Charles Terry Butler: An American Doctor in World War I

Posted on December 10, 2018 by nyamhistory

By Paul Theerman, Ph.D., Director of the Library

A hundred years ago this week, medical doctor Lt. Charles Terry Butler (1889–1980) entered Germany with the Army of Occupation. Yes, the Armistice had been signed a full three weeks prior, but “Charlie’s war” was not yet over. He would remain in uniform for over four more months. Through his detailed memoir, A Civilian in Uniform [1], we have insight into his war service and the work of Evacuation Hospital #3, which followed the American war effort across France and into Germany in 1918 and 1919.

1st Lt. Charles T. Butler, MRC, US Army Sept. 1917

Image: A Civilian in Uniform, b/t. pp. 124-125.

As detailed in a previous blog entry, in 1916, Butler, newly graduated from medical school, spent six months as a volunteer surgeon in a British-French military hospital outside Paris, the “war before the war” for Americans. His experience at Ris-Orangis turned out to be crucial for his later war service. Three months after he returned home, the United States entered the war on the side of the Allies. Butler’s adventures over the next two years capture much of the American medical experience of the Great War.

Butler’s first “battle” was to avoid getting drafted into the infantry so that he could serve in the medical corps. A draft started right upon declaration of war on April 6^th, and as a young man of 27, Butler was likely to be called up. He instead volunteered for the Army Medical Reserve Corps, where, with a medical degree, he received a commission as a first lieutenant in August. He was directed to go to Camp Greenleaf in Fort Oglethorpe, Georgia, by September 15^th for additional training. [2] Afterwards, Butler shipped from Hoboken on January 12, 1918, bound for Saint-Nazaire, France, at the mouth of the Loire River, arriving on the 27^th. Within a few weeks, Butler’s medical contingent was sent up the Loire and was divided, half to a hospital in Tours and half to one in Blois, both well behind the lines. He would serve separately in these locations over the next five months.

Postcard showing Evacuation Hospital #3. Image: Charles Terry Butler papers, New York Academy of Medicine.

Index to MOTC training lectures and notes. Image: Charles Terry Butler papers, New York Academy of Medicine.

In early July, as part of “Evacuation Hospital #3,” he was moved to Rimaucourt, in the département of Haute Marne, close to the front. On July 29^th, the operation moved to La Ferté-Milon “70 K. from Paris, about 23 K. from the Front.” [3]

The sound of guns was plainly audible; the signs of war were everywhere about. The station was almost wrecked—one end blown to atoms by a shell that had come through the roof. Everywhere were shell holes; among the tracks, in the platforms, and in the fields.… Houses everywhere were gaping ruins—roofs knocked off, holes in the walls, windows smashed. For, until the first Allied counteroffensive started, the enemy were within 4K. of the town. [4]

Entire route of Evacuation Hospital #3, 1/27/1918-4/12/1919.

Entire route of Evacuation Hospital #3 in France, where Butler served, from St. Nazaire to Brest. Image: A Civilian in Uniform, b/t pp. 354 and 355.

That afternoon he and his comrades explored the devastated town; less than a week later, the hospital was moved to Château-Thierry and then Crezancy. Butler’s hospital formed part of the medical services supporting the first major American military action in the War. “The camp at Crezancy was the first at which the organization came face to face with all kinds of casualties straight from the front.” [5] His unit remained close to the fighting, treating the wounded of the many battles of the Meuse–Argonne offensive, up until the Armistice on November 11^th that marked the War’s end. On that day, Butler wrote to his mother from behind the lines at Verdun:

Everyone is wild with joy! The war ended this morning at eleven. But it’s hard to realize. Automatically we camouflage our lights, but I don’t doubt will get out of that habit before long. . . . They had a big bonfire after supper [tonight] to celebrate with speeches, song, etc. . . . Now we are wondering what will happen to us. There is some talk of our going into Germany with the Army of Occupation, but we have as good chance of getting home fairly early. [6]

Home early was not to be: in December the unit moved north through Luxembourg to Trier, Germany. There it provided medical services for Allied soldiers held in a military prison hospital. For the first time, Butler noted the Spanish Flu in his war reminiscence:

Worn out by months of fighting, their resistance exhausted from the long march, hundreds fell easy prey to the virulent flu-pneumonia bug that was epidemic. While I was in charge of the pneumonia ward, of the 153 admissions, 50 died—one-third. A soldier would come in on his feet and be dead in 48 hours. The work was utterly frustrating. . . . [7]

Charles Terry Butler July to December 1918 personal diary

Pages from Butler’s diary, which was written from July to December, 1918. Image: Charles Terry Butler papers, New York Academy of Medicine.

After four months, the unit was ordered home. It left Trier on March 27^th and arrived in Brest, France, on the 31^st, then embarked by ship on April 12^th for Hoboken, arriving on the 20^th. On April 27^th, Butler was discharged from the military at Fort Dix. Between his volunteer service in 1916–1917, and his military service in 1917–1919, he had served over two years, or half of the war.

Charles Terry Butler in July 1975. Image: A Civilian in Uniform, p. 399.

After the war, Butler married, had children, and entered private practice, but by 1923 rheumatoid arthritis led him to retire. Moving to the Ojai Valley of Ventura County, California, he became a prominent civic and cultural leader. In 1975, after many years of work, he privately published A Civilian in Uniform as perhaps “the most complete account of one of the most active large mobile evacuation hospitals” in the First World War. Butler died in 1980.

Reading through A Civilian in Uniform one learns the reason for its writing: to combine the historical and the personal. Throughout the work, Butler mixed his letters and diary entries with understanding of the war and the official account of his hospital unit. He was justly proud of that unit:

This outfit, through trial and error and after many varying experiences in battle areas, had reached a state of efficiency in all departments that may have served as a useful guide for the structure and administration of evacuation hospitals in World War II. [8]

And of his role:

Yet when, from the multi-thousands of wounded who passed through the portals of these two hospitals, are sorted out the hundreds who owe much of their future physical well being to the professional performance of one single individual, and perhaps that man’s work during those years of bloodshed warrants, in philosophical perspective, a place a notch or two above the microscopic level. [9]

For many, the attraction of war may come from the desire to play a role in a venture of world-wide consequence. For Butler, this played out through his medical work in World War I.

The New York Academy of Medicine Library also houses Butler’s papers.

References:

[1] Charles Terry Butler, A Civilian in Uniform (Ojai, CA: “Private edition,” 1975).
[2] Butler was expected to outfit himself for his service, in the amount of $275.00 for uniforms, insignia, blankets, cots, and incidentals such as mirrors, electric lights, and candles. He received $2,000 a year in compensation, from which were deducted the premium for War Risk Insurance—life and disability insurance provided through the government—and $1.00 a day for officers’ mess! Butler, A Civilian in Uniform, 123–24.
[3] Butler, “Diary,” July 30, 1918, A Civilian in Uniform, p. 230.
[4] Butler, “Diary,” July 30, 1918, A Civilian in Uniform, pp. 230–31.
[5] Butler, A Civilian in Uniform, p. 248.
[6] Butler to “Mother” [Louise Collins Butler], November 11, 1918, in A Civilian in Uniform, pp. 312–13.
[7] Butler, A Civilian in Uniform, p. 332. There also Butler was assigned the task of writing the history of Evacuation Hospital #3, which formed much of the basis of A Civilian in Uniform.
[8] Butler, A Civilian in Uniform, p. 364.
[9] Butler, A Civilian in Uniform, p. 355–56.

Charles Terry Butler and the “War before the War”

Posted on October 6, 2017 by nyamhistmed

By Paul Theerman, Associate Director

The centenary of the United States entry into World War I was this past April. But wars—even those having such sharp cease-fires as this one did, on November 11, 1918—rarely have well-defined beginnings and endings. Even before the official American entry, Americans served in France from the outbreak of the war in 1914. Expats in Paris formed the American Ambulance (the term then meant field hospital), which spun off the American Field Service, charged with transporting wounded soldiers from the front line and providing immediate care. In direct combat, the famed Lafayette Escadrille was founded in 1916, made up of volunteer American air fighters under French command, who battled the Germans up until actual American military deployment two years later. And in the realm of battlefield medicine and surgery, Americans served as volunteers in France from 1914 up to 1917. One of the most noted was Dr. Joseph A. Blake (1864–1937) who, at the outbreak of war, resigned from his prominent surgical positions at Presbyterian Hospital and Columbia College of Physicians and Surgeons, and went to France. There he successively headed up three volunteer hospitals in Neuilly, Ris-Orangis, and Paris, up until his induction to the American military medical corps in August 1917 where he continued his work.

“Merry Christmas to J.A.B” [Joseph A. Blake, chief surgeon and hospital director], December 1916. Image: Charles Terry Butler papers, New York Academy of Medicine Library.

Blake had an outstanding reputation, so much so that he readily attracted both funds and workers. One such surgeon was Charles Terry Butler (1889–1980) whose memoir, A Civilian in Uniform (1975), and personal papers are held in the Academy Library. Butler was born in Yonkers, New York, to a prominent family. He was the son of lawyer William Allen Butler, Jr., whose father, William Allen Butler, Sr., both lawyer and author, was himself the son of Benjamin Franklin Butler, U.S. attorney general in the Andrew Jackson and Martin Van Buren administrations. Charles Butler led a life among the New York elite. As one example, he remembers that his family hosted William Howard Taft to dinner during his presidency.[1] Butler went to Princeton University, where he graduated in 1912, and then to medical school at Columbia University College of Physicians and Surgeons. After his graduation in 1916, he was due to take up an internship at Presbyterian Hospital that July. He postponed it to January in order to serve under Blake, then at the Anglo-French volunteer hospital in Ris-Orangis, France, some 25 miles southeast of Paris. As Butler put it:

My two year internship would be put off six months, but here was the opportunity to learn the treatment of serious war wounds under a great surgeon, perhaps my only chance to have such training, and if the United States were forced into the war, I would be much more useful to the Army.[2]

Blake promised Butler scant remuneration, 400 francs travel expenses each way, and 100 francs a month salary, relying on his “contribution” to aid the cause.[3]

Charles Terry Butler identity card for Ris-Orangis hospital, June 1916. Image: Charles Terry Butler papers, New York Academy of Medicine Library.

Butler left for Liverpool on May 27, and—after a long period of negotiating his credentials to enter France, as authorities were concerned about German infiltrators—he arrived at the Ris-Orangis hospital on June 10. A converted college, long empty before its refitting, the hospital was organized by two English patrons and operated by private donations and support from the French military. The hospital held about 200 beds, with a surgical theater and supporting radiology and bacteriological facilities, as well as, of course, kitchens and laundries.

Charles Terry Butler dressing a wound with the aid of two nurses, 1916. Image: Charles Terry Butler papers, New York Academy of Medicine Library.

A recovery ward, 1916. The flags of Britain and France are mounted at the window, as this hospital was a joint effort: operated within the French military hospital system, sponsored by private British philanthropy, and staffed by American surgeons. Image: Charles Terry Butler papers, New York Academy of Medicine Library.

Butler’s letters home trace his awakening to war and medicine. Within a week, he wrote to his uncle Clare:

The hospital has about 200 beds, and on my arrival I was put in charge of two wards with over 90 beds and some 80-odd patients. It was some contract to start with, and for two or three days I hardly knew whether I was coming or going. I did about forty dressings a morning with three nurses to help me, and two getting their patients ready for dressing ahead of me and bandaging up when I was through. It took over three hours of hard, steady work.[4]

After a month, to his mother:

Last Sunday, 65 new blessés arrive—the majority of them frightfully wounded. They come by ambulance from a distributing railroad station some 6–7 kilometers away. Arriving in bunches of four or eight, they are sent immediately to their beds. Most of the orderlies had been given leave that day, so we doctors had to turn to and help carry them to the wards. (It isn’t particularly easy carrying a large man on a heavy stretcher with his trappings up three flights of stairs.) There they are undressed; their clothes put in a bag, tagged, and sent to be sterilized and cleaned; and then bathed. . . . The next thing is food. Many have not had anything for 24 hours or more while en route from the front or the last hospital. Then the surgeon comes along. Dressings, casts, splints, etc. are removed so as to see the condition and nature of the injury. It would be impossible to describe the state of some of the wounds—many not having been dressed for several days, some even for 10 or 14 days. A hasty and rather superficial cleansing must suffice for the time being, until the patient comes back from the X-ray room. … All the wounds are terribly infected, and a large percentage have foreign bodies (balls, pieces of shell, clothing, stones, dirt, etc., etc.) lodged…. [Surgery followed, aided by X-ray and fluoroscopy.] The recoveries are wonderful. Men whom no one would expect to live, ordinarily, in a civil hospital, hang by a hair for days and come around O.K.[5]

Butler noted that the average length of stay at the hospital was almost 50 days.

The staff of the Ris-Orangis Hospital, 1916. Dr. Joseph A. Blake, director, is the central figure (second row, seated); Charles Terry Butler is the third man to his left. Image: Charles Terry Butler papers, New York Academy of Medicine Library.

Ris-Orangis was considered one of the most successful hospitals in the war. [One of the founders, Harold J. Reckitt, wrote a detailed history of the hospital, V.R. 76: A French Military Hospital (1921)]. Butler spent most of his time dressing wounds, with little occasion for actual surgery. He returned to New York in January 1917 to take up his internship at Presbyterian. But upon the American entry into the war in April 1917, he was commissioned a first lieutenant with the United States Medical Corps, serving into 1919—the topic of a future blogpost. Butler’s experience at Ris-Orangis was crucial to his surgical accomplishments in this second phase of war service. After the war, he entered private practice, but by 1923 ill health—apparently resulting from wartime conditions—led Butler to retire. Moving to the Ojai Valley of Ventura County, California, he became a prominent civic and cultural leader up to his death in 1980.

Transporting the wounded by train, 1916.

Ambulances and drivers of the Ris-Orangis, 1916.

References:
[1] Butler, Charles Terry. A Civilian in Uniform. Butler, 1975, p. 28.
[2] A Civilian in Uniform, p. 49.
[3] Blake to Butler, 29 April 1916, A Civilian in Uniform, p. 49.
[4] Butler to “Uncle Clare” [Clarence Lyman Collins (1848–1922)], 17 June 1916, A Civilian in Uniform, p. 57.
[5] Butler to “mother” [Louise Terry Collins (1855–1922)], 7 July 1916, A Civilian in Uniform, p. 62–64.

Images:
Charles Terry Butler, “Ris-Orangis, France, 1916,” photographic album. Charles Terry Butler papers. New York Academy of Medicine Library.

How to Become a Doctor (in 1949)

Posted on September 5, 2017 by nyamhistmed

By Allison Piazza, Reference Services and Outreach Librarian

How to Become a Doctor (1949) by George R. Moon.

While shelving books, I had the great pleasure of discovering a small book entitled How to Become a Doctor. Published in 1949, How to Become a Doctor is, at just 131 pages, “a complete guide to the study of medicine, dentistry, pharmacy, veterinary medicine, occupational therapy, chiropody and foot surgery, optometry, hospital administration, medical illustration, and the sciences.”

The author of the book, George R. Moon, was the Examiner and Recorder at University of Illinois Colleges of Medicine, Dentistry and Pharmacy. As for Mr. Moon’s qualifications, the writer of the forward states: “it is probable that no one person in the world has met more students seeking advice regarding entrance to schools of medicine, dentistry and pharmacy.”

As intended, I learned quite a bit about the medical school admissions process while reading this guide. I was surprised to learn that, in 1949, not many medical schools required a bachelor’s degree for admission, with only 4 schools requiring the degree, 58 asking for three college years, and 7 indicating they would consider 2 years of college work. This is basically unheard of today in the U.S.

Medical School by the numbers: 1948-1949 and 2016-2017

	1948-1949	2016-2017
Approved U.S. 4-year medical schools	71	147
Applicants	At least 20,000	53,042 [1]
Application fee	$5-$10 per school	$160 first school; $38 per additional school [2]
Enrollment	6,559	21,0301 [1]
Tuition at Harvard Medical School	$830*	$58,050 [3]
Female matriculates	11% (1947)	49.8% [1]
Medical school graduates	5,543	18,938 [4]

*The highest annual fee at any medical school in 1948-1949.

Further into the guide, Mr. Moon discusses the application process, offering a sample application from the University of Illinois. One question from this four page application is: How and where do you spend your summer vacations?

After the application comes the interview. Mr. Moon’s primary advice is on appearance, stating that “this is one place where the typical ‘Joe College’ attitude should be forgotten.” He goes on to say that the student should act natural and answer questions directly and fully but “avoid anything fancy.”

Chapter images from How to Become a Doctor.

To conclude, just who was the ideal medical school applicant in 1949? Mr. Moon offers the following description:

“The ideal will, of course, have superior college grades, a broad, balanced liberal arts program, be not over 22 years of age, have high moral standards and professional ideals, be reasonably attractive personally, be poised and at ease in his interviews, speak clearly and correctly, be clean and fastidious as to dress and appearance, and have enough financial backing so that he will not be forced to work or be worried by money matters, and last but not least, be physically strong and healthy.”

References:
[1] “U.S. Medical School Applications and Matriculates by School, State of Legal Residence, and Sex, 2016-2017.” Association of American Medical Colleges, December 6, 2016.
[2] “Applying to Medical School.” Association of American Medical Colleges, n.d.
[3] “Tuition and Fees.” Harvard Medical School, November 29, 2016.
[4] “Total Graduates by U.S. Medical School and Sex, 2011-2012 through 2015-2016.” Association of American Medical Colleges, December 19, 2016.

—

Sample Medical College Admission Test (MCAT) questions from How to Become a Doctor:

Vocabulary:

1. AUDACIOUS: (A) splendid (B) loquacious (C) cautious (D) auspicious (E) presumptuous

Quantitative Ability:

2. It is known that every circle has an equation of the form Ax² + Ay² + Bx + Cy + D = 0. Which of the following is the equation of a circle?
A) 2x – 3y = 6
B) x² – y² + 4x – 2y + 3 = 0
C) 3x² + 3y² – 2x + 6y +1 = 0
D) 2x² + 3y² + 6x + 4y +1 = 0
E) None of the above

Understanding of Modern Society:

3. Japan today presents no immediate threat to peace in the Far East principally because:
(A) so much of the country has been devastated
(B) she has been stripped of her colonies and conquests
(C) the present Japanese constitution outlaws war
(D) the new Japanese government is much opposed to the military party
(E)there is now unity of purpose among the various interest in the Far East

Premedical Sciences:

4. Which one of the following is 75 percent carbon, by weight, and 25 percent hydrogen, by weight?
(A) C₃H
(B) CH
(C) CH₃
(D) C₂H₃
(E) CH₄

Answers: 1. (E), 2. (C), 3. (B), 4. (E)

Deafness as a Public Health Issue in the 1920s & 1930s (Part 2 of 2)

Posted on July 8, 2016 by nyamhistofmed

Today we have part two of a guest post written by Dr. Jaipreet Virdi-Dhesi, the 2016 Klemperer Fellow in the History of Medicine at the New York Academy of Medicine and a SSHRC Postdoctoral Fellow in the Department of History at Brock University in St. Catharines, Ontario. She is working on her first book, Hearing Happiness: Fakes, Fads, and Frauds in Deafness Cures, which examines the medical history of hearing loss and “quack cures” for deafness. Some of these cures are explored on her blog, From the Hands of Quacks. You can find her on twitter as @jaivirdi.

Promotional photo by the New York League for the Hard of Hearing and its hearing clinic for testing and examination (The Bulletin, Dec. 1935)

The New York League for the Hard of Hearing launched several campaigns during the 1930s addressing the “psychological aspect” of acquired deafness mentioned by Wendell C. Phillips. Since deafness is an invisible affliction, Phillips emphasized the deafened person often feels isolated and unable to adjust to the sensory change, especially if the hearing loss occurred suddenly. Other otologists agreed as many patients narrated similar stories: their hearing was perfectly fine and normal, then one day something happened and they became deaf, and the process of coming to terms to the newfound deafened state was a difficult one. Illness such as influenza, pneumonia, meningitis, diphtheria, scarlet fever, measles, or ear abscesses were usually the culprit. So too were heard injuries, age-onset deafness in the elderly, misuse of drugs such as quinine, a poor diet (including too much sugar), and other ordinary factors:

“It is well to bear in mind the effects of hair-dyes, excessive smoking or drinking, and indeed, improper underwater swimming and diving. Vigorous blowing of the nose is also frequent causes of hearing impairment.”[1]

Otologists claimed individuals needed to take responsibility for their hearing—to conserve what hearing one had, through proper diet, lifestyle, and hygiene, before it disintegrated. This was a remarkable shift from the 1920s “prevention of deafness” campaigns that concentrated on a screening program of early detection and medical care. While constant surveillance was still promoted, the late-1930s campaigns transformed hearing loss into an affliction that could easily be treated or managed by good habits.

Pamphlets reveal how parents were encouraged to become more “ear-minded” toward their children, that is, to pay attention if their child exhibits any signs of hearing loss, to avoid a circumstance in which a neglected hearing issue ends up turning a deafened child into a problem.

Advertisement for the New York League Hard of Hearing (The Bulletin, 1934).

Advertisement for the New York League for the Hard of Hearing (The [Hearing] News, October 1935)

In other words, the “problem of deafness” became less about the triumphs of medical cures for hearing loss or social organizations providing communication services, but more about conserving one’s hearing before it was gradually diminished. Themes for “Better Hearing Week” especially reflect this: the 1937 theme was “It’s Sound Sense to Conserve Hearing,” while the 1938 was “Help Conserve Hearing.”

Front page of the October 1937 issue of The Bulletin magazine, promoting the National Hearing Week, with reprints of letters from FDR

The American Society for the Hard of Hearing also launched their own campaigns. In 1937, the organization listed a four-point program publicizing their mandates: the prevention of deafness, the conservation of hearing, the alleviation of social conditions affecting the hard of hearing, and rehabilitation. In addition to popular radio broadcasts on the National Broadcasting System, 327 feature articles and 189 editorials were released in over 1600 newspapers.

“Hearing through Life,” a national campaign launched by the ASHH (Hygeia, October 1937).

The publicity campaigns of the 1920s and 1930s were really about transforming public perceptions of the hard of hearing and deafened as handicapped persons, rather than as “defectives”—an important observation in light of the eugenicist concerns of the period. But they were also about addressing hearing impairment not as a social or educational issue, but as a public health issue, one that required cooperation between different levels of civic infrastructures. As otologist Edmund Prince Fowler noted in 1940, the hearing impaired “should never be dismissed with the thought, “Nothing can be done.”[2]

Promotional photo for the League’s “Children’s Auditory Training Project” campaign of the 1940s (The Bulletin, Nov-Dec, 1949)

Special thanks are owed to Arlene Shaner at the NYAM Library for her generous research assistance and lively conversations.

References

[1] Samuel Zwerling, “Problems of the Hard of Hearing,” Hearing News (January 1938).

[2] Bulletin of the New York League for the Hard of Hearing, 18.7 (November 1940).

Deafness as a Public Health Issue in the 1920s & 1930s (Part 1 of 2)

Posted on June 29, 2016 by nyamhistofmed

128

Today we have part one of a guest post written by Dr. Jaipreet Virdi-Dhesi, the 2016 Klemperer Fellow in the History of Medicine at the New York Academy of Medicine and a SSHRC Postdoctoral Fellow in the Department of History at Brock University in St. Catharines, Ontario. She is working on her first book, Hearing Happiness: Fakes, Fads, and Frauds in Deafness Cures, which examines the medical history of hearing loss and “quack cures” for deafness. Some of these cures are explored on her blog, From the Hands of Quacks. You can find her on twitter as @jaivirdi.

In 1935, physician Francis L. Rogers of Long Beach read a paper addressing the worrisome statistics of deafness. One study discovered nearly thirty-five thousand Americans were deaf. Another found that out of a million people tested for their hearing, 6% had significant hearing impairment. Yet another study reported three million people had some kind of hearing impairment. This “problem of deafness,” Rogers emphasized, “is primarily of public health and public welfare.” Not only were there too many people failing to adequately care for their hearing, but many cities, schools, and governments lacked the proper infrastructure to educate the public on the importance of hearing preservation. Indeed, as Rogers stressed: “Today the three great public health problems confronting the world are heart disease, cancer, and deafness.”[1]

A window display in Detroit (Hearing News, June 1942)

The notion of deafness being statistically worrying as a public health issue actually dates to the late nineteenth century, especially to the work of otologist James Kerr Love of Glasgow. Love conducted several statistical studies of the ears of deaf schoolchildren, discovering that the majority of them were not completely deaf, but had some level of “residual” hearing. With proper medical treatment, the hearing could be intensified enough to warrant a “cure.” For other cases, children could be taught to make use of that residual hearing through invasive training using acoustic aids and other kinds of hearing technologies.

Love’s research concluded that many deafness cases could actually be relieved if the ears of children were examined early and frequently—that is, deafness could be prevented. His “prevention of deafness” concept was influential for the new generation of otologists in America, especially those who were members of the New York Academy of Medicine’s Section of Otology during the first three decades of the twentieth century.

To raise awareness on the necessity of proper medical examinations and frequent hearing tests, these otologists collaborated with social organizations such as the New York League for the Hard of Hearing, which was established in 1910. The League was a progressive group catering to the needs of hard of hearing or deafened persons who were raised in a hearing society rather than in a D/deaf community and communicated primarily with speech and lip-reading rather than sign language. Composed mostly of white, middle-class, and educated members who lost their hearing from illness, injury, or progressive deafness, the League strove to construct hearing impairment as a medical issue. They argued hearing impairment was not an issue of education or communication, but rather a handicap.

An otologist examining a young patient’s ear (Hygeia, June 1923)

The collaboration between New York otologists and the League eventually created a national network of experts, social services, teachers, physicians, and volunteers who banded together to address the so-called “problem of deafness.” That is, the problem of how to best integrate the hard of hearing, the deafened, and to some extent, even the deaf-mutes, into society. One key achievement of the League was the establishment of hearing clinics to properly assess hearing impairment, especially in children, to ensure medical care could be provided before it was too late. This project was primarily spearheaded by Harold M. Hays (1880-1940), who was recruited as president of the League in 1913, becoming the first active otologist collaborating with the League. After the First World War, Hays set up a clinic for treating hearing loss in children at the Manhattan Eye, Ear, and Throat Hospital.

Group hearing tests of schoolchildren, using an audiometer. Headphones are used first on the right ear, then the left. (Hygeia, February 1928)

Hays claimed that hearing impairment might be a handicap, but “the sad part of it is that 90 percent of all hearing troubles could be corrected if they were treated at the proper time.” With regular hearing tests, this was possible. Yet, as Hays argued, regular hearing tests were not considered on par with other hygienic measures under public health services:

“We are saving the child’s eyes! We are saving the child’s teeth! Is it not worth while to save the child’s ears?”[2]

During the 1920s, Hays’ activism for regular hearing tests was so instrumental that in 1922, the League’s newsletter, The Chronicle, told its readers “we believe that the League would justify its existence if it did no other work than to prevent as much deafness as possible.” To achieve this mandate, the League launched a large public campaign to raise awareness on the importance of medical care. Indeed, in one report for the League, Hays remarked that with the increased publicity, there were 10,000 calls to the League in 1918 alone inquiring about aural examinations. A steady increase in patients would follow: 17 clinic patients in 1924, 326 in 1926, and then 1,531 in 1934.

Another publicity campaign spearheaded by the League was the establishment of “Better Hearing Week” in 1926, a week-long awareness program (later renamed “National Hearing Week”). Held in October, the campaign included symposium discussions on the “Problems of the Hard of Hearing,” including topics on the relationship between the physician and his deafened patient, how the deafened could build their lives, and even on newest technological developments in hearing aids. October issues of The Bulletin (the renamed League newsletter) and the Hearing News, the newsletter of the American Society for the Hard of Hearing (ASHH) included reprints of letters from prominent leaders supporting the mandates of “Better Hearing Week,” including letters from President Roosevelt and New York Mayor LaGuardia.

Advertisement for Western Electric Hearing Aid, the “Audiophone.” These before-and-after shots were powerful for demonstrating the effects of “normal” hearing, sending the message that outward signs of deafness, such as the “confused face,” could easily disappear once being fitted properly with a hearing aid. (Hearing News, December 1936)

The 1920s publicity campaigns were primarily focused on fostering ties between otologists and the League, in cooperation with hospitals and schools. In 1927, the League purchased audiometers and offered invitations to conduct hearing tests in schools across New York, so children with hearing impairment could be assessed accordingly. Two years later, the League worked with Bell Laboratories to further substantiate the conviction that deafness was a serious problem amongst schoolchildren and that something needed to be done.

At the same time otologists across America established joint ventures between organizations like the America Medical Association and the American Otological Society. They formed committees to write reports to the White House on the national importance of addressing the “prevention of deafness.” Wendell C. Phillips (1857-1934), another president of the League and the founder of ASHH, particularly emphasized the need to address the “psychologic conditions and mental reactions” of the deafened patient, for the tragedy of acquired deafness meant it is a “disability without outward signs, for the deafened person uses no crutch, no black goggles, no tapping staff.”[3] It was an invisible handicap that needed to be made visible if it was to be prevented, if not cured.

References

[1] The Federation News, August 1935.

[2] Harold M. Hays, “Do Your Ears Hear?” Hygeia (April 1925).

[3] Wendell C. Phillips, “Reminiscences of an Otologist,” Hygeia (October 1930).

Music and Medicine: Thoughts on a G-String

Posted on March 25, 2014 by nyamhistorymed

This is one of several posts leading up to our day-long Performing Medicine Festival on April 5, 2014, which will explore the interrelationships of medicine, health, and the performing arts. Register for the festival here.

Guest blogger Dr. Danielle Ofri, editor-in-chief of the Bellevue Literary Review, will moderate the closing panel discussion at the event. This essay was originally published in The Lancet and is reposted with permission.

By Danielle Ofri

Danielle Ofri. Credit: Joon Park

The moment has ﬁnally arrived. After three years of sweating through etudes, scales, and Suzuki practice books, my teacher utters the words that every cello student yearns to hear: “It’s time to start the ﬁrst Bach suite.”

It started on a lark, really, when I asked my daughter’s ﬁrst violin teacher how to coax a child to practice. She casually commented that the best thing is to see a parent practice. I hailed the nearest taxi and promptly purchased a cello. I started lessons, applying the same brute-force approach I’d acquired in medical school—playing the assigned notes over and over again until they were seared in my memory like the Krebs’ cycle and the 12 cranial nerves.

I added cello to the chores of my life—caring for patients, teaching, writing, and editing. But over the three years, an unexpected transformation occurred. Far from being a chore or a parental device to inﬂuence my daughter’s propensity to practice, cello turned out to be something that I genuinely wanted to do each night, almost to the exclusion of all else. Newspaper reading shrunk to cursory glances. Phone calls were avoided. Medical journals slipped to the subterranean level of the reading pile. Journal subscriptions lapsed.

I still love my “day job,” taking pleasure in teaching students and connecting with patients, but I have to be honest that, at this point in my career, the sense of growth has remained at a relatively steady state. With music, however, the intellectual challenges develop in ways that are new and surprising to me. The trajectory of learning, of frustration, and of accomplishment for the beginning musician has more in common with the intellectual vibrancy of life as a beginning medical student. I ﬁnd that I am more driven to enhance my musical skills than I am my medical skills, although I certainly don’t wish the latter to falter.

As I continued to pursue the cello in the evenings, hospital-corridor conversations during the day revealed musicians hidden in all sorts of unlikely clinical corners: the pathologist who played violin, the ER doctor who was an accomplished cellist, the clinic director who played saxophone, the student who’d ﬂipped a coin between Juilliard and medical school, the anesthesiologist who studied ﬂute at the Eastman School of Music before “retiring” to a more practical career, the pulmonary fellow whose legendary beer-chugging habits masked a prodigious violin repertoire. Was this just a matter of uncovering a common hobby by making the eﬀort to look, or might there be some intrinsic connection between?

I knew there was a doctors’ orchestra here in New York City, and as I started poking around I learned that there were others in Boston, Houston, Los Angeles, and Philadelphia. There was also one in Europe, one in Jerusalem, one in Australia; even a World Doctors’ Orchestra.

Was this merely because most doctors grew up in middle-class homes conducive to music lessons? I searched other professions, and uncovered one lawyers’ orchestra in Atlanta. But I couldn’t ﬁnd a single accountants’ orchestra, or architects’ orchestra, or engineers’ orchestra. There wasn’t any orchestra made up of Wall Street executives, computer programmers, government oﬃcials, or direct marketers.

There have been writings about the relation between medicine and the listening aspects of music, but nothing on the playing of music. Why do so many doctors pursue music? Why does the orchestra of doctors in Boston (the Longwood Symphony) receive audition inquiries on a daily basis?

Mark Jude Tramo, a neurologist, songwriter/musician, and director of The Institute for Music and Brain Science at Harvard and Massachusetts General Hospital, feels that “there is overlap between the emotional and social aspects of relating to sick patients and communicating emotion to others through music. Some would speculate that there is [also] an overlap between aptitude for science, which most premeds major in, and for music.”

Lisa Wong—violinist, pediatrician, and president of the Longwood Symphony Orchestra—speaks for the many who came to medicine after years dedicated to serious musicanship. “The music we create builds in us an emotional strength, sense of identity, and sense of order. Then it is given away—we play for others, we play in ensembles. We come to medicine and it is the same thing. The giving, the service—in music and medicine—is a natural connection.”

Michael Lasserson, a British double-bass player, retired family physician, and founder of the European Doctors’ Orchestra, speaks from the perspective of the dedicated amateur. Although he was raised in a family of professional musicians, it was clear rather early on that he was headed for medicine rather than the stage. But, “music never lets you go,” he says. And it is more than just a hobby to make one a happier doctor. “It is a means whereby one is lifted away from the essential loneliness of clinical decision-making and action, into a world of a common enthusiasm and endeavor as the group searches for the beauty of sound [and] the composer’s intent, and those few hours have what can only be described as a healing function.”

There is also the risk-taking that oﬀers parallels between medicine and music. It takes a certain amount of fortitude to slice open a patient’s abdomen with a scalpel. No less is required to take on Mahler’s seventh or the late Beethoven string quartets. “We hurl ourselves with suicidal courage against the commanding heights of the repertoire,” Lasserson says, hoping just to “touch the hem of that greatness”, though he acknowledges that sometimes, for the amateur, “miming skills will come to the fore.”

I debate this every night as I approach that single precious hour of energy after all the childcare has been completed and before exhaustion forces me to bed. Do I read that groundbreaking clinical trial that will surely impact my practice? Do I work on that unﬁnished book chapter? Do I read the newspaper and catch up on world events? Do I organize the entropy of my desk? Do I exercise for 30 minutes as I routinely exhort my patients to do?

Unfailingly, the answer is “none of above.” No matter how tired I am, no matter how much neuronal lint has accumulated throughout the day, I tighten the hairs on my bow and dig the end-pin of the cello into my rutted carpet. As I start to work on my assigned music for the week, I ﬁnd myself focusing ever more narrowly on a single page, a single line, a single measure—even a single note.

Temperamentally, this is the exact opposite of life in the hospital, in which I feel pelted by ringing phones, needy patients, impossible schedules, irritating bureaucracies, and a cacophony of meaningless minutiae. It is a glorious relief, instead, to struggle for—and occasionally achieve—precisely the right note. But then, there is a step even beyond that. The note doesn’t have to merely be right—it also has to be beautiful.

Beauty is not something that gets much shrift in medicine. Other than the experimental design of a classic study that might be referred to as “elegant,” there isn’t much in medicine that falls into the category of beauty. Beauty is inherently unpragmatic—it doesn’t enhance eﬃciency, increase productivity, earn a grant, or cure a patient. Maybe it is this lack of beauty that drives doctor–musicians to struggle to draw some into their lives via music.

But perhaps there is indeed something in medicine that is related to beauty. After all, medicine is about life—the wriggling, sensual, bodily aspects of being alive. This is not something that can be said about engineering, law, or accounting. Although being alive—and being sick—can frequently be unpleasant, it never ceases to be miraculous. That miraculousness—and the privilege of doctors to be part of it—is a beauty in itself.

Willa Cather once said, “Novelists, opera singers, even doctors, have in common the unique and marvelous experience of entering into the very skin of another human being.” The beauty of entering the very skin of another human being is how many musicians describe the emotional experience of playing music. And for many, it is the striving to achieve that—almost more than the attainment—that oﬀers the most pleasure. As we physicians strive to achieve the best for our patients in the messy, corporeal world of clinical medicine, we work to enter that very skin of another human being, and perhaps—with luck—we can touch the hem of that greatness.

Touching the hem is about all I can aspire to, but that’s enough. I’m willing to grovel for that. The sheet music of the ﬁrst Bach suite appears straightforward—two pages of evenly spaced notes in the key of G. No intricate timing, no double-sharps, no key shifts, no clef shifts, no fancy ornamentation. But as anyone who as ever tussled with Bach knows, that simplicity is ruthlessly deceptive. “One measure at a time,” my teacher has instructed me. “It needs to be completely memorized. Expect to put in about a year on this.” This is said without irony.

Week after week, month after month, I tiptoe gingerly through the music. The melodic phrases are simultaneously simple and horriﬁcally complex. But when I’ve survived a measure and can play several notes in sequence, the beauty is astounding—the type of beauty that really does take the breath away. I haven’t made it to the hem yet, and may never. But that’s okay. It’s all in the reaching.

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