Tracking the first reported sickle cell anemia patient, November 16, 1989

Moderator: University of Iowa History of Medicine Society. November 16, 1989. This evening's speaker will be Todd L. Savitt, PhD, Professor Department of Medical Humanities, East Carolina University School of Medicine, Greenville, North Carolina. Dr. Savitt's topic this evening is tracking the first reported sickle cell anemia patient. Dr. Todd Savitt: Coming out and I hope I can entertain you and inform you tonight. I'll be talking from slides and I hope everyone will be able to see them okay. The lights will be dim, so I have a double duty. I have to keep you awake also. I hope that won't be a problem. I just finished eating but we walked over from the other side of the river so I'm wide awake. In a couple of minutes I'll ... Well maybe I should do it now. Let me give out, I've got about 15 copies of the original paper, the first article on sickle cell anemia. The first article that described it. I obviously don't have enough. If I could just pass these around, if you can share some. Audience Member: I've got [inaudible 00:01:43] at a friend's house. [inaudible 00:01:46] and I'll copy it again. Dr. Todd Savitt: If we can dim the lights and turn on the machine, we'll be ready to go. Now, you may or may not appreciate this title, The Discovery of Sickle Cell Anemia 1910. I change the title from time to time, but this was my original idea. I was hoping that Paul Harvey would pick this up. You know his little series that he does on the radio called The Rest of The Story. I went so far as to send him a copy of this. But as far as I know, he hasn't picked it up. I assume he would have written back and informed me that he used it. I guess the rest of the story has not been told on radio. When the ship called the SS Cearense, that's C-E-A-R-E-N-S-E. If anybody knows what that means, I would love to know. The SS Cearense, maybe it's somebody's name? Docked in New York City on the 15th of September in 1904, after an eight day voyage from Barbados in the West Indies. One of its passengers had a medical problem. This person was a black male, 20 year old, from Grenada in the West Indies named Walter Clement Noel, N-O-E-L. He had a sore on one ankle. A very painful one. This is not the actual picture, this is one that I would assume resembles the one that Noel had. When he arrived in New York, he found a physician after clearing customs. Within a week he was better. The scar that it left looked like others on his legs. He continued his journey, presumably by train, to Chicago and went about his business there. Towards the end of November, right around Thanksgiving time, Noel, who was now a first year dental student at the Chicago College of Dental Surgery, developed severe respiratory problems. He coped with those problems, at least according to the case history, he coped with those problems until the day after Christmas. And then, feeling weak and dizzy, he, with two friends, at least according to the hospital record, with two people who were also students at the Chicago College of Dental Surgery, arrived at Presbyterian Hospital, which turns out to be right across the street from where he was living. Let me point out a couple of things on this map of the Chicago medical district, the near west side of Chicago. The Chicago College of Dental Surgery is here, number one. He lived at number seven. He had a short way to go to school. The hospital, Presbyterian Hospital was diagonally across the street. This was the hospital that he went to. One of the friends, one of the people whose name appeared in the registry, the hospital registry, lived just up the block, and he was registered as a dental student. I'm assuming that he accompanied him to the hospital. When they got to the hospital, this is what it looked like. Is it dark enough in here for you all to see? No problem? Okay. When he arrived at the hospital, here you see it. This is from an annual report of the Presbyterian Hospital from that period. This is an accurate picture of what it looked like. He met this man, Ernest E. Irons, who I'll say more about in a little bit. You know him? Audience Member: Yes, he was a [inaudible 00:06:15] member- Dr. Todd Savitt: That's right. Okay, well we'll have some more to talk about then, good. He's also an Iowan. We'll come back to that. Okay, He was at this time, in 1904, December of 1904, a 27 year old intern. He did an admission physical and all the other things that one does to a new patient. Here's a picture of an examining room from the annual report of the hospital. This is approximately what the room looked like that he was originally treated in, or at least seen in. Here's a picture of a laboratory also at that hospital at that time. Irons described in a blood smear that he took, shortly after Noel's arrival. He saw what he called, "Many pear shaped and elongated forms, some small". In his next report, which was December 31st of 1904, the last day of December ... I'm sorry, here's a picture of the actual admission record at Presbyterian Hospital, Dr. Irons, you see his name and Walter Clement Noel. He was a dental student, it just said "Dental school Chicago", 20 year old black male from Grenada, West Indies. This shows that he was discharged. I'll say more about that in a little bit. Admitted on the 26th, the day after Christmas. Here you see, the first picture of these funny looking cells, drawn by Irons on his ... This is a blood report from December 31st. Irons, being the good intern that he was, reported the information to his attending physician. That person ... oops. Here's a photomicrograph, that's the photomicrograph that you will see in the first report, the first reported case, the article that I handed out just now. His attending was this man, James B. Herrick. I'll say more about him in a few minutes. For the next two and a half years, just beginning in, let's say the first of January 1905 through the middle of 1907, these two physicians followed Walter Clement Noel, at least his medical problems. They tried to figure out his problem, and they couldn't. They never really did decide exactly what was wrong with him. Between 1907 and 1910, they lost track of Noel. They had no idea what happened to him, although they continued to puzzle over his case. Finally, in May of 1910, Herrick presented a case report to the Association of American Physicians in Washington D.C. at the annual meeting. That report then got published in the transactions of the Association of American Physicians, and in the Archives of Internal Medicine that November, just a few months later. What you have in front of you, the article that I handed out to you is this same thing. You can see the title, Peculiar Elongated and Sickle Shaped Red Blood Corpuscles in a Case of Severe Anemia. Only Herrick's name appears on the article. This was the first recorded documented case of Sickle Cell Anemia in western medicine. I remember reading that first article when I was a medical student. During my first year we were assigned preceptors, and I was assigned a microbiologist who happened to have a burning interest in sickle cell anemia. I don't know why. That was the only thing that I think he had a burning interest in. He was a very dull guy. We never did anything. He was not an advisor. We just started a lot of sickle cell anemia. So, I read that first article then and I read it again a few years later. I can remember wondering, who was the patient? Because you will see it under history, it says, "The patient was an intelligent negro of 20 who had been in the United States three months," and it goes on. It doesn't tell, it gives you some background about the guy, but enough to tantalize you and not enough to really know who it was, which is the way articles, medical articles, you are supposed to maintain the anonymity of the patient, protect the confidentiality of the patient. But, I was puzzled by the whole thing and I wondered what the origins were. All student learn about sickle cell anemia, all medical students do, because it's a unique disease in several ways molecular-biologically. It's genetics. It's just a disease that seems to be one that every medical student learns something about. I wanted to know more than what I had learned. The story is important, not only because it's a disease that we know something about and it has some medical interest, but because it illustrates a transition period in American medicine. It's a period when medicine becomes more scientific. It's also a period when medicine becomes racially integrated. It's a transition period in medicine for both social reasons, you might say, and medical reasons. As a historian now, as a professional historian, rather than as a medical student, I'm fascinated again and wondered what this story was all about. Other cases of sickle cell anemia were reported shortly after this one. Between 1911 and 1922, four more reports were published. This one, this is written by R.E. Washburn at University of Virginia. I was a graduate student. I got my PhD at University of Virginia. I earned some of my money by being the curator of the medical history collection there. I came across these old record books, the first record books of UVA Hospital. In going through them, I actually worked through them and did a little article about them, I came across, without realizing it at the time, the second sickle cell patient. I actually noted this case. I know what the ladies name was and stuff about her. I had never expected to ever use that information. When I started doing the research for this paper, I realized that I'd seen information on the original case records of both the first and second sickle cell anemia patient reported. Anyway, Washburn published a photomicrograph ... excuse me. As did everybody else, every time there was a reported case. You'll see here's the third case, St. Louis, and a photomicrograph to go with that. Then 1922, the fourth case of V.R. Mason with photomicrographs, and they all looked alike. They all referred back to that first article that Herrick had written saying, "We've come across a case just like this." Herrick's article attracted attention. It did just what it was supposed to do. Herrick said, "I can't figure out what's going on here. Maybe you can help," that is the big medical world out there. In fact, that's what happened. Others can up with similar findings. By the mid 1920's, and I'm not going to go any further than this in the history of the understanding of sickle cell anemia, but by the mid 1920's, the genetic nature of sickle cell, the familial nature of it was known. It was recognized as a disease primarily of blacks et cetera. There have been articles written on the history of sickle cell anemia, so I'm not going to go into that, but I'll be glad to give you citations later on. So, there were all these cases. I was not the only person who was puzzled by this first case. Where did it come from and what happened? About two years ago, I got a phone call from this man, Morton Goldberg, who was then the chair of the department of ophthalmology at University of Illinois, Chicago. He's now just moved to Johns Hopkins. He called me and said, "I run the world's only sickle cell eye clinic, and I'm very interested in trying to find out the origins of sickle cell. That is who was the first patient, where did that person come from, why was it discovered in Chicago?" Some of the same questions I had been in the back of my mind thinking about for a while. He said, "Look, I'll make you an offer." Someone had suggested that he call me to do this work. He said, "I'll pay all your research expenses if you will write an article, do the research, and write an article on this topic. It has to be a publishable article, one that would be acceptable to either a medical or history journal." "You can be the senior author," he said. That almost got us in trouble when we tried to publish this. I said, "Sure." It was a circumscribed amount of time. I was complaining to a couple of people before about how I have these great projects in mind, and then I find myself getting way late into these other side projects, and this was one of them. Circumscribed amount of time. It had to be done by the end of the next summer. I knew just what I had to do. I said, "I'll do it." I wound up digging around. We have an Irons in Greenville, a Dr. Irons in Greenville. I started with him, and said, "Look, this name Irons is in this original article. Can you give me any information?" He couldn't. Wound up, I had to go to Chicago. Spent a fair amount of time in Chicago tracking down information, which I was amazed at what I could find. The first thing I did was to find the original hospital record. I didn't even know which hospital it was. If you read the original article, it doesn't say the hospital. I assumed it was Cook County Hospital. Turned out to be a private hospital, Presbyterian, because both Herrick and Irons taught at Rush Medical School, which was affiliated with Presbyterian Hospital. Found the original hospital record, found out the name of the medical school he went to, found the catalogs of that medical school with his name in it. Went to the medical school, found a couple of ... The dental school that he attended, it was Loyola Dental School, which also has a medical school. Found his records, at least some of them. Looked for his picture, and unfortunately every class picture but the class that he was in is hanging on the wall at Loyola Dental School. Found out a lot of information about him, even to the point of finding the actual hospital ... the whole case file, which was not in Rush, in Presbyterian Hospital, but in the private papers of Dr. Herrick. How he got the original records out of the hospital and kept them in his own personal papers, I have no idea, but that's where the originals are, over at the University of Chicago archives. After doing as much as I could in Chicago, I went down to Washington and went to the national archives and to the Library of Congress and found some other materials there. And then, realized that I still didn't have enough information. I knew that the first patient was from Grenada, and deep down I was hoping I'd have to go back to my benefactor and asked him if it would be possible for me to go to Grenada. I wound up having to do that because the thorough historian that I am, I needed to get those last details. Actually, it was a wonderful experience. I did go to Grenada. He did get permission for me to go. He had to get special permission to do international travel from some of the grants that he was working off of. I wound up spending eight wonderful days in Grenada. It was so different because rather than being a vacation or on a tropical island, I was actually doing research and meeting people who live there, and digging into the culture of the country. It was a fascinating experience. You'll hear a little bit about that in a minute. From this phone call from Dr. Morton Goldberg came this wonderful story that I'm going to tell you now of the discovery of sickle cell anemia. Now it can be told. Chicago in 1904 ... I just want to give you a little bit of background about the people and the city. Okay. Chicago in 1904. Chicago in 1904 was an important place medically speaking. Some of the more important figures in medicine, American medicine lived there at the time and practiced there. Frank Billings, Nicholas [Sin 00:19:54]. The pathologist, Ludvig Hektoen. John Murphy, the surgeon. Daniel Hale Williams, black surgeon. Christian [Finger 00:20:02], and Arthur Dean Bevan, who was very involved with the A.M.A. In fact, the headquarters of the A.M.A was there as it still is. The Medical District, got color slides as well as black and white slides of the Medical District. The Medical District was an important place with lots of medical institutions. Hospitals, dental schools, nursing schools. Just a wide variety of medical institutions just outside the downtown area of Chicago. It was here that sickle cell was discovered. The two physicians in 1904, James B. Herrick, born in 1861, died in 1954. He was a very old man when he died. He never said a word about sickle cell anemia in anything he ever wrote. I'll say more about that. He had, by 1904, gained some measure of recognition for his teaching, his publications, and his medical skills. He was an attending physician at Cook County Hospital and at Presbyterian Hospital, and was a professor of medicine at Rush Medical School. He was born in Oak Park, just right outside Chicago. He had lived in Chicago almost, or for all of his life really. Lived and worked there. He received his MD degree from Rush Medical College in 1888, and became house surgeon at Cook County Hospital in 1889, and ran clinics at both Rush and at ... or should I say Presbyterian and at Cook County Hospital. That's he over here doing some surgery. Here he is again leading a clinic at Cook County Hospital. This is what Rush Medical College looked like at the time. Herrick published lots of case reports. He didn't publish many analytical articles. He published a lot of interesting cases, cases that I've come across, is what you might call them. This sickle cell article is one in a series then. He was very much a student himself, and in fact, in 1904, during that winter of 1904, 1905, he was studying chemistry every morning at the University of Chicago. Herrick later earned national attention and also won many awards for his descriptions and research into angina pectoris and coronary occlusion. That's more what he's known for than for sickle cell, although both were important. Ernest Irons. Born in 1877, so he's just 16 years younger than his mentor, Herrick. Died in 1959, five years after Herrick. Also lived to be a very old man. And again, wrote nothing about this discovery of sickle cell. It's fascinating to me that neither of them wrote much about it, nor among the people who ever worked under them apparently did he say much, either of them say much about their discovery. Irons was born in Council Bluffs, Iowa. Where is that? Is that near here? Audience Member: [inaudible 00:23:48]. Dr. Todd Savitt: The other end of the state? Okay. Pardon my ignorance. It never meant much to being told. Today, when I was going over my notes and I said, "My gosh, he's from Iowa." He graduated from Rush in 1903, so he was again, about 15 years. Herrick graduated in '88. Was completing his internship at Presbyterian Hospital under Herrick in December of 1904. His primary interests were in bacteriology and infectious diseases. In fact, in 1912, he earned a PhD in bacteriology from the University of Chicago. His interest in bacteriology was in focal infections, something that was very important at that time, and I'm not sure is very important nowadays. He became, as you said, dean of Rush Medical School in 1923 and remained dean until 1936, and served as president of the A.M.A from 1949 to 1950, a regular one year term. He was very important in the local and national medical world. Herrick and Irons were close. According the city directories, they lived in the same house. Herrick was married, Irons was not. I assume that Irons rented a room from Herrick. The city directories also indicate that the two of them shared a medical office for private practice between 1904 and 1909. They worked together and from what I have heard, Irons was always very ... always looked up to Herrick as his teacher all the way through both of their lives. Neither of them had any particularly great interest in hematology. Herrick had been thinking about hematology that fall, because he gave a lecture to the west side branch of the Chicago Medical Society called The Practical Value of Blood Examinations and in it, he describes a lot of the examinations that he probably did on Noel. Then I assume he kicked off a lecture series on hematology, so I'm assuming that he then went to the other lectures in the series at this west side medical branch, or Medical Society branch. Then he probably passed on the information to his junior protégé, Irons. Both could prepare blood examinations from microscopic study. When Noel, the sickle cell anemia patient entered their lives, it was at a good time. It was just at the time when they were thinking about hematology. 50 years earlier, they probably could not ... we know they could not have done what they did. Hematology was not a specialty in 1904, but knowledge of the normal appearance of blood and the normal composition of blood was known. Textbooks and articles discussed this information, and I looked at textbooks from that contemporary period. It's real nice to have libraries see old books, textbooks, even though they don't seem very important at the time. When you look back 50 years and say, "What were they teaching at the time? What did they know at the time?" Textbooks are wonderful for that. The library saved me here. Just to give you some idea. Okay, Rudolf Virchow had done his work in the mid 19th century on blood cells and defining the wide variety of white blood cells that existed. Robert Koch, Paul Ehrlich developed staining techniques. They were just a couple of the people who developed staining techniques. There were of course others, but for doing staining blood cells. Differential white blood cell counts were now available in the early 20th century, late 19th, early 20th century using a pipette like this, taking blood from someone's ear in this case. Putting it on a slide that has a, you can see here, the way there's a depression in the slide so you can just drop the blood into it, and then do some counting. I think that still hand counting is still done to a certain extent today if I'm not mistaken. These are from a textbook of medicine in the early 20th century. Different types of anemias and leukemias had been identified, not sickle cell of course. But hematology itself was not an integral part of medicine in December of 1904. It was around, but not the only thing ... not well integrated. Integration. Integration on another front was occurring in 1904. Hematology was slowly being integrated into medicine and blacks were slowly being integrated into the medical profession. Walter Clement Noel couldn't have come to the United States in 1904 without a certain change in race relations that had begun to occur in the late 19th and early 20th centuries. Specifically, black medical schools and dental schools opened up after the Civil War. A few white medical schools took black students, but also black medical schools opened. What I have up here is a map with just pinpointing the places, all of them in the south except for one in southern Pennsylvania, where black medical schools existed. Meharry and Howard had dental schools as well. Chicago became a black medical center at the turn of the 20th century. Daniel Hale Williams, a famous black surgeon, lived in Chicago, practiced in Chicago, and ran this hospital, Provident Hospital, which also had a nurse training school attached to it. A number of black medical students were studying at white medical schools in Chicago. If you look at the directories, the A.M.A directories of the time period, you can see that. There were a number of white dental schools that took black students. Chicago was a kind of magnet for black students, black professional students. It is that that brought Noel to study in Chicago. 2,500 miles from Chicago and 100 miles from Venezuela was Grenada. Right here. Here's Venezuela and of course Chicago. I stole this picture from the British West Indian Airlines book that they had. That's why the air routes are on there. I probably ought to get a better picture. What the heck. Grenada. Infamous now because of other things, but a wonderful island. Undeveloped. A wonderful place for a vacation because it's not a tourist trap at all. My wife went with me. I paid for her. I'd come back every day with reports. She would spend her time at the beach and I would be off doing my research, and I'd come back at the end of each day and give her reports of what I had found. It was great fun to be able unload everything that had happened, both the ups and the downs. Grenada is an island around 20 miles long by 12 miles wide, so it's quite small. It was a British colony at the time that Noel shipped off to Chicago. It had traded hands between the British and the French a number of times over the centuries. It was first settled by whites in 1650. It had previously been settled by Native Americans whom the whites took care of unfortunately. There's very little Indian presence at all in Grenada, as is true in many of the West Indian islands. But over the centuries, there were lots of mixing of French blood, British blood, and African blood former slaves in Grenada. The 1901 census showed that there were about 64,000 people living on the island. Most of them were of mixed blood ... No, I'm sorry. Most of them were of pretty much purely African blood. The economically well off people were lighter skinned. There were very few pure whites from what I have gathered living in Grenada. It was mostly a mixed group, but lighter skinned. Those were the people with the money. It was mostly rural, and here's a picture of Grenada in 1987. Still very rural. The roads are awful. There's only one road that goes all the way around the island and it's in bad shape itself. Agriculture was and is the main stay, although tourism is beginning to increase. But cocoa, coffee, sugarcane, nutmeg, cinnamon, mace, spices, bananas, plantains, tropical fruits like mangoes and papayas and coconut, all the things you think of when you think of a tropical island are grown in Grenada. Nutmeg is the big industry, the big agricultural industry. The capital city is St. George's down on the southern end of the island, southwestern end of the island, and is in a population of about ... 5,200, I'm sorry, in 1900, 1904. It's a beautiful town with a very protected harbor, a protected lagoon. Here's a picture of that protected lagoon, a drawing of it. It's quite nice. The place where Noel grew up was not on St. George's, although he did go to St. George's later in his life. Here's St. Georges on the southwest side of the island. If you're interested, the infamous airport, the airport that was no longer in existence and was being replaced was over here. The one that was being built was just south here, where the medical school where the students were saved by the Americans is right down here. I was jogging. I'm a jogger. One day I went out jogging, and wound up all of a sudden at the airport and at the end of the runway. It's all fenced in all the way around. We had landed there, but I guess I hadn't thought much about it. Oh I know, I wanted to see the medical school. I went jogging to the medical school and all of a sudden, bumped into the airport not realizing how close they were. But right at the end of the runway is the medical school. The airport is what the Cubans were building for the Grenadians, and that was one of the big issues is what was going on in Grenada? Anyway, Duquesne state where Noel grew up is way up there on north end of the island. The foundations of it are still standing, and I'll show you a picture of that in a minute. It's high up overlooking the land of the plantation and it's quite nice. Here's the area around Duquesne. It's very mountainous. They call it the bush country. It's very lush, very wet. Here is the foundation. That's all that's left of the home in which Noel grew up. I rented a car one day from St. Georges and drove around to the Duquesne. I was looking for Duquesne, and found ... One of the landmarks was a church that Noel's mother had built. I kept looking for the church, I kept getting lost, and finally found it. On the way to the church, the last little leg of it, I passed an older gentleman walking with a donkey and a little boy, about five or six years old. When I got to the church, I was wrapped up in thinking I finally made it. All of a sudden, I turned around, and there was this man, and a donkey, and the boy. I started talking to them and told them what I was doing. He was real friendly, wanted to know if he could help. Every time I'd mention something, he'd be able to answer the question. Finally I said, "Who are you?" Well, his name is Philip Alexis. This is he right here. He is the great grandnephew of Walter Clement Noel, so I had by accident stumbled on the very man who could tell me as much as I needed about Noel. He was as excited as I was, and he took me back to the estate. As you can see, the building no longer stands. This is where the kitchen was, by the way. That's the only other part of it that was in a separate building. We got to talking. I met his wife, and we talked a lot. It turns out the only picture that was available was of Noel's mother, Mary Justina Noel. Here she is here. The picture doesn't do justice to her, she's a beautiful woman. Just a beautiful person and very striking. The picture is, it hangs just as you enter this house that they live in, that Philip Alexis and his wife live in. We don't know Mary Justina Noel's original, that is maiden name. I was not able to find it when I was there. If I ever get back, I'm determined that I will. It was she who owned Duquesne state, not the husband. The husband came from a wealthy family over in Grenville, a different part of the island. But Mary Justina Noel's father came from Dominica, another island in the West Indies to Grenada and through agricultural trades. He was a businessman, was able to acquire a lot of land, and that's what became the estate here. That's how Mary Justina Noel got to own the estate, she inherited it. Noel's father was named John Cornelius Noel. He died at about the age of 35 of supposedly kidney problems. Whether he had sickle cell or not is not clear, although it's possible if that was what he died of. The article says that Noel was a healthy child. This is the article that you've got that I handed out, except that he had yaws with leg ulcers. Maybe it was sickle cell anemia, I don't know. He went to grammar school on the north end of the island and went to college at Harrison College in Barbados from 1901 to 1903. That's among the records that I got when I was at the dental school, the ones I dug out at the dental school. He was a smoker. Smoked quite a bit according to the article that you have there. He didn't do much exercise. Shortly before he left to go to the United States, he had palpitations and shortness of breath. It's all in the record there. I won't go through all of it. But at any rate, he had some health problems. What influenced him to become a dentist from all I can gather was the presence on the island of a Grenadian who went to Howard Dental School and returned to the island in 1901. Oliver Charles Arthur was his name. Arthur opened a practice, a black man, opened his practice 1901 or 1902 and helped Noel write letters and get into the dental schools, because I have those, that was also part of the record at Loyola. It was he who wrote the letters making all the final arrangements for Noel to go to dental school in Chicago. Truman Brophy was the dean of the dental school, the Chicago College of Dental Surgery. Here's a catalog of that school. Brophy was well known as a dental surgeon and had a great reputation, and developed a fine dental school by all accounts there in Chicago. Here's a picture of the building. It's no longer standing unfortunately. One of the treasures that I found in the record of Noel was this brief letter from his mother, from Noel's mother to Brophy saying, three weeks before Noel left for Chicago, "I will be very glad if you would take an interest in him, in my son, and see that he does his work especially as he is a stranger." A line only a mother could write to a dean of the dental school who's internationally known, but I thought it was wonderful. She was a tough lady. The stories I've heard about her and the will that she wrote, she knew what she was about. She got her stuff done. She knew what she was doing. On the seventh of September 1904, Noel left from Bridgetown, Barbados on the ship. I found that out the national archives because I found the record of the ship where seven U.S citizens, 19 non-U.S citizens. Noel had about $70 in his pocket, because that also had to been recorded. Okay. He enrolled at the dental school. He started getting sick around Thanksgiving. Here he is, by the way. You see Noel, British West Indies. This is the freshman class at the dental school, 1904, 1905. There's that hospital admission record, and I won't go through all the details again. What happened to him? There was no clear diagnosis during that first hospital stay, during those four weeks. They debated whether it was hookworm, yaws, syphilis, ground itch, malaria, intestinal parasites, the effect of a coal tar medicine preparation that they had given that they thought he might've taken. Whatever it was, it resolved itself within about four weeks and he was discharged well on January 22nd. See, it says result down at the bottom there, much improved. Audience Member: Year? Dr. Todd Savitt: Pardon? Audience Member: Year? Dr. Todd Savitt: 1905, about four weeks after he'd been admitted. He was admitted, say Christmas, December 25th, or December 26th '04, and then discharged about a month later. Over the next three or two and a half years, Herrick and Iron saw Noel four more times. Twice they saw him in hospitals. The hospital ... oops, okay. There's the hospital, I'm sorry. I forgot I had this slide up here. I've actually got a xerox, if anyone's interested, of the hospital record here. If anyone wants to go through it, I brought that so you can take a peek at it. That's one of the full microscopic examinations. Here's that picture again. This time, I had blown it up before. Twice he was seen at Frances Willard National Temperance Hospital, which was one of the four hospitals that the college, dental school had arrangements with to see medical students. They had to pay a dollar a year, and they got free medical care. This was one of the hospitals that he could be seen at, and he was seen there twice. Twice he was seen at home, and he had moved now- Audience Member: [inaudible 00:44:47]. Dr. Todd Savitt: ... That's right. Here's where Herrick and Irons lived. Here's where Noel had moved to. He had been living here, and he moved up to here. Again, he lived very close. Twice, he was seen at his home. Here, you'll notice at the top of the page it says, at the very corner, Dr. Ernest E. Irons, "All four visits to Noel were made by Irons," not by Herrick. It's really interesting of the dynamics of this relationship here. I haven't quite figured it all out. This is one of the scraps of paper with Irons, visit from his ... information from his visit to Noel. Always had anemia, always had these funny shaped red blood cells. April 1907, Noel disappeared and they had no idea where he had gone. He just disappeared from view and they never saw him again. Now, couple of questions and couple of observations. I'll put up this picture of Herrick. By the way, every time Noel recovered from whatever he was suffering from. Pneumonia, he had severe pneumonia one time, and other problems, but he always recovered. The two physicians made a special effort to keep up with this guy for two and a half years. Something kept them interested in him. Even after he left, they didn't publish the article until 1910, three years later. They were still trying to figure out what had happened, what the problem was. Something about this case captured them, even though it wasn't their primary interest. They were not hematologists. As I mentioned, they both went off in their own directions, some conjectures. Noel was, as the article that you have there, says an intelligent one time, and bright another time, negro. Noel was different from most blacks that they had encountered in the United States. He was educated, he was moneyed. His family was not a poor family. That was very different from the blacks who lived in Chicago at the time. Remember, this is the period of the beginning of the migration of large numbers of blacks from deep south to the big city of Chicago. Many of those people did not have much education and much money. Noel spoke with a West Indian accent, and I'd sit and listen to a West Indian accent all day if I could. If he spoke the way the rest of his family that I met did, then he was a charmer just by the way he spoke. He probably was able to give a good clear history of his problems, and perhaps even helped them to think through the problem. He was a student, and they were used to dealing with students. He went to a private hospital, not to Cook County Hospital or some other crowded public facility, but to Presbyterian Hospital. After all, his blood was interesting. Oh, let me just show you a picture of Cook County Hospital at the time. You can imagine. It still looks that way. It's a huge place. You can get lost in there and many patients did. That's not where Noel went. By the way, I should point out, I used Noel's name with the permission of the family. I did get permission to use it. The blood was interesting, and Herrick did a bunch of research. In his personal papers are little scraps of paper like this, and one of them is this very piece of paper that has a reference to an article by [inaudible 00:48:28], a German. The article was actually written in German, although he's translated it here as, "Sickle shape forms in leukemic blood." It was abstracted, but it was originally published in German and I dug up the original German article just to make sure. But that's where the word sickle cell came from. I assume this is where he got the idea of calling the sickle cell. Oh, okay. Let me just leave that up for a second. We know from one connect that Herrick made that ... I mean, that Irons made that Herrick consulted with a number of other physicians before he presented the case unsolved in 1910. To my mind, Irons is the unsung hero of this story. It was he who recognized the uniqueness of the blood smear and altered Herrick about it. It was he, actually, who followed the patients course over the next two years. It was he who saw him at the home, at Noel's home and at the hospitals. It was he who gave Herrick the notes, which are all tucked away in the University of Chicago archives, that allowed Herrick to write the article. Irons name is mentioned in that paper that I gave out, but he's not given much credit. Herrick did do a lot of the work of digging up the references, and it was he who got the credit for discovering sickle cell anemia. It's interesting to me that that's the way it worked. The paper was just a case study. By 1910, other things were more important to both of them. Don't forget, Irons was pursuing a PhD in bacteriology, and Herrick, in 1910, wrote his first article also on a coronary occlusion. So, they were doing other things. Noel just happened to come at an opportune time. The two physicians were thinking about hematology. Now, the epilogue to this thing is what happened to the patient? How come he got lost in 1907? It's a simple answer. He graduated and went back to Grenada. It wouldn't have taken very much for them to have figured that out. They had been following him for all these years. Why didn't they just walk across the street? Remember the Rush Medical School, and the Chicago College of Dental Surgery were directly across the street from each other. All they had to do if they were that curious, and see, that's another consistency, all they had to do was go across the street and say to Truman Brophy, "Hey, where'd this guy go?" They would've found out that he was down in Grenada. I was able to dig up these things called The Grenada Handbook, Directory and Almanac. There was one published for every year up through the 1920's. I was able to track him down. It turns out that there's a list of professionals in there including a list of registered dentists. Not for 1900, but for 1908. Arthur Oliver ... whoops. Is that his name? Arthur? That's not his name. They've got it wrong there. His last name was Arthur. At any rate, he was in it and [inaudible 00:51:37] helped him. Charles ... Audience Member: [inaudible 00:51:40]. Dr. Todd Savitt: ... Oliver Charles Arthur. They've got it ... okay. They just didn't put a comma in there. Oliver Charles Arthur is there. The third one down, Walter Clement Noel. Doctor of Dental Surgery of the Chicago College, whatever that is. Chicago, USA. But at any rate, he's in there. Noel went back to St. George's or went to St. George's. It turns out that his mother owned a building, and here it is at the corner of Young and Church Streets. It's now called The People's Pharmacy. He lived upstairs and practiced downstairs. I went in there and talked to the wife of the owner, who's a physician. The owner of the building was officially the physician. I told her a little bit about what I was doing, and she was fascinated, but there was nothing left. The building was completely renovated, so we really couldn't tell much except that there are two floors to it. Here's a closeup of the actual building. I tried to get it when there were no people around. You can see The People's Pharmacy on a sign there. The man in this picture is named St. Bernard is his last name. Cosmo St Bernard. He's a lawyer. The second day I was there, I'd gone to the birth and death records office, and then went to look at wills. While I was there, I had one of the people there looking through the wills with me and we found Mary Justina Noel's will. In it, she mentions giving something to Cosmo St Bernard. The lady who was helping me said, "He's still around. He's right down the street here." She called him. People were so helpful there. She called him and told a little bit about what I was doing, and he said, "Send him over." So, I went over. I met my wife for lunch, told her what I was about to do, and then went over all excited. He became my buddy for the rest of my visit there. He knows everybody on the island. He knows them and their phone numbers. He didn't even have to look them up. It was wonderful. Every day I'd sit in his office for a little while and ask him, we'd kind of exchange. I'd tell him what I'd found in the day before and he'd say, "Well, have you tried this, and this, and this?" One of the times, in fact very early on, he said, "Have you tried ..." I can't remember their names, but they lived right across the way. In fact, he dialed the number and I could hear the telephone ringing across the street. These two elderly ladies, her and her, were there, and they invited me to come up the next morning and talk because they were both a bit older than Cosmo St Bernard, but he knew them from his childhood. We talked, and they said, "Well ..." They didn't have any information, "But Aunt Edith might know something." Who's Aunt Edith? Well, it's one of their aunts. This is Aunt Edith in her 90's. I didn't even know she existed. They called Aunt Edith and she kind of trudged out and we talked. Turns out that when she was 16 years old and attending the Anglican School in St. George's, she got a toothache. You weren't allowed to go out as a young lady. You couldn't go out unescorted. She went out with an escort about three doors down from the Anglican School to the corner of Young and Church Streets and had a tooth pulled by Walter Clement Noel. She remembered that. I couldn't believe it. She remembered what he looked like. Just let me read you ... just brief. She described him as, "Smartly dressed with dark coffee colored skin, healthy looking, plump, with a round, fat face and a good body." That was her description of Walter Clement Noel. Noel never married. He died on the 2nd of May 1916. About nine years after returning to Grenada. He died of pneumonia, which is a familiar story for people who have sickle cell anemia. Intercurrent infection is one of the reasons that people with sickle cell died, their defenses were low. The family story is that he went to a race meeting, which means a horse race on the other end of the island. On his way, it was all by horseback I think, and on the way back he ... Oh, horse and buggy. On the way back, he caught a chill after taking a bath and developed pneumonia and died. Noel was not a healthy man, and he wrote a will about a year before he died. He knew somehow. I mean, you don't write a will as a young man. Generally, you wouldn't write a will as a young person and he did. Here's a typescript of it and he gave most of his possessions to his boy, who turned out to be his assistant. This was not his son, but an assistant who took those dental instruments and went to Howard Dental School, didn't like dental school, sold the instruments apparently, and went to medical school there and practiced in Princess Anne County, Maryland until just a few years before I went down to Grenada. I missed him by a couple of years. He died just shortly before I started this investigation. At any rate, he left a will, and I assume it was because he knew that he was not healthy and might not survive. His body was taken to the small town on the north end of the island called Sauteurs right near where he had gone to church every week in a Catholic church near Duquesne state. He's buried with his father, and there's his father's grave, John Clement Noel. Died in his 30's. His sister is a joint grave. You can't read it and unfortunately it's just because the tombstone is so worn, but the two of them are buried next to each other. Whether his sister also had sickle cell anemia, she died quite young, is not known. He never knew he had sickle cell anemia. He never knew he was the first patient to be described. He never knew that he was ever written up. The physicians never knew what happened to him. I feel sort of funny. I completed the circle by telling the family that he was an important person in the history of medicine. But at the same time, it's sad that Noel died not realizing that he had been written up, and it could've been avoided. He could've been told what had happened, because Herrick and Irons only had to inquire a little bit and they would've found out where he was. It's a story about three interesting people, two on the forefront of medicine pushing forward with new knowledge, applying knowledge that was very current. And yet, not particularly interested in hematology, is the area I'm talking about. And about a third man, who was on the forefront of integration in medicine came to this country at the time that medicine was becoming integrated, went back to his home country, and practiced dentistry for a number of years, and had a disease that is a well-known and famous disease now. He started it all. They started it all. Let me quit here. I've talked, again, too long. I did that this afternoon too, but I get excited and I can't stop going. I'll be glad if you want to ask some questions if you're still willing to do that. I'll be glad to do that. Thank you very much. Audience Member: [inaudible 00:59:37]. Audience Member: When you mentioned the case record being in Herrick's papers, the old Presbyterian Hospital was torn down many years ago, and many years ...