Background

Lewis was born on December 26, 1881, in Taffs Well, Cardiff, Wales, to Welsh parents. His father, Henry Lewis, was a prominent coal mining engineer from a long line of Monmouthshire yeomen, his mother's name was Catherine Hannah Davies.

Education

Lewis' family was well-to-do, and he was educated at home until the age of sixteen by his mother and a private tutor. His upbringing was Methodist and his father, to whose encouragement and stimulus he owed much, was a widely read and clearheaded man with a library of several thousand volumes. However, the young Lewis had no interest in books and spent every spare moment in sporting activities and in the local fields and woods.

He took up medicine because he hoped that by becoming a doctor he might emulate the skill of the family physician, who was an expert conjurer. After preclinical work at University College, Cardiff, where he was encouraged in critical thought and research by the physiologist Swale Vincent, in 1902 he entered University College Hospital, London, his medical home for the rest of his life. He graduated as a Bachelor of Medicine and Bachelor of Surgery (university gold medal) in 1905, Doctor of Medicine in 1907, and was elected fellow of the Royal College of Physicians in 1913.

Career

Lewis became a fellow of the Royal Society of London in 1918 and was knighted in 1921. Of his numerous national and foreign distinctions none was more significant than the Copley Medal of the Royal Society (1941), which had previously been awarded to only one clinician, Lord Lister. In 1916 Lewis was appointed physician on the staff of the Medical Research Committee (later Council), which, as he later said, broke the ice in Great Britain as the first full-time research post in clinical medicine.

Lewis’ career in medical research began while he was still a student, with the publication of papers on the hemolymph glands that later became standard works. But his interest in cardiac physiology, stimulated by a year in E. H. Starling’s laboratory, came from his work with Leonard Hill on the influence of respiration on the venous and arterial pulses. This association inevitably led him into contact with James Mackenzie, whose great work, The Study of the Pulse, had appeared in 1902. Their meeting in 1908 began a friendship that profoundly influenced Lewis’ life. Mackenzie urged him to study the irregular action of the heart, and Lewis acquired the new Einthoven string galvanometer, set it up in the medical school basement, and plunged into his investigations on the spread of the excitatory processes in the dog heart, coupled with bedside and electrocardiographic studies on clinical arrhythmias. In 1909 he showed that Mackenzie’s “irregular irregularity” of the heart was due to atrial fibrillation. Only two years later The Mechanism of the Heart Beat was published, and this scholarly scientific monograph soon became the bible of electrocardiography.

Lewis’ work from 1908 to 1925 gave him a complete mastery of all aspects of the electrophysiology of the heart, the human electrocardiogram, and clinical disorders of the heartbeat. It included his famous hypothesis of circus movement as the mechanism of atrial fibrillation. Much of this work, done with a succession of talented young men, of whom the first were Paul D. White of Boston and Jonathan Meakins of Montreal, was published in the journal Heart, which Lewis founded with Mackenzie’s help in 1909.

World War I interrupted these studies in 1914, just after Lewis’ return from America, where he had delivered the Herter lectures in Baltimore and the Harvey lecture in New York. Fortunately his talents were harnessed to a study of the condition known to the military as D.A.H. (deranged action of the heart), which was causing a serious loss of manpower at the front. His work at the Military Heart hospitals led to its redefinition as the effort syndrome, with “a system of graded drills employed remedially and as a means of justify grading soldiers for supposed affections of the heart.” This was the foundation of his later insistence on judging the state of the heart from the patient’s exercise tolerance rather than on the then fashionable method of assessing cardiac murmurs. He was also involved in the problems of diagnosis and prognosis in organic heart disease and with R. T. Grant instituted an unsurpassed follow-up over ten years of 1,000 soldiers with valvular disease.

Lewis’ third, and last, period began with his work on pain. One suspects that this subjective phenomenon taxed even his unique research talents to the utmost. Certainly, the summary of his researches published as the monograph Pain (1942) lacks the sparkle of his earlier writings. Nevertheless, much was accomplished.

Lewis’ worldwide fame as a teacher came from a number of books written for a wider audience than was reached by his scientific papers and monographs. The first, in 1912, was Clinical Disorders of the Heart Beat, followed in 1913 by Clinical Electrocardiography. Both went through several editions and must have been a godsend to clinicians trying to understand the then novel methods of investigating the heart, However, Lewis grudged the time spent on them, writing only from a sense of duty to the profession. His best-known book, Diseases of the Heart (1933) , was widely translated. Clinical Science, Illustrated by Personal Experiences (1934) recounted his methods of attack upon clinical problems such as intermittent claudication and bacterial endocarditis. Vascular Disorders of the Limbs (1936) is still a most useful acount. His last book, Exercise in Human Physiology (1945), demonstrates his interest in medical education and presents a detailed account of simple experiments that students may make on themselves.

At University College Hospital he worked constantly in the wards and in the out-patient department. His superb clinical teaching emphasized a meticulous examination of the patient followed by a penetrating analysis of the relationship of the symptoms and signs to the underlying hemodynamic and pathological disturbances. Few students other than his clinical clerks attended his rounds, however, the majority preferring didactic presentations. At his regular medical school lectures, he displayed his interest in the history of medicine, especially the French physicians of the nineteenth century.

Achievements

• Lewis’ most important contribution to medicine may have been his concept of clinical science, his insistence that progress in medicine would come chiefly from scientific studies on living men in health and disease, rather than from the basic science laboratories and from animal experimentation. With the controlled investigation of patients now basic to much of medicine, it is difficult to relive the time when Lewis, almost alone, fought for the creation of established career posts in medical research, now numbered in the tens of thousands. This must have been the most difficult period of his life and he signaled it in 1930 by renaming his own department the Department of Clinical Research and by founding the Medical Research Society, and in July 1933 by changing the title of Heart to Clinical Science.

Works

More photos

• book

  • The mechanism of the heart beat with especial reference to its clinical pathology 1911
  • Clinical Electrocardiography 1913

Views

By 1925 Lewis had had enough of his elaborate electrocardiographic work and, believing that “the cream was off,” he returned to observations on the cutaneous vessels which he had started during the war. He was also influenced by a growing belief that man, not animals, was the proper subject for hospital-based research. A series of observations on the vascular reaction of the skin to various injuries led to his description of the red line, flare, and wheal so produced as the triple response, with the postulate that the original stimulus acts by damaging the tissues, which produce a histamine like a compound that Lewis called the H-substance. This work was gathered together in 1927 in his monograph The Blood Vessels of the Human Skin and Their Responses. A notable feature of these experiments which became a hallmark of his later work was that they were carried out with the simplest apparatus, as was his brilliant elucidation of Trousseau’s phenomenon in tetany using only two blood-pressure cuffs. In parallel with this laboratory work, he was engaged in a study of Raynaud’s disease and other maladies affecting blood flow to the limbs and digits.

Membership

• Royal Society of London , United Kingdom

  1918

Personality

A man of outstanding intellect with an enormous capacity for unrelenting hard work, Lewis remained in full mental vigor until the end of his life, although he sustained a myocardial infarct at the age of forty-five. At the time of a second attack eight years later he said to Sir Arthur Keith, “Another arrow from the same quiver, my friend, and one of them will get me in the end.”

Connections

In 1916 Lewis married Lorna Treharne James of Merthyr Tydfil, Glamorgan, Wales; they had two daughters and one son.

Father:

Henry Lewis

Mother:

Catherine Hannah Davies

Spouse:

Lorna Treharne James

colleague:

Willem Einthoven

colleague:

Arthur MacNalty

He was the 8th Chief Medical Officer (the British office equivalent of the Surgeon General of the United States).

References

• Sir Thomas Lewis: Pioneer Cardiologist and Clinical Scientist
  1997
• Dictionary of Scientific Biography Volume 7
  1973