VOLUME ONE
                                                                 Revised - July 22, 1993




                                  Oral History

                   MICHAEL E. DEBAKEY, M.D.
                     (Born September 7, 1908)

                          Professor and Chairman
                          Department of Surgery

                       Chancellor
              BAYLOR COLLEGE OF MEDICINE




              Obtained for the National Library of Medicine on behalf of

    THE SOCIETY OF MEDICAL CONSULTANTS TO THE ARMED FORCES

                 Interviews Conducted by Larry W. Stephenson, M.D.
                      Professor and Chief, Cardiothoracic Surgery
                                Wayne State University*

        Transcribed by Donna Beck Hammond, B.A. and Robert M. Hall, M.D.

*(At the time of 1986 interview, Dr. Stephenson was on the faculty at the University of
Pennsylvania. He was formerly J. William White Professor of Surgery)
                                                                                      Page 1




 Tape 1, Side A

       Interview at the Annual Meeting of the Society of Medical Consultants to the Armed

 Forces, Hyatt Regency Hotel, Bethesda, Maryland, November 23, 1986.



 LWS: Dr. DeBakey, could you tell me about your family and your childhood and what got

you interested in medicine, please.



MD:    Well, I was born and raised in Lake Charles, Louisiana. My father was in the

pharmacy business, as well as in some other businesses, real estate and rice farming and

a few other things of that kind. I was the oldest child in the family. I had a brother and

three sisters and when I graduated from high school in Lake Charles, I went to Tulane

University in New Orleans.

       Following my bachelor's degree, I actually went into medical school before I got my

bachelor's degree. But I completed the units that I needed to get my bachelor's degree

while I was still in the medical school. In fact, I did a lot of work while I was in medical

school in a research laboratory, with some of the faculty members, and that's where I

developed the roller pump. Doing some work for one of the faculty members who was

interested in circulation and needed a pump for that purpose, and so I began doing

research on pumps and finally came up with a very simple type of pump, which is the roller

pump. As you know later I gave it to John Gibbon, and it was adapted for the heart-lung

machine.

      My brother followed me and became a doctor and my sisters followed me to Tulane.

When I graduated, I finished my residency under Dr. Alton Ochsner in surgery and then
                                                                                       Page 2


  I went abroad for two years and spent a year with Professor Rene Leriche, who at that

 time, was one of the leading surgeons in the field of vascular diseases. That's why I went

 there, because I had gotten interested in the circulation. And then I spent a year with

 Martin Kirschner, at the University of Heidelberg. Then I came back to Tulane as a full

 time member of the faculty, first as an instructor and later as an assistant professor. Until

 1942, when I went into the service during the War.

        I first went into a unit sponsored by Tulane, which was an Air Force hospital. I had

 only been in that unit for a few months when Fred Rankin heard about it. He was at that

 time the Chief Surgical Consultant to the Surgeon General and he wanted me to come up

 there and be a part of his staff, and that's how I got into the Surgical Consultants Division

 in Washington under Rankin.



 LWS: Dr. DeBakey, during your residency years in New Orleans, are there any special

 memories or stories you have that you'd like to get recorded as part of this history?



 MD:    Yes, I think the most memorable experience that I had there was getting to know,

. Rudolph Matas. He had retired, of course, as professor of surgery at Tulane, and Dr.

 Ochsner had replaced him after he retired, but he was still quite active. During the time

 I was a medical student, I was also working in the research laboratory, and I was doing

 some library research on the matters that I was interested in. The research work we were

 doing was on the circulation. I could read foreign languages. I could easily read and even

speak some French. I could read Italian and Spanish and German. From time to time,

I would have to refer to journals in these other languages and Dr. Matas had the best

library for foreign medical journals in New Orleans. He later gave that library to Tulane.
                                                                                       Page 3


 But in the meantime when I was a medical student, the only way you could get these

 articles was to submit your request to the Tulane Library, and they would in tum, ask Dr.

 Matas if they could get those journals. Well apparently, he became interested in the fact

 that he saw this name DeBakey, a medical student, who was constantly getting journals.

 He had never had the experience of having anybody request so many foreign journals. So

 he became interested to know who this fellow was. So he told the librarian that he would

 very much like to know who this medical student was and she told him I was that student

 and that I was doing part time research. "Well," he said, "I'd like to meet this fellow." So,

 the next time I wanted some journals, she arranged for me to go to his home directly and

get them instead of sending the messenger for that purpose. And I did. When I got there,

he was at the house. He greeted me very kindly, and then he became very interested in

all my background and wanted to know about my family, and what I was doing and so on,

and_ then he showed me around his library.

       His house was virtually converted into a library.   I mean, every room had shelves.

From the dining room to the living and all of the upstairs rooms had bookshelves. In fact,

they had to reinforce the foundation of the house because of the books, you know creating

such a weight on the house. I became very fond of him, and he took a great liking to me,

and invited me many times to his home. During Mardi Gras the parade used to go by his

home on St. Charles Avenue in New Orleans. The Mardi Gras parade would go up St.

Charles Avenue and they would stop at certain houses. The king, from his float would

toast, when they would stop at a certain house, they would toast that house and the people.

They always did that to Dr. Matas. So that was a wonderful place to see the Mardi Gras

parade. He would always invite us to come there and after I got married, my wife and then

later my son, as a child, we'd sit on his porch to see the Mardi Gras parade.
                                                                                       Page 4


        He wanted me to do some things for him before I left New Orleans to go to

 Houston, which unfortunately, I couldn't do. To show you the kind of person that he was,

 he had been asked years ago, by the Louisiana Medical Society to do a history of Medicine

 in Louisiana. His thoroughness in going back, historically in anything was so great, that he

 virtually became interested in the history of· medicine in the United, in America. And he

 went all the way back. He had a trunk, one of these huge trunks, old-type trunks, you

 know, they used to use for travelling to foreign areas, filled with notes. And he was anxious

 to finally put this thing together, and he said, you know, I don't think I'm gonna be able

to finish this. He was 80...8, 89, something like that at that time. He said I'd like to put

it in your hands to finish up. Well this was at the time I was getting ready to leave New

Orleans to go to Houston and take over the chair of surgery. I knew I was in for a lot of

work there. I knew I wouldn't have time to do that. So I told him, as kindly as I could,

th~t I would have to temporarily decline that until I saw what the situation was like in

Houston. I never did get back and nobody has ever done it. I don't know what happened

to those notes. I imagine they were given to the library. But, it was a great pleasure to

know him. It was one of the memorable experiences. He was a legend in his lifetime

actually.

       You have to remember that he performed the procedure of endoanuerysmorophy

in 1888. That was a really the first challenge to the Law of Scarpa about aneurysms. The

first successful technique for dealing with aneurysms from a surgical standpoint, since

Hunter. Hunter's procedure proved unsuccessful, even though it, lasted for a hundred

years. Dr. Matas did something with endoaneurysmorophy that cured the aneurysm. So

that was the first time that had ever been done. In a way it's a landmark in dealing with,

primarily, peripheral aneurysms, not aneurysms of the central system or aorta. He was a
                                                                                       Page 5


 very scholarly man, and inspiring to talk with, you know.        He spoke fluently, several

 languages and he was a very, very scholarly surgeon, which is unusual. (laughs)



 LWS: Dr. DeBakey, is there any special advice that you remember that Dr. Matas may

 have given you or anything special along those lines that you ... always look back on?



 MD:    Well, he was, as I say a very scholarly man, and one of the things that he sort of

praised me in a way and said one of the reasons he wanted to meet me was that I took the

trouble to read these journals and he said you know, so few people today can read these

foreign journals. He said I think that you have a great advantage to be able to read these

foreign journals. And as you know, at that time anyway, it was before World War II the

foreign medical scientific journals were way ahead of any thing in the world. The Germans,

the French, the English, and the Swedish were ahead of us in many ways.

       He emphasized the importance of scientific accuracy. He certainly showed that

historically in all of his articles. One of the problems he had was, and I saw this happen

at several meetings he attended which I attended, was that he would get up to discuss a

paper and he would give the background of that subject so much better than the man who

presented the paper. Often, bringing out something that the original author, didn't know

about, because he hadn't made a thorough search of the literature. Dr. Matas knew all of

this. Because he had done so much reading. He made this very clear to me. You know

it's a kind of teaching that rubs off. It's not the direct teaching, but in some ways its far

more impressive as a teaching device, because he inspires you to try to emulate him.

Secondly, he also inspired me in another way, and that is, in the prose of writing. He had

a style. His writing had style. This is very unusual, you know, for medical writers. In
                                                                                      Page 6


 general, medical writing is quite dull. There's no style and prose is lacking in any flavor.

 With some exceptions in the English medical journals. You see a few exceptions there.

 For example, (Lord Berkeley G.A.) Moynihan had a certain style as a surgeon.           Most

 surgeons don't. And that's understandable to some extent. But there's no reason why a

 surgeon can't be scholarly any more than any other medical specialty, you see. And I think

 it's far more interesting, you know, to go back and learn what has transpired historically,

 and what others have gone through. It's far more efficient, because there is not a reason

for you to make the same mistake. (laughs) That's why we have libraries.



LWS: Dr. DeBakey, just backing a step. You mentioned the roller pump, and of course,

that's famous all over the world as one of your many contributions. Could you tell us how

you got and exactly when the idea cropped up in your mind for the roller pump, and

secondly, what did you actually use the roller pump for before the days of the heart-lung

machine?



MD: I was working as a medical student in the research laboratory as an assistant and the

work that my chiefs and were doing, faculty members were doing, was concerned with the

mock circulation, and they wanted to have a pump that they could manipulate, and in a

sense modify and control, for the circulation. To really determine how the peripheral pulse

affected the circulation. So, they wanted something that they could use as a pump to pump

fluid and to create a pulse wave. You know, there are several different kinds of pumps

which the physiologists over the past several hundred years have used. None of these have

proved satisfactory for them. And they asked me to find another type of pump. Well I did

a lot of library research. I found out that historically, pumps have been with us for an
                                                                                       Page 7


 awful long time. But they were primarily used in the hydraulic area of engineering. So I

 had to go outside of medicine, in the engineering area to find a lot of the material. Most

 of these, fell into certain categories, none of which seemed to be useful for our purpose,

 so I continued to search for other types of pumping devices and I found a rubber tube.

 Now when rubber tubing came into existence, they used it for a lot of purposes. They used

 it also for compression, of a bulb, of course that didn't prove satisfactory for us, because,

when you're pumping a fluid, if you have a force that pumps it, you have to have valves,

 or some mechanism that wi11 allow for unidirectional flow. I was trying to avoid valves.

Secondly, I was trying to simplify the thing as much as possible. I found some references

to a tube, a rubber tube in which they compressed the tube. The compression was like

that, you see? A sort of a flat compression. The second form was the sigma type of

compression, which is what they call the piano-key compression.

       That was so complicated that I discarded it, but it gave me the idea of rolling a

roller over it. When I did that, I found that the tube would creep. If you take a rubber

tube and roll a roller over it, the tube starts here, when you get to this end, the tube has

crept maybe half a centimeter, or more depending on length. If you keep on doing that,

it keeps creeping. So that indicated that I needed to have something that holds it to keep

it from creeping. That's when I put a shelf on it and fDCed that shelf, you see. Then I

worked on a rolling device, which would roll around. I put it into a cup, fixed it and then

decided how many rollers I needed. Well I started with one roller, which rolled the tube

all the way around and the tube came out like that, you see. That created a kind of pulse­

wave that I didn't want. I wanted a more even flow. Then I would create the kind of

pulse-wave I wanted by compressing the tube with the compressor where the outlet part

of the tube took place. By compressing for the period of time, you can create the kind of
                                                                                       Page 8


 pulse-wave you want. That was easy to do.

       In time, I tried three rollers, four rollers and finally two. That simplified the whole

thing. And, that's what I finally came up with. Well, we used that, very satisfactorily in the

research project, and at that time, there was also a need for pumping fluids of various

kinds. Urologists wanted it to pump. The gastroenterologists wanted it for them, and then

I found that they also needed it for blood transfusions. . At that time, the blood banks

hadn't come into being. They were just experimenting. So, direct blood transfusion was

being used. I arranged to use the pump for that purpose. When I was a resident, I gave

as many as 10, 15, 20 blood transfusions a day with it, directly from the donor to the

recipient.      And then I wrote an article about that experience with the pump and

described it.



LWS: Dr. DeBakey, getting back to your surgical training. As a resident in New Orleans,

are there some comments that you would like to make about Dr. Ochsner, since he was

your chief?



MD: Yes, Dr. Ochsner was a general surgeon who was trained in the old German method

of training. As you know, in the '30s I would say that German surgery was at its peak.

And he had trained in Bern, Switzerland and Frankfurt, Germany. After I spent some time

in Heidelberg, I appreciated the kind of training he had.

      The German surgeons, generally speaking, were very direct in their surgery. They

would tend to use the simplest exposure method. They would tend to get through the

operation as quickly as possible. So they didn't waste a lot of time in the operation. Dr.

Ochsner had that background in training. However, I guess because of his nature and
                                                                                      Page 9


 temperament, was very precise. And that's one of the things I learned from him, was to

 be precise in everything you do. In speaking, for example if you used a word, like a patient

 "hemorrhaged", he would call your attention to the fact that there is no verb for

"hemorrhage". The patient 'bled". Things like that, you know. He also was a scholarly

 man. Very, very energetic, and he really took me in, almost as his son. In fact, he took

me in first as a medical student. He picked me up during my junior year, and he told me,

"You can make a good surgeon and I want you to work with me."

        Interesting, because I was working then in the research laboratory of the medical

people. They wanted me to be an internist. But I liked the idea of manipulation and in

fact engineering and working with my hands, and I admired Dr. Ochsner tremendously. So

his influence was very great on me, first in bringing me into surgery; second in training me.

       Now, as time went one, I became also more interested in the things I found during

my training. I liked to do some things different from the way he did it. Which I thought

was a much faster way of doing things. For example, I became interested in the midline

incision, without cutting across muscle for abdominal work. I thought I could do everything

through a midline incision. It was simpler. Easier to get in. Easier to get out. You didn't

cut any nerves or vessels. And you know, I developed some things for myself as time went

on. But, his influence was quite great. I'm amazed. And you have to remember that in

those days, there was virtually no cardiovascular surgery. For vascular work, there was

simplectomy, you know. There was very little thoracic surgery. Now he also had been

trained in the whole field of surgery, and I can remember when he first came down and I

was an intern under him. He did neurosurgery. You know, he would open flaps on brains

and things of that sort.

       After Evarts Graham did the first successful pneumonectomy, we became interested
                                                                                    Page 10


 in cancer of the lung. As you know, we wrote a whole series of articles on cancer of the

 lung. He said to me "You know, we can't depend on the otolaryngologists. In the first

 place, they're not very good at it.   Secondly, we are going to need to do endoscopy

 ourselves." He said, "Why don't you go and get some training in it." So I got hold of a

 man by the name of Paul Hollinger, who was an otolaryngologist, but he was doing some

 very good endoscopic studies, taking pictures, and moving pictures. He was in Chicago.

 We got in touch with him, and he said, "Sure, I'd be happy." So I went up there and spent

nearly a year with him. I became very proficient in endoscopy.

        When I came back I did all the diagnostic work for thoracic cases we began going

into the chest. Doing pneumonectomy, esophagectomy and things of that sort. We wrote,

as you know, quite a large series or articles on the subject. So it opened up the field of

thoracic surgery. Along with others, I mean we weren't the only ones. But we were among

the pioneers who opened up the thoracic surgery field. There was Churchill and Graham

and a few other people.



LWS: Dr. DeBakey, how did you decide to go over to Europe for two years of your

training, or who decided that for you? And how did you wind up picking the two places

that you picked to go?



MD: Well, it was a joint decision between Dr. Ochsner and me. I wanted to go because

I felt that I could expose myself to another point of view of surgery and secondly, I could

see what was going on elsewhere. I was interested in advancing surgery as much as I could

and I wanted to find out what was going on. Dr. Ochsner had that experience, so he was

strongly advocating it, you see.
                                                                                     Page 11


        In those days, there weren't scholarships or anything like that, and obviously, I had

 to find the means to do it. Fortunately, my father was able to provide that means, so I had

 no difficulty at all. Dr. Ochsner said he thought I ought to spend a year someplace in

 Germany.    We decided on Dr. Kirschner, because Kirschner was a kind of innovative

 surgeon. We still talk about the Kirschner law. He was a very innovative technical surgeon

 as well. Secondly, Leriche was probably the leading advocate of vascular surgery. And you

 know, we talk about the Leriche Syndrome. Well he had described the LeRiche syndrome

 in 1923 before we had arteriography. He was a great advocate of sympathectomy. He also

 had some philosophic views about vascular problems and syndromes, a very interesting man

 in many ways. And among the leading surgeons in Europe, he seemed to have more of a

 sort of advanced, creative thinking. That's why I selected him. I had a great time with him.

 He was very, very kind to me and had me at his home on a number of occasions. I wrote

 three or four articles with him in Strasbourg, and I had the good fortune of being there

· when (Jean Cid) Dos Santos, who later described the procedure of endarterectomy for the

first time, was also a fellow there. The French title for that fellowship was "assistant

etranger". Foreign assistant.    (Jean) Kunlin, who later described the femoral-popliteal

bypass for the first time was the chef de clinique. They also had an animal laboratory in

which they worked. So in the afternoon, when we got through operating, we would be able

to work in the animal laboratory. So I had a great experience while I was there.

END Side A



LWS: Could you converse with Professor Leriche in French or which language did you use,

and secondly what are the things that you feel rubbed off on you from Dr. Leriche. Things

that maybe changed your thinking or things that you still use today, thoughts or techniques.
                                                                                       Page 12


 MD: Well, yes, I spoke to him in French. I could speak French. He virtually spoke little

 or no English. He could understand a little English, but he really didn't have much in the

 way of ability to speak English fluently. He found it more comfortable, you know, to be

 able to speak French, and to understand French when it was spoken to him, so I had no

 difficulty with that.

        As far as what rubbed off, it's difficult to say, because his influence was again, an

indirect one.      I wrote an article about my experience with him in the Strasbourg

atmosphere. I think that my experience was more in the nature of the totality of the sort

of ambience of the people, and not just Leriche. It is true that he was sort of the master,

and I was there largely because of him, but in the animal laboratory, for example, I worked

with Kunlin. I worked with Dr. Dos Santos and other people, and the back and forth sort

of exchange that you get working very close with people has a certain amount of influence

on you and also on your thinking. Leriche was a very scholarly man too. Like Dr. Matas.

He came .from the old school of learned people.           He wrote beautifully.     He spoke

beautifully. He lectured regularly to the students. Every day in fact, he had a lecture to

give. We all were there to listen to his lectures because they were so interesting. He

would, in his lectures always give something that was fascinating and interesting historically.

For example on one occasion, he was talking about a kidney condition and he said the man

who described this is the man who, in a Flemish painting, which is a famous painting called,

'The Anatomy Lesson", where the doctor is pointing his finger, like that, and the cadaver

is on the table and in the background there are people in the amphitheater. This Flemish

paining, of course is a very famous painting. He said, "This man who is doing the dissection

and giving the lesson was also the chief of hygiene in the Netherlands. This was during the

Napoleon period. On one occasion Napoleon was driving in his carriage along the canal
                                                                                      Page 13


 going from one place to another when they came across a barricade in the road. The

 guard at the barricaded stopped the carriage. The driver said that he had to get through

 as he had a very important person in _ qis carriage. The guard said, "Well, I'm sorry but you

 cannot come through here because I have orders from 'this man who was Chief of

 Hygiene'. That road has to be barricaded while they and clean the road." And he told him

 , he said, "Even if you have Napoleon in there I can't go against my orders." Apparently,

 Napoleon heard him and he leaned out of the window and he asked the guard to come

over and he said to the guard, "Who do you say is in charge of this?" and the guard told

him. So he looked up at the driver and he told the driver, now, this is all Leriche's story,

he said "You wait here until they finish." And he told the guard that he was Napoleon and

to tell the Chief of Hygiene how much he admired what he was doing.

       That's the kind of a story that Leriche would tell from time to time in his lectures,

which was really fascinating.

       As a surgeon, a technical surgeon, if he was interested in the procedure, take for

example, the subject of cervical dorsal sympathectomy, he was really interested in that, he

really was a very fine surgeon. He wasn't interested in other types. Gastric resection, he

did a terrible operation for gastric resection. Kirschner did a much more effective and

efficacious type of technical procedure. That was the difference.



LWS: Dr. DeBakey, when you spent time with Dr. Kirschner, which language did you

speak, and which language did Dr. Kirschner speak? What do you think you learned, what

do you remember from Professor Kirschner?



MD: Well, again, Kirschner I found did not speak English. There were a few of the
                                                                                     Page 14


 residents who spoke English, but he didn't. So I had to speak German. I spoke enough

 German to get along with him. So I didn't have any problem with communication. He also

was very kind to me. He had me to his house for dinner on a number of occasions and

 I got to be very fond of him. I think the thing I learned there, was the preciseness of the

 man. I didn't consider him a scholarly person, but he was very, very precise. He was very

punctual. In contrast to Leriche who started anywhere from 8:00 to 10:00 in the morning,

and you never knew what time. You just waited until he got there. Kirschner started

everything at 7:00 in the morning. And everybody had to be there. If you were one minute

late, he gave you a regular tongue-lashing. He was precise. At 7 precisely, he arrived. As

far as his operations were concerned, he was the same way.          Very precise about the

operative procedure. He was a great advocate of local anesthesia. He had devised a

technique that consisted of a large pressure tank that forced through the pressure of carbon

dioxide the fluid that he used for local anesthesia into the tubing that hung up above the

lamp to the ceiling over the operating room. Then he would connect a sterile sort of gun

to which the needle was attached, so that you could press a button, and when you put the

needle into the tissue, it would force the fluid into the tissue. He used that for everything

in doing surgery. He even did some thoracic surgery that way, locally. First time I had

seen that done. I later saw that done in Berlin, too, at the old Charite. But he was not

a slashing type of surgeon. He was very precise, but he got the work done very quickly,

very rapidly and all of his assistants were that way. I mean, they were a rapid type of

surgeon. They would do a gastric resection in 50 minutes, 60 minutes. In those days, that

was phenomenal, you know, things like that. And the results were good. No question

about it. He also was innovative. It was the first time I had ever seen an exercise program

for patients. He had a man who would come twice a day through all the wards with some
                                                                                      Page 15


 martial music that he would play on a record, and the patients would exercise. He would

 get them out of bed, those that could. There were orthopedic patients who were in traction

 and so on and they could only move their arms, but they would do that. He was a great

 believer in exercise very early as a prevention of thrombosis and embolismectomy. As you

 know, he was one of the very first to do pulmonary embolism successfully. So, he believed

 in early ambulation, and it was the first time I had seen that done. This was one of thi~_gs

 I brought back with me. I started early ambulation at the charity.



LWS: Dr. DeBakey, one of the really big names, certainly on the continent in thoracic

surgery before the War was (Ferdinand) Sauerbruch. Did you ever meet him and would

you like to make a few comments about him either way?



MD: Well yes I did meet him. You see when I left Kirschner, I felt that I had to see

Sauerbruch before I left Germany to go back home.

       I wrote him a note and then I got Dr. Ochsner to write him a letter and I got Dr.

Kirschner to write him a letter for me. So when I arrived, he was very, very kind and

considerate, which was unusual, because we had had Americans come through who visited,

both in Leriche's clinic and in Kirschner's clinic and they all complained bitterly about the

treatment Sauerbruch gave them. He brushed them off, particularly Americans. They said

he didn't like Americans. Well that wasn't true. At least I found that wasn't true, because

when I arrived there, I showed a copy of the letter I had written him to his secretary and

she told me, again in German, that they had been expecting me, and Sauerbruch would

welcome me and would I wait just a moment. So she got in touch with him and in a few

minutes he came out and asked me to come in his office. He asked me if I liked coffee
                                                                                     Page 16


 or tea, this was in the morning. I said coffee, and so we had a cup of coffee. He chatted

 with me and wanted to know how Dr. Matas was. He was a great friend of Dr. Matas, and

 Dr. Ochsner. He said, "How long are you going to be here?" And I said, "Only a couple

 of days, unfortunately, Dr. Sauerbruch, I don't have time to be here much longer." He said,

 "That's too bad. But we have got a lot of surgery to do and you can see anything you want.

I want you to have dinner with me tonight."         Which was very kind of him.       I was

tremendously impressed with his hospitality and his kindness to me, and I was an unknown.

Young fellow, didn't know anybody and nobody knew me. In those days, the operating

room in the old Charite was way upstairs, and they had skylights. I had not seen this

before. We had the same thing in the Charity Hospital in New Orleans. They used the

daylight a great deal. The ceiling was mostly made out of glass. It was a big room. The

operating room was very interesting. He had five tables in that room. Five operating

tables. Five, one after another, in that room. He would go from one patient to the next

p·atient, to the next patient, to do what he wanted to do. For example, if one of the

patients was having a thyroidectomy. In those days they had big thyroids to do. He had

one or two of his assistants prepare the incision and exposure. He'd come in, put his finger

around the thyroid, like that, grab the blood vessels that he found with a. big clamp and

then cut it out. I mean in five minutes he'd have that thyroid out. And then he'd pack it

and move to the next one. Let his assistants clean it up. You see? In those days, he was

doing a lot of thoracoplasties for tuberculosis and so on. I saw him do one. I don't think

it took him ten minutes to take out four or five ribs. That's how rapidly he would do it.

Of course, they had already made the incision to expose it.



LWS: That's pretty quick.
                                                                                         Page 17


 MD: Well, yes. And he had a gastric resection. He was there twenty minutes. You see,

 so he was moving form one patient to another. Five patients on the five tables, and he was

 only in the operating room about an hour and a half. And then he turned around to me.

 Still had his gloves on, he just changed gloves. Still had the same gown and everything else.

 He changed gloves and he motioned to me like that to follow him and I followed him out.

 (laughs) And we had something to drink and sandwiches, something like that. (laughs) But

 that was an extraordinary experience. I've never seen anything like it.



[LWS:     Did you have a chance to meet with him after the war or talk with him or

correspondence?



MD: No, I never saw him any more. I never had any correspondence with him after the

war. I even tried to locate him at the end of the war. I was in Europe, in the European

Theater an~ I tried to locate him. He had sort of gone into hiding in a way. As you know,

later, there was a book written about his late experiences which, whether it's true or not,

I don't know. In fact, I get sort of mixed reactions from the people in Germany about him.

Some say that as he got older and at the end of the war he became bitter and began to do

things that probably weren't entirely rational and that he mentally was disturbed. It's hard

to know because he was isolated in a very small place in germany, in a small village. I

think it was a sad end to, certainly one of the great forces in thoracic surgery in that period.



LWS: What was his position during the war? Was it the same as Dr. Rankin's in the

Surgeon General's Office in the United States?
                                                                                    Page 18


MD: There was some question about what his position was. He continued to work during

the war. He stayed at the Charite for a long time. There are also a great deal of questions

as to whether or not he was a true Nazi. Most of the opinions I get from some of my

German friends is that he was not. That he only wanted to continue his work. However,

he did advise them on medical matters or surgical matters, but he never got into what you

might say, the war as an activist.



LWS: This leads us from Dr. Sauerbruch to Dr. Rankin. You mentioned earlier that Dr.

Rankin realized that you were with the New Orleans unit, a Tulane unit and recruited you

for the Surgeon General's Office. Did you know Dr. Rankin or how did he wind up picking

you for the job?



MD: Oh yes, I did know him. As you may recall he was at the Mayo Clinic. He married

one of the Mayo daughters. He was quite an active surgeon at the Mayo Clinic and in fact

had become well known and at one time was President of the American Medical

Association and was one of the most active surgeons in the country and one of the leading

surgeons. And from a medical standpoint, generally he was extremely well known. And

so he was a popular person to select for this job as the Chief Consultant in Surgery to the

Surgeon General.
                                                                                                 19


         Now, in 1942 the War Department authorized the appointment of Medical, Surgical and

Neuropsychiatric consultants to be attached to the medical branch of each Service Command. So

the Surgeon General, and the Service Commands, and the various Theaters of Operations had

Surgical Consultants. Rankin and his staff, including me, helped to select these individuals to be

appointed in the various service commands in this country, and in the theaters of operations, and

we got to know them quite well, and of course from a surgical standpoint we already knew many

of them. They were top leaders in surgery in their fields and they were members of the American

Surgical Association. They were top individuals.

         I knew them well, and Rankin knew them well, and certainly he knew me. As a matter­

of-fact Rankin gave me my Board exams in surgery. I had an interesting experience there. The

exam was held in Atlanta. and I drew Rankin and a man from Baltimore, his name was Stone

who, you may recall was well-known for his work in the field of cancer of the rectum and the

colon.

         Well, they had a patient with a subphrenic abscess assigned to me. Actually, Rankin gave

me my anatomy exam, and then my clinical exam with Stone. They always had two people for

the clinical. They gave you about ten minutes to go over the case in the hospital in Atlanta, Grady

Hospital. I quickly made the diagnosis that the fellow had a subphrenic abscess. It was a fairly

classical case. When the time was up and I was being examined they started asking questions and

I told them what I thought and Stone started asking me some questions about it. Rankin turned to

Stone and he said "I guess you havn't seen this last article that Dr. DeBakey wrote on subphrenic

infections in the SG&O." Stone hadn't seen it and he told Stone that "it's a complete review of

the subject with the largest series of cases analyzed yet. There's no sense in asking this man

about subphrenic infections. He knows a hell of a lot more about it than either you or me." And

that ended the exam.

         I got to know him quite well. Dr. Ochsner had him down for some lectures and I showed

him around, met him at the train, that sort of thing, and got to know him and he got to know me

very well, and he was very kind to me.
                                                                                                20

       He needed people on his staff, and he needed somebody to do some of the legwork for

him. He was the type of person who wasn't going to sit down and do a lot of writing.

       Nick Carter, whom he liked and knew very well from Cincinnati was immediately under

him, and I was immediately under Nick Carter, so I was low man on the totem pole. So

everything was handed down to me. If there was any writing to do I had to do it, and there was a

hell of a lot to be done. I wrote every memorandum that he signed, and often, the Surgeon

General signed. And every once in a while they had to go out and give speeches, so I had to

write their speeches. It was a great experience.


LWS: In the days that you were in Washington did you do any operating or was it all

administration?


DB:    It was all administration. A little later I did some operations at Walter Reed, in the

vascular area but during this early period it was all administration.

       Now, I spent an awful lot of time in the field because everytime they would have a

problem some place they would have to send somebody out to check the problem. For example,

in one station hospital they were doing a lot of pilonidal sinuses, a lot of operations on knees.

Well, that was sort of meddlesome surgery for the Army, and we had to finally write a

memorandum for surgeons to stop that kind of stuff. The surgeons had nothing to do for awhile.

Here you've got a whole lot of healthy men, and the pilonidal sinuses came from riding jeeps, and

some of them got knee injuries and things like that.

       A surgeon needs to do surgery, and if he's sitting around doing no surgery he pretty soon

deteriorates into a problem, doing unnecessary surgery. It was very interesting to see that

happen.


LWS: During World War I the US Army came out with the base hospital concept, and they were

organized around large hospitals and medical centers, but especially universities. That was

carried over into WW II, and many of the old base hospitals, or at least the university units now

were general hospitals and things like that. As I understand it, in certain instances that concept
                                                                                                2 I

worked well, and in other instances it didn't work out very well. From your perspective in the

Surgeon General's Office, can you make some comments about that.


DB:     Yes, you are quite right. What we found, over a period of time was that these general

hospital units that were sponsored by medical schools primarily, Penn had one, MGH had one,

Tulane had one, and so on. They were general hospitals with good staffs, highly specialized and

rounded out so you had a good medical staff, a good psychiatric staff and so on. What we found,

however was that they tended to operate as though they were the only unit in the whole system,

and very often this created a problem because the Army was concerned with the soldiers in either

rehabilitating them as quickly as possible, or getting rid of them because they were a burden if

they couldn't be rehabilitated quickly.

        There was a tendency for some of these large, base hospitals to try to do everything,

because they were capable from a personnel standpoint, but the Army didn't find that a very

efficacious thing to do. So we had to modify the whole concept, and create·what might be called

Centers in a given Service Command or in a Theater of Operations, and move the sort of primary

surgical need into the area as close to the combat as possible, so that we could get the patients

cared for as quickly as possible.

        This is what initiated the so-called MASH units. We called them Auxiliary Surgical,

originally. These were in tents in the theaters for the Army, for that given Army and we might

have four or five of these, depending on the number of casualties that was expected.

        As experience was gained it became more and more apparent that this was where they

could take care of the patient better in terms of injuries, and very often, if the injury was

sufficiently minor you could rehabilitate them and get them back into the service, back into their

units. If they were not, if they had a draining wound, a chest wound, or an abdominal wound

and so on, then they went back to the_~nters. There they were evaluated and treated, and if it

was obvious that they were not going to be rehabilitated and sent back to the service they were

sent home to the centers in the States.
                                                                                                22

         We had a man by the name of Ginsberg, a sort of an analyst/economist who became

interested. He was from Columbia University, Eli Ginsberg. He helped develop a kind of

pattern for moving these people into and establishing the centers for this purpose. He did a good

job. He continues his interest in medicine, in fact he's written a number of articles.

         So we had to modify the old World War I concept considerably. Later on, we modified it

even further in the Kore.an conflict, where we used ships even, as temporary, big centers, and

then moved them home or wherever, depending on whether they could be rehabilitated.

LWS: Do you think, if this country gets mobilized again, or if a war happens, that you would

recommend that they base some of the hospital units on the old university type concept, or do you

think it's better off the way it is, where we just have various reserve and other types of hospital

units?


DB:      You might say it's a two-edged sword. The big advantage is they know each other, and

they can quickly start working together.

End of Side B, Tape 1.

Side A, Tape 2

LWS: Dr. DeBakey, we were talking about the advantages of a university unit during the war

and the fact that they know each other. Any other thoughts along those lines?


DB:      Well, there is some disadvantage, too. The fact that they know each other is one

advantage. But that may also work in a disadvantageous way. As you know, there is a tendency

within the·hospital center for individuals to feel sometimes that they are not getting a fair shake,

jealousies develop, and I'm not sure that that system in the future ought to be used. I have some

reservations about it. I'd be inclined to plan a different system now, for the future. First, I think

there ought to be a better understanding of how to deal with casualties.

         Secondly I think there ought to be a better understanding of what kind of casualties we

will have for the future. There may be more bums in casualties in the future. We found in WW

II that the bum problem was a big problem, and that the sooner you got that bum patient into a
                                                                                                23

bum center the better off he was. You treated him very early just as you did in civilian life to

bring him to that bum center. But, transportation being the way it is now, so available that you

can move people within a matter of hours almost halfway around the world, there is no reason

why we have to depend upon having the units, the specialized units that close to the combat zone.

Secondly, I think we can be far more efficient in the utilization of personnel. In WW II I wrote an

article in the JAMA about the precious resource of personnel. We had reached the stage where we

in the Armed Forces had taken over forty percent of the medical personnel in the country. We had

about reached the stage in surgery where any further efforts to get more surgeons in was getting

close to the bottom of the barrel. Whether you want those people or not is another matter. It's

very difficult to utilize people who don't want to be in the service. They find ways and means of

getting out. Some of them will shoot themselves in the toe.

       I think that there ought to be a plan for an entirely different system for the future than we

used in WW II. One of the problems is that we are always one war behind when we start. For

two years in WW II we were learning. It took us two years to mobilize and learn what to do.

Well, that's too long for any future war. If we're going to take two years to learn what to do

we're going to lose it. I can only hope and pray that the rest of the armed forces is not going to

follow that principle. There ought to be a planning group, and I'm concerned about this because

I've talked to people in the regular medical services, and I don't get the impression that there is

any planning group.

       ·Do you know, for example in WW II I found out there was no medical logistic book at the

War Department. They had never developed any data to provide them with the basis for

determining what kind of personnel for what kind of casualties, and how many, let's say

surgeons are needed for a given battle casualty. They hadn't even had data on what the data

would be for battle casualties, given that there are a hundred individuals who are going to be

injured. Where are they going to be injured, in the eye, in the arm, in the leg, how many. They

had no data on that. A man by the name of Gilbert Beebe was in the office with me. One of my

jobs was to put out a journal called Hemth, mostly a classified journal. Beebe acted as the editor.
                                                                                                        24

Well, I was the editor but he acted as the chief kind of editor to prepare it. He was also an analyst

and a statistician, so we got together and decided we needed this kind of data. We wrote the first

book ever written on the subject. It's still in use.


LWS: For the purpose of this oral history, what is the title of this book?


DDB: Medical Logistics. [ Beebe, GW and DeBakey, ME: Battle Casualties: Incidence,

Monality, and Logistic Considerations. Charles C. Thomas, Publisher; Springfield, Illinois
1952.] It's amazing that they hadn't done that. It's things of that sort that they ought to be

planning now. You don't ·m1't mtcl1 a ·w& =6 tm '_ytJu mfim-c '_ytJu -s-cm\ -µccanincg •ain®> 1ilKt..hrd:L.

Secondly, they ought to be planning how to mobilize personnel, how to utilize personnel, based

upon experience. What kind of vascular surgeons they need, how many they would need, what

kind of resources they would need to provide the vascular surgeons with equipment, and so on.

And how to move patients that need this kind of. . . You've got a man who has a femoral injury

in the field. What do you do? There ought to be a well-described procedure for tha~. I finally

prepared and wrote the order for wound management, based upon the work that Dr. Churchill and

his group in the Fifth Anny had had experience in developing. And that became the standard

order and to my knowledge it still exists. Well, you know it has to be modified. [ TB MED 147,

Department of the Anny Technical Bulletin, "Management of Battle Casualties," March, 1945.]

        These are the kinds of things that. are wor.risome as far as the planning for the .futllfe i~

concerned. There may be, but I'm not familiar with, any group that's really planning in terms of

innovation and creativity for the future use of personnel, facilities and so on based on data that

they should be able to gather and to develop.


LWS: Dr. DeBakey, the Surgeon General of the Army during World War II, did you have any

personal interactions with him, and what type of a person was he?


DB:     That was General Kirk and yes, I had a lot of interaction with him, both under Rankin and

then when Rankin and Carter left I was left holding the bag, so to speak, and I was able to get
                                                                                                25


out, too. I think that there is a letter here that is interesting. When General Rankin and Colonel

Carter left the office, then I was the only one left in the surgical consultants division. General

Kirk said to me, "Mike, I know you have the credits to get out but we're in a crisis situation here

and we need your help and I'm going to beg you to stay on.

                                    0



LWS: When was this, about what year, and why were you in a crisis situation.


:MD:   Well, this was just at the end of the war, which was in November of' 45 and the reason

we were in a crisis situation was because at the end of the war the War Department had already

issued the orders that allowed the release of these civilians and this included the doctors. Many of ·

them had been overseas for three years or longer and they were just itching to get the hell out and

get home. Some of them hadn't seen their families in three years. They were very anxious to get

back, and there was no way to hold them. The war had ended and now we had thousands of

casualties in the General Hospitals in the European Theater and the Pacific Theater. Who was

going to take care of them? We had no specialists left. In the meantime, we had established these

various Centers in the United States, depending on the specialties, orthopedics, plastic, vascular

and so on. They also included highly specialized personnel, and they were getting ready to get

out.

        So they began moving the casualties back to this country in ships, and literally thousands

of them were moving back into these centers in this country and the doctors were leaving. The

Veterans Administration was not prepared to take them. They had no personnel. The Veterans

Administration was virtually nothing during the war. {\t the end of the war they had no

personnel. And the Army had no specialists. General Kirk was the only certified specialist they

had. He was an orthopedic surgeon.

       So we were faced with a crisis of all the specialists leaving, and many of these casualties

coming back, requiring all kinds of surgical treatment from wounds of the abdomen, drainage

sites, colostomies, drainage of the pleural cavities of various kinds, head injuries that required

repair, burn cases that required plastic surgery, and so on. So I went to see a man by the name of
                                                                                                26

Voorhees, who was the Adjutant General in charge of the medical, the health area. He was the

man assigned under what then was called the SOS, which was the Service of Supply in the War

Department. The Medical Service was under the Service of Supply. Voorhees was assistant in

the Adjutant General's Office. He was a lawyer. Very fine man. I later got to know him very

well. In fact, he was also in charge of this Health issue. He was the head man for it. It was

under his command. That's how I got the job because it was assigned to me. I got to know him

very well because every issue had to go through him.

        I got in touch with him after talking with the Surgeon General, and I said Colonel

Voorhees we need your help. We need you to ask the Secretary to do something because we've

got a crisis. We need a minimum of a hundred of these specialists, and what I'd like to do is to

ask them to volunteer to stay on. There is no way we can force them under the present orders

unless the Secretary changes that order, and it was difficult to get him to change that order

because it applied to the whole service. They didn't have a crisis. We were the only ones, the

Medical Department. The Surgeon General has approved this. If you will get him to approve our

promoting them one grade, I'll call each one of them, and beg them to stay on and say "this is

what we're going to do for you, and we'll try to assign you as close to home as possible in one of

the centers in this country."

       He got it done. And I called a hundred of them, and I told them we had arranged to give

them a grade, an appointment above, which gave them a little more money. And I said we need

you until we can at least clean up the problem, maybe six months, maybe a year. Everyone of

them agreed to do it. I was really tremendously impressed with that. I thought this was the most

patriotic thing I had ever experienced. Certainly, it reassured me that the medical profession were

fine people. And that's how we got it done.

       Now, most of them completed their experience within a year. A few of them stayed on

longer. Interestingly enough, this experience gave them a great interest in doing a little more in

terms of training the regular army people. And I began a training program and I started with

General Heaton, when he came back. And we got a few general hospitals like Fitzsimmons,
                                                                                              27

Walter Reed, the hospital in San Antonio, in the Army, and we got the local people who had been

in the Army to give some time, and they came there regularly and did training. Then we got the

Board to certify the residency program. That's how the training program in the Army got started.


LWS: Dr. DeBakey, do you have any stories to tell that would give us a little bit of the flavor for

the personality of General Kirk?


DB:    Well, General Kirk was a surgeon in the sense that he had the temperament of a surgeon,

very direct, but a very kind fellow. I got to know him quite well. In fact, I operated on him for

an aneurysm of the aorta later, at home. Unfortunately, he didn't survive. He subsequently

developed, not immediately but subsequently, some renal deterioration. He had some renal

disease before, and he later died from that. And that was a very sad thing for me because I was

very fond of him. He begged me to stay in the service and be a regular army officer. He was

going to promote me to brigadier general and keep me there. I didn't want an administrative job.

I frankly wanted to get back to things I wanted to do, and to really be an active surgeon, even

though he offered me chief of surgery at Walter Reed as well. I didn't like that idea. And

secondly, I really, temperamentally, am not the kind of person that fits into a very rigid,

bureaucratic position. I've turned down a number of them. When Lyndon Johnson was president

I turned him down. He wanted me to be chief of HEW, and I turned that down, too.

       I liked Kirk very much, and the other thing I liked about him was that if you came to him

with a proposal, and it had a reasonable basis, whether or not from an Army standpoint it fitted

the Army needs or requirements, he was for it. To exemplify this I became interested in the

Surgeon General's library. As I told you earlier, I'm kind of a library person. I like to roam

around in a library. And since I had to write most of the orders I had to do a certain amount of

library research. So I used to go down to the Surgeon General's Library, and I was appalled at

the building and the facilities they had. When it rained the roof leaked, and they had to put covers

over the books. And here was this real treasure of a library. I was appalled by this, and I

complained, and I wrote memos about it, and Kirk finally said to me "I agree with you
                                                                                                 2 8

completely, this library is terrible but we havn't been able to get the money. We can't compete

with a tank. We can't compete with a cannon. We can't compete with an airplane. Thafs our

problem."

        Well, this suggested to me that it ought to be out of the Army. It was a National Library.

And I said that. "We need a National Library of Medicine. Let's convert it to that." Oh, boy.

Some of the people in the Army just threw up their hands and said "that's terrible, we can't let the

Surgeon General's Library go. We own this." So I went to see Kirk about it, finally, before I

left, and said "I'm going to give you a memorandum of what I think about this thing," and I wrote

a whole memorandum about it. Finally, he said "Mike, you're absolutely correct. This library

shouldn't be in the Surgeon General's Office. We never will be able to take care of it. It needs a

special unit, on its own , and that's what led me ultimately to put the pressure on getting it done.

        They had an organization called "Friends of the Library," still have and they were all

librarians and I gave a talk and just shocked them by this idea. The librarian, who was a regular

army officer didn't like it at all. Finally they appointed this fellow McNinch. I got to know him

quite well, and finally convinced him. He was for it. I became a member of the Medical Task

Force of the Hoover Commission, because Voorhees, the same man, was appointed by Hoover to

the Hoover Commission to chair the Medical Task Force. He asked me to join that Task Force

and be the Secretary of it. So I spent virtually full time on it.

        I got a leave of absence from Tulane, and I was up here in Washington for about eight

months working on this thing, and I wrote the final report for the Task Force. One of the

prominent things I did in that was to emphasize the library. When I went with Voorhees to see

Hoover at his apartment in the Waldorf to brief him on the Report, Hoover turned to me--we had

lunch together, very nice--he turned to me and said "Dr. DeBakey, if there was just one of these

recommendations that you would select for the Commission, which one would it be?" I said "It's

the library." We had a lot of other recommendations. He liked that. He was a library man

himself. And so that was the only recommendation in the Commission Report that was made to

the Congress and the President.
                                                                                                29

       The only medical recommendation was the library. And that was picked up by Senator

Hill and Congressman John Kennedy. Their staff asked me to work with them in developing

legislation for it, which I did. To cut the story short because we're getting short on time, it got to

the point where they had the bill prepared, they had the votes for it to get through, but there was a

conflict between the people in Chicago, because of Fishbein who wanted the library in Chicago,

and the people here who wanted the library here. I was one who wanted it here. And I wasn't

giving up on it. I said "It belongs in the NIH." There was another element that wanted it in the

Congressional Library. Fortunately, the people in the Congressional Library didn't want it, so

that simplified the matter for me.

       It reached the stage where . . . a fellow by the name of Rayburn was the speaker of the

house, and he wouldn't let the bill come up because he didn't want this conflict to grow, because

the Democratic Convention was coming up in a few months, and he didn't want a big conflict

among the Democrats. So Hill called me and he said "We're in trouble. We can't get the bill

through. We have the votes if we can just get the bill through Congress, through Rayburn." By

that time I was in Houston. "Do you know anybody in Texas that knows Rayburn?" Rayburn

came from a very small town in Texas. The people in Houston didn't know him, and he was

very independent anyway. I couldn't find anybody who knew him. It suddenly occurred to me

that I had operated on the husband of the Secretary of the National Democratic Party, and I had

gotten to know the husband and wife very well. The wife was the Secretary. So I called her on

the 'phone, her name was Dorothy, and I gave her the back ground and said that she could do us

a great service, in fact she could do the country a great service, if we can get this bill through. We

have the votes to pass it. It's not controversial except for a small group. She said "Mike, I'll see

what I can do." The next day she called me and said "I've talked to Rayburn and he's going to let

it go through." Hill called me the next day and said "Mike, I don't know how you did it, but

we're going to get that bill through" and that's how we got the National Library of Medicine.

Isn't that amazing!
                                                                                                30

LWS: It's a great story. You were in the Surgeon General's Office during the war. Are there
any stories that you have, or things you would like to record about visits you made as a consultant
within this country, places you had to go, problems you had to straighten out, or things like that.


MD:    Well, there were numerous instances of problems that arose, primarily in surgery because

they were doing unnecessary work, surgeons were doing unnecessary work like operating on

pilonidal sinuses, and things of that sort, and laying up a soldier for weeks or months, and

finally, sometimes having to discharge him. Doing knees that they shouldn't have been doing.

Those kinds of problems occurred. And every once in a while we would get records, because we

had data from every hospital, clearly indicating that infections were too high, so we'd have to go

out and check on that, and we'd find all kinds of things happening. Sometimes the surgeon

wasn't qualified who was assigned to the station hospital. We used our best surgeons overseas,

and the station hospitals really had, I would say mediocre personnel for the most part. And from

time to time we would find things that were really extraordinary.

       I told the story last night about being sent down to a station hospital in North Caroline

where they had a warehouse with material from World War I. Now, when the war started we

were not prepared in any way for the war. This was true in all aspects. We didn't have enough

ships, we didn't have enough guns, we didn't have enough airplanes, anything. And in medicine

we were woefully unprepared. We didn't have enough surgical instruments, we didn't have

enough beds, mattresses and so on. Somebody finally thought up the idea of going to this

warehouse to see what we had in it that had been packed and crated from WW I. At least we

could use the mattresses, maybe.

       So I went there, they sent me there, and we opened it for the first time, we opened box

after box, crate after crate. The surgical instruments were all rusted to the point where you

couldn't do anything with them. You couldn't open a clamp, a hemostat, you couldn't use any of

the knives. In WW I they didn't have the replaceable surgical blades, and all the knives were

rusty. You couldn't open the scissors, they were so rusty. So none of the instruments could be

used for anything. They had to throw it all away. The mattresses were wrapped in newspapers,
                                                                                                3 1

and the rats had eaten pretty much most if it. So there was nothing we could use. And you

know, this stuff had been there for twenty-five years, crated in this warehouse. I don't know

how much it had cost over this period of time. And nobody had taken the trouble to check on it at

any time. So that was the end of this, bum it all up, throw it all away. That's an example of

negligence, inefficiency, incompetency, whatever you want to call it. Terrible. That's an

example.

       I'll give you another example, in a sense of what happens in a bureaucracy, and the

military is a bureaucracy. In the middle of the summer in Washington it's hot and humid, and I

got the idea that we weren't prepared for frost-bite and trench foot and things of that sort. We had

a few cases up in Alaska, in the commmand there so it seemed to me . . . I began to check on

this. We had no order about it, we had no instructions. So I went back to the library and I

checked on it, and I found out that in WW I they had a lot of trenchfoot and frost-bite. And I

checked in the British medical history in WW I, which was excellent, well-written. And they had

an experience, and as a consequence they had developed a procedure to train the soldiers what to

do and how to protect themselves. So I prepared a . . . .

End of Side A, Tape 2

Tape 2, Side B.

LWS: Dr. DeBakey, you were talking about trench foot and preparing the American Army for

this during WW II.


MD:    Well, this was during the summer of '44 and I prepared this long memorandum, and I

sent it to the Surgeon General, and I predicted that when the fighting would get going pretty

rough in Europe there was going to be some trenchfoot and frost-bite, and we ought to prepare

our soldiers, and they ought to be prepared with the right kind of equipment, including socks and

boots and so on, and the right kind of instructions for them. This was sent to the Surgeon

General. He approved it. You know, everything you did you wrote "For The Surgeon General"

and he sent it up to SOS, the Service of Supply, the command under which he was.
                                                                                                  32

       Well, obviously nobody paid any attention to this. It was the middle of the summer, and

who was thinking about frost-bite. Well, when the fighting got pretty heavy in France and

Germany, you recall it was in the middle of the winter, there were large numbers of frost-bite and

trenchfoot [casesJ and it became a little bit of a scandal, because the reporters who were following

the Armies were writing about this, and they were sending back these reports. Iin Washington

they were asking questions, "Why aren't these soldiers prepared? Why are you getting all these

casualties?" And so on. That put the Surgeon General on a hot spot. So I pulled a copy of this

memorandum out and sent it to General Kirk with a note saying "Give to General Kirk. The

Surgeon General isn't responsible for this. He predicted this and told them what needs to be

done, but they never did it. It wasn't his responsibility to prepare the soldiers." There were a lot

of red faces in SOS, and General Kirk thanked me very much for the memorandum, later. He

had forgotten about it, too. That's typical of what goes on in a bureaucracy.

       I remember, just to give you a quick. . . there's an old story about that. You know, we

had carpools in those days. I belonged to a carpool, and in this carpool was a Colonel in the

regular army who had been to Tulane and was a Tulane graduate. He took a liking to me and sort

of took me under his wing, and I was in the carpool with him. Every day when the day ended I'd

go by his office, pick him up and we'd go down to the car and the other people would meet us.

There were four or five of us in that carpool. I had a briefcase full of stuff to take home and work

on that I hadn't been able to get done that day. He never had any. In the wintertime he'd put on

his coat and gloves and that's all he had. His desk was clean as a whistle. So I said to him one

day "I don't understand this. I have so much work undone during the day that I have to take a

briefcase full of it and work late at night to get it done, and you never have anything left in your In

basket. We had an "In" basket and an "Out" basket. He said "Mike, come around here." He had

a deep drawer on the side, and he said "At the end of the day everything that I find in that In

basket that I didn't get done, I put in that drawer. And you'd be amazed." I said "But don't you

have to get to it?" He said, "No, I just leave it there. When the drawer gets full I pull out all

those memorandums and I throw them in the wastebasket." I said "Nobody ever . . . " He said
                                                                                                 33

"Rarely does anybody ever ask me about a memorandum in there." And they never ask me about

a memorandum once I've thrown them all away." He said "very occasionally I have to go in that

drawer and pull out a memorandum." That shows how little attention was being paid to some of

these things.


LWS: Dr. DeBakey, as I understand it, you actually went over to Europe and other places

outside of this country. Could you make some comments about that, and your experiences, and

so forth?


MD:     I was given temJX)rafy assignment to each one of the Armies in the European Theater. I

would spend as much time as I thought was necessary in each one. I was on this tour for the

Surgeon General, so I had the standing, and in a sense the rank, of the Surgeon General. I

travelled on a pass that gave me that rank as a Major General even though I was then a Major. I

also was able to bump somebody who was a Colonel or even a Brigadier General in travelling.

And since I was representing the Surgeon General, I went directly to the command and worked

under the Army General who was in charge of that Army, and was assigned to the Surgeon of the

Army. So I could collect all the data I needed. That's how I collected the data on vascular

injuries for each one of the Armies, which later led to the article that Simeone and I published.

       I collected data on many things that I thought we needed from each one of the Armies, as

much as I could get.

       While I was in the Fifth Army I worked very closely with Pete Churchill, who was the

Chief Consultant for the Fifth Army, and had been through North Africa and Italy. By the time I

got there they were in Italy, and I visited all of the branches that we had from the General

Hospital, like the MGH hospital, the Auxiliary Surgical hospitals which were like the MASH

units and [were] the preliminary first care units. And I saw, I was up with them when battles

were going on, and saw soldiers with their brains falling out of their heads, and mangled, and

everything else. It was a terrible thing to see what war does. You really see what a terrible,

terrible thing war is when you see these youngsters, eighteen, nineteen, twenty year old out there
                                                                                               34

lying in the field, completely mangled, dead, or barely breathing. Some of them suffering and

wishing they were dead.· That really was terrible. And I learned a great deal by that experience,

and it also gave me first-hand information about things that we were lacking, that we didn't fully

appreciate in the central office. I heard all their complaints and I made notes about everything, in

the hope that I could correct it when I got back, which I tried to do. Things that the personnel

needed help on, that they couldn't get from their local people because of the regulations and so on

changing. It was a great experience.

       Indeed, while I was in one of these commands the surgeon for that command, a regular

army officer had the idea of keeping half of his surgical personnel on reserve. Well, they would

be hit with a large number of casualties and he would have them still on reserve, and soldiers

would be delayed in getting treatment and some of them would die because of that delay. I had

compared this with the Fifth Army, the way they handled the casualties and use of their surgical

personnel much more efficiently and effectively, and I made a note of this. He got very upset

with this report, because I gave a report to each one. So, I had moved on to the Third Army

where I stayed with Patton because the personal . . . [Interruption.] The personal physician of

Patton was a young fellow by the name of Odom who was a classmate of mine and with whom I

lived, with his family, when we were medical students. So we were very close. So when I got

to the Third Army he insisted I come and stay with him in Patton's family, the six or seven

members of his family, you know, special family. So I had dinner with Patton every night for the

ten days or so I was there.

       While I was there Cutler, who was the Chief Consultant for the European Theater of

Operations called me from Paris, Headquarters and said "Mike, we need you to come here

urgently because the surgeon in Seventh Army is about to court-martial you."

       Well, that was a great shock to me. I couldn't figure out what the hell I had done to be

court-martialled and I told him so. He said "Well, come on as quickly as you can." So Patton

sent me back to Paris in his little observation plane, which they called a "grasshopper."
                                                                                                35

        When I got there Cutler told me that this fellow had complained bitterly of my report and

was accusing me of various things in doing this that could lead to a court martial, undennining

morale and various terms that people use.

        I pointed out what was the basis for my report, and said "I've tried to modify it to make it

a mild criticism,but I've got a lot more data and I'll give it to you. You can take a look at it"

        So he said ··well, let me have it, and I'll take it up with Hawley," who was the Chief

Surgeon for the theater.

        The next day I went back to the office and he said "Mike, Hawley and I have reviewed all

this and we called this--man and told him he'd better not ask for a court martial, or he would be

very embarrassed with the material you have on him."

        So, I went on back. It kind of irritated me. I prepared an article with Gil Beebe, in which

we developed an index of efficiency, and we showed that his efficiency was the lowest in all the

Army.


LWS: Dr. DeBakey, those days with General Patton. Do you have any comments or stories?


DB:     Well, every night we had dinner. He carried his own silver, his own china and his own

linen, and we had a formal dinner every evening. He was an interesting man in many ways.

There's been a lot written about him. But I found him to be a real gentleman,.highly scholarly in

the history of military medicine. He would tell us every evening stories about the history of

military engagements, pointing out why they occurred where they occurred, over and over

because, geographically, they constituted the critical phase of a battle. He knew a great deal about

military history and was a real military historian.

        But, he was a man with a very short temper. On one occasion, for example at dinner, his

niece I think it was, was in the organization that was sort of an auxiliary to the Army, the USO or

something like that. Anyway, she was over there, and she was visiting, so she was there that

evening for dinner. He had this formal dinner, we dressed formally for dinner, and apparently

his cook was sick and we had a new cook. This new cook didn't know how he liked the meat
                                                                                               36

prepared, the roast or whatever it was. When the waiter brought it in, this poor soldier who was

the waiter brought it in, he looked at it and he just blew up and he started using language like a

mule-skinner. I was embarrassed but apparently this niece of his was familiar with him, and it

didn't bother her very much. That was the first time I had seen him like that, so it was obvious

that he had another side to him, this temper display. Finally, this poor soldier explained to him

that his regular cook was sick, and this was a new cook. Well, then he calmed down and said

"Bring him in here and I'll tell him how to do it."

       This was a side of his character that I hadn't seen before, but others had seen it.

       His command was a very, very precise command and his soldiers were well-behaved,

well-dressed, and clean and neat. The MPs were just as neat as they could be. You could see the

difference when you moved, for example when I moved from one army to his army I could see it

very well. He had a briefing every morning and we would go to the briefing, and then I had the

great privilege and opportunity to move anywhere I wanted because I had his complete blessing to

go wherever I wanted. I had a jeep to myself, with Dr. Odom sometimes with me so I had a

chance to go right to the front lines and see what was going on. It was very interesting.

       We never have gotten to the development of. . . [ this ended midway through side B of

Tape 2.]

Tape 3, Side A.

LWS: This is Dr. Larry W. Stephenson completing the second part of the Oral History with Dr.

Michael DeBakey, this is on April 6, 1990 in Washington, DC at the Omni-Shoreham Hotel,

during the Annual Meeting of the American Surgical Association.

       Dr. DeBakey, apparently the Society of Medical Consultants to the Armed Forces or,

apparently as it was originally called The Society of Medical Consultants of World War II, was

formed when Dr. Elliot Cutler called a meeting of some of the consultants in February, 1946.

Could you please elaborate on that.


DB:    Elliot Cutler was the Consultant for the European Theater of Operations under Hawley.

After he had returned, and while he was still in uniform we met with him in the Surgeon
                                                                                                 37

General's Office early in 1946. He was on his way home. Fred Rankin had left by then; Nick

Carter had left. Elliot Cutler came in, indicating that it would be desirable to utilize the consultants

in some capacity during the transition, because they had had so much experience during the war.

This was because there was a big gap, so to speak between the Veterans Administration's ability

[and the need] to perform those functions that the Army had been performing in terms of medical

services, and particularly in terms of taking care of the wounded who returned [and] who still

required specialized care.

        We had established in the Army the specialized centers for vascular, neurosurgical,

plastic, orthopedic and so ·on, and there were thousands of wounded coming back from both the

European and Pacific theaters that were filling these hospitals. The Veterans Administration was

simply at that moment unable to take care of these patients. They didn't have the facilities, they

didn't have the hospitals. When I say hospitals they didn't have the facilities in terms of beds and

so on. Prior to WW II the Veterans Administration was hardly much more than a nursing care

institution. And, of course they didn't have the personnel. They had no specialists. All of our

specialists were civilians, and they were getting ready to leave. And so what we did to try to

bridge that gap was to request, and this was something I did in my recommendation to General

Kirk, that one hundred specialists stay on, and promote each one, an automatic promotion that

would give him an increase in pay, and ask them to volunteer to stay on for this sort of patriotic

purpose. These were all specialists. They were neurosurgeons, vascular surgeons, orthopedic,

plastic surgeons,and so on. Most of these people were professors or associate professors or

assistant professors. They were all in academic institutions. And they wanted to get back They

had been away for four years. They had all the points. They could go home. Well, we got that

through higher command, at that time it was SOS, the Service of Supply, which the medical

service was underneath. And I called every one of them, personal! y, from the Office of the

Surgeon General. I was the only one left in the Surgeon General's Office from the Surgical

Consultant's group. It is really gratifying to be able to say that not a single one turned it down.

They could have, but they didn't. They understood what it was about.
                                                                                               38

       Now there was another reason for this, and that was that we had to start a training

program. You've got to remember that at that time the only man who was certified by any board

was General Kirk, in orthopedics, in the regular Army. So if all the civilians had walked out,

there wouldn't have been a single specialist qualified to take care of any of these people. When

Elliot came back we talked about this, and Elliot said "Let's maintain the integrity of this group,"

the consultants' group. Many of them had worked together closely. There was a sort of unity in

the sense that they took pride in being a consultant because you see we had these consultants,

both in the Zone of the Interior and in the Theaters of Operation, both in the European and in the

Pacific Theaters. Ravdin, for example was in the Pacific Theater.

       Well, it appealed to Kirk, and I then talked with Rankin and Carter, and they agreed that it

was a good idea. Rankin was very proud of the consultant's group because he was the Chief

Consultant in the Surgeon General's Office, and in a sense it was his organization. He had made

the recommendation for the appointment of every consultant. So although he did not know them

all, their names were sometimes recommended to him, he was very proud of them, and he had

every right to be. So when Elliot made this suggestion I thought it was a hell of a good idea, and

we had this first meeting in the Army and Navy Club. We met there and they asked me to write a

kind of Constitution and By-laws for it, and I did.

I drafted one. Then they set up their organization.


LWS: Do you remember the fourteen people who attended that meeting? Didn't Brigadier

General Rankin attend the meeting?


DB:    Yes, and Brill, who was in psychiatry. Churchill and Cutler in surgery. I was in surgery.

Francis Dieuade was in medicine. Perrin Long was medicine. Bill Menninger, psychiatry.

Middleton medicine. Hugh Morgan was medicine, he was professor of medicine at Vanderbilt.

Pincoffs was medicine. Rankin, surgery. Lawrence Smith was medicine. Douglas Thom was

medicine. And Lloyd Thompson. Nick Carter wasn't there.
                                                                                               39

LWS: Were many of the people wearing uniforms at that meeting, or were most of you already

out?


MD:     Some were. I was wearing a uniform. Cutler and Chuchill were out. Brill I think was still

in. Dieuaide was still in. Perrin Long was out. Menninger was still in. And maybe Middleton,

I'm not sure. I think Pincoffs was still in. Hugh Morgan was still in, I believe. No, Morgan had

left. Rankin was out.


LWS: That first meeting was in February ... ?


MD:     Yes, in February, 1946.


LWS: Do you remember when the second meeting was held, and where that might have been?


MD:     I don't remember.


LWS: What would you say the major contributions were that the Society of Medical Consultants

made over the years?


MD:    I think the major contribution was to, in a sense, maintain and sustain some of the

concepts of wound management that had been pretty well established. You have to go back to

Technical Bulletin 147, which we published in 1946, based upon really the European Theater of

Operations, and mostly upon the Fifth Army experience, because that was the longest experience

and perhaps the best analyzed experience. Experience with Churchill and his people from Mass

General , and some of the others in the Harvard group. They did the best analytical study about

blood transfusions, for wound management, for wound healing, and for the [?] of surgery.

       The basic principle that they developed was really three phases. One was the first phase,

in which the field hospitals, at that time we called them Auxiliary Surgical and later they were

called the MASH, the same thing. They did the emergency, life-saving surgery. Then, if they

could be moved to the general hospitals they were moved. That's where the second phase went.
                                                                                                40

        The second phase was designed to continue the first phase. In the first phase you took

care of blood loss, and you took care of an emergency, for example if there was a hemorrhage in

the chest you took care of that. If there was a bullet wound in the abdomen you took care of that.

Then you moved them into the general hospital, where the second phase was taken care of,

whether it required an amputation, some vascular procedure if necessary, or something of that

sort. Then the third phase was to send them on back to the Zone of the Interior to one of the

specialty hospitals.

        It was this phased aspect of the management of the wounded that made a tremendous

difference in the mortality and the morbidity. And then, of course the care of the wounded. Of

course, they had to rediscover some of the old principles, like debridement and control of

infections. By that time we had some sort of antibiotics. We learned that putting sulfonamide into

a wound didn't sterilize it. We learned that the hard way. Things of that sort. In fact, if you are

interested, I can send you a copy of a manuscript that I presented today at my Presidential

Address, which talks about these things, and in a sense reminisces, particularly about the lessons

we learned, and the lessons that we didn't learn, which we should have learned from previous

wars. In fact, that's the thesis of my talk, that the lessons of history are never learned.

        Now, that's one of the things that I think the consultants group contributed. They kept the

fire going.


LWS: So that the people really didn't lose the lessons.


MD:     Exactly. At their annual meetings they would present some of these experiences that they

had analyzed. They had had time to do it. They had brought the data back home and had analyzed

it. Churchill gave a talk I published two or three articles on wounds of the chest, of the abdomen

and on the use of streptomycin and so on. Three, or four, or five articles that were presented at

the annual meeting. And this kept it at the forefront, because one of the things that has happened

in every war is that, at the end of the war, the tendency is to forget everything. You know, "I

don't want to have anything to do with that." "There's not going to be any more wars." And so
                                                                                                  4 1


there is a tendency not only to forget about it, but actually to want to forget it, and therefore to

forget the lessons learned from it. And we didn't want that to happen. And so this group took the

lead in saying that we needed to keep this going.

        Now the other thing, which is very important, is that they also, and this is where I think

Kirk deserves great credit, this group also wanted to make sure that the training program, the

certified training program was maintained in the service. They didn't have it before World War II.

Just think, from WW I to WW II there wasn't any specialized training. There were a few people

who, on their own, insisted on doing something. There was a general tendency to avoid that kind

of training, because they wanted a man for this stint to be virtually in preventive medicine, the

next stint he was to do medicine, the next stint he would do surgery. You can imagine what kind

of surgery he did. Or whatever he did in any area. It was all mediocre. We wanted to be sure that

the regular army medical officers would be up to date; would be conversant with what was current

in medicine. And this group helped very much in maintaining that kind of training program. Many

of these consultants locally took the initiative. For example, in Boston Churchill and Cutler both

took the initiative to do something in that area. And in some of the other places where they had an

Army hospital, like in Denver or San Francisco, where it was Letterman, people like Carleton

Matheson and a few others really gave a lot of time to going out there, and making rounds and

sometimes operating when necessary, and maintaining a training program so that they had

residents, and had it approved.


LWS: Now we think of places like Walter Reed and Brooke Army Hospital and so forth as

having really good, solid residency programs, not only in surgery but in medicine, and even in

things like pediatrics. Would you say that the Society was instrumental in getting this going?


MD:     Oh, yes, very definitely. They not only were instrumental but they really supported it.

They would call upon some consultant. You see, we had consultants all over the country, and we

would call upon them to go out there and help, and they did. They had, you might say, loyalty to

the organization they had been in for four or five years.
                                                                                                  4 2


        Fortunately, as time went on the effects of the Society diminished. The Army was on its

own. It had its own program. It had full-time people in charge, established surgeons who might

move, but if they moved they moved into another surgical position. They didn't move into

medicine, or preventive medicine, or something else. So now we had a good structure. It was

maintained, and didn't need this organization to do that. So in some respects, the only, I would

say the only value of this organization now is to perhaps recall that this particular kind of overall

organizational structure is a useful one during war. Let's hope we never do, but if there is a need

for having something of this nature in the future, then this is a very important thing.

        There is one other aspect of this I think we might point out, and this Society has supported

it. Before WW TI and during WW II for awhile, anyway, there was a tendency to almost prohibit

the use of research as though it got in the way of the military process. Well, of course it was

totally absurd to do that. You've got to define research as investigation in the broadest sense,

because obviously they are not going to do molecular biology. But there is a certain amount of

research, and you might say investigation, of problems relating to the military setting, of

medicine. And therefore, there is a need to test what you are doing. Is it effective or is it not? Is it

a waste of time; should it be done? I'll give you an illustration. For awhile we had surgeons in the

station hospitals operating on pilonidal sinuses, right and left , and what happened, essentially,

was that they made these soldiers unable to stay on duty. We had to insist, after analyzing the

data, that this was very ineffective. We had to stop that.

                                                    11
LWS: I believe the official name was "jeep seat.


MD:    Exactly. That's what it was called. We had to stop that, and if they got infected it was

dealt with in a conservative fashion. To try to cure them made the soldier completely unable to go

back to duty, so we had to discharge him. The operation was very counter-effective, as the

analysis showed, so we had to stop it.
                                                                                              43

       The same thing happened in other areas, including blood transfusions, shock, and things

of that sort. So this group did help to sustain the need for research that is directed towards what

is the best way to deal with the problems in the military setting.


LWS: When I think of a consultant I think of a situation where the surgeon general has a

problem in a hospital, in this country or overseas. Was there ever a situation when the surgeon

general asked these people to go and check things out?


MD:    Oh, yes. During the war the surgeon general would get a problem called to his attention at

some place. If it was a surgical problem he then would call on Rankin. Rankin would then decide

how best to deal with that problem, whether to call Cutler who was in the European Theater if it

was a problem there, or if it was necessary to send someone over. For example, he sent me over

to be on temporary duty with the Fifth Army, the Third Army, the Seventh Army and the Ninth

Army, all four armies in Europe. And I spent two weeks to a month in each one of those Armies,

with the Chief Consultant in the Army. In fact, when I was in the Ninth Army I almost got court­

martialed because I made a few remarks about the fact that the Surgeon, not the surgical

consultant, the Surgeon, who was regular army and didn't lrnow much about surgery had made

the decision that he would take half of his medical personnel at all times and they would be on

reserve doing nothing. Here, all of a sudden, a unit would be flooded with battle casualties and

they couldn't call on any help. And people died. If you have a limited number of personnel, and

five or six doctors, and you suddenly get flooded with a hundred and fifty patients all of a sudden

arriving in shock, how the hell do you deal with it? Some of them are going to die before the

doctor can get to them. So I made some remarks to the effect that I thought that this was

completely inadequate, and it was, in a sense jeopardizing lives with this policy.

       I gave him a report and I put that in there and went off to Third Army. Well, he got all

upset and all of a sudden I got a call. I was staying with Patton. I lived with Patton when I was in

Third Army because his doctor was a classmate of mine and one of my best friends in college and

medical school, so when I arrived in the Third Army he immediately took over and got me to stay
                                                                                                44

with him. I was living in a sense with General Patton's family, so to speak with his Chief of

Staff, and his aide, and his doctor and one other person and me. Every night we would have

dinner, and, incidentally he was really quite a character, a wonderful raconteur of history in terms

of the military. He really knew military history. He carried all of his own china, and silverwear,

and linen. We had a formal dinner every night.

        I got this call suddenly from Elliot Cutler saying that I ought to rush back to Paris for an

emergency. I didn't know what it was about and thought that it might be something at home.

When I got there Elliot said "Mike, what did you do in Ninth Army?" I said, "What do you mean

'What did I do?" "The Surgeon down there is threatening to court-martial you." I said "That

SOB. Hell, let me tell you what I did. I went down there and after I spent a couple of weeks

there I found out that what he was doing was taking his medical personnel and holding back a half

of them, and all of them complaining because they didn't have a damn thing to do. Half of them

wouldn't have anything to do half of the time. The others would be hit by a large number of

casualties and couldn't call on anybody for help." He said "You criticized that?" "I said, 'Yes I

criticized that. This was threatening lives. The consultant told me so. In fact, I quoted him in my

report." He said "Mike, he's all upset and he wants to bring a court-martial." I said "Let me show

you the data. I've got all the data on him." He said "Well, leave it with me." In the meantime he

showed it to Hawley. I was mad as hell, you see.

        In the morning I said "Tell the bastard to come on; I'd like to disclose everything I've

got."

        He said "Mike, he's not going to come forward with a court-martial. After I showed

Hawley all the material you had Hawley called that fellow up." Hawley didn't like him anyway.


LWS: Was Hawley the medical consultant?


MD:     No, Hawley was a regular army officer.


L WS: What was his title?
                                                                                             45

!\-ID:   He was the Chief Medical Officer for the European Theater of Operations. He was under

Eisenhower. Cutler was the surgical consultant under Hawley. Middleton was the medical

consultant.


LWS: What were their ranks? Do you remember?


~ID:     Cutler was a full Colonel. Hawley was a Brigadier General.


LWS: After the war was over, let's say in the fifties and so forth, were there people from the

Society who went out consulting?

MD:      Oh yes, in fact I did, and many others did. I went up to Alaska and I went to Europe.


LWS: What would a typical situation be where you actually went as a medical consultant.


MD:      They would put us back on duty, and give us orders, and we would travel as Colonel or

whatever we were, and we would be received in the military command, and we would be met by

whoever was in charge, medically. Whatever charge we had we would go over that with them,

and if we had to go out into the field we would do that in order to see what was going on. And we

would make up a report and give it to the Surgeon General with our recommendation.


LWS: So that was another function of the Society?


MD:      Yes, that continued for quite awhile. There were several other things that we did. We

recommended that there be established, after the Department of Defense was established .

The Hoover Commission came along and made some recommendations, and there was a

reorganiz.ation, and the creation of what was called the Department of Defense, DOD. We

recommended that there be established a Medical Advisory Committee to the Secretary of

Defense. We wanted a voice at the top. We didn't want to go through all this command. We had

had that experience, and we knew that we couldn't get our voice up high enough to do any good

if we were always going to be blocked by Colonels at a lower level in the military command.
                                                                                                4 6


       They had always argued that medical had to be a part of the military channels of the

command, and I don't argue with that. I think that if you're in the field and you have a military

situation, that the military commander has to be in charge. But when it was talk about policy we

wanted our voice heard where policy was made. So we finally got that done. We recommended,

and did get it done, and what's his name was the first one . . .


LWS: Was this the Assistant Secretary of Health for the Department of Defense.


MD:    That's right, he was appointed. Dr. Rousselot was in it from New York, he was a

surgeon and he was appointed as the Assistant Secretary for Health in the Department of Defense,

really Assistant Secretary of Defense.


LWS: The Society of Medical Consultants had something to do with getting this position?


MD:    That's right. And we recommended to him, to the Secretary. We recommended him for

the job to the Secretary, and then we recommended to the Secretary the members of the Advisory

Committee. I was on the Advisory Committee for awhile. Churchill was on it. Isidor Ravdin

was on it. And then later, I'm trying to remember the name of the fellow who took his place, we

recommended him, too.


LWS: Dr. DeBakey, I'd like to ask you a few other questions. When did you yourself get out of

the Army? Did you go directly back to New Orleans?


MD:    I stayed in the reserves for awhile. They wanted me to stay in the reserves, in fact they

wanted to promote me to brigadier general and stay in the reserves, but about that time I was

getting ready to move to Houston.


L WS: This was about what year?


MD:    This was in 1949.


LWS: When did you return to New Orleans?
                                                                                                47



MD:     I had returned to New Orleans at the end of 1946. I had stayed on an additional year at the

end of the war. At the end of '46 I returned to New Orleans. The reason I stayed on was to help

do what I told you, because there was nobody there. Nobody left. And then . . .

End of Side A, Tape 3.

Tape 3, Side B.

MD:    . . . . because it had great impacts. One was concerned with what I'm about to talk

about and that is the development of the research program for the Veterans Administration. I

initiated it. And the other is concerned with the National Library of Medicine. Both are very

interesting stories, and of course I lived through them because I initiated both of them.

        Coming back to the first one. We'll leave the library for another time. Coming back to the

first one. In 1946, the war was over but I was still on duty. I made the proposal, I think in

February, 1946, I can get the actual document for you that I wrote. I wrote to the Surgeon

General a memorandum in which I said that there was a great opportunity to take advantage of all

of the records, the medical records, that had been accumulated in the service, in the Army, the

Navy and the Air Force, and many of these records are going to go to the Veterans Administration

at some point, and you're going to have the opportunity to follow these patients because they are

going to be taken care ofby the Veterans Administration, the great majority. You will be able to

have a followup which will give you the natural history of some of these conditions that we don't

know the natural history of. Take, for example hepatitis that took place during the war. We don't

know what happens to these people. We know that some develop cancer, we know that some get

cirrhosis, but we don't know how many, we don't know the incidence, and we don't know the

terminal effects of some of these things, and we don't know how long it takes. And this applies to

so many of the diseases, medical and surgical. And therefore, this is a great opportunity from a     C




clinical standpoint to accumulate data that ultimately is going to be very, very useful.

       The Surgeon General thought well of it, and suggested that this memo go to the National

Research Council, the Academy of Science, National Research Council, to see what they thought
}I,                                                                                                 4 8


      about it. They then appointed a committee, headed by Churchill, to analyze this proposal and see

      what should be done. Well, I had an opportunity, therefore to meet with the Committee and talk

      with them. They were all friends of mine. They were all members of the Consultants Society,

      and they all thought it was a great idea, and so I then prepared a report. As a consequence the

      Academy recommended that I be appointed by the Surgeon Seneral to start this thing for them; get

      it organized.

             Then I got Gilbert Beebe, who had been in the office with me, in fact we wrote a book

      together on medical logistics, the first book of its kind on data that we had accumulated during the

      war. An interesting aspect of this is that there had never been a book of this kind, and we were

      amazed. Things like what proportion of soldiers engaged are going to be wounded in a certain

      way; how many are going to have head wounds; how many are going to have chest wounds, and

      so on. Nothing like it. In all the wars, you couldn't find anything like it. Isn't that amazing? And

      even today, I was out there giving . . . I was president of the Armed Forces Association, and I

      gave my Presidential address, and Jay Sanford who is Dean of the Medical School out there, at

      lunch brought this book and said he wanted me to autograph this book for him. I said "How did

      you findthis? We wrote this back in 1950 or something like that." He said Do you know this is
                                                                                    11




      the only book there is of this kind, even now?" I said 'Well, why don't you bring it up to date?"

      And he said "I don't need to."

             At any rate, as a consequence, I was still in uniform, I was put on temporary duty to the

      Academy and I worked with them to get this thing going, and that initiated the Veterans Research

      Program.

             Hawley and Magnuson were the ones who were brought in to reorganize the VA, and in a

      sense modernize it, and the way they did it, with Magnuson's help and with recommendations

      from several of us including some of the consultants, was to creat the Dean's Committee. That's

      how it started, in order to get personnel who were qualified to take care of these people.

             After that I got back to New Orleans, but I didn't stay long because in the meantime the

      Hoover Commission, the first Hoover Commission, was organized.
                                                                                              49

LWS: What was that about?


MD:     The first Hoover Commission was organized after the war to help reorganize the federal

government, and in a sense, from the lessons that were learned in the war, to determine whether

we were organized in the most effective manner in terms of function and in finance. It was a ,big

commission, and it made its report to Congress. It was a big report.

        They asked me to be the secretary for the Medical Task Force. They had a number of task

forces and one of them was the Medical Task Force. A general in the Adjutant General's Office

was my immediate boss, as I was also the Editor while I was there of Health, which was a

classified journal for the Army. He was my immediate boss, as that went through his office.

And so I got to know him well. He was at one time Chairman of the Board of the Long Island

College of Medicine, so he had some knowledge of medicine and was very sympathetic to

medicine.

        I worked full-time for the Hoover Commission and lived up here for awhile.


LWS: Did you do any surgery yourself, during the war or after the war?


MD:     Well, I did after the war, when I went back to New Orleans, but then I came back up here

to do this other.


LWS: You weren't operating here?


MD:     No, I wasn't operating here. Oh, I went over to Walter Reed, and would make rounds

with them, and there was an occasional case that I would help to operate on, but I didn't do any

major operations.


LWS: Can you make a few comments about your role with the Hoover Commission? Were

there any decisions that you made or did you get involved with any interesting . . . ?


MD:     Yes, let me just say this, that the major impact from my stand point, of the Hoover

Commission was to establish the National Library of Medicine. And that's quite a story , and as a
                                                                                              50

matter of fact Im going to give the Leiter lecture at the National Library of Medicine in a couple of

weeks, and so I'm preparing what my role was in developing it. I'll send you a copy of that.


LWS: This concludes Dr. DeBakey's interview. I will state here for the record that Dr. Elliot C.

Cutler was the first President of the Society of Medical Consultants to the Armed Forces, Dr.

Maurice C. Pincoffs was the first Vice President, and Dr. Michael E. DeBakey was the first

Secretary and Treasurer of the Society. This was in the year 1946.

       This tape was concluded April 6, 1990.
                                                                       VOLUME TWO
                                                                 Revised - July 22, 1993




                                  Oral History

                   MICHAEL E. DEBAKEY, M.D.
                     (Born September 7, 1908)

                          Professor and Chairman
                          Department of Surgery

                       Chancellor
              BAYLOR COLLEGE OF MEDICINE




              Obtained for the National Library of Medicine on behalf of

    THE SOCIETY OF MEDICAL CONSULTANTS TO THE ARMED FORCES

                 Interviews Conducted by Larry W. Stephenson, M.D.
                      Professor and Chief, Cardiothoracic Surgery
                                Wayne State University*

                     Transcribed by Donna Beck Hammond, B.A.

*(At the time of 1986 interview, Dr. Stephenson was on the faculty at the University of
Pennsylvania. He was formerly J. William White Professor of Surgery)
                                                                                     Page 51




LWS: This is Dr. Larry Stephenson continuing the oral history on Dr. Michael

DeBakey for the Society of Medical Consultants to the Armed Forces. It is April 6,

1992. We are at the Annual Meeting of the American Surgical Association being held

at Marriott Desert Springs Resort in Palm Desert, CA.




LWS: Dr. DeBakey, how is it that you came to move to Houston from New Orleans.

How did that happen?



MD: Beginning either at the end of '47, or early '48, I was at that time still full time on

the surgical faculty in Dr. Ochsner's department of surgery at Tulane. And I got this

letter inviting me to consider the chair of surgery at Baylor College of Medicine in

Houston, Texas. Now, up until that point, I had no interest in a chair at Baylor because

I still was thinking of Baylor being in Dallas and at that time, I thought it was a pretty

third rate medical school. But, Dr. Ochsner, my chief, had been asked to be a

consultant to the individuals who were very much interested in developing a medical

center in Houston, Texas. He informed me that it was worthwhile for me to go over to

Houston and see this. He said, you know, they have great plans, and development, and

the Baylor College of Medicine has moved from Dallas to Houston, and it's going to be

the main medical school for that medical center. So on his recommendation, I went to
                                                                                      Page 52


Houston, to see and visit with the people there. I found that they did indeed have a

building that they had just built with a medical school. They had actually moved to

Houston in '43, during World War II. At that time I was in the service and didn't know

anything about that they had moved, and so on. Until this new building was built, they

actually were teaching medical students in an old building that Sears and Roebuck had

been using as a warehouse at one time.

       The medical center itself, was on a plot of land that was quite a way from the

center of town, actually across the street from the Rice University campus. There was a

street car that was used primarily for the Rice University students who wanted to go

into town periodically, you see. That streetcar, of course, has since disappeared. But

that gives you some idea of how far out it was, and the plot of land, as I say, was pretty

empty. I mean they had 150-250 acres, something like that, and this single building was

part of the medical school, but there was no hospital. Although there were still students

there. They were teaching students by lecture mostly, and they had accepted a certain

number of practitioners in town to put on their faculty, and they would take these

students to these private hospitals where they worked, and sometimes showed them

patients. So the students weren't getting regular clinical activity. I asked them about

what kind of a clinical service is available, particularly from a surgical standpoint. I said,

you know, how am I going to develop a residency program here. There's no surgery.

They don't have a service. So I turned the job down. I wrote them a long letter and
                                                                                      Page 53


turned it down, and explained to them why. Well, then they wrote me back and said

they thought they were going to have an affiliation with Hermann Hospital, which was

going to set up a 20-bed surgical service for that purpose, and I would be chief of that

surgical service. Well I didn't like the tone of it too much. It seemed to me like they

were gonna do this, you know. Well !said when you do it let me know (laughs) if you

are still interested.   I was pretty happy at Tulane.   I had my own surgical service at the

Charity Hospital. I was doing a little private practice with Dr. Ochsner at one of the

private hospitals. And I had my own research lab. I was doing a lot of animal

experimentation. I was very happy about that you know, so I wasn't that interested in

moving a great deal.

       Anyway, the dean came to New Orleans, and told me, he said, now look we're

pretty sure we got over this. If you come, we're almost certainly going to have it just

exactly the way you want, and that affiliation will be cemented by your coming. That

will do a lot. I talked with Dr. Ochsner and he said, why don't you try it. And he said,

you know, if things don't work out for you, you always have a place here, you can come

back. You'll have a place. He said, I'd like to see them develop. Much as I hate to

lose you, still I think it's a great opportunity for you. So I went over. Well, after about

three months, nothing happened. And, I finally went to the dean and I said, you know,

I can't continue this way. l don't have a service. I can't develop a residency program,

you still haven't made a decision about this clinical service. Then a rather interesting
                                                                                   Page 54


thing happened shortly after that. In fact, I was planning on resigning and going back to

New Orleans, but something very interesting happened. I had worked with the Hoover

Commission shortly after the war, in Washington. And in fact, I had just completed the

medical report for the medical task force for the Hoover Commission. I was not on the

Commission myself, but I worked for them. In fact, I spent three or four months full

time in Washington doing the work.



LWS: The Hoover Commission?



MD: This was in '46. The first Hoover ... there were two commissions.



LWS: Now, what was the purpose of the Hoover Commission?



MD: Well, the purpose of the Hoover Commission was to review, and provide for

Congress and the President a report on reorganization of the Federal Government, and

to indicate where savings could be made where duplication of services could be

eliminated, things of that sort. But one of the things that I found was that at the end of

the war the Veterans Administration was unable, and that's why I stayed in the service

an additional year after the end of the war, because the Surgeon General asked me to

stay, and they needed somebody to help them take care of the large number of
                                                                                     Page 55


wounded coming back from overseas, that could not be sent to the VA because the VA

couldn't take them. So we set up these specialized centers, and remember we set up

the first vascular surgery center in this country in Indianapolis. That's where Harry

Shumacker, who was still in the service, we put him there in charge.

       We used neurosurgical centers, we had other kinds of centers, pulmonary centers

and so on. That was when the concept developed at that time. In that report, I

pointed out, as examples of duplication and waste of money, what the VA was doing,

trying to build new hospitals, veterans hospitals, when some of the military hospitals

could be used for that purpose and no longer were needed. One striking examples was

in Houston, where they had the Navy hospital of 500 beds, and the Navy would not give

it over to veterans, so the Veterans' Administration was about to build another new

hospital right across the way from them. I said, ''This is just a waste of money." We

even found a memorandum signed by Franklin Roosevelt, who was then president,

saying that at the end of the war, the Navy hospital was to be turned over to the VA,

but the Navy refused to tum it over even though, they were just taking care of veterans

patients in there. They had no more active-duty patients. But, it was, you know, a

plush job for some admiral and they wanted to keep it. That report came out, early

after the first of the year, March, or February, so on. I got a call in April that year, on

a Sunday morning from, the director of VA, who was a friend of mine, and he said, you

know, Mike, we've just been ordered to take the Navy Hospital over. But he said, we
                                                                                         Page 56


don't have the personnel to take it over with. Can you organize a dean's committee and

take it over for us, with your faculty?" I said, "By all means.ti So I virtually moved in as

chief of surgery, and there I had a service already available. And we had a medical

service, urology and so on. So, I was able to use that.

       It also happened during the same month that I was able to go and see the

chairman of the board of trustees of the city/county hospital, which at time was called

the Jefferson Davis Hospital. Now it's called the Ben Taub after the man who was then

chairman of the board, Mr. Ben Taub. Nobody had gone to see him about this before.

I explained to him that I we were doing some teaching there, but I said, t1you know, the

quality of the surgical service in that hospital, in fact all of the services in the hospital,

are terrible. I mean, they're doing terrible things there, and there are no trained

surgeons in the whole hospital.ti He had read someplace about the importance of

training, certification and so on, so he was prepared for what I was saying, and to make

a long story short, we did finally get that hospital affiliated with us, over the objections

of the doctors. So I had two major hospitals available with indigent patients to be used

for training purposes, and I immediately got hold of the board members and told them

what was going on and wanted them to come down and get us certified so we could get

residents. And so we did. That changed my whole career, you might say, because

otherwise, I would have gone back to (New Orleans). In fact, just before that

happened, I told the dean, I said, you know, I didn't see much hope for that hospital of
                                                                                    Page 57


making a decision, because they had made the decision to make me chief of what they

called the teaching service. When I asked who specifically was in charge of the patients,

they said, oh well the doctors that are there. And I said, "What am I supposed to do?"

and they said, ''You are going to be in charge of teaching the students." And I said,

what's going to happen if I go in there and tell the patients that the surgery that was

done was the wrong surgery? I said, you know, that's not going to work. They said

that's not going to happen. I said, from what I've seen around here, that's going to

happen a lot. (laughs) So I rejected that proposal and told the dean I wanted to see

the chairman of the board before I resigned. And we did. We went to see him. He

was first of all upset about it, and almost hostile, because he had been told that I was a

pretty radical fellow. (laughs) He kept on repeating these cliches about you have to

make changes in an evolutionary way, not a revolutionary way. So I finally said, "You're

not going to ever have a medical center worth its salt if you don't have some kind of

affiliated institutions to work in. You can have a professor of biochemistry, but if he's

worth a damn, he's going to want a laboratory to work in." I said, "Our laboratory is a

hospital, with clinicians." Its interesting, because later on, he and I became very good

friends, in fact I operated on him later. But, what turned the whole thing around, was

first the VA hospital situation and then the city/county Charity hospital, then called

Jefferson Davis. So that is how I really stayed. Otherwise I would have gone back to

New Orleans. In a way, it's a good example of the role Fate plays in some of these
                                                                                  Page 58


things, in your own career, in your own life, so to speak. You see Fate played a role in

giving me the opportunity to work with the Hoover Commission. Because, and we'll get

to that later maybe, but as a consequence of my working on the Hoover Commission,

we got the National Library of Medicine. And that's still another story, but that's how

Fate plays a role in what you do.



LWS: Let me just back up a step. Now, you left New Orleans in 1948. Wasn't one of

your fellow young faculty surgeons in New Orleans Dr. Champ Lyons?



MD: Yes.



LWS: Didn't he leave to be Chairman of the Department of Surgery at the University

of Alabama about the time you left to be Chairman of the Department of Surgery at

Baylor?



MD: That's right. Well you see, I brought Champ Lyons to New Orleans. Before the

end of the war, Champ Lyons came back with hepatitis. And unfortunately, things had

happened in Boston, Champ was from MGH. I think he worked with (Hans) Zinsser, if

l remember correctly, and he was interested in infectious disease, and as a surgeon, he

was recognized for his work in that field. In New Orleans we didn't have anybody that
                                                                                       Page 59


was very good in that area. Champ could therefore help out our department. So I

called Dr. Ochsner and I told him about Champ and I said you know, he was going to

be released from the service because of his hepatitis, and he has no place to go. I think

he'd be interested in coming here to Tulane, and I recommended him highly so he went

down and saw Dr. Ochsner and got a job. That's how he got to Tulane. Later, he got

the opportunity to go to Alabama as professor of surgery at the University of Alabama.



LWS: Going forward, you're now the chairman of the department at Baylor. When did

you start to recruit full time faculty?




MD: Well, I started immediately as soon as I had these services available to me. When

I arrived there, there was one young full time man who really was sort of mentally

disturbed. I didn't realize it at first, but a little later on, I realized there was something

wrong with him. So I had to get rid of him. He was the only full time surgeon. And

he wasn't well trained either. I don't know where they got him, and in fact, I don't

know what ever happened to him, but I had to get rid of him, at the time. So I was the

only full time person. After I got these two services, I therefore had to get some full

time people to come along on the faculty. I began to search. It so happened that

George Jordan had worked with me in the lab at Tulane before he went to Mayo Clinic,

so by the time I went to Houston, he had finished his training at the Mayo Clinic, and
                                                                                  Page 60


hadn't decided where he was going to go. I called him up and invited him to come

down. He came, and as you know, became a full time member of the faculty with me

and he's still there. Then Stan Crawford came to me as a fellow. He was in the

training program at the MGH (Massachusetts General Hospital). Pete Churchill, his

chief, became a great friend of mine when I was down in New Orleans. He told me

about Stanley being from Alabama. He said, "You know this is a bright fellow, he's a

good man," and he said, "I think he'd be interested in coming down to be a research

fellow." So I brought him down as a research fellow. When he left, to go back and

finish his residency, he was chief resident at the MGH, I said, "Stan when you finish up

there, you have a job here if you come by." So he did. He came back here, full time.

It was very sad seeing him down there today at this meeting paralyzed on one side from

his stroke. (This was on April 6, 1992 during the annual meeting of the American

Surgical Association.) You know he has been a great, great contributor, and I really

depended a lot on him as I did on George Jordan.

      Oscar Creech, was the chief resident at Charity Hospital when I left, so I called

him up. I said, "Oscar, if you have no plans, come over here and take a look at the

situation. Maybe you can join our faculty." Oscar is a great surgeon, so he did, and he

came over. Ravdin was a great friend of mine, too. It was interesting to hear Jesse

Thompson talk today (at this meeting - 1992 President of the American Surgical

Association) because I always had a very warm spot in my heart for Isidore Ravdin
                                                                                       Page 61


(Jesse Thompson's old chief). When          I first met him on my way to Lariche's Clinic in

19...30...9, I think it was '39, 40, just before the war started, I was there for a year with

Leriche, and I was on my way, and I stopped in Philadelphia to see Ravdin. He was

doing a lot of experimental work. I was doing a lot of experimental work. I wanted to

see what they were doing. He treated me like a VIP. Here I was you know, nobody.

Just finishing my residency training, and then doing a lot of experimental research, and

when I got there, I mean, you would think I was a VIP visitor. I have never forgotten

that experience, and what a tremendous impression that made on me as a young man. I

thought to myself, "If I ever have the chance to take care of people coming through, I'm

going to treat them just like he treated me." It was a great lesson. During the War,

and after the war, I worked with Ravdin on a number of projects. We were on

committees of various kinds, and we got to be very good friends. I stayed in his home

there in Philadelphia. He knew I was recruiting faculty because I talked to him. I said,

"You know, if you have somebody, some young fellow that you think would do it...." He

said, "Yes," he said, "John Howard is a good man." So I recruited him. So I began to

build up full time faculty people, you see, that way. They were just tremendous, really.

They were not only good people, as time has proven, but they were dedicated. Here we

were in sort of a new and exciting development, you know, setting up our own rules and

regulations. Then after a while we began to train some of our own people.
                                                                                  Page 62


LWS: I noticed that a lot of your papers on the aneurysms in the earlier period, Dr.

Garrett and Dr. Cooley as co-authors besides Crawford.



MD: Yes.




LWS: When did those two come on board? And how did you recruit them?



MD: Dr. Cooley came from (Alfred) Blalock. Dr. Cooley was originally from Houston.

His father was a dentist, a fairly prominent dentist in Houston, and (Dr. Denton Cooley

had gone to Hopkins after he finished part of his training, his medical work at the

University of Texas, in Galveston, I think, for two years, and then he moved up to

Hopkins, and then he took his surgical training under Blalock. When he finished, Al

Blalock said to me that he thought Denton wanted to come back to Houston. I said, "If

he wants to come back, and to be on our full time faculty, tell him to come by and let

me see him."   He did and he accepted a position as full time member of our

department. He again was dedicated, he worked hard, like the other fellows, and did a

great job.




LWS: How about Dr. Garrett? Did he come later?
                                                                                   Page 63


MD: Yes, he came along later. I suppose Ed Garrett was with us fifteen or sixteen

years after he finished his training with us. You see, after about five or six or seven

years, I began to train some of my own people. Now you take people like George

Noon, George Morris, Jimmy Howell, Charlie McCallum, these are all full time

members of my department, my senior members. They all came through my training

program. So they are my own trainees. A large, number of them that I trained myself.

They were all very able people, top, top students, and excellent residents, and excellent

surgeons, and I would invite them (to stay). I didn't keep all of them, but I would keep

some of them, two three or four years, and they'd then be attracted elsewhere. Then of

course I had fellows, like Bob Wallace, Lazer Greenfield, people like that, they all

trained with me in cardiothoracic surgery for a year or two after they had finished their

training elsewhere. They usually did surgery elsewhere. So we had a continuous group

of some excellent people in training with us. Particularly in the early days as we were

developing some of the pioneering developments in cardiovascular surgery and aortic

aneurysmal work.



LWS: Early on, within a relatively short period of time, your group became the world

champs in vascular surgery. Some of the early developments of your group included

your Dacron grafts, the carotid endarterectomy and a lot of the aneurysm surgery. All

of a sudden, you go to Houston in 1948, and start recruiting faculty. How, in such a
                                                                                     Page 64


short period of time after that, did you guys just skyrocket in vascular surgery?



MD: Well I think fate played a role again, in a number of different ways. If you recall,

going back to that period, during World War II, Clarence Crafoord and (Robert) Gross,

in Boston, had successfully resected a coarctation of the aorta and did it end-to-end. I

think that did a lot to excite the surgeons who were interested in the circulation. The

war came along and that put a damper on things for a while, .then in 1944 Blalock did

his first autopulmonary shunt. The operation was also in itself exciting. I moved to

Houston in '48 or '49. I was, of course, interested in doing experimental work. I was

always involved with the circulation, as you look you will see some of my earliest

publications, even as a medical student (involved the circulation). When I worked with

others as a technician, my name was on the papers. It was in circulatory work, that's

how we developed the roller pump, you know. I think it was in '46 or '47, maybe 48,

Bob Gross and his associate, who had just started recently (at that time) as professor of

surgery in Washington at Georgetown did the first aortic valve.



LWS:    (The associate was Charles) Hufnagel.



MD: Yes. Hufnagel presented a paper in which they had done· some experimental

work showing that homografts could be used to bridge the gap in the coarctation when
                                                                                    Page 65


you couldn't bring it in the end. That stimulated many of us who had been working in

the field and doing experimental work on the various arterial replacements. We had the

good fortune to do all the autopsies in Houston for the coroner. We were able to do

fresh autopsies and remove the aorta and large vessels and do some studies with them.

Well after showing (Hufnagel) that you could use a segment of fresh homograft to do

this part (bypass a segment of aorta), that gave us the idea, and others too, in fact. We

didn't realize that Charles DuBost had done this (resected an abdominal aortic

aneurysm and replaced it with an aorta homograft) on a patient with an aneurysm in the

abdominal aorta a few months before we did. We did it thinking we had done the first

one. It turns out of course, he had already done it several months before we did. But

we continued our interest in it, and in fact, you know somehow or other he either didn't

get the opportunity or lost interest, because we wanted to proceed with other areas,

segments of the aorta, especially the thoracic. So it wasn't long before we did the first

thoracic aneurysm, and we just kept climbing up the aorta, all the way to the arch ( and

then) to the ascending (aorta).



LWS: Were you using homografts?



MD: Homografts. Yes. Absolutely; we were using homografts and they were working

quite successfully. We didn't actually realize until later on that these homografts would
                                                                                         Page 66


deteriorate and become aneurysmal themselves and we would have replace them. In

the meantime, we continued to do experimental work, like others were doing on

substitutes.

        Now it's interesting, about Dacron. Again, it shows you how Fate plays a role. I

used to go downtown to the department store to buy a yard of cloth. (laughs) And the

first time I went down .there, I wanted to get Nylon. And they had run out of Nylon,

and they said you know, we have a new material called Dacron, you want to try that?

They didn't know what I wanted it for. I was, shopping in the section where women

shopped for dresses. You know, I talked like a person who knew how to sew. Well, I

do know how to sew. My mother taught me how to sew, and the reason she taught me

to sew was because she was an instructor in sewing, instructress, I should say. When I

was a little boy, in those days, girls were supposed to learn to sew before they got

married. She would have a class of oh, 7-8 girls. Every afternoon after school they

would come to the house. She would sit down there for an hour or so teaching them

how to sew, and she would teach them how to use a sewing machine, she'd teach them

how to cut patterns, and then she'd teach them how to do crochet and knitting and

tatting. Do you know what tatting is? That's a special type of lace making. You use a

tatting bobbin. I was sitting there as a little boy watching her, you see and she saw I

was interested, so she taught me. In fact, I taught my wife to sew. Incidentally, I want

to tell you, sewing is really a great kind of, well it's better than valium, you know.
                                                                                  Page 67


People who have any kind of disturbance that requires tranquility, this is the most

tranquil thing you can do, you know, sewing is a wonderful thing, because you use your

hands and you're concentrating, you see, what you're doing.

       So when I went into the store, I knew what I was talking about, you know, and I

said I wanted a yard of this. Dacron was the first one we tried and it turned out later

to be the best material. But anyway, we used other materials and I used to go around

and get other things, and we continued to work in the laboratory. I would make tubes

on my wife's sewing machine. I would cut the two sheets the size I wanted, and sew the

edges, you see, and then we'd put them in animals and get it well clotted. Then we

could use them as a tube. So we continued this work, and I had the good fortune of

operating on a man, for an aneurysm of the abdominal aorta, during the early days, and

he happened to be a fairly well-to-do individual who was head of the Stuart

Pharmaceutical Company at that time. In fact, he founded it, and it was the biggest

pharmaceutical company west of the Mississippi. He owned a half interest in a socks

factory in Reading, Pennsylvania. Well, I used a homograft in him, see it was very early,

and I told him we were working on a substitute, and we needed some help on this. He

donated a $25,000 grant to us. It was a lot of money then. And he said, "By the way, I

have a half interest in a socks factory in Reading Pennsylvania. Maybe they know how

to make these." What we needed was somebody who knew how to knit and weave

these things. He said you know they knit socks all the time. Maybe they know
                                                                                   Page 68


something about it. So he made arrangements for me to go up there and see the man

who was then the manager of the factory. Reading is not too far from Philadelphia, and

I think I took the train to Reading. Anyway, he was very nice and finally he said to me,

"You know, I doubt that there is any machine that would do this, but there is a man at

the Philadelphia Textile Institute who is probably the world's expert on fabrics. Maybe

you ought to go see him. He knows more about textiles than anybody in the world." So

I went over there. This fellow was originally from Switzerland. A very nice man.

Obviously a sort of a dedicated kind of a scientist. And, he got quite excited. I kept

telling him how important this was, and so on. He said, "Well let me see what I can do.

Maybe I can build a machine." So I called this man up and I told him what had

happened, and he said, "How much would it cost to build a machine?" I said, "I don't

know but I'll ask him." Well it turned out it cost about $10,000. He said, "Alright. I

will make you a check for $10,000." Later on, I got him to move down, and he became

a full time worker for us. He built the first machine to knit· and weave these grafts and

of the machines today go back to his machine that knitted and wove these grafts. All of

them. That's how we got started.



LWS: When is the first time you used one of these grafts clinically?



MD: Well, the first time I used one clinically is before we had the machine. In fact, I
                                                                       \'
                                                                                       Page 69


can't tell you how many dogs we did, when we became convinced we were going have to

go to humans. Well in those days, we didn't have an internal review board, we didn't

have the FDA We didn't have anything else. We had our own moral and ethical

values to go by. We had decided (to proceed), I guess in many ways like John Gibbon

decided when he first used a heart-lung machine on a human being. So, in 1954, I had

a patient at the Veterans Administration with an aneurysm of the aorta. I told him it

had to be removed, and I said, "You know we are going to put in a new graft, not a

homograft. It's a Dacron graft." I explained to him that we had been doing a lot of

experimental work on it. We were sure it was good, and he approved it. I felt,

personally (responsible), some of my people were saying, "Why are you going to tell him

all this? I mean, he doesn't know what you're talking about." I said, "Well I feel better

just letting him know." So I did. And he responded very well to it. He said, "Doctor,

anything you say. Go ahead." He said, "I want to live." And I said, "Well, I'm doing

my best." Fortunately it was successful. And this brings up another point. You know,

the first successful case has a tremendous impact, the first successful new surgical

procedure in any clinical area has a tremendous impact. Because it excites so many

other people. And now you are bringing in a lot of other people. Focussing upon the

same thing you see, and it accelerates the knowledge that you need to move it forward,

you see. There's no question about it. This has happened to me in so many areas~
                                                                                    Page 70


LWS: What was the advantage of the graft that this man from Switzerland could make

with his machine over the one you made on your sewing machine.



MD: He finished the machine.... I guess in about '51 or '52 and he would send these

samples to us. Now he was still working with different fabrics and different ways of

doing it, and we kept having -to make changes, because the machine was knitting these

and the interstices were just too great. I mean, it continued to pour· blood out, you

couldn't get enough clotting to take place to plug up these big holes. So we kept· having

to develop the machine to knit them tighter and so on, you see, so up until I would say,

'55 and '56, we continued to modify it and I think the first one I used that he produced

on one of his machines was I think in '55. Then you know we kept modifying it, and

finally, he built the machines to make bifurcations. There wasn't any machine that

could do that either.



LWS: How about that crinkles in the graft?      Who thought of that?   The crinkles are

there so when the graft is bent it does not kink.



MD: That was developed by (Sterling) Edwards and a fellow that worked for him. I

can't think of his name now. If you remember, he. got the idea from drinking straws

that were made that way. If you put a straw in a bottle, you know and bend it, it
                                                                                  Page 71


doesn't kink.



LWS: Yes, I know.



MD: The way we made it crimp, is to put it on say a pipe that fitted it, like a steel

pipe of the right diameter for it, and then we would wrap it with nylon thread, it would

be wrapped like that, you know and then you would push it together. That would crimp

it, you see. Then you heat it so that after that, you change the molecular configuration

so that it remembered, it had that memory to stay that way. So when you took it out,

then it remained that way. And that's how the crimping is done.



LWS: You stuck with Dacron. Others were using Teflon and in general you were

proven to be right.



MD: Yes, we were lucky in that regard. I must say. Dacron was our first experience,

and then we later tried these other things, and then as time went on, because Dacron

was our first experience, we had longer studies with Dacron, and we found that the

tissues would become attached to Dacron, whereas they wouldn't to Teflon. We found

that in animals. We thought that was a disadvantage of Teflon, even though Teflon was

inert, the fact remained that we wanted tissue adherence. The other thing we found out
                                                                                       Page 72


too was that nylon, in time, deteriorated in body tissues. The fibers actually would

deteriorate, lose their strength, whereas Teflon did not lose its strength. I've got

patients, we've tested the strength of Dacron after 20 years in the body, 30 years, where

for one reason or another we've had the chance to go back in, like a false aneurysm,

stuff like that, take a nip, take a piece of it out, and we'd test it. The last study where

our people tested it, showed that at the rate of its losing it's strength, it would take 250

years to lose it all. We don't have to worry.



LWS: You know, one patient that I think everybody associates with your aneurysm

surgery is the Duke of Windsor. Do you want to say anything about that?



MD: Before that, we almost had another great personality, but he refused to be

operated on, and that was Einstein. Einstein was dying in NY, I think it was either Mt.

Sinai or Montefiore... I think· Mount Sinai. He was in the hospital with a ruptured

aneurysm, and he had one of these types that ruptures slowly, you know, into the

retroperitoneal space and then tamponades then ruptures again. His surgeon there

called me on the phone, and he said, "You know, I really think he needs to be operated

on, it's kind of an emergency. Is there any chance you can come up?" I said sure. He

called me a little later, and he said, "Sorry; but we can't get him to agree to the

operation." And he finally died. Refused the operation.
                                                                                     Page 73


       As far as the Duke of Windsor is concerned, there was a doctor in New York by

the name of (Arthur J.) Antonucci, an internist who was often used as a referring

physician from Europe by people who knew him, and he had a nice reputation, and he

had this sort of celebrity status with patients. He called me one day and he said, "Mike

I've the Duke of Windsor here. He's got an aneurysm of the abdominal aorta. I think

he needs to be operated on. It's a little tender." He said, "I want to send him down." I

said, "Well do you think he needs to fly down?" He said, "I think he ought to fly down,

but the Duchess won't fly. She's never flown." So they came down by train. In fact, I

forced, almost forced her to fly when they left. I said to her, "Look," I said, "this fear of

flying on your part is going to interfere with your life." I made arrangements with a

Delta airlines pilot, I had operated on him and some members of his family. I knew

him quite well. I said, "Why don't you go out and really look at (the airplane). The

pilot will talk to you, look at the plane." She'd never even been in a plane. And when

they left, they flew. That was the first time she had ever flown. So anyway he came

down, and he indeed had a tender aneurysm. It was a big one. I guess you can call it

about 7 cm in size. So I operated on him the next day. We evaluated him that

afternoon and everything looked good. I said this needs to be operated on. I'll do it

first thing in the morning and I remember so well the anesthesiologist said to me after I

operated on him. I resected the whole thing and I sewed him up myself, which I didn't

usually do. The anesthesiologist said, "I think you made a record." I said, "What do you
                                                                                    Page 74


mean?" He said, "You know that from the time that you made that incision to the time

that you sewed up that incision was 50 minutes."



LWS: Wow! That's quick!



MD: Yes, well, I wanted to get through, you know, get it done as fast, done as quickly

as I could. By that time, you know, I had developed the technique which was entirely

different from our early technique, which was to go up and get the neck and get the two

main common iliac arteries (more recent technique), and then make an incision (in the

aneurysm), clean it out, put the graft on the inside, very simple. You know in the early

days, I dissected the whole thing (aneurysm) out, you know and occasionally got into the

vena cava and would have to repair it and had all kinds of complications. So we were

getting a lot of experience. Experience is the greatest teacher of all, and by that time,

we'd learned how best to do it.

       He was a very interesting patient in many ways. Here he was a celebrity, and

yet, a very simple man, and although he was you might say, worldly educated, I

personally found him to be relatively poorly educated. Especially for an Englishman.

You get on any topic, and you get into history, or even English literature, and it wasn't

long before you found out, he didn't know a great deal, which amazed me, really. The

other thing that I always carry with me is the impression, that he was an unhappy man.
                                                                                      Page 75


He really was. The duchess was a very shallow person mentally. But had a great deal

of charm, there was no question about that, and of course she had a great following.

About the second day after the operation she came to me and said, "You know I think

he ought to have this. He is used to taking this." And I said, "What is that?" And she

showed me a bottle of some pills. I never heard of them. And she said, "Well, it's

good for the bowels." I said, "We got a tube in him. Right now, his bowels are not

operating. He's got paralysis of his bowels." I said, ''There is nothing you can do right

now but wait until they come back, and we can tell when they come back (the intestines

start functioning again), and I can take the tube (nasal gastric tube) out and he can start

taking stuff by mouth, but I'm not giving him anything by mouth now." And she said,

"Well I'm sure that's what he needs. I wish you'd do this." I said, "Duchess, just let me

tell you something. His situation is dependent upon me right now. I'm responsible for

anything that happens to him. And therefore I'm in charge, and, with all due respect, I

don't think you know as much as I know about how to take care of this." And I said,

"We may as well be perfectly frank with each other. If you decide you don't want me to

take care of him anymore, I'll be glad to recommend somebody else to you, but as long

as I'm in charge, then I want to have the responsibility of carrying out the care that I

think he needs." And I said, "I'll inform you about his condition, and if you or he

decides you want someone to take care of him, I'll get somebody else to do it, but as

long as I'm in charge, I'm the one to take care of him." So I made it very clear to her.
                                                                                     Page 76


It was very interesting, because she responded in a very nice way. She said, "Well I'm

sorry. I didn't mean to imply that you were not taking good care of him." She said, "It

just so happens that I know that he does take this." I said, "Well, he may take this

when he gets through. I have no objection to that. I said, right now, I don't want to

give him anything by mouth, you know, not even water." (laughs) So we became good

friends after that.



LWS: Did he make a fairly rapid recovery?



MD: Yes, very rapid as a matter of fact. I would say, on about the 7th or 8th

(postoperative) day, I said to him, "Your honor, if you want to leave the hospital and

stay in town for a few days, it's up to you, but," I said, ''you can leave if you want." He

said, "Well, there's no sense in my doing that." He said "I'll stay here until I get ready

to leave." I said, "Well you're welcome to do that." So about the 10th day after the

operation, he said, "I think I'm ready to leave now," and he did.



LWS; Did he have other people with him, an entourage?



MD: I think he had a valet that went with him everywhere. She had a maid that went

with her everywhere. We fixed the hospital unit, where he was recovering after he had
                                                                                      Page 77


finished up in the intensive care unit for two days. We fixed up a section of the

hospital, where she could stay, and she lived there. She didn't go to a hotel, you see.

and so, they had fixed it up like a little apartment for them in that part of the hospital.



LWS: I suppose there were some important visitors, and important phone calls.




MD: I had to send Queen Elizabeth a note about him every day. She requested that I

send a little note about his progress every day, which I did.

       I'll tell you a little story about that, because it's interesting. I had met her and

Prince Phillip in India at least 25 years ago for the first time. I was visiting professor in

Bombay and I spent about 2 weeks teaching, having lectures and operating in a teaching

hospital in Bombay. It so happened that Queen Elizabeth and Prince Phillip made a

visit. Their first call in India was Bombay. My host was a good friend of Lady Rama

Rao (?), who was one of the real personalities of India at that time. She had a garden

party for the Queen Elizabeth and Prince Phillip. I was invited because my host was

invited and he invited me. When I was going through the line to meet them at the

garden party, they introduced me as Dr. DeBakey, a visiting professor at Bombay, from

Houston Texas. Prince Phillip asked me what I was doing, and I told him I was at the

King Edward Hospital and they became real interested because they knew King Edward.

So, I spent about 2-3 minutes talking with them, and they went on. I had no more
                                                                                  Page 78


contact with them until I operated on the Duke. Now everyday I had to send over a

note. Now, about three or four years ago, you may recall, she (the Queen) came on a

private visit to Kentucky staying with the Farrishes. The Farrishes have a big stud farm
     1




in Kentucky. The Farrish's are originally from Houston and we became good friends.

So they invited us to come up there when the Queen was visiting. My wife, Kathleen

had never been to that part of the country. I thought she might be interested in seeing

that region, so I took her up there. And, again, we went through the lines. She (the

Queen) was staying with them, and they had a little private party for her. Well, I got to

her and they introduced me and she said, "Oh yes, Dr. DeBakey." She says, "You know,

I first met you in India." Well, I was appalled. (laughs) I had forgotten about that

completely. How in the world she would remember that, I have no idea. I have a

feeling that they must have some means by which they were prepared for some guests,

and she said, "You know, I am so grateful to you for your kindness in sending me those

reports about the Duke. I appreciate it very much." And I thought to myself later on,

"How in the world could she remember things like the Duke?"      Now the other

interesting thing is, she was in Houston not too long ago, with Prince Phillip and the one

thing she wanted to see was something medical. So we showed her the new VA

hospital and they asked me if I would be kind· enough to show her around. When she

arrived at the hospital, they introduced me and they said, "Dr. DeBakey is going to show

you around." "Is there anything you would like to see," and so on. She said, "Oh, Dr.
                                                                                   Page 79


DeBakey. It's so good to see you again."     She remembered again! ·Amazing! And I

thought to myself, "My God, I know they have other things to do." So they must have

a way of being alerted to the people they come to meet. It's amazing.



LWS: Yes it is. I just want to tell a real quick story about a man who was at the

opposite end of the social ladder from the Duke, but like the Duke, had a tender or

leaking aneurysm and also, like the Duke, was not transported to the surgical center in

the most expeditious way. You were talking about the Duchess not wanting to fly

despite the Duke's tender aneurysm. When I was a resident at the University of

Alabama, on Dr. Holt McDowell's service, he had gotten a call one day about noon and

was told that there was a man with a possible leaking aneurysm in Montgomery, which

was about an hour away by ambulance. Dr. McDowell agreed to accept the patient as

an emergent transfer. We waited all afternoon, but never saw the patient. Eventually,

about 7 p.m., I got called down to the emergency room. The man had just walked in. I

asked him where he had been since we had been waiting for him all afternoon and he

said "Well, the Trailways bus didn't arrive in Montgomery until three· o'clock p.m.!"



LWS: Another thing that you're very famous for is the carotid endarterectomy. How

did that come about?
                                                                                   Page-80


MD: Well as you will recall, endarterectomy as a concept, was first developed by a

surgeon from Portugal whose father was professor of surgery there, and his father

actually performed the first abdominal aortogram, (Jean Cid) Dos Santos. His son and

I were in Leriche's clinic at the same time. So we got to know each other quite well.

He did this endarterectomy procedure, which came about by serendipity. He was really

trying to remove a clot. In removing this clot, because the clot was a little old, he found

that he had removed part of the endothelium. The endothelial lining with the

athromotous process. He didn't call it an endarterectomy. It was only later it became

known as endarterectomy, you see. He told me about this, and then after wrote about

it. This was in the 1940s, '46, '47, '48, something like that. Then we began do

endarterectomies in the femoral area. That's where he did it. And, you know, we had

a lot of experience with it, and it became a pretty standard procedure. In 1953, I had

this patient from Lake Charles, Louisiana, which is my hometown. He was a schoolbus

driver. (END SIDE 1)



SIDE B:

MD: A doctor friend of mine from Lake Charles, Louisiana knew me and my family

and he sent the patient to me but he didn't recognize that he was having TIAs.     He

was having these peculiar episodes, he said, whereby he would have- transitory paralysis

of his right leg and right arm. It would only last about a minute, but you know, he was
                                                                                      Page 81


a bus driver. He said, "We are getting a little worried about having him have these

things, and he's getting worried." He said it happened on one occasion, when he wanted

to stop and he couldn't stop. He couldn't use his right leg, and he passed up the point

where he was supposed to stop. He had to stop a block or so further on. He said, "I

don't know what's happening to him."



LWS: He didn't send him for a vascular condition.



MD: He sent him to me because he was a friend of min. So when he came in and he

told me about this, it clicked with me, the reason it clicked is because I had been

following work in the literature of a group at the MGH (Massachusetts General

Hospital) who had been reporting their studies, the neurologist there, on the

postmortem findings on patients who died of strokes. They were finding these lesions in

the carotid artery, I'm trying to think of the name of the doctor, it had a hyphenated

name. But anyway, it will come to me, but any case... On one of these papers made the

suggestion that possibly removing this athromotous process might prevent a stroke. He

described the syndrome of what was happening to these people beforehand. They were

having TIAs, amaurosis fugax, and so on. So, I said, ''This fellow's got the same thing."

You know, I recognized the symptoms and so, while I listened to him, he had another

one. Now this was before the time of doppler. In fact, we didn't even do a carotid
                                                                                      Page 82


 arteriogram, beforehand. In fact, I said to him, after I became quite excited about it, I

 said, "You know, I think you've got this syndrome," I said, "We've never done this

 before, but," I said, "it's been suggested, we have done the procedure elsewhere in the

 femoral (artery).   We know how to do this, and I think this is what you need to have

 done because you're going to have a major stroke." ·I'm sure, that one of the reasons he

 had confidence in me was because he knew my family. And, you know, I explained all

 of this to him. He said, "Well Mike, I'm in your hands. When do you want to do it?"

 So the next day I operated on him. There it was. Just the most beautiful lesion you

 ever saw with a little thrombus. I finally wrote it up. But it was highly successful, and

 this fellow, we followed him very carefully afterward, and I did an arteriogram

· afterwards, sometime later on. It was wide open. And you know, he survived for 19

 years. He died of a heart attack 19 years later. Never had another (TIA) attack.



 LWS: Now after you did this operation. What happened? Did this carotid

 endarterectomy operation just all of a sudden then mushroom into a popular operative

 procedure?



MD: No. No, no, no. Not at all. Very often when you do a successful case like that

you wonder a little bit at first, you're quite excited about it, but then you wonder a little

bit, whether you ought to rush into print and not have any follow-up, not know what's
                                                                                     Page 83


going to happen. So you feel like you ought to know a little bit more about it. I first

presented my experience with about, I guess, 10, 12 cases, at a neurological meeting in,

in New York. It was interesting because, although they (the patients) were all

successful, they (the neurologists) were very critical of my doing operations of this kind.

Well, I must say, and they may have been right. We didn't have good controls then,

and we didn't have good studies, but I was a little discouraged by this, so I said you

know, before I write this up, I think I've got to get a little more experience with this.

So that's one of the reasons it was delayed, and I did refer to it, in some other

publications, but I didn't write it up. Especially in that particular case, until I had good

follow~up on that patient. So the write-up on that patient came a little bit later. We

continued to do more and more, and finally we had well over a hundred cases, then we

felt secure in writing it up, but four or five years had elapsed.   During which we were a

little concerned and we were a little cautious about it, particularly after the severe

criticisms we got from the neurologists. But, as time went on, we got more and more

secure, largely because our experience was so good, you know. We were lucky to some

extent in the sense that we had no complications from the operation. There were no

neurologic deficits from doing it. We didn't have any events that created any problems,

so we were very lucky in that first hundred cases or so.



LWS: Now speaking of being cautious and not writing a case up, I think the most
                                                                                      Page 84


common operation or one of the most common done in the US and the world is the

coronary bypass operation, and you guys did the first one, but you didn't write it up for

years. Wasn't Dr. Garrett the first author? Can you tell us about this historical event?



MD: Yes, let me tell you that if you go back, and I've had ,the opportunity to write this

·up recently, so i- am familiar with it again. If you go back to that period, of say 57, 58,

to around 62 and '3, you will find that there was a great deal of work being done in the

experimental laboratory on coronary bypass, and coronary surgery. Not all bypasses,

but, doing experiments on how to restore circulation to the coronary arteries. By that

time, we were doing selected cases, and there were, oh...half a dozen centers in the

country were writing about it, endartectomy in the coronary arteries, with patch or

without patch. In 1961, we published our last article on the experimental work that we

had been doing. Like others. And it's interesting to see how few people refer to these

earlier experiments. While we didn't use the internal mammary in our dog experiments,

there were others who did, you know, and they were doing experimental work using the

internal mammary artery (anastomosis) to the coronaries. The fact that clinically it is

being used without any reference to the people who used it experimentally, I sometimes

wonder, you know, whether they're ignorant or deliberately avoiding referring to these

people who did do it. So in 1961, (we wrote) our last article on our experimental work

with animals. At which time we came out with the conclusion, that we had about a 50%
                                                                                     Page 85


success rate at the end of six months with patency. We said, that was very encouraging,

and we felt that more experiment work ought to be done. So we continued to try to do

more, and a little earlier than '64, we heard that David Sabiston had done one clinically.

We were quite excited about it, and of course our excitement was then dimmed quite a

bit when we heard he died a few days later of a stroke.



LWS: Yes, I remember reading about that after the fact.



MD: Yes. So, actually, if anyone deserves credit for the first coronary bypass, in

human beings, it's David Sabiston. Unfortunately, you know, that's exactly what I was

saying about how important success is in doing a clinical case. His case wasn't successful.

Well, we had this patient scheduled for an endarterectomy. This fellow had complete

occlusion of the right coronary, his obtuse marginal was gone, and the only thing he was

living on, really, was his LAD, and a little diagonal branch and he had a lesion in the

left main, right where the LAD began. It was a complicated lesion. Well, when we got

in and tried to do the endarterectomy. We kept trying to find the cleavage plain, but

we couldn't find it. Sometimes that happens, and then you have really destroyed the

segment of artery. We knew we couldn't get this fellow off the table unless we restored

circulation in the one artery that was supplying all the blood to his heart. So we

decided right then and there to do what we had been doing in animals, so we slipped
                                                                                   Page 86


down, got a little piece of vein out of his leg and put it in, and it worked. You know,

the nature of the way it happened. In a sense, we were sort of lucky, to get him off the

table and so on. We continued to do endarterectomies, and we were a little hesitant to

proceed with this procedure (coronary bypass), even though we were successful, because

we had this nagging feeling that we were just lucky in this fellow. Secondly, all our

experimental work didn't give us that kind of support, you see?



LWS: Yes, right.



MD: So we wanted to get more experience, more clinical experience. And that's one

reason we delayed reporting the case. Now, we did verbally report this experience at a

number of meetings. Because, after about a year or so, we got the courage to proceed

more, and by, I think '66, we had done about, something like 15 cases of bypass. If I

remember correctly, I think 13 or 14 were quite successful. But you know, it was slow,

largely because we just couldn't get up the courage to believe that this was going to be a

fully useful procedure. You just had to have more experience to do that, to get the

confidence. That's what delayed us doing it. Now in the meantime, Favaloro, up at the

Cleveland Clinic, if you go back and see what he was doing, he wasn't doing bypass at

all. At that, during that period. He was doing interposition grafts.
•

                                                                                            Page 87


    LWS: Right.



    MD: The first procedure that he made a great to-do about, was first endarterectomy,

    which everybody else was doing already, by that time, many people were a little

    disappointed with the procedure of endarterectomy, because it still had a high mortality.

    He reported low mortality. I guess that was lucky, and then he began to use

    interposition grafts.



    LWS: Right, the anastomoses were end-to-end. And they were all mainly for the right

    coronary.




    MD: Right. Exactly, almost all on the right coronary. So, when he started reporting

    the coronary bypass, we'd already done, oh I guess, 25 or 30 cases by that time. And

    we reported that at one of the meetings. He was there at the meeting, as a matter of

    fact, later, we reported this first case in detail, because the fellow was still living and

    doing well, you know, and we had now good evidence that he survived a long period of

    time. That's why we decided to report him. That's probably the reason we delayed

    doing a formal presentation of it, and you know, in the final analysis, I don't think we

    deserve all that great a credit for having done the first one. It was an accident! You

    know? I think the most important thing to point out about this, was the fact that we
                                                                                      Page 88


were doing experimental work and if we had not been doing the experiments, we

wouldn't have thought of doing it in the end. Which I think emphasizes the importance

of doing experimental work, in the technical area that you are in. You know? I think

that's about as good an example as you can provide for the usefulness of animal

laboratory experimental work.



LWS: Yes, I think that's right. Let me ask you about an area where you were not only

a pioneer, but a leader, mechanical assist. How did you get interested in that?



MD: Well, I tell you, that really came about, largely through our earlier experience with

the heart-lung machine in patients in whom we were having difficulty getting off the

machine. And so we'd carry them on (keep them on bypass) you just hated to give up.

We had nothing else to do. We had no intra-aortic balloon. We had no assist device.

Counterpulsation was just beginning to be thought of. There was no question in our

minds, because of the fact that a small percentage of the patients who you carried on

beyond, say, the usual time, we'd finished the operation, we'd finished the a valve

replacement or whatever it was, and patient was trying to be weaned off, and he

couldn't be weaned off. And so we'd carried him on with the heart-lung machine for

another hour, two hours, and a small percentage would recover. So it became apparent

to us, that supporting that heart for a short period of time, allowed some of them to
                                                                                       Page 89


recover, maybe if we supported their heart for a longer period, some of the others

would recover. You see? We didn't have enough knowledge about what was happening

to the myocardium at that time.

       Willem Kolff had already published some experiments in which he was

developing an artificial heart when he was at Cleveland Clinic. You see, this goes back

to, oh, about '50...'59, something like that. '60. So we decided, well, why don't we start

doing some experimental work in the animal laboratory on an artificial heart. At first,

we were following to some extent what Kolff was doing. Then it occurred to me, what

we need more than anything else is some kind of an assist device for the heart, which

would prolong the assist to the heart longer than the heart-lung machine does. You see,

after we had started following what Kolff was doing, I said to my assistants in the

laboratory, "You know, that isn't quite what I'm interested in, although if you want to

continue to work on a biventricular device fine, but," I said, ''what I'm interested in is,

primarily, is a single ventricle to act as an auxiliary to assist the left ,ventricle. You

know, support it for a longer period of time than the heart-lung machine can do it."



LWS: Yes, the heart lung machine is good for a couple of hours or so at the most.



MD: Some of these cases might do well if you could demonstrate the usefulness of this

assist for a few days to a few weeks and maybe the patient will survive. If the heart is
                                                                                        Page 90


already putting out one or two thousand cc's per minute the patient won't survive, but if

he puts out three or four thousand cc's per minute by adding another couple of

thousand with the assist device, the patient will survive and maybe time will tell (leave

the hospital). So that was the concept. And so that really was the start of a whole

concept of LVAD, left ventricular assist device.



       We began to modify our experimental approach to a single ventricle. We started

off by putting a valve at each end of a balloon structure, where you have a rigid outside

cavity and an inner balloon type cavity which you then compress it with the valves

determining the direction of flow.



       It's interesting that we had hardly gotten this thing developed in a few animals

where we could show that it worked, when we had a patient who had to have an aortic

valve replacement, and then shortly after that had. a cardiac arrest. And then was

resuscitated. The heart started beating again. It was beating very poorly and we

decided to put this in. Unfortunately, we didn't realize at the time, that he had brain

damage from the cardiac arrest, but we did demonstrate by putting this in, that his

congestive heart failure dissipated shortly after the arrest, within, something like,

between 12 and 24 hours. So, you know, we restored it. Unfortunately, he never

regained consciousness. He died ultimately later of a brain death. We published that
                                                                                    Page 91


report. We felt that was a good illustration clinically for the first time that an LVAD

had some value. So then we continued to work experimentally in animals.

       In 1966, we had a Mexican lady, who came in with mitral and aortic valve

disease. Ver:y severe. In fact, she came in with congestive heart failure. Ver:y sick.

Poor heart. And we decided that the only way to save her life was to go ahead and

replace her valves. We realized, you know, how sick she was. The cardiologist said,

"You know, there is only a 50/50 chance of coming through this." And we explained all

that to the family. They all knew that, so when we got through (explaining the

procedure and risks to the family), I said to them, "You know, this may be the first case

to use this on (assist device)." We'd been doing it (research) in animals. So, when I

finished, she wouldn't come off it (the heart lung machine), we tried to wean her off

over an hour, two hours, and I said, "You know, we can't continue this. We'd better go

ahead and get the LVAD." So we did. And, as you know, 10 days later, we reported

that she completely recovered.

       She was ver:y interesting, in a way, experimentally too, because after four or five

days, when we gradually began decreasing the LVAD, on one occasion, we obviously

decreased it too rapidly and she went into heart failure and urine output decreased, and

the blood pressure dropped, so we had to go back up (on the machine) very quickly.

Without doing anything, no medication of any kind, we brought the pressure back up,

the patients (end diastolic) pressure came down, we were monitoring all this. Within a
                                                                                     Page 92


matter of minutes, urine output started. And her lungs cleared up. It was a beautiful

illustration, experimentally, in a patient, clinically, what you can do by changing the

amount of blood flow.



LWS: You know, with that successful case, you must have thought that it was just

around the comer until the time that there would be devices for· general clinical use.



MD: As a matter of fact, yes, and you know, we actually had the Hewlett Packard

people make one. We thought it was going to be a very useful and common procedure.

We didn't fully appreciate the fact that this was an operative procedure. Another

operative procedure. And only occasionally, we would have the situation, exactly like

this one. It became clearly obvious that you needed a simpler way of doing this.

       Shortly after that, the intra-aortic balloon became available. In most of the cases,

with the intra-aortic balloon, we had exactly what we needed. You see, this made this

procedure less needed, however, we continued. I personally continued to believe that

there would be patients who, and we now know that there are, patients who, the intra­

aortic balloon wouldn't be helpful for. You have to go to LVAD to assist and we've

had that experience. Now, of course, we, we're using more and more centrifugal

devices, simpler devices. We continue to work in this field experimentally. Yuki Nose

has joined us in the last couple of years from Cleveland Clinic. He's one of the
                                                                                     Page 93


outstanding experimenters in this field. So we are still working in that field. Now I

think, in time, we'll probably have an LVAD device that we can implant with its own

energy source. It's really just around the corner from that right now. The people in

Stanford have one that they've used experimentally quite well, and we hope to be

collaborating clinically. Of course, it's obvious that this concept is established now. The

work that you have initiated and developed, really is another mechanism which,

hopefully will be a better mechanism in time for clinical application .... for this whole

concept. But I think the concept itself has .been pretty well established. And that is you

can get recovery in some patients by assisting them. And... perhaps more importantly

along the lines of your development is that you can improve the cardiac output using

human tissue, which would be so much better.



LWS: Let me ask you something else. Here you are the chairman of one of, if not the

most important world centers for heart surgery, vascular surgery and all of the sudden in

December of 1967, you hear on the news that there's been a human to human heart

transplant, and it's successful. What was your reaction? What were you doing when

you heard the news? Were you driving to work or what?



MD: I don't remember exactly what I was doing at the time. I think I was in the

hospital. But in any case, you know, it wasn't as surprising as it may sound now. The
                                                                                   Page 94


reason was that Norm Shumway had been working on that at the University of

Minnesota. I had gone up there on a number of occasions. Owen Wangensteen, who

was very kind to me had invited me up. I used to stay in his home. So I was familiar

with what Norm Shumway was doing in the lab, and on one occasion when I was up

there, Norm Shumway said to me, "You know, I going to suggest that it's time to start

doing (heart) transplants in humans soon, which is going to be published in JAMA"

       Now at that particular time, you know, he was the leading exponent,

experimentally, but we were doing experiments in the lab too, dog transplants, following

his work. There was nothing original about what we were doing. We were following

him. So, we were sort of waiting, in a way, for him to do it clinically, before we would

do it. Because we thought that he had a lot more experience than we had, and

secondly, we weren't quite sure enough of our need to go ahead in humans. When

Christiaan Barnard did this, he did it on the basis of what he saw, just passing through,

visiting Norm Shumway. He knew what Norm Shumway was saying, like we did. "We

really ought to go to humans."

      Now I know a little bit about the story of what happened to him (Barnard) when

he got back. He really rushed back with the idea that he wanted to do this. Now he

had experimental experience in doing it. The professor of medicine at that time, was a

man by the name of Covington who later. moved to England and became the president

of the Royal College of Physicians and a good friend of mine. I know him very well.
                                                                                   Page 95


And, actually, subsequently was knighted and became Sir Ray (?). Anyway he tells the

story himself. He was a professor down there at the time that Christiaan Barnard came

back, full of excitement about doing a heart transplant. They were sort of kidding about

this, you know, because it was sort of way out for them. After all, there was no

experimental work that they were doing to support it. When they were making rounds

they passed this patient who was in heart failure. He said, "Well, you know there's

nothing else we can do for this fellow, except a heart transplant." He did it kiddingly, in

a way, saying, you know, it's a hopeless situation, no medical treatment could do any

good. Not fully appreciating the fact that somebody told Christiaan Barnard what he

said. So Christiaan said, "You know, we need to find a donor for this fellow." It so

happened that shortly after that, a donor did come in. You know? You remember that

the first case died. He (Covington) said they were all so shocked that he did this.

Based upon a comment that he made which meant really that it was a hopeless

situation.



LWS: So he (Barnard) got the jump on Norman on that one.



MD: Our reaction to this was, well, this makes it possible for us to go ahead. We saw

it going in. So we began to gear up to do it clinically, you see. So I think the

contribution that he (Barnard) made, despite the fact that he doesn't deserve credit for
                                                                                    Page 96


thinking of it or for any background work. Norm Shumway is the one who deserves that

credit. Still, he precipitated the clinical application which allowed everybody to get

started and go ahead and do it clinically. And that's what happened. As you know, the

results weren't very good, initially. Many people like ourselves began to back off from it

a little. Norm deserves even· further credit, because he persisted in finding ways and

means of controlling rejection. In a way, stimulated the need to find other methods of

controlling rejection, including biopsy and so on. That put us all back into it again.

You know.



LWS: In 1969, you became the president at Baylor Medical School in addition to being

the department chairman. Any comments about that?



MD: That happened because at that time we were a part of Baylor University. Baylor

University was under the influence of Baptist and was supposed to be supported by the

Baptist Foundation, and therefore had to follow some of the rules of the Baptist. A

new chairman of the board had been appointed of what they called the executive

committee of the board for Baylor. Baylor University is in Waco. Baylor College of

Medicine is in Houston. So they had to have a board in Houston which they called the

executive committee. The chairman of that board was a little napoleonic complex-type

fellow, who became more and more autocratic about the operation of the school, and
                                                                                    Page 97


finally clashed with the dean, who resigned. Then the professor of medicine was asked

to be the dean, and his brother was a professor of medicine, and finally he clashed with

him and was also forced out. In the meantime, the situation was getting critical

financially, we were in a terrible deficit, and there was no way of getting the money,

largely because most of the people thought of the College of Medicine as being part of

Baylor University, they said it's up to Baylor to take care of it.

       In the meantime, of course, we were running our own department and

contributing to the school and he knew that. So he started putting pressure on me

about giving more money, and saying, "You can have Methodist Hospital give you more

money. You're making a lot of money from Methodist Hospital. Make them give you

more money." I said, "Well I can't do that. If you want to do that, you do it." So I

stood up to him and all the faculty knew that he and I were clashing, but I didn't give a

damn, you know, because, if he wanted to close the school, I had my own practice. So,

when the second dean left, by that time morale of the school was way down. We had

lost 7 chairmen. They began to leave like rats on a sinking ship. He appointed a

committee of the faculty as a search committee. And that's when he made a great

mistake, because they came to see me and said, "Mike, you are the only one who can

rescue us from this situation." I said, "You know I don't want to be a pain. I'm not

mean, I'm a surgeon." And, they said, "That's the only way we're going to rescue the

college. You're the only man who can stand up to this fellow and there's a lot of
                                                                                     Page 98


changes that need to be made." So I said, "Well look, if you want me to take the job,

I'll do it, on the basis that I remain head of the department of surgery because, we have

too much money invested, and we need the department of surgery." You know, we

were giving the school several millions of dollars each year. In addition we were

running our department. And they accepted that. So they sent the report to him. He

of course, didn't like that report.

       He told the board of trustees, when they asked him about what was going on,

what to do. He said, he hadn't gotten the report. That's when he made a big mistake,

because, he then set up another committee. A different committee. One of the

members of our faculty was on that new committee. He came to see me one day. He

said, "My God, what's going on?" He said, "There's something fishy going on, and I'm

worried about it." I said, "What's the matter?" He said, "Well, we had already sent him

a report. And now, he's set up another committee, and now he's looking for someone

else to be dean." He said, "They're also·· making remarks about you. He's bringing

people in to make remarks about you and your character."      I said, "What do you

mean?" He said, "Well, they're trying to assassinate your character." I said, "How?" He

said, "Well, they're saying that you're running around with a nurse, and that you are not

honest in your work."    By that time, I was getting madder and madder.

      This was on a Sunday afternoon. I had called Leon Jaworsky, who was my

lawyer, but also a very prominent man and also prominent in the Baptist hierarchy. I
                                                                                     Page 99


called him up, I said, "Leon I got to see you right away." I went over to his house and I

told him the story of what was happening, and I said, "I would like for you to begin a

suit against this man." I explained to him what was happening. But he said, "Mike,

just tell me one thing. Is there any truth in this?" I said, "Of course not, that's why I

want to sue him for everything he's worth." He said, "Well Mike, will you let me handle

it?"   I said, "Sure, that's why I'm coming to you." He said, "Let me see if I can avoid a

suit. If we are going to sue," he said, "it's going to be publicized, the College will be

harmed." He said, "You don't want that." I said, "No, I don't want that, but," I said, "I

certainly don't want my character to be assassinated, either." So he said, "You said that

this committee sent him a report." I said, "Yes." So he called me up the next morning,

he said, "Mike, I just talked to several members of the board. They tell me that he has

already met on one occasion and told the board members that he hadn't gotten a

report. Can you get me a copy of the report?" I said, "Sure." I got a copy of the

report and the date was there. The date was preceding this last meeting of the board,

so I caught him in an absolute lie. He called this fellow up. He said, "Look, DeBakey

is ready to sue you, for everything you got." He said, "I'm trying to avoid this. I think

the best thing for you to do is just resign. Quietly get out of here." (laughs) And that's

what resulted in my having to take over.

       The year I became the dean, I called up the president of the university, a good

friend of mine. I said, "You know, I need your help. We need to get out from under
                                                                                   Page 100


the university. If we continue to operate under the university, this deficit will never end.

We'll never get the money." He knew we couldn't get the money. lsaid, "We need a

new board of trustees, representing the whole community, so we can talk to people who

are wealthy, well-to-do, and get contributions, foundations, and so on." He helped me

to develop the rationale for it, because the Baptists were jealous of the college. You

know they weren't helping. There were four ministers on the board, and we went to

each of these four ministers. We got the support of the senior one and he got the

others. He said to me, "What about these other laymen?" I said, "Don't wony about

them. We won't get their support anyway. We don't need it. We got four ministers at

the foundation. We'll bring it up, pass a resolution, that'll be it." That's what they did.

We got out from under it as a consequence. We went to Austin, and we got a new

charter for the· college and a new board. The first year after that our board raised $33

million. We went on a $30 million campaign. We got out from under the deficit. We

never have had a deficit since.



LWS: How did you then become the chancellor in 1978?



MD: I felt that it was time. I think we were pretty stable. We stabilized things after

10 years or 12 years. I said to the board of trustees, at the meeting, "I want to bring up

a matter that has been on my mind for some time. And that is, I think it's time to get
                                                                                  Page 101


a new president. I'm involved in surgery, but you know, the school has grown a great

deal, and it really needs somebody who can give more time to it than I can give to it.

It's time to get somebody to take it over." I recommended a man who I had put in as

my executive vice president, who had been with me, actually, I brought him down from

the NIH when we started the transplant program, because he was an immunologist, and

a very good one. He continued the work as professor of immunology, but he was also

doing part-time work as vice president and really carrying on the day to day operations.

And doing a very good job. They finally accepted my request to be relieved of the

presidency. That's when they created this. They said, "You know, we'd like for you to

continue to have some role in the college's administrative leadership." I said, "Well give

me a role as an advisor or something." They said, "We'll make you chancellor. Then

you can do anything you want." (laughs) That's why they did that.



LWS: There was a question that I meant to ask you earlier. When you moved from

New Orleans to Houston, was there any problem getting the family to move?



MD: No. You see, my children were small. In fact, my last child was born in Houston.

The last boy. Before my first wife died. As you know, my first wife died about 20 years

ago and I remarried about 16-17 years ago. I have a fourteen year-old girl now. But

my children were very small then.
                                                                                  Page 102


LWS: Did your wife want to move?



MD: She was (willing to go) anywhere I wanted to go.



LWS: Where was she from?



MD: She was originally from Tennessee, but she had come to New Orleans and

became a nurse at Tulane and was a sort of a nursing instructor. We met at Tulane.

Then, after I came back from Europe, you know I spent two years in Europe, we

reviewed our relationship, and finally got married. No, she was very happy to live (in

Houston) She just wanted be a family girl by that time. Her nursing career was gone.

She was taking care of the children. She was really happy, she had a happy time in

Houston. She made a lot of good friends.



LWS: I have a couple last questions to ask. One is, as a professor of surgery myself

and chief of a division, when I look at your curriculum vitae, there are many aspects of

it that are just mind-boggling. For example, the huge number of awards that you have

received, in my view, they are almost all major league. Is there any one award, or are

there any two or three or four or five that really mean more to you or are more

significant?
                                                                                  Page 103


MD: Yes. I think the (Albert) Lasker Award (for Clinical Research) was the one that

meant a great deal to me because you got to remember that's an award given by not

only your peers, but your peers in medical science, not just in surgery. Then I think the

award that I got from American Surgical Association (Distinguished Service Award) is

very meaningful because that comes from your peers in surgery.



LWS: They have given relatively few of that award.



MD: Four, five or six of them. At the time that I got that, I think I was the fifth one

that they gave it to in science. You know the awards like the Medal of Science and the

Medal of Freedom.. These are given by the president of the United States. They're

meaningful, but let me say in general, When you get an award that is coming from your

peers, people who you respect, it has much more meaning



LWS: And people you're competing with.



MD: Yes, if they think you deserve the award, you see, that means they have a high

respect for what you do. And that, I think touches you. Many of these other awards

are nice, don't misunderstand me, I don't want to seem too humble about it. The fact

remains that as you get an award, you can't dwell on it. You get it, and it's nice, you
                                                                                 Page 104


put it up and so on, and then you go on with your life. You see?



LWS: So those would be the two biggies.



MD: Yes. I would think that those would be the ones that touch me the most.



LWS: Another thing that is just mind-boggling is the number of publications that you

have had. Well over a thousand scientific publications.



MD: Well, you got to live long enough. That's the first thing. The second thing is that

you have got to like to write. And I do, you know. I remember when I was in college,

the professor of English, when I was taking English literature, said to me one day,

"What are you going to do?" I said, "Well, you know, I'm in pre-med. I hope to be a

doctor." He said, "What do you want to be a doctor for? You have a great talent for

writing. Why don't you stay in English literature." He said, "I have a place for you." I

have never forgotten that, you know. It was a very touching thing, to get that kind of a

compliment. But you ~ow, Larry, I began very early in life because my parents were

great believers in education, and they believed that you need a broad foundation in

education. So they stimulated us to learn broadly, literature and everything else, and we

were implored to read at least one book a week, that we could go to the library and
                                                                                    Page 105


select. One day when I came home, I said, "You know, Dad, I found a book at the

library that they won't let us rent (check out)."   He said "What's that?"   I said "It's

called The Encyclopedia Britannica." I said "It's a wonderful book." And he said, "Well

let's see if we can buy one. And he did. Do you know that there were five children in

my family. I was the oldest. We all went to college. Every one of us read the whole

thing before we went to college.



LWS: Wow.



MD: This was irt addition to our work. So when we would get through... in fact we

used to compete to get to the book, you know. My brothers and sisters would complain.

They would go to my parents saying that I monopolized it, you know. (laughs) Because

they wanted to read it. But you know, it brought the world to you, you see, the great

adventure. We were taught very early in life, and then I had good training in grammar

and language, in fact, you know when I was in college, I mean when I was in Medical

school, I made about $400-$500 a year just translating for the faculty members, foreign

journals.



LWS: Which journals did you translate?
                                                                                    Page 106


MD: Well, I translated French. I translated German. Articles for them. And, and

largely because I had courses and learned to read, and of course I also learned to speak

a little French because I grew up in a French community, but this sort of education was

not forced on us, but encouraged, you see. And so writing came as a kind of a thing

that I liked to do. And then in my research work, and so on, I was doing a great deal

of writing, and after a while I was writing articles and chapters and things of that sort.

So, instead of going hunting, I was writing. By that time, all these things that I had

done in my early years, like hunting and fishing and so on, really became unimportant to

me. My time was devoted to my work, my writing, all my hobbies have gone by, you

know. I had hobbies of various kinds. All of them disappeared, because I was more

interested in this, you see.



LWS: It became your main hobby.



MD: Right, you know, and that took up all my time. And fortunately, I am one of

these people, genetically, who doesn't need a great deal of sleep, I would come home,

have dinner and then I would sit in my study and read and write, until maybe 12 or 1

o'clock. And at 5:00 or 5:30 I was up again. See. So, I was able to use a lot more

time than the average person. Writing came usually more easily to me than I guess it

does to a lot of people. I could sit down and write what I needed to write and say what
                                                                                  Page 107


I need to say. Usually, I don't do a great deal of editing. Once it's done, it's done. I

mean, I go over it a little, but I just like to do it. You know, what you like to do, you

do well.



LWS: One thing that I was really impressed with, in talking to you during these several

sessions, and particularly today, was when I would ask you about some very significant

contribution you made, usually a first or where you were one of the pioneers, you would

immediately go back and start talking about the laboratory research that was involved.

That was the one point driven home. So you published all of these papers, many of

them are landmark papers. And a lot of them are just based on good research. If you

had to pick a couple of papers, maybe even one paper or a couple of papers that you

would say really made a difference to other people, are there a couple of papers you

would pick?



MD: I would think that the work probably that had the greatest impact in the early

days or even later, was the aneurysms of the thoracic aorta. Because we opened up

that whole field. And then you'd think of dissecting aneurysms, I mean up until we did

our first case with dissection, nobody would even touch a dissecting aneurysm. So, while

we learned a great deal, and others learned a great deal too, we did open the field, you

know, and I think that's the important thing. Once you open a field and get other
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people involved, and get them interested in it, the advancements in that field accelerate

tremendously by getting more people in it. I think that's the first thing. The second

thing, which has become more and more established and recognized, is the pattern of

occlusive disease. In '58 I published the first article pointing out that these patterns are

reproducible and that they constitute a very important basic relation for the surgery of

vascular occlusive disease. Now, at that time, that was 1958, most people in the field of

arteriosclerosis would talk about diffuse arteriosclerosis, and so it was, in a sense, a new

concept to think about atherosclerosis as representing segmental lesions with reasonably

good vessels, distal to the lesion that you could ·restore normal circulation into. That's

what made bypass worthwhile and endarterectomy worthwhile. I pointed out at that

time that these lesions occurred in very specific parts of the arterial bed.



LWS: Which really made them a target of the surgeon.



MD: Right. It made it a surgical target, that made it in a sense a surgical disease,

whereas previously the medical people were referring to as a hopeless disease, you see.

And I think that had a pretty good impact, fortunately. That has proven also to have

accelerated the field a great deal. It was in 1958 that we started this.



LWS: You know there's another area I think you made a big contribution, I'll give you
I   ..




                                                                                           Page 109


         a hint. When I look at some old magazines such as National Geographic from before

         World War II, you can see advertisements where there is a picture of four or five

         doctors smoking cigarettes looking at an x-ray. The add says, "Four out of five doctors

         prefer Chesterfield," or something like that.



         MD: Yes. (laughs)



         LWS: You were one of the people that made the connection early, and yet before

         World War II, there were cigarette ads with pictures of doctors smoking cigarettes.



         MD: Yes, I used to go to medical meetings and my God, you could cut the smoke.

         Well, I tell you, I have to give credit to Dr. Ochsner for that, and my father. My father

         was a great believer in smoking being a very bad habit and very bad on your health.

         He didn't connect it with cancer or lung or heart disease or anything like that. He just

         thought it was bad for your health. So we grew up as children, with the understanding

         that tobacco was poison for you.   So you stayed away from tobacco. When I got under

         Dr. Ochsner's influence, he apparently came from parents who also thought tobacco was

         bad, then he had translated this, medically, into being bad for peptic ulcer, and being

         bad for cancer of the lung.

               The way we got on to cancer of the lung was interesting. You know Evarts
                                                                                  Page 110


Graham had done the first pulmonary resection for cancer of the lung and we followed

through very quickly after that and wrote a number of papers on cancer of the lung.

Then we began to recognize that this was beginning to be a common disease when it

was formerly considered an extremely rare disease. I said, "What's happening? Why

was it all of a sudden increasing?" Dr. Ochsner immediately connected it with smoking.

During World War I when the soldiers were given Lucky Strikes for nothing, they all

came back smokers. So smoking became a very popular thing, and everybody was

smoking. He and I began to· relate the possibility of smoking being related to cancer of

the lung. And I'll never forget when he said to me, "I'm going to give a paper in St.

Louis," I think it was. And he said, "I need some slides on the relation of the incidence

of cancer of the lung and maybe something relating to the incidence of smoking." So it

occurred to me to write to the Department of, I think Labor, or Commerce, I've

forgotten which, one of them to get the statistics on the production of tobacco per year

for the last say, ten or fifteen years. And I prepared a slide on that with the incidence

of cancer of the lung, and the two curves were parallel. I said, "You know, this is good

evidence." (laughs) Dr. Ochsner went to the meeting and he presented the subject and

he came back and told me about it. He said, "Evarts Graham, who as a smoker at that

time, got up and criticized the paper very severely saying if we had taken the production

of nylon stockings, we would probably have found the same curve," (laughs) which is

ironic in a way, because as you know, Evarts Graham later changed his mind. He
                                                                                   Page 111


decided smoking was (bad), and as you know, practically died of cancer of the lung.

But, we were poo-pooed, we were ridiculed, in the very early days. It was only much

later that people began to appreciate the fact that there was some relation between

cancer of the lung and smoking. And certainly, heart disease. You know, smoking was

bad for your health. There was no question about it. We wrote the· first article. This

was, as you say, back in '39, something like that. In fact I was a resident at the time we

wrote the first article. Dr. Ochsner, I must say, deserves primary credit for calling

attention to it, and I fell in with him, right away, because you know, I came out of this

influence from my father, so I thought smoking was unhealthy too.



LWS: This is Dr. Larry Stephenson, professor of surgery at Wayne State University.

Thank you Dr. DeBakey. This completes this session of the oral history on Dr.

DeBakey for 1992. Thank you.



We have other sessions from 1986 and 1990.