Graves Lecture 1977

13/09/1977 in Royal College of Physicians of Ireland, 6, Kildare Street, Dublin 2

Denis G. McDevitt, Department of Therapeufics and Pharmacology, The Queen’s University of Belfast.

The Clinical Importance of the Sympathetic Nervous System in Graves Disease

Robert Graves is almost certainly the most famous and most significant figure in Irish medicine. It must, therefore, be regarded as a quirk of fate that his name is remembered principally in association with a disease where, although his description was original and independent (Graves, 1835), it has not subsequently been found to be the first (Parry, 1825). However, the clinical description of a previously unrecognised disease epitomises the ethos of Graves’ philosophy in medicine and his most significant contributions. Before his influence, undergraduate medical education in the British Isles consisted of acquiring theoretical knowledge of medicine both from books and from didactic ward teaching, during which the student neither interviewed nor examined patients. On qualification he became, in Graves’ own words. “a practitioner who has never practiced’ (Graves, 1832). As a result of his experience of European medicine, particularly Carman, Graves sought to destroy this system and to replace it by one in which the medical student became an apprentice doctor in the fullest sense. To use his own words to the students in the Meath Hospital in 1821, ‘Employed elsewhere in learning the principles that constitute the basis of medical education, you ought to be impressed with a precise notion of the peculiar objects and utility of hospital attendance, you come here to convert theoretical into practical knowledge; to observe the symptoms of diseases previously known to you only through the medium of books or lectures, to learn the art of recognising these symptoms, and of appreciating their relative importance and value; to study their connection with morbid alterations of internal organs; and, finally, to become acquainted with the best method of relieving your patients by the application of appropriate remedies’ (Graves, 1832). His success in accomplishing this goal can be judged by the fact that this system became and has remained the basis of medical education. Most of us, therefore, have experienced his influence and owe a debt of gratitude to him.

Irish J Med. Sci December 1977, 146:353

This being the seventeenth Graves Lecture since its beginnings in 1961.