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Maxwell Myer Wintrobe was a man whose body of work not only established hematology as a distinct subspecialty, but also earned him a place in the pantheon of physician-scientists. This account of his career contains information and photographs not heretofore available.
The story begins on October 27, 1901, the day Max was born. Contrary to all previous reports, he was not born in Halifax, Nova Scotia. A few days before he died, Max told his daughter, Susan, that he was born in Austria of Austrian Jewish parents named Weintraub. He also said that during his early childhood, the three of them had fled to Canada because of religious persecution in their homeland. A meticulous search of Canadian census records showed that a Herman, Ethel, and Max “Weintrub” had arrived in Halifax from Austria in 1906 (Fig. 1). In that regard, Max's autobiography1 indicated that his mother (whose maiden name was Zwerling) had four brothers living in Halifax at that time.
In Halifax, Max was raised in the extended Zwerling family.1 As an only child, he was very close to his mother, whom he described as a caring person, liberal, and unprejudiced. He credited her for teaching him the values of a good education and hard work. His father, on the other hand, had no great ambition, either for himself or for Max. Nevertheless, Max writes of his father as an honest, independent man who never borrowed from anyone.
In 1912, at the age of 11, Max moved with his parents to Winnipeg, Manitoba, where he later attended St. John's High School. He was an excellent student, completing eight years of grade school in six. Consequently, in high school and in college, Max was always younger than his classmates (Fig. 2).
Current officials at St. John's High School* confirm that a Max Weintraub was, in fact, a student there in 1915 and 1916. Furthermore, Max's daughter is in possession of his high school art box that bears his name on the top (Fig. 3) with an address on the bottom. According to the 1914 Winnipeg city directory, a Herman Weintraub (almost certainly Max's father) was the occupant at that address.
At the age of 15 years and 10 months, Max entered the University of Manitoba, where he spent four years getting a general education. According to authorities at the University,** Max's last name on entry there was Weintraub; however, on his diploma, it was Wintrobe. Thus, sometime during those four years, Max's name changed from Weintraub to Wintrobe. How and why the change occurred remain unanswered.
In college, Max favored English, Latin, and history, but majored in political economy and French, winning gold medals in both upon his graduation in 1921 (Fig. 4). Of historical interest, his graduation yearbook listed his birthplace as Sanok, Poland. The village of Sanok was a part of the Austrian Empire in 1901, but became a part of Poland after World War I.
In 1921, when he was just under 20 years of age, Max entered medical school at the University of Manitoba. Why he chose a career in medicine is unclear, but he himself suggested that it probably was because medicine was a respectable and rewarding occupation.1 He divided his time in medical school between work and play, never working to the point of extreme fatigue or late into the night—a habit similar to that of his idol and role model, William Osler. During the summer, he liked to canoe and play tennis; in the winter, skating and tobogganing were his diversions. He also acquired a love for chamber music, triggered perhaps by his lifelong love of the violin.
In his sophomore year, Max learned about the Johns Hopkins School of Medicine and wanted to transfer there, but he couldn't afford the tuition or the added expenses of travel and living away from home. So he gave up the idea of going to Johns Hopkins but not the desire—a desire that strengthened when, as an intern, he read Harvey Cushing's The Life of Sir William Osler.
One other aspect of Max's sophomore year is noteworthy. To ease his financial constraints, he took a job in the hospital's blood bank. Many years later, he told me that working in that blood bank was the spark that ignited his passion for hematology.
Max enjoyed studying medicine and sailed through his courses. Excelling at every level, he graduated first in his class in 1925.2 Despite all he had learned, he realized that he still knew very little. Therefore, rather than enter private practice as all of his classmates were planning to do, Max opted for more training. Accordingly, he interned at the Winnipeg General Hospital during 1925–1926 and took a medical-biochemistry fellowship at the University of Manitoba during 1926–1927.
Throughout the years, Max's family lived extremely frugally, constantly struggling to make ends meet. To help the situation, Max held a variety of jobs: delivering newspapers, collecting bills, teaching art, and working in a vinegar factory. But the job he found most interesting was in a secondhand bookstore. There, he became acquainted with the titles and authors of many great books and pursued his love of English literature. Creating a Subspecialty: Tulane (1927–1930)
In September of 1927, Max accepted a job in New Orleans as assistant in medicine at Tulane University. At that time, there was no such discipline as hematology, but Max was soon to change that. In fact, years later, he considered the move to New Orleans as the most fortunate decision of his life.1
With a salary of $1,800 per year—modest as it was—Max could now marry his sweetheart, Rebecca (Becky) Zanphir, whom he had met when she was a freshman in college and he was a freshman in medical school. Born in Romania, Becky had moved to Canada around 1910. They were married in Winnipeg on January 1, 1928, and returned to New Orleans (Fig. 5) to live in a small, one-room apartment with secondhand furniture.
In New Orleans, Max's boss was John H. Musser, Jr., Chief of Medicine at Tulane. Dr. Musser had been asked to rewrite the section on Diseases of the Blood for the Tice Practice of Medicine—a 10-volume, looseleaf text. He invited Max to share the effort with him, but as things turned out, Max did all the work. That work, in turn, set the stage for Max's Clinical Hematology, a textbook that would later become the classic in its field.
His work at Tulane—enhanced by superb clinical material at Charity Hospital—produced monumental results. Among the most memorable was his invention of the now famous Wintrobe hematocrit3 (Fig. 6)—a glass tube roughly 10 cm in length, holding about 1 mL of blood, with straight sides meeting the bottom at right angles. Etched on its side was a centimeter (cm)/milli-meter (mm) scale, enabling easy determination of the volume of packed red blood cells after centrifugation. This instrument also proved valuable in measuring the erythrocytic sedimentation rate,4 determining the volume of packed white cells and platelets, and detecting changes in appearance of the plasma.5 Because Max devised his hematocrit for the public good rather than for his own financial gain, he applied for no patent and refused all royalties from the many millions of his hemat-ocrit tubes that were sold.
Regarding his hematocrit, he said:
I … discovered that there were no reliable normal blood values. What was called “normal” was based on only a few counts that had been made in the nineteenth century. So I proceeded to collect normal blood values. Others elsewhere, also mindful of this deficiency, were beginning to do the same. A major problem, however, was methodology, and this was what led me to devise the hematocrit as a simple and accurate means of quantitating blood.6
In his attempt to document statistically normal blood values in adults and children, Max made careful observations of various populations, including Tulane medical students and women from Sophie Newcomb College.7 An integral part of this effort was Max's derivation of the red blood cell indices8,9:
One practice I did develop … was to keep paper and pencil beside me when I went to bed because I found that an idea might come to me in the middle of the night. Unless I was able to get it down on paper it might have escaped me by the following morning. The idea of calculating the mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) came to me in this way.6
From these red blood cell indices, Max classified anemia into three basic forms—microcytic, normocytic, and macrocytic.10 That classification has been the standard ever since, and determining the red blood cell indices is still done daily in laboratories throughout the world.
In 1929, Max earned a PhD at Tulane. His thesis was a monograph titled “The Erythrocyte in Man,”11 which he submitted for publication in the journal Medicine. The editor of that journal, Alan Chesney, was also Dean of the Johns Hopkins University School of Medicine. Impressed by the monograph, Chesney invited Max to join the Hopkins staff as an instructor in Clinical Microscopy, a division that Osler himself had founded. Max happily accepted the invitation.
On arrival in Baltimore in 1930, Max and Becky encountered blatant anti-Semitism. Max had experienced this to a small degree in Winnipeg, but he and Becky had been welcomed everywhere in New Orleans. In Baltimore in the 1930s, however, there were areas of town in which Jews were not allowed to reside. Moreover, except for Dean Chesney and a few other faculty members, none of Max's colleagues at Hopkins invited him and Becky into their homes. Nevertheless, medically and scientifically, Hopkins was everything that Max had hoped for, and it was there that his reputation as a clinical investigator, teacher, and hematologist blossomed.
In 1933, Max and Becky took a 6-month sabbatical to tour major hematologic centers in England, Denmark, Germany, Holland, and Austria. During that trip, Max met the world leaders in hematology and established lasting friendships with many of them. On his return, he was made Chief of the Clinic for Nutritional, Gastrointestinal and Hematologic Disorders at Hopkins, succeeding Thomas R. Brown, one of Osler's early students. Then in 1935, Max's rank at Hopkins changed from that of instructor to associate in medicine.
While working at Hopkins, Max did more than build his professional image; he also began building his family. On January 23, 1937, Becky gave birth to their daughter, Susan.
On May 21, 1943, Philip Price—a graduate of Johns Hopkins and the Chair of Surgery at the newly formed, four-year medical school at the University of Utah—surprised Max with a letter inviting him to consider becoming the school's first Chair of Medicine. In a follow-up letter, the school's Dean, Dr. Cyril Callister, officially offered Max the job at $8,000 per year. After a 72-hour train ride to Salt Lake City, where he was “wined and dined,” Max did much soul-searching with Becky and finally accepted the offer. In doing so, he rose from associate in medicine at Hopkins to professor and chairman of medicine at Utah, arguably a jump in rank unequaled in the history of academic medicine.
Max, Becky (five months pregnant), and Susan arrived in Salt Lake City on September 12, 1943. There, he found the situation much worse than he had been allowed to discover. The medical school was housed in an antiquated World War I dormitory for cavalry officers.7 Moreover, the clinical facility was the Salt Lake County General Hospital, a dilapidated, neglected, and badly run structure with no blood bank, hardly a laboratory, and filthy accommodations for patients. Nevertheless, against tremendous odds and with little financial support, he was able to recruit a small but truly outstanding faculty, each member an excellent teacher, clinical investigator, and physician.
Max's goal was to establish a first-rate medical school, where teaching, research, and the best possible medical care would receive equal dedication. Not only did he achieve his goal, but he also became the guiding spirit of the school. The all-powerful Executive Committee, which consisted of all department heads, rarely passed any resolution without his consent; and on a few occasions, a decision made during his absence was revised the next month.
On January 7, 1944, four months into his new job, Max took pride in the birth of his son, Paul. For the next 8 years, the Wintrobes were a happy, handsome group (Fig. 7). Then, on August 14, 1952, disaster struck. The four of them were riding in a small convertible with another family of four on a slippery mountain road in Wyoming when the brakes failed, forcing their vehicle into the path of an oncoming car. The ensuing crash killed Paul, as well as the driver's son. Susan suffered serious head wounds and fractures of the spine and pelvis. Max, Becky, and the other three passengers escaped serious injury.
The loss of his son was devastating to Max. As a result, he dedicated subsequent editions of his textbook not only to his wife, as he had done before the accident, but also to the memory of their son, Paul.
One of Max's early achievements was to obtain the school's first research grant ever—$100,000 to study muscular dystrophy and other hereditary and metabolic disorders. It was also the first research grant ever awarded by the National Institutes of Health and was renewed annually for 23 years.
While at the helm, Max and his associate, George Cartwright, built a hematology training program second to none. It graduated approximately 110 fellows, 85% of whom became associated with medical schools or research institutes around the world.12
Accounts of Max's scientific and academic achievements are available elsewhere.2,7 A few of the highlights, however, are worth mentioning here: Max
He wrote more than 400 medical articles and three books. His textbook, Clinical Hematology, appeared in 1942 as a single-author, exhaustively and meticulously referenced, 792-page tome. For its first six editions, Max remained the sole author. For the seventh edition, which comprised 1,896 pages, he appointed five of his former fellows as co-editors. Now in its 11th edition, the book has six editors, 133 contributors, 2,719 pages of text, a 74-page index, and is available in Spanish, Italian, and Greek. Even today, Wintrobe's Clinical Hematology has few rivals.
Max co-edited Harrison's Principles of Internal Medicine from 1951 through 1966 (Fig. 8) and was its editor-in-chief for the sixth and seventh editions in 1970 and 1974, respectively.
He edited and partly wrote his second book, Blood, Pure and Eloquent: A Story of Discovery, of People, and of Ideas.25 It offers a history of scientific discovery in hematology and contains written accounts from some of the scientists responsible for those discoveries. This work won the 1980 American Medical Writers Association book award for physicians.
His third book, Hematology, the Blossoming of a Science: A Story of Inspiration and Effort,1 was published in 1985, a year before he died. It is his autobiography, together with a history of hematology, brilliantly unfolded in the context of the lives of the men and women who contributed to the development of the discipline.
Max lectured in numerous countries, received myriad awards for his research and teaching, headed many prestigious organizations and committees, and trained hundreds of house officers and scores of hematologists. He served as President of the Association of American Physicians (1956–1957), the Association of Professors of Medicine (1965–1966), and the American Society of Hematology (1971–1972). In 1973, he was elected to the National Academy of Sciences.
Max was the Chair at Utah for 24 years, stepping down in 1967. Three years later, the university named him Distinguished Professor of Internal Medicine, its highest academic rank.
Beginning in 1954, I spent five years with Max, four as his house officer (including one as Chief Resident), and one as a member of his staff. The more I reflect on those years, the more I have come to appreciate their immense value to me, and the more my respect, admiration, gratitude, and love for Max have grown.
He demanded much of those around him, but never more than he demanded of himself. He abhorred excuses, expected top effort, and praised only those whose performance was exceptional. He was firm but fair. He played no favorites and complimented or condemned trainees and colleagues just as rapidly and convincingly as he did the custodial staff or hospital administrator. He had the rare ability to criticize someone's work without making the individual feel personally attacked. He listened perceptively and spoke authoritatively, never leaving his audience in doubt as to where he and they stood, and why.
He rarely seemed satisfied. “No matter how good a job we do, we can always do a better one,” he would say. Indeed, had I discovered the cure for leukemia, his response surely would have been, “That's fine, Herb, but why didn't you do that last year?”
Two other statements of his have stuck with me through the years. “If I do my job well,” he said, “I'll never win a popularity contest.” And, in that regard, he often added, “I'd rather be respected than loved.”
Although he never wasted a moment at work, Max knew when to relax and how to play. He was an avid skier, appreciated the fine arts—especially the symphony—and enjoyed travel. He was all business in the hospital but charming in his home. He and Becky loved to entertain and were incomparably gracious, whether hosting one couple, such as my wife and me, or giving their annual lawn party for the faculty, house staff, fellows, newcomers, and other friends.
With trainees always high on his priority list, Max instituted a policy whereby students, house officers, and fellows were the first to examine all patients, whether private or nonpaying. Later, this policy was widely emulated.
As a teacher, Max used the Socratic method, asking many questions but giving few answers. He believed strongly that one could learn much from any patient, regardless of how routine the case appeared (Fig. 9). In that light, he said:
… the physical examination must be carried out with a watchful eye, a sensitive touch, discerning ears, and an alert sense of smell. Above all, what is needed is an alert mind, free of dogma and routine. Each clinical problem, no matter how routine it may appear to be on the surface, calls for an unprejudiced approach. Each possible clue must be pursued; nothing can be taken for granted.26
True to his words, he invariably discovered something in the medical history or physical examination that others had missed or inappropriately ignored. He taught best, however, by setting examples—particularly the examples of hard work, self-discipline, self-education, clear thinking, intellectual honesty, and intellectual curiosity.
His unwavering commitment to excellence made him intolerant of mediocrity. If, for example, the patient complained that the breakfast biscuits were cold, Max scolded the ward personnel. If the chest film was overexposed, he chided the radiologist. If the case presentation was not crisp and well organized, he rebuked the students and house staff. Observing all this, I worked hard in the hope that he would never have grounds to reprimand me.
Because I took pains not to be the object of his displeasure, I never fully appreciated his effect on me until years later. Only then did I realize that I, too, am intolerant of mediocrity, and that I teach as he taught, speak as he spoke, and think as he thought about medicine and life in general.
In the 20th century, Maxwell Myer Wintrobe (Fig. 10) was a giant among physician-scientists. His death from heart failure on December 9, 1986, at the age of 85, ended six decades of outstanding clinical research and teaching.
What he accomplished is truly amazing, considering that he had no mentors and no formal hematologic training. Yet, his work established hematology as a distinct subspecialty. His textbook, Clinical Hematology, was (and remains) the most authoritative in its field. And his model fellowship training program produced scores of academic and practicing hematologists around the world. No wonder this man, by his own efforts, achieved lasting international renown.
Even more powerful was Max's impact on those around him. He favorably and profoundly influenced countless medical students, house officers, and fellows, giving their lives—our lives—new impetus and direction. To me, that was, and is, his finest and most durable contribution.
I am indebted to Hendrik A. van Dijk for assiduous and tireless research efforts, Kimberley Concepcion and Mark Scheid for assistance in preparing the manuscript, and Susan Wintrobe Walker for family information and photographs.
*Personal communications: C. Dewar, Chair, St. John's History/Archives Committee; C. Kurdydyk, St. John's Anniversary Committee; W. Winslow, Librarian, St. John's High School; Winnipeg—contacted separately and on more than one occasion in December 2006.
**Personal communications: N. Marnoch, Registrar; M. Reid, Advancement Records; D. Turston, Record Advisor; and Lewis St. George Stubbs, Archivist, The Neil John Maclean Sciences Library—all at the University of Manitoba—contacted separately and on more than one occasion in December 2006.
Address for reprints: Herbert L. Fred, MD, MACP, Department of Internal Medicine, The University of Texas Health Science Center at Houston, 8181 Fannin St., Suite 316, Houston, TX 77054
Adapted from a speech delivered in Salt Lake City on May 18, 2007, honoring Dr. Wintrobe, the 1st Chair of Medicine at the University of Utah School of Medicine. This article deals more with Wintrobe the man than with Wintrobe the legendary physician-scientist. Throughout, therefore, the author refers to him respectfully as “Max.”