Great Feuds in Medicine: Ten of the Liveliest Disputes Ever

GREAT FEUDS

IN MEDICINE

GREAT FEUDS IN MEDICINE

Ten of the Liveliest

Disputes Ever

Hal Hellman

JOHN WILEY & SONS, INC.

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Copyright © 2001 by Hal Hellman. All rights reserved

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Published simultaneously in Canada

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Library of Congress Cataloging-in-Publication Data:

Hellman, Hal

Great feuds in medicine: ten of the liveliest disputes ever / by Hal Hellman.

p. ; cm.

Includes bibliographical references and index.

ISBN 0-471-34757-4 (cloth : alk. paper)

1. Medicine—History—Miscellanea. 2. Vendetta—Case studies. I. Title. [DNLM: 1. History of Medicine, Modern. WZ 55 H478g 2001]

R133 .H455 2001

610'.9—dc21

00-063349

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1

CONTENTS

Acknowledgments

Introduction

CHAPTER

Harvey versus Primrose, Riolan, and the Anatomists • Circulation of the Blood

CHAPTER

Galvani versus Volta • Animal Electricity

CHAPTER

Semmelweis versus the Viennese Medical Establishment • Childbed Fever

CHAPTER

Bernard versus Chemists, Physicians, and Antivivisectionists • Experimental Medicine

CHAPTER

Pasteur versus Liebig, Pouchet, and Koch • Fermentation, Spontaneous Generation, and Germ Theory

CHAPTER

Golgi versus Ramón y Cajal • The Nerve Network

CHAPTER

Freud versus Moll, Breuer, Jung, and Many Others • Psychoanalysis

CHAPTER

Sabin versus Salk • The Polio Vaccine

CHAPTER

Franklin versus Wilkins • The Structure of DNA

CHAPTER

Gallo versus Montagnier • The AIDS War

Epilogue

Notes

Bibliography

Index

ACKNOWLEDGMENTS

The Internet was helpful. I also made personal visits to several sites: for example, Volta’s monument at Lake Como and Golgi’s lab at Pavia, both in Italy; the Semmelweis statue in Budapest; and several Freud exhibits in London and New York. But by far the greatest part of my research was done in libraries. Most helpful have been the wonderful collections of historic materials at the New York Academy of Medicine, the New York Public Library, and the newer Science, Industry, and Business Library, all in Manhattan; the Marine Biological Laboratory in Woods Hole, Massachusetts; the American Academy in Rome; and the Burndy Library in Norwalk, Connecticut (now the Dibner Library in Cambridge, Massachusetts).

I would also like to thank the staff at my own local library in Leonia, New Jersey, which is, happily, part of a countywide library system, and through which I was able to reach out and retrieve a remarkable variety of materials from across the country.

A large number of colleagues and friends have been helpful, mainly in answering questions and/or reading and commenting on parts of the manuscript as it was being generated. These include Russell A. Johnson, Archivist and Cataloger, Biomedical Library at the University of California in Los Angeles; Dr. Constance E. Putnam, independent scholar, Concord, Massachusetts; Robert Gallo, M.D., Director, Institute of Human Virology of the University of Maryland in Baltimore; Arthur Peck, M.D., psychiatrist; Dr. Luc Montagnier, Director, Center for Molecular and Cellular Biology, Queens College, City University of New York; Phyllis Dain, Professor Emeritus of Library Science at Columbia University; Morton Klass, Professor Emeritus of Anthropology at Barnard College and Columbia University; Norman Dain, Professor Emeritus of History at Rutgers University; Dr Edward T. Morman, Associate Academy Librarian for Historical Collections, New York Academy of Medicine; Dr. Larry W. Swanson, University of Southern California; Dr. Sonu Shamdasani, Research Fellow, Wellcome Institute for the History of Medicine; and Leon Hoffman, M.D., New York Psychoanalytic Association.

Additional and special thanks go to my editor, Jeff Golick, who helped me through some difficult times; to my agent, Faith Hamlin, for her support; and especially, to my wife, Sheila, who read every chapter several times, and whose input was invaluable.

INTRODUCTION

In medieval times doctors had only a few ways to determine what was going on inside a patient’s body. With no laboratory analysis to aid them, they had to depend on their own senses to obtain a diagnosis. One useful technique was visual examination of the patient’s urine. Those who used this method came to be called piss-prophets. Later they would gather additional information by tasting the urine. Sometimes, for obvious reasons, the physician had the patient or even a servant do the tasting.

Uroscopy (diagnostic examination of the urine) eventually went out of fashion. Physicians then did the best they could with other external signs, such as skin and eye color. They also listened to and tried to make sense of the thumping, wheezing, whistling, and crackling sounds sometimes made inside the body, and especially inside the chest and abdomen, which contain the body’s major organs. But the activities going on inside that sanctum sanctorum remained mostly a deep, dark secret.

In 1761, Leopold Auenbrugger, a German physician, suggested a way to turn the listening technique from a passive to an active method. His idea was to rap on the patient’s thorax, and listen to the echo from the chest cavity. That insistent tap remains a basic tool of the examining physician; who among us has not had his or her chest thumped, and wondered not only what the doctor hears, but what the resulting sounds mean.

Auenbrugger spelled out a variety of different sound responses, and what they might portend. A dull sound correlated with chest congestion, for example, and the duller the sound, the more severe the disease.

Although Auenbrugger believed he had made an important advance, he had few illusions about becoming a medical hero. In making public my discoveries, he wrote, I have not been unconscious of the dangers I must encounter, since it has always been the fate of those who have illustrated or improved the arts and sciences by their discoveries to be beset by envy, malice, hatred, destruction and calumny.¹

We will see examples of each of these in this book. For when any scientist introduces a new theory, he or she is likely to be trampling on someone else’s idea. Depending on how well entrenched the original idea is, or how powerful its holder, the responses can take on the virulence expected by Auenbrugger.

In some cases, the attacks seriously disrupted the discoverers’ lives. Claude Bernard (chapter 4) worked under constant accusations by antivivisectionists that his physiological experiments on animals were a crime against nature and society. He was even disowned by his own family.

Ignaz Semmelweis, who argued that obstetricians should wash their hands before delivering babies, was dismissed from his hospital job, and ended up in a mental hospital (chapter 3).

Some objections, to be fair, were not entirely unreasonable, and our feuds will show some interesting twists. Semmelweis did indeed end up in a mental hospital, but it’s not entirely clear that the actual cause was the treatment meted out by his peers. At least one historian of science argues that his own actions were partly to blame for his sad end.

Another example of not entirely unreasonable objections is seen in the case of René Laënnec. It was Laënnec who had the idea of the stethoscope, which has become another major tool in diagnosis. His idea also faced strong objections, not all of which were foolish; another physician argued: You will learn nothing by it and, if you do, you cannot treat disease the better. Medical historian Brian Inglis says that this critic was wrong about there being nothing to learn from auscultation [listening for sounds in the body]: for purposes of diagnosis and prognosis it was invaluable. But he was largely right that it could do little to improve the treatment of disease, which had to await better knowledge of disease processes.²

And herein lies the difference between medical practice and medical science; in this book we distinguish carefully between the two. Medical practice is at least as much art as it is science, for physicians are dealing with the most complex structure on the earth. And they are attempting to put to work knowledge and procedures that have been developed by others—researchers who deal in biology, chemistry, engineering, mathematics, statistics, and a variety of other disciplines. Medical science, on the other hand, has laid the basic groundwork that has made possible whatever successes modern medicine has seen. What a glorious, astonishing search it has been.

As in any science, the quest for knowledge has been a driving factor. When, however, the science has, or may have, connection with human health—as is the case in medical science—then the researcher who comes up with a new idea may feel an added urgency.

But, of course, so does the holder of the entrenched method, which the new one may be trying to overthrow. And so it is no surprise that there has been plenty of controversy in the history of medical science.

The reactions feared by Auenbrugger—envy, fear, and so on—are bad enough. But what he got was even worse, and points up the difference between resistance and attack. His technique was not denounced; it was simply ignored, until championed by Corvisart, physician to Napoléon, several decades later.

Auenbrugger would probably have been better off if he had been denounced, or if his method had been attacked. As most advertising copywriters will agree: I don’t care what they say about us—as long as they spell our name correctly.

In fact, one of the points I hope to make in this book is that scientific controversy can have beneficial effects as well as negative ones. The controversy may very well bring the subject into a more public arena, promoting discussion. Getting to the truth may still take time, and the participants may take a beating, but the outcome is likely to be quicker than with a development that leads mainly to silence.

Ongoing controversy can have another beneficial effect: the participants themselves may prosper. Pasteur, for example, thrived in the midst of one battle after another (chapter 5). Not only did he love the fight but, in some cases, he was forced to probe even deeper into the problem at hand and thereby came up with greater advances.

It is worth delving into these controversies for another reason: Often what is behind an attack is some sort of subtle, or not so subtle, driving force. Examples include religion (Harvey, chapter 1) and nationalism (Golgi, an Italian, versus Ramón y Cajal, a Spaniard, chapter 6; and Gallo, an American, versus Montagnier, a Frenchman, chapter 10).

Harvey’s story also shows how intertwined were the science, religion, and mysticism of his time. Viscount Conway advised his daughter-in-law not to use Harvey as her physician; he felt that to have a Physitian abound in phantasie is a very perilous thing. . . .³

Another fertile area for controversy has to do with priority disputes. While simultaneous discovery seems surprising, it is actually fairly common. Well-known examples include Faraday and Henry (electro-magnetic induction), Newton and Leibniz (discovery of the calculus), Adams and Leverrier (discovery of Neptune), Darwin and Wallace (theory of evolution), Heisenberg and Schrödinger (quantum mechanics), Schally and Guillemin (thyroid-stimulating hormone), and, in this book, Gallo and Montagnier.

It is true that one of the major drives in any science is just the pleasure of finding things out, learning something new about the world around us. And, for the most part, scientists are not driven by monetary gain. But if they discover something, they generally want the world to know it. Tantalizing visions of a Nobel Prize may influence their actions.

And, as I noted earlier, once human health is involved, the drive to find a new method or new drug can take on added urgency, for a medical discovery can be highly valuable not only to the cause of human health, but can provide professional (and monetary) advancement as well to the discoverer.

As a result, priority disputes in medical science can be particularly vicious. There are many examples in medical history that I looked into and could have chosen—examples include patent and priority battles among Morton, Wells, and Jackson in the development of a useful anesthetic; between Banting and Macleod in the discovery of insulin; between Guillemin and Schally in the discovery of the brain hormone; and between Gallo and Montagnier in the discovery of the AIDS virus. I chose the last one mainly because of its powerful, and continuing, relevance today. Curiously, as we’ll see, these two both competed and cooperated.

The race to be first can also lead to superhuman effort, and, perhaps, even speed up the desired result. This seems to have been the case with Pasteur and his many battles (chapter 5).

A variation on the priority dispute involves arguments over whose method is better, as in the work of Sabin and Salk on a vaccine for poliomyelitis (chapter 8). Again, there are subtexts that are as interesting as the headlines. When Salk came up with the first real weapon against that dread scourge, he rapidly assumed the status of world-class hero. He suspected, however, that this meant trouble for him, and he was right.

In a different kind of dispute, two researchers may look at the same phenomenon and come up with different interpretations. This happened in the case of Galvani and Volta (chapter 2); the result was a lively controversy that dragged others in.

What, then, makes a feud great? From the many cases I scanned in making my choices, I have chosen those that seemed to me to have some special drama or scientific interest, that in some way influenced the future course of medical science, or that have had repercussions in our own day.

Freud (chapter 7), for example, is much in the news today. Freudians are celebrating the 100th anniversary of his pathbreaking The Interpretation of Dreams. But the controversy that still surrounds the very mention of his name began long ago. What we learn about his many battles with his contemporaries surely has relevance to the ever-present attempts to topple this icon, and perhaps can give those of us on the sidelines some greater insight into these attempts.

Another fascinating aspect of the Freud story is his connection with the medical establishment, again of current relevance because of the increasingly apparent linkage of mind and body.

In the case of Rosalind Franklin and Maurice Wilkins (chapter 9), two factors bring it into this book—the importance of the event, namely the discovery of the DNA double helix, and the poignant question of what might have been if the feud had not taken place. A case can be made that if Franklin had not feuded with her colleague Wilkins, she might have gone down in history as the discoverer of the double helix.

Here then is a personal look at medical history. In the same way that political history helps statesmen interpret today’s events, so, too, may these dramatic cases help us understand the halting, confusing, but still wonderful world of medical research—and to realize that it is at least as much a human enterprise as it is an organized activity.

We begin our journey with the story of William Harvey and his ideas on the circulation of the blood. His courageous stand against powerful conservative forces provides an excellent start for our examination of some of the great feuds in medical science.

CHAPTER 1

Harvey versus Primrose, Riolan, and the Anatomists

Circulation of the Blood

In the 17th century it had been known for some 1,400 years that the blood was created in the liver, moved outward from the heart toward the extremities, and, in nourishing the tissues, just disappeared there. The heart was also the source of some sort of vital spirit, which in some mysterious way had to do with the blood.

In 1628, British physician and anatomist William Harvey announced his discovery of the circulation of the blood and, just as shocking, reported that the heart was merely a pump that was pushing the fluid around and around in the body.

He had laid out his theory, carefully and clearly, and of course in Latin, in a small book consisting of 72 poorly printed pages. Its title, Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus,¹ is often shortened to De Motu Cordis (On the motion of the heart), or DMC. One reason for the poor print job was that it had to be published in far-off Germany, for the British censor forbad its publication, and no British publisher would touch it.² The publisher, Wilhelm Fitzer in Frankfurt, offered as an excuse for the many printer’s errors the unfavorable times, meaning the Thirty Years’ War that was then ravaging Germany.³

Nevertheless, no one had any trouble figuring out Harvey’s message. In the first half of the book, he presents his findings on the heart, and mentions some of his fears and hesitations. Though he published in 1628, he had started his work more than a dozen years earlier, and had been demonstrating parts of it at his own Royal College of Physicians for at least nine of those years,⁴ hoping to build up support among his colleagues.

A quick look at the first chapter of DMC tells us what his experience had been up to the date of publication. His discovery, he writes, pleased some more, others less; some chid and calumniated me and laid to me as a crime that I had dared to depart from the precepts and opinions of all anatomists.⁵ He also lays out his research program in this first half and, mainly, gives the first scientifically based description of the heart’s functions.

Then, in chapter 8, Harvey introduces the idea that the blood circulates, which, he feared, rightfully, would be even more shocking to his readers. In the opening paragraph, he states: What remains to be said upon the quantity and source of the blood . . . is of a character so novel and unheard-of that I not only fear injury to myself from the envy of a few, but I tremble lest I have mankind at large for my enemies. . . .⁶

Paranoia or Realistic Fears?

Was he just being paranoid? Hardly. Not long before, in 1591, Eufame Macalyane, a Scottish lady of rank, sought relief for the pain of childbirth. For this transgression—does not Holy Writ refer to the primeval curse on woman?—she was burned at the stake in Edinburgh.⁷

And in 1600, only a quarter century before Harvey’s book appeared, Giordano Bruno, a pugnacious Italian philosopher, had been burned alive for his stubborn espousal of the idea that the universe was infinite and not bounded, as maintained by the Greek astronomer Ptolemy (second century A.D.). The Ptolemaic system had been strongly supported by the Church, which took Bruno’s ideas to be sacrilegious and therefore dangerous.

A few years after Harvey’s book was published, the great Galileo Galilei did recant when faced with the fearsome might of the Inquisition. As a result, he was merely sentenced to house arrest for the balance of his life—because he had published a book that argued against the same Ptolemaic system. But Bruno and Galileo were only the better-known examples of theological intolerance. Many others suffered and perished for even lesser crimes.

Granted, Harvey was an Englishman and an Anglican in a non-Catholic country. But England had been a Catholic country not long before and could be one again if the monarch chose to convert.

And Catholicism was not the only source of danger. In the middle of the previous century, Spanish-born Michael Servetus, a sort of itinerant physician with a strong interest in theology, had come up with a correct description of the pulmonary circulation (the movement of the blood from heart to lungs and back again). Unfortunately, his insight was connected with and contained within one of his many theological writings. This tract particularly (On the Restitution of Christianity) managed to aggravate both Protestants and Catholics, and, in 1553, it was burned by Calvin in Geneva—along with Servetus himself.

Witch-hunting and a widespread belief in the occult was another possible source of danger. In 1618, Harvey became one of King James I’s personal physicians. But James was a strong supporter of witch-hunts, and had written a book on it. Harvey was fearful of the awful credulity of the time.

Harvey’s era was also one of extreme political unrest. The Royalists, those supporting the king, and the Parliamentarians, looking to overthrow the monarchy, were constantly at odds. One never knew from which direction trouble might come. Harvey, as one of James’s physicians, was blamed for bringing on the king’s death (1625) when he defended the use of a remedy suggested by the king’s favorite, Lord Buckingham. Fortunately, there were no serious consequences for Harvey, but the suspicions lingered.

All of this makes it a bit easier to understand why Harvey might be nervous, and perhaps explains why he walked around with a dagger strapped to his waist. The 17th-century biographer John Aubrey described him thus: He was very Cholerique; and in his young days wore a dagger (as the fashion then was) but this Dr. would be apt to draw-out his dagger upon every slight occasion.⁸ A more recent biographer, Geoffrey Keynes, adds that the dagger, which Harvey continued to wear in his middle years, reflected his earlier experience as a medical student at the University of Padua, where gangs of young students, representing factions from different countries, often battled each other.⁹ There were also scuffles and even more serious disorders between students and townspeople.¹⁰

Harvey has been described as rather on the small side, with raven hair, dark piercing eyes, somewhat sallow complexion, and a keen restless demeanour and rapid speech.¹¹ Science historian Jerome J. Bylebyl writes that Harvey seems to have been well liked by those who knew him, although he was an outspoken man and perhaps somewhat short-tempered.¹²

A small, outspoken, somewhat short-tempered scientific genius in a superstitious and dangerous age. Is it any wonder that Harvey was nervous?

Initial Response

Harvey himself initially stood apart from the controversy that erupted after publication; but although he was not subject to physical violence, he took plenty of flak nonetheless. He was given the nickname Circulator, a conflation of the idea of circular reasoning with his theory of the blood’s circulation.

The term’s derivation also contains the implication of quack or mountebank. Aubrey wrote: "I have heard him say, that after his Booke of the Circulation of the Blood came out, that he fell mightily in his Practize, and that ’twas believed by the vulgar that he was crack-brained, and all the Physitians were against his Opinion. . . ."¹³

Viscount Conway advised his daughter-in-law not to use Harvey as her physician: "he is a most excelent Anatomist, and I conceive [De Motu Cordis] to be his Masterpiece . . . but in the practicke of Physicke I conceive him to be to[o] mutch, many times, governed by his Phantasy. . . . [And] to have a Physitian abound in phantasie is a very perilous thing. . . ."¹⁴

What Conway meant by phantasie was, clearly, Harvey’s ideas about the circulation. Conway was writing in 1651, 23 years after DMC was published, by which time acceptance was relatively widespread. Yet the basic problem, that Harvey was attacking and overturning the ancient anatomists, still bothered many of his contemporaries.

The Galenic Corpus

Among those Harvey was overturning was Galen, a second-century Greek physician and anatomist. A genius and well ahead of his time, he produced enormous quantities of medical writings. Though Galen did not himself become a Christian, his search for design and purpose in all things, including the human body, made his works well-liked by the Church, and this in turn ensured the survival of his theories into Harvey’s day.

Galen argued, for example, that nature always acts with perfect wisdom; and that the body is nothing but a vehicle for the soul. Christian theologists found that these ideas fitted nicely with some of their own: disease is punishment for sin, and the body is sacred. As a result, dissection of humans is a sin, and anything that detracts from the Great Physician is anathema.

Now, Galen had a high opinion of both himself and his work, but he recognized the likelihood of advances beyond his claims and explanations. He would probably have laughed had he returned in Harvey’s day and seen what the academics had made of his doctrines—edifices to be admired, even revered, rather than foundations on which to build new ones.

One of these edifices was the Anatomy that Galen had put together, a comprehensive work that described much of the body and explained many of its functions as well. As attending surgeon at the gladiatorial games under the Romans, he had considerable experience with human bones, muscles, and blood. Not afraid to get his hands dirty, he had also done dissections and even experiments—which was more than could be said for most of Harvey’s contemporaries.

There are hints that he did some of these on human bodies, but virtually all of his physiological research was on animals. He performed vast numbers of dissections and experiments on a variety of animals, from which he certainly learned a great deal