Thomas Spens

Biography

• Born August 8, 1763 in Edinburgh; to physician, Dr Nathaniel Spens, of Craigsanquhar (1728-1815), and Mary Milliken
• 1784 – MD, University of Edinburgh with doctoral dissertation ‘De amenorrhoea’
• 1787 – Brigadier of the Royal Company of Archers
• 1788 – Fellow of the Royal College of Physicians, Edinburgh
• 1788 – Fellow of the Royal Society of Edinburgh (FRSE)
• 1803-1806 President of the Royal College of Physicians of Edinburgh
• Died May 27, 1842

Key Medical Contributions

In 1792, Thomas Spens published the first account in the English literature of Stokes-Adams syndrome with seizures secondary to heart block.

He described the case of a 54 year old male with a slow, regular pulse; random faints with loss of consciousness; an undisturbed pulse-rate with a static character, even under duress distress; and convulsions, which if prolonged, resulted in hardly any pulse being felt.

On the 16th of May 1792, about 9 o’clock in the evening, I was sent for to see T. R, a man in the 54th year of his age, a common labouring mechanic…I was much surprised, upon examining the state of his pulse, to find that it beat only twenty-four strokes to the minute. These strokes, however, as far as I could judge, were at perfectly equal intervals, and of the natural strength of the pulse of a man in good health. He informed me that about three o’clock in the afternoon he had been suddenly taken ill whilst standing in the street; that he had fallen to the ground senseless; and that, according to the accounts given him by those who were present, he had continued in that state for about five minutes…

From the time of his first attack till I saw him he had been affected with three other fits, mainly of a similar nature. These, however, were attended with some convulsive movements of his limbs, and with screaming during the fits… nor had he at any time any other complaint.

Upon visiting him on the morning of the 17th, I found that he had been attacked by several fits during the night. Upon examining his pulse I found that it beat only twenty-three strokes in the minute…an hour after I found it in precisely the same state as before. He was now directed to take some spirits of hartshorn; but, by mistake, it was given him very little diluted, and produced much uneasiness in his mouth and throat. From this cause I found him in great distress at one o’clock; but it seemed to have produced no change in the state of his pulse, which at this time beat twenty-four beats in a minute and was of the same strength and regularity as before.

In the morning of the 18th I was informed that he had been frequently faint…his pulse beat only twenty-six strokes in the minute. About 8 in the evening he had no sooner smelt it [newly toasted bread] than he felt some of the sensations of a beginning fit; and, as soon as he had tasted it, he almost instantly cried out, and fell back senseless, with smart convulsions of all his muscles. He apparently recovered in a few seconds; but hardly any pulse could be felt for a good many seconds. On the morning of the 19th I learnt that…had been attacked with frequent fits attended with violent convulsions…at three in the afternoon I found that it (the pulse) beat only ten strokes a minute, though it still continued equally strong and regular as before…he expired on the 20th.

The day after his death the body was opened by Mr. Fife, and, upon the most careful examination, no morbid appearance of any consequence could be discovered either in the thorax or abdomen

Spens 1792: 458-465

Major Publications

• Spens T. History of a case in which there took place a remarkable Slowness of the Pulse. Medical commentaries. 1792: 458-465 [Stokes-Adams syndrome]
• Richter AG. Medical and surgical observations. [Translation: Thomas Spens 1794]
• Spens T. Cases of Erythema Mercuriale, with Observations. Edinb Med Surg J. 1805; 1(1): 7-20.
• Spens T. Case of Conversion of the substance of the Heart accompanied by a sac at the mouth of the aorta. Edinb Med Surg J. 1816; 12(46): 192-194

References

Biography

• Papers of the Spens Family. National records of Scotland
• Thomas Spens. Peerage
• Former Fellows. Fellows of the Royal Society, Edinburgh
• Presidents of the College. Historical Sketch and Laws of the Royal College of Physicians of Edinburgh. 1867
• Dickson TG. The identity of Dr. Thomas Spens. Lancet, 1913; 182(4706): 1357
• Mosley C. Thomas Spens. Burke’s Peerage, Baronetage & Knightage, 2003; 107: 3385

Eponymous terms

• Lea CE. Dr. Thomas Spens: The First Describer of the Stokes-Adams Syndrome. Proc R Soc Med. 1914;7(Sect Hist Med):243-6.
• Lea CE. Dr. Thomas Spens: The First Describer of the Stokes-Adams’ Syndrome. Edinb Med J. 1914 Jul; 13(1): 51–55.