Jefferson Medical College - Clinic Yearbook (Philadelphia, PA)

Page 30 text:

His lectures, therefore, were not only informative, but were enjoyable, challenging experiences. There is evi- dence that they attracted, besides phy- sicians and medical students, members of other professions. Da Costa's long- time secretary, Mary A. Clarke, 1'el21fCS that a lawyer from a distant city ad- mitted that it had been his habit for years to spend three days of every win- ter in Philadelphia to hear Dr. Da Costa lecture. As a clinician, Da Costa contrib- uted both new knowledge to advance his profession and sound therapy to those patients referred to him. His rep- utation in cardiology followed publica- tion of a classic paper, On I1-ritalole Heart, which resulted from studies on soldiers during the Civil War. His writ- ings were significant but he was not pro- lific. Viewed in the light of his remarkable influence on the profession, Wilson points out, the list of titles of his papers appears singularly brief. Yet, as Wilson adds, he wrote when he had something to say, and he always said it well. His small bibliography notwithstanding, he was recognized everywhere for his professional and in- tellectual attainments. Evidence for this is the honorary degrees conferred on him by Harvard, the University of Pennsylvania and Jefferson. He ac- cepted each of these honors with a brief oration in faultless Latin-a legacy of his classical education. Commenting on the Harvard honor, a medical jour- nal of the day said: Harvard voiced the universal senti- ment of the physicians of America that this is the man whom we delight to honor. His work, teaching, exam- ple and advice have done so much to advance the art and science of medi- cal practice that no honor could be too great an acknowledgement. Da Costa held membership in many professional and scientific or- ganizations, but none was closer to his heart than the Philadelphia College of Physicians, which he served twice as president. He battled for years to get members of the College to speak out publicly on medical questions of the day. He set the example by campaign- ing for the city to change the source of its water supply from the Schuylkill, which was polluted even then, to the Delaware, which was clear. The Col- lege of Physicians backed Da Costa, but the politicians were unmoved. Nevertheless, many memberS Of the community benefited because they were alerted to the danger. A great number of them boiled their water be- fore drinking it, and many iIlfCCti0D5 were undoubtedly prevented- Leisure time is cherished by every physician, and Da Costa was no dif- ferent. He loved books, and spent many hours reading outside of his profession. According to his secretary, his one idiosyncrasy in this regard was his inability to truly enjoy a book unless he owned it. Thus, his library was one of the largest private collec- tions in Philadelphia. His interest in literature led him to membership in Shakespeare Club of Philadelphia. Other English authors he admired were Thackeray and Sir Arthur Helps. As with so many other successful men-before and since-Da Costa was extremely efficient in the use of his time. He was an early riser and ac- complished much of his reading before the work day began. He seized on brief moments in the day to dictate letters or accomplish other necessary tasks, wasting little of his precious time. Yet he was always gracious and never seemed hurried as he made his rounds or saw patients in his office. He gave all patients the impression that their illness completely absorbed him, and he never left the bedside without directing a last, comforting remark directly to the patient. Jacob Mendez Da Costa was the first of two brilliant clinicians of that sur- name to be associated with Jefferson. J. Chalmers Da Costa would dominate the institution years after him. The two men were unrelated, just as they were unlike. Jacob was a truly out- standing clinician, but when he began his career at Jefferson he had to share honors with the Samuel D. Cross and Joseph Pancoast, giants of medicine at that time. It is a measure of the man that he was included in what the medi- cal world began referring to as Jeffer- son's great trio. It is further to his credit that he continued to Contribute to his profession for nearlv a half- century-until the day of his death in 1900 of a heart attack. lf, as Wilson suggests, 'usefulness is the meagure of greatness in medicine, Jacob Mendez Da Costa surely ranks among the great clinicians of the last century. i l lf Sei HCCI- n0f ' canal mater Prem 3 CHIT cause fan cover openf lenC6 durin CHHCE Wooc charai ward since Jell Finlay ready studer Bache lost h Philac claims physit was Jr of me monog gin of foury ferson the et rect, J We that 5 not cg 51 vectr ll Parent Slllder Son, S The father Scienc. Career father faughr Stope- medic ICSEHI4 fflend H Wm. Finla5 few, A Finlay and 6 S0011 -

Page 29 text:

a n the medical profession, usefulness is the measure of greatness. So wrote Dr. C. Wilson in his Memoir of M. Da Costa. If that be the yardstick, Iacob Mendez Da Costa certainly merits the mantle of great- ness. His usefulness-as with so many other prominent men in Iefferson's past-was both as a clinician and a teacher. His clinical skills were ap- plauded by his colleagues and he was considered a doctor's doctor. His teaching skills were equally -fine. Ac- cording to Fielding Garrison, the med- ical historian, Da Costa was perhaps the ablest clinical teacher of his time in the Eastern States. - Da Costa didn't attain this emin- ence casuallyg he was well prepared and he worked hard to perfect his skills. He gained a continental educa- tion in the classics as a youth and was stimulated by language and literature throughout his life. His primary med- ical education came at jefferson, where he was graduated at the age of 20 in 1852 after three years of study. His talents were recognized early, for he was singled out even then to demon- strate pathological anatomy to his fel- low students. His appetite for medical knowledge whet by his Jefferson ex- perience, Da Costa traveled to Europe to study in the leading medical centers of the world at that time-Paris and Vienna. His fluency in French and German allowed him to make better use of his opportunities than other American students. It also allowed him to enjoy the cultural attractions, and he even took the time for lessons in water-color painting. This later proved of great use to him in the preparation of sketches and diagrams for his teach- ing. His acceptance by French phy- sicians made it possible for him to attend meetings of the Academie da Medecine, which were open to few American visitors. After studying under the leading physicians and pathologists of Europe, he returned to Philadelphia and began a career that was to stretch nearly 50 years. His initial successes were as a teacher, for he had to prove himself over several lean years before his prac- tice grew. His classes in physical diag- nosis were particularly popular and even drew graduate physicians. These classes were conducted in his office and added to his growing reputation. He continued to conduct private classes until he began lecturing at jefferson in 1858-a mere six years after his graduation. He remained closely tied to Iefferson for the ensuing decade and in 1872 when only 39 years old he was appointed to the Chair of the Theory and Practice of Medi- cine. Da Costa's greatest contribution came eight years before this, when the first edition of his Medical Diagnosis was published. This volume, revised nine times by Da Costa to stay abreast of new medical discoveries, was the preeminent work in its field for four decades. It was translated into every European language and was found on nearly every physician's bookshelf. Ac- cording to an early Da Costa biogra- pher: It claimed the admiration of the medical world. It was the forerunner of other works of its kind but has held its place during 38 years. New works have appeared, some modelled on its lines, but none has rivalled it in scope, in teaching power or in its matchless grace of composition. Competent critics have pronounced it to be the most elaborate work on diagnosis in the English language. Even in the library of the irregular practitioner it has an exalted place. - 1n his book, as in his lectures, Da Costa taught the method of diagnosis by exclusion, which has carried over to the present. His style of writing and speaking were described as simple, natural, lucid, emphatic. This was his strength. He was able to convey con- cepts in a nutshell to grateful stu- dents. Another great contribution was his emphasis on clinical teaching, which was revolutionary for the time. Most medical teaching at that time, according to Garrison, was a mere pedagogic rubbing in of what had already been heard in routine lectures with hardly any practical clinical ex- periences whatever. W. W. Keen paid tribute to Da Costa's contribution, pointing out that the Philadelphia clinics until Da Costa in the session of 1866-67 took hold of them were about as inane and useless as one could imaginef' Da Costa's style alone was enough to attract students and Ere their imaginations. Some feeling for his presentation can be gained from this description in an obituary in H arvard voiced the uni- versal sentiment of the phy- sicians of America that this is the man whom we delight to honor Medical News shortly after his death in 1900: His language was always well chosen and he never hesitated for the correct word. He was a student of correct diction, and both in his lectures and in his writings showed his familiarity with the English classics. He also showed his wide extent of medical readings by refer- ences to French and German au- thorities.

Page 31 text:

he Panama Canal is not an obvi- ous memorial to a medical man. lt seems more appropriate for an engi- neer. But it was medical science and not engineering skill that made the canal possible. Yellow fever had deci- mated the work crews and forced the French to abandon efforts to build such a canal. But Americans succeeded be- cause a little-known Cuban physician -an 1855 graduate of Jefferson-dis covered the vector of yellow fever and opened the door to control of the pesti- lence. Carlos Finlay won few honors during his lifetime, despite the signifi- cance of his work which Cen. Leonard Wood, a famed military physician, characterized as the greatest step for- ward made by the medical sciences since Jenner's discovery of vaccine. Jefferson was only 29 years old when Finlay matriculated in 1853, but it al- ready had the professors to inspire the student's subsequent work. Franklin Bache, Finlay's professor of chemistry, lost his father to yellow fever in the Philadelphia epidemic of 1798, which claimed nearly 4,000 lives. Another physician interested in yellow fever was John Kearsley Mitchell, professor of medicine, who published a historic monograph, On the Cryptogamous Ori- gin of Malarious and Epidemic Fevers, four years before Finlay's arrival at Jef- ferson. While Mitchell's thoughts on the etiology of the disease were incor- rect, he made the astute observation: We must, for the present, suppose that yellow fever is portable yet it is not contagious. This all but suggested a vector. Mitchell's influence on Finlay ap- parently was great, because the Cuban student chose the professor's brilliant son, S. Weir Mitchell, as a preceptor. The son later would outshine the father in his contributions to medical science, but this was early in his career and he spent many hours in his father's laboratory with Finlay. He taught the Cuban the use of the micro- scope-a relatively new tool in clinical medicine at the time-and the latest research techniques. They remained friends and though Mitchell became a world figure he retained his faith in Finlay when his hypothesis on yellow fever was universally scoffed at. -After his training at Jefferson, Finlay returned to his native Cuba and enjoyed an active practice. He soon was devoting much of his spare time to yellow fever research. But re- search without inspiration often is fruitless and Finlay was rewarded with inspiration. One night while medi- tating, Finlay was distracted by a mosquito. As usual, yellow fever was in his thoughts. Suddenly it was clear: the mosquito could be the vector of death. Critics have claimed that seren- Clipity guided Finlay, but this doesn't nullify the hours of painstaking work in cooperation with a naturalist that allowed the physician to identify the offender specifically as Aedes aegypti. Though he was sure of his find- ings, Finlay needed proof that would stand up to the most thorough scrutiny. Human experimentation was needed, but Finlay shrank from the possible loss of life. Finally he proceeded, con- ducting experiments on 102 volunteers, including 20 Spanish soldiers and a Jesuit priest who later became a noted tropical meteorologist. Considering his limited research facilities and the ne- cessity of financing the work himself, Finlay's results were impressive. He addressed three international con- gresses, wrote 45 papers Cin Spanish, English, French and CermanD and spent countless hours explaining his theory in what must have seemed a fruitless crusade at times. Finlay continued his work through the Spanish-American War and after- ward when the Americans took over his native land. Among the organiza- tions established in Cuba was the American Yellow Fever Commission he greatest step for- ward made by the medical sciences since Jenner's dis- covery of vaccine headed by Maj. Walter Preed. Finlay had been proposing his theory for years, but Reed had not encountered it. He was impressed and ordered a de- finitive test in 1901. Finlay gladly co- operated, turning over his data and his mosquito eggs. The death of a com- mission member, Dr. Jesse Lezear, and others proved the hypothesis and prompted Preed to order eradication of mosquitos in Havana. Yellow Fever disappeared with the mosquitos, and the Americans were armed with the weapon they needed to drive a canal across Panama. - ln 1902, in the glow of Finlay's success came two prized honors: he became Cuba's first sanitary director and received an honorary degree from Jefferson. He died in 1915, still relatively un- heralded, but belated honors kept his memory green. ln 1933, the centenary of his birth, the Pan American Medi- cal Association proclaimed a Finlay Day. In 1935, the International Con- gress of the History of Medicine rati- fied his right to be called the discoverer of the vector of yellow fever. In 1955, Pennsylvania marked the centenary of his graduation from Jefferson with a Finlay Day. Jefferson arranged a two- day international symposium on yellow fever. Cuba erected a bust of Finlay in the great hall of its Academy of Medi- cal, Physical and Natural Sciences in Havana. A replica-a gift of the Cuban people-is in the Scott Memorial Li- brary at Jefferson. - a