Winter 2004
The author (AΩA, Washington University School of Medicine, 1942) has served on the Berkeley, California, Health Commission since 2002. He is a former clinical professor of medicine at the University of Alabama at Birmingham, and was in private practice in internal medicine from 1950 to 1988. Treasure hunters differ in the nature of their pursuits. For some, such as Robert Louis Stevenson’s Squire Trelawney and his young protégé, Jim Hawkins, pirate gold may be sought and retrieved from an abandoned island after overcoming a few encounters with bloodthirsty semiretired buccaneers. For bibliophiles like me, treasures may be pursued closer to home on the shelves of a well-stocked bookstore or in the stacks of an excellent library. It was my recent good fortune to locate such a treasure in the history section of the incomparable library of the University of California San Francisco (UCSF), Medical Center. I was familiar with the work of the book’s author, the late Ralph Major. His text Physical Diagnosis (1) h ad been my introduction to the great bedside clinicians of the past, including Laennec, Skoda, and Babinski. Generations of medical students have had to endure my retelling of Major’s description of Auenbrugger’s introduction of percussion in medical practice (as a youngster in his father’s inn, Auenbrugger had to assess the degree of fullness of beer barrels). Major’s Classic Descriptions of Disease (2) is also a longtime valued possession. My find at UCSF was a third work of Major’s, Disease and Destiny, a first edition published by Appleton-Century in 1936.(3) When I discovered Disease and Destiny in the UCSF library, I found more than just the published work of a favorite author. Affixed to the back of the book with stamp hinges was a postcard sent by Major to his close friend and faculty colleague at the University of Kansas Medical School, Dr. Logan Clendening. The card bore Major’s initials and had been mailed from Greece. Although the date on the card is undecipherable, the two standard issue Greek stamps and postage due stamp indicate that the approximate time of mailing was 1937 or later.(4) The postcard depicts an ancient bas-relief of a man, presumably a physician, clasping a huge model of a leg on which a very prominent varicose or phlebitic vein is portrayed, copied from the collection of the National Museum in Athens. Major wrote, “Did you see these votive offerings from the Eskapian [sic] in Athens. This must have been a forerunner of John Hayden. Doubt if I reach Cos. Boat schedules all changed—go to Smyrna and half a dozen places before they reach Cos. Also it’s rather warm. Regards. RHM.” Disease and Destiny includes a preface by the same Dr. Clendening, written at least a year before he could have received the postcard. In the preface, Clendening mentions that Major traveled to the former homes of many of medical history’s giants, an observation that clarifies Major’s evident frustration in trying to reach Cos, putative birthplace of Hippocrates. Clendening goes on to say that Major was an accomplished linguist, at home with Latin, French, and German; he also enjoyed considerable familiarity with Italian, Egyptian, and Greek. In Disease and Destiny, Major describes in vivid detail the enormous impact pandemics of bubonic plague, tuberculosis, smallpox, and typhus had on world history and its leaders and notables as early as the time of Pericles in ancient Athens. Presented with charm and wit, the book is a trove of information. With his historical, quasibiographical approach, stressing the personal attributes of the individuals involved in medical works, Major brings potentially stodgy material to life. For example, Major points out the debt humanity owes to Dr. Bretonneau of Tours, who first described diphtheria in the early 1820s, and clearly differentiated it from other types of severe pharyngitis. Bretonneau prescribed the first effective remedy, tracheotomy. Thus, the strangulating aspects of this disease were effectively confronted, even though the antitoxin that would counteract the deadly systemic effects of diphtheria toxin was not to appear foranother 70 years. If he were here today, Major would probably modify some statements in his book. He attributed Franz Schubert’s death to typhus. Although it is now generally accepted that Schubert had contracted syphilis, historians are still in the dark as to the cause of the composer’s death.(5) George Washington probably died of acute epiglottitis, a condition recognized only in relatively recent years, rather than from diphtheria, as Major related.(6) Somewhat puzzling is Major’s failure to mention salvarsan “606” or neosalvarsan in his otherwise highly informative description of “the greatest plague of them all,” syphilis. These agents had been available since the early part of the second decade of the twentieth century. Elliott Joslin, for example, as early as 1916, in the first edition of his text The Treatment of Diabetes Mellitus,(7) described the successful treatment of syphilis with salvarsan. Such minor quibbles aside, Major’s book is a fascinating find, one that was, for me, immeasurably enriched by the inclusion of the postcard from the author. Finding this work by a long-favorite author stimulated me to look more closely into Major’s background and that of his friend, Logan Clendening. Physician, professor, historian, world traveler, author, linguist, and chairman of medicine at Kansas from 1921 to 1950, Major was an extraordinarily gifted and productive individual. Born in 1884 in Liberty, Missouri, into a family with interests in banking and lumber, he graduated from William Jewell College shortly before his eighteenth birthday. After his return from several years of travel abroad, Major became imbued with the resolve to study medicine, and enrolled in Johns Hopkins University School of Medicine in the class of 1910.(8) Major’s postgraduate training included two years on the Hopkins house staff, one year in Munich with Friedrich Müller, and a brief stint in pathology under William Ophüls, who had been appointed professor of pathology at Stanford in 1909. Major’s lifelong career with the University of Kansas School of Medicine, which had been formed nine years earlier, began with his appointment as professor of pathology in 1914. His department initially consisted only of himself, and the first laboratory assigned to him was said to be full of rubbish. He quickly began housecleaning and acquiring tissue specimens and making himself available for autopsies. Following service in World War I and a brief period of further training in internal medicine at Detroit’s Henry Ford Hospital, Major was appointed chairman of medicine at Kansas in 1921. In 1950, after relinquishing the chair in medicine, he continued at Kansas as head of the Department of the History of Medicine for an additional five years. As one would expect, Major was recognized by membership in many prestigious organizations and honorary societies. He was elected to Alpha Omega Alpha while a medical student in 1910, and was nationally recognized by election to the presidency of the American Association of the History of Medicine in 1950. In An Account of the University of Kansas School of Medicine,(9) Major describes the early days there. Prior to his acceptance of the chairmanship at Kansas, for example, Major insisted on the recruitment of his friend Russell Haden, who later became an internationally recognized hematologist. More personal information about Dr. Major is contained in a tribute paid him by his friend, Robert P. Hudson, M.D., following Major’s death in 1970.(8) Major married Margaret N. Jackson, with whom he had three children, Ralph, Jr., John, and Virginia, all of whom survived him. Two years after Margaret’s death in 1965, Major married a friend and valued companion, Wanda Graham. Major’s hobbies included playing the piano and getting together with old friends for an evening of what I suspect he might have characterized as “gemütlichkeit.” Major had been strongly influenced by his travels in Germany, particularly by the examples of Munich clinician Friedrich Müller, whom he cited in his textbook, Physical Diagnosis. Possibly also influenced by German professional standards, Major instituted certain disciplinary rules for medical students, prohibiting smoking in the presence of patients, and forbidding the use of elevators. Major’s clinical work was distinguished by the early successful use of insulin, acquired from friends in Toronto, in the treatment of uncontrolled diabetes, including diabetic coma. He took pride in the fact that of the three published reports in the June 2, 1923, issue of JAMA dealing with that revolutionary treatment of diabetes, one of them was from his department at the University of Kansas.(9) Finally, Hudson observed of Major that, “He stimulated faculty and student interest in the history of their profession to heights that probably never will be reached again in today’s curricular crush.”(8p285) Written over thirty years ago, this statement is certainly prophetic. For an account of Logan Clendening’s life, I turned to a memoir published by Major in 1945, shortly after Clendening died. Major met faculty colleague Logan Clendening soon after taking on his new duties at Kansas, and the two became lifelong friends. Clendening shared Major’s enthusiasm for teaching physical diagnosis and exploring medical history. Clendening’s Modern Methods of Treatment enjoyed eight editions, and he later became well known to the general public for his widely syndicated column of health advice. Logan Clendening was a native Kansan, born in 1884 of Scottish ancestry with strong Jacobite sympathies. In his memoir, Major describes him as a tall, handsome man of ample girth, and full of vigor and good spirits. Clendening was particularly known for his sense of humor, his expertise as a raconteur, and his infectious charm. He attended public schools in Kansas City, Missouri, the University of Michigan, and the University of Kansas School of Medicine. Following graduation from medical school in 1907, Clendening traveled through much of Europe, visiting medical centers in England and Scotland as well as those of the Continent. He entered private practice in Kansas City and married Dorothy Hixon in 1914. During World War I, Clendening served in the Army Medical Corps as chief of medicine at the base hospital at Fort Sam Houston. On his return to civilian life, he was appointed to the medical faculty of his alma mater, where his enthusiasm for teaching physical diagnosis extended to demonstrations of gastric lavage and abdominal paracentesis. Major commented that no student ever fell asleep in one of Clendening’s classes. Although Clendening later gave up private practice to become a full-time writer, he never surrendered the practice of medicine in the dispensary. Major wrote, “He initiated generation after generation of medical students into the mysteries of physical diagnosis.”(10p201) Clendening was a collector of rare medical books, in the tradition of Osler and Cushing; like other notable collectors who left their books to medical schools with which they had enjoyed a close association, Clendening donated his library to the University of Kansas; the collection is now known as the Clendening History of Medicine Library. So how did an old postcard from Major to Clendening find its way to San Francisco, and to the back of this copy of Disease and Destiny, so many years and miles from the University of Kansas? Its provenance remains a mystery. The votive image on the card was later reproduced in Major’s splendid two-volume work, A History of Medicine.(11) In that volume, the author indicates that the votive was originally found in the famous Asklepieion temple in Athens. An acknowledgment on the front flyleaf of the book states that it was given to the library by the estate of the late Dr. Esther Rosencrantz. A 1904 Hopkins medical graduate and a distinguished San Francisco physician specializing in chest disease, Dr. Rosencrantz served as a lecturer in medical history at UCSF, as well as an associate professor of medicine. When she died in 1950, she left her medical history collection (including a valuable accumulation of Osleriana) to UCSF. Finally, where does Ralph Major belong in the pantheon of physicians? Why are his contributions important today, to me, and, I hope, to many others? Major’s two principal achievements were developing the Department of Medicine at a young, Midwestern medical school, the University of Kansas, and arousing an interest in and appreciation of the glorious saga of medical history. Unfortunately, the history of medicine has always been a stepchild in the medical school curriculum. Yet the history of civilization can boast no more positive contribution to humanity than the development over the centuries of the modern healing arts, beginning perhaps with Vesalius and Harvey. Ralph Major revered medicine’s pioneers, and his reverence and esteem for those trailblazers is contagious.
Acknowledgments The unstinting assistance of Reference Archivist Valerie Wheat and Special Collections Manager Lisa Mix of the UCSF library is gratefully appreciated, as is the generous help of Ms. Dawn McInnis, rare books librarian of the Clendening History of Medicine Library, University of Kansas Medical Center, Kansas City, Kansas. I am also indebted to my daughter, Ms. Brady Kahn, for expert editorial criticism.
References 1. Major RH. Physical Diagnosis. Second Edition. Philadelphia: W.B. Saunders; 1940. 2. Major RH. Classic Descriptions of Disease, with Biographical Sketches of the Authors. Second Edition. Springfield (IL): Charles C. Thomas; 1939. 3. Major RH. Disease and Destiny. New York: D. Appleton-Century; 1936. 4. Kloetzel JE, editor. Scott 1999 Standard Postage Stamp Catalogue. Volume 3 Countries of the World G-I. Sidney (OH): Scott Publishing; 1998. 5. O’Shea JG. Franz Schubert’s last illness. J Royal Soc Med 1997; 90: 291–92. 6. Morens DM. Death of a president. N Engl J Med 1999; 341: 1845–49. 7. Joslin EP. The Treatment of Diabetes Mellitus, with Observations upon the Disease Based upon One Thousand Cases. Philadelphia: Lea & Febiger; 1916. 8. Hudson RP. Correspondence and reports: Ralph H. Major, 1884–1970. Bull Hist Med 1971; 45: 282–86. 9. Major RH. An Account of the University of Kansas School of Medicine. Lawrence (KS): University of Kansas Printing Service; 1968. 10. Major RH. Logan Clendening (1884–1945). Bull Hist Med 1945; 18: 198–206. 11. Major RH. A History of Medicine. Volume One. Springfield (IL): Charles C. Thomas; 1954. The author’s address is:
Ralph Major’s writings Among Ralph Major’s other medical writings, probably his best-known works are Classic Descriptions of Disease, first published in 1932, for which he is known to have made many of the translations into English himself, and the textbook Physical Diagnosis, first published in 1937. In the course of describing diagnostic bedside techniques in the latter work, Major supplied thumbnail sketches of medicine’s innovators in bedside diagnosis. Major was unquestionably influenced in this by Hopkins’s first chief of medicine, William Osler. Although Osler had left Hopkins for Oxford in 1905, before Major’s arrival in Baltimore, his emphasis on bedside teaching and his devotion to medical history continued to influence Major and his colleagues there. In addition to more than fifty articles on medical history, and numerous chapters in medical texts, Dr. Major published the following books: The Doctor Explains (Knopf, New York, 1931), written primarily for patients Classic Descriptions of Disease (C. C. Thomas, Springfield, Illinois, 1932; second edition 1939; third edition, 1945; fifth printing, 1945) Disease and Destiny (D. Appleton-Century, New York-London, 1936) Physical Diagnosis (W.B. Saunders, Philadelphia and London, 1937), with multiple subsequent editions, some of the later editions of which were co-edited with his colleague Mahlon Delp, as well as translated into several languages Ein Arzt Erzählt KulturGeshicte (Paul Zsolnay Vergla, Berlin-Wien-Liepzig, 1937) Faiths That Healed (D. Appleton-Century, New York, 1940) Fatal Partners: War and Disease (Doubleday Doran and Co., New York, 1941) A History of Medicine (C. C. Thomas, Springfield, Illinois, 1954, 2 volumes; Italian edition, 1959) Disease and Destiny, Logan Clendening (University of Kansas Press, Lawrence, Kansas, Logan Clendening Lectures, Eighth Series, 1958) An Account of the University of Kansas School of Medicine (University of Kansas Printing Service, Lawrence, Kansas, 1968) Memories of a Vanished Era, Kansas City, Missouri (private printing by the Lowell Press, 1968) Old Ties and New, Kansas City, Missouri (private printing by the Lowell Press, 1968) Torna a Sorrento (private reproduction, paper bound, 1967). |
|||