Robert James Graves

Robert James Graves (1796-1853) M.D., F.R.C.S., Irish Surgeon after which Graves Disease takes it's name, Founder of the Dublin Journal of Medical Science, leader of the Irish School of diagnostics.

Robert James Graves [http://www.mrcophth.com/ophthalmologyhalloffame/graves.html]

Early Life

Born 27th March, 1796 at Harcourt Street, Dublin, Robert was the eighth child of The Very Rev. Richard Graves (1763-1829) D.D., Dean of Ardagh, by his wife Elizabeth Maria Drought (1767-1827), the daughter of James Drought (1738-1820) of Ridgemount, Ballyboy, King's Co. (Offaly). After a brilliant undergraduate career at Trinity College, Dublin, from 1818 he went abroad for the next three years travelling the continent between stints at the medical schools of Edinburgh, London, Berlin, Vienna, Gottingen, Hamburg, Copenhagen and those of France and Italy. Graves had an exceptional talent for languages, and whilst on the contininent was imprisoned for ten days in Austria whilst travelling on foot without a passport, the authorities believing him to be a German spy. None of them believed that an Englishman could speak German so well. On another journey he saved a ship and its mutinous crew by assuming command during a storm in the Mediterranean on his way from Genoa to Sicily. During a gale the vessel sprang a leak, the pumps failed and the crew attempted to abandon ship but Graves holed the one lifeboat with an axe and then proceeded to repair the pumps with leather from his own shoes, so saving the ship and all aboard. Whilst travelling in the Swiss Alps he became acquainted with the famous painter Joseph Mallord William Turner (1775-1851). They travelled and painted together for several months, eventually parting company in Rome.

"Graves was travelling in a dligence in the Alps when a man who looked like the mate of a ship got in, sat beside him, and soon took from his pocket a note-book across which his hand from time to time passed with the rapidity of lightning. Graves wondered if the man was insane, he looked, saw that the stranger had been noting the forms of clouds as they passed and that he was no common artist. The two travelled and sketched together for months before they found eachother's name, Graves' companion was J.M.W. Turner. He tells that Turner would outline a scene, sit doing nothing for two or three days, then suddenly, "perhaps on the third day he would exclaim 'there it is', and seizing his colours work rapidly till he had noted down the peculiar effect he wished to fix in his memory."

Medical Career

Graves returned to Dublin in 1821, setting up his own medical practice and introducing new clinical methods that he had witnessed on his travels to the Meath Hospital and the Park Street school of medicine which he helped found. This included, among other things, bedside teaching, of which William Hale-White said 'this is real clinical teaching', and went on in his book, 'Great Doctors of the Nineteenth Century', to say that Graves held the honour of introducing this system to the British Isles,

"(Graves) insists that... mere walking the hospital must go. The Edinburgh system, in which the teacher interrogates the patient in a loud voice, the clerk repeats the patients' answer in a similar voice, the crowd of students round the bed, most of whom cannot see the patient, hears all this and makes notes, is of no use. Students must examine patients for themselves under the guidance of their teachers, they must make suggestions as to diagnosis, morbid anatomy and treatment to their teacher who will discuss the cases with them."

In this technique one of his students, William Stokes (1804-1878), soon became his collaborator. Together they made the Dublin School of Medicine famous througout the world.

Graves was possessed of the qualities that would ensure a great teacher. He was tall, somewhat swarthy with a vivacious manner, and like other avant-garde professors of his time, he gave his lectures in English rather than in Latin, or Dog Latin as was still the case in most classes in the 1830's. In his introductory lecture he said: "From the very commencement the student should set out to witness the progress and effects of sickness and ought to persevere in the daily observation of disease during the whole period of his studies".

"(Graves) was tall, dark, with expressive features, a good talker, with the power of converting others to his way of thinking. His kindness, his total want of arrogance and his love of truth made this really great man popular."

He was appointed Professor to the Institutes of medicine in the Irish College of Physicians and wrote essays and gave lectures on physiological topics. His "Clinical Lectures" were published in 1843 (and again in 1848), giving fame to his name throughout Europe. He was president of the Irish College of Physicians in 1843 and 1844 and was elected a fellow of the Royal Society of London in 1849. He received honorary membership of the medical societies in Berlin, Vienna, Hamburg, Tubingen, Bruges and Montreal.

Among the innovations introduced in the lectures were the timing of the pulse by watch and the practicing of giving food and liquids to patients with fever instead of withholding nourishment. It was on a ward round that Graves light-heartedly suggested to William Stokes,

"Lest when I am gone you may be at a loss for an epitaph for me, let me give you one - He Fed Fevers."

As well as the practical importance of bedside learning to ensure that a graduate was not "a practitioner who has never practised" he emphasised the importance of research, "learn the duty as well as taste the pleasure of original work". He corresponded with old pupils all over the world and continued as an inspired teacher until his death in 1853.

Graves was sometimes sarcastic. In dealing with a colleague's attack on the use of the stethoscope, which was advocated by himself and Stokes, he wrote: "We suspect Dr Clutterbuck's sense of hearing must be injured: for him the 'ear trumpet' magnifies but distorts sound, rendering it less distinct than before". Dr. Clutterbuck was Henry Clutterbuck, 1770-1856.

In recognition of his achievements in education, Graves was named Regius professor of the Institute of Medicine in Trinity College. With William Stokes he edited the Dublin Journal of Medical and Chemical Science from 1832 to 1842, a journal he had founded with Sir Robert Kane (1809-1890). His lasting fame rests chiefly on his Clinical Lectures, which were a model for the day and recommended by none other than Armand Trousseau (1801-1867), who suggested the term Graves' disease.

A bust of Graves sits in the Royal College of Surgeons in Dublin and a statue of him was erected in Dublin in 1878.

Private Life

His first wife (and cousin) was Matilda Jane Eustace (1806-1825), daughter of Richard and Catherine (Drought) Eustace of Valetta, Kingstown, Co. Dublin who died in child birth. His second wife was Sarah Jane Brinkley (1801-1827), daughter of The Rt. Rev. John Brinkley, but she also died after giving birth to a daughter. He married his third wife in 1830, by whom he had six children. She was Anna, the eldest daughter of The Rev. William Grogan of Slaney Park (formerly known as Crosbie Park) Co. Wicklow, by his wife, a daughter of Mr Saunders of Newtownsaunders, Co. Wicklow, a distant cousin of Graves' through the Dawson family of Kinsaley, Co. Dublin.

* Slaney Park [http://www.buildingsofireland.ie/niah/search.jsp?type=record&county=WI&regno=16402713&print=true]

Robert James Graves died at his home at Merrion Square, Dublin, on 20th March, 1853. The year before he died he bought Cloghan Castle, Co. Offaly, where members of his family continued to reside until 1908.

* Merrion Square [http://cache.virtualtourist.com/1999469-Merrion_Square-Dublin.jpg]
* Cloghan Castle [http://freepages.genealogy.rootsweb.ancestry.com/~jkmacmul/cloghan.jpg]

He left his library - worth £30,000 even at that time - to Trinity College, Dublin, and failed to patent his invention of having the hand denoting seconds fixed on to a watch. Instead, a Dublin firm of watchmakers to whom he casually prescribed this device for his own personal assistance made a fortune out of selling watches with second hands all over the world. A collection of various of his papers, including a biography, was published by William Stokes as Studies in Physiology and Medicine. London, 1863.

References

Biography of Robert James Graves [http://books.google.co.uk/books?id=t1gGjsscCeYC&pg=PA126&lpg=PA126&dq=robert-james-graves+ardagh&source=web&ots=A5hanIo5e6&sig=YuIBaFjHoL8kbybSdETOz77w_Pg&hl=en&sa=X&oi=book_result&resnum=5&ct=result#PPA126,M1]

Clinical Reports of the Medical Cases in the Meath Hospital and County of Dublin Infirmary During the Session 1826, 27, P. 1. With William Stokes. Dublin, 1827,

Lectures on the Functions of the Lymphatic System. Dublin, 1828.

Clinical lectures.First published 1835 in London Medical and Surgical Journal and London Medical Gazette. The series for two sessions were first collected and published together in Philadelphia, 1838, as: Clinical lectures delivered during the sessions of 1834-5 and 1836-7.

Newly observed affection of the thyroid gland in females. (Clinical lectures.)London Medical and Surgical Journal, 1835; VII: 516-517.

A System of Clinical Medicine.Dublin, Fannin & Co., 1843.3rd American edition with notes etc by William Gerhard (1809-1872), Philadelphia, 1848.German translation by Heiman Bressler (1805-1873): Klinische Erfahrungen aus dem Englischen von Robert Graves übersetzt. Leipzig, 1843.

Clinical Lectures on the Practice of Medicine.2nd edition of A System of Clinical Medicine, edited by John Moore Neligan (1815-1863). 2 volumes, Dublin 1848; French translation by Sigismond Jaccoud, Paris, 1862.Much new material was added to this edition, especially Graves' observation on the epidemiology of cholera. He was one of the first to clearly show that cholera was contagious and spread along the lines of human contact.

Graves published John Noble Johnson's :The life of Thomas Linacre etc. London, 1835.

Obituaries: Medical Times and Gazette, London, 1853, VI, page 351.

William Stokes in Medical Times and Gazette, London, 1854, VIII, page 1.

J. F. Duncan in Dublin Quarterly Journal of Medical Science, 1878, LXV: 1.