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With publication of The Legacy of Tracy J. Putnam and H. Houston Merritt: Modern Neurology in the United States, Lewis P. Rowland has produced both a valuable addition to the history of neurology and a scholarly, entertaining and highly readable work. The general narrative of this book contrasts Tracy J. Putnam and H. Houston Merritt’s discovery of the anticonvulsant drug “Dilantin” with a wider analysis of the institutionalization of twentieth-century American neurology. In so doing, Rowland’s book provides details about interwar neurology at the Boston City Hospital, Massachusetts General Hospital, and the New York Neurological Institute, three of the most significant centers for neurology in interwar and post-war North America. Putnam and Merritt warrant this close attention. So too does Rowland’s broader theme, the development of neurology, a topic that has been given short shrift in the secondary literature on the history of psychiatry, psychology, and neuroscience.
Tracy J. Putnam (1894-1975) was born in Boston, Massachusetts. The son of a physician and descended from a family that could trace its lineage back to the Revolutionary War era. Rowland describes Putnam as a Bostonian Brahmin. Putnam’s choice of career likely derived from influences in his father’s generation. In 1873, Harvard University Medical School had appointed his uncle, James Jackson Putnam (1846-1918), lecturer on the application of electricity in nervous disease, and he had subsequently became professor of the diseases of nervous system there in 1893. James Jackson Putnam had retired by the time Tracy Putnam completed his undergraduate degree at Harvard, and he was deceased by the time his nephew completed his medical degree at the medical school.


Merritt and Putnam began collaborating sometime in 1935, and they published seven papers together between 1937 and 1941. Bromides and Phenobarbital were then the only treatments available for epilepsy, and both had unpleasant hypnotic side-effects. Merritt and Putnam’s research thus had the simple goal of alleviating the side-effects while increasing anticonvulsant activity. Using an animal model of epilepsy, and examining 19 chemicals structurally similar to Phenobarbital and provided by the company Parke-Davis, Putnam and Merritt were able to demonstrate that the palliative properties of Phenobarbital could be separated from the hypnotic effects. In their second paper, they reported that the most active substance – Phenytoin – appeared highly anticonvulsant and less hypnotic that Phenobarbital. They were subsequently able to demonstrate similar effects in epileptic patients, and “Dilantin” soon became the best antiepileptic available in the market, and in many respects contributed to a broader shift in the ethos underlying drug development. And that, of course, is the larger story absent from Rowland’s otherwise outstanding effort to tell this story.
As many histories built ultimately on biographical foundations, Rowland’s generally wonderful work is uneven in some places and struggles whenever issues and questions about context arise. His analysis of anti-Semitism, for instance, is strikingly pragmatic and largely avoids delving too deeply into the substantial secondary literature now available on this topic. On the evidently less controversial history of drug development and standardization, Rowland’s book comes up equally short. Though hardly detrimental to the quality of his story, I nevertheless found myself regretting such lapses, especially the lack of attention to the history of drug development. Without an awareness of that history, the reader cannot fully appreciate the significance of Merritt and Putnam’s achievement for neurology.
Among the more significant and generally under-appreciated discoveries of the industrial revolution in the nineteenth century were natural and synthetic dyes that could selectively color biological tissues. These dyes, which were initially used to produce a wider array of colors in silk, cotton, and wool goods, were soon found useful in histological research, because they would selective bind to some tissues but not others. The implications of this observation was that chemicals existed that could be targeted to specific organ systems. Moreover, some of those chemicals might even possess therapeutic benefits.
With the further development of a model of cellular membrane chemistry (derived largely from Paul Ehrlich’s Nobel Prize winning research on side-chain theory and his work on Salvarsan), many clinical researchers began attempting to isolate and purify the biologically active components of these larger compounds.

Putnam and Merritt’s separation of therapeutic properties and side-effects was an important demonstration of the multiple types of biological activity possessed by large compounds. But their research was significant beyond that demonstration. Their work indicated that the psychical and organic effects of compounds might be distinct, a finding with profound meaning for neurology and psychiatry. The implications were two-fold: firstly, clinical research could remove the nasty side-effects of some drugs without jeopardizing their curative properties. Secondly, certain chemicals could be isolated precisely for their psychical properties. In addition to these demonstrations, Putnam and Merritt’s work was, as Rowland does note, also among the first studies to apply “basic science results in laboratory animals to disease in humans” (p. 11). In sum, Putnam and Merritt’s work, much in harmony with the times, rooted neurological treatment in a new clinical configuration and thus aided-and-abetted the subsequent rise of psychotropic drugs like chlorpromazine, which was also first discovered in the 1930s.
Even if this more subtle historical picture is missing from Rowland’s history of modern neurology in the United States, his book nevertheless remains important and useful. It represents one of a few works that have ventured into the almost completely neglected terrain of American neurology in the interwar and post-war period. It is a “must-have” for the historian of modern neurology and will be an equally useful book for those historians of medicine interested in the rise of the modern pharmaceutical industry. As a case-study, the work may also be useful for undergraduate teaching, since it addresses multiple salient issues in the history of medicine.
Sounds like a facinating book.
ReplyDeleteWhat is most amazing is Dr. Putnam's 1935 research pinching dogs jugular veins to produce MS type lesions is proving to collaborate all the research Dr. Zamboni is doing on CCSVI in MS. If someone had followed up this research 70 years ago.......
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