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Recalling Cocoanut Grove
At BCH reunion, doctors discuss horror and heroics of fire tragedy
By M. R. Montgomery, Globe Staff, 5/25/1992
The doctors came back by the hundreds this weekend, students who learned the reality of medical practice at Boston City Hospital. More than 500 doctors -- mostly male because they are of that generation -- came in from 30 states, six countries and dozens of hospitals and clinics of distinction. They gathered at dinners and at specialty reunions and at tours of the sprawling complex that is and was City Hospital.
For decades, until Boston University Medical School captured the flag in the early 1970s, three great medical schools -- BU, Harvard and Tufts -- worked in the warren of buildings along Albany Street, Harrison and Massachusetts avenues. It was an insane, wonderful, place: The medical schools and the hospital had separate surgical services, multiple medical departments, three and four of everything, including basic research laboratories in the brick and sandstone buildings. Two Nobel prizes were won at City, both for research on pernicious anemia. Thousands of medical students became physicians. At its height, more than 1,200 patients, most housed in large wards, were the objects of clinical interest and the recipients of exceptional medical care.
But as a hospital, Boston City had one defining moment -- the night in November, 50 years ago this year, that ambulances, taxi cabs, newspaper delivery trucks and private cars descended on City's emergency room with 132 living victims of the Cocoanut Grove nightclub fire and more than 300 others who were dead on arrival or would die before they could be admitted. It was the holiday holocaust, Nov. 28, 1942, the Saturday after the Thanksgiving Day football game -- as sports fans remember -- when Holy Cross knocked bowl-bound Boston College out of the running for a postseason game.
Dr. Stanley Levenson, then just a year out of Harvard Medical School, came to work at City on Nov. 18, 1942, as a young researcher in a unique role. City, with funds from the federal Office of Scientific Research and Development, had contracted to investigate methods of treating burn victims. The war was under way, and Pearl Harbor was proof that burns were the great enemy for civilian and military alike. Of all City's unusual practices, the "burn service" was the strangest. The burn service would be in charge of the study and the treatment of any burn patient, in any of the three medical schools' surgical services, as well as in the hospital's own surgical service and in the pediatric service at the then-new Curley building.
"I remember well," Levenson told a group of fellow City alumni, "that Thanksgiving Day: We had a wonderful meal in the hospital, and then I came down with food poisoning," an anecdote that brought knowing laughter from an audience that had survived years of City food. "I was still in bed on Saturday night, when I got a call from Dr. Charles Lund, chief of surgery, and he told me that no matter how I felt, I had to get to ER immediately, something terrible had happened.
"By the time I got there, two house officers were already at the door, sorting the patients into living and dead, stacking the dead along one side of the hall, the living on the other. Two more house officers were evaluating the living, giving morphine, directing them to surgeries. At one point, it has been calculated, we were receiving a patient every 11 seconds."
The leading cause of death, both at the scene and among the 39 who died inside City Hospital, was not burn wounds, but smoke inhalation and carbon monoxide poisoning. Indeed, most of the severely burned did not survive long enough to enter City (the only other large group of patients were treated at Mass General). One severely wounded exception was a Coast Guardsman, 21-year- old Clifford Johnson.
Levenson, in an interview before the reunion began, remembered the young Johnson well. "He was a hero. He'd gotten out quickly, he was near one of the few open exits, and then he went back in five or six times, carrying people out, and then collapsed, and was burned severely." Johnson, in fact, was burned over 50 percent of his body, and half of that was burned through to the bone. He would be, at the time, the most severely burned patient to ever survive.
"We had so little technology," Levenson recalled, "one respirator on each floor at best. The technology for studying blood gases and chemistrys didn't exist anywhere. We were giving oxygen directly through green rubber tubes." Even antibiotics were almost unknown, except for the earliest sulfa drugs. The nutritional needs of burn patients were not understood, the treatment of the wounds consisted of little more than painting them with sterilizing and protective mixtures of aniline dyes.
What pulled the patients through, including Clifford Johnson, was intensive nursing. "You simply kept them going, kept them breathing, getting them to cough, urging them on, physically clearing their airways, lending moral support. We had great attending doctors," Levenson said, "residents, medical students, and most of all, we had wonderful nurses.
"Clifford Johnson had two nurses at a time, 24 hours a day, and sometimes there would be a Coast Guard corpsman, too. All the patients got 24-hour one- on-one nursing as long as they needed it."
The burn service doctors had their work cut out for them. The patients were divided among 34 different wards in eight buildings, and each patient was seen several times a day by Lund and Levenson, and also by the hospital's chief of infectious disease, Maxwell Finland. "We wanted to have good records on the patients," Levenson recounted, "and to Finland, that meant accurate and consistent monitoring. He listened to every patient himself, every day, and Dr. Charles Davidson and I would take his dictation. It was the only way to get consistency. That was the kind of place City was, and Dr. Finland, of course, was famous for his work habits. His life revolved around City and the Thorndike a research center of Harvard Medical School. He actually lived there, sleeping on a cot in the house officers' building. He had a little house in Squantum, which he might visit on a weekend."
The treatment and follow-up of Cocoanut Grove victims produced dozens of papers, some of which remain classic descriptions of the effects of burns and smoke inhalation. Even the standard system of mapping the percentage of the body surface burned -- the Lund-Browder Body Surface Area Diagram -- is a Cocoanut Grove result. Treatment has evolved dramatically since 1942, based in part on the first recognition, in the cases of the Grove victims, that severe burns affect every major organ in the body indirectly, causing everything from gastric ulcers to brain damage, heart disease and extraordinary changes in basic metabolism. Where once Clifford Johnson was a miracle, surviving 55 percent burned surface with 25 percent of his body burned through to the underlying bone and muscle, now a victim of his age with his wounds will survive more than half the time.
Johnson, after a year in City and another year in military hospitals, walked out with full mobility and no lingering disabilities. Dr. Newton Browder had taken him on as a personal challenge, Levenson remembered. "Dr. Browder did thousands of pinpoint skin grafts moving bits of Johnson's skin from uninjured areas to wounds, all of them, as I recall, with a Gillette blue blade. Browder was unbelievably involved with all his patients." And so were the nurses. One of them, Marion A. Donovan, fell in love with the courageous patient, and married him.
Fully recovered, Johnson and his new wife went home to his native Missouri. He found steady work delivering fuel oil.
On Dec. 20, 1956, Clifford Johnson's truck skidded off a road near Sumner, Mo., and burst into flames. Trapped in the cab of the truck, he burned to death in the fire.
This story ran on page 30 of the Boston Globe on 5/25/1992.