A walk with giants

Herbert Ausubel
Valley Stream, New York, United States

 

Herbert Ausubel HMS making rounds with Dr. Eliot Joslin the morning after Dr. Joslin underwent an appendectomy. Drawing by Dr. Ernest Greenberg and Louise Chiasson.

Having had the opportunity to receive a medical education at Harvard Medical School, I was exposed to several individuals who were pioneers in the treatment of disease, something for which I will be forever grateful. And so, I would like to say a few words about my personal contact with some of these giants.

***

It was September and the Jewish High Holidays were fast approaching. I was informed that a Brookline synagogue had invited Harvard medical students to pray in the synagogue on the High Holidays without purchasing seats. So I attended, saw a vacant seat, and seated myself. An older gentleman, seated next to me, looked at me curiously. I explained to him I was a Harvard medical student and that we had been told we could come to the synagogue and seat ourselves in any vacant place.

The two of us went on with our prayers. At one point the elderly gentleman posed a question to me. He had a cousin who suffered from pressure that felt like a closed fist striking him in the middle of his chest when he was walking down the street, and the pressure subsided when he rested. What should he do?

I responded that I was only a first-year student, but that it sounded as if his cousin were suffering from angina pectoris and I would recommend that he see a heart specialist.

The two of us went on with our prayers. Then at one point it was time for the reading of a section of the Torah. Someone in the congregation is given the honor of being called up to say a prayer. A gentleman on the dais called up Dr. Samuel Levine to recite the prayer. He was the chief of cardiology at the Peter Bent Brigham Hospital and had been the senior author of the first article in the medical literature describing an acute myocardial infarction. It turned out that he was the elderly gentleman sitting next to me. When he returned from the dais, he smiled at me and we went on with our prayers.

Two years later, when I was a student at the Brigham, the resident physician was presenting a patient to Dr. Levine who had suffered an acute myocardial infarction three days earlier. Dr. Levine examined the patient and then declared, “Get him up in a chair and start him walking!”

Now this was in an era in which patients with a myocardial infarction were kept in bed for two weeks or so and discouraged from any activity that might result in the heart rupturing. Had it been anyone but Dr. Levine making such a recommendation, that physician might have been thought of as incompetent.

My next encounter with Dr. Levine was years later. There were annual meetings in Atlantic City at which major papers were presented to a large group of physicians. I had come to the meeting to hear of these new advances. It was the noon hour at which there was a pause in the meetings so that the attendees could eat lunch. I was walking on the boardwalk and spotted Dr. Levine sitting on a bench. I approached and introduced myself as one of his HMS students. He remembered me well and invited me to sit with him for a while. Then he told me a story:

A few years earlier he had been sitting on the boardwalk during the noon recess when a well-dressed gentleman approached him and introduced himself as a fellow member of the medical profession who had come to ask a favor of Dr. Levine. The physician had a patient in a nearby hospital who had suffered a myocardial infarction and was not doing well. The physician had a limousine nearby. He would take Dr. Levine to the patient and any advice Dr. Levine would give him would be greatly appreciated. Dr. Levine explained that he had to present a paper at the meetings in two hours. But the other physician assured Dr. Levine that the limousine would get him back to the meetings quickly. As the physician appeared very insistent, Dr. Levine accompanied him in the limousine.

At the patient’s bedside, Dr. Levine listened to the physician’s presentation. Dr. Levine then examined the patient and declared: “Stop all treatment, put him in a chair and get him walking.” The limousine then took Dr. Levine to the meeting hall.

The following year, Dr. Levine was again seated on the boardwalk during the noontime recess. A gentleman approached and said that he was eternally grateful to Dr. Levine for having saved his life. The man went on to say that Dr. Levine had come to his bedside the prior year and had given his physicians the advice that saved his life. “It was worth far more than the $2,000 I had given my doctor to give to you,” he said.

Dr. Levine mused to me, “$2,000! I never sent a bill nor received a penny!”

***

Dr. Louis Weinstein, who almost single-handedly ran the Hanes Memorial Hospital, which dealt with infectious disease, is another of my giants. In those days there were many patients confined to iron lungs set in rows. They were the tragic victims of polio who were condemned to live out their lives in iron lungs.

I was in my clinical years and was at the Hanes Memorial to learn more about infectious disease. At noontime we went to a local eating place for sandwiches and Dr. Weinstein had joined us. Dr. Weinstein was describing the treatment of patients while continuing to dig into a sandwich. Suddenly he stopped speaking and turned pale. He quickly pushed a closed fist onto the area below the xyphoid and pressed upwards. A chunk of pastrami flew out of his mouth, following which he went on with the presentation without stopping for a moment. Apparently, he used the Heimlich maneuver even before Heimlich described it.

A few days later we were making rounds on a young man with bulbar polio. Dr. Weinstein explained the approach to therapy. The boy’s father was at the bedside and interrupted Dr. Weinstein with a request for a consultant. Dr. Weinstein replied, “And WHO would you like to consult on a patient that I have diagnosed with bulbar polio?”

The father responded, “Conrad Wesselhoeft.”

Dr. Wesselhoeft was a noted physician before we entered Harvard Medical School. I believe that at the time he was off in Canada hunting moose or something.

The following day, Dr. Wesselhoeft arrived at the Hanes. Dr. Weinstein instructed us to go with Dr. Wesselhoeft and see what the old man had to say.

The patient was presented by a resident physician, following which Dr. Wesselhoeft briefly examined the young man. Then he asked the young man to repeat:

“KKK and Methodist Episcopal.”

When the patient repeated the two phrases, Dr. Wesselhoeft said that the young man had bulbar polio. “Now get me back to the airport! I’ve got a plane to catch.”

***

My next giant is an old man I met for the first time when I was taking an elective in radiology at the New England Deaconess Hospital. I was in the reading room, dressed in my white coat—residents and attendings wore the same.

The old man removed an x-ray from the envelope he was carrying and flipped it up on the screen in front of me.

“Is it intimal or medial sclerosis of the femoral artery?” he asked.

I thought he must be some senile general practitioner. How can you tell intimal from medial sclerosis of a vessel on an x-ray?

I thought I would have some fun with him, and so I rubbed my chin studiously and replied, “medial sclerosis.”

As the old man was leaving Dr. Marks, chief of the radiology department, entered the reading room. “What did Dr. Joslin want?” he asked me. I told him that Dr. Joslin had asked my opinion on an x-ray as to whether it indicated intimal or medial sclerosis of the femoral artery.

“And what did you reply?” he asked.

I must have guessed right because he had said Dr. Merrill Sussman (chief of radiology at the Peter Bent Brigham Hospital) had thought the same.

Now I knew who Eliot Joslin was. I proceeded to study the literature about this giant of medicine. I learned that Dr. Joslin was the first to employ insulin obtained from the pancreas of a pig to treat diabetes mellitus. You would think that the first man to treat diabetics with insulin would have settled for treating the problem with blood glucose. Yet, he went much further. In an article published in the 1920s he wrote that diabetes is a disease of fat: too much fat in the diet resulting in too much fat in the waistline, resulting in too much fat in the blood stream, resulting in too much fat in the walls of arteries. From all that fat, most diabetics die.

I was told that in his office a fresh slab of meat was placed on a table each day. He would ask the patient if he ate meat. If the patient replied in the affirmative, he would then ask the patient to slice off as much as he would customarily eat. If the patient cut off too large a chunk, Dr. Joslin would point out that the patient should limit himself or herself to a thin slice, not a half-pound chunk. Then he asked the patient to tell him what he would do with the slice. If the patient replied that he would cook it, Dr. Joslin would point to the yellow fat on the slice that should have been dissected away from the red meat.

My next encounter with Dr. Joslin was on a Saturday night in the emergency room of the Peter Bent Brigham Hospital. It was about 11 P.M. Dr. Joslin walked in, looked around, and then approached me.

“Call Dr. Leland McKittrick and tell him to come here and take out my appendix.”

I immediately went to the phone and called Dr. McKittrick’s office and told the answerer what Dr. Joslin had instructed me to say.

The following noon I was on the wards when Dr. Joslin approached the chart rack, dressed in a bathrobe and slippers, tugging his IV pole with a bottle of IV fluids behind him. I rushed over and inquired as to whether Dr. McKittrick had come to attend to him.

“Certainly. He took out my appendix.”

“Dr. Joslin,” I said, “I’m sure that it’s alright for you to look at your chart, but you don’t have to get out of bed. I’ll bring it to you.”

“I’m not here to look at my chart. I’ve got patients to see.”

As he reached for a chart, I said, “Dr. Joslin, you don’t have to carry the charts. I’ll be happy to accompany you and carry any charts you desire.”

We made rounds for an hour or so. Dr. Joslin borrowed my stethoscope to examine some of the patients. When we were done, he returned my stethoscope and said, “You are a bright young man. I have some good advice for you. Do a good day’s work before noon, and then do another good day’s work!”

For the past sixty years I have been trying to do that “second good day’s work!”

***

Dr. John Franklin Enders began work on mammalian viruses, years before we entered Harvard Medical School. In 1946 he established a laboratory for research in infectious diseases at the Boston Children’s Hospital of Harvard’s Medical School. His work on the cultivation of the poliomyelitis virus resulted in his being awarded the Nobel Prize in Medicine in 1954. In 1954, poliomyelitis was a most frightening disease that afflicted millions of people worldwide. I recall Dr. Enders lecturing on the solution to that scourge. He declared that we should use a killed virus or an attenuated strain of the virus to produce an immune response to the virus, and that will eliminate the problem. Dr. Jonas Salk employed a killed strain and Dr. Albert Sabin employed a live attenuated strain and polio is no longer the scourge of mankind.

Dr. Enders was, most assuredly, one of my giants.

***

Hal Upjohn, one of my classmates, was the son of the head of Upjohn & Co. He resided in Vanderbilt Hall, a few doors away from my room on the second floor. I had learned that a suite in the fourth floor tower was becoming vacant. It would appear to be a perfect spot for an affluent member of the class, and so I mentioned the suite’s availability to Hal.

“That’s an expensive room. I prefer to live modestly.” Yes, that was Hal Upjohn, a young man born to wealth, but he was one person that never flaunted it.

Which of us in HMS ’54 can forget that Upjohn & Company presented each member of the class with a leather physician’s bag? I carry that bag with me on house calls to this very day.

Four years at HMS passed quickly. It was getting close to graduation. The class met to choose a Permanent Class President to handle communication of the class with Harvard after graduation.

Hal Upjohn was nominated for Permanent Class President and several of us seconded the nomination. Then someone got up and nominated Ed Haley, whom most of us knew was suffering with a potentially fatal malignancy.

Hal Upjohn immediately rose to withdraw his own candidacy. Those of us in the know recognized the reason why Hal had withdrawn his candidacy.

Hal went to work in the pharmaceutical industry after completing his training. He has worked within the industry to improve the testing of new drugs and to monitor approved drugs to make sure that the benefits of their use far outweighed their deficits. As a thoughtful, concerned physician eager to make sure we are headed in the right direction, and a man of grace eager to see this country follow the principles that our nation’s founding fathers envisioned, Hal Upjohn deserves to be viewed as one who has advanced the cause of quality health care.

***

A rather quiet member of our class was Monto Ho, the only East Asian in the class of ’54. He had been born in the Hunan province of China, son of Feng Shan Ho who went on to serve as China’s ambassador to Egypt, Mexico, and elsewhere. In the late 1930s, Feng was serving as council general in Vienna. He issued visas to hundreds of Jewish refugees to get them out of Nazi-controlled territory. He is credited with saving these Jews from extermination in the gas chambers. Monto Ho’s father truly deserves recognition in Yad Vashem, in the place for righteous gentiles.

After graduation from Harvard Medical School, Monto went on to a career as a research virologist. He became an expert on interferons, which were newly recognized as molecules active in the body’s defense against viruses. In fact, he authored the first article on the subject, which he submitted to the New England Journal of Medicine. The article was accepted for publication and, following the then New England Journal of Medicine tradition, was to be published several months later. But a research group working in France submitted a paper on the subject to a French medical journal weeks after Dr. Ho’s article was submitted to and accepted by the New England Journal of Medicine. The French group’s article was published immediately after its submission, which was weeks before Dr. Ho’s article was published in the New England Journal of Medicine. As a result, the French group was credited with being the first to define the value of interferons. The policy of the New England Journal of Medicine was changed then as a result.

Monto Ho is unquestionably one of the giants I was privileged to know at Harvard.

***

It was at an HMS Reunion about ten years ago that I chanced to meet with one of my giants. For a while we reminisced on those days when several of us HMS students were working in his lab, transplanting a kidney from one rat to another. The work progressed to higher animals and finally to humans. That resulted in a well-deserved Nobel Prize in Medicine being awarded to Dr. Joseph Murray.

***

But not all individuals deserving a Nobel Prize received one. Several years ago, I attended a conference on hypertension. The lead speaker was Dr. Aram Chobanian, Director of JNC 7. Dr. Chobanian was a 1955 graduate of Harvard Medical School. Recalling that years earlier I had given him some pointers on dissection of a cadaver, he invited me to join him and his wife for lunch. Mrs. Chobanian had worked as secretary to Dr. William Castle, chief of the Harvard Medical Service at Boston City Hospital and director of the Thorndike National Lab. The three of us spoke in glowing praise of Dr. Castle. I said that he had won a well-deserved Nobel Prize as the man who found the solution to pernicious anemia.

“But he never won the Nobel Prize,” Mrs. Chobanian corrected me.

“How can that be?” I asked. “The discovery of the intrinsic factor was the solution and Dr. Castle was the one who discovered the intrinsic factor. I recall that they awarded a Nobel Prize to the one who solved the problem of pernicious anemia. To whom did the Nobel Prize go?”

“George Minot,” she replied.

“Dr. Minot?” I responded in surprise. “He wrote an article in which he noted that eating a lot of liver was helpful to patients with P.A., but nobody treats P.A. today with a daily consumption of liver. You give the patient a shot of B 12.”

“True,” she replied. “But Minot was Dr. Castle’s chief. Yes, years later the whole world realized that Dr. Castle’s work was the final solution, but they don’t give out two Nobel Prizes for one cure.”

“Well, they should have at least given the Noble Prize to both of them the way they did to Watson and Crick.”

In any case, Dr. William Castle is certainly one of the giants I was privileged to meet and learn from at Harvard Medical School.

***

One thing I learned in my years at HMS is perseverance. There are those in good health who go on to do great work. But how about those individuals who suffer from a severe affliction? Can they contribute to the world despite major infirmities? An individual who stands out for this was Dr. Fuller Albright.

Dr. Albright developed a severe case of Parkinson’s Disease in 1937. When he delivered a lecture to our class in the 1950s, his pointer rattled against the screen as he spoke in a monotone. It was considered an honor for each of twelve HMS students to spend a month with him, helping him to dress and get to his office, hold a tongue depressor in the patient’s mouth while Dr. Albright looked in, and so forth. While his body was deficient, his mind was ever active, and he did his major work during that period. Sadly, the tremors became so unbearable that he agreed to an experimental procedure. A hemorrhage resulting from the surgery left him totally incapacitated for the rest of his life. As one who made major finds in medicine despite physical infirmity, Dr. Albright will always be one of my giants.

***

In the Ashkenazic Jewish world, it is customary to name a newborn after someone the family would like to remember. In my case, it was after a great grandfather who was viewed in his town as the miracle maker because he designed medicines that saved lives. Medicine was to be my calling, rather than simply an occupation.

Early in my fourth year at HMS I chanced to meet a first-year student who also viewed medicine as a calling. Judah Folkman was the son of an Ohio rabbi. In his childhood, he oft times accompanied his father when the rabbi was visiting the sick in hospitals. Judah concluded that the best way to comfort the afflicted was to cure them of their illness, and so he decided that medicine was his calling. He obtained a bachelors degree from Ohio State University before entering Harvard Medical School. At that time, most cancer research was focused on new drugs to destroy cancer cells directly. After years of study on neoplasms as a surgical resident and as a researcher, Dr. Folkman concluded that all cancer tumors were angiogenesis-dependent. He was the father of the idea that you could keep tumors in check by choking off the blood supply that the malignancies needed to grow. While there were many in the cancer community who initially scoffed at the idea, I recognized how right he was when I first heard him present his hypothesis at a cancer meeting. It is now widely accepted and is being exploited in the treatment of many conditions including macular degeneration. It also pushed the study of a spectrum of biologicals for the treatment of cancer. Judah died of a heart attack in 2008, but the work goes on. As a major medical pioneer, Judah will always be one of my giants.

***

This year being our sixtieth Reunion, the last formal reunion of our class, I have been reflecting on the giants of medicine to whom we were exposed, before we meet with them and all our departed classmates again in that eternal paradise.

 


 

HERBERT AUSUBEL, M.D., F.A.C.P., graduated from Harvard Medical School in 1954 and then served as a medical intern in the Medical Division at Bellevue Hospital in New York City. He then served as a U.S. Navy physician with the 3rd Marine Division in the Pacific. He was on a troop ship going on maneuvers to Guadalcanal when one marine came down with acute appendicitis. His ship was headed into a typhoon and so they could not have the marine brought to a hospital by helicopter. Since he was the only physician on the ship, and having learned some surgery while doing some research under the direction of Dr. Joseph Murray (transplanting kidneys from one rat to another rat), he proceeded to remove the marine’s appendix in the middle of a typhoon. After completing his training in medicine, he went into medical practice with Dr. Milton Levine, a classmate at Harvard Medical School.

 

Spring 2021  |  Sections  |  Physicians of Note