From Tulane School of Medicine to the U.S. Army, 1928-1946
DeBakey attended Tulane University--then known as "the Harvard of the South"--for both his undergraduate and medical education. The opportunities and mentoring he received there had an enormous influence on his subsequent career path.
His undergraduate zoology professor fostered DeBakey's enthusiasm for academic research. Impressed by his student's coursework and lab technique, he hired him as a student instructor and, later, lab supervisor. Even with this demanding part-time job, DeBakey finished his pre-medical courses at Tulane in two years instead of the usual three, entering Tulane School of Medicine in 1928. The medical school did not require that he finish his undergraduate degree work, but DeBakey got permission to finish this work concurrently with the first two years of medical school, receiving the BS in 1930.
In medical school, he worked for a professor who was researching arterial pulse waves. Asked to find or devise a pump that could modify such waves, DeBakey immersed himself in the engineering literature. He found several designs for roller pumps, which could propel fluid through rubber tubing held in a circular frame by pressing the tube with rollers, and soon built a small, hand-cranked version of his own. This worked well for his professor, but DeBakey realized that his roller pump would also be ideal for doing blood transfusions. At the time, transfusions were often done by collecting blood from the donor in a glass container, then quickly administering it to the patient, before it could clot. (Sodium citrate had been used as an anticoagulant for transfused blood since World War I, but it sometimes had severe side effects and many physicians preferred not to use it.) DeBakey's simple device made it possible to gently pump blood directly from donor to recipient, leaving less time for the blood to clot. And, having no valves, the roller pump did only minimal damage to the blood cells. DeBakey did thousands of transfusions for the New Orleans medical community using the pump.
At a medical meeting a few years later, DeBakey met John Gibbon, who was developing the first heart-lung bypass machine. One of Gibbon's chief problems was the pump he used, which tended to destroy blood cells. DeBakey suggested his roller pump, and Gibbon incorporated a motorized version of it into his second prototype in the late 1930s. Modified versions of the DeBakey pump are still used in modern heart-lung machines.
The Tulane mentors who had the greatest influence on DeBakey were Rudolph Matas (1860-1957) and Alton Ochsner (1896-1981). Matas, who retired as Chair of the Department of Surgery in 1927, was one of the outstanding surgeons of his time. William Osler called him "the father of vascular surgery" for his early work on peripheral aneurysm repair. He was also extremely well-read and had an extensive library that included a number of foreign medical journals, which he made available to medical school faculty. DeBakey made his acquaintance when faculty members asked him to borrow and translate some of these works for them. Matas was so impressed with his voracious and wide ranging appetite for knowledge that he was soon given free access to the collection, and to Matas' counsel. Alton Ochsner had succeeded Matas as head of the Department of Surgery, and quickly developed one of the best surgical teaching programs in America. Because Tulane didn't have its own hospital, the program was run from the New Orleans Charity Hospital. Ochsner was a pioneer in the surgical treatment of lung cancer and was one of the first to link lung and esophageal cancers to cigarette smoking.
DeBakey met Ochsner during his third year of medical school, and in his fourth year began working in Ochsner's surgical laboratory, investigating peptic ulcer. He was soon in charge of the lab, sometimes doing eight to ten dog surgeries each day. He loved the research and technical aspects of operating, and was easily persuaded to continue in surgery as Ochsner's intern and then resident. After receiving his MD in 1932, DeBakey did his surgical residency at Charity Hospital, gradually becoming Ochsner's collaborator. In 1935, he earned a MS for his research on peptic ulcers.
Matas and Ochsner both encouraged DeBakey to pursue postgraduate training in Europe for a year or two, as they had. (During the 1800s and early 1900s France and Germany were at the forefront of science and medicine, and ambitious American students included a year of study there when they could afford it.) Accordingly, he spent a year at the University of Strasbourg with René Leriche, a pioneer in vascular surgery, and a second year at Heidelberg with Martin Kirschner. Returning in 1937, he joined the Tulane faculty and continued his surgical research collaboration with Ochsner. They published a number of papers during this time, including work on lung cancer and pulmonary lobectomy. In 1939, they published an analysis of 86 cases that was one of the earliest mentions of the connection between smoking and lung cancer. (Unlike many physicians of that era, DeBakey himself never smoked; his parents had discouraged such habits and he respected their advice.)
World War II Service: The Surgical Consultants Division
When the United States entered World War II, DeBakey, like most young men, wanted to enter military service. Ochsner wanted to keep him at Tulane and initially declared him as "essential personnel," but then relented. DeBakey was immediately recruited to Surgical Consultants Division of the Army Surgeon General's office by his colleague Fred Rankin, who was then the Chief Consultant. Together with B. Noland Carter, DeBakey and Rankin were responsible for providing the Surgeon General with recommendations concerning all aspects of optimal care for the surgical needs of army personnel. This involved a wide range of activities, including the selection of personnel, organization, provision of facilities and equipment, and surgical policies.
The consultants discovered that the Army's medical branch was seriously unprepared for the war in many areas. Their immediate concern, however, was to find a way to get excellent surgical care for seriously wounded soldiers at the field and evacuation hospitals. As they traveled to these installations in Europe and the Mediterranean, they found that well-trained surgeons were in short supply. The few board-certified surgeons trained at accredited surgery programs were available only in designated Army hospital centers far behind the lines or back in the U.S. This seemed backwards to the consultants, because most of the seriously wounded could not survive evacuation to the hospital centers. DeBakey and his colleagues conceived the idea of organizing mobile surgical teams, each comprising a well-trained chief surgeon, an assistant surgeon, an anesthesiologist, a surgical nurse and two technicians. The teams--initially called Auxiliary Surgical Groups--were assembled by surgical specialty (General, Thoracic, Orthopedic, etc.) The first teams were deployed to the Fifth Army in North Africa, Sicily, and Italy in 1943. The careful records the groups kept demonstrated a dramatic increase in survival expectations. Though there was initially some resistance to this re-organization of surgical care, the Auxiliary Surgical Groups were in great demand by the time of the 1944 Normandy invasion. They were later renamed Mobile Auxiliary Surgical Hospital (MASH) units and became well known for their service in the Korean and Vietnam conflicts. DeBakey was given the U.S. Army's Legion of Merit Award for this work in 1945.
DeBakey's duties in the Surgical Consultants Division also included researching and drafting all of the Surgeon General's medical policy orders, as well as articles for Health, a classified publication circulated to medical officers. Knowing little of military medicine at first, he spent many hours in the Army Medical Library in Washington, DC. He became familiar with its wonderful collections and equally familiar with the inadequate, dilapidated building that housed the library. After the war, he became a key advocate for moving the library out of Army jurisdiction and into new quarters as the National Library of Medicine.
When the war ended, the Surgeon General's office faced a new challenge: tens of thousands of wounded troops were coming home, and the military had no place to care for most of them. There were only 97 Veterans Administration hospitals in the U.S. in 1945 and they were poorly equipped to handle soldiers needing neurosurgery, orthopedic procedures, plastic surgery, and rehabilitation. For the short term, many military patients were put in Army medical units within civilian hospitals. DeBakey stayed in service for an extra year, and convinced 100 other specialists to do the same, to handle this transition. Meanwhile, General Omar Bradley reorganized the Veterans Administration and its hospital network, working with Paul B. Magnuson, an orthopedic surgeon who had been DeBakey's colleague on the Surgeon General's staff. (Magnuson went on to serve as the VA's Chief Medical Director from 1948 to 1953.) DeBakey also encouraged permanent academic affiliates for VA hospitals, correctly predicting that research projects and affiliates, plus training programs, would attract better-qualified staff and raise the level of care at those hospitals.
The Medical Follow-Up Agency
The medical activities of the armed forces during the war generated vast quantities of records documenting the health status of millions of servicemen deployed around the world from 1942 to 1945, and the experiences of thousands of physicians and surgeons. It was obvious to many, including DeBakey, that all these records also presented a remarkable opportunity for follow-up studies. In March 1946, DeBakey sent a memo to Surgeon General Norman Kirk, noting that "an enormous amount of material of great clinical value" had accumulated in the medical records kept by the armed services, such that in fact, "it can be fairly said that no similar amount of material has ever been accumulated, and it is doubtful whether a similar amount will ever again be available." He proposed turning this material to a "practical use by the establishment of a clinical research program, including a follow-up system to determine the natural and post-treatment history of such diseases and conditions as might be selected for the study." By this means, he said, it would be possible to ascertain the long-term effects of various forms of treatment, as well as the natural history of certain pathologic processes. He suggested that the project be a joint undertaking of the Army and the Veterans Administration, under the aegis of the National Research Council (NRC). Surgeon General Kirk heartily accepted DeBakey's proposal and passed it along to the NRC, which approved it and appointed a committee to set up the Medical Follow-up Agency (MFUA). The committee directed DeBakey and epidemiologist Gilbert Beebe to draft a detailed outline for the mission, structure, organization, and funding support for the MFUA, which became the blueprint for the agency when the committee approved it in June 1946.
The Medical Follow-up Agency has more than fulfilled DeBakey's vision, making possible hundreds of studies. MFUA projects have looked at morbidity and mortality in former prisoners of war, effects of exposure to atomic radiation and chemicals used in warfare; head injury, tuberculosis, and many other problems. One of the agency's outstanding achievements was the establishment of the NAS-NRC Twin Registry. Studies of twins, especially identical twins, had long helped investigators study the relative effects of genetics and environment. "In 1958, the MFUA began a project to identify white male twins who had jointly entered military service during World War II. Beginning with birth records provided by 42 vital statistics offices, 108,000 searches were made by hand against VA files to determine veteran status. In the end, nearly 16,000 twin pairs were identified in which both members had served in the military." Over 200 studies have made use of the Twin Registry, on topics such as smoking and respiratory function, heart disease, psychiatric disorders, blood pressure, cancer, diabetes, drug use, and many more. Expanded to include twin pairs who served in the Korean and Vietnam wars, it remains an important resource for epidemiological research.
DeBakey finally left the Army in the fall of 1946 and returned to Tulane. For the next several years, however, he would continue to shuttle to Washington to serve on the Medical Task Force of the first Hoover Commission, set up under former president Herbert Hoover to make recommendations for administrative changes to improve the efficiency and effectiveness of the federal government.
DeBakey's wartime work trained him to analyze, manage, and solve problems within large medical organizations. As he later noted, it also shaped his public philosophy, showing him the interrelationships between medicine, society, and government. Finally, it provided him with a large network of contacts in both medical and political circles, which would serve him well during the following decades.