PIETER KLAZES PEL

translated by Bineke Oort-Pel

Prof. Pieter Klazes Pel, my grandfather, a professor of internal medicine was well known not only in medical circles but also in general because, in his time, professors were few in number and held in high esteem.

The following anecdote illustrates his reputation. When, in 1963, I had established myself in general practice in Zwolle, an elderly woman came to me who had previously lived in Zwolle, and had returned from Amsterdam to live in a newly opened residence for the elderly. She shared with me that when she was young, her family owned a bakery in Zwolle. Her father moved the family and his business to Amsterdam because he was allergic to flour and could only be treated by a well known professor there. When I asked her for his name, she looked at me with surprise, telling me that the professor had the same name as I.

There are other indications that he was much appreciated. Among my collection of memorabilia I have a note dated 1893, congratulating him on his recovery from an illness. It was written on parchment and signed by more than 160 students. Another example is that 300 people signed the guest book at a reception celebrating the 25th anniversary of his professorship. These numbers are remarkable when you consider that the academic world in Amsterdam at the time was much smaller than now, My collection of memorabilia shows also that he was often written about in the popular press.

Regrettably, for me as his grandson, very little is known about his private life. The only surviving family member who actually set foot in his house on the Heerengracht in Amsterdam, is a granddaughter who being a young child at that time, remembers nothing of it. Thus what we do have is second hand information, and rather scant at that. For the most part, the stories we know of his personal life have been found in obituaries.

Pieter of Pieter of Pieter

Pieter Pel was born in Friesland, the Netherlands’ most northern province. His ancestors were millers, more specifically, "peel or husk millers" around the town of Leeuwarden. His great grandfather in 1811 when last names became required by law, adopted the name Pel, undoubtedly as a referral to his family’s trade. (Pel is Dutch for peel or husk ).

Pel’s grandfather, Pieter Klazes, went to Amsterdam to study medicine , still at the "chirurgijn" and became a doctor of surgery, internal medicine and obstetrics. He established a practice in the town of Drachten in Friesland. There he also became active in politics as an alderman and a member of the executive committee of the Frisian society of agriculture. Later he became involved with many land reclamation projects. His son, Klaas Pieter also became a physician. We might have called him a general practitioner. He wrote his doctor's thesis on an unusual topic: noma (a mutilating type of facial sore).

Pel was born to Klaas Pieter and Wibbina Santee on February 22, 1852 in Drachten. He was officially registered as Pieter. Klaas Pieter apparently neglected to add “Klazes”to his son’s registered name, for that name traditionally came with it. Most likely this is the reason for several different spellings of Pel’s middle name, among others Klazes, Klases and Klaases.

Medical education

Pel attended the gymnasium at Sneek and then left Friesland to study medicine in Leiden, from 1869 to1873. He greatly admired Dr. Rosenstein, Professor of internal medicine at Leiden.and became his avid student and assistant. Pel completed his studies in 1876, graduating cum laude. His doctoral thesis was on "The fever inducing effect of digitaline".

Following his studies he spent two years visiting the prominent medical centers in Berlin, Vienna and Paris. Among other things, he pursued the newly developing field of laryngology. In Vienna he met Dr. G H van der Mey, later well known as professor in obstetrics and gynecology, who introduced Pel to Prof. B.J Stokvis. Stokvis taught internal medicine and pharmacology in Amsterdam.

In 1878 Pel was appointed "chef de clinique” at the university hospital in Amsterdam, and with great dedication he embraced education and research in internal medicine. At the time, internal medicine included all aspects of medicine outside surgery or gynecology; for example it included neurology. Two years later, in 1880, Pel was appointed lecturer in contagious diseases and physiological diagnostics. In 1883 he became professor of internal medicine. In 1891 he was invited to go to Leiden University, but he stayed loyal to Amsterdam.

The following anecdote gives an example of how he blended his hobby into his practice.

An engineer with a stressful job had felt sick and miserable for quite some time. He went to Prof. Pel and later described what had happened: "After having listened to my list of complaints Prof. Pel questioned and examined me thoroughly. He then sat down at his desk to write a long letter and, having sealed it, handed it to me with the following words:’ Here is a letter for you. In it you will find everything you have to do. Open it when you get home, and read it at your leisure. No, you do not have to come back.’ With a friendly pat on my shoulder I was escorted out of the door. There I stood in the street again, without having asked all the questions I had on my mind. I walked along the Heerengracht, then the Blauwburgwal, and I had a look at the letter! It was impossible to wait to read it until I was home so I ripped it open and read the following: "Dear Sir, when, while walking along the Blauwburgwal, and having gotten out of sight of my house, you open this letter and you are walking in just the right direction! You cross over the N.Z.Voorburgwal and, just before the Nieuwe Kerk, you turn into the Gravenstraat. Here, in the third house on the left, is a tackle store. Go in, mention that Prof. Pel sent you, and order a complete fishing outfit. Tomorrow you leave for the village of Wilnis. There you will board with "Tante Anna" and stay there one week! You are to go to bed at nine and have yourself awakened at four o'clock in the morning to go fishing in a boat with "ouwe Jaap". For lunch you take along some sandwiches and a thermos bottle with tea (no Dutch gin!) Tante Anna will take good care of you and you must stick with her menus and the instructions of "ouwe Jaap". After one week of this you will return home cured.’ .....That was the end of Prof. Pel’s letter. And the result? After having followed the recommendations, I indeed was free of all symptoms! Since that experience I never had any more complaints.

Family Pel

In 1879 Pel married Marie Salomonson, the daughter of a well-to-do family from the area of Twente. At that time he was working under Stokvis as chef de clinique at the clinic in Amsterdam. In the course of the next 21 years, they had eight children. In the beginning they lived in de Huddestraat(je), later the family moved into an elegant house on the Heerengracht, nr. 52.

Regrettably not much is known about the Pel’s daily life, but it is clear that the atmosphere was one of quiet prosperity. For instance, one does not hear about large dinner parties despite the fact that there was ample help in the house. Excesses would not fit the sober, down-to-earthness that is visible in Pel's general life-style and that also is evident in his publications. Pel kept office hours at home. We are left to wonder during what hours he saw patients and how long, for that matter, the children had to be kept quiet.

That there was a certain amount of interface between home and his work life can be seen in the marital choices of the first four children. The oldest daughter, Wibbina (born 1880), at age 26 married the 40 year old Pieter Ruitinga, a professor-colleague of Pel’s. The son Lodewijk (1882) became an internist and was associated with the clinic for internal medicine until his death in 1936. He remained unmarried. Elisabeth (1884) married Dr. M.R.Heynsius van den Berg, pulmonary physician and known for his fight against tuberculosis. Johanna (1889) married W.A. Kuenen, later Professor in internal medicine in Leiden (a son from this marriage is L. Kuenen, internist in Leiden). The next three children went more their own way: a daughter Francis (1891) stayed unmarried, Nico (1893) studied at the poly-technical university at Delft, as did Santee (1898). The youngest, Pieter Klazes (1900) followed his father’s influence, took up medicine and became a general practitioner in The Hague. He was my father.

As mentioned before, Pel was moderate in many ways, also in his work. He probably was able to bring enormous energy to his work because he also knew how to take time off by pursuing his hobbies: sailing, fishing and hunting. The family bought a yacht that was renovated to house the whole family and two crew members. In vacations and on weekends the yacht, named "Wibbina” sailed throughout the Netherlands, especially in Friesland. On Fridays Pel absented himself from the clinic to go fishing. There are many stories about his fishing feats, perhaps some the tall tales of a fisherman; however, the family still owns an extra large bass that he caught, preserved of course in alcohol.

Teacher in physical diagnostics.

At the end of the 19th century in the Netherlands, a student could get a medical degree at four medical schools: Leiden, Utrecht, Amsterdam and Groningen. During the first part of the training the focus was on theory, followed in the second part by practical application. Pel played an important role in teaching practical application as became evident in his inaugural speech on the significance of bedside teaching. He said: "Whereas, formerly, the sick patient functioned primarily as an example or illustration of the dominating theoretical education; in the modern world the careful, objective examination of the patient warrants priority attention."

Pel was an arduous clinician who excelled in transmitting to the next generation of physicians his insights and his style of thinking and working. His courses were always well attended and his clinical demonstrations highly regarded.

His greatest interest was in physical diagnosis and he knew how to impart this to his students with inspiration. For the student whose turn it was to be the first one to question the patient, it was not always fun. Pel could be sharp but he never actually put a student down. Numerous are the stories about his pronouncements on these occasions. When a student came up with a diagnosis of a very rare disease, he used to say: “When someone tells me that an animal on four feet is walking around in the yard next door, it could be a small tiger or elephant, but I still would rather think of a cat or a dog.”

For a long time he personally took care of the training in physical diagnosis. Pel taught his students to percuss with a small hammer and he disagreed with his colleagues on the best weight of the hammer; he preferred a lighter weight. One time, when some construction that involved pile-driving was taking place in the neighbourhood he said to the students: "Let's be quiet, gentlemen, Professor Stokvis is percussing."

Pel also was loved by the patients he treated. In his approach he not only showed interest in the disease, but clearly also in the patient as a person. Also in this realm he was blessed with an outstanding memory, sometimes recognizing a patient whom he had not seen in ten years.

As manager of the hospital he seemed to have been effective. In the beginning of his professorship, and for some time, he was director of the "Binnengasthuis”

Publications

Pel has published much. His writing style was a fluid, mostly direct style of writing and his articles by and large are still very readable. Naturally, often something is posed that we now no longer agree with. Most often he was very careful in his assertions. Pel probably belonged to the last generation of clinicians who were still completely informed as to internal medicine in all of its facets. He wrote books about diseases of the stomach (1899), the liver and gallbladder and the portal vein system (1908), kidneys (1919) and the heart and arteries (1920). Of the first three he also did the revisions of the succeeding editions; the fourth edition was published one year after his death by his co-authors P.H.Einthoven and I.Snapper.

There is a list of 78 articles by him, of which 41 appeared in the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine). The rest almost without exception were published in German magazines, above all the “Berliner Klinische Wochenschrift”. The subjects covered specialties we now know as general internal medicine, pulmonology, neurology, cardiology, and gastro-enterology, and less frequently endocrinology, nephrology and ear,nose and throat medicine.

In addition he gave many speeches. Those too are still very readable and in them he shows himself to be a modern man, perhaps obsessed with his "real" profession: the teaching of clinical medicine; above all, diagnostics.

Especially mentioned should be the speech he made as Rector Magnificus (Dean of the University) in 1902, at the commemoration of the 270th anniversary of the founding of the University of Amsterdam. The title of the speech was "The Art of Living Healthily and Happily and the Prevention of Illness. (Eubiotics)". In this speech he advocated a moderate life style in all aspects without, however , going into extremes of avoidance of all social delights. He described the great progress made in medicine during the past century (19th), but warned that in spite of all science and possibilities, prevention always was to be preferred: "Preventative medicine, and especially individual prevention can already be called a child of our present times, but, undoubtedly it will become the pet of the twentieth century." This speech became well-known in his time and also in later years was often quoted That it also spoke to the students is shown in the following chant on the melody of the popular Dutch song "Piet Hein", that was published in Propria Cures (students magazine): "Have you ever heard of the magnificent man, The dean of the Profs.” The refrain was: "P.K.Pel, P.K.Pel, P.K.Pel, you sure know of him./ His hair is stylish, (bis)/ He has found the Eubiotics".

Fever of Pel-Ebstein

The discovery that made Pel very well known to many generations of physicians, possibly even to this day, is Pel-Ebstein fever. It is a type of fever that sometimes appears in the disease that we now call (non) Hodgkins disease. Pel-Ebstein can be found in almost all internal medicine textbooks. When, after my studies, I worked for a year as an intern in an American hospital, I experienced an elevation in my status when I casually mentioned that it was my grandfather for whom the fever was named.

In 1885 Pel described in the Berliner Klinische Wochenschrift two patients who had periods of fever for 12-14 days, alternating with about 10 days of fever- free periods. The post mortem examination showed a considerable enlargement of the spleen and swelling of the lymph nodes. At the time that was called "pseudo-leukemia". In 1887 Ebstein described a similar case in the same magazine. A polemic between them ensued whether it just was a symptom in pseudo-leukemia (Pel) or a separate disease (Ebstein). If we consider it now, it probably had to do with a rare phenomenon in untreated Hodgkin disease.

Professional associations

Pel was active in many professional and social services. Among others he was president of the Hooglaren Sanatorium in Amsterdam, president of the Society against Epilepsy and honorary member of the Amsterdam Society for the Advancement of Small Pox Vaccination for the Poor. Aside from that, Pel was an honorary member of a variety of foreign associations, among others Ehrenmitglied des Vereins for inneren Medicin in Berlin, and he was decorated with "de ridderschap in de the orde van de Nederlandse Leeuw" (Knight of the Order of the Dutch Lion"

Twice he was president of the “Nederlandse Maatschappij ter bevordering van de Geneeskunst” (the Dutch A.M.A.). The first was in 1886. The second time was twenty nine years later in 1915 when the NMG presumably saw the need for a "heavyweight" as president in order to preserve its unity . In the beginning of the 20th century there was much turmoil in the NMG caused by the emergence of socialized medicine, the rapid growth of the number of specialties and the question as to whether the NMG should become a trade union. There was also an issue about the degree of independence of the districts. In his opening speech at the general assembly in 1915, Pel did not address these problems but he gave an overview of the past 25 years in medicine.

Honorable retirement

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During 1918 Pel began to suffer from heart disease that in February of 1919 took his life. Even though I have many of his obituaries, I have not been able to discern the nature of his illness. That the illness in its last stage progressed rapidly is evident from the fact that on February 12, he requested retirement effective April 1, but he died just three days later, on February 15. He was buried in a pouring rain in the cemetery Zorgvlied in Amsterdam. The ceremony was attended by many. On his urgent request the Rector Magnificus, Professor K.Kuiper, was the only person who spoke.