Sir George Frederick Still (1868-1941) The father of British pediatrics.
England’s first professor in child medicine presented on 4th, 6th and 11th March 1902 a series of three lectures to the Royal College of Physicians in London, under the name “Goulstonian lectures” on ‘some abnormal psychical conditions in children’, which were published later the same year in the Lancet. He described 43 children who had serious problems with sustained attention and self-regulation, who were often aggressive, defiant, resistant to discipline, excessively emotional or passionate, who showed little inhibitory volition, had serious problems with sustained attention and could not learn from the consequences of their actions; though their intellect was normal.
one of the first to describe the nature of ADHD and related disorders.
Sir George Frederick Still (1868-1941) The father of British pediatrics.
Sir George Frederick Still (1868-1941) the father of British pediatrics. He was born in Highbury, England, and attended medical school at Cambridge University. His father died when he was 17 years of age, causing a dramatic change in the family economy. However, he had proved such gifts as a pupil of Merchant Taylors, that he received a scholarship enabling him to study at Caius College, Cambridge, where he received several awards and new scholarships.
At graduation, Cambridge
He was the first who described a form of juvenile idiopathic arthritis which bears his name Still’s disease. He was also the one of the absolutley first to initially describe the symptoms of ADHD (attention deficit hyperactivity disorder). A Few other medical terms after Sir George Still’s names is: Still’s murmur and Still’s rash. During most of his adult life George’s hobby was to read the antique works in their original languages. He was fluent in Greek, Latin, Hebrew and Arabic. His choice of profession, however, was medicine. His first salary at GOSH was only £20 a year (1894), and he had no private income, so Still’s early days at the hospital were spent in considerable poverty.
Sir Still gave his life to paediatrics. He wrote prolifically on childhood diseases and was secretary to the Children’s Clinical Club. Professor Still´s life was dedicated to improve the life chances of sick children, and especially to the patients at Great Ormond Street. Maybe just a look at his poetry can get us a glimpse of his thoughts. He wrote this poem in commemoration of his bellowed mother, Emma Andrew:
Years have gone since that sweet presence
And her ”boy” is old and grey,
But I hear my mother calling,
I am yet a child at play,
And my Mother has my heart-love,
And it seems but yesterday.
The same year he died, 1941, he published a volume of poems titled “Childhood and other poems”. These verses from this collection prove the importance of children to him, sick or healthy:
For my garden is the garden of children
Cometh naught there but golden hours,
for the children are its joy and its sunshine,
and they are its heaven sent flowers.
1989 Diana, Princess of Wales, becomes President of the Hospital
1991 Diana, Princess of Wales, laid the foundation stone for the new hospital building
1994 The Variety Club Building opened, funded by the Wishing Well Appeal
1997 The Princess of Wales’ final official visit on the hospital’s 145th birthday to open the Renal Unit
2001 Gene therapy lab opens, and clinical trials of gene therapy begin at GOSH
2002 150th Anniversary
Sir George Frederick Still (1868-1941) Den Brittiska pediatrikens fader.
Englands förste professor i barnmedicin presenterade den 4, 6 och 11 Mars 1902 sina sedermera berömda föreläsningar för the Royal College of Physicians in London, under namnet “Goulstonian lectures” som handlade om ‘some abnormal psychical conditions in children’, Föreläsningarna publicerades samma år i the Lancet. Han beskrev 43 barn som hade mycket allvarliga problem med att upprätthålla en kontinuerlig uppmärksamhet, att disciplinera sig själva och att inte bli ständigt överemotionella, aggressiva eller passionerat upptagna med något för situationen olämpligt.
Still skrev: “I would point out that a notable feature in many of these cases of moral defect without general impairment of intellect is a quite abnormal incapacity for sustained attention.” Alltså ett problem som verkade utgå från barnens oförmåga att styra energin i sin egna uppmärksamhet, trotts att barnen i övrigt hade välfungerande intellekt
Och drog slutsatsen att:“there is a defect of moral consciousness which cannot be accounted for by any fault of environment” När Still talade om moralkontroll vilket var dåtidens begrepp grundat i läror från William James så refererade han snarare till den tidigares begreppsanvändning. Still avsåg med moralkontroll egentligen:“the control of action in conformity with the idea of the good of all” Alltså förmågan att agera för allas bästa.
”Another boy, aged 6 years, with marked moral defect was unable to keep his attention even to a game for more than a very short time, and as might be expected, the failure of attention was very noticeable at school, with the result that in some cases the child was backward in school attainments, although in manner and ordinary conversation he appeared as bright and intelligent as any child could be. These considerations on the nature of the defect may appear to speculative to have any practical value, but I venture to think that they have some basis in clinical fact, and my reason for bringing them forward in this connexion is to emphasise the possibility that other morbid conditions beside defect of moral consciousness may be responsible for defect of moral control.”
George Frederick Still beskrev självfallet inte adhd enligt dagens terminologi men många historiker inom fältet anser att de beskrivna barnens svårigheter sannolikt skulle betraktas som adhd i dag med den samsjuklighet som ofta följer med.
References:
Alexander Crichton : An inquiry into the nature and origin of mental derangement : comprehending a concise system of the physiology and pathology of the human mind and a history of the passions and their e?ects. 1798.
Some abnormal psychical conditions in children: the Goulstonian lectures”. The Lancet’, 1902;1:1008-1012
Russell A. Barkley: The Relevance of the Still Lectures to Attention Deficit Hyperactivity Disorder A Commentary. 2006; 10; 137 J Atten Disord.
George F. Still Some Abnormal Psychical Conditions in Children: Excerpts From Three Lectures 2006; 10; 126 J Atten Disord.
Palmer, E. D., and Finger, S. 2001. An early description of ADHD(Inattention Subtype): Dr. Alexander Crichton and the ”MentalRestlessness” (1798). Child Psychology and Psychiatry Reviews, 6, 66-73.
Ett stort tack till
Ph.D. Russell Barkley för reflektioner och material.
Samt ett stort tack till Professor Stan Finger vid Washington universitetet i St Louis, för kloka och välgenomarbetade artiklar med exemplariska hänvisningar.Det känns tryggt att skriva till en av världens mest kunniga professorer inom neurovetenskaplig historik sent en fredagskväll och en kvart senare få svar från en professor som skriver Cheers och verkar allmänt glad samtidigt som han lämnar distinkta hänvisningar och snabbt erbjuder sig att skicka behövda referenser.
Snacka om bedårande skönt avslappnad kunnighet, med en djup kärlek till kallet. Hatten av, även bocken bugar.
Sir George Frederick Still (1868-1941) The father of British pediatrics.
England’s first professor in child medicine presented on 4th, 6th and 11th March 1902 a series of three lectures to the Royal College of Physicians in London, under the name “Goulstonian lectures” on ‘some abnormal psychical conditions in children’, which were published later the same year in the Lancet. He described 43 children who had serious problems with sustained attention and self-regulation, who were often aggressive, defiant, resistant to discipline, excessively emotional or passionate, who showed little inhibitory volition, had serious problems with sustained attention and could not learn from the consequences of their actions; though their intellect was normal.
He wrote “I would point out that a notable feature in many of these cases of moral defect without general impairment of intellect is a quite abnormal incapacity for sustained attention.
He concluded:“there is a defect of moral consciousness which cannot be accounted for by any fault of environment” When Still was talking about Moral Control, he was referring to it as William James had did before him, but to Still, the moral control of behavior meant “the control of action in conformity with the idea of the good of all”
”Another boy, aged 6 years, with marked moral defect was unable to keep his attention even to a game for more than a very short time, and as might be expected, the failure of attention was very noticeable at school, with the result that in some cases the child was backward in school attainments, although in manner and ordinary conversation he appeared as bright and intelligent as any child could be. These considerations on the nature of the defect may appear to speculative to have any practical value, but I venture to think that they have some basis in clinical fact, and my reason for bringing them forward in this connexion is to emphasise the possibility that other morbid conditions beside defect of moral consciousness may be responsible for defect of moral control.”
George Still certainly did not use the current terminology for this disorder, but many historians of ADHD have inferred that the children he described in his series of three published lectures to the Royal College of Physicians would likely have qualified for the current disorder of ADHD combined type, among other disorders.
References:
Alexander Crichton : An inquiry into the nature and origin of mental derangement : comprehending a concise system of the physiology and pathology of the human mind and a history of the passions and their e?ects. 1798.
Some abnormal psychical conditions in children: the Goulstonian lectures”. The Lancet’, 1902;1:1008-1012
Russell A. Barkley: The Relevance of the Still Lectures to Attention Deficit Hyperactivity Disorder A Commentary. 2006; 10; 137 J Atten Disord.
George F. Still Some Abnormal Psychical Conditions in Children: Excerpts From Three Lectures 2006; 10; 126 J Atten Disord.
Palmer, E. D., and Finger, S. 2001. An early description of ADHD(Inattention Subtype): Dr. Alexander Crichton and the ”MentalRestlessness” (1798). Child Psychology and Psychiatry Reviews, 6, 66-73.
Many Thanks to:
Dr. Russell Barkley for material and kind advice.
Stanley Finger at Washington university in St Louis.
The earliest well documented description of ADHD and ADD
In 1798, a Scottish-born physician and author, Sir Alexander Crichton (1763-1856), described what seems to be a similar mental state much like the inattentive subtype of ADHD, in his book: An inquiry into the nature and origin of mental derangement: comprehending a concise system of the physiology and pathology of the human mind and a history of the passions and their efects. In the chapter ”Attention”, Crichton described a ”mental restlessness”.
The book
“The incapacity of attending with a necessary degree of constancy to any one object, almost always arises from an unnatural or morbid sensibility of the nerves, by which means this faculty is incessantly withdrawn from one impression to another. It may be either born with a person or it may be the effect of accidental diseases.
When born with a person it becomes evident at a very early period of life, and has a very bad effect, inasmuch as it renders him incapable of attending with constancy to any one object of education. But it seldom is in so great a degree as totally to impede all instruction; and what is very fortunate, it is generally diminished with age.” p. 271
Crichton further observed:
”In this disease of attention, if it can with propriety be called so, every impression seems to agitate the person, and gives him or her an unnatural degree of mental restlessness. People walking up and down the room, a slight noise, in the same, the mowing a, the shutting a door suddenly, a flight excess of heat or of cold, to much light or to little light, all destroy constant attention in such patients. Inasmuch as it is easily is exited by every impression.” p 272
Crichton’s noted: ‘they have a particular name for the state of their nerves, which is expressive enough of their feelings. They say they have the fidgets” p 272
Dr. Crichton suggested that these children needed special educational intervention and noted that it was obvious that they had a problem attending even how hard they did try.
”Every public teacher must have observed that there are many to whom the dryness and difficulties of the Latin and Greek grammars are so disgusting that neither the terrors of the rod, nor the indulgence of any kind intreaty can cause them to give their attention to them.” p. 278
Alexander Crichton was almost two centuries ahead of his time in his observations of what is now known as the Inattention subtype of ADHD. He wrote about the salient features of this disorder, including attentional problems, restlessness, early onset, and how it can affect schooling, without any of the moralism introduced by George Still and later authors of the subject.
–
Dr Crichton described all the essential features of the inattentive
subtype of attention deficit hyperactivity disorder which were almost entirely consistent with the criteria for the inattentive subtype as portrayed in DSM-IV (APA,2000) (Palmer & Finger, 2001).
References:
Alexander Crichton : An inquiry into the nature and origin of mental derangement : comprehending a concise system of the physiology and pathology of the human mind and a history of the passions and their e?ects. 1798.
Some abnormal psychical conditions in children: the Goulstonian lectures”. The Lancet’, 1902;1:1008-1012
Russell A. Barkley: The Relevance of the Still Lectures to Attention Deficit Hyperactivity Disorder A Commentary. 2006; 10; 137 J Atten Disord.
George F. Still Some Abnormal Psychical Conditions in Children: Excerpts From Three Lectures 2006; 10; 126 J Atten Disord.
Palmer, E. D., and Finger, S. 2001. An early description of ADHD(Inattention Subtype): Dr. Alexander Crichton and the ”MentalRestlessness” (1798). Child Psychology and Psychiatry Reviews, 6, 66-73.
Many Thanks to:
Professor Russell Barkley for material and kind advice.
Professor Stanley Finger; at Washington University in St. Louis.
Har fått en del mail om historiken (del 1 & del 2) varav några tagit upp frågan om Hippokrates och huruvida han beskrev ADHD eller inte. Och visst skulle det vara bra med medicinens fader som en referens, det tyngsta namnet av dem alla. En del väljer att citera hans verk i detta sammanhang bland annat wikipedia.
In 493 BCE, physician-scientist Hippocrates described a condition that seems to be compatible with what we now know as ADHD.[citation needed] He described patients who had ”quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression”. Hippocrates attributed this condition to an ”overbalance of fire over water”. His remedy for this ”overbalance” was ”barley rather than wheat bread, fish rather than meat, water drinks, and many natural and diverse physical activities.”[81] (länkar etc är borttagna pga av att de numera är inaktuella)
Glömt Hippokrates?
En del undrade i all välmening att vi kanske glömt just Hippokrates. Njae, inte direkt , faktum är att det är just Hippokrates som berett mest arbete och tagit längst tid. Att Wikipedia nämner honom, ok. Visst. Tittar vi nu istället på referenserna till citaten så är det en viss ”Fancis” som ska ha översatt boken Hippocrates: Aphorisms. In The Genuine Works of Hippocrates (Translated from greek by Fancis Adams) Här kanske någon noterar att de som refererar till Hippocrates och adhd på nätet i varje fall har en sak gemensamt: De skriver till och med exakt samma stavfel, men någon Fancis verkar inte ha översatt Hippokrates däremot en Francis.
Vi hittar inte citatet
För att göra det hela lite enklare för alla att se, Francis översättning från 1849 av Hippocrates går nu att ladda hem här alldeles gratis, den som hittar citaten där kan väl vara så vänlig att kontakta mig för jag har inte hittat dem. Undrar om någon annan har det…
Att sedan Wikipedia, eller en massa andra böcker väljer att referera till Hippocrates ok. Här ser vi tre stycken böcker som är sökbara online alla har samma citat. Mitt problem är att jag hittar citaten i en del böcker om adhd men inte i originalet som alla hänvisar till. Hittar något det så skrik gärna till. Jag såg därför ingen anledning att ta upp just Hippokrates som relevant i adhd historiken, vilket andra gjorde och gör. Efter konsultationer togs därför Hippokrates bort då källan ej gick att verifiera. Inte heller Russell Barkley tyckte att det var rimligt att använda Hippokrates som en källa till adhd historiken. Gemensamt för alla som hänvisat till Hippokrates är att de aldrig lyckats säga från vilken sida citaten kommer från.
Det finns nog en del att säga i den frågan vad det lider. Att hänvisa till en massa citat ur en bok som ingen hittar är lätt, att visa vartifrån man citerar med bilder och hänvisningar är mycket svårare och tar längre tid.
Kortfattat
Referenser till vad Hippocrates anses ha sagt om ADHD finns på Wikipedia, flera hemsidor och i flera böcker, men är svårt att hitta i originalet. Lyckas du?
Vi tar historiken bit för bit, allt kommer sedan att presenteras samlat, fortsätt gärna med den kreativa kritiken.