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Page 1: Sir Frederick Andrewes. 37 - Royal Societyrsbm.royalsocietypublishing.org/content/royobits/1/1/37.full.pdf · Sir Frederick Andrewes. 37 SIR FREDERICK ANDREWES—1859-1932. Frederick
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Sir Frederick Andrewes. 37

SIR FREDERICK ANDREWES—1859-1932.

Frederick William Andrewes was born on March 31, 1859, and was the eldest of four sons of C. J. Andrewes, J.P., of Reading, and sometime mayor of that city, by his second wife, nee Charlotte Parsons. He was educated under William Watson at Oakley House School, among his schoolfellows being E. B. Poulton,* W. F. R. Weldon, Seth Smith, and Owen Seaman. In 1879 he obtained a scholarship or Junior Studentship at Christ Church, Oxford. Amongst his teachers were Rolleston and Hatchett Jackson. Even in his early days the unusual ability of Andrewes was patent to his teachers and fellow-under­graduates alike. In 1881 he was placed in the first class in the Final Honour School of Natural Science, taking biology as his subject, and had the distinction of being alone in the first class. In 1883 he obtained the Burdett Coutts University Scholarship in Geology and in 1886 the Sheppard Fellowship at Pembroke College, the holder of which has either to be called to the Bar or to proceed to the D.M. degree. Meanwhile he had gained the Open Entrance Scholarship at St. Bartholomew’s Hospital. He there became a President of the Abernethian Society and having qualified as M.R.C.S. in 1887 and taken the B.M. degree at Oxford he was House Physician to Dr. James Andrew. The latter, who had taken a classical degree and had been a Fellow of Wadham College, was a very sound physician of the old school and a good teacher. After visiting Vienna, where good opportunities were afforded of obtaining practical knowledge of the use of the ophthalmoscope, otoscope, and especially of the laryngoscope, then newly come into use, Andrewes returned and embarked at first on the career of a consulting physician. He was Casualty Physician at St. Bartholomew’s and later Tutor in Practical Medicine and he was Assistant Physician and Pathologist to the Royal Free Hospital. He became a Member of the Royal College of Physicians in 1889, and in 1895 was elected a Fellow of that College. In 1897 the joint appointments of Pathologist and Lecturer on Pathology at St. Bartholomew’s became vacant and Andrewes, who had always been attracted by pathology and had been closely associated with Kanthack, the previous holder of these posts, was elected to succeed him and continued in office for thirty years. In 1912 the Lecturership in Pathology was raised by the University of London to a Professorship.

The life work of Andrewes was carried out at St. Bartholomew’s and the story of the development of scientific pathology there has been told by him in two papers, one published in 1898, the other exactly thirty years afterwards. Post-mortem examinations are known to have been performed at St. Bartholo-

* Professor Poulton (E. B. P.) writes of his life-long friendship with F. W. Andrewes on a later page.

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38 Obituary Notices.

mew’s in the seventeenth century, and a museum was started in 1726. For a long time pathology was limited to observation of the changes perceptible to the naked eye, but during the latter half of the nineteenth century the microscope was being used more and more, and in 1881 a special laboratory was set aside for the microscopical diagnosis of tumours. In 1882 the tubercle bacillus was discovered by Robert Koch, and by 1885, when Andrewes began to work in this laboratory as a student, specimens were being received there from the wards for examination as to the presence of that micro-organism. Klein, “ the father of English bacteriology,” was attached to the hospital staff and already teaching bacteriological methods to the more ardent spirits. In 1893 a new step was taken, pathology was centralised and Kanthack, who had studied in Berlin under Virchow and Koch, was appointed lecturer on the understanding that he should restrict himself to pathology ; he was so success­ful in bringing pathological methods to the service of the wards that in 1895 the additional post of Pathologist to the Hospital was specially created for him. When Kanthack moved to the chair of pathology at Cambridge in 1897 Andrewes was selected to succeed him, and during the next thirty years presided over the pathological department and directed its activities while it grew from a single laboratory to a new block containing three floors of laboratories dealing with pathology, bacteriology, and biochemistry respect­ively, and crowned by a magnificent post-mortem room with glass roof and a special lift to and from the cold storage in the basement to which bodies are transferred from the wards.

During this vast expansion of his department the chief burden was borne by Andrewes himself. His lectures were continuous and exacting, for he lectured on both pathology and bacteriology not only in systematic courses to successive waves of medical students three times a week, but in short intensive courses to qualified men, and he also lectured to nurses. As a lecturer his success was uniform and complete : his equanimity was never disturbed, his memory never failed him, his modest and unassuming manner captivated his audience and contrasted forcibly with the polished diction, the complete candour, and the perfect arrangement of his matter. There was never any ambiguity, and he could explain an intricate and baffling problem as simply and easily as if he were telling a fairy tale to children. His rare gifts of irony and humour were employed with great discretion to drive his points home or to relieve tedium, and when in good form he could make even the dullest theme interesting and on occasion amusing.

Outside the hospital walls the services of Andrewes were in great demand. He served on many committees, gave numerous addresses, and contributed articles to standard works of medicine, surgery, and hygiene. He possessed the happy faculty of being able to mobilise his knowledge at a moment’s notice, to examine and balance the evidence, and to give a calm and scrupulously

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Sir Frederick 39

fair judgment so far as the evidence permitted. There was no pathologist of his day who carried more weight with the physicians ; this was partly because he himself had started as a physician and thoroughly understood their point of view. The times were new in pathology and he acted as interpreter.

Notwithstanding his many duties and engagements Andrewes was always occupied with research work of some kind. To pathology proper he made two chief contributions. An important duty of the hospital pathologist is to assist in diagnosis by giving his medical and surgical colleagues the benefit of his opinion on the nature and significance of the microscopical changes present in enlarged lymphatic glands or other tissue removed from patients under their care. To a pathologist of experience many of these “ biopsies ” present no great difficulty, but when Andrewes succeeded Kanthack at St. Bartholomew’s there was considerable uncertainty with regard to the histological changes characteristic of Hodgkin’s disease or lymphadenoma. Accordingly, for some years after he became chief of the pathological department Andrewes made a special collection of material from cases of lymphadenoma and submitted it to close histological scrutiny, with the result that in 1902 he was able to present the Pathological Society of London with a clear description of the chief changes characteristic of lymphadenoma, and to distinguish it from tuberculosis with which much confusion had hitherto prevailed. Although somewhat similar work was being done abroad at about the same period by Sternberg and Reed there is no doubt that this research of Andrewes placed the histological diagnosis of lymphadenoma in this country once and for all on a firm foundation that has stood the test of time.

The other pathological problem to which Andrewes contributed by his researches was arterial degeneration, in his words “ a subject of very great importance in medicine and surgery and indeed in economics and industry.” The work of previous observers had indicated the age of 40 years as the period of commencing arterial decay. His own observations carried out in the post­mortem department of St. Bartholomew’s confirmed this and he was able to add to the evidence by showing that chemical analysis of a series of aortas proved that the yield of calcium salts provided a trustworthy index of the degree of degeneration, and he found that it underwent a big rise after the age of 40.

Andrewes’ life was cast at a period when the darkness that had hitherto obscured the modus operandi of infective processes was being dispelled and he witnessed and enjoyed to the utmost the birth of bacteriology and its growth as a science ; and it was in this work especially that it was his delight to take a hand. In course of his official duties at St. Bartholomew’s he was con­tinually being confronted with problems in disease where he was called upon to expound the present state of knowledge and either to apply and test it himself, or to advise and instruct others how to do so, and in this way lie was

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40 Obituary Notices.

led to undertake personal investigations and experimental researches over a wide range. It has been aptly said by Boycott that Andrewes “ came into active work at a time when it was essential that the new bacteriology should be welded on to sanitary science on the one hand, and clinical medicine on the other.”

The earlier bacteriological studies by Andrewes of milk, sewage, and air, yielded nothing of importance because the outlook and methods then current- had not sufficiently advanced. Later on when chiefly from the work of Houston a quantitative basis had been laid for the bacteriological detection of pollution derived from sewage, and when the importance of droplet infection had come to notice, Andrewes took up the investigation of sewer air again, and in an elaborate research obtained abundant evidence of the pollution to which the air of drains and sewers is subject from sewage by splashing and droplet infection; thus confirming the work of Horrocks which had been carried out independently and was published while his own paper was in the press.

Although the importance of the normal human individual as a potential carrier of infection, particularly in epidemic times, is now generally admitted, this was not realised at the time that Andrewes was making his earlier bacterio­logical studies. A case of diphtheria then signified a patient in whom the clinical signs of that disease were manifest, and patients without these clinical signs even though they might be ill were not considered as cases of diphtheria. In 1895 therefore it was something of a novelty when Andrewes published a paper in which he showed that during an outbreak of diphtheria among nurses a considerable proportion of them who only developed sore throat were infected by the diphtheria bacillus and in reality mild cases of that disease.

The problem, however, that interested Andrewes most was that of bacterial variation and species. The nature and degree of the specific differences among bacteria held for him a special attraction because he was essentially a systematist, and in the case of certain important groups of the pathogenic bacteria this matter was still unresolved and he saw that no sound classification could be made until progress in differentiation had been achieved. The group specially studied by him first and last was that of the streptococci, but during the war he investigated from this point of view dysentery bacilli of the Flexner group, and after the war examples of the salmonella. Perhaps his most complete and happy contribution was the fruit of his early work embodied in the Horace Dobell lecture of 1906. There he described with all that charm and felicity of presentation of which he was a master the habitat, mode of life and characters of the streptococci and traced the action of evolution and natural selection upon them resulting in the emergence of three chief groups with pathogenic attributes, viz., pyogenes, salivarius and fsecalis. The relative clinical import­ance of each group was then described from observations made by himself in conjunction with his colleagues on patients at St. Bartholomew’s. A parody

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Sir Frederick Andrewes. 41

of this lecture which he contributed anonymously to the hospital Journal in the form of a short story entitled “ The Romance of the Streptococci ” was singularly apt and amusing and has become a hospital classic.

Numerous outbreaks of dysentery among troops during the war brought to notice the urgent need of further knowledge with regard to the various races of dysentery bacilli, particularly in case of those belonging to the Flexner group. In association with Inman, Andrewes made a careful and prolonged study of the serological races of these organisms by means of the agglutination test. Their results, which were in reasonably complete harmony with those of two other investigators working independently at the same subject, were of practical value, for they succeeded in showing that by employing some four sera in routine laboratory diagnosis of dysentery, the majority of the strains of dysentery bacilli of the Flexner group could be identified.

This work at dysentery bacilli lead Andrewes to undertake a study of the salmonella group, and after the war he became engaged in an elaborate investi­gation of individual examples of this family well known to bacteriologists from their frequency in giving rise to outbreaks of food poisoning, and from the difficulty that they offer to serological classification. By this time Andrewes had not only acquired a very high degree of skill with the agglutination test but had also obtained a complete mastery of the absorption test for checking his results. Doubly armed in this way he succeeded in bringing to light the remarkable fact that in an ordinary pure culture of certain types of salmonella the bacilli exist side by side in two forms or phases sharply distinguished in agglutination, but not in other respects. In one phase the specific properties of the type predominate, with only a scanty group element: in the others there is a predominance of the properties common to the group, the specific element, though present, being feebly developed. These peculiarities of phase were not stable, mutation occurring on subculture. This diphasic variation of salmonellas was subsequently confirmed by others and it illustrates the complexity of their nature and suggests a likely explanation of some of the difficulties they had previously presented to satisfactory serological classi­fication.

The last investigation undertaken by Andrewes was an attempt to classify along similar serological lines the haemolytic streptococci: perhaps the most harmful to man of all the pathogenic bacteria. The difficulties were very great and in this valiant effort he employed all the skill that he had acquired during his long and arduous labours at previous groups of bacteria, all the energy, accuracy, thoroughness and ingenuity that he could command, and he spent seven years at the task, ably assisted by two ladies who co-operated with him. He brought to light a number of important points hitherto either quite unknown or imperfectly realised, and he encountered once again and closely studied the phenomenon of diphasic variation. The report, written by himself

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42 Obituary Notices.

and edited after his death by his son Dr. Christopher Andrewes, has been published by the Medical Research Council. Up to the stage reached at his death the group resisted him successfully, but it was his special wish that this work should be published in order that others coming after him and attempting to classify the haemolytic streptococci along similar lines might profit from his own experience. It is conceivable that in this last work Andrewes attempted too much and that had he confined himself in the first place to suspensions of haemolytic streptococci freshly isolated from the body and heated in order to destroy the less stable fraction more progress might have been made. Handi­capped as he was with antigens that in many instances had been isolated for some time and were varying in course of continued subculture on artificial media, it is decidedly hopeful that nevertheless his observations confirmed the serological specificity of three out of the four types of the scarlatinal haemolytic streptococcus differentiated by Dr. F. Griffith. On the other hand Andrewes himself took the view that the haemolytic streptococci as a group are in such a state of flux as not to be amenable to satisfactory classification by agglutina­tion coupled with the absorption test. Time will show which view is correct. In any event this last contribution of his sheds entirely new light on the problem and is complete so far as it goes. It is bound to be of the greatest service to those who in future may attempt to classify the haemolytic strepto-. cocci by serological methods, and this is precisely what he desired.

Andrewes received numerous honours. At the Royal College of Physicians, besides the Dobell Lecture in 1906 he gave the Croonian Lectures in 1910, and the Harveian Oration in 1920. He served on various committees appointed by Government Departments and he was a member of the Medical Research Council. He was elected a Fellow of the Royal Society in 1915 and served on the Council from 1921-22, and 1923-25. For his services to the War Office and the Medical Research Council during the war he received the O.B.E. and the honour of knighthood. In 1924 the University of Durham conferred upon him the degree of D.C.L. On his retirement he was made an Emeritus Professor of Pathology by the University of London.

Sir Frederick Andrewes died on February 24, 1932, aged 73. He married Phyllis, daughter of Mr. John Hamer, J.P., who survives him, together with a daughter and a son, Dr. Christopher Andrewes, who is a member of the scientific staff of the Medical Research Council.

M. H. G.

Andrewes’s interests were far wider than the subjects of his life’s work. They extended to all branches of science and all living things. For many years he was an active collector of butterflies and moths. He took a special delight in his rock garden to which he and his friends were always adding treasures. In his younger days and throughout his life he keenly appreciated

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music and in his mature years he became much interested in architecture and in visiting cathedrals and churches. After a journey to Holland some ten years before his death in order to deliver a lecture, he became keenly interested in art.

I t was our common interest in natural history—especially entomology and geology—which led to a special intimacy between Frederick Andrewes and myself, and almost bridged the gap between our ages—three years that mean so much in youth and so little in later life. We were also brought together by circumstance. Reading during our boyhood and youth was a flourishing, efficiently administered business town, in which comparatively little interest was felt in intellectual subjects or intellectual pursuits. The happy change wrought by the University College and its culmination in the University of Reading—a change initiated by Andrewes’s own College, Christ Church—was still in the unimagined future. In those days the relatively few young men who were keenly interested in science were naturally brought together and bound by the closest of ties—mutual sympathy and help. Hence we were often companions on geological and entomological expeditions and always met to compare the experiences of the summer holidays and later on of the Long Vacations.

Andrewes was keen to detect any strange form of a common insect, and among the British butterflies in the Oxford University Museum there is an interesting lemon-yellow form of the male “ Clouded Yellow ” ( edusa, or as it is now called croceus) taken by him at Sidmouth in 1872, and an interesting variety of the “ Small Tortoiseshell ” ( Aglaisurticce from Caversham Warren near Reading (about 1873). Also from the same locality and about the same date a rare gynandromorph of the “ Brimstone ” (Gonepteryx rhamni) with patches of the greenish-white colouring of the female let into the bright yellow of the male wings. This remarkable specimen is figured in the ‘ Transactions of the Entomological Society of London,’ plate xxii, fig. 14, p. 524 (1928). Of even more significance was the description he once gave me of the wonderfully beautiful “ Herald Moth ” ( Scoliopteryxlibatrix), with a shape and colouring of reds and greys like a dead and decaying leaf, and the habit of hibernating in sheltered places where such leaves were likely to drift. He was especially struck by the minute dots, like touches of Chinese White, upon the fore legs and wings, and suggested that they represent one of the fungi which commonly grow on damp, dead leaves and pieces of stick. Then, as he was examining the living specimen in his father’s garden and thinking of these resemblances, the moth was suddenly startled and flew off, whereupon a robin caught and devoured it before his eyes—clear evidence of palatability to insect-eaters, and the danger which diurnal flight would bring to a species with the adaptations of the “ Herald.”

And quite apart from the joy of observing and collecting he had an intense

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44 Obituary Notices.

delight in the country, seen and loved as it could be before the deadly triumphs of the internal combustion engine.

I especially recall his kind and efficient help in the study of an interesting section of the Thames river gravels and the lower Tertiary beds below them, on the Redlands Estate near his father’s house at Reading (' Quart. J. Geo. Soc.,’ May, 1880, pp. 301, 302). It is a pleasant thought that in com­panionship of this kind was fostered the interest in geology which led to his becoming the Burdett Coutts University Scholar of 1883. I remember his saying to me that, when preparing for the examination, he thought that it would be a waste of time and memory to attempt to learn in its right order the list of Ammonites, each of which gives its name to one of the “ Zones of the Lias,” and how he constructed an amusing and, as it turned out, an invaluable memoria technica, to overcome this difficulty. When Andrewes entered for a Junior Studentship at Christ Church I was told that the examiners were especially pleased with his essay and the adventitious aid which it gained from his hand­writing, a result which provoked the hilarity of his family, but then families are apt to think lightly, or profess to think lightly, of qualities admired by others !

He was warmly appreciative of skill and good work wherever he saw it. I remember how, when an undergraduate working in Professor George Rolleston’s department, he spoke with admiration of the way in which the Senior Demonstrator, Charles Robertson, would display the anatomy of the leech by a single longitudinal incision, saying “ You mustn’t do it this way—I may ” ; and the enthusiasm with which he described an operation by Sir W. S. Savory, the great St. Bartholomew’s surgeon.

I cannot conclude these brief memories of a dear, life-long friend without referring to the home which did so much for him. To be, as Andrewes was, one of a large family—large in these days at least—with members differing in many ways but united by love and sympathy, is to grow up under the most favourable of conditions, and it is a sad thought that in these later years comparatively few of our young people are able to enjoy them.

E. B. P.