HOW STANFORD CAME AND WENT 

               FROM SAN FRANCISCO

                             

     On the southeast corner of Pacific Avenue and Divisidero Street in San Francisco stands a large beautifully preserved wooden Victorian mansion, replete with turrets, its own water supply on the top floor, and large windows looking out on perhaps the most expensive real estate in the city. Few who drive by as they cross

Ellinwood House (photograph by author)

Pacific Heights know that it belonged to perhaps the most hated doctor who ever lived in the City. His name was Charles N. Ellinwood (1838-1917). The story is an interesting one.

     Dr. Ellinwood was President of, and Professor of Physiology at the Cooper Medical College and Treasurer of its hospital, located at Clay and Webster Streets at the time of the great San Francisco earthquake in 1906. He was the sole legatee of the past owner of

the school, the successful and wealthy surgeon, Dr. Levi Cooper Lane (1830-1902), who had died some years earlier followed soon

Dr. Levi Cooper Lane (Medical History Center, Stanford,
Creative Commons lic.)

afterward by his wife. They were childless. Ellinwood was left exclusive control of the school’s endowment with the full expectation that he would continue the wise and successful administration that characterized Dr. Lane’s long tenure. Lane himself had re-established the proprietary school begun by his pioneer uncle Dr. Samuel Elias Cooper (1822-1862), and had made it a highly respected and perhaps the most prestigious medical school in the western United States. Lane was highly entrepreneurial and used his wealth to build the Lane Hospital, the most modern hospital of its time and form and endow the famous Lane Medical Library. It was and remains the largest library of its kind in the West. He gathered around him the finest skilled medical faculty in San Francisco to teach and manage the hospital’s wards and clinics. Lane also endowed the famous annual Lane Lectureship, which attracted a series of world-renowned speakers to San Francisco. Lane and his hospital competed successfully with the University of California School of Medicine, then under the direction of Lane’s archrival and one-time AMA President, Dr. Beverly Cole (1829-1901). The Toland Medical College, another proprietary institution, had been given gratuitously to the Regents of the fledgling Berkeley University of California in 1873 by its founder, 49er physician, Dr. Hugh Toland (1806-1880). UC migrated from its Stockton Street origins to Parnassus in 1895 thanks to then San Francisco mayor Adolph Sutro’s beneficence, where it later built its own hospital.

     The Lane Hospital, an imposing brick structure with its large auditorium, remained in use on Sacramento and Webster Streets until 1970 with it’s founder’s heart remaining, at his request, in an urn in a prominent place near the podium.

In April 1906, most of the City was destroyed by fire and earthquake and the Cooper College was severely damaged. The Trustees requested funds from Ellinwood to effect repairs and in a contentious meeting in June 1906, Ellinwood as Board President, whose relations with Dean Dr. Henry Gibbons Jr. (1840-1911) were not the best, simply refused to release any money to the school. Nor would he release money to maintain the important Lane Library and annual Lane Lectures.  As can be imagined, the trustees were frustrated and furious but Ellinwood stood firm insisting that the money left to him in the Lane legacy was a personal gift. He insulted them declaring that the quality of the school did not warrant the expenditure of any funds.  The trustees ultimately fired Ellinwood but were advised, considering the terms of Dr. and Mrs. Lane’s wills, that there was no way to break Ellinwood’s absolute control over the endowment. The faculty - all-volunteer in the days before outside funding - and the Lane Medical School and Hospital which they staffed, were left high and dry. Ellinwood kept the money.

     Gibbons as Dean, in desperation and with the approval of the trustees, approached Stanford University to finalize discussions begun several years earlier to turn over control of the school if the Palo Alto institution would maintain it in the City and keep its clinical faculty. Thus began the Stanford University Medical School in San Francisco.

     Stanford continued its significant presence in San Francisco for over 50 years, training a succession of successful doctors with a prestigious world-class faculty. It utilized the Lane buildings and added to them. It also ran a division of the San Francisco General Hospital with distinction until 1959, when consolidation occurred as construction of the new Stanford Medical School and Hospital was completed on the Palo Alto campus.

     At that point the local Stanford San Francisco Clinical Faculty again was faced with a crisis, as most of them had no intention of leaving their San Francisco practices for the hinterland. They also wanted to maintain connections with the hospital where they admitted their patients. For the next several years the hospital sans medical school continued under various iterations and sponsorships until it was re-built and became what it is today, Pacific Medical Center, a prominent and highly successful San Francisco institution, now part of the Sutter Health System.

     The origins of PMC and its hectic history is largely unknown today. Dr. Ellinwood has also been mercifully forgotten except by his descendants who continued to occupy the mansion he built on Pacific Avenue for many years. The Lane name persists as Lane intended: in the form of the fabulous Lane medical library and the annual Lane lectureship, associated with the world-class medical school on the Stanford campus in Palo Alto some 30 miles away from where the story originated.

Arthur E. Lyons MD

Source:

https://lane.stanford.edu/med-history/wilson/chap01.htm

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DAKIN’S SOLUTION and THE GREAT WAR

     There must be surgeons who still remember Dakin’s Solution, a tried and true antiseptic solution, named after its inventor Henry Dakin. 

     Like many surgical advances this one started in wartime – the First World War.  Soldiers attacked by shells and bullets ever more destructive to human flesh, fighting in fields and trenches in well-manured farmland, suffered gaping wounds prone to anaerobic infections and gas gangrene. Delays transporting the wounded to proper hospitals added to the burden. 

     To combat the problem Alexis Carrel, a French surgeon at the Rockefeller Institute in New York who already had a Nobel Prize 

Alexis Carrel (Wellcome Library)

for pioneering work in vascular surgery, stepped in. He and his wife were vacationing in France when the Great War broke out and being a French citizen was  called up.

     Through an influential American friend he was put in touch with the French War Minister who granted him a hospital for research if he could get his own funds for a laboratory. Carrel reached to the Rockefeller Foundation and received ample funds, and the name of a good chemist – Henry Dakin.

     Henry Dakin was born in London in 1880. As a schoolboy he was apprenticed to a City Analyst and did analyses of water, sewage, etc. He enjoyed chemistry and went on to obtain a degree and work in the field. In 1905 he accepted a job in the private

Henry Dakin (from Wellcome Library)

biochemical laboratory of Dr. Christian Herter in New York (on the top floor of his large house). Herter, a wealthy, respected, physician with ties to the Rockefeller Institute, had given up his practice to found the laboratory, do chemical investigations, and consult. He died in 1910, and Dakin stayed on as director of the lab at Mrs. Herter’s request. Dakin’s main work was in amino acid and lipid metabolism.

      When the war broke out Dakin, a British citizen, was eager to help and responded to the call from Carrel. They collaborated at “Temporary Hospital #21”, set up in the Round Royal Hotel outside Compiège, a village just 14 kilometers from the front. The Round Royal was a huge luxury hotel, once owned by Napoleon III, now housing 50 beds on the main floor and more (for officers) upstairs. The thunder of cannons not far away provided background noise to the constant flow of mangled, infected bodies arriving at the hospital. 

     Life at the Round Royal was hard. There were occasional shellings and bombings of nearby Campiègne itself, but no one deserted. Madame Carrel helped supervise nursing. On site were a radiologist, bacteriologist, pharmacist, biologist, and surgeons. 

     Antibiotics were unknown. Surgeons realized that debridement of damaged tissue was essential to survival but antiseptics for cleaning wounds proved either toxic or poorly effective (due to inactivation by proteins in tissue fluids). Almoth Wright, the British bacteriologist, had introduced concentrated saline as a way to draw out more lymph to clean wounds, but this too was inadequate.

     Dakin set to work. He tested over 200 compounds, finally settling on a dilute solution (0.05%) of sodium hypochlorite 

Carrel-Dakin tubing
(from Treatment of
Infected Wounds)

buffered with boric acid (to reduce tissue irritation). Dakin’s new solution was washed through tubing with holes in the wall that was introduced into deep areas of wounds. At first the fluid was pushed in by syringe but later IV drips were used. Nurses had to frequently adjust IV drips and change dressings and the solution, being unstable, was mixed on site. Using bacteriologic culture counts, wounds were closed when sterile on 2 or 3 cultures. The results were amazing. Suppuration was almost eliminated and healing accelerated, and the method quickly became the preferred one throughout the allied front. Dakin also invented an electrolysis process for making hypochlorite from sea water, allowing a hospital ship an unlimited supply. And he synthesized chloramine-T, a surface disinfectant.     

Method of wound irrigation (from
Treatment of Infected Wounds)

     When the U.S. entered the war Carrel returned to New York to head a school on the grounds of the Rockefeller Institute to train doctors in military medicine, where the Carrel-Dakins method was taught. 

Alexis Carrel teaching at Rockefeller Institute
(from National Library of Medicine)

     Dakin, on his return to the U.S., married Mrs. Herter, who was 16 years his senior, and moved into a large house in Scarborough overlooking the Hudson River. There Dakin built his own laboratory, pursued work on amino and fatty acids and published a Handbook of Chemical Antiseptics. His chemical work was of high caliber and earned him honorary degrees, a fellowship in the Royal Society, several medals, and later a directorship in Merck & Co. He was an editor of the Journal of Biological Chemistry. As a person he was reserved and shy, seldom collaborated, did not take on “post-docs”, did not have a university affiliation, and entertained infrequently. Thus he is less well-known than he might have been. 

     Henry Dakin considered his antiseptic work as less important “chemically” than his other work, but it was clearly important to grateful war surgeons and their patients.

Sources

Edwards, W.S.  Alexis Carrel: Visionary Surgeon. 1974

Malinin, T.I.  Surgery and Life: The Extraordinary Career of Alexis Carrel. 1979

Mottier, G.  L’Ambulance du Docteur Alexis Carrel.  1977.

Dis Colon Rectum 1983; 26: 354-358 (contains Dakin’s original   

          paper).

Hawthorne, R.M.  Henry Drysdale Dakin, Biochemist: The Option of Obscurity.  Persp Biol Med 1983; 26 (4): 553-67.

Carrel, A. and Dehelly, G.  The Treatment of Infected Wounds. 1917 

         (English Translation).

“Dr. H.D. Dakin” (obituary). Nature 1952; 169: 481-2.

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Nathan Smith

Motive Force of Four Medical Schools

Nathan Smith MD
(from "Life and Letters", Internet Archive)

     Perhaps the most important New England physician of the post-Revolution years, Nathan Smith, was born in 1762 in Rhode Island but raised in Chester, Vermont, a frontier town at the time. Nathan’s father died soon after, landing most of the farm chores on him, though somehow he accumulated enough education to later teach school. At age 22 he witnessed a mid-thigh amputation without anesthesia, an experience that, amazingly, galvanized him to study medicine. The surgeon, Dr. Goodhue, accepted him as an apprentice only after further study of basic subjects, and he apprenticed in midwifery as well. Finally he started a practice in Cornish NH, with no medical degree and no license (there was no state licensing board). Feeling inadequately prepared, he went 2 years later to Harvard Medical School (founded in 1783), studying under Dr. John Warren, to secure a Bachelor of Medicine degree (one year course). He was the school’s fifth graduate.

     Back in practice and noting the scanty education of his neighboring practitioners, he approached Dartmouth College in Hanover about opening a local medical school. Wisely the College advised him to first study in Europe, which he did in Edinburgh and London. Interestingly, he was not overly impressed with his professors and their complicated disease nosologies.

     On return he headed for Dartmouth, giving his first medical

Old Medical Building, Dartmouth
(from "Life and Letters", Internet Archive)

lectures in 1797. A few years later he was teaching medicine, surgery, materia medica, jurisprudence, and (for awhile) chemistry – a one-man medical faculty - and was awarded the full MD degree. His ten-week lecture sessions were popular, attracting both students and local practitioners. He was helped by Dr. Lyman Spalding, who covered for him in his practice and briefly taught chemistry. Spalding later founded the U.S. pharmacopeia.

      In medical practice Smith was conservative. He urged

cleanliness,  bled seldom, and was sparing with harsh purgatives, attitudes distinct from those of Benjamin Rush and other advocates of "heroic medicine". Regarding treatment of typhoid he wrote, “… I feel well convinced that all powerful remedies or measures adopted in the early stages of Typhous Fever are liable to do harm”. Though it is not known if he ever studied Morgagni’s work on pathology (that emphasized the local causation of disease), he practiced as if he had. Averse to grand theories he used autopsies to clarify his clinical impressions, an innovative approach at the time and one just emerging in Paris.

      He was perhaps better known for excellence in surgery. He operated reluctantly. Cleanliness helped his results. Most of his work related to trauma – fractures, horse kicks, injuries from axes, etc. “Couching” for cataracts (dislodging the lens from position with a needle through the sclera) was common, as were amputations. Particularly advanced was Smith’s advocacy of removal of bone affected by subacute or chronic osteomyelitis. He used a trepanning saw to remove a round area around the necrosis, which apparently achieved adequate healing. Another Smith, Joseph, underwent the procedure in his left tibia, saving him an amputation. Joseph Smith went on to found the Mormon Church.

     Over time Nathan became tired. Teaching duties, a growing family, and an expanding practice were taxing enough, but decisive were lack of financial support for his school and the stress of obtaining bodies for anatomy instruction. One grave-robbing student had been fined, a riot had occurred over another stolen corpse, and corporal punishment was contemplated by the legislature. Yale

Ticket to Smith's lectures at Yale - students paid the
professors directly.
(from "Life and Letters", Internet Archive)

University fortuitously asked him to join Benjamin Silliman, a chemist, to found a medical school at Yale, an offer he accepted, though he had to convert from Episcopalianism to Congregationalism. Smith was appointed professor of “The Theory and Practice of Physics, Surgery, and Obstetrics”, and was joined by Silliman and 3 other faculty members. He arrived in New Haven in 1813, penniless and having to borrow money.

      Next Bowdoin College in Maine wanted to open a medical school, hoping Smith would head it. He negotiated time away from Yale to give 10-week courses as one of 3 faculty members. But Yale soon pressured him to give up Maine, which he did 4 years later (1825). During his time at Bowdoin he also acted as an advisor in establishing a medical school in Vermont, thus being involved in some way in the founding of 4 medical schools and serving as full professor in three.

     In late 1828, at the age of 66, Nathan Smith suffered the first of a series of strokes, dying the next year. He left behind a wife and ten children. Four of his children were boys and all became

physicians, as did several grandsons. His second son, Nathan Ryno Smith, was a founder of Jefferson Medical College.

      Nathan Smith left a rich legacy. Beloved by both students and patients, he was easily the most prominent physician in all of New England, skilled in both medicine and surgery. He wrote little, but two of his works were influential and ahead of their time: A Practical Essay on Typhous Fever (praised by William Osler 72 years later) and Observations on the Pathology and Treatment of Necrosis (in bone). His influence on medical education is almost unequaled, and his teaching spawned a whole generation of physicians, many of whom became important educators.

    

SOURCES

     Smith, Nathan R, ed. Medical and Surgical Memoirs, by Nathan Smith, 1831. (contains his above-cited works)

     Hayward, O.S. “Nathan Smith (1762-1829), Politician”. NEJM 1960, v263, p.1235

     Hayward, OS. Improve, Perfect, and Perpetuate: Dr. Nathan Smith and Early American Medical Education. 1998.

     Field, WW. The Good Dr. Smith: The Life and Times of Dr. Nathan Smith. 1992.

     Smith, EA. The Life and Letters of Nathan Smith, M.B, M.D. 1914.

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 THE DEATH of PRESIDENT HARDING

     “PRESIDENT RAPIDLY IMPROVING”, ran the headline of the San Francisco Chronicle on August 1, 1923, referring to President Warren Harding, ill and bedded down in the Palace Hotel in San Francisco. 

     But the next day readers were astounded by, “HARDING DEAD. BELOVED PRESIDENT SUCCUMBS SUDDENLY IN EARLY EVENING”. 

     What happened? What was the illness that brought Harding to the Palace Hotel?  And who took care of him?

    

     Warren Harding was elected president in 1920, and was felt by some even then to not look well. He smoked a lot and his blood pressure had been high for some time, usually around 180. In January of 1923 he was laid up with “the flu”, with poorly defined chest complaints, after which he often had to sit up at night to 

Warren Harding (Wikipedia)

breathe comfortably. On the golf course he was panting, unable to finish the course. Close associates feared for his health.

      A trip to Alaska, to settle some political problems but mainly as a rest, should help restore him, and Harding’s doctor, Charles Sawyer, agreed. On the way he felt better but on the return trip, in Vancouver, he weakened, with abdominal pain followed by shortness of breath and intermittent chest pains. Sawyer incriminated recently consumed bad crabmeat. In Seattle Harding almost collapsed during a speech. His staff was alarmed and arranged to bypass an Oregon stop and rush him directly to a suite on the eighth floor in the Palace Hotel in San Francisco (visible at http://thepalacehotel.org ), arriving on July 29.

     The President’s physician, Dr. Sawyer, was a homeopathic physician and a family friend, but with rudimentary training. He had treated Mrs. Harding for a kidney problem and on her

Dr. Charles Sawyer (Wikipedia)

insistence was brought to the White House. (And Harding’s father was a homeopathic physician.) A better-trained naval physician Dr. Joel T. Boone was also hired, mainly to be physician on the presidential yacht. He had graduated from the Hahnemann Medical College, and the U.S. Navy Medical School.

     On the way to San Francisco Dr. Boone examined the President and, realizing that crabmeat was not the problem, alerted Herbert Hoover, Secretary of Commerce and part of the entourage, who in turn spoke to Hubert Work, Secretary of the Interior and a former doctor (trained at the U. of Pennsylvania). Work examined Harding and found his blood pressure low, his heart grossly enlarged, the sounds muffled, and his pulse regular but rapid. Hoover wanted consultation and telegraphed an old friend, Lyman Wilbur, president of Stanford University and formerly dean of the Stanford Medical School. Wilbur, on vacation in the Sierra Mountains,

Dr. Lyman Wilbur (Wikipedia)

rushed down, bringing Charles M. Cooper, a Stanford internist, with him to the Palace Hotel. 

     They agreed with the findings and noted tenderness over the gallbladder. Fever ensued, with pneumonia in the right lung seen on X-ray. Digitalis was administered with some improvement, but on August 2, as his wife was reading to him, she noticed her husband suddenly bathed in  sweat. Moments later he stiffened, then slumped, without breath or pulse. An autopsy was refused. Wilbur and Cooper suspected a stroke as the immediate cause of death. 

     The official statement, authored by all the physicians, was “apoplexy or the rupture of a blood vessel in the axis of the brain near the respiratory center”. Wilbur and Cooper added a further note that he had cardiac enlargement, probably with thickened blood vessels, angina, nocturnal dyspnea, and Cheyne-Stokes respiration. Gall bladder disease was suspected. Sawyer’s misdiagnoses were not mentioned.

     What was known about blood pressure and heart disease at the time, and might other measures have been taken? The auscultatory method of blood pressure measurement was invented by the

Nicolai Korotkoff (Wikipedia)

Russian Nicolai Korotkoff, first reported in1905, a method that was easy, allowed diastolic measurement, and rapidly replaced previous more cumbersome methods. After just a few years it became apparent that high blood pressure predisposed to cardiovascular problems, and by 1911 about two thirds of U.S. life insurance companies had made it part of their physical examination. Alas, there was no treatment until after WWII.

     Anginal pain, which Harding almost certainly had, was known to relate to coronary vessel disease, the case of John Hunter being a prime example. Myocardial infarction had been thought to be rapidly fatal and to have made this diagnosis in Vancouver, or instead of “the flu” in January, would have been unlikely (though occasional reports had described longer survivors). As late as 1919 James Herrick published the first case of myocardial infarction diagnosed by EKG findings, inverted T waves in this case, that were identical to those seen in dogs with ligated coronary arteries. Other features, such as Q waves, were still unrecognized and until then the EKG was used only for rhythm disturbances. No EKG is mentioned in Harding’s case. The only cardiac drug in use was digitalis and the only diuretics available were caffeine and theophylline, not very potent.

     In short, cardiac knowledge, especially of diagnostic tools, was still in its infancy. And aside from digitalis, little of medicinal use was available. Though earlier diagnosis of heart disease would have led to more rest and earlier use of digitalis, the tools for more sophisticated management were not at hand.

Sources

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

  Starling, E W and Sugrue, T.  Starling of the White House, 1946.

  Robinson, E E and Edwards, P C. The Memoirs of Ray Wyman 

         Wilbur. 1960

  Herrick, J. “Thrombosis of the Coronary Arteries. JAMA 1919. 

         72(6): 387-90.

  “President Harding’s Last Illness: official bulletins of attending 

         physicians”. JAMA 1923. 81(7), p603.

  Lewis, WH. The Evolution of Clinical Sphygmomanometry. Bull  

         N Y Acad Med 1941. November, p 971.

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/