Stokes, William (1804–78), physician and pioneer cardiologist, was born July 1804 in Dublin, second among ten children of Whitley Stokes (qv), FTCD, physician, and Mary Anne Stokes (née Picknell). His grandfather was Gabriel Stokes (1763–1806), DD, FTCD. He spent most of his childhood at his father's house in Ballinteer, Co. Dublin, and was educated privately in classics and mathematics by the Rev. John Walker (qv), FTCD, and by his father, from whom he absorbed a deep appreciation of archaeology and the natural world. He studied at RCSI, the Meath Hospital, Dublin, and Glasgow University before graduating MD (1825) from Edinburgh University, where Professor William P. Alison (1790–1859) inspired him with a love of clinical medicine.
His first contribution to medical progress was made while still a student: recognising the significance of the stethoscope, invented (1816) by René Laënnec (1781–1826), and of Laënnec's Traité de l'auscultation médiate (1819), he published An introduction to the use of the stethoscope (Edinburgh, 1825), the first work in English to describe systematically the relationship between the physical signs detected by the stethoscope and the pathological condition of the viscera. It was ridiculed by many of his contemporaries, but its value became apparent as postmortems revealed the accuracy of diagnoses made with its aid; he later published Two lectures on the application of the stethoscope to the diagnosis and treatment of thoracic disease (1828).
Returning to Dublin, he was admitted licentiate (1825) of the (R)K&QCP(I) and appointed physician to the Dublin General Dispensary. Deeply moved by his experiences among the poor, he wrote to his future wife of the ‘want and wretchedness that wring my heart, I wish for the fortune of a prince that I might relieve them’ (Stokes, 37); his sympathy never waned and he became known as the physician of the poor. Succeeding his father as physician to the Meath Hospital (1826–75), he became a central figure of the golden age of medicine enjoyed by the Dublin school in the mid nineteenth century. As a colleague of Robert Graves (qv), Stokes enthusiastically supported him in his pioneering system of clinical instruction: students were taught at the patient's bedside and given responsibility for all aspects of patient care, under the guidance of the physician. This transformed medical education and gave the Meath an international reputation as a leading clinical and teaching hospital. Graves and Stokes collaborated in clinical research and became close friends (Stokes, 40), and after Graves's death (1853) Stokes wrote a memoir, selected and edited his papers, and published his Studies in physiology and medicine (1863).
During a severe epidemic of typhus fever (1826) Stokes worked unremittingly in the hospital, ministered to the poor in their homes, and wrote graphic reports of the scenes he witnessed; after nearly dying from the disease, he and Graves published Clinical reports of the medical cases in the Meath Hospital (1827). He published his lectures given at the Meath and the Park Street School of Medicine (1829–42) in the London Medical and Surgical Journal (1833–4); reprinted as Clinical lectures on the theory and practice of physic (Philadelphia, 1840), they became a standard textbook in American medical schools. Exceptionally gifted with powers of accurate observation and diagnosis, complemented by the stethoscope, he published A treatise on the diagnosis of treatment and diseases of the chest (1837; Bremen, 1838). Containing many original observations and a masterly description of emphysema, it established his reputation as one of the greatest clinicians of his time. His classic work The diseases of the heart and aorta (1853; translated into Italian (1857) and French (1864)), helped to lay the foundations of modern cardiology and brought him international recognition. It contained excellent descriptions of pericarditis, and the first accounts of paroxysmal tachycarda and of conditions later known as ‘Stokes–Adams syndrome’ and ‘Cheyne–Stokes respiration’. He published Lectures on fever (1874), papers in professional journals, and seven articles in the Cyclopaedia of practical medicine (1832–5). In his writings he always paid credit to his colleagues, which contributed to the reputation of the Irish school of medicine; his bibliography is published in Medical classics, iii, no. 7 (March 1939), 710–26. Having assisted Robert Kane (qv) with the early issues of the Dublin Journal of Medical and Chemical Science, he became joint editor (1835–42) with Graves and W. H. Porter (1790–1861).
Assisted by Dr Robert W. Smith (qv), he founded (1838) and was hon. secretary of the Pathological Society of Dublin, established to encourage the study of pathology and develop the diagnosis and treatment of disease by relating pre-mortem symptoms and signs to post-mortem findings. The first society of its kind in the British Isles, it helped to overcome the traditional division between physician and surgeon (much deplored by Stokes), fostered their mutual cooperation, and proved a notable contribution to medical knowledge.
Seeking to improve medical care throughout Ireland, he was a founder of the (Royal) Medical Benevolent Fund Society of Ireland (1842) and of the Medical Temporary Relief Committee (1848), which distributed money to the families of doctors who were experiencing hardship. On the introduction of the medical charities bill (1843), he and James William Cusack (qv) gave evidence before a select committee of the house of commons; appalled by the high death rate among doctors working in the poor law services, they sought reasonable salaries for those who worked in dispensaries and fever hospitals, and provision for their widows and children. They presented statistics demonstrating that mortality rates among dispensary and fever doctors in 1818–43 (24 per cent) were almost twice as high as for combatant army officers in 1811–14; they subsequently published ‘On the mortality of medical practitioners from fever in Ireland’ (Dublin Quarterly Journal of Medical Science, iv (1847), 134–45; v (1847), 111–28).
Deeply affected by his experiences during the great famine, Stokes spoke of ‘loving my unhappy country with a love so intense as to be a pain, its miseries . . . have lacerated my heart’ (Stokes, 114). He worked tirelessly among his patients at the Meath; one of these – admitted in 1849, wretched, half-naked, and drug-ridden – he recognised as James Clarence Mangan (qv), who was given every comfort at Stokes's expense. Mangan expressed his appreciation: ‘You are the first who has spoken a kind word to me for many years’ (Stokes, 78). After Mangan's death, Stokes commissioned his friend Frederick Burton (qv) to make a sketch of him (preserved in the NGI), and had a plaster cast made.
Stokes succeeded his father as regius professor of medicine at TCD (1845–78), having since 1840 acted successively as his assistant and deputy. More than any other individual he contributed to the high reputation enjoyed by the medical school, continuing the pioneering methods of clinical teaching in Dun's Hospital that he had helped to establish at the Meath. Concerned to advance the medical profession, he repeatedly insisted on the necessity of a broad education for medical students and campaigned for equality of training and status for physicians and surgeons: ‘the human constitution is one; there is no division of it into a medical and surgical domain’ (Stokes, 131). He emphasised the importance of the highest ethical standards and the application of scientific standards in medical practice, and by precept and example sought to raise the medical profession in Ireland to a status comparable to those of the law and the church. Involved in much of the medical legislation that passed during his professorship, he represented TCD in the negotiations prior to the passing of the medical act (1858), which initiated medical registration; and on the formation of the General Medical Council he became the crown's representative for Ireland (1858–76).
Frustrated by the limitations of curative medicine and appreciating that many medical problems were due to poverty, malnutrition, and poor sanitation, he was one of the first to appreciate the importance of preventive medicine; he argued for the recognition of public health as a medical speciality before the sanitary commission (1863–4); and in his presidential address to the British Medical Association meeting in Dublin (1867) he stressed the primary importance of preventive medicine and the necessity of state responsibility for the health of the nation. He established the Dublin Sanitary Association (1871), and introduced a diploma in state medicine at TCD (1871), the first in Britain or Ireland and forerunner to the diploma in public health. Many of the provisions he advocated were later included in the Public Health (Ireland) Act, 1878.
As the leading physician in Dublin, he enjoyed a large practice and was consulting physician to several medical institutions. An honorary member of many foreign medical societies, he was awarded honorary degrees: MD (Dublin, 1839), LLD (Edinburgh, 1861; Cambridge, 1874), and DCL (Oxford, 1865). An hon. fellow (1828), fellow (1839), and censor of the K&QCP(I) he was elected its vice-president (1848), and president (1849, 1866), and was also appointed physician in ordinary to the queen in Ireland. Elected FRS (1861), he was the first physician to be elected to the presidency of the RIA (1874) and to receive the Prussian order of merit (1875).
His working day often extended from 4 a.m. to 8 p.m.; he suffered bouts of depression, which were assuaged by his travels in Ireland and Europe. His letters reveal a delight in nature, art, and architecture, and above all antiquarian interests, shared with his friend George Petrie (qv), to whom he was a constant source of encouragement. After Petrie's death, Stokes wrote The life and labours in art and archaeology of George Petrie, LL.D., M.R.I.A. (1868). He sympathised with catholic emancipation and deplored the disestablishment of the Church of Ireland, but never took part in political movements: ‘the real patriot is he, who . . . with integrity . . . labours onward . . . that his country shall rise, and with . . . justifiable ambition, that loving her he may rise with her’ (ibid.).
He lived at 5 Merrion Square, where he held open house, a magnet for men of distinction in every branch of learning from Ireland and abroad; he delighted in music, was a superb conversationalist and storyteller, and enjoyed family life. His thoughtful, kindly face is preserved in the portrait by Frederick Burton (qv) which is in the RCPI together with the marble statue (unveiled 1876) by John Henry Foley (qv); the college mace (1853) bears his name and crest. His health declined in 1876 and, suffering a paralytic stroke, he died (6/7 January 1878) at Carrig Breac, his country house in Howth, Co. Dublin. He was buried in St Finian's churchyard, Howth.
He married (1828) Mary Black of Glasgow (d. 1869); they had seven sons and three daughters. His eldest son, Whitley Stokes (qv) (1830–1909) was a Celtic scholar; his daughter Margaret McNair Stokes (qv) a noted archaeologist.
His second son, Sir William Stokes (1839–1900), surgeon, was born 10 March 1839 in Dublin. Educated at the Royal School, Armagh, he entered TCD, graduated BA (1859), MB, MD, and M.Ch. (1863), and was admitted LRCSI (1862). After postgraduate study abroad, he established a practice from Clare St., Dublin, and served as surgeon at the Meath (1864–8, 1888–1900), and the Richmond Hospital (1868–88). A skilful operator, he is noted for the invention of a double-threaded screw extension splint (1877) and for the Gritti-Stokes amputation of the lower limb.
He lectured at the Carmichael School of Medicine and became professor of surgery (1872–1900), fellow (1874), and president (1886) of the RCSI, examiner at QUI and Oxford University, and president (1881) of the Pathological Society of the Irish Medical Association. Author of many papers on clinical and operative surgery, he delivered a much praised address at the jubilee meeting of the British Medical Association (1882), and was hon. president of successive International Medical Congresses – Berlin (1890), Rome (1894), Moscow (1897), and Paris (1900) – and a fellow of several medical societies. Knighted in 1886, he was made surgeon in ordinary to the queen in Ireland (1892).
He possessed a fine tenor voice and was an excellent linguist and highly cultured; deeply respectful of his father, he published William Stokes, his life and work (1804–1878) (1898). Appointed consulting surgeon (1899) to the British forces in the second Boer war, he served at military hospitals in Natal, and died (19 August 1900) of typhoid fever at Pietermaritzburg, Natal. He married (1869) Jane Elizabeth, daughter of John Lewis Moore (d. 1876), vice-provost of TCD; they had a son and two daughters, one of whom died in infancy.