Interviewer: Marion Hunt
Interview #1 – October 19, 1990
As I review my life, I realize that it was not planned. Almost everything that’s happened to me resulted from the efforts of other people or outside forces. It wasn’t necessarily what I wanted to do or intended to do. It was a matter of opportunity or convenience.
My father had a difficult time obtaining an education. He was a son of Russian Jewish immigrants, and it was a struggle for him to go to school. He had to get up at six in the morning to deliver papers before school and he had to work his way through night school to become an accountant. He valued education as the most important aspect of life. I was brought up to believe that nothing was as important as developing intellectually. For my father, education was a means to an end, and he was self-taught to a large extent. But he made an enormous effort to teach me, and he dominated my childhood. My mother was a passive sort of woman whose role in the family was to keep house. My sister wasn’t born until I was six.
I was apparently capable of learning rapidly, or more rapidly than children who are left to their own resources. I could read books and do arithmetic at the age of three and did more advanced math and writing at the age of four or five. I started school in Brooklyn, New York at the age of six and was astonished to find how immature the children were intellectually. The school seemed surprised to find me capable of reading and writing. They immediately shifted me to second grade and a few months later to third grade. And so, I was then, and throughout my life, the youngest at whatever I was doing – high school, college, medical school, and even a professorship. It seems so bizarre to me now that I’m older than most people. And I always had to strive for perfection in whatever I did – in athletics, debating, school work, or whatever the function was. That was most important to me in attempting to please my father.
At James Madison High School there were eight thousand students and I felt compelled to be at the top of every class. When I finished high school, my father was still struggling with finances. I was offered a full scholarship to Princeton in 1937. Even with a full scholarship, the question was whether I could afford to go there. But with effort from the family and considerable sacrifice on their part, I did. It immediately became apparent that Princeton was an excellent place for an education but it was very much a rich boys’ school. And the anti-Semitism was evident. There were six Jewish students in my class of four hundred. And there was considerable discrimination. Black [students] were unheard of at that time, and there were no women. It was a very trying situation. I found that even with the full scholarship and the help from home it would not be possible to do this [financially]. In my first year I led the class academically and found it no more competitive for me than James Madison. With help from administration I hit on the scheme of tutoring students to earn extra money – to pay for food and attempt to do in some fashion what other students were doing.
First, I began teaching individual wealthy boys whose parents could afford it. I soon realized it was a better use of my time to organize classes in freshman math and chemistry, both of which I was taking. It was easy for me to see what kinds of questions were asked on the exams and to prepare students by sessions just before important exams. My reputation grew and I continued to do that throughout my stay at Princeton. It built up until I was getting fifty or sixty students. I’d josh with the instructors as to whether I could guess what they would be asking on exams. The word would get back that everyone attending my sessions passed. I built a large clientele and was bringing in a considerable amount of money; in fact, I accumulated a surplus.
I was a chemistry major, interested in research. I worked with a man who influenced my career enormously, a man named H. S. Taylor – a physical chemist and head of the department. At Princeton then, you could go on a complete research year, which I did in my fourth year. At that time Taylor was interested in and got me involved in the structure of polypeptides. We used models of atoms developed by Hershfelder to make amino acids and string them together as peptides. From this we could devise experiments to verify and alter the structure. At that time we used rather sophisticated methods, including x-ray diffraction patterns. At sixty, and nearing retirement, this was one of Taylor’s greatest achievements, and I felt very much a part of it. He toured the country lecturing at various colleges and meetings and he often took me along. I served as his chauffeur, carried his bags, showed his slides, and even on occasion substituted for him as lecturer. So I got to be pretty well-known at that time as a potential physical chemist. His plan was for me to go on at Princeton for a Ph.D. in chemistry. About that time my father died. That put more stress on my family and changed my concept of where I was heading.
My work on the polypeptide structures with Taylor was supported by the National Bureau of Standards and underwritten by the Wool Institute. One of their problems was moths. Taylor arranged for me to work in Washington one summer to help devise an alteration in polypeptide structure of wool so moths could not digest it. This was successful, but that same year DuPont came out with nylon. The research didn’t carry the weight it might have, but some people were impressed with the accomplishment. They offered me a job to work commercially. I was tempted financially but preferred continuing my education.
About that time, I met another mentor, Baird Hastings, a professor and head of the Department of Biochemistry at Harvard Medical School. He asked me on one occasion about my plans. I indicated my intention to stay on for a Ph.D. He pointed out to me that an M.D. degree would be much more flexible. You can do the same research, but many more pathways are open. When I came home to discuss this with my mother, she encouraged me to go to medical school. The concept of being a doctor was something she could understand. For the rest of her life, she always wanted to know when I was going to be the doctor and practice medicine.
Hastings arranged for me to get into Harvard Medical School with a complete scholarship, and he arranged for me to work in his lab. The plan was for me to go to medical school, getting background information, and then to return to full-time research. When I got to medical school, I found it all came very easily and I could continue to do research – first with Hastings, then with Eric Ball, and later with Clarence Gamble. The work with Gamble was for his newly-formed Planned Parenthood and involved the devising and testing of contraceptive preparations. This was not a major interest of mine but Gamble paid me well. When the United States entered World War II, we were all drafted, and they paid us for our tuition, room, board, and a salary. They pushed us through school more rapidly and permitted us a nine-month internship. I received my medical degree in 1944 and I entered the military in 1945. They made me a psychiatrist in three months at NYU. They needed psychiatrists behind the front lines for the invasion of Japan, to rehabilitate people immediately and send them right back. It meant that all of us would be right behind the front lines, too. Luckily, before we finished our training the war was over. They sent us to separation centers, and I worked in New Haven where my main job as a psychiatrist was to interview nurses and WACs who were coming back pregnant from the war. They had to be counseled and discharged. I saw literally hundreds of them. They were depressed, and there was no facility to take care of them. No one cared once the war was over. These were nice people, good people, who had difficulty returning to their families.
Again, in New Haven, I had the chance to spend evenings and weekends at Yale working in a laboratory. At this point in my life, I was much interested in the new specialty of enzyme histochemistry. This combined concepts of enzymes and biochemistry with histology. I had decided that this was an area in which I’d most like to do my research. While working at Yale, I met the most outstanding histochemist following a lecture he was invited to give. His name was Jonas Friedenwald. He was at Johns Hopkins, and I spent most of a day with him. He invited me to Hopkins after my discharge from the military. I spent several days with him at a meeting in Atlantic City. I was about twenty-five and he was about twenty years older. As far as I knew, he was a great histochemist. And I couldn’t wait to get out of the military.
But when I got to Hopkins I found out that histochemistry wasn’t his primary function. He was an ophthalmologist and an ophthalmic pathologist. He really was a basic scientist, a brilliant man with a fantastic intellect. He had no legal background but Felix Frankfurter would come to him for advice. A bibliophile, a chemist, a physiologist, and a clinician – he was sort of a god to me. I just thought he was the greatest. Whatever he said would influence whatever I did. I worked with him for a year in the basement of the Wilmer Institute. Cuy Hunt, Steve Kuffler, and George Koelle were there. We used to have wonderful sessions in the basement and I just loved the environment.
Friedenwald had inherited his father’s practice. He was from a public-spirited Zionist family who played a major role in founding major medical teaching in Israel. He married a woman twenty years his senior, his father’s former nurse, who treated him very much as a child. His mother had died when he was very young. I went to concerts with them, stayed with them, vacationed with them on weekends in Virginia and in some ways behaved as an adopted son. His wife was also an amazingly intellectual woman. Friedenwald and I worked on histochemistry, including localization of beta glucuroidase and the application of the Hotchkiss McMannis stains to the retina. I became intensely interested in the histochemistry of the eye. Friedenwald’s advice was for me to go through residency training in ophthalmology so as to have the proper background to tackle eye research.
Friedenwald was concerned with anti-Semitism at Wilmer although it didn’t affect him personally. It was a coup to have him in any department However, he wasn’t a full-time faculty member. He had inherited wealth and could limit the time spent in his private office to mornings. Afternoons were spent in the lab. In the pre-NIH era, he financed his own research and paid my fellowship. He arranged for my appointment as a resident at Wilmer. It was a three-year program but a fourth and fifth year were reserved for the chief resident. I was selected for that position. All through the residency training program, I continued to do research with him. The research moved from histochemistry to problems of diabetes and the retina. I worked on staining techniques. We were beginning to see a lot of diabetic retinopathy. His other main interest was glaucoma – intraocular pressure and the formation of aqueous humor, the fluid in the eye, and how it was secreted.
Every night, every weekend, I’d work in the lab. (I was married at the end of my third year). I helped develop techniques for diagnosing glaucoma, for measuring the rate at which aqueous humor was formed and techniques where, for or the first time, we could alter the rate of its formation. Having the patients available, and the regulations being less rigid than they are now, we could go directly from the rabbit to the human. At the same time I was running the residency training program, I was publishing papers.
In my third year of training I married Janet and went off to Europe on a fellowship. I had to present a paper at the International Congress of Ophthalmology in London, another paper in Paris, and a third in Copenhagen. I had friends of Friedenwald to visit. I worked in the Carlsberg Laboratory for a month with Heinz Holter. Then he sent me to work with Hans Goldmann in Bern. Lastly, we spent three weeks with Ernst Barany, who was a pharmacologist working on the eye, in Upsala. The only trouble with the trip as a honeymoon was that it was too oriented toward ophthalmology.
My love of books began with Janet’s father. I was interested in books, but he was interested in collectors’ items. What I did in Europe was to go through all the old book stores and find every conceivable thing available and ship it home. I also did that in Baltimore. Whenever I traveled anywhere I’d collect books. They knew when I was coming in Chicago, San Francisco, or wherever. My father-in-law would find things and give them to me as presents. He would never tell me what he paid for them. I never did find out. I supplemented the collection with purchases of my own, at very modest prices. It is amazing how these books have increased in value. I felt guilty about having them for my exclusive use. I gave them to the Washington University Medical Library so that others might enjoy them. Dr. (Estelle) Brodman (director of the library) was most helpful in arranging for the transfer of the collection and its housing at the library annex.
We’d left for Europe July 1, 1950. I published papers with the men I worked with overseas. I came back and worked in Friedenwald’s lab and continued my residency training. At the end of my fourth year, Robert Moore came to see me and offered me the job of heading the Department of Ophthalmology at Washington University. It seemed ridiculous to me. I talked to Friedenwald and Alan Woods and they both said it was foolish at my age and state of development. So I turned Moore down. He came back three months later. By then I was starting my fifth year. They were offering me a job to stay on at Hopkins as an assistant professor at the (at that time) magnificent salary of ten thousand dollars. Whoever heard of St. Louis and who would want to go to the Midwest?
Robert Moore convinced me to come out and visit. He set up a really grand visit. It was Barry Wood, first and foremost, who assured me that you could, at my age, come and continue to do research. He pointed out that there was a clinically outstanding eye department in St. Louis. I could come and do research and depend on the clinicians to run the department. He said that’s what he had done. If I would head up a research program, they would provide me with the space. Barry Wood said his department would move out of McMillan Hospital and I could gradually take over two full floors of space. And then I met with Arthur Kornberg and with Carl Cori, who were willing to take time to convince me to come to St. Louis. Most convincing of all was Ollie Lowry. He was working on histochemistry. He said if I would take on appropriate people, they could work with him on the retina. I put them off for a year so I could finish the Diamox and Diabetic Retinopathy research I was doing at Hopkins. I agreed to accept the job beginning October 1, 1953 but not to move permanently to St. Louis until December 30, 1953.
Interview #2 – November 2, 1990
The problems we encountered in St. Louis could be divided into a number of categories: the department, the medical school, Barnes Hospital, and the community.
The department was the first and foremost challenge. I was young and enthusiastic enough to try to mimic what Barry Wood told me he had done. He suggested disregarding all clinical aspects of the department because everybody knew that this was an outstanding clinical department. Its major weakness was in research. Barry said if I came as the first full-time chairman, I could depend on the part-time people to continue the excellent clinical work and I could devote my time to research. Unfortunately, that did not prove possible for me.
One problem I encountered was the lack of available space. Other departments occupied most of McMillan Hospital. What was available to me was essentially two rooms. I set up my laboratory in a single room. I hired a technician and a research assistant to help continue the research I was doing. I thought I’d be in the lab most of the time. Within a matter of weeks, however, I found I was being swamped with patients. At that time, there were clinical areas in ophthalmology that weren’t being covered here at all. For example, in evaluating retinal detachments, I was the only one trained to do indirect ophthalmoscopy. They were treating retinal detachments here, but without finding the break in the retina. Their success rate was essentially zero! In the area of my major interest, glaucoma, no one knew how to perform gonioscopy, visual fields were done in a most primitive manner, and applanation tonometry and tonography were not available.
There were seven residents appointed, one every five months. Thus, there were seven five-month rotations, and the appointments were out of synch with everyone else. Residents could assist at surgery, but never got to do any appreciable surgery themselves. We were turning out ophthalmologists with inadequate surgical training. The surgery on ward patients was done by post-residency physicians who remained in St. Louis to join private practice groups. The head of the department had turned over the resident training to these recent graduates in spite of their lack of experience. They did the ward surgery and the residents helped them. It was poor training and I could not tolerate this. The lectures were inadequate. The residents were required to read Duke Elder, a five-volume text at that time, and to memorize parts of it. The teaching was confined to assigning chapters and then quizzing the residents. Unfortunately, this type of teaching tends to recur when staff lose interest or are too occupied with private practice.
The seventh floor was for private patients only; the sixth floor was semi-private. The fifth floor was two open wards, one for men, one for women. Black patients were admitted only to the basement of another building (0400) [ed. note: “0400” was the ward number], a most unpleasant experience because of the crowding and inadequate ventilation. Blacks had separate bathrooms in both hospital and outpatient facilities. St. Louis was worse than Baltimore, more segregated. I was shocked. Even the situation on the white wards was bizarre. There were two wards, one for men and one for women, and they would shift the male and female beds so as to accommodate the maximum number of patients. The outpatient facility was one huge room, with four examining chairs and the hardest of wooden benches for the waiting patients. Four resident doctors sat in the chairs and called patients by name to come forward for examination. The examination was a handlight examination in a lit room. One visiting staff ophthalmologist was available for consultation and advice. A darkroom exam or a field or gonioscopy had to be scheduled for return visits and were carried out in separate designated areas.
The residents were not knowledgeable. I couldn’t depend on their workups. Besides the residents appointed every five months – these were the “elite” group – residents from the VA, City Hospital and Homer Phillips Hospital came over for teaching sessions. They were separate, a different class of people; they only visited. In addition to that, we had a postgraduate course, another route for people who wanted to go into ophthalmology. It was a year long and then you were supposed to get clinical training somewhere else. These people spent their days observing. They did very little “hands-on” work. There were anywhere from twelve to twenty of such postgraduates being trained under the GI Bill.
I was faced not only with the difficulties of the teaching program but also the clinical facilities. We had only one operating room for ophthalmology and one to share half time with otolaryngology. So we were doing our clean cataracts and they were doing their dirty infected sinuses in the same or adjacent rooms with the same circulating nurses. There was a lot of cross infection – we were losing many eyes unnecessarily. So, everywhere I turned I was frustrated. I had a big, well-financed NIH research program going, but I couldn’t ignore the teaching or the clinical facilities or the black [patient] situation. Since I was the only one familiar with new techniques, I couldn’t refuse to examine patients with detachments or glaucoma. I was working long hours every day. At the same time, in Washington we were organizing the NIH committees and councils. Jonas Friedenwald was the first appointed. He became ill and suggested that I replace him. I was traveling to Washington by train and later by propeller plane almost every month for periods of four to seven days. So this was a difficult time.
The offices that I had, and the laboratory, clinic, and hospital were not air-conditioned. It had been the practice to close everything down in the summer. Window units existed, but there were none in the hospital at all. It was stifling; you couldn’t work. I decided we had to do something about this, so we put air conditioning in first in the clinic. The total budget of the department was only fifty thousand dollars a year, very disappointing. I was not experienced or smart enough to negotiate for more. In fact, my own starting salary was only fifteen thousand dollars, but coming from a resident’s salary of one thousand dollars a year I thought this was quite acceptable. However, when I insisted on air conditioning they installed it. We were the first department to do this. Then we were swamped with patients; many people wandered into our clinic just to be comfortable. 1954 was one of the hottest years St. Louis has ever had, with temperatures over 110 degrees for days at a time. No air-conditioned cars or homes, either. Most of our staff spent their summers in Wisconsin or Michigan.
The next thing I did was to air condition the ward at department expense. That created quite a stir in the hospital. I revamped the whole residency program. We picked three and then four residents every year. One would be the administrative resident and stay five years. I insisted that ward surgery be performed by residents with staff assisting. There was a very interesting program set up by my predecessor, Dr. [Lawrence T.] Post – a prevention of blindness program. He convinced the state legislature that aid to the blind was so expensive that they could save money by having a prevention program. He set up a program where we would send residents to various parts of the state, examine patients, and refer patients in to the hospital here. The communities would organize clinics and we could come through, seeing 75-100 patients per day. We would select those that needed surgery and transport them to St. Louis. They would be cured by cataract surgery and no longer receive “aid to the blind.”
All of the surgery was done by visiting staff, who were paid by the state program. I convinced the part-time staff to give this up so that residents could begin to do surgery on these advanced cases. In those early years we did as many as one thousand cataracts a year! I had to add full-time people to help train the residents; it was a massive job. But within ten years we had a program with four residents a year for three years, twelve residents [in all], and all of the surgery was done by the residents. In the 1960s I decided we still had second-class citizens at other hospitals in the postgraduate course. We abolished the postgraduate course and then we incorporated the other hospitals into our training program. We increased our residents from four to eight a year, and rotated them through all the hospitals. By 1965 the program was in place.
I was away about one-third of the time, between NIH, the Association for Research and its journal, Investigative Ophthalmology. I started that and was its first editor. I was also on the American Board of Ophthalmology and helped to found the Association of University Professors of Ophthalmology. I found all of this exciting. In addition, I was able to build a large referral clinical practice. In order to be seen, patients had to be referred by an ophthalmologist. The attitude was very different then. We were not competing with the visiting staff but rather helping them with their problem cases. We weren’t doing this to make money but to see interesting problems for teaching and research purposes. More money was available than we could use from NIH for research and training. We didn’t want to accumulate patients but rather to return them to the referring physicians. We wanted to advise their doctors and by so doing help them.
The retinal work got to be such a tremendous job that I hired Paul Cibis, a German who had been brought to the United States after the war. He was selected by the Air Force for his research abilities. I hired him for a research position but soon recognized his clinical acumen and surgical dexterity. We sent him to Boston to be trained in retinal surgery. He developed one of the best retina services in the country, but sadly, literally worked himself to death.
At about this time (1970) I submitted my resignation and asked Ed Dempsey to set up a committee to find my replacement. I included several suggestions. I felt I had accomplished all I could in the department and wanted to tackle other projects, perhaps full-time research. Ed had a meeting with (Carl) Moyer, (Carl?) Moore and me and convinced me to give the chairmanship a few more years. Shortly thereafter I was considered for the job at Harvard but Janet and I decided we did not want to leave St. Louis.
The Executive Faculty consisted of only twelve people. The meetings were brief and perfunctory, carefully planned by the dean so as to minimize conflict. The dean would set out an agenda which we were supposed to approve. There was a lot of visiting among Executive Faculty before meetings. The other thing that seemed somewhat bizarre in those days was that nobody wanted to be dean. We felt it had to be a member of the Executive Faculty. After Ed Dempsey left, Ken King, as Assistant Dean and then Acting Dean, went around begging the Executive Faculty to find someone else to do it. I asked him why he wouldn’t take it. He said he wasn’t experienced enough or old enough. He was overwhelmed by it. I was on the committee, and we interviewed a number of candidates. The one I was most excited about was Bob Glaser, but he was too happy at Stanford.
My research went very well, and I was able to hire people who could work with Ollie Lowry and Carl Cori – among them a woman, Marguerite Constant. My research became more significant at the time because it turned out to have increased clinical importance. I had previously found a drug (Diamox) that could be given orally to lower intraocular pressure, the first time this was done. I was also able to make earlier diagnoses of glaucoma using newer technology (tonography). We set up the first NIH glaucoma center here. The NIH had a problem at that time because eye research was under the Institute of Neurologic Disease and Blindness. I was the only member of the council who represented ophthalmology. It was difficult because I was head of the Sensory Disease section, of an ophthalmology training grant committee, and the council, [all] at the same time. That doesn’t happen anymore, but there were so few people in academic ophthalmology at that time. I was traveling back and forth for meetings of each of these committees four times a year.
At that time we started the Association of University Professors of Ophthalmology and had organization meetings here, in New York, Boston, and Chicago. Its first task was to convince Congress to fund a separate National Eye Institute. Jules Stein and his Research to Prevent Blindness provided funds for us to lobby Congress for a separate Eye Institute.
We had more federal money in the department than we could use. There was no reason for us to do clinical practice. We could earn money more easily by writing grant applications. We obtained training grants so we could influence the residents to do research by providing facilities, stipends, and opportunities for academic appointments. Many of these resident-trainees are now heads of departments or doing academic work. The last time I counted it was seventeen or eighteen. Still others went on to head departments in basic sciences. At Washington University we developed interaction between clinical and basic science departments. This was and still is a very exciting thing. In all the other schools, departments tend to be competitive. The tradition for cooperation here is one of the most exciting aspects of this school. It’s one of our strongest features for recruiting the best of candidates.
I was fighting another battle in the hospital. I insisted I would leave if they didn’t integrate the hospital. So, McMillan was the first hospital to integrate. And I insisted that Mrs. Cornelia Knowles (the director of McMillan) put blacks on the sixth and seventh floors. There was less difficulty putting them on the wards. But on the private floors, there was a great deal of opposition from my own visiting staff. I appointed three black ophthalmologists to the visiting staff with the understanding that they would bring their patients here. (Dr. Philip) Venable was the first of these and I guess he was appointed in the late ’50s. But I had to keep at this. Whenever I turned my back, segregation was restored.
The hospital was run very autocratically. For example, Carl Moyer and I wanted to eliminate smoking. The hospital claimed that considerable money came from the cigarette machines. The administration and trustees turned us down on several occasions, even after we obtained a unanimous request from the Joint Medical Advisory Committee.
Most social functions of the Executive Faculty were held at the old University Club. Blacks were not offered membership or permitted into the building. I pointed these objections out to Ken King, but he continued to schedule Executive Faculty functions there, so Janet and I refused to attend. However, at a later time when the new University Club became the site of meetings and was integrated, I still avoided such functions.
I was never aware of anti-Semitism here at any time. It just never came up. Whether it had been a factor before Kornberg and others, I don’t know. Not only in Executive Faculty was it absent, but in appointments well below that level. We also never encountered anti-Semitism in our social life in St. Louis. In fact, we were more criticized for refusing to join a Jewish country club or to become active in any of the temples. We chose the Ethical Society for its adult discussions and children’s programs.
Interview #3 – [Fall 1990]
By 1960, I managed to spend time doing research but found I couldn’t spend as much time as I would have liked because the clinical and sociological aspects of the department were so disturbing to me. Also, there was a great deal of pressure to do things nationally. And there was a national shortage of clinical research workers in the visual sciences. The few of us in the field had to serve in many administrative and advisory functions. So time was very short and the pressures were great, but different than now. We didn’t have the administrative bureaucracy. The school was run by one phenomenal woman (Helen Kaiser) who was the finance officer. She didn’t have computers or extensive help. She kept most information in her head and did it all with the Dean and departmental chairmen on a one-to-one basis. If you needed anything, you went to her. Similarly, in each department there was one person in charge. The emphasis was different. We were in an expansion phase but our needs were not financial. One could earn and acquire funds very readily. The pressures were to go to Washington for NIH meetings; instead of being on one committee you were on three or four, and a council as well.
We traveled around the country to try to convince people to set up research programs so that they would apply for funds. My job, at one time, was to organize a training program for the NINDB (National Institute for Neurological Diseases and Blindness) so that we could get eye departments to set up programs to train visual scientists. There were more research funds available than people trained to use them. Our first attempt was to go to basic scientists and urge them to apply. But that wasn’t enough. So we devised a scheme to give money to key research departments to train people so that they could apply for the funds. Turning funds back to the government seemed inadvisable. So we set up research training programs in about fifteen different institutions. We overdid it and soon applications for research grants became overly-competitive because there were too many trained people.
I estimated at one point that I was away more than 50 percent of the time. I hired people with joint appointments in pharmacology, biochemistry, and physiology to help in the laboratory. I mentioned Cibis [earlier]. I recruited him in order to relieve me of the retinal detachment work. This became an outstanding retinal detachment center because of his skill. He was a real go-getter, particularly good with his hands. He did very daring surgery in the vitreous cavity before anyone else dared to do so. And he did it without the elaborate instrumentation. The full-time people at that time were very poorly paid. He was, at one point, bringing in hundreds of thousands of dollars and being paid about fifteen thousand dollars. This disturbed him and his family, and he asked for more. Dean Dempsey refused. So he quit and went into private practice. I spent a lot of time deciding whether to continue his appointment on the part-time staff. We resolved it by a half-time appointment to set up a retinal service for training the residents and fellows. He was paid a very small stipend for teaching and research but could keep all of his clinical practice income. He developed an enormous retinal service here. He worked long days and nights, teaching residents, doing clinical and laboratory research, and training ten or twelve fellows.
Unfortunately, he had a heart attack and died. One of my best residents, Ed Okun, who was one of his fellows, took over the retinal service. But this resulted in an anomaly in the school and in the department. The Retina Service remained on a part-time basis when the rest of the school was full-time. They kept the money they earned. As the referrals grew and the group numbered eight or nine surgeons, their incomes skyrocketed. They earned more than the entire clinical practice income of the full-time service. This was particularly bothersome because they worked side-by-side with the full-time ophthalmologists. This was in the late ’60s and early ’70s. Full-time clinicians felt that they were supporting the department and the younger researchers, as well as overhead for the medical school. They resented the income of the retinal group. This problem persisted until my retirement. At that time, the Executive Faculty again wanted the Retina Service to go full-time. Had there been a more liberal policy, we could have kept them full-time in the first place.
Dr. Dempsey and I disagreed about this. I wanted to increase Cibis’s salary to twenty-five thousand dollars, which would have kept him on full-time. Dr. Dempsey felt very strongly that academic clinical people should receive small salaries, similar to preclinical scientists. I did not feel that we had to match outside private practice salaries, but full-time clinicians had to feel comfortable with their clinical colleagues. We discussed this over and over again at the Executive Faculty level. Some of us felt that we could not have the school riding on the backs of clinicians. It is true that academic clinical appointments offer other benefits: a laboratory, more interesting patients, the challenges of medical students and residents. The differential in salary between full-time clinicians and preclinical scientists increased in the 1970s. In recent years I think the differential has gone too far. The government will no longer pay for the very expensive surgery, and the school is going to have to continue the high clinical salaries. The clinicians will have to spend more and more time with routine patients in order to earn enough money, and this will interfere with teaching and research.
These days, research has become so specialized that you no longer can have people who can do everything. You have to do either basic research or clinical research, not both. You can collaborate with basic scientists or you can become so highly specialized in clinical work that you have time to keep up with your research interests. When I came to St. Louis, I tried to be at the forefront of clinical work and fundamental research in ophthalmic aspects of biochemistry, physiology, and pharmacology. However, now that clinical work seems quite primitive and the research seems terribly naive and unsophisticated.
If I were starting out now, I wouldn’t accept the job of department chairman. It’s much more an administrative job and less appealing to me. Over the years I always attempted to get the administrative chores out of the way so that I could do what I really wanted to do – teaching and research. In the old days, you learned by experience. Now, you can take courses in how to run a department, raise funds, and manage people.
Unfortunately, I found that even taking part in the NIH and its activities was too time-consuming for me. It was taking me away from what I really wanted to do. And then superimposed on that were the other things that I wanted to do, such as founding the AUPO, organizing the Association for Research in Ophthalmology and the journal Investigative Ophthalmology. The first meetings of the Association for Research were with the AMA; they gave us a special room for half a day and 50-100 people would attend. Now, it’s eight or ten thousand people meeting for a week. We reorganized the American Board of Ophthalmology, and I was in charge of making up the written qualifying exams. I used to spend hours and hours making up multiple choice questions every year.
With the first four children, I spent very little time at home when they were young. I hit on the scheme of taking them on trips with me. But that did not prove to be very satisfactory. Later, with our fifth and sixth children, I attempted to devote more time to them.
Some aspects of being a department chairman were enjoyable. There was the formation of Research to Prevent Blindness and the lobbying for a separate National Eye Institute. We felt we were not getting a square deal from the NINDB; I was the only ophthalmologist on the Council. We organized an Association of University Professors of Ophthalmology. We got Jules Stein to organize Research to Prevent Blindness and to finance our meetings. We invited the heads of all departments of ophthalmology from across the country to come to Camelback in Phoenix, Arizona. We discussed the problems of academic departments. One of our early major accomplishments was to get RPB (Research to Prevent Blindness) to influence the setting up of a National Eye Institute.
I got to know Jules Stein quite well. We prevailed upon him to build an Eye Institute at UCLA. His wife recently gave another institute for pediatric ophthalmology. Rod Irvine, who was in charge of UCLA at the time, and I persuaded Dr. Straatsma to head up the department at UCLA. At the same time, we were working on an Eye Institute for Miami with Ed Norton to head it up. And I was active in the fund raising there. I was very active nationally in various organizations.
The time here was very busy, not with the politics of the institution but within the department. The department expanded, and I had key people that I had trained and kept on in various specialties: Allan E. Kolker, Michael A. Kass, Steven M. Podos, and Theodore Krupin in glaucoma, Andrew J. Gay, Ronald Burde, and William M. Hart, Jr. in neuro-ophthalmology, Stephen Waltman and Lawrence A. Gans in cornea, James E. Miller in pediatric ophthalmology. I was also training people who were taking over at other centers: Podos at Mt. Sinai, Robert Stamper in California, John Keltner at University of California at Davis, Krupin at the University of Pennsylvania, Burde at Einstein. But then I had another cadre of people who stayed on here. Many of them are still here: Kass, Kolker, Morton Smith, William M. Hart, Gans, (?) Stevens. The third cadre are practicing in the community: Robert C. Drews, Jack Kayes, George M. Bohigian, Waltman, Charles E. Windsor, James C. Bobrow, Bruce Cohen, Robert M. Feibel, M. Gilbert Grand, Michael J. Isserman, Stephen A. Kamenetzky, Harry L. S. Knopf, Matthew Newman, F. Thomas Ott, John C. Perlmutter, Mitchel L. Wolf, etc.
My interest in the Medical Library goes back to the early 1960s. There wasn’t enough room for books. The physical facility was a disaster and overall it was an embarrassment. The School and Executive Faculty developed more interest when NIH matching funds became available. We had a Library Committee, headed by Dr. Jim O’Leary. Murphy and Mackey Architects drew up several plans. We wanted to apply to NIH for matching funds, but the problem was that the School, the Executive Faculty, refused to consider this a top priority and refused to allocate funds for this purpose. We started another library committee some years later, but couldn’t get off the ground. The original plan was to build on stilts over Euclid; you’d be able to drive under it. I decided that a new library should have top priority. In the early 1980s, with my retirement coming up, I decided to put a major effort into doing this. Through a source that must remain anonymous, we obtained ten million dollars for the Library. That was accepted by Dean Ken King, Vice-Chancellor Sam Guze and the Executive Faculty.
Building over the street was impractical, for it would have required blocking access to the hospitals. So the architect, Harry Richman, came up with an alternate plan. The final plan came to about fifteen million dollars. We could get little help with fund raising for the additional five million dollars needed. We approached (August A.) Busch, Jr., and others but with little success. Chancellor Bill Danforth obtained one million for the atrium and two other gifts of three or four hundred thousand dollars. We appealed to the faculty and alumni but the total raised from them was less than 150 thousand dollars. In order to raise even that much we had to get a foundation to offer matching funds. Very slowly we have been able to raise or have pledged about half of the residual funds, but we still are trying. In spite of this we have a beautiful, functional library and it will soon be completed.
Summation by Dr. Becker – undated
I can summarize my accomplishments in several areas:
1. I inaugurated a full-time Department of Ophthalmology, developed adequate financing and created endowed funds over a period of years.
2. We established research programs, the first of which was glaucoma. We developed methods for earlier diagnosis and introduced new therapeutic agents. We established the first NIH glaucoma center. We collected data on families of glaucoma patients and on unrelated individuals. We developed good public relations and physician referrals.
Later, we wrote what is now the standard textbook on glaucoma. It is now in its 6th edition. I did the first two with Bob Shaffer, the next two with Al Kolker, and the most recent editions with Mike Kass. Another exciting achievement was the development of yearly glaucoma research conferences. These were great discussions with such invited experts as Steve Kuffler, Ernst Barany, Hans Goldmann, Bob Berliner, Lorenz Zimmerman, Tom Maren, and many others. Sponsored at first by the Macy Foundation, then NIH and Allergan, they were limited to 20 people and provided an enormous stimulus to important research in the field.
We also carried out innovative research as well as clinical work and training in retinal diseases. It was not just a question of recruiting people, but of choosing inspiring and innovative leaders such as Paul Cibis in retina and Andy Gay and Ron Burde in neuro-ophthalmology. We moved our pediatric ophthalmology specialists and research over to Children’s Hospital, rather than having children come here, and Jim Miller developed a fine division. We developed the first eye bank in the area and an excellent corneal transplant service (Steve Waltman).
3. In terms of training, we established a clinical research training program with federal grant funds. We trained academicians who went out all over the country, who were then able to apply for their own research grants. On the basis of this broad educational program, which involved clinical, research, teaching, and academic administrative training, this department had a major national influence. Many of the 250-300 trainees are now full-time professors or department heads. Department heads include Steve Podos at Mt. Sinai, Ron Burde at Einstein, Ted Krupin at the University of Pennsylvania, Bob Stamper at Pacific Presbyterian Medical Center, San Francisco, John Keltner at the University of California, Davis, George Bresnick at the University of Wisconsin, Mike Yablonski at the University of Nebraska, Irv Pollack at Sinai Hospital, Baltimore, George Blankenship at Hershey, John Gittinger at the University of Massachusetts Medical School, Ahti Tarkaanen, Helsinki, Ollie Holm, Lund, Ake Holmberg, Stockholm, Yoshihito Honda, Tokyo, Franz Fankhauser, Berne, Ivan Goldberg, Australia, Johannes Rohen, Mainz, Balder Gloor, Zurich, Bob Miller, at the University of Minnesota, Stephen Obstbaum, at Lenox Hill, and Thom Zimmerman, at the University of Louisville.
Approximately one-third of the current American Board of Ophthalmology are people that we trained, and we have more members of the Association of University Professors of Ophthalmology than any other training program.
4. In patient care, my major effort here was to upgrade and desegregate the clinics as well as the private service. I also worked to establish medical school scholarships for minority candidates and to recruit minority and women candidates for the residency training program and for the full-time staff. In addition, I tried to have the department complement the services of local ophthalmologists rather than competing with them, so that town/gown relations would be harmonious.
5. I enjoyed collecting rare eye books and gave them to the medical library so that they would be available to all interested. I played a major role in convincing the Executive Faculty that a new library was absolutely essential for the future development of the Medical School. For many years, there was interest but it didn’t have high priority. Now it is a beautiful structure, functioning well, and a center of attraction for the Medical Center.
6. On the national scene, I helped establish ARVO (Association for Research in Vision and Ophthalmology) and was the founding editor of its journal, Investigative Ophthalmology. I was also active in the Research to Prevent Blindness organization and helped to lobby for a National Eye Institute within the NIH. I had served on Training and Study sections of NINDB for eight years and then for eight years on its Council. I selected Carl Kupfer to be the director of NEI. He had been one of my junior residents at Hopkins. I then served on the first Council of NEI for an additional eight years. In addition, I was a member of the American Board of Ophthalmology and was in charge of formulating multiple choice questions for the written examinations for many years. I really enjoyed doing this.
It has been a delight for me to see my students take over different aspects of my former activities. For example, Ron Burde, Tom Pettit, Mort Smith, and Bob Drews have picked up on my work on the American Board of Ophthalmology. Steve Podos took over the editor’s job at Investigative Ophthalmology and he and Bob Stamper and Mort Smith serve as trustees of ARVO. Many serve in the AUPO (Association for University Professors of Ophthalmology): Ron Burde, Steve Podos, Bob Stamper, John Keltner, Ted Krupin, George Blankenship, Mike Yablonski, John Gittinger, Irv Pollack, William Knobloch, Stephen Obstbaum, George Bresnick, Mark Mannis, Thom Zimmerman, and others.
The challenges now are new and different. It’s important to realize that present-day administration is so demanding that it’s very difficult to do research. Recruiting alone consumes enormous amounts of time. When I was a department head, it was possible to be an administrator, a clinician, a research scientist, and to work on the national scene as well. Today, ophthalmology is too big a field for any one person to play as many roles as I did. These days, just applying for research and training grants consumes too much time. I gave up applying for competitive federal grants five years ago because I didn’t want to use funds that could be made available to younger persons. I had tried unsuccessfully to establish that as an NIH policy when I was on the Council.
I feel fortunate to have started out in academic ophthalmology when I did, and feel enormously grateful to Washington University for offering me the opportunity not only to head a department at an early age, but to be able to take part in so many aspects of the field’s development. At that time there were just a few of us doing everything. Even collecting rare books is a different and more mercenary game today than it was forty years ago. If I were to start out in medicine today, it wouldn’t be possible for me to develop such varied interests and accomplish as much; and it certainly wouldn’t be as much fun.
|
