JMS Pearce
Hull, England

Rival claims for priority in describing diseases or related investigations are only too common. Such vexing disputes are neither recent nor confined to medicine and science. An early example of publication rivalry is in Vergil’s Proverbiorum Libellus (Venice, 1498), often known as the Adagia, the first collection of Latin proverbs, which preceded the similar Adagia of Desiderius Erasmus by two years. Erasmus believed that his work was the earlier and a controversy for priority ensued; fortunately, it ended in their friendship.

By contrast, it is refreshing to read of those who have made significant discoveries, but assailed by modesty or self-effacement, have given credit or priority to one or more of their colleagues. Of several such instances, only a small sample is here recounted. One was Henry Klinefelter’s discovery of the 47XXY syndrome that bears his name.¹

A few days after beginning work with Fuller Albright at Massachusetts General Hospital, Klinefelter recalled:

[T]he first patient I saw was a 19-year-old black man with gynaecomastia and small testes. Dr. Albright had no clear idea about this disorder and suggested that I work on it. During the remaining six months of my Fellowship we found eight other patients with the condition and worked hard to try to fit together the different pieces of the puzzle.

He concluded:

This is really another of Dr. Albright’s diseases: he unselfishly allowed my name to come first on the list of authors.

With an incidence of 1 to 2 per 1,000 in newborn male infants, Klinefelter’s syndrome results in hypogonadism and infertility and is commonly undiagnosed. Henry F. Klinefeter (1912–1990) was born in Baltimore and trained in medicine at Johns Hopkins, graduating in 1937. He worked at Harvard in 1941–1942, then returned to Johns Hopkins where he was appointed Associate Professor of Medicine. His subsequent work was mainly in rheumatology, endocrinology, and the study of alcoholism.

Another example of such altruism is found in Jean Joseph Forst’s doctoral thesis on the straight leg raising test in sciatica.² It was plainly invented, taught, and practiced by his chief, Ernest Charles Lasègue (1816–1883), but he never mentioned it in his publications.³ Forst did not assert his own priority but gave the credit to his teacher. However, the sign is usually named Lasègue’s sign:

It was our teacher Professor Lasègue who pointed our attention to this sign.

Lasègue was a favorite pupil of Trousseau in Paris, where he studied medicine and became Chef de Clinique. He published studies on cholera, general paralysis of the insane, anorexia nervosa, alcoholism, folie a deux or shared delusional disorder, persecution mania, and hysterical anesthesia.

The French physician and naval surgeon Jean Baptiste Edouard Gélineau (1828–1906) reported in 1880 a 38-year-old man with a two-year history of frequent attacks of cataplexy and narcolepsy:

When laughing out loud or when anticipating a good business deal in his profession, he would feel weakness in his legs, which would buckle under him. Later, when playing cards, if he was dealt a good hand he would freeze, unable to move his arms. His head would nod forward and he would fall asleep. He would wake up a minute later.⁴

Thomas Willis had briefly mentioned a similar condition. Westphal also had described peculiar attacks associated with falling asleep in 1877. Though Gélineau’s was the first comprehensive account, he did not claim priority. He attributed the initial description of narcolepsy to a Dr. Caffe who in 1862 had published “Maladie du sommeil,” a case of a 47-year-old man with “an irresistible and incessant propensity to sleep.” Caffe’s patient did not have cataplexy, sleep paralysis, or hypnagogic hallucinations (later recognized by Daniels and by Adie⁵) and in retrospect may have suffered from sleep apnea, so that Gelineau’s attribution was perhaps misplaced.

A further instance was in 1906, when Alois Alzheimer (1864–1915) presented the case of Auguste Deter who had died from a “peculiar … disease of the cerebral cortex,” in which Alzheimer found neuritic plaques and neurofibrillary tangles⁶ also described by Oskar Fischer in 1907. Alzheimer believed he had found a hitherto unreported disorder but was reluctant to assert priority. Emil Wilhelm Kraepelin (1856–1926), director of the Munich Royal Psychiatric Clinic where Alzheimer worked, named the disorder “Alzheimer’s disease” in the eighth edition of his text Psychiatrie: Ein Lehrbuch fur Studirende und Aerzte. Funfte, vollstandig umgearbeitete Auflage (1910). Since the pathology was done in Kraepelin’s laboratory, and Kraepelin had contributed to the description, this was an altruistic, generous gesture.

Kraepelin is renowned for separating dementia praecox from manic-depressive disorders and for much of the taxonomy of psychiatric disease, based on an accurate delineation of symptoms and natural history.

We may conclude with Jean and René Dubos (The White Plague: Tuberculosis, Man and Society. London: Gollancz, 1953) that in science the credit goes to the man who convinces the world, not to whom the idea first occurs.

References

1. Klinefelter, HF, Reifenstein, EC, & Albright, F. Syndrome characterized by gynecomastia aspermatogenesis without A-Leydigism and increased excretion of follicle stimulating hormone. Journal of Clinical Endocrinology & Metabolism 1942;2:615-27.
2. Forst JJ. Contributions a l’Etude Clinique de la sciatique. Thèse pour le Doctorat en Médecine, Paris: Faculté de Médecine de Paris, 1881. Translated in: Lasègue’s Sign. Wilkins RH, Brody IA. Arch Neurol 1969;21:219-21.
3.  Lasègue C. Considérations sur la sciatique. Arch Gen Med 1864;6(4):558-8.
4. Gélineau JBE. De la narcolepsie. Gazette des Hôpitaux 1880;53:626-8. 54:635-7.
5. Adie WJ. Idiopathic narcolepsy: a disease sui generis: With remarks on the mechanism of sleep. Brain 1926; 49: 275-306.
6. Alzheimer A. Über eine eigenartige Erkrankung der Hirnrinde. Algemeine Zeitschrift für Psychiatrie und Psychisch-Gerichtliche Medizin 1907; 64: 146-8.