Physician contributions to nonmedical science: Sir Grafton Elliot Smith and PUtdown man

CMAJ continues the series by Dr. Swinton on who have contributed to nonunedical science. Sponsors of the articles are Associated Medical Services, Inc. and the Hannah Institute for the History of Medical and Related Sciences. Science and Art Is a department of CMAJ that presents medicine In relation to the humanities; readers' contributions, literary, serious and humorons, are welcomed. projects and publications supported that these studies were expanded into "Hu- idea. But all this seems routine for an man History" (1930) and "The Diffu- enterprising medical professor. He did, sion of Culture" (1933). however, see the need for much closer This last work was produced with cooperation between the institute and difficulties. The long series of studies the hospital, and he greatly enhanced and the organizing and lecturing began the prospects for comparative anatomy to take their toll, and in 1932 Elliot by forming a professional liaison with Smith suffered a stroke. None the less London Zoo. This last endeavour was in 1933 he became Fullerton professor something that might well be copied of physiology at the Royal Institution by some zoos in North America. in London. He resigned from this in 1934 - in which year he was knighted Two lines of interest but continued for 2 years more at University College, ultimately retiring However, it is time to concentrate on in 1936. He died on New Year's Day two of the great lines of interest that 1937. The story of his mummies could Elliot Smith pursued, Egyptology and be greatly amplified but another aspect anthropology. Though these were un- of his interest must be dealt with doubtedly derived from his medical anthropology or human paleontology. knowledge and investigative vigour, he Even at the height of his Egyptian dis- became involved in developments of coveries, he was beginning to be active great importance. His Cairo experience in Man's fossil past. had opened many doors for him, and Elliot Smith had transformed the they continued to be open even after teaching of anatomy in Manchester in the war. 1909, and the new vigour of his teach- The word "mummy" is derived from ing methods attracted students from the Persian mumiya, which means far and wide. He added the important pitch, and those mummies of distin- Smith: hoaxer or hoaxed? aspects of comparative anatomy, for guished persons that were carefully em- one thing, and when he was president balmed usually had the brain removed of the anthropology section of the Brit- from the cranium and pitch inserted. word the quotation of Sir Thomas ish Association at Aberdeen in 1912, The brain was not considered impor- Browne is taken. he belaboured the anthropologists for tant, but the thoracic and abdominal These remarkable works have been their neglect. Two things of importance contents were usually removed and somewhat overlooked in these days, happened at this time. The first was kept separately in the sarcophagus. when the autopsy of mummies is also the arrival in his department in Man- Many less notable persons and thou- adding to knowledge by work done in chester of a young Canadian, Dr. sands of ordinary people were pre- Detroit, Manchester (England), Paris Davidson Black, who came to study served by burial and dehydration or and Toronto (where Nakht has yielded neurology but was quickly infected by desiccation in the arid soil of Egypt. up his teenage cerebral hemispheres his chiefs enthusiasm for the compara- The bodies, or mummies, had long and his shrunken heart). But Elliot tive study of brains. The Canadian was been known. In 1658 Sir Thomas Smith was always equally interested in to make his own discoveries in Chou- Browne, the Norwich physician, wrote: the origin of ideas and the spread of koutien later. culture. His "Evolution of the dragon", A great part of antiquity contented their hopes of subsistency with a transmigra- published in 1924, was not only a Putdown man tion of their souls, a good way to refutation of a theory that the sight of continue their memories. Egyptian ingenu- ancient bones (such as dinosaurs) in- But far from China and much nearer ity was more unsatisfied, continuing their spired the dragon myth, but an attempt Manchester, a new and almost instantly bodies in sweet consistencies to attend the to rediscover the migration routes of controversial discovery had been made. return of their souls. But all was vanity, these myths. He assumed that the It was early in 1912 that an amateur feeding the wind and folly. The Egyptian dragon was a compound of character- geologist and archeologist, C. Dawson, mummies, which Cambyses or time hath istic animals of Northern Africa: lion, professionally a lawyer, discovered spared, avarice now consumeth. Mummy crocodile, vulture etc. Heraldically this some pieces of a skull in a supposedly is become merchandise, Mizraim cures is largely true and a study of dragon ancient gravel pit at Piltdown, Sussex, wounds and Pharaoh is sold for Balsams. lore suggests the close relation of in the south of England. Despite this and other works (such dragon and water, so that a crocodile Several persons still living were con- as Thomas Greenhill in 1705 on Nekro- is not difficult to believe. Lion and sulted by Dawson who seemed sincerely kedeia or the art of embalming), little vulture may be harder to believe, but interested in the specimens' precise was really known of these early Egyp- both would feed on stranded mammals. identification and almost nervous tians. Elliot Smith was the first person The book goes on to suggest that the of their possible significance. The to study the royal mummies and was garbled myths were spread, perhaps not pieces were unduly thick fragments and involved in the Tutankhamun study. always coherently, by pirates operating might be old. Fossil man of great anti- Elliot Smith added therefore to knowl- or sailors trading in the Mediterranean. quity might have come to England. The edge in his works "Ancient Egyptians" The early Christian news has equally responsibility was great. The site would (1911) and "Migrations of early cul- been suggested as having spread from have to be protected for geological ture" (1915). In 1922 and thereabouts, port to port through Cilician pirates. reasons as well as being a source of there was a series of important writings However true these theories may be, more, and perhaps more revealing, by Sir Armand Ruffer and Elliot Smith, there were substantiated accounts of specimens. by Elliot Smith himself, by Elliot Smith life in Egyptian times, life that sought Dawson consulted the appropriate and Wood Jones and, in 1924, "Egyp- elsewhere than Egypt for the pitches department of the British Museum's tian Mummies" by G. Elliot Smith and and waxes and the spices required for natural history section. Head of that Warren R. Dawson, from whose fore- embalming the dead. In later years department was Arthur Smith Wood- CMA JOURNAL/NOVEMBER 20, 1976/VOL. 115 1049 Diuretic/Antihypertensive ward, an unsmiling, outwardly cold and unresponsive person of much paleon- ZAROXOLYN tological fame, especially in the field of fishes, fossil reptiles and fossil mam- (metolazone, Pennwalt) mals. He was an admirable person to Indications: Zaroxolyn (metolazone) is indicated in treatment of edema accompany- consult; Dawson had known him geo- ing conge.tive heart failure; edema accompanying renal diseases and states of dimin- logically for many years. ished renal function, including the nephrotic syndrome. Metolazone is also indicated to reduce blood pressure in the management of mild to moderate essential hyperten- Smith Woodward was invited to sion, either as the sole therapeutic agent or in combination with other antihyperten- come to the site of the discovery and sive therapy. see for himself. He could, with his Contraindicatlons: anuria, hepatic coma or pre-coma, and in cases of known hyper- sensitivity to metolazone and other sulfonamide derivatives. practised eye, appraise the geologic Precautions: Patients receiving metolazone should be carefully observed and serum age of the find; with his practised electrolytes monitored for signs and symptoms of fluid or electrolyte imbalance; fingers he might discover more. Wood- namely hyponatremia, hypochloremia and hypokalemia. Blood urea nitrogen, uric acid, and glucose levels should also be assessed during therapy. Hypokatemia, an ward was not slow to see the oppor- ever present hazard with most diuretic therapy, will be more common in association tunity. Dawson had suggested that the with intensive or prolonged diuretic therapy, with concomitant steroid or ACTH therapy, and with inadequate electrolyte intake. The serum potassium should be deter- undoubtedly human fragments might mined at regular intervals and potassium supplementation instituted when indicated. be as old as the famous Heidelberg The blinical signs of electrolyte imbalance are: dryness of the mouth, thirst, weak- skull. Here then might be Britain's ness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscle fatigue, an- hypotension, oliguria, tachycardia, and gastrointestinal disturbances such as nausea swer to the anthropologic world. and vomiting. Woodward was ambitious, able and Metolazone may potentiate the effect of tubocurarine and decrease the arterial response to norepinephrine. On this basis it may be advisable to discontinue the in command of a great part of a great drug at least 48 hours prior to elective surgery. museum. He was internationally known Special caution should be used in treating patients with severe hepatic disease since diuretics may induce metabolic alkalosis in cases of potassium depletion for fossil studies, though not of man, which may precipitate episodes of hepatic encephalopathy. and he was a strict disciplinarian who Orthostatic hypotension may occur and may be potentiated by alcohol, barbitu- rates, narcotics or concurrent therapy with other antihypertensives. was not often amused. In North Amer- When metolazone is used with other antihypertensive drugs, particular care must ican terms he was a "stuffed shirt", but be taken, especially during initial therapy. Dosage of other antihypertensive agents, one of importance. This fact will prove especially the ganglionic blockers and guanethedine, should be reduced. Hydra- lazine in therapeutic doses may interfere with the natriuretic action of metolazone. to be significant. He felt, it may be Metolazone may be given with a potassium-sparing diuretic when indicated. In this supposed, that no-one in his department circumstance, diuresis may be enhanced and dosages should be reduced. Potassium retention and hyperkalemia may result; the serum potassium should be determined need be told or consulted; indeed there frequently. Potassium supplementation is contraindicated. when a potassium-sparing was one man who was much more of diuretic is given. While not reported for metolazone, use of diuretics have on rare occasion been a human anatomist than he was who associated with pathologic changes in the parathyroid gland and with hypercalcemia was really kept in the dark about the and hypophosphatemia. Sulphonamide derivatives have been reported to exacerbate whole affair. or activate systemic lupus erythematosis. These possibilities should be kept in mind with use of metolazone. Caution should be observed when administering the drug to patients with severely Photographic impaired renal function, since the drug is excreted primarily by the renal route. proof Caution should be observed when administering metolazone to hyperuricemic or gouty patients. The drug exerts minimal effects on glucose metabolism; insulin re- This last fact now seems difficult to quirements may be affected in diabetics, and hyperglycemia and glycosuria may believe, for Woodward was occur in patients with latent diabetes. soon the Until additional data have been obtained, metolazone is not recommended for centre of activity, spending odd days patients in the pediatric age group. and weekends digging at the site. And Usage in Pregnancy: Since metolazone crosses the placenta and appears in cord blood, its administration to women of childbearing age requires that the potential there were visitors, visitors of renown, benefits of the drug be weighed against its possible hazards to the fetus. The poten- around him: distinguished zoologists, tial effects on the fetus include fetal or neonatal jaundice, thrombocytopenia, and geologists and others. There are photo- possibly other adverse reactions which have occurred in the adult. However, terato- logic studies in mice, rats and rabbits, conducted for three generations in rats, have graphs to prove this, of Woodward, in not shown teratogenic effects in these animals. shirt sleeves, sifting the material, with Metolazone appears in breast milk. Thus it is possible that the effects of metola- zone may occur in the newborn under these circumstances. If the use of metolazone Dawson close by. They were assisted is deemed essential for a nursing mother, the patient should stop nursing. sometimes by a young Catholic priest Adverse ReactIons: Gastrointestinal reactions: constipation, nausea, vomiting, ano- who was interested in geology and rexia, diarrhea, abdominal bloating, epigastric distress, intrahepatic cholestatic jaundice, hepatitis. anthropology, Teilhard de Chardin. Central nervous system reactions: syncope, dizziness, drowsiness, vertigo, head- Among medically qualified visitors ache. Cardiovascular reactions: orthostatic hypotension, excessive volume depletion, he- were Elliot Smith, Davidson Black and moconcentration, venous thrombosis, pal pitation, chest pain. Sir Arthur Conan Doyle. The finds Hematologic reactions: leukopenia. continued. Dermatologic reactions: urticaria and other skin rashes. Pieces of the cranium were Other reactions: dryness of the mouth, symptomatic and asymptomatic hypokale- found (Piltdown I and II), a lower jaw, mis, hyponatremia, hypochloremia, hypochloremic alkalosis, hyperuricemia, hyper- teeth, animal bones and a bone im- glycemia, glycosuria, increase in BUN or creatinine, fatigue, muscle cramps or spasm, weakness, restlessness, chills, acute gouty attacks. plement of peculiar shape and in- Adverse reactions which have occurred with other diuretics, but which have not triguing age. been reported to date for metolazone include: pancreatitis, paresthesias, xanthopsia, agranulocytosis, thrombocytopenia, aplastic anemia, purpura, photosensitivity, and The whole affair has been massively necrotizing angiitis (cutaneous vasculitis). These reactions should be considered as documented and discussed. It is easy possible occurrences with clinical usage of metolazone. Whenever adverse reactions are moderate or severe, metolazone dosage should now to see the thing against today's be reduced or therapy withdrawn. wide background of human fossils dis- Dosage: Initial dosages: Mild to moderate essential hypertension: 21/2 mg to 5 mg, covered in Europe, Africa, Java and once daily. Edema of cardiac failure: 5 mg to 10 mg once daily. Edema of renal disease: 5 mg to 20 mg, once daily. The daily dosage depends on the severity of China and against a background of each patient's condition, his sodium intake, and his responsiveness. Therefore, geologic age that is as certain as dosage adjustment is usually necessary during this course of therapy. radioactive methods can be. But at that Supplied: Tablets, 2½ mg (pink), 5 mg (blue), and 10 mg (yellow). time, fossil examples were much fewer Complete prescribing information available on request. and less understood. The Pleistocene age from which all came was anything then from 150 000 to 10 times that EPEI.NW.L3 number of years. Reasonable men Pennwalt of Canada Ltd. Pharmaceutical Division 393 Midwest Road Scarborough, Ontario MIP 3A6 thought half a million years a good tellectual with no beetling brow like Queenland. Elliot Smith had lectured acceptable figure. And here in the ignorant Heidelberg. But later, on a on it in Manchester and Smith Wood- hands of a small group were thick skull memorable day in 1953, Kenneth Oak- ward in Sydney (a curious transposition bones and an ape-like jaw that had ley of the museum was making a chem- of lecturers educated the other way flattened molar teeth. The oldest Eng- ical test and required to bore into the round geographically), and Millar lishman? The oldest of all men? lower jaw to get a little dust to ex- claims there is no such place as Pilton. amine. As the drill bored, the bone There are some of us who think we Pride before fall smoked unusually and smelled in a way know the authors of the hoax. They that fossil bone does not. The alarm do not include Elliot Smith, who had Anthropologists are not without bell rank in Oakley's fertile brain; the pride, and discoverers no access to the repository from which of fossil men anatomists from Oxford were sum- all the specimens came. It is a case of are not unknown to regard their "geese moned, new and extensive examinations as swans." Woodward thought clever young men, with access to ma- him half were made. The jaw was that of a terials, who set out to disconcert a the age of the Pleistocene (250 000 modern ape, with artificially ground- years) and half way between ape "stuffed shirt" who never himself and down molars, a feature on which so seemed to have been young. How man. The other nonhuman finds were much was to depend. do older (elephant, mastodon and you stop a determined anthropologist rhino- Investigation showed that all the with a "gold mine" at his disposal? ceros) with a later group of beaver, fauna were genuine from different hippopotamus, horse and red deer. The places - but not from Piltdown. The Elliot Smith had also experience with stone implements were in two groups jaw was genuine too but modern. The much more important things, such as also. It was an ideal grouping for a skull bones have not been localized and the finds of his old pupil, Raymond little midpleistocene scene. come possibly from an old skull of an Dart, who discovered the Taung's skull The specimens were discussed and acromegalic. (A ustralopithecus africanus). Between described to a large and eager audience Eoanthropus had been planted! them it was once nearly lost in a Lon- on Dec. 18, 1912 in the Geological don taxi. It was Dart who once wrote Society's rooms in Burlington House, Elliot Smith accused of Elliot Smith, "He is tall, ruddy- London. England had its fossil man, complexioned with immaculate white Eoanthropus dawsoni Smith Woodward. In 1972, Ronald Millar published hair; Elliot Smith with all his brilliance, This being translated means that he "The Piltdown man", a full and fascin- in every sense, a man of the world." now had a name given by his scientific ating story in which he hazards a guess Sir Grafton Elliot Smith, MA, MD, "father" Smith Woodward - the dawn that Elliot Smith might have been the LRCP, DSc, LittD, FRS; may he and man of Dawson. The find, the bones hoaxer. Apparently Elliot Smith once the Piltdown hoaxers and Sir Arthur and the reconstruction of his living ap- told Dawson that the Talgai skull, a Smith Woodward and Dawson (Who pearance were all described later in a somewhat controversial specimen of in- were both hoaxed) and all fossil men, small book, "The Earliest Englishman", determinate age, had been found almost women and mummies (whether em- by Smith Woodward (1948). at the time of Piltdown at Pilton, balmed or not) rest in peace.E The book was for the many: for the scientists there were plaster casts, splendid reproductions of the bones and jaw made by a master craftsman, F.O. Barlow, of the museum. The original bones were in the department's iron safe, but the casts flowed free and the battles raged. The museum protagonists defended the authenticity and scientific exactitude of Britain's anthropologic treasure, but none was an anatomist. Elliot Smith reconstructed the skull from casts; Keith modified the recon- struction and claimed accuracy for his own. The meetings raged and the argu- ments ranged but it was clear that, contrary to expectations, primitive man had an ape-like jaw but a caucasian skull. The originals were handled by very few even of the museum staff, and the chemical nature and. specific gravity were not allowed to be investigated. Much later, I had the task of exhibiting them publicly and was among the first (if not the first) to put such things behind ar-ioured glass to save them from religious maniacs and antiDarwin- ians. By that time, Smith Woodward had become Sir Arthur and had retired. As evolutionary objects, the constitu- ents of Ecanthropus were an embarrass- ment. They stood out like a sore thumb - of course, it could be argued that he was an Englishman and thus an in- CMA JOURNAL/NOVEMBER 20, 1976/VOL. 115 1053