Sir Samuel Wilks was one of the most influential English general physicians of the second half of the nineteenth century. He was a careful clinician and an accomplished investigator, always trying to correlate clinical and pathology findings. Author of seven books and fifteen separate articles or pamphlets, he wrote some 450 papers, including one defending the practice of animal experimentation and on the history of the stethoscope and a history of Guys Hospital. His compendium of Lectures on Pathological Anatomy was based on 4500 autopsies.
His life and career are inextricably linked to Guys hospital, where he studied medicine (1842-1848) and returned in 1856, working his way from assistant physician to full physician (1867) and to consultant physician in 1885. He spent most of his professional life there, stepping into the shoes of those whom he called the three greats of Guys – Richard Bright, Thomas Hodgkin, and Thomas Addison. He was a pupil of the latter, and when Otto Biermer in 1872 reported pernicious anemia as a new disease, he pointed out that Addison had already included such patients in his classical monograph on adrenal insufficiency.
Wilks has been credited for naming Hodgkin’s disease. In 1856 he published a series of ten patients with enlarged lymph nodes and spleens under the title lardaceous disease (mainly amyloidosis). Later he was made aware and recognized that some of his cases resembled exactly those published earlier by Hodgkin and, lamenting that “Dr. Hodgkin did not affix a distinct name to the disease,” he published in 1865 a series of fifteen such cases as “cases of enlargement of the lymphatic glands and spleen (or Hodgkin’s Disease)”. All these observations were made without the aid of a microscope.
In 1875, when William Osler was still a medical student, he was so impressed by Wilks’s published letters on pathology that he began to correspond with him. He met him in 1878 on rounds at Guys, spent a pleasant evening at his house, and continued to see him each time he visited London. He called him the grand old man of British medicine, noted that he had drawn attention to Hodgkin’s disease, and subsequently wrote about him on several occasions, later referring to his having “a most attractive personality, which age so adorned, that at three score and ten there was no handsomer man in London.”
Wilks made contributions to many branches of medicine. He was one of the early physicians to recognize that typhoid fever and typhus were different entities. He wrote on Paget’s disease and osteoporosis, and on dermatological conditions such as cutaneous atrophic striae, “markings or furrows on the nails as the result of illness”, trichorrhexis nodosa (the formation of nodes along the hair shaft), and verruca necrogenica “caused by contact with fluid from the dead body”
Under the name of ulcerative colitis he described in 1859 the inflammation of the distal part of the ileum and the colon found at the autopsy of Isabella Banks, who died after a short illness of bloody diarrhea and abdominal pain. This is now believed to have been Crohn’s disease rather than ulcerative colitis, and he differentiated it from infective dysenteries (“febrile epidemic dysentery and other morbid fluxes”). His interest in the kidney is evinced by his publishing in 1853 a series of sixty-one patients with “Bright’s disease”, which he divided into two types, one group with edema and large pale kidneys, the other without edema but with uremia and contracted red kidneys. He was one of the first to suggest that hypertension might arise de novo in persons with normal kidneys, describing in 1853 “cases of diseased arteries and hypertrophic heart without the presence of diseased kidneys.”
He also studied patients with disseminated syphilis and described visceral gummatous lesions. He stressed the importance of “arterial pyemia” or “blood poisoning” in bacterial endocarditis, emphasizing that constitutional symptoms often preceded embolic phenomena and that endocarditis should be suspected in obscure febrile conditions. For him pneumonia was “the most important malady to which the human body is liable”, and on the analogy of endocarditis he deemed it to be a disease not of the lungs but a general disease with manifestations in the lung, warned against the use of anti-inflammatory drugs or of trying to slow the pulse with digitalis, but advocated using opium.
In neurology, he wrote on multiple sclerosis. He carried out an autopsy on what may have been one of the early reported cases of myasthenia gravis, but finding no changes at autopsy signed it out “bulbar paralysis, fatal.” He pointed out that alcohol was a depressant, not a stimulant, and published an article on alcohol induced peripheral neuropathy (“alcoholic paraplegia”) in which he also described the mental symptoms of Korsakoff’s psychosis. He recognized that epilepsy was generated in the cerebral cortex, not the medulla oblongata. Thinking that epilepsy was of syphilitic origin he treated it with potassium bromide, but finding it effective began to use it all cases of epilepsy. He wrote on the differential diagnosis between syncope and epilepsy (On Falling), and also on migraine, postulating a vascular mechanism and treating it by wrapping a cold wet bandage around the head.
He received many honors. He was elected to the Royal Society and to the senate of the University of London; became president of the Pathological Society and the Royal College of Physician; was Harveyan orator in 1879; was knighted; and became physician extraordinary to Queen Victoria. He lived to the old age of eighty-seven, dying a stroke in 1911, having survived at an earlier time prostate surgery and an operation for a gangrenous appendix (1904). He has been variously referred to as “the grand old man of British medicine”1 and the “most philosophical of English physicians,”2 a man who had the genius for observation, idolized by his students, beloved by his disciples, and implicitly trusted by his colleagues.3
- Stone,MJ: Samuel Wilks: The “grand old man of medicine”, Baylor University Medical Center Proceeding, 2010,23(3):263.
- Pearce, JMS: Sir Samuel Wilks (1824-1911): The most philosophical of English physicians. European Neurology 2009,61:119.
- Banerjee,AK: Samuel Wilks: a founding father of clinical science. Journal the Royal society of Medicine,1991,84:44
GEORGE DUNEA, MD, Editor-in-Chief