Dr. Feelgood (5 page)

Max described his neighborhood as a series of houses built around courtyards, separated from each other by tall, wrought-iron fences topped with sharp spikes. During the day, street merchants would enter the courtyards and call out, “Chairs to mend!” or “Knives to sharpen!” or whatever services they had to offer. Before the advent of shopping malls and centers, almost all of the commercial and retail activity was done in this manner, with many voices echoing off of many walls.

Max remembered the organ grinders in particular, along with other street musicians who traveled the neighborhoods. Children poked their heads out of windows in wonderment at the entertainment, and their parents, if they had the money, would throw coins into the courtyards. He was told that the coins people threw at them were the only way the street performers could manage to pay for their next meal. And those stories touched the young Max Jacobson. It was one of these very street performers, grinding away on his box organ while his costumed monkey danced for coins, who led to Max Jacobson’s becoming a medical doctor.

One day an organ grinder came into the Jacobsons’ part of the courtyard with his monkey, both dressed in shabby clothes. The people living above the courtyard, as was their custom, threw open their windows and tossed coins into the yard. As he looked out the window, young Max could see that some of the coins had landed on the other side of the fence. This was a chance for Max to perform a
mitzvah
, an act of pure altruism for no other purpose than to help someone else, which was a form of
tzadikah
, or righteousness, the definition of a good deed. Max tried to retrieve the coins for the organ grinder by climbing over the courtyard fence, but as he did, he impaled himself on one of the spikes. The shock was so sudden and intense that Max only vaguely noticed any pain, but he could feel the blood running down his leg. He managed to disengage himself by pulling himself across the spike, which only made the gash worse. When he ran into the house, his mother took one look at his face and knew something was terribly wrong. Fearing he would get into trouble for climbing over the fence, Max denied anything was wrong, but there was the blood to prove it. His mother called the family doctor.

Beloved by all the village, the village doctor was a middle-aged man with a big black mustache, who was always chewing on a cigar, even when it wasn’t lit. He always arrived in a horse-drawn coach driven by a uniformed coachman wearing large boots and a top hat. And when the doctor examined his patients, he would first place his cigar in a small metal etui—a small decorative box designed to hold personal items—which he would place on the window sill so that the smoke would vent outside. He was a compassionate and understanding man, Max remembered, and embodied qualities that were reassuring to a patient. All of this clearly made an impression on young Max.

As Max stood at the window waiting for the doctor’s arrival, the doctor returned Mrs. Jacobson’s call, telling her that Max’s wound would most likely require suturing and that his son-in-law should handle the case because he was a surgeon. When the surgeon arrived in a shiny new 1905 automobile wearing a cap, goggles, and a big duster, the sight was so thrilling that Max completely forgot about his wound. The surgeon removed his gloves, duster, and jacket, washed his hands, and positioned Max across the arms of a stuffed chair to give him unobstructed access to the wound. First, the surgeon stuck an iodine-drenched piece of cotton into the wound to disinfect it. Then, without any anesthesia, he threw suture after suture through the torn skin to close it. He covered the sutures with adhesive and gauze and promised to return to look over the stitches. By the time he returned to remove them, Max’s heart was set on becoming a doctor so that he, too, could drive such a magnificent automobile.

Mrs. Jacobson was determined that, in spite of the expense, her sons would receive the benefits of higher education. She enrolled her children in the Koenigstadtische Real Gymnasium, which covered elementary school, junior high, and high school. At the end of the ninth year, an examination called
das eingaerige
(“the one-year”) was administered to students entering their sophomore year of high school. Those who passed the test earned the privilege of one year of military service rather than the compulsory three years. At the end of his twelfth year, a successful graduate received the Abiturium, a kind of automatic college acceptance, to enroll in university.

Max was a good student who studied hard and was fascinated by medicine and science. When he was eleven years old, his parents gave him a microscope as a present. He often went with his father to the slaughterhouse to obtain specimens for his microscopic observation. He discovered the structure of tissue cells, examined the nature of cow’s blood, and taught himself how to prepare slides. What Max learned on his own was stimulated by the physics, chemistry, and zoology courses he took in school. He was also enrolled in a boys club, much like today’s Boy Scouts, through which he had more opportunities to study nature.

Like many young Germans at the outbreak of World War I, Max, now fourteen, was loyal and patriotic. German Jews as well as Gentiles supported their Kaiser, who marched them off to war. Max watched as the older boys took their school exams so that they could volunteer for the army and be rushed to the front. Max remembered how his older friends made the quick transition from school clothing to army uniforms, took what today would be called “army basic training,” and then marched in formation to the music of a military band. The early successes of the Kaiser’s army made for heady news on the home front, with stories of the German invasion of Belgium and France and victory in Russia; however, this was not a nineteenth-century Prussian war. The modern weapons, such as machine guns and large artillery, were so destructive that soon Germans were reminded of the toll of war when news of the deaths of their friends and relatives made its way back home. The German economy began to strain and then buckle under the burden of war. Shortages became obvious when food stamps were issued and rationing began.

People stood in long lines to receive bare necessities, and in 1917, when Max’s brothers were already at the Italian Front in the Signal Corps, the only food that was readily available was turnips. People found them in bakery shops disguised as cakes and bread. Potatoes were luxuries, as were milk and butter. People who could afford it obtained heavily rationed items through the black market, but amid the wartime controls, both the seller and the buyer became liable to the risk of severe penalties. And public health was also an issue because black market meats were not inspected and raised the risk of trichinosis and other diseases.

In 1917, when he was seventeen, Max graduated from Real Gymnasium, and was looking at the reality of being drafted into the army and sent to the trenches on the Western Front when he turned eighteen. Friends urged him to enlist as a library assistant at the front, which would preclude him from being drafted and land him a noncombat position, at least for the duration of the war. As he weighed this option, Max also had to deal with the news that both his older brothers, Heinz and Simon, had become war casualties—Heinz from a case of dysentery and Simon from shrapnel wounds.

Max broached the idea of enlisting as a library assistant to his parents, but they rejected it out of hand. He was still seventeen and not yet an adult. However, his mother had an idea. She called Dr. Adler, her surgeon, who was the head of Pankow Hospital just outside of Berlin, and asked him if there was any position open for Max at the hospital. She told him that Max wanted to become a doctor and that serving as a medical assistant, especially during wartime, might further that aim. Dr. Adler said there was a great shortage of medical personnel and arranged an interview for Max.

Working at the hospital was a revelation for Max. He got the job on the spot, working for Dr. Adler’s assistant surgeon and son-in-law, Dr. Lutz, and was assigned to clean instruments and disinfect the operating room. Max was even permitted to be among the attendants at operations and autopsies. It was a way for Max to learn basic anatomy and medical procedures, almost as if he were already a second- or third-year medical student. He even accompanied the doctors during their rounds, and he learned to take blood pressure and pulse, administer injections, and change wound dressings. Not only was Max exposed to the practice of medicine; he was also performing the duties of a hospital nurse.

The lack of antibiotics in those days resulted in rampant infections in the surgical hospitals. For example, if an inflammation was discovered in the thin tissue of the inner lining of a patient’s (the peritoneum), during a basic abdominal surgery, there was little a surgeon could do to prevent peritonitis, a progressively painful condition that resulted not only from the wound itself but also from infection entering the wound. Max said that this was an all-too-common condition because of the filthy conditions on the battlefield and the time it took to move wounded soldiers from the front to the hospital. Surgeons could remove the bullets or shrapnel, but the inflammation and infection were usually the killers. As a result, the ironic expression, in those days as it is today, was “the operation went well, but the patient died.”

The Pankow Hospital, like other surgical facilities across Germany, was inundated with war wounded and had transformed its specialty facilities to handle the triage and treatment of casualties. Max remembered that a wing of the hospital, which had been isolated because it was used for tuberculosis patients, was now transformed into a military hospital for the most severely injured soldiers. Drs. Adler and Lutz were the only surgeons in the hospital at that time and were required to treat both military as well as civilian patients. Because of the shortage of medical personnel, Dr. Adler’s own wife served as the operating room nurse, even while Dr. Adler himself had to cover the surgical service at two other Berlin hospitals.

Max described the conditions at his hospital as adverse at best and fatally critical at worse.
Infectious austeomyelitis
, an infection of the bone, often lingered in patients for many years. It was an infection brought about, during wartime, by the septic nature of bullets and shrapnel. It was difficult to treat before the development of antibiotics and severely weakened a patient’s entire immune system. Gangrene, always a problem in wartime because of the septic nature of wounds, often progressed faster than the amputations performed to arrest it. Moreover, because neither the means to prevent tetanus nor the means to treat it had been discovered, doctors had to stand by while patients died, their bodies wracked with cramps and their death masks a testament to the pain they endured as infection ravaged their bodies. Max would attend the two doctors and their nurses when they removed blood-drenched bandages applied at the front to soldiers’ wounds. Max saw how the wounds were literally infested with crawling maggots. It was a gruesome sight, but it wasn’t until years later that doctors discovered what indigenous and native populations already knew: Flesh-eating larvae cleansed the wound of decaying tissue. And Max watched all this and learned.

The Spanish flu pandemic in 1917 brought more chaos to a hospital already overwhelmed by the casualties of war. Max said that doctors watched helplessly as victims died within twenty-four hours of contracting the disease and were as horrified at the speed of the epidemic’s spread as they were at the speed of the acceleration of the patients’ symptoms. The bluish-black discoloration of the victims’ faces, resulting from a loss of oxygen as the flu filled up their lungs and brought on congestive heart failure, resembled that caused by the Black Death of the Middle Ages. Hospital beds were already filled up by wounded soldiers, and hospitals could not stretch their services or even provide beds for the flu victims. Morgues, too, were overwhelmed as the city faced the problem of providing for the families of the dead. But through it all, though the cause of the disease was unknown and there were no preventive measures or therapies for the patients, the flu did not strike the hospital staff in any great numbers. Max was among the lucky who never contracted the flu.

Max had a rude introduction to the social and moral deterioration of Germany when he first encountered victims of the “hunger riots.” He was heading home after working the night shift at the hospital when the tramway car he was riding stopped because of a street disturbance. Max saw three men beating two women; he left the train and rushed to their defense. But the men quickly overpowered Max, leaving him half-conscious on the street. He was handcuffed and taken to police headquarters, where he was thrown into a jail cell. As he was dragged to the cell, police officers left their desks to kick and beat him. He was then tossed into a cell containing other battered individuals, indigents, and drunks who were barely conscious.

Max heard about the hunger riots from the other prisoners. The two women Max had tried to protect were protestors in those riots and had been set on by the police. The riots had begun with the mutiny of a group of sailors in Kiel, the main base of the German Navy on the North Sea. Sailors were protesting conditions in the navy, lack of pay, and shortages of food. The mutiny was put down by the military, and the crown clamped down on the story, censuring news reports of the mutiny. But despite the censure, word of the rebellion spread across Germany and inspired the hunger riots. Germany was seething under the burden of war, war that was draining the civilian population of its resources and placing burdens on all of the public health systems. Max was among the lucky, however, because even though he had been beaten and thrown into jail, one of his father’s clients was the desk sergeant taking roll call of the jailed prisoners. He recognized Max, heard his story of how he ran afoul of the police, and released him from prison.

Max turned eighteen the following year and received his draft notice for the 65th Field Artillery Regiment in Deutsch-Aylau, a small city near the Russian Frontier. The war had been ravaging Europe for long enough that the populations in both Germany and in Russia were disaffected with their imperial leaders and disenchanted with any glory based on victory in war. As Max remembered it, Germany was demoralized, and the government was near collapse. Kaiser Wilhelm, the Hapsburg monarch who’d led the nation into war with Russia, Great Britain, and France, had fled to Holland as social unrest swept the country. In his place, the Germans had installed the Weimar Republic, a social democratic movement. For Max, this meant that by the time his basic army training was to have been completed, Germany would have already been defeated. But the war was still on, and Max still had to report to his draft board.