JMS Pearce
Hull, England, United Kingdom

 

Fig 1. Todd prize for Clinical Medicine (left). Medal by Joseph Shepherd Wyon, 1861. Science Museum, London, United Kingdom. Via Google Arts & Culture.  Robert Bentley Todd (right). Mezzotint by G. Zobel, 1860, after D. Y. Blakiston. Wellcome Collection. Public domain.

Students of King’s College Hospital London are familiar with the Todd Prize in Clinical Medicine and with Todd Ward. Robert Bentley Todd’s father, Charles Hawkes Todd, was a well-known surgeon of 3 Kildare Street Dublin. His mother was Elizabeth Bentley, a relative of the poet Oliver Goldsmith, who was himself a doctor.

Robert Bentley Todd (1809–1860) (Fig 1), one of fifteen siblings, was a student of Robert Graves and William Stokes in Dublin (both remembered eponymously). He became an accomplished clinician and investigator, often years ahead of his time.¹ One of the foremost early specialists in neurology, he wrote many papers devoted to the anatomy and physiology of the nervous system.^2,3 He published his Clinical lectures on paralysis, certain Diseases of the brain in 1854.⁴ He edited the 6000-page Cyclopædia of anatomy and physiology in five volumes (1835-59)⁵ (Fig 2), celebrated for its minutely detailed coverage of human and comparative anatomy and physiology.⁶ He contributed twenty-eight articles to the Cyclopædia, which did “more to . . . advance the study of physiology and comparative and microscopic anatomy than any book ever published.”⁷

His friend and pupil Sir William Bowman FRS wrote On the structure and uses of the Malpighian bodies of the kidney and demonstrated the part of a nephron comprising the capillaries of the glomerulus and its surrounding Bowman’s capsule. With Bowman he described the ciliary muscle, nerves, and ciliary body of the eye in The physiological anatomy and physiology of man (1856).

His name is best known for his account of post-epileptic (Todd’s) paralysis. Todd also gave clear descriptions of migraine and of peripheral neuritis.

One of the first microscopists, he recognized that the nerve cell body was in continuity with its axons. He also appreciated that the myelin sheath of nervous tissues had insulating properties and affected conduction of the nerve impulse. His article on the Nervous Centres in Vol. III of the Cyclopædia included his new terms, afferent and efferent fibers of the nerves, which he said serve to connect the nervous centers with other organs or textures, either by conveying the influence of the centers to them, or by propagating impressions from them to the centers. Influenced by Faraday, he described electrical polarization and depolarization, the fundamental processes of conduction of the nervous impulse between cells.

In 1825, long before Jackson, Ferrier, Fritsch and Hitzig, he discussed the roles of the cerebral cortex in mentation, the corpus striatum in movement, and the midbrain in emotion.

Fig 2. Cyclopædia of anatomy and physiology, Vol III.

 

Locomotor ataxia (tabes dorsalis)

At a time when syphilis of the nervous system was common and often fatal, he provided an original discourse on locomotor ataxia (tabes dorsalis).^1,8 Importantly, he distinguished motor paralysis from sensory ataxia in paraplegia:

The patient finds great difficulty in walking and his gait is so tottering and uncertain that his centre of gravity is easily displaced…. In two examples of this variety of paralysis I ventured to predict disease of the posterior columns…found to exist on a post-mortem inspection;

All his cases showed:

Disturbance of the locomotive powers, sensation being affected only when the morbid change of structure extended to and more or less involved the posterior roots of the spinal nerves.”^{5 (Vol 3)}

Duchenne de Boulogne in 1858 and Moritz Romberg in 1851 were to provide similar detailed descriptions. However, in his Harveian oration in 1934, James Collier gave him priority:  “Dr. Todd, who was by far the greatest clinical neurologist Great Britain has produced until the time of Hughlings Jackson was the first to begin the breaking up of the spinal diseases, at that time all classed as paraplegia, by his discovery of locomotor ataxy as a distinct disease.” And Gowers’ A Manual of Diseases of the Nervous System referred to the ‘‘epileptic hemiplegia of Todd.’’

 

Post-epileptic paralysis (Todd’s palsy)

In his three Lumleian lectures (1849-50) On the pathology and treatment of convulsive disease, he described chorea, tetanus, and epilepsy.⁶ They contained his account of post-epileptic paralysis (Todd’s paralysis), which remains as an important diagnostic phenomenon:⁹

A paralytic state remains sometimes after the epileptic convulsion. This is more particularly the case when the convulsion has affected only one side or one limb: that limb or limbs will remain paralytic for some hours, or even days, after the cessation of the paroxysm, but it will ultimately perfectly recover.¹⁰

When investigating epilepsy Todd used Michael Faraday’s new magneto-electric machine to induce seizures in rabbits to develop his concept of nervous polarity; this radically new electrical theory of epilepsy incorporated Faraday’s concept of ‘‘disruptive discharge.”¹¹  Lyons,⁶ Reynolds,¹¹ and Spillane² chronicled erudite and comprehensive descriptions of Todd’s several works.

 

Robert Bentley Todd

He entered Trinity College Dublin in 1825, intending to study law. The next year, he switched to medicine after his father died. He graduated in 1829 from Trinity before moving to London in 1831. He lectured at the Aldersgate School of Medicine and Westminster Hospital before further study at Pembroke College Oxford, proceeding MA 1832, BM 1833, and DM in 1836. Todd then toured France, Belgium and Holland before receiving his license from the College of Physicians in 1833. He was elected a Fellow of the Royal Society, and Censor at the Royal College of Physicians. He gave the Goulstonian lectures (1839) and the Croonian lectures (1842) on Practical remarks on gout, rheumatic fever and chronic rheumatism of the joints.

Todd styled himself a physiological physician, unusual in his era, and replaced Herbert Mayo as Professor of Physiology and General and Morbid Anatomy at King’s College (1836-53). There, in addition to his admired clinical work and researches in the basic sciences, he radically reformed medical practices and teaching. Described as a great clinical teacher, he became King’s first Dean in 1842. He was a keen reformer of medical education, and helped to found the St John’s House nursing training institution in 1848.

Although one of the first neurological specialists, as a general physician his eminence added weight to his evidence when he appeared as a prosecution witness at the Old Bailey, where in August 1859 Dr. Smethurst was arraigned on a much publicized, controversial charge of having poisoned his ‘‘wife.’’¹

One of his foibles was the excessive prescription of brandy and wine in cases of fever, perhaps influenced by Robert Graves’ epitaph: He Fed Fevers (though not with alcohol). In the French pharmacopoeia, the “Potion de Todd” consisted of brandy, cinnamon, and sugar, but he was not responsible for the so-called hot toddy.* Too fond of alcohol himself, he developed hepatic cirrhosis and aged fifty died in his consulting room of a massive hematemesis.

His statue stands outside the Hambleden Wing of King’s College Hospital.

 

*Toddy is recorded in 1611, from the Hindi tāṛī palm wine.

 

References

1. Lyons JB. Some Contributions of Robert Bentley Todd. Journal of the History of the Neurosciences 1998;7(1):11–26.
2. Spillane JD. The Doctrine of the Nerves. Oxford. Oxford University Press 1981. pp. 289-302.
3. McIntyre N. Robert Bentley Todd (1809-60) J Med Biogr 2008; Feb;16(1):2.
4. Todd RB. Clinical lectures on paralysis, certain Diseases of the brain and other affections of the nervous system. London Churchill. 1854.
5. Todd RB. Cyclopædia of anatomy and physiology, vol 3. London: Longman and Roberts, Longman, Brown, Green,1847:721.
6. Lyons JB. The neurology of Robert Bentley Todd. In: Rose FC, Bynum WE. eds. Historical aspects of the neurosciences. New York: Raven Press. 1982;137-50.
7. Beale LS. On medical progress: in memoriam R. B. Todd. London: J. Churchill, 1870.
8. Pearce JMS. Robert Bentley Todd (1809-60) and locomotor ataxia J Neurol Neurosurg Psychiatry 1994; 57(3):359.
9. Pearce JM. Robert Bentley Todd (1809-60) and Todd’s paralysis. J Neurol Neurosurg Psychiatry. 1994;57(3):315.
10. Todd RB. On the pathology and treatment of convulsive diseases. London Med Gaz 1849; 8:668.
11. Reynolds EH. Todd, Faraday and the electrical basis of brain activity. Lancet Neurology 2004; 3:557–63.

 

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JMS PEARCE is a retired neurologist and author with a particular interest in the history of science and medicine.

 

Winter 2022  |  Sections  |  Neurology