Dr W Jobson Horne – The Relationship of the Larynx to Pulmonary Tuberculosis

Written by Jonathan M Fishman (FRCS (ORL-HNS), PhD)

Walter Jobson Horne (2 Aug 1865–7 March 1953)

Claire College, Cambridge and St. Bartholomew’s.

B.A., 1887, M.B.B.S., 1892, M.R.C.P., 1896, M.D., 1901

Dr. Walter Jobson Horne, who died at Mereworth, near Maidstone, Kent, on 7 March  1953, at the age of 87, made important contributions to the advance of laryngology, mainly with reference to tuberculosis of the larynx.

Dr. Walter Jobson Horne studied at Tonbridge School (1877-84) and then went on to read Natural Sciences at Clare College, Cambridge (B.A. 1887. M.A.) and medicine at St Bartholomew’s (M.B.B.S. 1892). He became chief assistant in the throat department of St. Bartholomew’s before continuing his postgraduate studies at the University of Berlin. In 1896, when the Metropolitan Ear, Nose and Throat Hospital was reorganised by Hemington Pegler, he joined the staff and served for many years as honorary surgeon and honorary treasurer to the board. During the war of 1914-18, when his hospital became the ear, nose, and throat subsection of Millbank (Queen Alexandra’s Military Hospital), Jobson Horne took a prominent part in the care of aural casualties, and wrote on gun deafness and its prevention. Jobson Horne was a keen BMA man and an enthusiastic scholar of the history of medicine.

Jobson Horne was honorary secretary and editor of the catalogue of the museum of the British Congress for the Prevention of Tuberculosis in 1901. His reputation was made rather as a laryngological pathologist than as a clinical laryngologist and was the first to point out, by means of serial microscopic sections, that in tuberculous laryngitis the infection could begin in the laryngeal ventricle as well as in more obvious areas. Nevertheless, he was the inventor of two of the most useful and practical adjuncts to otolaryngology – the Jobson Horne ring-probe and the Jobson Horne head-mirror, both favourably known all over the world.

He became President of the Section of Laryngology of the Royal Society of Medicine in 1920 and in 1921 was the third person (following McBride and Killian) to be invited to give the Semon Lecture (instituted in 1913, but no lecture was given between 1915-1920). He chose as his subject ‘The Relationship of the Larynx to Pulmonary Tuberculosis,’ in which he stressed the fact that laryngeal tuberculosis was always secondary to pulmonary tuberculosis, a view which was not universally held at that time.

Although we know this much with certainty, one can only speculate what else Jobson Horne would have spoken about in his 1921 Semon Lecture. The most serious diseases treated at the end of the 19th century were diphtheria, tumours of the throat, cerebral abscess and tuberculosis (TB). Part of Jobson Horne’s lecture may have discussed treatments at the time for laryngeal TB. In 1891 Koch’s remedy for TB involved large quantities of tuberculin being injected into the throat, which was distressing to patients. It was eventually recognized that, while tuberculin was invaluable for identifying TB, it was not suitable as a treatment.

One can also speculate (although this is purely hypothetical) that at that lecture Jobson Horne may have made reference to Sir Morrell Mackenzie’s (1837-1892) assessment of the Crown Prince Frederick of Germany (later Emperor Frederick III), who was suffering from hoarseness in 1887. It was suspected that Frederick had cancer, but a biopsy proved negative. Mackenzie advised against surgery but within a few months it became clear that the Emperor did indeed have cancer of the larynx. A palliative tracheostomy was performed, but Frederick died in March 1888, having reigned for only 99 days. Although Morell Mackenzie was blamed for the death, the Emperor himself had held him in high esteem. Jobson Horne may have taken the view in this lecture that the Crown Prince was in fact suffering from laryngeal tuberculosis and had become malignant since his first examination, in consequence of the irritating effect of the treatment by the German doctors; a view held by Mackenzie.

Jobson Horne’s memory is perpetuated by his invention of the much-used Jobson Horne ring probe and by the eponymous lecture given under the auspices of the BMA by a leading otolaryngologist.

References

Obituary. British Medical Journal (March 21 1953), 1(4811): 679.

Weir N, Weir S, Stephens D.  WHO WAS WHO AND WHAT DID THEY DO? A Biography of Contributors to Otolaryngology from Great Britain and Ireland. J Laryngol Otol 1987;101(1):23-87.

Descriptive catalogue of the Museum of the British Congress on Tuberculosis held in London, July 22nd to 26th, 1901. Compiled and edited by W. Jobson Horne, MD. Hon. Secretary to Museum Committee. http://wellcomelibrary.org

‘Lost Hospitals of London’ website, http://www.ezitis.myzen.co.uk/