Robert Whyttt (1714–1766): from dropsy in the brain to tuberculous meningitis

Abstract

Robert Whytt was born and educated in Edinburgh and served the City in the Royal Infirmary. A prolific author, his major work is usually said to be his Essay on the Vital and other Involuntary Movements of Animals (1751), based on his belief that a 'sentient principle' was not limited to the nervous system but was distributed throughout the body, a view that brought him into conflict with Albrecht von Haller, who held that the sentient and motor powers of the body were those of a machine. Whatever about the speculative nature of the sentient principle, Whytt was a clinician blessed with unusual clarity, and he is remembered today for his Observations on the Dropsy in the Brain (1768). Therein he described the clinical signs and symptoms of what later came to be recognised as tuberculous meningitis, the acute disease which appears early in the haemic spread of the infection in a child, and which was fatal until the discovery of chemotherapy and antimicrobials. John Cheyne, in describing two terminal cases, recognised the connexion between hydrocephalus and scrophula, and Dorothy Price provided a precise guide to the clinical picture in 1942. When streptomycin became available Christopher McSweeney used it to alter the bleak picture in Dublin, and was helped by the prevention resulting from neonatal BCG immunisation. Later antimicrobials have facilitated the avoidance of emergent bacillary resistance.