Graham Steell

Biography

• Born 27 July 1851, Edinburgh, Scotland
• Educated at the Edinburgh Academy. Originally he wanted to be a soldier, but was persuaded into medicine by his brother.
• 1872 – Achieved M.B. from Edinburgh University
• 1873 –House-physician to George Balfour at the Edinburgh Royal Infirmary, who sparked Steell’s interest in cardiology
• 1874-77 – Practiced at several fever hospitals in Edinburgh, Leeds and London
• 1877 – Awarded M.D. with gold medal for his thesis ‘On scarlatina’ from the University of Edinburgh, which described patients scarlet, enteric and typhus fevers.
• 1878 – Resident medical officer at Manchester Royal Infirmary, where he was constantly on call and lived in the hospital
• 1883 – Honorary assistant physician to the Manchester Royal Infirmary and conducted extensive research into fevers.
• 1888 – Contracted Tuberculosis, but recovered after several months leave
• 1889 – Fellowship of the Royal College of Physicians
• 1907 – Elected chair of clinical medicine, Manchester Royal Infirmary
• 1911– Retired from the Royal Infirmary and university chair of clinical medicine
• Died 10 January 1942, Streatham Common, England. He was noted to have maintained his passion for medicine right up until his death.

Medical Eponyms

Graham Steell murmur (1888)

Soft, blowing, decrescendo early diastolic murmur of pulmonary incompetence caused by pulmonary hypertension

The murmur of high pressure in the pulmonary artery was described in an address to the Manchester Medical Society and was later published in the Medical Chronicle in 1888. The murmur was detected with a monaural stethoscope made of box wood, with a bell-shaped earpiece. The significance of the heart muscle and alterations in the valve in the production of abnormal signs on auscultation were emphasized.

Notable Quotables

In regards to the emergence of many new technologies in medicine:

Clinical medicine seems to me at the present moment to be in danger of losing something of its old charm, and in the future of losing much more

In relation to oedema:

 Capricious distribution of dropsy is especially apt to occur in cases of the cardiac muscle-failure of beer-drinkers and of the disease known as beri-beri, of both of which diseases, it is curious to note,peripheral neuritis is a clinical feature. . .  Curious special localizations of oedema met with, in cases of the kind, have been the scrotum, and together the upper trunk, upper extremities, and scalp and neck, so that the oedema simulates that resulting from mediastinal tumour

This type of heart failure is currently understood to be due to thiamine deficiency

Major Publications

• Steell G. Physical Signs of Cardiac Disease. 1881.
• Steell G. Thesis “On Scarlatina”. 1887.
• Steell G. Murmur of high-pressure in pulmonary artery. The Medical Chronicle (Manchester). 1888; 9: 182-186 [Graham Steell murmur]
• Steell G. Mitral regurgitation. The Practitioner. 1891; 47(2).
• Steell G. Diastolic murmur in dilatation of the heart without arterial incompetence or auriculo-ventricular constriction. The Practitioner. 1895; 52(4).
• Steell G. The Use of the Sphygmograph in Clinical Medicine. 1889.
• Steell G. A Clinical Lecture on Pericarditis: Delivered at the Manchester Royal Infirmary. Br Med J. 1900; 27;1(2039): 181-183.
• Steell G. Text-book on diseases of the heart. 1906.

References

• Bramwell C. Graham Steell. Br Heart J. 1942 Jul; 4(3): 115–119. [PMC503491] [Graham Steell Portrait]
• Fraser AG, Weston CF.The Graham Steell murmur: eponymous serendipity? J R Coll Physicians Lond. 1991;25(1):66-70. [PMID 2023159]
• Review: Graham Steell (1851-1942) JAMA. 1965 Feb 22;191:671.
• Brockbank,W. The Honorary Medical Staff of the Manchester Royal Infirmary, 1830-1948. Manchester University Press, 1965
• Obituary. Graham Steell (1851-1942). British Medical Journal. 1942;1:129-131
• Robbins A, Zhang G. Name that murmur. LITFL 2019