More Meanderings in Medical History

By Michael Nevins

These essays about various unrelated medical history subjects were composed over some three decades; some written recently, others published in my previous books. The title word meandering suggests randomness, but should not be mistaken for pointlessness for each vignette was prompted by something which at the time seemed relevant to my professional or personal life. The emphasis is on narrative history, stories of physicians at different times and places, for as my famous namesake Professor Allan Nevins once wrote, history should be enjoyed, not endured.

• Language: English
• Publisher: iUniverse
• Release date: May 24, 2012
• ISBN: 9781475927993

Michael Nevins

Dr. Michael Nevins practiced internal medicine and cardiology in northern New Jersey for nearly four decades and frequently lectures and writes on subjects related to medical history, bioethics and geriatrics. His recent books have included Jewish Medicine: What It Is and Why It Matters (2006), A Tale of Two “Villages”: Vineland and Skillman, NJ (2009), Abraham Flexner: A Flawed American Icon (2010) and Meanderings in New Jersey’s Medical History (2011). Dr. Nevins currently is president of the Medical History Society of New Jersey and in 2010 received that organization’s David L. Cowen Award in recognition of his career activities in the field of medical history.

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More

Meanderings in

Medical History

Michael Nevins

iUniverse, Inc.

Bloomington

More Meanderings in Medical History

Copyright © 2012 by Michael Nevins.

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ISBN: 978-1-4759-2798-6 (sc)

ISBN: 978-1-4759-2799-3 (e)

iUniverse rev. date: 05/21/2012

Contents

Introduction

1.All Fall Down

2. An Eponymic Clash

3. La Salpetriere

4. Medical Cut Ups

5. Civil War Amateurs

6. The Autocrat And The Apostle

7. Bad Seeds

8. A Duty To Die

9. Honorary Paternity

10. Flexner’s Report

11. Master Diagnostician

12. Days Of The Giants

13. Hairspray

14. Medical History In 3-D

15. Shtetl Medicine

16. Confronting Modernity

17. An Odd Couple

18. Fictional Jewish Doctors

19. I Shall Not Wholly Die

20. Two Doctors Of Terezin

Introduction

This is the second of two volumes of what I like to call meanderings in medical history. That word appeals to me because it suggests random exploration with no precise goal in mind. However, aimlessness should not be mistaken for pointlessness. The material described in each of these essays was prompted by something I’d either heard or read which at the time seemed relevant to my professional or personal life. Occasional overlaps notwithstanding, there is no unifying theme and each chapter differs in subject and style; as such, they should be read as separate entities. These vignettes were written over a span of many years, but are presented roughly chronologically, usually introduced by a brief explanation about when and why each was composed. While the first volume of my medical meanderings was entirely devoted to New Jersey’s history, this sequel reflects some of my other interests, especially those relating to Jewish medical history.

In the preface to his 1913 classic An Introduction to the History of Medicine, the outstanding medical historian of his generation Colonel Fielding Garrison wrote, The history of medicine is, in fact, the history of humanity itself, with its ups and downs, its brave aspirations after truth and finality, its pathetic failures. In 1926 Col. Garrison composed a speech The Study of History of Medicine as an Essential Coefficient to the Self-development of the Physician. It was intended to be delivered by him at the Hebrew University in Jerusalem, but was read in absentia by Garrison’s friend Emanuel Libman. In that talk, Garrison expanded on his conviction that it was important for physicians to study medical history and his words resonate for me because they help explain my long-standing interest in what some might consider to be arcane subject matter.

It is essential that the physician….should have a hobby, and physicians, as a rule, have not been slow to avail themselves of this privilege…. Among the many diversions or side-lines which a physician may choose, from music or etching to chess or golf, there is none less harmful and more rewarding than the study of the noble history of his calling. It is not only a source of inspiration in his professional life, but will prove to be, at need, the most effective check upon the knowledge he acquires at the bedside, in the clinic or the laboratory, reinforcing what he actually knows and more often convincing him that much which seems new to us is really old….It is only by understanding the past that we can interpret the present or see into the future, albeit, as through a glass darkly.

As soon will become clear, this is not a conventional history book, but merely a collection of unrelated and unreferenced stories about physicians who lived at different times and places. I’ve always preferred narrative history to dry scholarly analysis and find lengthy recitations of names, dates and events to be tedious. From student days, I’ve been dimly aware that the late Professor Allan Nevins of Columbia University, who shared my surname, was regarded as one of the 20th century’s greatest historians. There’s no possible way that we were related, but recently I was pleased to learn that we shared a similar viewpoint about studying history. Professor Nevins was a frequent critic of academicians whose writing lacked vitality or, as he put it, sometimes was actually repellant.

It is the pedant who….is chiefly responsible for the present crippled gait of history in America. His touch is death. He destroys the public for historical work by convincing it that history is synonymous with heavy, stolid prosing….He is responsible for the fact that today a host of intelligent and highly literate Americans will open a book of history only with reluctant dread and will shun like the plague any volume which contains a footnote. (From his 1939 essay, What’s The Matter With History?)

I wouldn’t dare to be so outspoken, but it seems, after all, that Professor Nevins and I did have something in common beside our names – a preference for story telling for, as he put it, history should be enjoyed, not endured. Hopefully, the reader of these meanderings will enjoy the winding journey and, in the process, perhaps even may gain some new insight. For my part, as I explained in the introduction to volume one, each essay was composed with no particular agenda -- just for the fun of it.

Dedicated to fellow members of the Medical History Society of New Jersey.

1.

All Fall Down

When a Bergen County surgeon and bibliophile retired in 2011 and returned to his native Japan, he donated more than 200 old medical books which he’d collected to the Englewood Public Library. In turn, the library arranged a book sale and one day when I had the opportunity to get an advance look, I couldn’t resist buying more than I’d intended – all in a good cause I reasoned. Among my trove were two dusty books which addressed a subject about which I knew nothing: The Great London Plague of 1665. However, I was intrigued by the authors: one book was a first-hand account by Daniel Defoe, the author of Robinson Crusoe; the other was a medical text based on the teachings of perhaps the 17th century’s greatest physician Dr. Thomas Willis.

Although skeptical historians will deny it, popular legend holds that the beloved nursery rhyme Ring around the Rosie had a grim provenance -- the plague epidemics which periodically swept through Europe from the 14th through the early 18th century.

Ring around the Rosie,

A pocketful of posies,

Ashes, Ashes,

We all fall down.

In this one of many versions, ring around the rosie presumably referred to plague’s characteristic reddish rash; pockets full of posies to the practice of carrying sweet-smelling flowers in pockets both to keep away the disease and to overcome the stench; ashes either to the results of cremation or blackening of the skin and falling down refers to the all too frequent outcome. Whatever the origin of the nursery rhyme may have been, in late medieval and early Renaissance Europe plague was a constant nightmare; mention the word and people would make the sign of the cross and say God deliver us from it. Once plague came it remained endemic, sometimes for centuries with cyclic flare-ups. The ancient Greeks called any human scourge plague from the word plaga, meaning a blow and there was a particularly severe pandemic which began in 541 A.D. with repeated outbreaks over the next two centuries. The notorious Black Death, which ran from 1347 through 1352, decimated between 25 and 75 million Europeans, best estimates being more than one third of the population.

In contrast, London’s cataclysm in 1665 was relatively minor; estimated to have killed less than 20% of the city’s population. The scarcely reliable official total was 68,596, some scholars have suggested more than 100,000. London was especially vulnerable -- overcrowded, unsanitary, offal and excrement thrown into the streets. The city had sustained earlier epidemics in cycles of roughly six to twelve years and few years failed to have lesser outbreaks, but the 1665 disaster was plague’s last gasp in England. Less than a year later, the city was purged of its disease-breeding slums by a great inferno which raged for four days. The next year, when London rose phoenix-like from the ashes, the young poet John Dryden eulogized:

O let it be enough what Thou has done,

When spotted death ran arm’d through every street,

With poisoned darts, which not the good could shun,

The speedy could out-fly, or valiant meet.

Dryden’s words were prophetic – as it turned out, it was enough. To be sure, on the Continent there would be two more large outbreaks, in Vienna (1679) and Marseilles (1720) but then the scourge retreated eastward and died out; eventually becoming more a disease of rodents than of men. The title Black Death had not been used by 15th century contemporaries and in England did not come into use until after London’s epidemic of 1665 which was called The Great Plague. It remains unclear whether the adjective black used for the earlier pandemic was meant to describe the characteristic blue-black rash and lymphatic swellings, terminal cyanosis or as a general comment upon the dismal times. When pandemics flared up they usually were devastating not only to populations, but to the economy and the sheer reduction of population wrought by the Black Plague had profound and enduring effects on society, politics and culture.

Many people believed that plague represented Divine punishment and even the most educated people had no idea of its true cause: something in the air, miasmas or poisonous vapors, perhaps certain weather conditions or natural phenomena such as earthquakes, comets or misalignment of the planets. Fires were burned in the streets to clear the air, and in sickrooms to destroy the clothes of victims. Since tobacco was thought to be protective, schoolboys at Eton were forced to smoke and those who disobeyed were flogged. Doctors advised shut-ins to think pleasant thoughts of gold and silver, rather than to brood about death. Some blamed the sickness on dogs and cats but their mass slaughter was counterproductive – after all, cats killed rats which carried fleas – alas, London’s rats were ignored. Others sought human scapegoats; infamously, during the Black Death of the 15th century Jews were accused of well-poisoning which led to murderous pogroms. Madmen roamed the streets of London prophesying doom and the city became a vast mortuary –according to one observer, a reeking prison house of the living, the dying and the dead. The wealthier classes fled the city – a mass exodus of some 200,000 out of roughly a half-million Londoners. To discourage the refugees, walls were built around cities, their gates locked; panicked itinerants had to bribe to gain entry. Vigilantes armed with pitchforks, plugs and muskets guarded the roads.

Members of the College of Physicians, fifty of the medical elite, evacuated London but for the benefit of those left behind, issued a manual called Certain Necessary Directions for the Prevention and Cure of the Plague. Ports were shut because they were understood to be entry points and isolating the sick was thought to be the only effective way of halting epidemics. The word quarantine was employed, derived from the 40 day isolation period that was required of ships entering Venice during the early 15th century when the municipality opened its first maritime quarantine station (lazaretto) for contagious diseases, including leprosy, on small off-shore islands. Indeed, the concept may have originated with Hippocrates who used 45 days to separate acute from chronic diseases. Within that period of time plague victims either were dead or recovered without having spread their contagion to others.

Both the afflicted and their families were confined in their homes which then were marked by a red cross, but quarantine was ill-advised. These charnel houses were locked airtight and closely guarded; keyholes plugged to keep the miasmic air inside so as not to endanger passers by or strike down birds in flight. Everyone inside, whether well or sick, were sealed off from the outside world. Medical supplies and food would be passed through a window by a courier. Although the municipality or the church were supposed to provide for the poor, the unafflicted were unwilling to be taxed to pay for those locked in the pest houses nor for the doctors and nurses assigned to attend them. The famed diarist Samuel Pepys acknowledged that the plague makes us cruel, as dogs, one to another, but harsh methods were necessary to preserve the greater good in dangerous times: But lord! How sad a sight it is to see the streets so empty of people. Bills of Mortality circulated every week charted the number and locations of the dead and buried; the only commerce which thrived was grave-digging, but the diggers were quickly overtaxed; church bells tolled day and night.

The relatively new science of medicine proved helpless. Physicians, surgeons and apothecaries were equally impotent as the quacks, mountebanks, wise old women and a mélange of alternative healers. In fact, most plague doctors were not really doctors at all, but municipally employed inspectors whose prime function was to count the dead in the pest houses. They wore floor-length leather or oil cloth robes (the filthy plague atoms were thought to catch on and cling to coarse wool or cotton fibers) which attracted rather than repelled fleas. Faces were protected by fearsome masks with bird-like beaks which were stuffed with a mixture of aromatics, not only to counter the repugnant odors but to combat air-borne poison. According to orthodox Galenic principles, corruption had unbalanced the humors which called for strong applications of whatever might eliminate the putrid matter, including bleeding.

Now we know that plague was caused by a bacterium Yersinia Pestis, formerly called Pasteurella Pestis, but that would not become known until 1894 when it was co-discovered by Alexandre Yersin a French-Swiss bacteriologist who then was working in Hong Kong. Modern DNA analysis of plague victim’s bones have confirmed that Yersinia Pestis was the culprit. Nowadays, it’s often said that the germ’s reservoir was the ubiquitous black rat, the vector was the lowly flea and infection was spread by sailing ships arriving from distant shores. To be sure, every one of these facts has been challenged by scientists and scholars. Some even have exonerated the rat flea and its host and while the same bacterium still is with us, it is far less lethal; perhaps climate, social conditions, the genetics of its victims or interactions with other infections such as small pox, typhus or cholera may have contributed to its former virulence.

The exact date of Daniel Defoe’s birth is uncertain, but he was no more than six in 1665 when the pestilence appeared in London; too young to remember many details, but old enough to later hear and read firsthand reports of others. He was a prolific writer with more than 370 publications, most written using a pen name and by the time Defoe wrote his journal, he would have been over age sixty. Even if he may have fudged on some of the facts, he was able to vividly capture the mood of the city in his dispassionate rendering. Why did Daniel Defoe feel obliged to write this fictitious journal so long after the fact? Especially when he was in the midst of his most productive period as a novelist – the first part of Robinson Crusoe was published only three years earlier. Not surprisingly, the simple answer was financial need. Beset with debt, accused of sedition, publicly pilloried for his political leanings and with a wife and seven children to support, Defoe seized upon national panic about events in Marseilles in 1720-21, the last great epidemic on the Continent with more than 50,000 deaths. The English feared that the Great Plague might come again; from their pulpits ministers urged parishioners to repent while the government quarantined French ships. Capitalizing on public anxiety, a supposedly newly discovered eye-witness recounting of London’s earlier experience was guaranteed to be a best seller – and so it was.

When the first edition of Defoe’s A Journal of the Plague Year appeared in 1722, its subtitle noted that it was written by a citizen who continued all the while in London [technically correct] and never made Publick before. A second edition was published in 1754 and it was an 1895 238 page reproduction of this which I had purchased. What follows here are some slightly edited selections which depict the pestilential horror much more colorfully than the drab prose of proper historians:

The nobility and gentry thronged out of town with their families and servants…Indeed, nothing was to be seen, but wagons and carts, with goods, women, servants, children, &c.; coaches filled with people of the better sort, and horsemen attending them, and all hurrying away…all loaded with baggage and fitted out for traveling…This was a very terrible and melancholy thing to see, and it was a sight which I could not but look on from morning to night, it filled me with very serious thoughts of the misery that was coming upon the city, and the unhappy condition of those who would be left in it.

This hurry continued some weeks, that is to say, all the month of May and June, and the more because it was rumored that an order of the government, was to be issued out, to place turnpikes and barriers on the road to prevent people’s traveling; and that the towns on the road would not suffer people from London to pass, for fear of bringing the infection along with them, though neither of these rumors had any foundation, but in the imagination, especially at first.

I had two important things before me: the one was the carrying on my business and shop, which was considerable, and in which was embarked all of my life in so dismal a calamity, as I saw it was coming upon the whole city….I went home greatly oppressed in my mind, irresolute and not knowing what to do. I had set the evening wholly apart to consider seriously about it, and was all alone; for already people had, as it were by a general consent, taken up the custom of not going out after sunset.

From the moment that I resolved that I would stay in town…casting myself entirely upon the goodness and protection of the Almighty, I was in his hands, and it was meant he should do with me as should seem good to him. With this resolution I went to bed; and I was farther confirmed in it the next day, by the woman being taken ill with whom I had intended to intrust my house and all my affairs.

It was a very ill time to be sick in, for if one complained, it was immediately said he had the plague; and though I had indeed, no symptoms of that distemper, yet being very ill, both in my head and in my stomach, I was not without apprehension that I really was affected, but in about three days I grew better…the apprehensions of its being the infection went quite away…and I went about my business as usual.

The face of London was now strangely altered…sorrow and sadness sat upon every face, and though some parts were not yet overwhelmed, yet all looked deeply concerned; and…so every one looked on himself and his family as in the utmost danger….London might well be said to be all in tears; the mourners did not go about the streets, indeed, nobody put on black, or made a formal dress of mourning for their nearest friends; but the voice of mourning was truly heard in the streets: the shrieks of women and children at windows and doors of their homes, where their dearest relatives were, perhaps, dying or just dead, were so frequent to be heard, as we passed in the streets, that it was enough to pierce the stoutest heart in the world to hear them.

When anyone bought a joint of meat in the market they would not take it off the butcher’s hand, but took it off the hooks themselves. On the other hand, the butcher would not touch the money, but have it put into a pot full of vinegar, which he kept for that purpose. The buyer carried always small money to make up any odd sum, that they might take no change. They carried bottles of scents and perfumes in their hands…but the poor could not do even these things, and they went at all hazards.

But I must go back to the beginning of this surprising time; while the fears of the people were young, they were increased strangely by several odd accidents which, put altogether, it was really a wonder the whole body of the people did not rise as one man and abandon their dwellings…I shall name but a few of those things; but sure there were so many, and so many wizards and cunning people propagandizing them, that I have often wondered there were any (women especially) left behind.

In the first place, a blazing star or comet appeared for several months before the plague, as there did the year after, a little before the fire. The old women and the phlegmatic hypochondriac part of the other sex, whom I could almost call old women too, remarked, that those two comets passed directly over the city…and foretold a heavy judgment, slow but severe, terrible and frightful, as was the plague…I saw both these stars and I must confess, had so much of the common notion of such things in my head, that I was apt to look upon them as forerunners and warnings of God’s judgment.

The apprehensions of the people were likewise strangely increased by the error of the times, in which I think, the people…were much addicted to prophecies and astrological conjurations, dreams and old wive’s tales than ever they were before or since. Whether this unhappy temper was originally raised by the follies of some people who got money by it, that is to say, by printing predictions and prognostications, I know not; but certain it is, books frighted them terribly.

One mischief always introduces another; these terrors and apprehensions of the people led them into a thousand weak, foolish, and wicked things, which there wanted not a sort of people, really wicked, to encourage them to, and this was running around to fortune-tellers, cunning men, and astrologers to know their fortunes…and this folly presently made the town swarm with a wicked generation of pretenders to magic, to the Black Art…and this trade grew so open and was so generally practiced, that it became common to have signs and inscriptions set up at doors; Here lives an astrologer; Here lives a fortune-teller; Here you may have your nativity calculated; and the like.

The public showed that they would bear their share in these things; the very court, which was then gay and luxurious, put on a face of just concern for the public danger. All the plays and interludes which, after the manner of the French court, had been set up…were forbidden to be acted; the gaming tables and public dancing rooms and music