HX27 Arthur Jacob: the Irish ophthalmologist with a keen eye for dermatology

Abstract Arthur Jacob (1790–1874), the first physician to describe basal cell carcinoma, was born in 1790 in Knockfin near Maryborough, Queen’s County (modern-day Portlaoise, Ireland). He was born into a medical family and was the grandson of Dr Michael Jacob and second son of Dr John Jacob, surgeon at the Queen’s County Infirmary. He initially served his apprenticeship with his father in Maryborough and subsequently entered the Royal College of Surgeons in Ireland (RCSI) in 1811, where he was a pupil of the esteemed Abraham Colles in Dr Steevens’ Hospital, Dublin. He graduated from the RCSI in 1813 and completed his MD at Edinburgh University in 1814. He then travelled to Paris and London to complete further studies before returning to Dublin in 1816, where he became member of the RCSI and worked as an ophthalmologist. He was appointed lecturer in anatomy at Trinity College around this time before establishing the celebrated School of Medicine alongside Robert Graves. He also founded two Dublin hospitals during his illustrious career. A truly outstanding figure in Irish medicine, he distinguished himself by his research, particularly his identification of the nervous layer of the retina, which earned him an eponymous title ‘Jacob’s membrane’ in 1819. His contribution to dermatology came later in 1827 when he published a paper in the Dublin Hospital Reports entitled ‘Observations respecting an ulcer of peculiar character which attacks the eyelid and other parts of the face.’ This is considered the first documented description of basal cell carcinoma, which was subsequently known as ‘Jacobs ulcer’ during the nineteenth century. In his paper, Jacob eloquently described characteristic features of basal cell carcinomas including the ‘extraordinary slowness of its progress, the peculiar condition of the edges and surface of the ulcer, the comparatively inconsiderable suffering produced by it, its incurable nature unless treated by extirpation and its not contaminating the neighbouring lymphatic glands’. He also shrewdly observed that there appeared to be varying clinical presentations ‘either in a state of ulceration, or in a fixed state’, with the latter having a characteristic clinical appearance including ‘elevated, smooth and glossy edges with a serpentine outline…having veins of considerable size ramifying over it’. Arthur Jacob retired at the age of 75 to Barrow-in-Furness, Lancashire. He died at the age of 84 in 1874 and is remembered for his outstanding contribution to medical education and research.