UMHealth System

Ralph H. and Ruth F. Gross Lecture Series


Origins of the Medical Examiner System

When Henry Lemkau called me and asked me to participate in this, I didn't quite know what could I talk about. And of course the first thing medical examiners are supposed to talk about is the drama of mystery in knowing the outcome of who-done-its. For example: What killed Elvis Presley or is he really dead? Who fired the shot from the grassy knoll at J.F.K or what shot? Who killed JonBenét? You know, that kind of stuff. But rather than start off with this type of thing -- this Quincy stuff -- I may or may not come back to that later. See, that'll force you to stay and maintain attention.

Let me give you a little brief history that leads up to this. Every organization, whether it is this Library in this room or this Medical School or the University of Miami or Dade County as it now exists - we call it now Miami-Dade County. When we look around and see what we have there actually is a history, there is a genesis, and it started somewhere. It didn't appear by magic overnight, and yet many of the younger people who come along -- that's their first glimpse of things and they have no concept of how things arose or where they came from. But everything has a genesis and even the genesis has a genesis before that and so on ad infinitum.

A little bit about medical examiners and where we fit into the scheme of things. Some years ago, there was a young lady who was studying orangutans in Borneo, and she wrote extensively on orangutans' social behavior, including anti-social behavior, because orangutans tend to be very docile, very nice, good people. But she saw a murder. And of course it was done by a young adult male, naturally. I always say if you want to stop all the murders and trouble, get rid of the young adult males and it will all go away. But that doesn't have its practicalities. Anyway, the group, the orangutan group, was concerned. They held an inquest. Not as we know it today, but a group of them gathered around and they poked the body, lifted its hand, let it drop, they scratched and they wondered. They were concerned about this aberration in their social structure. And of course, the guilty guy, where was he? Sitting on a branch over here, arms folded, looking the other way pretending he had nothing to do with it. Nothing has changed. I mean it is the same all over.

The point I am trying to make is that no matter what the social structure of society, there is an interest in maintaining the integrity of that social structure in that society. An untimely death within that social structure is disquieting and provokes questions. So gradually over years there has evolved, in the United States, in England, throughout Europe, South America, China or Asia -- in fact all countries of the world including all the African countries -- different systems of investigating these untimely events. The systems vary from one area to another. They vary as to who has the authority, who has the responsibilities and so forth. But there is one thing that does not change one bit and that is the principles that deal with the actual case investigation itself. The principles are identical no matter where you are in the world. Whether these principles are followed, and to what degree, depend to some extent on the system that has been set up to carry out these investigations. That's where the real variation is. I might add, because we're dealing with human beings, anytime you have a system, humans also inject variables. So there are variables even within single systems.

We had in the United States a coroner system that was carried over from 1776 in Britain. In some jurisdictions that still remains, the coroner being an elected person not necessarily a physician. But in some jurisdictions the word "medical examiner" arose. The first -- we will skip Massachusetts. They injected that term back in 1877 but didn't do much with it until after Chappaquiddick -- but the first real medical examiner system with a central laboratory, full time staff, etc. was in New York City during World War I times. That was the start. Then gradually, over time, some other places came up, but it wasn't really until recently, after World War II, that there was an impetus to create more and better systems, add more science to it, if you will, more stability and so forth.

There was in 1951 -- actually it was stimulated to a great extent by Milton Helpern, the then medical examiner in New York City -- the National Municipal League, which brought forth a model Post Mortems Act, which is really very good, and sets forth the principles of how to set up and run an operation. The only trouble is that it is geared toward very small states, what I call county states like Maryland or Delaware. Delaware, for example, is the same area as Dade County. The state of Rhode Island is half the size of Dade County. So, that type of law is good for a small jurisdiction that has the chief medical examiner and a pyramid structure and so forth.

Florida operated somewhat differently. The Office of Peace Justice was incorporated into the Office of Coroner back in one of the constitutional revisions around 1880 or there about. And over time the police and the prosecuting officials, who were mostly county solicitors in those days, would respond if there was an untimely death, make the decisions as to what was done, and then they would scout around and try to find a doctor to do an autopsy if one was felt to be necessary. And in general, throughout the judicial circuits of Florida, there was a cadre of physicians who more or less did this work part time on the side. Broward County abolished the Office of Peace Justice in 1951, and now, for the first time, the word "medical examiner" appeared. That was a part time job where Dr. Cronkheit was appointed as the County Medical Examiner, but he also did this in addition to his hospital pathology practice.

But the first real centralized, modeled after the idea of the New York office where you have a full sized centralized office with a full staff, etc., started in Dade County. It had an interesting genesis. The title of my talk, and I'll see if I can read it here: "The University/County Partnership: An Exciting Educational Experience." And it has been exciting. I shouldn't really say exciting. It's been fun. Right here. That man (gestering toward the portrait), Bob Spicer, the first Dean, known as acting dean -- that was when the Medical School started. It was local people, local physicians, a lot of it volunteers. What we know today as the School of Medicine, the structure, the hierarchy and so forth, that didn't exist back then. Dewitt Daughtry probably can remember all of those good old days, and Jim Hutson certainly can. But Bob Spicer was the first dean, acting dean. He was an obstetrician here in town and volunteered or was appointed, or whatever, as this University Medical School was being created.

In 1952, which is the year the Medical School was started, there was a meeting in Bob Spicer's home. Sheriff Tom Kelly, the newly elected sheriff, was there. Dr. Bob Poppiti, a pathologist at the north end of the County and in South Broward, who was one of the pathologists in the community who would do autopsies, attended. And I think there might have been one or two others. The discussion was the need for a medical examiner's office for Dade County. So we can see right from the year that the Medical School started, the Medical School had a stake, an interest in a medical examiner system in Dade County. Not many people know that. It is not in any archives or anything, but it is one of those things that happened. Time went on and everybody agreed that it was a good idea but the question was, "Who's going to bell the cat?" Then came Claire Weintraub.

Mrs. Weintraub was a civic leader. If you go look at the Museum of Science, Planetarium and so forth, that is a monument to Mrs. Weintraub. There are many things in this community that she and her group sponsored. But in 1955 they took it upon themselves to push through the first Medical Examiner's Law for Dade County. Their son Albert, still practicing law in Dade County, was picked to draft it. And as he told me, his mother wanted him to draft the strongest medical examiner law you could imagine, no loop-holes or anything else, and considering the fact that there was no prior experience here, they did a very credible job, and Chapter 30228 Laws of Florida, 1955 was passed. That was in 1955.

The next thing was to pick a Medical Examiner. So they had a search committee, and over time they went through candidates. The Search Committee, incidentally, involved not only the Medical School, but Jackson Hospital, administrators, prosecuting attorneys, etc. They picked Dr. Stanley Durlacher. Dr. Durlacher was Associate Professor, as I recall, at the Louisiana State University School of Medicine. He had a long illustrious career, starting at Yale and going on with some time working with the military at Edgewood Arsenal and then with the Medical Examiner's Office in Maryland and the University of Maryland. He had been picked by Dr. Chetta, who was elected Coroner in New Orleans way back when, to build, physically build, and set up a coroner's laboratory in New Orleans. And Art Fisk, who was his sort of right hand man, gofer, man friday, do-it-all, etc. He and Stan actually physically built the office. They set up the saws and cut the wood and hammered the nails and built it in the basement of the Courthouse in New Orleans. And to this day portions of that laboratory that they hand built still remain.

At about that time, I had left the Public Health Service and joined the faculty at Louisiana State University School of Medicine. One of the things that happened at Tulane Medical School and at LSU, is the young pathologists, the junior members of the department, do autopsies for the coroner. They did not have a full time coroner staff; it was done by the medical school staff at fifty dollars a head, I think it was, at the time. And you were paid just as if you had been supplying potatoes to the parish, but I found it extremely fascinating. For the first time, I was able to see disease processes, the pathology of the disease, fresh, untreated. And then I began to see other things that I had never been taught in medical school, that was injury, and then, effects of drugs and alcohol, things you just completely ignored in medical teaching. And it was fascinating.

Well, Durlacher brought me with him and the question was, "Where were we to stay?" The county had promised they would build a building some day, but the only space was Philbrick's old ambulance garage down here on Tenth Avenue. We didn't have a phone there, at first, so in a central building down the hall next to housekeeping for Jackson Hospital, was a small corner about like this. We had a little phone in there and our extension was 256 - the hospital extension, telephone. And our number, eventually when we got a number there, was Franklin 14521. How could I forget that? I probably can't tell you what our number is today. And we started off, and for the first six months every time the phone rang we set policy. There was no prior experience. We had to set policy constantly and just respond immediately to every case as if it were something new. And out of this developed this idea of doing things right. What was best for whoever was calling? What was the best way of responding? We didn't have any prior rules or regulations and in fact the County, our first budget, had no idea. They gave us a hundred thousand dollars and said, "Figure out what you can do with it, see how far it goes, and let's see." You know that is not too bad. I think the next year's budget was, now that we had a track record, one hundred and twenty-eight thousand. What is it now, 6 million? Which indicates, incidentally, that either it's costing more to render service or the dollar has been devalued that much. Probably both.

Well, unfortunately Dr. Durlacher died one month over one year in office. He had a berry aneurysm that failed. When he went to Chicago to a meeting, my last words to him were, "Stan don't have a heart attack 'cause when you are away I get a tight feeling in my head." Meaning that I depended on him. I was just young then. I was thirty-two years old or there about, fresh, didn't have anywhere near the experience that he had and so forth. And it always felt comfortable for me to have somebody there I could turn to and push it off on them. He didn't come back, unfortunately, and I was sort of on my own. The County Commission gave me the nod and made me acting Medical Examiner.

Departments of Medicine and Pathology and United Way

But let's go back to the Medical School. Dr. Durlacher had always been in academic medicine and had some research projects going in, particular with the coronary arteries. There was one that involved the studying of coronary arteries by clearing the arteries and looking at hemorrhages in them and mapping out lesions in coronary arteries. He brought that project with him and one of the stipulations was that the Medical Examiner of Dade County would have to be part of the University, affiliated with it, incorporated into it. At that particular time urgency required decisions, and for some reason or other the decisions from the Pathology Department were not as fast as from the Department of Medicine and we ended up, actually, in the Department of Medicine and for a good number of years I was on the faculty as a member of the Department of Medicine. In fact, that is where I went through the academic ranks. And of course, I was very happy with the University arrangement because we had 12 teaching hours in the senior class. In the old days students were taught every year in medical school. They didn't have this new curriculum approach that we have today. But over time, with the curriculum changes, the number of hours we had available for teaching, formal hours evaporated.

It became pretty clear to me that my best role with the University was with the Department of Pathology, because we identified with them and we had the opportunity to bring residents in and interact in those regards. So, we did it. We went through this sort of variation in the way we were associated with the University. But all during this time there was a constant informal interaction between students, house staff, other attendings, follow-up on cases that we had done, encouragement of students and others to come by and follow up on our cases, because if the person died in Jackson Hospital and it was a medical examiner case, we were close by and they could come by and share the autopsy experience with us and we encourage that.

Autopsy philosophy was sort of interesting. When we started in Dade County very few autopsies were done. If there was an automobile crash, nobody did an autopsy. About the only time they did was if the prosecutor was trying to develop a case for prosecution or if there was a real suspicion that there might have been a crime or something. Everything was crime oriented. When I started off in the beginning, because the law very clearly gave us this authority, I started off doing autopsies to the best extent I could for two good reasons. One reason was to learn. Rather than turn to books to learn you see a lot in autopsies. We were seeing things we never saw before. And the other was to get the community used to this as part of the investigative system that was already here.

With the data that we accumulated is where we really excelled and served the community. If you look at a community, it is made up of a number of components. It's a population, but there are subsets of that population and each subset has its own peculiar risks of diseases, injuries and what have you. The best example, I use this constantly in my teaching -- if you have a teacher, say a teaching nun at a parochial school, she's female, and some day she is going to die. If you have a prostitute who's an addict, crack addict, working the streets up around 79th Street or around there, she's a female and she's going to die. But nobody in their right mind would ever say that these two people have the same risks of diseases and injuries, and they don't. So you have to look at the community in terms of its subsets. The nice thing about the medical examiner situation is that one of the greatest indicators for a subset of population at risk is the untimely death of a member of that subset. If you look at the epidemiology of violence, as revealed by this, we begin to see patterns around the community. And if you are looking at trying to solve problems, trying to come up with educational or legislative needs, you can't write the same program for everybody because people are all different. You have to tailor make these programs to fit the areas of greatest need and try to work out what gives you the best response, best potential to minimize these injuries and these untimely deaths with the least expenditure of dollars. That's basically good common sense and it's good public health.

Very quickly I began to note, and I noticed this in New Orleans, that there was something going on on the highways, something I was never taught, something I had never read before called booze and driving. I had heard stories of drunk drivers, but I never realized the extent of this and I never realized what amount of alcohol it took to make a person unfit to drive. None of this was really well documented. So we started, way back in the very beginning, a program of performing alcohol tests on every driver, in fact on every violent death unless he lived for awhile in the hospital. We developed a data bank. This data bank was the beginning of our expansion out into the community in getting involved in community affairs. We had started talking about this, preaching about this. I had set up a program, a twenty-year program, to get an implied consent and chemical test law passed in Florida. The one we have today. You sign your driver's license. That's a contract with the state, and on there it says if you have been stopped legitimately and there is a request for a breath test or alcohol test, you've got to give it or you violate the contract and lose your license, which is a civil procedure. That is the principle of the implied consent law, and then there were some set limits. There were no limits before. The law used to say you shouldn't drive to the extent that your normal faculties were impaired. What does that mean? It was a lawyer's delight. There were no definitions, no nothing. And of course what was needed was to get some very definite "speed limits", if you will, in the amount of booze you could carry in your system and be on the highway. And that is the chemical test part of the law.

I set up a twenty-year program: five years to collect data, five years to teach in Dade County, five years to preach around the state and five years to get it through the Legislature. It only took eleven years, so I felt pretty good about that. We had this data and Senator Harry Cain -- he was no longer a U.S. Senator, but he was a senator when I lived in the state of Washington -- moved down here for some reason or another, I don't know why, but he became a County Commissioner and he called me one day and asked me if I would sit on the Committee on Alcohol of the Welfare Planning Council because I had all of this data available. And I did. That was the start of our office becoming very closely affiliated with community affairs outside of the Medical School. I'm talking about through the Welfare Planning Council, which later became the United Way, which later became the United Fund. We played a very active role in the genesis of these agencies as they developed over time.

In the meantime, we were continuing with the University and with JMH. In the old days when new house staff came, their first week was orientation. I remember talking about medical examiner cases and death certification, etc. for house staff. Of course, a lot of that is changed, but we were involved in those kinds of things.

Eventually, as I said, we joined the Department of Pathology and became more formal in that department. Dr. Anderson was the chairman at the time and now it is Dr. Morales. We've enjoyed a very good, close working relationship with the department. Dr. Morales has an interest in cardiac pathology but, of course, now that he has gone on to bigger and better academic administrative deals, he has had to back off somewhat from that. He has got many other irons in the fire. He is not focused in on one single thing. But we had a very good number of years of working with him on sudden death in cardiovascular disease. I might say we found some things over there, to tell you the truth, I would not have found without Dr. Morales saying, "Hey look at this." Things have been found in sudden death that had never been written about, never been understood before, particularly the influence or the distribution of acid mucopolysaccharide in the heart, the heart muscle and the conductions system of the heart. And it's still an area that is worth exploring, but out of that has come some papers and research. But it's really exciting to be able to see things first hand that have not been described before. Incidentally, they have been there before. They have been around. All of this stuff has been there. But the problem has been, these are people who died suddenly, unexpectedly and go into the usual coroner or medical examiner system. Many of them would never come to autopsy, and if they did have their hearts examined it would be just a routine perfunctory examination. But with the skills of Dr. Morales added to this, things expanded. In fact, one of the concerns was what was going on in the ground substance of the heart, the supporting structure of the heart, not the muscle which everybody talks about, but about the structure. That was a concern because we're looking at precursors of collagen, and Dr. Woessner here, that has been his life work, and it was very, very interesting for him to take some of those samples and check through and find out that there was some changes going on in there.

Department of Pharmacology and Toxicology

So much for pathology. Let's talk about some of the other departments that have been exciting. Let's pause a moment with the Department of Pharmacology. Way back when we first started, there was no toxicology laboratory in Florida. In the old building, the old garage, we were there for a bit. The Laboratory Animal House on the north side of the Jackson Complex, where the power plant is now, the chilled water plant, was a small structure. That's where they kept animals. Remember in the old days they had rabbit tests for pregnancy, and they used to do guinea pig inoculations for tuberculosis. There were small animals used in laboratory work. Well, we took over part of that space, moved the animals down to one corner, and in a very tiny area set up a morgue, office and laboratory. In fact, if I wanted to leave my desk, I had to get up and walk over the desk because there was no room to walk around the desk.

Art Fisk was our office administrator, but Art also had a background in chemistry, and he also had a couple of years in medical school under his belt before he came here. He started doing the toxicology. We got an old kitchen table out of the hospital supply room and our first laboratory was a gooseneck lamp. You had to have that because it was dark in the corner. And then there was a little heating mantel to heat a flask. You put some blood in there, and we would distill the blood and then gather the water and back titrate with dichromate and come up with an estimate as to alcohol content. Although, it really wasn't, it was material that reduced potassium dichromate, but we would infer it to be alcohol. And then for drugs -- a little porcelain dish, a bottle of isopropyl amine reagent, a bottle of cobaltous acetate reagent. We found a little grit in the stomach that might be a pill, put it in the dish, added a drop each of the reagents and stirred them. If it turned purple, maybe it was a barbiturate. And guess what, that was the only act in town. That was toxicology. I am talking about diagnostic forensic toxicology.

There was some other toxicology going on. Dr. William Deichmann was very interested in industrial toxicology, which is a totally different ball of wax. But as far as this type, toxicology involving acute death of somebody, that was it. We used to do that work. As we expanded and got a little more equipment, a little more expertise, we started doing that for free, for Jackson and for all the hospitals. Our theory was as follows: In those days the anesthetic care, the respiratory care of the unconscious patient, was nowhere near what it is today, and we knew that if a person with a secobarbital blood level of approximately this much was admitted to the hospital, that person is going to die in forty-eight hours. They are not going to live. And if they died in forty-eight hours and if we didn't do the test, we wouldn't be able to do any test forty-eight hours later because it is all gone. So our theory was to test everybody when they first came in the hospital and then, if they did die, we at least had a record started. And we did that for free and for many years we began to do more and more toxicology tests for free, not only for here but for Broward County as well. That was something that continued for close to a decade or more of free work.

The laboratory expanded. We got past the idea of carbon monoxide and cyanides, and we even had some interesting plant poisons. Incidentally, plant poisons, University of Miami. Julia Morton was a fantastic resource down in the Botany Department and just a delightful lady. We were very saddened at her untimely death. And we had a very close working relationship with Dr. William Deichmann in pharmacology, especially when it came to his interest in the overall pattern of poisoning in the community. I've worked with him in some of his things. Over time we had a Dr. Bednarczyk, who had a Ph.D. in toxicology, and then Dr. Lee Hearn who was a product of the University of Miami Department of Pharmacology and just absolutely a jewel. We've been extremely fortunate that Dr. Hearn joined us. This was the era of high-tech pharmacology and high-tech toxicology.

If you go into our laboratory today you will see the largest, most up to date, most modern, finest toxicology laboratory in the state of Florida. It is just a phenomenon to see that. And what goes on in there? A lot of good, basic service toxicology, and a lot of good research and a lot of good working in close collaboration with people who are interested in neurochemistry. And there are some new drugs. There's one, I tried to remember the name of it last night, but it's a most unusual drug in that it is derived from a natural plant. And heroin addicts, if you give them this drug, they lose the craving for heroin. Now, what else they get a craving for I don't know, but every time somebody comes up with something like that, there is always something that comes down the pike. And they came up with a new one - cocethylene -- people who were using cocaine and alcohol together. They've worked out, within the Department of Pharmacology and the Medical Examiner's Office, the basic chemistry and where this fits into the liver metabolism and the toxicity of this. It has been exciting to see these things happen, and these are things that could never happen were it not for that University link with the Medical Examiner. The Medical Examiner is the service part for the community, but the side issue is this ability to not only teach but to engage in research and the improvement of medical science.

Basic Work of the Medical Examiner

Let me go back to the basics of the Medical Examiner. I started with that when I got a little sidetracked with the University to set that tone, but back to the basic daily work. The legal duty is to determine the cause of death. That's in the statute. In order to do that, we have to take into consideration the circumstances of death, and the autopsy findings and any chemical tests that are done. Then we have a legal duty to take our opinions and go to court with those, both civil and criminal court. And that is enough, that is a handful, that is enough to keep everybody busy. But because there is so much fun with the other stuff, the educational stuff, and it's so fascinating we like to do that as well.

I would say one thing though, to clarify a misconception most people have who have watched Quincy and watched these X-files and all these other weird things. Most people have this idea that a medical examiner does an autopsy, comes up with the cause of death, tells you when the person died and who did it and it's a right-handed orangutan or whatever, and so on. That is absolutely false. In the first place, the autopsy itself rarely reveals -- unless it's major trauma, disruptive trauma with evidence of vital reaction to that trauma, or if it is some of the natural diseases, like a burst heart from a myocardial infarct -- aside from that, the medical examiner's autopsy, all it does is reveal structural changes of disease and injury. Whether those were relevant to the death depends upon the circumstantial investigation. What was the person doing when they died? And, that's something, which incidentally is not in the textbooks. That was the tight feeling in the back of my head that I had for ten years after Dr. Durlacher died and I didn't have his expertise to help me.

I remember one time I performed an autopsy upon a woman who had been in the hospital, brought in comatose, lived two or three days, died, was a mystery case. In fact that was one where they actually opened her up and thought it was a brain tumor and it wasn't. There were all these little red specks in the white matter of the brain. Just little red specks. I was amazed. I looked at that and Dr. Durlacher walked by and he says, "Oh, that is carbon monoxide." You won't find that in the toxicology books. They don't mention that. And it was. It was the end result of the hypoxic episode of carbon monoxide and we traced that back to gas refrigerators. Incidentally, carbon monoxide is one of the most fascinating poisons. When we get into a carbon monoxide case, sometimes the tracing of where this person got this and how it came about and going from one place to another is just phenomenal detective work and a lot of fun when you finally solve the case.

But these situations, this integration of community and circumstances to the problem solving, is not found in the textbooks. The textbooks of forensic pathology deal with circumstances, what the changes are with certain things. They don't tell you how to interpret the ones that aren't in the book. In toxicology, when I first began to consider the idea of working with the coroner's office in New Orleans, I got Gonzales, Vance, Helpern and Umberger's Textbook published in 1954 out of New York. That was the New York office. About one third of the book was Dr. Joseph Umberger's toxicology section. There would be arsenic, an amphoteric element of the atomic weight so and so commonly found in arsenic peroxide, a white powder that was soluble ... signs and symptoms, nausea, vomiting, diarrhea, weakness, paralysis etc. … analysis, test for this this and this and all these other tests. I was starting to wonder a little bit about it. How do you think about it in the first place? Nausea, vomiting, diarrhea, weakness -- boy that is specific. Yeah, must be arsenic. Nothing else in the world makes you nauseated, weak, diarrhea, vomiting. Those books don't tell you that. They don't tell you how to think about it in the first place. It took years to finally develop the concepts of circumstances and the subset of society, the epidemiological approach if you will, to the thought process, to get the thought process going in the right direction. Because if you don't think about it, you will never find out later.

There was another thing that I developed over time. As part of this circumstance and trying to emphasize how important that was, I developed a pattern that when a pathologist would call me and say, "I have a problem case. I've done this autopsy, and I can't …. and this is what I found …..." And I would say, "Wait a minute. I want to know the name of the patient, age, race, sex, address, marital status, occupation," which sets the tone for where this person fits into our society, because addresses, social economic things, even names, the ethnicity of a name, can get your thoughts going in certain directions. And then, what was the person doing when they became ill? Just basic medical history taking 101, something, which incidentally, we've seemed to have forgotten in medicine. At least they try to teach it in medicine, but by the time we get into the high-tech stuff and the abracadabra machines, we tend to forget to take a history.

Little side issue on that. Dr. Louis Villa is from Harvard Medical School. He was one of the bright students that we had in 1968. There was a program, sponsored by the Department of Transportation, to pick out peculiarly bright students and get them exposed to medical examiners in the hope that they would get interested in automobile trauma and transportation problems and so forth and the medical aspects of that. He was one of the group that came down here. Then he went on and finished up pathology and joined the department here, was a member of the department. Then he got interested in more clinical work and got his boards in internal medicine. While he was rotating through it, Villa told me this fascinating story. They had a patient with pneumonia. He was a senior house staff, and there was junior house staff around with all those little stethoscopes. One of them said, "Well now the chest x-ray shows blah blah blah blah." And one said, "The blood tests are this that and the other," and somebody else said something else. And Louis looked and said, "Did you listen to his chest?" "No." "Did you listen to his chest?" "No." He went around the room and not a single person had laid his stethoscope on that man's chest and done the basics of physical diagnosis, which is a good indicator of one of the problems we have today.

In getting the information, as I said, I start with the name. Dr. John Bergman. He was an osteopathic physician in private practice up in the north end of the county at the Osteopathic Hospital, got interested in pathology, went on and took a residency. He came back as the pathologist at the Osteopathic Hospital at North Miami Beach, called me one day and I knew him. I used to cover for him up there and do his autopsies for him, and I used to teach up there all the time. He says, "I've got a problem. I've got this woman and I've done this autopsy and I can't find any anatomical cause of death and I'm thinking in terms of poisons. I've saved a lot of specimens, and so forth." And I said, "Well John, in the first place, when it comes to poisons, there's five million things that could poison you, including drinking too much water or eating too much table salt. There is no way we can approach a poison case just blind. We've got to have something to go with." And I picked up my pencil and got a pad and said, "First tell me her name." And he said, "Patricia Van Stavern." And I said, "Oh, she died of primary pulmonary hypertension." How did I know that? I knew the family. I had autopsied her son and I also know that primary pulmonary hypertension grossly the lungs look normal. The books all talk about cor pulmonale, but no, no. Unless your eyeballs are saying, "It's going to be cor pulmonale" you never see it anyway.

The point I am trying to get across is the history and circumstances are so crucial in this. That's a very important part of any diagnostic test. For example, park rangers today, they're sworn police officers. In the old days, you know … butterfly nets and tell stories around campfires. No, no. Now they are sworn police officers. And we were involved in some of the training of these park rangers and one of them said, "At the training academy he was supposed to write on poisons." I said, "Take a look at your park, your people and concessionaires and their families. What's the chance of poison with that group? None. But you've got workers down there who come down, and they're putting in a new telephone line and they're digging ditches. OK, who makes up that work force? Well, you may have some drug abuse involved in that group, or alcohol abuse. Also, you are digging in mud. What's in mud underneath that anaerobic condition that is going to kill somebody fast? Just like that, hydrogen sulfide." I said, "Then you've got people who visit. Here this young family, children, they come down for a picnic, look around. What are the chances of poison with them? None. An elderly couple, retired. They are in a camper; it's got an air conditioning attachment. Now what runs an air conditioner? A gasoline engine, two people sick, one dead and pet parakeet dead, I mean, you've got carbon monoxide."

Incidentally, the mobile blood vehicles were going around collecting blood. Guess what, they were poisoning their workers with carbon monoxide from the air conditioning, from the gasoline engine exhaust. They had a defective exhaust center. We had to do all of the tests for them. In fact, we actually gave them our original carbon monoxide detector when we bought a new one, which I hope they are still using. But, anyway, that approach of knowing the different people who come in, the subsets. For example, you have a group of kids come down to Everglades National Park. They are late teenagers, and they are whooping it up and all that, and they are males and maybe there are some females in there. Pretty good chance of drug abuse and some of them get sick and die. So you have to stand back and look at the people you are dealing with in order to think. And those were the ideas that I gave him. Well, that is enough of pharmacology.

Department of Epidemiology and Public Health

Let's talk a little bit about the Department of Epidemiology and Public Health, which, incidentally, is that the correct title today, is it still called that? It didn't exist when this medical school was created. There was no such thing. Then Rachel Carson came up with her book Silent Spring. Congress reacted, started this program. Well, that told the NIH and the Public Health Service to get going on this. Out of this came this idea of pesticide programs and having pesticide research study areas around the United States, Hawaii and here and there. Dade County was picked. Now Dade County in 1964 had the dubious dishonor of having the highest death rate from organophosphate pesticides in the United States. We used enough parathion in our fields in the south half of Dade County, that if you took that parathion, which is an organophosphate poison, first cousin to the nerve gases of warfare, and you distributed what was put on our fields of Dade County equally throughout the entire world, it would be enough to kill the entire world's population. 80% parathion can wipe out the whole section of town if you wanted to, no questions asked. A three-pound sack of wetable powder, 15% wetable powder is $1.75, that could knock off a few thousand people. So we had suicides, we had accidents galore and we had some homicides.

It became a truism in Dade County that if a small black child, whether it was in the city of Miami or whether it was in the rural area, playing in the back yard suddenly began to cry, stagger, started seizures and was dead or dying or comatose and arrived at the hospital, that was parathion poisoning until proven otherwise. There was no time to wait, because the remedy for that, the antidotes, the atropine and the P.A.M., were miraculous. It's my favorite poison, because you would literally bring the people back to life. I did that in the emergency room over here one day. We had a young girl brought in. This was before we had rescue squad. A police officer actually got this call. She called somebody and said she was going to commit suicide. He found her frothing at the mouth, twitching, unconscious and threw her in the car, brought her right in. They didn't know what she had and they put a tube down, brought some stomach contents up. It was a Saturday, I was over there by myself, nobody from the lab was working. I sniffed it and, you know one of the best diagnostic machines God invented is still the nose, and I walked over and the intern was doing chest compressions and I said, "Do you know what she's got?" "No." I said, "It's an organophosphate poison like parathion. I don't know which one, but probably parathion or something like that." The nurse was there and I said, "Do you have atropine?" She said, "Yes". She had a 5cc syringe and I said, "Fill it up all the way and give it to her intravenously." They did. About 15 seconds went by and all of the sudden she went 'whoosh' and her pupils constricted and perspiration just poured out of her. Now she was showing the classic signs, the textbook signs of organophosphate poisoning. I told the nurse, "Fill it up and give her another shot." I had no idea what the dose was but all I knew was that she needed it more and she said, "But, but this is atropine" and I said, "I don't care. If she dies I won't say you killed her. Go ahead and give her another shot." We used to do that with the emergency room right next to our office, and I remember there was a nurse there. She married Bill Anderson who is up there in Orlando now. But she used to come over and I would be working late at night at my desk, and I would get the sense of something and there she was. She'd say, "We have a problem in the emergency room." A lot of excitement.

Back to epidemiology and pesticides and Dr. Milton Saslaw. The idea of this was to have this in the Health Department. Milton Saslaw was in our Health Department, extremely phenomenal fellow for those of you who remember him. Went up later to the Palm Beach Public Health office. It was clear that the research center couldn't be done out of the Health Department. We had to create an agency or group. It was done through the University, and Dr. John Davies was chosen. We established an extremely close working relationship. Incidentally I was extremely saddened, I was out of town last week and when I came back I was looking over the newspapers stacked up and I found that he had passed away. John was one of the greatest, and it's a sad loss for the community. But he established this program which included a lot of surveys on distribution of the various types of pesticides and organophosphates.

The cat story is funny. It became pretty clear that we were dealing a lot with socioeconomic problems. Took three cats, drew blood from them, measured their organochlorine, you know like DDT and DDE, those things. Then they put one cat in a very high socioeconomic community in Coral Gables, another cat in the lowest socioeconomic black neighborhood in Overtown, and another cat way out in a rural area in some Mexican labor camp. They let them stay there and then went back and took the bloods. And guess what they found? Coral Gables, no poison. Low social economic here, poison. Out there in the rural area, poison. Why? Because there was DDT all over the place for roaches and crops. I have never forgotten that cat story, because I thought it was interesting. In fact, if you wanted to you could say that homicides are caused by DDT, because of the amount of homicide victims. We see more homicide victims in low socioeconomic areas and we see more DDT in bloods in low socioeconomic areas. Therefore, DDT causes homicides. You can see the fallacy in that, but incidentally, there is a lot of that type of erroneous thinking that does get into public health and it is a problem.

Anyway, out of this came not only our studies with them and working very closely with them, but John couldn't make it to Pakistan. There was a University of California Agriculture group that was supposed to go to Pakistan, and I went in his place. I took Rose Marie with me and it was an eye opener. We traveled through the whole country, except Baluchistan, because there was a shooting war going on at the time. Went through the Khyber Pass up Landi Kotal and up near the Afghan border. In Landi Kotal, the whole economy is smuggling. The Puthan tribesmen have never been subjugated. They can be bought. The British had to buy them. But, they had everything up there … cameras, refrigerators. And while I was there, I said I would like to see how you handle the hashish that you smuggle through here. "Oh, come this way doctor." They took me past smuggled cameras to the back room, and here was this fellow dressed with the robes of the tribesmen. He has a little scale, with this powdered leaf, and he's piling it on making little packets, and I said, "What is that?" He said, "That is our number three grade." I said, "Oh, well what's your number two grade." "Oh, here, doctor." He spoke good English. Opened up a cupboard and he brought out a brick about this long and that wide and it was real hard like that, compressed. I've seen them in the crime laboratory in Vienna brought in from, smuggled in from Turkey. He said, "Here, buy one." I said, "Oh, no, no, no. I don't smoke and besides I am a government official. If I got caught trying to smuggle that, they would wipe me out." He turned to Rose Marie and he says, "Pssst, you can hide it in your shoe." "No, no we have dogs at the airport that can smell that." Then I said, "What is your number one grade?" "Oh, here doctor." He opened up another cupboard and brought out this little bottle of the resin, the liquid resin very high in THC. I said, "How much do you charge for that?" He said, "Fifty dollars." I said, "Fifty dollars! That is a lot of money." He said, "Oh no, today in Milwaukee, Wisconsin the price is …. and in Detroit ….," and he was giving me the street prices in the cities for the United States. Today! Now where were we in terms of closeness to Dade County? We were about as far away as you could get. In fact, the next day we went up into the Kingdom of Swat and had the privilege of looking up at K2, the second highest mountain in the world. I mean that is how remote we were, and it was an amazing thing to see.

Departments of Ob/Gyn, Surgery and Anesthesiology

And now lets talk a little bit about OB/GYN. I could go on and on with these. These are fascinating things. I was sitting at my desk, and the phone rings. It is somebody from Nairobi, and it had to do with an obstetrical death. I said, "I would be glad to look at the slides some day." The husband was a businessman. "If he is ever traveling through and if he comes down this way, I would be glad to look at it." Three days later the husband was there with all the autopsy material. His wife had died during childbirth. It was her fifth child in the Nairobi Hospital, one of the private hospitals. During a pitocin drip, she died suddenly and unexpectedly. Her husband was in charge of oil imports for Kenya. She was the Mrs. Claire Weintraub of Kenya. She was the lady who built the homes, the public this and public that. I could readily identify with her, because having worked with Claire Weintraub in the past and appreciating what she did for this community, I could see how this Mrs. Ambala was the Claire Weintraub of Nairobi, and it was a devastating blow when she died.

It was pretty clear from the clinical history that she had an amniotic fluid embolism, but the government pathologist -- here is the rub -- the government pathologist under the English Coroner System is appointed by the coroner. This pathologist did an autopsy and immediately said, "She died of myocarditis" without even taking a microscopic slide and looking at the heart muscle. He was saying it was inflamed heart muscle, infected inflamed heart muscle, and no microscopic slide. Impossible! It's a fraud, a made-up diagnosis. But to her Ambala, who incidentally has his Harvard Business background, was not to be outdone. He had a pathologist in the Aga Khan Hospital, Nairobi -- the Aga Khan Hospital is like our Mt. Sinai; the Jomo Kenyatta Hospital is Jackson. And that pathologist had taken a bunch of specimens. He didn't understand amniotic embolism too well, but he sure understood heart and there was no myocarditis. It was pretty clear to me. What Mr. Ambala stated, he wanted a clinician as well.

I knew that Allen McCloud of our Department of OB/GYN had written a paper on amniotic fluid embolism and besides Allen, being a good Scotsman from Glasgow and the University of Glasgow being tied in with the Medical School in Nairobi at Jomo Kenyatta Hospital, was a natural. So, I introduced them and Allen went over the clinical aspects and agreed that it was an amniotic fluid embolism. The only upshot was, Allen and I were invited to Nairobi to an inquest, which was fascinating. But here I learned something. I learned that what we see in the news media here is not really very much. I was sitting at the hotel and I'm introduced to the Finance Minister of Kenya and he says to me, "By the way, I understand that your Vice-president Mr. Agnew shall resign." "Oh!" One month later it was announced in the United States. They knew it in Nairobi, but one month later we're finally told. I mean that is the way things are. I found that to be true all over. Go all over the world, they know more about what's going on here than we know. All we know is MTV and all that other stuff.

The School of Engineering. This is an interesting story. Because of our death investigations and traffic and road traffic and so forth, we became very active with the rejuvenated Dade-County Citizen Safety Council. Jim Ryder came up with some money and dumped it in. I was on the board and we hired Glen Sudduth from the City of Miami Police Department to be the executive director. Glen was a mover and shaker. He was great. In fact it wasn't until then that we were able to get the Implied Consent and Chemical Test Law through, with Glen Sudduth and Hugh Layler, who was another local businessman and member of the Rotary Club, and myself. We did a lot of campaigning up in Tallahassee to get that law passed. But one of the things that Sudduth and I talked about was the analysis of crashes. The police would write their report, medical examiner would do their little thing, and if there was a criminal charge it would go to the state attorney. There was no coordination, no putting it together, no analysis of the factors and so forth. So we needed to sit down and get together with the police and have little miniature sessions on certain crashes.

One day Glen said that he had heard that the Department of Transportation was getting ready to start some crash research injuries studies. With that, Glen went down to Henry King Stanford. Stanford liked the idea and said, "Now, I know a young engineer in the School of Engineering, a civil engineer named Bill Fogerty," and the rest is history. Fogerty took it over and the University of Miami became a star when it came to traffic death investigation. Our office did all the autopsy and the toxicology. In fact, they sent me out to UCLA where they had a center on crash studies to study crash engineering, which I thought was a lot of fun. These are all things that are part of the University. Here is the medical examiner. All these weave together. But for this or but for that, it would have never have happened. But it did and it was fun. I would like to say, incidentally, that eventually those crash study teams had done all their work. They got the information they need and they'd trace it out.

The University of Miami here still is doing this, and the legacy carries on in Department of Surgery at the Ryder Trauma Center with Dr. Augenstein. They are doing seat belt crash analyses. They have Jim Stratton, a full term traffic engineer reconstruction expert. Incidentally, when Jim first came aboard they didn't have room over there, so we gave him room in our office. He set up a desk, and then there was a little aisle, and over here was a computer typing things. And they had it set up. It was very fascinating. They didn't have any wires going from the desk to the printer. You would hit a button and something would go up to a satellite and would come down and right across the aisle and the printer would start printing.

The Anesthesia Department has always been of interest because the anesthetists put people to sleep. In other words, they take them down to the edge of death. Also, if people are at the edge of death, it's the anesthesiologist who's called to bring them back. A young electrical engineer, later physician, Gene Nagel, joined the Department. Being interested in electrical engineering, he came up with the idea of radio telemetry EKG's, and the whole concept of what is now universal throughout the civilized world of advanced cardiac life support response started in downtown Miami in the mid 1960's. Gene Nagel, Manny Padron, who was the man in charge of the City of Miami Fire Department's rescue service, and Dr. Jim Hirschman, a cardiologist who is still in practice in Coral Gables and still oversees the Coral Gables Emergency Service, they got together and set this up. Some of the planning sessions were carried out in our office 'cause we had a room where we could meet. I remember one time when it got to where the firemen were supposed to actually start doing medical doctor care on the sidewalk, and Manny Padron said, " We ought to have a law. I mean, they're there practicing medicine." I said, "No, if you go to Tallahassee, those people up there don't understand, you will get a criminal abortions fit. Just go out and do it and do it right and do it well." And that becomes the norm and then that becomes the standard. Then later when laws are written, that becomes the law. And that's true. That is the way things should be done. Never put the cart before the horse when it comes to these kinds of things. Do it and then later the laws will follow and that is a very important concept.

These studies of cardiopulmonary resuscitation were great because out of that came the big study on sudden cardiac death that was run through the anesthesia department. We did intensive autopsies on the deaths. They also studied live patients, and out of it came a very interesting thing. You will find the pathology literature is loaded with articles trying to show the microscopic signs of myocardial infarction in sudden death. We know that if a person has a myocardial infarct there is a lag of several hours before you can see it microscopically. And there are always these articles trying to come up with new stains to see the earliest myocardial infarction. Guess what? Fifty percent of the people who were in ventricular fibrillation died and were resuscitated, brought back to life, and made it through the hospital, 50% of those people never developed an acute myocardial infarction. In other words, pathologists had been looking for a will-o'-the-wisp that never existed. It was very fascinating to see this kind of work.

It paid off. Tom Abdallah was our head morgue attendant; he died upstairs in our building. Fortunately, fire rescue was right next-door. They came in, pounded him, brought him back to life. He had a couple of bouts of VF, but he eventually came back to work. He had been without oxygen so long that he ended up with a transverse ridge in his fingernail that slowly grew out. I've got pictures of this, and he's still alive. It's amazing. Oh, another interesting story is the first successful CPR, defined as successful where the person died, was resuscitated, brought back to life, made it to the hospital, and returned to his former occupation. That's success. It was a fellow with the same surname as me. And he lived for another year, and then died again, and I autopsied him. Now what was his occupation? He was a street bum. Street person. And he was the first successful CPR in the system. I thought that was fascinating.

How many other people? Jim Jude, still in practice, cardiovascular surgeon, used to come down. I remember when he was interested in heart valves. We used to talk about transferring valves from dead people into live people. Tom Starzl, the big liver transplant man, pioneer in liver transplants up at Pittsburgh. I remember him as a resident here, coming down to our autopsy room, looking at bodies and seeing if I did this and if I did that. It's been a lot of fun to work with these people. Then, of course, we get into transplantation -- the corneas, the bone and tissue, and so forth. When we designed our building we actually built into it a suite for the Bone and Tissue Bank of the University of Miami, but we could not finish it off because our building was built with criminal justice bond money. Therefore, we got the Rotary Club to finish it off, and there is a plaque to the Rotary Club over there on the building for this. And incidentally, one of the fellows in the Rotary Club who was a very staunch supporter of this, eventually became a donor himself, and it's named after him, the Thomas Wolfe Memorial. Well, there's other things. I could go on. I remember Gene Mann when he was in charge of research for the University. Then later he stepped down and went back to the Department of Chemistry. He was interested in some brain things.

Cooperative papers? I went through my bibliography the other day. Just me, not counting Dr. Mittleman, Dr. Wetli, Dr. Ras and other people in the office who worked with the University. I looked at some of my cooperative papers. Two in the Department of Medicine, two in the Department of Dermatology, six in the Department of Epidemiology, five in the Department of Anesthesiology, plus, incidentally, one that just came out. It was sort of like Anesthesiology. It was Jerry Modell, who was here, did all the drowning, and I used to work with him on that and we just published a paper. He's up at the University of Florida now. He was assistant dean for a while and he's in charge of fiscal matters. We just had a paper published this month in the Journal of Forensic Science and we are still working at it. Pathology Department, five papers, again that very close working relationship. Orthopedics and Rehab one, Surgery two, Psychiatry one, and the School of Engineering two. And then of course there's the other people in the Department also who have been involved in cooperative studies. I was never one of those people, as the department chairman, to require my name to be on a paper that came out of my office. Some people do that. Not me. If I had nothing to do with it, my name does not appear. I might also point out, from the standpoint of medical examiners, there has been a close working relationship between the Broward Office and the Department of Pathology and some very excellent papers and studies have come out of that.

Politics and Public Health

How about the pedestrian crossing light and fence at US1 in Coral Gables? Interesting story. Interstate 95 was built. From 36th Street north to the county line was the first part. Opened to traffic, nine people killed. Crossover, head-on collision. Of course, they are all drunks, but innocent people getting killed as well. And there was a lot of activity from the Safety Council. We'd hit the creamed chicken and peas luncheon circuits. The end result was they built a divider up 95. The next year, zero deaths. Broward County extended I95 and guess what? No dividers. And guess what? First year, nine deaths. Same thing. Well, this time when they finally built I95 from 36th Street down to US1, they opened it and I drove, no dividers. I was appalled! So I wrote a letter to the head of the State Road Board, who was at that time was Mike O'Neal. He was president of General Tire, and those days the Road Board was sort of the governor's slush fund -- payback, political payback -- and very effective. It may be political, but boy was it effective! One letter, in no time at all we had the work done. Today, the beauracracy wouldn't work.

Then because of the success of that, we had a student at Coral Gables who was killed on US1, because the dormitories were here, the shopping center was there and US1 in between. Now the kids are young. They'd go fast, dodge through. They'd survive until the traffic volume gets to the critical point, and then they start getting killed. We didn't wait for more than one. One got killed. So I went down and saw President Stanford's office, talked to the people down there, talked of the politics and how to push and shove, and today we have a pedestrian light down there, and we have the fence that controls the kids. The coroner for the City of London, North District, was talking about how with his inquest power he got a pedestrian overpass built. I was taking him down to Coral Gables to drop him off where he was staying, and as we drove around I said, "See this, we had this put in but without an inquest … See this, we had this put in without an inquest." It isn't really the system; it is pushing the right buttons and dealing with the right people.

I would like to comment a little bit about government medicine, the work I did in the Public Health Service, being detached to the Bureau of Indian Affairs. One hospital was a decent hospital in Tacoma, Washington. That is where I met Rose Marie. She was a nurse there. But, the other hospitals, there were three hospitals out in the boonies. Ft. Belknap -- we had running water but you couldn't drink it, salmonella. It was raw water out of the Milk River, so every day Indians would go up into the hills and fill garbage cans with water at the spring and we had garbage cans to drink out of. San Xavier Hospital, outside of Tucson -- we had a clinical laboratory, consisting of a bottle of urine test tablets that were fused and corroded into a solid mass. That was it. San Carlos Apache in San Carlos, Arizona -- they had finally spent $1,500 and bought a new x-ray machine. Indian comes in with a broken leg. I'd set leg. I wanted to get an x-ray, pushed the button, the lights went out. We didn't have electricity. What did this teach me? This taught me that if you leave medical care up to the Government and the bean counters, this is the lowest common denominator that you will get. It takes total diligence to keep that from happening. It will happen if you don't.

Politics? Public Health? One of my favorite books is The Coming Plague by Laurie Garrett. She goes into a lot of fascinating things on public health and politics and fetches. It was interesting to see her comments about the influence of politics in public health. I remember Zermat in Switzerland. They had a little outbreak of typhoid and the local politicians decreed silence and the result was people left Zermat and typhoid was springing up all over the world. And then everybody knew it. If they had just come out and talked, it would be all right. Though it's not new, I was going through some old stuff and I came across a fascinating article, something about cholera and back in the 1870's of all things. There is a quotation. Dr. William Reed of Boston talked about cholera as being a contagion which did not fit in with people who liked to say, "Well, it was really due to the wrath of God, or something this or something else." Anyway, he was thoroughly reprimanded for espousing ideas "detrimental to the health, happiness and pecuniary interest of the citizens at large". In other words, telling the truth in public health will get you in trouble and it's still true today.

In fact, a variation of that, the Egyptian Airline Pilots Association was complaining lately that none of their pilots would ever crash a plane. In fact, I can remember back when I was a consultant for the FAA, there was a fifteen year stint in 1960 onward, hearing stories about union guys getting there to a crash site before anybody else and adjusting the records to fit their preconceived notions. That happens. So there is a lot of interesting publications in terms of politics and public health and I think current event histories are very good. Richard Rhodes writes some very good material. We take, for example, the people who made the atom bomb. We assume that a few of these scientists came together and they created the atom bomb. But there was an underlying background. How do the scientists happen to be there at the time? It all goes back to the Bolshevik Revolution. The Bolsheviks taking over Hungary, then being overthrown and the first fascist dictatorship under Horthy being established, and then people being forced out and that's the way of it. Incidentally, under Horthy they established a fair quota system for the university that student representation at the University should represent the ethnic makeup of their country. Sounds fair. Sounds like today, the preachings of today. No, it was an anti-Semitic law. It was passed strictly as an anti-Semitic act, but it was quota system. In other words 5%, which was the Jewish population of Hungary. You couldn't have more than 5% Jewish students in there. And that sounds strangely familiar today, with quotas and so on.

The future? I think the future is bright. I don't think it is going to be as exciting as it was because there has been all this evolution that's taking place. When things are evolving, it's more exciting than when things are stable. But, we have the office. There's a very close working relationship with the University. Dr. Mittleman here is working closely with the University. Dr. Michael Bell, who is his Deputy Chief, is carrying on the cardiovascular interest with the Department of Pathology, and of course Dr. Lee Hearn is tied in with Pharmacology. So I think the future is bright and I think there is room for more research, more teaching, more study. I might say that it has been a marvelous experience, a lot of fun. I'd like to say also to Dewitt Daughtry here, who is pioneer thoracic surgeon, I remember him recruiting me for a chapter in a book that he was writing. That was another thing, another aspect of this. It's been fun and I appreciate it. I only regret that I don't have time to come to this Library too often. US1 traffic thwarts me. It's no fun driving in that traffic, but it is a great institution and I think the Grosses are to be commended for their interest in the furtherance of this Library. This is a jewel. I can remember when the Medical School Library was over in one of those old buildings built in 1924, just a little collection of books and that was it. And, what we have today is just marvelous. I would like to end by saying thank you very, very much. Thank you.

Joseph H. Davis, M.D.
Chief Medical Examiner Emeritus
Dade County
November 18, 1999



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