Classics in clinical science: James L. Gamble and “gamblegrams”

Abstract

James Lawder Gamble (1883-1959) one of the most important contributors to the advance of clinical science in this country, graduated from the Harvard Medical School in 1910. Following a two-year medical internship at the Massachusetts General Hospital and a year on the staff at the Children’s Hospital in Boston, he visited various European clinics. His sojourn in Europe represented a turning point in his career, as he developed an interest in the study of disease by the quantitative methods of biochemistry, cumbersome as they were at that time [l-3]. On his return to Boston, Gamble worked for a brief period in the laboratory of Otto Folin, professor of biochemistry at Harvard, where simple chemical procedures applicable to the study of metabolic processes in man were being developed. He then returned to the Massachusetts General Hospital as an investigator in the small chemical laboratory under the direction of Fritz Talbot. While there, he formed an enduring friendship with his Harvard classmate Walter W. Palmer, who later became Professor of Medicine at Columbia’s College of Physicians and Surgeons in New York. Gamble fell under the spell of Professor Lawrence J. Henderson, with whom Palmer was working; he was fascinated by Henderson’s physicochemical approach to physiologic processes. In accepting the Kober Medal of the Association of American Physicians in 1951, Gamble [4] spoke as follows regarding the importance of these early influences on his career: “In 1913 the gentle and kindly Folin gave me headspace . . . and I found it an exciting experience to learn these new technics which made quantitative information so easy to come by. . . I had a great affection for Van Slyke’s first CO2 burette. It was not the large machine of nowadays with the noisy mechanical shaker. One rocked it gently by hand as a little girl does her doll. . . “On leaving Folin’s laboratory my luck continued. In a small chemistry laboratory at the MGH my classmate Bill Palmer was measuring pH in the urine for the first time and carrying out under Lawrence Henderson’s guidance their classic description of the process of acid excretion . . . Henderson appeared about twice a week to see how Bill was getting along. It was evident that he did not like the clatter that I made dashing about the Laboratory tending my various analyses and one day he came over, placed his hand on my shoulder and said: ‘Young man, you will never get anywhere in this game until you learn an attitude of leisure.’ From then on he took the kindliest interest in my endeavor in a direction for which I was so ill prepared. Although I never worked directly with Henderson I learned from him to admire the beauty of the physico-chemical systems which sustain the body fluids, the marvel of their automaticity and their remarkable resiliency in the presence of obstacles imposed by disease, and ever since I have been content to work in this field as a humble artisan applying the simple tool of quantitative description to the pattern provided by this great architect of concept. Lawrence Henderson’s friendliness, which came to me by sheer accident, I count as one of fortune’s largest gifts.” In 1915, Gamble was invited to become a staff member in the new full-time department of pediatrics under John Howland at the Johns Hopkins University School of Medicine. He remained in Baltimore until 1922 when he was recruited by Oscar Schloss to join him in the establishment of a full-time staff in the department of pediatrics at the Harvard Medical School. Schloss left Boston within a year to return to New York, but fortu-