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256 257 true, in a career in tropical medicine. The absolute teachings from my medical school days were, and are, the foundation of my professional life. But too many dogmatic teachings simply didn’t stand up to the new realities I faced; what professors taught as optimal solutions proved to be “ain’t necessarily so.” In fact, in the tropics, one had to adapt in order to survive . One developed a healthy skepticism, a respectful questioning, probing, experimental approach; this is the philosophic basis for all research. I shall offer two examples in my tropical medicine career, where new observations fundamentally changed the understanding and management of two major infections. The teachings of the classic texts “ain’t necessarily so,” at least forever. The filarial infections hold an honored place in the history of tropical medicine. When Patrick Manson, in 1877, in Amoy, China, demonstrated that Aedes mosquitoes transmitted filaria from man to man, this was the first time that arthropod vectors were identified as an essential element in the life cycle of a disease. The filarial infections cause widespread, horribleelephantiasisoflegs,scrota,andbreastsandcan damage the renal system resulting in patients urinating milky lymph fluid, or chyluria. These are widespread infections around the globe. Manson’s discovery of insect transmission predates by twenty years the work of Ronald Ross on the role of Anopheles mosquitoes in malaria. His early definition of the life cycle of the different forms of filariases and their clinical severity explains why these diseases were so well studied, and why their pathology and therapy were presented so unequivocally to a young student beginning tropical medicine in London in the early 1960s. It Ain’t Necessarily So Lenox Hill Hospital, 2003 I am grateful for the opportunity to honor the memory of a great surgeon and admired colleague who made a major contribution to Lenox Hill Hospital. Since I can contribute nothing to surgical knowledge, I was initially puzzled as to what should be the topic of this talk. As happens so often in life - or at least it has been true in my life - the solution came from a most unexpected source. I was listening to the George Gershwin opera, Porgy and Bess, and the classic song, It Ain’t Necessarily So, got me thinking. I hope to develop a cohesive lecture for you, one that begins a long time ago, when everything seemed so easy and direct; it then moves on to philosophic reflections and some detailed consideration of two tropical infections; the talk then goes forward four decades, citing two other infections once considered “tropical” but now known as important bioterrorist agents; and ends with further reflections on our profession, security, and life. I had gone to medical school and learned the formulas, memorizing the signs and symptoms of diseases, the useful acronyms, the differential diagnoses, the optimal therapies, and even the exact doses. My father and brothers were doctors, and I looked forward to a traditional career in the practice of medicine. But it wasn’t to be. I was fortunate - and that’s where the trouble started - to travel widely at an early stage of my career. One quickly, and recurrently, came to realize that “it ain’t necessarily so.” All those lessons you learn in the Bible, according to the song, ain’t necessarily so. And the same, at least in my experience, has been 256 257 true, in a career in tropical medicine. The absolute teachings from my medical school days were, and are, the foundation of my professional life. But too many dogmatic teachings simply didn’t stand up to the new realities I faced; what professors taught as optimal solutions proved to be “ain’t necessarily so.” In fact, in the tropics, one had to adapt in order to survive . One developed a healthy skepticism, a respectful questioning, probing, experimental approach; this is the philosophic basis for all research. I shall offer two examples in my tropical medicine career, where new observations fundamentally changed the understanding and management of two major infections. The teachings of the classic texts “ain’t necessarily so,” at least forever. The filarial infections hold an honored place in the history of tropical medicine. When Patrick Manson, in 1877, in Amoy, China, demonstrated that Aedes mosquitoes transmitted filaria from man to man, this was the first time that arthropod vectors were identified as an essential element in the life cycle of a disease. The filarial infections cause widespread, horribleelephantiasisoflegs,scrota...

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