This is the Washington University School of Medicine Oral History Program. Oral History number fifty-four. Thursday, April 22, 1982. I’m Paul Anderson, Archivist at the Washington University Medical Library. This interview is part of our series of interviews with medical school alumni. I’m speaking today with Dr. Harry Agress, class of 1932. Dr. Agress was born in St. Louis, December 27, 1908. He graduated from Washington University in 1932 and began practicing that same year in Missouri. For three years he was a resident at Jewish Hospital in St. Louis, and had further graduate study at the University of Minnesota from 1935 to 1936. In 1936 he entered private practice. His private practice was interrupted during World War II. In 1957, he started the Midwestern Cytology Laboratory, Inc. which is still operating. He was a member of the clinical faculty in Internal Medicine at Washington University School of Medicine, and has had emeritus status with that faculty since 1960. He has also been a consultant for the Department of Pathology at Veterans Hospital from 1948 to 1960. He is a member of professional societies including the American Society of Cytology, American Medical Association, Missouri Medical Society and the St. Louis Medical Society.
Were there any factors in your family background and childhood which influenced you to study medicine?
Yes, actually I was interested in becoming a concert violinist, but at age thirteen my teacher told me that I might be able to play in a symphony orchestra but not be concert quality, and our private family physician, Dr. David Todd, who practiced here in St. Louis, influenced me greatly in wanting to go into the practice of medicine.
Were there any family members who were in the medical profession?
No. My family background was that of merchants.
What secondary school did you attend here in St. Louis?
Central High School of St. Louis.
Can you recall in what major ways medicine was practiced when you were a young man that were very different from the medicine of now?
Yes. Medicine, in my early days, was mostly “the art of medicine” without all of the sophisticated technological advances that have occurred since, and most of those have occurred since World War II – and perhaps as a result of World War II.
There wasn't anything involving your own health that influenced your choice?
No, I had no personal health problem or family health problem that suggested the idea of practicing medicine.
Why did you choose to attend the Washington University School of Medicine?
Actually, I had scholarships at Harvard in the premed courses in a legal area because I had done a lot of debating, but my family didn't want me to leave St. Louis and their friends told them there just wasn't any medical school other than Washington University.
I notice from the list of your graduating class that at the same time you were awarded your MD degree, you also were awarded the Bachelor of Science in Medical Science. You didn’t note a bachelor's degree in your curriculum vitae. What was your premedical training in college?
Well this was not achieved through the premed course. I achieved this BS degree while I was a medical student, having spent the whole summer on a public health survey of the water supplies of the environs of St. Louis, and I think that this is a rather unique sort of combination. I doubt that anybody has ever had a BS in Medical Science from this university, and I doubt that anyone has a combination of BS in Medical Science and an MD.
This wasn't the equivalent of your bachelor’s degree?
I had three years of premed before I came here.
Where did you study?
Did the fact that you took this Bachelor of Science in Medical Science mean that you studied longer?
I had to put in a lot of extra hours. [I] put in a whole summer and then part of that fall to acquire the credits for this recognition.
Can you tell me something about the costs of being a medical student in those days? First of all, you would have entered in 1929, is that correct?
1928. It was around $600 a year tuition.
What was the source of your tuition? Did you have to earn it or did your family provide the money?
Well, it was a combination of all things. You’ll recall at that time we were heading into the great recession. My last two years of tuition were paid by my grammar school teacher who was a friend of the family, and I worked after hours selling shoes, [and] worked on playgrounds during the summer, St. Louis playgrounds, St. Louis School Playground System.
So the Depression hadn't begun. Everybody thought things were rosy in 1928 and then it hit while you were in medical school. Did you ever think that you might not have had this opportunity had the depression already begun?
That’s a possibility.
Did you live at home when you were a medical student?
Were most of the medical students in your class from the St. Louis area?
Not most. I don’t recall the numbers, but I wouldn't say that most of them were. No, there was a wide scattering over the whole country, actually, of medical students, and we had at that time what we called the eastern invasion. It was one of the first classes where we had quite a large representation of men from the New York area.
Do you think there was a conscious policy to recruit out of state at that time?
I was given to understand that that was part of the policy of the University in order to give us two things: First of all, widespread representation in our classes and widespread representation when these men left the St. Louis area.
There are few students in your class who might be interpreted to have foreign names. Perhaps they were Americans just like the majority, but I see, for example, some East Asian names. Were there foreign students?
Yes, I recall Inouye, who is from Hawaii. He’s of Japanese origin.
Do you know if anybody came from outside the United States? I realize Hawaii was an American territory, but were there any bona fide foreign students?
Offhand, I don’t recall any.
How about women in the class?
I see from the alumni records that the sole woman in the class of 1932 was Lillian Hadsell. She went on to take her residency at New York Infirmary for Women and Children. How about blacks or members of other minorities?
There were no blacks.
What do you recall about the preclinical facilities, the actual physical set-up when you began as a medical student? Were they, first of all, adequate to the needs of the program?.
In general, there was crowding and the rooms were old, unreconstructed, nothing like all the changes that have taken place in recent years with the facilities today.
Can you recall any situations that were – obviously there are countless things that are different now – but things that would strike you as radically different? How about, for example, in anatomy and dissection?
Well, that was an interesting situation. In the first place, the facilities were crowded, but the most interesting part of that was that they decided the year of our class to open the anatomy dissecting rooms to night work, which practically put everybody on notice that you'd better get up there at night and do the dissecting clean. That had a little spill-off that was fun. There was a very good saloon – you'll recall this was still Prohibition – on Clayton and Taylor, and around about 9:30 at night, we’d march ourselves down to this bar where we'd have a few beers and head back to the anatomy room, and then a few interesting episodes occurred along with that such as one classmate threatening another to dissect him.
Threatening with one of the—
It must have been rather strong stuff that they were putting out of that saloon. Is it the same building where there is a bar now?
I haven't checked that out in recent years.
There’s a bar called Kevin McGee’s at that very corner. It has to be the same place. Was it masquerading as a coffee shop?
No, they just called it a saloon.
And nobody raided it? Well, that's very interesting. How about the sciences, for example, physiology, that were using new kinds of equipment? What do you recall about that kind of course?
Physiology really didn't have much in the way of new equipment that I can recall. The thing I remember most is smoked drums that didn’t always work in these physiology experiments. Most interesting thing about physiology really was Dr. [Joseph] Erlanger, who became a Nobel prize winner and was a marvelous teacher. The other interesting thing about physiology is that they had a motor-driven screen for projection. That seemed to be the great thing about the course.
Would this be for projecting the experiments on nerve impulses?
It would be for projecting physiology literature and so forth during a lecture. But the screen was motor-driven, that seemed to be a great thing in that department.
You mentioned Erlanger. Do you have any particular reminiscences about him and his teaching methods?
Yes, he was very gentle, but he was thorough and without being dry, and this was an interesting combination, because we had many people instructing us who were quite the opposite.
With whom might you contrast him?
Well, let's take Dr. Ernest Sachs who was Professor of Surgery. He was a wild man who would get us down into a thing we called the “pit”, the snake pit, for our surgical lectures. And he would drop his glasses off to the end of his nose, put one hand on your right shoulder, and take some fullback from Kansas and back him all the way to the wall and by the time he had him well in tow, the student didn’t know what he was talking about.
Did this have any practical, pedagogical purpose?
Well, his forcefulness, I think, helped impress you with certain features of his area. He was a wild man in the operating room, too. He’d throw instruments and slap hands and so forth. I worked out a technique for stopping him. I also knew that after he got through with his tantrums, he was very apologetic and very gentle and so I kept my white shoes polished to a fare-thee-well until I got into the pit. Then I stuck my foot in front of him and he stepped on my shoe so it got dirty, and he apologized the rest of the time. Never did ask me a question.
Do you think he was threatening his own aseptic environment with all this wild behavior?
No. I don’t know quite what the faculty is like now, but what I’ve seen of them, they are not quite the cast of characters that we had back then, and I'll mention others to you as we go along. But this is one of the men who stood out in the minds of every student who went through Washington University.
Do you mean Evarts Graham?
Yes. I have an interesting story about him. He was very staid; when he lectured, he was forceful like all surgeons are. He'd cut everything to the bone, but it was again the same strong delivery of Ernest Sachs without his antics. He and I became very friendly because he and his wife sat behind us at the symphony concerts for many years. So I would stop in and visit him very frequently as I came through the hospital. One day I walked in and he said, “Get rid of that cigarette,” and I sort of looked at him and wondered what he was talking about because I knew he was a smoker. And so I got rid of it. A few weeks later, I came through again with a cigarette hanging out of my mouth and got the same reception, and I said, “Excuse me, what's going on here? You're a smoker.” And he said, “Tomorrow you'll hear.” The next day they published the first report on linkage of cancer of the lung and smoking.
We have some famous photographs of him working with a smoking machine, you know, to trap the tars and nicotine residue. Is that the experimentation that led to these results?
That was subsequent. The original work was primarily statistical, done by one of his associates. And incidentally, I was there at the first pneumonectomy he did for carcinoma of the lung on a physician. It’s interesting that Dr. Graham died years later of carcinoma of the lung. This physician lived to be eighty.
Yes, that is an ironic situation. How did it happen that you were present there?
We knew that it was coming off and I was still in the area you see.
So the attending staff of the area could come in?
Yes, these operating rooms had amphitheaters with seats up in a balcony overlooking the operating stage.
Going back now to when you were still a student, I notice you made a list of some of the other people that you particularly remember. Can you give me some of their names?
Yes, this list is rather long because I think we had a fantastically interesting cast of characters teaching us at the medical school. Perhaps the first contact is with the dean of the medical school who was Dr. McKim Marriott, [who had a] very shiny bald head. He was the dean, and we were assembled in this little auditorium at the entrance near the library, and he marched down the aisle and said, “Good morning gentlemen. In two months, ten percent of you won't be here. Get to work, and that's all I have to say.” That was our introduction to medical school. A lot of us were ready to walk out right then and there. There were many others, and if you’d like, I’d like to mention some of them.
There was a Dr. Ronzoni, a female physician. [Ed. note: Ethel Ronzoni Bishop held a PhD degree.]
Ethel Ronzoni whose husband was in the physiology department. She was in pharmacology.
Her husband was George Bishop.
George Bishop, right. She affected a very mannish attitude, always wore slacks back when slacks were hardly known among women, constantly smoked a cigarette and had a whiskey voice and a very pleasant personality that was helpful.
Were you in her lab at any time?
Yes. I was a student in her laboratory. We had a classmate named Cecil Charles who had an odd position. He had his PhD in anatomy, almost but not quite, and he couldn’t get it because he was lacking one credit from the University of Kentucky, where they would not teach evolution. So while he was an assistant in the anatomy lab for our class, he was taking second year comparative anatomy classes out on the Hill at Washington University in the undergraduate school to get the credit to meet this PhD.
Now where would the PhD be granted? From Kentucky?
He was going to get it here in anatomy, but he had gotten his undergraduate work in Kentucky with the exception of this one requirement.
It was still the old Scopes trial legislation.
Wasn’t that a curious thing? He was [a] PhD candidate, [a] classmate and still had to take a course there. In the GU [Urology] department, we had a man named John Caulk, they called him Johnny Caulk, very debonair, wore a flower in his lapel and had all sorts of interesting, but trite sayings. Like when he did his cystoscopies, he used ultraviolet for the treatment of some tumors, and his favorite saying was, “We’ll put sunshine in his bladder and sunshine in his smile.” And he lived up to that sort of thing.
Then we had a man named Albert Taussig, who was an internist of the old school and a fabulous teacher and a very forgetful man. He’d take the wrong car off the parking lot and that sort of thing, but he knew his medicine very well.
[We had] Dr. Willard Bartlett, Sr., who put on a sideshow like nothing you've ever seen. He was in thyroid surgery by the time we were there and he was working primarily at the Missouri Baptist Hospital, and we’d go over there to watch him do thyroidectomies. Now when you went there, you felt like you were in a movie set. First of all, he only had beautiful girls as his assistants. He had a woman as his assistant who opened everything up and got it all ready for Dr. Bartlett. Dr. Bartlett would come in with a great fanfare and beautiful women would put his gowns on and help him with his gloves and you just never had seen a sideshow like this.
Hugo Ehrenfest, who was in the Department of OB/GYN, was a masterful drawer, and he would draw pictures of anatomies on the blackboard using both hands and they always came out in the right place, but he had more than just drawing pictures going for him.
He must have been superbly coordinated when he was practicing.
Arthur Proetz who became a famous ear, nose and throat man, [was] very debonair. You could just feel the suave sort of personality go through you. J. Albert Key was just the opposite. He was a roughneck orthopedic man who said what he thought and thought what he said and was a real character. There was an ear, nose and throat man named Arthur Alden. You could follow him through the hospital by the odor behind him; he only smoked Turkish cigarettes.
I wouldn’t necessarily want to be his patient if he was that malodorous.
Well, those were the days before we got into prohibiting smoking. His debonair look went along with his perfumed odor. Dr. Jerome E. Cook was a very fine internist, whom I continue to see over at Jewish Hospital, who acted as a sphinx, practically never said anything, but when he did it was pretty worthwhile. Arthur Strauss who was a very, very meticulous cardiologist and an excellent teacher in cardiology. Roland Klemme, who was a wild man just like Dr. Sachs in neurosurgery, but not quite as wild, and he cut quite a swath throughout the community as a— There’s an internist named Louie Kohn who graduated from here. I think he was the first to introduce a very small bag for physicians rather than a standard doctor’s black bag – the Dopp kit size.
A smaller version of the old doctor’s [bag]? He wasn’t carrying around so many medicines.
Yes, and he was Dopp kit-size himself.
How about Robert J. Terry in anatomy?
Oh, yes, I'm going to get to him, I have him up here. He was interesting in one particular respect and that was that he generally lectured in a rather dry style, but along with it, he threw in humorous little things that he mentioned in his lectures. One of them was about a very famous anatomist who said to his class as he was holding up a specimen of a penis, “This is the finest penis I’ve ever held in my hand.” But he had a habit of keeping one hand in his pocket, and one of the students piped up with, “Which hand, Doctor?”
How about Mildred Trotter? Was she active?
She was our anatomy instructor and she’s still around and we all revere her very much.
Was she effective as an instructor then?
Yes, very effective, and she was young and she was beautiful, and I think she’s still pretty good looking.
In view of your work later in cytology, that word is associated in my mind with Edmund Vincent Cowdry, who had joined the staff just about the same time as you began studying medicine.
We were the first class he had here in histology. He was helpful to me personally. We became personally good friends after I graduated and I had decided I’d like to go into hematology. In those days fellowships weren’t around like they are now. You sought them out and I knew the work of Dr. Hal Downey at the University of Minnesota. So I wrote Dr. Hal Downey and told him I would like to come there and sit at his feet, and he is a very gruff sort of guy when you first meet him, and he said, “Nothing doing, I don’t have any time for you.” So I went over to Dr. Cowdry with Dr. Gray, my mentor in pathology at Jewish Hospital, and Dr. Cowdry said, “Of course you’ve got to go,” and he just put in a long distance telephone call to Dr. Downey and that got me placed.
So Cowdry was personally a very sympathetic individual?
You mention not having a lot of grants. We have Dr. Cowdry’s papers and I gather from that that he was one of the first individuals who really knew how to swing big money and big financial grants and other support.
Yes. He was one of the early movers in that direction and he was very politically minded. He didn’t look like a politician, but he somehow or other got into it. I got my money from a patient; a grateful patient at Jewish Hospital gave me $1,000 to go away.
So that’s when you went to the University of Minnesota?
Let’s continue a little bit further with Cowdry. When he came and set up a division of cytology within the Anatomy Department, were there any kind of hard feelings of the older faculty members, as though Terry was shunted aside?
I don’t think we students were into that sort of thing. If there was, I wasn’t aware of it.
Officially Cowdry was a division head under Terry and yet he always referred to himself as a department chairman, and I often wondered if that represented any sort of dispute between an older kind of anatomy and a new line of thought.
No, I never got any inkling.
Of course, now anatomy has really drifted far from the old gross investigations. They still teach gross anatomy, but it’s primarily oriented at this medical school toward neuroanatomy as the research specialty and that all bespeaks the kind of microscopic analysis and investigations that began about this time.
Well, back then one of the first ultra-microscopes was built in that department. There was a lot of hubbub about that, what this machine was all about.
This was the early electron microscope?
I can see that you had quite an interesting period as a medical student. Of course, the university prided itself then as now as a research center. Did you have any opportunity to do research when you were a medical student?
The nearest thing to it was that health survey, which I consider a form of research.
How did you happen to get this opportunity?
It came through the bacteriology department, Dr. [Jacques J.] Bronfenbrenner. I asked him if there wasn’t something I could do and he suggested this possibility. He said, “We can’t give you any help; you’re on your own,” so I simply set out with a set of boots and I went through sewers and water works and whatnot.
Why did the situation come up? Had there been a crisis in public health? Some epidemic or something like this that set it off?
No. It was the unique situation of St. Louis as an independent city and the county separated from it politically, which still exists. And this created a number of problems in particularly water supply in the early days. Some of the county communities were buying water from St. Louis, and it was just this problem of whether there was a possibility of bringing them together – of why they were separated – that made the study interesting.
Some of the water lines in that day, and maybe even to this day, were very old. Did you encounter problems that resulted from St. Louis being an old municipality?
No. Even back then they considered St. Louis as one of the best water supplies in the world from a treatment standpoint, and there were no special problems except in isolated areas where water was not obtained from the St. Louis supply – private wells and that sort of thing where typhoid existed back then. So we saw some typhoid, but these were primarily private water supplies on a piece of property rather than public water supplies.
On the subject of urban public health, let’s digress a moment. There were major kinds of urban public health problems that have changed quite radically, like air pollution. Smoke abatement or smoke pollution was a big problem in the thirties, was it not? I’ve seen pictures – horrible pictures of the sky just black with smoke.
Absolutely coal black. The major problem here was the coal supply, soft coal coming from Illinois. Once the ex-mayor of St. Louis, whose name I can’t recall at the moment who was an engineer, [ed. note: refers to Mayor Raymond R. Tucker, earlier a Washington University mechanical engineering professor] suggested banking techniques in firing furnaces and the treatment of the coal prior to firing a furnace, it eliminated this almost overnight. It was like drawing a curtain off the city, but there were times [before this] when it was absolutely [black]. You couldn’t see a foot in front of your nose.
Park J. White, who was a clinical pediatrician, did some public health surveys. Do you know anything about them?
I don’t know about those, no.
I think he was investigating lead poisoning in some of the inner city homes.
That’s a problem that still exists because a lot of these homes were painted with lead paint and as the paint came loose, children would eat the chips and these chips were loaded with lead.
What do you recall about the medical library?
Well, the medical library happened to be a very favorite place of mine because I rarely bought a book, even rarely bought a textbook. I liked studying subjects independently and in-depth and I used the library to a great extent. I fell asleep in it many a night.
When you moved across the street to the clinical training, [do you] recall anything about the facilities or situations that you faced there? We’ve already touched upon them to some degree in talking about hospital amphitheaters and the like.
Well, compared to the present auditoriums that we have today, these little pits, as I call them, were very small, crowded, antiquated.
What about Barnes Hospital? Most of the patients were on wards, were they not?
A good number of patients on wards, and these wards were huge practically open things, with draw curtains to separate a bed. I’d say many of the wards had as many as thirty or forty patients in them.
St. Louis, in those days, was a legally segregated city in some prominent respects and I think this affected hospitals. Do you recall how black patients were treated?
Black patients were segregated. Practically no hospital in St. Louis had black patients other than Barnes Hospital, and those patients came through the clinic which was a very large operation back then. Still is. So that there were no black patients in any other hospital. I think, if I’m not mistaken because I was involved in this, Jewish Hospital was the first private hospital to take in black patients and put some black physicians on the staff.
Barnes Hospital treated them, as you say, because they came through the Washington University clinics and the clinics were housed in what they now call the West Building, which is the Pathology area. Can you describe that building as it used to be? It’s been so vastly renovated.
Well, it was just a bunch of corridors on different floors with hard backed seats, back-to-back, and always full of people sitting there waiting to be called into this little side cubby hole.
So all sorts of medical treatment was rendered in that building?
There was one clinic that had a special character. It was called a night clinic and it was primarily a VD clinic where shots of 606 [ed. note: salvarsan] were given. That was a pretty busy place. I don’t know that VD has been separated as a clinic anymore.
Let’s talk about your experience at Jewish Hospital. In the first place, Jewish Hospital was already on the location that it is now, right?
It was at Kingshighway, but in a much smaller building and it was not yet a part of the Washington University Medical Center.
That’s right. That’s correct.
It was physically separated from the School by St. John’s Hospital.
Do you recall when Jewish became a part of the Medical Center or began cooperating more closely?
I think that all started about eighteen years ago. I’m not sure of the dates, they are vague to me now. But there was a long period of preliminary sparring and then final culmination of the arrangements that exist today.
Why do you think Jewish, and not St. John’s which was physically closer, became part of the Medical Center? Were there rivalries between the medical staffs that prevented it?
No. I think if we had to choose, find some criteria for why this took place between Jewish and Barnes rather than St. John’s. First of all, St. John’s never was a teaching hospital. It’s not much of a teaching hospital today, although it does have some teaching facilities and some full-time men. Jewish Hospital, postwar, dedicated itself to more private, full-time teaching. It’s always been a teaching hospital. Men who have been members of the faculty here at Washington University Medical School have taught there, too, and so teaching has been a tradition. I think this separates the two hospitals. One was traditionally oriented to teaching, the other was not oriented to teaching, and this I think was the reason for the thing. Postwar there was this tremendous movement for full-time men and in doing this you had to tie into a medical school where you could have an executive faculty that could determine a choice of people that they wanted as well as that you wanted. So I think that was really the beginning of this idea.
Was Jewish at that time a general hospital?
Correct, but always a teaching hospital.
We’ve talked about medical breakthroughs briefly in connection with the World War, but already by the late thirties there were significant changes in internal medicine being introduced, were there not? Can you think of anything? How about sulfa drugs?
Sulfa drugs were really the only big pharmaceutical breakthrough in medicine. Another breakthrough was partly accomplished right here, and that was the kind of surgery that Dr. Evarts Graham introduced. He developed the technique for opening the chest and removing a lung. Improved anesthetic methods also contributed to surgical successes.
And Radiology, too?
Radiology, of course, with the gallbladder visualization in which Dr. Graham had a leading role. But aside from these few things, the big things happened postwar. For instance, a postwar resident in surgery would consider one gastrectomy a year as disastrous training; he never got to do any. There was only one man who could do a gastrectomy in St. Louis prewar – who was considered capable of doing it. Early ambulation and, of course, all of the computerized techniques. These are all postwar. Blood transfusions really got their go in postwar and I think I played a role in it. I prepared for Dr. Graham, while I was at Jewish Hospital, the first plasma that was used in this city and he used it on a patient postoperatively. I think I’m the first to have brought blood banks to this city in the thirties.
This was at Jewish Hospital?
How did you come upon that concept? Was it something that you had followed in the literature and followed in other cities?
Well, before I left my medical school training, I developed a very deep interest in microscopy and when I went to Jewish Hospital, I went to Dr. Sam Gray, who was head of the Department of Pathology, and told him of my interest in blood cells and so forth and the microscope. I spent almost as much time in my three years in training as a resident in internal medicine in a laboratory [as in seeing patients]. At the same time, I got involved with Dr. Michael Somogyi, who was in the Department of Biochemistry here and was one of the early founders of the isolation of insulin. In fact, I think Washington University would have had the grant money for insulin if Dr. [Philip A.] Shaffer hadn’t stopped Dr. Somogyi from publishing his work.
Why did he do that?
Well, that was his opinion and he was the department head and could stop such a publication, and two months later Banting and Best published it in Canada. But Somogyi had worked out the technique and actually the real technique is still his technique for preparing insulin. I got to working with these two men as much in the laboratory as anywhere else, and in the course of this blood study I encountered this idea of blood storage, and I was told that I was a crazy young man, you can’t keep blood in bags. Time has proved how crazy I am.
Did it have any prewar applications at all?
No. Blood transfusion required calling in some specialist like a Dr. Ivey, here, and he’d stick a needle in a vein and a sterilized bottle here and a stream of blood would flow through the air into the bottle. You had to have a good catching hand with the bottle. That’s the way transfusions were given.
Let’s proceed to your work at University of Minnesota. Dr. Downey was reconciled to your presence there. What was the experience like? First of all, was this in Minneapolis?
In Minneapolis, 1935 to ’36. Well, first of all, he turned out to be as gentle as he could be and that gruffness was only on the surface. He was a fabulous teacher and a hard taskmaster. He made me really learn how to prepare tissue, how to stain tissue and how to look through a microscope. I had the good fortune of sitting at his elbow at least an hour every day while I was there. In addition to that, the University of Minnesota had a fabulous all-American football team so I got to see them play. Minnesota in the winter is gorgeous, but that was a hard winter. At no time for thirty-two consecutive days did the temperature go above zero, and when you walked across the campus there, the wind would howl at around 40 below zero. I also got to know Eugene Ormandy, who was a symphony conductor there, through some people I met, so I visited with him, and that was a nice.
You were still interested in the fiddle I take it? He himself was a violinist.
He was a violinist in a movie orchestra or something like that. He’s gone a long way since. But that year turned out to be a marvelous social and medical year, and then on weekends I would go down to the Mayo Clinic and consort with their hematology people. One of their men was working on lupus and that was the first description of the LE cell. I followed that up in some work I did here.
Who was this person who was doing it?
The name slips me. All I know is it begins with an “H.” He was one of the fellows at the clinic, I just don’t recall. But you know Dr. Albert Taussig here kept insisting way back that lupus was a generalized disease and not a skin disease. He preached that all the time. And he was excited when I came back and showed him some of these LE cells in bone marrow.
Good times at a good university notwithstanding, we’re still talking about the Depression all throughout the thirties, really. Can you tell how that affected medical practice, I mean the economics of medicine?
The economics of medicine, I felt, was tied in with the rest of the economic situation and so people lived at a lower level and enjoyed their lives just as much, I think in some respects more, than they do today with the affluence that they have. Good medical men were men of stature I think. As a matter of fact, the medical man was considered at a higher level back then than he is now. I think part of the difference is that there was this art of practicing and this art of living rather than the mechanistic money-making thing that people accuse us of today. I think it was a much more pleasant way of living than the practice of medicine today.
Well you had to, at times, show great forbearance if you were treating people who just didn’t have any means to pay.
It was very simple: you just forgot about it. You treated them without pay. Clinics, of course, were much more active, but today what’s happening with your clinic is [that] with third-party payments, clinics are vying for business in a community where there isn’t this low-level pay. Let’s take the set up here with faculty and so forth. They’re furnishing faculty with complete medical care at low costs; you’re furnishing unions special contracts.
Prepaid health plans, health maintenance organizations.
Those weren’t around back then.
You lived and practiced most of your life in the big cities and perhaps didn’t meet doctors from a really early era who were still in practice. Did you ever run into homeopaths or people who were from a very different kind of approach to medicine who might have now disappeared from the scene?
No. I think they still exist, this same sort of thing, just under a new coat: cultist, very questionable medical practices. I think it’s no different now than it was then.
Except that, of course, when you met doctors who were, say, trained in the 1890s and were still practicing in the thirties, you had at least a rational explanation for the way they were. They were trained in a different world.
That’s very true, but then if you look at it from the patient’s standpoint, the patient didn’t know the difference and these men developed techniques of satisfying patient needs. And inherent in the practice of medicine is the matter of good luck; nature takes care of an awful lot of stuff that the doctor may think he does, but he doesn’t really. So the odds favor the physician, whether well-trained or poorly-trained, in the vast majority of medical problems.
Let’s talk now about World War II. How did you happen to get involved with General Hospital 21?
Well, during our medical school days, there was a section of military training and I stayed with that program from 1932 on, and went to summer camps and so forth, and this unit then was formed. I actually was assigned to the 36th Infantry down in southeast Missouri, but the man that had been chosen to be the lab director at the Washington University unit developed some pulmonary disease and was ineligible and they had heard of my background and training in laboratories, so I was asked to join the unit as the chief of the laboratory service. There was a question of whether the head of the internal medicine department – a classmate of mine, Sim Beam – should have that assignment or whether I should, and they figured that since I had all this lab background they’d make me the lab officer and Sim Beam, the chief of the medical service.
Who was making the decisions in this regard?
There was some committee here at the University and the major power in that committee was a man who subsequently became our commanding officer – Lee Cady.
What contact did you have with him before the unit was activated?
Practically none. About six months before, I was called by the University, I don’t exactly remember by whom, and they asked if I’d be interested and I said yes. Then they arranged my transfer to the unit from my original assignment. We never really met but once or twice subsequently. And then we – that was about six months before – on the day before Christmas, we got our alert and I had to keep my wife off the telephone because everybody was calling wanting to know when we’re leaving. I held off on her until Christmas night, that was Christmas Eve. I just simply shut my drawers in the office, I had all the notices prepared to go out to patients and we left on January 10.
So then you were among the original contingent that went down to Fort Benning?
Right. The 21st and the Cleveland unit were also among the first in World War I. So they both seemed to be eager beaver to get there first.
What was the training at Fort Benning like? You were introduced, of course, to the real army to some degree and [to] all the paperwork and orders and discipline. Did you practice situations that you might find in the combat zone?
Well, in this introduction to the army, I might say that the army had more trouble with us than we had with them. We had a bunch of really fine medical men – like Henry Schwartz, this caliber of person – and so we had fine, trained people. But they also happened to be characters. I think they picked some of it up from their faculty here at Washington University. But, we had an offset. We had a whole hospital, a whole station hospital operating and no medical personnel to run it. So they were glad to see us coming. We just took over the whole hospital and the regular army men who were around were primarily administrative and so we went our way and they went their way, and whenever there was a conflict they usually lost.
Except that there was friction between the commanding officer and others.
This was a commanding officer who was “regular army.” He had been trained for many years as an expert in the health service. He was one of the top ranking army officials in the health service field.
Was this Colonel Thomas?
No, no, [Charles F.] Davis. We called him “Stinky Davis.” Now this was a man who, despite all this training, had a Napoleonic complex that couldn’t meet the situation. He was a nitpicker and he was crazy. He woke me up in England at 4 o’clock in the morning, cold as I could be and said, “You are now the executive officer.” That’s the sort of thing we ran into. Finally, he made the mistake in North Africa of locking horns with our chaplain and told him that if he spent more time with his army problems than with his religion, we’d all be better off. Of course the chaplain went right straight to headquarters and that was the end of Colonel Davis. We had Colonel Thomas prior to Colonel Davis and he was transferred, and then we got Lee Cady as a result of Davis’s being sent home, and that was a tremendous break. Lee Cady had a fabulous way of making friends with the French, with the engineers, with everybody around us. At the same time, he did not follow the principle of hanging onto his all-stars, which is what other hospital units did, and they stagnated. We had tremendous numbers of promotions as a result of Lee Cady letting men go. I forget, I think we ended up like something like thirty-two colonels at the end of the war who went to other units. And so we developed a reputation through him of being the friendly hospital. Engineers came to get baths.
We had very interesting experiences when we got overseas. We happened to land in Oran and then go onto a little town called Bou Hanifia. This was an old second-class watering place. We cleaned the place up, we scoured it up and [when] I was walking in Mascara, a few kilometers from our hospital one day, this man walked up to me and said, “Do you know who I am?” I said, “No.” He said, “Well, I’m Chung How. You saw me every Saturday in the movies when you were a little boy.” And that’s the guy with the big glasses, you know, the Chinese character. Through him I met the man who ran the spa there, which was a government-owned thing. Mascara is the largest area for producing table wine for France – it was back then. I made his acquaintance and a very lucky thing happened. The Americans were sending over canned milk for feeding infants, but they didn’t know how to use it and [Lucille S.] Spalding was our head nurse. She had trained with McKim Marriott, who had worked out all this formula business. So off she trotted with a bunch of cans of milk and we were buying wine at two francs a liter (that was 4 cents a liter back then). And we had a beautiful roof on the top of our hotel and name bands liked to come through, because we had hot baths. So every Saturday night we had a dance and we’d furnish the wine for the dance and these guys got a hot bath and a clean bed overnight. This is all part of the sort of thing that Lee let us do and it made it a fun family. We worked like the devil. We were supposed to handle a thousand patients, and at times we were handling three thousand, but nobody grumbled.
Was your lab right in the Grand Hotel?
Oh yes, I had the old wine shop, it was my lab, and it was very unique. We kept the big wine casks around, cleaned the place up, and set up a lab. In Italy, we went to the place [where] Mussolini had planned to have the 1940 Olympics outside of Naples, and there my lab was covered with magnificent murals made of ceramic tile.
I’ve seen pictures of that, too. But that had been severely bomb damaged.
Well, we got enough roof on us to handle it.
Back to Algeria though. Didn’t you have some considerable sanitary problems when you first moved in?
Oh yes. [It was a] question of getting water supply straightened out. What we did was tap into some of these deep wells. The other sanitary problem we had was that the local physician would always say (in French) “There’s no malaria around here.” We’d take him out to a little dunk of water and show him the anopheles mosquitoes, then he’d say (in French), “The wind blows it in from the desert.” But we had the sanitary problem with the help. They were almost one hundred percent infested with worms and ninety-five percent infested with malaria and it meant special caution in treating them.
Would these have been the native Arabs?
Native Arabs. Of course we used a lot of Arab help because we expanded so tremendously, and this again was Lee Cady’s idea. He didn’t play it by the book, he played it by what we needed. He was a very practical sort of guy.
So you had to inoculate [these Arabs]?
Well, we had to treat their malaria and give them medication for their worms and also keep scrub brushes in the toilets so they’d scrub their hands when they came back to work. [We had to] teach them about such sanitation details.
Now it wasn’t just the big Grand Hotel where you operated; there were other hotels in town?
There were buildings all around the place. We took over a whole city on the edge of the desert. It looked like something out of Lawrence of Arabia, you know.
It was probably not safe to stray too far from the area.
No. There were no problems, really. The natives didn’t cause any problems. I think one of the craziest things that happened was that the colonel sent a captain and me to a little town, a railroad junction, with .45s [.45 caliber pistols] and we were supposed to protect the medical supplies of the 21st General Hospital with three Arabs who could have shot us dead any second. That was quite a sight; I wish I had a picture of it. But there they had this fire built, no shoes, and they kept sticking their feet in the fire. Of course, their feet were like shoe leather. Here were two medical officers with two .45s in the middle of the desert supposedly protecting supplies. But by the time we had arrived all of the enemy was gone east.
The Germans and Italians had been wiped out of that area and also the Vichy French had been defeated.
The Vichy French weren’t going to do anything. Politically they tried to present obstacles, but we simply brushed them aside and went on with our business.
When you got to Italy, you were pretty close to the zone where there was still fighting going on.
Well, they were bombing Naples every night almost and we were just on the outskirts of Naples. Right behind our bivouac there was a battery of 90-millimeter anti-aircraft guns and they’d go off every night. I got to where I got tired of running to the caves so I just slept through them. But the bombing was primarily for the harbor of Naples.
When the big invasions that led to the fall of Rome took place – Anzio – you must have taken a lot of casualties.
Oh yes, tremendous numbers, and again we were an expanded hospital, but our use of civilian help and know how— By that time you see, we were the most know how hospital in Europe because we had been through a year – almost to the day in North Africa – [and] learned the ropes. A funny thing happened in Italy. I set up the first blood bank there and we advertised on a radio. We’d take natives. About ten of them came and after that they didn't want any part of it. And we were paying them to give blood. The other thing was that I set up a shot of whiskey for everybody that gave a blood transfusion and I caught hell from the base section surgeon who said, “What are you doing, running a blood bank or a bar over there?” But, see, the young guys would come out and have their ticket and then there’d be others waiting for them. Either donors or non-donors would buy the ticket to get a shot of whiskey. It was the best use of medical whiskey during World War II.
You also had a hot water spa in that vicinity of Naples where you were billeted.
We were billeted in the Terme di Agnano, which is a world famous watering source and Agnano water would sell for around ninety cents a bottle here in the United States back then. So, you see, it was given quite a bit [of publicity]— The Italians [talked] – well, so did the North Africans – because there was a spa there and we hooked showers into them. “These crazy Americans, letting this beautiful water [flow] – just to take a shower!”
But was it at least pure enough to drink?
Oh, yes. Naples had a very fine water supply actually. Most of their water came through old aqueducts going back to Roman days, from the mountains. It was pure mountain water with no treatment in between.
I understand that Vesuvius erupted when you were there.
Yeah, we were treated to that. You could see it going for days and we all went there and walked through the ashes; saw how they were buried back [in the days of Pompeii].
Were you concerned that the winds might shift and threaten your hospital operation?
It was too far away to hit us. The big damage was done to one of the airfields where the commanding officer really got his tail rapped. He let his planes stand there burning up with this ash. Another interesting thing about Naples (this all started back in North Africa): Dr. Ferdinand Isserman, who is a rabbi at Temple Israel here in St. Louis, was a Red Cross worker in North Africa. His main objective was that he felt it was important to educate the young GI. So he started a town hall of the air. I ran into him in Algiers and he was telling me about his experience and he was very sad because the thing was so successful that one of the army special service men wanted to take it over as his project. I said, “The important thing is [to] run the project. Forget about whose prerogative it is. Let him have the credit if he wants it.” He was very dismayed and I think he went home not too long after that, but I picked the idea up for our hospital.
As a result of that, we had entertainment galore. We had a beautiful theater in Naples and the Barretts of Wimpole Street came with Katharine Cornell in the lead, and I’m trying to think of the male who was a very famous actor. They came to our hospital and spent 10 days and it was a magnificent experience. There was one part of the play where the mean father – who happened to be [played by] a very gentle Texan – throws the redheaded daughter on the ground because she announces she’s going to marry this captain. And one of the kids [in the audience of GIs] yelled out, “Kick ’em in the ass! Kick ’em in the ass!”
[Katharine Cornell] made rounds. One day I made rounds with her and she went up to this young soldier, a wounded soldier, and asked him if he liked theater and he said, “Well, yes ma’am.” And she said, “What kind of theater do you like?” And he said, “Well, I like burleycue. I go to it once a month. Do you do burleycue?”
Another time, we had a special officer we had picked up in North Africa who had been hit in the head – and that explains some of his behavior – but he had a knack for finding things all over the place. We were known as scavengers of the worst kind and he comes to me one day and he says, “Hey, Colonel, I got a fellow, his name is ‘Heifer,’ or something like that. He plays a fiddle, and the guys over at the airport told me he’s just arriving fresh from the United States. What do you think?” I said, “Just bring him by.” So I had just finished dinner and I was sitting in the lab and in walks Jascha Heifetz with his accompanist. We just sent word out that there was going to be entertainment tonight. Other hospitals were in the area and [the audience] filled the theater. Heifetz didn't know what the hell to do. He was shaking. I said, “Just be Heifetz. Just go out there and play.” So he played and they wouldn’t let him get off the stage. They tore the handles off the seats and banged them just to keep him on. Finally, I waved to him, “Come on, I think you’ve had enough.” But it was a great experience to have people like that come through.
I think I’ve seen pictures of a banquet where you had him as a guest.
It wasn’t all a bad war, you can see, because in this Terme di Agnano was a little walled garden, the most gorgeous little thing you’ve seen, and off to one side was a special house. I gave the first dinner party there and then the colonel took it over, but it was a gorgeous setting. So you see it wasn’t all bad. We also had an Olympic-size swimming pool on the grounds.
And that was in operation?
Yes, and since I was interested in health, they made me health officer which gave me a set of keys to the thing and I could use it anytime I wanted to. We were sitting there at the pool side one day and it had a forty-foot Olympic tower and here’s this guy going off, and Henry Schwartz puts his hands over his eyes and says, “My God, I just put a plate in his head two days ago!”
Did the diver survive?
Oh, yes. Henry almost didn’t.
When the time came when you had to move on to France, wasn’t it the case that you didn’t really know where you were going?
I understand that the Allied forces hadn’t really even cleared the territory in Lorraine. There was a lot of trepidation about that.
Oh, we just went. I don’t think we ever thought very much of the dangers of war after awhile. For instance, if you stopped to think about it, we were practically unescorted across the North Atlantic. If they had sunk our ship all of the medical personnel that we’re talking about would have gone down with it. So we weren’t very tuned.
The French experience was a very interesting one because we took over what had been planned as a neuropsychiatric center. It was called Ravenel Hospital, and it was in the northwestern part of France not too far from Nancy. By that time we had developed a great deal of expertise and we had developed good contacts with engineers. They were terribly important in setting up a hospital, getting electrical things going. We used cyclotherms to furnish the power for a good part of it, but we had extra power and we picked these things up along the way, and these utilities become a tremendously important thing in a hospital, much more important than your instruments, your doctors and so forth because you can’t work without them. As I say, we developed a lot of these know-how things that make it easy, because a lot of things were unfinished in the buildings. They were gorgeous buildings spread out all over a large area and they lent themselves beautifully to operating a hospital.
We have pictures of them here in the Archives. I showed you earlier a picture of the laboratory, and we have you squinting into a microscope and then a table full of your colleagues. Lucille Spalding is there. We’re now making reference to official photographs that were part of the report – the narrative report on General Hospital 21 – and we have them in the General Hospital 21 collection. Some were reprinted in the Washington University Medical Alumni Quarterly, and included is that one particular picture of the laboratory. We see a number of the other people. Was Abe Bolotin among them?
Yes, our executive officer.
Lucille Spalding is in the picture. In the larger picture, I think there were even some POW’s, [and] some nurses. I think they cropped the picture to exclude them. But you had quite an operation going.
Yes, we took some German personnel and we had a German section to our hospital. They were German prisoners of war. We used their personnel in the laboratory to help carry out some laboratory techniques. We found they were very poorly trained. They were not very knowledgeable and we had to get rid of them because they were [spreading] the Nazi propaganda, especially a very gorgeous blonde who was about eighteen years old and the daughter of the ambassador to Brazil. We just couldn’t have them around.
You had prisoners playing in an orchestra, though, I understand.
Yes. Music was in our soul around the hospital always. The little village where we were stationed is France’s center of violin making.
This is Mirecourt?
Mirecourt. And there are several luthiers there who have been there for a long, long time. They come from the families down in Italy who made the Strads and so forth from the village of Cremona. They came up to this area and they set up as luthiers and it was a very interesting experience because they had real artists making these violins. They would have this man set up a violin on an easel about twenty feet away, walk back, take a dash, take a spot, put it on the violin and wait two days for it to dry. They made some good violins. They’re known for that. And it was through that that my wife got to know where I was. I said, “Just ask my friends who play the violin about violins in France.” It’s a very famous violin center. I took up the violin again.
That was the way to get around the civil censorship as to location, I take it.
Yes. We had all sorts of signals in that direction. The censorship had much to be desired. It was amazing, some of the leaks that took place.
Sam Harbison, who was one of our surgeons and a very good violinist, picked up the violin along with me and we played there. One of the other musicians was John [Patton], our GU man. He was a piano player and a darn good one, and that would make for much gaiety, especially at the Officers’ Club.
And, don’t forget, we were not too far from the famous wine country of Burgundy so our Officers’ Club was well stocked. One of my missions once a month was to inspect the laboratories of the hospitals in the northeastern part of France. So I'd go down to Dijon, which was just outside of Nuits, a very famous Burgundy country, and then I'd go over to a rest home in the Vosges Mountains that the 36th General Hospital ran, and from there we would cross over to Evian-les-Bains, which was an old watering place like Atlantic City, and no troops there at all, American or whatever. But a can of coffee went a long way, a pound of butter went a long way. So we had first-class hotel accommodations and fabulous food like fresh trout taken out of a trout run, and frog legs. That was one of the jobs the Colonel gave me.
There were also some hunting expeditions, I’m told. Did you go on any of the boar hunts?
I didn’t go any of the boar hunts. The big boar hunter was Joe Edwards. We called him “Killer” Edwards because I think he caught two boars on one of the expeditions. I couldn’t figure out why they all didn’t get killed going out the way they did and the natives fanning the brush. They came back alive. That was an interesting thing. Another one was a bombing Christmas Eve night at the hospital.
This was during the Battle of the Bulge. Did you ever think that the Germans would overrun you at any moment?
No, we didn’t feel that way. We felt that the 7th Army was invincible. Although, that’s the nearest I ever came to any close combat. There was one fellow who dropped a bomb, [and] scraped the hospital. I fell into a ditch; I could see his tracer bullets and I would say, I could feel the impact of the tracer bullets maybe twenty-five feet away. That’s the closest I ever came to anything.
Right after that, of course, you had a big flood of casualties from the engagement.
Yes, the Battle of the Bulge.
It wasn’t too long after that that Germany was defeated. Did you travel at all in occupied Germany before returning?
I got up into Frankfurt and into Cologne and saw the devastation that was carried out. War is a funny thing. The accidents that happen are inexplicable. For instance, the Cathedral at Cologne was partly pockmarked with shells, but this whole plaza around it was nothing but skeletons of buildings and a railroad station immediately behind it, and here was this beautiful cathedral well preserved.
That was because the pilots were under orders not to hit the cathedral.
I know, but when you start burning out things like they did there, I don’t see how they could do it.
What were the circumstances of your return? Did you stay with the 21st until the end?
No, as soon as the war in Europe was over, they wanted experienced medical officers to take command of units going to the Far East of the Pacific, and I was one of those chosen. I was cleared out of the hospital overnight and back in the United States in 48 hours. There was a special deal. I really worked this over fast.
Can you tell me more about this assignment?
It was called Green Project and it was, as I say, primarily a medical officer replacement deal primarily for command positions with station hospitals and lesser units in the Pacific. So I came back to the United States and I was assigned to Indianapolis and from there to North Carolina and then the war was over.
Did you really think that you might have to be sent?
Well, I actually had all the protocol handed me for the command and so forth.
Were you going to be on a hospital ship that was in the fleet that was going to attack Japan?
No, probably set up station hospitals which would be land-based hospitals, smaller than a general hospital. Could have been a general hospital, too.
In 1945, early 1946, you resumed civilian practice. Why did you choose to return to your practice? So many others at this point had a break in their careers. Dr. Cady, for example, went into the VA. Did you have any temptation to shift?
No, I think I can understand Dr. Cady’s doing it. He became very professional at this business of being a military physician and he developed a tremendous know-how in the management of hospitals and so forth. So his interest was not the practice of medicine; his interest was primarily in the area of hospital management: administration, and so forth. My interest was going back into the practice of medicine.
So you returned to Jewish Hospital. You also resumed your position at Washington University on the medical faculty. Tell me at this point – if I can jump ahead in time – about your experience with the Midwestern Cytology Laboratory, Inc.
When I was in North Africa, the first publication of the Pap smear was made. I got interested since I had been interested in a microscope. On my way home, I contacted Dr. [George N.] Papanicolaou in New York and went out on my own. I had to teach myself because this was an early stage in the field. You couldn’t give it away back then. Then I was instrumental in getting some showings of the Pap smear in movie theaters here in the St. Louis area through the American Cancer Society. We took bus loads of women to various theaters and showed them these movies of the Pap smear, and that was really the beginning of the expansion of it.
Now the Cytology Laboratory is a private medical service, right?
Where is it housed?
Well, I had an office set up where its work is carried out.
Where is it located?
8631 Delmar, right with my medical practice office. It’s diminished considerably from what it was. I was running a factory for a while, which I didn’t want.
At the height of its operation, how large an operation did you have?
Oh, a tremendous operation. I had eleven in help just doing cytology and we were doing thousands of smears a month, now a few thousand a year. Pathologists have taken it over.
There are lots of independent laboratories doing this work – perhaps particularly in the smaller cities that don’t have the large hospitals to do this.
Well, I ran into a practical problem. When the pathologists went into this and set up their private laboratories, they started cutting prices and I wasn’t willing to do it. I felt it couldn’t be done at these low-level fees.
How did you come to be consultant in pathology to a Veterans Hospital?
When I came back from the Army, they didn’t have a hematologist, they didn’t have a pathologist. They knew that I had done the work with the 21st General, so they asked me to take over and we would get a new pathologist every month while it finally squared away.
Are you a believer in the system that the Medical Center has developed whereby only certain area physicians become clinical faculty? Is this a kind of quality control?
It’s a tradition I’ve been raised with, so I do believe in it. And I do believe that along with it is a necessity for full-time people. The problems that arise, not infrequently – more particularly in private hospitals than in a large hospital like this university hospital – is that there’s poor correlation between a full-time and a part-time man. Part-time are not utilized the way they used to be. That’s a change. But we also raised a new era of prima donnas in the full-time faculty. These guys take a job one place and they’re already looking for where they’re going next at a bigger salary and a more prestigious—
Regretfully our tape ran out just as Dr. Agress was completing his views on this important issue. This is the end of the interview with Dr. Harry Agress.