The Kelloggs Read online

  Will Kellogg, age 15, selling his father’s brooms in St. Charles, Michigan, April 7, 1875 Credit 20

  In addition to working at the broom factory, Will performed many other tedious chores. Armed with a hoe, a spade, and a youthful spine, every spring and summer Will tilled the soil, growing vegetables on the vacant lots his father owned. The backbreaking work of weeding and planting never left Will’s memory, even in old age. “Before daylight in the summertime,” he recalled, “we boys were routed out of bed to weed berries and vegetables, or to root, bunch, and wash onions and lettuce for the local market. I cannot say I enjoyed weeding the onions and other vegetable beds.” During the harvest that coincided with his ninth year of life, Will estimated that he “pulled and topped three hundred and fifty bushels of Bermuda [onions].”54

  Perhaps the most memorable episode of Will’s childhood centered on Old Spot, the family’s swaybacked, speckled horse, a steed reputedly of Arabian heritage. John Preston assigned Will the task of tending, washing, and feeding the nag. The Kellogg children loved Old Spot because he was gentle, smart enough to do all sorts of horsey tricks, and fun to ride along the dusty, unpaved streets of Battle Creek. They mischievously pulled at his tail to get his attention, and, after the local farrier trimmed and balanced the animal’s hooves, played games with his old, discarded horseshoes. Will was especially proud of an equestrian trick he mastered that never failed to impress the neighborhood children. He would ride Old Spot while hanging upside down, underneath the horse’s belly. That is until the fateful day when Will returned from school to learn that his father had sold the horse. Heartbroken but unable to demonstrate a hint of emotion, Will promised himself that someday he would own a stable of Arabian steeds. It was a pledge he would make come true. In 1925, Will established the W. K. Kellogg Ranch in sunny Pomona, California, which became one of the world’s finest Arabian horse farms.

  At times, the boy fantasized about escaping the family broom business and becoming a doctor like Merritt and John or, perhaps, finding wealth through a business of his own choosing. Such dreams seemed futile every time he was called to return to the mind-numbing task of making still more brooms. Nowhere is this despair better expressed than in a photograph taken of him in 1875, after his father promoted him to become the firm’s principal sales agent. The picture depicts Will during a sales trip to St. Charles, Michigan, a village near Saginaw. Upon alighting from the train, Will spied a local photographer’s shop and, with the impulse of a teenaged boy, decided to have his portrait taken. Dressed in an ill-fitting vested black suit and a derby that sat on the back of his head, Will posed with one hand in his vest pocket and the other holding a bundle of four brooms. It is his face that best reflects the state of his mind.55 Nearly a century and a half after the photographic plate was exposed to the light, one cannot help but be saddened by the image of a young man with little hope, even less joy, and a weary resignation of many uneventful years of drudgery ahead.

  4

  Long-Distance Learning

  THE ELEGANT DR. AUSTIN FLINT began his daily hospital rounds precisely at 12:00 noon. At 11:59 a.m., his eager “house pupils” listened for the click-clacking of his boots down the corridor, knowing a moment later would welcome the entry of a large man with an overwhelming pair of muttonchop whiskers, sparse silvery-white hair combed over a patch of baldness, hazel eyes so piercing that they trespassed his gold spectacles and proceeded directly to whoever or whatever was in his gaze, and a booming voice exuding confidence. Dr. Flint always carried his black leather “doctor’s bag,” whether he was in his clinic, his private office, or along the halls of the many hospitals he attended. The battered satchel was filled to the brim with the tools of his trade, from rubber mallets and pleximeters (small ivory plates to contain the blow of the mallet when eliciting a reflex movement) to hypodermic syringes and vials of morphine. More important to the young interns and medical students straining to hear his every word, Dr. Flint was the author of one of the leading American medical textbooks of the late nineteenth century. Between 1865 and 1888, more than 75,000 medical students purchased, clutched, and memorized six successive editions of his Treatise on the Principles and Practice of Medicine.1

  Dr. Flint was, perhaps, the most prominent teacher in a high-powered faculty at John’s third (and last) medical school, the Bellevue Hospital Medical College. The school was founded in 1861 and attached to the largest and oldest public hospital in America. In its day, Bellevue was the premier institution of its kind in North America. The distinctive feature of a Bellevue medical education was its application of “a system almost universal in Great Britain,” which had “the advantage of combining clinical with didactic teaching during the entire collegiate course of the student.”2 Today, such a combination seems intuitively obvious, although it was not until the early twentieth century when the troika of lectures, books, and clinical teaching on hospital wards was finally embraced by all American medical schools as a better means of building doctors.

  Austin Flint, MD, circa 1880s Credit 21

  Attending the Bellevue Hospital Medical College did not come cheap. John’s tuition for the first session amounted to about $155 (or $3,320 in 2016) and, because of an extra charge for graduation, $175 (or $3,750 in 2016) for the second session.3 The Bellevue bursar was quick to inform every student that these levies covered all matriculation fees, dissection laboratory costs, graduation fees, and a full slate of tickets for the professors’ lectures.4 Such dear expenses were only the launching point in the mad dash to obtain a Bellevue MD. There were also the steep admission costs for after-class “quizzes,” led by select professors to help students prepare for their oral examinations and to obtain references for future work opportunities. The quizzes were not included in the formal tuition but they signified an important percentage of the medical school professors’ annual salaries. The price tag for such after-hours “cram sessions” was more than twice the fees charged for the regular term. And, of course, there were the expenses of living in the costly city of New York. When John sent his bills back to Battle Creek for James White, the Elder likely shook his head in dismay at the mounting expenses it took to train his protégé.

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  THERE WERE SEVERAL REASONS why so many of the nation’s most ambitious physicians coveted the opportunity to work at Bellevue. The hospital offered an endless river of what doctors then euphemistically termed “clinical material”—impoverished and vulnerable “public ward” patients whose bodies and conditions helped teach generations of students how to become doctors. By the time John walked Bellevue’s hospital wards, thousands of desperate New Yorkers sought entry into its doors every year and filled its more than 1,200 beds each night. Situated at the foot of Kips Bay on the East River, its pastoral name was derived from the farm that once stood in its place. By the 1860s, Bellevue’s long, bed-filled wards, affording little privacy or dignity, were a human potage reeking of poor hygiene and filth. Those patients looking outside the hospital windows were wise to leave them shut because the East River was the stopping place for much of Manhattan’s raw sewage, via a jumble of pipes and shovels, making it a stream that positively stank.5

  When John Harvey Kellogg first crossed the wrought iron gates of the hospital’s imposing red brick portal, he entered the largest physical plant devoted to health care in the United States. Its campus spanned from East 26th Street to 30th Street and was bounded by First Avenue and the East River; it included dozens of interlocking pavilions of differing styles and heights, containing a beehive of charity wards, laboratories, surgical suites, psychiatry units, and the “dead-house,” or morgue, where countless autopsies were conducted to figure out exactly what caused the deaths of so many Bellevue patients.

  The conduct of so many postmortem examinations reflected the state of medical care at the time. In 1876, for example, 5,165 patients were admitted. Only 4,313 lived long enough to be discharged, meaning 16.5 percent of those admitted to Bellevue did not leave alive. Many fam
ilies failed to claim the remains of a loved one because they did not have the money for a funeral, a situation that forced the City of New York to handle such rites in a perfunctory manner. Moored alongside the dock serving the hospital was a funeral ferry that transported the unclaimed dead up the East River to potter’s field on Hart Island.6

  In retrospect, it is easy to see why so many died at Bellevue. Beyond the paucity of medicines or effective treatments available at the time, there was also the very real risk of succumbing to the surgeon’s scalpel. Even if a patient did manage to get off the operating table while still drawing breath, the grimy hospital wards, attended by doctors and nurses who rarely washed their hands or changed out of blood-stained clothing, all but guaranteed contracting overwhelming infections such as erysipelas and pyemia, or what we now understand to be bacterially mediated forms of blood poisoning.7 When John matriculated into Bellevue Medical, the most medically prudent decision a patient could make was not to seek care in a big hospital and, instead, stay at home under the watchful eye of a relative, hoping and praying that nature and time would heal one’s wounds.

  Nevertheless, from morning to late at night, year after year, the sick and needy did come to Bellevue, pounding on the hospital’s doors and begging for admission. The majority were the urban poor, immigrants, “lunatics,” the chronically and acutely ill, and the mentally or physically broken, all of them without the means to pay for their hospital stay. Those in most desperate need of attention were rapidly transported there in horse-drawn ambulances, thanks to another marvel of modern technology—the telegraph. Twenty-four hours a day, seven days a week, an operator at Bellevue received calls through an independent telegraph wire that connected every New York City police precinct with the hospital. In the busy accident room, or what we today would call the emergency room, doctors attended those in the building trades who spent their days transforming Manhattan from a colonial village into a modern Gotham until they encountered a serious mishap or fall. Above the tables on which these battered patients were placed, a sign painted on the wall suggested the chances of recuperation. It read, in six-inch-high black letters, “PREPARE TO MEET YOUR GOD.”8

  Interior of the Bellevue Hospital central courtyard, 1893 Credit 22

  Unlike today’s pristine, high-rise, and profitable temples of medicine, most nineteenth-century American hospitals were primarily charitable affairs.9 The wealthy trustees running and funding these hospitals, rather than the doctors, made the final decisions of who would be admitted each night and who would be turned away. They often based their judgment on a moral compass rather than the triage of illness. Sinners and social outcasts—drunks, criminals, prostitutes, unwed mothers, and other members of the “undeserving poor”—understood there was little chance of attention even when suffering from the most dire of medical conditions.

  Although Bellevue was a public municipal hospital, the politics and decisions of the New York City Board of Commissioners of Public Charity could be just as byzantine and judgmental, if not more so, as the hospitals run by private charities or churches. Despite the best efforts of a cadre of crusading doctors struggling to pull the profession out of the mire of antiquity, many hospital trustees focused on improving the unhealthy living environments and spiritual ways of patients. Equally problematic, too many hospital trustees still considered the new-fangled tools, therapeutics, and surgical operations secondary to the whole “charitable enterprise.”10

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  EACH DAY during his rounds, Dr. Flint dispensed a slew of clinical pearls that his students resolutely committed to memory. Flint’s great gift was an uncanny ability to synthesize all the data, signs, and symptoms he gathered while on his hospital rounds and then relate them to the latest discoveries being made in clinical medicine. Walking down the open wards, Dr. Flint bowed at each bedside and courteously greeted patients assigned to his care, regardless of their social station or mental status. He explored the luster of their eyes, reached into their mouths to examine the coating of their tongues, and thumped on their chests and bellies to fathom the hidden processes brewing within their bodies.

  The most exciting moment of these displays of clinical legerdemain occurred when Dr. Flint reached into one of the pockets of his splendid waistcoat and pulled out a set of two ivory earpieces connected to metal tubing converging in a hollow ball meant to amplify sound and attached to a conical, or bell, chest piece. Called the stethoscope (from the Greek roots stethos, or chest, and skopein, to look at or to observe), it was invented in 1819 by a French doctor named René Théophile Hyacinthe Laënnec. The device allowed doctors to peer into the body of a patient’s chest by means of auscultation (from the Latin auscultare, “to listen”).11 So adept was Dr. Flint at using the stethoscope that he discovered and reported a low rumble heard at the apex of the heart, signifying aortic valve regurgitation and which still carries the eponym “the Austin Flint murmur.”12

  Dr. Flint exhibited an unending allegiance to the future of science, even if it challenged or overthrew dogma that doctors held dear for centuries. As a successful textbook author, he kept scrupulously abreast of the latest advances in medicine. In practice, he avoided the dangerous medications of the day, opting instead for nature-based therapies, a concept known as “therapeutic nihilism.” As a teacher, he drilled into his students a strict code of ethical conduct and new discoveries on the infectious nature of many deadly and all too common diseases.13 A knowledge-hungry John Harvey Kellogg attached himself to Austin Flint like a suction cup on a ceramic-tiled wall.14

  Dr. Flint’s services cost a great deal of money. John paid an additional $500 (about $10,700 in 2016) in order to study physical diagnosis privately under Flint and his associate, Edward G. Janeway, a brilliant physician who created Bellevue’s system of medical charts so that the clinical symptoms of those patients who died in the hospital could be better correlated to their autopsy results.15 Walking the wards with these learned men on a daily basis was a medical student’s dream come true. Before Dr. Flint arrived each noon, Janeway polled the medical students and internes to help select the most interesting and complex cases for presentation to the chief. Other times they drew patient cases from Flint’s private practice or his charitable rounds for the city’s Bureau of Medical and Surgical Relief for Out-Door Poor.16 Dr. Janeway would then direct the medical students to elicit the patients’ histories, examine their ailing bodies, and report back what they had found and what they believed to be the best course of action. By evening, John reliably amazed them all with his natural aptitude for clinical diagnosis and rational, therapeutic solutions. When evaluating John for his “report card,” Dr. Janeway remarked, “Young Kellogg from Battle Creek, Michigan, is the brightest student I have.”17

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  TWO OTHER CLINICAL luminaries who made a lasting impression on John were the genitourinary surgeons William H. Van Buren and Edward Keyes. Each year, they presented a series of simultaneously titillating and repulsive lectures detailing the work of “the venereal department…[which was] extremely rich in cases illustrating all forms of specific diseases, and in this respect is second to none other in the world.”18 The same year John learned about the many health risks of sexual activity, 1874, Dr. Frederic R. Sturgis, a surgeon at the city’s charity hospital on Blackwell’s Island, reported before the American Public Health Association that at least 50,450 New Yorkers (5.4 percent of the total population of 942,292) suffered from syphilis. This number underestimated the true incidence because it was based only on those residing in the city and not the thousands of unreported sailors, soldiers, and merchant marines who came to New York every day, all eager for fun and highly susceptible to syphilis, gonorrhea, and other venereal diseases. These relatively incurable, hugely debilitating, rampant, and morally suspect illnesses remained a significant public health problem during Dr. Kellogg’s entire career. By 1895, 1 out of every 20 Americans, 3,445,000 men and women, were infected with syphilis. In 1937, the incidence doubled; 1 out of ever
y 10 Americans suffered from the “great pox.”19

  In Ann Arbor and New York, John listened to lectures on venereal diseases. His student notebook entries for March 13, 1874, ominously list every disgusting symptom of gonorrhea (which John refers to as “the clap”) and syphilis—from the creamy yellow-green, purulent discharges and severe pain in “making water” seen in the former malady to the raging systemic infections, skin rashes, cardiac damage, and insanity seen in those infected with the latter. The extant treatments included direct injections of burning silver nitrate into the urethra and massive doses of mercury and iodides. As he recorded these prescriptions, John astutely observed, “sometimes the cure is worse than the disease.”20 Leafing through his yellowed and frayed notebooks, one can almost feel John’s revulsion transform into a lifetime edifice of strict sexual abstinence.

  Although John favored the teachings of an obstetrician named Edmund Randolph Peaslee, Dr. Fordyce Barker, a flamboyant professor of midwifery and diseases of women, also impressed him. Barker lectured to John’s class on puerperal disease, or childbed fever, one of the leading causes of maternal mortality during the eighteenth and nineteenth centuries. Professor Barker taught them the work of Harvard’s Oliver Wendell Holmes Sr. and Ignaz Semmelweis of Vienna. Both men independently made the contagious connection between the rising incidence of childbed fever and the fatuous obstetricians who moved freely between the delivery room and the autopsy suite, delivering babies in one room and practicing pelvic examinations on cadavers in another. Over two summers, Dr. Barker “select[ed], fus[ed] and ma[de] homogenous” a collection of his Bellevue lecture notes on “the puerperal diseases.” They were published in 1874, while John was still sitting in his clinical amphitheater. On the page or at the lectern, Barker taught that the disease was “transmitted by the physician from one patient to another” and all doctors must vigorously wash their hands as “the greatest precaution to guard against so terrible a calamity.”21