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Thomas Barlow was born on 4 September 1845 at Brantwood Fold, Edgworth, near Bolton, Lancashire, the eldest son of James Barlow (1821-1887), mill-owner, and his wife Alice née Barnes (d. 1888). He attended local schools and in 1863 went to Owen's College Manchester to read natural science, graduating BSc. (London) in 1867. He went up to University College London to study medicine in 1868, and on qualifying in 1870 was appointed house physician to Sir William Jenner at University College Hospital. He was awarded his MB and BS in November 1873 (MD 1874). In April 1874 he was appointed medical registrar at the Hospital for Sick Children, Great Ormond Street, which was to be the principal locus of Barlow's research activities. He later served successively as assistant physician and full physician at Great Ormond Street until 1899. He also held the posts of assistant physician at Charing Cross Hospital (1875 -77) and at the London Hospital (1877-80), and assistant physician and later full physician at University College Hospital from 1880 to 1910. From 1895 to 1907 Barlow held the Holme chair of clinical medicine.
Barlow made his name as a specialist in childhood diseases in the 1870s and '80s; he is above all associated with the isolation of infantile scurvy - so-called 'Barlow's disease' - as a disease distinct from rickets, with which it was routinely confused prior to the 1880s. In 1883 he published his first findings on infantile scurvy in a paper entitled 'On cases described as "acute rickets" ... the scurvy being an essential and the rickets a variable element', in Medico-Chirurgical Transactions,1883, 66: 199-220. He greatly expanded the number of cases investigated for his Bradshaw lecture of 1894, entitled 'Infantile scurvy and its relation to rickets'. Barlow also made significant research contributions in the areas of meningitis and rheumatic illness in children. Later he turned his attention to neurological illnesses such as Raynaud's disease and erythromelalgia.
Barlow enjoyed a successful private practice, based first in Montague Street, Bloomsbury, and from 1887 at number 10, Wimpole Street. His patients eventually included members of the highest social circles, such as the dukes of Grafton and Rutland, lords Selborne and Salisbury, and Randall Davidson, archbishop of Canterbury. In 1896 he was appointed physician to the royal household, and spent part of September 1897 deputising for Sir James Reid at Balmoral; from 1899 to 1901 he was physician-extraordinary to Queen Victoria, being present at her deathbed. He continued to hold appointments at court under Edward VII and George V. In 1901 he was created a baronet and later the same year appointed KCVO. In 1902 Barlow was one of the royal doctors who successfully piloted Edward VII though his appendectomy.
Barlow's was made a Fellow of the Royal Society in 1909, and served as President of the Royal College of Physicians from 1910 to 1914; in August 1913 he presided at the 17th International Medical Congress in London.
In December 1880 Barlow married Ada Helen Dalmahoy, a former ward sister at Great Ormond Street Hospital; they had three sons and two daughters, the younger of whom died in infancy. The eldest son was Sir (James) Alan Noel Barlow (1881-1968), the second was Sir Thomas Dalmahoy Barlow (1883-1964); the third, Patrick Basil Barlow ( 1884-1917), died on the Western Front.
Barlow was brought up as a Methodist, and was a lifelong teetotaller. From 1923 to 1930 he was President of the National Temperance League. In retirement he spent more time at his country home, Boswells, near Wendover in Buckinghamshire. He continued to travel, at home and abroad, accompanied by his surviving daughter, Helen, who never married. Barlow died at no 10 Wimpole Street on 12 January 1945, aged 99.