Gregg, Sir Norman McAlister

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MB 1915 MSurgery 1915 Hon DSc 1952 FRACS Hon FRCOG Hon FRACP Hon AAOO Hon DSc (ANU)

Sir Norman McAlister Gregg showed that maternal rubella infection in early pregnancy caused birth defects. His work profoundly influenced further clinical and experimental research into birth defects and their causes.

Norman Gregg was born in Sydney in 1892 and graduated from medicine in 1915 with honours. Aside from his studies, he led and active student life, becoming President of the Undergraduates Association and a director of the University Union. He was an exceptional sportsman – described as a “tall, lithe and vigorous young man” – and played on numerous University teams and representing the State in cricket and tennis. As an adult, Norman continued his love of sport. He became captain and later President of the Royal Sydney Golf Club.[1]

During the World War I he served with the Royal Army Medical Corps in France and was awarded the Military Cross “for conspicuous gallantry and devotion to duty during a raid”.[1] Paul Lancaster states that “like many other Australian medical graduates of his era, Norman later went to England for postgraduate training and experience, working at the Moorfields Eye Hospital and the Royal Westminster Ophthalmic Hospital in London, and also at the Birmingham and Midland Eye Hospital.”

He returned to Sydney and took up appointments as Paediatric Ophthalmologist Senior Surgeon at Royal Prince Alfred Hospital and the Royal Alexandra Hospital for Children, as well as commencing private practice. When World War II broke out, many young doctors were in the army and consequently Norman saw most of the children with eye problems needing surgery.[1]

Norman became alarmed at the number of babies who came to his office with congenital cataract, at least two or three times more than what would be expected by heredity alone. He heard two mothers speak in the hall outside his office, who both had affected babies. They were discussing how both had had German measles (rubella) in pregnancy. Out of the 78 children born in the early months of 1941 who went to see a doctor in Australia for cataract (13 in his own office), 68 had been exposed to Rubella in utero.[1]

Although the possibility that maternal infection during pregnancy could cause birth defects and other serious consequences had been considered, this hypothesis lacked evidence. Examining young babies, Norman noted that aside from congenital cataracts, many of the babies he observed:

had congenital heart defects and that most of them were 'of small size, ill nourished and difficult to feed'. Microphthalmia was also sometimes present. In seeking an explanation for this atypical pattern of birth defects, he elicited a history of rubella infection in early pregnancy from the babies' mothers.

Epidemics of meningitis and rubella in army camps just outside Sydney was brought home to the community. Norman was convinced that the outbreak of cataract amongst newborns was most likely due to a rubella infection during the mothers’ pregnancy. Norman gathered epidemiological evidence from his own practice and cases of other ophthalmologists and drew the conclusion that "children exposed to rubella virus in utero during the first trimester of pregnancy are at risk for not just cataract, but also deafness and other severe problems".[1] However, Normans findings were not immediately accepted amongst the medical profession as Margaret Burgess notes:

There was no laboratory test for rubella, Norman just had a clinical association. He presented his data at a meeting of eye surgeons. While in Australia his results were met with praise and belief, ‘overseas’ people did not trust his data. The Lancet in 1944 wrote ‘Gregg did not prove his case’. When Sir Lorimer Dods, an Australian paediatrician, travelled to the US in 1947 to speak about Gregg’s work, he wrote of the assembly of physicians who listened to his talk. ‘You could see them all doubting’. Only when Gregg’s data was analysed by a mathematician, Professor Oliver Lancaster, a former physician, then statistician and epidemiologist at the University of Sydney, who proved the association between the virus and the congenital syndrome highly significant, only then did the outside world listen and believe Gregg’s data.[1]

Hence, it was not until 1961, two decades after Norman’s initial findings that research scientists were to isolate were able to isolate the rubella virus. When there was a worldwide outbreak of rubella in 1964, resulting in 20,000 cases of congenital cataract in the United States alone, a vaccine was developed. Paul Lancaster notes that “Norman’s discovery also stimulated rapid development of the fledgling field of teratology, the study of birth defects and their causes.”[1]

In 1964 Norman Gregg was awarded the Britannica Australia Award for medicine. Norman Gregg died in 1968. At the University of Sydney his work is commemorated by the naming of the Norman Gregg Lecture Theatre.

Citation: Mellor, Lise (2008) Gregg, Sir Norman McAlister. Faculty of Medicine Online Museum and Archive, University of Sydney.

An alternate version appears in: Mellor, L. 150 Years, 150 Firsts: The People of the Faculty of Medicine (2006) Sydney, Sydney University Press.