January 2011

In 1878, not long after Reconstruction ended, Memphis appeared likely to emerge from the ashes of Confederate defeat as one of the regal cities of the New South. Her population had doubled during the 1860s in spite of war and occupation, and by 1878 it had reached nearly 48,000. She lay almost midway between New Orleans and St. Louis and had rail and river connections to all the major cities and growing markets of the South. Her experienced merchants, bankers, and warehousemen were ready to collect and sell cotton and other commodities produced in the rich hinterlands of western Tennessee and northern Mississippi and Alabama.

Moreover, she had something special for a resolutely Southern city sitting on the Chickasaw bluffs—a touch of cosmopolitanism. Of the 25,000 white Memphians in 1870, some 7,000 were foreign-born. The biggest group was Irish, and the next German, but there were sprinklings of Italians and French, a few Chinese residents, and enough Jews to sustain a Hebrew Benevolent Society.

WHEN HIPPOCRATES wrote in the fifth century B.C. that “he who would learn surgery should join an army and follow it,” he illuminated the central irony of military medicine. Destructive as war is, it makes possible quantum leaps in the art of healing. And it is the surgeon who benefits most directly: war has been described as an “epidemic of trauma,” and the vast supply of wounded men provides opportunities for experimentation and innovation unthinkable in a world at peace. But surgery is not the only branch of medicine that advances. In all wars fought before World War I, more men died from disease than from military action, so the necessity of keeping troops on the field provides a powerful impetus to wipe out the illnesses that prey on armies. Finally, there is the matter of logistics—how to move a man quickly to a place where he can be treated. Here, too, lessons learned in wartime have dramatically improved health care when peace came.

IN 1884 ALMOST three-quarters of America’s fifty million people lived on farms or in rural hamlets. When they fell ill, they ordinarily were treated in their own homes by someone they knew, someone who might not be a trained physician but a family member, neighbor, or midwife. Only a handful of smaller communities boasted hospitals, for they were still a big-city phenomenon. And in those cities, only the workingman and his family, the aged and dependent, the single mother, or the itinerant laborer would normally have received institutional care. For the middle class, a bed among strangers in a hospital ward was a last resort. Even within the working class of America’s rapidly growing cities, the great majority of patients too poor to pay a private physician never entered a hospital but instead received free outpatient care from dispensaries, from paid municipal physicians, and from hospital outpatient departments. The hospital was a place to be avoided—often a place in which to die—and not the fundamental element in medical care that it has become in the twentieth century.

TWO CENTURIES AGO drugs were thought to counteract illness by correcting certain dynamic imbalances in the body. The principal pathological imbalances were in the four liquid “humors”—blood, phlegm, yellow bile, and black bile—and in the tone, the strength, the irritability of the solid organs, especially the blood vessels and nerves.

These imbalances were most often attributed to the weather or to contagions transmitted in the air from sewage, stagnant water, or other patients; the microbes that actually were responsible would not be understood for another century. Other illnesses were blamed on factors ranging from alcohol to volcanic eruptions.

Whatever the supposed causes, treatments were designed to counteract the associated symptoms. Diarrhea, coughing, pain, weakness, convulsions, flushed skin, and skin rashes were common clues that both patients and doctors understood. The doctors also interpreted fast pulse rates as signs of fever: the short clinical thermometer had not been invented.

HE WAS A sixth-generation American, white and Protestant, educated at Princeton and the University of Pennsylvania Medical School, which, at the time, was the best in the country. Even in 1912, hiring David Linn Edsall would hardly seem to be a blow for equal-opportunity employment. But the place was Boston, the job was to lead the medical staff of the Massachusetts General Hospital. In the decades since 1821, when the hospital first opened its doors to patients, only Bostonians had been invited to practice at Mass General. Edsall was from Hamburg, New Jersey, of all places. Moreover, his main rival for the position was an ideal candidate—Richard Clarke Cabot, an extraordinary man, a gifted physician, a cousin by marriage of the retiring chief, and a member of Boston’s aristocracy.

In 1977 the sociologist Harriet Zuckerman published a comprehensive study of the American Nobel laureates in science called Scientific Elite . She used these words of Simone Weil for an epigraph: “Science today must search for a source of inspiration above itself or it will perish. There are just three reasons for doing science: (1) technical applications; (2) chess game; (3) the way toward God. (The chess game is embellished with competitions, prizes and medals.)”

Of all the prizes awarded to the players of the game of science, the Nobel is the most prestigious. Since the Second World War, Americans have won more of them than any other country—we have fifty-four laureates in the category of physiology or medicine. The Germans won most before the war, and their decline may be attributed to Adolf Hitler himself.

“It was near Thanksgiving Day of 1884,” wrote Dorr E. Felt, “and I decided to use the holiday in the construction of the wooden model. I went to the grocer’s and selected a box which seemed to me to be about the right size for the casing. It was a macaroni box. For keys I procured some meat skewers from a hardware store for the key guides and an assortment of elastic bands to be used for springs. When Thanksgiving Day came I got up early and went to work with a few tools, principally a jack knife.”