Background

During the first half of this semester, we studied three articles that emphasized the structure and function of hemoglobin in physical and chemical terms. We now leave that theme temporarily in order to pick up a second theme that will eventually will merge with the first. Our next article contrasts in a number of ways with our earlier articles. As a medical case study, it deals with human illness and relies on careful description and differential diagnosis rather than experimentation. Physicians, like Herrick, seek to understand the causes and discover effective treatments for human disease. In order to do that properly, they must first describe accurately the unusual symptoms and syndromes of their affected patients. After a physical examination and patient interview, physicians usually examine and analyze blood (1). Why examine blood? A recent article (2) answers the question as follows:

"Abnormalities in the blood may be either the cause or the result of disease. Because of the information these abnormalities convey to a physician, and because a sample of blood can be taken in almost any clinical setting, the complete blood count is one of the tests most frequently performed in the medical laboratory. The complete blood count includes measurement of the total quantity of red blood cells, white blood cells and their subtypes, and platelets. Each component of the blood has its own function (2)."

As you will see, Herrick knew he had discovered a previously undescribed human condition but he was totally stumped as to its cause. In 1910 when Herrick published his article on sickle cell anemia, the germ theory of disease was well established (3). Disease-causing viruses had been discovered recently in plants and animals (4). A few nutritional diseases such as scurvy (5,6) and beriberi (7) were known. Archibald Garrod (8) had recently published his classic work on inborn errors of metabolism (9). However, antibiotics were decades away and the causes of major diseases such as cancer and atherosclerosis were unknown. The nature of medicine changed considerably in the late 1800's and early 1900's, and blood analysis was one of the new techniques available to physicians. The first accurate estimate of the number of red blood cells in blood was done in 1852 (10). Many of the cytochemical staining techniques used on blood cells were rather new in 1900. "Routine" blood analyses were routine only at major hospitals. Herrick worked at a time when medicine was becoming a science and there was tension between the traditional patient-oriented approach and the newer laboratory approaches to diagnosis (11).

James Bryant Herrick, M.D. (1861 - 1954) became a nationally recognized heart specialist (12). He was the attending physician for Ernest Edward Irons, M.D. (1877 - 1959), then an intern who became the president of the American Medical Association in 1949 (12). Although Irons had most of the patient contact and did the blood analyses, Herrick was the author of the first clinical description of sickle cell anemia. Neither physician became a specialist on the condition. They lost track of their patient before the article was published. Over half a century later, Dr. Todd Savitt, a medical historian with an interest in African American medicine (13) and now at East Carolina School of Medicine, tracked down the identity of the patient. More recently, he has published on the second reported case of sickle cell anemia (14). Dr. Savitt visited here in 1994 and told the class that fascinating story (12).