Sunday, April 24, 2016

Alfred Baring Garrod (1819–1907) and Rheumatoid Arthritis


Garrod was born in Ipswich. He was the son of Robert Garrod, himself the son of a tenant farmer who had founded a successful firm of auctioneers and estate agents. Alfred decided to follow a medical career. He was initially apprenticed to Charles Chambers Hammond at Ipswich Hospital but moved to University College Hospital, where he qualified MB in 1842 and MD in 1843. He was then appointed clinical assistant to the chemical department, where he ‘shall be occupied chiefly in the analysis of morbid fluids and other substances occurring in cases in the hospital and sent to him by the medical officer’. He was then assistant physician to the West London Hospital and also physician at the Aldersgate Dispensary and lecturer at the Aldersgate School 1846–7. In 1848 he made his major contribution to our knowledge of the causation of gout. At a public lecture on 8 February 1848, reported in the Medical Chirurgical Transactions, he demonstrated the increase in uric acid in the blood of patients with gout, whereas there was no such increase in acute rheumatism or Bright's disease. At this time he was assistant physician to University College Hospital. Later, in 1854, he developed the ‘thread test’ and, in 1859, demonstrated smaller quantities of uric acid in the normal serum. He also demonstrated deposits of urate in the articular cartilage of gout.
The importance of his results did not at first receive universal acceptance and it was not until 1960 that Hollander identified uric acid crystals in the synovial fluid in gout. Garrod was appointed full physician to University College Hospital in 1849 and continued lecturing at the hospital, sometimes starting at 8 a.m. in the summer. He played a full part in hospital affairs and organized the establishment of a museum of materia medica. In 1859 he made his other major contribution to rheumatology. It is likely that rheumatoid arthritis had been present as a disease for a long time, certainly since the time of Sydenham, but the nomenclature had been confused with terms like rheumatic gout, chronic rheumatism, rheumalgia, scorbutic rheumatism, etc. And it was not until 1800, when Londré Beauvais described typical cases with pathology, that it became clear that the disease was a separate entity.

Garrod, in his treatise of 1859, discussed the differential diagnosis of these various conditions. He rejected the chronic rheumatism of Heberden and the rheumatic gout of Fuller and chose the name ‘rheumatoid arthritis’ for the disease, and provided illustrations. He divided it into acute, chronic and irregular forms of generalized and localized type. The name has remained ever since.

Garrod attained a leading position in the hospital and was appointed Professor of Materia Medica and Therapeutics and of Medicine. He was elected FRCP in 1856 and elected FRS in 1859. It was therefore surprising that, in 1863, he resigned his appointment at University College Hospital. This seems to have been precipitated by the appointment of Dr William Jenner as Professor of the Principles and Practice of Medicine (on the death of Dr Walshe in 1862), and Garrod was offended at being passed over. It was said that his lectures were too much devoted to chemistry and botany with a lack of therapy and pharmacology.

However, he was appointed Professor of Materia Medica and Therapeutics at King's College Hospital in 1863. The move was not altogether a happy one as it gave rise to a certain amount of heartburn among some junior members of the medical department at the introduction of an outsider to occupy a senior post. He left hospital practice in 1874 and became an honorary fellow of King's College and consultant physician to the hospital. Nevertheless, he continued to collect honours. He was knighted in 1887 and appointed Physician Extraordinary to Queen Victoria in 1890. He was Censor of the Royal College of Physicians 1874–5 and 1887, Vice President in 1888, President of the Medical Society of London in 1860 (Orator in 1858). He was Chairman of the British Pharmacopoeia Committee for many years.

In 1845 he married Elizabeth Ann Colchester, also of Ipswich. There were six children, four boys and two girls. A boy and a girl died young, but the other three boys in this remarkable family all reached eminent positions in their chosen careers. Their home, latterly, was 63 Harley Street, where they lived the social life of an upper middle class family and entertained many personalities of Victorian England. His wife died in 1891, but his daughter, Edith Kate, lived at home and survived him. He died on 28 December 1907 and was buried in the Great Northern Cemetery, Southgate. A memorial service was held at All Souls Church, Langham Place, on 2 January 1908. There is a street in Aix les Bains named after him.


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