Tape # 13
Dr. M. E. DeBakey
Houston, Texas

8/14-15/72

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One, two, three, four, five. Five, four, three, two,
one.

Well,..

Where was this?

Well, you see, you have to go back to that period. At
that period in time, blood transfusion was no further
than its infancy. And it was used as.. It was kind of
a major effort to give a blood transfusion. And the
experience with. . clinical experience with the use of
blood transfusion was relatively small. There were..
There had been some pioneers who had developed various
ways--techniquee of doing it, but as I say, it was kind

of a major effort. Almost a major operation.
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How was it done?

Well, there were several different ways it was done.
One was to take syringes of blood from a donor who

was lying next to the patient. And you would take the
blood--50 cc. and inject it into the patient. Another
way was to take it in a large container, glass container,
that was coated with a kind of a paraffin. The idea being
to keep the blood from clotting during that period in
time. That was the so called pressure tube, if 1 remem-
ber. Then... And I wrote a chapter. .. Well, I wrote

a book with another man on blood transfusion. And I

wrote.. One of the chapters that I wrote in the book was

' on the history and it tells all of this.

Then there came into being a method by...where you
do a direct transfusion from the donor to the recipient
by using tubes that connected to two needles and you
pull it out in the syringe and then turn the stop-cock and
then you shove it back into the recipient. So that there

was no good, efficient, easy way to do it. But it almost
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had to be done by...directly from a donor who was
there. There was no way to preserve the blood. That
came into being much later. So..

Bleed and often develop embolisms and that kind of
problem?

Well, the blood would clot while you were doing this
so that you often made a.mess or you never got it all
done,

Well, as I say, I was working in the laboratory at the
time trying to develop a pump to make a model for
circulation--the study of circulation outside the body.
I was interested in pulse waves and that sort of thing.
In fact, the blood flow of people. When I perfected the
pump for that purpose, then it became apparent that I
had a pump which could be used for blood transfusions.
This was the roller pump?

Yeah, And so we began using it for blood transfusions,
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Before that though didn't you design an improvement

on that...

Yes, what I did was I designed a.. Well, actually

it was based upon, you know, in motors in the auto-
mobile, there is what's called a sleeve valve. It's
used..was used in old motors, you see, to shift the
intake and output of gas going into the cylinder. And

it was called the sleeve valve. Well, I just used.. All

I did was borrow that principle, you see. And I made

a sleeve valve that automatically when you hold back

on the syringe, the sleeve pulled back automatically

and pulled the blood from the donor. When you were ready
to shove it into the recipient, the sleeve shifted and that
changed the direction of the flow to the recipient. So

all you had to do was hold it like that and go up and down.
Is that thanks to your taking cars apart when you were

a child?

Yeah, exactly. I knew that principle. WhenI was a

kid, I used to take cars apart and learned all about
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the motors. So, I knew that principle and just applied
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You used it clinically?

Oh, yes. Oh, yes. Quite successfully. As a matter
of fact, they made quite a number of these and sold
them all around the country. And then when I made

the roller pump, with this past experience on trans-
fusion, I realized I had a much better way of doing it.
So all I had to do then was to sterilize the tubing and
the needles. And I'd just take my pump around. I
used to give blood transfusions all over the hospital
because I was so expert at it and everybody that wanted
a blood transfusion ona patient, they'd call me and

I'd have ten, fifteen, twenty of them scheduled in a day.
And I'd go around and give them.

Were you then a resident?

Yeah.

Or an intern?

No, I think I was an intern--no resident. I guess I

was a resident.
 

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When you first used it clinically, then a first

tested this with animals or?

Oh, yes. Oh, sure. We tested it on animals, in

fact were doing some experiments on them.

With what? Cats, dogs?

Dogs.

Dogs. And did you have no..... ?

No, I could give 500 cc. of blood in five minutes or
less, And that was less time than the blood would
clot. The blood was outside of the body sucha short
time.

Right. What was the previous rate in the old fashioned
method? 50 cc. in five minutes?

Well, in the old fashion method... Yeah, well, yeah.
It would sometimes take longer than that and then some-
times it would clot and everything..all your equipment
was clotted. You have to start all over.

You couldn't go on.

You couldn't go on. It was a mess.
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Do you remember when you first used it clinically?
Yeah, sure.
What was the situation?

Oh, you mean the exact patient I used it on first

’ clinically? No, I'm afraid I don't remember the

exact patient. But, I remember this. Shortly after
I started using it, there was a doctor's wife who is
still living in New Orleans, He was a classmate of
mine. No that's not quite correct. He was in the
class ahead of me. But we were interns and residents
together. So we were colleagues. And very fine old
French family in New Orleans. And his wife hada
gynecologic condition where she was sort of bleeding
from the uterus. Well, it was actually...it was
following delivery, I think. And they couldn't stop
the bleeding. She kept on bleeding. She nearly bled
to death. And they couldn't get blood into her fast
enough, And they called me to come and help them.
She was in another hospital which was several blocks

away. ‘
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What a the name of the hospital?

The Hotel Dieu.

Was it late at night, do you recall? Day time?

I think it was in the late afternoon or evening.
Anyway, I got there and she was white as a sheet

and really almost bled to death. And we had donors
lined up for her, so I lined them up and started my
transfusion almost immediately. And in a matter

of a few minutes, I had replaced her blood--just a
few minutes--five or ten minutes. And she was
breathing again and doing well, you know. Her blood
pressure came up. She was in shock--apparent shock.
And, you know, they all felt I had saved her life and
they've always felt--you know, they still refer to the
fact that I saved her life.

I'm sure that's true.

There was no way you could have gotten blood into her
that fast. And I just quickly got this blood right into

her from the donor,
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. This you.. You worked your pump manually?

Yeah. Yeah,

What happened after that? You used it all around

New Orleans because you had it...

Oh, yes. I even took it to...when I went to Leriche's
Clinic, I took it with me. And I used to get blood

for them,

For example?

Yeah. Well, Leriche would ask me to come and

give blood on his private patients. Yeah. I wrote

an article while I was there, by the way.

Was it developed subsequently by others and used?
Yeah, And actually the pump was used for a number
of other purposes, And is still being used for a number
of other purposes, It was used, for example, for
feeding purposes. You see, you put a motor on it, you
can control with rheostat , you can control the rate
of the pump. And so, it was put on the market and

sold and used, not only for transfusions but for other

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purposes, And, of course, the greatest use, of
course, came with John Gibbon~-the heart-lung
machine.

Yeah. In developments like this, I know you never
patent them. Is this generally true of the profession.
Doctors simply don't patent this kind of thing?

That's right. The instrument companies will often
record them. They have an association which allows
them to rec,..to sort of record the thing, and there-
fore get priority and also and the companies ethically
respect the companies that do this.

They don't trespass on their... ?

That's right, exactly.

».. priorities. Do they have any system of retaining
the doctor or institution that's responsible for the
invention?

No.

Nothing ever comes back from this? Monetarily and

so on?
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No. I think there are some things like.. I think

they patented one of the vitamins, for example,

at the University of Minnesota and it was put into

a foundation and used. Things of that sort. They'll
do something like that from time to time. But
generally speaking most instruments are not patented
by surgeons, for example, that develop them. Fre-
quently they're sold or identified by their names,

but that's all. I have some fifty odd instruments that
I designed for--that Penning makes, for example--
and they're sold as my instruments, but they're not
patented.

Do you remember other stories about that--about

the transfusion device besides the doctor's wife?
Well, you See, at that particular time it made quite

a nice, sort of advance in the clinical application of
transfusions. But, it wasn't too long after that before
the preserved blood saturated, I mean, stored blood--

refrigerated blood--came into being. And once that
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came into being, why then it wasn't necessary. .
Patient to patient transfer.

That's right. Now, then, you see, the war came
along and by that time the preservation method was
perfected. And blood was even flown preserved.
The war really--you know, sort of accelerated that
particular development. And then, so there wasn't

any longer any need to give that kind of a direct

transfusion.

What was the next important step in medicine that

you took after that?.

Well, I would say that from that point until the war

I was really mostly... Well, I'd been to Leriche's then
I'd come back and gotten started in vascular surgery
and then the war came atus. So then I went to war for
four years, Just preceding the war, I also began to
sort of pioneer with Dr. Ochsner opening the chest,
Opening up the chest and doing blunt surgery on the

chest. So I became a thoracic surgeon, so to speak,
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and did work with him on cancer of the lung and
resections of the lung, resections of the esophagus,
certain types of surgery that we did for coronary
disease, like.. They were sympathectomies really.
But, the war then intervened and, of course, that
had a profound influence upon my whole thinking. It
opened up my whole idea--you know, my whole vista
and horizons. It gave me a much broader and greater
understanding of the political process, of the national
role, and that sort of thing.

Did it give you more confidence in the feeling that
you could move things?

Yes. Yes. Because I did move things,

Whereas, earlier you made no effort to do this?

No, I wasn't,..well, I wasn't even aware. I had no
awareness of these things. But the next clinical
development took place here. Because I.. Shortly

after the war, I did move here. And then I began
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to develop my department and then to develop a
research laboratory and to work more directly in

the cardiovascular field.

To go back to 1939, even though a good deal of it

was speculative, you and Ochsner were voices in

the wilderness linking smoking and lung cancer.
That's right. Well, you see, actually we... What
we did really was not entirely original, because there
were others that had linked smoking and cancer of
the lung. You've got to remember that in animals it's
possible to demonstrate certain aspects of tobacco
products producing. ..being cancerogenic to various
types of animals, whether it's the lung or other areas
of the body. And there had been some experimental
work that had been done--that had linked it. Now, we
were impressed, like others, with the fact that there
was a steady and rapid phenomenal increase in cancer

of the lung. And this concurred statistically. And
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looking around for various possible causes for this, .

smoking seemed to be an obvious one because of the
increase in smoking that was taking place, This is
particularly demonstrated by the statistics on the
production of tobacco in this country. It had rapidly
increased, and it had increased particularly since
World Wari. And with the, you might say, the manu-
facturing of cigarettes in the form that they have been
manufactured--see, prior to that time, people smoked
but there wasn't... They smoked cigars and they
smoked pipes and chewing tobacco and, or they Bull
Durham--you know, they made their tobacco to smoke
it. But with the machines that came along to develop
cigarettes, why there was a great increase init. And
when you plotted the rise in the production of tobacco,
you found that it paralleled the rise in the incidence of
cancer of the lung. So we pointed that out and spoke

about it.
 

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You did a number of reports in '39, '40, '4l on

cases,

That's right. Exactly, Exactly. We had an interesting
experience at one of the medical meetings. Dr. Everest
Graham, who is one of the great pioneers in thoracic
surgery, challenged this sort of hypothesis at one of

the meetings. And he did it in a very sort of devastating
way because he pointed out that if we use those kind

of statistics, that he was sure that if you took the
increased production of nylon stockings, you would find
out the same thing. See?

Or automobiles, or...

Yeah. But the interesting part of that story is that

Dr. Graham later became converted to that hypothesis
and was a stronger advocate of that hypothesis than
anyone, And then finally died from cancer of the lung.
Were you laughed at frequently at medical meetings?

I know.. I've heard stories that people were actually

being rude to Ochsner over this.
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Well, I wouldn't say we were laughed at, but

we were in those days--we were in the minority.
And we were ina sense subject to a certain amount
of criticism for taking such a strong position on it.
Did you get pressured by the tobacco interests or
any others?

No. I think they disregarded it at that time.

Two nuts down at Tulane.

Yeah. But later they did take cognizance of it, of
course,

Were you subjected to any other notable criticisms,
other than Dr. Graham, that you recall?

Well, I would say that there were others, yes, who

_were critical of it, but politely so. I wouldn't say

that they were..

Do you have any memorable flashes on....?

No, they.. You know, at the meetings they'd tend
to be gentlemanly about it. Even Dr. Graham was

gentlemanly, but he did make this remark, you see,
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and ina sense, it was kind of a devastating

way of putting it. And, of course, he got a big

laugh. It was understandable.

Did either you or Ochsner have a reply to that?

Well, only in this sense, let me point this out.

That if you use that kind of reasoning, of course, then
you would have to point out that there are many other
things that!‘would not have any remote relationship. But
the fact is that there is some experimental evidence

to indicate there is a relationship between smoking

and the production of cancer of the lung in animals,
And there isn't for nylon stockings, you know.

Ochsner became something of a missionary in this
conflict, but you never did, really, did you?

Well, you see, my interests... You see, he stayed in
that field. He didn't get into cardiovascular surgery.
My interest was in cardiovascular surgery and so

I never did,. I wrote one article when I was president

of one of the societies in which I as a presidential

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address--~called attention to this for the last

time really. It was the last time I was out-

spoken about it, as important a health matter to

the people of the country as any’epidemic and there-
fore should be regarded as such and therefore

given that kind of priority. But that was the last
thing I said about it. From that point on I was

really a missionary for cardiovascular disease

and I was trying to spread the word there. So

I had to, in a sense, devote my time and energies

to the area that I was primarily interested in.

Did you, when you were working with Ochsner, didn't
you perform-some.of the first complete pneumectomies,
Yes, oh yes. We were..

Were they successful?

Oh, yes. We didn't perform the first successful.

Dr. Graham did that. But we were right on his toes--
right behind him--right on his heels, And we had the

largest series for quite a while, We did more of them,

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And we had a.. And we did more of them suc-
cessfully, so that we had quite a nice series, nice
experience and we reported all of these. We did
the same thing in carcinoma of the esophagus too.
We had a nice, large series, So that we were
among the pioneers in the field.

As surgeons were you apprehensive about this kind
of pioneering surgery?

Well, you know, when you say apprehensive, you've
got to keep in mind that when you're starting any
new field, you're apprehensive. Not because of any
sense of apprehension that you can do it. You have
the confidence of being able to do the job. You're
apprehensive about the success. And what's going
to happen, you don't know. So you always begin this
kind of development with a certain degree of concern
and anxiety, but you're not uptight about it. I don't
think you're ever uptight about it.

Well, describe for me if you can the manifestations

of the anxiety that you feel.
 

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Well, I think it's mostly...

Going back to the first pulmonectomy you did.

Well, I think it's best described as sort of being
concerned with whether or not it is...it's really
justifiable. You don't know whether itis. And you
don't know what the success rate is, And until your
success rate is written up, why it may not be. Now

you take, for example, when I did the first successful
resection of an aneurysm of the aortic arch, which

was the first one, it was successful. AndI was sort

of jubilant, you see, with the fact that it was success-
ful. It was a tremendous challenge and I succeeded

in getting it done,

You did this with a shunt?

Yeah, that's right. With a shunt. Now we did... Then
I did several more and they were all failures. Well,

I, you know, that shook me up and I was really concerned
that maybe this was a fluke that the first case was a

success, you know. And then to have three or four of

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them go bad, And, there are little complications

that can occur that. over which you really don't

have any control, exactly. You don't... You can't

be sure. The patient's under an anesthetic. And

you don't know what's happened or why. He wakes

up and he's paralyzed or he's had stroke or so on,

you see,

These are things you can't know until the anesthetic
wears off,

That's right. Exactly. And so, you have that kind

of anxiety and.. I was so concerned about this that
frankly I had to stop and wonder whether I ought to

do any more, .

The arch one?

Yeah, And it was only because of the pressing necessity
of doing something to a patient who is suffering and
going to die that I felt justified in doing something more,
Trying it again, That's what I mean by the kind of

anxiety you have. If you're going to have a success rate

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of 5 percent or 10 percent, it's not very good.

And that's the kind of anxiety you worry about.

Like.a pitcher who wonders if his arm's going to

hurt.

Yeah, That's right.

Well, what sorts of things go through your mind,

if you can recall, when you're a young surgeon

and you're just beginning to assume major responsi-
bility; - You've been well-trained so you have some
kind of ability to do things,

Well, you see, if you've had any experience in surgery,
when I say experience I mean if you've been through
training and you've seen a lot, you've helped on a lot

of cases, you know that all kinds of things can happen,
And gowrong. All kinds of complications--many of
which you have no control over, For example, I
remember a patient that I operated on who did extremely

well. And I went by to tell him good-bye. He was
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perfectly well, ready to go. His wound was healed.
Walked out with his wife to the elevator and dropped
dead right there at the elevator. Because, they were
leaving.

What kind of an operation had he had?

He had had a Leriche syndrome that I operated on
him for, Well, that shakes you up. And when you
get a post-mortem on him, you find he's had a
pulmonary embolism, Massive pulmonary embolus.
You see? Ali the manifestations were silent. There
was no evidence that this was going to happen, Now
you have no control over that. There's no way to
prevent it. And it almost,., You get the sense that
this is fate. That this was his time to die, no matter
what you did for him. You have no control over it
and even though this happens very infrequently, this
happened to you. You know it can happen. -

Is this an awareness that comes to you fairly early -

in your career? :
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Sure,

When did it come to you?

Oh, it came to me in my early experience in
surgery, because I saw it happen. I saw it

happen.

This is a knowledge you acquire as an intern,and

a resident.

That's right. Exactly. Exactly. And, you see,

the incidence of some of these complications is
relatively uncommon. They vary, of course, from
hand to hand, but still they occur. They occur to
everybody. And that's the way itis. If you're
lucky, you know, you might go for some time and not
have one and you begin to feel sort of... you'll forget
that it'll happen to you. And then "bang", there it is.
And what does it do to you when it happens?

Well, it's very depressing when it happens. You

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over it. It's frustrating, for one thing. And you

feel why does this have to happen to this poor
gentleman, you know. He was doing so well. I

did a perfect job on him. It went well and then
"bang", he dies from this. Or he has a massive
myocardial infarct and dies,

Well, that is just fate, isn't it?

Well, I think we have to call it that because we don't
have enough scientific knowledge to be able to
predict, to be able to say why it happened. You know,
there's a reason for everything. But sometimes we
don't know the reasons. When you don't have enough
scientific knowledge, you have to put it in the sort of
category of fate, Of course, it's fate anyway, but I
mean it's unexplained.fate, You know, I remember that
old story that --I think it's told maybe in the Arabian
Nights or someplace. . something like that--where
this man found out that death was looking for him,

That's in Appointment of Sumara,

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That's right. So there you are,

‘I think we have to clas sify some of these things as

fate, or the destiny of the individual because we
don't know. Some day the scientific knowledge will
be able to explain them and we'll know why a patient
develops a massive pulmonary embolism, And we'll
maybe know how to prevent it completely.

When you first : began surgery, do you recall your
feelings on the very first time you participated.in
surgery? And what the circumstances were?

Well, you see, when I first participated in surgery

on human beings IJ was a junior medical student. And
I participated in the hospital during the summer--working,
I had just finished my sophomore year. AndIwas
working in the hospital. And Iwas taking one of these
summer jobs. Solwas virtually an intern in the
hospital, And I actually began giving anesthetics. ,
Using drip ether, which was on a patient who was
going to have atonsilectomy. And..

A child?

Yeah, Yeah, And naturally I was very much concerned
 

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that Iwas giving.. give him.. do it right, you see,
And so, I was very slow about it and the surgeon

was pushing me.

Who was it? Do you remember?

Yes, I remember the surgeon but I can't think of

his name now. Erwinwas his name. Erwin. Fine
man,

Older surgeon?

Yeah, Very fine man, Not too old. He was much
older than I was then,

Is he what used to be called an Eye, Ear, Nose and
Throat surgeon?

Yeah, But very good. Very precise. Very careful.
He later offered me a job to come in partnership with
him, AndI got to know him very well. | I liked him
very much. He liked me, Then later, I assisted.
Actually acted as an assistant. And it was interesting.

Iwas assisting a man who was doing a hernia operation,
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And I kept thinking the whole time he was doing
this--as he was doing it--because I had watched
others do it, you know. As he was doing it, I
wanted to do what he was doing, because I felt

I could do it better. He was tying a knot and fumbling
around. JI knew I could tie that knot better because

I had been practicing tying knots, And I wanted to
tie that knot. And I'd watch how he held the scissors
andIwas.. All the time I was assisting him, I was
thinking to myself how I could better do it. And

so I developed a kind of confidence in myself about
it. I'd go.. Afterwards I'd go and read about these
things and think about it and kind of..

Plan a strategy of your own.

Yeah, Exactly.

When did you first pick up a scalpel and use it?

On a human patient?

Oh, by the time Iwas... Actually, even then I did,

because I also worked in the emergency room,

4
 

Tape # 13

DR, DeBAKEY:

SCHANCHE:

DR, DeBAKEY:

SCHANCHE:

DR, DeBAKEY:

-30-

I'll never forget, I was still, I guess, a sophomore
or a junior, I've forgotten now. But 1 was working

in the same hospital in the summer,

Was that Charity Hospital?

No, this was Mercy Hospital. And they brought a
little child in with an abscess right here on his face,
And it was pointing and you could see pus under it

and all you had to do was knick it. And we used to

ase local anesthesia which was called ethel chloride
spray, which would freeze the tissue. You'd press

a button:and out of it would come a spray under pres-
sure because ethel chloride had been putting..was
compressed in this little small container, But ethel
chloride is also a general anesthetic if you inhale it--
its fumes, And then was used as such, Sol puta
towel. -around this little baby--like that--with an opening
just where the..

Where the chloride wouldn't...

Well, no, you see, supposedly you have a sterile towel

to put around it so that you wouldn't contaminate. And
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DR, DeBAKEY:

SCHANCHE:

DR, DeBAKEY:

SCHAN CHE:

DR, DeBAKEY:

-3]-

had a little hole in this towel. And the hole exposed
the little abscess. The rest of his face was covered
up with the towel. And I took the spray and sprayed it.
And then I just knicked it and got all the pus out, put

a little dressing on and took the towel off, and the
child was,..looked like he was dead. He was actually
sound asleep, but I didn't realize it at the moment.

I didn't realize what I had done. I had given hima
general anesthetic because the towel was over him and
the fumes had gotten under the towel and he was just

breathing these fumes. And I.had put him sound to

' sleep, but he looked dead. And I was about the most

frightened person that I just.. I'm sure I turned white.
How terrifying.

Just absolutely terrified. And I couldn't say anything,
Iwas.. |
Was his mother or father. .?

His mother was there. And fortunately about that

moment he started taking a deep breath. And I saw

+
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DR, DeBAKEY:

SCHANCHE:

DR, DeBAKEY:

SCHANCHE:

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SCHANCHE:

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~32-

him breathe and I then quickly realized what had
happened to him. And I turned around to her and
I said he'll wake up in just a few minutes.

And trying to keep your cool.

‘Trying to keep my cool, yeah. But my.. I can still

remember this. My heart was racing. It must
have been going 200 beats a minute,

What were you? A junior in med school?

Yeah. Iwas still in medical school. And, of course,
it was a great lessonto me. I realized what I had
done. But it simply goes to show how these things
can happen to you and without--just suddenly, this
child could have died, You can imagine the fix I'd
have been in then,

Were you even supposed to be doing that kind of
work as a student?

Well, I would say yes and no. We were supposed to
be supervised --the doctors ran it, but there was so

much of this kind of little stuff going on that very often

4
Tape # 13
-33-

DR, DeBAKEY: the doctors would come by, see what it was, and say
go ahead and just make that abscess, And goon
to another patient or something like that.

SCHANCHE: What was the first major surgery you participated in?

DR, DeBAKEY: Well, even.. Oh, I did it even before I graduated.
They.. Iwas still working in the hospital and by
that time J may have been a junior or a senior. AndI..
One of the doctors let me do an appendectomy. And..

SCHANCHE: That was your first?

DR, DeBAKEY: Yeah, and Iwas so thrilled because I did it well and
everything went well.

SCHANCHE: You had assisted at a number of them,

DR, DeBAKEY: Oh, yes. Oh, yes. And I knew everything I was doing,
I had read about it. I knew it well and I was so pleased
when he said to me, "Would you like to do this?! And
I said, "Sure." AndIdid. He was right there with me
all the time,

SCHANCHE: | Did you do a great deal of general surgery before
you...?

DR, DeBAKEY: Oh, yes, I did all kinds,of general surgery. I seized
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~34—

every opportunity. When I was a resident at the
hospital--an intern--the boys used to check out
onme. You see, in those days everybody was
assigned a service-~-a certain number of patients
from a certain area. And you had that assignment
allthe time, You didn't have it just eight hours a
day. No, you were assigned. So when they went
out~-see, we lived in the hospital--in interns quarters~-
we lived right there in the hospital. So whenever
they went out on dates or anything like that, they had
to sign out on somebody. And I used to let them sign
out on me because I was there and I liked to do the
work, At night, there was a lot of work to do--all
the emergencies and things like that, I was working
all night, you know. And I just..

Thrived on that?

Yeah, ohI loved to stay there and get as much work
as I could do and do as many operations. So TI had

a tremendous experience. AndlI...
Tape # 13

SCHANCHE:

DR. DeBAKEY:

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DR, DeBAKEY:

-35-

Do you feel that you sort of doubled your residency
by doing that?

Absolutely, Yes. The more experience you have

the better you are, if you learn from it. AndI

tried to learn from it. That's one reason I feel

so confident in the area of general surgery even
today, -you see, And en passant, I do it, you know
whenever it's, whenever I have to do it, even in my
own patients. You know, [I'll do a hernia in my own
patients, a gall bladder, a stomach resection, what-
ever needs to be done. I feel absolutely competent
and confident of being able to do it well. Because I've
simply done so many of them.

Well, let's take you back to Houston now and your next
development which was, whic was what--using homo-
grafts and...?

Yeah, you know, I think that it would be better if you
would take these Annual Reports. [I'll just show you |
why. Becausel...

..-On the pump, you see, when you cannulate to put
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SCHANCHE;:

DR, DeBAKEY:

~36-

them on the pump, one cannula or two cannulas go

into the venae cava to get the blood to come out.

The other cannula goes into one of the main arteries,

It could be the ascending aorta or axillary artery or

the femoral artery. Now it's extremely important

that the cannula is put in precisely in the artery,
because any damage to the | intimal layer of the
artery will result in what's called a dissection, That is
the wall separates. The pressure of the blood acts

as a means of separating the wall.

It'll create a dissecting aneurysm?

It creates a dissecting aneurysm. And once this happens,
it's a hopeless situation. There's no way to correct

it. I have only saved one patient in all my experience
with this kind of a problem and that was because I

was there. I recognized it virtually before it occurred

and quickly stopped the pump and immediately went

-up to the ascending aorta, occluded it, put a cannula
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-37-

into the normal lumen and got flow going into the
normal lumen again. So as now to reverse the

flow and to flatten out that dissecting area. And I

did save that patient. But I wasn't in the room

when this happened. They had cannulated it and

had started off on the pump. And when I got to them,

it was too late to do anything. And it's all due to

the fact that they were not precise and careful in
cannulating this and killed the man. And you see,

you have to take the responsibility for all of this.

You can't say, "Well, my assistants and my associates
made an error." You can't tell the family that.

What can you tell the family?

Well, you tell them that things...that there were compli-
cations that developed during the operation which you
can't explain all of the basis for it. You can't explain
how you feel about it. And you see, it's your responsi-
bility and it's your responsibility to tell the family.
They don't talk with the family. So they never feel this

very keen responsibility. And they don’t know how it
Tape # 13

DR, DeBAKEY:

SCHANCHE:

-38-

feels until, of course, it will happen to them.

But it's an error, And you see how.. And you see

I keep saying constantly, I'm raising hell about

small things because I know from experience that
small things can develop into big things. It doesn't
make any difference how small or“ how insignificant

it may seem, in surgery every error is a significant
one. and may be a fatal one. And how do you teach
that? You say it over and over. You're constantly
calling attention to the lack of concentration and paying
attention to what they're doing. I say to them, "Look,
the reason the retractor has moved is because you're
not concentrating on holding it in the place that I
showed you to hold it. The retractor doesn't move on
its own. It's the fact that your hands have gone to
sleep. You're no longer in control of your hands, because
you're mesmerized. You're not concentrating on what
you're doing! Your mind is flitting in all directions."
That is a chronic problem, isn't it, with people who

are essentially students, They're going to be watching
Tape # 13

SCHANCHE:

DR, DeBAKEY:

SCHANCHE:

DR, DeBAKEY:

SCHANCHE:

DR, DeBAKEY:

-39-

you, instead of what they're doing?

It's a chronic problem with all of them, It's even

a chronic problem with the anesthesiologists. You've
got to constantly be calling his attention to what he's
doing. He should be watching the pressure and the
pulse and the E.K.G. and everything else, But I

have to call their attention to it. I have to wake them
up and say, "Look, the pressure is down. Look, he's
having P.V.C's. He's got anarrhythmia." This

is what you constantly are doing. And then, you know,
you get the reputation for being a kind of mean old
bastard, because you're constantly calling their atten-
tion to what--you know, to their own deficiencies,

And yet, these deficiencies, you see, are so important.
They're vital.

Absolutely vital, you see. They cause death.

Were they aware they had dissected the artery before
you got into the operating room? |
Oh, yeah, sure. Oh, when Dr. Daniell.. By the

time Dr. Daniell got there and started, yes, he
 

Tape # 13

DR, DeBAKEY:

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DR, DeBAKEY:

SCHANCHE:

DR, DeBAKEY:

-40-

finally recognized it. But it was too late when he
recognized it.

But, you know, it's so depressing. It just knocks

you out when it happens, It's so hard to take because
I know if I had been there it wouldn't have happened.

If I had done the thing, it wouldn't have happened. And
yet, I can't be everywhere all the time. That's my
problem.

Is it a very delicate and difficult thing to do?

No, ordinarily.

Not if you exercise care,

And if you exercise care and judgement, itt won't
happen, because if you find an artery that's, let's say,
diseased, you just don't cannulate that. You know this
can happen ina diseased artery, You don't do it there.
Many times, and I showed them this, this is the thing
I say to them: "Why can't you learn?" Repeatedly
I've got to say the same damn thing over and over

case after case, I just can't understand why they can't
| Tape # 13

DR, DeBAKEY:

SCHANCHE:

DR, DeBAKEY:

~4)]-

learn! That's why I say my definition of stupidity
is the inability to learn from experience. To me
that's being stupid, That's the definition of stupidity.
Well... |
Did you get a chance to go through any of this.....
(PAUSE)
...early origins, you see, of the Medical Center
which I had to fight and overcome and constantly.
And that is the fact that this medical school arrived
in Houston with no really agreements for a clinical,
let's say, services--for clinical services for their
clinical departments. They brought down mostly
second and third rate basic science people, you see,
in the basic sciences--anatomy, pathology, bio-chemis-
try. And no clinical people. And what is more, there
was no clear understanding or agreement as to how
the clinical services were to be organized. And that's
the reason when I first came here to look over the

job I was offered, I turned it down, because they

+
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SCHANCHE:

DR, DeBAKEY:

-42-

had none. And I said, "Well, I.. What do you want
me todo, I can't. create these for you. You've

got to have a hospital, You've got to have a clinical
service in a hospital, There have got to be a certain
number of beds that are going to be under the control
of the professor of surgery, the professor of medicine,
and so on, And there isn't any," ‘And they said,
"Well, you can use the teaching beds at the Jefferson
Davis Hospital and we're going to plan to do something
at the Hermann Hospital,"' I said, "Well, when you
have that worked out, then I'll be glad to reconsider
it.”

So..

Was it Dr. Moursund you were talking to then?

Yeah, Dr. Moursund. And they had a committee that
Dr, Moursund had appointed of surgeons mostly--clinical
surgeons here intown. And they were all for me
coming. They wanted me here. But, I explained to

them I couldn't do it under the cir... So they asked
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~43-

me to come over a second time, whichI did. They
hadn't made any more progress, as far as ] could

tell.

Several months later or..?.

Well, several, yeah, several months later. And they
hadn't made any more progress and I turned it down
again. Well, Dr. Moursund, apparently, was deter-
mined to try to get me. So he came to New Orleans

to see me a third time. I had written him a rather
lengthly letter and I must try to find that letter. And
then.. And he came to New Orleans and said, "Well,
now I have the assurance of this committee of surgeons
that they will see to it that you get a service. But we
need you to come help organize it--the way you want it."
So, I did talk to a few of them and they said, "Yes.
Definitely we are backing Dr. Moursund on this. We're
going to get it at Hermann first and also at Jefferson
Davis,"

Well, hell, when I arrived here, you see, they were all..

it was nice, you know. They were very affiable, They

a
Tape # 13
-44-

DR, DeBAKEY: were very.. You know, they invited me to their
| . homes and all that kind of stuff. But nothing happened.
i SCHANCHE: They'd let you work in their hospital, but they
wouldn't let you run it, is that it?

DR . DeBAKEY: Well, you see, at the Jefferson Davis Hospital that |
was organized... The staff ran it. The Board didn't
really runit. The staff ran it and had been. That was
traditional. And iat the Hermann Hospital, the staff
ran it there as a private institution, really. They had
about twenty beds that were the service beds, but they..
These private doctors ran that. And they had meetings
and they discussed it and so on.. Some six months
later they came to see me and said well, they had it
all settled there. It was all ready to go. And that I
would be made chief of the teaching service. And I
said, ''Well, who's chief of the surgical service?"
"Oh, that's Dr. so and so." Dr. Waldron, I think. He
was still the chief of the surgical service. AndIl
said, "Well, who does,, who's in control of the

patients as far as operating is concerned?"
Tape # 13

DR, DeBAKEY:

~45-

"Well, Dr. Waldron is." And I said, "Well, I

don't understand how that's going to work. You

going to put me in charge of teaching on these

patients. And I'm going to be teaching students on
these patients that somebody else operates on!’ Am

I said, "Suppose that in doing my teaching I call
attention to the fact that it's the wrong operation that's
done for the wrong condition. How do you think that's
gonna go?"’ "Oh, well," he said, "that's not going to
happen at all." I said, "Don't tell me." I said, "From
what I've seen around here, that will happen more often
than not."

And they didn't like that at all. So they said well, they..
that's the way they had decided to do it. And I said,
"Well, can you tell me if there's any experience with
this anywhere else in the country? Because, if there
is, I'd like to know how it..what that experience has
shown." ‘Well, we don't have to do what they do

everywhere else," AndI said, "Well, as far as I'm
Tape # 13

DR, DeBAKEY:

~46-

concerned, that's not going to work for me,'' Sa
they left and that's when, apparently, they went
to see some of the members of the Board, you see,
And I got this later when I went to see them--some
of the Board members. They had said that I was
trying to sweep--come in with a new broom and
sweep them clean and I had proceeded with evolution,
not revolution, and used a few cliches like that.
But, as I indicated, two things happened, you see,
that changed the whole course of events. And these
were, and it's brought out in here, the..

(Telephone Pause)
...very good friends and supporters, And, asa
matter of fact, I went to her to get her to get her
husband to take the Chairmanship of our Board,
And he.. And she was very helpful to me in getting
him to do it, because I knew that if she pressured him
into doing it, he'd do it, And in addition, I got the

son to help me. So, I had the family all on my side
Tape # 13

DR, DeBAKEY:

SCHANCHE:
DR, DeBAKEY:
SCHANCHE:

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-47~

and they're a wonderful family and I'm very fond

of them. And she's one of my favorite gals, She's

ase

Do they have a problem that needs medical attention?
Yeah, it's her sister,

Her sister?

Her sister, yeah. She's out at the ranch and then
she's coming from the ranch.

Well, to come back:

There were two things that happened, you see, that
changed the whole course of events and are very
significant, One was the conversion of that Navy
Hospital into a Veterans: Hospital. Now, as I think
T've already told you the story about how that occurred,
so that's interesting in itself, you see. And the second
thing was, of course, was the Jefferson Davis Hospital.
Now the background of that is not in here, but you
remember I told you the background of that and that

was Mr, Taub, You see, actually, you remember the

.
Tape # 13

DR, DeBAKEY:

~48-

man whose name I couldn't think of. It was

Basil Mc‘Lean, Now what happened was that

Basil was an old :friend of mine, In fact, he was

the administrator of the Touro Infirmary Hospital

in New Orleans when I was there. SolI got to

know him very well. And during the war he was one
of our chief consultants in hospital administration-~-
really a great fellow. And I was very fond of him.
We worked together during the war. I went up to

his home and visited with him. He used to come
down and visit with us. He and his wife. His wife's
name was Dixie~-charming lady. And when..after

I got started with Mr. Ben Taub and I was absolutely
green, fresh, never had met him before and he was
kind enough to give me this appointment. I went down
to his office. He looks like an old Southern gentleman,
you know. He's just a fine looking man, very. soft-
spoken, very kindly looking. And extremely well-

respected in this community. And it was interesting to

+
Tape #13

~49~

DR, DeBAKEY: go back to his office because he.. the wholesale.
He has wholesale tobacco.
SCHANCHE: Described as kind of a warehouse for..
DR, DeBAKEY: Yeah, you go through what looks like a warehouse,
Of course, actually it's not the warehouse, because
the warehouse was in another place. But this is where
they had the various products, you see, on display.
And you go through that...through this whole open
kind of building with..looks like a warehouse, except..
with all the tobacco products and candy and that sort
of thing, And then finally you get in the back and
there's his office, you see, in the back. And he has
a roll-top desk, old fashioned looking office, very
cluttered. And obviously he knows where everything
is. And he had me sit down in a chair near by him.
And I told him right from the start, you know. I said,
"Jive come downto talk with you about Jefferson
Davis Hospital because you're chairman of the

Board of Managers and I understand that you're very

+
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DR, DeBAKEY:

-50-

much interested in it. n And I said, 'I just wanted

to give you a kind of point of view about this and

then have you think about it."

(Telephone Pause)

I said to him, "This is really what I'm going to say."
When I had called for the appointment, I told his
secretary who I was and I said I just wanted to see
Mr. Taub for about fifteen minutes, So I told him,

"TI promised you I would be here only fifteen minutes.

I know you're busy and I won't take any more of your
time, in that I think I can tell you all I've got to say

in fifteen minutes." So I expressed in general the
point of view that a charity hospital in the community,
since it was Jefferson Davis, was a very valuable
source of teaching. ButI said, "From your standpoint
you're really not interested in teaching, except as a
person who's interested in improving the quality of the

teaching of doctors in the community. Because you're
Tape # 13

DR. DeBAKEY:

-51-

primarily interested in what is in the best, . what kind

of quality care you can give the poor sick. Because
that's your primary responsibility." And I said,

"This is the way to do it, because you cannot teach

poor quality. You're teaching the best quality you:

can, And your teachers know quality in a medical
school and they're going to see that the standards of
good medical care are being provided to the patients
because they're teaching that. And that is why in

any large community, the university teaching hospital

is where you eet high quality care." I went on to say.
Interestingly enough, he had read a book by Allen Gregg
that..who was chairman of the..director of the Rockefeller
Foundation for many years, And in this book Allen
Gregg had made some statement to the fact that, if he
ever got sick in a strange place, he would like to have

a sign on him saying 'Take me to the university teaching

hospital."' You see. He had read that and remembered
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DR, DeBAKEY:

DR, DeBAKEY:

~52-

it. So it struck a good chord in him, Well, after
I got through explaining all this and explaining that we..
The problems we would have in doing it, because of
the way the staff was organized, he... I said,

"Now my fifteen minutes is up. And that's all I wanted
to say. Iappreciate your time. I hope you'll give
some thought to this. And if there's anything else

I can do, would you please call me."

END SIDE A,
",..questions I want to ask you."’ And I said, "I'm
willing to stay as long as you want me. I just didn't
want to take up your time,"
He said, "Well, if you've got a little time, let me ask
you some questions."’ So he started asking me some
questions, particularly about what would the teaching
faculty do, how they would relate to the present staff,
and that sort of thing. Well, I stayed there for over

an hour. And he said, "I may want to talk to you some
Tape # 13

DR, DeBAKEY:

~53-

more," I said, "Well, by all means.'' Well,

it wasn't long before he called me again and wanted

to know if I could come down and talk to him, which

I did, And now he was more interested in how to

do this. Now he was asking questions how to go

about it. What it would involve, and that sort of thing.

And I said, "Well, it's going to create a problem from

the staff standpoint. They're not going to like it,

I can tell you that, And so you're going to have a
problem,"

He said, "Well, we've been thinking of making a

survey at the hospital for some time." He said,

"What do you think about having a survey made? On

the basis of this maybe some recommendations could
be made." And I said, "I think that's an excellent
idea,'' I said, 'Why don't you propose to have a survey
made by an outstanding hospital consultant that no one
could in any way question. I mean his reputation is

so established nobody could question it."
Tape # 13

DR, DeBAKEY:

SCHAN CHE:

DR, DeBAKEY:

SCHANCHE:

DR, DeBAKEY:

-54-

He said, 'Do you know anybody like that?"

I said, "I certainly do. I know the top man in the
world,"

He said, ''Who is that?”

I said, "Basil."

He said, "Can you get him to come down?"

I said, "I certainly can."

That's Basil McLean,

Yeah, I said, "I certainly can."

Is it M-C-L-E-A-N?

Yeah, He said, "Oh, will you call him?" I said,
NSure.'' Sol called Basil and he was at Rochester at
that time and I told him what the problem was, And

I said, "Basil, we can certainly use your help."' Well,
Basil McLean came down and Mr. Taub set it up quite
cleverly, And all this, of course, wasn't known. He
set it up very cleverly as asurvey. Well, Basil did.
He spent a couple of days and he made a survey of the

hospital, Then he met with Mr. Taub privately and
 

Tape # 13

DR, DeBAKEY:

SCHANCHE:

DR, DeBAKEY:

SCHANCHE:

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~55-

told him what he would recommend, And, of course,
one of his major recommendations was that he'd
affiliate with Baylor, which was a foregone conclusions.
He would have recommended this with or without

your influence, wouldn't he?

Oh, yes. Oh, yes. No question about that. No
question about tmt. No, I didn't really influence

him to do this because this was..

Was obvious.

Not only obvious, but this was a recommendation

that would have been made in any other situation,

you see, Well, then the question came about how

to proceed to‘do this and get the staff to go along.

He had the report. Basil made quite a splash locally
in the papers, too, you see. So, he.. Mr. Cullen
was living there and Mr, Cullen wanted to talk to him,
because Basil also said that the Medical Center..

well, he said the hospital was too small, That it
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DR, DeBAKEY:

SCHANCHE:

DR, DeBAKEY:

SCHANCHE:

DR, DeBAKEY:

SCHANCHE:

~56-

needed, ‘It was too old.. It needed to be.. They -
need a new one. And he made the recommendation
that they build a new hospital in the Medical Center.
So, that, you know, was highly publicized on the

front pages of the papers and then he went to see -

Mr. Cullen. Mr. Cullen asked to have him come and
see him.

Was Cullen then chairman of the Medical Center?

No, no, no, Cullen was living...

He was not involved. He was just very rich and very
interested.

Yeah, that's right. So, he spent several hours with
Mr. Cullen. I went down there with him one evening.
Had dinner. The next day, Mr. Cullen made a big
splash in the papers by saying that he strongly supported
this and would give money to start it in the Medical
Center,

Well, that put the staff, of course, at a disadvantage
in opposing all of this,

They'd already been hit by the heavy artillery.

%
Tape # 13

DR, DeBAKEY:

-57-

You see? And so some of the leaders of the

staff were very strongly opposed to this, but

there were others who weren't and were ready

to go along. So they had a meeting-- a staff meeting.
And Mr. Taub had talked to several of them. Called
them up and talked to them and they finally agreed
with him that they would go along with this. Well,
they came to the meeting and the votes were just
about to go the other way. So the chairman sort of
tabled it. He said, Well, we don't have enough
people. Other people ought to be here. I want to
postpone it."

So he was clever about that. And so they postponed

it and Mr. Taub really put a lot of pressure on them
by simpley, ina sense, not threatening, but indicating
to them that he may go to higher authority--that is

the city council or commission or whatever it was
that had the authority for this--and make them change

all the by-laws. So, they., At the next meeting which
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-~58-

was, I think, a week or so later, something like
that, they voted to agree with this. Well, then I
wrote up, in the meantime, I had written up an
agreement and given it to Mr, Taub,

The affiliation agreement,

Yeah, affiliation agreement, based upon. Well, I
didn't write anything denotable.. We had several of
them that we used. as a pattern. And that constituted
the real agreement.

You had Dr. Moursund's active collaboration all
this..

Oh, yes. All this time, of course, Of course, He
was in complete.. But he kind of let me carry the
ball, because of my relationship with Mr. Taub.

So, that's how that came about, But, you see, that's
the.. I'm referring here to the Medical Center in
some places here you can see, where I say about:
"In view of the misconceptions which have prevailed
concerning the role of the College and the Medical

Center and the difficulties encountered in providing it
Tape #13

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-59-

with the clinical facilities essential to its proper
function, the importance of these events can not

be over-emphasized."

You see, I used "misconceptions" because it was

a misconception on the part of the Medical Center
Board, They were the ones that had misconceived

the organization of a medical center, which really

as far as they were concerned consisted essentially

of a gathering together in a general area of some
buildings--hospitals.

And a post-graduate,..

And a post-graduate medical school, Now, and this
was something we were constantly really fighting

in those early days. Now, you'll notice that I point

out the two important events: the Jefferson Davis
Hospital and then the Veterans Administration. And

it was with their..once we got those two, then of course
it became possible for me to start functioning effectively

in the development of a surgical service. Now, it's
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more than that, because, you see, sur gery was
simply highlighted and in a sense sharpened into

focus the problems that effected all the other
services. All the other services. Now you could
never get quality people to come and take any of the
other services either. And here I was about to leave.
Until these events occurred.

How did they get Dr. Hoff here? He came a few
months before you did?

There's a difference. He was professor of physiology.
That's a basic science. He doesn't need a clinical
servicé, There's the big difference.

They had someone else in pediatrics, I guess,

They brought a young man in pediatrics, Russell
Blatner, and he had a service at the Hermann Hospital.

They gave him a service, which he ran, Now in this

service--in running this, he really didn't interfere with

the private practitioners, There's a difference there.

And they had already indicated they were going to
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-6l1-

build a children's hospital. So, he had something

to look to.

Maybe it will help if I just direct you to some

pages on that report that you're looking at on

page 7, You've described how the surgical service

at Jefferson Davis is organized in "white and colored
division” in both male and female units.

AndI,. I remember this very well and I changed

it, you know,

Well, I noticed that a few years later in the '50's

it was still...there was still a reference to white

and colored, I think in '58.

That's right. Something.. Well, I don't know whether
it's fif., how long afterwards, but I got. . . The first
things I changed..

158-'59..

But the first thing that I changed was the recovery ward
and the emergency wards, That became completely

integrated. Mr, Taub was very progressive in this

*
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DR, DeBAKEY:

~62-

regard, And I used to complain about this organi-
zation, because I said, "You see, it's very ineffi-
cient.'' I mean you've got to have a male and female
service divided into two parts duplicating all these
functions, And I used to complain about this all the
time. And then I used to refer to the fact that I got

the approval of the Board to let me integrate the
emergency... We can't have two emergency services,
We can't... We just don't have that kind of personnel.
We don't have the money to do it. We don't have
segregated operating rooms. We don't have segregated
recovery rooms, It works and there are no problems.
We've had no problems. There's been no complaints,
Nobody's complained about it. It works beautifully.
And Mr. Taub was all with me. He allowed me..actually
gave me the go ahead to integrate these other areas,
And I used to complain about this, And we finally inte-

grated these areas, And I think probably the first

\
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hospital in town that integrated. We did it on the

qt. We didn't say anything about it. Yeah, we

just did it, you see. And it worked fine, Nobody
complained.

That must have been terribly burdensome, though,

to have to break down like that into...

Well, it's irrational, not only burdensome, absolutely
irrational. If there's anything , if there's anything
that makes people the same, it's illness. They're

all the same--rich, poor, all colors and everything
else, And you treat them the same way. They were
treated the same way. So that it was ridiculous,
absolutely ridiculous and it simply illustrates even
better than anything I know the irrationality of segre-
gation, It's absolutely the most irrational thing in
the world. Now I'm not saying that you.. that in your
personal life and in your family life and in your home

you have to take everybody in. Well, hell, you don't.
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You take the people you like and want. But, it
shouldn't be based on color. You see? That's

the point I was making here.

On page 31 of the Report, this is at a. time when you
were doing very little.research. You mentioned

the research program of shooting dogs in the femoral
artery and grafting preserved arteries... Was that

the first of the arterial research projects?

Yeah, trauma was the earliest research program

that we began, because you see, we had a lot of
trauma, And..

Particularly in the city. hospital.

That's right. Notice on page 21 of the Report, it says
that these two institutions, the Veterans Administration
and the Jefferson Davis, thus became the only hospitals
and for the first time in the city of Houston to receive
full approval for complete graded residency program
in surgery. You see,

Then on page 22, I point out: "At the request of the

Methodist Hospital and in light of their expressed desire
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to affiliate with Baylor responsibility for their
surgical residency training program was assumed

by the department of surgery.'' You see. That was
the first actual affiliation with Methodist Hospital

we had, And that was sort of a verbal agreement with
the Methodist Hospital before they came in the Center,
This is when they were,.

What year did Methodist build this building? There's
no mention of it in this report,

I think it was in'53, Ithink so, We can get that
figure. In fact, I think it was '53. I think they
started in '5l.

Well, you: can see we really began to move from that
point on, because once we had the service organized
we got some people. And then the research activities
we put into effect. These included both laboratory and
clinical research. The laboratory ones we did ina
small room about the size of this room, That's the

only laboratory we had. And the arterial injuries was..
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That was your laboratory on the roof?

Up there. Onthe roof, That's right.

Now, we also began a study on dextran for the Army. °
Now I was getting some money from the Army for
this. That's how I got started with the research.
Baylor College of Medicine, I mean Baylor University
gave me no money. I had.. I think my total budget
was forty some odd thousand dollars, This included
salaries for all the personnel,

Including you?

Including me, That's right. So that we had to find
our own way. But because of my relationship with

the Army and the fact that they had funds for grants

for research, J applied for these kind of things.

The dextran we did as a clinical study, too, at the
Jefferson Davis Hospital, And that's how I set up the
first research laboratory in any hospital in town.

The first... And that was done at Jefferson Davis.
 

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Now the first research laboratory in any private
hospital was done here. Again with funds that I
obtained through the Army. And we did this dextran
study for them because they were ready to release
this but they wanted to know whether it was effective
in the treatment of shock before they sent it to Korea.
It was a substitute. So we did the study and proved that
it was and it was on the basis of that report that the
Army released it for it's use in the Army.

What: is dextran actually? Is ita dextrose and

and water mixture or?

No, it's a heavy molecule and it's water-soluble, of
course, it's a heavy molecule and therefore it doesn't
seep through the blood vessel wall rapidly. You see,
water goes through pretty rapidly. It doesn't stay and
it doesn't build the volume up. Dextran builds the
volume up --quite well tolerated. It is excreted--
absorbed and excreted without any toxic reaction, But

it's a heavy molecule and therefore it stays in longer.
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So it held the volume of the bloodstream,

I note in your ten year report to Stanley Olson,

you said that the Armed Forces' policy of accepting
dextran as a plasma substitute was based on observa-
tions made in the you were responsible for.
That's right. Correct. That's right.

There's no link between that and the dextrose priming
of the pump?

No, it's a different thing. It's a different thing.

I noticed that the key to your...to the beginning of
your research program,

That's right.

Who paid for the trauma studies~-the arterial?

The Army.

The Army paid for that too?

Yeah. That's right.

Did anything truly significant come from it?

Yeah. We demonstrated the need... You see, what

you've got to keep in mind is that up until that time
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-69-

really up until the Korean War, there was.. Because
right after World War Il.. See, I wrote..I did a

sort of a classic study now because it's the largest
experience of war injuries of arteries that we reported
that and analysed it and reported it. And we showed
that the incidence of amputation and complications
from the way they were treated was very, very high.
This is because there was no effort made to repair
and restore circulation in the injured extremity.

What we were trying to do in this experiment was
demonstrate that this could be done at the first stage
at the time of the injury. Even if you have to use a
graft, you see? So what our goal was to demonstrate
that primary repair of an arterial injury was the best
way to save the extremity. And this, of course, is now
fully accepted, of course, But, that was a new
re

Yeah, Were you active in the laboratory on this

project?
 

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DR, DeBAKEY:

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Oh, yes. Oh, yes. I did a lot of the work myself,

And my associates, Well, there were only..you see how
many people there were. When I arrived here there
was one man full-time. He was hired before I

got here. And he was nuts, And there was one
secretary who wasn't much better, She wasn't nuts

but she was stupid. That was the department of
surgery. So I had to get rid of this nutty fellow and

get rid of the secretary because she was stupid and
start getting some new personnel and getting some
more people in the department with me. And I

point out the people that I got in here, And they were
really very fine people and I must say going back to
those days that they really did everything. They worked
like dogs and they. were very loyal, very close-knit
group because we were very small working together all
day. And it was a lot of fun. They were a fun group.
They enjoyed their work. They were happy together.

And there was a lot to do and we had a lot of fun.
! Tape # 13

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-~ 71+

Was this..this dog program a sort of an essential

first step to the development of the homografts and
then Dacron grafts?

Yeah, Sure. Sure. We.. This was where we really
started. In preserving grafts we learned..we developed
techniques, some of which had already been known

of course. And we either perfected them or improved
them and worked with them. We developed the freeze-
dried method, not originally with us, because this

had already been developed. But we learned to do it
well and we collected the grafts ourselves. We tried
various types of heterografts and so on. We learned
that heterografts weren't any good. And..

I noticed in a later report the heterograft program,
That was in '52-'53. Incidentally, the other night
when you mentioned that somebody came up with the
idea of giving giraffes as likely donors for them. Was
that seriously considered at that time?

Oh, yes. We did get horse aortas, you know. And

they've got a pretty long,aorta. You see, it goes all

'
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the way up the neck. And we did.. Oh, yes, we
didn't use any of these, but it came up because

there were some African surgeons who had suggested
that idea. But we never did try it, of course, We
had no giraffes. But, the.. We tried the horse aorta,
but that didn't work either, Heterografts just don't
work on it. They rejected it.

They never did.

No, they never did. But we had to go through that
experience and we did.

Was this experience, you know, this experience in
the background of your telling Liotta not to bother
with heterografts ... right?

Yeah, yeah. Sure. But that was.. Inthe pump, you
see, the reasonI didn't want to bother with it in the
pump too was because it is very difficult to take a
heterogiaft and the configuration of the pump and put
it in the right position and place and make it function

effectively. That I know, you see. I knew that. That's
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why I told him it would be ridiculous,

Now in the '50-'51 report, you will notice that in

the research activities we expand a little bit on
some of the things that...

And you'll notice that again..

There's a little more in '50-'51, but it's '55 that

you really zoomed up to fifty-three different projects
versus thirty in '52-'53,

No, but you see, I was saying that in the '50-'51
there's a research project on hetrologous arterial
and we point out, you see, that we're doing studies
in that area in there. I have the feeling that maybe
Methodist Hospital came into the Center about '51 or
'52. Let me see, it says Methodist Hospital here,
Yeah, Methodist Hospital was mentioned every time,
but never does it say that..

. twenty...

.. Methodist moved during the period or they built

a new building. It says a certain number of beds were

4
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-74-

added every year, which will finally get up to

nine hundred. Unless, I overlooked it, I didn't...
Well, let me see, it ways here Methodist Hospital--
affiliated thospital--twenty.

Now wait a minute, it does say in the '52-'53 report
that "the affiliation of Methodist Hospital was formally
completed on October 3rd..which was described in
the last annual report, An account was also given
into the organizational structure of the staff which
was similar in principle to that described by the
other affiliated hospitals. This even, along with the
subsequent occupancy of the newly constructed 300
bed hospital in the Medical Center, brought the
Methodist Hospital under the orbit of educational
institutions." So it must have happened in '52-'53,
I think '53 is when it occurred, You see.

Are you in the '52-'53 report?

Yeah,

On page 36 you mentioned the outstanding contri-

bution of the period is the surgical removal of
Tape # 13

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~75-

. aneurysms of the aorta. This was the beginning

of that..

Uh-huh,

As I recall there is no detail given there,

Surgery on the Aneurysm of the Aorta. For the

past two years it has been the policy of the surgeon

to attempt excision of the aortic aneurysm in:almost
all cases,"

Well, you see, we began that actually--The first one

I did at Jefferson Davis Hospital in '49, the first
aneurysm of the thoracic aorta,

Well, now this was a realization of an almost life-long
dream. Something that you and your colleagues had
talked about when you were with Leriche. A powerfully
Significant advance in surgery.

Yeah, well, you see, historically aneurysms... You
See aneurysms in the historical Span as a very interesting
lesion. It has fascinated people throughout history.
And it is a very interesting lesion, you see, because

in its own way it's like.,in the vascular way.. it's
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-76-

like cancer because it represents a lesion that

can be diagnosed clinically. And once you know

it's there you know if that fellow lives long enough
he's going to die from it. And there have been some
dramatic kinds of deaths from it because they used

to develop in such a way sometimes as to even
erodé-right through the sternum, And a patient
would bleed to death and he could see himself bleeding
to death. You see? And there have been interesting
case reports in the background where they put a

cork into the hole to stop the bleeding.

Put a cork temporarily?

Temporarily, yeah.

Not very long though. That's an interesting phenomenom
to me. I've noticed in some of your papers that

aneurysms pressing against the spinal canal against

the spine had eroded..

Eroded the spine. Absolutely.

What causes this?
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The constant pounding pressure. Like a drop of

water hitting a stone down below. Ultimately

it will erode it. You wouldn't think water would

be able to do that, But it's that constant pounding
pressure, And it is well-known throughout history

and in the earliest recorded, .the earliest recordings
on..in medicine, you'll find something about aneurysms.
So it has fascinated medical men throughout history.

It has challenged medical men throughout history and
surgeons have done all kinds of things to aneurysms

in an attempt to overcome them,

Did they wrap them with cellophane?

Oh, they've wrapped them with cellophane, with other
things. They've put powder, They've put asbestus,
They've put all kinds of things around them in the hope
of trying to develop some kind of tissue reaction that
would strengthen them. Keep them..keep it from expanding.
They have put all kinds of things inside the aneurysm.

Wire of all kinds, metal of a kinds, hair, everything
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in an effort to.. gold..in an effort to clot them up,

so as to stop this pounding and dilatation. They

have put ligatures around the vessel to stop the

blood flow through it. That eroded, All that did

was kill them -sooner. Matas.Dr. Matas and others
developed a kind of pinsor device that would.. that you
gradually screwed and put the pressure on it so

it's obliterated. One surgeon in Ireland used his..
used a series of assistants to pressure.. put pressure
on by hand, To compress it, you see.

Like for hours doing it one at a time..

Oh, yes. Just one assistant would get tired and the
next one would take his place over a period of hours
and hours, and days.

This is what killed Albert Einstein,

That's right, This is what killed him, Aneurysm,
Upper abdominal aneurysm, That's right,

And weren't you called by his..

Yes, I was called by his doctor and I told him that

he should be operated on. And he said..the doctor
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-79-

said I think sotoo. And he said, 'Can you do it?"
NOf course,''I said. ‘''Will you come up here?"

I said, "Sure, I'll bring my whole team if you want
me to.) He refused. Wouldn't consider an operation.
Did you ever get his reasonings?

Only to the extent that he just refused operations.

He didn't want to be operated on. If he was going

to die, then it was time for him to die. He took

it apparently very fatefully.

And stoically. |

And stoically..Yeah. I guess he.. You know there are
some people when they reach a certain age are

really tired of living. And life doesn't mean a great
deal to them anymore. And I can understand that. If
you don't have any reason to live and enjoy living..
He was still working on his unified field theory. Maybe
he thought it was hopeless,

Yeah, Frustrating because he couldn't..

He left a lot of physicist and mathematicians in the

lurch,
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That's right. Well, ..

While you're on that, do you remember the
circumstances of the call, what time of day or

night it was and what perhaps the conversation was
with this doctor?

I don't remember whether it was in the afternoon.

or evening. It seems to me it was in the evening
when he called. It seems to me it was in the evening.
And he described his symptoms to me and he said,

"J think it's a rupturing aneurysm of the abdominal
aorta, It sounds like it.'' He had backache. He

was shocklike, temporarily he'd recover and. get
more shocklike and recover. AndI said, "It sounds
absolutely characteristic." Characteristic.. He had
some tenderness in the abdomen and it was a little
swollen. And I said, "He needs to be operated on
immediately or he's going to. die. There's no question
about it. He's lucky that he's lived this long because

you see, some of them just go like that. Others go
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~Sl-

in stages,

That's ing a catastrophic blow on him

in the abdomen,

Yeah, That's right. That's right.

Well, I think it was in the evening.

Well, the, you see, that's one reason that aneurysms
are so exciting to surgeons because of the challenge
it has had for four thousand years or longer. It has
challenged medical men, And this challenge was
never fully met until we were able to remove the
segment and replace it.

This must have been a terribly exciting thing.

Well, itwas. It was. Very exciting. To be able
to successfully do something that had been tried
unsuccessfully for four thousand years. See?

When you say four thousand years, you're going
back into reading the Egyptian hieroglyphics,

Yeah, Sure. It was known then.

Was it?
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Oh, it was known to be ancient. Aneurysms? Yes.
You..

Do you know whether they made the effort to repair
them at that time?

Uh, not repair them, no. Nobody could repair them,
The idea was to stop the progression.

They couldn't do brain surgery either, but they
opened skulls.

Oh, yes. That's right. Oh, yes. No, it's amazing
how much they krew and could do in clinical medicine.
It really is. It's hard to believe, when you think
back. I mean you read what they did. The Arabian
physicians were extremely knowledgeable in the
field of aneurysms and also in clinical medicine,
especially the Arabian surgeons. They did a lot of
writing about it. And really set the stage for much
of the medicine that developed in Europe later.

They had great teachers. They had a lot of experience,
Tape # 13

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Was anyone else close to the same achievement

as you who did the first successful aneurysm?

Well, as I said to you before this Dr. DuBost in
Paris had done one before we did in the abdominal
aorta. You see? And we didn't know it.

That was the one you didn't know about?

Yeah, We didn't know it. But nobody had done
anything in the thoracic aorta. And that's under-
standable in a way, because you see there's a

big difference between the abdominal aorta and the
thoracic aorta. You can occlude the abdominal

aorta without too much trouble. But you can get into
serious problem with the thoracic aorta. And that's
because it's closer to the heart and it's because it's
closer to the , you might say, the basis for circulation,
you see, The initial thrust of the circulation, And
the organs that, you might say, are dependent upon
blood flow become increasingly more jeopardized

in handling that part. So that's why once we had

done the first thoracic aorta successfully, it was a
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~84-

major accomplishment,

This wasn't a thoracic aorta that's referred to

here?

Referred to where?

In the '52-'53 report.

Yeah,

The surgical review for aneurysms of the aorta.

Well, but you see, in that report we were talking
about all of them. We began..

I thought the progress you...there was great triumph
in doing an abdominal aorta and then a thoracic
aneurysm too,

Well, it was. It was, you see, But that's what..

I mean the success in these first cases of aor..

The success in that was what, ina sense, gave us

the courage to attack the ones in the chest, See

there had been a policy to attempt excision of aortic
aneurysm in all cases. For aneurysms of the thoracic
aorta, particularly of the arch, it is possible to excise

the lesion tangentially and perform lateral aortorrhaphy.

*
Tape #13

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85-

In aneurysms of the thoracic aorta, the lesions
have been resected and continuity restored by
means of preserved aortic homografts. See,
That's in the '50-to '52-'53 report.
The next step after that was doing a dissecting
aorta on aneurysms?
Yes. Yes, Yes, That's right.
Which was a monumental step..
Yes, well, actually, I'm not sure whether that was
the next major event or,. I think the carotid was the
next major event. Because, I think, if 1 remember
correctly, it was in 1955 that we did the first successful
dissecting. It was in 1954 that we did the carotid,
This must have been a very, very exciting period for
you.
Oh, it was.
It was advance following advance, wasn't it?
That's right. Exactly. But you see, it's really

‘

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sort of following through. You take your.. It was
taking one advance and using that as a springboard

to the next advance, From the aneurysms of the
abdominal aorta, we then moved to the thoracic aorta,
Once we had the thoracic aorta, we then..we were
then where we were able to move to bridging the defects
involving the critical vessels like the carotid vessels,
the renal arteries. You see, the celiac, superior
mesenteric... Wewere sort of embolden really by
our experience, Success in one area gives you the
courage to move to the next area. And that experience
allows you to feel that perhaps you can solve this next
problem using basically the same principles.

Your basic two problems with it were how much time
you had if you did cut off circulation to the, let's say,
the kidneys, and how much blood flow you had...

Yeah, well, you see, the concept of temporary --use
of temporary circulation around a diseased segment
came into being with the bypass principle. Now the

5 .

fellow that deserves credit for that principle and that
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concept was this man Kunlin.

Your former colleague, :

Who was one of my colleagues in Leriche's Clinic.
And he was using it. You see, he.. It shows you
how once you put-~-plant something in the mind of

a person, he can expand on it. Now, his concept

was to bypass the block in the femoral artery, And
his idea was to take that vein out and just go around
that block, Very simple concept, yet nobody thought
of it. Well, I soon as I knew it, he sent me--soon as
he did the first case, he sent it to me, before it was
reported.

Was this something he had incidentally had talked about
wanting do to when you were young?

No,

No. This is something he did after he started,
Started. Yeah, that's right. But he sent me the case
and he was so successful and he was so overjoyed

with it--he sent me the case report and told me
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about it and what did I think about it. Well, I

was highly excited about it. I thought it was -
wonderful. And, of course, it immediately started
my mind to working. Well, if you can do that why
can't you use a temporary graft.,

A shunt.

A shunt, You see? And this whole concept of
temporary bypass. Now to show you how that is
further expanded in your thinking. When I first

had a patient with an aneurysm of the,.what we call

a thoracal abdominal. That, again, was the first
successful one whichI did. The bypass concept
became critical to its application. But what is more,
I even converted that concept into using a bypass

as a permanent bypass by simply bypassing it first
as a temporary, using the graft as a temporary shunt
to get circulation down below and then attaching grafts
to that..

To renal arteries,
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To the renal arteries and the celiac, superior
mesenteric and then taking out the aneurysm,

Once J had the aneurysm out, then I let that bypass
function as a permanent graft. You see?

And that's the step by step development.

That's the step by step development, Exactly. And
that's how you march, you see, from one step to the
next step, once you have made that one step.

Can you recall the circumstances of each of these
epical conquerations?

Well, I can recall when they occurred, yes, because
they were pretty dramatic cases in that sense,

Now the fellow with the thoracic aneurysm, for example,
was a man who had been a soldier in Korea and was
ina jeep accident. He nearly died. He recovered and
after he recovered came home and they found that |
he had this mass in his chest from an X-ray. They
weren't sure it was an aneurysm, but they suspected

it might be. Well, we saw him because, I think he
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was referred to us thinking it might be an aneurysm,
and we examined him and indeed it proved to be,

We studied him and found out it was, Well, then
actually, you see, it was a traumatic aneurysm which
really is a kind of false aneurysm because it's a
break in the tear and then a big clot forms in the
tissue that surrounds that and it becomes a false
aneurysm. Now, we operated on him--I'll have to
get the details of it, because we reported it as a
case, And if I remember correctly, the first time
we operated on him, we only removed part of the
aneurysm.

I read the paper on it and as I recall there was a

lot of spinal erosion from it and didn't the aneurysm
adhere to the spine in that case?

Yeah. J think that's right. In fact, wasn't hea
sheriff,

No, I think you're right, Well, he may have been,

but it was a war connected injury.
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Well, I'll have to get the reports and refresh

my memory about that aspect of it, But in any

case, we used a homograft finally, And this was

not a frozen homograft, if I remember correctly.

It was afresh one, And it seemed tome... You
know, we used to have all the information about
where these grafts came from. Some of these were
criminals. You know, they had been killed in a..

by the police or in fights, or something of that sort.
We used to get all the bodies over here, And a good
many of them were Negroes. And I remember when
I operated on Dr. Mims Gage he used to brag about |
the fact -~he had an aneurysm and he was one of my
former teachers at Tulane. And he developed an
aneurysm of the abdominal aorta and he came over here
for me to operate onhim. And it was a great kind of
a pleasant service for me to render to him because..
What did he teach you?

Oh, he was a great clinical surgeon. He was one of

my teachers in surgery, And I was extremely fond
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of him. Wonderful man. A very kind and he was

so kind to me and my family and loved them all,

you know. We loved him. He and Dr. Ochsner were
two people my mother used to say a prayer for
every night because they came to Lake Charles.

I was living abroad in Leriche's Clinic when my
brother who was in medical school at the time got
burned during Christmas, And he was severely
burned and they had him in the hospital and he was
very deathly ill. And they drove to Lake. Charles
and picked him up and took him back to New Orleans
and treated him and got him well, of course, And
they.. My father and mother were so grateful, my
mother used to say a prayer for them every night
because she loved them so much for what they did.
And it was a wonderful thing to do,

How old was he when he developed the aneurysm?
Oh, he was in his sixties,

Was this during your early period of..
 

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Yeah. Oh, yes.

He was one of the first?

Yes. Well, I used a homograft, And he used to
tell the story --he was pretty cute about it --that
his homograft came from a Negro prostitute. And
then. .you know..of great sex value to him,

Was there any truth in the rumor?

Uh-huh.

It did actually?

Tt did. Yeah. Well, he liked to tell the story. No,

you see, we had all the facts about the.. where we

-got the grafts from.

How long had you been doing them when he came?

Had you done more than a hundred by then or was it
still earlier than that?

well, I don't know. I'll have to go back and see,

Not many more. You see, once we had reported this
first at a meeting, And it's interesting. It's worth-
while going back to the proceedings of the transactions

of the Southern Surgical Association. And I need to
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get that for you, because I have a copy of it.

This surgeon from New York had been interested

in aneurysms for years and he had sort of made his
reputation on what he did with these aneurysms which
was to put wires in. And he developed a technique

of putting these wires in these aneurysms. He'd
thread this wire, you know, yards and yards, of this
wire into these aneurysms into the lumen. Then he
had or unusually had built a very special electrical
transformer contraption that would put into this wire

a special kind of current, which supposedly..
Negative pull..

Yeah, which supposedly would help precipitate clotting.
And he had done thirty, or forty, or fifty cases--a
large series at that time. And he came to the meeting
and this was one of the major papers. Now you can
imagine, here he was coming up to this meeting,
giving a major paper ona large series of cases; he

was a great expert in this; he made his reputation

+
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on doing this, And here comes an up-start at

the meeting to discuss his paper and in the
discussion presents three successful cases of
removal of the whole aneurysm and replacement
with a graft and shows these beautiful pictures,
photographs, showing the aneurysm, showing the
graft replacement, and then showing the patient

well afterwards. Perfectly normal, you see,

That must have been electrifying to the people in

the meeting,

It was. Of course it was electrifying. Everybody
was buzzing all-over the place, you know. And

here this poor fellow was left.. He never did recover,
you know. He subsequently I think had a little stroke
and he went into almost a fibrillate from the shock.
And his pitiful response to the discussion too was
even worse, Instead of saying something nice about
it and saying,.being in a sense a good sport about

it and saying well, there's no question.. Yeah..

He tried to downgrade it by saying well, this might
Tape #13

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-96-

be possible in an occasional case, but I can

assure you from my large experience that you
simply cannot sew the walls of these arteries,

And therefore, it's kind of a trick operation to

to," You know.

And Dr, Gage was at the meeting and, of course,

he came up to me and told me how proud he was,

He said, "The greatest advance since Dr. Matas in
this whole field of aneurysms." Dr, Matas had
been,. had made the only advance in over a hundred
years inaneurysms. The procedure that he had
developed of endo-aneurysmorically, which was to
sew it up from the inside--obliterate it. So, it

was kind of electrifying at the meeting. And, of course,
it became quickly know all over by the doctors, and..
This must have been a year or so before you did

Dr. Gage's then?

Yes, oh yes. It was I would say several years. I'd
have to go back and get his chart. I have his chart.

I could tell you exactly when it was done. I would
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guess it must have been..I would say maybe '55, '54,
"55,

In these meetings, I notice frequently at the end

of a paper that's been delivered there is comment
afterwards.

Discussion,

Discussion,

Yeah.

Is the author of the paper or address usually informed
of what the discussion is going to be.

Sometimes.

But frequently the man who is discussing will have
slides and a..

Sometimes and sometimes not. It's done in different
ways. There are some organizations where the people
who discuss are assigned to discuss it. In other
meetings in the great majority, anyone can get up

and discuss, if he's recognized by the chair, Now
that means the chair must determine the number of

people that can because of the time limitations.
Tape #13

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You know, otherwise, there.. You've gota
schedule to keep and if there's time they'll

allow you to discuss it, so you can get up and

say anything you want. And usually the author
has the right to close the discussion, And that's
what this fellow did in closing the discussion he
made avery, really inadequate and certainly an
unprophetic type of comment. You see.

Well, you want to go back to the reports now.
Well, you know, let's see.

I noticed in that same year, '52-'53, on page 40
among your accomplishments, I noticed ..

Oh, that was quite of a highlight for me to be per-
fectly honest with you. That was.. It's kind of an
honor to be a visiting professor of surgery at
Harvard and the Massachusetts General Hospital.
And Dr. Churchill, Edward Churchill, who was
professor of surgery there, was certainly one of

the great surgeons of this country, had been.. I
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got to know him well during the war, Again you

see the relationship of how important the war was
forme, And he and I got to be great friends. We
took a great liking to each other, I think, largely
because he recognized that I admired him. Intellectually,
I think he's one of the great people that J know, And

I think he took a liking to me in terms of my reaction
to his intellectualism, so to speak. So, he wanted
me to come and be a visiting professor. So Iiwent

up there and spent a couple of weeks and I lived with
the residents in the residency building.

Isn't that a bit unusual?

Yes, you see, that's right.

Being a professor of surgery and..

It is. There are supposed to.. They have a V.I.P.
kind of headquarters up in the hospital where they
keep them, but I told them I'd rather stay at the
residents, if it was alright with the residents, I would

rather stay in the same hall with the residents.
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Largely because I wanted to kind of associate with
them and I wanted to sort of get close to them and
see their reactions and talk to them and so on.

And I had a great time with them. In the first place
they have unusually good people there, They are
very well screened and they're top-quality people.
Secondly I enjoyed my stay there largely because the
residents were with me. The staff] found was very
conservative. You know, it's the old conservative
school. And a little stuffy too. I'll never forget
when we were making rounds one day and there was
a patient there who had gall stones--gall blatter disease--
and what's called a hiatal hernia. This is a hernia
in which the diaphram allows too big an opening for
the esophagus and the stomach slips up, slides up.
Now, sometimes the symptoms of a patient with a
hiatal hernia and with gall bladder disease is very
much the same. Like for example an eruptation of

gas, you see, and discomfort in the abdomen, It
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can be very much similar. Well, they in making
rounds and I was making rounds with them... One
of the residents was presenting the case and he
said the patient needs to be operated on. And the
staff man on whose service it was said, Yes, it
does sound like she needs to have an operation,"
But he said, "Which one of these lesions should be
operated on first? Which one is causing her symp-
toms?'! And he said he really couldn't be sure.
And so they got to discussing it. The staff man turned
around to me and he said, "What do you think?
Let's ask Dr, DeBakey."

Hold it, Mike.

END SIDE B,

(END IN MIDDLE OF HARVARD ANECDOTE)