History of Medicine

 

FROM PRISON TO PROMINENCE: A FOUNDER OF

AMERICAN PEDIATRICS

 

         At four o’clock in the morning on July 9, 1853, in Manchester, England, a servant roused a grumbling Friedrich Engels from his bed to greet a shabbily dressed caller. The visitor, Abraham Jacobi, a young German physician of short stature and unkempt hair, produced a letter from Karl Marx asking Engels to accommodate him. Engels, though peeved, found Jacobi lodgings and helped him open a practice in Manchester.

         The disheveled visitor, born in 1830, had received his medical degree at the University of Bonn in 1851. He had been a student radical during the 1848-9 revolution, was part of the communist underground, and knew Karl Marx. His subversive activities had earned him two years in prison, after which he fled to Engels in Manchester.

Abraham Jacobi (from "Festschrift" in honor
of Jacobi, 1900. Internet Archive.)

Dissatisfied with Manchester, Jacobi opted for a try in America. He settled in “Kleindeutschland” (Little Germany), an area in the lower east side of Manhattan, and opened a general practice. German immigration to New York at the time was heavy; only Berlin and Vienna hosted larger German populations. Little Germany was notable for poverty, overcrowding and stifling tenements. Thirty percent of its population was under ten years of age. Many would not reach adulthood.

         Jacobi, true to his communist leanings, also cared for the indigent, established contact with trade unions, and was a contact for Marx. The high child mortality rate convinced Jacobi and his colleagues to view disease as a social and political problem, as their contemporary Rudolf Virchow had proclaimed in Germany. Inadequate sewage disposal, contaminated water and milk, Tammany Hall inaction, and other problems generated malnutrition, epidemics and disproportionate deaths. Finding that older physicians paid little attention, Jacobi and six other 1848-refugee physicians founded their own dispensary and medical association. They reviewed current European medical literature, discussed cases, and wrote articles. Jacobi focused on eliminating adulterated and contaminated milk and water, evils that were killing so many infants.

         Jacobi’s activities and writings caught the eye of the sanitary reformer Elisha Harris and of Stephen Smith, an editor at the New York Journal of Medicine. Smith had helped found

Stephen Smith (Wikipedia)

New York’s Metropolitan Health Board, focused on public health measures. He solicited journal contributions from Jacobi, emphasizing European literature.  Smith’s brother, Job Lewis Smith, was another pioneer in child health who published an early text on childhood diseases in 1869. These contacts brought Jacobi and colleagues into academic circles, such as the New York Academy of Medicine and the New York Pathological Society. The latter elected Jacobi its president in 1864. The newly organized New York Medical College offered Jacobi, in 1860, a chair in diseases of children, the first such appointment in the U.S. (J. Lewis Smith became Clinical Professor of Diseases of Children at the Bellevue Hospital Medical College the following year.) Jacobi instituted bedside teaching, home visits, and attracted patients from surrounding areas. He continued to translate European literature; two journals in Germany already dealt with childhood pathology.  

Text by Job Lewis Smith, 8th ed. 
(Internet Archive)

         He railed against institutional orphanages as death houses. At a large orphanage in New York, Jacobi noted an extremely high mortality. After careful study, he concluded that the institution should be closed. Instead, Jacobi himself was ousted. “The younger the child, the larger the institution, the surer is death,” he said later, pleading for home placement of abandoned children, even in the poorest of homes. In general, Jacobi stressed the preventive nature of the care of children: breast feeding, uncontaminated milk and food, and a clean environment.

         His influence widened. The College of Physicians and Surgeons appointed him Clinical Professor of Diseases of Children in 1870. In 1893, the University of Berlin, forgetting Jacobi’s earlier jail time, offered him the chair of pediatrics when Eduard Henoch, known for the description of Henoch–Schönlein purpura, was retiring. Jacobi preferred the U.S., though, and declined. He was elected president of the American Pediatric Society (which he helped found), president of the New York Academy of Medicine, and, at the age of 82, president of the A.M.A. He helped found the German Hospital, later named the Lenox Hill Hospital, and the pediatric section of the Jewish Hospital, later renamed Mount Sinai Hospital. 

The German Hospital, opened 1869. Renamed Lenox Hill Hospital (Wikipedia)

         His writings, the majority by hand, amounted to hundreds of papers and letters, collected later into eight volumes of over 4000 pages. He wrote a popular text, Therapeutics of Infancy and Childhood and contributed to others. His primary interests focused on safe infant feeding and diphtheria (his only son died of it at age 7). He helped Macy’s owner Nathan Straus set up charitable clean milk stations in New York, a major step in curtailing deaths of young children. He was an early proponent of laryngeal intubation to relieve fatal obstruction of the throat in diphtheria, a technique devised to replace the more dangerous tracheotomy. He continued to see adult patients throughout his life, shunning overspecialization.

Mary Putnam (Wikipedia)

In 1893 he married Dr. Mary Putnam, daughter of the publisher George Palmer Putnam. (Two previous wives had died.) Mary was the first woman to graduate from the École de Médecine, Paris, and the sixth woman in the U.S. with an MD degree. The marriage was a happy one, marred only by the death of their son, Ernst.

         At the age of 88 Jacobi was writing an autobiography in his summer home at Lake George, N.Y. when fire, from which he barely escaped, destroyed the cottage and his remaining papers. He died the following year, 1919.

         At the time of his death virtually all medical schools had established pediatric professorships, children’s hospitals were growing, and research in childhood health and disease was active. From dubious beginnings, Abraham Jacobi had risen to be a celebrated founder of pediatrics in the America he called home.

 

Another example:Thomas Morgan Rotch, first full Professor of
Pediatrics in the U.S. at Harvard Medical School, 1893.
(Wikipedia)

SOURCES:

Leopold, J S, “Abraham Jacobi,” in Veeder, B S, ed., Pediatric Profiles. 1957; C V Mosby.

Nadel, S, Little Germany: Ethnicity, Religion, and Class in New York City, 1845-80. 1990; Univ of Illinois Press.

Halpern, S A, American Pediatrics: The Social Dynamics of Professionalism, 1880-1980. 1988; Univ California Press. Chap. 3.

Cone, T E, History of American Pediatrics. 1979; Little, Brown.

Ligon-Borden, B L, “Abraham Jacobi: Father of American Pediatrics and Advocate for Children’s Health.” Seminars Ped Inf Dis, 2003; 14 (3): 245-9.

Viner, R, “Abraham Jacobi and German Medical Radicalism in Antebellum New York.” Bull Hist Med1998; 72(3): 434-65.

Link, E P, “Abraham and Mary P. Jacobi, Humanitarian Physicians.” J Hist Med All Sci. 1949; 4 (4): 382-92.

Mahnke, E B, “The Growth and Development of a Specialty: The History of Pediatrics.” Clin Pediatrics 2000; 39: 705-14.

Faber, H K, “Job Lewis Smith, Forgotten Pioneer.” J Pediatrics 1963; 63 (4): 794-802.

Truax, R, The Doctors Jacobi. 1952; Little, Brown.

A full index of past essays is available at:https://museumofmedicalhistory.org/j-gordon-frierson%2C-md