George Frederic Still (1868–1941)

George Frederic Still studied pediatrics and childhood conditions in England during the early twentieth century. In Still’s time, pediatrics, or the branch of medicine that focuses on treating and caring for children, remained largely unexplored according to biographer Joseph deBettencourt. Still helped advance pediatrics as a field by classifying and writing about diseases and conditions that arose in children. In 1897, he discovered a unique type of arthritis in children, now referred to as Still’s disease. Still also was one of the first to correctly describe what is now known as attention deficit hyperactivity disorder, or ADHD, a disorder that can cause children to act impulsively and have trouble focusing, among other behaviors. He shared his understanding of those conditions and pediatrics as a whole in a popular textbook called Common Disorders and Diseases of Childhood. Still’s work helped establish pediatrics as a separate field of medicine and provide a foundation for pediatricians throughout the twentieth century to understand and expand on a variety of conditions developing children can face.

Still was born on 27 February 1868 to Emma Andrew and George Still in London, England. Still’s parents had twelve children, but only eight of the children survived infancy. Still was the oldest of the surviving children. His father worked as a customs inspector in the Port of London. When Still was 17 years old, his father died. As a young adult, Still had to support himself and his family. According to biographer deBettencourt, Still’s childhood prompted his interest in caring for children. Money was tight in Still’s family, but Still won a scholarship to attend Merchant Taylor’s School, a public boarding school in London during his teenage years. Afterwards, Still won another scholarship to attend the University of Cambridge in Cambridge, England, where he studied classical languages. Still graduated from Cambridge with first-class honors and the Winchester Prizeman distinction in 1888.

Still went on to study medicine at Guy’s Hospital in London, England, and qualified to work as a house physician under the doctor James Goodhart in 1893. Goodhart had an interest in pediatrics and influenced Still to specialize in children’s diseases, according to biographer P. M. Dunn. Still won a scholarship from the Royal College of Physicians in London, England, in 1893, and then transferred to the Hospital for Sick Children in London, England, in 1894 where he worked towards his medical degree. During his time at the Hospital for Sick Children, Still advanced from working as a house physician to working as a medical pathologist.

While pursuing his medical degree at the Hospital for Sick Children, Still reported on children with a distinct kind of arthritis, now known as Still’s disease, as the subject of his thesis. He examined nineteen cases of children with Still’s disease and published his results in the 1897 paper, "On a Form of Chronic Joint Disease in Children." In that paper, Still characterized the disease as a continuous enlargement of joints, accompanied by general enlargement of glands and enlargement of the spleen. Still noted the subtle onset of the disease, usually spreading from one joint to multiple joints. Still noted that his disease was distinct from rheumatoid arthritis, which is known to affect bones, because children with Still’s diseases did not see a change in their bones due to the disease and experienced swelling of the glands and spleen. In ten of the nineteen cases that Still examined, the children were under six years old. Furthermore, Still’s case study showed that girls are more prone to the disease than boys. Despite his concrete findings, Still never returned to study arthritis in children. After four years of working for the Hospital for Sick Children, Still left to work as the leading physician at King's College Hospital’s department of childhood diseases in London, England, in 1899. King’s College Hospital was the first hospital with a medical school in the United Kingdom to create a department of childhood diseases.

In 1901, Still was elected to be a fellow of the Royal College of Physicians of London, a professional body dedicated to improving the practice of medicine. In 1902, Still was invited to deliver a series of lectures, "On Some Abnormal Psychical Conditions in Children," as part of the Royal College of Physicians of London’s annual lecture series, the Goulstonian Lectures. His three lectures focus on what Still calls an abnormal defect of moral control in children, now recognized as ADHD, that he observed in forty-three children he studied while working as a physician at King’s College Hospital. Still defines moral control as acting in conformity with societal standards of what is good for all people. In his lectures, Still seeks to define the varying degrees of the moral defect and how it develops in children. Though Still acknowledges the difficulty of assessing moral control in people, he highlights eight qualities, including passion, spitefulness, and dishonesty, that can be used to recognize children who have the moral defect. Still explains that all eight qualities a child with a moral defect could exhibit, show that the child is more concerned with self-gratification than other people’s well-being. By defining those distinct qualities, Still was able to effectively identify trends among children he studied.

Still concluded that the moral defect could arise as a result of three distinct impairments. Still called the first impairment a defect of cognitive relation to environment, which Russel Barkley, who researches ADHD in the twenty-first century, explains is currently understood as a child’s lack of self-awareness. Still called the second impairment a defect of moral consciousness. Barkley explains that this impairment is currently understood to mean a child’s lack of foresight of the long-term consequences of one’s actions for the good of all. Still called the third impairment a defect of inhibitory volition, currently understood to mean a child’s inability to suppress impulses and responses to stimuli.

In addition to just characterizing what he called the moral defect, Still also studied how moral defect could arise in children. Moral defect could arise from developmental failure at birth or by losing previously existing moral control due to an incident later in life, such as physical damage. For example, Still describes the character of a boy whose personality changed after he fell down some steps and struck the left side of his head. Within a few days of the fall, the boy’s behavior was different altogether from what it had been previously. According to Still, the boy had become passionate, disobedient, and destructive.

Still’s observations and conclusions on moral control were some of the first to correctly describe what is now known as ADHD according to Barkley. In his 2005 paper "The Relevance of the Still Lectures to Attention-Deficit/Hyperactivity Disorder," Barkley points out that many of Still’s conclusions on the condition are still widely accepted as true today, such as Still’s observations that many of the children he studied were unable to focus for extended periods of time, were insensitive to punishment, and had heightened emotionality. Still also pointed out that men were three times more likely than women to develop the condition, a statistic that current psychology literature confirms. Still’s work does not include the term ADHD because the disorder had not been named at the time of his discovery. The American Psychiatric Association began referring to the disorder as ADHD in 1987, after renaming the disorder from Attention Deficit Disorder, or ADD. Before 1987, physicians classified two types of ADD, one with hyperactivity and one without. The inclusion of "hyperactivity" in the new name for the disorder eliminated the two subtypes, which were not all that different to start, to group people with ADHD into one group.

In 1905, Still reconnected with Goodhart to help edit the sixth through twelfth editions of Goodhart’s textbook The Diseases of Children, one of the most popular pediatric textbooks of the time. Soon after, Still became a professor of pediatric diseases at King’s College in 1906, the first person to hold that position in England. In 1909, Still published a textbook of his own called Common Disorders and Diseases of Childhood. The textbook drew on Still’s extensive background in pediatrics to describe a variety of childhood conditions he understood. According to biographer G. J. Piller, the textbook was met with immediate success and he wrote five editions of it by 1927. Still continued writing extensively on children’s diseases while working at King’s College Hospital throughout those years.

In 1928, Still called a meeting of twenty-four pediatric physicians at his home to establish the British Pediatric Association. Though only six of the twenty-four invited physicians attended, the group founded the association and elected Still as its president. Later that year, the Association held its first full meeting, which forty-five members attended. According to biographer Dunn, the British Pediatric Association, along with many other pediatric associations forming across Europe at the time, helped establish pediatrics as a field separate from standard clinical medicine.

By the time Still retired from King’s College Hospital in 1933, Still had contributed extensive work to the field of pediatrics, helping it gain recognition. In addition to improving the understanding of several childhood conditions, Still also helped spread awareness of the relatively new field through his work as a professor, physician, and writer. Throughout his career, Still had published over 108 papers and five books. In 1934, Still received the Dawson Williams Prize for his work in pediatrics, and in 1937, Still was made an honorary fellow of the Royal Society of Medicine, one of the largest medical societies in England. Also in 1937, Still was knighted after King George VI appointed Still to be Physician Extraordinary to the King and his family. During his retirement, George Frederic Still lived in Wiltshire, England. He fly-fished on many of the rivers in the city and focused on English language and literature, teaching at the Salisbury Cathedral School and publishing poems.

Still died at the age of seventy-three years old on 28 June 1941.