Contributor: Henry McIntosh: Chief Resident VAMC 1954-1955

It has been almost a half-century, 49 years, (1954-55) since I served as Dr. James Warren's chief resident at the VA Affiliated Hospital. Dr. Stead recruited Dr. Warren to the Department of Medicine from Emory in 1952. Dr. Warren's major responsibility was to develop the Department of Medicine at the newly established Durham, VA Hospital.

I recall that my year as chief resident was very busy because of the multiple activities associated with establishing the new VA Service, especially the Department of Medicine, the Cardiovascular Division and the supporting laboratories. Dr. Warren was very interested in and skilled in cardiovascular laboratory techniques. I was pleased that he expected me to be very involved in all of the cardiovascular activities since I had decided to specialize in Cardiology.

Dr. Warren remained at Duke only until 1958 when he became Professor and Chair of the Department of Medicine at the University of Texas.

Although I was based at the VA, Dr. Stead expected me to participate in many activities at the University Hospital. The resident physicians rotated through services at both hospitals. Morton Bogdonoff was designated chief resident at Duke. Our relationship was very close and I thought beneficial.

I was very gratified that Dr. Stead arranged for me to have biweekly "therapy sessions" with Dr. Bingham Dai. This experience was most beneficial, not just for my personal life, but also my teaching and administrative activities. I am confident that I have enjoyed a more peaceful and productive life, even to this day, because of that experience.

I have always considered that serving as a chief resident was one of the most beneficial experiences that I had in academic medicine.

Title: Alligators and their Bulbus Cordis

Some of my most memorable experiences occurred in the cardiovascular laboratory. In the 60's we began to study, by catheter techniques, patients with hypertrophic subaortic stenosis. During this we learned about the function of the bulbus cordis, a muscle ring found in some hearts which could cause serious problems similar to those in patients with subaortic stenosis.

But we knew such a ring could serve a useful purpose in forms of life that spent long periods of time both under water and on land, so we obtained from a Florida reptile farm, with special permission from the Florida State Wildlife commission, eight North American alligators, five to eight feet in length.

We had learned that, as a result of having a bulbus cordis and being poikilothermic (unable to maintain a body temperature higher than environmental temperature), alligators can spend long periods of time underwater as well as above.

In preparing to study an alligator, we put the subject "to sleep" by leaving it in a walk-in refrigerator overnight. It's body temperature would become about 50 degrees and it would become unresponsive.

When we were ready to study it, we would lay it on the catheter table covered with ice chips to maintain a low temperature and hopefully sedated state.

I recall the fear I had when an eight foot alligator we were studying, between two patients scheduled in the catheter lab, warmed up enough to regain consciousness. It opened its large jaws, despite having a large chest incision and an intra-cardiac catheter.

My assisting nurse and technician both departed and left me with this frightening situation. I injected anesthesia through the catheter into the heart and the gator's jaws gradually closed and it again became unresponsive.

My assistants returned, appearing a bit "sheepish," and we completed the study, the results of which were published in the Trans America Clinical & Climatological Association Journal.