Parallelisms of Medical Greatness, 1970
Page  1

Parallelisms of Medical Greatness By MARTIN M. CUMMINGS, M.D. Bethesda, Maryland Reprinted from THE JOURNAL of the Oklahoma State Medical Association August 1970, Pages 385-390 Copyright 1970 by Oklahoma State Medical Association

Page  2 [ Presented at the University of Oklahoma Medical Center, Department of Medicine, on May 11th, 1970.] MARTIN M. CUMMINGS, M.D. The life and accomplishments of a distinguished Oklahoma physician, Stewart Wolf, M.D., are compared with that of S. Weir Mitchell, the father of American neurology. The parallelisms of their medical and cultural interests are identified and discussed. NO PERCEPTIVE PERSON could return to this medical center after an absence of a decade without reflecting on the profound changes which have occurred here - and particularly those changes which are attributable to the person most responsible for them. The dreams and aspirations of Doctor Stewart Wolf were so persuasive that, like many others, I succumbed in 1960 to observe and follow this remarkable Pied Piper (Figure 1). His clinical prowess, investigative talent, and personal charm were characteristics cultivated in the environment of Baltimore, Boston, and New York. However, his diversity and versatility of interests and accomplishments came into full display in this setting where I am now privileged to compare my views of Stewart Wolf with another cultured and creative physician, S.Weir Mitchell, the father of American neurology (Figure 2). Stewart Wolf was born in Baltimore in January 1914 a few days after Weir Mitchell's death. They were raised and educated only a few miles apart on the Eastern seaboard. Both Mitchell and Wolf served in the great wars of their times and both returned to troubled societies, determined to improve the lot of their fellow men by fulltime devotion to teaching, research and the practice of medicine. Both gave much of their medical careers to the health affairs of veterans (Figure 3). Both were members of the Association of American Physicians, American College of Physicians, the American Clinical and Climatological Association, and other prestigious medical organizations. Stewart's alma mater, Johns Hopkins University, awarded Weir Mitchell an honorary LL. D. in 1912. Both shared a love for literature, libraries, and the fine arts. Mitchell was a noted poet as well as a physician. I have always suspected that if we were free to examine the Wolf's attic we would find there lyrics written to his beloved ones, or poems which extol the virtues of persons or causes which captured his attention. Stewart Wolf was a choral and choir singer and served as President of the Oklahoma Symphony for five years. Weir means "fishing place" or "enclosure for taking fish." True to his name Weir Mitchell was an avid fisherman and if for no other reason, this attracts me to him (Figure 4). Unfortunately I can find no

Page  3 parallel interest on the part of Stewart Wolf, although we might expect him to become similarly involved in his new position at the Marine Biomedical Institute at Galveston. The remarkable parallelism of their medical interests is the main focus of my remarks today. A man's character and contributions can often best be seen from his bibliography and his portrait. This is reflected in Mitchell's bibliography which I would like to review with you briefly. Like Weir Mitchell, Wolf's earliest medical research interest was in the field of gastrointestinal physiology. Mitchell followed with studies of neurophysiology, the effects of drugs and toxins on animals and man, and finally clinical studies of the central and peripheral nervous systems. There were excursions into psychosomatic medicine with interests in headache, sleep, hysteria, and finally the full integration of neurology as an important specialty of clinical medicine, including neurocirculatory relationships. Stewart Wolf's parallel contributions to medicine are of such currency that they need no recounting here. They are taught to contemporary students as distilled from some 246 publications, including 11 books and monographs. The similarity of sequence of interests between Mitchell and Wolf I believe to be truly remarkable. A cynical observer might even be tempted to suggest that the younger deliberately emulated the older. Even if this were true, which I do not believe, it is still more remarkable that he succeeded so well. It is more likely that Stewart's interests were influencd most by his mentor and friend, Doctor Harold Wolff. How many of us fail to reach the level of attainments of our heroes in medicine, be

Page  4 they Osler in internal medicine, Cushing in surgery, or Jacobi in pediatrics. [Figure 1. Full-time members of the Medical Department, University of Oklahoma School of Medicine, 19521953. First row: Professor R. H. Bayley; Doctor S. G. Wolf, Professor and Head of the Department; Doctor R. M. Bird. Second row: Doctor R. C. Lowe; Doctor R. A. Schneider; Doctor J. P. Colmore. Third row: Doctor B. L. Bailey; Doctor C. G. Weiman, Chief Resident, Doctor C. Liebrand; Doctor R. M. Gastineau. (Doctor W. W. Schottstaedt and Doctor J. F. Hammarsten joined the Department in September 1953, and are not in this photograph.)] [Figure 2. Doctor S. Weir Mitchell.] In addition to these medical parallelisms there remains the striking social and cultural parallelism of complete men. Particularly, I am in a position to relate that segment of history which reveals Mitchell's influence on my predecessor, Doctor John Shaw Billings, who founded the National Library of Medicine. I shall comment also on Stewart Wolf's influence on the same institution and its present director a full century later. Weir Mitchell came to know and respect Billings during the Civil War when Mitchell's brother came under his care for a mortal gunshot wound. Billings, who had performed more than 500 amputations during the battles of Chancellorsville, Gettysburg, and the Wilderness Campaign, although unable to save young Mitchell, demonstrated his tender care for the sick and disabled and thus captured the esteem and friendship of Doctor Mitchell. [A graduate of Duke University School of Medicine, Martin M. Cummings, M.D., is Director o f the National Library o f Medicine at the National Institutes o f Health in Bethesda, Maryland. Doctor Cummings is certified by the American Board of Microbiology and other medical affiliations are the American Academy of Microbiology, Inc., the American Federation for Clinical Research - Emeritus, the American Society for Clinical Investigation - Emeritus, and the American Thoracic Society.] [Figure 3. Doctor Mitchell examining a Civil War veteran.] He became a strong supporter of the Surgeon General's Library and along with William Osler, Oliver Wendell Holmes, and William H. Welch, became intimate friends of the young surgeon, Billings, who was to develop the Index Catalog and the Index Medicus, said to be America's greatest contribution to medicine in the 19th century. Billings and Mitchell are described driving around Washington together "in a queer ramshackle buggy with an indifferent-looking nag, Billings holding the reins and applying the whip," while Mitchell is remembered for his courtly manner and appearance waving his tall hat to acknowledge someone en route. Many in this room will be reminded, I'm certain, of the Homburg which Stewart Wolf uses with gestures of equal nobility while driving or being driven around this community and elsewhere (Figure 5). He was recently observed at a meeting in Germany using his hat as an umbrella in a rainstorm. Billings and Mitchell met often during meetings of the National Academy or of the Carnegie Institution of which Billings was a founder. In addition to their work for these organizations they also exchanged their most personal views of leading figures of their times as well as their common interests in cultural and other affairs. I was pleased to find a letter from Mitchell to Billings importuning him to use his influence to get the "fish commission" to transfer black bass to a pond where I'm certain Mitchell intended to fish. He also wrote to Billings in 1890 to gain access to a veteran patient he wished to study, a practice which

Page  5 I'm certain that Wolf and others here still engage in. [Figure 4. Doctor Mitchell fishing on the Restigouche River in Canada.] In 1890 Mitchell convinced Billings that he should leave government service after 30 years and give greater scope to his interests by becoming the first Professor of Hygiene at the University of Pennsylvania. Billings accepted this position serving the first few years commuting from Washington. The affection between these great men is expressed in a letter written by Billings to Mitchell in 1904 after being notified of the death of a mutual friend. ... One by one, the majority of my old friends have passed away, but so long as you remain, life is still worth living for me . . . When I think of you it is not as a great physician - or as a poet - or as a leader in science - but as 'Weir,' just 'Weir' - And I have a comfortable cardiac (or pre-cardiac) sensation in the thought that I have the right to call you 'Weir.' May you live long to enjoy life as you do and when the end comes - may it be painless and prompt! I mean by this the end of this life - yet I don't think that will be the end for you - but rather that it will be a new beginning. I suppose you have had beginnings before the Nineteenth Century -probably Philip Sidney may have been one of your trial-trips. Be that as it may, you have been mine in a sense for forty years now - in a rather special way - and I am yours, J.S.B.1 Billings came to Pennsylvania, established the first Institute of Hygiene in our country, but left after several years to design and establish the New York Public Library and its system of branch libraries with five million dollars which he had charmed from Andrew Carnegie. This event was chronicled by Fielding Garrison as follows: On November 27, 1895, Mr. John L. Cadwalader, one of the Executive Committee of the Board of Trustees of the New York Public Library informed Doctor Billings that he had been chosen as the Director of the proposed Library. After due discussion and deliberation, the latter referred the question to Mr. Charles C. Harrison, Provost of the University of Pennsylvania, at the end of the year (December 30th), stating that he had been in the service of the University for five years, during which time the Department and Laboratory of Hygiene had been organized, the University Hospital reorganized, and competent assistants obtained, who could carry on the work without interruption, if he resigned. To this end, he proposed carrying on his university work till the end of the scholastic year at a reduction in salary, in order to give two days in the week to the New York Library until June 1, 1896, upon which date he proposed his resignation should take place. 'I make this request,' he concludes, 'not because I am in any way dissatisfied with my position and work here, nor for the sake of obtaining greater compensation, but because I believe I can best contribute to the public good by undertaking the New York work.' The situation was a delicate and embarrassing one for both sides. Doctor Billings had given hostages to the University of Pennsylvania, he had planned two of its finest laboratories, he had less than a month before being tendered a banquet in the city with a gift of perhaps the largest purse ever raisee Board of Trustees of the e Board of Trustees of the New York Public Library informed Doctor Billings that he had been chosen as the Director of the proposed Library. After due discussion and deliberation, the latter referred the question to Mr. Charles C. Harrison, Provost of the University of Pennsylvania, at the end of the year (December 30th), stating that he had been in the service of the University for five years, during which time the Department and Laboratory of Hygiene had been organized, the University Hospital reorganized, and competent assistants obtained, who could carry on the work without interruption, if he resigned. To this end, he proposed carrying on his university work till the end of the scholastic year at a reduction in salary, in order to give two days in the week to the New York Library until June 1, 1896, upon which date he proposed his resignation should take place. 'I make this request,' he concludes, 'not because I am in any way dissatisfied with my position and work here, nor for the sake of obtaining greater compensation, but because I believe I can best contribute to the public good by undertaking the New York work.' The situation was a delicate and embarrassing one for both sides. Doctor Billings had given hostages to the University of Pennsylvania, he had planned two of its finest laboratories, he had less than a month before being tendered a banquet in the city with a gift of perhaps the largest purse ever raisee Board of Trustees of the New York Public Library informed Doctor Billings that he had been chosen as the Director of the proposed Library. After due discussion and deliberation, the latter referred the question to Mr. Charles C. Harrison, Provost of the University of Pennsylvania, at the end of the year (December 30th), stating that he had been in the service of the University for five years, during which time the Department and Laboratory of Hygiene had been organized, the University Hospital reorganized, and competent assistants obtained, who could carry on the work without interruption, if he resigned. To this end, he proposed carrying on his university work till the end of the scholastic year at a reduction in salary, in order to give two days in the week to the New York Library until June 1, 1896, upon which date he proposed his resignation should take place. 'I make this request,' he concludes, 'not because I am in any way dissatisfied with my position and work here, nor for the sake of obtaining greater compensation, but because I beli eve I can best contribute to the public good by undertaking the New York work.' The situation was a delicate and embarrassing one for both sides. Doctor Billings had given hostages to the University of Pennsylvania, he had planned two of its finest laboratories, he had less than a month before being tendered a banquet in the city with a gift of perhaps the largest purse ever raised for a physician by private subscription, and he naturally felt disinclined to resign his professorship without express permission from the authorities of the University. Yet, so important were the issues at stake, that, largely through the good offices of Doctor Weir Mitchell, the whole matter was adjusted in a few days, the authorities waived their claim in favor of New York, and Doctor Billings resigned his professorship in the University of Pennsylvania to take effect on June 1, 1896.2 The banquet referred to was given to Billings in Philadelphia, November 30th, 1895, in appreciation of the vast services rendered to the medical profession for his labors on the Index Catalogue. This was accompanied by a unique gift of a silver box containing a check for $10,000, from 259 physicians of the United States and Great Britain, in grateful recognition of his services to medi-

Page  6 cal scholars. The contributers to this fund included all the leaders of British and American medicine. The toastmaster of the banquet was Doctor S. Weir Mitchell. These funds were used for Billings' portrait which now hangs prominently in our library. In 1850 Mitchell spent a year in Paris, studying under Claude Bernard. His stay there was marred by a bout of smallpox and was recently described by Richard Walter as follows: "In addition to attending Bernard's lectures and the microscopy lectures, he took a course on auscultation and opthalmology. Neither did he neglect the Grand Opera, the museums, the plays, or the Parisian Cafe. But Weir felt dissatisfied with himself; he had not accomplished all that he would have liked, he had lost time because of the smallpox, and time was running out."3 Stewart Wolf, in a similar manner, convinced me to leave government service to rebuild the Department of Microbiology at the University of Oklahoma. Like Billings, in this one respect only, I left Oklahoma after several years to establish the International Research Program at the NIH. With characteristic unselfishness, Stewart loaned Doctor Kelly M. West to this program and it was he mainly who was responsible for its success. In addition, Stewart's own interest in international medicine led him to agree to spend a year in Paris serving as the first full-time consultant to our European activities. There he spread good will and brought credit to American medicine as a distinguished lecturer and friend of European medical scientists. There, also, he became interested in the encyclopedic French physiologist, Charles Richet, and wrote a clever history of his contribution to the invention of the airplane. Stewart became interested in Richet after studying the "dive reflex" by dunking the faces of his children into the sink to observe the slowing of the pulse rate, a phenomenon which Richet also studied. Amazingly, as Mitchell left Paris because of smallpox, Wolf acquired hepatitis during his stay and was forced to slow his pace of study and lecturing accordingly. [Figure 5. Doctor Stewart Wolf.] Later, like Mitchell before him, he gave his talents and energies to the National Library of Medicine as a presidentially appointed member of its Board of Regents. Billings, as our nation's greatest medical librarian, didn't need Mitchell's advice - but he did get his political support for a congressional appropriation to move the National Library of Medicine from Ford's Theatre, where it was housed after the assassination of Lincoln, into a new building which Billings himself designed in every detail. Evidence of this is seen in this letter from a Pennsylvania Senator in which he advises that they take money appropriated by the House of Representatives without amendments by the Senate. Stewart Wolf worked for NLM in many ways. As Chairman of the Board of Regents he was not only an advisor, but also proved to be a man of action. The present Lister Hill Center for Biomedical Communications in large measure was created through his stimulation and effort. In an editorial which appeared in the May 15th, 1969, issue of The New England Journal of Medicine, Doctor Wolf described the need for such a facility as follows: Much of the process of keeping up with developments requires the physician and medical scientist to travel far and frequently away from his regular responsibilities, his patients, his laboratory or his classroom. Some of these meetings run to tens of thousands of people who crowd into rooms where limited facilities for projection of sight and sound impair his ability to grasp the material -a process that would be readily and effectively carried out at home through modern communication media and at much less cost. Physicians in medical practice in all parts of the country must deal with incomplete and often poorly presented information, when proper mod-

Page  7 ern methods could quickly supply their needs from nearby or even distant teaching centers .4 Some men are frightened by, or indeed never contemplate a new career. They may move back and forth like the tide, but never change the imprint of the shores they frequent. Wolf, like Billings, and Mitchell, left his mark everywhere he visited or worked. I am sure Oklahoma will long remember Stewart's contributions as they are remembered at Hopkins, Cornell, and in Washington. I am equally confident that the Texas shoreline will never look the same after he explores and exploits its marine resources. I can see Stewart pouring trouble on their oiled waters in his effort to improve the ecology of man. For the students and house staff present may I suggest that a more careful study of the men I've touched upon here - Mitchell, Billings, and Wolf - will enrich your social perspective, your appreciation of medicine, and above all your sense of humility. Mitchell wrote, "All the vast hygienic, social and moral problems of our restless, energetic, laborsaving race are, in some degree, those of the future students of disease in America." Wolf writing about the expectations of society was even more eloquent when he said, "The age of automation has indulged us all in a surfeit of laborsaving and lavish comfort. In our part of the world, at least, we have been made relatively secure from hunger and homelessness. The epidemics that once decimated whole communities have largely been conquered and yet man is not happy, not fulfilled. Neither is he particularly healthy. From a vast number of experiences, man has been shown - but has not altogether learned - that his health and wellbeing depend not only on his capacity to adapt to the tangible environment, but also to prevailing attitudes and values in his society and to his own goals and aspirations. Repeatedly over the course of recorded history, man's preoccupation with material comforts and convenience has, like an unbalanced diet, somehow sickened him."5 Unfortunately greatness sometimes is recognized least in the home or local setting. Often this recognition comes at a time when the principal can no longer be aware of the high esteem he has earned through his actions and contributions. Therefore, on this occasion I ask that you join me in this recognition at this time and in this place. I do not wish to stand alone ! REFERENCES 1. Burr, A. B.: Weir Mitchell, His Life and Letters, New York: Duffield & Green, Inc., 1930, pp. 292-293. 2. Garrison, F. H.: John Shaw Billings, a Memoir, New York: G. P. Putnam's Sons, 1915, pp. 281-282. 3. Walter, R. D.: S. Weir Mitchell, M.D., Neurologist: A Medical Biography, Springfield, Ill.: Charles C. Thomas, 1970, p. 27. 4. Wolf, S.: Closing the Communications Gap, New Eng. J. Med., 280: 1125-1126 (May 15), 1969. 5. Wolf, S. G., Jr.: The Expectations of Society, J. Med. Educ., 40: 5-6 (Jan., part 2), 1965. Department of Health, Education, and Welfare, Public Health Service, National Institutes of Health, Bethesda, Maryland 20014