Dr. Feelgood (6 page)

Max’s mother did not want her son to go to the front. She had already lost one son to war. How ironic would it be, as all of Germany gradually collapsed and submitted to a bitter peace, for her son to be one of the final casualties of the war? She vowed she would not let this happen. Through the grapevine, Mrs. Jacobson heard that the district draft board director, a retired military officer of great stature and even greater pomposity, had an obsession for the nearly unobtainable Liederkranz cheese, so precious in ration-driven Germany that finding it was like finding gold. Max’s mother, the wife of a butcher who knew where items could be found at a price, managed to bargain for a piece of Liederkranz, wrapped and boxed it, and sent Max off to his local draft board with, as he described it, a big wooden box under his arm.

The rumors about the draft board director of Max’s district were true. He was a crotchety old man, hobbled by wounds from prior wars, limping around his office and weighed down by a long cavalry saber that dragged across the floor. Under his bald crown, he stared hard at Max, a stare made even more menacing by the man’s thick walrus moustache. Max remembered that moustache challenging him as he entered the director’s office, a moustache that began to quiver ever so slightly as the director sniffed the air. Then he focused his glare at the box tucked under Max’s arm.

His hard glare seemed to melt as he looked at the box. “And what can I do for you, young man?” he said.

“I’m Max Jacobson,” Max said, announcing himself and continuing that he was following his orders to report for induction.

“Very commendable,” the director said, staring longingly at the box under Max’s arm. He walked around the desk toward Max. “The Kaiser needs every man he can get at the Polish Front.”

Max began his pitch. Though he had received his induction notice, he already had two brothers serving in the army, both of whom had suffered casualties. Max was the sole son left at home. Max also said tha the was working at the Pankow Hospital in Berlin, serving as a medical assistant in surgery. The shortage in medical personnel was acute, Max explained, which was why his duties in the operating room dealing with wounded combat veterans was so important. He would soon be entering medical school, Max said. And then he put the box of cheese right on the director’s desk.

The district draft board director stared directly at the box on the desk, his moustache twitching as the aroma of cheese permeated the room. Then he said, “Well, what’s one man more or less at the Polish Front?” And Max left the office. He was not inducted.

Max enrolled as a pre-med at the Fredrich Wilhelm University in Berlin, where his first class was human anatomy, and was quickly overwhelmed by the huge volume of reading his professor piled on his desk. In fact, the stack of books was so tall that it obscured the tiny professor who was sitting behind it. Max later remembered that he believed he was staring into the face of failure and feared even more that he would have to confess to his mother that he was just not up to the task.

But as he sat in the lecture hall and looked around him, he saw that many of the students in his class were just very young soldiers, almost all of whom were officers, only recently returned from the front and discharged from military service. They were dressed in shabby uniforms, and many had been wounded and were on crutches. Max also noticed that the officers had removed their insignias, probably to avoid being killed by their own men as they retreated from the front. Things at the front were that bad. As he looked over his competition, Max’s confidence returned. He told himself that if others in his class could do it, so could he. And he did. He passed his anatomy course within the year, and when he was nineteen, he transferred to Albert Ludwigs-Universitat in Freiburg, one of the oldest universities in Germany. It was at Freiburg that Max attended the lectures of Professor Wilhelm C. Roentgen, the developer of X-ray photography. Max had worked with X-ray technology at the hospital in Pankow where it was used, as it is today, for diagnostic evaluation.

X-ray technology had opened up an entirely new window into the study of anatomy. Instead of looking at detailed drawings or examining the internal organs of cadavers, X-rays allowed young medical students to see the actual process of the functioning body. By having patients or subjects swallow a substance called barium sulfate, a metallic substance that illuminates the digestive tract, doctors could use X-rays to see if there were any abnormalities in the soft tissue. Barium X-rays were used by gastroenterologists. Max remembered how he liked to see the X-ray machine come to life when the switch was thrown. He would marvel at the way the bare copper wires connecting the vacuum tube to the transformer began sparkling in the dark with a crackling sound. Then Max would watch the fluorescent screen in fascination as the barium paste traveled down the esophagus, through the stomach, and into the intestinal tract. Barium illuminated the soft tissue in the chest cavity, bedazzling the students who watched the rising and falling of the diaphragm during respiration, the mechanism of joints in use, and the simultaneous peristalsis of the intestines. Through the lectures at Freiburg, Max acquired an understanding of the nature of the X-rays and saw how Roentgen opened a new field of radiology in medicine. And after his studies in Freiburg, Max returned to Berlin to continue his medical study.

Max had returned to a different Berlin, a city no longer peaceful in a country wracked by the terms of the treaty of Versailles. The economy was in ruins, the Army was now a local police force, and the old generals who had lost the Kaiser’s war were organizing a fifth column called the Black Army. The generals claimed that leftists had become the enemy that destroyed the empire, and by 1919, there were street fights between the forces of the Weimar Republic and the Schwarzer Reichswehr, the Black Army.

The right wing claimed that the leftists were liberals stabbing the military in the back. Social democrats, the Black Army claimed, were little better than the communists who undermined the structure of the country’s moral fiber. Public demonstrations turned into violent confrontations and to open fighting in the streets. During one of the street fights, Max took shelter in a recessed entrance to a building. As the fighting raged outside, Max looked around to find that someone was also taking shelter in the doorway. Max introduced himself, and the gentleman extended his hand and said that his name was Albert Einstein. Max knew who he was, of course. The two men shared their fears about the country, but Einstein had only one fear, he said: “Only that I wouldn’t be able to find things on my desk after my maid had tidied it up.”

In 1920, Max transferred to the University of Wurzburg to continue his studies. Wurzburg was still a medieval city housing a great university where Max, refusing to join one of the dueling fraternities that still practiced the illegal sport, became the surgeon in training, repairing the physical injuries to the duelists. And after that year, Max returned to Berlin, where he became a “candidate of medicine,” meaning he passed his basic exams in anatomy, physics, chemistry, and physiology and was set to advance to attending lectures at the city’s teaching hospitals. There he studied internal medicine, gynecology, obstetrics, surgery, and pathology at lectures in auditoriums where the instructors demonstrated everything from diagnoses to operations and post-operative care. Max and his fellow students also followed hospital rounds and served as interns in outpatient clinics, where they learned the actual practice of general medicine.

Amidst the changing cultural milieu of the 1920s, medicine, Max noticed, was still an art at the turn of the century. Doctors had to rely on their own sensory impressions of patient presentations and the symptoms doctors could see for themselves. Radiology and laboratory tests, the lynchpins of today’s medicine, were not always readily available, even in Berlin, and very often beyond the means of the average patients. And given the sometimes difficult task of differentiating between diseases presenting similar symptoms, Max learned the art of diagnosis. It would be a skill that he would boast about and would stay with him throughout his career.

Max considered himself a scientist as well as a healer. He experimented with new medicines, particularly for the treatment of diabetics. Max learned that it was not only his stethoscope that was an essential tool, but also his ability to listen to a patient describe symptoms, the tone of a patient’s voice, and even his choice of words. As successful as he was as a diagnostician, he, too, was among those doctors who stood helplessly by as infectious diseases ran their course and took a toll on the population.

Max’s interests centered around biochemistry, the subject of his doctoral dissertation and one of the core elements of his practice. Max was fascinated by development of new medications, a route opened up for him by his interest in biochemistry. He was so fascinated by the research into new drugs that he and his fellow doctoral students often tried out the new medications on themselves. They believed it was the best method of familiarizing themselves with the new drugs and their effects, as well as their side effects. When he tested a substance called nicotinic acid, a member of the B-complex vitamin group, to see whether it would enhance his feeling of well-being, Max suffered a painful reaction so severe that he thought he would die. However, because the effects almost immediately subsided, he was not dissuaded from self-testing.

Max’s next internship was at the Surgical University Clinic of the College of Sports and Gymnastics working under Professor Auguste Bier, a man in his early sixties, who sported a large, white moustache and spoke in a deep voice that always sounded patronizing to his patients and students. Dr. Bier, in Max’s words, was a combination of surgeon and homeopathic physician. Dr. Bier’s theory of injecting patients with small doses of infectious bacteria so as to trigger the formation of antibodies specific to fight that bacteria became the basis for the modern medical procedure of inoculation. The theory behind vaccinations and immunizations today stems, in part, from Dr. Bier’s theory of immunization. Bier used this same theory to experiment with controlling the infections from meningitis as well as from endocarditis, an infection of the heart muscle. Endocarditis, in the 1920s, had a 100 percent mortality rate. But Dr. Bier’s treatment of burning the skin above the infection to increase the body’s resistance to the infection did not work, and Bier’s experimental treatment ended in failure.

In addition to surgical procedures, Bier experimented with creating antibiotics, skin grafting, spinal fusion, and other techniques that required an understanding of cellular composition. His methods were questioned by his peers in the medical community primarily because they were quite controversial at the time. Jacobson recalled that Bier was always looking for new therapies to remedy various disorders. Bier had grown up in a farming community, what Jacobson referred to as “peasant stock,” and observed in detail how nature could provide him with clues he could apply to medicine.
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According to Jacobson, Bier was also a free thinker, who respected the work of scientists and microanalyses, the study of molecules and chemical structures. Despite the advances made in science and medicine during the mid-nineteenth to early twentieth century, Bier remarked that he had greater admiration for his dog because just by sniffing a lamppost, it could tell whether a friend or foe had been there.
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Under Bier, Jacobson refined his already sharp skills as a diagnostician, explaining that

I learned the danger of a physician’s jumping to an obvious diagnosis that was impressed on me indelibly by an emergency case that had been admitted after an accident. The patient was brought to the auditorium where an intern proudly diagnosed a broken clavicle. Professor Bier walked over and reexamined the patient. “Sir,” he said, “this is a splendid diagnosis and a good presentation. There is only one thing you overlooked. This man also has a busted spleen.” He then turned to the class and said: “Gentlemen, you may be very satisfied when you discover something on which you can hang your diagnosis. But don’t stop there. Remember, a human being, too, can have both lice and fleas.”
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As Jacobson pursued his medical internship with Bier, he was very aware of the deterioration in the German economy. Terrible inflation had set in, causing great unrest in the population. Jacobson’s father, for example, complained to him that prices were rising so fast that no matter how much he sold a steak for, he had to pay more for meat from his supplier at the slaughterhouse.

Jacobson, too, needed to find a way to finance his studies. He took a job trading stocks by telephone at the Berlin Stock Exchange, where he discovered, to his happiness, that his knowledge of math enabled him to make quick currency conversion calculations for currency trades. Thus, Jacobson began to succeed as a day trader even as he helped support his family’s failing business and his own medical studies.

In 1929, Jacobson graduated from medical school. The only thing he needed to complete his requirements for a medical license was his final internship, which he took at the Charité University Hospital. His surgery internship was at the Surgical University Clinic, where he had worked under Dr. Bier, and where he had learned how biological cells operate, reproduce and can be regenerated.

Jacobson, while on a vacation from his internship at the surgical hospital, made a short trip to Marienbad to join his parents, who were staying at the health spa, bathing in the natural springs, and simply taking a break from the economic worries afflicting most of Germany, particularly Berlin. It was at Marienbad where Jacobson met a quiet and studious young woman named Alice Lowner. The two hit it off and became engaged. The couple decided to get married after Jacobson received his medical degree, which he did. He then became a general practitioner with his own office while volunteering as a surgical assistant to Dr. Bier.

With a new wife and a newly minted medical degree, with a new office as a general practitioner, and with what he hoped was a bright future before him, Dr. Max Jacobson thus began the third phase of his young life as a professional physician in Berlin.