My first contact with Dr. Jesse Myer [Jesse S. Myer, M.D.], was at the old medical school building at 18th and Locust Streets in the third year of my medical school career. The course called clinical chemistry and microscopy was then given by four physicians, young practicing internists: Drs. Albert [E.] Taussig, John [C.] Salter, Dr. [W. H.] Rush, who did not remain long in St. Louis, and Dr. Jesse Myer. The class of about 65 was divided into several sections: urinalysis, hematology, and gastroenterology, and met for two hours once a week. Jesse Myer was in charge of gastroenterology, the segment of internal medicine which had a special appeal for him. This was before the days of GI x-ray examinations and diagnosis depended upon history and physical examinations along with examination of the gastric contents and feces. As students, we were required to learn the technique of passing the then standard 13mm stomach tube, which had been designed by the German gastroenterologist, [Carl Anton] Ewald, who had also established the standard test meal breakfast of bread and water. We students took turns as patients and physician in passing the stomach tube, thereby obtaining knowledge of the sensation peculiar to each extremity of the tube in its passage through the esophagus.
We were taught the titration method of free and total acidity determination and the determination of lactic acid in the removed stomach contents, an important factor then, in establishing a diagnosis of gross gastric retention. Stool examination, besides the test for blood, was mainly in the realm of recognizing the microscopic appearance of common food residues and particularly the gross and microscopic appearance of intestinal parasites and ova. Parasitic infestation was an important section of medical practice in those days. Plumbing facilities were not as common in rural or even in urban regions as at present.
At the close of the school year, Dr. Myer asked me if I cared to spend part of the days of the coming vacation months in his office, an opportunity which I welcomed. During the busy fourth year of clinics I saw little of Dr. Myer. Then came a year of internship at the City Hospital in St. Louis. In those days there was no regular visiting staff at the hospital; the training was by the senior [students] and residents. Some of us would from time to time assemble a list of interesting clinical problems and invite our former teachers at the medical school to make rounds with us. Among the men helping us in this regard were Dr. [Robert] Luedeking, Dr. Washington Fischel, Jesse Myer and others. Toward the close of the intern year, Dr. Myer invited me to put up my shingle at his office and continued to help with his laboratory and clinical work. The former preceptor method of medical teaching had passed, but some of its advantages were still appreciated by the older practitioners and even by the young graduates. Many medical graduates sought associations of this sort as post-graduate training. This and European post-graduate courses were, aside from a few eastern clinics, the only source of post-graduate training available, particularly specialty training. Germany and Austria, however, were well-organized for such teaching and I betook myself in April of that year to Europe with introductions from Jesse Myer to some of the men with whom he had studied some years before. Among these was Dr. Herman Strauss, the originator of the electrically-lighted proctosigmoidoscope.
I spent the better part of the year in Berlin and on my return to the United States in 1908, set up an office of my own in the Lister Building, but most of my time I spent in the office of Dr. Myer in the Linmar Annex on Washington just east of Vandeventer. The building is still standing. There I served as an assistant in one or another phase of his practice, much of it in laboratory work and history taking, combined with a few hours here and there, a week of house call, and hospital calls. Those were horse and buggy days and hospital visits and house calls took up more time than they do at present. I helped in compiling literature reviews for Dr. Myer’s section in the Interstate Medical Journal, of which he was an associate editor of the section on internal medicine.
This journal was established and edited by Dr. Ball, who later established the journal known as Modern Hospital, which still exists. He called attention to the pioneer work of William Beaumont, some 75 years before, in the field of gastric physiology. Beaumont, in his later years of life, had been a resident of St. Louis. It came to the attention of Jesse Myer that Beaumont’s daughter, the elderly Mrs. Keim, resided here and was in possession of many of her father’s manuscripts. Dr. Myer approached her with the suggestion of writing a Beaumont biography, if the material was available to him. She showed him two old chests full of yellowing manuscript papers, books, letters and so forth. We were permitted to transport these, a market basketful at a time, to Dr. Myer’s office and then he started two years of feverish activity.
First, learning to decipher the difficult handwriting with its many corrections and underlinings, letters, clinical notebooks, all manner of personal and medical data, were transcribed for inclusion in the writing of the biography. He journeyed to the places in New York and in New England where Beaumont had passed the early years of his life and had studied medicine. He consulted the old township records in the various localities in the eastern states in search of biographical data, all with his usual eager and painstaking methods. The results are evident in the completed volume.
Tragically enough, in the midst of all of this he became aware of some abatement of energy and growing fatigue. A search for a cause disclosed that he was suffering from leukemia. A few days after the discovery of the condition by his laboratory technician, he told me about it, and of his determination to keep the fact secret and to share it only with the necessary consulting physicians and to carry on as usual without informing family or friend. I have never witnessed a more Spartan-like adherence to this determined course of action than in his case. His greatest anxiety was [that] he might not bring the work of the biography to completion. He worked at top speed late into the hot summer nights on the final printer’s proofs. His compelling wish and effort was that it should be a worthy and enduring piece of work. The fact that a second printing was brought out in 1939 is a testimony of its enduring worth.
Jesse Myer was born in a small Missouri town, but most of his life was spent in metropolitan St. Louis. Born in the Victorian era, he had a somewhat austere manner and presence, echoing the best phases of that culture. The doctrine of noblesse oblige was one of his ideals and his last years were a fine witness to that ideal. I often heard him quote as a guide for good medical practice the lines of Pope – “be not the first by whom the new are tried nor yet the last to lay the old aside.” But he was by no means blind to the newer things in medicine. He was quick to adopt the aids which the laboratory was bringing to the practice of medicine. He journeyed to Europe about the year 1909 to study with Killian the use of the esophagoscope and was, I believe, the first in St. Louis to use the esophagoscope as a diagnostic instrument. As one of the editors of and contributors to the Interstate Medical Journal, he became known outside of St. Louis and was early elected member of the American Gastroenterological Society.
One of his hobbies as a young man was the collection of old furniture, including several canopied beds, and also the collection of crystal chandeliers. After his marriage in 1907, these became a feature in the home which he established on Washington Avenue east of Taylor. He continued an active practice until an acute phase of his leukemia made him take to bed for the final week of life without a wavering in the iron fortitude that had sustained him during the past several years.
[End of remembrance of Dr. Jesse Myer]
It may be of interest to detail here something of the nature of medical practice at the era around the turn of the century. A more complete picture, however, might be gotten by consulting a copy of the standard textbook of the day, William Osler’s Practice of Medicine. This volume opened with a section of about 100 pages on typhoid fever to be followed by a chapter of almost the same length on tuberculosis and a somewhat briefer one on syphilis. Diseases of lesser importance followed in order: the many infectious diseases, scarlet fever, rheumatism, measles, etc.
Somewhat earlier, Pasteur, Claude Bernard, Lister, Koch, Loeffler, Roentgen, and Virchow were among the important figures in the foundation of modern medicine. In gastroenterology, Pavlov’s work in Russia was becoming known here and Ewald, Buss and Herman Strauss, in Berlin, were among the leaders in that specialty. Cannon of Harvard, and Melser and Einhorn, in New York, were adding important knowledge in this country, and the possibilities of the x-ray as a diagnostic medium were just dawning on the horizon.
During the first few years of the century the Washington University Medical School had, I believe, only four full time men on the faculty, in anatomy, physiology, chemistry and pathology. All the rest of the teaching was done by part-time volunteers all of whom were in medical practice of one sort or another. Intern training was available to only a smaller percentage of the graduates in medicine. There were several medical schools in St. Louis that have since passed from the scene.
Washington University itself, in the Medical Department, was an amalgamation of two schools, the old Missouri Medical College and the St. Louis Medical College. The medical department of St. Louis University had been formed by an amalgamation of the Beaumont Medical School and the Marion Sims College. I think that Dr. Myer was a graduate of the last named. In addition to these, however, there was the Barnes Medical College – no connection with the Barnes Hospital of today – the Physicians and Surgeons Medical School, and a so-called Eclectic Medical School.
The City Hospital offered the main opportunity for internship. The other hospitals had either no medical intern, no resident staff, or perhaps one man who had just finished his medical course. Laboratory facilities in the hospitals, except the City Hospital, were scant or non-existent and those who practiced in the various hospitals and wished laboratory work done had to collect their own specimens and bring them to the office. Parasitic infections, including malaria, were prominent in the field of diseases and amebiasis was one of the infestations frequently seen and often overlooked in practice. The soldiers returning from the Philippine Islands in the several years following the Spanish American War often brought the infestation with them and the disease became rather wide-spread in this country when, in fact, it had existed in a lesser degree before and not been recognized. The therapeutic value of ipecac in its treatment had been established by physicians in India and in Egypt, but the causative factor organisms had only very recently been established.
The alkaloid emetine was not yet available and the arsenicals and the present day amebicides were yet to come. I can recall the difficulty we had in the administration of the ipecac. Because of its emetic action some means had to be found for its administration so that it might bypass the stomach. Some pharmacists here or perhaps elsewhere, had found that coating the ipecac-filled capsule with melted salol [phenyl sallicylate] would allow the capsule to bypass the stomach. This was a satisfactory sort of thing when it worked but occasionally the amount of salol used in the coating was so great that salol poisoning occurred if any protracted treatment of the ipecac was being carried through. Because of this danger, Dr. Myer would try to make his own ipecac salol-coated capsules so that he might know that a minimum amount of salol was used in their preparation.
As I have mentioned, internships were rare in proportion to the number of graduates that were being turned out by the medical schools and there was considerable competition for the available positions. Not all of this competition was on the aboveboard basis. But we at Washington University in our graduating class decided that we would try to make the competitive examination which was held at the end of each school year for the senior classes as fair as such an examination could be. We therefore determined that in the large room that had been set aside for the purpose at City Hall we would disperse ourselves around the room, allowing no men from any other schools to sit next to each other and therefore we ourselves would be scattered and separated one from the other around the entire room. When some of the contestants discovered this form of seating they quit the examination then and there. As a result of that examination the great majority of internships in that year went to the Washington University graduates.
In the days when Jesse Myer was in practice, malaria and typhoid fever, along with tuberculosis ranked among the first [most prevalent diseases] in order. Malaria was particularly prevalent in St. Louis and at the City Hospital practice many cases of the falciparum type came in with hyperpyrexia and expired after a few hours in coma because of the massivity of the infection. Much of the typhoid fever was treated at the patient’s home and those patients who were hospitalized were taken care of as the practice of the day permitted. In the City Hospital, the admissions for typhoid fever were so numerous at certain seasons of the year that there were three wards set aside for that disease alone. Much of tuberculosis went unrecognized in its earlier stage before the employment of x-ray became wide spread.
Typhoid fever showed a rapid retreat after the purification of the Mississippi River water supply which had served St. Louis for the many years previous. The present system of water purification was initiated around the year 1903 and became perfected in the next several years. Following this, the importance of the milk supply as a spreader of typhoid fever became recognized. The infection came from the fact that much of the milk shed in the rural districts was from typhoid-infested areas and the washing and sterilization of the milk pails was of a most indifferent type. Pasteurization of the milk was not employed, at least not for some years to come, in a uniform and thorough manner.
Malaria disappeared [as a result of] the lessons learned in the construction of the Panama Canal. It may be recalled that the first attempt at the construction of this canal came several decades earlier and had to be abandoned because of the tremendous toll from malaria and yellow fever among the working crews of the canal construction.
It might also be recalled that the spirochete pallidum, or treponema as it is now called, was discovered during the first couple of years of the century while I was in medical school and that all the problems of the later phases of the disease of syphilis were only gradually uncovered as a part of the remaining activity of infection. Previously these later manifestations had been known as parasyphilitic and the reason for their late appearance had remained quite a puzzle. So prevalent was the disease and so protean its manifestations, that Osler once wrote that to know syphilis was to know medicine, meaning, of course, that the question of syphilis arose in the differential diagnosis of so very many diseases.
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