John Howship

Biography

• Born 1781
• 1799 – Commenced medical school under tutelage of Dr. John Heaviside (1748–1828). Practised ‘Museum Medicine’ honing dissection skills to define anatomical sites of disease
• 1805 – Assistant surgeon at St. George’s infirmary and lecturer at the school of the St. George’s Hospital
• 1833 – Hunterian oration; Royal College of Surgeons in London
• 1834 – assistant surgeon to the Charing Cross Hospital – promotoed to Chief surgeon ousting Dr. Thomas Joseph Pettigrew (1791–1865), who demanded and obtained £500 from Howship for the assistant surgeon position.
• Member of the Royal Medico-Chirurgical Society of London; Medico-Chirurgical Society; Royal Medical Society Edinburgh, Copenhagen Royal Academy of Medicine; Society for Natural and Medical Sciences, Dresden; and Academy of Naturae Curiosi, Bonn.
• Died 22 January 1841 following hemorrhage from an abscess of the lower leg due to a chronic disease of the tibia

Medical Eponyms

Howship-Romberg sign (1840, 1847)

Pain and paraesthesia along the inner (medial) aspect of the thigh, down to the knee; and pain on internal rotation of the hip along the distribution of the obturator nerve. Caused by compression of the obturator nerve most commonly associated with entrapment of the small bowel in the obturator canal which may lead to ileus, incarceration, and strangulation of the hernia sac. Named with German neurologist, Moritz Heinrich Romberg (1795-1873).

Howship published a case entitled ‘Strangulated Thyroidal Hernia – Diagnostic Symptom – Appearances on Dissection‘ in 1840. He describes then case of an aged and emaciated female under the care of Mr. Weatherfield.

In November 1838 she was seized with violent spasmodic pain in the left side of the abdomen running down the left leg, with sickness, vomiting, and, as she said, diarrhoea…March 23, 1839 Mr. W. found her again suffering under extreme pain and tenderness in the abdomen, especially in the left side, with constant vomiting, preceded by diarrhoea, and attended with the same pain as before, down the left leg. The symptoms, those of strangulated hernia, Mr. W. made a careful inquiry and examination but could nowhere ascertain outward tumour.

Howship 1840: 323

Postmortem examination revealed:

…a portion of small intestine was seen stretched towards the obturator foramen, where a knuckle was firmly impacted, forming a small hernia, no larger than a nutmeg, protruding through the opening. The intestine, highly inflamed, was almost gangrenous. The parts were carefully removed and admirably dissected; demonstrating the hernia to the best advantage

Howship 1840: 324

Howship lacunae

Small pits, grooves or depressions or bone pit (>100 microns in length) with an accumulation of osteoclast cells indicative of bone resorption

Key Medical Attributions

1816 – Howship published on Practical Observations in Surgery and Morbid Anatomy which work contains the preliminary description of what is now known to us as “growing skull fracture.”

Medical illustration

Major Publications

• Howship J. Experiments and observations in order to ascertain the means employed in the animal economy, in the formation of bone. 1815
• Howship J. Practical observations in surgery, and morbid anatomy: illustrated by cases with dissections and engravings. 1816
• Howship J. Practical observations on the symptoms, discrimination, and treatment of some of the most common diseases of the lower intestines, and anus. 1820 [2e 1825]
• Howship J. Practical remarks upon indigestion. 1825
• Howship J. Practical remarks on the discrimination and successful treatment of spasmodic stricture in the colon. 1830
• Howship J. The Hunterian oration; Royal College of Surgeons in London. 1833
• Howship J. Some account of two cases of inflammatory tumour, produced by the deposit of the larva of a large fly (Oestrus humanus) beneath the cutis, in the human subject. 1833
• Howship J. Practical remarks on the discrimination and appearance of surgical disease; with an appendix containing the descriptive catalogue of the author’s collection in pathological anatomy and the Hunterian Oration for 1833. Churchill, 1840
• Howship J. Strangulated Thyroideal Hernia – Diagnostic Symptom – Appearances on Dissection. In: Practical Remarks on the Discrimination and Appearance of Surgical Disease. 1840: 323-4

Controversies

Pettigrew vs Howship in 1836, quite the kerfuffle

Pettigrew: Upon its being known that the appointment of a second Surgeon was thought of, Mr. Howship applied to me upon the subject. He represented to me that he should be delighted to be connected with me in the Charing Cross Hospital, and that he should consider any assistance rendered him in attaining this object as the greatest of obligations, and never forget it. He urged the particular advantage of his collection of preparations, foolishly eulogizing them as exceeding in value those of St. George’s Hospital, and put forward other reasons to induce me to favour him as a colleague….

Howship: I stated that I had seen the collection at St. George’s, and that I considered my own to be, although less extensive, more valuable than many others in this respect, that I had the complete history of every preparation in it, which was not the case in most other collections that I had seen…With regard to the alleged expression of the delight which I should feel in being connected with Mr. P. at the Charing Cross Hospital, I beg to say, that I do not recollect having used that word on the occasion, and that, as it is not precisely in keeping with my usual style of expression, I should much doubt it having been so applied by me

Pettigrew: I stated the offer made to me of naming a person who should be acceptable to them, and their conviction that I was entitled to receive the whole of the emoluments derivable from my department for the period I have named; but I proposed to Mr. Howship, as a private arrangement between two gentlemen, that instead of my receiving the entire emoluments, he should be entitled to an equal portion upon the consideration of paying to me in lieu of those emoluments the sum of £500.

Howship: The next matter on record, is the pecuniary transaction connected with my appointment. This proposition arose, as Mr. P. has stated, with himself. The first and most important point, in my mind, in this transaction, certainly was, the becoming one of the Surgeons to the Hospital; but I was not unmindful that, in time, the fees to be derived from the attendance of pupils, might, in all probability, prove remunerative. The proposition included, as stated in the pamphlet, that the fees should be equally divided ; and so they since have been. Such prospect, it may be said, might have been considered to be rather remote than otherwise; however, to me, as far as this was concerned, it was sufficiently satisfactory

Pettigrew TJ. 1836 and Howship J. 1836

• Pettigrew TJ. Address to the governors & subscribers of the Charing Cross Hospital, on some extraordinary proceedings that have lately taken place at that institution, and on the management of the Hospital in general. 1836
• Howship J. A reply to some of the statements put forth by Mr. Pettigrew in a pamphlet. 1836

References

• Bir SC, Kalakoti P, Notarianni C, Nanda A. John Howship (1781-1841) and growing skull fracture: historical perspective. J Neurosurg Pediatr. 2015; 16(4): 472-6
• Domenico Bertoloni Mel. Visualizing Disease. The Art and History of Pathological Illustrations. University of Chicago Press,  2017: 160-162
• Rastogi V et al. Abdominal Physical Signs and Medical Eponyms: Movements and Compression. Clin Med Res. 2018; 16(3-4): 76-82.