Tag Archives: COM

Community Medical School Launches Spring 2014 Series, New Schedule

 

Now entering its 16th year, the Community Medical School program launched its Spring 2014 lecture series with a new schedule – the first Tuesday of each month – on Tuesday, April 1, 2014 with a presentation by Garrick Applebee, M.D., assistant professor of neurological sciences, on “More Than a Snore: Causes, Treatment and Risks of Sleep Apnea.” The lectures take place from 6 to 7:30 p.m. (including a question-and-answer session) in Carpenter Auditorium in the Given Building at the University of Vermont College of Medicine.

A joint program between the UVM College of Medicine and Fletcher Allen Health Care, Community Medical School features lectures by the top faculty experts who teach and inspire the next generation of physicians and scientists at Vermont’s academic medical center. Each presentation reviews a current medical science topic in an easy-to-understand format, including informational handouts and a question-and-answer session following the lecture.

Upcoming Spring 2014 lectures include:

May 6: Personality or Mental Illness? Understanding the Links between Traits and Disorders
David Rettew, M.D., Associate Professor of Psychiatry.

June 3: Digestive Detail: The Role of the Gut Microbiota in Health and Disease
Peter Moses, M.D., Professor of Medicine; Rebecca Wilcox, M.D., Assistant Professor of Pathology; and Jessica Wood Crothers, M.D., Instructor in Pathology

July 1: Hitting a Nerve: The Triggers of Sciatica
Bruce Tranmer, M.D., Professor of Surgery

Community Medical School lectures are free and open to the public, but registration is requested. To register or learn more, call (802) 847-2886 or visit Community Medical School online. Visit the Community Medical School Archives to view presentations and materials from previous semesters.

photo by Raj Chawla

The UVM College of Medicine 2012 Alumni Reunion

The UVM College of Medicine 2012 Alumni Reunion is scheduled for Friday, June 8 through Sunday, June 10. Registration Headquarters and Hospitality open at noon on Friday in the Health Sciences Research Facility (HSRF), Room 200. The Dana Medical Library is included in the Tours of the College of Medicine, scheduled to begin at 1:00 pm at the Hoehl Gallery in HSRF. Visit the Reunion 2012 Home Page for more information.

Scientific Journals & the UVM Connection

An exhibit highlighting the contributions of UVM College of Medicine faculty to scientific journals is now on display at the Dana Medical Library.  “Scientific Journals and the UVM Connection” spotlights former and current COM faculty members serving as Editors-in-Chief or Associate Editors of a biomedical journal. The exhibit also includes information about the history and publication of the first scientific journals, dating back to 1665.

Come visit the Library to check out the display and read about the accomplishments of our faculty.

The Miracle and the Martyrs

Portraits of Lawrie B. Morrison, M.D. (at left) and Walter Dodd, M.D. (at right) from the classes of 1902 and 1908, respectively, overlay a late 1890s cyan print of a glass-plate radiograph of Dodd's hands. Dodd became an early expert on the newly discovered X-ray process while working at Massachusetts General Hospital. This X-ray was taken as part of the effort to determine what was causing burning and severe pain in Dodd’s hands. It would later be determined that the culprit was the excessive amount of X-rays to which Dodd (and Morrison) subjected their hands and arms. Both men would undergo extensive amputations before succumbing to cancer.

By Sarah Zobel

At a professional meeting of roentgenologists in 1920, a chicken dinner was served. Soon after the plates were set down, it became apparent that few of the attendees were able to enjoy the meal. After years of working with X-rays, so many had lost fingers or hands to radiation-induced damage that almost no one was able to cut the meat by themselves. Among them, perhaps, were some of the men who would forever be known as radiology martyrs.

Two who earned that unfortunate sobriquet had significant ties to the University of Vermont College of Medicine and in their short lives left a definitive mark on the field of radiology: Walter James Dodd, M.D., of the Class of 1908, and Lawrie Byron Morrison, M.D., who graduated in 1902.

On a Friday afternoon in November 1895, German physicist Wilhelm Roentgen was working in his laboratory with a Crookes tube — a glass bulb with the air evacuated from it and two or more electrodes sealed inside — connected to an electrical induction coil. The room was dark and the tube was covered with black paper because Roentgen hoped to measure the rays coming from it. When Roentgen switched on the electrical current, however, this cathode ray tube cast a glow on a screen coated with barium platino-cyanide that lay a few feet away. Through further investigation, Roentgen would determine that a new kind of radiation was emanating from the tube. In addition, he observed that the rays passed through most substances, including soft tissue, but not certain metals and human bones. He termed this radiation “X-rays” because its source was unknown to him. Days later, Roentgen took his first photographic X-ray: his wife’s hand, her wedding band and bones easily discernible. Though she was horrified by what she saw as a visible reminder of her mortality, others were more appreciative. In a matter of months — before it had been fully tested and understood — the X-ray would become both scientific tool and entertaining curiosity worldwide. To the medical community it seemed a miracle — where definitive internal diagnosis had required risky surgery, a simple machine could now supply the view. For his work, in 1901, Roentgen received the first Nobel Prize in physics.

Walter James Dodd, M.D., of the Class of 1908 was sent to Boston from his home in London in 1879 at age ten, soon after his father’s death. Dodd was raised by his sister; when he was old enough to work, she made it clear that she thought it a poor choice for him to follow his plan of going to sea as a coffee and tea merchant. So Dodd’s Sunday school teacher recommended him to her cousin, Harvard University’s President Charles Eliot; Eliot found Dodd a position as assistant janitor in the Boylston Chemical Lab at Harvard, beginning in 1887. In the lab, Dodd was expected to clean, but he asked permission to also be allowed to prepare materials for chemical experiments.

At the same time, Dodd began attending lectures in chemistry and qualitative analysis, and in 1892 he was appointed assistant apothecary at Massachusetts General Hospital (MGH), advancing to the chief’s position within two years. The apothecary’s work required the filling of prescriptions, but he was also the hospital’s official photographer of “interesting” people, whether dead or alive.

In early 1896, reports of Roentgen’s discovery reached MGH, and Dodd immediately set about conducting experiments to produce radiation. Within a few months Dodd constructed a machine that took the first X-ray exposure in an American hospital.

Not long after, by the autumn of 1896, Dodd had begun to suffer the effects of radiation exposure.

Class of 1902 member Lawrie Byron Morrison was born in Barnet, Vermont, in 1875, one of 12 children. His path to medicine was less circuitous than Dodd’s: he graduated from Peacham Academy and went directly to the University of Vermont, where he earned both undergraduate and medical degrees. After training in Philadelphia and Montreal, Morrison returned to the university as instructor in embryology, histology and pathology. In short order, he was appointed medical director and assistant superintendent of the Mary Fletcher Hospital.

Dodd, meanwhile, had been advised by his colleagues at MGH that he would never enjoy the prestige and respect accorded physicians and surgeons unless he, too, had a medical degree. In short order, he enrolled at Harvard Medical School, but left after one year because he was too distracted, constantly sought out for his expertise in radiography. He transferred to UVM, where he hoped he would be far enough removed to be allowed to focus on his studies. Not one to rest, he continued to serve as pharmacist at MGH during that time, even as he was elected president of his medical school class. After graduating, Dodd was formally appointed roentgenologist at MGH, making official what he had been doing for years. He also joined forces with George Holmes, M.D., to establish a private radiology practice on Beacon Street.

At UVM, Dodd had studied under Morrison. Yet the student was also the teacher: during that time, Dodd ignited Morrison’s interest in radiology, and helped him install the first X-ray equipment at Mary Fletcher, where Morrison was then appointed radiologist. After Dodd returned to Boston, he invited his former professor to join him in his practice, and in 1914, Morrison left for Boston. He was one of the few radiology pioneers to enter the field as a physician rather than as a physicist, an engineer, or a photographer.

Dodd is recognized for his importance in the field of early American radiology. Though his name is less familiar, Morrison’s contribution to the emerging field was no less significant. After moving to Boston, he went on to establish radiation centers at several Boston-area hospitals, including New England Deaconess (now Beth Israel Deaconess), New England Baptist, Faulkner, Robert Bent Brigham (now part of Brigham and Women’s), and Corey Hill. He focused his extensive research career on osteocarcinoma, the calcification of vessels in diabetics, and the role of radiology in the diagnosis of colon cancer and hip disease. Perhaps most important, he was the first radiologist to show a hiatal hernia in the esophagus and stomach through use of an X-ray and contrast medium.

As with so many scientific discoveries, the early reaction to the development of X-rays was exaggerated. Physicians, of course, were eager to use them as both diagnostic and treatment tool, but they weren’t the only ones who fell prey to “roentgen mania.” Department stores installed machines to show the bones in customers’ feet, so that employees could be sure new shoes fit properly. Cranial X-rays were suggested as a means to cure criminal behavior, as well as a way to reform drunkards and smokers. Medical schools talked of using X-rays to reflect diagrams directly ontostudents’ brains, in the hopes of creating a more lasting impression than traditional methods of learning. One experimenter claimed that he had caused a dog to salivate by projecting an X-ray image of a bone on its brain, and there were rumors of someday using X-ray glasses to see through women’s clothing. But medicine reclaimed X-rays when the novelty abated, particularly when negative side effects began to be routinely reported.

Complications from X-rays were observed from their earliest use — published reports of hair loss after prolonged exposure to X-rays appeared within weeks of Roentgen’s discovery. In 1896, there were nearly two dozen reports of skin damage related to radiology — redness, itching, drying, and blisters on exposed hands, arms, and face. Thomas Edison began experimenting with X-rays shortly after Roentgen’s discovery. Most of Edison’s lab work was actually performed by his assistant, a former lightbulb glassblower named Clarence Dally. Dally became the first American to die of radiation exposure in 1904, a development that shocked Edison into abandoning all X-ray research. Later that year, the first American radiologist died from related causes. The speed with which burns developed into metastatic epidermoid carcinoma startled the medical community.

Because a great deal of the early X-ray equipment — like Dodd’s and Morrison’s — was homemade, the dangers of X-rays were magnified. And even those that were not homemade tended to be unreliable, producing radiation that was intermittently too weak to be effective and then strong enough to irradiate people in nearby rooms. Physicians worked with a variety of tubes, depending on what they needed for a given patient. Gassy tubes had less penetrating rays, and could be used on less dense parts of the body; to look at the abdomen, however, they needed to use better-evacuated tubes, which produced more energy and emitted powerful rays. These tubes were not enclosed when in use, which exposed both doctor and patient to their rays. The seat-of-the-pants approach to the new technology only added to the risk. One early X-ray therapist said that because dosages were uncertain and results capricious, the best one could do was put a patient on a table under the machine and hope for the best. Patients were often burned from inaccurate doses, and occasionally even electrocuted.

Radiologists were learning as they went, in many cases unaware of the dangers of their procedures. In calibrating the fluoroscope used in daily practice, for example, they would pass their own hands beneath it, in direct exposure to the X-rays. Early fluoroscopes were worn like masks, and rays passing through or around them fell heavily on the user’s face, hands, and upper torso. Sometimes, to calm anxious patients, physicians would personally demonstrate how safe and easy the process was, taking unnecessary X-rays of themselves. Others did the same thing to amuse patients with the novelty of it all. Though there were many who suspected the risks, others operated under a false sense of security, wearing only leather, silk, or rubber surgical gloves as protection. And all kept up the innocent hope that a cure for radiation-related illnesses would soon be discovered.

Dodd suffered his first bout of dermatitis, on his face and hands, in 1896. He reported that the pain was “beyond description”; his skin appeared as though burned. Soon Dodd’s hands became so inflamed that he couldn’t sleep; instead, he covered them with a salve and gauze and walked the floor of the hospital pharmacy all night, hands held above his head. When the inflammation quieted down, after a couple of weeks, he would get back to work — until it recurred. In 1897, he received his first skin graft, but it was unsuccessful, and within five years, cancer had spread through his fingers. He began a series of what would eventually be 50 operations lasting an hour and a half to three hours each. During these procedures, bits of his fingers were removed, one piece at a time. He sometimes went to the operating table not knowing how much of his hands would be left when he woke up. Decisions were made by Dodd and his surgeon about how much to remove from each lesion-ridden hand, based on a given finger’s level of usefulness. Although it was burdened with a cancerous ulcer, Dodd kept his little finger as long as he could so he would have something to press against when using the X-ray equipment.

And still he kept working. In 1915, Dodd volunteered to serve with the Harvard Medical Unit attached to the British Expeditionary Forces in France. He was transported to the train station by ambulance, a wound in his upper arm and chest wall raw from a recent operation. It was reported of Dodd that despite his continued outwardly sunny demeanor, it pained him to go out in public, where people would inevitably stare. He dreaded going to the houses of friends, even, for a meal, since he was certain there would be some mishap with his food. Though he still frequently went to the theater, he would stand in the back, so as to be able to leave without drawing attention. A photograph taken in 1915, before Dodd shipped out from Britain to France, shows him sitting cross-legged, with his hands purposefully hidden behind one knee.

Morrison would suffer the same effects, losing his fingers a knuckle at a time, beginning with his left hand in 1929. In quick succession, his right hand was affected, and by 1931 his entire left arm had been amputated. Like Dodd, Morrison put off as long as possible any amputation that would affect his active practice.

Both men continued to practice medicine until close to their deaths — Dodd’s in 1916 at age 47 and Morrison’s in 1933 at age 58, of generalized pulmonary metastatic disease.

One might wonder why these men continued to expose themselves to radiation, even when there had been concern as far back as 1896 about doing so. In the first few months of roentgenology, reports of alopecia, erythema, and skin lesions had been shared by doctors who implored practitioners to hold off until the action of the X-rays was better understood. But Dodd and Morrison, and many of their colleagues, were willing to suffer the consequences associated with their specialty in the name of science.

“I think that Dodd and Morrison were just too intrigued by the potential of this specialty to worry about it,” said John Tampas, M.D.,’54, former chair of radiology at the UVM College of Medicine. “Were they practicing a little self-deception? Probably to a partial degree, yes. There’s no question that these men had an utter disdain for any distraction that took them away from their totally fascinating work.”

One contemporary said that Dodd had won the respect of the entire MGH staff through his “careful, painstaking work and by his ever-willing self-sacrifice.” Some referred to him as a “roentgen saint.” Both Dodd and Morrison were willing models for their patients, many of whom were hesitant to undergo diagnostic or therapeutic X-rays until their doctors showed them how easy and painless it was. At the same time, the two men knowingly served as models for their colleagues in what not to do in working with X-rays, and as a reminder to take all available precautions.

They were far from alone. Roentgenology, it is said, was understood to be a field in which certain individuals were willing to suffer pain and disfigurement. Those so-called X-ray martyrs eventually earned international recognition. In 1936, a monument at Saint Georg Hospital in Hamburg, Germany, was dedicated to them. It is inscribed:

To the roentgenologists and radiologists of all nations — doctors, physicists, chemists, technicians, laboratorians, and nurses — who sacrificed their lives in the struggle against the diseases of mankind. They were heroic pioneers who made possible the successful and safe use of roentgen and radium rays in medicine.

The monument’s vertical stone shape is said to represent an amputated finger; the names of 350 individuals, including 40 Americans, are listed in alphabetical order on its faces, so as to downplay any one person’s importance over another. Walter Dodd’s and Lawrie Morrison’s names are among them.

It wasn’t until 1928 that X-ray safety guidelines would be issued by the International Congress of Radiology (ICR). They specified the amount of lead needed to shield X-ray tubes of varying voltages and even the necessary size, temperature and color scheme for X-ray rooms. But even those guidelines were inadequate, and the justifiable fear of X-ray exposure continued. As he lay dying in 1931, the elderly Thomas Edison provided his doctors with a detailed written list of his symptoms, but the Wizard of Menlo Park, who had watched his assistant die piece-by-piece so many years before, resolutely refused to submit to an X-ray.

By 1934 the ICR was prepared to issue revised guidelines based on decades of research and a better understanding of how even a seemingly small difference in doses could affect radiologists and patients. Those are the direct forebears of the standards that today protect radiologists in their work. In countless ways, two quiet, Vermont-educated doctors played a significant role in their evolution.