In September 1878, a young Arkansas surgeon named Edward Tandy Easley, MD, became ill in Memphis, TN. A graduate of the Louisville Medical College in Kentucky and Civil War veteran, Dr. Easley left his practice in Little Rock, AR, to volunteer in the city during a yellow fever epidemic. Overwhelmed by the sick and dying, in a 鈥渟tate of utter desolation,鈥� he wrote a letter to a friend, stating, 鈥淭he facts are worse than the newspaper accounts鈥� and that quarantines were needed to keep the epidemic from spreading further.*听
Dr. Easley succumbed to yellow fever on September 30, cutting short a meteoric surgical career that, in less than 4 years, had seen him elected secretary of the American Medical Association surgical section and author of 18 publications. His posthumous final paper addressed a topic of significant concern鈥攕hock. To the 19th century surgeon, shock was an ever-present yet elusive foe. In a time when diseases were largely understood by the pathologic changes they left in tissues, shock鈥攁 functional rather than structural disorder鈥攄efied attempts at characterization.
His contemporaries saw shock as a bottom-up phenomenon鈥攁n injury to the body that disrupted the central nervous system, leading the heart to fail鈥攚hereas Easley took a more top-down approach. While allowing for shock from injury, Easley鈥檚 model also gave thoughts, perceptions, and emotions the same power to harm as the force of a bullet. 鈥淭hat joy, grief, and terror may produce every degree of mental or nervous shock, is a fact both rational and well attested,鈥� he noted.鈥� The mind created bodily reality. It could not only slow or stop the heart, but it also had sufficient power to degrade the blood, poisoning its character and rendering it incapable of sustaining life. If emotion were of sufficient intensity, Dr. Easley argued that there were 鈥渕any authentic cases recorded鈥� of the rupture of the heart itself, 鈥渃onsequent on tremendous mental agony鈥� and terminating in fatal shock.鈥犔�
During an era when surgery began looking to statistics for proof, Dr. Easley was an anachronism. While he saw value in numerical data, Easley also relied on metaphor, rhetoric, and literature.鈥� He wrote that the 鈥済enius of Shakespeare鈥� was revealed in his description of how shock produced Lear鈥檚 madness; he cited the biblical gospels as evidence that mental anguish alone could lead to death. 鈥淪orrow, uncomplicated, sometimes kills outright,鈥� he noted, adding, 鈥淸It] so paralyzes the functions of the brain and heart that the sufferer can no longer live.鈥�鈥�听
Dr. Easley鈥檚 writing came at a time when surgeons were trying to understand diseases, such as shock, without access to the physiologic language and concepts we use today. It remains a useful case study in how the profession approaches problems that do not fit well into its existing theoretical models.鈥�
