A Curious Letter in the Archives: Jonas Friedenwald and the New Duke University School of Medicine

An interesting letter about an important figure in the history of American ophthalmology was recently discovered in the archives of the Duke University School of Medicine, Durham, NC. The letter, dated September 29, 1929, is from Dr Julian Deryl Hart (1894-1980) to Dr Wilbert Cornell Davison (1897-1972).¹ In the letter, Hart discusses plans for the new Duke University School of Medicine. Midway through the letter, Hart writes,

I think Friedenwald is a good man, but I do not know how he will go down there. I rather felt it advisable to keep away from that race on the clinical side. I do not know how well he works in eye, but when he was an interne on medicine and was permitted to come over to surgery for 4 months preparatory before going into eye work, he laid down on the job, a few talks did no good, and he was fired. Medicine took him back on, and I am 1 of the 3 or 4 who know about this. Hohman was resident and was instrumental in his being fired. I was consulted since it was thought that I might be able to get someone to take his place. I was substituting in the house as a student at the time.¹

The recipient of the letter, Davison, was born in Grand Rapids, Mich. The son of a Methodist minister, he grew up while being moved from parish to parish. Davison entered Princeton University in 1909, earned membership in Phi Beta Kappa, and was active in water polo. He won a Rhodes Scholarship in 1913 for study at Oxford University, Oxford, England. Using the catalog from The Johns Hopkins School of Medicine as a guide, he outlined a course of study at Oxford under the supervision of Sir William Osler, the Regis professor of medicine. Davison received BA and BSc degrees from Oxford University. He attended Osler's weekly ward rounds at the Radcliffe Infirmary and frequently spent time at Osler's house. In 1916, Davison returned to the United States. He was given credit for 3 years of the usual medical school curriculum and entered the senior class at The Johns Hopkins School of Medicine, Baltimore, Md.^2,3

From 1919 to 1927, Davison held a variety of teaching and administrative posts in the Department of Pediatrics at The Johns Hopkins University, published 36 papers and 2 books, and became assistant dean. On the recommendation of Dr William H. Welch, of The Johns Hopkins University, Davison was appointed founding dean of the Duke University School of Medicine in 1927. The medical school and the hospital opened in 1930.^2,3

The author of the letter, Julian Deryl Hart, was a native of Georgia. Hart held a BA degree and an AM degree in mathematics from Emory University, Atlanta, and received an MD degree from The Johns Hopkins University in 1921. He completed a surgical internship with Dr William S. Halstead and served for 8 years as a surgical house officer at The Johns Hopkins Hospital. Hart, a reserved and formal man, was skilled in mathematics and in administrative matters. Davison named him Duke's first chairman of surgery. Later in his career, Hart became well known for his use of UV light as a method of reducing the frequency of operative infection. He served as president of Duke University from 1960 to 1963.³

Leslie Benjamin Hohman (1891-1972), mentioned in passing in Hart's letter, was a graduate of the University of Missouri, Columbia, and received an MD degree from The Johns Hopkins University. After serving in World War I, he studied neuropathology at the University of Vienna, Vienna, Austria, and then joined The Johns Hopkins University faculty in 1924. Hohman, a professor of psychiatry, would join Hart and Davison as an original faculty member at Duke University School of Medicine.³

Jonas S. Friedenwald (1897-1955) was born in Baltimore, Md (Figure). He inherited a great tradition of leadership in ophthalmology from his grandfather, Dr Aaron Friedenwald, one of the first ophthalmologists in Baltimore. Jonas' father, Harry Friedenwald, was also a distinguished ophthalmologist, scholar, and medical historian. Jonas' 2 uncles were Julius Friedenwald (1866-1941), professor of gastroenterology at the University of Maryland School of Medicine, and Dr Edgar Friedenwald, a professor of clinical pediatrics.^4,5

Jonas Friedenwald graduated from the Friends School of Baltimore in 1913 and from The Johns Hopkins University in 1916. In 1918, he was elected president of the Inter-Collegiate Zionist Association of America.⁵ He graduated from The Johns Hopkins Medical School in 1920 and, according to his biographies and the catalog of The Johns Hopkins University School of Medicine, spent a year as an intern on the medical service at The Johns Hopkins Hospital. There is no indication in his biographies that he was fired (Allen Harrison, MA, material cultural archivist of The Johns Hopkins Medical Institutions, written communication, February 3, 2006).^6-10 He then moved to Boston, Mass, and spent a year in ophthalmic pathology under the direction of Dr Frederick Verhoeff, and was granted an MA degree from Harvard University.⁷ A second year of training in ophthalmology took place under the clinical preceptorship of Dr George D. Schweinitz of Philadelphia, Pa. Returning to Baltimore, Friedenwald began a practice of ophthalmology with his father at 1212-1214 Eutaw Pl, and was appointed director of the pathology laboratory at the Wilmer Eye Institute, The Johns Hopkins Hospital (Allen Harrison, MA, material cultural archivist of The Johns Hopkins Medical Institutions, written communication, February 3, 2006).^7-9

Friedenwald's scientific contributions to ophthalmology are well known.¹⁰ He was the author of more than 140 scientific papers and the textbook Pathology of the Eye. He was considered one of the country's outstanding ophthalmic pathologists and was a recognized investigator in ocular histochemistry, biochemistry, and intraocular fluid movement.^7,11 Among his most notable awards were the Howe medal for distinction in ophthalmology by the American Ophthalmological Society in 1951, the Ophthalmic Research medal by the American Medical Association in 1935, the Donders medal by the Dutch Ophthalmologic Society in 1952, the Jackson Lecture of the American Academy of Ophthalmology and Otolaryngology, and the first Proctor Award of the Association for Research in Ophthalmology, both in 1948 (Allen Harrison, MA, written communication, February 3, 2006).^9,10 He was an active supporter of the Hebrew University of Jerusalem Medical School, and a wing of the Hadassah Medical Center was named in his honor.^6,12 After his death, Friedenwald was eulogized by his colleagues in ophthalmology^12,13 and by Felix Frankfurter, associate justice of the US Supreme Court.¹⁴ Frankfurter said Friedenwald had “a superlative brain” and “undoubtedly learned more in one year than the average student could assimilate in three.”^14(p30) He was viewed by a contemporary as “an intellectual giant, productive, and phenomenally successful in fostering research . . . one of the warmest and most pleasant persons I ever had the privilege of working with” (Arnall Patz, MD, oral communication, April 3, 2006).

The letter from Hart to Davison is clearly part of an exchange about who should be hired to the faculty of the new Duke University School of Medicine. I cannot locate a letter that initially proposed Friedenwald's name for the Duke University faculty; however, it seems that Hart is responding to such a recommendation.

There are 2 notable excerpts in the letter. First is Hart's advice to “keep away from that race on the clinical side.” Hart is certainly referring to the fact that Friedenwald was Jewish.^7,12,14 Second is the allegation that Friedenwald “laid down on the job.” The massive wave of Russian Jewish immigrants to the United States at the beginning of the 20th century and the interest of these immigrants and their children in pursuing medical education produced an influx of first- and second-generation immigrant applicants to US medical schools. Overt anti-Jewish prejudice in the academic community in the United States reached a zenith when the children of these eastern European Jewish immigrants began to enter college and medical school in large numbers.¹⁵ While the Friedenwalds were an established Baltimore family and not part of the Russian immigrant wave, they were active in the Baltimore Jewish community and certainly were affected by it.

Twentieth century US quotas restricting the access of Jewish students and physicians to medical school and postgraduate training were commonplace and have been extensively documented in the literature, based on interviews and primary sources.^15-19 Jewish medical students and house officers were frequently accused by their gentile colleagues of being unsuited for the practice of medicine. Common accusations were that Jews were more suited for book work than for working with their hands and, thus, did not do well with clinical work. Other contemporary writers complained that Jewish medical students were unethical, radical, or neurotic.^18,19 Friedenwald himself recognized the pervasiveness of academic anti-Semitism. In a June 7, 1922, letter to his father, he described, with great perception, Harvard's president, A. Lawrence Lowell, who was a proponent of quotas to restrict the access of Jews to higher education:

He is a deeply anti-Semitic person, but that conflicts with his tradition of a gentleman, so he can't even admit it to himself and is forced to go into all sorts of devious routes to find excuses for himself. As a result, he has involved himself in so many dishonesties that he is trapped, and now he is trying to lie his way back again.⁷

Hart's accusation, leveled at Friedenwald, is consistent with the general academic medical anti-Semitic prejudices of the time.^7,15-19 The Duke University Department of Surgery did not have its first Jewish division chief until 1996. Freidenwald's stellar career in ophthalmology and ocular pathology indicates that Hart's accusation that he was the type of person who “laid down on the job” was unsubstantiated by subsequent events. It is clear that Hart really did “not know how well [Friedenwald] works in eye.” At the time of Friedenwald's internship, when Hart writes that “I was consulted” and Hohman “was instrumental in his being fired,” the historical record indicates that Hart was a fourth-year medical student and Hohman was pursing a career in neuropathology and psychiatry.^2,3 It seems unlikely that Johns Hopkins would have hired someone on the ophthalmology faculty who had been recently been fired from his internship.

At the time of his death, Friedenwald was an associate professor at Johns Hopkins. Dr Alan C. Woods wrote that

due to the fixed distribution of academic titles . . . the title of full professor was denied him. Nevertheless, there was never a member of the faculty who more richly deserved this title. . . . In 1933, I was appointed the administrative head of the department, a position for which Jonas Friedenwald was equally well, and probably better, qualified than I was. . . . If my selection was a personal disappointment to Jonas, he never showed it by word or by deed.”^14(pp27,28)

Friedenwald was not fond of administrative work and probably did not actively seek the position of department head (David Epstein, MD, MMM, written communication, March 3, 2006). Unsubstantiated rumors of anti-Semitism have been associated with Friedenwald's lack of promotion to full professor and director at Johns Hopkins, but there is no evidence that Friedenwald himself ever leveled such a charge.⁶

Hart's comment that it was “advisable to keep away from that race on the clinical side” is representative of the prevalence of anti-Semitism in US medical schools at the time.^15-19 In view of Friedenwald's career, it seems highly unlikely that he “laid down on the job” as an intern. Dr Arnall Patz, a colleague of Friedenwald, labels this allegation “inconceivable” (David Epstein, MD, MBA, written communication, March 3, 2006). Friedenwald had close ties to family, friends, and professional colleagues in Baltimore, particularly his father and sister. He would never have seriously considered leaving Baltimore (Arnall Patz, MD, oral communication, April 3, 2006, and David Epstein, MD, MMM, written communication, March 3, 2006).⁷ Perhaps the ophthalmologic community should be grateful that Friedenwald was neither offered nor ever considered taking a position at Duke University.

Correspondence: Edward C. Halperin, MD, MA, FACR, University of Louisville School of Medicine, Abell Administration Bldg, 323 E Chestnut St, Louisville, KY 40202-3866 (edward.halperin@louisville.edu).

Submitted for Publication: April 4, 2006; accepted April 25, 2006.

Author Contributions: Dr Halperin had full access to all the documents and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Financial Disclosure: None reported.

Funding/Support: This project was funded in part by a grant from the Josiah Charles Trent Memorial Foundation, Inc.

Acknowledgment: I am grateful for the assistance of Emily J. Glenn and Suzanne Porter of the Duke University Medical Center Library and Archives; Erin L. Titter, Archivist and Librarian of the Jewish Museum of Maryland; Andrew Harrison of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions; and Walter Campbell, PhD, who brought the letter to my attention.