Thomas Lewis Mackesy (1790–1869): Eminent surgeon of Waterford

Early life: 1790–1808

Thomas Lewis Mackesy was born in Waterford, on the south coast of Ireland, in 1790. ¹ The precise date is uncertain, however, what is known is that he was the son of an apothecary, most likely of William Mackesy. William Mackesy's obituary in the Westmeath Journal from 1823 reads: ‘On Friday morning at his house in Broad Street Waterford, after a short but painful illness, Mr William Mackesy, apothecary [died]’. ² Although there is little information available about Thomas’ father other than his name, there is unfortunately even less available about his mother; the only verified information relates that her maiden name was Lewis. ¹ It is likely that Mackesy had siblings, given the geographical location and time period, but this remains unconfirmed.

Young adulthood (1809–1816): beginnings of a medical and military career

Despite arguably inauspicious beginnings, Mackesy studied well under his father's tutelage and, as a young adult, chose to sit the membership examination of the Royal College of Surgeons of London (RCS) (which later became the Royal College of Surgeons of England in 1843). The examination book archives of the RCS confirm that Mackesy was examined and awarded membership on 20 January 1809.^3,4 It is not entirely clear why he sat the examination in London rather than closer to home – the answer may lie in his young age. It was customary at the time for medical students to undertake an apprenticeship of around seven years before becoming eligible to undergo examination for membership. As the archives of the Royal College of Surgeons of England do not list Mackesy in the register of apprentices at that time, it is likely therefore that Mackesy, who would have been aged approximately 19 years at the time of the examination, had not pursued a conventional apprenticeship. Instead, he appears to have obtained the bulk of his medical knowledge from his father, to whom he was apprenticed. ¹ This would likely have expedited paid employment and may have allowed his father to appoint another apprentice for further financial gain.

Soon after receiving his diploma, Mackesy went on to be trained under a man named Kirby, of Dublin. The evidence unfortunately does not relate precisely who this person was, although it is possibly refers to John Timothy Kirby (1781–1853). ¹ The History of the Royal College of Surgeons in Ireland (RCSI) includes an autobiography written by Kirby. He served as President of the Royal College of Surgeons in Ireland (RCSI) in 1823, led a medical school in Peter Street in Dublin, and was appointed Demonstrator in Anatomy by William Dease (c. 1752–1798) and Abraham Colles (1773–1843). ¹ Colles, who was RCSI president in 1802 and 1830, ¹ is renowned for his contributions to anatomical teaching and his eponymous fracture, fascia, and ligament. ⁵

It is entirely possible, therefore, that Thomas Lewis Mackesy, having completed his examination, was trained under the same John Timothy Kirby. If so, it was under Kirby that Mackesy trained for twelve months to become an assistant surgeon, with an eye on gaining clinical experience. ¹ On 1 September 1801, by Royal Warrant, the Ordnance Medical Department (OMD) was formed, which delineated the various medical ranks in use within the military. Following another Royal Warrant of 7 May 1806, which is the closest in date to Mackesy's military beginnings, there were six medical ranks in the army: Supernumerary Assistant Surgeon, Assistant Surgeon, Surgeon, Assistant Surgeon-General and Deputy Inspector, Surgeon-General and Inspector, and lastly Inspector General of Ordnance Hospitals. ⁶

Evidence of Mackesy's appointment to this service can be found in his service records, which read as follows: ‘Thomas Mackesy, 2^nd A.S., O.M.D., 21 Jan 1809. res. 7 June 1811.’ ⁶ In other words, Thomas Mackesy, second Assistant Surgeon, Ordnance Medical Department. The dates listed match his military record exactly - he registered to join the Royal Artillery on 21 January 1809, just one day after being appointed a member of the RCS, and resigned on 7 June 1811, less than three years later. ⁷ It is of note that his record states ‘Resg^d’ rather than ‘Ret^d’, i.e. ‘resigned’ rather than ‘retired’. That is because certain sources suggest that he may have continued his army service for several more years after June 1811.

Few details are available concerning Mackesy's military service. According to Cameron, Mackesy served in the Royal Artillery for seven years, ¹ rather than just two, possibly continuing his service until 1816. Furthermore, Cameron states that Mackesy was ‘present when the British were repulsed at Guadeloupe, where his speed as a runner saved him from captivity; and that he was in one of the ships which received the British troops after the battle of Corunna’. ¹ The first reference, to Guadeloupe, may refer to one of several invasions of Guadeloupe by British forces. In the years following the French revolution, Guadeloupe, alongside other overseas islands such as Martinique, remained under French control, and represented the final obstacle to total British domination over the West Indies. ⁸

Given the timeframe of his confirmed service, Mackesy could have been present at the first of two invasions of Guadeloupe. The first took place in January of 1810, which resulted in British control of the island. ⁸ Guadeloupe was returned to France in 1814 following the signing of the Treaty of Paris that same year, before another invasion by British forces in 1815 once more successfully regained control. ⁹ The second reference suggests that Mackesy may have served at the battle of Corunna during the Peninsular War which took place on 16 January 1809. ¹⁰ The battle was the culmination of a disastrous retreat, ending in the death of Sir John Moore (1761–1809), ‘the hero of Corunna’, ¹¹ and the evacuation of the British from Galicia. ¹²

It is certainly not impossible that Mackesy, who would obtain his membership four days later, could have tended to the military wounded evacuated from the battle before later returning to Dublin to begin his training in earnest. Nevertheless, it is of note that his name is not included in Challis’ Roll Call of the Peninsular war, the list compiled by Lionel S. Challis (dates unknown) of army officers who served in the Peninsular war. ¹³ Interestingly, the name ‘Mackesy’ does appear on the roll call for the Peninsular war, but as the name of a regiment rather than an individual. As the roll call only concerns officers, this may be why his name is absent, as he would have only just begun his military career. ¹⁴

A further narrative of Mackesy's military career is offered by the British Medical Journal (BMJ) where his obituary states that he ‘served in many memorable actions, including Waterloo’. ³ However, there is one obstacle to this conclusion. Although his BMJ obituary clearly states he was present at Waterloo, Mackesy's name is absent from the Waterloo roll call, ¹⁵ casting doubt on this assertion. It is interesting to contrast the apparent absence of proof of Mackesy's involvement in these historic battles with the assurances of several sources that he was, indeed, present. One explanation may be that he had a relative who served at these engagements.

Although it is clearly difficult to precisely delineate Mackesy's military career, what is clear is that he left the armed forces whilst still a young man, in order to return to the city of his birth and begin to practise medicine in earnest. His obituary in the Lancet, in the year 1869, states that he

Commenced life as an Assistant-Surgeon in the Royal Artillery, but early in life left the army and settled in Waterford, where he speedily gained the confidence of both rich and poor, and for many years enjoyed a large and remunerative practice. ¹⁶

Adulthood proper: marriages and early beginnings (1813–)

Upon his return to Waterford from military service, Mackesy began to develop into an assured surgeon. He lived on Lady Lane, where his blue plaque now hangs (Figure 1), but it would still be several decades before he became renowned. He was first appointed as a surgeon to what were then known as the Leper and Fanning hospitals in Waterford. ¹ Although little information could be found regarding the Fanning hospital, the Waterford Leper hospital dates back, at least according to tradition, to the time of King John (born 1167, reigned 1199–1216),^17–19 and potentially as far back as the year 1207. ¹⁷ It is also possible that this hospital refers to the hospital of St Stephen, which was also founded for patients suffering from leprosy, but dates from 1185. ¹⁸

In his personal life, and early on in his career, Mackesy married Mary Poulter (1777–1818),^20,21 the first of his three wives and 13 years his senior. ²¹ The listed Marriage Licence Bonds in the diocese of Waterford and Lismore show that Mary Poulter married Thomas L. Mackesy in 1813. ²² Mackesy's first two children were sons, very close in age. The first, Joseph Poulter Mackesy (c.1815–1866), followed his father into the profession of medicine ¹⁶ ; Joseph's two sons, George (c.1845–1917) ²³ and William (died 1898), ²⁴ also became physicians. ¹ Like their grandfather, both George and William worked in the Leper Hospital in Waterford. ²⁵

Sadly, Thomas Lewis Mackesy outlived his eldest son; the latter died in Waterford at the age of 50 or 51, on 3 April 1866.^26,27 This places the year of Joseph's birth around 1815 or 1816. William Poulter Mackesy (c.1814–1894), ²⁸ the second son, is estimated to have been born the same year; according to the records kept of the 1851 England census, rather than following his father into medicine, William Poulter Mackesy had instead become a minister to the parish of Kirkby Malham, in Yorkshire. ²⁹ His marriage record states that at the time of his wedding to Jane Anne Hudson on 10 February 1857, six years later, and also in Yorkshire, he was 41 years old. ³⁰ This would place the year of his birth around 1815 or 1816, precisely like his brother. However, he was also reported to have been 80 years old when he died in 1894, which would mean his birth year was closer to 1814 instead. ²⁸ It is unclear whether William, rather than Joseph, was therefore the eldest son. This contradicts the assertion that it was Thomas L. Mackesy's eldest son whom he outlived (Figures 1 and 2). ¹⁶

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Figure 1.

Thomas L. Mackesy blue plaque, Lady Lane, Waterford, Ireland (2024) (February. Reproduced with thanks to Julia van Riel-Jameson, permission dated 5/02/2024. Image copyright Julia van Riel-Jameson, 2024.

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Figure 2.

Mackesy as an old man (date uncertain). Reproduced courtesy of the Royal College of Surgeons in Ireland (RCSI), permission dated 27/09/2024. Image copyright RCSI.

Sadly, in an early blow to Mackesy's personal life, Mary Poulter died on 18th of October 1818, aged approximately 41 years, after only five years of marriage. It would be another four years before Mackesy married again, this time to Charlotte Vincent (dates unknown), whom he married in 1822. ²² This union produced a third son, Henry Vincent Mackesy (c. 1826–1889).^31–33 Henry became neither a doctor nor a clergyman, becoming instead a solicitor, including to his father. ³⁴ He was married, by his half-brother William, to Mary Isabel Beaumont (dates unknown) in Liverpool on 1 June 1859. ³¹ A fourth son, Vincent Mackesy (c.1831–1855), took part in the Crimean winter campaign (1854–1855), including the battle of Balaclava, ³⁵ which took place on 25 October 1854. ³⁶ Sadly, he died from illness (he was ‘attacked with fever’) in Scutari, aged just 24. ³⁵ Scutari was famously the location of a military hospital where Florence Nightingale (1820–1910), ³⁷ ‘the angel of Scutari’, ³⁸ became known for her work caring for injured and sick soldiers. ³⁷

Later life: politics, honours, and successes (1841–)

In his later years, Mackesy devoted himself to the wellbeing of the citizens of his city, being described in an obituary as possessing ‘noble and philanthropic views’. ¹⁶ He began to involve himself in politics, he was elected mayor of Waterford, ³ and was listed as mayor in 1841. ³⁹ Interestingly, he was followed in this capacity by his grandson George in 1879. ²⁵ Three years after his tenure as mayor of Waterford, in 1844, Mackesy married his third and final wife, Helen (or possibly Helena) Madden (died 1870)^22,40; at that time, Mackesy was aged in his mid-50s. In the same year, the RCSI received a new charter and offered Mackesy a position as Fellow of the College. ¹

Other public offices included working as a magistrate and, most tellingly, as a Poor Law Guardian.^3,16 The Poor Law legislation of 1838 referred collectively to a series of measures intended to reduce the level of poverty in Ireland, including the introduction of workhouses. ⁴¹ Mackesy, as a Guardian of this new legislation, was directly involved in this approach to poverty reduction. In one case reported in the Waterford Chronicle, he explained the need for a specialised ward in the poor house in order to accommodate ‘such prostitutes as from residence and total destitution the Guardians may deem proper objects for admission’. ³⁹

At that time, many urban areas were notoriously unsanitary and overcrowded. Taking a keen interest in the social but also public health of his city, Mackesy also went so far as to suggest Waterford should require an Act of Parliament similar to the Dublin Improvement Act Amendment Act. The aim of this act would be to improve the living conditions of labourers in overcrowded living spaces. Mackesy also argued that it should be legal to remove an ill person from such a dwelling to a hospital, in order to reduce the spread of disease. ⁴²

In the years that followed, more honours were bestowed upon Mackesy in quick succession, the most prestigious of which was the presidency of the RCSI in 1862. ¹⁶ Mackesy achieved ‘the hitherto unequalled honour of being the only provincial surgeon who ever became [the RCSI's] president’ ¹⁶ and ‘the only country surgeon upon whom that high honour has ever been conferred’. ⁴³ Although other RCSI presidents had also been born outside of Dublin - the aforementioned William Dease and Abraham Colles, for example, were born in Cavan and Kilkenny, respectively^44,45 - Mackesy was the first to be appointed RCSI president as a surgeon practising his trade outside of Dublin.

One year later, in 1863, he was also awarded, honoris causa (the title of M.D. from Trinity College Dublin. ³ Scarcely a year after that, on 6 June 1864, several of his colleagues at that time chose to honour him for his achievements and commissioned a large silver ornamental centrepiece in recognition (Figure 3). The plaque (Figure 4) is engraved with the following text:

Presented with a portrait of himself to Thomas Lewis Mackesy. F.R.C.S.I., M.D. Honoris causa Trin. Coll. Dub, Late president Royal College of Surgeons in Ireland, The first Provincial Surgeon who obtained that distinction, by a large number of his medical brethren, to testify their high sense of his disinterested and untiring efforts while consulting the best interests of the Public, to sustain and elevate the profession which he adorns.

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Figure 3.

Thomas Lewis Mackesy centrepiece. Reproduced courtesy of the Royal College of Surgeons in Ireland (RCSI), permission dated 27/09/2024. Image copyright RCSI.

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Figure 4.

Thomas Lewis Mackesy centrepiece (engraving detail). Reproduced courtesy of the Royal College of Surgeons in Ireland (RCSI), permission dated 27/09/2024. Image copyright RCSI.

In addition to these celebrated achievements, Mackesy was also the president (on several occasions), vice-president, and chair of the Irish Medical Association ³ ; a contributor to the BMJ, ⁴⁶ and also to the Transactions of the Social Science Association, a journal in which he was known to write on the subject of public health. ³ This further shows his deep and active interest and involvement in public, rather than solely private, medicine. Another notable but rather unconventional achievement in the interest of the public was Mackesy's solving of the murder of Richard Darcy and his wife in 1820 by his brother James Darcy. Mackesy discovered evidence of arsenic poisoning, laying the blame on Richard's brother, who was subsequently hanged. ⁴⁷

Death and legacy: 1869

Mackesy died at the age of 78 on 8 April 1869, from what was then known as Bright's disease, having also been deeply affected by the death of his son Joseph several years before. ¹⁶ Bright's disease, a disease of the kidney, is known today as glomerulonephritis. ⁴⁸ Despite his advanced age and declining health, Mackesy continued to practise medicine in Waterford, according to his obituary, until two weeks before his death. ³ His son William, who was ordained, acted as first executor to his father's will. ⁴⁹ At the time of his death, Mackesy was also vice-president of the Irish Medical Association. ¹⁶

News of Mackesy's death was received with sadness, his death was considered a great loss, and he was acclaimed in several obituaries. His colleagues at the Irish Medical Association, for example, upon hearing the news of his death, stated their ‘sense of the severe loss which the profession in this country has sustained by his removal’ and praised his ‘disinterested services’ (i.e. his impartial, modest attitude). ³

Impressively, Mackesy was also noted to have: ‘refused the honour of Knighthood tendered him by the late Earl of Carlisle on the occasion of the inauguration of the Albert Hall in our College of Surgeons during his year of presidency’. ¹⁶ The ‘late Earl of Carlisle’ is most likely referring to George Howard, the 7th Earl of Carlisle (1802–1864), ⁵⁰ who was Earl during Mackesy's tenure as RCSI president and, like Mackesy, was also a Poor Law guardian and magistrate in Yorkshire. ⁵⁰ The choice to refuse this honour led to the lauding, once more, of Mackesy's; disinterested […] spirit’. ¹⁶ In the same obituary, he was also praised for his ‘energy of character’; his ‘unselfish devotion to the advocacy of the best interests of his professional brethren’; his ‘commanding intellect’; and his sense ‘of untiring energy and zeal, of great self-abnegation’. Few, the obituary claimed, ‘are so blessed by the gifts of Providence as he was’. ¹⁶ Throughout his posthumous honours, Mackesy was praised for his humble attitude and humanitarian approach, reflecting deep and enduring respect from his professional peers.

The trajectory of Mackesy's life, with its numerous professional accolades and deeply personal tragedies, delineates a noteworthy career devoted to public service. It offers a fascinating insight into the life of an established 19th-century surgeon, hitherto largely uncelebrated outside his native city, from his humble beginnings as an apothecary's apprentice to his presidency of the RCSI. Despite his successes, many aspects of his life unfortunately remain something of a mystery, especially with regard to his childhood years and his time spent in the Royal Artillery. What is especially interesting, however, is the contrast between the account of his life and the historical background in which he existed.

The Great Famine, also known as the Irish Potato Famine, lasted for six years (1845–1851) and resulted in the death of at least one million people and the emigration of an even larger number. ⁵¹ Despite Mackesy's established position as a surgeon during this period, and although his life is a valuable historical account of the first half of the nineteenth century, no explicit references to the Famine were found in any source used during the preparation of this biography, for reasons that remain unclear. It may be important to note here that given his son William (who was ordained) was married, Mackesy himself was very likely from a Protestant family.

Despite the lack of records, it seems highly unlikely that Mackesy, a medical man and known philanthropist, made no effort to assist with the Famine's victims. Historian Dermot Power, for example, claims that Mackesy and several of his friends purchased land in Waterford city intended for the burial of Famine victims. ⁵² The burial ground, known as Ballynaneashagh, opened in 1847. The majority of people buried within its walls had been workhouse deaths. Due to this, there was a strong stigma associated with it, and it came to be known as the Pauper's Graveyard. ⁵² Mackesy, as previously stated, was also a Poor Law guardian with an interest in public health. For these reasons, he would have undoubtedly been involved in the care of Famine victims, and it is likely that the lack of precise records of his involvement is simply due to the chaotic nature of Ireland at that time.

Conclusion

Thomas Lewis Mackesy's life was centred around his medical practice and the health of the city of his birth. Although his early life is marked by an at times uncertain military experience and personal tragedies, his gradual rise to the pinnacle of his field should be celebrated, just as it was by his peers both during and after his lifetime. His biography offers valuable insights into everyday life as a medical practitioner in 19th-century Ireland. Despite the potentially prevailing view of medicine in that era as a rudimentary practice, especially outside urban centres, his career showcases Irish medicine of that time as an increasingly scientific (albeit privileged) world – for example, its associated conferences and formal journal publications.

Mackesy was clearly a humble and self-effacing doctor. Mackesy's keen passion for the public health of Waterford is noteworthy. It not only illustrates growing concerns at that time about quality of life in urban areas, but also is testament to an increasingly collective and organised approach to resolving social issues. The enactment of the Poor Laws, intended to address Irish poverty, is another example of 19th-century proposals designated to reduce social deprivation. It is perhaps humbling to note that although the largely publicly funded healthcare system of today would not exist in its current state in Ireland for many more years, one can find elements of its origins in the philanthropic projects of that period.