George Dunea
Chicago, Illinois, United States

The appointment of young Thomas Blizard Curling as assistant surgeon at the London Hospital through the influence and recommendation of his uncle, Sir William Blizard, raised eyebrows and caused at least some resentment, for he was barely twenty-one years old and did not yet even have an MD degree. Yet the appointment did not prove ill-advised. He became a successful surgeon, specialized in diseases of the testes and rectum, and was careful and meticulous, though not considered particularly brilliant.

He was also not thought of as a remarkable teacher. But he was a strict disciplinarian and always insisted that his students and house staff were neatly dressed. He became a member of the Royal Society, an examiner at the University, and in 1873 President of the Royal College of Surgeons. His colleagues remember him as a tall, thin, upright man, always willing to assist, and one whose opinion in consultation was much valued. He retired in 1869 and later went to live in Brighton. Towards the end of his life, he became very pale and was suspected of suffering from pernicious anemia. He died at Cannes, France, in 1888.

For someone engaged in a busy practice, his scientific contributions are remarkable. Early on, in 1834, he won a prize for his essay on tetanus. Later he wrote on “atrophy of bone” (1837), congenital absence of the pericardium, worms voided by the urethra, a rare species of hydatid cyst in the liver, the treatment of varicocele, hypertrophy of the fingers of the hand, and an aneurysm of the ophthalmic artery treated by ligating the common carotid artery. In 1849 he described two girls from an “idiot asylum” in Lancashire with clinical features of congenital hypothyroidism (cretinism). On their deaths, he conducted autopsies and found complete absence of the thyroid glands, thus attributing their condition to a lack of thyroid function, rather than to an excess of it, as was believed to be the case in iodine deficient goitrous subjects. His paper was long overlooked, and credit for attributing hypothyroidism to thyroid deficiency (in 1870) has traditionally been given to William Gull.

Yet perhaps Thomas Curling might have been completely forgotten had he not reported in 1842 a peculiar ulceration of the stomach or duodenum in a series of cases, some his own and some from elsewhere, who had sustained severe burns and developed severe and sometimes fatal bleeding from acute ulcers in the stomach or duodenum. To this day, the mechanism of how thermal injury impairs the protective barrier of gastrointestinal mucosa remains poorly understood. Many factors, such as liver or kidney failure, reflux of bile salts, or changes in acid and gastrin hormone secretion have been implicated. But the clinical syndrome is known eponymously as Curling ulcers, not to be confused with the linguistically and probably etiologically similar Cushing ulcers occurring with diseases or surgery of the central nervous system.

In his capacity of overseeing the education of medical students at the London Hospital, Curling emphasized the importance of students receiving a good general education before entering medical school. He wanted them to have read the classics and to have learned modern French and German. This was at a time when physicians were still expected to be cultured, educated men, and he thought that learning was essential for “physicians constantly employed in the varied intercourse and correspondence of a busy professional life.”

Further reading

• Obituary. British Medical Journal March 10, 1888.
• Editorial: Thomas Blizard Curling (1811-1888). Curling’s ulcer of the duodenum. JAMA 1966;197:198.