AN ARTICLE CONTRIBUTED TO AN ANNIVERSARY VOLUME IN HONOR OF DOCTOR JOSEPH HERSEY PRATT SAMUEL JONES GEE AND HIS FRIENDS * By SIR HUMPHRY ROLLESTON, Bt., G.C.V.O., K.C.B. PERHAPS the best way I can join in a tribute to Joseph Hersey Pratt— the clinical physician^—is to offer a sketch of another clinical physician, at St. Bartholomew's Hospital, with some sidelights on contemporary medical London when I was a student there half a century ago. The names of great physicians have often been linked by their admirers with recently recognized forms of disease, and also with favourite prescriptions—the least of their achievements. Samuel Jones Gee is an example of this eponymous association. Fifty years ago what is now known as posterior basal meningitis or, as Still showed in 1898, chronic meningococcal menin­ gitis of infants was colloquially known in London as " Gee and Barlow's disease " after their account in 1878 of cervical opisthotonos in infants which in his aphorisms Gee later summarized as follows: " not a tuberculous affec­ tion; it is due to a chronic meningitis, of the medulla. It may, however, occur as a symptom in tuberculous affections of this region." In 1899 Sir Thomas Barlow (1845- ) and David Bridge Lees (1846-1915) gave an expanded account of the condition under the title of " posterior basic (occlusive) meningitis; acquired hydrocephalus." These three writers were colleagues at the Hospital for Sick Children, Great Ormond Street, W. C. In 1888 Gee published an article of four pages " On the Coeliac Affec­ tion " beginning " There is a kind of chronic indigestion which is met with in persons of all ages yet is specially apt to affect children between one and five years old." At the time it attracted very little attention perhaps because, like most of his original papers, it appeared in the St. Bartholomew's Hos­ pital Reports and not in the medical periodicals with their much wider cir­ culation. In 1903 W. B> Cheadle (1836-1910), his colleague at the Hospital for Sick Children, gave an account of cases under the name of " acholia " and ascribed them to " inhibition of the liver " ; Sir Byrom Bramwell (1847- 1931) of Edinburgh in several papers between 1901 and 1915 described the condition as pancreatic infantilism; C. A. Herter (1865-1910) of New York "rediscovered" the disease in 1908 and started metabolic investiga­ tion of what he termed infantilism due to intestinal infection; Heubner (1843-1926) in the following year followed on the same lines, and the dis­ ease was sometimes called Gee-Herter and Llerter-Heubner disease. The eponym " Gee's disease " appeared in 1926 in The Manual of the Inter­ national List of Causes of Death, as Adapted for Use in England and Wales, Scotland and Northern Ireland, by the Registrar General; this tabular list contained a number of terms used by practitioners in signing death certifi- * Received for publication May 24, 1937. 387 Downloaded From: http://annals.org/ by a Penn State University Hershey User on 05/08/2016 388 SIR HUMPHRY R0LLEST0N cates, and thus differs from The Nomenclature of Diseases, Drawn up by a Joint Committee Appointed by the Royal College of Physicians of London (1931) which gives very few synonyms and does not include " Gee's dis­ ease." The comprehensive article on this disease by Izod Bennett, Hunter, and Vaughan in 1932 was entitled " Idiopathic Steatorrhoea (Gee's Dis­ ease), A Nutritional Disturbance Associated with Tetany, Osteomalacia, and Anaemia." Since 1926 Thaysen of Copenhagen has written 10 papers arguing that the coeliac affection, non-tropical sprue, and tropical sprue should be grouped together under one designation " idiopathic steatorrhoea," and Mogensen of Copenhagen in 1937 suggested the eponym " Gee- Thaysen's disease " for those three conditions. Henry Moore and his Dublin colleagues recommended that the coeliac disease of children should be called the " Gee-Herter disease," that idiopathic steatorrhoea of adults and adolescents of non-tropical countries should be known as the " Gee-Thaysen disease, and that the name sprue for the tropical disease should be retained." Years before his paper on the coeliac affection Gee's name became familiar in connection with a linctus composed of equal parts of compound tincture of opium, syrup of tolu, and oxymel of squill. It was said that this prescrip­ tion was not his, but that of a lady bountiful of a village, who had thus cured the obstinate cough of one of his hospital patients. It became widely popular, and in Smithfield, at the doors of the hospital which so freely sup­ plied it to out-patients, " linctus tarts " were on sale. It is interesting to recall his philosophical indifference to posthumous fame as merely meaning " the number of times after death the letters composing the man's name were put together in one order " (Legg). Samuel Jones Gee was born on September 14, 1839, in London where his father, William Gee, wras in business but was much interested in litera­ ture and frequented the British Museum. His mother Lydia Sutton (1797- 1888) was, like many mothers of great men, a remarkable woman. His parents were somewhat puritanical. Gee, the only one of their four off­ spring to survive infancy, was a delicate boy and never robust. When eight years old he went to a private school in Enfield, a few miles from London, and from 1852 to 1854 he attended University College School. Three years later he matriculated at the University of London, and as a medical student of University College Hospital came under the influence of Sir William Jenner (1815—98), whose example may in some degree have accounted for Gee's successful dogmatic teaching at the bedside. In 1861 at the final examination for the degree of bachelor of medicine at the University of London he was bracketed with C. Hilton Fagge (1838-83) for the gold medal and the University scholarship in medicine; in 1865 he proceeded to the M.D. degree and became a member, being elected five years later a fellow, of the Royal College of Physicians of London. In the meanwhile he had become a member of the Royal College of Surgeons in 1863, and been appointed resident house surgeon to Richard Quain (1800-87) at University College Hospital in December 1862; earlier in that year he had been resident Downloaded From: http://annals.org/ by a Penn State University Hershey User on 05/08/2016 SAMUEL JONES GEE AND HIS FRIENDS 389 house surgeon at the Hospital for Sick Children, Great Ormond Street. This hospital, the first solely for children in London, was founded in 1852 on the site of the mansion of that medical Maecenas, Richard Mead (1673— 1754), largely as the result of the exertions of Charles West (1816-98), an almost exact contemporary of Sir William Jenner; from 1848 to 1860 West lectured at St. Bartholomew's Hospital Medical School on Midwifery, with which at that time diseases of children usually were nominally combined. It was not until 1904 that a special department for diseases of children was Downloaded From: http://annals.org/ by a Penn State University Hershey User on 05/08/2016 390 SIR HUMPHRY ROLLESTON established at St. Bartholomew's Hospital, and was then placed under the care of Sir A. E. Garrod (1857-1936) and Dr. H. Morley Fletcher, physi­ cians to the Hospital and also on the staff of the Hospital for Sick Children and the East London (now Princess Elizabeth of York) Hospital for Children respectively. In Gee's time and for some years after, almost all the members of the staff of the Hospital for Sick Children were also attached to general Hospitals. Gee was appointed assistant physician in May 1865, physician in February 1875, and consulting physician in March 1885 to the Hospital for Sick Children. Like Thomas Addison and Hilton Fagge, particularly as regards dermatology, he was anxious to avoid the reputation of a specialist in any branch of medicine, and removed from the Medical Directory his title of consulting physician to the Hospital for Sick Children. That Gee was house surgeon at University College Hospital and at the Hospital for Sick Children might now suggest that he inclined more to surgery than to internal medicine. But it is perhaps not generally realized that the post of house physician is more modern, at any rate in name, than that of house surgeon. At the Hospital for Sick Children the separate post of house physician was first established in December 1879. During the first half or more of the last century the work now done by house physicians was at most hospitals part of the duties of a resident medical officer, known as the apothecary, a title then in use for general practitioners. Thus at St. Bartholomew's Hospital, London, Frederick Wood (1820-1906) was apothecary from 1847 to 1867 and performed the work later carried out by 14 qualified medical men, namely 10 house physicians, two junior assistant physicians, and two casualty physicians. In December 1867 four house physicians were created, and within a quarter of a century increased to ten. At Guy's Hospital the Stockers, father and son, were apothecaries, and the first resident house physician was appointed in 1868, a non-resident junior house physician being added in the following year; a house surgeon had been appointed in 1856. At the Radcliffe Infirmary, Oxford, there was a resi­ dent house-surgeon-apothecary until 1860 when a house physician was ap­ pointed; the last house-surgeon-apothecary but one there holding office for 12 years. At University College Hospital the name house physician at any rate was in use many years earlier, as is shown by the following information courteously supplied by the Secretary: From its opening in 1834 the Hospital had an apothecary and a house surgeon.