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The continuing rise of complementary medicine, with a sympathetic report from the House of Lords1, provides an incentive for revisiting an incident in the early twentieth century when the issues of empirical and orthodox medical treatment exploded into the public arena.
Empirical treatment was represented by Mr Herbert Barker, a bonesetter, and the extent to which his activities had penetrated to the core of public life is illustrated by the transcript of the discussion of the Parliamentary Standing Committee dealing with the Dentists Bill in June 19212. Colonel Wedgwood (Newcastle-under-Lyme), who throughout the discussion was vocal in defence of liberty, pointed out that the Bill as it stood made dentists different from doctors, for they would not be permitted to practise even without fee or reward unless registered. He said:
‘We know that in the case of the medical profession, men like Barker, the bone-setter, can continue to practise without being fined, so long as they have no legal right to claim payment of fees. I believe Barker does bone-setting rather better than some of the registered practitioners. Does this mean that if a Barker springs up in the dental profession and cures people of the tooth-ache without the usual paraphernalia of pincers, and so forth, he will be fined £100, or will he be able to practise as long as he has not the legal right to recover fees? In other words, are you making a distinction between the dental profession and the medical profession?’
In reply Sir Kingsley Wood (Woolwich, West), said, ‘Future practitioners must comply with the regulations and examinations of the Board, but I hope that if a Barker does arise he will be just as successful with the Dental Association as he has been in the medical world.’
So who was Barker, and just how successful was he with the medical world? The account that follows of the extraordinary events that surrounded Herbert Atkinson Barker (Figure 1) in 1920 and 1921, and which led to his name being so familiar that he could be used as the stereotype empiricist, is gleaned mainly from a press cuttings file at Lambeth Palace (Davidson Papers Vol. 404) and from Barker's autobiography3.
The start of the affair was signalled in a dramatic fashion when, on 14 April 1920, the Archbishop of Canterbury, Randall Thomas Davidson (Figure 2) was petitioned to award Mr Barker, who had no medical qualifications, a Lambeth degree in medicine, honoris causa. This petition was signed by hundreds of people, most of them MPs and many of them eminent; its first page alone bore the names of the Lord Chancellor of England, the Attorney General, the Solicitor General, the Chief Secretary for Ireland and the late Home Secretary. The key points of the petition were that Mr Barker had brought relief to many thousands when all other aid had proved ineffective and that offers by him to teach his system freely in the medical schools of the Kingdom, and to place his services gratuiously at the disposal of His Majesty's forces, had been rejected because he was not a qualified physician or surgeon. The petition concluded:
‘Your Petitioners humbly submit that Mr Barker's case is eminently one for your Grace's favourable consideration in order that his assistance may be more generally available for injured soldiers and sailors at the present time, and in view of the unique and distinguished services he has rendered to suffering humanity and the cause of science through a long period of opposition, contumely and persecution.’
Reporting the event on 16 April, the Daily News Reader remarked that, although the petitioners might achieve their aim, the value of a degree depended on its source; the Archbishop's degree ‘might sound very well, but it wouldn't mean very much.’ In the next few days, comments in other papers were friendly in tone, whether favourable or not. The Daily Sketch, referring to Barker as the ‘bloodless surgeon’, mentioned the authority of the Archbishop to award such degrees under the Peters Pence and Dispensations Act of Henry VIII. The Pall Mall Gazette hoped that the Archbishop would ‘make no bones’ about consenting to the award.
This calm was broken by an editorial in the Daily Telegraph of 20 April, based on an interview with Dr Cox, medical secretary of the British Medical Association. Cox was quoted as stating (incorrectly) that the Archbishop had voluntarily surrendered his right to award degrees in 1858; Mr Barker was as free as anyone to seek his degree in the ordinary way and be registered. Rashly, he then added that a Lambeth degree was nothing but a relic that conferred no rights, and if granted would make both the Archbishop and Mr Barker ridiculous.
This brought into the open a strand of popular feeling about the medical profession that might otherwise have remained unaired. Two days later the Daily Telegraph published a reply from Mr George Bernard Shaw, whose wife had been successfully treated by Barker. ‘It is a curious fact,’ Shaw remarked, ‘that the registration of a practitioner by the General Medical Council seems to deprive its victim of the power of thinking before he speaks... As far as I know, no Registration Act has ever been put into force without providing for the registration of the “bona-fide practitioner,” meaning the man whose qualifications through establised practice are unquestionable, but who is too old and eminent to be sent to school for five years’. His letter ended as follows:
‘Until the General Medical Council, which at present exhibits every constitutional vice that a trade union or professional association can have, is completely reformed by establishing the majority of educated laymen provided by its legal constitution we shall continue to hasten more and more precipitously to the not far distant day when the vogue of the unregistered practitioners, already very great (Mr. Barker is only a specially famous example of a large and growing body), will become so irresistible that the registered will be shunned by the public and driven to earning a scanty wage by signing death certificates for their unregistered employers.’
The ambiguity in the last few words notwithstanding, this letter provides a useful summary of a lay view which still surfaces eighty years later. From then on the press reports leaned much more to the Shavian line than to medical orthodoxy. The Daily Telegraph of 26 April carried four letters, all strongly supporting the petition. One was from a ‘grateful patient’ saying that, if Dr Cox feels the Lambeth degree is worth nothing and confers no rights, why does he object to it? This letter to the press is representative of several private letters in the Archbishop's file. During the centuries when the Church was the main non-university registration authority for medical qualification the submission of testimonials was an essential part of applications, and these testimonials in the Barker case read as exact comparisons with those retained in the Palace Library from the seventeenth century.
On 28 April Truth fleshed out the history of the Barker case with a passionately resentful account of the treatment given to Dr Axham, who had acted as anaesthetist to Barker and had been struck off the Register in 1911. When Barker had been sued for damages after a mishap, the General Medical Council had been unable to avoid ‘seeing’ the improper association between Barker and Axham, with the inevitable consequences. The Daily Express of 30 April pointed out that, nonetheless, many members of the orthodox profession recognized Mr Barker's skill, going to him and referring to him for an art consisting of procedures unknown to surgeons.
On 7 May the Archbishop wrote briefly to the Rev JL Walton, Secretary of the petitioners, confirming that it was within his power to grant the degree, but asking how ‘possession of that title would render his assistance more generally available’. In his reply, Walton said that Mr Barker had something he wished to teach the medical profession and did not wish his skill to die with him. The granting of the degree would end an embarrassment, and provide a bridge.
The Archbishop then drafted his reply to the petitioners and forwarded it to Sir Lewis Dibdin, ecclesiastical lawyer, friend, and fellow-member of his club, the Athenaeum. In a covering letter to Dibdin he remarked, ‘I feel bound to have a fling at the medical men who have, it seems to me, acted in a rather intolerable way towards a man of genius who has got a knack denied to them’. One of the Archbishop's most influential medical advisers on this matter had been the surgeon Sir Alfred Pearce Gould, another member of the Athenaeum, who had pointed out that, however ‘hard’ the case of Barker might be, the protection of the public by the 1858 Act could not be compromised by granting the degree. Ultimately the Archbishop agreed with this view.
Writing to the petitioners on 21 June 1920, the Archbishop declined to award the degree:
‘...The legislation which limits registration to men qualified by the ordinary professional training expressly, and I think rightly, provides that the status acquired by registration is not given by the Degree which the petitioners invite me to confer on Mr. Barker.... You point out, justly as I think, that Mr. Barker could not reasonably be expected at his age to enter upon the course of study necessary for obtaining a Medical Degree in the ordinary way. But, this being so, I am at a loss to know in what way Mr. Barker's assistance would be made more generally available by his holding a Lambeth Medical Degree, unless it were by leading the public to suppose that he possesses the technical qualifications of a registered practitioner. The popular use of the title “Doctor” in connexion with his name would, I imagine, have this probable result, but the supposition would not be in accordance with facts. On these grounds I come distinctly to the conclusion that I should not be acting in the public interest were I to accede to the prayer of the Petition. I should feel more at liberty to grant the request if the Degree were being sought simply as the public recognition of Mr. Barker's beneficial work in the past and were being given, for example, on his retirement from practice so that it could not have the misleading result which I have indicated. Indeed I cannot help hoping that some means may be found of marking the public appreciation of what I cannot but call Mr. Barker's eminent services to sufferers to whom his manipulative method has proved beneficial when other efforts of a more normal sort had failed’ (Davidson Papers, Vol. 404, pp. 110-12).
The cloistered austerity of Lambeth—correct, scrupulous, and strong—contrasts sharply with the no less resolute public passions of the bonesetter's tale. Herbert Atkinson Barker was born in 1869, the son of a solicitor and Coroner for south-west Lancashire. At eighteen, while on a sea passage to work on a farm in Canada, he had his first case of success in manipulation, either revealing an hereditary ability or responding to subliminal knowledge that his cousin John Atkinson was one of the foremost bonesetters of his day. Atkinson, who took Barker on as apprentice two years later, had been taught in his turn by Robert Hutton (1840-1887), who had inherited, via his training with his uncle Richard, two hundred years of experience in the art, and had built up a glittering clientele including Paderewski and members of the Royal Family.
Taking over Atkinson's practice in 1905 Barker set about building his own list, no less illustrious than that of his cousin. He was much helped in this when in 1906 Dr Frederick Axham, in full awareness of the professional risk he was taking, volunteered to act as his anaesthetist. The autobiography then takes an odd but revealing course, for, when already successfully established, Barker chose to make himself as conspicuous as possible by lodging the great sum of £1000 with the Daily Express newspaper, to be forfeited if he could not treat with success eight cases in which the medical establishment had failed. The contest was to be refereed by two doctors, who were obtained with difficulty.
Seven of the cases were successful, the eighth was much improved, and the bond was returned. As if this and the engagement of Dr Axham as his anaesthetist were not enough to bait the established profession, in the same year, 1906, Barker published an open letter to the president of the Royal College of Surgeons, Manipulation or the Knife, in which he put himself alongside Harvey and Simpson:
‘What is any Science—apart from mathematics—but a result of empiricism? Somebody finds out something, and experiments on it, and perfects it. He is an empiric...I make my appeal to Experience, and to her offspring, in the full and perfect assurance that if I am permitted to live out the allotted span of human life, I shall see the principles of manipulative surgery accepted by every medical school, and taught there under competent professors’ (Leaves from my Life p. 67)4.
While it was through his practice that Barker approached the younger Court and establishment, the Archbishop had long been an insider in the old Court. Born in 1848, Randall Davidson had been appointed Dean of Windsor and domestic Chaplain to Queen Victoria at the age of 35. In this post and capacity, it was said of him: ‘The Dean was indeed an irresistible Dean; not because he fought (he never fought), still less because there was anything dramatic about him (he was never dramatic), but because he was so cool and Scotch and right and always to the point’4. On appointment as Archbishop of Canterbury in 1903, one of his first acts was to sanction alterations in the requirements for the Lambeth MA degree (Davidson Papers, Vol. 403, pp. 1-91), and he continued to take a personal interest in these degrees, demanding the highest standards. At the time of the Barker episode he was 72 years old and heavily engaged in the 6th Lambeth Conference which was to be held in July/August that year. Only his habit of hard work and his pre-existing network of contacts in the wider world allowed him to swallow the Barker affair.
Connoisseurs of the class system would find much to enjoy in the subtleties surrounding the relationships of the two men with their supporters. The Archbishop was at all times discreet, where the bonesetter had no compunction in publishing the names of the great and good who had been his patients. From his autobiography an idea of the waiting room at his Park Lane practice can be gained. There could be found Princess Marie Louise's cat, whose dislocated jaw had been treated; the Duke of Sutherland; Augustus John who painted Barker twice (Figures (Figures11 and and3);3); Baron Bentinck; Lord Charles Beresford; the Maharaja of Kutch; Mrs George Bernard Shaw; and the daughter of Sir Derek Keppell, through whom, as Barker puts it, he gained powerful friends. Sir Gerald du Maurier, another patient, offered Barker a part based on himself in Miss Dorothy Brandon's play The Outsider, as Ragatsky the bonesetter. His sports injury practice had from the earliest days been remarkable. At one time or another he was treating footballers from Bristol City, Queen's Park Rangers, Portsmouth, Everton, Norwich City, West Bromwich Albion, Fulham, and Manchester City, as well as boxers and rugby players. More to the point, there also were to be found the patients referred to him by orthodox medical practitioners such as Sir Bruce Bruce-Porter and Dr Frank Collie (who after Dr Axham's retirement in 1922 took over as Barker's anaesthetist). Clearly part of Barker's success lay in his ability to identify those cases which were beyond him, and to cultivation of a network of orthodox practitioners to whom he could refer such cases. Barker's consulting rooms provided a salon in which he revelled. He neither asked for, nor would accept, fees from the medical practitioners or their families he treated.
After the Archbishop's decision not to award a Lambeth degree, the debate rumbled on. It is noteworthy that at no stage did anyone suggest that Barker's methods were anything less than successful, despite the court case that had led to a modest award (of £50) against him. Then, in The Globe of 2 July, Walton (Secretary to the petitioners) picked up on the Archbishop's suggestion of an alternative method of recognizing Barker's work. On 23 July The Daily Chronicle headlined an article ‘Title For Mr. Barker?’, and The Star of the same day, in an editorial entitled ‘The Barker Joke’, drew attention to the uncomfortable fact that the medical profession, for all that its involvement was ostensibly peripheral in the matter, had nevertheless come out badly. With Mr Barker condemned to the outer darkness of the medical world—along with the faith healers, the witch doctors and the American tooth-breakers —‘the medical profession may yet realise with pain that its persistence in this particular joke had cost it a great part of the confidence of the public’ (Davidson Papers, Vol. 404, p. 121). A piece in the Glasgow Herald Weekly, in disclaiming any suggestion that the ‘medical trade union’ had in any way influenced the Archbishop in the matter, hinted at just that.
On 9 July the Manchester Guardian entered the fray in no uncertain terms. The Archbishop had clearly been right to refuse the degree, but if the medical profession persisted in regarding such a safe and successful healer (the figure of forty thousand cases being quoted) as a quack, the intervention of the Government was indicated to counter the ‘trade unionism at its worst’ of the profession (Shaw's phrase surfacing again) and to give public recognition to the man himself. On 10 July both the Daily News Reader and the Glasgow Herald Weekly came up with Shaw's alternative to both the public honour and the Lambeth degree—an honorary degree from Oxford or Cambridge. This idea had its irony, for the holder of a Lambeth Degree takes the gown not of Lambeth but of the college of which the Archbishop himself is a graduate—in Randall Davidson's case Trinity College, Oxford.
It is noteworthy that nowhere in the records at Lambeth, or in Barker's autobiography, is there recognition that if Barker had received any sort of degree that allowed him to practise, then Dr Axham would have had to be restored to the Register or the public outcry would have been deafening. A broadside in Truth of 21 July brought the Axham matter to the forefront of the debate, in somewhat intemperate language. Not only was Dr Axham's case said to be an atrocious wrong, exemplifying an intolerable danger and evil, but it was a gross abuse of the statute from which the General Medical Council derived its powers. Truth proposed a right of appeal from the General Medical Council to the High Court, and said that the 307 Members of Parliament who had signed the original petition should introduce an enabling Act as soon as possible.
For the next year, many editorials and letters were published on the Barker affair, without adding much of substance. Then on 19 November 1921 something new arrived. The Daily Mail, The Star, and the Daily News reported that the Prime Minister, Lloyd George, had received a letter on the subject from Sir Henry Morris Bt, ex-president of the Royal College of Surgeons, Sir Alfred Fripp, surgeon-in-ordinary to the King, Sir Arbuthnot Lane Bt, consulting surgeon to Guy's Hospital, and the physician Sir Bruce Bruce-Porter. The covering letter came from Barker's friend and surgical saviour William Clayton Greene, who had operated on Barker's right hand, which had been poisoned by a rose thorn at the very time of the Lambeth petition. Here at last was the backing of the medical profession which could not be given to that Lambeth petition.
These letters, reprinted in Barker's autobiography3, specifically draw attention to the Archbishop's comment, in his reply to the petition, that he hoped some other means might be found of marking the public appreciation of Barker's eminent services to sufferers.
The application was successful, and a knighthood was conferred on Mr Barker in the King's Birthday Honours of May 1922.
Not until 2000 did osteopaths receive official status with the institution of the General Osteopathic Council. This had no connection with the English tradition as exemplified by Barker, growing rather from the American school which reinvigorated the native stock in the mid-20th century. In the Barker case the medical profession maintained its integrity but somehow emerged tarnished, not least because of one careless remark from Dr Cox, given wings by George Bernard Shaw. The abscess of Barker's long campaign had itself been lanced, and all that remained was the scar of Dr Axham's case. He had been in his mid-60s when he became Barker's anaesthetist, and was 71 when he refused the GMC ultimatum to sever the connection, but his age had not in the least lessened his distress at exclusion from the Register. Sir Edward Marshall Hall KC offered his services to Dr Axham free of charge had he wished to take proceedings against the GMC, but ‘he had not the heart to carry the matter further’, and he died still off the Register in 1926, at the age of 86, though restored to his Licentiate by the Royal College of Physicians of Edinburgh at the beginning of that year3. Sir Herbert Barker retired from regular practice in 1925 and died in 1950. No reader of his autobiography is likely to be in doubt as to which of the two honours, a Lambeth degree or a knighthood, would have been the more agreeable to him. Randall Davidson, Archbishop of Canterbury, retired on the day of his golden wedding in 1928 and was created a Baron, Lord Davidson of Lambeth. When he died in 1930 the pallbearers at his funeral were Stanley Baldwin, Mr Ramsay MacDonald, Lord Stamfordham, the Earl of Selborne, Sir Lewis Dibdin, Sir Frederic Kenyon, the Rev J Scott Lidgett, and Sir Thomas Barlow his personal physician.
The Lambeth MD was reactivated in 1977 by Archbishop Donald Coggan, with an award to Dame Cicely Saunders. Subsequent recipients were Mr James Thomson (surgeon), Professor Andrew Sims (psychiatrist) and Mr John Graham (surgeon). The matter of the Reform of the General Medical Council on Shavian or other lines continues to occupy the attention of press, politicians, and the profession.
I am greatly indebted to the Librarian and Archivist of the Lambeth Palace Library for making material accessible, and for guidance in the preparation of this work. The London Library and the Librarian of the Athenaeum also provided material.
Quotation from George Bernard Shaw by permission The Society of Authors on behalf of the Bernard Shaw Estate.