, it is not surprising he began administering anaesthetics when he accepted the position just over a year later: ‘On leaving my post at UCH in 1853 I made a calculation of the number of cases in which I had given chloroform during the preceding 5 years & found them to amount to 1900’. ¹⁴

Clover took his responsibilities to the medical students seriously and befriended many of them. One of the students he became close to was Joseph Lister. For a while, Lister shared lodgings with another medical student, Joseph Sampson Gamgee, a man who had made an unusual start to his medical career. ⁴

Joseph Sampson Gamgee

Joseph Gamgee, or Sampson as he later preferred to be called, was born in Livorno (Leghorn), Italy on 17 April 1828.^4,15 His father, also Joseph, had established a successful veterinary practice there after moving from England in 1825. Later they moved to Florence where the young Joseph Gamgee grew up, accompanying his father on travels around Europe, becoming proficient in languages and developing rudimentary veterinary skills. The Gamgee children seem to have had happy, carefree childhoods; the three boys, Joseph, John and Arthur, were sent to the best schools, the girls, Mary Ann, Clem (often known as Pam), Emma, Clara and Fanny had a stream of teachers providing lessons in languages, writing, drawing and music. English society in Florence was at its peak with the arrival of Elizabeth and Robert Browning, artists such as Hiram Powers and John Ruskin, and a steady stream of English nobility bringing fine horses to Italy for the hunting and racing seasons. Joseph Gamgee senior courted the rich and powerful, assisting them with their important purchases: ‘Prince Ottajano and the Duke of Mirenda order a pointer dog in July. Bought pointer Dog £5 September … H.R.H. Prince Carregni 2 first class riding horses to carry H.R.H …’ ¹⁵ None of this good fortune was to last but this extravagant life shaped the children and their expectations.

Joseph Sampson Gamgee travelled to England in 1847 to study at the Royal Veterinary College. ⁴ Since he also had a letter of introduction to the surgeon, Mr Moncrieff Arnott, he attended his lectures at UCH, as well as those of physician, Dr Charles JB Williams and anatomist and physiologist, Professor William Sharpey. His participation in these lectures was so impressive, they suggested he change courses to study medicine. He completed his veterinary training, obtaining his Member of the Royal College of Veterinary Science (MRCVS) qualification in 1849. He then commenced medical training at UCH with the young Joseph Lister, supporting himself by practicing as a veterinary surgeon for at least the first year or two. ¹⁶ Although he and Lister were friends and classmates, and for a while shared lodgings, they were very different. A relative later commented: ‘Lister was comfortably off but very careful, Uncle Joe was poor but spendthrift’. ¹⁵

A debt commences

At the time Gamgee began his medical training at UCH in 1849, Clover had been the Apothecary for one year. After completing his surgical fellowship in April 1850, Clover chose to continue as the Apothecary. His diaries record he also began seeing private patients outside the hospital, performing minor surgical procedures and prescribing a variety of medical treatments. ⁶ Then in 1853, his life underwent an upheaval. His sister Fanny died from tuberculosis in Aylsham and his Uncle Joseph, an artist in London and his closest mentor, also died, leaving Clover as an executor and final beneficiary of his estate. ¹⁷ Clover’s final inheritance was just over £1400 ¹⁸ ; he used this money to lease a house at 44 Mortimer St (later renumbered as 3 Cavendish Place) where he established a private practice. He remained at this address for the rest of his life. He resigned from his position at UCH, inviting his parents and sisters to London to live with him. However, he did not completely abandon his obligations to his medical student friends and, with his newfound financial security, began lending money to young doctors to help them establish themselves. One of the doctors who borrowed from him was Joseph Gamgee. ‘Three other young doctors have borrowed of me – How happy I was in the thought I was doing them a service!’ ¹⁴ It was a practice he was later to regret.

On 23 June 1854, Clover noted in his diary that he had sent £10 cash to JS Gamgee. ¹⁴ This was about the time that Gamgee obtained his MRCS, winning five gold medals. ⁴ The same week, Clover drafted a character reference for Gamgee: ‘Gamgee highly honorable & good tenant’ ¹⁴ Clover also lent money to a patient, asking a relative, M Clover, if she also wished to lend the patient money at 5% over three years. His letter reveals something of his financial situation: ‘I can assure you I am in a position to be a good banker. My professⁿ income during the last 12 m was over £560 & my private property is worth more than £1000’. ¹⁴

Gamgee travels to the Crimea

Gamgee worked as House Surgeon to Sir John Erichsen at UCH in 1854 before coming to the attention of the War Office. ⁴ He was appointed Staff Surgeon and Principal Medical Officer of the British-Italian Legion in Turin in 1855, a job which also involved overseeing a hospital in Malta where many of the wounded from the Crimea were evacuated.^4,19 Although this would have been a paid appointment, Gamgee evidently needed further funds – an IOU to Joseph Gamgee is recorded by Clover for the sum of £120, £60 to be paid in November and the remainder on or before 1 January 1856 ‘to complete the sum you have this day borrowed of me’. ¹⁴ How much had been lent up to this point is not documented.

As Gamgee travelled to Italy to assist with the war effort, Joseph Gamgee (senior), his wife and children moved from Florence to 16 Upper Woburn Place, London. ¹⁵ This was the beginning of a number of monetary problems for the family as the father settled a sum of money on each of his children at this time. Ruth D’Arcy Thompson, his grand-daughter, later wrote: ‘They [the parents] seem to have had little common-sense about money … The children inherited the same lack of money-sense and alas! less thought and generosity’. ¹⁵ The amount of money is not specified but despite it, or perhaps in anticipation of it, Gamgee borrowed from Clover.

Clover’s letters were friendly at this stage. He checked up on the Gamgee family’s arrival in London and reported to Gamgee, Poste Restante, Turin ‘All but Clem pretty well. She anaemic and weak but will be better in 2 or 3 weeks. London dull to them after Florence but the climate will not hurt them’. ¹⁴ Gamgee had taken out a number of life insurance policies and letters to Clover’s solicitor and friend, Richard Garnham, indicate that he signed over these policies to Clover as surety on the loan. When the Crimean War ended in February 1856, Gamgee returned briefly to England, sending many articles to the British medical press from 16 Upper Woburn Place. Clover’s correspondence to Gamgee from March onwards is addressed Poste Restante, Turin and one in June to Malta, but the reason for his return is not clear; his earlier articles to the medical press are signed ‘Late Staff-Surgeon 1st Class, &c’, but he may have been employed again in some capacity. ²⁰ Either way, his financial position had become precarious. Clover was doing everything he could to assist him; by April 1856 Gamgee, far from repaying the original loan, owed Clover £950, with no way of paying the interest. Clover even paid the life insurance premiums to maintain his security: ‘Let int on 950 acc & I will pay Life Ins. I could furnish 100 or 200 more if needed’. ¹⁴

When Gamgee returned to Malta, his sisters began asking Clover for financial support. ‘Miss asked for £30 before July 1 & £15 to £30 by 1st August. I have promised to do so and will economize by sacrificing my [illegible] visit’. ¹⁴ At this point, Clover suggested Gamgee’s sisters should seek employment: ‘Miss is anxious and does not know what to do. I suggested one or more sisters taking governess instructions – to which she will consent only if a matter of necessity’. Two of the sisters did eventually take up this suggestion, but not to the benefit of the family as a whole. Mary Ann returned to Italy where she settled in Rome, ‘building up a good connection of pupils and teaching at a famous school’. ¹⁵ Clem also became a teacher, and ‘struck out by herself’, becoming a Lady Superintendent at the Ladies Institution in Edinburgh.

Gamgee returns to England

At the end of summer 1856, Gamgee returned to England, accepting a position as Assistant Surgeon at the Royal Free Hospital in London. ¹⁵ This position was short-lived. There are no details available other than a letter Gamgee wrote to the British Medical Journal:

… I was simply actuated by a sense of public duty. Firmly believing that the management of that hospital was not in accordance with the only principles consistent with due regards for the interest of mankind and science, I felt bound to tender my resignation. ²¹

Gamgee’s next move was to travel to Birmingham to investigate a potential position at Queen’s Hospital. ⁴ Birmingham had a large Italian community, which may have been what drew him to the area. ¹⁵ He moved early in 1857, renting rooms in the Queen’s Hotel and sending to London for his sister Emma to keep house for him. His debts to Clover remained unpaid.

During this time, the position in Birmingham was advertised, but competition was fierce and the contest dragged on for months. Gamgee appeared the best qualified for the job but the local favourite candidate J F West was eventually elected to the position, largely by the lay members of the panel who knew him well.^4,22 There was an outcry from Gamgee’s backers who refused to accept the decision. Emma wrote to her father ‘the latter is considered wholly incompetent to fill the post, for above his lack of ability, he is unfortunately short-sighted … the election of West came upon them all like a thunderbolt’. ²³ While the battle raged in public, Gamgee seemingly had no income other than from a limited private practice so money was tight. His sister Emma wrote from Birmingham:

Let me assure you, dear father, that although we are in a difficult position, yet we feel comparatively happy and we have good courage … His honour is intact and will remain so. Yesterday a new patient came in who gave us 5s. ¹⁵

Debt becomes unsustainable

Throughout this, the correspondence from Clover remained friendly, but there were signs of strain. Some draft letters are scored through and marked ‘Not sent’, with the next letter reading: ‘I have written two or three other letters to you but retained them because I let slip sentences that might seem harsh & I have still too much regard for you to say anything unkind’. ¹⁴ In February 1858, Clover wrote to Mr Richards at Lincoln’s Inn requesting he discontinue proceedings against Gamgee since he would settle the debt of £65.15.2 immediately on Gamgee’s behalf; the nature of these proceedings is not revealed. Once again Clover raised the issue with Gamgee of his sisters seeking employment. By this time, Emma and Gamgee had moved from the hotel into a rented property in Birmingham with their sisters Fanny and Clara. ¹⁵

Despite the appointment in Birmingham, Gamgee’s financial situation continued to deteriorate. Clover became increasingly frustrated:

I am doing now more than I expected to be asked for & more than I according to my view I ought to have been asked to do. In your increasing pecuniary embarrassments your sisters ought to have helped you instead of remaining at home & increasing your expenses … You cannot sincerely have supposed that I should be able to furnish maintenance over several years for your sisters as well as yourself. ¹⁴

By October 1858, Gamgee’s debt to Clover had blown out to £2500 (including interest) ³¹ ; Clover reported that he had borrowed £750 of that. Both men were now in trouble. Clover had been unable to work for the autumn due to ill health, finding himself unable to pay his own debts. At this point, the depth of the problem became clear. Gamgee had offered bills of sale to other people for property he had originally offered as security to Clover. Clover, in good faith and with some naivety, had refused them ‘… before he went to the Crimea he offered to give me a bill of sale for his furniture which knowing it would injure his reputation I declined …’ ¹⁴ The situation became worse when Gamgee, now threatened with bankruptcy, began sending his creditors to Clover. Clover finally refused to pay any further money and reiterated his belief that Gamgee’s sisters should start supporting themselves: ‘I believe that your sisters have never had a truer friend & I have sacrificed enough to help you’. ¹⁴

Curiously, this letter is addressed to JS Gamgee, Rue Honoré Paris. Around this time, his three sisters returned to their parents, now living in Edinburgh; Emma then travelled to Paris to marry her Italian fiancé. The family biography only records Pam’s attendance at the wedding, but it is possible that Gamgee was there for that event. ¹⁵ It appeared to Clover though that Gamgee had run away from his creditors and his position at Queen’s Hospital: ‘This last move of yours to Paris. Expensive & unprofitable is further to be deprecated because it looks so much like running from the reach of the law & yr position in Birmingham must be injured by it’. ¹⁴ He concluded that he hoped he himself would remain sufficiently healthy to work his way out of his debts and avoid bankruptcy. He remarked that he had lent money to a number of young doctors and ‘one of them I also have my doubts about. There is but little I shall see of the money lent to my unfortunate brethren’.

Frustratingly, the book ends there and there are no other records of this correspondence among Clover’s papers. The debt in February 1859 was £2800; according to Clover’s accounts from 1881, it remained at this level and was never repaid. ¹⁴ Sadly Clover’s last letter was correct – whatever else Gamgee was doing at the Hotel de Mayence in Paris, it does seem that he was hiding from the law (Figure 4). In April, having returned to Birmingham, he was arrested and imprisoned in Warwick Gaol. ³² The prisoner’s records from these months are no longer available so how long he remained in prison or who brought the action against him remains unknown. His case was heard on 27 May 1859 ‘before the judge of the Country Court of Warwickshire’. ³³ He was discharged unopposed. ³⁴ OPEN IN VIEWER

Consequences of an unpaid debt

Although possible, it is extremely unlikely that Clover brought this action against Gamgee; a period of incarceration in a debtor’s prison was not going to improve Gamgee’s chance repaying the debt. Oddly, this episode does not seem to have had a major impact on Gamgee’s future career. No mention of his imprisonment has ever been made in any biographical material although his recklessness with money seems to have been common knowledge, at least among his family. His niece, Ruth D’Arcy Thompson, remarked that he died with no savings and considerable liabilities noting: ‘he had earned well but had often been generous beyond prudence in charity to all and sundry, and added to this his wife had enjoyed every luxury …’ ¹⁵ It is possible though that this period of imprisonment led him to change his name from Joseph to Sampson. The family biography reports that he changed his name on travelling to London to begin his veterinary studies. ¹⁵ However, a search of his many publications reveals that all his papers published up until 1858 were in the name of Joseph S Gamgee or Joseph Sampson Gamgee.^20,21,27 From 1858, the year of his imprisonment, he began publishing as J Sampson Gamgee, and eventually just as Sampson Gamgee.^35–37 It may be just a coincidence but the timing is interesting.

Was the loan realistic?

Over less than four years, Gamgee borrowed an enormous sum of money from Clover, leaving Clover himself in debt to the sum of £750 by 1859. Clover commenced private practice as a surgeon in 1853 but, while the debt escalated rapidly out of his control, he must have believed that he could earn enough to repay it. Clover had an inheritance and a Fellowship of the Royal College of Surgeons, a qualification which allowed him to charge more for his services. Successful London surgeons around this time had incomes ranging from £1700 to £10,000. ³⁸ As previously stated, Clover earned £560 in the first few months of practice so was probably not unrealistic in expecting he could meet his obligations with a London based practice, providing his health was maintained. ¹⁴

Presumably, Clover also anticipated Gamgee would ultimately repay him. Once the debt passed £950 and Clover began borrowing from others, there is more urgency about the letters, but it is not clear why he continued to support Gamgee. Gamgee’s position was entirely different to Clover’s. He only had the MRCS and never obtained the LSA, limiting his ability to earn money. Without the LSA, he could not legally prescribe medications or earn money as a general practitioner, a useful way to maintain an income while establishing a surgical practice. ³⁹ Although he enjoyed a good reputation as a surgeon, travelled widely and was occasionally consulted about clients on the continent, his practice was based in Birmingham, then a rapidly growing industrial town of around a quarter of a million inhabitants. ⁴⁰ Although the location possessed great potential, it concerned Clover:

I complain still of your having become so largely in debt … & of you not candidly telling me of them before – where perhaps I should have foreseen the futility of your attempting to establish yourself & family in Birmingham even more strongly than I did. ¹⁴

Beyond the debt

The correspondence ended in 1859, the debt remained unpaid and both men went on to have successful professional and personal lives. Joseph Sampson Gamgee remained at Queen’s Hospital, Birmingham. On 12 August 1860, he married Marion Parker, the daughter of veterinary surgeon, William Norton Parker. ⁴¹ William Parker had died some years earlier, leaving his estate in the hands of his brother and brother-in-law with instructions to keep his financial assets in trust and provide his wife and children with an adequate income. ⁴² Whether Gamgee’s marriage provided him with any financial security is not recorded but his wife and her family must have been aware of the situation. When the four years was up at Queen’s Hospital, West was appointed to the senior position, despite many feeling that Gamgee was the better surgeon. ⁴ This may be one significant consequence of Gamgee’s brief sojourn in prison.

Despite the unpaid debt, there is evidence that Clover and Gamgee remained in contact. In 1864, Clover travelled to France to anaesthetise the Baroness Narjot de Toucy for an ovariotomy performed by Gamgee. ³⁵ The operation was relatively new and very risky. The patient, despite being emaciated and unwell, made a good recovery from the initial surgery and, a few days later, Gamgee demonstrated the specimen at a meeting in Paris. Unfortunately, the Baroness then became acutely ill and died suddenly, leading to criticism from Gamgee’s European colleagues at his haste in presenting a case with an unknown outcome. ⁴³

Nothing more is known of the friendship between Clover and Gamgee, but there is a final ironic twist to the tale. Apart from his surgical accomplishments, which were many, Gamgee is often remembered for the part he played in the establishment of the Birmingham Hospital Saturday Fund.^44,45 Gamgee suggested that the working people of Birmingham be invited to work overtime on one Saturday afternoon in the year, especially to donate their earnings to the fund, which would then distribute the money to the local voluntary hospitals.

The first Hospital Saturday, held on 15 March 1873, raised £4215 2s 5d. ⁴⁴ Shortly after this, Gamgee resigned from his position as Secretary and was presented with a testimonial, a gold watch, £440 (raised independently from the principal residents of Birmingham) and a diamond bracelet for his wife. ⁴⁶ The Birmingham Hospital Saturday Fund (BHSF) has undergone many changes but remains a health insurance company to this day. In 1976, the BHSF moved to new premises known as Gamgee House.

Gamgee died in 1886 leaving many liabilities and no money for his widow and children. ¹⁵ The gross value of his personal estate at probate was £817.14.6, but the net value was only £20.5.3. ⁴⁷ Fortunately, his family was subsequently well supported by Lawley Parker, his wife’s brother and a long-term member of the Hospital Saturday Fund board. ¹⁴

The consequences for Joseph Clover

The discovery of this debt sheds further light on the career choice made by Joseph Clover in the late 1850s. Following the death of the leading anaesthetist in England, John Snow, in 1858, Clover largely abandoned his surgical career for anaesthesia. The principal reasons offered for this have been Clover’s chronic ill health and the void left by John Snow’s death.^2,3,48 This correspondence suggests there may have been more to this decision. John Snow died in the summer of 1858 in June. Clover was unwell during the autumn and did not work, leaving him unable to pay the debts incurred to assist Gamgee. When he returned to work late in 1858, the void left by John Snow’s death would have been obvious to him. He had the skills, acquired at UCH as the RMO, to provide an anaesthetic service, and the surgical contacts. It must have seemed like a golden opportunity to increase his income to repay his debts.

Clover died in 1882. His accounts of 1880 record his estimated losses by lending as £7750, including the £2800 from Gamgee; with compound interest, he calculated this amounted to £15320, with Gamgee’s debt worth £8300. ¹⁴ Despite this, Clover died a relatively wealthy man, leaving an estate worth £27000, more than enough to support his wife and four young children. ⁴⁹

Much is known and written about Joseph Clover and Joseph Sampson Gamgee, but these letters reveal new information about their financial affairs, including a spell in a debtor’s prison for Gamgee. While Clover’s willingness to continue lending money to his friend in the face of obvious inability or unwillingness to repay is difficult to explain, it does tally with descriptions of him as patient, generous and kind.^10,50