The First Two Sickle Cell Anemia Patients in the Medical Literature - A Study in Contrasts
Todd L. Savitt, Ph.D.
In the November 1910 issue of "Archives of Internal Medicine," James B. Herrick of Chicago reported on "Peculiar Elongated and Sickle-Shaped Red Blood Corpuscles in a Case of Severe Anemia." Three short months later, in the February 1911 issue of the "Virginia Medical Semi-Monthly," an author identified erroneously as "R.E. Washburn, University of Virginia" (it should have read "B.E. Washburn") published a case report citing Herrick's article and using precisely the same descriptive title as Herrick. These two reports introduced modern medicine to the disorder that came to be known as sickle cell anemia (SCA). Who were the people involved?
When the "SS Cearense" docked in New York on September 15, 1904, after an eight-day voyage from Barbados, one of its passengers had a medical problem. A sore on the ankle of a 20-year-old Grenadian, Walter Clement Noel, had become quite painful. He sought help from a physician in New York. Time and iodine healed his wound, leaving a scar similar to others on his limbs. He continued his journey to Chicago.
Around Thanksgiving Day, Noel, then a first-year dental student at the Chicago College of Dental Surgery (CCDS), developed severe respiratory problems. He coped with these symptoms until the day after Christmas, when he walked, weak and dizzy, across the street from his lodgings to Presbyterian Hospital. There Dr. Ernest E. Irons, a 27-year-old intern, obtained a history and performed routine physical, blood, and urine examinations. He noticed that Noel's blood smear contained "many pear-shaped and elongated forms--some small," and alerted his attending physician, Dr. Herrick, of the unusual blood findings. In his next blood examination report, on December 31, Irons drew a rough sketch of these erythrocytes--the first pictures of sickled cells.
For the next two years Herrick and Irons followed Noel through several episodes of severe illness as he continued his dental studies, but never could confirm a diagnosis for Noel's illness. In May 1910, three years after losing track of their patient (who had graduated from CCDS and returned to Grenada to practice dentistry), Herrick finally published a description of the case, still undiagnosed, in the "Archives of Internal Medicine," barely mentioning his medical colleague Irons.
The second SCA patient, Ellen Anthony, a cook and housemaid when she was able to work, was born about 1885, though no available documents record that event. She grew up, probably the descendent of slaves, in the rolling farmland and wooded hills of Campbell County, Virginia, not far from Lynchburg. Almost no documentary or oral information exists about Anthony or her family. Sickly all her life, Anthony suffered a severe abdominal crisis in 1907 that took her to a local physician who sent her to the charity ward at the University of Virginia Hospital (UVA) for the first of many admissions. During her fourth admission, lasting 284 days beginning in September 1909, a third-year-medical student, Benjamin E. Washburn, from Rutherfordton, NC, no doubt encountered and cared for Anthony during his medical rotation. She was readmitted to the hospital in July 1910 and so was there when Washburn, who earned his BA at UNC, returned for his last year of medical school. Washburn's favorite instructor at UVA, John Staige Davis, Jr., served as Anthony's physician.
Herrick's article on Noel's case appeared in November. Though records do not identify who at UVA first recognized the similarities between Herrick's patient and Anthony's medical problems, it appears to have been Washburn. Dr. Davis, who served on the editorial board of the "Virginia Medical Semi-Monthly," suggested that Washburn submit an article to the journal describing Anthony's case. He did so and thus became the author of the second article reporting a sickle-cell disease. Herrick, in a similar situation in Chicago, gave only a passing nod in his 1910 article to his resident and protege‚ Irons, who actually first saw the patient, Noel. Irons recognized the oddly shaped red blood cells and treated Noel over a 3-year period. Extant records do not indicate why Irons did not receive equal credit with Herrick, nor why Washburn received sole credit for reporting the second case.
The contrast between the first two SCA patients bears comment. While opportunities in the United States for aspiring persons of color to study and enter medicine, dentistry and law were increasing at the time, segregation in the South was becoming more rigid and formalized. The stories of the first two reported SCA patients illustrate these differences. Noel, a man of color, was, in many ways, the social and professional equal of his physicians. He came from a monied family on the island of Grenada, attended college in Barbados and was a dental student. Members of his family were landowners and known figures on the island where most residents, largely people of color, lived in poor circumstances with little opportunity for advancement. The fact that Noel was well-educated and well-spoken may have stimulated Herrick and Irons' interest in discovering the nature of the young man's illness. Noel may have even assisted them in thinking through the problem.
Anthony, by contrast, was typical of many African Americans of her day. She grew up poor, had little education, earned little money, and was thus quite different, economically and socially, from her physicians, including the medical students who treated her. In Virginia's racially segregated society of the late 19th and early 20th centuries, Anthony remained a relatively anonymous citizen. Public records reported neither her birth nor her death, as was also true of her father and the rest of her family. Whereas Noel's history is easy to trace from family, school and official government sources, almost nothing is available on Anthony from any sources. How ironic, considering that the disease from which she suffered became one of the most studied in medicine.
(This article is based on two previously published articles, "Herrick's 1910 Case Report of Sickle Cell Anemia," "JAMA" 1989; 261: 266-74 and "The Second Reported Case of Sickle Cell Anemia: Charlottesville, Virginia, 1911," "Virginia Medical Quarterly" 1997 (Spring); 124: 84-92.)
