Frederick Novy and the Development of Bacteriology in Medicine

Frederick Novy and the Development of Bacteriology in Medicine

Critical Issues in Health and Medicine

Edited by Rima D. Apple, University of Wisconsin–Madison, and Janet Golden, Rutgers University, Camden

Growing criticism of the U.S. health care system is coming from consumers, politicians, the media, activists, and healthcare professionals. Critical Issues in Health and Medicine is a collection of books that explores these contemporary dilemmas from a variety of perspectives, among them political, legal, historical, sociological, and comparative, with attention to crucial dimensions such as race, gender, ethnicity, sexuality, and culture.

For a list of titles in the series, see the end of this book.

Frederick Novy and the Development of Bacteriology in Medicine

Powel H. Kazanjian

Rutgers University Press

New Brunswick, Camden, and Newark, New Jersey, and London

Library of Congress Cataloging-in-Publication Data

Names: Kazanjian, Powel H., 1953– author.

Title: Frederick Novy and the development of bacteriology in medicine / Powel H. Kazanjian.

Other titles: Critical issues in health and medicine.

Description: New Brunswick, New Jersey : Rutgers University Press, [2017] | Series: Critical issues in health and medicine | Includes bibliographical references and index.

Identifiers: LCCN 2016032167| ISBN 9780813585093 (hardcover : alk. paper) | ISBN 9780813585109 (e-book (ePub)) | ISBN 9780813585116 (e-book (Web PDF))

Subjects: | MESH: Novy, Frederick G. (Frederick George), 1864–1957. | Bacteriology—history | History, 19th Century | History, 20th Century | United States | Biography

Classification: LCC QR74.8 | NLM WZ 100 | DDC 616.9/201—dc23

LC record available at https://lccn.loc.gov/2016032167

A British Cataloging-in-Publication record for this book is available from the British Library.

Copyright © 2017 by Powel Kazanjian

All rights reserved

No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, or by any information storage and retrieval system, without written permission from the publisher. Please contact Rutgers University Press, 106 Somerset Street, New Brunswick, NJ 08901. The only exception to this prohibition is fair use as defined by U.S. copyright law.

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For Sahira, Sarine, Powel III, and Louisa

Contents

Introduction

Chapter 1. Frederick Novy and the Origins of the Michigan Hygienic Laboratory

Chapter 2. What Novy Did in His Medical School Laboratory

Chapter 3. Making Medical Education Scientific

Chapter 4. Defining Bacteriology as a Discipline in Its Early Years

Chapter 5. Significance for American Culture: Arrowsmith

Chapter 6. Making a Scientific Career in Medicine

Conclusion

Acknowledgments

Notes

Index

About the Author

Read More in the Series

Introduction

This is a book about Frederick Novy (1864–1957) and his scientific contributions to medicine. Novy was a leader among a new breed of full-time bacteriologists at American medical schools in the 1890s. He was atypical for his time, as he was a scientist who had earned a doctorate in chemistry before he entered medical school. As a medical student, Novy traveled to Europe to learn the new science of bacteriology with the preeminent scientists of the day: Robert Koch in Berlin and Louis Pasteur in Paris. Upon returning to America, he obtained a newly established position at the University of Michigan Medical School as a laboratory-based researcher-educator. He was not required to directly practice medicine. The scientific work Novy carried out in this position was different from the work of his American peers and helped form the historic roots of biomedicine as we know it today.

This book examines what was exceptional about Novy and his scientific activities. Novy’s research program sought fundamental truths about microbial behavior. This quest to elucidate basic microbial truths stood in stark contrast to the mainstream focus of American bacteriology at the time—namely, practical applications. Novy designed novel equipment to seek what he and his circle of colleagues and students at the time called fundamental knowledge about microbes, how they survive in nature, spread in their environment, and cause disease in humans. He strove for this ideal of of what he and his peers called pure science—to seek basic biological truths about microbes—as the principal endeavor of his laboratory and sought to impart this ideal to the students in his bacteriology course, the first full-semester course of its kind offered in America. To his students, Novy strove to instill what he called a spirit of science in medicine—a duty to search for fundamental biological truths solely for the sake of adding to the sum of knowledge. His mastery of technological innovation as a means to, as he said, solve nature’s puzzles earned him a reputation as a preeminent figure whose own brand of laboratory science led to a greater understanding about basic microbial biology.

The activities of this first-generation American bacteriologist who was devoted to what his peers called the truth-seeking science ideal had an enduring legacy for medicine, bacteriology, and American society. His colleagues and students viewed his devotion to producing new knowledge as adding legitimacy to a medical profession in need of certainty. His medical instruction was considered instrumental in establishing a foundation for the reforms in American medical education and the establishment of the basic science departments that would follow. His scientific activities demonstrated a role for a new breed of physician, the physician scientist, in American medicine. As a founding member of the Society of American Bacteriologists in 1899, he insisted on the development of basic microbiology, which helped to establish bacteriology as an independent discipline with a special scientific knowledge. Evidence of the infiltration of Novy’s science into American culture can be found in the widely read novel Arrowsmith. Author Sinclair Lewis used an account of Novy’s activities to construct and popularize a heroic image of a truth-seeking medical researcher, an image that had widespread and lasting appeal in American society.

Novy’s scientific activities helped to form the historical roots of several key elements that comprise today’s biomedical world. His bacteriological investigations and instruction helped to integrate basic scientific courses in medical instruction, establish a new role of the physician scientist in the medical profession, and popularize the scientific activities of physician scientists whose discoveries are prominently highlighted by the press and media in American society today. Historians have not explored the foundation of these important facets of modern biomedicine. This is a story of Frederick Novy—a leader among the first generation of researcher-educators in bacteriology in the 1890s whose scientific activities helped to shape the contours of our contemporary biomedical world in America.

Who Was Frederick Novy?

Frederick George Novy was a leader among a new breed of full-time researcher-educators who began working in laboratories that were newly constructed at a handful of American medical schools in late nineteenth-century America—Harvard, the University of Pennsylvania, Michigan, and Johns Hopkins.¹ Unlike most American physicians at that time, Novy worked exclusively in a university-affiliated laboratory and did not practice medicine. His role as a researcher-educator at the hygienic bacteriology laboratory was established and directed by Victor Vaughan, Novy’s professor of physiological chemistry and hygiene at the University of Michigan Medical School.² This position involved no clinical work or private patients, and Novy devoted his entire effort to research and teaching. In the context of his duties as an assistant to Vaughan at the Hygienic Laboratory, Novy developed an independent research program and introduced a comprehensive lecture-laboratory course to instruct students about the new science of bacteriology.

Until Novy’s time, physicians taught medical students through lecture only, with a complete absence of laboratory work in the curriculum. Physician teachers earned their living primarily by collecting fees from their private practices, but they also received supplemental payment for teaching courses. The researcher-educators like Novy who had emerged at Harvard, Pennsylvania, and Michigan by the 1880s, however, began to provide new laboratory-lecture courses (later referred to as basic science courses) that provided students hands-on training in subjects including bacteriology that would become standard for American medical schools following Abraham Flexner’s report on American medical education in 1910.

To date, historians have not systematically examined the work that first-generation, full-time bacteriological researchers conducted in their medical school laboratories and what those researchers taught their students. Likewise, the meanings of their educational and research activities for American medicine, bacteriology, and American society have not been fully explored.³ This book examines the research and educational activities of one such American bacteriologist from 1889 to 1933.

To understand the activities and events in Novy’s life as they unfolded, I have used his published papers, laboratory notebooks, and private correspondence with students, scientists, and family members, materials archived at the Bentley Library and the Taubman Medical Library at the University of Michigan.⁴ I have used these sources to examine the ideas that drove Novy’s laboratory work, what he taught his students, and how they viewed this instruction. Novy used his chemistry training together with his newly acquired bacteriological skills to seek a greater understanding of fundamental microbial behavior. Novy’s circle of colleagues and students referred to his scientific investigations and instruction as fundamental or pure science that generated what they called pure truths about basic microbial biology, as opposed to providing a practical means to kill or prevent germs. They regarded him as a preeminent figure and leader among a new breed of full-time bacteriologists based in medical schools in late nineteenth-century America. Despite Novy’s one-time renown, no scholarly work has been written about him. His distinct contributions to science had important implications for medical education, bacteriology, and American society.

Novy’s Scientific Activities and Their Significance for Medicine, Bacteriology, and Society

Novy stated that his major goal was to carry out original investigations in search of new knowledge about microbes and their behavior.⁵ He insisted on having the freedom to pursue his goal of original investigation without the restraints of practicality—developing therapies to eradicate microbes or means to prevent them.⁶ What may have predisposed Novy to value most highly what he called his spirit of scientific medicine—a rigorous search for new knowledge about fundamental microbial biology above practical considerations? In what ways did Novy’s research focus and activities differ from the mainstream focus of American bacteriologists during this time period? How did it differ from that of his colleagues with whom he studied in Europe? How did his peers characterize the emphasis, quality, and scope of what they called his pure scientific research?

Novy promoted the ideal of pure scientific investigation of nature’s fundamental truths, which in turn inspired his educational activities. He used his research investigations as a springboard for his instruction of medical students. This book will address what he was trying to accomplish in his full-semester lecture-laboratory course first taught in 1889. What was his rationale for insisting that having a laboratory component was essential in medical education? Why did he feel that teaching the logic and methods of the laboratory would be valuable for all medical students, even those who would become practitioners as well as researchers? What specifically did he try to teach these students? In trying to instill in his students the same spirit of research in medicine that guided his experimental research, was he seeking to do something more than teaching critical thinking and training their minds? How does an exploration of Novy’s educational goals add to what historians have previously described for late nineteenth-century American medical educators? How would he try to teach scientific methods to the majority of medical students in the late nineteenth century who had no prior training in the principles or methods of science? What did his students think of his intentions to teach bacteriology and expand the instruction of laboratory science in medical education, a course of instruction that would later be referred to as the basic science curriculum?

Novy’s pedagogical efforts to establish his full-semester lecture-laboratory bacteriology course were a key step toward integrating basic science departments into American medical schools in the 1890s.⁷ Before this time, laboratory-based research was almost nonexistent in either for-profit proprietary schools or university-affiliated medical schools.⁸ Small groups of medical practitioners taught part-time in both types of schools, and the typical medical faculty in 1880s consisted of instructors who taught students in lecture halls in didactic settings.⁹ It took three years to earn a medical degree at university-affiliated schools like Michigan; there were no formal admission criteria for any medical schools.¹⁰ The introduction of intensive basic science lecture-laboratory courses like Novy’s bacteriology course in 1889 was a key factor that lengthened the curriculum to four years at the University of Michigan in 1891, led to higher admission criteria (e.g., mandatory high school graduation and prerequisites in math and science), and reshaped the medical school into a center of advanced teaching and research.¹¹ By 1893, Johns Hopkins exposed a more select group of students to scientific medicine, a trend established by Harvard, Pennsylvania, and Michigan that was an important facet of the overall medical education reform that took place in the 1890s in America and then expanded to other American medical schools following the Flexner Report, Medical Education in the United States and Canada, published in 1910.¹² The creation of what were later called basic science courses at Michigan and a handful of other university-affiliated medical schools in the 1890s helped to build an important foundational component of the biomedical system as it remains today.

Novy’s fundamental research operation also had significance for the developing field of bacteriology in the 1890s. Bacteriology was a nascent field when Novy and other officers of the newly formed Society of American Bacteriologists were striving to turn their field into a distinct specialty. Bacteriologists crafted arguments to justify the creation of their new area into an independent, distinct field. They rallied around the theme of basic biological research as a way to unify an area that they believed was becoming fragmented by practical applications in diverse realms. They asserted that a unifying pursuit, such as investigating the fundamental science of microbes as had been carried out by Novy, rather than a focus on the practical applications of bacteriology, would distinguish their field from others and free it from what they viewed as subservience to the field of pathology.¹³ This enabled bacteriologists like Novy to create independent departments of bacteriology in their respective institutions in which they could pursue basic research in microbial biology and physiology. Their ideas dictated that a distinct and growing body of knowledge not only justified fashioning their field into a separate science—it compelled them to do so.

Novy’s activities and pure science ideal had implications in a broader sense by forming the basis for the construction of the noble image of a medical researcher in American society. The author Sinclair Lewis’s popular, accessible novel Arrowsmith is used as a vehicle to explore the meanings of Novy’s activities for early twentieth-century American society. Lewis based the characters and major themes of his novel on firsthand information about Novy’s scientific attitude and research ideals supplied by Novy’s former student, Paul de Kruif. Arrowsmith was the result of a 1925 collaboration between Lewis and de Kruif. Lewis took de Kruif’s worship of Novy as the revered medical researcher who occupied the highest strata in the medical world and applied it to American society at large. Lewis’s novel was a portal through which the public could view Novy’s specialized academic activities and ideals, which had previously been known to his scientific colleagues and students like de Kruif. In Arrowsmith, Lewis demystified the unfamiliar work done by Novy and made that work accessible to the public, providing large-scale recognition of the ideals of pure science that Novy symbolized.

The pure science ideal that characterized Novy’s research and educational activities had broad-reaching implications in the realms of medical education, bacteriology, and American society. Novy’s scientific activities were at the roots of today’s biomedical world—the central space for the basic sciences in medical education, the durable role of the physician scientist, and the popular interest in their activities. The work done by Novy—a first-generation American bacteriologist based at a medical school rather than a public health department—differs from traditional characterizations of early bacteriology in America. Novy’s ambitions to discover the basic aspects of microbial behavior without practicality or competing interests entering into his experimental motives is distinctly different from the conventional characterization of American bacteriologists at that time. To best appreciate how Novy’s work differed from that of other bacteriologists, the conventional portrayal of American bacteriology during this period is now provided.

Early Bacteriology in America

Histories written about the beginnings of bacteriology in America have focused on the activities of European-trained American physicians who worked in public health department laboratories.¹⁴ According to these histories, these well-established physicians gradually defined the field.¹⁵ The role of the public health bacteriology laboratory was to control disease processes through the application of the germ theory of medicine, which had originated in Europe. Their activities led to the development of specific methods to control the spread of disease among populations (cleaning drinking water of feculent material, vaccinating the uninfected, and controlling other vectors) or therapies for individual patients (antisera and later chemotherapy).¹⁶ Historians have depicted the practical activities of American bacteriologists working in public health departments. Consequently, bacteriology in America during the late nineteenth century has been characterized predominantly as a period of germ theory practice—the application of theories and practices developed in Europe.

Bacteriology laboratories were first introduced in the American public health setting during the early germ era in the late 1880s. Prior to this period, public health departments in nineteenth-century America focused on rectifying unclean public environments, chiefly urban ones.¹⁷ Public health measures were based on the belief that filthy environments were responsible for contagious diseases. Sanitation interventions to rectify susceptible environments had been the focus of public health campaigns targeting the spread of contagion.¹⁸ But the public health doctrine identifying sanitation and the removal of filth as a sufficient barrier against contagion was challenged soon after the germ theory was postulated. Historians Barbara Rosenkrantz, John Duffy, and Judith Walzer Leavitt have noted that during the 1890s the emphasis of public health began to shift away from sanitation programs and was directed instead toward interventions based on pathogen identification and eradication.¹⁹ These interventions were derived from the germ theory of medicine that had flourished in Europe in the mid- to late nineteenth century. The theories informing these interventions were then imported to American public health departments by American-schooled physicians who had traveled to Europe to study the new European science of bacteriology.

What practices in Europe so compelled American physicians to travel abroad in the 1880s to learn about the new germ theories? The excitement had begun earlier, when the German pathologist Joseph Henle in 1840 postulated the germ theory of disease—a premise that microbes correspond with specific disease entities.²⁰ Henle acknowledged that he did not have the technology at hand to unveil what he called the secretive lives of invisible organisms.²¹ The technology Henle desired—tools that would allow him to separate a specific microorganism from a specific disease process and culture it in pure form—did not exist in his day.²² In the 1840s, individual characteristics of microbes remained difficult to decipher because technology that allowed bacteria to be seen with sharp borders was not available. Stains were not available to contrast bacteria with their background. Henle could not identify distinct bacteria because he could not differentiate them according to morphology.

By 1870, the invention of these technologies enabled experimenters to test Henle’s germ theory.²³ The Abbe condenser, for example, allowed bacteria to be seen with greater clarity; aniline dyes first used in the clothing industry allowed different forms of bacteria to be distinguished according to the stain they incorporated, thereby allowing bacteria to be differentiated according to their size, shape, and color; and the development of solid media by Robert Koch in 1876 allowed bacteria to be isolated in pure culture.²⁴ By 1884, researchers possessed instruments capable of achieving what Henle in 1840 desired. Using these instruments and techniques, in 1884 Koch developed systematic methods to formulate his criteria for proof that a specific bacterium is the cause of a specific disease.²⁵ Organisms could now be isolated in pure culture and then reinjected into healthy animals to induce the same disease as observed in humans. After demonstrating the presence of these same bacteria in the diseased animals, he posited the bacterial nature of a particular disease, tuberculosis, in 1884.

The prospect of learning the methodology that Koch utilized for his postulates compelled enterprising physicians throughout the world to search for a bacterial cause of an array of human diseases besides tuberculosis.²⁶ The isolation of anthrax and tuberculosis encouraged physicians to take up a search for the specific microbial causes of more diseases: streptococcus (1883), diphtheria (1884), typhoid fever (1884), tetanus (1884), pneumococcus (1886), plague (1894), and botulism (1896). The American neurosurgeon Harvey Cushing likened the excitement of the possibility of identifying causal bacteria for numerous common infections to new discoveries . . . being announced like corn popping in a can.²⁷ Physicians excited by the possibility of making new discoveries came from America and elsewhere to Europe in search of expanding the repertoire of disease-producing bacteria.

By the 1880s, European germ researchers had already expanded their efforts beyond microbe hunting toward the practical applications of preventing or remedying human diseases. Their goal became discovering the means to kill disease-causing germs or inactivate their toxins. Louis Pasteur, for example, began a series of investigations to show that immunity could be produced through inoculation of attenuated live germs.²⁸ He induced immunity in animals by injecting bacterial cultures that he rendered nonvirulent by laboratory manipulation. Later, Koch attempted to treat tuberculosis, albeit unsuccessfully, by using immunization with tuberculin.²⁹ Emil von Behring, Koch’s student, successfully produced immunity to tetanus in rabbits, which resulted in the discovery of the diphtheria and tetanus antitoxins by Pasteur’s student Emile Roux.³⁰ These discoveries allowed physicians to treat previously lethal infections by injecting the ailing person with an antitoxic serum prepared by earlier immunization of an animal. Adherents of bacteriology heralded diphtheria antisera as tangible evidence that dramatic cures for infectious disease could be attained through the application of the principles of the germ theory of medicine.³¹ Historian William Bulloch noted that American physicians who traveled to Europe were captivated by the European scientists who were using germ theories to devise practices to control human diseases.³²

Upon returning to the States, American physicians translated their newly acquired knowledge into the creation of public health departments to control communicable diseases.³³ They imported their European methodology to newly constructed public health department laboratories in New York City (1887); Providence, Rhode Island (1888); and the state of Massachusetts (1888).³⁴ In the realm of public health, they applied European bacteriological techniques to treat disease causing bacteria, nullify their toxins, or prevent infection.³⁵ William Park, bacteriological diagnostician at the New York City Health Department, for example, began to mass-produce diphtheria antitoxin for the protection of the community.³⁶ The New York City Health Department laboratory later sought to mass-produce sera and vaccines to combat tetanus and other lethal diseases.³⁷ Directed by physicians educated about European germ techniques, the focus of American public health laboratories at their inception was the practical application of bacteriological methods to identify and control epidemic diseases.

Physicians and public health officials began to write about how bacteriology laboratories improved the capacity of public health departments to control epidemics. Stephen Smith, surgeon and officer in the New York City Metropolitan Board of Health, posited in 1921 that the use of bacteriological testing enabled the department to establish a more precise diagnosis, permit specific targeted therapy, and better control epidemics than had previously been possible.³⁸ At the time Smith was writing in 1921, his department had been using standard culture methods along with a new immunologic Schick test to identify cases of diphtheria and target who should receive a vaccine with greater certainty. About these new diagnostic tests and practices, Smith said that the brilliant research and discoveries abroad were accepted and extended in this country.³⁹ Because of bacteriology laboratories, Smith said, Knowledge has replaced guess work; experiment has superseded empiricism.⁴⁰

Like Smith, Charles Chapin, superintendent of the Department of Public Health in Rhode Island, maintained that bacteriological testing eliminated guesswork and permitted the targeted use of biological products in a discriminating fashion.⁴¹ Chapin claimed the bacteriology laboratory targeted public health measures by keeping human feces out of food to fight dysentery, destroying mosquitoes to combat yellow fever, and vaccinating against smallpox. Chapin argued that laboratories enabled health departments to pinpoint the mode of transmission of each infection and discover its most vulnerable point of attack.⁴² Chapin argued that the advent of vaccines and antitoxins, together with diagnostic testing to direct their proper use, provided health workers with a targeted method for both preventing and curing contagious disorders. The positive stories that physicians like Chapin and Smith told about early bacteriology in the realm of public health resonated with the optimism about the promise of science and a faith in the reality of progress that characterized the Progressive period in which they wrote.⁴³

Later in the twentieth century, medical historians continued the positive theme of the practical applications of early American bacteriology. George Rosen, physician and medical historian at Yale University Medical School, argued in 1958 that bacteriologists opened a path for the control of infectious diseases on a more rational, accurate and specific basis.⁴⁴ He wrote that epidemics could be handled more efficiently because the empirical shotgun methods of an earlier day could now be made more precise and definite.⁴⁵ Likewise, Howard Kramer, medical historian at the University of Iowa, wrote in 1948 that bacteriology replaced older fallacious ideas and provided certainty as to diagnosis and knowledge of the method of disease transmission.⁴⁶ Kramer noted that twentieth-century epidemics were giving ground as they were faced with man’s increasing scientific knowledge.⁴⁷ In 1992, John Duffy, medical historian at the University of Maryland, also argued that the bacteriology laboratory yielded more precise methods of diagnosing disease than had been possible in previous times and saved lives by the targeted use of vaccines, antisera, and antitoxins.⁴⁸ These historians maintained that bacteriology improved and reformed public health departments.⁴⁹ Their positive themes resonated with a widespread confidence during the postwar period in mid-twentieth-century America that the nation’s success in the war had to a degree been a product of its scientific and technological prowess.⁵⁰

Scholars have also portrayed a pragmatic phase of early American bacteriology devoted to destroying disease-producing germs at the expense of pursuing original knowledge. Esmond Long, pathologist at the University of Pennsylvania, noted in 1959 that little original work in the field of bacteriology had been done in this country.⁵¹ Similarly, Rosen argued that American physicians were behind the Europeans in the development of basic bacteriological science, as they focused their attention on the practical application of bacteriological principles.⁵² Rosen stated, while Americans contributed only in a limited degree to the growth of microbiological knowledge, they were more alert than their European confreres to its practical applications.⁵³ Duffy said in 1990, Americans contributed little to the development of bacteriology.⁵⁴ Barnett Cohen, a chemist from Johns Hopkins University, wrote in 1950 that the practical applications of bacteriology carried out in America followed the germ theories of Europe.⁵⁵ Kramer said in 1948, "European germ theory as applied in public health departments in