ABSTRACT

KEYWORDS

I met Dr. Gastón Madrid (Figure 1) at the beginning of my undergraduate rotating internship year in the summer of 1975, when he was already a legend in the local medical community and already had an enormous prestige as a pulmonologist and expert in coccidioidomycosis at a national and international level.

Originally from Mexico City, he studied at the Faculty of Medicine of the Universidad Nacional Autónoma de México and later trained in the care of tuberculosis patients under the tutelage of Dr. Ismael Cosío Villegas at the Tuberculosis Service of the General Hospital of Mexico City in the early 1930's. After receiving a job offer, he decided to emigrate to the city of Hermosillo in the state of Sonora, taking charge of the tuberculosis clinic of the Department of Health and Assistance.

In April 1942, Casa San Vicente, a sanatorium for the care of patients affected by tuberculosis, opened its doors in Hermosillo, and shortly thereafter Dr. Madrid was appointed medical director, a position he held until shortly before his death. This sanatorium, with its 80 beds, became a reference center for tuberculosis patients, not only for other regions of the state, but also for neighboring states. In addition to hospital care for periods of up to one year, as was recommended until the beginning of the 1960's, the sanatorium had the necessary infrastructure to carry out surgical treatment of the disease, which was an integral part of the treatment at the time.

Don Gaston, like all pulmonologists trained in the first half of the 20th century, in addition to clinical care, practiced thoracic surgery throughout his professional career, initially almost exclusively on patients with tuberculosis and later on patients with other pulmonary pathologies. As the only treatment available for tuberculosis before the advent of effective chemotherapy in the 1950's, multiple techniques were developed including collapse therapy (thoracoplasty, extrapleural pneumothorax), phrenisectomy, pneumonolysis, pneumoperitoneum and later, as an adjunct to chemotherapy in some cases, resectional surgery (lobectomies and pneumonectomies). I had the opportunity to review the operating room books in which surgical procedures were recorded at the sanatorium and I found more than three thousand records, with excellent results in spite of the rudimentary anesthetic techniques and the non-existence of postoperative advanced care units during that period.

Since the 1940's Dr. Madrid held the position of Chief of the Pneumology Service of the General Hospital of the State of Sonora, serving as its director during the period 1943-1950. Being a pioneer of medicine in the state, he participated in the creation of the Hermosillo Medical Association and later of the Medical Federation of Sonora, being president of both shortly after.

I had the privilege of working with him on a daily basis for over seven years, and I have not met a better clinician in my nearly 50 years of practice. He possessed a masterful physical examination technique (today we cannot diagnose even a pleural effusion without ultrasound), which he combined with his enormous experience in fluoroscopic examination of the thorax, which he performed with an old upright fluoroscope that still required a darkroom. As a clinical practitioner, he possessed an inexhaustible curiosity; every case had some interesting aspect for him and he argued that each case was unique and should be evaluated in this way. He always demonstrated an impeccable ethical sense, dedicating himself for more than forty years, with great empathy, to the care of the most helpless patients suffering from a disease, which, to this day, is a cause of stigma in our society. In spite of being a legend in the institution, he treated with the same simplicity and respect a chief of service as the most novice undergraduate intern. On his 50th anniversary as a physician, this icon of Hermosillo received a tribute from the city by naming the street in front of Casa San Vicente as Dr. Gastón Madrid Street.

The state of Sonora is an endemic area for coccidioidomycosis and being a disease that shares epidemiological, clinical, radiographic and even histopathological characteristics with tuberculosis, it is not surprising that cases of this mycosis were referred to Casa San Vicente when there was clinical suspicion of tuberculosis. Over the years, Dr. Madrid became the leading national expert in the diagnosis and treatment of coccidioidomycosis. He reported in a publication the first case of coccidioidomycosis in Mexico, and also the first isolation of the fungus from soil in the country. In 1974, he published a book on coccidioidomycosis, the only monograph in Spanish to date on this disease.

Don Gaston passed away at his lifelong home on January 12, 1996 at the age of 87, surrounded by his family and friends. The state of Sonora will be eternally grateful for his dedication and devotion to the health of its citizens. We will always remember him with admiration and affection, dear master.

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