Makers of Modern Medicine Part 19

How thoroughly Dr. O'Dwyer realized all the difficulties attached to the practice of intubation may be gathered from some of his articles on details of the treatment of patients necessary in order to make intubation a success. One of the great difficulties in the matter was the liability, when a tube was in place, for food and drink to find their way, during the process of swallowing, into contact with sensitive tissues of the larynx. To overcome this difficulty, Dr.

O'Dwyer made many modifications of the upper part of the tube.

Accordingly he made many wax models of the larynx, and studied the function of the epiglottis and its method of covering the larynx in order to facilitate the complete protection of the laryngeal tissues during the process of swallowing. Finally, he succeeded in making a tube that enables most patients to learn how to swallow without much difficulty.

In the mean time O'Dwyer was full of practical suggestions with regard to the management of these cases. His clinical experience showed him that it was better to teach the patients to swallow rapidly and then cough up any material that might find its way into the larynx rather than to take small sips with a spasm of coughing after each sip. He showed that, notwithstanding the apparently great danger {340} of portions of food being carried past the larynx into the trachea, and so to the lungs, there was not nearly so much risk in this matter as had been antic.i.p.ated. The almost inevitable occurrence of pneumonia was supposed to be one of the serious objections to the use of the intubation methods. Careful pathological investigations, however, soon showed that pneumonia developed much less frequently than had been expected, and, as a rule, when it did develop, it was due to an extension of the diphtheritic processes from the throat rather than to any infection by material that, because of the presence of the tube, had been inadvertently allowed to find its way into the respiratory tract.

However, O'Dwyer's work was not done without considerable opposition.

Bouchut's original invention of tubes for the larynx had failed to attract attention because of its condemnation by the Academy of Medicine of Paris, under the influence of Trousseau. When O'Dwyer's tubes were first suggested, then, there were not lacking critics, who said at once that his method was not new, that it had been fairly tried already and found wanting, and that it was hopeless to expect that any intubation method would succeed, since the larynx would not tolerate such a foreign body. There are always those who are sure, on _a priori_ grounds, that a new invention cannot succeed because it infringes on certain well-known physical laws that make it impossible.

Similarly there were a number of experienced clinicians who were sure that O'Dwyer's reported results could not be as represented.

It was not only from members of the medical profession that O'Dwyer met with discouragement. His work at the Foundling Asylum was carried on in spite of many difficulties and disappointments. His first contrivances for keeping the larynx open in spite of the inflammatory swelling were all failures, and, as owing to unfamiliarity considerable {341} difficulty was experienced in the insertion of the various mechanical appliances, he seemed to be adding to the torture of his little patients. Many of the attendants at the hospital became discouraged and almost dreaded to see any attempt made to save the children. From one of the sisters attached to that inst.i.tution O'Dwyer received the greatest possible encouragement. Sister Rosalie had often been known to weep at the death of her little charges, orphans though they were, and, though death frequently seemed a welcome relief from suffering, she hoped against hope that something would be accomplished to make deaths by asphyxiation rarer; so that even in the face of repeated failure she was ever ready to encourage O'Dwyer in further attempts in the accomplishment of his humane purpose. Not a little of his ultimate success is due to her sympathy and the enthusiastic faith inspired by her motherly love for the little homeless waifs who had come to occupy places in her heart.

At the beginning, some of the specialists in children's diseases gave the new method a trial, yet without obtaining satisfactory results.

Professor Jacobi, our most distinguished specialist in that field in America, to whom the German government offered the chair of pediatrics at the University of Berlin, contended, in writing his article on diphtheria for Pepper's _System of Medicine_, that intubation could not be expected to accomplish all that was claimed for it. It was not long, however, before Jacobi realized his mistake in this matter and handsomely made up for it. While he was president of the Academy of Medicine, in opening a discussion on intubation before the academy, in 1886, he said that O'Dwyer's work deserved all possible praise, and that his untiring devotion to the subject, in silent patience until he had brought it to perfection, was a model {342} that might well be held up for the emulation of American physicians, commonly only too p.r.o.ne to announce discoveries even before they were made.

Besides the application of O'Dwyer's tubes in acute diseases affecting the larynx and causing difficulty of breathing, the method of intubation has proved of special service in the treatment of stenotic diseases of the larynx. There are certain diseases in which deep ulcerations of the vocal cords, and of the laryngeal structures in their neighborhood, are followed by persistent contraction. This contraction may extend so as to cause serious narrowing of the c.h.i.n.k of the glottis, producing difficulty of breathing, and an intense breath-hunger that usually causes excruciating agony. Such patients formerly were objects of very special pity, but unfortunately very little could be done for them. Since the introduction of O'Dwyer's tubes, the lot of these patients has been made not only more tolerable, but, in course of time, even actual cures have been obtained, the tendency to contraction in the scar-tissue in the larynx being eventually overcome, with consequent relief of all the symptoms.

Dr. O'Dwyer himself tells the story of the first patient thus treated.

It was a woman, about forty years of age, the innocent victim of a dissolute husband, who came suffering with labored, stridulous breathing. The morning of the previous day she had visited a prominent laryngologist of New York City, who advised her to have tracheotomy done before the sun went down. A colleague suggested that she should go to Dr. O'Dwyer to see if he could not give her relief by means of his process of intubation. The stricture in the larynx had resulted after the healing of frequently repeated ulcerations. The tissue all around the site of the old ulcers was densely cicatricial, with a very marked tendency to contract. The aperture through which the breathing {343} had to be done was just sufficient to admit air enough to allow the patient to continue on her feet, but it was becoming ever narrower, while her discomfort was very marked. The stenosis had been coming on for two years, and was slowly progressive in spite of every form of treatment then known to the medical profession.

At this time there was no such thing as intubation tubes suited for adults. Dr. O'Dwyer, therefore, had a set made, using as models casts taken from a series of various-sized bodies, and furnishing directions to the instrument-maker from careful measurements of adult larynxes.

The tubes were made in various sizes for different-sized people, but none of them was small enough to be of service in this case, and even the largest of the tubes that had been made for children could be inserted only after the use of considerable force. This tube was inserted and allowed to remain for several days and then the next larger size was introduced. As considerable irritation had been set up by the previous tube, however, an interval of several days' rest was allowed. At the end of about eighteen days, breathing had become quite comfortable and the patient was allowed to return to her home in a suburban town. In two months and a half, however, all her symptoms had returned.

Another course of dilatation was then undertaken, and the patient was instructed to return thereafter every week for some time, until the tendency to contraction had been overcome. After a time, the intervals between dilatations were increased to a month, and then to six weeks, without any return of the dyspnoea. It is characteristic of O'Dwyer's very conservative view of things to find his prognosis of this case as given to the "Laryngological Section" of the Ninth International Medical Congress. He said:

"It is now one year and nine months since I began the {344} dilatation of this patient's larynx, and there is scarcely any doubt that it will be necessary to continue it during the rest of her life."

Later, however, we find the report:

"The cicatricial tissue in the larynx (as reported by the doctor) lost its tendency to contract, and the patient has remained now for over five years free from any return of the stenosis."

This last sentence is from Dr. O'Dwyer's note of the case, when by special invitation he discussed the subject at the annual meeting of the British Medical a.s.sociation, held at Bristol, England, in July, 1894.

Interesting as is the career of Dr. O'Dwyer as an investigator and discoverer in medicine, his character as a man is still more worthy of attention. For nearly thirty-five years he was a member of the staff of the New York Foundling Asylum; during which time he endeared himself to sisters and nurses, to his brother-physicians on the staff and to his little patients. He was eminently conscientious in the fulfilment of his duty, and had a tender sympathy that made him feel every slightest pain of his child-patients almost as personal.

One very stormy evening, in the closing years of his life, after his more than twenty years' service as a member of the asylum staff, a little child fell ill and he was sent for. Though not well himself, the doctor came out into the night and the storm to attend the little patient. As he was leaving the hospital, long after midnight, one of the sisters, who had been longest in the hospital and who knew him very well, said to him:

"But Doctor, why did you come out on such an awful night? The house physician might have gotten on very well without you until morning, even though the little one was much worse than usual."

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"Ah, sister," he said, "it was a child suffering, and I couldn't stay home and think that perhaps there was something I might suggest that would relieve that suffering even a little during the night."

It was this beautifully tender sympathy that urged him on against many discouragements to continue his investigations with regard to the possibility of intubation, and finally led him to his brilliant and perfected discovery. Yet it is even more interesting to find that after all these years of labor, just as soon as ant.i.toxin was introduced, and it became clear that a new and great advance in therapeutics had probably been made, O'Dwyer immediately took up the new remedy in order to test fully its possibilities. If ant.i.toxin were to prove the success that was claimed for it abroad, if cases of diphtheria were to recover under its influence as they apparently had done in France and Germany, then the role of intubation would soon be a very small one and O'Dwyer's years of patient investigation would go for very little. Such considerations, however, had no weight with him, and it may be said that during his superintendency at the New York Foundling Asylum ant.i.toxin had for the first time a full, unrestricted opportunity given it to demonstrate its power for good.

Notwithstanding discouragements of many kinds, the test of the efficacy of diphtheria serum was persevered in when others with more apparent reason for interest in it became disheartened and were ready to give it up, if not even actually deprecating its use. The medical profession understands very well now how unfavorable were the conditions under which diphtheria ant.i.toxin was used at first. The original experiments had been made in the laboratory with small animals, and the amount of ant.i.toxin necessary to produce good effects in human beings was not well understood. As {346} a distinguished authority in children's diseases, who is himself a great advocate of the efficacy of ant.i.toxin, once said: "It can practically be admitted that when first ant.i.toxin was introduced its use was scarcely more than expectant treatment." That is to say, so little of ant.i.toxic power was contained in the serum injected at first that the children were practically only kept from other and more exhausting forms of treatment, while the physicians awaited the results with nature as the only really active therapeutic agent.

After all, it must not be forgotten that the first doses of ant.i.toxin contained at most 50 to 100 ant.i.toxin units, as we now measure serum efficacy for the treatment of diphtheria. At the present time no one would think of using less than five hundred units as a beginning dose, and those who obtain the best results begin with 1000 to 1500, or in severe cases with 2000 to 3000 units of ant.i.toxic strength. It is almost providential that, notwithstanding this failure to understand the serum properly, the verdict of the profession did not go so generally against ant.i.toxin as to condemn its use hopelessly. It is owing to O'Dwyer and a few other sympathetic souls, who "hoped almost against hope," that finally experience succeeded in demonstrating the true value of diphtheria ant.i.toxin.

There was another difficulty, however, in the way of the adoption of ant.i.toxin that had to be overcome, one that proved no little source of discouragement to many of those who were testing the remedy. The original diphtheria serum employed was not concentrated; so when a sufficient amount of ant.i.toxic units to neutralize the toxins of the disease under treatment was employed, a large quant.i.ty of serum had to be injected. Experience shows that the injection of any foreign blood serum into an animal is followed by a certain amount of haemolysis, or blood destruction, and by {347} certain cutaneous manifestations, such as urticaria, erythemata, the familiar hives-like eruption and red itchy spots, which prove a great source of annoyance. In very susceptible cases the injection of even a small amount of foreign serum is followed by some fever, by restlessness, and red and swollen joints. In the early days of the employment of diphtheria ant.i.toxin, all of these complications were noted in many cases. They were sufficient to make many who were interested in the demonstration of the value of ant.i.toxin so disappointed and discouraged that they gave up the task. Not so, however, with O'Dwyer, who continued its use, and encouraged others by his example so that in spite of these objections ant.i.toxin obtained a firm foothold.

Dr. O'Dwyer's conduct, with regard to the continued use of ant.i.toxin under the discouraging conditions we have sketched, stamps him as a great member of his humanitarian profession, whose only purpose was the relief of suffering and the cure of disease, without any thought, moreover, of self-glorification. The use of ant.i.toxin has made the necessity for intubation occur much less frequently than before, and thus has undone some of the good contemplated by Dr. O'Dwyer, but has accomplished it in a way which he eminently approved and helped on as far as lay in his power, even at the time when others were doubtful, not without good reasons, as to the results that were being obtained from the use of ant.i.toxin.

Perhaps the best index of the sincere simplicity and frank goodness of O'Dwyer's character is to be found in his relations to the religious community of which he had been so long a medical attendant. In the words of one of their superiors, he was looked upon by the sisters at the Foundling Asylum as the father of the house, who had, as might be expected, the confidence and trust of every member of the {348} community. His relations to Sister Irene, the famed superior of the asylum, became those almost of brother to sister. Sister Irene (as is well known), though a woman who accomplished some of the best philanthropic work that, at least, our generation has known, was always in delicate health. For several years before his death, Dr.

O'Dwyer scarcely ever let an evening go by without coming to see her personally. He, better than anyone else, realized how much she had done for the Foundling Asylum, and how much her wonderful influence was still accomplishing in making the extension of that work possible.

There is, of course, another side to this story of Dr. O'Dwyer's solicitude for Sister Irene that deserves to be noticed. Few women have ever accomplished work of the extent and character that Sister Irene succeeded in doing with so little friction. In the parlor of the Foundling Asylum there is an engrossed scroll--a tribute to her memory from the medical board of the Asylum--which shows how well she was appreciated. As a bit of hospital history it deserves a place here, especially as there seems no doubt that O'Dwyer's mutual relations to the sisters and to the medical staff were of a kind that helped wonderfully in securing the frictionless co-operation that meant so much for the inst.i.tution. The memorial scroll reads as follows:

"Tribute to the memory of Sister Irene--to the Sister Superior who secured friends and funds for the building of the first and largest foundling hospital in America.

"To the sweet-souled woman--the friend of the foundling and fallen; to the best friend any medical board ever had, this tribute is presented with their sympathies to the Reverend Mother and the Sisterhood of the Sisters of Charity by the Medical Board of the New York Foundling Hospital."

While an extremely modest man himself, and one of very {349} few words, Dr. O'Dwyer delighted in teaching others anything he felt that he knew well himself. His conduct with regard to the teaching of intubation was especially admirable. He was ready to show any serious-minded physician just how the operation was accomplished, and many a young doctor obtained precious training in the exercise of the rather difficult manipulation involved in placing a tube in a child's larynx from the hands of O'Dwyer himself. He never lost patience with the awkward ones and never seemed to consider that too many calls were made on his time. He might easily have made money on the operation or the instruments, but deemed such considerations unworthy of his professional dignity. Personally he was a very reticent man, but, as a number of friends have said of him, "he made every word count;" and those who knew him best justly appreciated the expression of an opinion from him, since it was always sure to be the fruit of mature consideration and the result of personal clinical experience, usually extending over long periods.

The opinion held of Dr. O'Dwyer by his colleagues in the profession--and, be it well understood, there is no more searching appreciation of practical methods and theoretical opinions than that obtained by brother-physicians--is the best possible tribute to his greatness as an investigator, his honorableness as a pract.i.tioner, and his distinction as a man. We quote the summing up of his character given by Dr. Northrup, who had been his colleague for a score of years at the New York Foundling Asylum, and whose paper on the subject was read before the New York Academy of Medicine shortly after O'Dwyer's death:

"What the world knows of O'Dwyer," said Dr. Northrup, "is his genius as an inventor, his achievement in adding a great operation to the equipment of the profession, and thus {350} making the most conspicuous real contribution to medical progress within the last fifty years. This the world knows and has acknowledged. To us there is another and a pleasant duty to testify, that with this genius there was all that goes to make a man. His home life, his religious life, his civic life, his professional relations with both colleague and patient, his hospital relations, were such as befit a high-principled man. As highly as we esteem him as an inventor and genius and pract.i.tioner of wide knowledge, as much as we valued his superior medical judgment, we would write upon the monument of his achievements, 'O'Dwyer the Man.'"

In a previous pa.s.sage of his address before the Academy, Dr. Northrup had said:

"If I were asked what most contributed to Dr. O'Dwyer's medical excellence I would say his habit of thinking and his good logic. He had a good medical mind, an excellent medical judgment. Above all, that quality of intellect which allows a man to grow after the age of forty. To the New York Foundling Asylum, with which Dr. O'Dwyer was connected for twenty-five years, he was everything; to the maternity service he was the expert obstetrician; in intubation he was the inventor and teacher; in the general medical service he was the constant consulting mind, whose opinion in times of difficulties and in the midst of puzzling clinical problems every one voluntarily sought. To the Sisters of Charity he was physician and friend, consulted with regard to every important concern of the house, whether medical or not. All adored him."

Dr. O'Dwyer's domestic life was most happy. He had married, very suitably, a woman of bright disposition, who was a foil to his own soberer and more melancholy ways, and the relations between husband and wife growing tenderer with the progress of years, their home-life became the model {351} of an ideal Christian family. When he lost her through death, more than half of his life seemed to have gone, and he never quite recovered from the blow. The circ.u.mstances of her death added to his sense of loss, as it must have increased his appreciation of her worth. She died a martyr to what she considered her duty as a Christian mother. During the course of a pregnancy she was taken with what is known as pernicious vomiting, an affection that is likely to prove fatal unless the irritated uterus should be relieved of its burden--a means that neither she nor her husband would consent to adopt. Her death thus was the result.

During the years after the death of the doctor's wife, intimate friends found out what an effort of Christian fort.i.tude it was for him to keep up his spirits and his work. Though he was one of the busiest of professional men, in very active practice, not a week pa.s.sed but he found time to go to her grave and put flowers thereon. Just after her death he was as a man stricken by some dazing mental affection. Yet his sense of duty was so great that on his return from her funeral, being informed that a little child suffering from diphtheria needed his services for the performance of intubation, he at once made haste to comply with the untimely demand on him, and had given the little patient relief within the quarter of an hour after he had alighted from the funeral carriage.

Personally, Dr. O'Dwyer was of cold exterior, nor had he many close friends. Those who knew him well understood that beneath the layer of ice there was a warm, considerate, tender heart for those whom he admitted to the penetralia of his intimacy. On the other hand, few men have ever had friends more devoted than were O'Dwyer's. He was, however, of an extremely sensitive disposition. His conclusions in medicine had always been worked out with {352} the greatest care, and were the results of personal observations. To have them criticised then by those who had much less experience, or who had never thought along the same lines, was always intolerable to him, and generally kept him out of medical discussions. Those who knew him best realized that his opinions were of the greatest value, nor ever failed to contain a germ of original thought, the result of his personal experience. After his long years of work at intubation, many of his medical brethren refused at first to accept his new method of treatment, claiming that it did not reduce the mortality, even though it did for a moment relieve the sufferings of the patient. This position was a source of the keenest disappointment and depression to O'Dwyer.

After the method of treatment by intubation had been for some time before the medical profession of the country, a thorough discussion of it was held at one of the meetings of the Academy of Medicine of New York. Authorities in children's diseases from several of the large Eastern cities were invited to be present to give their opinions of intubation. Most of them were agreed that O'Dwyer's invention was of very little service. It was not a novelty in the history of medicine to have a really great and helpful discovery thus at first rejected by those who were later to be its ardent advocates. To O'Dwyer, however, who was present and took part in the discussion, the criticism of his method of treatment was a source of veritable torment. He did not show at the meeting how deeply wounded was his spirit, but for three days afterward he practically shut himself up in his room and refused to see anyone.

Naturally he was of a rather melancholic tendency, p.r.o.ne to dwell on the sadder side of things, and was constantly interested in sad stories and songs. He liked sad music, {353} and usually refused to listen to the livelier airs that others, especially of his race, were apt to find so refreshing. Something of this sterner side of his character entered into all his relations with others, and even with his own family. Though deeply affectionate, he very seldom permitted them to see and appreciate that fact. He was rather apt to be stern than otherwise, fearful lest his affection should in any way spoil them. To the very young children, in whose regard he did not consider this objection to hold, he was almost demonstratively affectionate, and those who knew his love for little children appreciated the sacrifice he made in denying himself demonstrations of affection to his own.

With all his sadness there was, as might be expected from his racial descent, a vein of dry humor, not infrequently manifest, though only to very near friends. He appreciated a good story, though the slightest tendency to vulgarity was extremely displeasing to him. He is said to be the originator of the humorous expression that has since been used often enough. While one day calling at a friend's house, in the absence of the friend, the servant asked him to leave his name, but was met with the reply (from the doctor) that "he preferred not to, as he thought he might have use for it before he got home."

The religious side of O'Dwyer's character is intensely interesting, because it represents a successful professional man--the maker of an important discovery in medicine; a logical, scientific thinker, whose opinion was valued by all his professional brethren--as one of the simplest of believers, tenderly pious and faithful. The s.e.xton of the church near which he lived tells (since his death) of frequently seeing him steal in during the day to say his prayers at the foot of the altar. He was one of the most faithful attendants at the communions and retreats of the Xavier Alumni Sodality {354} of New York City, of which he was an enthusiastic member. His deep piety can, perhaps, be best appreciated from a characteristic incident, which ill.u.s.trates his faith in prayer--his confidence in Providence. He had asked for something with regard to one of his children over and over again, and finally thought that his prayer had been heard. Later on he had reason to regret the fact that his wish had been granted, and to a friend, to whom he told the circ.u.mstances, he said:

"All that we can do is to say with resignation, 'Thy will be done,'

and then we shall be sure that whatever happens will be for the best."

The story of O'Dwyer's death serves to ill.u.s.trate some of the weaker points of modern medicine. During the nearly ten years after his wife's death he had never been quite the same man, but had succeeded in doing a large amount of work and had continued to care for a very large practice. In December, 1897, he began to develop some anomalous symptoms, pointing to a serious pathological condition within the skull. He seemed to have had what are known as "Meniere's symptoms,"

that is, a tendency to vertigo, some ringing in the ears and other unpleasant feelings. Toward the end of that month some hemiplegia, or at least some weakness of one side of his body, developed. He was rather neglectful of his personal health, as most physicians are, and until this time had paid very little attention to his symptoms. Most of the prominent New York consultants and nervous specialists were called in, but there was a marked disaccord as to the cause of the symptoms.

After some days in bed, comatose symptoms began to manifest themselves, and on January the seventh following, after having been lethargic for some days, Dr. O'Dwyer died. The _antemortem_ diagnosis of his case was dubious, lying amid the possibilities of tubercular meningitis, {355} secondary infection after ot.i.tis media, and secondary infection from some external cause. During the previous December, O'Dwyer had been treating a patient with carbuncle, and developed himself a small carbuncle on his chin. By some it is thought that infectious material from this lesion had been carried by emissary veins or their accompanying lymphatics to the inside of the skull, affecting the meninges, and perhaps portions of the brain-substance itself.

The _postmortem_ examination did not entirely clear up the doubts of diagnosis. The lateral sinus was found thrombosed, while there were some suspicious signs in the middle ear, but no distinct inflammatory condition. Just how the infection took place, then, is not clear, but O'Dwyer's condition of lowered resistive vitality was evidently at fault, to an important degree, in permitting infection to take place and in not throwing it off afterward.

At the time of his death he was about fifty-seven years of age. He had reached the maturity of his powers, and with the consciousness of having accomplished one good work was ready for further original investigations in practical medicine. A thought that had occupied him very much toward the end of his life was the possibility of a mechanical method of treating pneumonia. He had made a series of experiments on the lungs, and many clinical observations with regard to the possibility of producing over-inflation by mechanical measures.

He confided to one of his physician friends, who had been closest to him during life, that he hoped thus to secure a method of treating pneumonia successfully. This, after all, is the most serious problem in present-day medicine. Our death-rate from pneumonia is at least as high now as it was a century ago. O'Dwyer started from the observation that those suffering from emphysema seldom develop true pneumonia. And he hoped {356} to prevent the progress of the disease, or to abort it in its inception, by producing artificial emphysema for the time being. Had he lived, it seems not unlikely that we would have had further original work of a high order from him.