Hilton's Rest and Pain, Guy's Hospital personalities and Guy's South African rugby connection.

Guy's Hospital occupies a unique position in medical history. John Hilton (1805-1879), as anatomist, physiologist, morbid anatomist and surgeon in his classic Rest and Pain, published in 1863 (reissued in 1950), formulated principles for the diagnostic significance of pain and the value of rest in healing. An array of personalities graced Guy's Medical School in that era. The triumvirate of Richard Bright (1789-1858). Thomas Addison (1793-1860) and Thomas Hodgkin (1798-1866) contemporaneously discovered the diseases that bear their names. Sir Astley Cooper, a leading surgeon of his day (1768-1841), performed the first amputation of the hip joint before the era of anaesthesia. John Keats (1795-1821) qualified as a surgeon at Guy's but, realising his unsuitability of temperament, became a leading English poet. This change of direction caused him anguish and suffering, mainly because of the rejection of his poetry; tuberculosis led to his death in Rome, where he is buried. Guy's Medical School also allowed South Africans to enter as rugby players before the 1920s, when they were required to qualify overseas.

The humanitarian and scientific interests of Thomas Hodgkin (1798-1866), discoverer of a disease.

Thomas Hodgkin is generally famous for the discovery of a lymphoma in 1837, but not for his remarkable relationship as physician and friend with the philanthropist, Sir Moses Montefiore (1784-1885), and their six shared journeys to Europe, the Near East and North Africa to alleviate the plight of religious and ethnic minorities. Also less well known are Hodgkin's humanitarian activities, inspired by his being a Quaker: his assistance of freed slaves, and his involvement in the movement for the abolition of capital punishment and in mental hospital and prison reform. His wide range of scientific interests included medical education, geography, ethnology and social anthropology. He is buried in Jaffa, Israel, where he died of dysentery while on a trip with Montefiore.

George Orwell (1903-1950)--writer, socialist, eccentric and tuberculosis sufferer.

George Orwell, born Eric Blair in India in 1903, the third generation of colonial service stock, joined the Indian Imperial Police in Burma in 1922 after leaving school in England. Rejecting the racial and cultural barriers of colonial rule he encountered there, he returned to England to become a writer. He became allied to leftist and labour causes and, based on personal participation, documented the life and work of the underprivileged and working classes in England and Paris. He also fought with the leftist alliance in the Spanish Civil War against Franco's army revolt against the Republican Government. Although a fine essayist and master of English prose, he is best known for Animal Farm and Nineteen Eighty-Four, two political satires on the Soviet system and totalitarianism respectively. These brought him fame and financial security shortly before his death of tuberculosis at the age of 47, after a life of recurrent ill health and economic hardship.

Artificial pneumothorax in the treatment of lung tuberculosis.

Artificial pneumothorax (APT) was the first positive treatment of tuberculosis to cause improvement. As a basic of therapy after 1910 it was replaced by chemotherapy 30 years later. Its development followed an early 19th century observation that spontaneous pneumothorax improved a tuberculosis patient. In 1822 James Carson originated the concept and principles of inducing a collapse after discovering the elasticity of the lungs in animal experiments. He also defined the limits of animal tolerance in induction by open chest incision, but failed in his only clinical attempt at an APT. Fornalini in 1984 independently revived the concept of APT using the closed method of needle induction, as later accepted. The principles of APT promoted thoracic surgery with the concept of permanent collapse in thoracoplasty; the experience of the management of postoperative shock in turn benefited the development of lung resection.

Correspondence with a pioneer, Jürgen Lehmann (1898-1989), producer of the first effective antituberculosis specific.

Correspondence between the author and Lehmann provided evidence that the latter evolved the first effective antituberculosis drug, para-aminosalicylic acid (PAS), contrary to accepted belief that this honour belonged to Nobel Prize-winner Selman A. Waksman for his production of streptomycin. While both drugs appeared in 1943, successful animal and clinical trials of PAS preceded those of streptomycin. PAS has been discarded in modern treatment regimens because of gastric side-effects, but was available at a critical time to demonstrate the principle of multiple therapy in prevention of bacterial resistance in tuberculosis therapy. It probably saved streptomycin, which causes bacterial resistance and clinical regression within 3 months when used alone, from being discarded as an unsuitable drug of temporary benefit and a public health hazard.

The Jewish contribution to medicine. Part III. The 19th and 20th centuries in the USA.

The Jewish hospital movement in the USA, which started in the last century for Jews as foreign immigrants and was extended to the general population this century, is an extensive organisation. Refugee physicians from Europe laid the foundations of Jewish medical involvement in medicine in the USA with Abraham Jacobi, the founder of paediatrics, Landsteiner, who discovered blood grouping, and Waksman, who evolved streptomycin. Other eminent workers, such as the Flexner brothers in medical education and research, Libman, who pioneered blood culture in the USA, and Salk and Sabin with the poliomyelitis vaccine were prominent in the major contribution of Jews to medicine in the USA.

The Jewish contribution to medicine. Part I. Biblical and Talmudic times to the end of the 18th century.

Jewish interest in medicine has a religious motivation with the preservation of health and life as religious commandments in the Holy Scriptures. Despite a basic belief that God caused disease and effected cures with physicians as agents, Jews accepted the rational medicine of ancient Greece. They assisted in the spread of these teachings in the Roman and Arab empires but carried them to the rest of Europe in their migrations. Jews were able to bridge the educational gap of a 500-year period of exclusion from universities and medical schools in the Middle Ages through the Talmud, which started as a commentary on the scriptures in the 5th century BC, but developed over the centuries into a comprehensive body of learning incorporating law, art and the sciences.

The Jewish contribution to medicine. Part II. The 19th and 20th centuries.

Despite the opening of German universities to Jews in the 1860s, they were restricted to fields not attractive to their gentile colleagues, e.g. the basic sciences, dermatology, psychiatry, neurology, paediatrics and venereology. They pioneered these specialties when the latter were still in their infancies and made fundamental discoveries. This brilliant period of Jewish medicine in Germany included the renowned immunologists Ehrlich and Wassermann and neurologists Romberg and Freud. Eminent workers from France were Metchnikoff, who discovered phagocytosis, Haffkine for his plague vaccine and Widal, who discovered bacterial agglutination. Chain, the biochemist, shared the Nobel Prize for medicine for his part in the discovery of penicillin in England.

Famous physicians-botanists.

Two hundred years ago a group of physicians laid the foundations of botany with their study of plants for medicinal purposes. Linnaeus of Sweden devised the binomial classification of plants, which is still in use today. Boerhaave of Leyden revitalized bedside teaching and was a major influence in the English-speaking medical schools. Sloane founded the still-existing Physic Garden in London; his natural history collection formed the foundation of the British Museum. Withering prepared digitalis from the purple foxglove and wrote a standard work on the cultivation of vegetables. The gardenia and poinsettia are named after New World physician-botanists Alexander Garden and Joel Poinsett. Swedish physicians Sparrman and Thunberg, pupils of Linnaeus, were the major and original describers of the Cape flora. Atherstone of Grahamstown--the first doctor to use a general anaesthetic (ether) outside America and Europe--is a 19th century example of the naturalist physician as an ardent botanist; he was also a geologist and identified the first diamond found in South Africa.

John Keats (1795-1821)--poet, physician and tuberculosis patient.

Keats trained as a physician at Guy's Hospital, but abandoned medicine for poetry. Progressive tuberculosis, a family disease, led him to Italy in the hope of a cure and to join Shelley and Byron at Pisa. He died in Rome in an apartment overlooking the Spanish Steps. Since 1909 this has been a Keats-Shelley literary memorial. During World War II its most valuable manuscripts narrowly escaped destruction during the bombardment of the Cassino monastery, where they had been sent for safekeeping. Able to devote but 4 years of his short life solely to poetry, Keats achieved distinction as a major English poet known for his sensitivity and sensuous imagery.

Anton Chekhov (1860-1904). Writer, physician and tuberculosis patient.

Chekhov chose writing as a career after a childhood of hardship and poverty. Tuberculosis manifested soon after medical graduation and caused his death at the age of 44. Essentially a short story writer, he used simplicity and impressionism to portray sympathetically the psychology of the common man. Similarly his plays, popular today, written in a light and ethereal style, while static, have an inner psychological evolution. The best example is The Cherry Orchard.