Monday, August 29, 2016

1887: The infamous Dr. Gee

Samuel Gee (1839-1911)
When I was a student at Ferris State University in 1990 I had a philosophy teacher who made sure we were not one second late for class.  I was reminded of him as I learned about the punctual Dr. Samuel Jones Gee.

The Historic Hospital Admission Records Project (HHARP) said:

"His reputation as a teacher was second to none, and his punctuality the stuff of legend. He was leaving his house in a cab one day, when a patient detained him. As the conversation continued, the door of the vehicle swung open, hit a tree, and fell off its hinges. He insisted on carrying on to Bart’s minus the cab door, so that he would not be late." (1)

He was born in 1839 and developed a love for history, and because of this he became proficient in many languages, including Ancient Greek.  His ability to read and write in Greek would eventually benefit children around the world, as it allowed him to compare ancient accounts of diseases with what he observed during his own personal assessments and examinations on autopsy.

He attended college at University College School in London and studied medicine at the University College Hospital.  He impressed as a student enough to be hired as house surgeon at University College Hospital where he worked until 1865 when he earned his medical degree.

He was then hired at the Hospital for Sick Children, Great Osmond Street where he would eventually serve as pediatrician and pathologist.  He was passionate about learning about diseases and how to treat them, and he loved performing autopsies.

While his main job was working at the children's hospital, he also worked at St. Bartholemew's Hospital and managed to maintain a private practice.  A private practice back then involved the doctor traveling to the patient's home instead of the other way around as it is today.  So, while lucrative, it was a lot of work, and often quite risky.

He wrote 2 books and published 46 papers in St. Bartholemew's Hospital Report, with almost all of his writings on pediatric diseases -- which included asthma, bronchitis and consumption (tuberculosis).   HHARP mentions that one of the biggest complaints against him was he didn't write enough. (1)

He was best known for is a lecture he gave in 1887 in which he gave the first modern day description of coeliac disease, a condition that affected many of the children he treated.  He described the condition this way:
“There is a kind of chronic indigestion which is met with in persons of all ages, yet is especially apt to affect children between one and five years old. Signs of the disease are yielded by the fæces; being loose, not formed, but not watery; more bulky than the food taken would seem to account for; pale in colour, as if devoid of bile; yeasty, frothy, an appearance probably due to fermentation; stinking, stench often very great, the food having undergone putrefaction rather than concoction".
He learned a lot about this disease by reading ancient accounts written by Aretaeus of Cappaocia who was a master clinician about 100 A.D.  Areteaus was known for providing some of the first descriptions for many diseases, such as pleurisy, diphtheria, tetanus, pneumonia, diabetes epilepsy and asthma.

He was also the first to describe the symptoms of coeliac disease, although he referred to it as coeliac diathesis.  Gee chose to respect Areteaus and referred to the condition as the coeliac affection.  Today we refer to the condition as coeliac disease. (2)

The condition causes it's victims to become pale, weak and appear to be wasting away, symptoms similar to tuberculosis.  Aerateaus believed it only occurred in adults, yet Gee recognized it could affect anyone, although it was most common among children aged 1-5, which was one of the main reasons Gee became so enthralled by the disease.

Gee was the first to differentiate between coeliac disease and tuberculosis, and he brought coeliac disease to the mainstream in the medical world.  He was also the first to suggest the cause and cure might be in the diet. 

Coeliac disease is similar to asthma in that neither disease causes any changes in their respective organs.  Of Coeliac disease Gee wrote, "Naked-eye examination of dead bodies throws no light upon the nature of the coeliac affection: nothing unnatural can be seen in the stomach, intestines, or other digestive organs."

Aerateus had a theory as to what caused asthma, and he likewise had a theory for coeliac disease.  He believed a "natural or indwelling" heat was needed for proper digestion, or "pepsis" as he referred to it.  Pepsis was the natural breaking down of food which occurred in the heat.  (2)

Aeratus explained that Coeliac affection was caused by a "chilling of the natural heat needed for 'pepsis.'"

Gee didn't agree with this, although he didn't pretend to know a cause or remedy.  A cause and treatment of the disease alluded the medical world until the 1950s when the condition was linked to the consumption of gluten in the diet.

Coeliac disease is now considered an autoimmune disorders, and some say astma is too.

Dr. Gee passed away in 1911, yet many of his publications are still available thanks to Google Books. His writings have come very useful in writing this history of difficult breathing.

References:

1. "Dr. Samuel Jones Gee", Historic Hospital Admission Records Project,  http://hharp.org/library/gosh/doctors/samuel-jones-gee.html, accessed 8/21/14
2.  Dowd, Brian, John Walker Smith, "Samuel Gee, Areteaus, and the Coeliac Affection," 1974, British Medical Journal, April 6, page 45
3.  Gee, Samuel, "Bronchitis, Pulmonary Emphysema, and Asthma,", Lancet, March 25, 1899, page 817
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