Just the facts

I have become used to accepting regular misstatements of historical fact in Yale Medicine, but the Spring 2002 issue has tried my patience with two certain errors.

On page 7: “Yale scientist E.M. Jellinek pioneered the notion that alcoholism is a disease. …” Not so. Thomas Trotter, a British Royal Navy physician, clearly defined alcoholism as a disease or medical condition in An Essay, Medical, Philosophical, and Chemical, on Drunkenness and Its Effects on the Human Body (Bouvier, Philadelphia, 1813). In the United States at about this time Benjamin Rush in Philadelphia was defining alcoholism as a disease.

Charles A. Janeway is presented on page 35 as the person who “discovered gamma globulin deficiency.” This is not true, as the present Dr. Janeway [his son] would be the first to confirm. Ogden Bruton described the syndrome in “Agammaglobulinemia,” Pediatrics, 9, 722-728, 1952. The condition is now known as X-linked agammaglobulinemia (Bruton) and the enzyme affected is known as the Bruton tyrosine kinase.

Our medical school has one of the very best history of medicine faculties in the United States. I urge you to have them review articles which purport to state historical facts before you publish. This would save you the nuisance of chiding like this letter!

Robert J.T. Joy, M.D. ’54
Bethesda, Md.
The writer is emeritus professor, Uniformed Services University of the Health Sciences, Department of Medical History.

Dr. Joy is correct that Drs. Rush and Trotter regarded alcoholism as a disease almost 200 years ago. Jellinek, however, is considered by many to be the most influential proponent of alcoholism as a disease in the 1950s. He presented a disease model for alcoholism, described four classes of drinkers and invented what is known as the “Jellinek curve,” which describes the progression of the disease. His work is considered a major factor in the medical establishment’s acceptance of alcoholism as a disease. Although the World Health Organization had recognized it as a medical problem in 1951, and the American Medical Association (AMA) declared it a treatable illness in 1956, it was only in 1965 that the American Psychiatric Association called alcoholism a disease. The AMA followed suit in 1966.

As for the senior Dr. Janeway’s contributions, his son replies: “I have always resented the claim that Ogden C. Bruton ‘discovered’ X-linked agammaglobulinemia, as my father had collected 13 cases and was about to publish his findings when Col. Bruton published first. Instead of publishing his original work on agammaglobulinemia, my father worked on the intramuscular and intravenous administration of the crude gamma globulin fraction of blood, which he had isolated as part of Dr. Edwin Cohn’s plasma fractionation project during the Second World War.”