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In the 1830s the obstetrician Robert Lee made a series of observations on the gravid uterus that ran counter to received wisdom. This paper recounts the way in which Lee's work was handled by the premier scientific institution of the day, the Royal Society.
Born in Scotland in 1793, Robert Lee graduated in medicine at Edinburgh in 1814. He had been a pupil of James Hamilton, professor of midwifery at the Infirmary, where he remained as physician's clerk until 1817. After spending the winter of 1821-1822 in Paris he travelled to the Russian Provinces on the Black Sea (where in the Crimean he was physician to the governor general1). Returning to Britain he practised midwifery and obstetrics in several posts, including a brief spell as professor of midwifery in Glasgow. By 1830 he was in London, where he became a Fellow of the Royal Society; and in 1835 he finally won appointment as lecturer in midwifery at St George's Hospital.
During the 1830s and 1840s Lee had numerous opportunities to examine gravid and non-gravid uteruses. Aspiring to publish his work in the Philosophical Transactions of the Royal Society, Lee presented a memoir on the ganglia and nerves of the uterus to the Society in 1839. His chief assertion was that, contrary to the teaching of William Hunter, the gravid uterus was served by an enlargement of its associated nervous system. Like the neurophysiologist Marshall Hall2, whose lecturers on diagnosis he had attended as a student in Edinburgh, Lee believed that, when a paper referred to experiments, dissections and the like, these aspects should be examined by referees just as thoroughly as the written work itself3. Thus, before submitting his paper Lee requested the surgeon Sir Astley Cooper, a member of the Physiological Committee which would referee Lee's paper, to examine his dissections and give an opinion on them.
From Lee's Memoirs on the Ganglia and Nerves of the Uterus3 published a decade later it is clear that Astley Cooper agreed to do so, but he saw Lee's dissections of uterine material only once on a dark foggy morning in a downstairs room lit by two small candles. Lee himself had needed the bright sunlight of summer mornings to carry out the dissections. Astley Cooper concurred that in the gravid condition there were great plexuses at the cervix and on the body of the uterus which appeared to have the character of ganglionic plexuses of nerves. But he would not admit them to be true nervous structures because he believed Hunter's assertion that the nerves of the uterus never enlarge in the slightest degree during pregnancy. Astley Cooper advised Lee not to submit his paper and was offended when Lee disregarded this advice.
Lee had already shown his dissections to several other London colleagues and Fellows of the Royal Society, most of whom, including Herbert Mayo at King's College Hospital, agreed that Lee's newly delineated structures were nervous tissues. After examining the dissections, Mayo even wrote Lee an official letter congratulating him on his discovery and inviting him to attach this letter to the paper when submitting it to the Royal Society. But five days later Mayo was writing to ask Lee for samples of the ganglionic plexuses from gravid and non-gravid uteruses for microscopic examination by Mr Tomes the house surgeon at the Middlesex Hospital. Tomes declined to give any opinion, and later admitted to Lee that at the time of his examination he was almost entirely unacquainted with the microscopic character of nerves, having worked largely on teeth and bone. Mayo then requested the return of his official letter. Like Sir Astley Cooper he urged Lee not to submit the paper.
Having submitted the paper, Lee learned that his referees were to be the anatomist and dinosaur palaeontologist Richard Owen and the surgeon Thomas Kiernan, who declared that the microscope would resolve the issue. They examined small portions only and decided that there were no nerve plexuses. They gave no reasons for their decision and were not obliged to do so. For Lee it was incomprehensible that, despite the undisputed continuity of the ‘new’ structures on the gravid uterus with the sympathetic and spinal nerves, together with their form, colour and vascularity, his referees were implying that there was no nervous system; how could this be reconciled with the pains of labour? He withdrew the paper rather than have it rejected and continued his researches even more assiduously.
Lee did privately publish The Anatomy of the Nerves of the Uterus in January 18414. In June 1841 and, according to Lee, at the request of Peter Mark Roget, the powerful Secretary of the Royal Society, and William Lawrence, a member of Council and of the Physiological Committee, Lee read another paper, ‘On the nervous ganglia of the uterus’, which was published in Philosophical Transactions5. The following year two further accounts appeared, with three engravings. Lee concluded his main 1842 account by declaring:
‘These dissections prove that the human uterus possesses a great system of nerves which enlarges with the coats, blood vessels and absorbents during pregnancy, and which returns after parturition to its original condition before conception takes place.... If these nerves of the uterus could not be demonstrated, its physiology and pathology would be completely inexplicable’6.
Lee was elected to the Council of the Royal Society and served for two years.
After the 1842 publications and at one of the Royal Society's soirees, Professor William Sharpey from University College London commented abruptly to Lee—no doubt with a glass of wine in his hand and a charming smile on his face—that in three years Lee would give up or be compelled to forego all that he had published respecting the nerves of the uterus.
The source of Lee's future problems was the work of Thomas Snow Beck, surgeon and former pupil of Sharpey and Quain at University College London. Snow Beck had sought Lee's help in obtaining a specimen for making his own dissection and Lee had been horrified on enquiring about his progress to find the putrid state of the preparation Beck had obtained from Sharpey. On examining what was left, Lee found that the great blood vessels and accompanying ganglia and nerves had been cut away. Lee saw this as a scheme for destroying both the nervous system of the uterus and his reputation.
Continuing his efforts to establish the validity of his own research Lee presented to the Royal Society in 1845 a brief note ‘Supplement to a paper on the nervous ganglia of the uterus’7. This was read on 19 June together with the title only—‘On the nerves of the uterus’—of a paper by Snow Beck. Lee learned from his network within the Society that most of Beck's paper still had to be written. Nevertheless Sharpey and R B Todd, a member of the Physiological Committee, were appointed as referees to judge its suitability for publication whilst Lee's ‘Supplement’ was left unrefereed at this stage.
At the Autumn meeting on 27 October 1845 the Physiological Committee would normally have considered recommendations for the award of a Royal Medal for Physiology which had fallen due that year. Roget, who was at the meeting, told William Lawrence who had chaired the meeting in the absence of Sir William Brodie that it was not necessary to consider the issue of the Royal Medal. Lawrence dissolved the meeting and left the premises. But the issue of the Royal Medal was immediately raised again and it was pointed out that, according to the statutes, a recommendation had to be considered. The meeting was reconstituted with Todd in the chair and it was ‘Resolved that the Council be recommended to award the Royal Medal in Physiology to Mr Beck for his paper “On the Nerves of the Uterus”.’ But the paper had not yet seen the light of day in the Society.
Three days later under the President, the Marquis of Northampton, Council met and on the recommendation of the reconstituted meeting ‘Resolved that one of the Royal Medals in Physiology be awarded to Snow Beck Esq’. A week later on 6 November the Physiological Committee met and the minutes of both committees were confirmed and Lee's ‘Supplement’ was rejected for publication. Council met on the same day and confirmed the minutes of their own recent meeting. Not surprisingly on the next day Lee sought a meeting with the President and pointed out what he described as the illegalities of what had occurred: the medal had been awarded to a paper which had not been read to the Society nor even yet ordered to be printed, both of which were conditions laid down for the award of a medal. Furthermore, Lee declared, the recommendation had not proceeded from the Committee of Physiology but from an illegally constituted meeting after the Committee had been dissolved by the chairman. According to Lee in his 1849 publication, the President shrugged his shoulders and merely said ‘The thing is done and it is too late to say anything more about it.’
Lee pursued the matter further. He wrote to Roget asking if he should not have compared the dissections of both Beck and himself before reaching the decision which effectively declared his own (Lee's) descriptions and delineations incorrect. Roget replied the same day explaining that the decision had been influenced by two separate reports on the paper, from Todd and Sharpey. Roget reminded Lee that such reports were confidential. How relieved he must have been about this ruling. Todd's report, which is among the Royal Society manuscripts, contains the following passage at which Lee would have been justifiably even more outraged but which he went to his grave never having seen. Todd's review says:
‘I do not think that Mr Beck has clearly determined the question of enlargement of the nerves in the impregnated uterus. It seems to me that more careful examination of the nerves in the fresh state, comparing those of the gravid with those of the unimpregnated uterus are still wanting to decide this question. I venture therefore to recommend that Mr Beck be at liberty to make such amendments in his paper as may render it more fitting a place in the Transactions.’ (MS RR. 18, Royal Society, London)
And this, in addition to the further impropriety of returning the paper to the author for amendments, was written about a paper which was awarded the Royal Medal before the month was out8. Over and above these factors was the contravention of a Royal Society ruling which prohibited the Society from taking sides on controversial issues such as that between Lee and Snow Beck. In fact the papers of neither of them should have been considered for a Royal Medal at this stage.
Lee called on Roget and, according to his account, Roget became confused and said he himself was the cause of all the trouble because he had allowed Lawrence to close the meeting having mistaken a Physical for a Physiological Medal. Lee told Roget that if he had not known him for more than twenty years to be a man of honour he would have regarded the excuse as a premeditated trick. Lee followed this meeting with a formal letter to Roget, a copy of which was sent to the President, whose annual report, due in a few days, would need to make some reference to the Society's medals. Meetings hurriedly took place and Todd and Sharpey were requested to draw up a report—this would of course be a new one—on the claims of Beck's paper. The President also requested that the paper quickly be sent to some members of the Physiological Committee resident in London. Lawrence immediately asked if he could see it and was told that it was with the author, infringing yet another rule that papers once submitted should not leave the Society unless withdrawn. The report of Todd and Sharpey (MS RR. 1.21, Royal Society, London), in which there had been a complete volte face, was adopted and as the MS copy of the President's annual report reveals, reference to it was added in a space left especially for it when the rest of the report had already been prepared. Thus the President was a party to these numerous attempts to make appear regular a series of highly irregular transactions within the Royal Society.
Lee simply could not let the matter rest. He wrote to the President and Council calling for suspension of the award but made no headway. Meanwhile wider dissatisfaction within the Royal Society among many of its Fellows, seeking reforms in its practices, continued. In January 1847—just over a year after the official award of the Royal Medal—Wharton Jones, a friend of Thomas Wakley the owner/editor of the Lancet and campaigner for reform within the medical profession, submitted a requisition for a Special General Meeting. This would consider and determine on the legality of the circumstances under which the Royal Medal in Physiology for 1845 was first recommended and under which it was actually made by the President and Council9.
The meeting was called for 11 February 1847 and was announced in the Athenaeum, which later reported on the meeting itself10. On 25 January a leaflet setting out to exonerate the Council and the Physiological Committee was distributed within the Society. A copy in the British Library has marginal notes which dispute the contents and claim that it was the work of Roget even though it bears the name of an assistant clerk, Weld11. The meeting itself, which lasted from 2 to 5.30 pm, was noisy. Wharton Jones was eventually invited to move a resolution. He called for the award to be declared null and void. The President agreed that an error had been made, at which point an opponent to the protesters immediately leapt in and declared that following this confession he wished to propose an amendment that nothing further need now be done. The senior hierarchy quickly supported this amendment, closed ranks to maintain the status quo and the amendment was passed. Wharton Jones's resolution was lost and there was to be no change over the award of the Royal Medal in Physiology. But change in the house there was. At the next annual meeting the resignations of both the President and the Secretary were announced and it was widely acknowledged that the Lee affair had played no small part in this outcome.