Sir Benjamin Collins Brodie (1783–1862)

Benjamin Collins Brodie (Fig. 1) was born in Winterslow, Wiltshire, England. His father, a clergyman, was a classical scholar, who had his son educated at home rather than at one of the English public schools and universities. In 1801 the 18‐yr‐old Benjamin was ready to take up his medical studies in London, where he attended the anatomy lectures of John Abernethy (1764–1831), a pupil of John Hunter (1728–1793), at St. Bartholomew's Hospital, and later at the Great Windmill Street School of Medicine established by the older Hunter brother, William (1718–1783). Two years later Brodie became the trainee of Sir Everard Home (1756–1832), the brother‐in‐law of John Hunter, at St. George's Hospital, London, where he graduated in 1805. It was Sir Everard Home to whom Brodie dedicated his famous book on Pathological and surgical observations on diseases of the joints [1].

Fig. 1.

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Sir Benjamin Collins Brodie (1783–1862). Drawing by D.J.M.H. Moll of Sheffield, England.

Fig. 1.

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Sir Benjamin Collins Brodie (1783–1862). Drawing by D.J.M.H. Moll of Sheffield, England.

Brodie published some 87 papers, including books. His early publications were on physiological experiments, the most important of which was the effect of the vagus nerve on gastric secretion [2]. Brodie delivered his Croonian lecture to the Royal Society ‘On the influence of the nervous system on the action of muscles in general and the heart in particular’, which followed on from John Hunter's lecture of 1776 on the actions of muscles [3]. The Royal College of Physicians of London subsequently founded a Croonian lectureship, and in 1810 elected Brodie as a Fellow. In addition the College awarded Brodie their prestigious Copley Medal, the previous awardees being John Hunter, Benjamin Franklin (1706–1790) and Captain James Cook (1728–1779).

Brodie's eponym is still in vogue in relation to a mass of inflammed anal mucosa at the lower end of a fissure in ano, ‘Brodie's pile’, and ‘Brodie's tumour’ of the breast (giant fibroadenoma). He also gave the first description of intermittent claudication, and the test for incompetence of the valves of the saphenous veins [4], now credited to Friedrich Trendelenburg (1844–1924), Professor of Surgery in Leipzig. Brodie first operated on a patient with varicose veins in 1814 [5].

However, Brodie's best work was undoubtedly on diseases of bones and joints which included his description of chronic bone abscess, ‘Brodie's abscess' [5]. In his famous textbook on joint disease [1], first published in 1818, which ran to further editions until 1850, Brodie recognized the role of both acute and chronic inflammation of the synovium in causing joint damage. It is difficult to know what the diagnosis was in many of the patients he described, some of whom appear to have had haemarthroses. In one patient with polyarthritis and tenosynovitis he would appear to have identified rice bodies, which he referred to as ‘coagulable lymph’ when he reported ‘a number of small loose substances of a soft consistence within the cavity of the joint’. A number of young patients described by Brodie almost certainly suffered from tuberculous synovitis, with cold abscess and sinus formation, which he recognized as belonging ‘to the same order with tubercles of the lungs’. Brodie also described and illustrated caries of the spine (Fig. 2) which in a young girl presented with psoas abscesses. The description of spinal tuberculosis was, of course, originally given by Percival Pott (1714–1788) of St. Bartholomew's Hospital in 1779. Brodie recognized that tuberculous arthritis could begin in the subchondral cancellous bone and from there spread to erode the cartilage. He recommended ‘keeping the limb in a state of perfect quietude’ which would later meet with approval by John Hilton (1807–1876) of Guy's Hospital in his famous book on Rest and pain published in 1863. Brodie also recognized that the prognosis of tuberculosis of the joints was largely determined by social class, ‘usually possible in rich, rarely in poor, for whom amputation may well offer the best remedy’.

It is very difficult to be certain whether Brodie described rheumatoid arthritis, although several of his patients who had a polyarthritis, bursitis and tenosynovitis may well have had the disease. He was aware that synovitis can be chronic with ‘slow inflammation’. In patients with septic arthritis his recommendation was ‘removal of limb by amputation’, not altogether unreasonable in the first half of the nineteenth century. With hip disease he noted that pain could be referred to the knee and that wasting of the gluteal muscles often occurred. What is somewhat surprising is that he did not suggest joint excision as recommended by James Syme (1799–1870) of Edinburgh, the father‐in‐law of Joseph Lister (1827–1912). One can only presume this was due to rivalry between Edinburgh and London.

Fig. 2.

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Severe tuberculosis of the spine of a child illustrated in Pathological and surgical observations on diseases of the joints published in 1818 [1]. Brodie believed the disease began in the intervertebral disc and then spread into the vertebral body, but opined that the reverse could also occur (as it does!); indeed, rarely the vertebral bodies may be diseased while the discs remain involved.

Fig. 2.

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Severe tuberculosis of the spine of a child illustrated in Pathological and surgical observations on diseases of the joints published in 1818 [1]. Brodie believed the disease began in the intervertebral disc and then spread into the vertebral body, but opined that the reverse could also occur (as it does!); indeed, rarely the vertebral bodies may be diseased while the discs remain involved.

Brodie's recommendations regarding treatment of joint disorders include the beverage, sarsaparilla, from smilax, colchicum, diaphoretics and ‘when several joints have been affected at the same time, the patient “could derive” benefit from the use of moderate doses of some mercurial preparation’. This would be in keeping with the modern use of chrysotherapy! Leeches, bleedings, warm fomentations and poultices, blisters and ‘cold evaporating lotions' of unspecified nature complete his therapeutic armamentarium. Today we are wont to mock such remedies, but can we be so sure our present‐day poisons are really that much better?

Brodie made the interesting observation that cartilage destruction could result from purulent matter produced by an inflamed synovium, or that it could be a ‘primary disease’. The latter presumably reflects degenerative joint disease. he observed that hip disease in children could be self‐limiting, presumably due to transient synovitis or Perthes' disease. In his book on joint disease [1], Brodie describes patients with tendinitis and prepatellar bursitis, and a patient with an inflamed bursa between the latissimus dorsi and inferior angle of the seapula.

Brodie also described several patients who presented with the triad of purulent urethral discharge, purulent conjunctivitis and arthritis, particularly affecting the knees, ankles and feet. He assumed these patients suffered from gonorrhoea, but some might have had the disease described almost a century later by the French workers Noel Fiessinger (1881–1946) and Edgar Leroy and the German Hans Conrad Julius Reiter (1881–1968). Some of the patients developed an iritis, and one a rash which might have been circinate balanitis. Several of the patients suffered from recurrent relapses, but this could have equally been the result of further gonococcal infections as well as Reiter's disease.

Sir Benjamin Collins Brodie was elected President of the Royal College of Surgeons of England in 1888, and of the Royal Society from 1858 to 1861. He became the first President of the General Medical Council, holding the post from 1858 to 1860. Henry Gray (1825–1861), lecturer in anatomy at St. George's Hospital, published his famous textbook Anatomy descriptive and surgical in 1858 and chose to dedicate it to Sir Benjamin Collins Brodie.

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