Some

Personal Recollections

of

Dr. Janeway



By

James Bayard Clark



G. P. Putnam's Sons New York and London The Knickerbocker Press 1917



COPYRIGHT, 1917 BY JAMES BAYARD CLARK



The Knickerbocker Press, New York



BIOGRAPHICAL NOTE

Edward Gamaliel Janeway was born in New Brunswick, New Jersey, August 31, 1841. He was graduated from Rutgers College in 1860, receiving the degree of B.A. and M.A. from that institution. In 1864 he was graduated from the College of Physicians and Surgeons in New York, receiving the degree of M.D. Later in life, the degree of LL.D. was conferred upon him, by Rutgers in 1898, by Columbia in 1904, and by Princeton in 1907. While in the medical school in the years 1862 and 1863, he was made acting medical cadet in the United States Army hospitals at Newark, New Jersey.

He began to practise medicine in New York City where he continued and ended his professional career. In 1869, he became professor of pathology and practical anatomy in Bellevue Hospital Medical College, continuing in that capacity until 1876. From 1868 to 1871 he was visiting physician to Charity Hospital. In 1871 he became visiting physician to Bellevue Hospital where he remained for many years and where, in the pathological department, he won such distinction. He later became visiting and consulting physician to other hospitals in the city.

In 1874 he was vice-president of the New York Pathological Society. From 1875 till 1882, he was Health Commissioner of New York. In 1876 he was president of the New York Medical Journal Association. His principal contributions to medical literature appear in the medical journals of New York.

He was president of the Academy of Medicine in 1897 and 1898 and a trustee from 1899 until 1903.

He died in Summit, New Jersey, on February 10, 1911.



IN MEMORIAM

On April 6, 1911, the Fellows of the New York Academy of Medicine met to honour his memory and to give reverent tribute to the sum of his accomplishments as Pathologist, Sanitarian and Physician.



Some Personal Recollections of Dr. Janeway



I

What it is that has kept urging me to write down these recollections of Edward Gamaliel Janeway, the physician, would indeed be rather hard to define, but the desire to record a little something of what I had personally come to know of this unusual man made itself felt very shortly after his death, now over five years ago. Since that time this feeling—steadily growing—seems irresistibly to have drawn me on to this endeavour to add some little part to the perpetuation of his memory—this man, who without pretence held the reputation of—one stops to take a breath before writing it—the reputation of being the best diagnostician in the world.

If by some happy chance these pen-pictured glimpses should bear some likeness to the man—if they should bring out here and there a line or colour which will recall some characteristic, show some quality, reveal some trait which, for those who knew him, will help to keep his memory fresh, they will have earned for themselves a very good reward. But beyond this, if they should fall to the notice of a younger generation and, more especially, to those choosing the profession of the physician, and the reader can discern therein something of the man himself, can get some glimpse of his life and its meaning, can gain some sense of the sincerity, the simplicity, the self-sacrifice and singleness of purpose which guided him and finally lifted him so far out of and above the ordinary, then will the pleasant task of recalling fully justify this venturesome effort.

* * * * *

It was in the midst of my medical schooldays and in the unrestraint of Adirondack holidays twenty years ago that I first met Dr. Janeway. As I look back at this first memory I can see a vigorous, well-built man a little way on in the fifties, dressed for a mountain climb or a game of golf. His fine, firm-featured face would have struck one as rather stern if one happened to miss that blessed kindliness which always lighted his steady eyes. Though dressed for outing, it was not difficult to see by a brief study of his face that his choice of exercise was intellectual rather than physical, yet he went to his game or his walk with the same directness of purpose with which he went to his work.

Ordinary social intercourse was an effort for him. It seemed as if he had to focus his mind down to the mental horizon of the everyday world of everyday people around him, yet he did not appear impatient of the small talk going on about him so long as it was plain he was not to take part in it himself.

One characteristic which never failed to impress those who met him was his reserve. It was the quality of it which was so striking. It was not a reserve which was raised of aloofness; there was no particle of that, no self-esteem, no egoism—common builders of reserve—yet on the other hand it was not the retreat of shyness as many might have thought, though out of it a certain constraint was undoubtedly born. One might almost say it was a result rather than a reserve; the result of a something hard at work within; a preoccupying something; a gestating something, the offspring of which was—well—what he was.

Another quality which leaves itself deep carved in the memory of these early days of acquaintance was the quiet, unconscious respect he seemed, with equal unconsciousness, to inspire in all about him; and more, even in those who in kinship and friendship were closest to him, and with a constancy which never wavered. In those days only the more evident traits of his character came home to me. It was rather by feeling, by intuition, that he impressed me. I had no measure of my own with which to estimate his mental attainments. I had a kind of awe, of hero-worship in knowing him, which left me reticent in the discussion of any medical matters with him—so I usually stuck in those days to safer subjects.

It was not until two or three years later, after I was graduated, that I had any association of a professional nature with him. It was near the end of the summer, up in the mountains. An elderly lady, a member of a well-known family, was suddenly taken ill. I was hurriedly called to see her, and on arriving at her cottage was told that Dr. Janeway had been sent for also and would be there soon; but they were anxious to have me go to the patient at once. The state of excitement into which this, my first professional call, threw me, was in itself enough without the crushing thought of what the great man might think of me, a then full-fledged M.D. I was ushered into the bedroom where she lay, totally unconscious and breathing heavily. As I hastened to the house, I had been formulating in my mind just the questions I should put to her—for I had learned in the medical school how to take a careful history—and there she lay without speech, without hearing, and without response. As I stood looking at her I could feel, rather than see, the family anxiously crowding about the doorway, waiting for me to tell them just what the trouble was, how serious it was, what were the chances of her recovery. At that moment I wondered why I had ever thought of studying medicine. I sat down by the bedside and felt her pulse. Why was she unconscious? I tried to think of all the things which caused a state of unconsciousness. Suppose she should die before I could think of what the trouble was, and before I could do anything to save her life! The thought was staggering! And then as I looked down at the patient again I realized, alas, that my chance of making a diagnosis to give to the family and then to proudly repeat it to Dr. Janeway, had vanished—for at that moment the doctor's voice could be heard outside the door and the next he was quietly stepping into the room. As he came forward, I stood aside to give him my place at the bedside. He asked one or two simple questions which I was fortunately able to answer. As I look back, I feel sure he did this to put me at my ease. This was the first time I had ever seen Dr. Janeway in the sick-room. It would be hard to describe the difference between this man I now saw examining the sick woman and the Dr. Janeway I had known before. There was a light in his eyes and an alertness in his voice, entirely new to me, as he deftly built up his diagnosis, pointing out this physical sign and that, until the complete pathological picture seemed to stand out as on the page of a book.

A little later as we came out from a talk with the family, he turned to them and said: "Now the doctor and I wish to have a little consultation together." How well I remember my feelings at that moment as he led me into a room apart and closed the door. Anticipating what seemed to me inevitable I said: "Of course, Dr. Janeway, they will want someone who is older, someone with more—" He cut me short with, "You are going to take care of her." "But—but—" I said. As if reading my thoughts he smiled as he remarked: "That's what we are going to talk over now. Get a pencil and paper and we will outline the necessary treatment." I wrote down what he suggested, we arranged about getting the trained nurses, and then, somehow, as the Doctor rose to go, the feeling came over me that after all this was more of a job than, perhaps, I had any right to undertake alone. I stood for a moment with these thoughts in my mind when the Doctor put his hand on my shoulder and said: "If things don't go just right come up any time and see me and we'll have a little talk; or if you need me here, let me know. I am going now to tell the family you will take charge of this case."

And thus it was that the old lady was guided back to consciousness and comfort by the steady head and generous hand in the background; while the fledgeling physician reaped praise for her progress.



II

It was not until a year or two later that I was again brought, in a medical way, into association with the Doctor. It happened to be at the beginning of summer and at a time when I was waiting for a hospital position in the fall, that I received word from him offering me a position in his office in New York to take the place of his regular laboratory assistant who was to be away for several months. No offer before or since ever sounded so good to me. The morning of the appointed day saw me there bright and early. This was to be a rare opportunity. I felt it then; I know it now. Some of the secrets of his greatness were to be unfolded to me, and I was eager for the work which would teach me something of his ways.

I was shown to the laboratory which was to be my special province. This was equipped for carrying out by microscopical and chemical analysis, all the practical tests which were necessary, as well as some bacterial breeding. Absolute accuracy of results was the single aim and the simple motto of this workshop. It was a room built on at the back of the house, where light and quiet were assured. To the front of this were the waiting-rooms for the patients, and at the front of the house, the Doctor's office. Simple and sound and always of the best quality, would serve as a description of the furnishings; there was a striking similarity between these and the advice that a patient was sure to receive.

Several days went by without seeing much of the Doctor beyond saying "good-morning," but no time went by without feeling that force in the farther office. It seemed to shape itself into one's work, into one's results. One was not told to do his best—it would not have been necessary; somehow, one did it.

One day about noon, word came from the Doctor asking me to lunch with him upstairs after the morning's work was finished, which was usually half-past one. We sat down to table together, his family being away for the summer, and luncheon was served. I waited quietly to hear what the Doctor wished to speak with me about, but as he said nothing, we ate on in silence until the end of the meal. When we rose to leave the table, the Doctor turned to me and in his blunt way said: "Better have your lunch here every day." As he hurried off to keep an appointment, the suspicion fell across my mind that perhaps he had surmised that my pocketbook would be better for this little noonday rest he was suggesting; but quite apart from that, I was more than glad to have this extra opportunity of being with him and of learning from him.

For some little time we met daily at lunch without the conversation getting much above the level of the small civilities incident to eating, when one day it suddenly came over me that I was not making the best of my opportunities. But Dr. Janeway was a man of very few words. Through doing, not talking, had he risen to his reputation—to his results. How was I to begin? How was I to gain his interest? Surely not by airing that new and conventional structure of scanty knowledge the medical school had so recently assisted me in setting up in my mind, its storerooms so empty of experience, its machinery still rigid for want of real use. No, I did not mean to burden him by trying to open the ball of intercourse in that direction. And yet, if somehow we could only get on some common ground, and I could commence to learn something from his rich experience; if, somehow, I could get by my diffidence of nature in the presence of his depth of knowledge!

I do not know how it came about, as he sat there opposite me, so serious, so silent, but something seemed suddenly to plunge my mind into a perfectly irrelevant region of thought, and drag therefrom to the surface some droll tale I had happened to hear only a few days since. Before I knew it, I was telling the Doctor that story. Fools rush in; but there is a Providence that cares for them, for the Doctor enjoyed it—he laughed, and from then on interchange of thought was less restrained.



III

As time went on, the structural elements of this extraordinary man's character became more and more evident. He was then at the very apogee of his useful career. His fame had found its way around the world. The makings of a material monument were within his easy reach—the thing which spells supreme success in life for so many men and women, and not a few physicians, was at his very door had he cared to look in that direction; yet his face was set steadily forward toward other things. If his income was ample, his energy was enormous, and he spent both freely for the best interests of his profession and his people whom he loved. One hears of the fabulous fees physicians sometimes get. Dr. Janeway never used his unique position to prey upon the pockets of patients, simply because they were people of large worldly wealth. To him a patient was a human being who was sick and who needed to get well by the shortest possible route science and sense could secure. Each patient also provided a problem, and it was here where his masterly mind with its prodigious store of pathological information, derived a singular satisfaction. Illustrating the Doctor's direction of mind in matters of money in comparison with his interest in the patient's condition, this story, which belongs to the period of his beginning prominence, is significant even if its verity cannot be vouched for.

To one of the smaller Hudson River valley towns the Doctor was called by a local practitioner to see in consultation a man noted for his wealth, who lay critically ill. All the afternoon and evening were consumed in this rather trying trip. When the next morning at breakfast his wife made some mention of his arduous journey of the previous day, his face lighted up with interest at the recollection. To a practical wife, what could be more natural than an interest which embraced with some satisfaction the thought of her husband's immediate reward—that reward which could be readily converted into the shoes and frocks constantly needed by the little brood about her? So led on with the thought in her mind, she inquired how far the Doctor had travelled—the town to which he had gone. He told her with readiness the name of the railway station where the practitioner had met him and driven him to the patient's house; then his face relighting with the memory of the case which had so engrossed him, came out in his characteristic way with: "Very sick man; pneumonia; unusual type—very unusual." "But that very long trip, a whole afternoon and evening, that should mean a pretty good fee," said his wife. The Doctor, his mind still occupied with the sick man's problem, replied: "It was in the upper lobe, right side, quite solid, very rare—very rare to see that in these cases."

Then very gently from his wife came: "Did you remember to put down his address?" "No, no," was the somewhat irritable response. His mind then going back to the patient again: "But I have my notes on the case—on his condition." "But his name?" she came out with, "so that you can send your bill; you put that down?" "His name?" repeated the Doctor slowly, a slight frown of annoyance coming over his face as his train of thought was by then definitely derailed. "His name? No. Didn't get that."



IV

One morning I happened, for some reason or other, to be in the Doctor's office. A lady from a near-by town had been consulting him. As she was about to leave, she said: "Tell me, Dr. Janeway, about Dr. N. in our town. We have just gone there to live, you know, and we want to be sure to have the best doctor in case we have to call one in." Dr. Janeway replied: "You cannot do better than Dr. N. I know him very well. He is a good doctor. He won't do you any harm." The lady went away and I went back to my work in the laboratory, but that phrase kept ringing in my ears. "He is a very good doctor. He won't do you any harm." What had he meant by that? I kept wondering. Well, the woman seemed to be satisfied; at least she went away without further comment. Later on—perhaps two or three weeks later—I heard him make very much the same remark again: "Dr. R. is an excellent doctor. He won't do you any harm." I did not understand his meaning then, but the thing got stuck in my mind, and I remembered it. It was some years, I think, before that saying, for it would keep coming back to me, commenced to make its real impression. Then, as time and experience went on, clearer and clearer became its significance until I have come to see it as an expression of that wisdom—that deeper wisdom of the man whose simple words often revealed such subtle truths.



V

Dr. Janeway's relation to his profession and to his fellow physicians was one of rare felicity, and well it might have been, for his code of professional conduct stood squarely upon that principle of consideration for others, on which the hope of a some-time civilization in reality, must ever rest. "Do unto others as you would have them do unto you," was more than his motto; it was his motive; more than his precept, it was his practice. The revised version: "Do others before they do you," which has come so largely into recent vogue, both professionally as well as commercially, would have had little appeal to a man whose real goal lay so far on beyond personal position and private gain. In no better place than here, with his simple and straight code of conduct, can I mention something of Dr. Janeway's religion.

In days when doctors are flying from creeds and more—from faith, seeking to solace their souls in science alone, this great man's simple adherence to the teachings of Christ become dramatic proof of his powers of vision. But it was not the conventional Christ drawing a fashionable flock to a Sunday morning service to church and a Monday morning service to self, which gave the angle to this man's uprightness; his religion was one of action rather than exhibition; he used it to control his own life rather than to coerce the lives of others.



VI

There is one notably outstanding memory of Dr. Janeway which dates from those earlier days in his office and which deals with that large class of people who imagine they are ill—those people whose numbers are directly proportionate to periods of so-called prosperity, who call forth innumerable cults of curing, and who are the mainstay of much of the mummery in medicine.

I shall never forget one day at lunch after Dr. Janeway had been seeing some of these mentally mortgaged men and women. As he sat down at table his face wore that expression of perplexity which one at times sees as the outward sign of that inward sense of the futility of things in general. I inquired how matters had been going in the office that morning. His reply, "Neurasthenics!" as it came out with all his characteristic bluntness, set me to asking questions. What I learned that day from the Doctor, coupled with later observations of his methods in dealing with these unfortunates, has never needed unlearning. He saw in these patients, wholly free from organic disorder, yet a prey to aches and obsessions, to fears and depressions, the unhappy results of that conflict in the subconscious self between the natural order of life and the socially ordered life. He saw it and I am sure sorrowed over it. Yet he never entered into a compact to treat them for what he knew they did not have. He never left a stone unturned to prove to himself that they suffered from no physical fault, and with his positive terseness he rarely failed to prove that fact to them—freeing them, oftentimes for good and all, from the fears and symptoms which assailed them, and giving them in few and frank terms the key to their unconscious calamity.



VII

All too soon for me passed that period of service in Dr. Janeway's office, but as good fortune would have it, my future was still to feel the touch of that fine association.

A year later, when my hospital work as an interne was over, Dr. Janeway's son, Dr. Theodore Janeway, asked me to make my office in his house. This arrangement continued for two or three years, when I found myself going to Europe for a winter's special study. With my return to New York, the necessity of a larger office brought that one-time closer affiliation with the Doctor to an end. But the seeds were planted which were destined to bear for me the fruit of one of those infrequent friendships, the influence of which still goes on, finding fresh inspiration from its memory.

I had not been long in my new quarters before I again began to feel the result of Dr. Janeway's and his son's thoughts of me, for it was from them that many of my first patients were referred, and it was from this beginning that the happy relationship with the Doctor was steadily continued as long as he remained in practice.

There was one remarkable thing about all these patients who came from Dr. Janeway's office, or to those I was called to see at his suggestion; one thing in which they seemed to differ from all other patients. They came full of that faith which his thoughtful study and understanding of their cases forced them to feel—and full of that faith which the deep sincerity of his interest in their welfare inspired. It made my part easy and it helped secure good results for the patients, from whom I would often harvest a gratitude where he had scattered the seeds, and reap a reward which was due to his husbandry.

It may be trite, nothing more than a frayed commonplace, perhaps, to say that the force of good goes on, is never lost—yet the sincere, the straight, the strong something that went out from this man and entered into others, certainly continued on, and was not lost.



VIII

Self-contained and self-controlled as Dr. Janeway was, there were some things which kindled his righteous wrath to a state of militant activity. And one of these was petty political plotting in the ranks of his own profession—the profession he loved and believed in as an institution of sound progress when not soiled by selfish purpose. An instance of this came to me through a personal experience. It was soon after my return from study abroad, while I was seeking a suitable position in a city hospital. This particular place was all but secured when another post was offered to me by the head of one of the largest medical institutions in town. With youthful naivete, I expressed my appreciation of the offer but explained my reasons for wishing to secure the appointment I had been seeking. Incensed by the fact that I did not directly jump at his offer, the noted doctor brought the interview rapidly to an end, and I departed. Some weeks went by and from the position which I had been in quest of and from which I should have received word, I heard nothing. And then, I found out why. The powerful gentleman, whose offer I had not accepted, had lost no time in going to the hospital head who had practically arranged to assign me to the desired position, and telling him it would be a great mistake to give me the post.

When Dr. Janeway found this out, it was plain that there was still another side to the Doctor, for his strength to strike out at foul play showed its sufficient force on that occasion. It is almost needless to say that the desired appointment was very soon mine.



IX

There were three things I should say the Doctor did not like. One of these was the newspaper reporter who tried to get "inside" information when some especially prominent person happened to be a patient of his. This was not just a simple, single-sided dislike which the Doctor felt, either. The idea of any physician inviting press publicity was bad enough, but the idea of any physician telling the public about the private affairs of a patient was—well—. I happened one day to be with the Doctor when a reporter approached on such an errand, so I know quite well how the Doctor felt on this subject, and I am inclined to believe the reporter must also have carried away some impression of it.

The other two things the Doctor seemed to dislike were writing medical papers and speaking in public; anything, in short, which might by any chance give an impression of putting himself forward, was distasteful to him. As for display of any sort, any external polishing, for the purpose of appearing prosperous and thus inviting prosperity, would have been to Dr. Janeway utterly impossible.

As far as personal success and advancement went, I am convinced his mind was never concerned beyond that measure of reward which might openly be balanced against actual attainment and actual ability. What a sorrowful satisfaction that would be for many of us!



X

Now that these few ingredients of Dr. Janeway's greatness, which have come out of memory to mind, have found their way to paper, it is hoped they may not wholly miss their mark. Incomplete though the picture is, it should carry some clue to the character of the man who made the profession of medicine a finer and a better profession for his having been in it. To bring into any walk of life so much talent and truth, so much candour and courage, and withal, such simplicity and sincerity, is to leave it raised to a higher level for all time.

Such lives need no tribute to their memory. On the contrary, they levy an unforgettable tax on all who would live on by lower standards.

To those whose minds can grasp the general disorder in which we try to live—the moral indirection of our everyday endeavour to get somewhere, this day toward a gilded goal, tomorrow toward the promise of fame, the day after seeking applause for our benevolence, or one after one thing, another after another thing, and hardly any one after anything that counts—it is to these that this man's unaffected, unselfish, upbuilding life must come as a strong and refreshing draught of reality.

A life worth knowing about for those with ideals; a life to study for those who are sincere; a life with a lesson for every student of medicine.

THE END