QJM Advance Access originally published online on March 24, 2009
QJM 2009 102(5):365-366; doi:10.1093/qjmed/hcn167
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A chance meeting
The meeting was the weekly medical and surgical staff conference held on Wednesday, 22 March 1961, at 5.15 p.m. in the Courtauld Lecture Theatre of the Middlesex Hospital, London W1. It was the routine weekly staff meeting of Professor Alan Kekwick's Department of Medicine, but this one turned out to be memorable. The notice board poster stated that Mr D.P. Burkitt, Makerere College, Uganda would talk on ‘The commonest children's cancer in Tropical Africa: a hitherto unrecognised cancer’.
Denis Burkitt (1911–93) was an Ulster graduate of Trinity College, Dublin in 1935 and FRCS (Ed) in 1938. He served with the RAMC in East Africa during World War II, and afterwards in the Colonial Medical Service in Uganda. His astute foot-slogging epidemiological surveys provided a vivid profile of a previously unrecognized lymphoid cancer in African children.1 He postulated that a biological agent, possible an oncogenic virus was spread by a climate-dependent arthropod vector.
The lecture attracted a full house and included Tony Epstein who was at that time a research fellow in the Bland-Sutton Institute of Pathology, working on oncogenic viruses with the newly acquired electron microscope. Yes, you are correct in saying that such an occasion would at least be mutually agreeable. Let us go further and proclaim that this meeting of Burkitt and Epstein was epoch-making: a surgically trained epidemiologist had met a highly intelligent tumour pathologist with a burning conviction that the agent responsible for Burkitt's lymphoma was the Rosetta stone for tumour virology.
Burkitt sent samples of the tumour to Epstein and his team who eventually isolated the causal virus by thin-section electron microscopy. It became known as the Epstein–Barr virus. Co-worker Yvonne Barr (nee Balding) was born in Eire and graduated with honours in zoology from Trinity College, Dublin. She earned her PhD from the University of London for her work in Epstein's laboratory. Epstein became Professor of Pathology at Bristol, Vice-President of the Royal Society (having been elected a Fellow in 1979), earned a knighthood, and, in retirement, joined the University of Oxford. Yvonne Barr migrate to Melbourne to live and raise a family. Epstein–Barr virus can transform human B lymphocytes into continuously lines growing in vitro, and is also responsible for several other disorders including infectious mononucleosis, nasopharyngeal carcinoma, Hodgkin's disease and oral hairy leukoplakia.
This is not the end of the story on the tropical virus detected by cooperation between an epidemiologist in Uganda and the expertise of thin-section electron microscopy in London. Two different research teams have reported on the use of gene-expression microarray technology to improve the accuracy of the diagnosis of Burkitt's lymphoma.2
References
1. Burkitt DP. A children's cancer dependent on climate factors. Nature (1962) 16:379–86.
2. Harris NL, Horning SJ. Burkitt's lymphoma–the message from microarrays. N Engl J Med (2006) 354:2495–8.
The immortal medical portrait
Artist John Singer Sargent (1856–1925) was born in Florence where his parents happened to be spending the winter.1 His father, Dr Fitzwilliam Sargent, was an ophthalmic surgeon at the Wills Eye Hospital, Philadelphia. He resigned from this hospital in 1857 to support his wife Mary's hypochondriac desire to live permanently in Europe to restore her health. She was wilful and spoilt, and addicted to the watering spas of Europe; she managed to find just enough illnesses to keep the ill-health myth alive. Son John, born in 1856, rotated around Europe as part of the family, mainly to Nice, Venice, Rome, London and finally to Paris where he trained to be a professional artist. Eventually John acquired his own studios in both 31 and 33 Tite Street, Chelsea, where he flourished particularly with portraits of healthy attractive Americans. But let us concentrate on one medical masterpiece which hangs gracefully and for all to see in the Welsh Medical Library of the John Hopkins University Medical School. The first sitting was on 9 June 1905 at Sargent's Chelsea studio where he brought together the Big Four Founding Professors of the John Hopkins Medical School—William Osler (Professor of Medicine), William Stewart Halsted (Professor of Surgery), Howard Kelly (Professor of Gynaecology) and William H. Welch (Professor of Bacteriology). These founding professors of the new John Hopkins Medical School helped to set the John Hopkins tradition: they were quite young and full of zest and vitality—a marvellous team of pioneers.
At this first sitting, Osler tried to relax Howard Kelly by offering him a whisky-and-soda which was refused because Kelly was about to embark on a tour of temperance lectures. The dates for the portrait sittings had been chosen because all four professors also had many other engagements in Europe. Halsted and Kelly were about to receive Honorary Fellowships at the Royal College of Surgeons, Edinburgh. Osler was to receive an Honorary Doctorate in Oxford. It is said that Sargent quarrelled with Professor of Surgery Halsted, who was a taciturn somewhat lugubrious drug addict, certainly not as amiable as Osler, Welsh or Kelly; so the story, surely apocryphal, says that Sargent used inferior paints to depict Halsted. Everybody aware of this quarrel, visits the portrait, time and again, to see whether Halsted is fading out of the picture. The most convincing proof that this tale is untrue is the fact that now, a century since Sargent's painting, Halsted remains erect, authoritative and professional and the only one of the four standing; the paint has not faded.
At another sitting, Sargent regrouped the sitters around a vast Venetian globe which he sketched into the background. In order to bring the vast globe into his Tite Street studio, he was forced to chop down the frame of the door but this seemed of small concern compared with his repeated triumphant declarations ‘We have got our picture’. On seeing Osler, Sargent exclaimed that he had never painted a man with an olive-green complexion. To offset this colour, he was painted in a black gown with a red hood. After the first sitting on 9 June 1905, they all joined Mrs Osler for lunch at the Carlton.2 The eventual unveiling of the portrait entitled ‘The Four Doctors’ took place on 19 January 1907 at the Welch Medical Library of the John Hopkins. Harvey Cushing recalls the unforgettable evening. ‘It is wonderful – a masterpiece of the highest rank. Kate and I dined with Dr Welch beforehand.3 He was at his best. We heard lots of the inside gossip in regard to its painting – the way Sargent brought in the globe, Sargent's delight in the sitters – Osler, Welch, Halsted and Kelly .... The people stayed till almost midnight talking about the picture’.
In 1907, Edward VII recommended John Singer Sargent for a knighthood but this was not conferred because he was American. He died a bachelor Friday, 24 April 1925 and was buried at Brookwood Cemetery, Surrey following a memorial service at Westminster Abbey on Friday, 24 April 1925. On the plain stone is inscribed ‘Laborare est orare—to work is to play’. Beneath these words is his name in the style he adopted throughout his life—John S. Sargent.
References
1. Olson S. John Singer Sargent: His Portrait (1986) London: MacMillan.
2. Bordley J, McGehee Harvey A. Two centuries of American Medicine (1976) Philadelphia: W. B. Saunders. 149.
3. Freeburg VO. William Henry Welch at Eighty (1930) New York: Millbank Memorial Fund.
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