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Cobb, Stanley (1887-1968)

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sc1 cobb9Stanley Cobb was a uniquely creative man. Possessing the mind of a natural scientist, which in his youth had been formed through exposure to wildlife and by the study of ornithology, and with medical training in human and comparative anatomy, neuropathology, neurohistology, clinical neurology, and finally psychiatry, he was able to cross back and forth into all of these fields and piece together fragments of these sciences into an understanding of the nervous system that was imaginative and unique. In the doing, he added several important building blocks to the foundation structure of the modern neurosciences. Believing that all bodily functions were interrelated and that some somatic diseases had their origin in mental and emotional processes, he drew no narrow line between functional and organic illness. He recognized that in varying degrees all disturbances of the human brain demonstrated both tissue changes and some forms of dysfunction. As a result, he attempted to correlate the physical and the behavioral aspects of the human condition in order to understand better the underlying causes of disease and treat the patient as a whole.

On December 10, 1887, Stanley Cobb was born at his parents’ home on Walnut Street in Brookline, Massachusetts. He was only five years old when his family moved in 1893 from Brookline to Milton.

His relationship with his father was open and businesslike. Mr. Cobb maintained a close interest in Stanley’s activities at Harvard College, during his years of medical school and internship, and throughout the period of postgraduate study in Baltimore. During Cobb’s third year at medical school he and Stanley conferred with Dr. David Edsall, then Jackson Professor of Medicine at the Harvard Medical School, about the most promising approach to an academic career in the neurosciences. At that time Mr. Cobb was doing well financially and was prepared to help Stanley survive the inevitable lean years. Correspondence between father and son was matter-of-fact, yet each appeared to have a real feeling of concern for the position of the other. When Mr. Cobb’s real estate ventures bogged down during World War I, Stanley sensed that his father could no longer help materially and made every effort to become self-sufficient as rapidly as possible.

In Milton Mrs. Cobb maintained a home in opulent good taste. She kept up with the social amenities of the community and attended the Unitarian Church. Stanley had a very close relationship with his mother. He began to stammer early, and stammering may have been one reason for her keeping him out of school until the age of eight. In any event, he got off to a slow start in reading and writing. Later, Mrs. Cobb kept him out of school two more years because both the school boys and faculty members at Milton were teasing him about his stammer.

sc2 cobb11A severe handicap, which creatively motivated Stanley Cobb’s entire life, was his stammering. There were in his family tree a large number of ancestors and living persons with speech disorders of one sort or another, so a genetic factor is a possible explanation. Too, Stanley Cobb was born left-handed and in infancy had his left arm bound in a sort of sling to encourage the use of his right. He was ambidextrous all his life; so mixed right-left cerebral dominance may have been a factor in causing the stammering. However, in his own mind the stammering clearly dated from the birth of his sister Beatrice on March 24, 1892, when he was four.

On that day strange happenings were taking place at the Cobb household on Walnut Street in Brookline. Stanley had not seen his mother that morning. She had retired to her bedroom, and an unfamiliar woman in a white uniform came and went with pitchers of hot water and other paraphernalia. A dignified older man with black bag had come and gone more than once. There was an uneasy feeling of excitement and expectancy from which Stanley felt that he was being excluded. His curiosity was piqued because on several occasions he thought he heard groans coming from his mother’s room. Later in the day the children were all shooed out of the house to play. Stanley was on the lawn with his older brothers and sisters when he heard violent screams coming from his mother’s room. His younger sister, Beatrice, was being born. Not knowing what was happening, Stanley stood transfixed with fear. His older brothers and sisters ran away, and he chased after them as hard as he could, but he could not catch up. At that point he felt a great rush of wind into his chest and was unable to catch his breath. From that day on he had trouble talking. He was a stammerer.

The stammering was such a source of embarrassment that not only was Cobb’s schooling interrupted but his social life was limited as well. On the other hand his loneliness and free time in the country made it possible for him to develop his interest in nature. Moreover, it was his curiosity about the origin of his stammering that later led him into the medical neurosciences and particularly into analytic psychiatry. So, the entire course of his productive life may well have originated in this handicap.

Cobb’s classroom work in college was better than respectable but not outstanding. In his senior year Cobb was in the cast of the Hasty Pudding Club play. He was in a chorus of males, while other members of the cast were decked out to look like Indian maidens.

sc3 cobb1Admission to the Harvard Medical School was not highly competitive at that time. There were seventy-six men in the class of 1914, with a capacity for one hundred and twenty-five. In 1901 Charles W. Eliot, then president of Harvard University, in his effort to improve the academic standards of the graduate schools, had recommended to the medical faculty that all candidates for admission must have obtained the degree of Bachelor of Arts and also show evidence of knowledge of physics and chemistry. This academic restriction had grossly limited the number of qualified applicants.

Although Cobb’s undergraduate grades were not outstanding, in medical school things were different. He took his work seriously from the beginning; yet he found time for horsemanship and other interests.

He first met Elizabeth Mason Almy, whom he later married, on the railroad platform in Lake Placid. The marriage took place at Cotuit, on Cape Cod, July 10, 1915, and the couple departed for a nautical honeymoon, cruising in a leaky catboat. After his marriage, Cobb’s stammering showed considerable improvement. It was an exciting time when, after their four-month wedding trip, the Cobbs moved to Baltimore, where for the next three years Stanley was to work in physiology and psychiatry. Baltimore was exciting, too, because of the brilliant men in many departments of the Johns Hopkins Hospital and in the medical school laboratories.

The years of training at Harvard and Johns Hopkins had come to an end, and the war had given Cobb an opportunity to see some of the problems that faced practitioners of medicine.

When he arrived on the Boston scene in the late spring of 1919 Cobb had worked out with Dean Edsall a program of activities designed to support him financially. He had also developed a milieu that would allow for his own professional growth and at the same time permit him to make a contribution to neurology and psychiatry at the Harvard Medical School. Cobb’s base of operations was to be at the Massachusetts General Hospital, where he would have an office in which to see his private patients and would be available as a psychiatric consultant in the hospital. In addition, he was to carry out investigations with Alexander Forbes and Walter B. Cannon in the physiology laboratories in the quadrangle of the Harvard Medical School.

sc4 cobb7By the time that he and his family sailed for England in October 1923, Cobb had already demonstrated his ability as an investigator, clinician, teacher, and laboratory director. He had learned to seize the opportunities that came within his grasp and to pursue his objectives with an appropriate degree of flexibility.

He thought that Carl Jung was indeed a most remarkable man, a bit too interested in dreams and world interpretation of neurotic phenomena, but very helpful to people in treatment and provocative of creative thinking.

Cobb’s domestic life during the latter half of the twenties had many delightful aspects. The parents and the growing children continued to live in the old Cherry Hill Tavern in Ponkapoag until 1929, when they moved to Milton. A particularly joyous feature of the Cotuit vacations was sailing on Pamaho, the yawl that Cobb and his father bought in 1925 after the European trip. Prior to 1930, the Pamaho was used primarily for day sailing and for brief cruises to nearby islands such as Martha’s Vineyard, Tuckernuck, Muskeget, and Naushon, where Cobb’s sister Hildegarde and her husband, Harry Forbes, spent their summers.

A neurological unit that Cobb built at Boston City Hospital was a remarkable achievement. It had grown out of his own deep interest in the neurosciences, his imagination in seeing the creative possibilities of various situations as they arose, his unselfish dedication to the interests of students, house staff, and colleagues, and his manifold administrative talents. The neurological unit had become in all probability the leading center where scholars of varying disciplines could cooperate closely in studies of the nervous system. Nineteen hundred and thirty-four was the year of Cobb’s departure for the Massachusetts General Hospital. It was in 1937 that a symposium on electrical activity in the nervous system was held by the Congress of Psychology in Paris. Nineteen thirty-nine was an eventful year at the neurological unit. On Cobb’s retirement from the Massachusetts General Hospital in 1954 the Harvard Medical School class yearbook, the Aesculapiad, was dedicated to him.

For a number of years Cobb took an active interest in the Boston Psychoanalytic Society. Psychoanalysis, as such, was not one of Cobb’s major problems when he opened the doors of the Massachusetts General Hospital psychiatric service in 1934. A much greater challenge was the monumental task of organizing a psychiatric service at that conservative institution where he encountered doubts and some overt hostility about the place of psychiatry in a general hospital setting. Some colleagues resented the number of Jews on the psychiatric service, and the neurologists, most of whom looked upon themselves as neuropsychiatrists, felt threatened by the competition from a new department of psychiatry.

sc5 cobb3Cobb was receptive to opportunities to welcome other psychoanalysts on his staff. Chronologically, the very first was a young man named Erik Homburger, who had worked with children in Freud’s home in Vienna. Homburger, who later became internationally known as Erik H. Erikson, arrived in Cambridge during October, 1933. Although Erikson had known Anna Freud and had been exposed to child analysis when living at Freud’s home, he presented a problem for both Cobb and the Boston Psychoanalytic Society because he had no academic degree whatever. However, in 1934 Cobb was successful in obtaining for him an academic appointment at Harvard. Erikson reported that he was a research assistant in psychiatry at the medical school.

Available only on a part-time basis because of her busy analytic practice was Helene Deutsch, who came from Vienna in October, 1935. As a recognized European training analyst in Boston, she soon took on a number of the staff members for analysis. Moreover, as a physician, she was able to do hospital work and in later years made ward rounds on a regular basis. When Helene Deutsch completed her volumes on The Psychology of Women, Cobb wrote a sympathetic and warm foreword. She died in 1982 at the age of ninety-seven.

sc6 cobb5Psychoanalysis was an exciting field that gave promise of adding a powerful new dimension to psychiatry, and the aspiring young men returning from World War II were anxious for experience at this growing edge of knowledge. Cobb, too, saw psychoanalysis as important. He had been helped with his own speech defect by analytic therapy. He knew that it could be effective, and he wanted his resident staff to be analyzed and to plan their future lives in the light of what they learned.

One of the most significant things Cobb did for psychoanalysis was to view it as important. He gave psychoanalysis respectability at a time when it was almost an underground cult in Vienna. He saw psychoanalysis as one approach to the incredibly complex relations of mind, body, and environment. He was effective in establishing psychoanalysis as an academically recognized empirical science. With his impeccably proper Bostonian background he was able to introduce a number of talented foreign analysts into the conventional and ultraconservative Massachusetts General Hospital. He promoted psychoanalysis as an important new therapeutic and investigative method and looked upon it objectively. He never became entrapped in the quasi-religious fervor which, possibly because of their emotional rebirth experiences during analysis, took over many of his colleagues. He was not one to honor orthodoxy, whether in a conventional religious setting or in psychoanalysis.

Although Cobb and his co-workers were interested in psychosomatic problems, the chiefs of other services such as gynecology, orthopedics, pediatrics, and even neurology were either blind or did not want to see.

At one conference in about 1936 a patient with anorexia nervosa was presented, and Cobb in his summary concluded that anorexia nervosa was a disease entity in its own right, not a manifestation of schizophrenia.

The conference was presided over by Cobb, then forty-seven years of age. He was strikingly handsome in his long white clinical coat with a Queen Square reflex hammer protruding from one of the pockets, yet the arthritic deformity of his hands could not be overlooked.

In addition to influencing the nonpsychiatric members of the medical profession through psychiatric consultations, emergency care, joint research projects, clinical teaching, and work on the curriculum committee at Harvard, Cobb from 1935 through 1959 published each year a review of neuropsychiatry in the Archives of Internal Medicine. Other writings for the general medical public which appeared during the thirties included an article on shock therapy in the New England Journal of Medicine and a paper on the psychiatric approach to the treatment of epilepsy.

While Cobb was carrying on the multitudinous tasks inherent in the building of his psychiatric service, he also had other interests that were important to him and broadened the scope of his knowledge and effectiveness. One of these interests had to do with the physicians, mostly Jewish, who were fleeing from European dictatorships, especially in Germany and Spain. Walter B. Cannon, professor of physiology at Harvard, was active in submitting names of appropriate émigrés.

A review of Cobb’s activities during the late thirties would be incomplete without mention of the honorary degree awarded to Jung by Harvard at the time of its tercentenary in 1936. To the department of psychology was delegated the authority to make one nomination for an honorary degree candidate. They would have liked to nominate Freud, but they feared he would decline, and they had no authority to make a substitute nomination. So they settled on Jung, who promptly accepted and visited the Cobbs when he came to this country for the presentation.

The demands upon Cobb during the late thirties when he was establishing the new psychiatric service were taking their toll from his physical and emotional reserves. The rheumatoid arthritis, from which he had suffered for many years, gradually became more crippling, yet he continued to need the change of pace that he found in such activities as sailing, skiing, watercolor painting, and the study of nature.

Although Cobb had suffered from rheumatoid arthritis all his adult life—it was demonstrable on the group photograph taken during his internship—there was marked progression in its severity during the thirties. Still, Cobb remained active physically. He used his fingers deftly in the watercolor painting that he so greatly enjoyed and in other activities requiring manual dexterity.

sc7 cobb2The full impact of Cobb’s work was to be developed in the future, which was to see psychiatric wards in general hospitals throughout the country, widespread acceptance of psychiatry as a respected specialty of medicine, effective new forms of therapy, a marked decrease in the number of patients occupying state hospital beds, and vital new knowledge of neurotransmitters, which became important in psychiatric brain research. Cobb’s work during the forties was destined to include a number of classified studies of direct importance to the war effort and, in spite of a limited staff, the expansion of cooperative studies with other hospital departments. In the late forties and fifties psychoanalysis assumed an increasingly important role and, with various forms of funding available, there was a vast increase in the number of residents and fellows in training. The psychiatric service was destined to become one of the largest and most important in the entire hospital.

Cobb wrote a number of other papers on psychosomatic medicine and on psychiatry in a general hospital, as well as the decennial report of the psychiatric service at the Massachusetts General Hospital. This report contains a wealth of information about the work done there from 1934 to 1944. In addition Cobb brought out a new edition of his classic volume, Foundations of Neuropsychiatry and wrote a new book entitled Borderlands of Psychiatry .

Cobb was making preparations in his mind for the transition to postwar psychiatry and the demands that it would make upon him and his service. So a new interest in psychiatry was growing up among the doctors on military duty. Along with this greater awareness of the importance of psychiatry came the G.I. Bill of Rights which insured financial aid for students during the early peacetime years.

The postwar years constituted for Cobb a period of rapid adjustment. Of course, during these later years he continued to teach the neuropathology course at the Harvard Medical School, and through their clinical work the members of his attending staff were constantly teaching the residents, fellows, and medical students.

When Cobb retired in mid-1954 after twenty years as psychiatrist-in-chief at the Massachusetts General Hospital, he was faced with quandaries about the future. Cobb made up his mind to remain in Boston. He established himself in a number of settings that would keep alive his interests in ornithology and in the human mind. He recalled his former pathology teacher, William Councilman, as having said in his old age, “When you have to retire, find a narrow field you love and till it extensively.” Having been an ornithologist and having spent most of his professional life trying to learn how the brain worked, it was natural that he chose avian neurology as his niche. However, he also felt a need to carry on some work in human psychiatry.

Cobb’s next most important work area was the Museum of Comparative Zoology at Harvard, where the atmosphere and aromas brought back nostalgic memories of college days. Making a collection of brains adequate for studies in comparative anatomy took several years.

Cobb’s third work area was the department of student health at the Massachusetts Institute of Technology. He was a psychiatrist to students three days a week for several years.

During retirement Cobb published more than sixty papers from his office and laboratory in the Warren Building.

During the second trimester of Cobb’s retirement years, from 1959 through 1963, enough specimens of bird brains had been accumulated so that he could make some meaningful studies of comparative anatomy. During the final trimester of retirement, from 1964 until his death in 1968, Cobb continued to write primarily on ornithological topics.

sc8 cobb8The most widely read article Cobb ever wrote was “Death of a Salt Pond,” which appeared in Audubon Magazine in May, 1963. It was one of his writings on social issues and more particularly on protection of the environment. He was concerned with the use of insecticides, especially DDT. In I962, as a mosquito control measure, ponds and marshlands on Cape Cod were sprayed with this insecticide, which proved fatal to crustacea such as fiddler crabs as well as to insect arthropods.

When his own salt pond was sprayed Cobb was furious. His wife wrote the story of his anger and how he transformed it into the most widely read publication of his life:

“Nineteen sixty-two was the summer that Stanley lost his eyesight. We had a great Scandinavian doctor who kept saying, “You will get your vision back. I have seen many cases like this at home in Scandinavia.” Stanley did not believe him and was very depressed.

“Then came the day at Cotuit when an airplane flew over and sprayed us and the salt pond in front of our cottage with DDT. Stanley was furious. He asked me to call various governmental agencies until we located the person responsible for the spraying. We then left word for him to call back. The call came as evening approached. Sparks flew, and we had our dinner. After dinner, two men arrived and asked to see Stanley. I told them he was not seeing anyone now because of his bad eyes. They told me who they were. Immediately I let Stanley know and he came in. I did not hear the conversation that followed, but I am sure that Stanley did not mince words. When the men departed an hour later all they could say was that they had agreed to disagree about the wisdom of the spray.

“Next day Stanley took pen and paper in hand and began to write in letters one-half inch high, carefully keeping the sheets of paper in sequence. I remember Aunt Helen came in, and because I was busy, she undertook to write for him, just what I don’t recall. Gradually, during the next few days Stanley discovered that he could write his thoughts in large letters and see what he had written. Then he decided that he needed someone to whom he could talk or even dictate. Finally, I found a Cotuit woman who had previously done secretarial work for Erik Erikson. She was just right, silent when she needed to be, but very attentive, having taken in at one swallow‚Äî as it were‚Äîmy few words about the situation‚ÄîStanley’s eyes, his strong feelings, and his need to write about the spraying situation. I drove Stanley to the lady’s house on several different days. She took much of what Stanley dictated directly on the typewriter. Stanley then took her rough drafts home and edited them. I had no function in this. Stanley and his amanuensis understood each other perfectly.

“And so, to make a long story short, Stanley decided to publish what he had written in the Barnstable Patriot.

“I was in the local grocery in Marston’s Mills the night the article came out. When I asked for a copy of the paper the girl who sold it said, “Read that first article. It is very good.” She had no notion of why I wanted the paper.

sc8 cobb10“The article was reprinted or quoted all over the Cape and later in Audubon Society publications across the country as far away as Texas. There were more requests for reprints than for anything else Stanley had ever written.”

“The Death of a Salt Pond” was not the last thing Stanley wrote, but it was something of vital importance into which he put his whole self.

Because of Cobb’s long-standing interest in nature and in conservation of natural resources, he had deep admiration for the pioneer environmentalist, Rachel Carson, whose Silent Spring aroused widespread interest and concern. When Rachel Carson died in 1964, Cobb wrote a tribute to her:

To Rachel Carson, who died April 14, 1964

Silent and cold this April dawn for you
No robins pipe the coming of the sun.
Gulls cry, a mourning dove complains.
I’m glad you cannot sense this from your bier.
Your foresight and your courage wakened us
To dedicate our anger and our strength
Against shortsighted poisoners of life,
To resurrect a glorious, singing dawn.

Cobb died on February 8, 1968. A service was held in the Memorial Church in the Harvard Yard. Officiating were the Reverend Ralph Helverson, minister of the First Parish (Unitarian) Church in Cambridge, and the Reverend Charles Price, the University Chaplain. Stanley Cobb and his wife were members of the First Parish Church in Cambridge (Unitarian).

In the field of religion per se, he said that with the passage of time he had become more definite. In the fiftieth anniversary report he wrote: “In all humility, facing the vastness of the universe, I believe that the directiveness which I see in the evolutionary drive toward making whole organisms and whole societies is God. I appreciate the forms and rituals of religion; they give solace and solidarity. It is enough immortality for me if I may become even a very small part of advancing wisdom, hoping that I have done my bit to make the world a better place.”

— By Benjamin V. White, M.D. Abridged from Stanley Cobb, A Builder of the Modern Neurosciences by Benjamin V. White with the assistance of Richard J. Wolfe and Eugene Taylor (Boston: Francis A. Countway Library of Medicine 1984).