|Old building of the Peking Union Medical College in Beijing|
The great professor of medicine with the Charles Boyer accent would make ward rounds followed by some thirty students living in constant fear of being publicly humiliated. “You” he would say “where do you come from ?” – and wherever it was he would then pronounce that “in the country of the blind the one eyed man is king.” Or, if a student did not know some basic fact, he would point to his head and exclaim, “Gobi desert, nothing grows ” or “what the peasant does not know he does not eat.” If a new drug became available he would recommend using it now, before it stops working. Skeptical about statistics, he said that if you did need them the treatment was likely not to work – as you did not need a statistician to tell that penicillin worked in pneumonia.1
Born in Amsterdam the son of a diamond polisher, I Snapper (as he liked to be called) graduated in medicine in 1913 and then worked with the famous professors van den Bergh (of the difference between direct and indirect bilirubin) and Pieter Pel (of the intermittent fever in Hodgkin’s disease). He had an early successful academic career and was professor of medicine at age twenty-nine, but in 1938 emigrated to the United States. Encouraged by the Rockefeller Foundation he went to China as professor of medicine at the Peiking Union Medical College. He supposedly was popular with his Chinese colleagues because a bald head indicated that he read under a lamp at night and wearing glasses showed he read the small print.2 In China he studied bone disease, especially rickets, and also formed ideas about diet and preventing heart disease that he published later as Lessons from Chinese Medicine.
He also wrote a delightful book called Bedside Medicine, no longer easily available in its first edition and succeeded by a second edition that was no longer personal and chatty but more like a standard textbook of medicine. In the original edition, for example, he tells how a Western professor of medicine was shown by his Chinese staff a patient covered with a vesicular rash. The professor gave it a learned Greek name. “Very interesting,”said his resident, “but in this country we call it smallpox.”
Dr. Snapper was captured by the Japanese when they invaded China, exchanged for Japanese diplomats and repatriated to the United States. He worked in Washington on tropical medicine, and for one year served as chief of medical education at Cook County Hospital in Chicago (1952). But he spent most of his time in academic appointments in New York, including being chief of one of the medical sections at Mount Sinai Hospital, teaching and carrying out research on many diseases – especially on multiple myeloma.
He passionately believed in the primacy of clinical medicine based on common sense, stressing that at the bedside the physician was to apply clear logical reasoning derived from his profound experience in the practice of medicine. While expecting the physician to also study the basic sciences, he derided “the modern medical scions” who did not respect the empirical knowledge necessary for diagnosis and therapy, their interest being captivated almost exclusively by animal experiments and complicated laboratory methods.
He also noted interesting analogies between the practice of medicine and nonmedical crafts such as navigation. The introduction of radar had been supposed to make navigation safer, yet in his time three major collisions between large ships had occurred in New York harbor. He believed that the crews of the ships had come to depend unduly on instrumentation and had lost the qualities that once characterized excellent seamanship. In the same way he thought that overreliance on laboratory and x-rays has resulted in clinicians no longer utilizing the wisdom and common sense of previous generations, “because optimal results will be obtained only if laboratory methods are used solely to complement Hippocratic empirical medicine.”
With age Dr. Snapper mellowed considerably, which he attributed to cerebral arteriosclerosis! When he became ill in 1973 at age eighty-four, his Dutch compatriot William J Kolff came to visit him in his hospital room and found him lying semi-conscious on the floor with no nurse in sight. He says that he picked him up and lifted him back in his bed, then left. The next day he heard that he had died.
- A colorful chief I have known. Rounds with Dr. I Snapper. Resident and Staff Physician, June 1983.
- Book review. Medical History. 2006,50:263
GEORGE DUNEA, MD, Editor-in-Chief.