The case of Anne Gresley Free

By 1781 William Withering was 40 years old and had been in Birmingham for 6 years. During that time he had become a very successful and much sought after physician renowned for his clinical acumen and diagnostic skills. His practice was one of the largest outside London and he travelled large distances (6000 miles in 1 year) throughout the Midlands and beyond to see patients. His prosperity seemed assured and his earnings had reached £2000 per annum. He shared consulting rooms with Birmingham’s senior physician, John Ash, and both were the first physicians to be appointed to the newly opened Birmingham General Hospital in 1779. Withering and Ash got on well both at a personal and professional level, they were friends not rivals. The same could not be said of that other giant of medicine in the Midlands, Erasmus Darwin. Darwin had been instrumental in persuading Withering to come to Birmingham in 1775 seeing him as a pliant junior who would not threaten his practice. How wrong he was on both scores. They loathed each others company and engaged in repeated abusive personal attacks, especially after Darwin had in 1780 cynically claimed the credit for discovering the diuretic action of digitalis in cases of dropsy.

On the 5th October 1781 Withering was requested to see a Mrs Gresley of Tamworth in Staffordshire. Anne Gresley was the daughter of the Reverend Richard Watkins, Vicar of Clifton Campville and was married to William Gresley, a surgeon and the cousin of Sir Nigel Gresley (6th Baronet) of Drakelow Hall in Derbyshire. The Gresleys were important people in the local society, the family was long established in that part of the country and their Baronetcy was the sixth oldest in the Kingdom. Mr Gresley was 4 years younger than his wife and was described as highly strung. In September 1781 Mrs Gresley, then aged 29, was delivered of her first child. The confinement was attended by Mr Lyon and Mr Oldershaw, surgeon and apothecary, respectively. It must be supposed that one or both of these men was a ‘man midwife’ and the fact that the two attended her suggests that it may have been a difficult birth and perhaps not surprisingly she developed a purpural fever.

Withering attended her on the day of the request, 5th October 1781, at her father’s rectory. He revisited her 2 days later on the 7th October. Unfortunately on the 9th October Withering was involved in an accident while returning to Birmingham in his coach from a consultation at Bilston in Staffordshire. The horses bolted and Withering broke his collarbone and was concussed. Unable to travel he requested that the Gresley family call in another physician but they declined. Withering then requested his colleague, Dr John Ash, to see her but unfortunately he was unable to help because of his own commitments. Withering did manage to visit Mrs Gresley on 13th October but he was badly shaken up by the journey. On the 17th October he ‘Went over, took a gentleman with me with a view to render the chaise more steady and to assist to dress and undress me’. His opinion was that ‘She was better and in a fair way but still had much to contend with’.¹ Withering continues ‘I saw her next morning (18^th) and dined at Drayton Manor’. Although it is not entirely clear from his narrative, the sense is that he remained there and was joined by Mrs Withering ‘On the Wednesday following (24^th) my wife had a good account (of Mrs Gresley) brought to the manor by Mr Oakes; on Thursday (25^th) I had another good account and about the same time a letter arrived from Mr Gresley desiring me to come over again when convenient to me, not that he thought her worse, but she desired to see me. After what I have suffered in consequence of my former journey, which was more than I wished to recollect, I did not propose going until I should be more able to bear so much motion and fixed my own mind for Sunday (28^th)’.¹

Drayton Manor is only 8 miles from Clifton Campville so if Withering and his wife were staying there it gives an indication of how rough Withering was feeling. However, on the Saturday evening (27th) Mr Gresley came personally to ask Withering to visit his wife whom he thought was worse. Withering felt he was unable to make the journey at night but promised to see her in the morning and was reassured by Mr Gresley’s report that his wife was eating well, appeared strong and that her pulse was not worse than it had been. He assured Mr Gresley that his wife would recover. Mrs Gresley died that night!

Withering’s first knowledge of trouble came in a letter from his friend Dr John Turton dated 17th December 1781. Dr Turton came from Wolverhampton and was physician to both George III and his son the Prince of Wales. The letter must have alarmed Withering ‘Before I went to London (from whence I have been returned a week) I purposed writing to you in consequence of circumstances that have arisen amongst some of my friends which very materially injure your credit as a physician and in order to prevent the progress of ill founded accusations and their disagreeable affects I think it highly necessary that you should be informed of the general calumny against you that you may if you think proper have an opportunity of doing yourself justice. For this purpose I gave a letter into the hands of Mr Dickenson which I received from Mr Gresley on the occasion of his wife’s death in which there seemed a very dark hint throughout that you had failed in your duty upon that occasion. By some fatality servant of opportunity Mr Dickenson did not show you the letter when at Birmingham and it now remains for me to acquaint you with it as far as I know… I proceed to tell you that you are charged with being the cause of Mrs Gresley’s death, that you pronounced her out of danger the day before and that your conduct through the whole of the attendance was extremely improper. Had this kept within the walls of Tamworth or Clifton it might have been of little consequence. The whole county and the first families in it are strongly impressed with the representations against you and I am persuaded your credit will be infinitely hurt in that part of the world without some steps taken on your part to put a stop to their progress’.¹

Withering was dumbfounded; in his reply he commented ‘Charged with being the cause of Mrs Gresley’s death this is a heavy charge indeed, but not knowing the meaning of it, it is impossible to give a pertinent answer. I am not accused of being ignorant of her case, for that was sufficiently obvious and a consequential death is not by any means uncommon. I am not accused of treating her improperly and if such a thing was laid to my charge I would plead that upon looking over my notes and reconsidering the case I know not how to do better, so that if I erred in that respect it was an error of ignorance and I have nothing left to acknowledge it… The case was not of that kind that rendered a doubtful or hazardous practice necessary, the practice was such as all the world would agree on pronouncing proper for the case was neither obscure nor uncommon. But perhaps the charge is meant to imply that I did not see her sufficiently often or that I neglected her …’.¹ Withering went on to describe in detail his involvement in the case, how his accident had prevented him from travelling, how he had suggested another physician be called, how he had tried to get Dr Ash to see her and why he could not and how he had been reassured by Mr Gresley on October 25th that his wife was no worse. He went on ‘It is certain that my wrong conduct must have been an afterthought for would any man in his senses have continued to apply to a physician for his further advice and direction to the very last day of a case, who suspected he had acted wrong…’.¹

Turton wrote again to Withering on the 4th February 1782 and included extracts from a letter he had received from Mrs Gresley’s brother the Reverend John Watkins. It was insulting to both Turton and Withering. In Turton’s opinion ‘The truth of the case is that he wished I should be acquainted with his sentiments of your conduct in respect of his sister…’. However, Turton was clearly on Withering’s side ‘I have not spared him in my answer and yet I think I should not have given him enough, I believe however it is likely to make a breach with the Sugnal and Clifton families which I would have avoided but that I wish not the friendship of a man that is capable of making general and dark charges to the prejudice of a well known fair and honest character’.¹

In September 1784 Dr John Ash came to Withering’s aid and wrote to the Reverend Watkins explaining why he was unable to accede to Withering’s request that he visit Mrs Gresley ‘Dr Withering and Mrs Withering both applied to me to go over to Tamworth to visit Mrs Gresley, once in my absence from home and the other when I was at home, but so engaged that I could not possibly undertake the journey, being obliged to go out immediately a direct contrary road’.¹

On the 4th January 1783 Withering wrote a long letter to the Reverend Watkins setting out his position and stressing Dr Ash’s support and the fact that Mr Gresley had not given him any sense of immediate danger before October 27th ‘You say Mr Gresley does not deny telling me the evening preceding his wife’s death that he did not apprehend immediate danger and add neither did Mr Lyon or Mr Oldershaw or anyone else but he and everyone thought her worse that day and therefore in your opinion that I ought to have visited her or else sent another physician—but another physician had before been refused when she was apparently to all about her in much graver danger and I could not visit her before the next morning which I readily promised to do…’.¹ He made plain to the Reverend Watkins the damage that this dispute had done to his personal and professional reputation ‘Perhaps you don’t see how much this unhappy affair has injured me. It would be sufficient to say that from that time I have not yet been once called to Tamworth or its neighbourhood, so that had my principal business lain in that direction I must have been ruined’. Withering demanded an apology ‘Now Sir as the injury has been made public reparation must not be altogether private. What I demand from you and Mr Gresley is a paper such as some of our column friends shall approve. It must state in short the general terms that after considering the answers to the things objectionable in my conduct and thought most culpable by you that you are now convinced that you had judged me too harshly and that the situation being considered and misconceptions being done away with you are now satisfied that I had done my duty both as a man and as a physician…’.

Watkins replied to this letter 2 months later on the 7th March 1783 and conceded that he had been misled ‘…At that time I was much displeased with you for having at any rate prevented Dr Ash seeing my sister (as I had then been made to believe you had)… I therefore do not hesitate to declare that the matter now appears to be in a very different light from that in which it was first represented to me—I was told you absolutely refused to see my sister the night preceding her death without being informed that Mr Gresley had told you he did not apprehend danger. I was informed you had prevented Dr Ash’s attending her without being told that you had repeatedly requested his attendance without knowing you had received a favourable account of your patient at the same time. After this it would be greatly of injustice did I not declare I had judged too harshly of you’. However, the Reverend Watkins declined to publish an apology ‘I hope you will look upon this matter as a sufficient satisfaction for any supposed injury—as to signing any particular form jointly with Mr Gresley I must beg to be excused as not being conscious of having so far offended as to render such a humiliating condition necessary’.¹

Reading the facts of this case one must sympathize with Withering and it is difficult to criticize any of his actions given the circumstances. It is highly unlikely that even if Withering had attended Mrs Gresley on the 27th October it would have made any difference to the outcome. He was well aware of the reputational damage that this slight on his integrity had caused. Writing to his son some years later Withering noted ‘a real physician of integrity and ability in this country ranks high in the estimation of every class of society’.¹ The grief of Mrs Gresley’s husband and her family at her death is understandable but does not excuse their behaviour towards Withering and the Reverend Watkins’ refusal to make public the withdrawal of his accusations against Withering is particularly egregious.

One aspect of this case that has been entirely overlooked by previous commentators is the fact that the Gresley family were well known to Erasmus Darwin.² Gertrude, Lady Gresley, stepmother of Sir Nigel, was in fact Darwin’s patron. When Darwin, a newly qualified physician, first arrived at Lichfield in November 1756 he was armed with a Letter of Introduction from his brother-in-law the, Reverend Thomas Hall, to Lady Gresley. She was a formidable lady and a prominent member of the local society. For reasons that have long been forgotten she was known as ‘Lady Black Wig’. It was through her that Darwin gained access to the upper strata of local Society which was essential for the success of any physician. Darwin and Lady Gresley became firm friends; she helped him in the purchase of his house in Cathedral Close, Lichfield, and regularly gave him presents ‘Lady Gresley has given me two queer coloured rabbits’.² Darwin and his family were guests at social events at Drakelow Hall, the Seat of the Gresleys, near Burton-upon-Trent. In 1759 Lady Gresley appealed to Darwin to help her when her son, Geoffry, then aged 18, eloped from Bristol to Scotland with a young lady that he intended to marry. Darwin was unable to prevent the elopement and he had a poor opinion of the boy ‘Geoff is a weak boy and has been spoilt in his education by being always treated like a child. And being always governed never was taught to govern himself’.²

Given this intimacy with the Gresley family it is inconceivable that Darwin was ignorant of Mrs Anne Gresley’s case. One might wonder why he was not consulted in the first instance; perhaps it was Mr Lyon and Mr Oldershaw who insisted on Withering. Darwin may have been asked and declined, 1781 a busy year for him. In March, after 11 years of widowhood, he married, Elizabeth Pole, widow of Colonel Edward Pole of Radburn Hall, Derbyshire and the illegitimate daughter of Lord Portmore. After their wedding they had spent 6 weeks in London and on returning to the Midlands the couple took up residence in Radburn Hall and Darwin transferred his medical practice from Lichfield to Derby. These circumstances could have had a bearing on Darwin’s involvement. Why did the Gresley family not consult Darwin when Withering suggested that a second physician be called because of his accident? Perhaps Darwin was consulted, but had no wish to help his rival, perhaps he could foresee how the case might end and did not wish to be associated with failure. Whatever he would have known about the case and might well have encouraged the Gresleys to traduce Withering’s reputation in order to land another blow on his bitter rival. In the long-term Withering’s reputation survived this unfortunate episode, although it undoubtedly cost him patients in that part of the Midlands. Darwin and his son, Robert, would later use it against him in their ongoing quarrel with Withering.

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