Intuition, the Welcome Stranger

INTUITION, THE WELCOME STRANGER HENRY R. JACOBS* When at last one has time, during that brief interval between retirement and dotage, to contemplate one's experiences, one seizes upon the remarkable and the miraculous to wonder about. And one writes, whether naive or experienced in the art. The impulse is historic. Juvenal (a.d. 60-120) knew it well. That venerable Roman wrote, An inveterate itch of writing, Now incurable, clings to many And grows old in their distempered body. A measure of urgency attends the writing, owing to the certainty of a visit presently by That One with a Summons: When a man knows he is to be hanged in a fortnight, It concentrates his mind wonderfully. [Samuel Johnson] This memoir describes a number of remarkable occurrences encountered in research in medicine. Each one doubtless qualifies as an intuitive experience. Because the intuitive process is still poorly understood, these instances are offered to enrich, in small degree, the understanding of a valuable function of mind. The first occurrence happened in 1930 while I was a resident at Presbyterian Hospital (Chicago). It was on a football afternoon with beautiful weather for a game at the University of Chicago. I had the duty in medicine, but all was quiet. The house staff had gone to the game. I wandered over to Dr. Woodyatt's laboratory at Rush next door and sat down on a laboratory stool. I noted how well scrubbed the old floor looked. The janitor, Mr. Holcomb, was a jewel. Nothing more crossed my mind. I felt slightly put off at being confined on such a day and wondered how the game might be going at Stagg Field. ?Associate professor emeritus, Northwestern University. Chicago. Address: 525 Grove Street, Evanston, Illinois 60201.© 1981 by The University of Chicago. 0031-5982/81/2403-0228$01.00 Perspectives in Biology and Medicine ¦ Spring 1981 ) 457 One wall of the laboratory was solid with shelves loaded with bottles of chemicals. The bottles were too far away for me to read their labels. I gazed idly at them from across the room. After sitting quietly for a time in what now seems to have been a trance, I walked to the shelves and took down three bottles (and only three). Without reading their labels I placed them on a table and sat down again. I gazed absently at them for a while, then for the first time read the labels. They were cobalt chloride, choline chloride, and sodium ferrocyanide. Although I had studied organic chemistry in graduate school these three reagents meant little to me. Choline is a quaternary ammonium compound that forms complexes with certain metals, perhaps with cobalt, but ferrocyanide could not be given a role. I was ready to replace the bottles but paused, thinking I might as well mix the reagents and note that nothing would happen. I put a few particles of each in separate test tubes and added a little water to each. All dissolved. Then I added the cobalt to the choline and that mixture to the ferrocyanide. A clear emerald color appeared instantly . A new colored compound of cobalt had been discovered. It became the basis for a colorimetrie method for potassium in blood [I]. The method was standard for many years [2, 3]. This experience is puzzling because it suggests elements of automatism . Selecting three appropriate bottles from among 100 by chance alone has a chance for success of about one in a million. The second occurrence, the discovery of the hypoglycemic action of alloxan, had a different setting. It took place at the Billings Hospital of the University of Chicago during the starving thirties. What led to the discovery is as obscure as what led to the discovery of the green cobalt compound. I had had a cold that kept me in bed for several days. While I recovered, it was hard to keep my mind on what I was reading. (I am sure I felt sorry for myself, but that might have been profitable, since Allah favors the compassionate.) It was then that alloxan entered my mind with no prior thought. The exciting circumstances associated with the first experiment were described in the...