Medicine: A Love Story
In this engaging autobiography, Dr Stollerman provides a unique and highly informative overview of the development of academic medicine during the 20th century. (Full disclosure: I came to know and admire Dr Stollerman when we sat together at Dartmouth Medical Grand Rounds during the past 20 years.)
The book begins when the author was cupped for lobar pneumonia at around 4 years of age: “Rinse the little cups in alcohol, then flame it off. Apply the warm cups to the chest quickly so that when they cool they create a vacuum and stick. Pull them off with a resounding ‘pop’ – not too painful and quite intriguing as you watch the welts rise under them.” The interest in medicine kindled by this experience was reinforced when, at age 15, his mother gave him a copy of Paul DeKruif’s Microbe Hunters, and his father an old microscope that “thrust me into the world of microbiology.” He attended Dartmouth College, where the “scene was poster New England”; here, the curriculum stimulated a “four-year growth spurt in learning the origins of human values [that provided] a firm basis for the science, ethos and ethics of medicine.”
As a freshman medical student at Columbia in 1941, he found gross anatomy “mesmerizing” and “reveled” in physiology. The following year, he was found to have a “remarkably high titer” of antitype I pneumococcus antibody and so was asked to donate blood samples that made him a “direct contributor to the … development of the pneumococcal vaccine” and “seeded the germ of vaccine research as my subsequent lifetime interest.” Descriptions of medical school and residency abound with fascinating anecdotes such as the cardiologist who “seeing the long stethoscope tubes we brought from the tuberculosis service, wielded a pair of scissors to cut them in half. ‘You can’t hear aortic insufficiency of syphilis or the tambour quality of the second sound without a short stethoscope ….’” He tells of the first patient he saw with subacute bacterial endocarditis whose life was saved with penicillin, and how a primitive dialysis machine consisting of sausage casings wound around a wash tub immersed in physiological salt solution was used to remove urea from the blood of a ship builder who had been exposed to carbon tetrachloride.
Dr Stollerman’s monumental work on prevention of rheumatic fever (RF), then the major cause of heart disease, began in 1949 when he was a research fellow in microbiology at New York University. Here he studied the possibility that RF, which at that time was “strongly suspected of being a complication of strep throat but nobody knew how the bug caused the disease …,” was caused by antistreptolysin antibodies. This work, along with his clinical skills, led in 1951 to his appointment as medical director of Irvington House, a hospital designed to care for children with RF. Treatment of strep throat with oral penicillin had previously been shown to prevent RF, but many children had difficulty completing the needed treatment because the short half-life of the early preparations required daily dosage. Taking advantage of a method he developed to measure small amounts of penicillin, he injected himself with 600 000 U of a new, long-lasting benzathine penicillin G and noted that in addition to “a moderately sore behind …, to my astonishment I detected small amounts of penicillin in my blood for at least two weeks.” This led to a study of 145 patients with RF who, after receiving monthly injections of benzathine penicillin G, had neither recurrent strep throats nor increases in antistreptolysin. In addition to providing a practical way to prevent RF, the long-acting penicillin was to revolutionize the treatment of syphilis, which at that time required frequent injections of short-acting penicillin and heavy metals.
Typical of the many anecdotes in this book is the story behind a major lecture on RF, given in the 1960s when Dr Stollerman was suffering severe back pain caused by herniated lumbar discs. His understanding of pathophysiology led him to conclude that his pain was caused by nerve irritation from collagen squeezed from the nucleus pulposus rather than nerve compression; “by the way,” he notes “pressure on nerves … usually numbs them, a simple well-known form of temporary anesthesia!” Accordingly, he refused surgery but instead took corticosteroids and opiates. He then gave his lecture in the Anheuser-Busch opera house in St. Louis, where, “following a flattering introduction, I was sufficiently euphoric and pain-controlled to approach the lectern steadily, to look around me slowly, and to exclaim, ‘I have an overpowering urge to sing the prologue from Pagliacci! But you will be pleased to know that I have overcome it!’ That brought the house down, relaxed me completely, and I delivered a well-prepared oration ….”
In 1955, Dr Stollerman accepted an assistant professorship at Northwestern University in Chicago, IL, where he directed a research laboratory that had been endowed to study RF. Here he sought to determine why some but not all strep throats were followed by RF. Stimulated by an earlier observation that virulent colonies of group A streptococci isolated from mice had phagocytosis-resistant hyaluronate capsules that formed “oily” mucoid colonies on blood agar plates, whereas less virulent streptococci lacked a capsule and formed opaque (“pearly”) colonies, he examined streptococci isolated from Chicago children and confirmed that virulence depended in part on the capsule. This suggested that rapid passage of the bacteria between hosts in overcrowded living conditions had contributed to the high incidence of RF before the mid-20th century by maintaining the capsule and that subsequent improvements in sanitation reduced the incidence of RF when decreased passage of streptococci attenuated the capsule.
Although his reputation as a basic scientist had been established, Dr Stollerman remained committed to a career that included patient care because he “loved teaching medicine, contact with patients, and the organization of health care.” In 1964, therefore, he accepted the chair of the department of medicine at the University of Tennessee, a huge job where he was to become a leader in American academic medicine. He was an early advocate for training primary care physicians in a division of general internal medicine, as well as for the establishment of a geriatrics subspecialty. As chair of a department of medicine, he automatically became a member of the Association of Professors of Medicine. He describes his first meeting in 1965 as “a dazzling experience. A peer of the realm, What was I doing sitting next to, and chatting with, my most admired medical heroes and role models.” One of his talks to this group described an “administrative council” he formed to help run the large department at Tennessee; this “touched some sensitive nerves,” led several of his colleagues to adopt this model, and, he suggests, might have led to his becoming president-elect in 1974. The same year, he became president of the Central Society for Clinical Research, and in 1975, he published his monograph, Rheumatic Fever and Streptococcal Infection, events that were to represent “the zenith of my academic career.”
In 1981, Dr Stollerman retired from the chair of medicine at Tennessee to become a University Professor at the Boston University School of Medicine, where, as an “influential, senior, old-fashioned-clinician-role-model,” he focused on geriatrics and health services research. However, he soon became chair of the General Medicine Division. Eight years later, he moved to the Edith Nourse Rogers VA Hospital in Bedford, MA, to lead a new division of geriatrics. Here, in 1991, at the age of 70, he developed a large grant for a Health Services Research & Development Field Program that he directed until his final retirement in 1995. He then returned to Hanover, NH, where he remains active in outcomes research, a much sought after teacher in the Institute for Lifelong Education at Dartmouth, and one of the wise attendees at Medical Grand Rounds.
Dr Stollerman writes with a warm style that makes it difficult to put down his book. However, the book is lightly edited, contains many typos, and lacks an index. These might bother some compulsive readers, but I found the misspellings and punctuation errors contributed to the charm of this autobiography. Most important, this authoritative yet personal narrative captures the excitement and spirit of the remarkable evolution of academic medicine during the second half of the 20th century.
I know and admire the author of the book reviewed; I have no other disclosures.
Arnold M. Katz, MD
Professor of Medicine Emeritus, University of Connecticut
School of Medicine
Visiting Professor of Medicine and Physiology, Geisel School
of Medicine at Dartmouth
Visiting Professor of Medicine, Harvard Medical School
- © 2013 American Heart Association, Inc.