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Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990.

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Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.

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Trudeau at Lake Saranac

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When Edward L. Trudeau was carried to the Adirondack Mountains of New York in 1873 at age 24, "it was to die," he later remarked. He had graduated from the College of Physicians and Surgeons of Columbia University in 1871, had entered general practice in New York City, and had been married less than a year when Janeway found the upper two-thirds of his left lung involved by active tuberculosis. The effect on Trudeau's life was overwhelming. In his autobiography he wrote:

I think I know something of the feelings of the man at the bar who is told he is to be hanged on a given date, for in those days pulmonary consumption was considered an absolutely fatal disease. I pulled myself together—escaped from the office, after thanking the doctor for his examination. When I got outside, I felt stunned. It seemed to me the world had suddenly grown dark. The sun was shining, and the street was filled with the rush and noise of traffic but to me the world had lost every vestige of brightness. I had consumption—that most fatal of diseases! Had I not seen all its horrors in my brother's case? It meant death and I had never thought of death before! Was I ready to die? How could I tell my wife whom I had just left in unconscious happiness with the little baby in our new house? And my rose-coloured dreams of achievement and professional success in New York. They were all shattered now, and in their place only exile and the inevitable end remained. (1916)

What transpired in Trudeau's 43 years at Lake Saranac in the Adirondacks was remarkable. With virtually no knowledge of bacteriology and no scientific training, he began investigations on tuberculosis and a medical practice that would eventually draw patients from all over the world. The attraction, apart from his vivacious personality, was the sanatorium Trudeau established at Lake Saranac, the first devoted exclusively to the treatment of tuberculosis in the United States of America.

The investigative work of Trudeau concerned primarily the tubercle bacillus. He was the first in this country to cultivate it, and his Environment Experiment, conducted in 1886 and 1887, was simple and brilliant. He found that: (1) rabbits subject to confinement, bad air, and restricted food, but not the bacillus, did not contract tuberculosis; (2) rabbits under the same poor conditions, inoculated with the bacillus, suffered greatly from tuberculosis; and (3) rabbits similarly inoculated, but turned loose on an island near his camp, recovered. This experiment gave him confidence in the environmental therapy he advocated to his patients:

This showed me conclusively that bad surroundings of themselves could not produce tuberculosis, and when once the germs gained access to the body, the course of the disease was greatly influenced, by a favorable or an unfavorable environment. The essence of sanitarium treatment was a favorable environment so far as climate, fresh air, food, and regulation of the patient's habits were concerned, and I felt greatly encouraged as to the soundness of the method of treatment the sanitarium represented, even though it did not aim directly at the destruction of the germ. (Trudeau, 1916)

Trudeau was much loved by his patients, who included Robert Louis Stevenson in 1887. Although Stevenson was "not really ill," according to Trudeau, the two men enjoyed stimulating conversation and became friends. Trudeau loved the Adirondack wilderness and was an avid hunter and fisherman. His skill with the gun and rod gained him the admiration and frequent fellowship of mountain guides. Cabot said of Trudeau:

In 1888, when I first saw him, he was splendid, to look at. His upright, trig, military carriage, his fine, resonant voice, the warmth and beauty of his smile, struck everyone at first glance. These three attributes he preserved even to the end of his life. They were all manifestations of his unquenchable courage. (Cabot, 1915)

Osler (1915) wrote that Trudeau "had the good fortune to be made of the stuff that attracts to himself only the best, as a magnet picks out iron" (p. 20).

Trudeau wrote 53 medical papers, most of them short, often representing experimental work of 5 or more years. He confined himself mostly to pulmonology, in which field his diagnostic and prognostic abilities were exquisite:

These he used for years with wisdom and skill in determining just who, among the many patients who presented themselves as applicants for admission to the sanitarium, were most likely to be benefited by the advantages which it offered. As he has said himself, this was not an easy task; it was one in the exercise of which he was often criticized; but it was precisely those patients in whom the process was at its earliest stages, to whom the sanitarium was especially likely to give that help which might turn the scale. From this standpoint Dr. Trudeau exercised remarkable ability and discrimination. But often he went farther and exercised an insight and charity so exquisite that those of us who have experienced it can never forget. He knew not only how to choose those whose lives were most likely to be saved; but he knew how to choose those whose lives were most worth saving. (Laennec Society, 1916)

Trudeau left a legacy in pulmonology. He was not only a careful clinician and investigator but also a magnificent teacher. No young physician under him ever voluntarily left his service.

References

  1. Cabot RC. Edward Livingston Trudeau, MD. Am J Med Sci. 1915;150:781–783.
  2. Laennec Society. Memorial meeting to Dr. E. L Trudeau. Johns Hopkins Hosp Bull. 1916;27:96–107.
  3. Osler WA. A tribute to Dr. Edward L. Trudeau—a medical pioneer. Am Med. 1915;21:20–21.
  4. Trudeau EL. An autobiography. New York: Doubleday, 1916.
Copyright © 1990, Butterworth Publishers, a division of Reed Publishing.
Bookshelf ID: NBK699PMID: 21250278
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