John Alfred Ryle

Biography

• Born December 12, 1889, Brighton. Third in a family of 10 children, son of Dr RJ Ryle.
• 1913 – Qualified in medicine, Guy’s hospital, London. Won Gold Medal in medicine.
• 1914-1918 – Royal Army Medic Corps WWI, investigated typhoid and trench fever.
• 1920 – Assistant Physician at Guy’s Hospital.
• 1924 – Fellow of the Royal College of Physicians (FRCP) and elected physician to Guy’s hospital, London.
• 1932-1936 – Physician to King George V, his household and then Physician Extraordinary to the King.
• 1935 – Regius chair of physic at Cambridge. Surveyed the hospital on the East Coast from Newcastle to London to determine which locations would serve well as Emergency Hospitals in the event of war.
• 1939 – Consultant Adviser to Ministry of Health in addition to clinician and educator at Guy’s Hospital.
• 1943 – First professor of social medicine (epidemiology) at Oxford studying the environmental factors in the production of disease, and in spite of poor health traveled widely
• Died February 27, 1950, Sussex. Heart attack was the cause of death – see angor animi.

Medical Eponyms

Ryle Tube (1921)

The Ryle tube was a new type of nasogastric tube, developed in 1921. Ryle made modifications to the brass-tipped nasogastric tube introduced by Max Einhorn (1862-1953). Ryle implemented a thin, all rubber design to his nasogastric tube.

Patients of the time requiring enteral feeding were experiencing starvation, dehydration, and immanent mortality unless the underlying condition improved spontaneously. The barrier to sufficient administration of nutrition and fluids via the enteral feeding route was due to poor patient compliance swallowing and maintaining the large, hard tubes.

Ryle identified the lack of hollow, flexible tubes when his wife failed to swallow the original tube, which suggested a smaller and all rubber tube could be swallowed or inserted for better effect.

The establishment of Ryle’s thin, all rubber, flexible tube enabled routine nasogastric feeding. Ryle’s nasogastric tube is inserted into the nostril, down the nasopharynx, oesophagus and into the stomach. Ryle recorded experiments performed on himself:

…to ascertain (1) the degree of discomfort entailed by swallowing and retaining the gastric tube, and (2) the secretory response to a standard test meal in a healthy subject; on no occasion was any real difficulty experienced in swallowing the tube, and after the first trial no unpleasant symptom of any kind was noted, talking and even mastication not being interfered with.

Ryle 1921; 71: 43

Angor animi (1928)

Ryle coined the phrase to describe “the aura of a nervous storm having its origin in those medullary centres upon which the act of living depends” during his work on vertigo and tumours of the vagus nerve and CNS.  He considered it a ‘medullary aura’, akin to aura’s associated with seizures or migraines. 

What a strange force it is that can stir, and with such intensity, a consciousness of the imminence of an event of which there can never have been any actual experience, and yet is so frequently inoperative when death is at hand.

Ryle JA, 1928; 78: 371-376

Ryle later developed angina in 1942 and described his own experiences of angor animi in 1950, linking the term to a cardiac origin and not only neurogenic phenomena. His son completed the postscript after his death.

• Ryle JA. Angor Animi, or the sense of dying. Guy’s Hospital Report. 1928; 78: 371-376
• Ryle JA. The sense of dying–a postscript. Guy’s Hospital Report. 1950; 99(4): 224-229.

The term persists today but is most often used to describe the sensations from either acute myocardial infarction or the administration of adenosine. 

When asking in your history taking if a patient has ever directly experienced angor animi, we hope you have a better experience than that described in 1964 in the BMJ by Dr J.C. Barker:

I was called to examine a man aged about 60 with a history of effort angina which had increased progressively during the preceding few weeks. He was sitting up in bed chain-smoking and appeared extremely tense.

I inquired about the character and distribution of the pain and its relationship to exertion, and his replies were lucid and gave a classical picture of angina pectoris. I then inadvertently asked him whether he ever felt he was going to die during one of the attacks. He did not reply to this question but his attitude immediately changed. He seemed to become increasingly distressed and looked at me with fixed staring eyes.

He died about one minute later while I was auscultating his heart.

Barker JC 1964

Controversies

Firm advocate of the National Health Service and creating less disparity between consultants and other doctors led to incomprehension and hostility from many of his colleagues

Major Publications

• Ryle JA. Studies in Gastric Secretion. Guy’s Hospital Report. 1921; 71: 43.
• Bennett TJ, Ryle JA. Studies in Gastric Secretion. Guy’s Hospital Report. 1921; 71: 286. [gruel test-meal]
• Ryle JA. Discussion on the diagnosis of gastric ulcer. Proc R Soc Med. 1922;15(Med Sect):7-8.
• Ryle JA. Case of Erythraemia (Vaquez-Osler Disease). Proc R Soc Med. 1922;15(Clin Sect):28.
• Ryle JA. On the study of gastric function in health and disease. Goulstonian Lectures. Lancet 1925; 205(5299): (I 583-594) (II 641-650) (III 697-705) (IV 754-759)
• Ryle JA. Angor Animi, or the sense of dying. Guy’s Hospital Report. 1928; 78: 371-376
• Ryle JA. The Aims and Methods of Medical Science. OUP 1935
• Ryle JA. The natural history of disease. OUP. 1936
• Ryle JA. Medicine and eugenics. Eugen Rev. 1938 Apr;30(1):9-19.
• Ryle JA. To-day and To-morrow. Br Med J. 1940 Nov 16;2(4167):657-9
• Ryle JA. The Future of Medical Education as Seen by a Teacher. Br Med J. 1941 Sep 6;2(4209):323-7.
• Ryle JA. Fears may be liars. London, Allen & Unwin. 1941
• Ryle JA. The Science of Health. Br Med J. 1942 Dec 26;2(4277):745-8.
• Ryle JA. Changing disciplines; lectures on the history, method and motives of social pathology. OUP 1948
• Ryle JA. The sense of dying – a postscript. Guy’s Hospital Report. 1950; 99(4): 224-229.

References

Biography

• Obituary: J A Ryle MD FRCP. 1950; 1(4653): 611–613.
• Symonds C. John Alfred Ryle. Guy’s Hospital Report. 1950; 99(4): 200-222.
• John Alfred Ryle. Munks Roll. Volume IV: 595

Eponymous terms

• Birch CA. Ryle’s tube. John Ryle (1889-1950). Practitioner. 1974; 213(1276): 581-582.
• Ban TA, Lohrenz JJ, Lehmann HE. Observations on the action of Sernyl-a new psychotropic drug. Can Psychiatr Assoc J. 1961; 6(3): 150-157.
• Chernoff, R. An Overview of Tube Feeding: From Ancient Times to the Future. Nutrition in Clinical Practice. 2006; (21), 4, 408-410
• Jones B. From Ryle’s tube to PEG and beyond; a personal journey. Journal of Human Nutrition and Dietetics: The Official Journal of the British Dietetic Association. (2011; 24), 205-208.

angor animi

• Angor animi. The Lancet, 1951; 257(6660): 898
• Ban TA, Lohrenz JJ, Lehmann HE. Observations on the action of Sernyl-a new psychotropic drug. Can Psychiatr Assoc J. 1961; 6(3): 150-157.
• Barker JC. Angor Animi. Br Med J 1964; 2: 688