Friday, July 23, 2010

Ball 10. The Tragic Case of Dr. John Hancock Douglas

[A book idea I've been working on. Thought the anniversary of Grant's death would be a good news hook. Turned down--graciously, I guess--everywhere. Good to have a blog.]

On July 23, 1885, Ulysses S. Grant, the nation’s 18th president and arguably its greatest military leader, died at the age of 63. His death ended a struggle against cancer that had begun 10 months earlier, when the general walked into the Manhattan office of Dr. John Hancock Douglas, a noted throat specialist.

In that brief time, the two men had forged an intense and intimate doctor-patient relationship. Grant acknowledged that without the round-the-clock care Douglas provided, his life would have ended earlier and in miserable pain. Instead, the former general was given sufficient reprieve from suffering to finish his memoirs, widely considered the best ever written by a U.S. president.

Yet Grant’s death left Douglas broken and ultimately cast aside by his professional peers. As Grant benefited from his relationship with Douglas, the doctor suffered in return. He was destroyed financially, physically and almost certainly emotionally by his devotion to his patient.

Grant had come to Douglas, whom he’d known during the Civil War, in October 1884, about a troubling mouth sore that made swallowing increasingly difficult.

“Is it cancer?” Grant asked.

Douglas understood immediately what he was seeing. “The question having been asked, I could give no uncertain, hesitating reply,” he wrote of the meeting. “I realized that if he once found that I had deceived him, I could never reinstate myself in his good opinion.”

With incurable cancer, what Grant needed most was time. He was well into the writing of his autobiography, which promised to resurrect the family fortunes wiped out in 1884 by the scandalous failure of Grant & Ward, the stock firm of Ulysses Grant Jr. Thanks to the help of Mark Twain, who arranged the publishing deal, the memoir would give Grant’s heirs financial security.

But he had to finish the book. Over the coming months, Douglas helped keep Grant as comfortable as possible while his patient wrote, seeing him as often as twice a day, holding bedside vigils and, toward the end, sleeping on a cot in the dying man’s room. (Historian Joan Waugh quotes Douglas telling a Boston newspaper that his sense of duty to Grant gave him a “degree of physical endurance that might otherwise have been impossible.”)

Grant bounced literary notions off Douglas while undergoing treatment in Manhattan and later at a cottage on Mount McGregor, a resort near Saratoga where he spent the last weeks of his life and finished the memoir. It was Douglas who urged the family to relocate there in hopes that the mountain air might invigorate his patient.

Grant benefitted from the change of scenery. He also felt the effects of Douglas’ prescription for the painful tumor: applications of cocaine—which in part due to the work of Sigmund Freud had just begun to appear in the medical literature as an anesthetic—and injections of brandy and morphine.

Born in Waterford, N.Y. to a farming family, Douglas graduated from Williams College and the University of Pennsylvania. He trained with the preeminent throat specialist of his day, his brother-in-law Horace Green. He edited the American Medical Monthly and was published frequently in scientific journals. He was among the earliest members of the American Laryngological Association and the New York Academy of Medicine.

During the Civil War, Douglas volunteered to assist the U.S. Sanitary Commission, the health arm of the Federal military charged with improving the medical care of soldiers. He rose to become Associate Secretary for the Commissions’ activities west of the Mississippi, under the command of Grant. Douglas also was instrumental in founding an old soldier’s home and is credited with the use of pickles and sauerkraut to prevent scurvy.

But he and the other physicians caring for Grant were not beyond reproach in the press. When articles questioning their choice of treatment, particularly the use of cocaine, appeared, Grant steadfastly defended his medical team. At one point he wrote that were he to heed the clamor, “I would die within a few days, suffering the extremist [sic] agony in the meantime.”

After Grant’s death Douglas returned to New York to find his medical practice, which had provided him an income estimated at $20,000 a year (equivalent to roughly $450,000 today) irretrievably floundering. Soon his health began to fail. A stroke landed him in a charity room of Presbyterian Hospital, prompting a plea for financial aid in the trade press from two well-known New York physicians.

Desperate for money, Douglas pressed to recover earnings lost when treating the general forced him to abandon his practice. He received $12,000 from the Grant family, a substantial sum but not enough to keep him afloat.

In 1890, Douglas was expelled from the laryngological association. Although the reason for Douglas’s rejection remains uncertain, he may simply have been too poor to pay his dues—then $5 a year.

Douglas certainly had a history of money woes. As early as 1879, his wife complained in a letter that he had “lost so largely in money matters” that she could not afford to send their daughter, then suffering from an eye ailment, to Europe—“for we would be obliged to pay for a companion to go with her, because she could not read.”

Douglas may have fallen for one of the rampant stock schemes of the era. For a time one tenant in the tony apartment building at 48 East 26th Street where the Douglas family lived was Ulysses Grant Jr. It’s tempting to speculate that the young man might have sought out investors among his neighbors.

Whatever the case, the once prosperous physician spent the final years of his life in want. Douglas eventually moved to Washington D.C., where his daughter and her husband, the Episcopal Bishop of the city, were living. He died there in 1892, at the age of 68.

An 1892 obituary of Douglas in the Journal of the American Medical Association noted: “Without doubt under some forms of Government, having more gratitude than Republics, Dr. Douglas would have been, in his latter days, in the receipt of a comfortable pension.”

Douglas himself agreed with that sentiment. In a September 1891 letter to his friend, Frederick Law Olmsted, the great landscape architect with whom he had served in the Sanitary Commission, Douglas, in a hand frail and shaken by stroke, lamented that "if anyone is entitled to a membership in the Loyal Legion, it is certainly myself, for not only was the head of the Army (Gen. Grant) my patient, but his chief of staff, Gen. [John] Rawlings--and so many others of the Army [illegible] under my medical wing that I cannot attempt to enumerate them."

Alfred J. Bloor, another titan of late-century architecture with whom Douglas was acquainted, arranged a collection for the doctor from former colleagues in the commission. Olmsted and his wife gave money, prompting a profusion of gratitude from Douglas.

Instead, he had neither pension nor good standing. More than a century later, the American Laryngological Association has refused to reinstate Douglas despite attempts to do so. A 2005 scholarly article pleading his case in the association’s journal, Laryngoscope, did not budge the group’s board. And a more recent request to restore him also failed to arouse any interest in the matter, according to Dr. Gayle Woodson, the association’s former historian and a co-author of the journal article. No other member has ever been dropped for failing to pay dues, Dr. Woodson added.

Considering his professional contributions, the services he rendered to his country, and his devotion to his patients, Dr. Woodson and her colleagues wrote, Douglas’ fate “seems an unjust ending to the life of this magnanimous and noble” physician. The 125th anniversary of his most famous patient’s death would be a chance to remedy that injustice.

Tuesday, July 13, 2010

Ball 9. Going Fishing

Does an ancient fish fossil in the Caribbean have the potential to reshape the conventional wisdom about marine life in the Western hemisphere? Prosanta Chakrabarty thinks so.

Dr. Chakrabarty, an ichthyologist at the Louisiana State University in Baton Rouge, believes that the preserved remains of a 5-million-year-old member of the cichlid family on the island of Hispaniola—home to Haiti and the Dominican Republic—is evidence that a prevailing theory of how freshwater fish spread throughout Central and South America needs revisiting.

Biologists generally believe that the upwelling of the Isthmus of Panama out of the sea 3.5 million years ago led to a major migration of species in the region, a phenomenon with the automotive-sounding name of “the Great Biotic Interchange.” The new isthmus—the spit of land that bridges Central and South America—allowed freshwater fish and other creatures to colonize habitats previously forbidden them, diversifying the animal life in North and South America in the process.

Analyzing genetic material from more than a dozen fish families, Dr. Chakrabarty and a colleague, James Albert, of the University of Louisiana in Lafayette, found that many species appear to have spread across the region far earlier than can be explained by the isthmus model.

“Cuba and Hispaniola may have connected the continents long before the Panamanian isthmus did, allowing fishes to disperse across fresh waters from South America to North America 50 million years ago instead of just in the last 3 million years,” Dr. Chakrabarty says. “We find that the closure of the Isthmus of Panama was just the most recent event in the rich geological history of this region. The rise of the Isthmus of Panama actually allowed more fish to move south from Central America to South America—more species than in the other direction. This is a very different view than that proposed by the Great Biotic Interchange.”

In addition to fish, toads and some lizards also appear to have enjoyed the same mobility as fish, he says. “In 100 million years, when Central America breaks up and drifts away, no one will believe the current state of having these four disparate geologic masses aligned as a land bridge,” Dr. Chakrabarty says. “That fish can tell us how these land masses fit together and broke apart is pretty cool.”