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DIRTY ELECTRICITY
Electrification and the Diseases of Civilization
By SAMUEL MILHAM
iUniverse, Inc.
Copyright © 2010 Samuel Milham, MD, MPH
All right reserved.
ISBN: 978-1-4502-3821-2
Chapter One
THE EARLY DAYS
I was born in The Albany Hospital, in Albany, New York, on May 12, 1932. I would later attend medical school in the same old red brick building where I had been born, and my first son would also be born there.
My parents were Lebanese and Syrian, and both were Orthodox Christians. My dad, Sam, was actually born in Albany, but his parents had come to the United States in the early 1900s from Brummana, a small town near Beirut, Lebanon. My mother, Louise, was born in Tartous, Syria, and had immigrated as an infant with her parents. My mother graduated from high school, while my dad only finished the fourth grade, because he and his three siblings became trapped in Lebanon by World War I with their mother while visiting her parents. They were out of touch with my grandfather, Alex, for nearly four years, and were often hungry during the Turkish occupation of the Middle East. They all survived the war, but tragically, before I was born, my grandmother, Libby, died in a roll-over car accident while on a family trip. My dad was so traumatized by her death that he never drove a car.
I attended grades one through eight at Public School 26 in the west end of Albany, which was one hundred feet from our front door. The school was torn down a few years ago to make way for an office complex. This location was important, since I spent the seventh grade in bed with a respiratory infection but lost no school time, because the teachers were able to drop off my lessons after school on the way to their bus stop. After ninth grade at Philip Livingston Junior High School, I attended Albany High School, one public bus ride from home. Academically, the school skimmed off about twenty bright students out of the five hundred who attended and put them in special classes taught by system-wide department chairmen. The tangible benefit of the special high school education that a few of us received was that we could compete with the New York City kids, who had the benefit of attending special technical and science high schools for New York State scholarships. I won the German Prize and the Solid Geometry Prize at high school graduation. One day near the end of twelfth grade, I took an examination that won me a full tuition scholarship to any New York State college of my choice. I decided on Union College in Schenectady, New York, so I could live at home.
Union College was one of the oldest colleges in the country and was affiliated with a state university system that included the Albany Medical School, the Law School, and the Pharmacy School. With an early love of science, I enrolled in the pre-med program. The college had a lovely park-like campus, a fraternity system, and some exceptional teachers. With no family car, I hitchhiked the sixteen miles to and from college every weekday for four years. One of my pre-med classmates helped me find a weekend job at St. Clare's hospital in Schenectady working in the clinical laboratory on weekends for one dollar per hour plus room and board from Friday evening until Monday morning. Within a few months, I was single-handedly running the lab at night, drawing pre-op bloods, doing blood counts and chemistry profiles, taking blood samples for transfusions, typing, cross-matching, and doing bacteriology. The pathologist who oversaw the lab allowed me to assist in autopsies. He also loaned me his books, an old monocular Zeiss microscope, and a hematology slide collection that I could take home to study. Here, I got my first taste of the practice of medicine, and working in the lab gave me hands-on experience in clinical pathology.
In my senior year at Union, I took another test for a state scholarship and won full tuition to the Albany Medical College (AMC). At that time, I also won another small scholarship, the Fuller Chemistry Prize for Excellence in Chemistry, awarded to a Union graduate headed to AMC. I don't know if New York State still has full scholarship programs, but without them, my life would undoubtedly have taken a different course. Without such financial help, I would surely be doing something else today, and it's likely that none of the research described in this book would ever have taken place. This is something to keep in mind when government programs for education are cut.
Chapter Two
ALBANY MEDICAL COLLEGE (AMC)
After four years at a good liberal arts college, I thought that medical school was an intellectual step backward. It was trade school in the literal sense of the word. The scientific basis of medical education could be boiled down to the study of pathology, which is the physical, pathologic, and cellular basis of all disease. There was no formal course in medical history, but reading about those who went before us and how they solved the medical mysteries of their time inspired me then, and it still does. Most doctors arrive at their choice of practice by a process of elimination, balancing the positive and negative aspects of each specialty. Helping patients in their time of need and watching how the good doctors went about their craft was the best part of the process, and how I really learned. In terms of teaching medicine, I don't think that the apprentice system has ever been improved upon. I also think that it would be a very good experience for every med student to be an inpatient for a while.
When I attended the AMC medical school beginning in 1954, it was physically part of The Albany Hospital. The students had a locker room and had use of a lounge and the hospital library. There were fifty-four men but only one woman in my class. A Veteran's Hospital was across the street, and the New York State Laboratory and Health Department were within walking distance.
Although I'd already been acquainted with many aspects of medicine, including autopsies, while working at St. Clare's lab during college, the AMC years gave my fragmentary lab experience a medical perspective. The first two years of the curriculum were devoted to basic sciences like human anatomy, physiology, pharmacology, and pathology. Like all anatomy courses then, ours involved the yearlong process of dissecting a corpse. Our corpse was a male who looked like an unwrapped Egyptian mummy. It was hard to believe that this person was ever alive. The tissues were leathery hard and dark brown. The contrast between how the tissues looked in our corpse as compared to how they looked at autopsy or in a living person during surgery was striking.
I lived at home, worked nights at the New York State Laboratory as a biochemist, and in my four years, contrary to popular med-student stereotype, managed never to take a book home. I found plenty of time during the day to study and learned that medicine was in fact as much of an art as it was a science.
The third and fourth years were when we learned how to be doctors. We rotated through the various specialties, learning how to diagnose and treat actual patients. All the specialties were interesting, but in pondering what to do after medical school, I began a triage of what kind of medicine I didn't want to do.
Psychiatry was out. It had no pathologic foundation. Psychiatry also had treatments I found repugnant. I didn't like the use of electroconvulsive therapy back then and am sickened to see it making a comeback now. I also thought that psychoanalysis had no scientific basis.
My obstetrical rotation, on the other hand, was a happy service, because it involved young women doing what comes naturally. Every delivery of a baby was exciting to me, and I enjoyed helping the mothers get through their labor. There was a lot of induced labor back then, mostly for the convenience of the obstetricians. I also thought that the cesarean section rates were way too high. Though rewarding, I crossed obstetrics off my list because it was too much of the same thing, with very little diagnostic challenge.
I did find pediatrics very interesting, but heartbreaking. I couldn't handle watching an innocent child die. Pediatric oncology was the worst, because in those years, all childhood leukemia was fatal. At the time, we used Nelson's Textbook of Pediatrics. In each section was a brief discussion of the epidemiology of a given condition. I quickly discovered that the epidemiology of a disease, and how it was understood, was a lot more interesting to me than how to actually treat a disease. After more independent reading, especially about how the acute communicable diseases of childhood were understood, I suspected I had found my medical niche.
We also had a surgical rotation. I liked the diagnostic part of surgery, because you could use your clinical, detective, and laboratory skills to reach a diagnosis and could find out directly if you were accurate.
However, I saw some things at the operating table and on the wards that made me wonder how anyone could survive hospitalization. Eventually, I crossed surgery off my list, because only the diagnostic part was interesting to me.
I did like internal medicine. The teacher I admired most and tried to emulate was a tall, soft-spoken gentleman named Gilbert Beebe. He said many times that listening to the patient was critical and that the patient, if properly questioned, would always tell you the diagnosis. That wisdom would later come in handy with my work on dirty electricity and with people who had become hypersensitive to electromagnetic fields. Their doctors typically don't believe them, but they are being given the diagnosis.
Throughout the various rotations, it had become increasingly obvious to me that I was a lot more interested in understanding what brought people into the hospital than in how to treat them. My path toward epidemiology became stronger by the day.
My personal life had also taken some interesting turns during medical school. Between my sophomore and junior years at AMC, I taught archery at a summer camp in Vermont. There, I met an attractive school teacher named Lorna Galbraith, who taught tennis and had a car. We married a year later in 1956 and had our first of three children, a son named Richard, in 1957. By the time I graduated, I was a husband and a father. A daughter, Suzanne, was born in 1959, during my internship in Boston; and a son, Sam, was born in 1961, while I was at Johns Hopkins in Baltimore getting a masters degree in Public Health.
One recollection I have about medical school graduation was that as each of us walked across the stage to get the piece of paper we had worked so hard for, I asked myself which of my fifty-four classmates could I trust with the life of my kids. Sadly, I came up with only six names. It's probably a good thing that I have absolutely no say in who gets to practice medicine.
Chapter Three
INTERNSHIP
I interned at a U.S. Public Health Service (PHS) Hospital in Boston called Brighton Marine, which is no longer there. The PHS looked after fishermen, U.S. Coast Guard personnel, and other military dependents. With no money and a growing family, I needed a paycheck to stay afloat during internship and residency, so my internship options were few. PHS offered a small but livable stipend for interns and residents, unlike most private hospital training programs.
We packed up our Studebaker Commander V8 and headed east to Boston. By then, Lorna was pregnant with our daughter Suzanne. I was the last intern to arrive, and learned that I would immediately begin a two-month obstetric rotation at St. Margaret's Hospital in Dorchester. After that, I would have two months at Boston City Hospital learning pediatrics, before coming back to the PHS hospital.
It was a difficult year. Lorna had a first trimester bleed and was put to bed, and Richie, our toddler, had recurring streptococcal throat infections.
St. Margaret's was a very busy place. Boston was a Catholic city. With only the rhythm method for birth control, Catholics had lots of babies. The work was forty-eight hours on call, followed by twenty-four hours off. In busy periods, it was hard to get any sleep.
We had to do circumcisions every day, using a crushing clamp. I still can hear the cries of those little guys. While doing the circumcisions, I noticed that a few of the babies were mildly jaundiced. After a little record checking, I found that they were all delivered by one obstetrical group that used a lot of heavy-duty narcotics to knock the mothers out to the point that they didn't remember anything about their labor or delivery. I think the technique was called "twilight sleep." It was bad for the mothers and especially bad for the babies. The mothers would thrash about on their cots, sometimes soiling themselves, and pulling out IVs. The babies were born depressed and difficult to resuscitate. They also were jaundiced. When I reported my findings to the hospital director, he told me to keep my mouth shut or they would terminate my training. What an auspicious start to my research career. It was a hectic, exhausting, exciting, and rewarding time, but two months of it was enough.
I transitioned right from obstetrics to pediatrics at Boston City Hospital. Dr. Sidney Gellis was chief of service then, and I think I saw him once. I had no ward responsibilities, but worked the evening shift in the pediatric emergency room, as well as the following afternoon in specialty clinics. When I saw interesting cases at night, I could refer them to the clinics the next day, when there were senior pediatricians around for consultation. The emergency room (ER) was a crowded, busy, chaotic place. Assuming all that responsibility right out of medical school was something I never anticipated. There were four experienced nurses who showed me the ropes, and because of them, I survived. I learned in all my new clinical assignments that it was critical to get the head nurse, oftentimes someone who had been there for twenty years, on my side. To my misfortune, I started my pediatric rotation in the middle of an epidemic of aseptic meningitis. The kids would come in with fever, stiff neck, and vomiting. There was no effective treatment, since the disease was caused by a number of different viruses. Every meningitis patient needed a spinal tap, and I had to do the lab work myself. During the epidemic, this meant one or two cases per evening, and the spinal fluid always ran clear, indicating that it was a viral meningitis. One night before the night shift took over, however, another meningitis case showed up. I was tempted to bypass the spinal tap, but a little inner voice said, "What if ...?" That one turned out to be bacterial meningitis, the only such case I saw in my two months. Instead of a clear spinal tap, pus ran out of the needle. Any delay in treatment could have been fatal. The children in the ER were wonderful, and I loved treating them.
After pediatrics, I returned to PHS to begin rotations in medicine, surgery, orthopedics, and the emergency room. I had been away from PHS for four months at St. Margaret's and Boston City Hospital, and was disappointed to learn that all the specialized clinical residencies for the next year had been assigned. That left me the choice of working in the hospital ER for another year and then getting a clinical residency, or taking a public health residency, which was still open. I decided on the latter.
Working on the wards was very interesting, because this was real "doctoring." I got to admit the patients, decide what was wrong with them, work out a treatment program, check on their progress, and finally send them home if everything worked out well. There were some memorable cases that taught valuable lessons.
A young fisherman was admitted with swollen lymph nodes, fever, tiredness, and a general malaise (feeling lousy). His working diagnosis was some sort of lymphoma or Hodgkin's disease, and I remember the tears and the anguish when his wife and family got the news. But something about the diagnosis just didn't ring true. There was no weight loss, and the onset of his illness was sudden. Usually, cancers develop slowly, with symptoms evolving over time. The first indication of a lymphoma is often a painless swollen lymph node in the neck.
(Continues...)
Excerpted from DIRTY ELECTRICITY by SAMUEL MILHAM Copyright © 2010 by Samuel Milham, MD, MPH. Excerpted by permission.
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