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Transcript: William Dock, 1981

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This is Oral History number 53. October 5th, 1981. I am speaking today with Dr. William Dock.  Dr. Dock was born in Ann Arbor, Michigan in 1898.  He is the son of George Dock, a distinguished physician and educator who was to serve on the faculty of this medical school.  More about Dr. George Dock later.  Our subject was educated here in St. Louis.  He attended the Smith Academy which was a preparatory school for Washington University at the time.  He entered Washington University School of Medicine in 1918 and he studied for two years of the preclinical training course.  [Interviewer speaks to Dr. Dock]:  My sources say that this gave you the equivalent of a Bachelor of Science [degree] by 1920.

Dr. Dock transferred to Rush Medical School for his clinical training, and studied there from 1920 to 1922.  His M.D. degree was officially granted in 1923, but Dr. Dock informs me that it was the policy at Rush not to grant a degree immediately upon finishing but to wait until the first year of internship was completed.  He was an intern from 1922 to 1923 at Peter Bent Brigham Hospital in Boston, and continued there as assistant resident from 1923 to 1924.  In 1924 he was at the Allegemeinen Krankenhaus in Vienna.  In 1925 he returned to the United States and became a resident at Stanford University Medical School.  In 1926 he joined the faculty at Stanford, starting as an instructor and moving up the academic ladder.  He was Assistant Professor, in 1929 he became Associate Professor and in 1936 became full Professor of Pathology at Stanford University Medical School.  In 1941 he transferred to Cornell and became Professor of Pathology there.  In 1944 he became Professor of Medicine at Long Island College of Medicine.  This institution, in 1950, became the Downstate Medical Center of the State University of New York.  Dr. Dock retired from academic medicine in 1963 and he became Chief of the Medical Service at the Brooklyn Veterans Administration Hospital.  In 1973 he became a consultant to the Lutheran Medical Center in New York and since 1977 he has been retired and living in Paris.

Dr. Dock, did I get all that correctly?

Yes.  All that’s as it should be.

We talked about your being at Smith Academy.  That was an important part of the early history of Washington University.  Can you tell me what it was like to be a student there?

It was an extremely good, purely masculine school.  We had a teacher of German who was a German lady and a teacher of French who was a French lady, but all the faculty aside from those two language teachers were men and of course the student body was masculine.  The equivalent for the ladies of St. Louis was known as Mary Institute.  We had a little magazine that came out eight times a year, The Smith Academy Record, and we had one communication from Mary Institute in each issue.  Our relations with Mary Institute were distant geographically and in terms of teaching, but we were on friendly terms with the young ladies there.

The location of the school was where?

Mary Institute was to the east from Union and Smith Academy was to the west of Union, close to Delmar, I believe, which was the east-west line.

So they had moved up [ed. note: moved west] from their old campus which had been downtown?

Both of them had been downtown.  But they’d been uptown for a good many years by the time I came to St. Louis in 1910.

Was there any doubt in your mind at that time that you wanted to study medicine?

I hadn’t even thought of it at the time I was in high school.  Like any sensible early-teenager, I wanted to be a poet.  I outgrew this because I had a classmate, Johnny Johns, whose father was the editor of the Post-Dispatch, is it?  Anyway, I used to go and spend weekends at their home out in the county somewhere and the guests that Mr. Johns had made a great impression on me – people like G. K. Chesterton and so on.  So Johnny Johns and I would lie on the rug with our chins on our fists and listen to his father talking to these distinguished people from England and Scotland and the United States, of course.  That made a great impression on me.  I decided I wanted to be a newspaper editor.  Between my junior and senior years in medical school [ed. note: “medical” school seems to be incorrect.  Dr. Dock is referring to high school], during the summer, I suddenly realized that I not only wouldn’t make a good poet, but I wouldn’t make a good editor.  And I decided I’d better go into medicine and see what I could do in that field.  So I then began taking courses like chemistry and physics which I hadn’t taken in high school until my senior year.  And then I entered Washington University – the College – in 1916.

Was this different?

No.  The other schools: Mary Institute and Smith Academy and the Manual Training School were drains on the finances of Washington University, but they were pre-college level.  And then I started in college in 1916.

So you did have some undergraduate training.

Well, I managed to get out of it, but to get credit for it.  In the class fight of 1916 the week before Christmas, I managed to get a good whack on the eye with a knotted rope and the ophthalmologist thought my whole retina was going to come loose from its moorings.  So I had considerable bed rest and didn’t get back to school for two months.  But since the College had allowed this fracas to go on year after year they felt that they should give me credit for the first semester of the freshman year on the basis of my being whacked in the eye during that semester.  Which wasn’t more education than I’d have gotten if I’d stayed on.

Did you have tutors?

I had nothing.  I wasn’t allowed to read.  They didn’t know in those days that your eyes are always moving whether you’re awake or asleep.  And when you’re dreaming you have rapid eye muscle movement so that the purpose of keeping that eye immobile by having me in bed and not allowed to read, was physiologically unsound.  A great deal of medicine is always physiologically unsound and this was a classic example.  But that gave me credit for the first half of the freshman year.  About April of that year the United States got involved in the war and my eye was just right so I couldn’t get into any unit of the armed forces.

But you told me you tried.  You had some inclination to join up.

Among young men the mass movement toward a war is very great whether it’s a civil war, the Spanish war or World War I.  So before I got whacked on the eye with a knotted rope, I belonged to a reserve unit of Washington University people.  I think we were a machine gun company or something like that.  I got kicked out of that as soon as my eye was obviously permanently altered and down through the years this has kept me out of the line of fire in every war afterwards.

But you did have some experience in World War I.

I went into the American Ambulance, which had been started in 1915.  My brother, who had graduated from Dartmouth, went over there and was in the American Ambulance in 1916.  In 1917 I knew I could go sightseeing, so I went over and was in the Ambulance until the American Army took it over.  Despite the fact that I’d been driving an ambulance for months and fairly close to where things were lively, the American Army tested my vision and allowed me to come home and enter medical school.

You got a Croix de Guerre out of the experience.

Oh, volunteers who came from a distance always got them.  You didn’t have to do anything to distinguish yourself.  My citation reads that I was “a devoted and conscientious conductor,” as they say in French.

And then you entered medical school in 1918?

Yes.  I went to summer school.  I had almost all of the second semester of the sophomore school year at Washington University and in the summer I went up to the University of Michigan and took some courses I thought I’d better get.  And the next year, when I was already in medical school, I went to the University of Chicago summer school and took physical chemistry.  The ones I took at Michigan could be called “pipe” courses, things like embryology, which was lots of fun, and English; I was studying Wordsworth and Tennyson and things like this.  So I got as many units of credit as I could.

Was it common for students to be admitted to medical school so early in their academic training at that time?

Yes.  You could enter with two full years of college.  While I didn’t have two full years, my father was a professor of medicine and they leaned over backward to treat the little boy right.

So you got a sort of preferential treatment on account of your father?

Well, that’s only part of it.  The number of freshmen entering that year was very low.  The 1918 recruiting was interfered with by all the decent people being off at the war.  Some were in the navy, some were in the army, but they weren’t looking for medical school that year.  They got back a year or two later, most of them.  So I was admitted because the freshman class at medical school was practically depopulated.  They even let women in, which they hadn’t done before.  We had two delightful ladies in that course.  I can remember one name because it was Aphrodite Jannopoulo and she married one of her classmates and the son of this family, Dr. [Robert J.] Glaser is quite well-known. [ed. note:  Dr. Robert J. Glaser is the son-in-law of Drs. Armin Hofsommer and Aphrodite Jannopoulo Hofsommer.  He married Dr. Helen Hofsommer, WUSM 47.]  He became a Dean and was out at Stanford later on.  So our class was an unusual class because most of the men who were curious about what was going on were in the army or navy.

What was the attitude toward women medical students then?

We had no objection to them as students.  I think faculty had such pressure to admit men that they hesitated to admit women unless they had some particular reason – unusually bright or unusually influential.

The war gave some impetus—

By reducing the number of applicants to medical schools it made the women applicants get more places than they’d ever gotten before.

As a freshman medical student, many of your hours in study and the classroom and the laboratory were in Anatomy.  And there, I think you—

I took a dim view of dissecting cadavers.  I thought it was a waste of time.  This detailed gross anatomy which might be useful to a surgeon, I knew would never be of the slightest value to me.  So I regarded that as time wasted.  I enjoyed the histology course.  I even made some modest contributions – they were short of some organs that they needed sections of and I cut sections of the uterus and sections at various stages of the uterine cycle and I cut sections of the trachea and the bronchi, I think, many sections – enough to provide one for each student in histology.

It sounds as if you were already thinking about becoming a pathologist.  Is that correct?

No, I was just thinking of learning how things were done.  Obviously, somebody had to make these sections and I wanted to see what the technique was.  The only way to do it is to do it.

Later on, did you think that your attitude toward gross anatomy was a mistake.

No, I’ve always regarded it as a waste of students’ time.  The cadavers should be kept for the seniors who know or think strongly that they want to be surgeons.  For them, detailed anatomy of the human being is worth spending a lot of time on.  When you’re motivated, you know you’re going to use this, you learn very fast.  When, like me, you’re unmotivated, you don’t learn anything.

Doesn’t anatomy teach you a lot about the general physiology of the human body?

No, you don’t see anything in motion.  [When you study,] cadavers [are] pickled, you don’t learn any physiology.  It’s obvious that this is so because people who did the original anatomy, mostly Arabs and Italians who started this whole business, all their physiological guesses were off.  They had the opportunity to look at hearts, but they didn’t know what those valves were for.  They didn’t realize that blood flowed through the heart.  In fact, they were all taught and they all believed, that the blood came [flowed] in waves from the liver and that it was a flux and not a circulation.

Would you be of the opinion, then, that in the history of medicine, more understanding about the way the body works has come by analogy to machines?

No, [through] an analogy to animals.  [William] Harvey tied [the aorta of a snake] and saw the heart blow up as though it was going to bust and saw the arteries all become empty and the pulse of the snake disappeared.  He then did the same thing on dogs.  He had no anesthesia, of course, so a dog having its circulation interfered with by having its chest opened is not an ideal thing to learn from.  But he saw the heart beating in a dog and he could see that the pulse was simultaneous with the contraction of the left ventricle.  So, he decided that blood circulated, and as you know, French and Italian doctors had a wonderful time writing refutations of Harvey’s curious heresy.  It was a good idea that they didn’t do it because the Catholic Church at that time was doing things to people who taught anti-Galenic.  They thought that if they weren’t right about Galen and medicine they certainly couldn’t be right about religion.  One of them, Servitus, was burned in Switzerland, not by Catholics as it happened, but he was burned and tied to his chest was his treatise on circulation.  [John Calvin] was presiding over his demise, cheerfully.  So it was hazardous.  In Protestant England it was all right to teach that the blood [circulated].  There was no great objection to Harvey’s work in England, but in France and Italy they just raised Cain about it.  There are two famous letters of Harvey which I’m sure didn’t go through the post, but got published in Frankfurt where the original book by Harvey had been published.  They refuted him and he refuted them in these two letters.  There’s quite a lot of useful information.  He describes the first autopsy with a ruptured heart – obviously healing myocardial infarct that had busted, but he didn’t know anything about coronary arteries.

You studied under Dr. [Joseph] Erlanger, I understand.

Yes.  Dr. Erlanger and Dr. [Herbert S.] Gasser were the two teachers from whom I learned the most.  Dr. [Philip A.] Shaffer taught me the most important thing you ever learn and that is, “You’re not going to learn what you need in this course and you have to go and get a foundation.”  So I went to Chicago and took physical chemistry.  So he did me a lot of good in that he inspired me to work and to study.

Let’s take these gentlemen in order.  You mentioned Erlanger first.  Why was he an effective instructor?

Oh, he was a wonderful person.  He was a very good experimental scientist to begin with, and he put on class demonstrations of everything from the removal of dust from the trachea and bronchi to the heart, and the way voluntary muscles contracted when you stimulated the nerve in the frog, and the usual things that physiologists can show you [about] how physiology is working in experiments.

He, at this point, was not yet experimenting using the cathode ray oscillograph?

It was hardly a tool for the physical chemist or the physicist even.  It had just been shown that you could use this for recording rapid fluctuations in voltage.  The cathode ray tube is quite old.  It went back to 1840, I think.  [Julius] Plücker, I believe was the first one, and his technician, [Heinrich] Geissler, made the first good cathode ray tube.  So, the tubes went a long way back and they had no practical use except to physicists until [Wilhelm Conrad] Roentgen found that they were producing rays that would go through skin and bone and flesh and even thin sheets of copper.  That was interesting because the tubes to demonstrate this had been around for 60 years.  All the physics laboratories all over the world had a Geissler tube or whatever manufacturer it was – Crook’s tubes and so on.

They called them Braun tubes, too, didn’t they?

[Spells] B-R-A-U-N.  Yes.  So there were a lot of them available.  The Ilford firm, a photographic firm in England, had complaints from various physics departments that the films that they were sending them were fogged.  And they’d write back, “You’re the only one who’s had any trouble with the emulsion that went into that set of plates.  You’d better look around your laboratory and see what’s fogging them.”  Not a one of them looked.  Roentgen was a very observant fellow and he had a fluorescent screen that normally he used sunlight or ultraviolet light, which we can’t see, so that when you put invisible ultraviolet rays on the thing and it lights up, you can see it very well in the dark.  These were usually some sort of cyanide compounds – barium was a favorite one – which would light up when it was touched by sunlight and keep glowing for a while.  About that time, the Becquerel family had begun studying phosphorescence with great seriousness and they knew all about phosphorescence.  Roentgen’s ray was discovered by Roentgen because he had one of these fluorescent screens in the same poorly-lit room [where] he had his Geissler tube, known as Crook’s tube – his version was the Crook’s tube – and it lit up.  He could see it suddenly light whenever he turned on the current for his tube.  So he discovered the Roentgen ray and all the essential facts about it.  He put out immediately the fact that the Roentgen ray will discharge an electroscope.  In other words, it ionizes air and makes air a much better conductor.  And this was used from then on to quantitate the output of Roentgens from a Roentgen tube, and also the output of rays from uranium and from radium and polonium and thorium and so on.

So Dr. Erlanger’s application of the tube to study nerve action potentials was—

This was related to the use that was made of it in physics laboratories.  Rapid current oscillations could be recorded this way.  So physicists were the first people to use it, and Dr. Gasser went up to the University of Wisconsin and studied in the electrical engineering department where they were authorities on cathode ray tubes and Roentgen tubes and he learned how to use a cathode ray tube as the physicists had used it for years for recording.  But he needed something else.  The currents that the physicists used were quite strong, and the currents that come out of the frog, which they started in on, are quite weak.  So they had to have amplifiers and what he studied up at Madison was not the operation of the cathode tube, which is very simple, but how to make amplifiers to make a trillionth of an ampere look as though it was 10 amperes.  This could easily be done in his day, but most doctors didn’t know that, and he knew where to go to study it.  He came back here and he and Dr. Erlanger put it to work recording nerve action currents.

When I look at photographs of those early machines they fill half a room.

That’s because, in the first place, they used batteries to power them.  They didn’t have good transformers.  The x-ray people had good transformers, but they weren’t good enough for these things so they were working with batteries at first.  And that occupies a lot of space – A batteries and B batteries.  You have a lot [of space] for the amplifier tubes because they amplified with modified cathode ray tubes that they modified to amplify currents.  So they had their amplifier tubes in series and they had their sources of straight, not alternating, current – direct current.  They had quite a lot of equipment when they were doing that.  I was the first one to do cathode ray work on human beings, naturally, heart currents.  So I recorded the first electrocardiograms and when I thought I was a very bright boy like Jack Horner and sent this paper off with nice, human electrocardiograms recorded with cathode ray oscillograph, the editors said, “No, doctors won’t be interested in this sort of thing.”

Where were you experimenting?

At Stanford.  In the outpatient clinic after hours.  I could set up my apparatus in a room that was used for other purposes during the day.  It’s convenient to work in the dark.

Wasn’t Dr. [George H.] Bishop of this medical school working in that same area?

Yes.  He was one of the colleagues of Erlanger and Gasser.  And they were the first people to apply cathode ray tubes to physiology.  They used mainly frogs, whose currents are very weak and they’re not very fast.  As soon as you switch to a hot-blooded animal the waves are bigger and not as slow, so the obvious thing was to apply them to man.  I had plenty of men in an outpatient clinic so I set up my little show there with A batteries and B batteries and a Graybar cathode ray tube, which cost me $70.  No one had any budgets in those days, so if you were curious about something like this you spent your money on it.  The only other person who had the slightest interest after seeing my gadget, was a doctor whose name, I think, was Franklin, but I’m not sure of his name, who practiced over in the San Joaquin Valley.  He was a hi-fi [enthusiast] or whatever it is – fan – on picking up radio signals.  He made a really superior amplifier.  It was a direct current amplifier, which I couldn’t have put together.  The AC amplifiers are very simple.  But he had a direct current amplifier, so he had faithful electrocardiograms.  With my system, the slow waves, the T-waves and the P-waves were flattened out because it’s discharging all the time.  Oh, his name was Barber.  With Dr. Barber’s cathode ray EKG was faultless.  The T-waves looked just as they did on a string galvanometer, which was the standard instrument.

Do you recall Dr. Barber’s first name?

No.  I haven’t the slightest.  It was quite a feat of imagination to bring back his last name.  I suddenly realized that it was Barber and not Franklin.  Of course, I could find it out very easily by getting a State of California Licensed Doctors [directory] in the 1920s.  So, he had the first really good one.  My paper was turned down by every journal I sent it to, either a physiology journal or a clinical journal, so I put it in the Proceedings of the Society of Experimental Biology and Medicine because they had to publish everything that a member wrote.  So it got published, but they didn’t think it was worthwhile wasting space on a picture of one of my electrocardiograms, so I didn’t publish the first one, which was done on myself one evening.

How about medical experimentation in those days?  Did the lack of rules allow you to do things that you couldn’t do today experimenting on patients?

On people it’s no problem.  It never was a problem all through World War II.  [There was a] whole school of human physiology that grew up around Homer Smith, who was a Professor of Physiology at NYU, and he trained a lot of bright young men and they studied renal function.  Dr. Smith would work out how to do it on a dog to measure the equivalent of the renal blood flow and the glomerular filtrate per minute, using different chemicals which are eliminated in different fashions by the kidney.  The phenolic substances are eliminated five times as fast as the urea, say, or the creatine.  He had quite a school there and they just moved into Bellevue and all the patients they worked on thought they were getting treatment and felt much better after a session with these young men who were working so hard.  They had a catheter in the patient’s bladder and a needle in an artery and a needle in a vein in order to collect urine while getting AV differences of whatever they were studying.  All of this was done with the patients thinking they were getting unusually fine attention.  They recovered from their illnesses faster than controls.  So as long as the patient thinks he’s having something useful done, he doesn’t mind it.  As soon as you tell him “This is an experiment and it’s only of interest to me”, you have to do a little talking to get permission to keep them with so many tubes in them at one time.

These days, of course, they would raise all sorts of medical ethics questions.

I often thought about this because the first blood flows were done at Bellevue under the same circumstances.  Dr. [Hans] Eppinger was doing the same thing in Germany.  Eppinger was a great internist and a great experimentalist and he was doing renal blood flows and renal glomerular clearances on patients at the same time that other people were doing that at Bellevue.  When it got to cardiac output, which was first done by a fellow named Klein in Prague in 1930 on about 8 or 10 patients, he put a catheter down a vein until it got it to the right side of the heart.  So he could collect venous blood from that catheter.  He had a needle in an artery and could collect arterial blood from that one.  He could measure the AV differences in dextrose or whatever was being metabolized.  It was lower in the vein than in the artery.  The forearm would take dextrose out for its own purposes.  So he had AV differences in oxygen and carbon dioxide, and the patients were breathing into what we called a basal metabolism machine, which measured your uptake of oxygen and your output of carbon dioxide.  This was done by Klein in Prague in 1930 and it’s the first article in one of the numbers of the Klinische Wochenschrift.  He has never had the slightest reference anywhere.  When [André Frédéric] Cournand and [Dickinson W.] Richards did the first blood flows at Bellevue, they didn’t mention Klein, so they were pioneers, you see.  You can be a pioneer if you don’t know the literature.  When Eppinger did his work he knew about Klein but he was violently anti-Semitic and Klein migrated to the Argentine when Hitler came on the horizon, so he ignored Klein completely.  So there’s no reference to Klein anywhere.  But you’d have no trouble finding him here.  I don’t know what his first initials were myself.

It’s hard to be ignorant of the literature these days unless you really want to be.

When they gave the Nobel Prize to Cournand and Richards, the war crimes commission had already sentenced Eppinger to be hanged for having done experiments on people on their way to the crematories in life.  So if you’re on the winning side, you get the Nobel Prize; if you’re on the losing side you’re sentenced to death – for precisely the same experiment.

Let’s go back to medical school a little bit more.  Did you meet Leo Loeb?

Yes.  Dr. Sam Grant and his colleague [Dr. Alfred] Goldman, with whom he did some very important research work, founded a little club to meet with Leo Loeb in the evenings.  He’d give us a topic to study and we would discuss the topic with Dr. Loeb – most wonderful evenings!  If Dr. Goldman is still around I’m sure his memories of all this are more accurate than mine.

What sort of things did you talk about?

He was mainly interested in cancer and things like that.  So, we talked about topics that he selected.  I’ve forgotten what they were now.

He was interested in in vitro tissue culture.

Yes.  We probably did discuss this, but I don’t have any recollection of it.

How about Eugene Opie?

Opie was my pathology teacher and I had no intimate, personal contact with him.  He was a very poor lecturer and a very good teacher.  In other words, he showed you what you should be reading and if you read it you got a good education.  If you didn’t read it you just missed the boat.

You mentioned Philip Shaffer earlier and biological chemistry.

I gather that he was not popular.  But I didn’t know he was unpopular and I had nothing against him.  I didn’t know he was supposed to have an unpleasant personality.  But I hear rumors that this was the feeling about him.  I thought he was a better lecturer than Dr. Opie, for example.  He didn’t “ah, ah” all the time.

He wasn’t an M.D.  Did that have something to do with it?

It had nothing to do with it.  The finest person I’ve ever known in the field of medical education was Joe Hinsey, and Joe Hinsey never got an M.D. degree.  He did beautiful research work – he worked with Erlanger and Gasser.

Where did you meet Hinsey?

The first [time] was out at Stanford, I think.  And then again in New York because I was in New York for a while and we saw the Hinseys.  It was Dr. Hinsey, when he was dying of leukemia, who wrote a letter to Dr. Hunt when he knew he was going to Paris and told him to look up Bill Dock.  And he wrote a letter to me and told me to be looking for Hunt.  Each time he wrote eulogies which neither of us deserved.  But he was a wonderful fellow.

As a matter of fact, I think we have a copy of that, courtesy of Dr. Hunt, in our files.  Well, the fact that you didn’t like anatomy – how did that—?

Oh, I liked Dr. [Robert J.] Terry very much.

Tell me about Dr. Terry.

Dr. Terry I knew mainly as a friend of my father’s who was interested in Indian doings in this part of the world.  He took us on scouting trips over into Illinois to see mounds built by the mound builders.  He had collected quite a lot of skeletal material which as an anatomist he had a right to study.  No, I thought he was a wonderful fellow.  He didn’t waste much time teaching; he saw that we worked hard at histology and he saw that we dissected vigorously and he did a minimum amount of lecturing as I recall it.

Some people said that he was a very dry lecturer.

Well, it’s better to be dry than to be like Dr. Opie and be full of “Ohs” and “ahs” and “ums,” which does detract from attention to what you’re saying.  You wonder when the next “ah” will come out.

Was Terry assembling his skeleton collection at that time?  He had quite a famous one that was ultimately transferred to the Smithsonian.

I guess he was.  He was doing this before I ever met him.  But he was very kind and let me come along on some of his scouting trips.  Some of the other lads came along – I forget their names.  We’d go on a Sunday and spend the day wandering around looking at mounds.  I don’t think I ever was present on a dig.  On a Sunday you can’t do a decent dig – I think that was all done in the summer.

I’m told you have to spend 10 hours in the lab for every one you spend in the field when you’re doing archaeological work.  What other faculty do you recall at the medical school at that time?

I think there was a Dr. [Edwin A.] Baumgartner who was one of my teachers, I guess in anatomy.  Probably he taught histology.  He was a good teacher; what he taught he presented concisely and clearly and eloquently, so that histology was a pleasant task for me, both the lectures, which were not too many and the lab work, which I found fascinating.  So fascinating that I went up to the University of Michigan to take embryology.  I didn’t see how you could be much if you didn’t watch all this histology developing from those tiny little dots in an egg.  I had a fine time up there.  Embryology was a wonderful course.  But I don’t know the names of my teachers at Michigan.

The medical school buildings here were very new.

Yes.  They were built after my father came here.  In fact, he’s blamed for any defects that they find in the medical school buildings.

Did they blame him for defects?

Well, he was responsible.  At that time Robert Brookings was a bachelor.  My mother was a southerner who saw [to it] that cooking was very well done.  We had a servant, which nowadays I guess no one has any more, but we had a servant whom she taught to do good cooking.  Mr. Brookings apparently got better food when he came down to spend an evening going over the plans.  He was the spark plug and distributor for this medical school, so I was present during quite a few dinners when Robert Brookings and my father were not wasting dinner time on any topic except the plans for the medical school and the plans for Barnes Hospital.  They were integrated.

What was new and innovative about the medical school?  Do you recall anything that they particularly wanted to put in?

No.  I don’t remember anything.  This was out of my line, as they say, and I wasn’t paying proper attention.

You didn’t study clinical medicine here so you didn’t spend much time at Barnes, but do you recall anything about Barnes?

Oh, yes, because I had friends over there, interns and residents who were pals of mine and I got all kinds of gossip about what went on on my father’s rounds, and other things that they knew about clinical [activities].  I recall the impression that Dr. [Evarts A.] Graham made when he joined the faculty – a very favorable impression on people who were interns even on the medical service or assistant residents in medicine.  One of these men became Professor of Pediatric Radiology at Columbia and is quite famous.  He discovered the battered babe syndrome, and it’s sometimes called the “Caffey Syndrome” because it is Dr. John Patrick Caffey who discovered as a radiologist that there are too damn many broken bones in this child.  So he brought to light this battered babe syndrome.  I knew him quite well.  He liked to walk and he and I walked to Ypsilanti and back and to other places quite often on Sundays.

[This was] when you were up in Ann Arbor?

In the summer when I was in summer school there.  Caffey had not yet graduated and he came here after I had been in Ann Arbor in summer school, so we kept up our friendly relations for the rest of our lives.

You mentioned Graham.  Wasn’t there some controversy when he was called here?  Wasn’t another man expected to be head of surgery?

I don’t remember any of this.  All I remember is that he had come from Rush and this is one of the reasons that made me go to Rush for my last two years.  I thought, “If they can turn out people like this—”  It turned out they had lots more surgeons than internists but they had some of the best internists in the world.  The man who put coronary disease on the map was James Herrick.  He also discovered sickle-cell anemia, two major discoveries which other people didn’t take much interest in in the beginning, were known to James Herrick by 1905.  He was a very good teacher; he had taught Greek to earn his way through medical school.  He taught it in high schools – in those days they taught Greek in high schools.  We had a Greek teacher at Smith Academy, but I didn’t have sense enough to take Greek.  I got as far as Virgil and quit.

I’m told you know something about the building of Children’s Hospital, too.

I knew Mrs. Robert McKittrick Jones, who was more interested, I think, in Children’s than in Barnes.  So I heard but did not record conversations about the Children’s Hospital problem, and I knew the early pediatricians. [Dr. Borden] Veeder was one of them and the other one, I think, began with a “B”.  But I didn’t learn anything from these people – I never got to pediatrics.  I got to the introductory course in physical examination, but that was performed at City Hospital #2 on entirely dark-complected people.  We had all our physical examination.  As a result of this, we didn’t get an adequate course because we didn’t know the patients as people.

City Hospital #2?

That was a black hospital down near – is there a Grand Avenue?  That’s where it was.

Yes.  That was a precursor of Homer G. Phillips Hospital.

Probably.  At any rate, that’s where we went to do our physical examination and so we didn’t know the patients we were examining.  We didn’t take histories.  When I got around to teaching this, I did the teaching mainly on convalescent surgical patients and convalescent obstetrical ladies who didn’t need to convalesce but who were kept in hospital for two weeks after delivery in those days.

This was a matter of course?

This is the way obstetricians treated them.  So they were there as captive people who were glad somebody was taking an interest in them after the operation or the delivery was over.  They were very nice people to do physical examinations on, but we didn’t get to do history-taking on them.  It’s much more important to have a good history than to have a good physical examination.

What do you recall about the neighborhood in those days?

I never even thought about it.  I lived in “D” of the ABCD Apartments over on Kingshighway.  It’s still there and looks as though it’s still a fairly good apartment house.

Was it considered a very elegant neighborhood?  [It was] obviously a new neighborhood.

It was elegant halfway down to Grand Avenue in those days.  It was beginning to be less elegant even in my day.  It was not as elegant as it had been in 1910.  By 1922 there already was a changing neighborhood.  But I notice that Westmoreland Place and Portland Place still look pretty good.

Let’s talk about your father for a little bit.  He was born in 1860, is that right?

That’s right.  He was born in a coal-mining village in Pennsylvania.  I forget the name of it – Mount Hope or something like that.

Yes.  Hopeville, Pennsylvania.

His father was a mining engineer and very good at gadgetry.  He loved to make fine furniture – carpentry.  Cabinet maker, I guess, is the word usually used for people who make rather nice things rather than houses.  He was good at this and he was also a gun enthusiast and he could make his own guns.  I never met my grandfather but I gather that he was, like me, a gadgeteer.  So if I’ve inherited any genes with gadgeteering in them, they came from Hilliard Dock, my grandfather whom I never saw and heard very little about.  I had five maiden aunts but they didn’t talk at all about “Papa,” who had left an adequate fortune so that all of them could take trips to Europe every other year or something like this, and had a lovely, big home halfway between Chambersburg and Gettysburg in Pennsylvania, up on the south mountain.  It had quite a lot of land around it and they had one tenant whose daughters waited on table as they were growing up.  So I knew the Hassler family quite well.  But the rest of my father’s family I didn’t know at all.

Why did your father go to medical school?

It ran in the family.  The standard name in the family was “William” from the man who first invested in Harrisburg real estate and founded the family fortune.  As real estate went up when Harrisburg became the capital of the state, he did all right and died relatively young.  His son, William, was a physician – he went to Jefferson, I think.  One other grandson, also named William, was a doctor.  I don’t know anything about them as doctors; I just know the silver serving plates that I inherited with “William Dock” on them with different dates and know that they were in the doctoring trade, except for my grandfather who was a trained engineer and ran coal mines.

Your father got his degree in 1884, but was medical education very different in those days?

Of course it was different.  Everything was different in those days.  What was different and very fortunate for my father was – I guess the very year he graduated – a dark, swarthy, alert Canadian came down to be Professor of Medicine at the University of Pennsylvania.  There were no interns, [and] there were no residents in those days.  My father was independently financed and so he could attach himself to Dr. [William] Osler as a volunteer – we would say resident.  He did all the autopsies under Dr. Osler’s direction and after Osler thought he could do them by himself, he did all the autopsies.  Whenever an opening occurred and people asked Osler, “Who should we get for Professor of Medicine?” he always gave them my father’s name.  So when my father was 29 – in other words in 1889 – he went to Galveston as Professor of Medicine at the University of Texas.  And when the University of Michigan wanted a professor, Dr. Osler recommended Dr. Dock, and he got that plum over at Ann Arbor and was there until 1908.  Then he went to Tulane, again on Dr. Osler’s recommendation, and was Professor there for two years.  Of course, his coming here was due entirely to Dr. Osler’s recommendation because the new Washington University was based on the Flexner family and they were closely tied to Johns Hopkins.  So Dr. Welch, who knew my father well, and the other people recommended him as the professor for the new school that they were organizing with full-time Medicine.

The first two full-time departments were at Hopkins and Washington University.  But the people who went to Hopkins as full-time professors found out in a few weeks that the money was not in that job and so they stayed on the clinical faculty but they went downtown and hung out shingles and practiced in various hospitals, as well as Hopkins.  One of these was a Canadian, whose name I always forget, but he was at Hopkins full-time for, I think, one year, and said that his growing family made it impossible for him to stay on that measly salary.  So then they got Dr. Janeway, who stayed on until pneumonia killed him off.  Then Dr. [Warfield] Longcope came on and started the distinguished line of Hopkins internists who were on full-time.

So the full-time system did survive?

Oh, yes.  They got people to do a good job.

You jumped over a stage in your father’s career – the fact that he studied abroad.

Everybody went abroad.  Dr. Osler had gone abroad from Canada.  He was a preacher’s son – not a very prosperous way to earn your living but a scholarly way to earn your living.  So Osler grew up as a scholar.  Once he had gotten his degree, he and my father, I think, went to Europe every summer.  They went as far east as Budapest and as far north as Moscow for post-graduate training.

What could one learn in Moscow?

Medicine.  They had a very good medical school there.  You know how they take blood pressures here over the arm with a stethoscope and a cuff?  That was done by a Russian by the name of [Nikolai Sergeievich] Korotkov in 1904.  There were things to learn.  You could go there and learn how to take diastolic blood pressures.  An Italian had shown how to take systolic blood pressure.  You put the cuff on and felt the wrist, and when the mercury went up and the pulse went down, that was systolic pressure.  But they didn’t know what the diastolic pressure was until Korotkov discovered how to measure this business with a stethoscope under the cuff.  It was a perfectly fabulous discovery; this is the kind of discovery I refer to as a “real discovery” in that it might never have been discovered, literally.  Doctors weren’t putting stethoscopes under the cuff when they were feeling the wrist.  Korotkov was.  So this is the difference between amateurs and professionals.  Korotkov was a wonderful fellow.  So there were things to learn in Moscow; there were things to learn in Budapest and in Vienna and Leipzig, and in Munich and in Berlin.

But Germany really was the center?

Yes.  My father went often.  He went to Germany and France and spent some weeks in each one of them because he knew Widal, who developed the test for typhoid.  The Widal test [was] the first immunological test for the presence of reaction to a disease.  He knew Hambart (?), who was a great kidney function specialist, measuring urea, which not everybody could do in his back yard.  No one had a laboratory with a technician in it in those days.  If you wanted to do anything you did it yourself.  My father was still doing his urinary sugar determinations up to the time he left Ann Arbor, and how long after that I don’t know.  I could see him do it at Ann Arbor because he had his office in our home and so you could see his laboratory, and he showed me these funny little tubes in which they did fermentation tests and measured the amount of sugar by the amount of gas that was produced by the fermentation of the sugar.  No copper reduction test in his day.  So it was a different world entirely.

Was there still a difference between French medicine and German medicine?

There always have been differences in French music and German music and French medicine, French engineering and German engineering.  The English thought both of them were rather parochial and hardly worth going to study.  So the English steadily fell behind Americans in keeping up with what was going on.  My father also went to England to study, but he went to study with a Scot named MacKenzie.  MacKenzie was a country practitioner in Lannockshire, I believe.  He was the first clinician to make tracings of pulses on smoked paper.  So he knew a lot about cardiac arrhythmias when no one else knew a damned thing about it.  The only other person, and my father immediately went to visit him, was a Hollander named Winkebach who was doing pulse wave tracings.  So Father was a friend of both MacKenzie and Winkebach because this American came to study with them when everybody in England and Holland thought they were crazy.  So they were good friends of his as long as they lived.

Do you think it was a sort of pragmatic American attitude that allowed your father to see value in somebody who had been ignored as an experimenter?

I think about the time my father was seeing the light, Bernard Shaw was writing, “Your doctor is no more a scientist than your tailor.”  And that is still true in 1981.

It’s still trial and error – is this what you’re saying?

It isn’t that that he was talking about, it was that they were not scientific.  You can be scientific and still get in trouble with trial and error.  But his point was that doctors didn’t need to be scientists; they didn’t need to do controlled experiments.  Now, everybody is beginning to point out that we put people in sanatoria for two generations for tuberculosis.  No control was ever run on patients who were allowed to stay in their own homes and be properly looked after at home where they wouldn’t get homesick.  At the same time that they were sending everybody to sanatoria they were teaching that one of the causes of tuberculosis was homesickness.  This had been taught originally by the man who invented percussion of the chest – [Josef Leopold] Auenbrugger, a Viennese.  He had good evidence that it was due to homesickness because of the people he saw with active tuberculosis, the young ones – a very high percentage – were either soldiers who’d been torn from home to be in the army and packed in barracks so the tubercle bacillus would have minimal difficulty in getting to the next patient, [or] in the cities, the girls were practically all country girls who’d come to town to earn their living either as prostitutes or laundresses or housemaids.  They were all homesick.  Even the prostitutes, apparently, were homesick.  They thought that this disease was caused by homesickness.

It was just like coronary disease is due to stress and strain – the same sort of nonsense.  Paretic insanity of the insane was due to “ambitious striving” and when they found they all had positive Wassermanns they thought that there might be a hitch in that theory and that maybe syphilis had something to do with this – not using their brains so much.  So this happened over and over again – some psychogenic causes appeared to be the cause of something and when you find the tubercle bacillus is regularly present, that psychogenic basis is entirely ignored.  It should not have been ignored, because one of the things that weakens you is being upset internally.  Having psychosomatic trouble predisposes you to tuberculosis.  I don’t know how it would predispose you to paretic insanity.  But it was certainly true that laboring men got mainly syphilis of the aorta and white-collar jobs got mainly taboparesis – syphilis of the central nervous system – which either affected their legs and made them have a funny gait or affected their brains and made them have funny behavior.  But this is the way things go in medicine.

The Wassermann test completely changed the attitude toward the causes of many lesions that were due to syphilis and had to be recognized as syphilitic when they all had positive Wassermann tests.  In the same way, when they had sputum stains for tubercle bacilli, the disease in the chest was tuberculosis if you had red bugs in it.  No matter how much you’d been thwarted in love, which was another cause of tuberculosis.  That was a big cause, both in men and women.

Is that the way all the nineteenth century heroines got consumption – thwarted in love?  Violetta in La Traviata?

The girl in Bohème, of course, coughs herself to death.

Osler reportedly said about your father that, “He is the man who knows more about clinical laboratory procedures than anyone else in the United States.”

That was because he’d studied with these Frenchmen who were measuring urea, and the English and other people who were measuring sugar in the urine.  He did quantitative studies.

So you saw the serious development of clinical laboratories?

Yes.  I not only saw it, I experienced it.  When I began as an intern we had no laboratory.  I did my own sugars in the urine and I did my own proteins in the urine.

What encouraged people to start including these laboratories in their hospitals?

You mean the sort of thing my father did or that I did as a boy?

Yes.  What kind of economic impetus or whatever sort of—

You could make an accurate diagnosis, whereas before you could only speculate.  You speculated that your patient with funny sounds in the chest probably had tuberculosis and you waited for the autopsy to see what it looked like.  With sputum and proper stain, you had it made.  You could see the bugs that were causing his disease.  You could do a Wassermann test.  When my father went off to the Spanish-American War he was at camps in Tennessee.  They were diagnosing everybody with fever there as malaria.  They were all typhoid fever.  But they didn’t know how to culture for typhoid bacilli, which my father knew.  He learned in France how to culture for typhoid bacillus and he knew how to do these immune tests which were just coming in and were not much help at the time of the Spanish-American War.  So with laboratory tests, whatever they are, whether they’re waves recorded from the vein or an artery recorded on a smoked drum, objective evidence settles the question.  The patient either has an irregular pulse of one pattern and you have a name for that or another pattern and you have a name for that.  You don’t just say he has delirium cordis, which isn’t much of a help.

It’s clear why scientists, or even physicians if you want to draw a distinction, would know this, but when it came to the people like [Robert] Brookings who were movers and shakers  behind the building of hospitals—

Well, they were influenced by the Flexner family, by Abe, particularly, not by Simon who was running the Rockefeller Hospital.  But Abe Flexner was really an earth shaker and Washington University is due entirely to the effect of Abe Flexner on not only Mr. Brookings but other people – Bixbys and Busches and so on.

So when they came to build a hospital like Barnes they planned right from the start the—

That there should be what are called clinical scientists in it.

So that was one of the major differences that you began to see at this time?

Yes.  Of course, the x-rays came along and that again was objective evidence, very important.  About the same time that they began doing these other things Roentgen had given them the way of seeing a broken bone in detail and also seeing lesions in the lung without any trouble.  The GI tract came later, after a physiologist in Boston had shown that you could visualize the stomach and the small bowel and the large bowel with barium without hurting the patient.  It’s very important not to hurt the patient as far as I’m concerned.  Testing should do a minimal amount of inconvenience and discomfort and absolutely no morbidity.  Anything that makes the patient ill or puts him at risk is not the solution to the problem.  There has to be a better way to do it.  It turns out now that isotopes and echographs are the better way to do it.

To go back to the operation of the medical school – your father was actually Dean for a couple of years.

Yes.  This was against his will.  Dr. [David L.] Edsall came here the same time my father did and Dr. Edsall was supposed to be the Dean.  He was a good politician and he saw how he could increase his status by going to Harvard and becoming the Dean of the Harvard Medical School.  My father had to take on the Dean’s job.  Within two years he recognized that the Associate Professor he had brought from Hopkins and the Rockefeller Institute, G. Canby Robinson, was far better at executive work than he was.  Far more tactful, in other words.  So Canby Robinson took over the deanship here after my father had held it for two years.  Canby did such a good job that he was taken as dean to Vanderbilt when a new school— He organized and planned the hospital and the buildings at Vanderbilt just the way my father had here at Washington University.  He was taken from Vanderbilt to Cornell when they were rebuilding and reorganizing and there he got into trouble.  The depression came on and the Payne Whitney gift to Cornell Medical School decreased by $17 million, which is quite a decrease, especially in those days when a dollar was worth about 10 of our current dollars.  So Canby was fired because the money disappeared.  But he was a good, tactful, intelligent and scientific dean.  And a charming person.

Apropos of tact – weren’t there some people who criticized your father on account of tact?

Well, my father, like me, was not tactful if he could avoid it.  He was blunt and he didn’t go out of his way to hurt people’s feelings but he didn’t go out of his way to keep from hurting people’s feelings.  I have some feeling of trying to keep out of people’s hair, but I think he never realized how seriously they took him.

He was physician-in-chief at Barnes, however, until he moved out of St. Louis altogether.

He felt, as Osler felt, that the retirement age for department heads should be around 60.  Osler thought it should be at 56 and that’s the age at which he left Hopkins to go to a highly-honored position at Oxford as Regis Professor, which allowed him to go down to London once or twice a week and make a hell of a lot of money as a consultant.  He was doing this at Baltimore because he was not a full-time teacher.  He was going to Philadelphia and Washington and New York and seeing great people in consultation.  So these men were able to make a great deal of money without seeing many medical students.

Was that true for your father, too?

No.  He was full-time here.  The last year he was not full-time he was down in New Orleans.  And he was the leading consultant for a wide belt which stretched into oil-rich Texas.  So his income the last year he was not full-time was three and one half times what his income was the next year as the full professor at Washington University.

Did he know that he was going to take such a cut when he came here?

Yes, he knew that.  And he also didn’t believe in the full-time system.  But he was a great believer in the experimental method and he thought if you didn’t seriously and honestly try to make this system work you wouldn’t know that it wasn’t the right system.  He was an odd character.

What led him to move on to Southern California?

He’d had close ties socially with Los Angeles and Pasadena through my mother’s brother-in-law, who was a millionaire through stock and bonds, which is what he went out there for.  But as soon as he got there in stock and bonds he found there was more fun in buying and selling ranches and gambling on an oil field being hit.  His name was on the firm’s office in downtown Los Angeles as long as he lived, but his main fun was in buying and selling ranches, which was wonderful for me because I learned to enjoy ranch life as a little boy.  So that’s how he happened to have ties out there.  Pasadena is a nice place to live.  Even then, Cal Tech was the center of high-powered wisdom, so you had a congenial community to be in.  Some of them were rich and some of them were wise, but they were all nice people to know.  So he made a beeline for Pasadena when he decided that the people at Washington University would be happier if he left.  After Evarts Graham came, Evarts Graham made it quite plain that my father wasn’t the kind of Professor of Medicine that he wanted to have here and gently but firmly made my father realize that what Osler told him was right.  That is, the head of a Department of Medicine should get the hell out by the time he’s 56 or, at the latest, 60.  Well, my father retired at 62.  He could have stayed until 65 under the ground rules they had.  I retired at 62 from being Professor of Medicine at the State University of New York where you could stay on till 70 because they treated a doctor just like a geology professor.  A geology professor is not the right [comparison].  A good geology professor can earn a living going out into mining and other fields – oil and mining and things like this.  It’s more like being a professor of mathematics; once you’re fired from your university there isn’t a high demand for your services.  An occasional mathematics professor does very well when he’s retired, but most of them retire.

So there are people who are retired when they retire and there are others who make more money after they’re retired than they ever did before.  My father stuck it out to 62 and Osler stuck it out in Baltimore to 56.  He gave a talk on “fixed period” which you may have heard about.  It got in all the papers all over the world when he said that it would be better for the world in general if politicians and generals and professors were retired as a matter of course soon after the age of 60.  There were cartoons showing Dr. Osler anesthetizing healthy-looking gents who’d reached this critical age.  Hippocrates’ age for senility was 56, but the definition was different.  Fifty-six was an age at which a Greek no longer could carry his sword and his shield and three-days’ food and water effectively.  He was a drag on the army after 56, on the average.  So he thought senility was when you couldn’t be counted on as helping to get the Persians the hell out of your city.

Their definition of senility must have been totally different.  It just meant becoming old, right?

Well, he couldn’t carry out the duties that were of great importance to the state.

It didn’t mean your mental capacity?

No, no.  It had nothing to do with that.

Why did you go to Stanford?

At the time I left Boston and the year of sightseeing, I wanted to work with a good clinical physiologist – in fact, in a place where there was a team of clinical physiologists.  And Stanford University had a Hopkins graduate who had been Professor of Medicine at Michigan before he went to Stanford, Albion Walter Hewlett, who was one of the best clinical physiologists in the world in his day.  The method he used for measuring the blood flow in the leg, accurately and quantitatively under varying circumstances, is still in use.  It was used in 1970 by the man who is now head of the Department of Medicine at Harvard, Eugene Braunwald, to study the reversal of the lesions in the arteries when you put people on a diet that brings down their plasma lipids and makes the xanthomas in the skin, which are yellow, fatty lesions, disappear.  As the lesions disappear from the skin, the blood flow in the leg increases.  If it hadn’t been for Hewlett and Van Zwallenberg’s technique, he wouldn’t have had a useful method of showing that the arteries are reversing at the same time as the skin is reversing.  It’s very important; it’s carefully concealed from all modern medical students.  It was in the Journal of Clinical Investigation, which is a very good journal, in 1970, and it is universally ignored.

At any rate, you went out to Stanford.

To work with Dr. Hewlett.  Dr. Hewlett met me and shook my hand and said, “Dock, I’m awfully sorry, but I have a brain tumor and I’m on my way to Philadelphia to see Frazier.  Cushing is out of the country and I don’t think this is a slowly-growing tumor.”  And with that he said good-bye to me and he died after Dr. Frazier had opened his skull and found that in fact he had an untreatable, infiltrating brain tumor.  However, another clinical physiologist was there working on kidneys: Thomas Addis.  And Addis and Oliver, Oliver was the pathologist, are still a landmark in the history of renal function and renal pathology.  Tom Addis was lots of fun.  He did me lots of good.  He had a wonderful rat laboratory and there were lots of experiments that I could do on rats that had nothing to do with their kidney function.  He allowed me to make myself at home and use all the rats I wanted.  Since I cleared up some of the things that worried him, he thought I was quite a bright boy.

Stanford in those days was located in San Francisco?

In San Francisco.  It was a wonderful place and moving out was the death of the University medical school.  They do a good job down in Palo Alto, but I still think that Cornell is right in not having its medical school in Ithaca and that the University of California is right in having its medical school in San Francisco, although the school is in Berkeley.  I think it was a mistake [at Stanford] to move the whole medical school.  It cost a great deal of money and I don’t think that the money was well invested.  So that’s one reaction to moving a medical school out of town and into the country.  Theoretically, you’re near the basic scientists and the philosophers and whatnot, but as a matter of fact, half a block is all it takes to separate these people.  I used to go down to Stanford University quite often.  Of course I was interested in some things where the library down there was essential for what I was interested in.  This was the history of mountaineering.  They had a wonderful library because David Starr Jordan had been interested in mountains and he had seen that any book on mountaineering that was published they had, over a long period of time.  I used to go down there at least once a week over a three-year period.

Did you enjoy living in San Francisco in general?

San Francisco, of course, is one of the two places in the United States that environmentally are very much worth living in.

Where is the other?

The other is New York City.  It’s not as hot in the summer as Philadelphia and Baltimore.  It’s not as cold in the winter as Boston and you don’t have to go far to get good walking in the woods.  The Hudson Palisades that are right across the George Washington Bridge are wonderful wilderness.  That’s all I need to be happy in a town.  Also, it has good music.

I take it you enjoy urban life, having chosen to live in Paris now.

Well, I’m a civilized man and civilization is dependent on cities.

Tell me about life in New York.  How did it compare?

I had a very interesting time there because I went to Cornell as one kind of a pathologist – a pathologist who’s interested in the seats and causes of disease of men, women and children.  They weren’t interested in that at all.  They were interested in people who were doing basic biological research.  My successor was an expert on the enzyme that’s present in the blood of guinea pigs but not of dogs and cats and which is the suppresser of cancer – Dr. Kidd – [who] was ideal for them.  They didn’t want somebody to explain to the students the reason that the post-operative and postpartum death rate in the first two weeks is five times as high at the New York Hospital as it is at Bellevue Hospital.  This is pulmonary embolism, post-operative or postpartum, which can kill you.  It can also give you lesions in the lungs that heal and there are more of these than there are fatal ones, and they’re easily diagnosed with x-rays.  So an obstetrician who says you’ve got to keep a girl in bed for two weeks after she delivers and a professor of surgery who says you’ve got to keep her in bed for two weeks after she has her breast off, didn’t like to have the sophomores being shown objective evidence, statistical evidence, the kind of evidence that led Oliver Wendell Holmes to preach about the horrors of doctors transmitting puerperal sepsis and [Ignaz] Semmelweis in Budapest doing the same thing over there – that puerperal sepsis is a doctor-transmitted illness.

I guess you’re really talking about two very different philosophies of operating a medical school then.

As far as I’m concerned, the professor of pathology has to be split into three.  There has to be an experimental pathologist, there has to be surgical pathologist, dealing with all these tissues, and there has to be a pathologist who’s interested in seeing that autopsies are meticulously done and sections are properly studied and you learn all you can from the dead.

I guess you have no particular objection to the experimental [pathologist].

In my department I had some very good experimental pathologists and I would have thought that doing autopsies was a waste of time for them.

What you were objecting to was somebody telling you that the clinical aspects of—

That there was no need for a man who could do autopsies properly.

What advantages did moving on to the Long Island school—?

It got me back into clinical medicine.

They were less interested in this—?

Brooklyn is a very big community and there’s only one medical school in it.  They had extremely competent people there.  The professor of surgery had been trained, like everybody in his generation that was any good, by [William] Halstead at Hopkins.  He was a Hopkins graduate.  He had made some very useful contributions to our knowledge of thyroid disease.

Who was this person?

Emil Goetz was his name, [spells] G-o-e-t-z.  He was a Hopkins graduate and he was the professor of surgery who was my opposite number when I went there in Medicine.  And they had Gene Oliver there in Pathology and he was the leading authority on the pathology of the kidney.  Even after retirement, the boys down at HEW were subsidizing him to do renal pathology in relation to their experimental work.  So he was still active 10 years after retirement and being well-supported in terms of research – technicians, secretarial help and things of that sort.  So I had very good colleagues there in Brooklyn and I knew this.  They had never had a full-time Chief of Medicine.  I could afford to go there as full-time Chief of Medicine and not have any private practice.  I let people know when I got there that any doctor who wants me to see any patient in consultation, whether the patient can pay for it or not doesn’t make any difference, but if the doctor and I can learn something from seeing the patient together I’d be delighted – I had a car – I’d be delighted to go to the patient’s home or wherever he wants to have me see the patient.  If the doctor thinks the patient should be paying a bill, I’ll send the bill that he thinks is appropriate.  This made me quite popular in the community because practically everybody who moved in there tried to make as much money as possible.  Dr. Goetz did, naturally, and the internists that had been there had all had downtown offices until I got there.  So I was more popular in Brooklyn than anyplace any Dock has ever been, I think, except the ones who were older (who were very popular) than my father because they weren’t mixed up with teaching institutions at all.

What did the internists think?  You didn’t bar them from practice outside?

No.  I was free to practice outside but not have an office.  The people would have to come to see me.  There were facilities provided where I could have seen outpatients.  The only people I ever saw as outpatients there were doctors and their relatives.  I don’t like to compete with the doctors in town for a practice.  I think it’s a serious error.  In that respect, full-time is sensible – to keep them out of competition.  The town and gown problem disappears as long as you don’t compete between town and gown.  I never had any trouble.  In fact, I had only been in Brooklyn a few years before they insisted on my becoming the vice president of the county medical society – the last job I wanted.  When I took this on I said, “It’s now understood that I’m not running for president in the future; you’ll have to find somebody else that would like to be president.”

What was it like to be at the V.A.?

The V.A. was agreeable.  It’s a demoralizing place for doctors and it’s particularly hard to staff a V.A. hospital in a relatively high-expense town like Brooklyn or Manhattan.  When you think that the federal government pays the same salary for the same title in a 1,500-bed hospital in Manhattan as it does for a 400-bed hospital right next to a golf course up in Fall River Junction [ed. note: White River Junction] or whatever it is that’s across the river from Dartmouth!  If you pay salaries like that, all the good people are going to be where their wives want to be and it certainly isn’t Brooklyn.  So they just defeat themselves by having the same salary for the title regardless of the clinical load that you’re responsible for and regardless of the cost of living in the community.  It’s just insane.  So we had an awful time getting decent doctors in Brooklyn, and they have the same problem in Manhattan.  Whereas up at the V.A. Hospital at White River Junction, they have no trouble recruiting staff there.  Wives like to live there and men like to work there.

Do you think the V.A. is a necessary institution?

No, I think it’s a very bad business.  Once you got all the various Medicaids and so on it should have been abolished.  They should have sold these V.A.s for whatever they could sell them for and go out of the business.  If they want to have an out-patient clinic in towns to size up what the patient needs and see that he goes to the right place, that’s all right with me, but I don’t think the V.A. should be practicing medicine.  They keep people in very long.  As an example, when I was a consultant after I’d gone out of business and was going over as a consultant, I saw a man one day who’d been there for four weeks.  He was ambulatory, of course – he was going downstairs three or four times a day to buy cigarettes and candy and milkshakes.  So there was no point in having him occupy a hospital bed, quite obviously.  He had been there four weeks.  They were interested in his blood because he happened to be on a service where a hematologist was on service.  They overlooked completely what he’d come there for – he had urinary incontinence and they never even put through a consult for a urologist.  When I made ward rounds I chatted with him a bit and said, “Was it difficult for your family to take care of you at home?”  He said, “It was difficult for my family because I peed in bed.”  No one had gotten this information from him in four weeks.  So, it’s not a place that makes for ideal clinical medicine.  There are good doctors in those places and there are extremely bad doctors.  There are good doctors who are lazy and don’t use their full capacity.  So the V.A. is not a well-run show; at least the ones I’ve known.

The V.A. Hospital at the University of Washington at Seattle is a splendid teaching hospital.  Paul Beeson was Professor of Medicine at Yale and then was the Nuffield Professor of Medicine at Oxford till retirement age – there is no retirement age in the V.A. – and one of his former students was Chief of Medicine and had him come out as Distinguished Service Professor, full-time at the V.A. Hospital there.  So they have in the V.A. Hospital there five men who are members of the Association of American Physicians.  At Long Island we had a peak level of three and after Dr. Austrian (?) and I left they’ve only had one man who belongs to that top-level internists club – the Old Turks.  They have five [ed. note: this apparently refers to the number of members of the Association of American Physicians on staff in Seattle] at the V.A. Hospital and they have four more in the medical school at the University of Washington.  I regard that school as competing with Washington University and the University of Chicago as among the best medical schools in the country.  [It’s] better than Hopkins and better than the University of Pennsylvania, certainly – better than either Columbia or Cornell.  So you can have a V.A. Hospital – if it has the right connections and wants to have a V.A. Hospital – that’s as good as anything you can get anywhere.  So it isn’t because it’s a V.A. Hospital, it’s because it isn’t properly sponsored.  Here, I think, you have a fairly well-sponsored V.A. Hospital from what I’ve heard.  Bill Danforth worked there at one time.

Tell me about life in Paris.

When I went there I had a working objective.  I wanted to write up the history of Henri Becquerel and the discovery of radioactivity.  Unlike the discovery of the Korotkov sound, this is a discovery that didn’t need to be made.  You could have gone another 200 years without making it.  So the history of that discovery seemed to me a top-level thing to work on.  I’m not a very good writer, but I did the best I could and soon found that the story went back to 1626 when the Garden of Plants was inaugurated and financed by the King.  It was the King’s Garden of Medicinal Plants when it was founded.

We’re sorry, we’ve run out of time.  This is the end of Oral History #53.


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