Henry Bence Jones (1813-1873): The Best ... - Clinical Chemistry

CLIN. CHEM. 33/9, 1687-1 692 (1987)
Henry Bence Jones (1813-1873): The Best “Chemical Doctor” in London
LouIs Rosenfeld
A New Eponym
In September 1844, a wealthy London grocer, forty-four
years of age, developed chest pains after an accidental fall.
His pain was relieved by a plaster cast, but returned a
month later to persist until his death. He was first seen by
Dr. Thomas Watson in the spring of 1845 after he had been
treated for pleurisy. In June the patient developed edema of
the legs. He improved during the summer while vacationing
in Scotland, but his legs continued to swell. He had a
ravenous appetite and claimed that he dreamed of eating
cats and dogs (1). After several months of care, Dr. Watson
called in William Macintyre, physician to the Metropolitan
Convalescent Institution and the Western General Dispensary
in St. Marylebone, to see the patient. It was Friday,
October 30, 1845. By then the patient was confined to his
house with excruciating pain in the chest and back.
From the history and examination, Macintyre noted
many important clinical features, including the severe bone
pains and the peculiar reaction of the urine when it was
heated. In view of the history of edema, this was one of the
first tests he performed. Macintyre also noted, and later
described, the ability of the heat-precipitated protein to
redissolve upon continued heating of the urine, only to
reprecipitate when the urine was allowed to cool. He also
noted that the protein was heat-precipitated at a temperature
much lower than was necessary for albumin (2).
It seems that Dr. Watson had not examined his patient’s
urine, but he either was present when Macintyre tested the
urine or was told about the unusual results, because both
physicians independently sent a specimen to the noted
chemical pathologist, Henry Bence Jones. The specimen
sent by Dr. Watson was accompanied by the following note
(1):
Saturday, Nov. 1st, 1845.
Dear Dr. Jones, -The tube contains urine of very high specific
gravity. When boiled it becomes slightly opaque. On the addition of
nitric acid, it effervesces, assumes a reddish hue, and becomes quite
clear; but as it cools,assumes the consistence and appearance which
you see. Heat reliquifiesit.What is it?
When Jones arrived, the patient was severely emaciated,
with yellowish skin, clear conjunctivae, and dry lips. Urine
was not passed in large quantities and there was no urgency
or frequency. The patient complained of pains in the left
shoulder and side, and had to be moved most gently in bed
on account of the pain. The patient died on January 2, 1846.
The autopsy revealed that the sternum and cervical,
thoracic, and lumbar vertebrae were soft, fragile, and easily
Department of Pathology, NYU Medical Center, 530 First Avenue,
New York, NY 10016.
Fig. 1. Henry Bence Jones (1813-1873)
Courtesyof J. R. Clamp.Bristol,England
breakable, and could be cut with a knife. The kidneys were
grossly and microscopically healthy. The only marked disease
present was mollities ossium (abnormal softening of
the bones). A histological examination of the soft gelatinous
blood-red substance from the interior of the affected bones
was made by John Dalrymple, surgeon to the Royal Ophthalmic
Hospital and a member of the Microscopical Society.
He described the great numbers of nucleated cells, varying
in size and shape, and for the most part larger than the
average erythrocyte. He also noted that the larger and more
irregular cells often contained two or three nuclei (3). These
descriptions, though incomplete, are not inconsistent with
malignant plasma cells with some multinucleated forms.
Dalrymple, Bence Jones, and Macintyre believed this disorder
was a malignant bone disease. In 1873, von Rustizky
described the pathology of this condition of tumors of the
bone marrow and named it “multiple myeloma.” This disease
was first related to H. B. Jones’ proteinuria by Otto
Kahler (1849-1893) in 1889.
Bence Jones carried out extensive chemical analyses on
CLINICAL CHEMISTRY, Vol. 33, No. 9, 1987 1687

this unusualheat-precipitable substance and concluded that
it was an oxide of albunun-specifically, the hydrated
deutoxide of albumin. The ultimate analysis he represented
by CHssNsOis or CH31N5O15, depending on whether
protein is equal to CH37N6O15, or C40H30N5012. According
to his estimate, the enormous quantities of this peculiar
albuminous substance voided in the urine were in the same
concentration as ordinary albumin in the serum. No amount
of food could compensate for such a loss (4).
The identity of the patient in this first recorded case of
multiple myeloma remained unknown for more than a
century. Macintyre referred to him only as Mr. M., and
Bence Jones never identified him by name. Then, in 1967,
by careful and meticulous research of the Register of Deaths
for the London area for the first quarter of 1846, and by a
process of elimination based on the known information on
age, date of death, occupation, and cause of death, the
correct death certificate was found. The patient was identified
as Thomas Alexander McBean and the cause of death
was given as “atrophy from albuminuria” (5). At that time,
albuminuria was the term used nonspecifically to mean
proteinuria.
Henry Bence Jones examined the urinary protein in some
detail and reported on its properties, analysis, and significance,
whereas Macintyre’s paper dealt mainly with the
clinical features of the disease. For this reason, Bence Jones
came to be credited with the discovery of the protein. This
case history and the strange protein that bears his name
were not mentioned in his obituaries, the Dictionary of
National Biography, or his own brief autobiography. This is
not unusual. Eponymic fame is often a matter of chance and
good luck and is usually bestowed years after death when
the discovery assumes an appropriate significance within
the context of subsequent investigations and findings. Had
the case report been made in more recent times, the cause of
death might have been recorded as “McBean’s disease with
Maclntyre’s proteinuria” (5).
Education and Early Years
Henry Bence Jones (6, 7) was born on December 31, 1813,
at Thonngton Hall, Yoxford, in the county of Suffolk, the
home of his maternal grandfather, Mr. Bence Sparrow
(1749-1824), Rector of Beccles. His father, Lt. Col. William
Jones, was of Irish descent and had only recently returned
from army service with the 5th Dragoon Guards in the
Peninsular War.
After some preparatory private schooling, Henry entered
Harrow in 1827. Of his classical education at Harrow, Bence
Jones recollects that he acquired nothing more than is
generally learned at Harrow, and derived little pleasure
from classics and verse-making. He learned to read and
write French, but not too well. He picked up some knowledge
of turning in wood and ivory, did some etching,
mezzotint, and copper engraving, and also learned to play a
little on the clarinet and bugle. If classroom activities were
not especially noteworthy, it appears that he did find
considerable enjoyment in school sports. He became quite
skilled in football and racquet ball and made the Harrow
cricket team.
Bence Jones left Harrow to spend the final year in a
private school studying mathematics and otherwise preparing
for Cambridge. He entered Trinity College in 1832 and
soon found himself on an eight-oar rowing team. Henry had
given some thought to joining the Dragoons but it was his
youngest brother who joined the army, while Henry was
intended for the Church. He studied Hebrew, with little
success, attended lectures in divinity, read German and
Italian with a tutor, attended lectures on modern history
and geology, and eventually took his Arts degree in January
1836. At this point, although he had completed all the
necessary steps for ordination, he decided against a career in
the Church. At loose ends about what to do, he wrote to a
relative of his father’s family in Liverpool asking for ajob as
a clerk in the family business, but nothing caine of this. He
considered emigrating to New Zealand and even picked up
the necessary papers.
Then, while discussing professions with a friend in London,
he learned the differences between apothecary, surgoon,
and physician, and what the educational requirements
were for each. Since he showed some interest in
medicine, his father suggested he spend a year of study with
the local general practitioner. Usually, this was someone
qualified as an apothecary and surgeon, but without the
university training in medicine and the M.D. degree that
denoted a physician. But this was not to Henry’s liking.
A Choice of Career
What happened next was an introduction to his friend’s
brother, a surgeon at St. George’s Hospital in London. The
surgeon arranged for Bence Jones to enter St. George’s as a
pupil of the apothecary, to learn how to prepare and to
dispense the pills and powders, draughts and mixtures in
use in the hospital. The apothecary stood on the bottom rung
of the triple-tiered medical hierarchy serving the health
needs of early nineteenth-century England. This does not
take into account the quacks or the thousands of untrained
and irregular “practitioners” who daily endangered the
health and lives of the public, especially in the rural areas.
Anyone, licensed or not, could practice in England and
Wales on any patient who, knowing his lack of qualifications,
would allow him to do so. Licensure was only a
certification of training. It was, however, always an offense
for anyone to claim to have had training that he had not
received.
Bence Jones’ 18 months of association with the apothecary
were very useful and valuable because he picked up a
considerable amount of practical knowledge of how drugs
were used. He rarely visited the wards alone, but frequently
accompanied the apothecary at night when he attended the
most seriously ill of the physicians’ patients.
The following year, on October 1, 1838, Jones enrolled as
a perpetual pupil (full-time medical student) at St. George’s
and began to attend lectures and the dissecting room, as
well as the general chemistry course given at the Royal
Institution. For a while he became a dresser (assistant) in
the surgeons’ wards, but as soon as he had acquired some
practical knowledge he returned to the physicians’ wards.
He worked hard to learn all he could about the stethoscope
from Dr. James Hope (1804-1841), assistant physician at St.
George’s. Unfortunately, no one else at the hospital knew or
cared about the use of this relatively new instrument. The
older men tended to ridicule something they did not understand
and found difficult to learn. Besides, as many pointed
out, there was no advantage to this new technique since the
treatment was usually the same anyway. Humoral pathology,
established by the ancient Greeks, dominated all of
medicine until the middle of the nineteenth century. Most
physicians believed that different illnesses were just variations
of humoral disorders. Therapy was not directed
against a disease as such, whatever it was called, but
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against the diseased state of the patient. Treatment was
selected to restore the body’s huinoral balance, by removing
unsatisfactory fluids by bleeding, purging, sweating, blistering,
and (or) inducing vomiting.
Chemical Diseases
Bence Jones was interested in chemical diseases and tried
to gather some information on this in the medical wards.
However, despite the correlations found by Dr. Richard
Bright of Guy’s Hospital connecting edema, albuminuria,
and diseased kidneys at autopsy, this kind of information
was of no interest to most medical men. As long as disease
was believed to resultfrom one underlying condition of the
body, and presumably could be treated and cured by one
system of correcting that condition, there would be little
interest or advance in identifying and treating particular
diseases (8). Anatomical diagnosis was of little value to the
doctor who still regarded illness as an essentially general
phenomenon and considered local manifestations as secondary.
Such doctors did not think it necessary to look for an
association between symptoms in the living and structural
pathology in the dead.
There were no facilities for investigation at St. George’s
except for an alcohol lamp and some nitric acid in one of the
surgical wards, and although he tried to run some experiments
on albumin in urine, he ended up with more questions
than answers. Then, in the spring of 1839, Bence Jones
was sidelined with rheumatic fever and returned home to
recuperate. By October, still weak, he felt well enough to go
back to London, but it was not to St. George’s. Instead,
determined to acquire a knowledge of chemistry and some
skill in laboratory work, he entered University College
London for a year as a private pupil of Professor Thomas
Graham (1805-1869), and paid for it with #{163}50 of his own
money from a small legacy. Graham was rarely in the
laboratory, so the chemical instruction was obtained chiefly
from his assistant, Mr. George Fownes (1815-1849). It
proved to be a very valuable association.
Fownes had studied with Justus Liebig (1803-1873) at
Giessen (near Frankfort) and taught Bence Jones general
laboratory work and the techniques and methods for accurate
organic analysis according to Liebig’s methods. During
his year with Fownes, Bence Jones acquired an appreciation
for experimental chemistry and an attraction to Liebig’s
work that had an important influence on his subsequent
research and career.
I
First Publication
One of his student exercises was to examine a calculus
from the collection in the Museum of University College
Hospital. His analysis led to his first publication. The stone
turned out to be a cystine calculus, a rare type. Cystine had
been firstdiscoveredin a calculus by W. H. Wollaston
(1766-1828) in 1810. Indeed, it was the first amino acid to
be discovered. The presence of sulfur in cystine had only
recently been found by A. E. Baudrimont and F. J. Malaguti
in 1837, and its content was successfully determined by
M. C. J. Thaulow the following year. Bence Jones’ analysis
of the sulfur content was 19% rather than the 25% obtained
by Thaulow, a discrepancy no doubt ascribable to the
inexperience of the analyst. Bence Jones suggested that
“there may be two similar cystic oxyde calculi, which differ,
in the one having more or less of its oxygen replaced by
sulphur,” and proposed the names of cystic and sulphocystic
oxydes to distinguish them (9).
Bence Jones resumed his medical education at St.
George’sin October 1840. His plan was to take the examination
for Licentiate of the College of Physicians as soon as he
could, and then spend six months studying in Liebig’s
laboratory in Giessen, a common goal of aspiring young
chemists in the mid-nineteenth century. The College of
Physicians at this time, wishing to compete with the new
University of London, had lowered its requirements and
now admitted to examination, for its license to practice as a
physician, those who had no University medical degree, and
agreed to call those who passed doctors of medicine. He
passed the examination in the spring of 1841 and was
admitted as a Licentiate of the College. Soon afterwards he
traveled to Giessen, where he was warmly received as a
result of introductions from Graham and Fownes. He immediately
got down to laboratory work, even taking German
lessons daily before coming to the laboratory. Jones was
greatly impressed with Liebig and his views on animal
physiology, and became a close friend of his teacher.
Justus Liebig
Liebig’s school of chemistry was attracting students from
all over the world. Justus Liebig was one of the forces
making chemistry (in which France had led the way in the
eighteenth century) almost a German monopoly in the
nineteenth century. In 1824 he established the first systematic
laboratory course designed expressly to train new
chemists. Previously, practical laboratory exercises were
almost completely neglected in the universities and students
were taught only theory. Experiments were almost
always limited to demonstrations by the instructor and his
assistants. Liebig developed techniques and apparatus to
overcome difficult operations and eliminate sources of error
in order to obtain accurate knowledge of the composition
and reactions of organic compounds. His ideas on animal
physiology (10) had a very pronounced impact on contemporary
chemists and on the course of physiological investigation.
Although often wrong in his explanations and inferences,
which were shaped by wishfulthinkingand speculation
that went far beyond the available experimental
evidence, and though he hever performed an experiment on
living animals, Liebig showed how the quantitative methodsof
organic chemistry could be applied to the study of the
chemical composition and the reactions of physiologically
important substances (11). The most important result of
Liebig’s work was the large volume of further research that
he helped to stimulate.
First Employment
In October 1841, after six months at Giessen, Jones
returned to the medical wards at St. George’s Hospital. The
following May he married his first cousin, Lady Millicent
Acheson, daughter of the second Earl of Gosford. Soon
afterwards, he journeyed to Cambridge, where he picked up
the M.A. degree-presumably in chemistry, on the basis of
his work with Graham and Liebig-for which no residence
or additional course work was required. He was back in
London in October for the start of the school year to begin
work at St. George’s. The Governors requested that he
analyze and catalog all the calculi in the hospital’s museum.
He conducted this work in a small laboratory, which he
outfitted at home. Meanwhile, Fownes had been appointed
lecturer in medicinal chemistry to the Middlesex Hospital.
Kept busy with lectures at the Charing Cross Hospital,
where he was chemical professor, as well as with another
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course at the Pharmaceutical Society, Fownes arranged to
have Bence Jones appointed as his temporary substitute.
The lectures, begun in the autumn of 1843, were prepared
from Fownes’ notes with the help of the assistant to the
previous lecturer. There were only six students in the class,
and, “In preparation for these lectures I acquired more
practical knowledge of chemistry than I could possibly have
done in any other way” (12). Fownes received the fees, but
rewarded Bence Jones with 10 guineas. Some of the topics
covered in the lectures were: chemical means of obtaining
information; organic analysis; schools of animal chemistry;
fluids of the animal body; solids of the animal body; organic
processes; nutrition; respiration; secretion; death.
Appointment
and Promotion
In December 1845 he was appointed to a vacancy as
assistant physician at St. George’s. He was also assigned the
post of Lecturer on Medical Jurisprudence, a position usually
filled by the youngest physician on the staff. Only a few
months later he advanced to a new vacancy as physician.
His rapid climb was quite unusual. For most physicians on a
hospital staff the wait ranged from a few to many years; for
others the promotion never came. Bence Jones was overwhelmed
by the new responsibilities. Fortunately, he was
able to consult at any time with the hospital’s apothecary
under whom he had begun his training. If not for this, he
would have been in a constant state of bewilderment regarding
treatment of his patients.
“In this way the alliance I had formed in the shop became my
greatest support in the wards of the hospital, and I rapidly acquired
knowledge in the management of the patients and confidence in
myself, though my private practice was very small indeed for some
time. Gradually, however, my chemical knowledge brought me
medical men to ask for my opinion on their own cases,and thiswas
followed by their occasionally bringing me their patients for consultation”
(13).
In 1846, with a growing reputation as an animal chemist,
and sponsored by Fownes and Graham, he was elected a
Fellow of the Royal Society. In 1849, having obtained the
B.A. from the University and a medical education elsewhere,
Henry Bence Jones received the M.D. degree from
Cambridge University. There was no residence requirement.
Friends and Patients
Bence Jones soon had a large and profitable practice, and
was well acquainted with the leading scientists at home and
on the Continent. Among his friends and patients were
Thomas Huxley (1825-1895), the famed biologist and
grandfather of Aldous, who mentioned in his autobiography
that Bence Jones loaned him the use of his home for three
months; Charles Darwin (1809-1882), who was half-starved
by Bence Jones’ dietary regimen during a period of ill health
in 1865; and Hermann von Helmholtz (1821-1894), physiologist,
renowned for his work in thermodynamics and his
invention of the ophthalmoscope, who described Jones as “a
charming man, simple, harmless, cordial as a child and
extraordinarily kind” (14). Bence Jones was also physician
and friend to the celebrated chemist A. W. Hoffmann (1818-
1892), and was quoted in the autobiography of philosopherbiologist
Herbert Spencer (1820-1903) to the effect that
there is scarcely a drug which may not under different
conditions produce opposite effects. Benjamin Disraeli borrowed
a Bence Jones prescription from a friend for loss of
voice (probably laryngitis).
Jones was also well acquainted with Florence Nightingale,
who managed the Hospital for Invalid Gentlewomen in
Harley Street before she left for the Crimean War and the
work that made her famous. He had a high opinion of her
ability, and she regarded him as the best “chemical doctor”
in London. He wrote to her during her convalescence in the
Crimea in 1855 to ask her advice about a project he had in
mind for reform of nurses’ training in London’s hospitals.
Bence Jones wanted to start a nurses’ training school at St.
George’s and thought that such schoolsshould be part of all
London hospitals. Later, when a national fund was raised in
honor of Miss Nightingale, Bence Jones was one of the
original members of the Council of the Nightingale Fund
(15). This was not a new endeavor for him. Some years
earlier, in 1850, he was very influential, through his many
social contacts outside of medicine, in the establishment of
the Hospital for Sick Children, on whose Board he served.
The Royal Institution
Bence Jones was very much interested in natural science
(physics). The most important part of his nonmedical work
was his association with the Royal Institution, from which
he derived much enjoyment. The Royal Institution sponsored
research and experimentation in natural science and
served as a forum for popular-science lectures to the public.
Bence Jones first began attending the Friday evening
lectures while a pupil at St. George’s Hospital, when one of
the Governors gave him an admission ticket. It was there
that he first heard Michael Faraday (1791-1867). Faraday
later became his close friend and patient. Their friendship of
many years led to a two-volume biography of the prominent
scientist by Bence Jones in 1870.
During the 1850s Bence Jones lectured at the Royal
Institution on animal chemistry for medical students (open
to the public); alcohol, sugar, and acid content in wines; and
ventilation. He was Secretary from 1860 to 1873. His
connection with the Royal Institution led to friendships with
Emil du Bois-Reymond (1818-1896), founder of modern
electrophysiology, and with John Tynda.ll (1820-1893),
physicist, both of whom he recruited to lecture at the
Institution. Bence Jones later translated and edited an
account of du Bois-Reymond’s important discoveries in
animal electricity (1852). As a result of this contact Jones
tried to revive an earlier technique of applying electrolysis
for the in situ dissolution of urinary calculi (16).
Sugar
and Diabetes
His researches with diabetics showed that sugar is still
found in the urine when sugar-forming food is withheld
from the patient, and he suggested that the disease might be
due to blockage of the action of oxygen on the non-nitrogenous
constituents of the food and tissues. He believed
diabetes was due to deficient oxidation, affecting first the
non-nitrogenous and ultimately the nitrogenous constituents
of the food and tissues. He explained the error of
calculating the quantity of sugar in urine from specific
gravity tables as follows: “But diabetic urines contain a
multitude of other substances besides sugar, each of which is
variable, and each of which may cause the specific gravity to
vary, whilst the quantity of sugar remains constant” (17).
He supported this contention with many examples of comparisons
of specific gravity and sugar content measured
directly with a saccharometer. His treatment for diabetes:
“Whatever is beneficial for excessive acidity is still more
useful in diabetes. Small meals, free from sugar and acid,
1690 CLINICALCHEMISTRY, Vol.33, No. 9, 1987

and the substances which can give rise to sugar and acids,
constitute the best diet” (18).
The Influence of Liebig
Bence Jones was impressed with the elegance of Liebig’s
concept of the oxidative metamorphosis of tissues, and was
convinced that it was essentially correct. He accepted it
uncritically and set out to show how it might be applied to
medical diagnosis and treatment, and based most of his own
future work on it. Liebig’s work was attractive because his
theories were based on a balanced system of oxidative
reactions, all fitted neatly together to explain the animal
functions.
Soon after returning to England from Giessen, Jones
published his first book, On Gravel, Calculus, and Gout;
chiefly an Application of Professor Liebig’s Physiology to the
Prevention and Cure of those Diseases (1842). Liebig had
suggested that oxidation of uric acid in the body yielded
urea, oxalic acid, and CO2. Using Liebig’s concept to explain
the causes, treatment, and prevention offormation of stones,
Bence Jones saw the problem as having to increase the
oxidation of uric acid to the more soluble urea, while
simultaneously blocking the breakdown of muscular tissue.
His plan was to increase the oxygen supply by promoting
the circulation while controlling the intake of non-nitrogenous
food-too much of which was believed to reverse
normal oxidation. To facilitate uric acid oxidation in the
blood, he administered alkaline medication to keep the uric
acid in solution where it was more readily in contact with
oxygen. The major fault with his book was his uncritical
acceptance and strong reliance on Liebig’s theories. He was
also guilty of speculative applications without prior experimental
investigation. Critics noted the absence of medical
case histories and experimental results, the same shorthornings
as in Liebig’s Animal Chemistry.
One critic noted that Jones’ book crowded together too
many physiological doctrines-the reviewer called them
“novelties”-into a very few pages, without explanation or
discussion. A great deal more discussion of the data would
be needed, he added, to change the minds of those with
preconceived notions (19).
In his systematic analytical studies of the urine in health
and disease, Bence Jones sought data that would make the
diagnosis of chemical diseases more reliable. He tried to
correlate the alkaline and earthy phosphates with diet,
exercise, and certain medications and found wide day-to-day
variations. When he followed the normal variations in
urinary acid he noted the 24-hour cycle of ebb and flow (the
“alkaline tide”). He observed that the administration of
ammonium salts produced an increased acidity in the urine,
owing to conversion of ammonium ion to urea. But, applying
Liebig’s theories of oxidation, Bence Jones explained the
effect as due to the oxidation of ammonium salts to nitric
acid.
Because of the strong impression made by Liebig’s work,
Bence Jones always preferred the findings of German chemists
over those of the French. This led him to ignore or even
to reject some important findings in physiological chemistry
made during his time. For example, he was not satisfied
with Claude Bernard’s experiments showing that pancreatic
juice saponified neutral fat, and he cited the contrary
opinion of a German researcher (20).
The weak point of his (and Liebig’s) work was a too-direct
application of the laws of chemistry to the complex phenomena
of the human body. In retrospect, it is obvious that
neither the chemical knowledge nor the techniques available
were up to the task.
A Role for Chemistry in Clinical Practice
In an age when the description of disease was often a mere
catalog of symptoms, Henry Bence Jones was one of only a
few medical men to appreciate the value of chemistry in the
explanation and treatment of disease. Chemistry was a
rapidly developing science in the early part of the nineteenth
century, and animal chemistry in particular, dealing
with the materials and functions of living organisms, appeared
to offer a foundation of firm scientific principles on
which to base both diagnosis and treatment. In Paris,
Antoine Fran#{231}ois Fourcroy (1755-1809) had studied biliary
and urinary calculi while, in Sweden, J#{246}ns Jakob Berzelius
(1779-1848) was utilizing improved analytical techniques
for animal fluids and tissues. And in Germany, at the
University of Giessen in 1824, Justus Liebig established the
first systematic laboratory course designed to train new
chemists. In England the medical applications of chemistry
were investigated by Alexander Marcet (1770-1822) (21)
and William Prout (1785-1850) (22) at St. George’s Hospital,
and by Gelding Bird (1814-1854) (23) and George Owen
Rees (1813-1889) (24, 25) at Guy’s Hospital.
It was at Guy’s Hospital that two wards of 42 beds were
set aside for a team of students and young physicians under
the direction of Richard Bright (1789-1858) (26) in his study
of albuminuria and renal disease. This special unit-the
first of its kind-was the forerunner of today’s metabolic
wards, and one of the earliest attempts to apply the physical
sciences systematically to the study of a specific disease. The
application of chemistry to medicine was new in the 1830s
as these investigators tried to correlate chemical tests with
symptoms of a particular disease in order to reach a more
reliable diagnosis. Although the utility of chemistry in
medicine was just coming to be recognized, the medical
profession in general was still indifferent and even hostile to
the idea that investigative work in animal chemistry could
lead to improved methods of diagnosis, prevention, and cure
of diseases.
Ideas on Medical Education
Henry Bence Jones was elected president of the chemistry
section of the British Association for the Advancement of
Science in 1866, the first practicing physician so honored. In
his welcoming remarks to the section’s annual meeting he
appealed for greater attention to chemistry in the training
of doctors, and said: “. .. whatever sets forth the union of
chemistry and medicine tends to promote not only the good
of science but also the welfare of mankind.. . chemistry is
absolutely requisite for the detection of a large class of
diseases.. . it is daily becoming more and more certain
that. . . every medical man [must] become a chemist if he
wishes to have any clear idea of the action of air, food, and
medicine. . .“ (27).
He also urged a revision in the curriculum for all wouldbe
physicians to include a first-rate instruction in English so
they “could explain the nature of the disease and the course
to be followed in the most idiomatic and unmistakeable [sicl
English. . .“ Medical men would be much better served, he
said, if they spent some time in acquiring knowledge about
chemistry and physics instead of “learning some Latin and
less Greek” (28). And, he contrasted “the present state of
medical education with that reasonable knowledge, which
ought to be possessedby those who attempt to under-
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stand and to regulate an apparatus that works only whilst
oxygen is going into it and carbonic acid is coming out of it”
(29).
In a separate report to the meeting he stated that only
through the use of exact chemical and physical experiments
will the actions of medicines become accurately known and
“the practice of medicine lose its doubts and difficulties, its
disagreements and deceptions. . . “ (30).
Opposition to these ideas came from those who still
believed that the chemistry of life was governed by a vital
force. Most physiologists were vitalists, as were many of the
leading animal chemists-including Liebig, who equated
the vital force with gravity, magnetism, and electricity, and
believed that, like these forces, the vital force would obey
experimentally determinable simple physical laws. Bence
Jones postulated a quantitative relationship between physical
and chemical forces with a minor contribution from the
vital force, but believed, as did other nineteenth century
chemists, that advances in chemical knowledge would eventually
obviate the notion of a vital force (31).
Personality
Traits
Bence Jones was not adept at clinical teaching, and for
this reason and because of his notorious lack of punctuality,
the students did not seek out his clerkship. Fascinating and
brilliant, he pronounced his diagnosis quickly and briefly.
Jones was self-reliant and strong-willed. Irritable in his
manner and at time impetuous, he was sometimes too quick
with criticisms for those with opposing views-a trait he
may have picked up from Liebig-and as a result was
himself not free from hostile criticism (32).
Illness and Failing Health
In 1861, after experiencing frequent palpitations of the
heart, his self-examination with the flexible stethoscope
revealed that chronic rheumatism had permanently injured
one of the valves of his heart. He resigned the following year
from St. George’s.
His health began to fail late in 1866 when he detected
fluid in one side of his chest. He was seriously ill in the
winter and spring of 1867. He recovered slowly, but his
health began a gradual decline. In 1870 Oxford awarded
him the honorary degree of D.C.L. (Doctor of Civil Letters).
By then his failing health was becoming progressively
worse. Early in 1873, too ill from enlargement of the liver,
ascites, and anasarca, he completely gave up his practice.
His weakened state worsened, and on April 20, 1873, he died
in his London home on Brook Street, Grosvenor Square,
from cardiac dropsy (congestive heart failure). By a strange
coincidence, his friend and mentor, Liebig, died a day
earlier. Henry Bence Jones was survived by his wife and
five of his seven children. A bust of him stands in St.
George’s Hospital and in the Royal Institution.
The Hyphen
Henry Bence Jones did not use the hyphen in his name
and it does not appear in any of his more than 40 papers and
books (33). Reference books published during his lifetime
enter him under Jones, as does the Royal College of Physicians
and the Dictionary of National Biography. The dictionary
of eponymic diseases (34) refers readers from Bence to
Jones. The hyphen was added by his descendants in the
autobiography published more than a half century after his
death.
References
1. Jones HB. Papers on chemicalpathology;prefacedby the Gutstonian
lectures, read at the Royal College of Physicians,1846.
Lancet 1847;ii:88-92.
2. Macintyre W. Case of mollities and fragilitas ossium, accompamed
with urine strongly charged with animal matter. Med-Chir
Trans 1850;33:211-32.
3. Dalrymple J. On the microscopic character of mollities ossium.
Dublin Q J Med Sci 1846;2:85-95.
4. Jones HB. On a new substanceoccurring in the urine ofa patient
with mollities ossiurn. Philos Trans R SocLondon 1848;138:55-62.
5. Clamp JR. Some aspects of the first recorded case of multiple
myeloma. Lancet 1967;ii:1354-56.
6. Bence-Jones H. An autobiography with elucidationsat later
dates (privately printed). Tottenham, London:Crusha & Son, Ltd.,
1929:33pages.
7 Coley NG. Henry Bence-Jones, M.D., F.R.S. Notes and Records
of the R SocLondon1973;28:31-56.
8. Holloway SWF. p 302 in: Medical education in England, 1830-
1858:a sociological analysis. History 1964;49:299-324.
9. Jones HB. On the presenceof sulphur in cystic oxyde,and an
account of a cystic oxyde calculus. Med-Chir Trans 1840;23:192-8.
10. LiebigJ. Animal chemistry or organic chemistry in its application
to physiologyand pathology.Edited from the author’smanuscriptby
William Gregorywith additions,notes, and corrections by
Dr. Gregory,and othersby John W. Webster. A facsimile of the
Cambridge edition of 1842, published by John Owen. Johnson
Reprint Corp.,New York, 1964.
11. RosenfeldL. Origins of clinical chemistry. The evolution of
protein analysis.New York: AcademicPress,1982:12-6.
12. JonesFIB. Autobiography(ref. 6) p 18.
13. Ibid., p 19.
14. Ibid., p 24.
15. CopeZ. Florence Nightingale andthe doctors.London: Museum
Press Limited, 1958:21-3.
16. Jones HB. On the dissolution of urinary calculi in dilutesaline
fluids, at the temperature of the body, by the aid of electricity.
Philos Trans R Soc London 1853;143:201-16.
17. Jones HB. pp 403-4 in: On intermitting diabetes, and on the
diabetes of old age. Med-Chir Trans 1853;36:403-32.
18. Ibid., p 430.
19. Lancet 1842-43;i:442-4.
20. JonesFIB.On the saliva and pancreatic juice.Med Times
1851;2(n.s.):579-82.
21. ColeyNG. Alexander Marcet (1770-1822), physician and animal
chemist. Med Hist 1968;12:394-402.
22. Brock WH. The life and work of William Prout. Med Hist
1965;9:101-26.
23. ColeyNG. The collateral sciencesin the work of GoldingBird
(1814-1854). Med Hist 1969;13:363-76.
24. RosenfeldL. George Owen Rees (1813-1889): an early clinical
biochemist. Clin Chem 1985;31:1068-70.
25. ColeyNG. George Owen Rees,M.D., F.R.S. (1813-89): pioneer
of medical chemistry. Med Hist 1986;30:173-90.
26. Peitzman SJ. Bright’sdiseaseand Bright’s generation-toward
exact medicine at Guy’shospital. Bull Hist Med 1981;55:307-21.
27. JonesFIB. Address. p 28 in: Rep to the Br Assocfor the Adv of
Sci 1866;36:28-33.
28. Ibid., p 32.
29. Ibid., p 31.
30. JonesHB. On the chemical action of medicines.Rep to the Br
Assocfor the Adv of Sci 1866;36:38-40.
31. Jones HB. (ref. 1) p 92.
32. Obituary. Med Times and Gazette 1873;1:505-8.
33. Verm JA, ed. Alumni Cantabrigienses (1752-1900). Cambridge:
Cambridge University Press, 1947: vol 3, part 2, p 599. This
biographical list states that Jones addedthe hyphento his name.
34. Jablonski S. illustrated dictionary of eponymic syndromes and
diseasesand their synonyms. Philadelphia:WB Saunders, 1969.
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