Historical Trail of the “Magic Bullet”and Jewish Medical Pioneers

The exhibit documents their struggles to enter the profession and to gain acceptance from an essentially hostile medical establishment. Jews were excluded from medical schools in Europe. Papal edicts throughout the Middle Ages and even in 1598, prohibited Jewish doctors from treating Christians. But  there were exceptions… "Almost every pope in history had a personal physician who was Jewish."

 
On display is a 1492 medical license shown with a Rembrandt etching of a Jewish doctor;  a vial of the first syphilis cure discovered by Dr.. Paul Ehrlich, a German Jewish physician who called it "a magic bullet."  Dr. Ehrlich won the Nobel Prize 1908. However, the University of Frankfurt did not grant him full professorial rank until a year before his death.
  
The climate changed somewhat  in the late 19th, early 20th century, when European and American medical schools opened their doors to Jewish students. Jews entered medicine in large numbers.  Medicine was an entrée into the modern world. Many Jews saw practicing medicine as a way to integrate into the larger society, to improve the health and economic conditions within their own communities, and to benefit mankind. 
 
Since the prestigious medical specialties such as surgery, barred Jews, they applied to less prestigious specialties such as, dermatology, microbiology, and psychiatry–most notably, psychoanalysis.  

 

In Europe and America, Jews entered medicine in disproportionate numbers. In 1920, the proportion of Jewish students at Columbia University Medical school was 47%.  American medical schools instituted admission quotas. A letter on display at the exhibit, written by an admissions official of Columbia’s Medical School in 1933, reveals that the applicant was “probably Jewish, but there is no unpleasant evidence of it.” 
 
After quotas were adopted, the number of Jewish students admitted to Columbia’s Medical School dwindled to 6% in 1940.
Exclusion of Jewish doctors from Columbia’s medical faculty in the 1930s and 1940s is shrouded in secrecy because it was practiced informally.  However, a book by an emeritus professor of neurology at Columbia (2009) provides insights into how the quotas worked in practice.  [1]
 
 
 
The same year 1933, Nazi Germany enacted the first wave of legislation effectively barring Jews from participation in German public life. By law, Jews were excluded from civil service, forbidden from practicing medicine and law, and established a 1.5% quota for admission to public schools and universities.
 
Perhaps the most important contribution the exhibit makes is a Video presentation, Heal, You Shall Heal, (16 minute) in which doctors, Rabbis, mothers and fatheers, sons and daughters, and ethicists grapple with agonizing current medical ethics issues. Issues that each of us will, at some point face, personally, given medicine’s techonological, if not therapeutic advances.
 
The participants offer their very different moral perspectives when considering such issues as:prenatal genetic testing for dreaded genetic diseases–what would you do with the knowledge?  Some welcome genetic information as a blessing, but others regard it as a great burden.  One participant expressed horror at the thought of having to make a Faustian choice.  Other issues discussed: What if you parent or grandrparent refused a life-saving pacemaker?  What’s the right decision, and who makes it?  How would you deal with the excruciating end of life decisions, such as–whether to employ all technological resources to artificially extend the end of life process in a terminally ill person who will be subjected to pain and suffering with no hope of recovery. 
.
Jewish tradition does not provide absolute answers for these life-death decisions–except to emphasize the infinite worth of a human being.
 
References:

1. “The Legacy of Tracy J. Putnam and H. Houston Merritt: Modern Neurology in the United States,” by Lewis P. Rowland, Oxford University Press, 2009.

Vera Sharav
 

THE NEW YORK TIMES

Tracing the Path of Jewish Medical Pioneers

By

The young man who applied to medical school in the spring of 1933 had graduated from Dartmouth College with good grades, a keen interest in medicine and, according to the university official who interviewed him, a nice sense of humor.

The application did not ask about religion, but the interviewer surmised it. “Probably Jewish,” he wrote in a scribbled evaluation, “but no unpleasant evidence of it.”

The handwritten note was found in the admissions files of the College of Physicians and Surgeons at Columbia University. After the implementation of quotas, the proportion of Jews in the student body fell to less than 5 percent in 1938 from nearly half in 1920.

The note is displayed in an exhibition called “Trail of the Magic Bullet: The Jewish Encounter With Modern Medicine, 1860-1960,” on view at Yeshiva University Museum in Manhattan. The exhibition offers a rare look at a topic few patients ever stop to consider: the emergence of European and American Jews as innovators in medicine, despite their status as outsiders frequently scorned by the medical establishment.

While some religions place ultimate responsibility for healing in divine hands, “Jews don’t see a conflict between faith and medicine,” said Alan M. Kraut, a professor of history at American University who helped put together the exhibition and has written extensively about immigration and health.

“The healer is seen as one of God’s instruments, not a competing force,” he said. “The physician is someone held in the highest esteem, doing God’s work — preserving life.”

During the Middle Ages, European Jews were instrumental in the spread of medical knowledge, translating many important early medical treatises from Arabic into Hebrew and other languages. One of the books in the exhibition is said to be the first medical textbook printed in Hebrew, a translation of a treatise written by the Persian physician-philosopher Avicenna in the 11th century.

But Jews were not admitted into most medical schools in Europe; they learned medicine through apprenticeships or were self-taught, said Dr. Edward I. Reichman, a physician and rabbi who practices at Montefiore Medical Center in the Bronx and teaches medical ethics. One university in Padua, Italy, admitted Jews in the 1500s, but charged them higher fees than other students.

In 1598, a papal edict issued by Pope Clement VIII reaffirmed edicts by previous popes that prohibited Jewish doctors from treating Christians and barred Christians from seeking treatment from Jewish physicians.

There were exceptions, however. “Almost every pope in history had a personal physician who was Jewish,” Dr. Reichman noted.

In the late 1800s, medical schools in Europe started opening their doors to Jews, and many entered the profession, including some of the first women to study medicine, said Josh Feinberg, who curated the exhibition. By the early 20th century, half of the physicians in Berlin were Jewish, as were 60 percent of the physicians in Vienna and 70 percent of the physicians in Warsaw.

Because they were barred entry to established specialties like surgery, Jews flocked to new, less prestigious fields, making their marks in areas like psychiatry (psychoanalysis was for a while called the “Jewish science”), dermatology, neurology, immunology, pathology and gynecology.

Few escaped the pervasive prejudice, however. In the early 1900s, Dr. Paul Ehrlich, a German Jew who discovered a treatment for syphilis and is considered the father of chemotherapy, popularized the term “magic bullet” to describe a medical compound that would “aim exclusively at the dangerous intruding parasites” yet not “touch the organism itself.”

But though Dr. Ehrlich was awarded the Nobel Prize in 1908, he was not made a full professor at University of Frankfurt until 1914, a year before he died. In the 1930s, as the Nazis came to power, his name was removed from textbooks and taken off Frankfurt’s street signs. Paul-Ehrlich-Strasse regained its name only after World War II.

Many of New York’s most familiar medical institutions have their roots in the late 19th century. An influx of poor Jewish immigrants from Eastern Europe to the Lower East Side raised concern over cramped living conditions in the tenements, leading to the development of several Jewish health organizations in New York, from the Jewish Consumptives’ Relief Society to the Visiting Nurse Service, and the establishment of Jewish hospitals, open to patients of all religions.

As the importance of early child health became clear, the Visiting Nurse Service focused on maternal health and pre- and postnatal infant care, using graphic posters with Yiddish captions to encourage breast-feeding and to teach basic hygiene.

In the 1920s and 1930s, as American medical schools like Columbia cut the number of Jews they admitted, many went to Scotland to study. The doors to hospital-based training programs were closed, but new Jewish hospitals absorbed the trainees. The Albert Einstein College of Medicine of Yeshiva University, a sponsor of the exhibition, was established in the 1950s.

A last section in the exhibition grapples with Jewish medical ethics and religious approaches to questions posed by modern medical science, from genetic testing and stem cell research to end-of-life issues and organ donation.

Whether Jewish physicians were observant or not, their practices incorporated teachings from around the globe, said Bert Hansen, a historian of science and medicine at Baruch College and an exhibition adviser.

“There was never a ‘Jewish medicine’ the way there was Chinese or Eastern medicine,” he said. “Jewish doctors wanted to learn and then use the best medical techniques and thought of the time.”

THE NEW YORK TIMES
In a Time of Quotas, a Quiet Pose in Defiance

Top of Form

Bottom of Form

By BARRON H. LERNER

Published: May 25, 2009

As a Jewish physician practicing medicine in 2009, I hardly ever pay attention to my religious affiliation.

RESISTANCE In the 1940s, Dr. Tracy Putnam found a way to avoid quotas on Jewish doctors at Columbia’s Neurological Institute.

Tracy Putnam Columbia Neurology

But in the years before World War II, at my institution and at other medical schools, Judaism was very much on people’s minds. Informal quotas limited the numbers of Jewish medical students and physicians.

Within hospital walls, some non-Jewish physicians supported the quotas and others opposed them. An untold story from Columbia’s Neurological Institute demonstrates an ingenious attempt by one physician to thwart what he believed was an unjust policy.

A central reason that colleges and medical schools established quotas in the early 20th century was the immigration of millions of Eastern European Jews to New York and other cities. When children from these families pursued higher education, the percentage of Jewish applicants increased.

This competition from Jewish students promoted the emergence of traditional anti-Semitic stereotypes, Edward C. Halperin wrote in 2001 in The Journal of the History of Medicine and Allied Sciences. Educators limited the number of Jews based on beliefs that they were too bookish, aggressive and greedy. Religious affiliation was deduced by studying students’ names, interviewing them and asking them directly on medical school applications.

“We limit the number of Jews admitted to each class to roughly the proportion of Jews in the population of the state,” the dean of Cornell University Medical College said in 1940, according to the journal article. At Yale Medical School, applications of Jewish students were marked with an “H” for “Hebrew.”

As a result, the number of Jewish students dropped. At the Columbia College of Physicians and Surgeons, for example, the percentage of Jewish students fell to 6 percent from 47 percent between 1920 and 1940.

It is harder to document the exclusion of Jewish physicians, but this was occurring too. In “Time to Heal,” the medical historian Kenneth M. Ludmerer writes that quotas were even stricter for senior physician positions at university-affiliated hospitals.

Because hospitals put quotas into effect tacitly and rarely documented them, little has been written about how non-Jewish physicians responded to them. But in a new book, “The Legacy of Tracy J. Putnam and H. Houston Merritt,” Lewis P. Rowland, an emeritus professor of neurology at Columbia, provides insights into how such quotas worked in practice.

The quota system eventually began to break down, and Dr. Rowland suggests that one reason was the influx of refugee European Jewish physicians fleeing the Nazis in the late 1930s. At Columbia, the department of neurology had quietly hired several of these doctors, many of whom were quite eminent.

One, for example, was Otto Marburg, a Viennese neurologist who emigrated from Austria in 1938 with his friend Sigmund Freud.

But how could the presence of these physicians be squared with the informal policies discouraging the hiring of Jews? At Columbia’s Neurological Institute in the 1940s, Dr. Rowland writes, a curious solution emerged: the neurology service was divided in two. The East service contained no Jewish physicians while the West service contained 5 to 10 European Jews.

The mastermind behind this compromise was Dr. Putnam, a neurologist, neurosurgeon and psychiatrist who was named head of the Neurological Institute in 1939. A Boston Brahmin, Dr. Putnam was the vice chairman of the National Committee for Resettlement of Foreign Physicians. “It seems likely,” Dr. Rowland concludes, “that all of these European neurologists were appointed by Putnam.”

Dr. Putnam was forced to resign in 1947, ending his career at Columbia. Colleagues at the time suspected several reasons, including a lack of administrative skills, enemies on the staff and the conflicts that arose from having a neurosurgeon running a neurological institute.

But Dr. Rowland unearthed another explanation. A New York newspaper of the era, called PM, reported in 1947 that Dr. Putnam had been told to fire all of the “non-Aryan” neurologists, something he was unwilling to do.

Dr. Rowland corroborated this story when he discovered a 1961 letter written by Dr. Putnam to a fellow physician. Dr. Putnam reported that Charles Cooper, then head of Columbia’s affiliated hospital, Presbyterian, had told him in 1945 “that I should get rid of all the Jews in my department or resign.”

Although Dr. Putnam left, most of the Jewish neurologists stayed, under the leadership of Dr. Merritt. But Columbia did not have a Jewish physician as head of neurology until 1973, when Dr. Rowland was named to the position. He was only the third Jewish clinical chief at the institution.

Quotas for Jewish medical students and physicians disappeared fairly rapidly after World War II, partly in response to Nazi atrocities against the Jews. But Dr. Putnam’s quiet advocacy on behalf of Jewish physicians when such a stance was unpopular should not be forgotten.

Dr. Barron H. Lerner teaches medicine and public health at Columbia University Medical Center.