THE FIRST VA SCANDAL

     “Hospital delays are killing America’s war veterans.”

     Thus flashed a headline from CNN in November 2013, news that revealed widespread system failure in the Veterans Administration. But this was not the first VA disgrace. A major corruption scandal marred the hospital system at its very inception.

     Following the Civil War Congress established the National Home for Disabled Volunteer Soldiers to care for soldiers with

National Home for Disabled Soldiers, Virginia
(National Library of  Medicine)

war-related disabilities. After World War One Congress agreed that veterans of that war should also receive medical care and appropriated money to the National Home and to the Public Health Service to use their facilities. In 1921 the veterans’ scattered medical care and hospital services were consolidated into one organization, the Veterans Bureau. President Warren Harding appointed Charles Forbes to run the Bureau.

     Forbes was unusual. Educated at Columbia University and MIT, he enlisted in the Army as an engineer, was arrested for desertion but reinstated without trial and remained for 8 years. After discharge he worked as a civilian engineer, dabbled in politics, and ended up in Hawaii involved in construction at the Pearl Harbor Navy Base. When (then) Senator Harding visited Hawaii on

Charles Forbes (Wikipedia)

vacation Forbes hosted him and the two became good friends. Forbes later enlisted in WWI, earning the Croix de Guerre and the Distinguished Service Medal. Soon after the War Harding ran for president and Forbes, now a civilian, helped him gain the Republican nomination.

    

    Harding rewarded Forbes by appointing him to head the newly created Veterans Bureau, in spite of advice by advisers not to. The annual budget was near $500,000,000 – almost a fifth of the national expenditures.

     Once in office Forbes threw out all restraints. He hired large numbers of his friends and “good Republicans”. He took long trips to inspect hospitals and hospital sites with contractor friends, nicknamed “joy rides”. Drinking parties and expensive hotels took more time than inspections. He paid excessive sums for new sites, pocketing the difference, and engaged in various kickback and insider bidding schemes with his construction firm cronies chosen to build new hospitals. He gave the general counsel for the Bureau, Charles Cramer, a generous cut on the profits, ensuring legal cooperation. Hospital conditions for the veterans were often inadequate, and often patients who no longer needed treatment were kept in, depriving others of needed care.  The newly built hospitals were poorly made, one without a kitchen and another without a laundry (the one in Palo Alto).

Veterans Bureau meeting, with Forbes
(Library of Congress)

     A huge government warehouse in Maryland full of medical supplies caught Forbes’ attention. The contents were valued at between 5 and 7 million dollars (between 70 and 98 million today). He sold most of it for about 20% of its value to a Boston firm, Thompson and Kelley, expecting profits on resale. 150 freight cars showed up, into which disappeared sheets, pajamas, bandages, drugs, liquor, and many other supplies. Protests erupted, especially from Hugh Cumming, Surgeon General of the Public Health Service, entitled to 20% of the warehouse contents. It proved to be Forbes’ downfall.

     President Harding had brushed off earlier rumors of Forbes' shenanigans, but now called him in, twice. At the second interview Harding became so enraged that he grabbed him and shook him “as a dog would a rat”, ordering him to resign. Forbes slipped off to Europe and resigned from there, returning later. On March 2, 1923, the Senate announced their intention to investigate.

     Twelve days later Charles Cramer shot himself in the head in a bathroom, leaving on his bureau a poem about death that he had clipped from a newspaper. The Senate hearings brought out the whole story, relying especially on testimony from Elias Mortimer, a contractor included in the scam who had become incensed when Forbes took a trip with his wife. Forbes and John J. Thompson, purchaser of the warehouse contents, were later convicted at trial of defrauding the government and each fined $10,000 and sentenced to two years in prison. Thompson was sick and died before he got to prison and Forbes was let out after eighteen months. His wife had divorced him. He lived quietly in Florida until his death in 1952.

     The VA scandal was one of many that the Harding administration endured. It was costly in money and in neglected care of veterans. But the Veterans Bureau lived on and was reorganized to the modern Veterans Administration in 1930, though not thoroughly immunized against subsequent scandal.

Sources:

    Murray, R K: The Harding Era. 1969

    Ferrell, R H: The Strange Deaths of President Harding. 1996

    Werner, M R: Privileged Characters. 1935.

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                                   THE GUAIAC TREE:

 From syphilis to blood detection

     In 1496 a new disease broke out in Italy, producing large, disfiguring, sores over the body. It emerged after an invasion by Charles VIII of France followed by a severe winter of heavy snowstorms and floods, destroyed crops, and a malnourished population. But the French troops got the blame, hence the name “the French disease”, though some called it the Spanish or the Neapolitan disease. It surged through Europe when the troops went home.

     Treatments varied, but were oriented toward removing morbific material by means of bleeding, purging and, quite prevalent, “sweating” in enclosed hot fixtures. Soon mercury, both topical and ingested, came into practice, with its attendant symptoms of mercury poisoning.

Eventually the idea surfaced that the disease originated in America and reports came of a concoction used by the natives of Hispaniola – an extract of the guaiacum tree – that produced miraculous cures.

guaiac tree 

News of the remarkable remedy soon reached the emperor Maximilian I who ordered his chancellor, Cardinal Matthew Lang, to send a commission to Spain to investigate. The members of this commission are not known for certain, but almost certainly one was Dr. Nicolaus Pol. Pol was court physician to the emperor, a theologian, and a bibliophile.

     Nicolaus Pol published a tract on the use of the guaiac wood that appeared between 1517 and 1519. In it he clearly stipulates, bowing to Galenic theory, that before taking the guaiac potion the body must be “purged of offending humors”, the exact methods left up to the physician. This to be followed by 3 days of reduced dietary intake. Then comes a 30-day course of twice daily ingestions of a liquid made from the wood. After the morning dose the patient should be in bed, covered with blankets, to sweat. Dietary intake is gradually increased and sexual intercourse forbidden. The wood went under many names, common ones being lignum vitae or lignum sanctum.

Patient with syphilis on left drinking extract of guaiacum. On right, chopping, weighing, and boiling of wood.
Line engraving by P Galle after J van der Straet, about 1600. (Courtesy Wellcome Library, Creative Commons license:

http://creativecommons.org/licenses/by/4.0/)

     To make the concoction a pound of guaiac wood was cut into small pieces and boiled in 12 pounds of water until half was boiled off. A dose of ½ pound of the liquid was administered twice daily, altogether requiring 5 pounds of the wood for a 30-day course. The foam accumulating on the top was skimmed off, dried, and used as a powder on the sores.

     Another, and more well-known treatise on the treatment was published by the German poet-laureate and humanist Ulrich von Hutten, appearing in 1519. (David Starr Jordan, first president of Stanford, was so 

Ulrich von Hütten (Wikipedia)

impressed by von Hutten that he wrote a short book about him – see below. A phrase of Hutten's, "Der luft der Freiheit weht" - the wind of freedom blows - is on the Stanford emblem.) Von Hutten had the French disease himself and describes the treatment in this widely read book, De guaiaci medicina et morbo gallico (English translation made in 1730). His recipe is basically the same except a little stronger - one pound of wood only lasts 4 days - and the diet stricter. Von Hutten’s book sold widely and boosted the use of guaiacum immensely. He intimates that doctors and vendors of the wood were in cahoots financially, and that could be so. Jacob Fugger, the richest man in Europe and

Jacob Fugger by Albrecht Dürer
(Wikipedia)

Maximilian’s chief banker, was a major trader in the wood. He erected 3 houses for the treatment of syphilis as part of a larger “Fuggerei” – colony of houses for poor people (which still exists in Augsburg). He promoted guaiacum treatment and no doubt profited well from it.

     Finally, Fracastorio, in his treatise on syphilis, also praised the benefits of the wood. The treatment was expensive, though, and over time fell out of favor, yielding once again to Mercury.

     There are 3 varieties of guaiacum tree, 2 of which were probably used. The wood is hard and heavy, sinking in water, and has been used for mallets, bowling balls, ball bearings, and for propeller shaft bearings in steamships (they outlast steel). It grows in the Caribbean and adjacent shores and is a good shade tree. An extract of the resin of the tree is the basis of the “Guaiac Test” for occult blood, something else that is fading into medical history.

Sources:

    Muinger, R S. Guaiacum: The holy wood from the New World. J   

        Hist Med All Sci 1949, 4: 196-249.

    von Hutten, U. De Morbo Gallico (English Translation), 1730.

    Fisch, M H. 1946. Nicolaus Pol Doctor 1494. 

    Arrizabalaga, J, et al. The Great Pox: The French Disease in 

         Renaissance Europe.1997.

    Record, S J. Lignum-Vitae: A study of the woods…., 1921.

    Jordan, D S. 1910. Ulrich von Hutten: "Knight of the order of 

         poets". 

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Alexander Hamilton to Rockefeller Center:

David Hosack MD

           Tension gripped the air as two men faced each other in a tragic duel. Alexander Hamilton had just arrived at a lonely spot amongst dense cedar trees on the New Jersey shore where Aaron Burr was awaiting him, early July, 1804. At a prearranged signal Burr fired, wounding Hamilton in the right side, the bullet lodging in his lumbar spine. Hamilton sank to the ground, partly supported by his second who shouted for medical help. Doctor David Hosack, waiting at the shore by the boat that had ferried them over, scrambled up to the site. The devastating scene is best

Scene of the Duel (Wikipedia)

recounted in his own words: “His countenance of death I shall never forget. He had at that instant just strength to say, ‘This is a mortal wound, Doctor', when he sunk away and became to all appearance lifeless…. His pulse was not to be felt; his respiration was entirely suspended: and upon laying my hand on his heart, and perceiving no motion there, I considered him irrecoverably gone…” (from a letter to the editor of The New York Evening Post). Hosack liberally applied spirits of hartshorn (an ammonia solution distilled from the horns and hooves of deer, later called smelling salts). On the skiff back to New York Hamilton regained consciousness, started breathing more normally and his pulse felt stronger. He complained that he had no sensation in his legs. He was placed in the house of a friend and given laudanum and other pain relievers. Hosack called in consulting surgeons, but none had more to offer and Hamilton expired in pain the following afternoon, a great loss to the young nation.

     Who was Dr. Hosack? He was, in fact, an important figure in the early history of medicine in New York. As physician to Hamilton’s family, he had watched over one son severely ill with scarlet fever, and had attended another son dying from wounds inflicted in a duel 3 years earlier. He had also been consulted by Burr in the past.

      David Hosack was born in 1769 on Manhattan, where he spent his childhood during the Revolution while British troops roamed the Island. He attended Columbia College (the name “King’s” College had been dropped) and the College of New Jersey at Princeton. He studied medicine at the Medical College of the University of Pennsylvania, where he befriended Benjamin Rush, followed by nine months at the University of Edinburgh and a year in London. In London he studied botany at the Linnaean herbarium under James Edward Smith and became a dedicated plant lover.

David Hosack by Rembrandt Peale (Wikipedia)

     Back in New York Hosack entered private practice and did well. He was on the faculty of the Columbia Medical School, and later partnered in practice with Dr. Samuel Bard, perhaps the best-known physician in New York. In 1795 and 1798 he and Bard worked through yellow fever epidemics, both contracting yellow fever in the process. As treatment he employed Glauber’s salts (sodium sulfate, a moderate laxative), bathed the patient with vinegar and cool water, and applied warm blankets while feeding liquids (called the “stove-room technique” by some). Aware of Benjamin Rush’s regimen of bleeding and violent purges he tried it in the 1798 epidemic. But after losing 40 patients he reverted to his milder method, with better results. The milder treatment also brought him many patients. He was a cofounder of the Medical and Philosophical Register, a respected medical journal, was the first in the U.S. to ligate the femoral artery for aneurysm, and innovated treatment of hydrocele by injection. He wrote many medical essays, and his practice included most of the luminaries of New York Society.

     Botany was little taught in New York and there were no large herbaria in the country. Hosack saw the need and purchased twenty acres of land between what is now 47^th and 51^st Streets to create the Elgin Botanic Garden (named after his father’s home town in Scotland). He poured his heart, and his money, into the garden,

Engraving, Elgin Garden. (Medical Repository 1810)

 ordering plants from around the world, quickly becoming recognized as an expert botanist. As Professor of Botany and Materia Medica at the College of Physicians and Surgeons he regularly took his medical students through the garden, teaching. 

     Hosack fostered the development of arts in New York. He was a founder of the New York Historical Society, the NY Academy of the Arts, and supported other organizations. He was an outgoing person, enjoying his students as well as social company. In 1825 he married a wealthy woman (2 other wives had died) allowing him to purchase a large estate at Hyde Park. There he built a large garden and entertained in style, hosting many notables of the day and giving up most of his practice. He died after a stroke in 1835.

     The Elgin Garden of his dreams had long before proved too expensive to maintain and he sold it to New York State in 1811. It was transferred to the College of Physicians and Surgeons, then to Columbia College. John D. Rockefeller Jr. leased the land in 1928 and built the giant Rockefeller Center on the site. Columbia sold it only in 1985. Now, strolling in Rockefeller Center on the way to the ice rink one can see a small plaque commemorating Dr. Hosack, part of which reads, “In memory of david hosack, 1769-1835, BOTANIST, PHYSICIAN, MAN OF SCIENCE AND CITIZEN OF THE WORLD”.

    

Sources:

   Robbins, C.C. David Hosack: Citizen of New York. 1964

   Hamilton, A.M.: The Intimate Life of Alexander Hamilton. pp 395-404, 1911.

   New York Academy of Medicine Site:  

   http://nyamcenterforhistory.org/2016/01/21/dr-david-hosack-physician-to-    hamilton-and-burr/

   Garrison, F. “David Hosack”. Bull N Y Acad Med 1925. 1: 167-71

To view the plaque:     http://blogs.nybg.org/science-talk/2014/07/rockefeller-center-botanical-history-underfoot/

BONES and WORMS

A WRITER ON PARSITES INVENTS  “ORTHOPEDICS”

     It is ironic that the term “orthopedics” denotes a surgical specialty, considering that the inventor of that word, Nicolas Andry, was a fervid enemy of surgeons. Andry was born in Lyon in 1658. He studied for the priesthood, left that path to teach humanities, then decided rather late on medicine and studied at the University

Nicolas Andry de Boisregard (courtesy Wellcome Library and
Wikipedia)

of Reims and the University of Paris, obtaining his degree at age 39. His thesis was “The relationship in the management of diseases between the happiness of the doctor and the obedience of the patient”, a subject not unusual at the time (and relevant today!). He rose to become a professor at the College de France and finally, in 1724, dean of the faculty.

     He wrote two important books. The first appeared at the start of his career, at age 42: An Account of the Breeding of Worms in the Human Body, a book that earned him the name “father of parasitology”. Though it is an early work on parasites, with several illustrations (some of them fanciful), its real importance lies in Andry’s strong stand against spontaneous generation. Belief in spontaneous generation of intestinal worms went back to Hippocrates and continued through Galen and Avicenna. But Leeuwenhoek’s

Tapeworm, from "An Account of Breeding..."
(from Haiti Trust)

microscope and Redi’s experiments with flies in the late 1600s shed doubt on that notion. Andry never experimented; he simply stated, “Worms breed in the bodies of men and other animals, by means of a seed that enters there, in which those worms are enclosed. For all animals are bred of a seed which contains them…” (Grove). He describes a patient with fever, chest pain, and coughing blood who, after a purgative, expelled a long tapeworm, complete with head. Andry was the first to illustrate the tapeworm head (see illustration), though they had been described previously.

     At the other end of his career, at age 82, he published Orthopaedia or the Art of Correcting and Preventing Deformities in Children (English translation). This book earned him the title “father of orthopedics”, and though that is a little off the mark, the  author introduced the word “orthopedics” by saying “As to the title, I have formed it of two Greek words, viz. orthos, which signifies straight, free from deformity, and paidos, a child. Out of these two words I have compounded that of Orthopaedia.” The word persisted and infiltrated many languages.

     The book was actually a manual for the use of parents to treat or prevent, in their children, deformities of the skeleton and in part 2, those of the head. Various massages and braces are recommended for crooked spines and limbs, and exercises, proper posture, etc., for prevention of deformities. The section on the head covers skin problems, smallpox, deafness, nasal deformities, and the like. Overall, measures are conservative.

     One remedy is of particular interest. If a child is becoming bow-legged (usually from rickets at that time) Andry advises placing an iron plate on the

Straightening the tree trunk, in Orthopaedia
(from Hathi Trust)

inner side of the leg and binding it with a linen bandage, tighter each day "as is used for making straight the crooked trunk of a young tree” (see  illustration). The famous tree image has been adopted by orthopedic associations around the world. The logo of the American Board of Orthopedic Surgery is one example:

Logo, Amer Board of Orthopedic
Surgery

An interesting variation was created by the Arizona Orthopedic Society - a curved cactus:

Logo, Arizona Orthopedic Society

     Andry was described by colleagues as irascible, scornful, jealous, and superb. As a critic for the Journal des Savants he carried on a prolonged campaign against barber surgeons, abolishing surgical positions at the school and requiring that surgeons operate with a medical doctor present. Ironically,

Jean-Louis Petit (from Wikipedia)

he unjustly targeted Jean-Louis Petit, a famous surgeon who invented the screw tourniquet, was the first to drain the mastoid bone, and wrote a highly regarded work on bone surgery, the first comprehensive orthopedic surgery text.

    

Sources consulted:

    Grove, D I. A History of Human Helminthology. 1990.

   “Eulogy of Jean-Louis Petit”. Chirurgie 126: 475-81, 2001

   “A History of the Ecological Sciences, Part 30”. Bull Ecol Soc

       America, Oct 2008, pp 407-433.

   “Nicolas Andry de Bois-Regard, the Inventor of the Word

       Orthopedics and the Father of Parasitology”. J Child Orthop

       4: 349-55, 2010.

   Kirkup, J R. “Nicolas Andry and 250 years of Orthopaedy”. J

        Bone Joint Surg (Br) 1991. 73-B: 361-2.

   Andry, N. De la Generation des Vers dans le Corps de

       l”Homme. 1700.

   Andry, N. Orthopaedia: or the Art of Correcting and Preventing

      Deformities in Children. 1741 (Eng trans 1743).

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Theodor Kocher and the Birth of Endocrinology 

     At one time almost everyone in the valleys of Switzerland was afflicted with goiter. Mark Twain remarked that the two principle sights in Switzerland were Mont Blanc and goiter. Large goiters were burdensome and could impinge on the trachea, impairing

goiter patient, from and side (from Wellcome Library)

breathing. But the medical world was ignorant of the thyroid's function. Claude Bernard declared in 1879, well after surgeons started removing the gland, that nothing was known of its importance. Iodine was perceived as helpful for goiter by some, but little used. Not surprisingly it was in Switzerland where progress was made.

     Theodor Kocher, a Swiss, played a leading role in revealing the impact of the thyroid on human physiology. His surgical skills and wide knowledge were legendary and attracted students from around the globe.

     He was born in Bern in 1841. After medical school he decided

Theodor Kocher (from NIH via Wikipedia)

on a surgical career. He rose quickly to be Professor of Surgery at Bern University (at age 31) and remained there for the rest of his career. His influence was enormous. Only a partial list of achievements would include: rapid adoption of Listerism, inventing the “Kocher maneuver” for reducing shoulder dislocations, using physiological saline to combat shock  (later taken up by George Crile), and introduction of “Kocher clamps” for hemostasis. His neurosurgical researches greatly influenced Harvey Cushing and his deliberate, careful surgical technique helped cement a friendship with William Halstead. He published the first complete chart of human dermatomes (1896). Between 1909 and 1914 an average of 40 Americans visited his clinic every year. His textbook of surgery went through five editions and was translated into six languages. His discoveries concerning the thyroid gland earned him a Nobel Prize, though not without heartache and strife.

     Removal of goiter by surgery had been risky. The famous Theodor Billroth had removed numerous ones, but with frequent

Goiter removal, from Kocher's Surgical Text, 2nd edition
(Hathi Trust)

 complications and significant mortality. But with careful study of anatomy and adherence to asepsis Kocher managed to render thyroid removal a safe procedure, using a horizontal incision whose scar was barely visible. He performed the operation frequently.

     In the fall of 1882, at a Congress in Geneva, Kocher met Jaques-Louis Reverdin, a Geneva-based surgeon, who had noted that two of his own thyroidectomized patients had developed features of cretinism. He asked Kocher if he had observed the same. Kocher abruptly realized that he had - once. A local practitioner had informed him eight years earlier that an eleven-year-old girl had become sullen and zombie-like after losing her goiter. Kocher tracked her down and was stunned to find the “ugly appearance of a half-idiot” before him. He halted further

Jacques-Louis Revedin 9from Wikipedia)

thyroidectomies, contacted former patients, and turned up many with hypothyroid features - but only those with total loss of thyroid tissue.  Though the record is unclear he must have been shaken by the damage he had inflicted. He reported the findings in a long paper in 1883.

     Reverdin referred to the clinical picture of his patients as “myxoedéme opératoire”, after the term “myxoedema” coined a few years before (1877) by William Ord in England for patients

William Ord (from Wellcome Library)

with adult onset of cretinism and atrophied thyroid glands. Reverdin also acknowledged William Gull’s earlier description of the same syndrome. Kocher invented the name “cachexia strumipriva” and initially thought the syndrome due to oxygen insufficiency related to removal of the thyroid and adjacent vasculature.

     Kocher attempted transplanting thyroid tissue to improve his sluggish patients, noted initial improvement, but was discouraged that it was transient. He tried isolating an active substance from thyroid tissue, in vain. In England George Murray gave injections of thyroid extract, with positive results, then switched to oral administration of thyroid extract, also effective. Trial and error led to a reasonably accurate dosage. Kocher and others adopted similar replacement therapy, starting with thyroid tissue spread on bread much as caviar would be, and moving on to extract.

     Kocher was awarded the Nobel Prize in 1909, the first surgeon to receive one, for contributions to the physiology, pathology, and surgery of the thyroid. In his acceptance speech he ungenerously neglected the work of Ord and Gull that had clearly described myxoedema (he had actually corresponded with Ord on the subject) and failed to admit Revedin’s priority (Revedin is remembered also for performing the first skin allotransplant).

     But Kocher’s achievements should not be diminished. He went on to perform over 4000 thyroidectomies (partial), with excellent results. In addition to the accomplishments noted above he pioneered new techniques in gallbladder and stomach surgery, neurosurgery, and head and neck surgery. He taught a whole generation of surgeons and left a great imprint on American surgery. And his thyroid work ushered in a new medical specialty – endocrinology.

Sources used:

World J Surgery 2000, 24:2-9. (Biography)

J Roy Soc Med 2014, 107: 376-7 (Biography)

J Roy Soc Med 2011, 104: 129-32 ( thyroid work)

BMJ Sept 29, 1923, pp 560-1 (transplants)

Nobel Lecture, available at: http://www.nobelprize.org/nobel_prizes/medicine/laureates/1909/kocher-lecture.html

 Wellbourn, R B: The History of Endocrine Surgery. 1990

Tröler, U. Der Nobelpreisträger Theodor Kocher, 1841-1917. 1984

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San Francisco’s First Radiographer

      In November of 1895 William Conrad Roentgen first saw the bones of his hand on a fluorescent screen and gave the name “X-rays” to the mysterious radiation that penetrated human flesh. His 

report of the discovery that December “went viral”. Primitive X-ray tubes flooded the market and science magazines instructed do-it-your-selfers (and there were many of them) on how to make their own tubes. By February of 1896, only two months after Roentgen’s publication, an X-ray image was crucial in a gunshot court case in Canada. Meanwhile a San Francisco woman paid close attention to the reports.

X-ray apparatus in Roentgen's lab, Würzburg.  (photo by author)

     Elizabeth Fleischman was born in 1859 in El Dorado County. Her father had arrived from Austria in the Gold Rush, settled in El Dorado, and later moved to San Francisco. Elizabeth entered high

Elizabeth Fleischman

school and was later trained as a bookkeeper. Her brother-in-law, Dr. Michael J.H.Woolf (with whom she lived after her mother’s death)  interested her in the new X-rays. She  took a quick course in electrical science and with borrowed money bought her own X-ray apparatus. She quickly became adept at using it and offered X-ray and fluoroscopy services to the medical community. She is first listed in the San Francisco City Directory (an old version of the Yellow Pages) in 1897 as “radiographer, X-ray laboratory, 611 Sutter”.

From City Directory 1897

     The Spanish-American War and subsequent guerrilla activity in the Philippines after 1898 generated numerous injuries, cared for at the Presidio of San Francisco. Many were brought to Fleischman’s office in order to locate bullets and visualize fractures. Eventually the military purchased their own equipment and Fleischman consulted at the Presidio. She was especially skilled at using

different angles to locate foreign bodies. “We have never failed to go straight to a foreign body embedded in the human anatomy

Bullet in chest, Fleischman image (from Borden, WC, below)

which is shown by her radiographs, while when we have depended on the work of others we have been led into many grave errors”, stated a colonel from the Presidio.[i] One of Elizabeth’s images is shown here, its quality good compared with others from the war. Surgeon General Sternberg, astounded at the work produced by this self-educated woman, commended her in a report. The introduction of X-rays greatly facilitated the treatment of fractures and put an end to probing bullet wounds, saving many a wound from unnecessary infections.

     The American Roentgen Ray Society convened its first meeting in 1900. They were interested in affiliating with the AMA but that would mean excluding non-physicians. But the members were so dependent on non-physicians like Fleischman that they decided to remain independent. Strictly speaking, doctors became “radiologists” while others were “radiographers”.

     Early X-ray images were developed on glass plates coated with silver emulsions, and exposure times were one to twenty minutes depending on body part.[ii] Before long Elizabeth was making dental images and later added cancer treatment to her repertoire. She made radiographs of animals and took others for artistic reasons, submitting some to Camera Craft Magazine. She was a member of the American Roentgen Society and contributed many images to their collection.

     Elizabeth paid a price for her innovative work. The beams from the early X-ray tubes were not well focused, the exposures were long, and she worked up to twelve hours a day with unprotected hands. It was common to place one’s hand in the beam to check exposure quality. By 1903 a dermatitis was irritating her hands, attributed to darkroom chemicals. By 1904 ulcerations appeared, then a carcinoma. She consented to local excision but refused amputation. Next her axillary glands enlarged, and in January 1905 an arm, scapula, and adjacent clavicle were removed as her only hope of recovery. But to no avail, and she succumbed to cancer on August 3, 1905, a victim of her own pioneering work.[iii]

     Elizabeth Fleischman was not the only early user to suffer.

     Clarence Dally was a glassblower who worked for Thomas Edison making light bulbs. Edison created an early fluoroscope and assigned Dally to demonstrate it and similar instruments to customers. He encountered the same dermatitis, ulcers, and local cancers on his hands. He was treated with skin grafts, then amputation of the left hand, four fingers of the right hand, and finally amputation of both arms before he fell victim to metastatic cancer.

     Walter James Dodd was born in London, came to the U.S. at age 10, and worked in Boston. He happened to meet Harvard president Charles Eliot who gave him a job as janitor in the chemistry lab, “the best janitor we ever had” said a professor. He went on to

Walter James Dodd  (www.archives.org)

become the chief pharmacist at MGH. When X-rays were discovered he built his own machine and soon was the “radiology consultant” for the entire hospital. Only then did he go for his MD degree. But his hands had suffered since 1897 - skin grafts and partial finger amputations. When he finally passed away in 1916 of carcinoma he had undergone over 50 operations under ether.

     Briefly mentioned is Frederick Henry Baetjer, a student of Osler and the first radiologist at Johns Hopkins. He submitted to over 100 surgical procedures since the onset of the first dermatitis. There were many others, recognized by Percy Brown as “martyrs to science” in a book.[iv] At least a decade passed before the full dangers of X-rays were appreciated by the larger community.

      Elizabeth Fleischman, San Francisco’s first “radiographer”, while blazing new trails met a tragic end that was all too common.

---

[i]  San Francisco Chronicle, June 8, 1900.

[ii] Borden, W C. The Use of Roentgen Rays in the Medical Department of the U S Army in the War with Spain. U.S. Govt Printing Office, 1900.

[iii] Trans. Amer Roentgen Ray Soc. 1908, p155-6.

[iv] Brown, Percy. American Martyrs to Science Through the Roentgen Rays. 1936.

Other sources:

  Kevles, B H. Naked to the Bone: Medical Imaging in the Twentieth Century. 1997.

  Macy, J. Walter James Dodd – A Biographical Sketch. 1918.

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