At the time of his death in 1965, Russell LaFayette Cecil could plausibly be called “the best known American physician in the world” (1) due to his editorship of his Textbook of Medicine (2). He was born on 13 October 1881 in Nicholsville, Kentucky, son of the Reverend Russell Cecil DD, and Alma Miller Cecil (3-6). Cecil’s father became pastor of the Second Presbyterian Church in Richmond, Virginia and his son Russell graduated from Princeton University in 1902 and from the Medical College of Virginia in 1906. Cecil’s Princeton graduation yearbook describes the typical member of his class as male, Presbyterian, Republican, a history major, and a baseball fan (7). The class’s favorite teacher was Woodrow Wilson who later became President of the United States. Their favorite authors were Scott, Dickens and Thackeray.

Cecil described himself as a 150 pound, 5 feet 10 ½ inches tall, Presbyterian Democrat, whose favorite author was Dickens, favorite study was biology, and favorite sport was tennis. During each of his four years in the class he made the ‘second honors’ group list. His classmates reported their best friends (‘Kid’, ‘Bunt’ and ‘Charlie’ for example), but unlike them, Cecil said his ‘familiarity’ was his mother (8).

In his class report seven years after graduation (1910) he had the following to say about his life:

The story of my life since leaving Princeton can be told in brief and simple measures. I took up the study of Medicine in the fall of 1902 and pursued it with considerable strenuosity for four years. (9)

Cecil spent the summer of 1906 in Vienna and the winter and summer of 1907 at Johns Hopkins. He then became resident pathologist at Presbyterian Hospital in New York, where he had a junior clinical faculty appointment at Columbia University Medical School from October 1911 to June 1916, (10) when he joined the faculty at Cornell University Medical School in New York City.

He remarked at the time: “The truth is I have been working too hard during the last seven years to give the matter of matrimony its proper consideration. He’s promising a reform and an early desertion from the ranks of bachelorhood.” (9 p 31). It took him another 13 years to decide to marry Eileen Cumming, a native of Sydney, Australia on Sept. 20, 1923. They had one son, Russell Cumming Cecil, who was born on 6 October 1926 (3, 7) and became an architect in New York. (11)

Cecil joined the US Army on 16 June 1917. He was approached by the Surgeon General to study pneumonia, and carried out two very large trials of vaccination. (12, 13) He was creative in conducting these trials in difficult circumstances, beyond his control, including one of history’s greatest wars and pandemics. Cecil left the Army on 30 September 1919 as a Major, (7) and returned to the faculty of Cornell Medical School (where he became a full professor in 1933 and became Emeritus Professor in 1950). (14)

Cecil’s experience with large controlled vaccine trials in the army was relevant when he became a visiting physician at Belleview Hospital, New York, between 1921 to 1932. He took advantage of the great size of this hospital to pioneer the development and implementation of controlled trials (15-18). Cecil was also one of the first physicians in the United States to decide that rheumatic disease would be his area of special interest. (14) In 1922, he opened one of America’s first arthritis clinics, based at the Cornell Medical Center, (19) and his interest in arthritis and rheumatism became central in the second half of his life (he was a founder of the American Rheumatism Association and its president from 1937 to 1938, and founder of the Arthritis and Rheumatism Foundation, and its medical director from 1954 to 1958). (6, 14)

Cecil was elected to the Inter-urban Clinical Club in 1923. (7) This group, founded by Sir William Osler, consisted of a small group of America’s elite clinical medicine researchers. This can be seen as a clear indication of respect by the leaders of academic internal medicine. By 1928, he had received an honorary doctorate of science from the Medical College of Virginia. (14)

In the 1920’s Cecil found himself still using Sir William Osler’s monumental Principles and Practice of Medicine. (20)  Although this had been revised in 1919, it was becoming dated (11). Osler may have been the last physician who could hope to cover all of internal medicine by himself. Cecil’s response to the challenge presented by the new era of medical specialization was brilliant in its simplicity. He invited 130 experts to write chapters covering their fields for the textbook he edited. Reviewing the first edition of Cecil’s textbook, it is clear that there is a strong editorial hand at work. Most of the hundreds of entries about an illness or health condition are organized in a similar way with sections titled: Definition, Incidence, Etiology, Bacteriology, Morbid anatomy, Symptoms, Diagnosis, Complications, Prognosis, Treatment and Prophylaxis. At the time of his death the 12th edition was in preparation, and the 22nd edition was published in 2004. Cecil’s textbook seems likely to last until it is succeeded by an on-line Wikipedia for internal medicine, which can be revised constantly and is not limited by the economics of the printed page.

After practicing medicine for over 50 years and receiving the American Medical Association’s Distinguished Service Award in 1962, Cecil died on 1 June 1965 at the age of 83, in New York City. He had many interests outside medicine, including Greek classicism, golf, poetry, painting, sailing, walking and swimming. He was described as an “urbane and witty man” with an uncanny ability to note the strengths in others that stood him in good stead in his work (1). His wife said of him, “He is impatient with stupidity, unforgiving of unreliability and deeply resentful of careless medical practice.” (8  p 79).

Acknowledgements

Thanks for the very great generosity of Jim Gehrlich, Head of Archives, New York-Presbyterian/Weill Cornell Medical Center, New York City; Arlene Shaner, Historical Collections, New York Academy of Medicine. New York City; Steven Novak, Archivist at Columbia University Medical Center Library, New York City; and the librarians of the Princeton University Club of New York City and Allen Memorial Library, Cleveland, Ohio.

References

1   “In memoriam”. Walsh McDermott (plus brief vita). Arthritis and Rheumatism 1965;8:577-580.

2   Cecil RL. Textbook of Medicine. Philadelphia: WB Saunders, 1st edition 1927.  The editions from 1951 to 1979 were co-edited with Robert F Loeb, whose name was dropped with the 16th edition. The 22nd edition of Cecil’s Textbook of Medicine was published in 2004.

3  “Russell LaFayette Cecil” (1881-1965). Who Was Who in America Vol. IV, 1961-1968. Marquis Who’s Who, Chicago 1968, p 163.

4   Obituary. Canadian Medical Association Journal 1965;93:374.

5   Obituary. New York Times 1965, 2 June.

6   Obituary. Journal of the American Medical Association 1965;192:43.

7   Riesman, David ed. History of the Interurban Clinical Club 1905-1937. Chicago: John C Winston Co.,1937, p 100-103.

8   The Nassau Herald of the Class of 1902 of Princeton University, Vol 38. Princeton University 1902, New Jersey.

9   Septennial Record of the Class of Nineteen Hundred and Two, Princeton University Press 1910, p 31.

10  Letter from Dean Willard C. Rappeleye MD to R L Cecil dated Sept. 21, 1936.  Columbia University Medical Library Archives, New York City.

11  “Textbook Titan”. MD Magazine, March 1958, p 78-79.

12  Cecil RL, Austin JH. Results of prophylactic inoculation against pneumococcus in 12,519 men. Journal of Experimental Medicine 28:19-41.

13  Cecil RL, Vaughan HF. Results of prophylactic vaccination against pneumonia at Camp Wheeler. Journal of Experimental Medicine 29:457-483.

14  “In Dedication to Dr. Cecil”. Arthritis and Rheumatism 1963;6:vii-viii.

15   Cecil RL, Larsen NP. Clinical and bacteriologic study of one thousand cases of lobar pneumonia. JAMA 79:343-349.

16    Cecil RL, Sutliff WD. The treatment of lobar pneumonia with concentrated anti-pneumococcus serum. Journal of the American Medical Association 91:2036-2040.

17    Cecil RL, Plummer N. Pneumococcus Type 1 pneumonia: a study of eleven hundred and sixty-one cases, with especial reference to specific therapy. JAMA 95:1547-53.

18    Neuhauser D, Diaz M, Chalmers I (2007). A puzzling omission in a great medical textbook edited by a pioneer of controlled trials. The James Lind Library (https://www.jameslindlibrary.org/articles/a-puzzling-omission-in-a-great-medical-textbook-edited-by-a-pioneer-of-controlled-trials/).

19  “Distinguished Services Medical Award to Dr. Cecil”. Medical World News 1962, 20 June.

20   Osler W (1892). The Principles and Practice of Medicine. New York: Appleton. 9th edition 1920 (edited by Thomas McCrea).