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«Lawrence Koblenz Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Graduate School of Arts and ...»

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From Sin to Science: The Cancer Revolution of the Nineteenth Century

Lawrence Koblenz

Submitted in partial fulfillment of the

requirements for the degree of

Doctor of Philosophy

in the Graduate School of Arts and Sciences

COLUMBIA UNIVERSITY

© 2013

Lawrence Koblenz

All rights reserved

ABSTRACT

From Sin to Science: The Cancer Revolution of the Nineteenth Century

Lawrence Koblenz

This dissertation analyzes the critical importance of the late nineteenth century to the development of a novel, radical approach to cancer that continues into the twenty-first century.

From the 1870s to the 1890s, physicians and the public came to understand cancer in an entirely new light, founded upon the application of scientific principles, methods, and instruments to cancer medicine as well as upon a major change in the social perception of the disease.

Cancer as it was conceptualized, diagnosed, and treated prior to this revolutionary transformation will be explored. The birth of cellular pathology will set the stage for the transition of cancer from a macroscopic, eponymous malady to a microscopic, cellular disease.

The founding of an institution devoted solely to the care of cancer patients and the investigation of the disease will illustrate how societal beliefs, combined with personal tragedy, philanthropy, and medical expertise, legitimized the disease and fostered cancer research.

The histories of the cancers of two Presidents of the United States, Ulysses S. Grant and Grover Cleveland, who were diagnosed with the disease only nine years apart during these critical years, will be compared and contrasted for the insights they provide on this great transformation.

The scientific underpinnings of these changes will be examined from their roots in physics, chemistry, and biology to their applications in microscopy, anesthesia, and antisepsis. Modern cancer will be shown to be based firmly on the medical microscope and the advent of scientific surgery that occurred in the late nineteenth century.

Contents Abstract Introduction 1 Section I: Traditional Cancer

1. Traditional Cancer 24

2. Institutional Beginnings in America 60 Section II: From Traditional to Modern Cancer

3. General Grant's Cancer: Twilight of the Traditional 91

4. The Reflection of Modern Cancer: The Secret "Anxious Summer" of the President 199

5. From Grant to Cleveland: Small Steps and Giant Leaps 306 Section III: Science and the Making of Modern Cancer 325

6. New Visions, Newer Insights: The Birth of Medical Microscopy and The Rise of Modern Cancer 327

7. The Treatment of Cancer: From Ancient Antidotes to the Golden Age of Surgery 671 Conclusion 1036 Epilogue 1044 Selected Bibliography 1060

–  –  –

I wish to acknowledge a debt of gratitude to many people spanning the several years since I began work on this dissertation. Any merit is theirs; any errors are mine.

First, I thank Professor Kenneth T. Jackson, Jacques Barzun Professor in History and the Social Sciences at Columbia University. Professor Jackson has been a strong advocate, ally, and friend, guiding me with a sure hand over one obstacle after another throughout this long process. I would not have been able to complete this work without him and for that I am eternally grateful. In my professional career of many years, I have met few people like Ken Jackson.

I thank the members of my Dissertation Defense Committee: Amy Fairchild PhD, Robert Pollack PhD, Samuel K. Roberts PhD and David J. Rothman PhD, who, along with Prof.

Jackson, saw fit to accept my defense of this dissertation one cold, wet day in January,

2013. Their friendly suggestions are likely to make the next stage of this work much better than it would be otherwise. I would also like to thank David Rosner PhD and Elizabeth Blackmar PhD, members of my original Dissertation Prospectus Committee, who gave me useful criticism early on.

Many other members of the Columbia community helped me immeasurably along the way, including professors, other students, librarians and administrative personnel. I wish to thank Professors Alan Brinkley, Jeannette Chloe Bulinski, Claudia Bushman, Richard L. Bushman, Eric Foner, Barron Lerner, Solomon and Debra Mowshowitz, Daryl Scott,

–  –  –

Ellen Stroud, and Thorin Tritter for their camaraderie and sage advice. Dean Jan Allen, former Associate Dean for Ph. D. Programs at Columbia, gave me resources and the incentive to use them to complete this work. Robert H. Scott, Digital Humanities Librarian at Columbia, has been so helpful and supportive not only throughout, but especially in times of crisis. He is the epitome of an expert librarian and a good friend. I thank Barbara Locurto, former head of the Columbia History Department office, and so many others in the office throughout the years who made the many administrative tasks associated with this work much easier. I thank Kathy Davis and Christopher Babilaa of Columbia's Inter-Library Loan, who found those sources impossible to find.

Archives, manuscripts, and rare books have been a mainstay of this dissertation. In my weeks, months, and years researching these many sources, I have met several very special people. Katherine Frumento, then head of the Memorial Sloan-Kettering Cancer Center Library, and Kathy Brennan, MSKCC archivist, facilitated the transfer of numerous boxes of priceless materials from the Rockefeller Archives in Sleepy Hollow, New York, to the Library on East 67th Street in Manhattan at the same time that they made me feel at home. Stephen Novak, Head of Archives & Special Collections at Columbia's Health Sciences Library found innumerable medical student, nurse, and physician records that added a you-are-there feeling to this work. My longest sojourn in Archives was undoubtedly at the New York Academy of Medicine, then headed by Dr. Jeremiah Barondess, one of my esteemed professors in medical school. Edward T. Morman, then Associate Academy Librarian for Historical Collections, introduced me that unique

–  –  –





at the Malloch Rare Book Room at the Academy (now the Drs. Barry and Bobbi Coller Rare Book Reading Room), found me the best sources and the best light to see them in.

Conversations with Arlene always led my research in the right direction. My travels to archives at the College of Physicians of Philadelphia, which holds the best original sources on President Grover Cleveland's secret cancer, were enhanced and made pleasurable by Ed Morman (who had by then moved to the CPP), Charles Greifenstein, and the late Gretchen Worden of the incomparable Mütter Museum.

As a physician, I learned long ago that the practice of medicine (and the beauty of life) is so much more than words on a page. A patient's history is so much less meaningful without feeling his handshake, looking him in the eyes, and hearing the tone of his voice.

So it has been with my work in history. Those mentioned above have provided humanity as well as materials to make this the work that it is, but there are others whose classification by institution or archive is not so obvious who also deserve thanks. Albert S. Lyons MD (1912-2006), co-author of the magisterial Medicine: An Illustrated History, opened his Central Park West apartment to me and shepherded me through the early stages of my investigations into the history of medicine. Mrs. Ann Wandell, daughter of prolific cancer history author Francelia Butler, shared her insights with me into her mother's interest in cancer and her relationship with Memorial Hospital in general and Dr. Hayes Martin specifically. I will always cherish her gift of her mother's work to me.

In the Fall of 1999, I had the unequaled pleasure of speaking with Mrs. Helen Coley Nauts in her Park Avenue apartment, surrounded by photographs of her family, including

–  –  –

writings from the late nineteenth century first piqued my interest in cancer history, so the ability to speak one on one with his daughter (63 years after his death) was incredible.

To her enormous credit, Mrs. Nauts carried on her father's work as founder of the Cancer Research Institute. She also kindly bestowed upon me a rough draft of the biography of her father that she had been working on for many years. There were many others, but one other personal interview of note was with Dr. Paul Marks, then President and CEO of the Memorial Sloan-Kettering Cancer Center. He generously gave of his time to me as I researched the evolution of the culture of cancer over the course of the nineteenth and twentieth centuries. MSKCC is arguably the premier institution for the treatment of cancer in the world. Thus, when I asked him what he considered to be the greatest advance in cancer in the past century, I expected a response related to cancer therapies, which made enormous strides in the twentieth century. His answer struck me: "earlier diagnosis." Of course, he was correct, for cancer is a physical presence — generally easier to expunge earlier in its course. And time has more than proven his answer right, from the halls of medicine to the politicization of cancer diagnosis in the Affordable Care Act.

Without my family, there would have been little reason to undertake this work. A brother in mind if not blood, Irwin ("Win") Robins, Esq. made this work possible. It is safe to say that without his steadfast encouragement, gentle (and sometimes not-so-gentle) prodding, and infinite hospitality (with wife Sue), this work would never have come close to completion. He is an editor's editor, with a command of the English language and love

–  –  –

to Win Robins.

There are those who contribute to a work like this, and those who give it meaning. My family gives it meaning. My mothers, Elsie Koblenz RN and Helen Kapelman MS, for many years along with now-passed fathers, Stuart Koblenz MD and Leonard Kapelman CPA, kept my eye on the goal throughout. My children, Adam Koblenz, Esq. and Jessica D. Koblenz PsyD, helped in innumerable ways, not the least of which was to set an example for me as to how to earn a doctorate, since they both began and completed their doctorates before I completed my doctorate in history, even though I had begun mine while they were both in high school!

From before the beginning up to and including this temporary ending, there has been one who stood above the rest. One whose love, support, encouragement, sacrifice, understanding, technical help, (usually) gentle demeanor, intelligent thoughtfulness, and complete selflessness, has made it all worthwhile. That love, who surely deserves the fruits of this labor more than I, is my wife and love, Barbara Ann Kapelman MD. To her I dedicate this work.

–  –  –

CANCER.

The very word strikes fear into the heart of every adult. As it should. In 2012, cancer killed more than 8 million people worldwide, of whom about 577,000 were Americans. 1 It is the second leading cause of death in the United States, behind cardiovascular diseases. 2 And if current trends continue, cancer will become the most common cause of death sometime during this second decade of the twenty-first century. On an individual level, the pain and suffering caused by cancer and its treatments—surgery, immunotherapy, radiation, and chemotherapy— are comprehensible only to those who have experienced them. The importance of cancer transcends the medical world. A culture of cancer influences what we eat, where we live, and even our choice of romantic partners.

–  –  –

The study of "cancer" can be approached from a panoply of perspectives, including the historical, the scientific, the medical, and the cultural. This dissertation weaves these strands together to reveal the major period of change in the nineteenth century – change that transformed cancer from a death sentence with end-stage heroic medical intercession to a scientifically understood disease with social, economic, and political overtones caught up within a web of research and industry. The cancer revolution was part and parcel of the scientific revolution that swept over medicine in the mid-to-late nineteenth century. This thesis argues that specific elements of this transformation revolutionized the understanding of cancer. Indeed, the investigation, diagnosis, and treatment of the phenomenon of nature that became the modern http://www.cancerresearchuk.org/cancer-info/cancerstats/world/cancer-worldwide-the-global-picture and http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-031941.pdf accessed November 14, 2012.

In 2009, the last year of finalized mortality data, heart disease accounted for 599, 413 deaths in the United States; cancer for 567, 628 deaths. http://www.cdc.gov/nchs/fastats/lcod.htm accessed November 14, 2012.

disease were in many ways uniquely positioned to benefit from the scientificization of medicine and the medicalization of cancer that occurred at that time.

In essence, the transformation of cancer as viewed from the socio-religio-medical standpoint by physicians in the eighteenth to mid-nineteenth century – which I call "traditional cancer" – gave rise to a new comprehension of the disease by the end of the nineteenth century – which I name "modern cancer." Modern cancer was born not in the twentieth century – as most historians suggest – but in the late nineteenth century. How that nineteenth-century transformation came about and, in particular, the ideas, protagonists, and instruments involved – reified in the diagnostic and therapeutic modalities of our time – is the subject of this dissertation.



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