DESPERATE MEASURES.(surgeon Francis Daniels Moore)

On November 28, 1942, an errant match set alight the paper fronds of a fake electric-lit palm tree in a corner of the Cocoanut Grove night club near Boston's theatre district and started one of the worst fires in American history. The flames caught onto the fabric decorating the ceiling, and then swept everywhere, engulfing the place within minutes. The club was jammed with almost a thousand revellers that night. Its few exit doors were either locked or blocked, and hundreds of people were trapped inside. Rescue workers had to break through walls to get to them. Those with any signs of life were sent primarily to two hospitals--Massachusetts General Hospital and Boston City Hospital. At Boston City Hospital, doctors and nurses gave the patients the standard treatment for their burns. At M.G.H., however, an iconoclastic surgeon named Oliver Cope decided to try an experiment on the victims. Francis Daniels Moore, then a fourth-year surgical resident, was one of only two doctors working on the emergency ward when the victims came in. The experience, and the experiment, changed him. And, because they did, modern medicine would never be the same.

It had been a slow night, and Moore, who was twenty-nine years old, was up in his call room listening to a football game on the radio. At around 10:30 p.m., he heard the familiar whine of an ambulance arriving outside, put on his white coat, and went to see what was going on. Making his way to the ward, he heard another ambulance arriving--then another, and another. He broke into a run. In less than two hours, he received a hundred and fourteen burn victims. He described the scene several days later in a letter to his parents:

Down the hall were streaming stretchers with burned people on them. One a young girl, with her clothing burned off, and her skin hanging like ribbons as she flailed her arms around, screaming with pain. Another a naval lieutenant who kept repeating over and over again, "I must find her. I must find her."His face and hands were the dead paper-white that only a deep third-degree burn can be, and I knew only looking at him for a moment that if he lived, in two weeks his face would be a red, unrecognizable slough. He didn't live.

Moore grabbed a syringe full of morphine and gave anyone he found alive a slug for the pain. Dozens died in those first few hours. Many succumbed from shock and overwhelming injuries. Others, some without a single burn on them, died of asphyxia, their singed throats slowly swelling closed. In all, nearly five hundred people died from the fire. Of M.G.H.'s hundred and fourteen patients, only thirty-nine survived long enough to be admitted to the hospital and treated for their burns. Bodies were laid in rows along a corridor; a hospital floor was cleared for the survivors. And, at Oliver Cope's insistence, the experiment began.

The conventional treatment for severe burns was to tan the burn surface as quickly as possible, and at Boston City that is what the surgeons did. People who initially survive bad burns remain at high risk of dying from infection in the days to follow. Your skin protects you from the germs of the outside world; a burn opens the portals. Applying tannic acid to a burn was a way to create a thickened, protective cover. Patients were given morphine and soaked in a bathtub; then their blisters were cut off and the acid slowly poured on their wounds. The process was extraordinarily painful and laborious, and sometimes fatal. It also took four or five trained personnel to care for one patient. Still, it was a proved therapy, and it had been standard practice for years.

Medicine, especially surgery, is a conservative profession; a physician departs only reluctantly from the established techniques and lessons. And for good reason: the stakes, if you are wrong, are too high. Doctors are expected to adopt new treatments only with strong evidence that they will have better results. But Cope was a believer; and one of the things he believed was that tannic-acid treatment was no good.

Earlier that year, he'd been called on for advice following the Japanese bombing of Pearl Harbor. Investigators had found that the major casualties were not from blast injuries but from burns from the fires that followed. Medical personnel had been overwhelmed by the labor required by tannic-acid treatment. A day and a half after the attack, they still had not completed the initial care for victims. Many patients died waiting. Cope proposed wrapping people's burns in gauze coated with petroleum jelly, and then leaving them alone. The treatment would be far less painful, and a single doctor could care for four or five patients by himself.