Interviewer: Estelle Brodman
[Thanks] to all of you for taking the time to come and talk to us about the history of the medical school, and particularly to Dr. Arneson who did so much work about getting it all organized and ready to go. What I thought I would do, if you didn’t have any objection, is to speak into the tape recorder a little biographical sketch of each of you which I have here, and then turn it over to Dr. Arneson as chairman for the group. Is that all right with you? [All agree]
If you would, please talk about the changes in the educational scene that you have seen over the years here in the medical school: the physical quarters and also – since you’re all obstetricians and gynecologists – the practice of obstetrics and gynecology in the last half century. I think that would be very, very helpful to future historians.
So, without introduction, let me start alphabetically with Dr. Arneson, who was born in Ft. Worth, Texas in 1905 and got his M.D. degree here at Washington University in 1928. He interned here and was a fellow and a resident in gynecology at the Memorial Hospital in New York for several years. He came back to be various things in Barnes Hospital: associate attending gynecologist and so on. Now he is Professor of Clinical Obstetrics and Gynecology and Associate Professor of Clinical Radiology. During World War II he was a lieutenant colonel. The number of offices he has held is so large that I just put down a few of them, including the presidency of CAOG (the College of American Obstetricians and Gynecologists) and the AMA-ARC. He is so distinguished that I’m almost afraid to talk to him, but he’s very kind when I do.
Dr. John E. Hobbs was born in Waynesville, Missouri in 1901 and got his degree at Washington University in 1927. He was intern in obstetrics and gynecology for one year – I’m not quite sure what that meant – at Barnes, a resident for one year and then interned in pathology. So you’ve had both pathology and obstetrics and you were telling me [that] you were in surgery, too. You were an intern in general surgery here at Barnes and you were at St. Louis Maternity Hospital and were an associate in surgery and pathology and an associate in obstetrics and gynecology. Now you are Clinical Professor Emeritus of Obstetrics and Gynecology. Like Dr. Arneson, you’ve been in many of the associations.
Dr. Melvin A. Roblee was born right here in St. Louis in 1900 and got his degree from Washington University in 1925. He did his internship and residency at Barnes for several years and then was assistant in obstetrics and gynecology at both Barnes and St. Louis Maternity here and at St. Luke’s Hospital. He was in the outpatient department of the University clinics in obstetrics and gynecology and Professor of Clinical Obstetrics and Gynecology. [He is in] many associations, including [membership as] a fellow of the American College of Surgeons.
Again, let me thank you gentlemen for coming here and being willing to do this for us. Let me now turn it over to Dr. Arneson.
ANA: Thank you, Dr. Brodman. You’ve been very generous. We appreciate the opportunity to meet here with you and to talk about the early history of the school and the hospitals. From the dates of birth that you’ve recorded there, you can see that you’ve got a group of individuals who will enjoy reminiscing. Dr. Roblee was the first one on the premises here. He began his medical education in 1921. Melvin, when you came in at that time, tell us a little something about the classrooms and departments and the medical school offices and of your impressions when you first came here. But I’d like to preface this by asking a question: At that time, Dr. [Evarts A.] Graham was already here?
MAR: Yes, he was, Dr. Arneson.
ANA: But I suspect Dr. [George] Dock was still here as Professor of Medicine, was he not?
MAR: Dr. Dock was just leaving. He left the first year [when] we were freshmen. We didn’t get acquainted with Dr. Dock. That was one of the things, I think – that through our four years in the medical school we didn’t have any strong department in medicine until Dr. [David P.] Barr and Dr. [Harry L.] Alexander came. Which didn’t mean that we didn’t have a lot of younger men who were expert clinicians. They gave us a background in clinical diagnosis, which we enjoyed very much.
Who were some of these younger men? May I interrupt?
MAR: Well, Dr. [William H.] Olmsted – he had been in the 21st Unit [ed. note: Base Hospital 21 in World War I] in the medical department. Later, during the time we were in medical school, insulin was discovered and Washington University had a grant at that time. Dr. Olmsted was in full charge of all the diabetic work at Washington University. Dr. Drew Luten was head of the cardiology department and a very promising graduate by the name of Barker – Dr. Paul Barker – was one of his assistants. Dr. Paul Barker was my wife’s oldest brother. Not at the time – I was in medical school – that came later. Paul left here to be the associate head of the department at Ann Arbor, Michigan due to his work in cardiology under Dr. Drew Luten. We could go on down the line. One person, briefly, Dr. Arneson, that stands out in my memory and all of our class, was Dr. Elman. Dr. Elman had a class in physical diagnosis at 7:30 in the morning. It was a little difficult for those of us—
ANA: (Interrupting) Excuse me. Wasn’t it “Elmer?”
MAR: Elmer is right. Very many amusing instances occurred in Dr. [Warren P.] Elmer’s physical diagnosis class, which we can reserve till later.
ANA: Let’s hear it right now.
MAR: [Dr. Ralph] Kinsella, that really, I think, was sort of borrowed from St. Louis U., gave us a good many very practical lectures. Some of the younger men in addition to Paul lectured. We had no definite outline until Barr and Alexander came in our junior year. Then we had a very strong medical department.
ANA: Melvin, would you tell us about the setup at that time for obstetrics and gynecology?
MAR: I’d be glad to, Dr. Arneson. Because there wasn’t a department of obstetrics and gynecology. Gynecology was simply a branch of surgery. I understand from the juniors and seniors at the time we were freshmen, that [Dr. Fred T.] Murphy [ed. note: Head, Department of Surgery, starting in 1919] had a very strong department. Murphy was head of Unit 21 in surgery. Apparently, from gossip, hearsay and our own observations, Murphy just wasn’t around after Graham came. I don’t mean that in any disparaging way for either man because Graham, I think, made Washington University what Washington University is today.
Dr. Erlanger used to say that Dr. Murphy really wasn’t interested in staying—
MAR: I don’t think he was interested in a full-time position and of course this was the beginning of full-time department heads. I really don’t ever recall seeing Murphy in action. (To Dr. Hobbs:) John, did you?
JEH: No.
MAR: The whole development of a department of obstetrics and gynecology at Washington University and other schools, too, from history – we were in the transition period. By the time you had come on, Dr. Arneson, it was a department, was it not?
ANA: Yes.
MAR: Dr. Otto [H.] Schwarz was back from his sabbatical year in Europe to be the Professor of the new department. I was a resident obstetrician at Barnes Hospital from July 1 to August 15, which was a short residency at Barnes. Then, the St. Louis Maternity Hospital was open. And still the department wasn’t OB/Gyn. John Hobbs was my intern, although he might have been on surgery at that particular time when we first moved in. Were you, John?
JEH: No, no. [I was] on OB.
MAR: Crossen, H. S. Crossen, had the professorship of gynecology at Washington University, theoretically under Graham. Graham wanted nothing to do with gynecology in his department. He was the chest man, so I’m completely a half-breed. I had all my residency and so forth zigzagging back and forth between surgery and gynecology and obstetrics. Does that answer your question?
ANA: Yes, it does, Melvin. You mentioned Dr. Otto Schwarz had been away for a sabbatical. Are you referring to the period of one year [when] he went abroad and Dr. [Albert] Taussig took over the department?
MAR: That’s right. And with Dr. Taussig I would like to add that Dr. [William Joseph] Dieckmann, Bill Dieckmann really did the active work.
ANA: But it wasn’t until about 1928 that Otto went abroad and Taussig took over the department.
MAR: That’s right. I’m sorry, I didn’t mean to imply the earlier date. I skipped a bit. When I was a house officer in 1925, Mrs. Otto Schwarz was in labor over a period of two weeks of induction by “Daddy” so that the new baby could come before Otto went to Europe. Does that fit your dates all right?
ANA: Yes. “Daddy,” of course, was Henry Schwarz.
MAR: That’s right.
ANA: Let’s turn over to Dr. Hobbs a minute. You know, John, it seems to me that the University has gone through different “pushes.” They’ll push in this department, they’ll push in that department and those pushes have resulted, as you look back over past years, in the construction of different units, different hospitals and different departments. The push for obstetrics and gynecology was really one of the first ones in the medical school. Tell us about the classrooms, tell us about the hospital facilities and tell us about Dr. Henry Schwarz and the yellow apron that he always wore. Where was the delivery room? Where were the patients housed?
JEH: Well, when I came on obstetrics in 1927 the Department of Obstetrics was on [Floor] 3418 in Barnes Hospital. That was the ward department. The delivery suite was located in that area. The private OB patients were on the third floor of the [Private] Pavilion. We had to bring our private patients from the third floor Pavilion, down the old elevator to the basement. We brought them through the basement to the elevator on 3418, up to 3418 delivery suite. That was a long way. I delivered some babies in the elevators and some babies in the basement at Barnes Hospital.
ANA: Without chloroform.
JEH: Without chloroform. Then, in 1927, [St. Louis] Maternity Hospital was dedicated – it was started in 1926. At the dedication ceremonies we had a professor from Copenhagen. He wore a stovepipe hat. I remember he collapsed his hat and put it under his chair. The dedication was held at what is now between McMillan and Maternity – McMillan hadn’t been built yet. I remember standing by Dr. Hugo Ehrenfest and after the dedication ceremonies I said to Dr. Ehrenfest, “This is supposed to be the finest maternity hospital in the world and I wonder how long it will be before it will be antiquated.” I’ve seen it – I’ve seen it completely replaced. At the site of Maternity Hospital there were two residence buildings, two-story brick buildings. One was occupied by the superintendent of Barnes Hospital, the other by the assistant superintendent.
Were these the buildings that originally had been for colored patients?
JEH: Yes, that’s right. And they were demolished at the time Maternity Hospital’s building program was started there. There was a parking lot – the parking lot is still present – at the power house. That was the only parking lot in the whole area. Parking was then done on the street; there was a little semicircle in front of Barnes Hospital and a little area in back of Barnes Hospital. But most of the parking was done on the street. I remember looking down from anatomy many times on that parking lot and there would be two or three cars on it. Two of my colleagues had cars – one [had] an old Dodge and the other an old Ford roadster. [There were] no other cars. Today, all students have big cars, and so forth.
When did they put the colored patients in with the white patients?
JEH: That’s fairly recently. I remember – all of us do – that colored people couldn’t ride the elevators, colored people couldn’t enter any of the dining rooms, and they had segregated wards for all colored patients. I would say that integration occurred in Barnes Hospital sometime in the 1930s, wouldn’t you?
ANA: John, I believe the colored wards were in the basement of Barnes, weren’t they – when those buildings came down that you referred to. We did have, as I remember it at Maternity, colored patients on the second floor at Maternity.
JEH: Yes, that’s right. But they were segregated.
MAR: About the elevators – I don’t recall that.
MAR: That’s right. They couldn’t ride. Colored patients couldn’t ride elevators, they couldn’t go into any of the dining facilities at all.
If they were on the second floor—
JEH: They walked up.
MAR: I don’t recall that.
ANA: That’s amazing. I’d never heard of that.
JEH: That’s right. Then, talking about the power plant, it was coal-fired and the power plant furnished electricity for all of the institutions. We had big piles of coal out there dumped at the railroads and the smoke stack belched coal smoke. We used to get our lectures in anatomy up on the corner of the building across from the power plant. Coal smoke would come into those rooms and almost choke you. Talk about pollution today – in those days we had such dense coal smoke, a lot of times we wore masks. Our collars were dirty, our handkerchiefs were filthy. We had coal in our noses and people that came to autopsy all had black lungs, I guess anthracosis, right?
It also ruined our books. We have had to spend thousands of dollars to have them—
JEH: In walking to school – I used to walk from over on North Kingshighway – sometimes you couldn’t see your hand in front of you. You could hear cars “Crash, crash” – of course, people drove slowly – and you could see a little halo of light. That’s all you could see. You have here [ed note: Dr. Hobbs apparently refers to a list of interview topics] something about street lights. Of course all the street lights here were gas. We had lamplighters that came around.
In the twenties?
JEH: Yes. They came around to turn off the lights in the morning and light the lights in the evening. Old Tony Randazzo – I’ll never forget Tony – there’s a stench in my nostrils when I think about him. Dr. Arneson will say more about him later on.
You have down here something about Barnes Hospital. The surgery department was located at that time on the second floor of the medical school building. All the staff men had their offices over there, including Dr. Graham. They moved over to the Barnes side when Rand-Johnson was built, right? So they had pathology and all of the experimental laboratories located on the second floor of the medical building. For Medicine, Dr. Barr came here in 1927. [One of Dr. Hobbs’s colleagues corrects the date to 1924] Anyway, Dr. Barr was head of medicine when I came here and he gave us our first orientation lecture in the old auditorium, [ed note: in the North Building] which is now the Carl Vernon Moore Auditorium. I can remember very distinctly [that] he talked about thyroid disease. In pathology Dr. Leo Loeb was the head of the department. He was a very distinguished man and he spoke very poor English. It was difficult for us to understand his lectures at times. Another thing I remember very well: we had an associate professor named Dr. [Frank A.] McJunkin. He was a lame man.
MAR: Step-and-a-Half.
JEH: Yes. They called him, “Step-and-a-Half.” He was a very lame man and he had an impediment in speech. He gave us an orientation lecture in pathology – what to expect and so forth. Then he ended up – he said, “Um, um, um, I hope that you’ll be a good class. We had a good class last year, much better than the year before since, um. Only 15 failed the course last year.” You’ve never seen so many pale, scared kids in your life.
You have down here “railroad noises.” The railroad tracks, of course, are still in the same place. When we had our lectures in pathology the trains would rumble by there, lots of trains. Coal smoke – of course we had no air conditioning – hot, windows were open, coal smoke would waft into the rooms. When the train would go by you couldn’t hear the lecturer at all.
Now, the OB/Gyn residency program. When I came on, it was a three-year program; one year on obstetrics, one year on surgery, then a year as resident on OB and Gyn. As Dr. Roblee said, the Gyn program was part of surgery at that time. When we moved into Maternity we had call letters, allotted call letters up on the side of the wall. We had certain letters for certain individuals. [When] we’d see those letters then we’d answer the telephone. In Barnes, we had a loudspeaker during the day. At night, an old fellow named Jack would come and awaken us. He’d shine a flashlight in our eyes and shake us. Sometimes some of the fellows were pretty deep sleepers and he’d have to come back two or three times. He had some choice words for those fellows.
ANA: John, I don’t mean to go back [but] I wonder if we can’t establish a little more clearly for the Department of OB/Gyn where the research laboratories were, prior to the construction of Maternity Hospital. I don’t recall, but I think they were in the clinic building.
JEH: Yes, third floor.
ANA: On the third floor of the clinic building. And pathology also had their headquarters on that same floor.
JEH: That’s right.
ANA: I think the Department of OB research laboratories and offices actually looked southward out of the window and they could overlook the construction of the Maternity Hospital.
JEH: That’s right.
ANA: You mentioned Jack. In the rotunda of Barnes there was a round area where the entire, complete telephone system was harbored. All the connections went through there. Jack answered this telephone at night and he’d get relief and run up and try to awaken a resident who was on call. I don’t think we ought to pass by without mentioning some of the nurses. If you recall, Dorcas Drake was the night supervisor at Barnes. Here was a hospital in which one woman was the total and complete supervisor of the entire establishment with the exception of Children’s. After Maternity Hospital was built, Lucille Spalding was the night supervisor there. Lucille Spalding later went with Unit 21 in World War I [ed. note: Spalding served with the 21st General Hospital during World War II] over to Europe. If you remember, even after Maternity Hospital was built, the gynecology was left in Barnes and left in the Department of Surgery under [Dr. Harry S.] H. S. Crossen [ed. note: Professor of Clinical Gynecology]. We had patients housed with female surgery patients on 2219. There was a very pretty, brown-eyed nurse who was the head nurse up there. The best I can recollect, her name was Helen Moffatt. Does that ring any memories?
JEH: Yes, that’s correct.
ANA: I think at a later time when Rand-Johnson Hospital was constructed – and this gets to a time period of about 1934, I guess – the Gyn ward then became 5200 or part of 5200. I think Miss Moffatt was also the head nurse up there. It was left in that fashion, with gynecology there, but it fell strictly under obstetrics and gynecology when the department was turned from surgery back to OB/Gyn, when Dr. Otto [H.] Schwarz completed his sabbatical leave – during this period Dr. Fred Taussig administered the department as head of the department – and came back. He was the one who gave me my appointment as an intern. I started in 1928 with the internship, so he was there at that time. And then Dr. Otto Schwarz took over the full management of the department and gynecology, but left Crossen on as pretty much responsible for gynecology, along with [Drs.] Quitman Newell and Charles O’Keefe.
Could I ask a question? Dr. Hobbs has mentioned McJunkin who said, “Fifteen of you will fail,” or words to that effect. You were telling me the same story. This is extremely different from today’s attitude of the faculty toward the students.
MAR: Very much so.
Could we discuss that point – how it has changed over the years?
MAR: Briefly, our orientation was a very brief one. I’d like to say “we” all the way through here instead of just plain “I.” Let me put it this way: there were 71 of us in our freshman class. The dean was Dr. [Nathaniel] Allison, an orthopedic surgeon right fresh back from World War I. Dr. Allison stepped up on the platform and the first-year medical school class was assembled, 71 of us. He didn’t call us “gentlemen”, he just said, “You all out there are 71. That’s too large a class; we don’t intend to graduate that many. Ten of the men sitting here will not get into their sophomore year. We will build up the sophomore class by taking on additional [students]. Ten from the sophomore class will not make junior and senior year because we have an influx from the University of Missouri at Columbia because they are only a two-year medical school and we take their junior and senior years.” Now, John, we didn’t turn pale.
Most of us had had a little more exposure to the 1918 flu epidemic than you had, although you mentioned it in an article. We were out on the Hill, at least I was, and some of our classmates were. We were in wooden barracks and we filled up Barnes Hospital with flu cases. I didn’t get the flu; I don’t know why. I guess I was too mean. At any rate, our Student Army Training Corps was called SATC - Stick Around Till Christmas. That’s why I had three years out on the Hill and then got my B.S. degree in 1923.
The percentage of men in our freshman class, the first year, [who] had degrees – either B.S. or M.S. degrees [was] 25 percent. In our fourth-year class 50 percent of the men getting their M.D. degrees in 1925 had B.S. degrees and some of them had M.S. degrees.
Was this unusual in medical schools in the United States at this time?
MAR: I think it was probably about average. Nine of us in our class, graduating in 1925, got our B.S. degrees in 1923. That B.S. degree was given through Washington University only to those who had their premed two or three years or four, whatever it was, out on the Hill before coming to medical school. That made us awfully aggressive. It made us suddenly realize in our freshman year that we were no longer individuals in an alma mater – a nursing mother institution – but our survival depended on us alone in a hostile environment. I think that explains what was later said about our class, which was “the worst class that Washington University ever graduated.” Not from the standpoint of degrees, but that we were arrogant, we took no advice from anyone and we insulted the entire faculty.
JEH: That sounds like today.
Today the faculty doesn’t dare say that. One of the things that interests me tremendously is how very different the attitude of the faculty today is. You gentlemen have all been here in this period and you must have seen the change.
ANA: Oh, yes. Very much so.
Now they almost never flunk out any student; they try very hard to keep him in. They’ve got 138 students as opposed to 71 and they take very few transfers. The whole idea is to let the student decide what he wishes to learn rather than the faculty setting the rules. How did this change occur? I’m sure it didn’t come overnight, but it must have come over the years. Can any of you give me some help on that?
ANA: I’d like to speak to that a little bit, Dr. Brodman. The students at that time, and our periods in school overlap to some degree, worked very hard. This created a tremendous cohesiveness between students. I daresay that both of you will agree. You came here and you had friends, but your own classmates – the people you went to school with – became some of your most intimate friends and associates.
JEH: Very definitely.
ANA: And this was a collective effort to get through. I think there was also a spirit of reasonable helpfulness. However, each one worked as an individual. If you weren’t keeping up and you got the pink slip from the administrator’s office you didn’t have too much help from your colleagues – they were too busy. On the other hand, the attitude of the faculty was a very warm, generous feeling, in my opinion. There started, about the time I came into the school, the concept of the faculty adviser. This didn’t survive; it didn’t live. I had heard some sophomore students ahead of me talk about physiology and I just blatantly put down my request for Dr. Erlanger as my faculty counselor. My classmates chided me very much, [they] said, “That’s the worst thing you could do.” It turned out not to be. As an example, in physiology we got to chronaxie. Chronaxie was a miserable thing which consisted of measuring a time characteristic, a measurement of excitability of nerve tissue. I was on my knees on the floor trying to connect some wires together – actually hoping that I could rearrange the wires to make the test come out all right. I was conscious of a pair of black shoes standing by me and I said, “Damn chronaxie and damn Joe Erlanger.” About that time [I heard] “Are you having trouble, Mr. Arneson?” And there was Dr. Erlanger.
He was a very warm advisor. I remember at Thanksgiving [dinner] – he lived on Waterman. He invited three medical student representatives. He had Dick Taylor out of your class [ed. note: remark is directed to one of the interview group]. He had Jerry Levy as the junior, Dick Taylor as the sophomore and he had me as a freshman. He had us at his house for dinner and it was very pleasant. Now, he wasn’t a man you could go to on the spur of the minute. But I would cite this as an example of the attempt on [the part of] faculty to be very warm. On the other hand, they were disciplinarians. This was sort of the Geheimrat atmosphere. I don’t know of any graduate of any school I’ve run across that had more moral incentive instilled into them than we did in this school at that time. I think it’s much different now than it was then. But I think that the moral concept of responsibility was the big thing that the faculty at that time delivered to the students.
One of the things which the Committee on Medical Education struggles with these days is the fact that when the students feel pressure put on them, instead of this reasonable helpfulness and soothing cohesiveness that you mention for your class, the students get to be antagonists to each other. If a student leaves his notebook on the table, the other students will tear it up and throw it away. If an assignment is given to a class, the first student will come in and take the book and hide it so that the other students will not be able to get it. Why did your classes react so favorably to pressure and the modern classes react so unfavorably?
JEH: First, I want to say to Dr. Arneson that after 50 years in medicine I just learned about chronaxie. I never did understand chronaxie. I can tell you – there was lots of fear. Everybody was fearful of being a failure. [There was] lots of fear in our class. We didn’t dare talk back to the professors, which they do today. When we were students our professor would often come into the room to talk to us [and] we’d stand up. Today, [when] the professor talks to them they don’t even listen – they don’t give him attention. I’ve seen them take chairs – I saw all this happen one time in our conference room – Dr. Willard Allen was speaking and a senior student came in, took his chair from behind him and sat down— When Dr. Allen was ready to sit down he had no chair. We were taught respect and we felt that we should be respectful. That is gone today with too many of us. Some, I’m sure, have it.
ANA: There’s another factor, too. In that period of time there were giants. There isn’t the chance for an individual to be a giant today that there was then. Graham was a tremendous figure. During the war, with the flu epidemic, he was the one who delayed this incision into the chest to drain pus, laudable pus.
Ernest Sachs, who was the neurosurgeon here, was a very forceful individual, a very demanding individual. One time when I was on surgery I had a cold. You didn’t dare go into his operating room when you had a cold. I got Paul Rollins to take my place. Later on, Paul was on the same service and we exchanged because he had a cold. I was scrubbed up then; I knew pretty soon that Dr. Sachs was going to want the so-called bayonet forceps. I spoke to the scrub nurse, who is now Mrs. Bricker, and asked if she would get the bayonet forceps out. But they didn’t get them out – the intern had to pick all the instruments out – Paul Rollins had picked them out and he hadn’t put in the bayonet forceps. Dr. Sachs asked for them and I said, “Dr. Sachs, they will be ready in just a moment.” He said, “Just a moment? Dr. Arneson, haven’t you been on this service for six long weeks?” I said, “Yes, sir.” He said, [ed. note: Dr. Arneson affects an accent to sound like Dr. Sachs] “Well, if you don’t know now, you’ll never know. Get out.”
They were domineering and they were giants of the time. This made a lot of difference.
Why do you think that we cannot have giants now? Has medicine changed to the extent where it’s a group—?
JEH: It’s too complicated.
MAR: I’d like to correct an impression that I [may have] made. I referred to Dr. Elmer’s class in physical diagnosis. We worked in small groups. We were not competitive in the sense of being childish and interfering with others. The four men who worked together in our first two years were split up in our junior and senior years, but we always worked in groups. I don’t think any of us ever did anything alone in periods either in the clinic or preclinical work. For example, Ben Fox, who was associated with us a great deal, was an intern in obstetrics. He later went to the Mayo Clinic in general surgery. We both elected Graham’s course in our senior year. Ben was a late sleeper in the morning and every time that Elmer called on Ben Fox, Fox was asleep in class. One time he suddenly awoke. I was sitting next to him and I dug him in the ribs and said, “He’s talking about mitral stenosis; you’d better give it a bad prognosis. Ben came to with a jump and said, “Well, they linger on for a while and then they drop off.” Elmer blew his top. He said, “This is the worst, [censored], blankety-blank class I have ever taught. [There are] a bunch of idiots in here and I’m going to flunk a bunch of you.” Ben was wide awake by then. The exam was coming up in the next two days. I had fair notes, and what we did in Forest Park – Arnie [Dr. Arneson] spoke of baseball diamonds over there – we didn’t have a baseball diamond. We went over and literally hung from trees – not with a rope around our necks – but I think that’s what we were thinking about. We’d swing from trees, Tarzan-style, and study over there; groups [of] 4, 5 and 6. Of course, the fraternities were pretty well glued together. Ben studied all of my notes, plus the textbook. I studied with him the second day. He got 98 on the examination and I got 94. I never have forgiven him.
But that was all the way through – our work in electives was always in groups. We were highly competitive with each other, but it was on a basis of trying out. We simply told the faculty that we didn’t like them. We were in competition with the faculty, largely, I think, because we had so very many young men teaching us. Some of us had had just enough of the army experience, or a memory of what the older ones said about it, that we weren’t anxious in the 1920s to take anything from anybody.
ANA: Could I be forgiven for another story of faculty-student relationship? The old amphitheater was up the third floor of Barnes Hospital. We had our general class meetings up there during the clinical period. And Dr. Sachs held a conference once a week. He would call students from his roll down to examine the patient. This particular day there was a man with a huge, swollen ankle. It was a chondroma – I didn’t know it at the time. He had me examine the patient and he kept asking me what I could feel – the texture of the thin shell on this. We finally got around to something about ping pong balls. This passed by and there appeared in the newspaper a little article about the manufacturing of ping pong balls and I cut this out. I went into the lavatory at the medical school one day and Dr. Sachs walked in. I didn’t function after that; I just got ready to leave. So Dr. Sachs finished what he came in for. He was rinsing off his hands and I was trying to edge my way out. He reached into his vest pocket and pulled out the same clipping about ping pong balls which he had saved. He’d cut it out of the paper at the same time.
Underneath that rough exterior beat a heart of gold!
ANA: It certainly did. Could I tell one more little story about a faculty member? Dr. Henry Schwarz – we passed him by and we shouldn’t have passed him so rapidly. During the year that I was in the path lab, which was just before I went back in as a resident, I took him home each day for lunch. Now you said that the students didn’t have automobiles, but I did acquire one on the outpatient service and I want you to tell about that in a moment. Driving home, I recounted what had just been in the newspaper announcement: Professor [Edward A.] Doisy of St. Louis University had isolated theelin [ed. note: crystalline follicular hormone, J Biol. Chem. 1930, 86:499-509]. I said, “Dr. Schwarz, that was a pretty important thing.” He said, “I’ll tell you something – that fellow Doisy isn’t so smart.” He said, “You know, my office is in my home. I’ve got that carriage trade that comes in.” I said, “Yes, sir.” He said, ”Those women come in to have their babies and they bring those little bottles of urine.” I said, “Yes, sir.” He said, “I suppose they think sometimes I look at it; maybe others think I throw it away. But from my nicest, cleanest patients, I take those bottles of urine and put them in the back of the refrigerator. When I have enough of that collected together, I go across the street to Mazarelli’s drug store and I get some of their very best raspberry syrup. Then I mix those bottles of urine and the raspberry syrup and I put it up in little four-ounce bottles with corks in them. And when those old women come in with hot flashes, I give them that and tell them to take a teaspoonful every day. Now, here was the art of medicine – he didn’t know what these things were. He knew the Abderhalden reaction; that was what you were worried about. But he knew that something in that urine relieved hot flashes.
JEH: I think something more we should say about Dr. Henry Schwarz – of course he was a beloved man. He organized the Department of Obstetrics here and he maintained it with his own money for many years. On Sunday mornings he’d have some of his rich patients come in to a little office he had up on 3418. He’d have an intern come up there and be with him at that time.
MAR: That was Sunday School.
JEH: We called it Sunday School – I’m sure that you all remember them. He used to call – he’d be over here at Mike’s, you’d see him smoke his cigar. He’d call his wife and he’d say, “Hello, Laura. This is Henry.” He’d been calling her for 50 or 60 years and you’d never mistake his voice, but he always said, “Hello, Laura. This is Henry.” This one morning for Sunday School, I was the intern. I got up there and Mrs. Schwarz was there. She was sitting in the chair alongside the table. When I went in the room she popped up like a jack-in-the-box, and he said, “Dr. Hobbs, meet Mrs. Schwarz.” [Then] he said, “Mama, sit down and keep sitting.”
One of you mentioned before that this was the time of the changeover to full-time practice here. There was a great deal of controversy, was there not? Could we discuss that for a minute or so.
MAR: John, you were here all during that time. Were you considered part-time then or altogether full-time?
JEH: Part-time. I was always part-time.
MAR: Did the University pay you anything?
JEH: No. I was always part-time.
MAR: You never got a check from Washington University? Well, by golly, I did. I thought John got checks all the time. I had a commission in the Navy, which was inactive, thank goodness, and I was assigned to teaching at City Hospital where juniors and seniors, the whole medical school, were on a complete rotation basis. It turned out the M.D.s fast for World War II. I was paid $1,200 a year for the four years’ teaching, which I enjoyed. I think it was probably the most enjoyable part of my whole medical career, because I had private patients and taught at City Hospital besides. I still think [Evarts] Graham was a great power in Washington University and outstanding, and perhaps was one of the last giants in the pioneering work that he did. When Graham first came – I’m just dropping back a little bit – the most proud things that he would tell us as a class was that he had been court-martialed in the army. [He was] court-martialed because he refused to stick needles and drain off the pus before it became thick enough. When we first came on surgery, our elective work on surgery in our senior year was rib resection. If the rib wasn’t resected in an organized area with thick pus in the connective tissue, the axe fell. Those patients got well, of course.
Graham envisioned what we’re seeing, I believe, taking place in all of our departments now and that’s the full-time department. When those of us like John, myself and others, not in the armed services, saw the 21 Unit [ed. note: 21st General Hospital, World War II] revived and sent out in World War II, we suddenly got pressure from [Philip A.] Shaffer. Shaffer did not have an M.D. degree. A good many of us who were on the so-called “essential teaching list”, would invite Graham [ed. note: Shaffer] to come over and have noon lunch with us. He did, until the time was made so unpleasant for him that he didn’t come any more.
Why was it unpleasant?
MAR: Because he and Graham, among some others, wanted very much to have a full-time department and were writing the men in the second Unit 21 [21st General Hospital] telling them that they would be taken on as full-time men [upon return from military service.] The rest of us resented it and we had Willard Allen back us up in that resentment. He did not want a full-time department in OB/Gyn at all. He wanted it to be a mixed department and have the part-time faculty teaching. Arnie, is that fitting pretty much with what you have to say? You weren’t around here then. You were a colonel in the army. Did you get a letter along this line that we’re talking about?
ANA: Yes. You see, the full-time urge came really in two ways, the first one from the Flexner Report. This brought in the strong heads of departments, preclinical as well as clinical.
JEH: In 1910.
ANA: It really got started in 1917. That’s when George Dock got [to be Dean]. Each of these departments had a small, hard core of full-time people to maintain the department. The concept of a Mayo Clinic type of organization was indeed conceived during World War II. Anyone who was in the armed forces was indeed contacted and they were offered – and sometimes persuaded, and the persuasion was sometimes pretty strong – to take these positions. That brought in Gene Bricker [ed. note: in General Surgery]; it brought in Henry Schwartz [ed. note: in Neurological Surgery].
MAR: There were quite a few others. We contacted everybody that we could think of and the report, at least in OB/Gyn as far as the way Willard Allen interpreted it, was that they wanted to come back as part-time and have private practice and still have their faculty appointments right on through to being full clinical professors. That’s the way it turned out, but Shaffer was a big stumbling block. We – a group of us – not individual but “we” plural, told Phil Shaffer to his face that he didn’t know any medicine; he never had had any medicine. He was envisioning the kind of a medical school in the future that was written up in the Reader’s Digest. Now, that sounds pretty tough, and that’s why some of our class’s people talked back to faculty. We did.
ANA: The situation became acrimonious at the time. There were meetings between the then Barnes Hospital Society, the trustees of the University and so on. The opponents of a solid, carte blanche full-time list right down the line had a great deal of support from Dr. [Harvey] Lester White.
MAR: Yes, you did.
ANA: He had been away in the army, too. He was in physiology and he gave a great deal of support against a total full-time swing. The situation became quite acrimonious for a while.
JEH: D. K. Rose and Sam Grant and the surgeon – Albert Key – were key men in arguing against the full-time scheme. Finally, it was fait accompli. Dr. Shaffer called me into his office and said, “I don’t care what you people do. We’re going to have a full-time clinic.” I said, “I’m surprised at that.” Then, Dr. [Frank R.] Bradley convinced Mr. Rand that it was the thing to do and Dr. Graham thought it was the thing to do. Dr. Erlanger thought it was the thing to do. So, it was stated that Dr. Shaffer was going to resign [and] Dr. Graham would resign if it didn’t go through. So we [the staff] decided to go out on the Hill and talk to the trustees of Washington University. I was one of eight people that went out there and we convinced the trustees that it was the wrong thing to do.
What were the arguments on each side?
JEH: That every evening the whole thing was quashed [and] Dr. Graham didn’t resign, Dr. Shaffer didn’t resign. That was the end of it. One thing it shows you [is] the power of the trustees of Washington University. They squelched it.
ANA: Mr. [Harry Brookings] Wallace was the Chancellor at the time. In answer to your question, Dr. Brodman, it was set up with the concept of improving teaching. The argument against it was that it had no bearing or relationship to improving teaching.
JEH: And that the medical school wanted control.
ANA: Yes. And at the meeting you refer to, Mr. Wallace said very flatly, “If this plan will not improve teaching, we don’t want to have the plan as [proposed].”
That argument continued right through till the building of Queeny Tower where the geographical full-time was involved.
MAR: That’s where Mr. [Edgar M.] Queeny said that he wouldn’t take a censored penny from anybody. He was going to put the entire thing up himself with his own money and there would be a combination of part-time as well as full-time [faculty]. That was done, also, by getting some outside help to come and review the whole situation at Washington University. [H. Rommel] Hildreth and you, John were in on a good deal of that.
JEH: Joe Hinsey was brought back [and John H.] Knowles was also brought back.
MAR: My goodness, you’re getting a lot of stuff, aren’t you, Dr. Brodman?
This is delightful – I’m so glad. I wouldn’t have gotten it otherwise because you people don’t write it down.
MAR: May I tell a good joke on Dr. Sachs? [It was] the only time I ever saw Dr. Sachs put in his place. Dr. Arneson is an ideal spokesman for me, only I had Sachs’s operating room and it started before that. Ernie Sachs was doing general surgery with Murphy. As a matter of fact, Murphy and Sachs did the first appendectomy in Barnes Hospital when it was first opened. Sachs gave us lectures in diagnostic and general surgery. Graham couldn’t stand Sachs; Graham and Sachs were entirely at each other’s throats. Sachs and A. O. [Arthur Oscar] Fisher didn’t get along. Fisher gave Sachs a black eye one time when Fisher was told how to do a certain operation. Dr. Fisher said, “I’ll see you later, Dr. Sachs,” and that’s what Fisher did – A. O. Fisher. These are the men who taught us just a few years before. Sachs had our class in the operating room amphitheater. That’s where you all met; the idea of sepsis was not too good, although all of Sachs’s people had their hands washed in antiseptic solution. Sachs this day had a woman and her abdomen was enormous. We all thought the woman was pregnant – she was a black and she was on a stretcher. Sachs looked the class over to pick out the meekest and the mildest. The meekest and the mildest in our class came down. Sachs had considerable affront – literally, that was called the bullpen and Sachs was the bull. He would butt a poor student around who wouldn’t stand up to him, whereas if he called some of us down, we didn’t have the stomach but we didn’t back up. We just took the butts or if he backed away we took a step forward.
The conversation went like this: “What do you see, Doctor?” For some reason or other, the poor student was completely overwhelmed by the situation and he was getting nowhere. Finally, the black [patient] sat up on the stretcher, swung her feet over the side and said, “For God’s sake, Doctor, if you see something that the young doctor don’t see, please tell him. I want to get out of here.” Sachs just held up both hands and walked out. It was the first time I ever had seen anybody get the best of him and we all laughed and laughed. Arnie, you know about his kicking?
ANA: Go on, you tell it.
MAR: Yes, I saw it happen. You know what happened to the man he kicked, don’t you? That was Henry. Not the professor. From Oklahoma – Henry, that is in charge of all the animals for experimentation in the whole neuro department. Something went bad. I guess [Dr. Sachs] didn’t have his bayonet forceps. Sachs left the operating room and Henry, a new orderly – I thought he was an orderly [but] maybe he wasn’t at that time. I know Henry very well; I like to chat with him. [Henry was] bending over and Sachs simply hauled off and booted him right in the rear. Henry nearly went through the instrument case and he did fall on his face. That was just the wrong man because Henry came from a financially influential family in Oklahoma and he wanted medicine but couldn’t get into medical school. He’s really a brilliant person; he’s still in the department with the animals and invented anesthesia machines and is really a big asset. He said, “You do that again, Dr. Sachs, and I’ll kill you.” It scared Sachs, and Sachs said, “You’re fired.” Henry said, “Okay,” and immediately left the operating room and went to the head of the Neurology Department and got a job. About two or three months later Sachs walked in and his knees started shaking and he said, “What are you doing around here? I fired you.” [Henry said] “It didn’t make any difference.” He said, “Dr. O’Leary just hired me.”
ANA: Another thing I think would be interesting to hear is the transfusion story. Do you want to do that, John?
JEH: In those days we had three methods. One was called the old Unger machine which was used on medicine, and the second was the multiple-syringe cannula method which was used on surgery. We on the obstetrical service used citrate transfusions. We were the first to use citrate transfusion in the institution. Dr. T. K. Brown was in charge of laboratories at that time, he and Dr. Dieckmann. We got lots of reactions in those days because there were a lot of pyrogens in the test tubes and in the rubber tubing. They cleansed them with solutions, but still we got quite a few reactions. One time we were getting reactions just constantly, so they tore everything down to try to find out what was doing it. At that time we had our own still; we made our own distilled water. They tore that down thinking there might be some leakage there, and they found a dead mouse in the still. Finally, the citrate method superseded the other two methods, so we have to say that Dr. Brown was the first to start the citrate method in our own department.
ANA: Another thing will show you some of the progress that’s been made. There was an anesthesia machine on a tripod with wheels. It had a cylinder of carbon dioxide and a cylinder of nitrous oxide on it. If an emergency came in at night – we had a relatively limited emergency service for many, many years – the resident, or intern as the case might be, it might even be Jack from the telephone board sometimes, would wheel this in. Somebody would put the mask over the patient and turn on a little carbon dioxide to make him breathe more and a little nitrous oxide to put him to sleep. This was done by anybody that came along.
JEH: The year I was an intern on surgery – I’d given lots of anesthetics at [St. Louis] Maternity – all of the anesthetics at Maternity were given by the housestaff. We used ether – drop ether – and we used chloroform. Then we got a nitrous oxide machine sometime later on. I had had quote, unquote, question mark, a lot of experience in anesthesia when I went on surgery. So they called on me a lot for anesthetics over there. I was Dr. Copher’s favorite anesthetist – I don’t know whether you know that or not. At that time we started them off on the old tripod machine and then we’d switch to drop ether. I can see that first old McKesson machine that they brought in. We had one paid anesthetist at that time in Barnes Hospital – Lucille Osterman – remember her?
MAR: May I briefly tell a good joke? We haven’t mentioned Dr. [Louis H.] Burlingham, superintendent of the hospital. I suppose every class and every house officer in our age group has had experience with Dr. Burlingham. John said that [none of the] students had an automobile. I had an old Model T Ford that my dad got for me. I got rid of it when I was on the house delivery service. That’s another story. The OB Department did use the Model T Ford, which was not old but brand-new then, in the outpatient service. All the private patients had special nurses over on the Pavilion and a lot of food. We could not get in the cafeteria at night, and we were hungry. The temptation was to go and get a little cream, a little something or other, from the private Pavilion. Those of us who were on private Pavilion considered that those patients were our patients, not that we would ever under any circumstances take any of their food, but we resented it if anybody else on the OB staff would come over to private Pavilion. We policed it. That sort of put the pressure, when food was missing, on the private person.
I remember going to Otto Schwarz and saying, “Couldn’t we use the outpatient machine to go to Garavelli’s?” This was Bob Burlingham – he said, “Yes, you may, if you’ll just go there and come right back with the food.” I said, “We’ll pay for our own food, but can we eat on quarters?” [He said,] “Well, you’re not supposed to,” and I said, “Well, then, you don’t have to know we’re going to.” He said, “Okay.”
One time we went over there in a very, very heavy rain and there were wooden paving blocks. Anybody remember the wooden paving blocks around Garavelli’s? Ben Fox was with me and Fox and I got each other into trouble and out of trouble all through [our time] out on the Hill and in medical school. For no good reason, we stuck a lot of these paving blocks – maybe four or five or six – on the floor of the car and came back heavily loaded with hamburgers and baked ham and all the rest of the food. When we got back we all ate the food, and here were the paving blocks. We didn’t know what to do with them; we didn’t have any reason for bringing them, but there they were. At the end of the hall [in] the intern quarters on the third floor were some of the paving blocks. One of the assistants, one of the older men – I’d agree that what we did was a little more refined, meaner maybe – but one of these fellows that was in the house picked up a paving block and zipped it down (like a billiard ball) and it whammed against the door just as the black orderly was going by outside the door. The black orderly let out a yell and said, “Somebody’s trying to kill me. They threw something at me.” The five of us that were house officers realized that we were in trouble with Burlingham – real trouble. We went together in a huddle, just like a football game. Jointly, we said this, “The glass fell on the inside of the door, not the outside. So we didn’t throw anything outside the door. True? Yes. Furthermore, why not take the automatic door opener off the door so the door would be loose and free to bang in the wind. Good idea. Then, let’s all get the hell out of here as quickly as possible and get to breakfast and wait till we’re called in individually. What are we all going to say – the same thing – individually?” That’s what the real huddle was about. When we finished breakfast, we came back up, noticed glass on the floor, door stopper off the door, the door freely swinging, and that’s it.
Did you hear anything more about it.
MAR: Every one of us – all five – were called down into Burlingham’s private office and grilled and grilled and grilled. I think I was the fifth one to go in. He said, “Dr. Roblee. I can’t understand this. You said that to the best of your knowledge and belief there was nothing thrown through the door.” I said, “When we got back from breakfast,” just repeated the same thing, “we found glass on the inside. If anything was thrown through, from the inside [to the] outside, I should think that the glass would be outside not inside.” “Ooh,” he said. He looked at me. “Well,” he said, “I guess that’s all.” I said, “Thank you, sir.”
You ought to write a detective story about that.
ANA: I think, Dr. Brodman, you also ought to know something about the obstetrical outpatient service. The patients were seen in the clinic. They were booked and would call in when they went into labor and they were delivered at home. There was a big, heavy box of instruments and towels and drapes and things that we took with us. The resident would round up two students; we worked in pairs. We’d go out into all sections of the city. That was done fearlessly; there was no problem.
JEH: By streetcar.
ANA: Yes, on the streetcar. It was an all-night job; you stayed there until the child was born. There was never any fear or any question. We were never molested at all.
JEH: We scrubbed our hands in sinks. In cold weather we’d go out in the yard and scrub our hands. Sometimes we would be there for hours and hours. I remember the first case I went on, we went out one afternoon. We were there all night. We came back the next afternoon – it was a Negro’s house. They fixed us some food. Bedbugs were running around everywhere and it was a little bit different than the boys have it today.
This is the old, traditional way. My father used to tell a story just like it. He was in the class of 1901 and my brother, who was in the class of 1932, was doing exactly the same thing.
ANA: We had to have 14 cases. That’s what you all had to have, too. We had to personally deliver – of course, the two of us worked in pairs.
JEH: We delivered them on the ironing board. We put the old ironing board under the bed, if they had an ironing board.
ANA: Dr. Roblee mentioned going to Garavelli’s to get food. There were certainly very strict rules about eating. I’m shaken today when I see all the food being carried around the corridors of the hospital – people walking along drinking soft drinks out of the tin can. It’s an entirely different atmosphere than it was then.
MAR: One thing I’d like to ask about: I think that John said that their senior class, which came along right after mine, did not have the third trimester entirely elective. Is that correct, John?
JEH: Yes.
MAR: Well, we did. We had to elect a minimum of 300 hours and we couldn’t take more than 450 hours. That had to be divided between two departments. You couldn’t work in a department unless the department head gave you permission. I worked with Graham in his department on a project that, to our surprise, concerned tuberculosis of the mammary gland in dogs. We got active tubercle bacilli from the head of the department in bacteriology because we knew the first thing Graham was going to ask was, “Where did you get the TB bugs?” Our article was published under our own names a few months before we got our degrees. That’s from the Department of Surgery, which overwhelmed both of us.
The 150-hour deal was with Otto Schwarz. That was our brainstorm again, Fox and Roblee. We said we felt sure that we could work out the induction of labor – the cause of the onset of labor – if we had guinea pigs. We would take the placenta of the guinea pig at time of delivery, grind it up and inject it and have a group of pigs one way or the other. We thought that we could produce an antiphylactic reaction by injecting ground-up guinea pigs. It was an awfully messy sort of thing. I think Otto was quite intrigued by the idea – he went along with it. When we reported to Otto he said, “What did you learn about guinea pigs?” Dr. Fox said, “We learned how guinea pigs copulate. Otto Schwarz blew his top that he had given both of us a house officer job. He said, “What else did you learn?” “Well,” I said, “we also learned, because we tagged the male’s ears at the time of copulation, that it didn’t seem to interfere with his sex function.
ANA: Dr. Brodman, stop us when you want to, but another little item I’d like to mention on the record is the old night clinic. The night clinic was for the treatment of syphilis, which was a very prevalent disease. You just don’t see it any more. Patients were brought in for injections of mercury, I think it was. Arsphenamine-(606-Salvarsan) and bismuth. This also offered an opportunity for young people starting out to have employment there. The students were obliged to go and give these injections through a rotation. Dr. Dudley Smith, a member of the OB/Gyn Department, had a salaried position there for a long while. [The patients] would drive up in cars – sometimes pretty good-looking cars – and would go in for their shots and away they would go.
I want to mention one more thing and this was the emphasis that was given research. That hasn’t changed – the emphasis is still given research. I remember, I came here as a freshman student, and Professor [Stephen Walter] Ranson from Northwestern was here for a very brief time in neuroanatomy. [I had] a classmate whose name was Morris. How it happened no one knows, but we hadn’t been here very long before Ranson invited Morris and me to take some extra time and come up to count nerve fibers. This was a menial task of looking through a microscope and counting nerve fibers, which we did. He appreciated it so much that he didn’t have us take the final examination. We probably would have flunked out if it hadn’t been for that.
In my senior year there was a great deal of work that was done in surgery and research over there. Bob Elman, with Dr. Graham, had gotten the idea of trying to develop a test for pancreatic disease by measuring blood amylase. This was done by dropping a little serum into a starch solution in a little tube where it would drip through. You measured the viscosity or the change in viscosity. I fell heir to a job going over there and running these tubes through for Bob Elman. I offer this again, maybe because it was a smaller place then, [to show] the cross-fertilization and feeling between faculty and students. This gave stimulus to individuals of that time. Dr. Hobbs, tell us about our old friend, Twilight Sleep, and our duties as a resident.
JEH: Could I interject? We’ve spoken of most of the heads of the departments, with the exception of one that I know. That was Dr. [Greenfield] Sluder. Dr. Sluder was a famous ENT man in those days and he invented the Sluder tonsillotome. We used to take out tonsils in the clinic; I’ve taken out many tonsils with the Sluder tonsillotome. Well, anyway, he was a tremendous man. He must have been about six feet five, [with] broad shoulders. He wore a speckled vest and he lectured to us once a week. He had a routine. He’d come in and take off his coat, slowly, and hang it up on a tree. He had a gown hanging there and he’d put this gown on. I sat on the corner and he’d back up to me to tie his gown in the back. I felt like a pygmy beside this tremendous man. Then he’d walk around, he’d go up to the lecture desk, and then he’d walk back to the door. He’d say, “Harry, oh, Harry. Where the hell are you, Harry.” Harry was the Diener. Here’d come Harry with two baskets in his arms full of skulls and dissections – beautiful dissections – that he’d brought from Germany. He lectured through a megaphone – a little, tiny megaphone. He had a big handlebar mustache. So he’d pick up this little megaphone with a flourish, put it up under his whiskers, and he’d say, “Can you hear me back there? Dammit, can you hear me?” And we’d all say, “Yes.” And then he’d start off with his lecture.
Okay, now about Twilight Sleep. Twilight Sleep started in Germany, [and] consisted of giving the laboring woman morphine and scopolamine. Dr. Henry Schwarz introduced Twilight Sleep into this country in this department. We had some men who would Twilight the patient and they’d promise them that they were going to have a painless labor. They’d give them Twilight Sleep, then they’d rupture the membrane, and the woman may or may not start in labor. Sometimes they’d be in labor or in the delivery room for 24 hours – or more. Of course, the woman was completely snowed. They gave them a lot of morphine and a lot of scopolamine – today, we would never do that.
Every patient had to have an attendant there at all times. Nobody ever left the room. The house officer or nurse, or both, had to be there at all times. You had your hand on the abdomen, feeling the contractions and the nurse would have her hand there – the student nurse. I’ve heard that there was a little hand-holding sometimes under the sheet when they were timing the contractions. Anyway, Twilight Sleep now is passé and all to the good.
ANA: Sometimes you sat there for 24 hours.
You’ve all been so very kind to give us all this time. Let me ask you whether you could tell me what you think are the greatest changes which have occurred in obstetrics since you started in this field.
MAR: That’s an excellent question. The change has been terribly dramatic. The department came to life with the American Board of Obstetrics and Gynecology in 1930, with examinations in Philadelphia. The question of board certification in OB/Gyn has stood up very nicely from 1930 to 1976. At the present time, the national organizations – and Dr. Arneson knows more about that than I do because he’s a member of two of them – are fragmenting a bit with the oncology and splitting up again just a little bit. I hope it never happens, but [there is] a little bit of a split between OB and Gyn. Arnie, I know you specialized in Gyn with the original oncologists around here in tumor work. It is quite conceivable that gynecology – I hope it will never become another department of surgery – but it certainly could, the tumor part, become a department of oncology in the future, and probably will. The unification of OB and Gyn really is based upon having a patient who first is a female and second, the part of her anatomy [involved] is the genital organs. Around here, we don’t do breast surgery; in the east they do radicals and other kinds of mammography. I think the change in OB/Gyn is away from surgery. Having been a surgeon until I retired, I regret it, but I’m also quite confident that the big development, along with oncology, has been the understanding of all the steroids, not only the female hormones but the entire [range of] steroids.
Now, a personal experience, if you’ll pardon me. When Tom Burford had his day, two years ago in June with the professor in research on the causes of cancer – I like to attend those and I figured that would be the last time I’d ever stand up in that big Wohl amphitheater. I always do stand up in the back because I like to move around and get the feel of those around me. A very attractive young woman, I imagine she was a junior or senior, came and stood next to me just because I was in a position where she could see. I noticed her notebook. She was putting down things and I could read everything in her notebook. I couldn’t understand one, single word the woman wrote down. She was following the lecture; I could get about every tenth word the lecturer [spoke]. It confirmed my impression that I should retire. Now, does that summarize things?
The second thing, in closing, is the computer. Those who program computers – not just for medicine, unfortunately – I wish they would feel that way about it more in medicine. But the industrialists that are programming computers say, “Garbage in, garbage out.” Unfortunately, we in medicine are not saying, “Garbage in—” We expect garbage in and good stuff to come out and it does not.
Very good. I approve of that feeling. Dr. Hobbs, what do you say?
JEH: Well, retrogressing some, we’re going back to the old days. No anesthetic, in many cases, [or] mild anesthesia. A lot of them are going back to home deliveries now. We have fathers in the delivery rooms now, which we didn’t used to; they couldn’t even come near the delivery suite in those days. Tremendous strides have been made in the use of anesthetic agents – much safer than in our day when they gave so much morphine and scopolamine.
What do you say, Dr. Arneson?
ANA: I think the biggest change that has taken place in obstetrics and gynecology has been the move of obstetrics from an art into a science. At the time that we were in school, and residents, and early practitioners, you “caught” babies. You had some fears of eclampsia, you had magnesium sulfate that you injected into some to stop the convulsions. The whole field of blood chemistry was still unplowed. Today, if you look through a journal of obstetrics and gynecology, the articles there on obstetrics deal with all kinds of endocrinology – things which I don’t understand. But this has elevated obstetrics into a science that is compatible on a level with medicine, surgery – and even ophthalmology has got quite a bit of science to it now. I think that has changed the picture more than anything else. The surgical phases of gynecology – they, too, have advanced. When we had our training, we did an un-Halsted type of operation; we did lots of supravaginal hysterectomies. We took great big bites of tissue with cat gut. But the Halsted concept of surgery moved into gynecology and today, a resident finishing here with his program of obstetrics and gynecology is a far better surgeon than were we at the time we had our training. I don’t think this will necessarily take gynecology out of obstetrics back to surgery. This won’t happen unless obstetrics becomes a self-sufficient phase of its own. If that ever occurs, then I think the two might be allowed to separate.
May I say one more thing? There was a Dr. Schuman in Philadelphia who was a great story teller. He’s been here; he’s entertained people. As he grew older he went to fewer and fewer meetings. Some of his friends approached him and asked why he didn’t come to the meetings. He said, “Well, you know, I don’t get around as well as I used to get around. Besides that, I don’t hear as well as I used to. But most of all, when I do hear, I don’t understand.”
I’m sure that will never happen to this group. There are students who are still interested in this field. I’d like to call your attention to a Mr. Stephen Brody, who is a third-year student now, just going into his fourth year. [He] just won the History of Medicine prize of the American Association of the History of Medicine for a biography of Sir Fielding Ould, the first male midwife in Ireland. He is going over to the Rotunda in Dublin with the money he got, to do further work in this field. Apparently Sir Fielding worked on the dynamics of delivery and the relationship of the sacrum to the way in which the child was turned when he came out. I think as long as we have young students who are interested in this field it’s going to be extremely an interesting and dynamic field, as it was in your time.
Let me again thank you all for taking this time and for helping us. We’re delighted to have you here. Let me also invite you to stay a moment and see our rare book building and our archives where your tape will be put.
ANA: We’ve enjoyed this very, very much.
JEH: History is very important; we don’t pay enough attention to history.
I’m prejudiced. A lot of people don’t feel that way about it.
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