The Final Scientific Endeavor of Mary Putnam Jacobi

On June 10th, 1906, American physician Mary Putnam Jacobi died of a brain tumor. Her death, similar to her life, was not without careful contemplation. Dr. Jacobi detailed her own demise in an account, titled “Descriptions of the Early Symptoms of the Meningeal Tumor Compressing the Cerebellum. From Which the Writer Died. Written by Herself.” Few women have changed medical history as much as Dr. Jacobi, a woman who proved to be a remarkable author, physician, and scientist to the very end.

Overlooked by many, Dr. Jacobi is arguably one of the earliest, most influential feminists. Unlike many physicians of the time (primarily men), Dr. Jacobi made a radical claim: women aren’t controlled by their menstrual cycles. The prevalent belief was that women could not operate their reproductive systems and their brain separately. This led to the exclusion of women from higher education – particularly in science and medicine – until Jacobi came along. The first woman admitted to the prestigious Ecole de Medecine in Paris as well as the Academy of Medicine, Dr. Jacobi was adamantly against the idea that women were intellectually inferior. In addition to dozens of writings on pathology and neurology, she published several prominent reports showing that women’s menstrual cycles did not make them delusional or incapable of learning, as many believed. Her early research was some of the first to turn the tides in favor of gender equality in science and medicine.

Her final scientific endeavor, however, was quite different and incredibly personal. Writing on her deathbed, Dr. Jacobi’s passion for neurology and understanding was relentless. Even with full knowledge of her condition, her spirits were high as she reflected on her 54 years of relatively good health:

It seemed to me often as if I lived in a glass house on the summit of a lofty mountain where I could see in every direction an almost illimitable distance looking through an atmosphere of blue and gold… I emphasize this habitual condition because it was on account of it that the first symptoms of the present illness became so conspicuous from contrast and attracted my attention, as otherwise they might not have done.

The “present illness”, described as a pain at the back her head, began in 1896 and continued every morning for four years. Soon after, the pain became more frequent, widespread, and severe, often causing vomiting. Dr. Jacobi diligently detailed all of these symptoms as her condition worsened and began to affect her balance:

From time to time I have fallen suddenly — not when out of doors, most frequently upon arising after sitting for a long time, perhaps especially in the evening. I would fall to the floor, and experience considerable difficulty in getting upon a chair. The fall was unaccompanied by either vertigo, giddiness or pain. Indeed no different sensation in any part of the body: the legs simply gave way as if I had been on skates. After a moment or two, I could climb to my feet again and felt none the worse for the adventure.

At this point, Dr. Jacobi thought her condition was quite curious. She did not have any paralysis, cramps, or stiffness in her muscles, but did have a slight change in mental state; surely, this was not simply a muscle condition. In her words, “a fine gauze veil [was] thrown over all the objects in which I had formerly been so intensely interested.” Unlike the rest of her life, marked by intense motivation to learn and succeed, Jacobi felt indifferent and mentally exhausted.

It’s unclear exactly how or when Dr. Jacobi diagnosed herself with a tumor above the cerebellum, the “little brain” under the cortex that helps us adjust our balance and coordinate movements. Still, the clues are all listed in Cerebellar Tumorher account: pain near the affected area, headaches and nausea, issues with balance and motor control, and slow but noticeable cognitive decline. It’s likely that the location of the pain and the subsequent movement deficiencies helped Dr. Jacobi narrow the location down to the cerebellum. The headaches and nausea point to the fact that it was a tumor, likely one that originated in the meninges, the outer covering of the brain. These types of tumors, termed meningiomas, are now known to be the most common type of brain tumor, constituting about 30% of brain tumors diagnosed.

In our age of medical technology, we can quickly localize and identify tumors with a quick brain scan (see image at right). However, in 1905 there was no magnetic resonance imaging to allow Jacobi to see inside her brain (though people were quite creative). Yet, with careful consideration of her symptoms, this clever woman unraveled her own internal mystery. Although we cannot confirm that she did indeed have a cerebellar meningioma, the symptoms she describes align perfectly with recent accounts of cerebellar tumors, or even the complete absence of a cerebellum.

In the last paragraph of her account, Dr. Jacobi further contemplates her loss of volition, and then reverts her attention back to her limbs:

There was a facility of fatigue after mental exertion, quite comparable to that after walking. This became marked at the same time with the latter, that is after June, 1903, although the sense of loss of initiative had begun, as I have said, six years before. In the last week I have had for the first time a dragging heaviness in my left arm, and some stiffness when I move it backward.

The account ends here, quite abruptly. One year after writing, Dr. Jacobi passed away, leaving perhaps the most honest medical record ever written – by the patient herself. Dr. Jacobi’s holistic and insightful views of her condition as well as her relentless struggle to place women at the forefront of medicine will forever be remembered in medical history. Her controversial work is a reminder to all female scientists, including myself, to never let societal norms get in the way of your goals. Looking at her signature and considering the times in which she lived makes me tremendously grateful for the path that she and so many other individuals paved for 21st century women in science like myself.

Signature

Mary Putnam Jacobi Images: Drexel University Collections

Brain Image: Medscape

Further Reading

Jacobi, M.P. (1905). Full text

Jacobi, M.P. Mary Putnam Jacobi: A Pathfinder in Medicine. Amazon.

Swaby, R. (2015) Headstrong: 52 Women Who Changed Science – and the World. Amazon.

NIH Biography: https://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_163.html

Biography in Drexel Archives: http://archives.drexelmed.edu/blog/?p=732

New York Times. (2013). Honoring Female Pioneers in Science.

Advertisements