Maxwell Wintrobe, in his own words (2003)

What follows is a story rich in irony that illustrates the influence of chance in human affairs. It is a story about a man without specific career objectives who founded a Department of Medicine and was instrumental in the development of a medical school: a man without formal scientific training who was the recipient of the first research grant awarded by the National Institutes of Health and was elected to the National Academy of Sciences; a man without formal training in haematology who wrote the most authoritative textbook on the subject; a man who had no mentors but trained 110 postdoctoral fellows; a man who believed that internal medicine should be an indivisible entity but whose work was responsible for establishing haematology as a distinct subspecialty; a man who experienced discrimination but who always made others feel welcome; a man who, by his own efforts, achieved international renown but whose autobiography includes the biographies of all his colleagues and contemporaries. Finally, it is a story demonstrating that what is important is the journey, not the destination. ‘We lived on what we had and tried to do the best with that’ (Wintrobe, 1985). Maxwell Myer Wintrobe was born on 27 October 1901. His childhood was spent in Halifax, Nova Scotia where his parents, both from Tarnopol in Austrian-ruled Galicia, had emigrated to join his mother Ethel's family. Lacking a formal education, Wintrobe's father tried many jobs to make ends meet, an accomplishment achieved only by dint of extreme frugality on the family's part. This situation not only left a deep impression on Maxwell but was also one from which he would not escape for many years. Indeed, in his autobiography, when using the careers of contemporaries to illustrate the status of haematology in the 1930s, it was probably not coincidental that Wintrobe's choices were two physicians, Claude Forkner and William Moloney, who themselves had experienced severe financial hardship during their early years (Wintrobe, 1985). In 1912, in search of better employment opportunities, Wintrobe's father moved the family to the cold, wind-swept province of Manitoba, far from the warmth of their extended family in Halifax. Ironically, although he could not know it then, this was not to be Wintrobe's last journey to a far-flung Western outpost. Wintrobe's situation, however, was mitigated by being an only child with a doting mother, who encouraged him not only to excel at school but also to participate in other activities, including playing the violin. One suspects her admonitions to study reflected the attitude of Maxwell's teachers as class work came easily to him and he would only study as hard as was necessary to keep up. Even this effort, however, was sufficient for Wintrobe to complete 8 years of grade school in 6 years and to enter the University of Manitoba at age 15 years. At the same time, he held a variety of jobs: selling and delivering newspapers, collecting bills, teaching art, working in a vinegar factory, selling used books, teaching the violin and cooking for farm workers as his contribution to the war effort. Although the Canadian educational approach required only 1 year of college before matriculation in medicine, because of his age and a desire for a complete general education, Wintrobe chose to enroll in the 4-year curriculum, a choice made possible by the award of two scholarships. Interestingly, Wintrobe's premedical interests did not include science, though he took the required courses, but rather English, Latin, history, French and political economics; for the latter two, he was awarded gold medals and he also excelled in composition (Wintrobe, 1985). Given the eloquence of his prose and the breadth of his literary allusions, Wintrobe obviously made the most of his liberal arts exposure. ‘I do not recall why I chose medicine except perhaps for the fact that it was a respectable and rewarding occupation’ (Wintrobe, 1985). Wintrobe found his medical courses, with the exception of Pathology, more interesting than his teachers and even inquired about transferring to Johns Hopkins during his third year. Nevertheless, he excelled at every level, standing first in his class and receiving scholarships for his efforts. Yet at graduation, he felt less than well educated and was not interested in following his classmates into private practice or to England for further study, even if the latter was an attainable proposition. It was at this point that a postgraduate fellowship, newly created for the medical school's retiring Dean, Gordon Bell, was offered to Wintrobe. ‘Having no other interesting or promising alternatives…’ (Wintrobe, 1985), he accepted. The fellowship provided Maxwell with his first stipend and gave him the opportunity to participate in both an epidemiological and a basic research project involving pernicious anaemia. This was the exciting topic of the day as Minot and Murphy had just published their report on the success of liver therapy in this previously fatal disorder (Minot & Murphy, 1926), a report that had a profound influence on Wintrobe. Little came of Wintrobe's survey of the gastric contents of residents in several Manitoba towns; his attempt to create achylia gastrica in dogs using steam was also a failure, but this did not diminish his interest in research or in the pathogenesis of pernicious anaemia (Wintrobe, 1928). More importantly, the fellowship gave him the opportunity to read, think about his future and search for a job. At the point of decision, he was left with three choices: a fellowship at the Mayo Clinic, a position as a physician for a Chicago plumbing company or as an Assistant in Medicine at Tulane. The only opening at Mayo was in paediatrics not surgery and Wintrobe decided on New Orleans rather than Chicago; after all, the salary was such that he could now afford to marry (Wintrobe, 1985). ‘That I chose to go to New Orleans was without doubt the most fortunate decision that I ever made in my life’ (Wintrobe, 1985). With respect to what follows, it is worth remembering that Wintrobe was only a 26-year-old when he began his first faculty position. New Orleans and Tulane could not have been a more different experience for Maxwell and his bride, Becky. The semitropical climate was a far cry from the −50°F environment of Winnipeg and Southern racial segregation came as an unpleasant surprise, but the couple was warmly welcomed into the Tulane medical community. Wintrobe was enthralled with the academic environment. Here there were full time physicians engaged in both clinical care and laboratory research while Charity Hospital provided the full spectrum of medical illness. Furthermore, the scenario of a wise Dean with an interest in laboratory medicine recruiting a promising young physician would become a familiar one in Wintrobe's career. His first research project, concerning a method for measuring renal function, also had a theme that would become familiar: the development of a simple laboratory test that would be useful to clinicians (Wintrobe, 1929a). The resulting publication also demonstrated a meticulous and thorough approach to laboratory research on the part of its author. Based on Wintrobe's fellowship projects, John Musser, Tulane's chief of Medicine suggested that he determine whether the so-called ‘anaemia of the South’ was a true clinical entity. What would appear today as a rather pedestrian assignment of no academic merit was then a formidable task. Clinical medicine at the time was more art than science, largely because of lack of adequate technology and, with respect to the study of blood in particular, the technical problems involved in counting blood cells or measuring their haemoglobin content were substantial (Gray, 1921). Haemoglobinometers were difficult to use, inaccurate, not standardized and only gave results in proportion to a ‘normalized’ value, although no one had ever adequately established what ‘normal’ was, or even whether it was influenced by age or sex. Furthermore, the methods that existed for the measurement of red cell number, packed cell volume and red cell size were also technically demanding, in addition to a paucity of up-to-date data on what constituted normal and continued reliance on values obtained a half-century earlier using crude techniques. However, as early as 1903, Capps had described the volume index, a means of using the red cell volume to distinguish primary (macrocytic) anaemias from secondary (microcytic) anaemias. This approach had considerable value in identifying patients with pernicious anaemia, which was the of in that and when Wintrobe began his at such as in & in William Murphy of anaemia in & and in more for his & were the red cell volume and haemoglobin content in normal and for Wintrobe chose to the by his colleagues and demonstrated that blood values in normal in the were not different from in other of the & However, the of the technology and of the of the data Wintrobe to the an for measuring the more importantly, that the packed red cell volume offered the most and method for identifying anaemia, he an for this (Wintrobe, The was simple that it did not to Wintrobe or Tulane to it did he when which was his financial The useful not only for measuring the volume of packed red cells for which it but also for the & and for of the blood (Wintrobe, Indeed, it was in the of a blood in this that Wintrobe the first & methods for packed cell volume and haemoglobin Wintrobe his to the of red cell volume and haemoglobin he was not the first to this but his approach would the which haematology practice is with the of using the volume and that on as Wintrobe decided to red cell volume and haemoglobin content as cell volume cell haemoglobin and cell haemoglobin (Wintrobe, In his own of the size and haemoglobin content of the red in this came to in the of the after I had been for time about one could and make more what had been by the of the but required and was in that were (Wintrobe, 1985). This approach Wintrobe to the anaemias in a not previously In a involving the of more than patients and normal Wintrobe established that anaemias could be into on the of and that not only reflected in their but also their to (Wintrobe, the of this it is necessary to the of anaemia at that This is best by the by one of the of that of anaemia on red cell number, volume and haemoglobin Although Wintrobe's the practice of haematology on a it was not it is that the publication of his haematology textbook had more to do with its than the of his In Wintrobe to join him as of the of the of of a Wintrobe but other him from except in and Wintrobe haematology was left to his own His was to every with the that the was a from the practice at that time (Wintrobe, 1985). The however, was and one that is to even if only as medical It is an irony that when Wintrobe decided to this into a the opportunity to One further in Wintrobe's Tulane illustrates his and that his research would be for a he in Tulane's with the topic in This decision had more far as it in Wintrobe's to Johns the of his Wintrobe had from a in of and him to to his data and Dean to the the Wintrobe was to Dean, was also the of the Medicine and in of the medical school's of Clinical Wintrobe decided to his to Medicine for there to be a faculty opening in only was his for publication (Wintrobe, but Wintrobe was also offered this his to work at the that William had to It is interesting to Wintrobe's during his at Tulane. and before his he had published including a and a counting its This would be a accomplishment but it be with the fact that he had created a of anaemia using and methods that would become the of practice in in he had established haematology as a scientific (Wintrobe, 1985). of years in New Orleans Maxwell & Wintrobe for in in this as well as and the from in or even such as the of or where many of the faculty Indeed, when the at my years it was their first to and one that would not have been possible for family a years the and couple a of the Hopkins the situation left an impression on and was responsible for their to in however, Hopkins was all that Wintrobe could have for faculty with a for and and residents interested in research and a of clinical for In a familiar because of as Dean, the for the of Clinical to Wintrobe. In he the teaching of third year laboratory by involving patients and a laboratory that as a for the haematology of the year the when the of cell the practice of a and a to the he made blood as to physicians as their and a practice that to this day in the at With respect to Wintrobe continued to his of anaemia and his results on normal blood values and, as also the of the Wintrobe One important of his was the that so-called anaemia was & as a of his interest in pernicious anaemia, his on the in this situation the that was the of the anaemia, an that was left for William and colleagues to make Maxwell Wintrobe at Johns Hopkins in with from The of the Johns Hopkins Lacking to for technical Wintrobe to work for including for a time In Wintrobe trained and employment if This approach was a of with he and One of was a college who was in and at Hopkins to be that was offered a position 6 and as of the for teaching of residents and the art of and blood is worth not just because was Wintrobe's first but also because was instrumental in the of the in the half-century of haematology at Johns the and the in the many red cells on the blood of a of and on her own an However, the cells were and the blood was test gave the same on a blood and of that blood the same Wintrobe was of he suggested that a have been made but was that would not make the same in a years a with anaemia was to the medical and Wintrobe decided to the blood of the which had been the blood the two patients who had the same red cell Wintrobe that were with a of and his publication about patients established the of this Wintrobe's of the blood during this were in with he was to distinguish and on the of their the first of the of the latter also described the of to future about The of red cell size and haemoglobin to his of the anaemia with liver & a of in dogs to create an His also extended to With the of his he he the blood of a variety of during at the in at the that of red cells from all had a haemoglobin content (Wintrobe, also encouraged medical research and it was in his laboratory that the that with red cell an that to However, his was at establishing the of pernicious anaemia by to with that many with that of pernicious anaemia, he to an using the because the could be to the after study, but was when the mother the and the of her whose is to and whose to be more (Wintrobe, 1985). However, there was no published on the of the and this had to be before Wintrobe and his could test the what is today about the pathogenesis of pernicious anaemia, Wintrobe's the one the profound that Minot and had on Wintrobe at a in his career. an in I was with the medical one of which was in the of many and a other for were in the Hospital we but specific such as were for that could be patients as a of their own or to their The report in that liver was in the of an fatal pernicious anaemia, came as a of on this (Wintrobe, 1985). on what we know Wintrobe to the pathogenesis of pernicious anaemia. However, years of the of on but and had and with a Hopkins medical a the two as the University had from a Wintrobe's for the project from the to the development of an that today would be but is (Wintrobe, 1985). In would be in but were or other the data a scientific by the Wintrobe and his the of before this was in and the of in also described the of and the of this in the of as a (Wintrobe, anaemia was in the but it to both and for its and no However, the of had an and, although it Wintrobe would probably be with by an Lacking a for the of a that was to be used as a in his Wintrobe decided to test the by it to pernicious anaemia his surprise, of the a the of his Wintrobe demonstrated that was as as liver therapy but not did not the same (Wintrobe, had though he could not have it at the could Wintrobe have been that the of in the of pernicious anaemia to although he would that the anaemia in liver could not at the clinical in in the study it also the of a which Maxwell a of (Wintrobe, 1985). Wintrobe's attempt to create an for pernicious anaemia, not only demonstrated his with this it also demonstrated his of and meticulous approach to a research However, even he that his to and his was as who have experience in research that been made that it did not even though the not have been of the or even the (Wintrobe, In in science, as in it is the journey that is In a familiar during his at a Dean Wintrobe to In this it was to to with a about Although this did not useful to his Wintrobe also used his time to the important medical and and blood in including and in and in in and in At although was Wintrobe's and he was of the for and who had trained with now Wintrobe had her at Hopkins as the for the In after years of their first was the in this by financial including the to Maxwell's (Wintrobe, 1985). The of with the of the for the first of Clinical a textbook for the of and not to at the However, it was to become the most of its ever published and, true to Wintrobe's the a on Wintrobe's assignment during the war was to study an assignment that would to a publication with and others on the of the when used as In Wintrobe was offered the opportunity to be the first of the Department of Medicine at the University of Medicine which was from a to a 4-year The was and the were to a who, although in and who had been a for about At the time, Wintrobe's research was well and, he and his who was their were (Wintrobe, 1985). the other at Hopkins were and Wintrobe felt that there was no for one from his to become a Furthermore, both of the and of Johns Hopkins encouraged Wintrobe to because the opportunity last medical in the as it did one third of the of the (Wintrobe, 1985). was also not Finally, of for his research by the Dean, Wintrobe moved ‘I on in that what had to was an but (Wintrobe, 1985). It should be at this that opportunity was all that Maxwell Wintrobe ever required and he made the most of it In a situation to that which the and Wintrobe and his in and had the of a medical school from the (Wintrobe, The basic was and in of its The situation at the which was to the medical school as its teaching was even was a political and the it with his and was to the and if were interested in their be one only to the on the of the even the was to to the political (Wintrobe, 1985). an to the of the also had a and the for the medical school were The situation on Wintrobe when he found that there were no for him to the many of and that he had the years. The was with the of Wintrobe's Dean, to Wintrobe to the he had used at the of the was required for this a though it have had to do with the of such during the The situation with respect to haematology laboratory was not for both clinical and research activities, was by the of a two story the Finally, although the of a medical was in that was only in just years before Wintrobe's (Wintrobe, In Wintrobe his as a to the of teaching and the of the or in every of the faculty was and to participate in his experience at Wintrobe was to as he and during the of his his training was one of the in the and In that of time, Wintrobe trained 110 haematology many of in academic medicine and in their of came from Hopkins to be the first of and Wintrobe as of John as of a position now held by a Wintrobe Wintrobe's and clinical did not him from the of his research research involving the continued but at the same time with an academic training clinical research a more The of as a been Wintrobe also on a of of the newly and on the one in and, on the of pernicious an that the that this had an This also the of the of the anaemia of the involved in the pathogenesis of this In Wintrobe the first of in the and to the that was a of anaemia on was in the of and of the in of cells were by and while extended the to the of was also the of In with no of the blood and a of clinical were published Wintrobe's clinical extended the however, and as a he the first research grant awarded by the National Institutes of for a research that as a of for the medical school as a he on a disorder that a of grant was with the of Wintrobe for but was to the sufficient he it to then the into a establishing the National Institutes of Health Although Wintrobe the in an the him to because had to to the (Wintrobe, 1985). to today the University of one of the of research in the Wintrobe's did not with his haematology although that have been sufficient for many as an for of Medicine and as its More importantly, being of the of his position at age years and now to its Wintrobe demonstrated his deep for haematology and medical by and of of and of a to the of scientific in haematology and by of the responsible for and in to the of his his autobiography, the of a of and (Wintrobe, the latter being a of haematology in the of the of the and who to the development of the I do not think it that the was by William with his scientific Wintrobe was now in as a both in the and and he gave his time on his first he had been the now it was his that was being Given his on the study and of the National Institutes of Health and on the of the the the the and the Health to but a it is that he had a influence on the of not only but also medicine during its after Interestingly, because he believed that internal medicine should not be into Wintrobe was to participate in the haematology that were the of his he to the and was elected of all of with success came but Wintrobe was to also in the of from the of Manitoba and others and by every was Wintrobe's to the National Academy of in (Wintrobe, 1985). In Maxwell Wintrobe's it is not to it with William could there be a more were who achieved their success in the both did this at Johns Hopkins and both left Hopkins for both the of as a both also the of clinical when most others did took clinical teaching to the Wintrobe took clinical both were of the blood and made many about were in their wrote an textbook of Wintrobe wrote an textbook of haematology and was of a medicine both founded a Department of Medicine and a both the of a and both left an on the practice of In Wintrobe's it is to that he did the best with what he The is for the of of the Health at the University of of The at Johns Hopkins John and Wintrobe in this