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MORSELS OF
HISTORY
Dr. Francis Wood
A lot of these anecdotes will be woven in and around Philadelphia, but since I am not a native of that city, and only moved there 58 years ago, I hope you will forgive my geographical focus, if it seems narrow. I will talk not entirely about great facts of history, but also recount what seems to me to be the more interesting sidelights. To begin your orientation, you will recall that William Penn arrived in Philadelphia in 1682, on a vessel where one third of the occupants had died of small pox during the voyage. Imagine being on that vessel. Sixty-eight years later (in 1750) the City of Philadelphia had 25,000 inhabitants, and 4,000 buildings. It is said to have been the largest city in America, and the third largest city in the British Empire (after London and Edinburgh). Until 1765 there was no medical school in the British Colonies in America. John Morgan (1735-1789) was a young Philadelphian. He had served six years as an apprentice to John Redman of that city. The next four years he had been a military surgeon. In 1760 at the age of 25 he went to Edinburgh to complete his medical education, armed with a letter from Benjamin Franklin. Morgan received his medical degree in 1763, and after travel on the continent, returned to Philadelphia in 1765; and presented to the Trustees of the College of Philadelphia his plan for establishing the first medical school in the colonies. (It sounds up to date enough to be a plan which someone might write today). He stressed the importance of a sound preliminary education in literature and science, and a thorough grounding in medical science, as a necessary basis for clinical medicine, i.e., anatomy-materia medica-botany, chemistry, pathology, physiology (he calls it: “animated anatomy”). He insisted that the medical faculty should be an integral part of a university, and should control adequate hospital facilities. He stressed the importance of research. He wrote, “observation and physical experiments should blend their light to dissipate obscurity, we must dive to the bottom of things by repeated and different experiments, and, as it were, force nature to yield herself to our enquiries.” Morgan’s plan was accepted, and the trustees appointed him the first Professor of Medicine. Now I would like to take you back a few years, to see how the ground was prepared for the planting of Morgan’s seed. The person primarily responsible was Benjamin Franklin (1708-1790). First in 1743 he proposed the organization of what later became the American Philosophical Society. His enumeration of the subjects with which it was proposed that this society should be occupied, included: to quote Franklin, “Botany, medicine, chemistry and all philosophical experiments that light into the nature of things, and tend to increase the power of man over nature, and multiply the convenience and pleasures of life.” He was always inventing things, bifocals, for instance. In the second place, Franklin was the prime mover in establishing the Academy of Philadelphia, which later became the University of Pennsylvania (1749). In 1755 it became a degree granting college. Third, Franklin was responsible for creating our clinical facilities, ten years before the medical school began. It happened this way: in 1750, Dr. Thomas Bond of Philadelphia decided that the provinces needed a hospital. He tried to interest the citizens, but failed, so he went to Benjamin Franklin, who, immediately and enthusiastically, threw his influence behind the project and prepared the public mind by newspaper publicity. Then, realizing that the amount of money which could be expected from private subscriptions would not suffice, he went to the legislature and asked for financial help. Failing in his original attempt, he suggested to them that, if private subscriptions could be secured, from Philadelphians, totaling two thousand pounds, the legislature might supply an equivalent sum? The legislators, feeling confident that no such amount could be raised privately, agreed to the proposition. Thus armed with the first matching funds in history, Franklin was able to obtain 2,000 pounds from the local citizenry and got his 2,000 pounds from the legislators. He says in his autobiography: - “I do not remember any of my political maneuvers, the success of which gave me more pleasure, or wherein, after thinking of it, I more easily excused myself for having made some use of cunning.” The cornerstone of the Pennsylvania Hospital was laid in 1755. Franklin himself wrote the inscription, which you can still see. “In the Year of Christ MDCCLV(1755O George the Second Happily Reigning (for he sought the happiness of his people) Philadelphia Flourishing (for its inhabitants were public spirited) This Building By the Bounty of the Government And of Many Private Persons Was Piously Founded For the Relief of the Sick and Miserable May the God of Mercies Bless this Undertaking.” Later in 1874 the Medical School of the University of Pennsylvania moved from the center of Philadelphia, out across the Schuykill River to west Philadelphia, and built their own Hospital at 34th and Spruce Streets where it now stands. I thought you might like to hear a list of the “Duties of Floor Nurse” as of 1887, 13 years after the hospital was built. DUTIES OF THE FLOOR NURSE In addition to caring for your 50 patients, each nurse will follow these regulations: 1. Daily sweep and mop the floors of your ward, dust the Patient’s furniture and windowsills. 2. Maintain an even temperature in your ward by bringing in a Scuttle of coal for the day’s business. 3. Light is important to observe the patient’s condition. Therefore, each day fill kerosene lamps, clean chimneys, and Trim wicks. Wash the windows once a week. 4. The nurse’s notes are important in aiding the physician’s Work. Make your pens carefully, you may whittle nibs to Your individual taste. 5. Each nurse on day duty will report every day at 7 a.m. and Leave at 8 p.m., except on the Sabbath on which day you will Be off from 12 noon to 2 p.m. 6. Graduate nurses in good standing with the director of nurses Will be given an evening off each week if you go regularly to Church. 7. Each nurse should lay aside from each pay a goodly sum of her Earnings for her benefits during her declining years, so that She will not become a burden. For example, if you earn $30 A month you should set aside $15. 8. Any nurse who smokes, uses liquor in any form, gets her hair Done at a beauty shop, or frequents dance hall will give the Director of nurses good reason to suspect her worth, intentions, and integrity. 9. The nurse who performs her labors, serves her patients and Doctors faithfully and without fault for a period of 5 years will be given an increase by the hospital administration of 5 cents a day providing there are no hospital debts that are outstanding. Now I want to tell you a few odds and ends about Benjamin Rush. He was probably one of the most important and certainly one of the most brilliant and accomplished physicians in America in his time, he was outspoken and dogmatic. He was a liberal, against capital punishment, slavery and alcohol. He believed in education for women, and in the humane treatment of the insane. (He is often referred to as the Father of American Psychiatry). He suggested that the medical school should teach veterinary medicine. Rush did many important things, which you have probably heard about but I want to tell you about his treatment of disease. In 1797 he treated for yellow fever, Philip Syng Physic (the famous surgeon who introduced absorbable ligatures). Physic subsequently wrote, in the Gazette of the United States, September 14, 1797, describing Rush’s treatment, which he was convinced had saved his life. He said that he had been bled 176 ounces in 22 bleedings in 10 days (about 1 ¼ gallons) and he had had much purging of his bowels. In 1799 one of Rush’s disciples treated George Washington in his final illness, and bled him 82 ounces in 12 hours (over 2 ½ quarts). I had always wondered why Rush took such large quantities of blood from his patients, until I found, in one of his lectures to students, the statement that the body contained 26 pounds of blood: “A pint is a pound the world round,” so Rush thought there were 26 pints—13 quarts of blood in the body, twice as much as we now know the body contains: Incidentally, I suppose you know the name of the first President of the United States? One of my favorite Swedish friends handed me this pamphlet about a year ago, entitled, “John Hanson, First President of the United States.” The thrust of the pamphlet was this: After Cornwallis surrendered at Yorktown in October 1781, the states were governed under the Articles of Confederation by the Continental Congress. The first President of the Congress was John Hanson of Maryland, who functioned as President of the country at that time. You may be able to astonish some of your friends by asking them the question I posed to you, I suppose you know the name of the first President of the United States.” Have you heard the story of the secret operation on President Grover Cleveland? The denouement of this mystery has not yet been published, so I am giving you some strictly new information about it this evening. Before Cleveland was elected in 1892 for a second, non-consecutive term, near disasterous troubles were unleashed upon this country by the passage of the Sherman Silver Purchase Act of 1890. This act required the purchase 4.5 million ounces of silver annually by the government; which of necessity printed federal notes (fully redeemable in gold) for payment. Its net effect was to drive gold out of the country, to cause an unabated production of paper money and to produce a rampant inflation. Cleveland was re-elected on a platform calling for a repeal of the Sherman Act and calling for other conservative fiscal and monetary policies. In the midst of all this financial confusion known as the “Panic of ‘93”, President Cleveland noticed a lesion in the roof of his mouth on the left side. When examined by his physician, “The ulcer was as large as a quarter of a dollar extending from the molar teeth of 1/3 of an inch from the middle line, encroaching slightly of the soft palate. The Vice President, Adlai E. Stevenson, was a silver man, who was opposed to the repeal of the Sherman Act. Consequently the President decided that anything indicating ill health on his part would be seized as a sign of weakness. Therefore, after his dentist and the White House Physician (Dr. O’Reilly) had seen the lesion and recommended consulting a surgeon, Cleveland decided to proceed with the utmost secrecy. The upshot of it was that Cleveland went aboard the Yacht “Oneida” belonging to a close friend, Commodore Benedict, on June 30, 1893 and went out into long Island Sound with Dr. W.W. Keen, Dr. Edward G. Janeway, Dr. Robert M. O’Reilly, Dr. Joseph D. Bryant, Dr. John F. Erdman, and Dr. Ferdinand Hasbrook, a dentist. It is said that the ship’s steward performed the functions of an operating room nurse. The entire left upper jaw was removed/ from the first bicuspid tooth to just beyond the last molar, and nearly up to the middle line, the floor of the orbit was not removed. The President’s recovery was rapid. He walked around the yacht on the night of July 2. Shortly thereafter he was taken to his summer home at Green Gables on Buzzards Bay. On September 5, 1893 about two months after the operation, he addressed a combined session of Congress concerning the silver question, and it is reported that no one noted any significant change in his voice. The Sherman Silver Purchase Act was repealed. The specimen of Cleveland’s jaw, containing the tumor was given to the Mutter Museum of the College of Physicians of Philadelphia by Dr. Kasson C. Gibson thru Dr. W.W. Keen, on October 5, 1917, and all my adult life, I’ve seen it there in that jar. Cleveland died on June 24, 1908, fifteen years after this secret operation, of causes unrelated to the lesion of his jaw. The tumor never recurred, and from that day to this, there had always been a mystery about it. For one thing, no written report of any biopsy or microscopic study of the tumor had ever been found; as if someone might have tried to cover up the nature of the lesion. It is recorded by the President’s physician, Dr. O’Reilly, that he gave the President mercury and iodides, before the operation, and noted that the edge of the tumor seemed to recede. As most of you know, mercury and iodides would have a favorable effect on a gumma, and to give this possibility a slight nudge, it was rumored that Grover Cleveland may have had an illegitimate child. I understand there was a jingle going around about it during the presidential campaign, “Ma, Ma, where’s my Pa? He’s going to the White House, ha, ha.’ Because of this possibility, although, we were asked repeatedly to cut sections of the tumor, we refused these requests until Cleveland’s oldest son Richard died. Finally, in 1976 the Philadelphia College of Physicians gave permission. Our pathologist, Dr. Horatio T. Enterline cut sections of the tumor and examined them microscopically with the promise that if a gumma were found, we would not reveal this fact, until all of Grover Cleveland’s children had died. To make a long story short, it was a malignant tumor of a somewhat unusual type, a verrucous carcinoma, of low-grade malignancy, much less likely to metastasize than the usual oral cancer. There is one other episode you might be interested in: Shortly after the Sherman Act was repealed by Congress, a detailed and accurate account of the entire operation on President Cleveland was published in the Philadelphia Press under the pen name of “Holland”. Apparently the dentist, Ferdinand Hasbrook had betrayed the secret and supplied a young reporter late identified as E.J. Edwards, with all the information. His account was vigorously denied, not only by the White House, but by all other participants in the episode. Mr. Davis, Editor of the Philadelphia Public Ledger, and a close friend of President Cleveland wrote that Holland’s statement, “had a real basis for a toothache.” The story thus was discredited. Hasbrook was never spoken to again by Dr. Bryant, the captain of the surgical team. The reputation of the reporter, Edwards was not redeemed, until 1917, years after Cleveland’s death, when another participant, Dr. W.W. Keen, recounted the entire incident in the Saturday Evening Post. When I was a freshman in medical school in the fall of 1922, I remember a clinic given by Dr. O.H. Perry Pepper to us on a patient with diabetes, whose life had been saved by that new discovery, i.e., the drug insulin. There were several unusual items in the history of the discovery of insulin. We might list them as: 1. flies, 2. beer, and 3. the loss of the toss of a coin. Do you know about these? First, flies: - In 1889 Von Mehring and Minkowski noticed a strange phenomenon in their laboratory, one of the two sinks had a lot of flies all over it; the other did not. So they asked the diener what was the difference in the two sinks. Oh, he said, that one with the flies, is where we pour the urine of the dogs you are operating on. The operation was the removal of the dogs pancreas. They examined the urine and found sugar. That was when the connection between the pancreas and diabetes was first suspected (as a result of the flies). Second, beer:- Dr. C.N.H. Long told me years ago that Frederic Banting had told him how he had gotten his idea for producing insulin. He was a practicing physician in Callender, Ontario sitting in his office one evening with nothing much to do, with his feet on the table, drinking beer, when he picked up a medical journal. Browsing through this number of surgery Gynecology and Obstetrics of November 1920, he came across an article on page 437 by Moses Barron of Minneapolis, recording an autopsy on a patient with a pancreatic calculus, in which the obstruction of the pancreatic duct had caused atrophy of the acini which produce the digestive juices of the pancreas, leaving the pancreatic islands intact. If you read the article you will find that the patient had died of diabetes probably produced by a recently occurring infection behind the stone. However Barron reviewed all the literature and reported several published experiments where an investigator had ligated the pancreatic duct in animals, causing the acini to atrophy leaving only the Islets of Langerhans. Banting at that moment appreciated the fact, that this gave him a method of collecting the islet tissue, which, without preliminary duct ligation, had always heretofore been digested, postmortem, by the digestive juices of the acini. (Beer helped to bring this about). Third, the loss of the toss of a coin: Banting took his idea to Dr. MacLeod, Professor of Physiology at Montreal, and asked for permission to work in his laboratory, that summer. MacLeod gave permission, and had two medical students scheduled to work there, either on of whom he said could work with Banting. The story I heard was that these two students looked at Banting, were not enthused, and then tossed a coin to see who would have to work with him. Charles Best lost the toss of the coin. The other one hasn’t been heard of since. I actually asked Charles Best one evening at dinner whether he had lost the toss of that coin. He looked at me with a smile and didn’t answer! If I mention the name of Dr. A.N. Richards, would you know about whom I am speaking? He was the man who in 1921 with Dr. Joseph Wearn put a micropipette into the glomerular capsule of a frog’s kidney, obtained a few drops of glomerular fluid, and comparing it to the plasma of the frog, showed that it was an ultra filtrate of plasma, thus, for the first time, showing that glomerular function was filtration. Dr. Richards was a great influence in the University of Pennsylvania Medical School. When the Second World War came along he was asked by Dr. Vannevar Bush, Head of O.S.R.D. (Office of Scientific Research and Development) in Washington to take the Chairmanship of the Committee on Medical Research; during which activity his was the guiding and deciding influence in the development methods of producing penicillin. A number of chemists believed we should have waited until it was synthesized. Dr. Richards reviewed the evidence, and decided to proceed with growing it in liquid media, which turned out to be the right course at the time. The first attempts resulted in the production of merely two units of penicillin per cc, after a few months of experimentation, this yield rose to 900 units per cc. Between Florey’s visit to America in 1942 bringing with him the first penicillin, and June 1944, enough penicillin had been produced to treat all casualties of the Normandy Invasion; and by August 1945 (the time of the Japanese surrender) the production was 650 billion units per month. Dr. Richards is recognized as mainly responsible for this miracle. After the war he became our Vice President for Medical Affairs at the University of Pennsylvania. He was mentor all through my years as Chairman of Medicine. I would like to tell you an anecdote or two about this great man, who was one of my heroes. One August, Dr. Richards and some of his associates were in their laboratory doing a frog experiment, when a knock came at the door. A student came in and told Dr. Richards he had come for his reexamination in Pharmacology, having flunked the course that year. Dr. Richards was in the middle of a crucial experiment, so after a moment’s thought (having forgotten until that moment all about the young man’s reexamination) said, “There is a large pad of writing paper in the upper drawer of my desk. Go and write out what you think is a fair examination.” After a while the student reappeared. Dr. Richards read the examination and said, “That’s fair, now sit down at my desk and answer it.” Several hours later the student knocked again. The experiment being still in progress, Dr. Richards thought for a moment, then said, “There is a Cushney and several other pharmacology text books in the bookcase over my desk. Will you consult them and correct your examination.” The next knock, and the student had flunked himself. The sequel to this episode is, that fall Dr. Richards tutored the young man until he finally passed the course. One time when I was a second year medical student, Dr. Richards, then our Professor of Pharmacology, was lecturing on Strychnine, and, to illustrate this drug’s action, injected some of it into the lymph sac of a frog. Very soon the frog went into strychnine evoked convulsion and, gave a funny little squeak, which brought forth a titter from the class. Dr. Richards stopped, looked up at us, and said, “Gentlemen don’t laugh at this frog. He isn’t having a good time.” We were all much ashamed. Think of it; A man who had experimented on frogs for years, had not lost his sensitivity to that little animal’s feelings. Are you aware of the unreported items, which helped Alexander Fleming discover penicillin, i.e., a holiday, and two coffee breaks. I’m told, by one of the men in his laboratory that Fleming once went away on a long weekend, and it was after that weekend, which had given the penicillin mould time to grow, that he found it in a bacterial culture with a ring of destroyed organisms around it. In addition to that holiday, I am told by this same person that the reason there was a lot of penicillin mould in the air was because right next to Fleming’s laboratory was an empty and unfurnished room where a number of the laboratory workers ate their lunch, and that the bread and food they left around are credited with the penicillin mould which contaminated Fleming’s culture. Next I’d like to tell you how Dr. John Gibbon happened to start to work to develop the hear lung machine, which has revolutionized cardiac surgery. He told me the story, and I have here the account from his wife Maly (Mary) Gibbon published two years ago in the - Journal of Extra-corporeal Technology, from which I am quoting: “In January 1930, she says, Jack had finished his internship at the Pennsylvania Hospital in Philadelphia and came to Boston to do a year of surgical research with Pete Churchill. He held the position of Research Fellow in Surgery at the Harvard Medical School and he and I (Maly Gibbon speaking) first met in Boston in Pete Churchill’s laboratory when he started to work there. Since I was Pete’s laboratory technician at that time, we worked together for about a year, and then became engaged to be married early in 1931. In October 1930 a female patient at the Massachusetts General Hospital suffered a postoperative massive pulmonary embolism. She was taken to the operating room and Jack’s assignment was to take her blood pressure and pulse rate every fifteen minutes, while, during a long night’s vigil, Churchill and his operating team stood by. They waited to operate on the patient until it appeared that she would otherwise die. In those days the operation of pulmonary embolectomy carried such a high mortality that operating before the patient was moribund was taking an unjustified risk. Only nine of 142 patients operated upon in Europe had survived embolectomy and no successful operation had yet been reported in the United States. The patient was in the operating room from 3:00 p.m. in the afternoon, until 8:00 a.m. the following morning, when her condition became very much worse and the blood pressure could no longer be recorded. Dr. Churchill immediately operated and removed the embolus, all within the space of six and a half minutes, but the patient did not survive the operation. (Maly continues) I have often wished that her family might know of the thousands of lives that have been saved throughout the world because this woman lived and died when and where she did.” “During the hours that night that Jack watched the patient’s distended veins and recorded the faltering pulse, respirations and blood pressure, the thought occurred and constantly recurred to him that her condition could surely be improved if only there were some way of continuously withdrawing some of the blue blood from the swollen veins into an apparatus where the blood could pick up oxygen and discharge carbon dioxide, and then be pumped back into the patient’s arteries.” Jack thought, and talked about this possibility; then finally in 1935, five years later while again working as a surgical fellow in Dr. Churchill’s lab with his wife as his lab technician, they were able to clamp a cat’s pulmonary artery completely and maintain the heart and lung function with the machine they had developed to oxygenate the blood. When this was finally achieved they did an impromptu dance around the laboratory. I like to remember one day in the early 1950’s when Jack Gibbon was making tests of his heart lung machine on dogs. He invited me to come down to his operating room at Jefferson Hospital. He opened a dog’s heart, cut a hole in the interatrial septum, them patched it with a piece of pericardium, then sewed up the heart; and a week later the dog was running around healthy and happy. I couldn’t believe it. I had no idea until I saw it with my own eyes that one could open the heart wide, work in a bloodless field, then sew it up a half hour later and have it function normally. It was three years later on May 6, 1953 that Jack first did this very operation (closing a congenital atrioseptal defect successfully) in Cecelia Bavolek. Just think, that was only 27 years ago. She is still living.
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