| Features | Spring/Summer 2007 |
Anatomy of a Doctor’s Life The news tolled through the chill air of the late winter dusk: Edward Augustus Holyoke was dead. The church bells were only the first of In keeping with the stature of the man, a newspaper notice for the funeral invited all to gather at Holyoke’s home before processing to the church. But days earlier, in keeping with the nature of the man, Salem’s physicians had been invited to convene what would be Holyoke’s final contribution to the advancement of medical education: his autopsy. Cold Case Those physicians who could attend gathered in a room as chilly as the wintry outdoors. On a table before them lay Holyoke’s draped corpse. Muffled by their cutaways and frockcoats, the men may have talked quietly as they stood around the table, smoked cigars or pipes, perhaps even fortified themselves with Holyoke’s prescription of “a dram of Rum or some spirit or a Glass or two of Wine.” They may have intoned a prayer or raised a solemn toast. Then one of them, with little intro-duction, had plunged a scalpel into the body’s sternal notch. With that act, heads converged as the men leaned forward to learn the secrets of the death—and life—of their colleague and friend. Their investigation received assistance from the subject himself. A meticulous journal-keeper, Holyoke had described symptoms that had been troubling him during the previous three years. These included the sensation that water was moving back and forth in his skull. “[I] perceived an odd and unusual sensation in my head when I suddenly changed my posture…as if a moderately ponderous fluid fluctuated over the surface of the brain....” And indeed, the autopsy revealed that serous fluid had accumulated beneath the dura, the thick parchment-like membrane that separates the brain from the skull, a condition that likely explained the sloshing sensation. Holyoke had also written of an abdominal pain that spiked after he ate. The physicians probing the final aspects of their former colleague found an explanation for this symptom, too—a large, most likely malignant, “schirrous” ulcer that girdled his stomach, dividing it into two regions by a contraction so tight “as to hardly admit the passage of a finger.” Aside from these conditions, the assembly found Holyoke’s organs and “textures” to be in a surprisingly sound state more akin to those of a person five decades younger. But as to how this esteemed member of their community achieved his extraordinary longevity—and became the first Harvard man to pass the century mark—the autopsy gave little insight. A Cabinet of Cure Born in Marblehead, Massachusetts, in August 1728, “Neddie,” as Holyoke was known to family and peers, was seven years old when his family moved to Cambridge so his father could serve as president of Harvard College. At age 14, Holyoke entered Harvard. After graduating in 1746 and spending a year as a teacher, he moved to Ipswich, Massachusetts, where he began the study of medicine as an apprentice to Thomas Berry, a well-respected local physician. Two years later, Holyoke relocated to Salem to set up his own practice. At first the decision seemed unwise: Holyoke had difficulty building a patient base and so, for several years, seriously considered abandoning the town and his practice. But a fear of distressing his father—and perhaps an early showing of the patience and perseverance that would come to characterize his approach to work—held him to the place and his practice. In the decades to come, his steadfastness would be amply appreciated. During his 80 years in Salem, Holyoke became a mainstay of the community, respected as much for his avocations as for his profession. His colleagues, for example, in their posthumous memoir—and autopsy report—of the man, described the town’s indignation at the pilfering of a thermometer that had long been suspended from the doorpost outside Holyoke’s home. The instrument was one Holyoke had regularly consulted as part of his long-term observation of weather conditions. The theft was “viewed as a sort of sacrilege, and it was generally agreed that it could not have been the deed of a Salem thief, for it was thought there could be none in town so base, as to not respect the property of the Salem patriarch.” Holyoke was recognized throughout town, having ministered to the residents of nearly every Salem home. In his early years, his visits were on horseback. This mode of travel, however, did not work out well for Holyoke; he could not keep his steed from slipping its bridle. So from age 20, the physician made his way on foot, an effort that, by his own calculations, totaled nearly 150,000 miles. This man who, when seen on his way to the celebration of his one-hundredth birthday, pleased passersby with “ his elastic step and cheerful looks” and “his accustomed nosegay slipped through his button-hole,” was also the man who impressed young doctors with the elegant simplicity of his practice of medicine. One such protégé wrote in 1797 of a conversation in which Holyoke, while showing the young man his shop, said, “there seems to you to be a great variety of medicines here…but most of them are unimportant. There are four which are equal to all the rest, Mercury, Antimony, Bark [quinine], and Opium; of these there are many preparations, however. Of Antimony I think I have used thirty.” Although seen as a cautious practitioner, Holyoke stayed current with new modes of practice and read the latest medical literature; he was a long-term subscriber o many of the important journals published in England and on the Continent. He was one of the earliest physicians to experiment with the use of digitalis and other medicines, and colleagues acknowledged that there were “several medicines which owe their introduction into use entirely to him, and may in fact be said to have originated with him, as he was the first to settle their best mode of preparation and administration.” A Full Man Holyoke exhibited a zest for learning and life that seemed unquenchable, even in the face of personal tragedy: He lost his first wife and child in childbirth, and eight of the dozen children born to his second wife died in their first few years of life. In the memoir penned by his colleagues, Holyoke was described as someone who exemplified what Sir Francis Bacon had styled a “full” man, capable of speaking and writing Latin and French and “well versed in astronomy, and in the several branches of natural philosophy and theology, and the belle lettres.” They wrote of how he admired the aurora borealis, compiled daily weather readings, and recorded his astronomical observations. And although they noted that he failed in his effort to correlate the prevalence of certain diseases with weather and seasonal changes, they were clearly impressed with his habit of chronicling his daily activities and observations. Notable among his recordkeeping efforts was his work during a smallpox epidemic that threatened Salem in 1777. An advocate of vaccination—Holyoke was himself inoculated for smallpox in 1764—he was asked to head a smallpox hospital just outside of town. Here he and his staff undertook the not-always-safe method of inoculating healthy individuals using extracts from the pox lesions of recovering victims. Of the six hundred people they vaccinated, only two died. Ten years later, Holyoke confronted a different epidemic, this time of measles. During the several days of that event, Holyoke performed yeoman’s service by daily making more than a hundred visits to patients throughout town. Even during quieter periods, Holyoke was an active practitioner, averaging eleven professional calls a day. During both calamity and calm, however, he always took time to note the details of his visits to patients. The merits of keeping complete records seemed obvious to Holyoke: “The observations of many, made at the same time, and in different parts of the country, and continued for a course of years, must...doubtless be the readiest and most effectual method of furnishing materials for a history of those diseases which are either epidemical or endemical in our country.” Following his own advice, Holyoke amassed 120 daybooks on his practice, each book filled with observations written in a fine hand. Although Holyoke’s dedication to and exploits as a physician and intellectual were lauded while he lived, time has suggested that his more profound and lasting legacy may be that of a mentor and a pioneer in medical education. Bag Men Until Harvard Medical School was established in 1782, the apprentice system was the only method of physician education in New England. Some wealthy individuals were able to travel to Europe for their formal education in the field, but most doctors were trained by apprenticing themselves to an established practitioner. It was, and still is, a privilege to learn from a master. Indeed, even well into the twentieth century, many surgeons spent time after their training working for highly experienced and respected surgeons. In the 1930s at Massachusetts General Hospital, surgical greats such as Richard Sweet ’26 and Leland McKittrick ’18 spent years as “assistants” to master surgeon Daniel Fiske Jones, Class of 1896, who had, in turn, spent years working under the famed surgeon Maurice Richardson, Class of 1877. As late as the 1970s, young doctors “carried the bag” for older, successful, and experienced practitioners. Holyoke mentored many aspiring physicians; between 1762 and 1817 he was preceptor to 35 medical men. Many of these men went on to establish outstanding professional records. James Jackson, a force behind the establishment of Massachusetts General Hospital, provides one such example. A physician acknowledged for his comprehensive grasp of the needs of medicine and medical education in the early nineteenth century, Jackson regarded Holyoke as a “glorious old master.” Another of the young men who learned from Holyoke became known for a range of accomplishments, including the instrumental role he played in the founding of Harvard Medical School. That young doctor was John Warren. In 1773, Warren moved to Salem to study with Holyoke and to open a practice. With time, he thought, he would be able to succeed Holyoke as the town’s leading physician. Things did not proceed as Warren had planned. A year had not passed before the young Warren was writing to his brother Joseph to complain that although he was busy and his practice was second only to Holyoke’s in volume, he was unable to earn much income. “The people here are accustomed to being dealt with so very easy by their physicians,” wrote Warren, “Dr. Holyoke having reduced fees to a very low rate and never troubled [his patients] for their accounts except when they troubled him for them.” But the onset of the American Revolution presented Warren with an opportunity. His extraordinary talents as a surgeon were recognized, and he soon was commanding hospitals for George Washington’s army—and creating a name for himself as a lecturer on anatomy. His skill and knowledge in this field ultimately led to Warren’s appointment as the School’s first professor of anatomy and surgery and to his appointment, with Jackson, as one of the first two staff physicians at Massachusetts General Hospital. Degrees of Separation The end of the American Revolution ushered in a vigorous time in this country, one that Holyoke participated in with verve, founding and often leading many of the new professional, cultural, and historical associations. It was during this admirable frenzy that Harvard Medical School was born. Its origin was the result of a number of influences, including intense lobbying by Holyoke and other members of the newly formed Massachusetts Medical Society.It is unclear why Holyoke, among the many fine men of the period, was chosen to be the recipient of the first medical degree to be issued by Harvard, although few would have denied he was a deserving candidate. As a physician, he embraced new principles and methods and put them into practice, as exemplified by his smallpox vaccination work. His skills as an observer had allowed him to connect the disappearance of the once-common “dry belly ach” complaint with the disuse of lead-containing pewter dishes. And, as a scientist, his experiments on ether and the role of evaporation in lowering temperature had not gone unnoticed. Another strong contender for the honor may have been undone by the political climate of the time. James Lloyd, perhaps Boston’s most prominent physician between 1765 and 1790, had spent time at Guy’s Hospital in London, where he had received training that surpassed that of almost all his contemporaries in the colonies. But Lloyd was also a moderate royalist. That politically unpopular position could have tipped the balance on this momentous decision; the degree, after all, would be conferred in 1783, just as the nation was breaking free of England. Although Holyoke was also well acquainted with the Tory crowd, in 1775 he had joined others in writing a public declaration disavowing any support of Royal Governor Thomas Hutchinson and declaring opposition to English rule. In addition to having the right political stance for the times, the role that Holyoke’s connections played in the decision to award him this degree cannot be minimized: He was, of course, the physician–son of a former president of Harvard. And, as the first president of the Massachusetts Medical Society, Holyoke worked with two of its other founding members, Warren and Aaron Dexter. These men, who represented two-thirds of the School’s first faculty, undoubtedly helped influence the decision. Climate Change The hundred years of Holyoke’s life coincided with a period of great change in the country’s history. The emphasis on religion in daily life shifted, and society became more secular and tolerant. The intellectual awakening of the period saw a flowering of literature and newspapers and the introduction and acceptance of modern scientific ideas, methods, and teachings. A strong democratic society emerged, one that clearly announced its rejection of the rigid class system of its former colonizer. Holyoke was a product of this intellectual and scientific ferment. His generosity in sharing his good fortune and talents with his students helped establish many of this country’s fine medical lineages and led to the formation of some of the more important medical and intellectual institutions, many of which stand tall even today. Anthony S. Patton ’58 is a retired thoracic and vascular surgeon whose career was centered at Salem Hospital in Massachusetts. Photo: The Boston medical library in the francis a. countway |
many to carry the message. Days later, the Salem Gazette would tell its readers that on the last day of March in 1829 their town had lost “the skilful Physician, the learned Philosopher, the active Philanthropist, and the Good Man” who had lived in their community for 80 of his 100 years. Two weeks earlier the Gazette had posted a short item warning readers that the “venerable” man was sick and his recovery doubtful. Now it was time for the community to pay its respects to Holyoke: a son of Edward Holyoke, a clergyman who had served as Harvard’s president in the late 1730s; a founder and the first president of the Massachusetts Medical Society; a charter member of the American Academy of Arts and Sciences; and the first person to receive a medical degree—albeit an honorary one—from Harvard. 
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