Rosenthal Book: Pandemics of Past, Modern Medicine’s Roots

In his history-based novel, “Bloodletting & Germs: A Doctor in Nineteenth Century Rural New York,” the professor emeritus of family medicine tells the story of Jabez Allen, a doctor who worked in the Western New York village of East Aurora during the 1800s.

The book describes the evolution of medical practices in the 19th century through the eyes of Allen, whose life and experiences Rosenthal painstakingly researched and recreated. It explains how Allen’s medical practice developed during a period of enormous social and scientific change that included the Civil War and the cholera epidemic of the mid-1800s.

Rosenthal knows something about the practice of rural medicine. A 1975 graduate of the Jacobs School of Medicine and Biomedical Sciences, he chaired the Department of Family Medicine from 1994 until his retirement in 2013. During his tenure, Rosenthal was instrumental in establishing the Division of Rural Health, the medical school’s rural health campus in Cuba, N.Y., and its groundbreaking residency program in rural health.

Due to his efforts, UB was named a New York Rural Health Research Center in 1992 and in 1993 became one of only five universities in the country designated as a national rural health research center.

Rosenthal’s interest in rural health came from the eight years he worked as a family doctor in the small Western New York farming community of Perry. He established the practice in 1978 after completing a family medicine residency at the former Deaconess Hospital in Buffalo. In 1986, he became medical director of Buffalo General Medical Center’s Department of Family Medicine.

Rosenthal was named director of UB’s family medicine residency in 1987, and executive director of UB’s rural health programs in 1988.

Rosenthal first came across the story of Jabez Allen on a visit to the East Aurora Historical Society, where he discovered an intriguing artifact: a handwritten copy of a medical school diploma belonging to Allen, alongside the official document.

He wondered: Why would a doctor need to make a copy of his diploma? As it turns out, Allen was reluctant to send out his diploma to the Erie County Medical Board for fear of losing it. Instead, he sent them his copy.

“Allen practiced in East Aurora from 1834 to 1884, making him the perfect protagonist for a book on 19th-century family medicine,” Rosenthal says.

“The century is often referred to as a period of medical enlightenment,” he explains. “In retirement, I indulged myself in the question, ‘Why did it take so long?’ And ‘How did family doctors in the 19th century deal with the pandemics of cholera, smallpox and typhoid at a time when anesthesia, antisepsis, the Civil War and germs transformed basic medicine theory?’’

Although Anton van Leeuwenhoek reported finding bacteria under his microscope in 1667, it took two centuries for germ theory to catch on, Rosenthal says.

“I have long wondered why this took so long, what was the rationale for bloodletting, and what it would have been like to practice rural medicine in Western New York in the 19th century,” says Rosenthal.

“I also wanted to create a medically accurate accounting of the 19th century, yet keep the story relevant to a non-medical reader,” he continues. “I wanted the reader to understand the reason things were done and the reason why they were eventually abandoned in the context of a dramatically changing American society.”

Rosenthal anchored his story on the known events of Allen’s life drawn from a family bible, property deeds, medical society minutes, diaries of contemporaries, newspapers and an oral history passed down to a great-great-granddaughter.

The patients, events and motives he attributes to Allen are based on over 400 19th-century textbooks and journal articles.

Writing the book gave Rosenthal a number of insights into the current coronavirus pandemic.

“In the 19th century, communities were on their own, each having to invent public health programs long before contagions were understood. State and federal government efforts were largely ineffective or simply non-existent. Village residents seemed to grasp that cholera was contagious long before traditional medicine abandoned the idea that it was passed by ‘miasma,’ or bad air. Quarantine was incredibly effective, and enforced by the local constable, but nearly half of all patients contracting cholera still died.”

Then, as now, death could be swift, Rosenthal says. As he recounts in the book, President Millard Fillmore’s daughter, Abbie, died 12 hours after her first symptoms in the home of her grandfather, Millard’s father, Nathaniel, who lived next door to Allen.

“Today’s medicine gives COVID-19 victims a much greater chance of survival, but they often pay the price of a prolonged convalescence,” Rosenthal says.

“The bottom line is the same: social distancing (modified quarantine), masking and surveillance.”

One of Rosenthal’s favorite elements in the book is the composite character Phineas McCarthy. “He is a character created from several sources, but accurately represents the role of the ‘snake oil’ salesman of the period. Cabaiba oil is a real substance and was often a component of ingredients hawked by these itinerant salesmen. His story shows how disruptive these men could be to a small village,” Rosenthal says.

In the course of his research, Rosenthal discovered that a member of the original UB medical school faculty, Austin Flint, conducted an examination of a typhoid pandemic in the Western New York hamlet of North Boston in 1847.

“His paper became a model of epidemiological investigation and was referenced by John Snow of London in his treatise about cholera spreading from a well in London,” Rosenthal notes.

“Bloodletting & Germs: A Doctor in Nineteenth Century Rural New York,” which took Rosenthal four years to complete, is available in paperback and e-reader formats.