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Sir Thomas Clifford Allbutt
  1. J M S Pearce
  1. 304 Beverley Road, Anlaby, Hull HU10 7BG, UK; jmspearcefreenet.co.uk

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    Thomas Clifford Allbutt, (b. 20 July 1836; d. 22 February 1925) is of interest to neurologists as the main instigator, along with Gowers, of the routine clinical use of the ophthalmoscope.

    He was born in Dewsbury, Yorkshire, the only son of Reverend Thomas Allbutt and his wife Marianne, daughter of Robert Wooler. He was educated at St Peter’s School, York, and Caius College, Cambridge, where he graduated in 1859 with first class honours in the natural sciences tripos. He trained at St George’s Hospital, graduating MB in 1860. After training, Allbutt was appointed in 1864 to the staff of the General Infirmary at Leeds, and lectured on the practice of physic and anatomy at the Yorkshire College. Leeds remained his home for 28 years.

    Allbutt was one of the first to employ the ophthalmoscope in Britain1; importantly, he extended its use beyond the diagnosis of ocular diseases. Like Gowers, he tried to use fundoscopy to show the numerous and important signs (optic atrophy, papilloedema and such) of intracranial disease that the ophthalmoscope could provide. He observed:

    “The number of physicians who are working with the ophthalmoscope in England may, I believe, be counted upon the fingers of one hand.”1

    In 1866, Allbutt invented the conveniently portable 6 inch clinical thermometer, able to record temperature in 5 minutes. It replaced a 12 inch standard model that required 20 minutes.2 Other studies also led to the improved treatment of arterial diseases when he proved that narrowing of the coronary arteries causes angina.

    By 1889, Allbutt had acquired an unrivalled reputation in northern England, but curiously he retired from consulting practice to become a commissioner in lunacy. After 3 years in London, however, he was tempted to the Regius chair of Physic at Cambridge. Election as physician to Addenbrooke’s Hospital followed in 1900; thereafter his work and reputation were more widely acclaimed. He established and edited the System of medicine,3 published in eight volumes between the years 1896 and 1899, to which he contributed 15 sections (volumes VI, VII, and VIII contain diseases of the nervous system, demonstrating his neurological predilections); a second edition, with which Sir Humphrey Davy Rolleston was associated, appeared in 11 volumes (1905–11). Along with Osler’s textbook, it remained the finest comprehensive text on medicine for many years. A good scientist, one of his aphorisms was:

    “The use of hypotheses lies not in the display of ingenuity, but in the labour of verification.”4

    Allbutt was prominent in the Royal College of Physicians.5 He delivered the Goulstonian Lectures in 1884, the Harveian Oration in 1900, and the Fitzpatrick Lectures in 1909–10. He was awarded the Moxon Medal in 1921, and became a Censor. He was a founder member of the Medical Research Council, and in 1916 at the age of 80 was elected president of the British Medical Association—an office he held until 1921.

    Allbutt was a man renowned for his industry, energy, and protean knowledge of medicine. However, he realised that the growth of knowledge made specialisation a necessity:

    “It is obvious that the results of such advances prescribe for the clinical physician methods which cannot be pursued without expert assistance; a physician engaged in busy practice cannot himself undertake even the verifications required in the conduct of individual cases. Skill in modern laboratory work is as far out of the reach of the untaught as performance on a musical instrument. In spite, therefore, of the encyclopaedic tradition which has persisted from Aristotle through the Arab and medieval schools down to Herbert Spencer, it is forced upon us in our own day that in a pursuit so many sided as medicine, whether in its scientific or in its practical aspect, we have to submit more and more to that division of labour which has been a condition of advance in all other walks of life.”6

    He received the KCB in 1907 and was made Privy Councillor in 1920.

    The many honorary degrees bestowed upon him signify his distinction: Hon DSc Oxon, Manchester, Leeds, Hon LLD Glasgow, McGill, Toronto, St Andrew’s, Durham, Hon MD Dublin.

    Allbutt was a student and scholar in both classical and modern medical history. Among his writings was Greek medicine in Rome and other historical essays.7 His own writing was plain but stylish and he hated the careless or ungrammatical English8 of some other medical writers. He was described as sanguine and calm in demeanour, his bearing courtly and aristocratic. It is suggested that the author George Eliot’s character Lydgate in Middlemarch was based on Allbutt, whom Eliot knew in her time in Yorkshire.9

    He married Susan, daughter of Thomas England, a merchant from Headingley, Leeds, in 1869, but they had no children.10 He died in Cambridge.11

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