Dr. Kildare’s Strange Case: Sex, Drugs and …….

Dr. Kildare's Strange Case (1940) Poster

Well, of course there is no Rock and Roll.  The movie, Dr. Kildare’s Strange Case, which I recently watched at an alumni seminar at New York Medical College, was released in 1940.  Songs on the radio were Glen Miller’s In the Mood, Bing Crosby’s Only Forever, Cliff Edwards playing When You Wish Upon a Star on the ukulele, and Coleman Hawkins’ Body and Soul.

The sex is only the vaguely implied in the rivalry between James Kildare and the surgeon Gregory Lane who are competing for the body and soul of, or at least dinner with, nurse Mary Lamont.  Mary however has her heart set on a nice house with a white picket fence and will give herself to the doc with the bucks to get her there.

It’s the drugs that are the stars of this film.  But before getting into the pharma particulars here’s a brief synopsis of the cast and plot:

Cast

Lew Ayres as Dr. James Kildare

Lionel Barrymore as Dr. Leonard Gillespie

Laraine Day as Nurse Mary Lamont

Shepperd Strudwick as Dr. Gregory ‘Greg’ Lane

Dr. James Kildare gets competition for the heart of nurse Mary Lamont, when a brain surgeon, Dr. Gregory Lane, enters the scene at the hospital. James has not proposed to Mary yet because of his bad financial standing.

One day James is offered a well paid job at the Messenger Institute, but he rejects the offer to continue working with his inspiring mentor, Dr. Leonard Gillespie. Mary gives up all her hope of marrying James.

James and Lane are put together on a case where a man has had his skull fractured, and Lane, who has been quite unfortunate recently and failed to rescue the lives of his patients, wants James to perform the surgery instead. James manages to persuade Lane to perform the surgery anyway, and when the man wakes up again he shows clear signs of insanity and mental illness. Lane’s reputation as a surgeon is damaged again.

James is convinced that the man was mentally ill even before the accident which had fractured his skull, and risk his whole career by trying to prove this by injecting the man with insulin as treatment for the insanity. He succeeds, and restores both his and Lane’s reputations.

After the patient is sane again, James reconciles him with his wife from whom he was separated five years ago. Seeing the couple reunited makes James propose to Mary even though he cannot afford a wedding, and she accepts his proposal.  THE END

So insulin is the drug of choice here, curing the patient of insanity, reconciling him with his wife,  saving Dr. Lane’s reputation….. and Dr. Kildare gets the girl.  Pretty powerful stuff that insulin.

Insulin shock therapy or insulin coma therapy (ICT) was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks.[1] It was introduced in 1927 by Austrian-American psychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs in the 1960s.

To keep the plot moving along, the process in “Strange Case” takes a few hours through the night during which Kildare and Lamont lock themselves into the patient’s room, administer the insulin and wait while the patient (who by the way could not provide informed consent because he was insane) becomes comatose and goes through various violent convulsions and regressions.  Alas, as the sun rises, he regains sanity, tells Kildare his name and his wife is found and brought in for the happy reunion.  Ah, medicine in movieland.  (Interesting sidebar:  Lew Ayres died in 1996 at the age of 88 of complications from a coma.)

(Here is the NYT April 12, 1940 movie reviewhttp://www.nytimes.com/movie/review?res=9C01E1D81F3CEE3ABC4A52DFB266838B659EDE )

Aside from the administering of an experimental drug without consent from the patient or next of kin, and with the presenting goal of saving Dr. Lane’s reputation, there are various other practices at this 1940 hospital that boggle our current health care brains.  Clearly HIPAA was not even a dim light on the horizon.  The doctors, nurses, the switchboard operator, and the ambulance driver all chat about the patients and their diagnosis/treatments.  No one seems to wash their hands except directly before surgery and it’s a perfunctory splash.

There is also the use of another experimental drug in a bizarre little subplot.  Joe, the ambulance driver fancies Sally the switchboard operator, but he like Dr. Kildare does not have the money to wine and dine Sally into romance and he knows that a certain fellow from Philadelphia has been taking her to nice restaurants and thereby winning her heart.  Predicament indeed for Joe which he shares with the bar tender, Mike Ryan, and Dr. Kildare at Sullivan’s Hospital Cafe.  They arrive at a plan for Joe to ask Sally out for a lovely lavish dinner, but bring her to Sullivan’s bar first for a drink.  Mike will give her a “special drink” that will cause her legs to be paralyzed, (yes paralyzed!) so she can’t go to dinner and Joe in fact can be the hero taking her home in this embarrassing state.  The three men all agree that this will get Joe the date and perhaps much more.  This certainly seems like the precursor to a date rape drug.  In the film it is presented as so very clever with our sweet idealistic Dr. Kildare as a co-conspirator.

And then there is the ubiquitous smoking of cigarettes.  Dr. Leonard Gillespie, Kildare’s mentor in medical research, is constantly lighting up to imbibe his steady dose of nicotine.  Gillespie, as played by Lionel Barrymore, is in a wheelchair and there is an implied serious health issue that has caused his disability.  In fact, Lionel Barrymore himself often used a wheelchair off the set. By the time the Kildare movies were made, he had broken his hip twice and then arthritis set in.  There is a “suggestion” that Barrymore’s arthritis was the result of his contracting syphilis in 1925.  The character of Dr. Gillespie adopted the same disability so that Barrymore could play the part, a switch on current Hollywood casting in which often the part of a character who is disabled is played by an actor who is not.  (Think of the film The Sessions, or of Lieutenant Dan Taylor in Forrest Gump who was a double amputee, but Gary Sinese was not.) The staff at the hospital, especially Superintendant Molly Byrd, are committed to keeping him healthy.  In one scene as Dr. Kildare and Dr. Gillespie share lunch, Nurse Byrd enters and actually says, “Drink your milk or no cigarettes!”  Dr. Gillespie, does an “Ick!!!” but gulps down the bottle of (undoubtedly whole) milk so he can retrieve his cigarettes from the matriarchal nurse.  Despite these efforts the real life Lionel Barrymore died of a heart attack.

It’s hard to know what the author of Dr. Kildare’s Strange Case had in mind.  Max Brand, born Frederick Faust, was a successful screenwriter who also wrote Westerns and loved mythology.   Perhaps in addition to the medical introduction of experimental drugs, he was portraying a world where men were men and gods were gods and magic potions to seduce women were de riguer.  And the smoking…well everyone did it.  Brand, himself had a heart attack and suffered from chronic heart disease until his death at the age of 52 from shrapnel in World War II.

Mingled within the issues of drugs and romance in the “Strange Case” is another vital difference between the world of Dr. Kildare and our current medical practice, and it’s death, the separation of Body and Soul.  When Dr. Lane fails the sheet is drawn over the patient’s face and death declared when the heart stops as per the 1816 determination of death by a French physician.  Prior to heart function as the definition of life, it was breath.  When a person ceased to breathe, as when the daughter of King Lear, Cordelia does not fog the mirror held to her lips by her grieving father.  Death could be determined by anyone who could hold a mirror or put their ear to a chest and hear, or not hear, a heart beat.  But 20 some odd years after Dr. Kildare, in 1968, Dr. Henry Beecher declared a new definition of death, the cessation of the brain to function, and this required the use of sophisticated medical equipment and the declaration of death by a doctor.  And, lingering questions about the blur between life and death.  There was a fascinating Radio Lab session called Afterlife on March 8, 2014, that I listened to on my drive up to DIA: Beacon on a sunny early spring day when all was poised for rebirth with the appearance of snowdrops and crocuses.  You can listen to it here:

https://www.wnyc.org/radio/#/ondemand/91681

I wish I could have had the Doctors Kildare, Lane and Gillespie, and Nurse Mary Lamont, the writer Max Brand on that drive to Beacon with me.  I would love to hear their reactions to the complex medical, spiritual, philosophical questions raised in the 11 vignettes of life and death, body and soul.  But of course I would not have let them smoke in my car.

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