This is George Grenville (1712-1770): Whig Politician, once First Lord of the Admiralty, then Prime Minister of Great Britain from 1763-1765, and later Chancellor of the Exchequer. Probably also a myeloma patient! And…the subject of #HematologyTweetstory 30, about old bones.🙂/1 
Over here in America, Grenville is best known for an ill-advised policy he championed in 1765 called the “Stamp Act”: a tax on colonial documents & newspapers, which could only be printed on special paper shipped from London. This notorious Act outraged the colonists./2
In fact, when I learned about the Stamp Act in elementary school more than 200 years later (!), the teacher described it in such virulent terms that we 7-year-old lads were ready to take up muskets to defend the Stars & Stripes. There were even scuffles on the playground./3
Here in Boston, Grenville's Stamp Act was so hated that the Sons of Liberty (Sam Adams et al) formed, and the official responsible for implementing it, Andrew Oliver - depicted below in a John Singleton Copley painting - was hanged in effigy from the famous Liberty Tree./4
Having badly misjudged the Zeitgeist and under criticism from Parliamentary opponents, Grenville stepped down as Prime Minister & the Stamp Act was repealed, as commemorated in this 2016 stamp @APS_stamps & this @peabodyessex teapot. Grenville died on 13 November 1770, aged 58./5
Before his death, Grenville was seen in consultation by Dr. John Hunter (1728 – 1793), a noted surgeon, for an illness affecting his bones. His case records have been lost. After death, Hunter (depicted here in a Joshua Reynolds painting @ExploreWellcome) performed an autopsy./6
Dodsley's Annual Register for the year 1770 included these comments about Grenville’s autopsy: "When his body was opened, the blood vessels in the head were nearly empty; the rib bones on one side rotten, and two on the other side the same.” Not much patient privacy in 1770./7
Keep in mind Grenville died 75 years before Sarah Newbury, whom Samuel Solly treated in 1840 - often called the first clearly described case of myeloma - and the famous case of grocer Thomas McBean, who died in 1846 and whose urine was analyzed by Henry Bence Jones./9 @VincentRK
Hunter was a remarkable Scottish surgeon/scientist, who supported Jenner’s early vaccination studies & conducted the 1st artificial insemination. Many years ago I read the 1970 Kobler biography, “The Reluctant Surgeon”. @wendymoore99 wrote excellent 2010 bio, “The Knife Man.”/10
Hunter’s biggest academic goof? He was convinced that #gonorrhea and #syphilis were the same disease. Allegedly he injected someone – possibly himself! - with a needle with pus from a patient with gonorrhea, not realizing the patient *also* had undiagnosed syphilis…/11
When the patient (possibly Hunter) contracted both gonorrhea and syphilis, Hunter considered his hypothesis ‘proven'. He wrote about it in "A Treatise on the Venereal Diseases" in 1786 and it muddled the field for 50 years. Whoops. An early foray into experimental confounding/12
Hunter convinced many patients to give him their bodies after death or surgical specimens during life. Some specimens, like the skeleton of ‘Irish Giant’ Charles Byrne, were obtained by illegal means. Hunter amassed a huge collection of anatomical specimens, useful for teaching.
In 1799, after Hunter’s death, the UK government purchased his anatomical collection and gave it to the Royal College of Surgeons @RCSnews. The Hunterian collection still exists, but was heavily damaged during the London Blitz in early WW2 by German bombs./14
The Hunterian Museum @RCSnews at Royal College of Surgeons' buildings in Lincoln’s Inn Fields in London is currently closed & will reopen in 2022. I can highly recommend a visit. The first time I went was around 2004, when I lived in Oxford; museum had just been refurbished./15
During my visit, I saw Grenville’s skull in a display case. Here it is from the RCS SurgiCat. Hunter wrote, "From the Hon. George Grenville- many other bones were found in the same condition, where, in place of the bone that was removed, there was found a curdly substance."/16
Spigelman and colleagues imaged the calvaria. Below right is a figure from their paper, as well as 1) two sketches of several representative bones drawn by one of Hunter's autopsy assistant, William Bell, and 2) upper right, another SurgiCat photo from RCS./17
I noticed these punched out lesions on the skull & wondered if Grenville had myeloma. I met with @RobertK68033234 when I returned to @MayoClinic and he had not only been to the Hunterian, he'd noticed it as well. Typical of RAK. No one knows more about the history of myeloma./18
The only way to prove Grenville had myeloma would be to do further molecular analysis on remaining tissue and look for characteristic genetic alterations - probably protein is all gone. There have been other old bones described with lytic lesions... /19 nationalgeographic.com/news/2016/07/o…
...but whether these are due to myeloma, metastatic cancer, infection or something else can be difficult to prove. Definitive retrospective diagnosis from ancient bones is tricky. Paleopathology has evolved as a field, but there is still much to learn. 💀🦴 /20End
