My two years in the navy lasted a lifetime, or so it seemed. At the end, I left Texas a more experienced general physician, but with some important decisions to make.
First, I needed more training. The age of specialization had begun and it was becoming evident that a young physician would no longer be able to do it all. Even though legally the state’s license granted me the authority to practice medicine and surgery, modern urban hospitals required appropriate residency training in order to have admitting privileges. There was even talk of postgraduate certification for the family doctor or general practitioner. Great progress in medical research was making it impossible for even the most astute physician to keep up and be fully knowledgeable in all phases of medicine.
The problem was that I liked it all. I needed to choose a field that would give me the intellectual stimulation and satisfaction of diagnostic and therapeutic challenges. At the same time, I wanted a specialty that would allow me to assume the role of a family physician and provide for the nonsurgical needs of my patients.
The field of internal medicine was the logical choice. However, I felt that I was making a tremendous concession in becoming an internist. I would be giving up the thrill of delivering babies and taking care of children, and I’d miss out on the ego boost of being the “god in white” of surgery. I looked for a teaching hospital where I could be exposed to the greatest variety of patients as well as good teaching facilities.
I found what I was looking for in 1958, when I walked into the monstrous, three-thousand-bed Charity Hospital in New Orleans, to begin a residency in internal medicine. Charity Hospital was one of the most unusual facilities in the country. It had provided medical services, often free of charge, to patients on all rungs of the socioeconomic ladder since the 1920s. It was built, along with other charity hospitals, by the infamous and corrupt governor of Louisiana, Huey Long. Charity was one of the good results of Long’s stormy, dictatorial leadership of the state. Two medical schools shared this behemoth, and were located on each side of the hospital. The facility was so large that two residents at the same hospital could go to Tulane or LSU medical schools and never run into each other in their four years of training. Charity Hospital survived many physical, legal and economic crises over the years, but Hurricane Katrina was too strong an adversary; the beloved old giant took water damage from the levees and the gunshots of looters until it just rolled over and closed its doors.
What I remember about my days at Charity are the interesting and inspiring teachers, more than the facts they taught us. I remember the patients’ personalities and their concerns. I observed how they adjusted to their illnesses. Some of the more difficult and less compliant patients were so demanding that staff, caretakers and often their physicians rejected them and they received even less attention; they were always unhappy and lonely. These patients, I found, were really depressed and frightened. They had the most difficulty communicating and needed more attention and understanding than the passive patients, who simply accepted their illnesses without resistance. I could see that the art of medicine was to be able to win the confidence of the patient, no matter how grave the diagnosis might be. I found that what patients needed most was for people to care. When the young physician realized that, caring became natural, and the real physician was born. From then on, science and humanity worked together in harmony, with the physician being the conductor. That’s what I learned and remember most, and I pray that those lessons will never be forgotten.
I learned so much more from listening to my patients than from textbooks and medical journals. The famous medical teacher Dr. William Osler, from Johns Hopkins, once said, “Listen to your patient, he is telling you his diagnosis.” He said this in the early twentieth century, before CAT scans and MRIs. I teach my students to organize their approach to a patient by following this firm rule in any situation: first, the patient; second, the patient; third, the patient; but always, the patient.
On a rainy late afternoon in my second year of residency at Charity, I saw my last patient of the day, a seventy-year-old Cajun woman from the bayous of Louisiana. She had the distinction of having been in the Charity Hospital system all of her life. She had grown up there, delivered her babies there and received whatever other medical care she needed over the years in that same old, uncomfortable, crowded medical clinic. This lady had what she called a big problem. In the late 1950s, oil was discovered in some of the bayous, and those who, like my patient, owned land there could lease the oil rights for large sums of money. She would gain significant income for the first time in her life, but this made her ineligible for the medical services of Charity Hospital. She needed to choose a physician in the community to take care of her.
There were hundreds of Charity-trained residents who practiced in the New Orleans area. My patient had contact with many physicians over the years, and we all wondered who she would choose as her family physician. After all, she knew from firsthand experience who the best real doctor was.
Speculation ran high for weeks. Finally she chose a man who practiced on the periphery of the city, although it was inconvenient for her to go out to his office. I was quite surprised at her choice. This man was a perfectly acceptable physician, but he was certainly not someone with “Best Doctor of the Year” potential. In fact, he was one of the blandest and least exciting residents I had ever worked with—I even thought him rather lazy. How had she come to choose him? I couldn’t suppress my curiosity any longer, so I asked her how she had made her choice.
“You know, Doctor,” she said without hesitation, “I have seen many, many doctors over the years—as a little child, a grown mother and now as an old lady. In all those years, this man is the only one who helped me put on my coat.”
In all the years and of all the doctors, only one had thought to extend that courtesy to her. It was clear to me that she had made the right choice.
As a second-year resident in medicine at Charity, I had the traditional benefit of accompanying the famous Dr. Edgar Hull, who was chief of medicine at Louisiana State University School of Medicine, on his annual visit to Carville for his consultations on cardiovascular problems in the leper colony there. Carville was one of the only leper colonies still in existence in the United States, and it was always fascinating to go there and see numerous patients in the presence of a revered medical teacher. But Dr. Hull was also very savvy about medical politics and how to get his programs accredited and funded at a time when there was stiff competition for federal support of medical teaching hospitals.
A few days after our Carville trip, Dr. Hull and I entered a hospital elevator along with one of the inspectors from the Joint Commission for Accreditation of Hospitals. As we were riding up, Dr. Hull commented that his hospital should be accredited because the residents had such extensive clinical experience.
“For example,” he said, “here’s one of our residents. Dr. Banov, how many cases of leprosy have you seen as a medical resident in the last week?”
Of course, “the last week” included my visit to the leprosarium a few days before, so I said, “Last week I saw, oh, at least twenty-five cases of leprosy.”
“Thank you very much, Doctor,” Dr. Hull replied, then got off the elevator (rather quickly, I thought) at his floor.
I do not think any further inspection was necessary at the hospital after it was reported that this training program was the best in the world because the physicians had such excellent opportunities for study.
Dr. Edgar Hull was an extraordinary teacher. He could do more, diagnostically, with a stethoscope than modern cardiologists can ever begin to do with all of their sophisticated equipment. When Dr. Hull made his rounds in the morning and pointed out heart murmurs, he had as many as twenty-five physicians following him, just to hear one or two beeps from his stethoscope. His ears were magic and his touch the quintessence of diagnostic sensitivity. He co-authored one of the original books on electrocardiography and always elected to remain as a medical school professor rather than accept the many offers he received for lucrative private cardiology practice.
He once attended a medical meeting in Nevada and became ill. He was treated in an ER facility by a young family practitioner whose potential was evident to Dr. Hull’s keen eye. He invited this young man to come back to Charity Hospital and train in internal medicine. This physician, whose expenses were all paid by Dr. Hull and his family, became a leading teacher and practitioner of geriatric medicine. He achieved national and international accolades for his teaching and practice.
In the early 1980s, pharmaceutical companies and medical professors realized that no one had heard anything about or from Dr. Hull for several years. He seemed to have disappeared. The staff of Modern Medicine, one of the popular medical journals of the day, took on the task of locating the famous medical teacher and cardiac researcher. They found him doing family medicine in the bayous of Louisiana. He was working twelve hours a day, delivering babies at home and, in general, handling an extremely difficult practice.
The searchers asked Dr. Hull if he had financial problems, or some difficulty in his family. Perhaps he was ill and needed funds for extra medical care? His reply was very simple: all of his life, he told them, he’d wanted to be a country doctor and practice good, solid medicine. Events led him to become a medical school teacher, and before long he had many responsibilities, nationally and internationally, in medical education. But he was undeterred from eventually achieving his dream.
To me he was another true example of a real doctor.
There aren’t many Charity Hospital trainees, besides me, who would list Dr. Walton R. Akenhead among the more interesting and influential teachers of their medical career. He rarely officiated on grand rounds, although he made many significant remarks and generally arrived at the correct diagnosis. Dr. Akenhead is not remembered at all in the scientific community outside of LSU and Charity Hospital because he did not subscribe to the “publish or perish” principle. He once told me that in the time he might spend preparing a publishable paper, he could see any number of sick patients, not to mention do more of what he loved most—teaching.
Dr. Akenhead had two major dislikes in medicine—one was stuck-up Ivy Leaguers, and the other was the science of statistics. He often emphasized that in statistics, if the odds were one in one million, for one patient statistics just didn’t matter.
One memorable grand rounds session was chaired by a visiting professor who won the Akenhead jackpot: he was a stuck-up Ivy Leaguer giving a boring lecture on statistics. No one understood the lecturer, but only Dr. Akenhead would admit it. It so happened that the visiting professor was quite tall, about six feet five inches. At the conclusion of the lecture, he asked if there were any questions. No one responded except Dr. Akenhead, who exclaimed, “Doctor, I don’t like or understand statistics, but I do know one thing: according to statistics, you should be five feet eight inches tall, and if that is the case, why you wearing them long pants?”
Dr. Akenhead had just made another of his marvelous clinical diagnoses in a way that only he could do, and he made it to an audience that will remember well the lesson and the man. He insisted that we appreciate each patient as an individual, unique and independent from the faceless and indistinguishable disease statistic. This is why I get upset when I hear a student or house officer ask me to see a lung abscess or a sinusitis in Bed Four. Dr. Akenhead would have retorted, “No, Doctor, there is a patient with a lung abscess in Bed Four.”
It was Dr. Akenhead who witnessed my patient having the symptoms of paroxysmal cold hemoglobinuria, which led to my first published article in a medical journal. Here was a classic example of serendipity. There is a hematological condition in which the patient has red-colored urine after exposure to cold conditions. The color is due to hemoglobin, a part of the blood, which has separated from the blood cells and is then expelled from the body. It is a very frightening and embarrassing experience for the patient. It’s thought of as one of those many diseases that medical students learn in school but never see.
When I was the on-call resident in medicine at Charity, a patient was admitted one night for pneumonia. While I was in the course of taking his detailed history, the patient described to me a classic case of paroxysmal cold hemoglobinuria, but he said that he was now cured of the disease. Even at three o’clock in the morning this information caught my attention. With the rare exception of associated syphilis, I remembered that this blood condition was untreatable and certainly not curable.
I continued asking about his past history and learned that he had had an automobile accident some years before, and had ruptured his spleen. The organ was removed. After that, no more paroxysmal cold hemoglobinuria. Interestingly and quite by chance, Dr. Akenhead had witnessed the patient having grossly discolored urine prior to his automobile accident. Both the patient and Dr. Akenhead were at a family wedding some years before, and Dr. Akenhead noted the discoloration of the bowl after they both had used the toilet. He advised the patient to consult his personal physician and he recalled some annoyance and resistance at this unsolicited advice, especially since the patient was feeling quite well and had not seen his doctor in over five years.
I could not wait until the morning for the medical library to open. A literature search showed that a splenectomy, although used to treat other blood conditions, had never been tried for this condition.
I published this information as a clinical note in the Journal of the American Medical Association. It appeared in two pages way at the back of the journal. However, I had requests for reprints from all over the world. I had unintentionally discovered a possible treatment for an incurable condition. In addition, the information led to the further investigation of the immune properties of the spleen, and indicated a new direction for immunological research. I sent a reprint of the article to one of my mentors at the Medical College of South Carolina. His comment meant so much to me: “Well, Charles, you’ve just repaid your debt to those of us who educated you. The rest will be profit.” Thanks, Dr. Vince Moseley of blessed memory. I hope your investment has paid a good premium.
During our orientation session on the first day of my residency at Charity, I met another new trainee, Dr. John Salvaggio. He was a Cajun Italian who had never been away from New Orleans. He reminded me of my good friend Julian Atkinson from South Carolina, but there was something about John, a look or a manner, that made me believe he would make a significant contribution in medicine.
John Salvaggio viewed each patient’s medical situation as a mystery to be solved, and also as an important research statistic, one that might eventually lead to a cure for disease. He had that twinkle in his eye when he had an idea about a disease, an intellectual curiosity that itself was contagious. He spread it immediately to anyone who observed him at work.
John and I saw many patients together, but we approached the same patient in different ways. I would worry about the disease’s influence on the patient, and John would look at the disease as a scientific challenge. Since we were both intending to sub-specialize in allergy and immunology, we spent hours discussing the merits of private practice medicine versus academic university care and research.
John Salvaggio became a professor of medicine at Tulane, as well as a prolific researcher in the field of allergy and immunology. I went into private practice, but not before helping John get out of New Orleans for a time, and into his future career.
There was no doubt about it: the residency was hard, and I was always thoroughly exhausted by being on call every other night and portions of most weekends. Although my fellow residents and I complained constantly, we realized that the busier we were and the more responsibility for patient care we had, the more we would learn. It has been axiomatic for years that the better teaching hospitals work their residents more, pay them less, respect them less, feed them less and permit them to sleep less. In the end, those are the most desired residencies. Survivors of those programs spend the rest of their lives complaining to their families, colleagues and patients about how they suffered, how they were merely cheap labor for the hospital. And they are partly correct: it is only now, in the twenty-first century, that monitors of physician training have realized that perhaps the patients for whom these tired house officers minister suffer as a consequence.
In the 1950s, the conventional wisdom was that long hours with resultant sleep deprivation make a better doctor. But too many incorrect doses of medication are given or surgical errors are made by a conscientious resident trying to extract maximum learning from every minute of his residency period. I learned a great deal while at Charity—and the hospital got a great deal out of me for fifty dollars a month.
Obviously, one could not support a family on fifty dollars a month, even in the 1950s. For the physicians this meant either moonlighting and doing some out-of-the-hospital practice on the weekends, or borrowing from family, a demeaning action for a thirty-year-old son who had been subsidized most of his life. I did both.
While walking one evening in the French Quarter, my wife and I had an idea: we would hire a babysitter and Nancy would join the group of sidewalk artists doing portraits and caricatures. She’d always had a talent for painting and we were sure she had infinitely more talent than the artists we observed.
There was only one problem: she needed a license. This was no big deal in most places, but in 1958 New Orleans, a significant number of the “artists” truly did not have painting talent. They were quite successful in more horizontal skills.
The city was just beginning to enforce their anti-prostitution ordinances. In order to obtain a license to paint in the French Quarter, it was necessary to provide a document stating that you were not a prostitute.
My wife refused to ask her friends to provide such a document. That left only my parents to vouch for her. Nancy simply would not ask her new in-laws to state that their daughter-in-law was a virtuous woman. I guess I can say without exaggeration that my wife could not help with the family expenses because she could not prove that she wasn’t a prostitute.
It was during my residency in internal medicine that I found myself drawn to the subspecialty of allergy and immunology. At that time, it was one of the newest, and perhaps smallest, fields of focus. In 1960 there were very few truly great training centers in the subspecialty of allergy. It was a significant achievement to be selected as one of two fellows at the Massachusetts General Hospital Allergy Training Unit under Dr. Francis C. Lowell.
Even so, upon arriving in Boston I felt as if I were a young child on the first day of a new school. I was irritated at myself for feeling anxious. After all, I had spent four years in college, four years in medical school, a year in a rotating internship and two years as an internal medicine resident. All that, plus two years as a physician in the navy, should have given me some degree of confidence. It didn’t! The profession of medicine seems to demand of its members the continuous presence of self-doubt and constant self-assessment. I realized this decades later, when one of my sons, after a grueling medical school exam, asked me when it was that I felt I really knew enough to consider myself a good doctor. I replied, “Not yet.”
My first hurdle was to find an affordable apartment for my family, now grown by the addition of our first daughter, Lori Lynn Banov, on August 4, 1959. Nancy and the two children were staying in Milwaukee with her parents while I apartment hunted. At the same time, I needed to extract every opportunity from my fellowship, which meant spending as much time as possible in the hospital—day and night. To me, this second imperative meant that I need not find a place to stay during my first weeks alone in Boston. I would do what I’d done before.
In the past I had learned that I could find out about hospitals and training programs by traveling and sleeping during the day and wandering about the wards and chart desks at night, hearing the comments and complaints of the staff. I recalled my good fortune in my first week in Milwaukee, when a chance meeting with a medical student in a men’s room netted me the telephone number of an attractive medical technologist who became my wife. This time, however, I was a staff member (even if one step lower than the assistant janitor) of the most famous hospital in the world. The physicians’ lounge might serve as my networking center and hotel room.
At good old Charity Hospital in New Orleans, it had been perfectly acceptable to plop into any vacant bed in the physicians’ lounge. It was most certainly not acceptable at Harvard’s august Mass. General. Since I didn’t know that, I plopped, uninvited, into an empty bed belonging to the chief resident, Dr. K. Frank Austen.
Dr. Austen was the only physician I’ve ever met who was so outstanding that he passed his board examinations while still in training. A world-class researcher and professor of medicine, Dr. Austen was president of our American Academy of Allergy and the International Association of Allergy and Clinical Immunology.
He was a bit surprised to find a stranger in his bed, especially since senior residents at Mass. General were not known for logging much sleep when on call. He was a gentleman about it though, and elected to find another place to sleep. The problem was that I didn’t find an apartment for my family for a week, and I’m not certain what Dr. Austen did for that time. He was probably out looking for a hit man to take care of me. He never mentioned the subject during the entire year I was in Boston and I thought he’d forgotten about the stolen bed.
Years later though, I had a problem, almost a Catch-22: I was unable to obtain a formal endorsement of my character, integrity or ability from any board-certified physicians or Fellows of the American Academy of Allergy—not because I was disreputable, dishonest or incompetent, but because there were no other persons in my state (or in the neighboring states) who were themselves certified. Without the endorsement, I could not take the allergy subspecialty examination. Without the examination, I could not become certified!
I finally wrote to Dr. Austen, reminding him of our year together at Mass. General and keeping my fingers crossed that he would remember only my first-rate medical work and not our awkward introduction across the rumpled bedsheets of the physicians’ lounge. His reply both reassured and unnerved me: “How could I forget you? You stole my bed!”
Dr. Austen wrote my recommendation, declining to brand me an uncouth bed thief, and as a result I was able to become one of the first and only certified allergists in the Charleston area.
The Boston physicians were so impressive and dignified that it was a big surprise, on that first day, to recognize a familiar face from my medical school days in Charleston: Dr. Andrews, who had made such an impression on my parents when he came to dinner one Friday night with his friends, the chimps. After medical school I hadn’t seen or heard from him until that encounter in the lobby of Mass. General. I asked him about the chimps, but something in his answer made me ask no further questions. I never saw Dr. Andrews again.
It was not until I returned to Charleston to practice that I found out what had really happened. Dr. Andrews had accepted a two-year grant to allow his chimps to live in his world, observing them to see if neurological changes occurred. According to the grant proposal, after extensive neurological testing with the primitive electroencephalography available at the time, he was then to sacrifice them. He couldn’t do it. Dr. Andrews might have lost his scientific credibility, but not his loyalty to his best, and probably only, friends.
The chief of the Allergy Training Unit, Dr. Francis C. Lowell, was of the famous Massachusetts Lowells. If ever there were regal Americans, the Lowells would be classified as such. They were high society. There was no greater social achievement than to be invited to the home of a Lowell.
Francis C. Lowell could have been a spoiled aristocrat; instead, he became one of the most respected immunological researchers in the world. He fine-tuned the double-blind technique of scientific inquiry, whereby any medical therapy could be evaluated accurately for its effectiveness. Medical science did not know then, nor do we know now, the answer to many disease treatment mysteries, but through Dr. Lowell’s efforts we do have the techniques to determine whether something is true or not. That is crucial after so many useless treatments over the years. Fortunately, Dr. Lowell’s work preceded the AIDS and SARS epidemics, and his techniques of evaluating treatment programs have made major contributions to world health.
Dr. Lowell was never impressed with his heritage, and people smiled behind his back about the Lowells not talking to the Cabots and the Cabots talking only to God. Yet Dr. Lowell was a true gentleman, with impeccable dress, superb manners and an adolescent innocence about how the rest of the world lived. I recall that when John F. Kennedy was elected to the presidency, I asked Dr. Lowell if he had visited the Kennedys, since they lived quite near each other at Hyannis Port. One of Dr. Lowell’s other colleagues told me I had embarrassed Dr. Lowell when I asked that question, because it would be unthinkable for the Lowells to have any social connection with the Irish Catholic Kennedys. Nevertheless, one could find every possible color and creed—a true American melting pot—in Dr. Lowell’s laboratory. Honesty in scientific research was his sole criteria for a person’s worth as a physician and researcher.
After spending a year at patients’ bedsides and in research laboratories, I came to see that I did not have sufficient interest in research to become a Dr. Lowell. I would have to make my contributions in a less dramatic way. I had such respect for Dr. Lowell that I often felt that if I were ever in armed combat with my life threatened, Dr. Lowell could lead me anywhere. He just had that charisma. Yet he could not lead me into the path of research, despite trying very hard. Instead, my personal contribution to the field of allergy and immunology came when I introduced him to John Salvaggio.
I hadn’t been in Boston more than a few weeks when I called John, described the fascinating research being conducted in our field and implored him to come up and join me. Most die-hard New Orleans residents (and John was one if anyone was) would never move even as far as Mississippi. Boston was unthinkable. Nevertheless, John did come up to spend a few days with me. I was able to make the intellectual marriage between Dr. Lowell and Dr. Salvaggio that persisted until both of their deaths a few years ago. They did fascinating research together in Boston. Dr. Salvaggio took a three-year fellowship with Dr. Lowell. There he learned the laboratory and research techniques that enabled him to make major contributions to understanding diseases of allergy and the immune system. For example, he helped determine the cause of the New Orleans asthma crises, a condition that suddenly sent hundreds of people to local hospitals in just a few hours. Dr. Lowell is credited with determining one of the causes of diabetes treatment failures, among many other significant contributions.
John Salvaggio went back to New Orleans to build what became a very prominent career in academics and research. I became successful in private practice and gained some attention on a national and international level, but Dr. Salvaggio was one of the most sought-after lecturers and researchers in the world. Whenever I was on a program with him, I was fascinated by how much I learned just by being around him. But our private conversations were often about whether we made the right choices in our careers, because we started off together and took such divergent paths. He often expressed the wish that he could have earned more money in private practice for his growing family; I often wished I could make a greater contribution to the world. We two were clearly opposites but, just as clearly, had the same moral values and goals for our lives. In the scope of things, there has been room for both of us.
I knew I’d chosen the right specialty for me—one that involved a good bit of detective work—when one of the most interesting mysteries to occur in immunology was solved during my fellowship year.
All physicians and most laypeople knew that exposure to house dust could produce nasal congestion, sinusitis and even asthma. But the elements of house dust aren’t usually very interesting or toxic—just assorted junk. Nevertheless, by giving tiny injections of house dust, allergists could help patients build up their resistance or immune response to dust.
At the clinic, we prepared injections using dust from two different sources. Both sources came from very reputable, FDA-controlled laboratories, but even using the same technique of extraction and preparation, the dust from one source was far more potent than the dust from the other source. Allergists had known this for years, but until one bright student thought to question it, no one asked why there was such a difference in strength. As with Lister, Banting, Fleming and other famous researchers, this student simply was not satisfied until he solved the mystery.
First, he discovered that both of the companies that supplied the dust had contracts with used furniture businesses. They used dust from old mattresses. But why would the mattresses from one company contain more potent house dust than from the other?
He delved further into the problem and found that the company with the most antigenic—most effectively potent—dust obtained its used mattresses from the red-light district of New Orleans. The other company, which had the less antigenic material, acquired its used mattresses from the Bowery flophouses of New York. We thought this an amusing but insignificant bit of information. But while we were snickering about the mattresses from the red-light district, our young inquiring scientist was asking another question: “What is so unique about house dust collected from mattresses?”
People are not allergic to house dust, but to the house dust mite, a microscopic organism that obtains its nutrition from human dandruff and skin flakes. Flakes from human bodies produce adequate food, and the more scales from the human body and the more dirt and debris, the more mites proliferate. The injections we were giving patients consisted of a small amount of mite and a good deal of nonspecific protein (the dust) that did nothing for the patient. So the dirtier the mattress, the more mites per ounce of dust; the more mites per ounce, the more potent the dust injections.
Again, when this information was presented, we all thought it amusing, but our inquiring student was not satisfied. It didn’t make sense, he said: the occupant of a mattress in a Bowery flophouse must be far dirtier, filthier and therefore more mite-producing than the occupant of a mattress in a swanky New Orleans bordello. What was so unique about the red-light district’s mattresses that made them such rich breeders of mites?
Our colleague would not rest until he found the reason: mites like different varieties of food, as do humans. The more variety in a restaurant, the more customers; the more types of human dander produced, the more mites. The ultimate difference between the mattresses from the Bowery and the mattresses of the red-light district was that there was only one body per night on the flophouse mattress and many bodies per night on the bordello mattress.
Recent studies have suggested another factor in the dust-allergy saga. There was a very high exposure of cat dander in the red-light district, as most of the inhabitants of that area owned cats, compared to the alcoholic homeless, who had no pets. Perhaps the cat exposure was also a factor in this mystery. It also suggests a possible derivation of the slang word for a house of prostitution—a cathouse.
Now that’s research.
In 1960, I was peripherally involved in an incident that led to a breakthrough in our understanding of asthma and a certain kind of lung disease. An airliner had crashed on takeoff at Boston’s Logan Airport. Investigators determined that a flock of starlings had been sucked into the jet intake of the plane, causing it to crash. One of the survivors was critically ill with inhaled jet fuel. The injured man was en route to a trauma center in central Boston, but dense traffic kept the ambulance from moving fast enough. The patient was almost dead from obstructed breathing. The ambulance attendants panicked and deposited their passenger at the first hospital they saw, which was Mass. General, not usually considered a trauma center. As the allergy fellow on call, I saw the patient when he came in. He was in severe respiratory distress. He seemed to be dying from asthma.
Not long before, cortisone had come into favor as almost a miracle drug. It was already used for so many diseases that the joke phrase “no one dies without cortisone” was practically an unwritten (and unscientific) principle. So for no acknowledged medical indication of the time, the patient was given an intravenous injection of cortisone—with dramatic results.
Up to that time, asthma was thought to be a disease of spasm of the breathing tubes. All of our therapy was directed toward relieving that spasm. We now know that there is also a strong inflammatory component to the illness. The spasm is only the trigger. Cortisone treatment addresses the inflammatory component of the disease.
Forty-five years later, while volunteering as a physician after Hurricane Katrina, I applied that knowledge. Hurricane victims were exposed to contaminated water from the broken levees. This time, we knew that the life-threatening component would be the inflammation produced by the water. We immediately administered high prophylactic dosages of the cortisone drugs and saved many lives. What a cycle—an airplane crash, an unplanned visit to the wrong hospital (which turned out to be the right hospital) and lives saved after a hurricane many decades later!