The following year, 1953, a paper was published in the British journal The Lancet, arguing that insulin coma therapy was not only dangerous but of no value at all. Within a decade it was a dead letter in Australian hospitals, and had vanished from any respectable hospital that purported to offer state-of-the-art care.
As far as we know, John did not undertake any further lithium research in his first year at Royal Park, but around Melbourne lithium was being used here and there, largely by individual psychiatrists who were keen to try it out. But its future was uncertain. It was at this point that a remarkable man emerged who changed everything, and who kept afloat John Cade’s discovery.
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Everyone who knew him, it seems, has a story about Eduard Michel Trautner. It is quite possible that lithium treatments would have died a natural death if it hadn’t been for this exotic figure—a man who cut his medical research teeth in the drinking clubs of bawdy Berlin after the First World War; clubs where he researched the sex lives of flaxen-haired farm girls. At least, that’s how the story goes. Or, more correctly, just one of the many stories about him. Everyone who knew him had a tale to tell; exotic and mischievous, and more than a little salacious, Eduard Michel Trautner, or as he was lovably called, Trautie, is the forgotten hero in the lithium story. Without Trautie the lithium story might well have trailed off into nothing.
A Bavarian Catholic by birth and atheist by choice, Eduard Trautner was a lance corporal in the German Army during the First World War; the story has it that he, lance raised, thundered on his stallion with the German cavalry into Belgium in the early days of the war. At war’s end he studied medicine in Berlin and had a practice ‘with the very rich and very eccentric’; he had a bent towards a study of sexuality and, according to one of his friends, took a particular interest in the study of homosexuality. Later in his life, Trautner enjoyed teasing his colleagues in Melbourne with his tales of the Weimar Republic’s Berlin nightclubs and his clientele’s libertine sexual behaviour. A radical man with the sniff of the dissident, by the early 1930s Trautner was a man on the run in Germany. Detesting Hitler and fearful of fascism, this very left-leaning doctor, it is speculated, was hunted out of Nazi Germany.
Rumour has it that he fled to Spain during the Spanish Civil War and ran a bar until he gathered together the exotic strands of his life and decamped to England. A man of many dimensions, he studied science including botany; one of his co-workers recalls Trautie vaguely saying something about working in a lab ‘at either Cambridge or Oxford and marrying a daughter of the English nobility’. As war raged with Germany, to speak with a Teutonic tongue in 1940 in England was always going to be a tricky business. Predictably, soon afterwards, Trautner—this non-Jewish radical German dissident—was rounded up and incarcerated. Churchill, fearing the corrosive effect of so many free-ranging Germans in England, decided to rid his country of potential spies. These ‘enemy aliens’—often a gross and unfair label—were to be exiled to foreign lands. And there was no country better to take them than Australia. After all, Australia was a place where the English had form when it came to dumping their unwanted.
To this end, Trautner was forcibly boarded onto the infamous Dunera. On the vessel were crammed over 2500 men of different political and ethnic persuasions—Nazi detestors and a few Nazi sympathisers—a hotchpotch of England’s rejects; the vast majority were Jewish refugees who had fled fascism in Europe. Laden with this teeming glut of men, the Dunera departed England in July 1940 and made its way to Sydney, in much the same way as convict vessels did for the first half of the nineteenth century, voyaging and decanting its load on the Sydney docks. Trautner, at close to 50, would have been one of the older detainees to step upon the shores of Australia.
Trautner, along with his fellow travellers, was interned in the township of Hay on the south-western plains of New South Wales. From here Trautner was moved to Orange and finally to Tatura in central Victoria, 180 kilometres from Melbourne. That’s when luck came waltzing his way.
Trautner may have rotted in an internment camp until the end of the war were it not for another remarkable man—‘Pansy’ Wright. Roy Douglas Wright was professor of physiology at the University of Melbourne, and had a ‘habit of collecting strays’ with scientific talent. A perpetual fighter for the underdog, Wright was made aware of Trautner’s imprisonment and organised his transfer to the university to work under him in the physiology department. Wright turned heads wherever he went; he was coarse-tongued and swashbuckling, and had a large face whose porcine features earned him a role in a student review and the ironic nickname ‘Pansy’. He was an academic doing all that apparently well-behaved professors were not supposed to do. For Trautner, the rough-edged ‘Pansy’ Wright was a godsend. Trautner’s future was secured in 1944 by a man gruff in nature but abounding in human understanding.
It was while at the university that Trautner’s roving eye settled upon John Cade’s 1949 paper on lithium. Within weeks of reading it, it seems, Trautner had joined forces with a psychiatrist by the name of Charlie Noack from the Mont Park Mental Hospital and set about treating patients with lithium. With a stroke they had over a hundred patients on their books—the largest single collection of lithium patients anywhere—and published their findings in 1951 in The Medical Journal of Australia. John Cade had little to do with this paper; Traunter did communicate with John, but their relationship was a distant one.
It was at about this time that another man, eager to study lithium, arrived on John Cade’s doorstep.
Sam Gershon, brash and breezy, descended on Melbourne in 1952 to take up a post as a young trainee psychiatrist at Royal Park. Born in Poland, and in his second year as a doctor, after graduating from the University of Sydney, he packed energy and enterprise in a featherweight’s frame that peaked on a good day at 5 feet 4 inches. From the time of his arrival, Gershon sought out ways to involve himself in lithium research and to meet John Cade.
Gershon was precocious and smart; as a medical student, he had read John’s article on lithium. Remarkably, even as a junior doctor in Sydney, he had had the enterprise to trial lithium on patients. He recalled this episode:
my rotating residency included a period in the psychiatry unit at Prince Alfred Hospital . . . The senior honorary was Dr George McGeorge . . . he was in private forensic practice and he drove a Rolls-Royce and he was a very nice man and a very unusual fellow . . . because when I discussed this [the use of lithium] with him, he said ‘Look, we really don’t know what we’re doing . . . we don’t know what these diseases are. If this is reported and claimed to be something from this institution in Melbourne it’s worth a trial. My only concern is safety.’ I only used it in a few patients.
Infected with a desire to further study lithium, Sam Gershon landed on John’s doorstep in Melbourne, one eye on ambition and the other on science: ‘I was interested in lithium—why this particular substance had this extremely important, dramatic effect on psychotic patients.’
Although we don’t have any written words to this effect from John Cade, there is a sense that he was, from the start, irritated by the youthful bustle of Gershon. On the one hand, Gershon was an outgoing, overtly ambitious man on the rise, and, on the other, John was a man of formality and reserve. It was a difference that never found resolution. Gershon’s own reflections affirm this picture: ‘We had a highly formal and slightly hostile relationship.’ And as for lithium? Gershon’s memory of his time at Royal Park is that John Cade had gone off the idea of lithium. He recalls that John ‘didn’t want anything to do with the use of lithium; he’d banned it, he didn’t want to hear about it’.
Gershon, by the way, is not the only person who recalled John’s reluctance to use lithium in the early 1950s. Dr Neil McConaghy, another junior doctor, who shared a house with Sam Gershon at Royal Park, had similar memories, and Pansy Wright, in a lecture at the University of Melbourne in the early 1980s, recalled that ‘Cade had dropped lithium like a hot potato’.
So
what was going on in John’s mind? How worried was he about lithium in the early 1950s? Well, if you believe those who later sought to stake a claim in the history of lithium therapy, and who worked most closely with him at the time, very worried, perhaps terrified. John had sat before the coroner once; he was not prepared to do so again. But is this assessment fair? Or more importantly, accurate? Later on in life John never gave the impression of ever having lost interest or, indeed, faith in lithium as an effective treatment. And not everyone accepts the view that John dropped lithium at this time. His oldest son, Jack, retired professor of intensive care at Royal Melbourne Hospital, mused:
This is misunderstood. In those days, in the late 1940s, when one published a paper, people didn’t go on to keep publishing as they do now . . . he was a busy clinician and administrator . . . I don’t think he felt the need to be at the front. He felt he had done what he could and left the rest to others with more research skills, to follow this up. He also moved on to other areas. He was always curious about what caused schizophrenia. He left lithium for a while looking for something similar in schizophrenia.
The most important voice in this whole debate is that of John Cade. But it is hard to fathom what John’s thoughts were, and it remains one of the great imponderables in the lithium story. Curiously, John himself never reflected on this key period of uncertainty and, sadly, no writer or historian pressed him on the point later in his life. It seems though, that John’s belief in lithium did, at the very least, waver. There can be little genuine doubt that John was troubled by lithium. The real question is did he lose faith in it altogether? The answer depends on whom you ask, and whom you believe. It is a flight of the biographer’s vanity to think it is possible to reassemble the mind of a man from over 60 years ago.
Regardless of the reasoning behind John’s willingness to let the use of lithium rise or fall during his early years at Royal Park, Sam Gershon and John Cade fell out before they fell in. So Sam Gershon, irrepressible as ever, looked to start his lithium research elsewhere. That’s how he met Eduard Trautner.
Before arriving at Royal Park in early 1952, Sam Gershon, had read not only John Cade’s 1949 paper but also Trautner and Noack’s 1951 paper. From the start, Gershon was impressed by Trautner and struck up a close professional and personal relationship with the German refugee. There are many recollections of Trautner at this time, all memorable. This is one of the best, from Gershon’s wife, Lisl:
I knew him very well and my memories are vivid and positive. He was truly a bohemian. He was his own person; he didn’t care about convention or what people thought of him. He was dedicated to his science, loyal to his friends, and he looked like Yoda from Star Wars.
I’ve never seen anyone so wrinkled in my life but Trautie was unbelievably youthful. He chain-smoked. We all smoked. He smoked like a chimney. He smoked ‘Players’ . . . He was a jovial person, jolly, a bon vivant. He knew things about art and music and Europe. Very European, cosmopolitan. He was devoted to science but he was also devoted to living.
Gershon’s wife remembers these vintage times: ‘we’d smoke, and drink Cointreau and Benedictine. We’d drink coffee and he [Trautner] and Sam talked a lot about lithium and art and Europe.’ Then, with a shiver of distaste, she conjures a contrasting image of Melbourne at the time:
Melbourne in the 1950s was very British, very white, very pink, very WASP, it was so boring. There was no good food, so people like Trautie were unusual; the only restaurant worth eating at was Florentino’s, then Pellegrini’s Brothers in, I think, Bourke Street.
In a post-war Melbourne of comfy cardigans and trundling trams, and where the average person’s idea of nightlife was to huddle about the radiogram on the mantelpiece for an episode of ‘Blue Hills’, Eduard Trautner rose like a comet that lit up the Melbourne skies.
Trautner’s thick, heavily accented voice exposed with every syllable his Germanic background, and in a country reeling with post-war Teutonic sensitivities about ‘the enemy’, he made the decision—like so many others—to do something about his telltale name. He anglicised what he could; Eduard silently, by stealth, became Edward. Even for an iconoclast, acceptance is important.
Trautner and Gershon—mentor and acolyte—laboured on lithium’s mysteries during the 1950s. They were a productive team. As we look back at them, they make an odd pairing: a non-Jewish German radical and a Polish-born Jewish Australian. Modern Australia in a snapshot.
While migrants were slowly remaking Australia’s culinary culture, they were also, it seems, silently helping to revolutionise its medicine.
By the end of 1952 the newly anglicised Edward Trautner and the effervescent Sam Gershon were experimenting with lithium in various hospitals around Melbourne—but largely away from Royal Park. By year’s end, Gershon had left Royal Park and was working at Ballarat Mental Hospital. Here he continued experimenting with lithium. His memories of the asylum are unprepossessing.
Ballarat was a hospital of near 1000 patients; there was one psychiatrist superintendent who spent all of his time locked in his office writing those long folio sheets of follow up notes; I don’t think he ever stepped out of his office. In addition to him on the staff there was one other resident doctor senior to me . . . and then there was me. That was the total [medical] staff.
[The hospital] was like a Gulag. You know, the 1950s in Ballarat, there was nothing there. A big mental hospital and there were the ruins of the gold mines; and a derelict city. There really wasn’t much; I continued to drive down to Melbourne to go to the University. The work with lithium continued . . . I could do what I liked up there at Ballarat. I’d take the samples of blood for testing lithium levels down to Melbourne.
There was one day in particular that Sam Gershon should remember: 7 December 1952. On that single day, two patients died at the Ballarat Mental Hospital—Bessie Lorraine Hawksworth, a 33-year-old ex-hosiery employee, and Mary Vera Raselli, aged 41, whose sad and meagre life description in her file states simply ‘home duties’, though, locked in asylums, she had not done this for years. The coronial review found both patients perished from lithium toxicity; Sam Gershon was the doctor in both cases and presented his evidence before the coroner. Several months later, after Sam Gershon had left the hospital, a third patient died from lithium toxicity in Ballarat.
In recent years, when asked about his recollections of these deaths, Sam Gershon could not recall any details. In fact, he could not remember the deaths at all. But he did remember the general air of wariness, of nervousness around the use of lithium, which pervaded not only the mind of John Cade but also the minds of a string of coroners:
At the time there must have been a lot of deaths . . . deaths were reported in the newspapers that went to coroners’ courts . . . I mean, a lot of them were reported by hearsay . . . and you can’t really track them all down, like this bizarre one we heard but never verified that some farmer was using lithium citrate on a celery crop to treat rust . . . and the family ate the celery and some got lithium poisoning. Whether that was true or false I don’t know but there were a lot of stories going around.
Back at Royal Park, John Cade would have known immediately about these further lithium deaths in Ballarat. He may have felt they justified his urgings for caution in the use of lithium; more likely this feeling would have been overtaken by his still strong desire that lithium might yet prove its worth.
As the year drew to a close, John may have spent time thinking about lithium and these further deaths, but it is unlikely he did so, for his world was overwhelmed by only one thought: that he might lose another child. John Cade had already borne witness to the death of his daughter, Mary; now his oldest child, Jack, lay critically ill in the Mercy Hospital in Melbourne. It would be fair to say that lithium was the furthest thing from John’s mind at the end of 1952.
As John’s children tell the story, Jack Cade—fourteen, then a student at Xavier College—had a life-threatening, but to this day mysterious illness. How his father res
ponded tells us a lot about what offered John fortitude in life. David, then twelve years old, remembers visiting his brother in hospital:
Jack nearly died. He was at the Mercy Private Hospital for close to 3 months, if I remember well. He was ill a long time. I remember going in; he was wasting away. Formerly he was a tall athletic boy. Now he was lying in bed, his arms flexed at the elbow, skin and bone; and looked close to death.
John, of course, had no shortage of medical connections throughout the city of Melbourne, and he pressed the most skilled physicians to watch over his son. In particular he sought counsel and care from the man whom he regarded as the finest physician in Melbourne—Dr John Horan. But, despite lengthy observation and investigations, Dr Horan was unable to conjure a diagnosis, much less a cure. The family to this day believe that no precise diagnosis was ever unearthed.
Jean remembered this awful time:
Jack had been desperately ill for 4–6 months . . . the nearest we could call it would be polio but it wasn’t . . . he had pains in his legs . . . extraordinary pain and could not walk . . . His forehead, that was swollen. He couldn’t hold things to feed himself . . . I had to lift him to the pan . . . his cry was ‘Take me home, take me home’ and the pathologist took blood every day . . . and he said he felt ‘wicked pricking John’s fingers’ . . . when I put a bell by his side he couldn’t press the bell . . . he said: ‘I can’t Mum, look at my fingers’. They were so thin there was no flesh on them.
Whatever the nature of Jack’s illness, death was near. John and Jean visited daily, holding vigil by their son’s bed, taking great store in the utterances of the nuns who nursed their boy. As David said:
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