The Medical Story of Early Texas, Carlos Hamilton MD March 2, 2016

Transcription

1 Carlos Hamilton MD About three years ago, a friend of mine named Jim Davis, who happens to be the husband of a nowretired physical medicine specialist here in Houston, loaned me a book, which was this book, The Medical Story of Early Texas. He knew I had some interest in history, although I really think that the reason he thought I would be interested in early medicine was because I'm so old, and I might be in the book. But I'm not that old. At any rate, the book was so interesting to me, that I went online like you always do when you have a problem, and I found one to buy from ebay or somewhere. I bought the book because it took me a lot longer than just a few months to put this work together. It was so interesting, that I told Tom, "This might be a good subject for this group" and we'll see if you think so or not. The book was written in the nineteen-thirties. And a lot of the information that Dr. Nixon had to draw on was very much out of date, considering modern medicine understandings. It was one of the things that I wanted to do today; try to update some of his conclusions as to what might be a better diagnosis that we might come up with now and to relate some of it to some other things that we have learned. But it's a book that is really of interest. This is the front page; Doctor Nixon himself was really a distinguished fellow. He graduated the University of Texas in 1905 and then he went to Johns Hopkins graduated there in 1909 and then he practiced mainly OB/GYN in San Antonio for over fifty years. Back in those days, people didn't really have specialty boards, and you just sort of did what you could do the best. And he considered himself an OB/GYN specialist, which he undoubtedly was. At any rate, he was quite a historian; was the president of the Texas State Historical Association and the Permanent Director of Medical History at the Bexar County Medical Library. He's of interest to me; there was some question, and Tom and I talked about this earlier, of whether he was related to a Dr. Nixon, who was the president of the Texas Medical Association and Harris County Medical Society about twenty years ago. As best as I can tell, they probably are not directly related, but they ve got to be related somehow or other because they are both from Guadalupe County and there just aren't that many Dr. Nixons in Guadalupe County, I don't think. Guadalupe County, if you don't know where it is, it's on the Guadalupe River. And Seguin happens to be the county seat.

2 At any rate, this is the book 1528 to Well, how did they pick 1853? It was an arbitrary date, but it's before the Civil War because that creates a whole new spectrum of stuff. But it happens to be the year that the Texas Medical Association was organized and that's how he came up with that date. Now, when we're talking about the early medicine in Texas I want to qualify that because this is the early medicine as it relates to the Europeans that came to Texas. Obviously, there was a lot of medicine being practiced by the original native Indians that lived in this part of the world for a thousand years. But we have absolutely no record of that, at least in Texas; there is some record that is related to the Incas and to the other Mayan groups, but that's not part of this talk. What we are talking about is medicine with the advent of the Europeans. Spain was the first European country to have any influence in Texas. We're going to be talking a little bit about we won't go over all six of the six flags over Texas those of you that have been to the amusement park might be familiar with that. The Spanish influence was, by far, the longest influence in the state of Texas or in the area that is now the state of Texas, of any of the others. It began with the conquest of Mexico by Cortés in This conquest of Mexico, from a medical standpoint, was of incredible significance because it introduced the greatest public health disaster that has ever occurred at least in the western hemisphere. You might question whether the plague in Europe was worse, but it was certainly over a much longer period of time, but this was truly a disaster. The Spaniards brought with them three diseases: smallpox, measles, and influenza, that absolutely devastated the native population. Up to ninety percent of some tribes in Mexico and what eventually would be North America, died as a result of their contact with the Spaniards. We'll talk a little bit about this, but these three illnesses all have one thing in common, and that is that they are all viral infections. And we'll talk a little bit more about why they were so severe in their effects on the native Americans. Have all of you guys studied this in microbiology or bacteriology infectious disease? You're familiar with this? We'll talk about it just a little bit. Now, this introduced what we refer to now as the Columbian Exchange. Obviously, the Spaniards gave the Native Americans these diseases. Well, the Columbian Exchange was extended to the southeastern part of the United States, which really affects us a little bit more, perhaps, by DeSoto, in The advent of these diseases in the southeast US absolutely decimated a quarter of the Native Americans that we refer to now as the Mississippian Culture. There's essentially none of it left. Two hundred years, three hundred years later, when people started finding all these Indian mounds, they had no idea what it was. But this was a very sophisticated culture that had been there but was completely wiped out by these particular diseases. What did the Spaniards get in return for having given the Indians these diseases? Well, you probably know that they get syphilis. That was the exchange. Who got the best of the deal? I think they probably both got the short end if you ask me. But the reason these diseases were so devastating in the Native Americans was that they had no immunity to any of these illnesses in the entire population. And there's a very simple reason for that, Page 2

3 which you probably know if you study this. But all of these infections have arisen from mutations and viruses that are endemic in domestic animals. Smallpox, for example, and measles are both endemic in cattle. Influenza, as you know, is endemic in ducks and chickens, hence, the various influenzas, if you are not familiar with them. The Native Americans, amazingly and I didn't know this, until I started looking into this a little bit, did not have domestic animals. And that it just seems hard for me to believe; that is what's been widely distributed. But they certainly had no domestic cattle. And whether they had domestic ducks or not, I think is problematic, but they may well not have. But they had no tribal or significant population immunity to these diseases. One of the things about especially measles and smallpox is that they are much, much worse in adults than they are in children. And this is true for a lot of viral diseases. Chickenpox is another good example of that. Small children can have chickenpox and hardly even know it. If an adult gets chickenpox for the first time, it could be a very serious viral infection it can cause death. At any rate, these viruses devastated the native population, so from a medical standpoint, this is certainly one issue that needs to be brought up. When it comes to medical practice in the Western Hemisphere, especially in the area of Texas, the first person that we point to is Cabeza de Vaca. Cabeza de Vaca really had no formal medical training, but that is okay, because the other doctors that worked here in these early days, didn't have much training either. But his circumstances were really unique. He had the first successful medical practice in Texas. He performed the first recorded surgical procedure, and he's in such high regard, that he's now the socalled patron saint of the Texas Surgical Society. We'll talk a little bit about why. In the first place, Cabeza de Vaca wound up in Texas quite by mistake. He was the chief financial officer for an expedition of over 600 men that was assigned to discover gold in Florida. They had no idea where Florida was, with respect to Mexico. Evidence for that is in that the leader of this expedition, after they landed in Tampa Bay, promptly sent his ship back to Cuba, thinking that, "No problem, they'll just come back and get us in no time at all." Well, six months later, he had now made it from Tampa Bay up to North Florida, and all he had found were swamps and mosquitoes and hostile Indians and a lot of mud and no gold. And there weren't even any golf courses there, by the way. He just found nothing good about it. But only about half of his men survived to get to North Florida. Thinking that Mexico was probably somewhere right about here, they put together some rafts, after it became obvious that their ships weren't coming back, in order to sail to Mexico. But they didn't realize that Mexico was 1500 miles away, and these rafts are going to be probably good for twenty, thirty miles, at the best. But they made it along pretty well until they got to the Mississippi River. The water coming out of the Mississippi River blew them away from the shore or carried them away from shore a significant distance; far enough for one of the hurricanes that comes along in this part of the world periodically, to wipe them out. And it destroyed three of their five boats, and it only left forty men, out of 250, that made it to Galveston. They landed in Galveston under rather extreme circumstances. They were taken captive by a tribe of Indians that are referred to as the Page 3

4 Karankawas. Have any of you heard of a Karankawa Indians? You know who they are. Well, they had some tribal characteristics that make them not really good hosts. That is that they're cannibals. And they managed to consume a number of the Spaniards that had arrived. After Cabeza de Vaca and his surviving men had been there for a little while, an epidemic of an undiagnosed and unknown illness attacked the Karankawa Indians. And it managed to kill about fifty percent of them. What that was, we don't know; there's a lot of speculation. Was it cholera? Well, maybe it was, but probably not, because what we consider Asiatic cholera did not show up in North America until 1830 we'll talk about that in a minute. But, despite an unknown diagnosis, the Karankawa Indians put some demands on Cabeza de Vaca. This is quoting from Doctor Nixon, "When Cabeza de Vaca and the survivors of the expedition were slaves of the Karankawa Indians on Galveston Island, an epidemic of intestinal symptoms appeared with fifty percent mortality. The Natives had used the Spaniards as part of their diet as cannibals, but ordered Cabeza de Vaca to use his presumed skills to provide medical care." This is a level of stress that very few health providers had ever experienced. You either cure these people, or you're done. Cabeza de Vaca must have had a sense of humor, because twenty years later, when he wrote his book about this expedition, he says, "They wished to make us physicians, without examination or inquiring for diplomas." That didn't bother him at all. He relates in this medical work publication in 1542, "They cured by blowing upon the sick and with that breath and the imposing of hands, they cast out infirmity. They order that we also should do this. We laughed, telling them that it was a folly, that we knew not how to heal. They withheld food until we should practice what they required. An Indian told me that I knew not what I uttered, for stones in the field have virtue and that passing a pebble along the stomach would take away pain and restore health. And we were extraordinary men, and we must possess power over all other things. We were constrained to obey. Their custom is to apply the cure; they give the physician not only all they have but seek more to give them from their relations. They made cauteries with fire and afterwards blew on the spot, and the patient considers that he is relieved. Our method was to bless the sick, breathe on them, recite a Pater Nostra and an Ave Maria, praying with all earnestness to God to give health and for this, the Indians treated us kindly. Apparently, some of them actually got better. At least half of them got better, and the other half died. "They deprived themselves of food, to give to us, and presented us with skins and some trifles." Later the writer stated that "the Spaniards emerged from the forest in which they were lost, as holy men messengers from Heaven, marching forward from tribe to tribe, taking what they would for themselves, as a divine right. So much was that all of the Indians had for them, that when the Indians disobeyed the command to guide them, they, in fact, died of fear. I want to tell you about one little experience and see if you can help me make a diagnosis. In his travels, Cabeza de Vaca and three other guys managed to get away from the Karankawa tribe on Galveston Island; at this time, they were sort of local heroes and they did have guides that were trying to show them how to get back to Mexico City. Obviously, they didn't know exactly where that was, because they took nine years to find it. At any rate, as they were traveling through Texas, on one Page 4

5 occasion, he was asked to minister to an ill patient. He writes this; he says, On one occasion, coming near their huts, I perceived that the sick man we went to heal was dead. Many persons around him were weeping. I found his eyes rolled up and the pulse gone. I supplicated our Lord that He would please give health to him and to the rest that might have need of it. That night, startling news came that he who had been dead had got up whole and walked, and had eaten and spoke with them. Obviously, he did have a pulse, although Cabeza de Vaca may not have been able to feel it. What do you think he might have had? What can cause you to be completely unconscious and have a thready pulse and then wake up and be okay? Any suggestions? Well, my diagnosis of course, you've got to understand I'm an endocrinologist; this is a classic example of a severe reactive hypoglycemia. And that, as you might know, is fairly common in Native Americans; they had this great propensity for type 2 diabetes and one of the complications of type 2 diabetes is reactive hypoglycemia. I must say, this would be a rather severe case, but I could not think of anything else that would cause a person to look like he was dead, then get up and have something to eat and feel a lot better. At any rate, their journey across Texas became a procession of triumph, healing the sick and receiving the adulation of the Indian followers. Now, because he is the patron saint of the surgeons, I want to tell you about his operation experience. He and his three survivors on their expedition across Texas and then reaching Mexico City, nine years later after a 2000-mile plus trip. During this, Cabeza de Vaca performed the first recorded surgical procedure in Texas, probably in Brewster County, the home of the Big Bend National Park. He describes this in his narrative. Quote, They fetched a man to me and stated that a long time since he had been wounded by an arrow, that the point of the shaft was lodged near his heart, which he said gave him much pain. And in consequence, he was always sick. He probably had a chronic infection, probably a chronic empyema. Probing the wound I found the arrowhead and found it had passed through the cartilage. With a knife I carried, I opened the breast to the place, and saw the point was aslant and troublesome to take out. I continued to cut, and putting to the point of the knife, at last, with great difficulty I drew the head forth. It was very large. I can imagine. With the bone of a deer, and by virtue of my calling, I made two stitches that threw blood over me, this guy was not into the current standards. [chuckles] and with hair from a skin, probably a deer hide, I stanched the flow of the blood. They asked me for the arrowhead after I had taken it out, which I gave and the whole town came to look at it. In consequence of the operation, they had many dances and festivities. The next day, I cut the two stitches and the Indian was well. The wound I made appeared like a seam in the palm of the hand. He said he felt no pain in it whatsoever. This cure gave us control throughout the country. Page 5

6 That was the first operative procedure performed in Texas. It was obviously a great success. The surgeon was well compensated, and he was very proud of his work. Lots of things haven t changed a bit, have they? [laughter] At any rate, we've got to move on, we've got a lot more history here. Oh, incidentally, Cabeza de Vaca did a lot of other things; there's virtually no written record of what the Native Indian tribes were like, prior to the coming of the Spanish colonies. And that didn't happen for another nearly 300 years. There really weren't any Indians left that had any kind of a reasonable culture. There were a lot of Indians that were really hostile; the culture of the Native Indians was basically unknown. Cabeza de Vaca relates virtually all the information that is available about them in his book, which was published in He was an explorer, a medical practitioner, an anthropologist, an ecologist, CFO he was truly a Renaissance man. This is the next fellow who came to Texas from Europe. He is known as La Salle. Interestingly enough, La Salle is not his name; his name is Robert Cavelier. He happens to be the squire of the town of La Salle, but he is known from all time since as the explorer La Salle so we will call him that. But the reason I put his picture there is that he's got the coolest-looking hair I believe I've ever seen and for a guy like myself man, people with good hair, really I don't know. [laughter] You've got to admire a fellow who can keep his hair like that. At any rate, La Salle has a rather bad press, in that a lot of people think he's really a pretty bad explorer because he was trying to find the mouth of the Mississippi river and he missed it and wound up in Matagorda Bay, which of course, is in Texas. Well, he was really a pretty good explorer, but what he did have were very bad maps. The maps just were not up to speed at all, and you can't really see it on this, but there is a considerable difference between where the Mississippi River is on this map and where it actually is, and it's no wonder that he missed it. But after he got to Texas, he landed in southern Victoria County, which is right at Matagorda Bay. He spent a good bit of time over the next couple of years trying to find the Mississippi River. He went west, all the way to the Rio Grande and didn't find it; he was going east when some of his men, including his surgeon, got tired of waiting, and they assassinated poor old La Salle. That finished him off, but his expedition really did not accomplish anything material, except that it stimulated the Spaniards to occupy Texas. His surgeon, a fellow named Liotot, was the first person to perform an amputation in Texas; a leg got infected after a fellow was bitten by a rattlesnake. The amputation didn't do much good because he died two days later, so it was not exactly a great success. But at any rate, the encouragement to the Spaniards to occupy the Texas area was very significant. In 1715, they started sending settlers and missionaries to come to Texas. And this was really the first European occupation of Texas that amounted to anything significant. They had missions in East Texas, in Nacogdoches, in Bahia, which is the Mexican name for San Antonio and in Goliad. Now, the presidios are the army barracks that went along with the missions. The Indians apparently weren't too happy about having people over there inviting them to Sunday school or whatever [laughter] and they had to send Page 6

7 the army to kind of make sure everything went okay. At any rate, the Spaniards did indeed come to Texas in a big way. It was in 1805 when they built the first hospital; it was at the Mission de Valero, which you probably know as the Alamo. This is an opportunity for me to point out, as we did last month, that today is Texas Independence Day celebration. This is the 180th anniversary of the independence, Declaration of Independence of Texas. Four days later, on the 6th of March, the Alamo falls. And we're going to talk a little bit about the Battle of the Alamo and some of its medical implications here in just a minute. But this particular chap was hired as the professor of surgery and medicine; he shows up in San Antonio from New Orleans, with a pretentious convoy of his personal belongings, he brought his library with him. Within two years, he gambled it all away, and it generally made everybody quite unhappy, and he was fired. He had a pretty good paying job; it's hard to know exactly what a peso was worth in 1805, but it was twenty times as much as you got if you were a cook or a reporter, so it must have been reasonably well paid. At any rate, he was replaced by a barber who had had some experience with surgery at a much lower salary. The point is that if you get a really good job, try to really do a good job, because if you don't, you're likely to get fired and replaced by somebody that works a lot cheaper. Just kind of help you out with your practice. [chuckle] What about this hospital? Well, the thing that interested me the most about it was their order for drugs that they had shipped from the local pharmacy, which was in Monterey, in 1805 and These are some of the pharmaceuticals that they had. And I was really interested in what were these for. What did they use these things for? Well, opium obviously, analgesic and antidiarrheal. Camphor is basically what s in Vicks VapoRub so it's good for respiratory things. asafetida is just generally good for indigestion. It's also good for keeping away werewolves and vampires if you wear it around your neck and it has lots and lots of uses, apparently. Corrosive sublimate is the generic term for mercuric chloride, and white arsenic is the generic for arsenic trioxide. These were both treatments that were used to treat syphilis, which, in part of the Columbian exchange, was still a very important disease 300 years later, in the nineteenth century. Of interest is that cantharis is the generic name for Spanish fly, which is used as an aphrodisiac. So the Spaniards brought over their version of Viagra you've got to have it all. The one pharmaceutical that completely stumps me and maybe one of you guys, girls, can help me is frog cordial with mercury. I have never, in my life, heard of what that is, and I tried to find it, and of course, going to the Internet, I found a reference to it in the 1857 Lancet. The only reference is, it's a poison that is related to prussic acid, and it's highly toxic to frogs. Now why in the heck the pharmacy in Bexar would need this, is beyond me. (audience member) It's an after dinner drink. Yes, maybe not for frogs, though. [laughter] At any rate, I just thought I'd show you for those of you interested in pharmacology. There's still some challenge. They did do some surgery there, they brought some lancets, they brought some syringes and the syringes were such a new invention, that they had to have instructions for how to use one. Thought I'd mention that. Page 7

8 What about the diseases during the Mexican era? The Mexican era really began in 1810 and ended in 1836, at the Battle of San Jacinto. But there were several episodes that occurred here, that were really of some significance in medicine. One of them is that smallpox had been very infrequent between 1808, when they first started coming, and Why was that? Well, it's pretty clear that the adults that had never had smallpox mainly died. The young people that got smallpox when they came through survived because they were now immune. For twenty years, there was not a group of hosts that were susceptible to smallpox. But then, the disease did come back, and it was a significant epidemic, and it was the first time that the government had ever been called upon in what is now the state of Texas, to participate in any sort of a public health venture. They did actually immunize people at that time to the best that they could, and although there was no epidemiological data collected, the impression was that they probably did some good. The other disease that we want to mention briefly because it's of great significance and it's one that you may or may not ever see is cholera. There are lots of different strains of cholera; the cholera bacteria is called vibrio, but there are lots of different vibrios out there. There is one that is endemic in oysters in the Gulf Coast. And all of you that ve lived here for any period of time know that oysters are really good, but they're only eaten in months that have the letter R. Between May and August, you don't eat oysters because they're sometimes contaminated. From September to April, oysters are really good. If you're going to eat raw oysters, don't pick them at a month that does not have an R. I don't know for sure if that has anything to do with that epidemic of intestinal problems that Cabeza de Vaca was trying to heal, but it might have, because oysters were a big part of the diet of the Indians that were living in the 1500s. At any rate, what we consider to be Asiatic cholera really first appeared in the New World in June of 1832, in New York City. Cholera was a devastating disease and still is a devastating disease we just now know how to treat it. It spread by the trade routes to San Antonio and then to Mexico City and it killed at least 10,000 people this is in San Antonio and Mexico City; killed a lot more in the other parts. One of the problems with cholera is that they didn't have a clue as to how to treat it. And this, for the professor of medicine proposed to treat cholera morbus is what they called it his treatment was chamomile tea with laudanum, a diet of corn gruel, poultice and laudanum and you apply that to the abdomen. You massage whiskey and salt, apparently, into the abdominal area, and you apply hot bricks to the feet. The secret for this to work is you've got to get started really early. Obviously, this doesn't help you at all. Cholera is a serious, very severe diarrhoeal disease and people die of dehydration. The mortality of untreated cholera is extremely high. We're going to talk a little bit about this in a minute. Since this is the anniversary of the Texas Declaration of Independence, I don't want to belabor Mexican history too much, because it's very complex and I don't really know that much about it, and many of you probably know more about it than I do. But ever since the Mexicans really sought to get free from the influence of Spain, there was a big conflict between those members of the leadership that wanted a centralized government and those that wanted a federal government, that is states with various Page 8

9 responsibilities, similar to what we have in the United States. We have a central government, and the states have their own government. There was a big controversy as to whether this was going to be the way they were going to do things in Mexico. There were a number of insurrections and changes in government during this period of time. In 1824, the Federalists took over, and they drew up a constitution which was fairly similar to that of the United States. It gave authority to the states to do what was not constitutionally mandated to the federal government, to the central government. This was overthrown several times during the next twenty years. It is this that really precipitated the Texas Revolution. In 1834, Santa Anna seized power in Mexico. He voided the Constitution of 1824, which gave a lot of individual rights to the people and the people living in Texas were very happy to have individual rights because they were used to the Bill of Rights, as most of them came from the US. When Santa Anna voided the Constitution, the Texans started getting really kind of rowdy. The Mexican government had given the settlers at least those living in Gonzales a cannon, to protect themselves against the Indians. But they decided that giving a cannon to these guys who kind of are rowdy is probably not such a good idea. So they asked for it back. But needless to say, the Texans in Gonzales, Texas said, If you want this, what would you have to do? Come and get it. And that's on the flag of the Gonzales Battle it's Come and Get It. The Mexicans came, and they got it, but they didn't get the cannon they got severely defeated by the Texans in Gonzales. And this is what really precipitated the Texas Revolution. This all took place in December of 1835 or in October of In December of 1835, the Texans then attacked San Antonio de Bexar, and they win the battle. They defeat a fellow who happens to be the brother-in-law of Santa Anna. This affected Santa Anna very greatly, which made him really unhappy with San Antonio. And this is why later in the spring when he came back, his first place to go was to the Texans that were in San Antonio and they were in the Alamo. That's why he attacked the Alamo. The Alamo was of virtually no significance in terms of its military position, and it didn't have enough people there to make it worth the trouble. But he was insistent on vindicating his brother-in-law, General de Cos. At any rate, Santa Anna arrives in February, on March the 6th four days from now, they will celebrate the fall of Alamo. All the Texans were killed. In March, Colonel Fannin leaves Goliad to join Sam Houston, but his troops were surrounded by a very large Mexican army, and they surrender and are subsequently executed. Then, April 21st is the Battle of San Jacinto. I want to tell you a little bit about the medical events that happened during these three battles. First, I want to tell you about some of the people that were involved; one of them was Amos Pollard. He was a physician that had come to Gonzales, had gone to Bexar during the siege as a soldier, but he was a very experienced and very well-educated physician. Stephen F. Austin appointed him as the surgeon of the regiment that was based in Bexar and during the Battle of the Alamo, he was the physician; he created a hospital there, and he died on March the 6, defending the hospital that had to battle the Alamo. He is truly a hero of the battle and a hero of the Republic of Texas. We've got lots of heroes in Texas and everybody (and those of you that want some lunch, go on and get some. There's lunch back there Page 9

10 (male speaker) We're sorry, it became late. It won't bother me; eat all you want. (male speaker) The idea was that Alma was going to bring it up to people, so you wouldn't be interrupted by people coming back here. That s all right, go on back there and get you a lunch if you want one.) At any rate, there was a fellow named James Grant. I'm not going to belabor his experiences because I have some other things I want to tell you about. But he was a physician who was a very highly-trained physician, that studied at the University of Edinburgh. He had taken a job with the East India Company, which was a shipping company, as the ship surgeon. In order to advance his career in the company, he married the daughter of one of the executives. They had several children, but the marriage apparently was never very happy and he didn't bother to get a divorce, but he left his wife and children in London, and he moved to Mexico. Well, in Mexico, he gets with another girlfriend, and they have seven more children. It gives you some idea as to what something about his ethics. The reason I mention this is that personal and medical ethics really cannot be successfully separated. If a person's personal ethics are not up to speed, you have no reason to think that their medical ethic is going to be much better, and he is a good example of that. He while he s in Mexico, he has great success in acquiring a fairly large ranch. He becomes politically involved in the American Federalist government. Becomes a colonel of a militia in the state of Parras, which is just South of the Rio Grande. When Santa Anna tries to take over the government, he has a battle with General de Cos, Santa Anna's brother-inlaw and James Grant's troops are defeated. Grant then leaves Mexico, comes to Texas to try to recruit more men to come back and help him fight General de Cos, and he goes to San Antonio, just in time for the Battle of Bexar. He gets wounded in that battle, and he stays on there, and he demonstrates that he has tremendous charisma. He is able to talk these guys into coming with him, leaving James Bowie and Colonel Travis, going with him to go back and try to fight against General de Cos. This was something that was greatly decried by Sam Houston. At any rate, he organizes the so-called Matamoros expedition; he assumes command, and they leave Bexar on January 1st. Most historians feel that his real motive was to try to recover his landholdings that he had lost had little to do with anything else virtuous. He induced 300 men to join his venture only left a hundred to defend the Alamo. He not only took the men, but they also carried off most of the supplies. The people at the Alamo were a fraction of what they might have been, had it not been for Dr. Grant, and they were poorly supplied. To make a long story short, Dr. Grant does lead his men, he is severely defeated, he was killed in the battle, and most people feel he got pretty much what he deserved. But this is a diagnosis. And all of you that are going to build a life as a physician or in whatever field, to be aware that this is not normal behavior. When you get to psychiatry, you will know what this diagnosis was. Those of you that have had psychiatry may know what it is any of you have a suggestion? All right, I'll tell you; this is a classic example of a sociopathic personality. He is absolutely the prototype of it. He has no concept of right or wrong in his personal life or in any other aspect of life, and he is very charismatic. He can talk people into loaning him money or going in to fighting a battle or whatever he wants. He just has this charismatic ability to Page 10

11 [coughing] You've got to be very careful as you go through life, dealing with people like this because you are guaranteed you will run into some of them. All right, so much for my pontificating. [laughter] Let's get to a real hero. Jim Bowie obviously was not a physician, but he had an illness that has been widely recognized by anybody that has ever seen any Alamo movies. They all have a big part in there about a Jim Bowie. Jim Bowie was best known for the Bowie knife, which he did in fact invent. Let me tell you a little bit about him. Jim grew up in Louisiana in a highly literate family, very well educated. He and his brother were able to read, write and fluently speak Spanish and French, as well as English. He mastered the skills of frontier and plantation life; had a reputation for fearlessness and was very proficient with rifle, pistol, and knife. He also learned how to rope alligators from his Indian friends. If any of you had been alligator hunting, I think that's got to be pretty good. He and his brother developed a profitable plantation and were successful land speculators in Louisiana and Arkansas. In 1830, Jim moves to Texas and was elected Colonel of the Texas Rangers, which was a militia to protect San Antonio from hostile Indians. He and a business partner, Juan Veramendi, began to build cotton and wool mills, and his land speculation gave him control of 700,000 acres. That's what you call a pretty big ranch. He married the daughter of Veramendi her name was Maria Ursula, and they had two children, which were very important to Jim Bowie. He established himself as an effective Indian fighter; he and his brother and ten others fought off they were outnumbered fourteen to one by a band of Indians. They fought for thirteen hours and only lost one man severely defeated the Indians, and this got reported widely in the newspaper, and he was already known as a wartime hero, and this did nothing to diminish that. In September 1833, his wife, their children, and her parents all died in the cholera epidemic. This was devastating to Bowie and from then on, he drank heavily and was said to be careless in his appearance. Bowie was a staunch Federalist. He was very much in favor of states' rights and individual freedom, as you might expect. He participated in the battle of Nacogdoches, which was a skirmish in In January of 1836, Bowie was influential in the decision to stay and defend the Alamo. Most people would have thought that the best thing to do is to get out of here and go join Sam Houston, where you've got more people. But Jim Bowie basically talked him into staying and defending the Alamo, because he had family living there and he just felt strongly tied. At any rate, he was elected as the Commander of the Alamo troops. But in his attempt to celebrate his election as their Colonel, he went on a drinking spree in the town, which became a near riot and within the next one to two weeks, he became very ill. He became ill after he had secured the safety of his family. During the week prior to the fall of the Alamo, Bowie became so desperately ill, that Davy Crockett wrote in a memorandum that was sent out, that he was barely able to crawl from his bed and to stand up for roll call. At the end, his degree of prostration was so severe, that Bowie had his cot carried across the line drawn in the sand by Colonel Travis. Those of you that saw John Wayne in The Alamo and all those good movies have seen that many times. Bowie thought that he had a contagious disease, and he ordered his cot placed in the back room of the Alamo. It was there that he dispatched Page 11

12 several Mexican soldiers with his two pistols and his Bowie knife, before being killed, as were all the 179 Texans in the fight. Now what kind of a diagnosis would you give to Jim Bowie? What do you think he had, that made him so sick in the last two weeks of his life and would create this kind of a circumstance? Well, Dr. Nixon has some very distinctive opinions about this. He thought that it must either be TB or typhoid or pneumonia. And he goes into some detail as to why he thinks it's one or the other. Maybe you have an opinion? How many think it was TB? Probably not. TB is a chronic disease; he was not chronically ill. He was feeling very well in fact, he was leading troops in battle two weeks before he got sick. What about pneumonia? Well, pneumonia can cause you to be pretty sick and to feel really bad, but being prostrate and unable to stand up, because you're so weak and so depleted, seems unlikely. But what about typhoid fever? Well, Dr. Nixon thinks, or thought, that typhoid fever was a seasonal illness and the season of March is not when typhoid usually occurs in that time. We now know that typhoid is a worldwide infection and that it's not really seasonal, as much as it is related to the amount of rainfall. And it turns out that March of 1836 was a very rainy time. Those of you that have read anything about Sam Houston and his attempted retreat from Gonzales to San Jacinto they basically had to slog through 200 miles of mud. Well, you don't get 200 miles of mud without a lot of rain, so there was a lot of rain in that particular season. My diagnosis is that he had typhoid fever. I'll just mention a little bit about typhoid. Most of you have never seen a case, and I must say I've never seen a case of typhoid fever either. I've seen similar things, and we've suspected it in many, but I'm not sure I've ever actually seen I know I've never personally diagnosed it. I have diagnosed a case of cholera, however. A friend of mine and we were on a hunting trip one time. They woke me up in the middle of the night and said, You need to come here and see Brad, he's really sick. So I go in there, and he's basically had diarrhea for twelve hours. And he was barely able to get up out of bed. I said That's incredible! What happened to you? What have you been doing? He said, Well, I've just gotten back from India. Oh, Jesus, you got to be kidding. He got back from India, and he got on a plane, and he came over here to Georgia to go on this quail hunt. But he had cholera. We rehydrated him, got him started on some antibiotics which may or may not have helped him, but at any rate, he survived and is doing very well. But typhoid is different. If you look at these things, and if you study a little bit about typhoid fever, Jim Bowie's story was almost a prototype of the way this disease affects people. Any questions about that? Anybody want to discuss that, debate that? Yes, sir. (audience member) If Jim Bowie had typhoid fever, wouldn t the others who were around him have had it as well? They may have, we don't know. There weren't any survivors of the Texans, and nobody else had it, so I suspect that when he went into San Antonio into the town of San Antonio to celebrate and was drinking and raising hell for a week or so, he undoubtedly got into some bad food or water or something. There may have been a Typhoid Mary living in San Antonio for all we know. But I just pieced it together. Yeah, you are certainly right, you would expect it to be epidemic, but we just don't have any information on that. Any other questions about my diagnosis? [chuckles] Anybody disagrees, I wouldn't mind arguing with you too much. I can't prove it. (audience member) Five minutes. Page 12

13 Okay, we've got to move on. Let me tell you a little bit-- how many of you went to or go to are going to Baylor Medical School? Nobody? Do you know for whom Baylor was named? Have you ever heard of Doc Baylor? Well, it was not named for Doc Baylor. [laughter] Doc Baylor is one of the few people that actually was at Goliad, the Alamo and San Jacinto. He managed to survive all of these, he was wounded at San Jacinto and he went to visit his uncle R. E. B. Baylor, who indeed, was the founder of Baylor University, and he died of sepsis. Who was R. E. B. Baylor? Well, I'm not going to belabor this, except that he was a very notable lawyer, legislator, had a religious conversion, became a missionary to Texas and he established the Baptist Church in Texas and he and two other men started Baylor University and they named the school after him. The medical school didn't appear for many, many years later. Actually, in 1900, the University of Dallas became Baylor University College of Medicine in 1903, moved to Houston in '43m became independent in The international prominence really occurred with the coming of Michael DeBakey and I'm sorry his son Denis isn't here today; he usually comes to these meetings and I was hoping that he would be here, so he could see that. Dr. DeBakey was in the same class at Tulane Medical School as my father and a good friend of my parents, and his son, Denis s older brother, is a good friend of mine. When I applied to Baylor Medical School I'm not as dumb as I look, I got Dr. DeBakey to write a letter. [laughter] And a lot of my friends think that s how I got in. And they may have been right, I don't know. I spent four years trying to prove that I really needed to be there. Sam Houston, of course, was really the remarkable individual that provided leadership that has been hardly ever duplicated. But he had an illness that has never really been very well explained to me. He had a chronic infection of his arm and his groin, which he had had ever since the Battle of Horseshoe Bend, in So, twenty-two years later, he is injured he has a bullet wound to his ankle, and he gets over this eventually, but in 1863, he has an illness of cough and shortness of breath. And there's a lot of questions as to what he had, but I am convinced that he died of congestive heart failure. And I suspect that what he had at least, he may have had multiple other things too was a condition that we never see nowadays, and that is primary amyloidosis. Amyloidosis affects the kidneys and the heart, and it occurs in people that have long-standing chronic infection. It used to be rather common in people with tuberculosis and in people with osteomyelitis. And he undoubtedly had chronic osteomyelitis from the wounds that he had for thirty years. I won't belabor that point. There is one other thing I want to mention: there are other doctors that participated in the Republic of Texas and in our history. Lorenzo de Zavala was certainly one of them. He was the Interim Vice President of the Republic of Texas. Played a critical role in the negotiation of the recognition of Texas by Mexico. He was a physician; he studied medicine when he had been put in jail because of his political views. He studied medicine well enough so that he became a licensed physician. He probably never actually practiced, but he certainly could have if he wanted to. Anson Jones was a person who did practice medicine with great success. He had come to Texas and had practiced in Texas and then was a surgeon at the Battle of San Jacinto the surgeon of the Second Page 13

14 Regiment at the Battle of San Jacinto. He eventually became the President of the Republic of Texas at the time that it joined the Union. He, unfortunately I was going to tell you a little bit more about his story but he had suffered from chronic depression and unfortunately very sadly he took his own life in I just wanted to make the point that highly successful, well-educated people, with everything going for them, are subject to this disorder, this disease, if you will. And depression is a serious problem, especially in physicians, because we kind of tend to overlook stuff. Don't let that happen to you or to any of your colleagues, if you can ever recognize it. One last person I want to mention is Ashbel Smith. Did any of you go to the University of Texas Medical Branch? Well, he is the hero of UTMB. Ashbel Smith was educated at Yale, he was in Paris during the cholera epidemic. Wrote a very interesting paper on cholera. He came to Texas, he became a friend of Sam Houston, and he eventually became he obviously learned how to speak French he became basically the US Ambassador to England and France not the US, the Republic of Texas Ambassador. He was very much involved in the Civil War, provided tremendous leadership in keeping the troops from rioting at the end of the Civil War. He served in the state legislature, and he was the one that was responsible for the founding of the University of Texas and for the funds that would eventually become the University of Texas Medical Branch in Galveston. He was a very skilled physician and truly a Renaissance man. Just one of the great people of Texas's history. That really concludes all I wanted to say maybe a little more but if any of you have any questions, I'll be glad to try and answer them. If you have other things to do, please leave and I'll be glad to stick around and answer any questions that you have in mind. Thank you very much. [students clapping] Captioned by AdeptWordManagement.com Page 14

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