Book Review

Archibald Garrod and the Individuality of Man

N Engl J Med 1994; 330:581-582February 24, 1994

Article

Archibald Garrod and the Individuality of Man
By Alexander G. Bearn. 227 pp., illustrated. New York, Oxford University Press, 1993. $49.95. ISBN: 0-19-262145-9

Bearn's biography of Archibald E. Garrod is a joy to read. It portrays the man's character, his defects, and his remarkable scientific insights in the setting of his home, his schools, and his friends and associates. The author provides a family tree inside both the front and back covers, which helps the reader follow the family relationships and hints, perhaps, that Garrod was of the right genetic stuff to make the scientific breakthrough that he did. Bearn does not neglect nurture either. Garrod's father's household was renaissance in style. Young Archie attempted several treatises as a schoolboy despite his shaky grammatical skills. His father, Alfred Baring Garrod, a Harley Street consultant, was perhaps the foremost clinical investigator in rheumatic disease of the 19th century, rivaled only by Robert Adams of the University of Dublin. A.B. Garrod first clearly separated gout from rheumatic gout, which he renamed rheumatoid arthritis. He also developed the first clinical laboratory test, incubating a thread suspended in acidified plasma. The formation of uric acid crystals on the thread signified hyperuricemia and helped identify patients with gouty arthritis. The senior Garrod watched over the scholastic progress of his sons closely. At one point, he decided that Archie was best suited for a career in business. Fortunately, his son's teachers realized that their underachieving student had a gift for science. A.E. Garrod later wrote a classic book on rheumatoid arthritis using data from his father's clinical notes.

Archie's early interest in astronomy led to a knowledge of spectroscopy, which he later applied to the study of urinary pigment. His studies of alkaptonuria, cystinuria, pentosuria, and albinism led to his famed Croonian Lectures and subsequent book, Inborn Errors of Metabolism (London: Frowde and Hodder & Stoughton, 1923). At the advanced age of 63 years, he was appointed to the Regius Chair of Medicine at Oxford University as the successor to Sir William Osler. The styles of the two contrasted sharply: Osler at the bedside, charming patients and students alike; Garrod detached and chiefly interested in the patient's urine, perhaps the first scientifically oriented “pisse prophet.”

The literary portrait of Garrod that emerges is that of a scholarly, disciplined man with a strong sense of duty to his country (he served as a colonel at Malta in World War I). His inquiring spirit led him to overcome an inauspicious academic start. The loss of two sons in the war and the death of his sole surviving son in the postwar influenza pandemic took the fire out of him. The grip of culture appears to have bound even giants like Garrod and Osler, who lost his only son in the same war, to such an extent that neither man ever seemed to doubt the necessity of the war. In their view it was fought for a just cause; neither perceived it as the mass insanity that hindsight has suggested.

The author's chief point is that Garrod first appreciated the biochemical individuality of humans. He may even have anticipated the relation between genes and enzymes. His close, nearly lifelong friendship with the doyen of biochemistry of his era, Frederick Gowland Hopkins, first in London and later in Cambridge, presaged the many fruitful relationships between clinical investigators and basic scientists that followed. Mendel's work had been rediscovered by the turn of the century and undoubtedly also influenced Garrod's thinking, especially on the subject of recessive traits. I was particularly intrigued by Bearn's account of the intellectual battle then being waged between the Mendelians and the biometricians over the nature of heredity.

In summary, this scholarly, readable biography depicts a very human scientist-clinician whose good genes and rich intellectual environment combined to produce an original contribution. The reverberations of his work represent a main line of inquiry in contemporary medical science. This book should be read and will be enjoyed by clinical investigators of all ages.

Daniel J. McCarty, M.D.
Medical College of Wisconsin, Milwaukee, WI 53226