Perspectives in Biology and Medicine

SETTING THE RECORD STRAIGHT: ANEPISODE IN THE LIFE OF SIR WILLIAM WITHEY GULL JOSEPH HERMAN* The reputation of Sir William Withey Gull rests securely on his brilliant delineation of the signs and symptoms we now associate with severe hypothyroidism , still referred to as Gull's disease [I]. Less well known are his investigations in other areas of clinical medicine, among them hypertension , arteriosclerosis, brain abscess, and anorexia nervosa [2-4]. His contemporaries stood in awe of him, some feeling that his main contribution to medical practice was doubt concerning the indiscriminate use of drugs of unproven worth [5] . He had a commanding, charismatic presence, as attested by the following remark that came hard on the heels of a description ofhis character: ''Yet none of these things wholly explain the qualities that not seldom laid men and women at the feet of Sir William Gull" [4] . He was awarded a baronetcy for collaborating in the care ofAlbert, Queen Victoria's prince consort, who was taken critically ill with typhoid fever [5] . Although Gull could be caustic and was known to give incompetence short shrift, he was famous for his generosity to younger colleagues on whom he lavished encouragement and even material help [5] . It is this aspect of his life on which I shall enlarge in describing an occasion when he took pains to attribute an important discovery for which he had received credit to someone else. In order to set the stage for the incident, I give a brief account of some of Gull's work and his philosophical writings. The Physician In his 1902 textbook, Osier stated that the conception of arteriosclerosis as a systemic disease was due to Gull and Sutton, and a now obsolete eponym for arteriolar nephrosclerosis, still given in the 1982 edition of a standard medical dictionary, is Gull-Sutton disease [3, 6]. According to Willius and Dry, Gull and Sutton, 125 years ago, were very close to differentiating between blood pressure elevations associated with Bright's disease and what Correspondence: 24 Megadim Street, Yfe Nof 96185, Jerusalem, Israel. *Assia Community Health Center, Netivot, Israel.© 1999 by The University of Chicago. All rights reserved. 0031-5982/99/4204-1116$01.00 Perspectives in Biology and Medicine, 42, 4 ¦ Summer 1999 507 we, today, call essential hypertension [7]. Pickering quotes from a lecture given by Gull: It is always dangerous to rest in a narrow pathology; and I believe that to be a narrow pathology which is satisfied with what you now see before me on this table. In this glass you see a much hypertrophied heart and a very contracted kidney. This specimen is classical. It was, I believe, put up under Dr. ¿right's own direction and with a view of showing that the wasting of the kidney is the cause of the thickening of the heart. I cannot but look upon it with veneration, but not with conviction. I think, with all deference to so great an authority, that the systemic capillaries, and had it been possible, the entire man, should have been included in this vase, together with the heart and the kidneys; then we should have had, I believe, a truer view of the causation of the cardiac hypertrophy and of the disease of the kidney. [2] This statement, aside from its prescience, demostrates Gull's scepticism concerning pat answers to questions ofpathophysiology. It also exemplifies his recognition of the frequent need to challenge authority [8] . Finally, Gull's doubts about empiric drugging are thought to have changed the philosophy of medicine in his day. He . . . refused to confound sequence in time with causation in fact . . . One of his most noted answers to an eminent and justly esteemed colleague, who suggested that a recent prescription had had a happy effect in checking the course of the malady in a patient under consultation was: "Medicines act best when there is a tendency to get well." [5] The Man Shortly after Gull's death in 1890, a number of trenchant aphorisms he had composed were found in his study, many of them relating to his philosophy of life [9] . He had reservations concerning how medicine was taught: "Education is not learning, but the...