Sir Benjamin Collins Brodie

Philosopher, writer, statesman and physcian, Benjamin Collins Brodie was among the outstanding surgeons of nineteenth-century London. One of his major contributions to surgery was doing as little of it as possible, opposing the prevailing practice of indiscriminate amputation, always trying to save the limb instead.

Brodie was born at Winterslow rectory in Wiltshire, the third son of Reverend Peter Brodie, the rector of the parish of Winterslow, and Sarah Collins, the daughter of a banker from Salisbury.

He received his early education at home, being taught -along with his elder sister and brothers - by his father. In 1801, at eighteen, he went to London to study medicine and began attending the anatomy lectures of John Abernethy - a pupil and «disciple» of John Hunter - at St. Bartholomew’s Hospital. He was also a pupil of the anatomist James Wilson (1756-1822), entering the Windmill Street School of Anatomy in 1802, and in 1803 was apprenticed to Sir Everard Home (1756-1832), enrolling at the St. George’s Hospital in June 1804.

His father died in March of that year, leaving the family in difficult circumstances. Fortunately, through his uncle, Thomas Denman (1733-1815), a distinguished obstetrician, Brodie became known to, and was helped by, many of the prominent medical men in London at that time.

A career
Brodie was a researcher, a surgeon and general practitioner, and a member of the medical establishment. In May 1805, he was appointed house surgeon at St. George’s Hospital, and on October 18 that year was admitted as a member of the Royal College of Surgeons. He was a demonstrator of anatomy at Great Windmill Street School of Anatomy for eight years, 1805-1812. In March 1808 he became assistant surgeon and then, in 1822, was appointed surgeon at St. George's Hospital, with which he was connected uninterruptedly for 32 years. In 1819 he was appointed professor of comparative anatomy at the College of Surgeons, lecturing there until 1823

Brodie was an excellent diagnostician who built a flourishing practice and at this time was assuming the leading position among the London surgeons, the more so the more Sir Astley Cooper retired from the scene. In 1828 he became personal surgeon to King George IV and, in 1832, following the death of Sir Everard Home, became Sergeant-Surgeon. Brodie was once called in to attend an operation for removal of a skin tumor performed on the king. He was knighted a baronet in 1834. In 1844 he was president of the Royal College of Surgeons, having been an active and reforming member of its council for a number of years. In 1858 he was elected president of the Royal Society, the first surgeon to hold this post.

In 1843, Brodie introduced the Fellowship examination of the Royal College of Surgeons in order to improve the education and standing of surgeons.

Doctor first
Brodie contributed six papers to the Philosophical Transactions of the Royal Society of London between 1809 and 1814. These papers were not so much concerned with physiological theory as with factual experimental reporting. They were widely recognized, however, and their impact on the Royal Society gave Brodie considerable professional prominence. He was elected member of the Royal Society in 1810, at the age of twenty-six, and in 1811 was awarded the Copley Medal, the youngest member ever to receive it. He was the Croonian Lecturer in 1810 and 1813.

Around 1811, Brodie realized that he would, in effect, have to choose between research and teaching on the one hand, and surgery and private practice on the other. Thus, from that time on, his written publications consisted mainly of reports to the clinical journals. He had kept scrupulous case notes from the very beginning of his career, and sixteen volumes of these were given to St. George’s Hospital by his grandson.

A joint effort
The main achievements of this great surgeon, however, were in diseases of the joints. He is particularly remembered for his classic work Pathological and Surgical Observations on Diseases of the Joints, which included a good description of Reiter's syndrome. This work was extremely influential and ran in five editions, the first appearing in 1818 and the last in 1850. It is based on an analysis of case histories

In 1814 Brodie described synovitis in the knee joint, in 1843 a tuberculous abscess in the head of the tibia, Brodie's abscess. This designation is now used for this condition in all lower extremities. He also described a tumor in the chest and a pseudofracture of the spine, and is said to be the first to describe recurrent limping in man.

Brodie devoted much of his attention to the study of localized nervous afflictions, delivering a series of lectures on hysterical pain and other manifestations of a disordered nervous system. ”Brodie’s knee” came to refer to a condition of stiff knees frequently observed in hysterical patients. The term now denoted a particular form of chronic inflammation of the knee joint, also known as ”Brodie’s disease.”

Save that limb!
Despite his manual dexterity Brodie always avoided operation, when possible. He clearly preferred to retain limbs rather than to amputate them. Many of his patients had good reason to thank him for still having their limbs intact, or even being alive, as asepsis and antisepsis were still unknown. He pioneered the surgery of varicose veins.

Physiological research
Brodie’s papers made their impact almost solely because the empirical results they presented challenged the whole chemical theory of animal heat, with respiration (and, by implication, combustion) as the actual source of heat production. The results were indisputable. He destroyed the animal’s brain by pitching, decapitation, or poisoning, yet maintained respiration and heartbeat artificially - managing to do this for periods up to two and a half hours, getting the appropriate changes of colour in the blood. If respiratory changes were the immediate cause of the heat in animals, then the temperature of the animals should be maintained. This did not occur. Moreover, if Brodie inactivated the higher cerebral centres by poisoning, then gradually allowed the animal to recover, as the «sensibility» was recovered, the animal also recovered the power of generating heat, until it could counteract the loss of heat due to the cold of the surrounding atmosphere.

Brodie recognised the association of arthritis with gonorrhoea and that all children's hip disorders were associated with infection.

In an age when women were cosseted indoors, he was a pioneer advocate of fresh air and exercise, and was able to demonstrate how many joint afflictions probably had hysterical origins. In 1859 he received a letter from Florence Nightingale, asking him to help Elizabeth Blackwell (1821-1910), the first woman in the United States to receive a medical degree. Despite much ridicule, Elizabeth Blackwell had graduated at the head of her class at Geneva Medical School (now Hobart and William Smith Colleges), the only medical school to accept her. Blackwell established a practice in New York but by 1869, she had decided to settle permanently in England.

Florence Nightingale’s letter, dated Great Malvern February 13th, 1859, reads

My dear Sir Benjamin Brodie,
Do you consider me as having the advantage to be sufficiently known to you to ask you to do me a very great kindness? The Bearer of this is an English lady, Ms. Blackwell² MD. who graduated in America - has worked her way up to a physician's practice among women and children (not exclusively in midwifery) at New York, and is now returned to England where she is very anxious to have the benefits of your counsel as to her future career, if you can spare her time for an interview. I will not take up more of your time by writing - I beg that you will believe me dear Sir Benjamin Brodie
Yrs very truly obliged Florence Nightingale

In 1816 Brodie married Anne Sellon; they had four children, one of whom, Benjamin Collins Brodie Jr. (1817-1880), became a famous chemist, noted for the discovery of graphitic acid. In 1837, three years after he was knighted, as he felt befitted his new station in life, bought a landed estate in Surrey. A tactful, self-effacing man, Brodie endeared himself to both colleagues and patients

Brodie was a friend of Hugh Owen Thomas (1834-1891), "the father of British Orthopaedics".

Quotations by Sir Benjamin Collins Brodie

«You must feel and act as a gentleman. .... But let there be no misunderstanding as to who is to be regarded as a gentleman. It is not he who is fashionable in his dress, expensive in his habits, fond of fine equipages, pushing himself into the society of those who are above him in their worldly station that is entitled to that appellation. It is he who sympathizes with others, and is careful not to hurt their feelings even on trifling occasions; who, in little things as well as in great, .... assumes nothing which does not belong to him, and yet respects himself; this is the kind of gentleman which a medical practitioner should wish to be. Never pretend to know what cannot be known; make no promise which it is not probable that you will be able to fulfil; you will not satisfy every one at the moment, for many require of our art that which our art can not bestow.»
Clinical lectures on surgery, Introductory Course.

«Integrity and generosity of character; the disposition to sympathize with others; the power of commanding your own temper, of resisting your selfish instincts; and that self respect, so important in every profession, which would prevent you from doing in secret what you would not do before all the world; these things are rarely acquired, except by those who have been careful to scrutinize and regulate their own conduct in the very outset of their career.»
Clinical lectures on surgery, Introductory Course.

Philosophical Transactions of the Royal Society:

• Account of the dissection of a human foetus, in which the circulation of the blood was carried on without a heart. 1809.
• The Croonian lecture on some physiological researches, respecting the influence of the brain on the action of the heart, and on generation of animal heat. 1809.
• Experiments and observations on the different modes in which death is produced by certain vegetable poisons. 1809.
• Further experimenst and observations on the action of poisons on the animal system. 1809.
• Experiments and observations on the influence of the nervous system on the action of the muscles in general and of the heart in particular. 1809.
• Physiological Researches.
  A compilation of four of the above papers. Medico-Chirurgical Transactions, London, 1813:
  
• Pathological researches respecting the diseases of joints.
  Brodie’s knee.
• Further observations on the diseases which affect the synovial membranes of joints.
• Further observations on the ulceration of the cartilages of joints.
  The following work is a collection of above three articles:
  
• Pathological and surgical observations on diseases of the joints. London, 1818, 1822, 1834, 1836; 5th edition, 1850.
  Philadelphia, 1843.
  French translation by Léon Marchand, Paris, 1819.
  German by Georg Philipp Holscher (1792-1852), Hannover, 1821.
  Brodie’s treatise on diseases of the joints is his most important work and includes pathological observations and case studies on inflammation (including Brodie's abscess), ulceration and tumours of the joints. Medico-Chirurgical Transactions, London, 1816:
  
• Observations on the treatment of varicose veins of the legs.
• Pathological and surgical observations relating to injuries of the brain.
• Pathological and surgical observations relating to injuries of the spinal cord.
• An account of a case of aneurism by anastomosis of the forehead, treated by the application of ligatures.
• An account in which a foreign body was located in the right bronchus. Others:
  
• On abscess in the brain.
  Transaction of the Society for the Improvement of Medical and Chirurgical Knowledge, London, 1812.
• Lectures on diseases of the urinary organs.
  London, 1832; 4th edition, 1849; Philadelphia, 1843.
  French translation by Patron, Montpellier.
  German translation in Chirurgische Handbibliothek, volume XV, Weimar, 1833.
• An account of some cases of chronic abscess of the tibia.
  Medico-Chirurgical Transactions, London, 1832, 17: 239-249.
  Brodie’s abscess.
• Lectures on diseases of the rectum. III. Preternatural contraction of the sphincter ani.
  London Medical Gazette, 1835; 16: 26-31. Brodie’s pile.
• On the influence of the nervous system on the action of the muscles in general and the heart in particular.
  Croonian lecture in the Royal Society, 1836.
• Lectures illustrative of certain nervous affections.
  London, Longman, 1837.
  German translation by Kirschner, Marburg, 1838.
  Brodie’s disease I.
• Lectures on serocustic tumors of the breast.
  London Medical Gazette, 1839, 25: 808-814.
  Brodie’s syndrome I.
• Clinical Lectures on Surgery. Delivered at St. George’s Hospital.
  Philadelphia, Lea & Blanchard, 1846: 201-210.
  Brodie’s syndrome II.
• Lectures illustrative of various subjects in pathology and surgery. London, 1846.
• Psychological inquiries. Part I.
  Anonymous, 1854, 1855, 1856, 1862. Part II, 1862.
• On quacks and quackery. 1842.
• On the use and abuse of tobacco. 1860.
• On homeopathy. 1861.
• Clinical Remarks. Ulcers.
  Lancet, London, 1839-1840, I, 231-234.