This is the interview with Dr. Robert J. Glaser and it’s March 7, 1985. To begin at the beginning, Dr. Glaser, you were born in St. Louis, I understand, in 1918, son of Joseph and Regina Glaser, right? Were they long-time St. Louisans?
Essentially yes. They lived here until my father retired in 1959 when he was sixty-five. I was born in the forerunner of St. Louis Maternity Hospital, which was then not out here at the medical center. I think it was someplace else.
What was it called?
It was called St. Louis Maternity Hospital but it wasn’t in this complex. At least that’s my understanding. My wife, who is a physician and a graduate of this medical school, was born in the same place; my children were born here, so we have a long connection going back to the beginning. I grew up in South St. Louis till I was about nine years old. In 1927 we moved out to University Hills, just a few blocks behind the University campus. I went to the public schools, Flynn Park School, University City Junior High and University City Senior High. Of course, it was a much smaller place. I recall [that] when I was a high school student there were only 800 students in the whole high school.
Were you there when they had the big real estate boom with the mayor who built the tower?
No, that was all before. I’m old but not that old. That, as I understand it, was right after the World’s Fair, in the period before World War I. But I’m not sure.
You did your undergraduate studies at Harvard College and received a bachelor’s degree in Science in 1940?
Right. I went there in the first wave of the public high school kids from the west. When Jim Conant became president of Harvard in 1932 or 1933, he was very anxious to make Harvard a more national university. Of course it was a distinguished university but it still had, at least in the undergraduate body, a very high preponderance of people from New England – the New England prep schools. In those days because the public schools, at least outside maybe Boston and New York, didn’t prepare people for College Boards, unless you happened to go to private school here you weren’t in much position to apply. He instituted what was called the “upper seventh rule.” If you were in the upper seventh of your class, one of the boys in your class, you could apply without taking National Boards.
I never had any intention of going anywhere except Washington University because we lived right behind it. I’d known I wanted to go to medical school since I was nine. I’d had a lot of trouble with my leg and a bunch of operations and I’d gotten turned on to medicine when I was a young kid. When I was a junior in high school one night we were sitting around the fire talking. My father, was in a firm here in which one of the people who went to Yale and Harvard Business School was a close associate, said “How would you like to go to Harvard or Yale?” I only knew those places from history books, but it sounded pretty good.
My father’s firm had an office in New York and he used to go there fairly often. He went up to Cambridge and found out about the program and I applied and got in. I think from University City High School there had been only one other person who had gone to Harvard. In my class there were three of us and subsequently that program attracted many people from all over the country. It was quite an interesting experience for me because I had never been anywhere, except maybe to Michigan for a couple of weeks in the summer. Harvard was a totally different place. In those days it was a different culture, if you will. I was fascinated by it and I had a wonderful time at Harvard College. It was a great place. Like all universities it was much smaller [then].
Was premedical study as intense as it is now?
No. There was competition to get into medical school and I’m not sure the statistics would have been greatly different. As you know, there are now 128 medical schools and there were only 80, I think, at that time. There was competition, I suppose, but nothing like developed in more recent years. It’s always been a source of pain to me to see the kind of dog-eat-dog business that goes on. In my class I think there were about 1,000 people – all men in my time at Harvard. I think about 125 or so were premedical students. But I never remember any feeling of competition. We all worked together in courses we were in. There was a rumor around Harvard in my time that if you wanted to go to the Harvard Medical School that you had to get at least a B in organic chemistry, which was the big course that everybody had to take. So I did a moderate amount of work in chemistry.
I’m ashamed to say today that I didn’t work very hard at Harvard College. I had an absolutely wonderful time. I had a very good record in high school, but I’ve never really learned how to study. It’s quite interesting – that’s one of the things that prep schools, particularly in those days, really did. I had lots of friends who came from the well-known prep schools in the east and I think the discipline there was much tougher. I had a wonderful English teacher at University City Senior High School. My senior English course included a very detailed study of Hamlet and Macbeth, which I still look back on as one of the high points of my education. She was as good a teacher as I ever saw anywhere. But, on the other hand, I took physics and I didn’t really learn very much; part [of it] may be my fault. But it was pretty unsophisticated.
In those days a lot of the courses at Harvard were beginning courses. And then they had courses “for those with school physics or school chemistry.” “School” meaning Exeter or Andover – places like that. I got into an advanced physics course because I’d had high school physics and I didn’t know what they were talking about from the first day to the last. It was given by a couple of hot rod atomic physicists, J. Curry Street and Ken T. Bainbridge, who went on to great fame. And I just wasn’t prepared for it. As a matter of fact, I got a D in physics. But I got a B in Chem II and a B in advanced biology and I guess I did very well on the Medical College Aptitude Test. At any rate, the answer is that I didn’t have a great feeling of competitiveness.
Although I concentrated on biochemical sciences, I took a course in music history [and] the famous survey course in fine arts. Again, I look back on those as very high points in my education because they opened up— I liked music but didn’t know much about it. I still don’t, but it was a wonderful experience – both of them taught by distinguished members of the Harvard faculty. In those days, many of the beginning courses, particularly, were taught by the great names of the Harvard faculty. I found that interesting.
At any rate, I went along with a very undistinguished undergraduate record. After I got that D in physics I was terrified. I thought “My God, there goes my career.” I remember going down to the medical school to see a man named [William] Worth Hale, who was the Assistant Dean of Students. He was really a czar. They had a committee but Worth Hale was the guy who really decided if you got into medical school or not, I think. Funny guy – I think he was a pharmacologist, but not really a very distinguished one. I don’t think he ever had a tenured appointment at Harvard. He had a twinkle in his eye. I walked in and told him that I’d gotten this grade and that I’d really wanted to go to medical school since I was nine years old and that I’d gotten into a course that was over my head. And he looked over and said, “You know, if you had to depend on your grades to get into this medical school you wouldn’t have a chance anyway. Why don’t you just keep having a good time?” I later was chairman of the admissions committee here and I don’t think I would have put it quite that way.
The facts were, I had done a lot of other things. I was chairman of my house committee and a lot of other stuff and my tutor, Dr. Ronald Terry, who was also master of Winthrop House, the undergraduate house in which I lived, knew me well. I think what Worth Hale did in those days was [give his approval] if you came from a college that he knew well, as he obviously did the Ivy League colleges and some small liberal arts colleges scattered around – several in Michigan, he’d originally come from there. And [he gave approval] if somebody he respected said “This guy’s all right”, and if you had some credentials – as I say I did do pretty well in an advanced chemistry course. Subsequently, years later when I was dean here I looked up my medical college admission tests and I was in the 98th percentile, and I’m sure that helped. I only applied to three medical schools: Harvard, Yale and Columbia University College of Physicians and Surgeons. I got turned down by Yale by return mail, got into Harvard and Columbia and said “never mind” because I really didn’t want to go there to medical school.
As I said, I had a marvelous time at Harvard. It was a very broadening experience and I made a great many friends. Staying there for medical school there were something like 25 guys from my Harvard College class out of 125 students in the medical school. So, I spent eight years in Boston and never had any intention of coming back to St. Louis. But I did.
You mentioned your father’s firm. What was the firm?
It was called Curlee Clothing Co. It was a firm that was started in the South by a fellow named Shelby Curlee. In its time it was a very large company which did very well. His great friend was Shelby Curlee, Jr., who was somewhat younger than my father. He was the guy who went to Yale and to Harvard Business School. Unfortunately, old man Curlee and Shelby, Jr. both died in the same year and the firm really didn’t move with the times. For example, at the end of World War II it was a larger company than Levi Strauss. Old Mr. Curlee came from Corinth, Miss. I never did understand how he got in the clothing business, but they sold nationally. They had a very fine reputation and my father spent his whole career there and he was vice-president of the company and in charge of all the woolen buying. His trips to New York were involved in buying the woolens that they used to make clothes. A lot of the New England mills were owned by old Yankee families, so people like the Stevenses were great friends of his and when he got to looking into colleges that was one of the ways he found out what he needed for me to apply.
What are your most important memories from your medical studies?
I had a great time at medical school. I’ve had a pretty good time all the way along the line. I didn’t much enjoy the first few months because I didn’t like anatomy. I’d been looking forward to going to medical school since I was nine years old and the very first day in anatomy we got up there in the dissecting room. We used to have four people to a cadaver and the three guys I was with were all people I’d known at Harvard – we were all good friends. They seemed to be enjoying it like mad and starting to do the dissection. The smell of the formaldehyde got me and I still remember walking back to lunch after doing dissection that whole first morning. I’d pick up a roll and smell that mixture of formaldehyde and dead body and I was really very unhappy.
It’s a funny thing the way something that seems minor can influence you. I was walking back across the street with a classmate of mine from Harvard who’d done brilliantly in chemistry. He said “How do you like it?” With a bravado act I said “Oh, it’s okay.” I said, “How do you like it?’ and he said “I hate it. I wish I’d stayed in chemistry.” Well, I thought everybody was loving it – all these other guys seemed to be having a great time. Then I suddenly realized the obvious fact – that everybody was putting on a big act. Probably a lot of people found it not very— I never did like anatomy very much but I went along. At any rate, from there on out I really enjoyed it. I worked harder than I did in college and did reasonably well in medical school. I loved getting into biochemistry and ultimately bacteriology and pathology and into the clinical fields. I had a marvelous time from there on out.
There were only eight guys in my whole class who were married in those days. We lived in the dormitory and when I started taking clerkships I’d go down to the hospital early in the morning and I’d stay till eleven o’clock at night. I worked at the Brigham, the Mass General, Beth Israel – we’d take clerkships in different places. Again, the places were smaller in those days and the big names were people you got to know. I took an elective at the Boston City Hospital, Harvard services there, with Dr. George Minot, the Nobel prize winner and got to know him very well. I knew all those people and they knew me; they knew all the people in the class, so there was a wonderful esprit. Since I wasn’t married if I finished working up my patient I’d go hang around the emergency ward or something and had a very, very good time.
I assumed I was doing all right although it was amusing because in our senior year – we all knew that theoretically you could graduate with honors – and toward the end of the spring notices suddenly appeared calling you in for an examination. I should say about the competition, even in medical school we never got our grades. We’d get grades on blue books and things – it wasn’t a pass/fail system – but you never got grades at the end of the year, nor ranking. You were only told when you came in that if you were in trouble you’d know about it and if you didn’t hear to the contrary that you could assume that you were doing all right. So one never knew how he was doing, really. In the basic science course you would have these exams from time to time and you’d get a blue book back with a grade on it, but it wasn’t a final grade. It wasn’t like college where you could put a postcard in your blue book and you’d get a [final] grade.
At any rate, I got one of these letters saying I was supposed to come up for an examination at the Brigham. I honestly thought I was a control because it was always rumored that there was some guy who was a control. So I went in and it was quite a rigorous experience. You got to the hospital in the morning and they’d assign a case to you. And you’d go down and work it up and you came up and there were five distinguished senior faculty members sitting there. They’d ask about the case you saw and have a lot of questions. When that was over somebody came around with a little box and you’d reach in and pull out a piece of paper that had a title on it – a subject.
Again, luck has a lot to do with one’s career. I’d spent this elective with Dr. Minot at the Thorndike Memorial Laboratory, which was a great center for hematology in those days. Most of the day I’d spent working in the lab and reading literature. Lo and behold I pull out a slip that said discuss the medical and surgical significance of an anemia of a red count of two million. Well, I sat down there and you only had about five or ten minutes to organize your speech, but I got in there and I knew a lot about anemias because I’d been doing it for a month. Now if they’d asked me to discuss multiple sclerosis it would have been another— I began to orate and after five or six minutes they said “fine” and “thanks” and “good-bye.” Well, I got one of two magnas in my class. I tell you, nobody was more shocked than I because, as I say I thought I was a control in the exam and needless to say, I was thrilled and delighted and very happy.
A control meaning that you would be the mediocrity?
I still don’t know to this day. The story was that they called up some people who apparently had outstanding records. But it was always thought that they called up a few, perfectly adequate, just in contrast. Clearly, I wasn’t a control and I don’t know that there were any controls. I don’t know how that story got started. A day or two later they posted on the bulletin board that a guy and I got a magna and other people got cums, but it was a great thrill. It was a wonderful way to end one’s medical school education.
Did you ever have a yen during those medical school years to go into basic sciences as opposed to clinical?
No, I never really did. I was very interested in clinical medicine. I went to medical school wanting to be an orthopedist. I had this congenital problem with my leg and had a lot of operations. Until I was nine years old I was scared to death of doctors. My mother literally had to take a newspaper along when she’d take me to the doctor for anything because I was liable to upchuck from fright. But when I had these operations done by Dr. Leroy Abbot who was then the professor of orthopedic surgery here, given the terrible situation I had – really a mixed-up leg problem – they did quite a good job. While I was in the hospital at age nine I decided I wanted to be a doctor. I never wavered from that point. I remember writing the essay you had to write about why you wanted to go to medical school and saying that I wanted to be an orthopod. Well, it wasn’t long after I got there that I didn’t want to be an orthpod, but I got interested in internal medicine. I didn’t really go into medical school thinking that I was going to end up in an academic career. But things went well and my years back here had a lot to do with my ultimate decision, because as you know when I finished medical school I came here.
I had a very funny experience. We were sped up during the war. I would have graduated normally in June 1944 and I graduated in December 1943. We were the second class – the first class got out three months ahead and we got out six months ahead. I was in 1943B. A and B still reune [sic] together.
I said to you earlier that luck has a lot to do with it and I really believe that. There are all kinds of little things if one looks back over his career – anatomy for example. I didn’t like anatomy, I didn’t study it very hard. One of the exams, [and] there were only three or four [one] hour exams, I happened to study the circulation around the knee as I was walking across the street to take the exam. Don’t ask why, I just happened to open the book. What was there on the exam? Describe the circulation around the knee. Well, I wasn’t an ace on it but I’d just looked at it four minutes before. They could have asked me sixteen other things and I would have flubbed up. So, I think it’s worth keeping a degree of humility as to why something goes well.
Anyway, in those days, Harvard had its own matching plan. Now when people apply for internships it’s a national matching plan. In those days there wasn’t one but at Harvard they had their own little local one. I’d never had any intention of not staying in Boston. I’d had a wonderful time at the medical school, I’d worked at the Brigham, I’d worked at the other places and I was very torn between applying for an internship in medicine on the Harvard services at the Boston City and at the Mass General. I’d had third year medicine at the Boston City and I’d had an elective [there]. I’d had fourth year medicine at the General, and they were both great fun. I was really torn. Bob Williams, who later went on to be Professor of Medicine at the University of Washington in Seattle, had been my instructor in third year medicine and he was very anxious for me to come down to the City. They weren’t supposed to make any promises, but he was a great one. He closed the door and said “Now if you tell me you put this first I’ll guarantee you’ll have a job.” Dr. Bill [W. H.] Daughaday, who was my classmate and a distinguished professor here did intern down there.
At any rate, I had taken third year medicine with Williams. He’d been at Hopkins for his training; he knew Barry Wood. Barry Wood was a great name around Harvard, particularly when I was a student. He graduated in 1932, I graduated in 1940. As you know, he was an All-American football player, he graduated summa cum laude; you name it, he was it. Every football program had his name in it and he was really a legendary figure. I think back on it now – he came here at age thirty-two. I’ve got two kids older than thirty-two and they’re still kids to me, but Barry was like a great Olympian god. I was coming home for Christmas toward the end of my third year and Bob Williams said “While you’re in St. Louis, why don’t you go meet Dr. Wood?” I said, “I’d love to.” So he said, “I’ll write him a note.” So he wrote him a note and another guy and I came in and met Barry and he was very pleasant. I didn’t talk to him about coming to St. Louis; I didn’t have any intention of coming to St. Louis. He’d just gotten here.
The following March when we had to turn this local matching plan into Harvard, literally the night before it was due, I came home from the hospital. I was working at the Mass General. [It was] about 9:30 at night and there was a letter under my door from Barry Wood. It had been misdirected; it had been sent to Cambridge and had taken about ten days to get over to the medical school. It said, “I remember meeting you at Christmas. I’m about to appoint interns and I wondered if you’d like to come here.” I’d never, obviously, given it a second thought. On the spur of the moment – it’s a fairly big decision where you intern and I was struggling over it – I got on the telephone. Making a long-distance call in 1943 was a big deal, at least for me. It cost money and you didn’t do it. I called Barry and said “Dr. Wood, I got your letter but it’s been lost for a few days. I presume you’ve made the appointment.” He said, “No, I’ve been hoping to hear from you.” I said, “I’ll come.” I said “Shall I send an application?” He said, “Oh, no. Have Dr. Hale write me a letter.”
That’s the way I decided to come to St. Louis. It seems incredible. Of course, Barry had just come here. I think he was anxious to start – you know, the medical school had a great reputation, but frankly when I first came back here it hadn’t attracted as many people from some of the comparably distinguished schools in the east. I think he probably thought it would be a nice thing. At any rate, that’s how I came to St. Louis. On January 1, 1944 I came back here as an intern. I hadn’t been here more than a couple of months when Dr. J. Howard Means who was Professor of Medicine at the Mass General and Dr. George Thorne who was Professor of Medicine at the Brigham each wrote me and asked if I wanted to come back as an assistant resident. In part I think that reflected the fact that they thought I was reasonably able. Also, keep in mind that this was during the war and it was clear I wasn’t going to get pulled into the war and I think they were anxious to have somebody who had the likely continuity.
I remember going up to see Dr. Wood. I’d only been here two months and Barnes Hospital was a little different from the General or the Brigham and I’m sure it was a sign of immaturity. It didn’t seem like Harvard; I didn’t have the feeling it was quite the same, and so I decided that I ought to go back to Harvard. And he said, “Why don’t you wait and see how it goes here?” Now Means wanted me to cut my internship short to come back and Barry wouldn’t hear of that. Thorne wanted me to come at the end of the year and I went ahead and said I’d go back and I don’t think Barry was very happy about it.
By the time I finished my internship I had come to realize what a wonderful spot it [Barnes] was. I really had a very good time and it was a stimulating place. Of course it wasn’t as huge as it is now, but it was a hell of a good place. So, I went back to the Brigham.
So you had been here for six months at Barnes?
No, I was here nine [months]. Instead of a year, they shortened it because of the war. I started January 1 and September 30 I left and went to Peter Bent Brigham where I was one of only two assistant residents because during the war things were short. What Barry Wood had done – they all had quotas as to how many house officers they could take in those days because of the war – what he had done, wisely, was to take more assistant residents, fewer interns, and then get really top notch fourth-year students to be part-time interns. Sam Guze was a student intern when I was here and that worked much better. George Thorne hadn’t done that. He took a full complement of interns but only two assistant residents. So a guy who had been a classmate of mine at Harvard and I were the only two assistant residents and we worked our tails off covering the whole medical service. For weeks on end we wouldn’t even get out of the hospital because we were so busy.
The Brigham was a good place, but I realized how much I enjoyed this place [Barnes]. In a sense Dr. Wood did just what Means and Thorne had done. I hadn’t been at the Brigham more than a month and a half or two when Barry wrote me and asked if I wouldn’t like to come back as senior assistant resident on the medical service at Barnes Hospital. In those days we had a ward service and a private service. The ward service was the elite teaching service. In those days the plum jobs were on the ward teaching service. The private service was not bad but it didn’t have the same prestige and there was quite a distinction made. Now they’ve finally put them all together but you were always very careful to say “Resident on the ward medical service.”
Well, I came back. Dr. Thorne wanted me to stay and become chief resident, but I decided to come back. So in July 1945 I returned here as senior assistant resident and then Barry asked me to be the chief resident which I began the following April. And then I was chief resident for 15 months because by that time they were going back to a year schedule, so I started three months early as chief resident and finished my residency in 1947.
I had a great time. Barry Wood was a remarkable guy. He was, I thought, one of the two or three best teachers I’ve ever seen. He was a very good clinician and allegedly hadn’t been when he first came. He was a terribly intense guy and as you probably know he died at age sixty-one of a coronary. If you would have asked anybody who knew him to name somebody who wasn’t going to have a coronary it would have been Barry Wood. He never gained a pound, he continued to be an active athlete, he didn’t smoke, drink – didn’t do any of that sort of thing. Mac Harvey, who was his contemporary at Hopkins and for many years professor of medicine at Hopkins, said when Barry died that Barry’s death was the greatest invitation to dissolute living that he’d ever heard. Because Barry always did it exactly right. He was in some ways a very intense sort of guy. People didn’t realize that. He could be very pleasant and charming, but when his door was closed it was really closed. He worked very, very hard.
In later years I got to know him in a different way than I had as a young guy and his wife told me that he used to program everything. Apparently, even as an undergraduate he’d schedule 5:30-6:00, read the paper; 6:30, eat; 6:30-8:00, study chemistry, and so on. He had a bad family history – both his mother and father had coronaries. But I think that inwardly Barry was much tenser than most people. He was devoted to science. I think the thing he would have really loved was to make a great contribution to basic science. He did very good research, [but] I don’t think he made a seminal contribution. He was great fun. He was adored by the house staff but also highly respected – there was a certain line between them.
In those days, as chief resident you would meet him every morning at 8:30 to report and you’d tell him about all the patients who came in the night before and anything that was going on in the service. It was wonderful. For 15 months I’d sit up there every morning. He wasn’t gone much because in those days people didn’t travel the way they do now. He did some things in Washington during the war, but he was around a lot. After the war – I didn’t get married until after I finished my fellowship – we began to have a fair number of married people who came back from the war. But as house officers throughout my residency when you were on call you lived in the hospital. There was a lot of esprit and a lot of informal education went on in the evening, including poker games and various other things. But if you got a very sick patient at two o’clock in the morning you’d call the chief up and talk to him about it. It was a great thing in that respect and he [Dr. Wood] would make rounds on every ward once a week and he’d come to see sick patients if you wanted. I guess I got more interested in staying in academic medicine. This was a place – people like Carl Moore and all the others who were here. When I got my first appointment in the Department of Medicine, as instructor, there were only twelve full-time people. We could sit down at a table and have lunch together.
The way it was organized here is each senior assistant resident had one area of, if you will, specialization. It was the Hopkins system – Barry organized it very much the way Hopkins was organized. When he first invited me to come back, he advised me that I could be the hematology fellow with Carl Moore – I’d had hematology earlier. I decided I wanted to do infectious disease so I could work with him and he said, “Fine.” So while I was a house officer I got involved in some clinical research – it was when penicillin was first coming in and we had studies for the National Research Council and we studied syphilis and bacterial endocarditis and I wrote a few papers with Carl Harford and others.
And then I was nominated by Barry for a National Research Council fellowship in the medical sciences. In those days there were only twelve such fellowships in the country – there weren’t all the NIH things. So, if you wanted to go into academic medicine you really had to want to go into it. You didn’t do it because it paid well. I remember Barry saying that if you wanted an academic career you ought to be prepared to sacrifice. Well, I don’t think that’s a good way to do it, but I didn’t have any money. The year I was a chief resident I got paid all of $100 a month. Of course I had room, board and laundry. But I decided I wanted to do it and I was fortunate enough to get one of those [fellowships]. And so I spent two years up in the lab working on streptococcus and its relationship to rheumatic fever.
You were technically an assistant in medicine with the School of Medicine by this time?
Yes. I guess it’s still true – when you were on the ward service you got a title as an assistant in recognition of the fact that you did a lot of teaching. So I had that appointment as an assistant in medicine. And in those two years I worked essentially full-time in the lab. I think I maintained a half-day a week clinic for kids I was studying with rheumatic heart disease. But basically I was full-time in research. Barry had an active research program with the pneumococcus but I did a lot of what I did with him and he was co-author on a couple of papers with me.
As was Carl Harford.
Carl Harford was in the clinical studies, not in my basic research. I eventually got a technician and then I had a couple of students working with me. One of them, Jim Darnell, who’s now the Astor Professor of Virology at Rockefeller University, is one of the great basic scientists. The other, a guy named Steve Morse, came here as a medical student and became professor of microbiology at the [SUNY] Downstate Medical Center. Unfortunately, he died of rheumatic heart disease. I was very proud of the fact that the students who worked with me all went on to far greater things.
I met my wife, who was a fourth-year student when I was the chief resident. She had a heritage here because her mother and father both had gone to medical school [Washington University School of Medicine]. I taught the section on therapeutics. That was the chief resident’s job for the clerks in medicine. I spotted her then, but everybody was very uptight back then. I didn’t even ask her for a date; I didn’t know how that would look at that point. But the first day she came back to the Children’s Hospital as an assistant resident I called her up and embarked on a vigorous courtship. We got married when I was finishing my fellowship and she was a junior assistant resident. She finished the residency over there – just barely made it because she was highly pregnant by the time she finished. Our first child was born about three months after I became an instructor.
She was the former Helen Hofsommer – is that correct?
Right. Of Webster Groves.
And she was the daughter, as you said, of physicians, Armin and Aphrodite Hofsommer [ed. note: both graduates of the Washington University School of Medicine, 1922]. Evidently, your mother-in-law must have been a very early female graduate of this medical school.
Yes. She was the first woman admitted here. She got admitted during World War I. She always remembered the fact that a faculty member, a guy named Nathaniel Allison, told her that they’d take her because the men were off at war, but if they came back they might have to throw her out. She never felt kindly about that. She and Helen’s father were classmates. He became a pediatrician. He trained with Alex Hartmann. I guess they were almost contemporaries, although Hartmann, I think, was a little ahead of him. He had his residency at Children’s Hospital and was a very much-beloved pediatrician in Webster Groves.
Helen’s mother became a school physician. She couldn’t get an internship because they wouldn’t take a woman intern. She also was a very talented artist. She illustrated an ophthalmology book that Wiener [Meyer Wiener] who was a very well-known ophthalmologist here [wrote]. She also did some work for Ernie Sachs, who was a professor of neurosurgery. And Helen’s brother went to the medical school here, so she has a very long series of attachments. She was trained in pediatrics at the Children’s [St. Louis Children’s Hospital] and got very interested in the relationship between pediatrics and psychiatry. She had the courage at age 46 to decide to take formal residency training in psychiatry. She took four years of residency and is qualified now in child and adult psychiatry and is an associate professor of pediatrics and psychiatry at Stanford. So she’s got a very good position. She practices and teaches and joins me in editing the Pharos, which is the journal of Alpha Omega Alpha.
Back to infectious diseases here. You tell a story in one of your articles about how penicillin was such a rare commodity – at least for research – during the war that it was locked up in a vault every night.
Oh, there’s no question. Part of my job as senior assistant resident on infectious disease, was that we had this program as part of the National Research Council study, on what penicillin would do and what it wouldn’t do. Nowadays nobody thinks about that, but when it came along there was some debate even whether it would be good in bacterial endocarditis. We’d get a shipment in and we’d keep it up on the tenth floor of the McMillan Hospital where our laboratories were, and when a case came in with bacterial endocarditis or syphilis, which were the two things we were studying, I would go see the patient. Carl Harford and Barry Wood were, of course, the senior investigators. But I would see the patient and if it was decided that the patient would come into the study then I’d go up and get a couple of vials.
But it was so precious that we published our paper on bacterial endocarditis treating patients with 40,000 units of penicillin every two hours. Let me just put that in context for you: if you were treating a patient with bacterial endocarditis today you would treat them with hundreds of thousands of units. But it was so scarce you couldn’t do that. It was remarkable – because of course there weren’t any resistant organisms at that time. Most of the organisms we were treating were exquisitely sensitive. But I’d go up and get it and we’d mix it.
I remember one time a nurse did spill some on the floor and we spent an hour and a half trying to figure out how to reclaim it. It was just very, very rare and you could only use it in those patients who were entered into the study. It was produced in those days by a fermentation process and what was being produced was largely was being sent overseas because of the problem of infections in the military. The only things that were going on in this country were the scientific studies of what it would and wouldn’t do. It was pretty clear that it was going to be effective in certain kinds of infections.
What happened was that the fermentation process was something that the distilleries understood. So the Hiram Walker Distillery in Peoria was pressed into duty to make penicillin. They knew how to do it on a big scale. And pretty soon, within a couple of years, penicillin did become relatively available. It’s interesting for me to look back and think how rare it was and how hard it was to get. You didn’t give to anybody unless they fit into these particular categories.
In 1947 you had your first taste of academic administration by becoming an assistant dean, at least for seven months. You replaced Dr. Franklin Walton. Did this concern his performance in any way?
I was the chief resident at that point. I knew Bob Moore who was the dean. I didn’t know him as “Bob” in those days, I knew him as “Dr. Moore.” He was also the Professor of Pathology. He was a superb pathologist and a wonderful teacher. He was of that old school. He’d studied pathology intensely in Europe in an earlier day when all the pathologists were really there. Bob Moore could come to a CPC or a conference or something and I knew damn well he’d never seen the case before. But he knew so much he could get up and you wouldn’t have known. It was beautiful; it wasn’t made up, he just had seen it all.
So I got to know him a little that way. Once or twice he came up to discuss cases and I’d pull the literature out on them and he’d be impressed with the fact that I’d done that. Again, in the days when nobody was married I’d come over to this library every day. There were two tables – there weren’t nearly as many journals, of course – but the new journals would go on this table, next they’d go on that table and next they would go on the shelf. So I’d look at literally every journal that came in. I obviously didn’t read them all but I was young and had a better memory than I have today so I’d have a pretty good idea of who was writing about what. Barry Wood once paid me the great compliment, saying I was the best assistant resident he’d ever seen. I think that wasn’t because I was a genius. I did know a fair amount and I don’t make any bones about the fact that I'm reasonably bright, but I worked at it and I had a great time working. I mean I just got a great joy out of it. If you were here you were just immersed in it and you didn’t have anything else to do.
At any rate, I got to know Bob Moore. Frank Walton, I think, did screw up in the dean’s office. I knew Frank pretty well and I liked him. In those days, he’d come back from the war and he was kind of a colorful character, would joke about everything. The reason I know some things he screwed up: My wife as a fourth-year student wanted to go to the University of Rochester as a pediatric intern. Sam Clawson, who was then the Professor of Pediatrics at Rochester had been trained here at Children’s Hospital. He was interested in having her come as an intern. Walton used to take the responsibility of sending out all the applications. We discovered later he’d never mailed hers out. He sort of ran it like a czar. He decided where somebody was going to go, which of course was not very good. I think there was a good bit of unhappiness about this setup and so he was moved out.
Bob Moore, I guess with Barry Wood’s approval, asked me if I would come over and do some counseling of students. I was chief resident and had a hell of a lot to do, but the plan was that I would come over around 3:30 or 4:00 o’clock in the afternoon, be here for an hour or an hour and a half, work only with the senior students and advise them about internships. Having been in the east and recently knowledgeable about other places, I said “Fine.” So I did that and when the year ended he wanted me to be Assistant Dean on a full-time basis. Well, I had this National Research Council fellowship coming and I wanted to get in the lab so I said, no, I didn’t want to do that. But I did recommend to him and to Barry Wood a guy named Tommy Hunter, Thomas Harrison Hunter, whom I’d known from my medical school days. He was at Columbia Presbyterian Hospital [New York] and would be an ideal guy.
Tommy Hunter was a guy who was one college generation ahead of me – a little more, actually. He graduated from Harvard College in 1935, graduated from medical school in 1940 because he won a Henry Fellowship and spent three years at the University of Cambridge, taking the first three years of medicine in that system, and then came back and finished at Harvard. I got to know him because in those days internships, the beginnings of them, were staggered. Everybody didn’t start in July, they’d start every three months or so. So he was still hanging around the medical school doing some work over at the Children’s Hospital.
He and I had an interesting parallel. Tommy had polio when he was six and was on crutches from then on and had much more trouble getting around than I did. He and I have remarkable parallelisms. He was interested in infectious diseases, he worked on bacterial endocarditis. Before that he was at Harvard College, he was chairman of the Winthrop House Committee five years before I was chairman of it. He married a pediatrician, I married a pediatrician. She subsequently became a psychiatrist, my wife became a psychiatrist. He became a dean, I became a dean.
At any rate, I’d gotten to know Tommy a little. He had just started in practice at Columbia as a part-time faculty member. I knew he had a wonderful personality and I’d corresponded with him a little, though I didn’t know him nearly as well as I subsequently did. So I said to Barry Wood and Bob Moore, “I think you ought to go after Tommy Hunter.” And they did. They met him and of course they liked him and they lured him out here. So he came out here as Assistant Dean of Students and Chairman of the Admissions Committee and stayed here from 1947 to 1953. When he’d go on vacation or something, I’d come over and fill in for him.
In 1953, at which time I was in the Department of Medicine, he left to go to Virginia as Dean and Bob Moore then asked me to come back as Assistant Dean. Barry Wood wasn’t so keen on my doing it. But I had the best of all worlds because I continued to be in the Department of Medicine, and when they built the then-new Wohl Hospital, my lab was going to be on the sixth floor of the hospital and I didn’t want to have to come all the way back over here every few minutes, so we made the Assistant Dean’s office on the first floor of the Wohl Hospital. So if I had to come down, I just rode the elevator down six floors.
So I was Chairman of the Admissions Committee, and did all the recommendations for internships. I had an absolutely marvelous time. Bob Moore, who was an interesting fellow, had a sad ending of his career in one sense. He was a fine guy to work for. He was always available but he never looked over your shoulder. I used to go to see him once in a while – every other day or so I’d sit down and spend half an hour telling him my problems. Then he left here to go to Pittsburgh as vice chancellor. He wanted me to come. It was sort of sad because here he was: Dean of this great medical school and Professor of Pathology. Allen Gregg of the Rockefeller Foundation allegedly talked him into going to Pittsburgh as vice chancellor.
Bob Moore, who was a tremendously good guy, nonetheless was, in one way, sort of childish. The thing that appealed to him about going to the University of Pittsburgh was that he was going to be a member of the Duquesne Club, which is the fancy men’s club there. Well, that’s fine, but it’s hardly a reason to move. He persuaded me to come over and look at this associate deanship. There was a guy there named Fitzgerald who’d been the Dean there for a long time – an old Pittsburgh guy. It was apparent to me almost immediately that Fitzgerald was going to do things exactly the way he wanted to, and that Bob Moore, even though he was his boss, was not in a position to make Fitzgerald do anything he didn’t want to do.
Bob had an unhappy time there and then he became the first head of the [SUNY] Downstate Medical Center. It was sort of tragic; it was a perfectly all right place but he ended up dying in Brooklyn in the King’s County Hospital. Having been at this place, it was tragic. At any rate, he was very good to me and I enjoyed very much working under him and having my foot in the Department of Medicine. I got promoted to Associate Professor and head of the Division of Immunology and I edited the CPCs that we started that were in the new American Journal of Medicine. I started that when I was chief resident. They started up this new journal, which started with a fair amount of fanfare, and Barry and I were talking about it one day and he said that Al [Alexander] Gutman, who was Professor of Medicine at Columbia in those days, was going to be the editor and wanted to know if we’d like to have the CPCs. He asked me if I’d do them and I said “Sure.”
Why Washington University’s or this medical center’s CPCs?
Well, this was a highly respected medical center. They published some clinical conferences from Columbia and I think they wanted some representation. I guess Gutman knew about these CPCs, which had a very good reputation. So we did those and I did that till about 1953. I used to do them all by myself and then I got Dave Smith, who was in the Department of Pathology to be co-editor of the Pathology part of it. Finally I felt that I couldn’t keep it up – it was an awful lot of work – Lillian Recant, who was in the Department of Medicine, took them over. But they’re still doing them, I know, so it’s a long-running show that started almost forty years ago. Those were very pleasant years. We got a lot done in the lab, taught and took care of a lot of patients. It was fun.
Tell me about the rheumatic fever clinic and how it was set up and how it operated.
I was interested in Group A streptococcus, which is the organism that produces streptococcal sore throat. In those days rheumatic fever was a big problem, particularly before penicillin came along. I’d gotten interested in [that] in Boston because there was a lot of rheumatic fever in Boston. So I decided to work on it and I worked at a fairly fundamental level in the sense that I was producing streptococcal infection in animals. I developed a method of producing pneumonia in rats and ultimately lymph node infection in mice and tonsillitis in rabbits to try to recreate a model of rheumatic fever. But I also was interested in the clinical side of it and in young people, who, of course were susceptible to bacterial endocarditis as a complication of rheumatic fever. Having penicillin in a plentiful supply by then, you could start kids on small does of penicillin to keep them from getting streptococcal infection and thus keep them from getting recurrence.
This would be in 1949?
I started the research in 1947, but I forget when the clinic got set up. It probably got set up after I became an instructor or an Assistant Professor. I ran this clinic only for young people who had rheumatic fever and who had rheumatic heart disease. It was a good way to see a number of patients with the disease. I’m not 100% sure that I ever published any of the clinical studies we did out there, but we did institute a few projects. Mostly it was an opportunity for me to just follow a bunch of kids with the disease and see what happened to them on a consecutive kind of basis. The only way you can really do that is to have a body of patients who keep coming back. I guess if I’d stayed here we would have done more but of course I moved on.
You were a consultant to crippled children’s [agencies] relating to rheumatic fever in both Illinois and Missouri?
Right.
Back to the subject of the clinics. You continued your long-term interest in health care delivery at major medical centers. The clinics in the 1940s had a long history already here at this medical school, but they were midway in a transition. The Wohl Building, I gather, represented a major change in how the clinics were operated. You came here when they were still operated on the old—
No. The whole time I was here they were still where they are out there. They were the characteristic teaching hospital clinics. They didn’t have very many amenities. The patients sat in a big room and got called in and they were all indigent patients. In Wohl Hospital we took care of private patients. I used to take patients and if I took them on I was really their doctor. If they called me at two o’clock in the morning and I thought they ought to be seen, I’d get up and get my little back bag and go see them. But most of people I took care of were either faculty or people sent to me as consultations. I enjoyed that, and [it was] one of the things I subsequently came to miss when I got more and more into administration. I finally had to give that up.
But the old clinics really left a lot to be desired. I think the patients got reasonably good care, but there was a lot of discontinuity and it certainly wasn’t pleasant. Now, most places have moved to something more of a one-class service, which I think is important. When I went to Colorado and we designed the new medical center there, one of the things we insisted on was that we were going to have a one-class hospital. The University Hospital out there had been set up for indigent patients and was a lousy physical facility. My feeling is that everybody ought to get the same kind of care and it ought to be the best care and it ought not be related to whether you can pay for it or you can’t pay for it. So the clinics here during my whole stay here were out there in what’s now a different building. Wohl did have some private patient facilities but we didn’t see the indigent patients.
Did you see the end of the old clinics here?
No. I think that came after I left.
Talking about your family life – we mentioned that you had moved out to Webster Groves. You were a suburban commuter?
My wife had grown up in Webster Groves. When we were [first] married we lived in the back end of an old apartment on Pershing – one of those big old apartments they split up. When I was a National Research Council fellow I got $2,400 my first year and $3,000 my second. When we got married I think my wife, as a resident, was making about as much as I was. So we didn’t have any money.
Then we bought our first house in Webster for something like thirteen or fourteen thousand dollars. It was a very nice house and when we left it Paul Lacy, a distinguished professor here, bought it from us and still lives in it. I’m sure he’s done a lot to it. It was a big old sort of Victorian house on a nice street called Marshall Place. We moved in September, 1950 and then in early 1956 we bought a house on Plant Avenue in Webster that was known as the Tyler House, which my wife had always eyed. By today’s standards it’s amazing. The Tyler House cost us, I think, twenty-eight thousand dollars – it was a great, big three-story house. We bought that and moved in around Memorial Day and we hadn’t been in it more than a couple of weeks when I got a letter from the University of Colorado saying that they were looking for a dean and would I be interested in being considered.
Again, that was sort of funny, although by that time I’d been an associate dean and I guess I could have gone either to take over a department of medicine or become a dean. But I guess I was getting more interested in deaning. I keep mentioning how luck influences you. I was at the Atlantic City meeting of the Society of Clinical Investigation. I got on an airplane with a guy called [S.] Gilbert Blount, a very distinguished cardiologist, [who] had just gone to Colorado from Hopkins. I’d met him a couple of times at the Central Society for Clinical Research in Chicago. We happened to sit [together] flying from Atlantic City to Newark. In those days Eastern used to fly a plane up there. He asked me what I was doing because he knew I’d been elected to the Young Turks, which was quite an honor in those days.
What were [the Young Turks]?
It’s the American Society for Clinical Investigation – that’s the so-called elite junior society of the Association of American Physicians, which I [joined] a few years later. So I was telling him that I was doing research and was also an associate dean. He said, “Do you like that?” and I said “Yes.” He said, “We’re going to be looking for a dean. Do you mind if I put your name in?” I said “No.” And he went back to Colorado – this was the first week in May in 1956.
Gordon Meicklejohn was the Professor of Medicine at Colorado and a great friend of mine and was the chairman of the search committee. It was he who then wrote me a letter and as it turned out, I was the first guy they asked to come out and look. We couldn’t get a date when the committee was all going to be there and the summer passed and nothing happened. We agreed that I would come out early in September. I went out on a Sunday, stayed through Thursday noon, met with the committee on Thursday morning, on Friday I got a call from the president of the University offering me the job and on Saturday I accepted it. Nowadays these things [can go] on and on for years.
My wife was a little upset in the sense that we really liked that house we’d just bought in Webster Groves and she really didn’t want to leave St. Louis, but she’s always been wonderful about doing things. So we did move and we had a marvelous time in Colorado.
Before we get into that – out in Webster Groves you knew the Coris – Carl and Gerty Cori?
Yes. Of course I knew them here. They actually live near my wife’s parents. Helen’s mother was from a Greek family. Her great-great grandfather was a Greek priest who started the Greek church here. Her father came from an Evangelical Lutheran family in a southern [Illinois] farm community called Breese. They were classmates, but there was a little suspicion on both sides, and they got married in both the Greek church and the Evangelical church and Helen was baptized in both. Then they decided after they got married to work out some mutually convenient agreement, so they became Presbyterians and Helen actually taught Presbyterian Sunday school in the Webster Groves Presbyterian [church]. By the time she and I got to know each other we both were about as agnostic as you could be. So when we got married we decided we didn’t want somebody to tell us what we had to believe and we got married in the Unitarian church.
Helen’s mother’s family had a great place out there called Parnassus. Her grandfather was the Greek consul in St. Louis and had been quite a successful businessman and they were – in those days – well-to-do. We seem to have had a great penchant for anybody in our families who had any money losing it someplace along the line. So there was never any inheritance around. When her mother wanted to go to medical school her family was very much against it. They didn’t think that was what a nice Greek girl did. The Greek Metropolitan, the head of the whole Greek Orthodox church, came to St. Louis and because of her grandparents’ position he came there to dinner. Helen’s grandmother, who was a great old gal, said to this guy that her granddaughter wanted to go to medical school, assuming that this guy would put the kibosh on it once and for all. [He said] “Oh, madam, you are blessed if your daughter wants to serve.” Well once he said it was okay there was no way they could do anything about it.
Anyway, they knew the Coris from out there and of course I knew them here. Gerty used to come in here – she had a very long illness and Carl Moore took care of her. She’d drop into my office when young Tommy [Tom Cori] was trying to decide where to go to college. We talked about it and so forth. And I used to see Carl in subsequent years. He mellowed a great deal as he got older. He was a fairly austere guy in his early days, but he was a great person. Of course I knew Carl Moore very well, was very close to [him], and he also was a great guy.
There’s one other little episode that I think you might be interested in just from a historical point of view. I got to know Dr. [Evarts] Graham, who was an Olympian figure in surgery. He was much older than Barry Wood but he was almost Mr. International Surgery. I got to know him in a way I might not have otherwise because his son, David, was an intern in Medicine when I was. I guess because our names both began with G we roomed together. Those old house officers’ quarters left a good bit to be desired – a double-decker bed. Dave Graham was married, so on those nights when he wasn’t on call he went home. But we got to know each other and I got invited out to the Graham’s once or twice for dinner.
The year I was the chief resident – in those days the chief resident in each department would see the consultations on the ward service of the other departments. So I would see the surgical patients, the ophthalmology patients, and so forth. It was one of my duties to see those patients and if I wanted, to get one of the senior staff to see them. In my year as chief resident, one day I got a call to come up to Dr. Graham’s office. He was a very impressive fellow and I thought “Jesus, what have I done?” So I went up there and walked in. As soon as I walked in he said, “I want to ask you something, Bob, but I don’t want you to say ‘no.’ ” I knew I was off the hook then. And then he proceeded to say, as I knew, that he’d been trying to get somebody to be head of anesthesiology. Mr. Mallinckrodt had given them a professorship of anesthesiology. He’d tried to get Harry Beecher, who was a famous guy at Harvard, one of my teachers, and one or two other people. But they had nurse-anesthetists here and Graham didn’t want to let them go and most of these guys didn’t want to come.
So he said to me – mind you here I am in a white suit, making $100 a month, “I’d like you to be the Mallinckrodt Professor of Anesthesiology. I’ll let you go, you can go anywhere you want for three years and learn it and then come back and be—” Well, that was a pretty heady invitation. I said “Thank you very much, Dr. Graham. I’m flattered.” He said, “You think about it.” So I thought about it for a day. I didn’t really want to be an anesthesiologist; I was going to work in the lab. So I went up the next day and thanked him again for thinking about me and [said] how honored I was, but that I’d decided— And he said “Well, that was what I thought.” Then, as sort of an afterthought, he said “By the way, I haven’t mentioned this to Dr. Wood,” which was sort of amusing because I was Wood’s chief resident and he probably should have cleared it with him, but he didn’t. I often think about it, as I was a great admirer of Dr Graham’s. In later years when I was in the department, I’d often see patients up there. He was a great fellow, a remarkable man.
You were active in those days in the Washington University Medical Society, which has since become defunct. You were the secretary of the organization.
Yes. I don’t think it was a terribly potent thing even then. I can’t remember much about it. I know we had it and it was supposed to—
Develop papers.
Yes, right.
You had an appointment to Homer G. Phillips Hospital?
Yes. Washington University had a teaching service at the City [Hospital] and also at the Homer Phillips. [The two universities] shared City Hospital. St. Louis U. had one [service] and Washington U. had one. Barry asked me to go down to the Homer Phillips, which was a pretty tough place in those days, and sort of be chief of the service. Of course I wasn’t going to move out of here, but I used to go down there two or three days a week and make rounds.
Do you remember when this was? I couldn’t find a date.
My guess is that it must have been in 1949-50. It wasn’t while I was working in the lab, but it must have been when I became an instructor. There were one or two guys down there – there was a guy named Ed Williams, who unfortunately died of hypertension. He was a fine guy. I think all of them had gone to either Meharry or Howard and most of them were very badly trained. But Ed Williams had been sent off to Harvard and worked for several years and was a cut above all the rest of them. I remember he used to say “If Meharry were a white medical school it wouldn’t exist because it wouldn’t get accredited.”
I did that for a year and it was slow going. I also visited Meharry once because Barry was on a commission to look at Meharry Medical School – [for] one of the foundations – and he asked me to go down. It was a miserable place, the facilities and the teaching.
After that, I went to the City [Hospital]. They decided to organize it and really try to do something about the teaching at City. So I became chief of the Washington University medical service at City and Tommy Hunter was associate chief. We converted to a straight internship and we began to attract some very good people. What I was prepared to do at that point was what they had done at Harvard, which was to set up a unit there with labs and everything, but Barry didn’t want to do that. So I’d go down three or four days a week and make rounds, but it wasn’t the way to really do it. He didn’t want to have two units, so after a year or two of that I came back out here and then I stayed here. I guess at the time I became assistant dean I gave that [the City Hospital program] up. I guess they continued to run it for awhile.
By the early 1950s the Washington University School of Medicine had at long last begun to renovate and rebuild its research plant, beginning with the Cancer Research Building, constructed in the early 1950s. Did you have any part in that?
Not a great deal. I had much more of a part in the Wohl Hospital, because the Department of Medicine was moving over there. It was great fun – we got a chance to design the laboratories. At the time, it seemed like an enormous addition of space. What’s happened to this place – as it has to most of the great medical centers – by today’s standards it’s very small. But at the time it was terrific, and as I told you earlier, it was particularly nice for me because my lab and my office were going to be in the same building. That made it very efficient in terms of getting back and forth and I didn’t waste any time wandering around. Of course, if I’d make ward rounds or something I’d go over to the hospital – over to the old Barnes Hospital wards. But it was a very good setup.
We’ve heard already that in 1953 you resumed the position of assistant dean, with specific responsibility for students. You characterized this event humorously in a later article as a “fall from grace.” I trust you were [being] humorous?
That’s right. Or [as] a mouse learning to be a rat. There were those who felt – I think Barry Wood always had some question about it – [but] he knew it was important. As a matter of fact, years later when I was at Stanford he was on the search committee for a new dean at Hopkins and he tried to get me to come there. But I think, at the time I was working in the lab, and I think I was doing pretty well. I suspect, all things being equal, he would have liked to see me go on to become head of a department of medicine somewhere, because that was what most professors of medicine liked to see their people do. I think the most important thing if you get into a position where you have young people working with you is to let them have enough running room so they can do what they want to do. I don’t mean to suggest that Barry said “You can’t be an assistant dean” or “You can’t go into deaning.” But I’m very proud of the fact, for example, that everybody who worked with me at Colorado as assistant deans all went on to become deans. [I’m proud] only in the sense that I think it was an indication that they grew, and developed, and were able to take on responsibilities.
I mentioned earlier that Jim Darnell and Steve Morse [ed. note: both Washington University School of Medicine, Class of 1955] started as medical students in my lab. Both have gone on – unfortunately, Steve died – but they both went on to distinguished careers. Darnell is one of the really top-notch people in molecular biology anywhere in the world. I don’t take credit other than I think he got a start in my lab and got a chance to learn something about doing investigation and had an opportunity to grow and develop at a stage when he was just beginning.
In the ten years since you were a medical student [from] the 1940s into the 1950s, had you already begun to see changes in the character of medical students?
Not really so much. As I say, when I got to be chairman of the admissions committee we still only had five people on the admissions committee, one of whom was Mr. [William B.] Parker, who was the long-time registrar here. He was a wonderful guy – a guy you really had to get to know. He seemed to be sort of serious and not [to have] much of a sense of humor. But as time went on, we had a lot of fun together. It was a pretty simple thing – we did the interviewing; we didn’t have a big democracy in the sense that so many people were involved. I think we made honest decisions. We didn’t take people into medical school because their fathers were somebody, or that sort of thing. But Tommy Hunter, who was my predecessor, was the guy who spotted Johnny Knowles [John H. Knowles]. He was a graduate of this school who went on and was appointed a trustee of the University and then became president of the Rockefeller Foundation.
Johnny Knowles went to Harvard College, class of 1947. He was a great athlete – hockey, baseball, various other things. He had a lousy record, unlike Barry Wood – and even by my standards a lousy record. He applied to twelve medical schools and got turned down by eleven. I remember Tommy Hunter coming back from his interview trip. We used to interview – Mr. Parker used to go west and Tommy and then I, later, used to go east to the Ivy League. He came back and he said “I saw a kid that I really was impressed with. He’s got a lousy record but I think he’s got it.” And he took Johnny and Johnny assimilated into medical school – graduated at the top of the class and so forth.
The point I make about that is in those days – and I think it’s much harder to do today – you could take an occasional guy who really struck your fancy. It was sort of the way Worth Hale did at Harvard. I look at my own record, and I did reasonably well in Medicine. But I suspect that if I were in the same place [today] I was in applying to medical school I probably wouldn’t have gotten into any medical school because I didn’t have high enough grades. Whether anybody would say “Well, this guy did awfully well on the aptitude tests and we ought to take a shot at him,” who knows.
But we used to take one of the kinds of people that I was always impressed with in the years I was doing it – and we had some good examples – the people who hadn’t done very well in college and then went off to the Korean War. That was the period of the Korean War. They came back, really grown up, really went to work, and they did very well in medical school. I remember a couple of guys we took like that who didn’t have good college records at all, but really impressed us as mature, highly-motivated people. It’s very hard to measure motivation. You know, people who were around when the veterans came back from World War II will tell you that the best medical students, as a group, who ever were around were the post-World War II people. They were older, they’d been through a lot, they were damn serious about medical school. That may have been overblown a little, but I think they were, by and large, people who were very serious about it all.
But in those days, in answer to your question, I think we still had a fair amount of running room. We were out to get good people. This School began to attract students as it did house officers and I like to think I had a role in the house officer business. I think one of the reasons Barry Wood wrote and offered me a job is he was trying to get people from a larger group of places. Because as good as this school was when I first came back here, I don’t think it attracted good students. They were mostly from this very local area. I don’t think it had the draw – and it certainly didn’t on the house staff. There were very few people who came here.
In the years when I was doing house officer appointments – when I first joined the Department I was sort of Barry’s executive assistant and I did all the house officer screening. We really began to go out and attract people. Now, this is far and away one of the most desirable house officerships in the country. We got good people. We didn’t have the choice in the days before the matching plan you had to do it by telephone. We got a lot of the people we wanted but if they got an offer from the Mass General or three or four other places they most often would go there rather than coming here. Nowadays, I don’t think that’s the way it is – I think that this place could compete with anybody. So, its draw expanded greatly as a result of all that.
In 1954 Robert Moore was succeeded by Carl Moore [as dean]. Carl Moore was a long-time colleague of yours in the Department of Medicine, as you’ve already mentioned. What can you recall about him?
Carl was a wonderful guy. He was a superb doctor, a very productive investigator, one of the most widely-respected people around – quite different from Barry. In a funny way, although they were very close and had the most wonderful relationship – Barry shared the medical service with him, Carl would be chief part of the year – I think Carl always felt dwarfed by Barry because Barry always had so much aura and glamour about him. I think after he left to go back to Hopkins and Carl became the professor, that in a way he finally got the kind of status that he deserved and was not in Barry’s shadow.
One of the things I remember very well – Carl thought deaning was a lousy job. He was not the least bit interested in being a dean. Later on, when they wanted me to come back here when I was at Boston, he was vice chancellor [for medical affairs]. One of the reasons I didn’t come back was I knew damn well he wasn’t going to stay on as vice chancellor and I wasn’t going to take a deanship not knowing who the vice chancellor was going to be. I’d gone through this in Colorado where I’d gone as a dean and there was a director of the medical center who wasn’t a terribly good person. In short order he got bounced and I was made vice president of medical affairs and dean both, and for better or worse things prospered at Colorado.
When I was asked to come back here and at the same time to come to Stanford, I said I’d do it if I had both jobs. Stanford had never had a vice president of medical affairs and the reason I wanted it there was that the Stanford Hospital was half-owned by the city and half by the University. It was a terrible mess and it was clear that the University was going to have to acquire the hospital. Somebody was going to have to do those negotiations. Stanford is organized with executive officers and academic officers. As a dean I was an academic officer reporting to the provost. I knew the president Wally Sterling wasn’t going to have the time to go down and negotiate and I wanted to be able to negotiate as an executive of the university, and that’s how they happened to set that up.
I was asked to come back here at the same time and really wanted to come back because I had tremendous feeling for the place. I came out here in September 1964 prepared to sign up, having had talks with George Pake, who was then the Executive Vice Chancellor out at Washington University. As I say, I knew Carl didn’t want to be Vice Chancellor; he wanted to get out. The last visit I had on Friday afternoon that last week in September was with Tom Eliot who was then the Chancellor. I went in prepared to sign up. I got in there and much to my amazement he said, “Well, we certainly want you to come as dean but I’m not prepared to offer you the vice chancellorship,” which of course reversed everything that Pake had said to me. I said, “Well, thanks very much, but if that’s the way it is I’m not going to do it.” So I went back and Stanford came after me again. I didn’t get into one of these bidding games. I had told Stanford that I was talking to Washington University and didn’t negotiate with Stanford. As soon as that happened I told Stanford I’d start talking to them again.
Three months later on a very snowy day, Tom Eliot called me from the Logan Airport in Boston and said “I’d like to come out to see you.” He came out and said “You were right and I was wrong. I’d like you to come as vice chancellor.” I said, “Well, that’s very nice but now I’m involved in negotiations with Stanford. If they fall through, I’ll come back.” They didn’t fall through and that’s how I didn’t happen to come back here.
Carl Moore was a reluctant administrator, a great teacher—
A great professor of medicine – not unwilling to administer the Department of Medicine. But he thought deaning was sort of a step down, I think. I think part of it was tongue-in-cheek and part of it reflected his interest in clinical medicine and in doing his research. Ollie [Oliver] Lowry who served briefly as dean was the same way. He used to brag about being a micro-dean or a mini-dean, or something. In all fairness, in those earlier days people could be the dean and still do other things. It wasn’t the kind of demanding job that it became. I used to like to refer to the fact that at Harvard Medical School in 1904 or ‘08 or something there was a phrase in the catalog of the medical school saying “The dean will be in his office from 12:15 to 1:00 on Tuesday and Friday to do the business of the medical school.” Now you know how these places are. They’ve gotten enormously complicated – the whole change in growth in the research enterprises with all the NIH, the changing nature of medical care and financing thereof. It takes an enormous coterie of people to do it. When I was assistant dean here I think there were only two assistant deans. Now, most medical schools have ten assistant deans, associate deans.
In 1956 you were invited by the Rockefeller Foundation to study medical education in Latin America. Can you tell me about that?
That was a wonderful opportunity. I was, by then, an associate dean here. I’d met a couple of people from the Rockefeller Foundation. In those days they were very active in medical education, particularly overseas. They decided it would be nice to have two fairly young guys to go down and take a look at what was going on – to look at their program. So they invited a guy named Bud Grewley(?) – Clifford Grewley from Tulane and I to go down, and gave us a six-week trip, starting in Mexico – where we visited most of Mexico City and couple of provincial medical schools and then all the way down the west coast. We didn’t do anything in Central America. We stopped one day which was sort of fun, but we went to Peru and to Chile, then over to Argentina Uruguay, and Brazil.
It was a great experience. It was tough being away for six weeks. I left my little children at home with my wife and I didn’t like to leave her like that. But it was a fascinating thing and I saw a lot about what was going on and saw a lot about the Rockefeller programs and met some bright, young Latin Americans who became friends. It was the first time I’d ever been out of the United States. I never went to Europe until 1968. Subsequently I’ve gone a lot but that was my first overseas visit and it was fun from that point of view. It was great fun to see something about the medical schools and what they were trying to do.
In most medical schools in Latin America they had a policy where they had to admit anybody who wanted to come. In Argentina when I was there they had 3,000-4,000 students in the first-year class in medical school. There were some very bright, able people, but they were few and most of them were a bunch of loafers. There was no real discipline. At that time, however, a few medical schools, including one or two provincial ones in Mexico and a couple in Chile, had begun to have real admissions policies. One of the reasons, I think, they wanted us to do this was to talk a little about how we did that [admissions] process in this country. But it was a very broadening experience.
As you’ve indicated, in 1957 you became the Dean and Professor of Medicine at the University of Colorado School of Medicine in Denver. Could you compare this Colorado school with Washington University?
Yes. It was a very interesting thing. When I went there I was, I think, the youngest or second-youngest dean in the country. I had just turned thirty-eight a couple of months before I went. I guess I was interested in having a shot at something. It had been a great experience here and I had a hell of a good time. But I don’t remember thinking long and hard about whether I wanted to go.
Colorado was not much of a medical school. It had a lousy plant. But there were a few young people there – Gordon Meicklejohn who was the Professor of Medicine, Ed Puck [Theodore Puck] who started the first Department of Biophysics in a medical school, Henry Kemp who was the Professor of Pediatrics, who were really very, very impressive, dedicated people. Denver was an interesting, pleasant town. And what I’d learned at this school, the standards and values and so forth, were a wonderful background.
In some ways I hadn’t been well prepared to become a dean, because the way this school operated, particularly then – the Executive Faculty, which had been one of the great strengths of the place, was a very much closed society. The dean went [to Executive Faculty meetings], but the assistant deans didn’t come. I went to one Executive Faculty meeting. Just before I went to Colorado, Bob Moore said “Come on in so you’ll see what it’s like.” I think in retrospect that was wrong. If you were training people to go on they should have had a better chance to see it. On the other hand, there was a lot about this school that I did know. And when I went there [Colorado], I put into practice some of the things I’d learned. For example, they didn’t have a full-time system there. They had a lousy system because the state law prohibited, when I went there, the collection of fees from patients in the University hospital. The hospital was, by law, for indigent patients. It didn’t say you couldn’t bring in a patient who wasn’t indigent, but you couldn’t collect any money from them.
Right after I got there, back in 1957, I looked into it and discovered that forty some-odd percent of the patients who were in the Colorado General Hospital had insurance. So I went to the legislature and persuaded them to change the law so that if somebody did have insurance we could collect it. I did it by saying “What we’ll do is put in a full-time system.” I might add that the rule was that since you couldn’t charge patients for care, and you could only have 1/6 of your time free, theoretically, for private practice, what happened was that the surgeons, a few surgeons, would do private practice but they’d have to do it at another hospital because the facilities weren’t any good there anyway. And the people in Medicine and Pediatrics really couldn’t do that much at all. That seemed like a dumb thing to me.
So, with the concurrence and great approval of my colleagues, and of Quigg Newton who’d come as president of the University at the same time, we went to the legislature and said “Let us collect money. We’ll put it all together in a pool [and] we’ll pay both basic scientists, who don’t take care of patients, and clinical people in the same way.” The highest salary when I went there was $12,000 for the Professor of Medicine. Just collecting that insurance money, we boosted those professors’ salaries to $25,000 and we boosted the basic science thing.
Furthermore, that was the period when money was beginning to be available from the NIH. We began to start competing effectively for research and we took the overhead from the research, which you can’t believe today, and used that in what we called the Continuing Research Fund instead of putting it into the University. We used that as sort of discretionary funds. If a new person came we’d have some money to buy them some lab equipment or something. I’m not the least bit modest about it – we made an enormous change in the place. Then we went to the legislature and persuaded them to build that new medical center, which at the time was the biggest project the state had ever undertaken. So, in a very short space of time, we changed it from kind of a plus/minus place. Again, it was a nice place to live – it’s not a hard place to attract good, young people. Because of all the NIH money, people could come to a place like that and get support. Today, it’s a lot harder, even in a distinguished place. It was great fun and I give great credit for what we accomplished to the background I got at this place and to the feeling about the full-time system and all that sort of thing. Because we put that in and it worked beautifully.
Did you make it like a reserve school of the University in that your Dean’s overhead accounts were yours to allocate rather than turning it over to the main University.
In a sense that’s the way it was. We got a separate budget. Now, it’s a totally separate campus like a lot of these state universities. The medical center campus now has its own chancellor and there’s a university president for the whole system. In those days that wasn’t the case. But we did get a separate appropriation from the legislature, although it was under the university. Again, I had good luck. Quigg Newton, who is a wonderful guy— I was so naive I took the deanship not knowing who the president was going to be. Now that’s dumb as hell, because in a medical school you really have to have a president or a chancellor whom you can really relate to. Quigg was an old Denverite – I mean he was from an old Denver family. He’d been mayor of Denver and he’d been vice-president of the Ford Foundation. We both came at the same time, but I was actually appointed before he was.
We hit it off – he really understood what quality was. He’d come out of Yale College and Yale Law School. So, again, we accomplished a lot, I think. But we couldn’t have accomplished it without a president who was interested in seeing it done, without some faculty colleagues. We had a terrible town-gown situation because the medical society was reactionary as hell and didn’t want the medical school to do well. At least the leadership of the medical [society]. That’s true in a lot of places.
They had their loyalties elsewhere?
Oh sure. If you look at the history of medical schools, particularly after the war when some of the schools that hadn’t done much began to develop. It’s not most doctors, but the leadership of the medical society was very jealous of its prerogatives and they didn’t like the idea of a bunch of outsiders coming in. So they’d try to make it tough as hell for you. But we had such strength within the medical school that we could take them on. So we had great fun.
[Interruption in tape]
. . . medical affairs as well as Dean after—
I went there and then in a couple of years they got rid of this other guy and I was asked to do it. I was one of the first people to have that sort of a setup. It reflected the complexity that had developed in medical centers as they grew because of research and so forth.
Would the equivalent then be for the dean here to be vice chancellor as well?
Yes, that’s right. As I said earlier, when they wanted me to come back here, I would have done it if they’d put both jobs together. Now [some] places, including Stanford years after I left, split the jobs because there’s a feeling by some people that it’s too much for one guy. The facts are that it depends on how you organize it. You can have both titles, and if you have both titles you’re going to need more associate deans or helpers. Many universities do still have both positions – I mean have one person having both positions. You can work it various ways. But I had both titles there [Colorado] from ‘59 till I left in ‘63 to go to Harvard. As I say, it worked very well.
Looking back from Denver [to] here, you are certainly aware that the introduction of a vice chancellor was not a happy event for many people. Why do you think that this was? That’s really too broad a question – you had difficulty between the medical school and Barnes Hospital and its administrators. But also you had this great fear on the part of the faculty, the research faculty in particular, that a vice chancellor would clip their wings.
That’s right. I think in all fairness as I look back on it – I wasn’t here at the time – I think a very large part of the creation of the vice chancellorship really had to do with the Queeny problem. I think if that hadn’t come about, I’m not sure it would have happened. I don’t know that, obviously. But Ed Dempsey, who had become dean, got into a terrible battle with Queeny.
Edgar Monsanto Queeny, chairman of the Board of Trustees of Barnes Hospital?
That’s right. Queeny decided to move into the hospital. That’s a terrible arrangement when the chairman of the board of the hospital moves in and really becomes the chief executive officer, which is what Queeny did. There were all these stories – he’d look at the clinic and if he thought the clinic wasn’t making money he say, “Close the clinic.” Well, Barnes Hospital and Washington University had this wonderful relationship which dated back to the Flexner period. It was true of Columbia Presbyterian, New York Hospital-Cornell, etc., Western Reserve. I think Dempsey and Queeny got into a terrible, terrible interpersonal problem.
Queeny was obviously a difficult character. I really have the feeling – and you’ve got to talk to a lot of people around here still who went through it, like Ollie [Lowry] and others, and Bill Danforth – that a large measure of the reason for the creation of the vice chancellor was to put a buffer between Dempsey and get somebody who could deal with Queeny. I think what you say however about the Executive Faculty is true. The Executive Faculty has been very, very jealous of its prerogatives. It’s been one of the great strengths of this school and I admire it tremendously. I don’t think it’s a perfect setup as things have developed, but I think it’s probably as good an example of an administrative organization that’s maintained quality as you can find. I think that the dean was elected every year and there’s no question about who ran the school.
One of the good things about that – when I was a young guy and got in the place – things are different [now] – they’re so much more complicated. But one of the reasons I was able – here I was an assistant dean, I was an assistant professor of medicine, I was doing research – I never spent any time at all on committee work or anything of that sort. We’d have a department meeting once a week and Barry Wood would tell us what was going on. Even in the dean’s office when I was doing the admissions, there were five of us. We’d meet a couple of times a week for a couple of hours and get it done. We didn’t have these interminable meetings and committee meetings and this, that, and the other thing. Travel was much more limited then – the airplanes were flying but not the same way they are today, and people were around. Barry Wood was Professor of Medicine – when he was on service he just never went away. Neither did Carl Moore. So you really got an awful lot done. The Executive Faculty had the confidence of the School and the faculty and they did the work. And they only met once a month. In fact, when Bob Moore was Dean, Carl Cori, Evarts Graham and Barry Wood were really sort of the kitchen cabinet. But they were men of great esteem and stature and I don’t think anybody ever had any concern about it. I think the School’s values were very high and there was a minimum of red tape.
I think the Executive Faculty is always concerned about what is going to happen. They’re going to have a problem in a couple of years here because Ken King [M. Kenton King] has been dean for such a long time. It’s worked out very well – he and Sam Guze are two different kinds of people. When the time comes to replace Ken King that’s going to be a very significant step because the whole business of somebody taking a job where he has to get elected every year – some people might take a dim view of that. Some people who now want to be deans may not want to be quite as much under control. I’m sure they’ll work it out, but it is a different kind of a world today than it was and it’s quite remarkable if you think about it. The Executive Faculty is the reason this School developed as it did and prospered. But it’s very hard to run that sort of thing and it’s very hard to keep it – it’s much bigger now than it was – they’ve got other representatives. It’s hard to keep a thing like that [Executive Faculty] small enough so that people really know one another and can really get down to the issues.
I adopted that system at Colorado. They had an executive committee as most schools do of the faculty department heads, but they didn’t have the same kind of arrangement. I put it in and it was one of the reasons, I think, that we were able to develop the program we did there. Of course, that group took a lot of the responsibility.
At any rate, here are the consultants that were called in. I believe that John Knowles was one of them.
Yes, and Joe Hinsey.
[They] made recommendations [to] the Executive Faculty. They had been called in by the medical school, and then the Executive Faculty felt betrayed.
Well, I wasn’t here then, you see. I read a lot about it. Of course, Hinsey was influenced by the fact that he was at Cornell where the hospital has always been dominant. Cornell-New York Hospital Medical Center has never achieved what it ought to because the hospital has been the dominant part of the ball game. That’s true of Columbia Presbyterian but the medical school at Columbia did much better. Knowles, with all his attributes, was the head of the Mass General. If you know the Harvard setup, the Mass General, although it’s part of Harvard, is also its own institution – very strong. I think John never wanted to feel that he was reporting to the dean of the medical school. So that was another push to do it the way they did it.
I think as it turned out it worked out very well and Sam Guze has done a remarkable job. I don’t know how he can be vice chancellor and also head of the Department of Psychiatry. Maybe that’s why he had his bypass. The development of the Washington University Medical Center and the evolution of the whole place, I think, has been terrific. I think it’s a model to be looked at. I often tell people; I just told the people at Stanford because there’s going to be a new children’s hospital [there] which has a separate board. I was asked to consult with the committee and I said you ought to go look at the St. Louis university [Washington University] setup, Because I think it’s a great way to organize a railroad.
All of these things have gotten much tougher because of the financial problem. In the days when there was plenty of money around— When Bob Moore was dean I still remember he used to talk about “hard money, soft money” ratios, “soft money” being NIH money. He had formulas for everything – only 1/3 of the money could be soft money and the rest had to be hard money. As time went on, the soft money seemed to get harder and harder and nobody, including people like me who were ultimately deans, really stopped to think enough about the fact that this 15 percent per year growth couldn’t go on, and that the time was going to come when there would be some problems.
This place has done remarkably well. When the NIH cuts back it’s a great tribute to a place like this that it attracts the amount of dough it does. The competition is getting tougher and tougher and you could get yourself into a tough spot when you’ve got an awful lot of people, including people on tenure, who are on soft money, really. I think some people still haven’t faced up to it. One of the difficulties is that, particularly in good places, there are lots of opportunities you want to exploit. So you tend to get bigger and do more things. But there’s got to come a time when you say “We’d better start putting a clamp on because we can’t keep growing at this level.” You’ve got people here – take Dave Kipnis. For my money, Dave Kipnis is probably the best Professor of Medicine in the United States. He’s terrific. He’s still only fifty-something. But he’s going to be a terrible act to follow – terrible in the sense of a hard act to follow. I don’t know anybody who doesn’t think Dave Kipnis is six levels above almost anybody else. So he’s really got an enormously strong setup. But the whole succession problem – here it’s worked very well – you went from Barry Wood to Carl Moore to Dave Kipnis. It’s a wonderful thing and maybe it’ll go that way again.
The weakness has perhaps already been seen in terms of the surgery situation.
That’s right – it went through a terrible— In a sense, you see, that’s another kind of thing. Despite of the strength of the Executive Faculty and all that, they made a lousy appointment. Carl Moyer, I knew him – he came while I was here. He was a perfectly bright guy but he was a lousy appointment as a Professor of Surgery. Carl Moyer was a funny guy in the first place and he had a lot of idiosyncrasies. He just really wasn’t the kind of guy they should have gotten here. That’s part of the problem when you’re great. The only reason that you stay great is that you hold the line and you really make sure you don’t boob it. Now, nobody can bat 100 percent. But it’s very easy if you bring in the wrong person, you can be in bad trouble. They’ve done remarkably well here.
There are a lot of places that haven’t done remarkably well. There are some places – Stanford is a good example, which I know well. Stanford is a superb medical school, a superb university. You take the whole molecular biology business; you travel, as I do, around a good bit, in England, Stanford is almost the gold standard. On the other hand there are a bunch of people who don’t work well like they do here. When I went to Stanford as dean, I was told by George P. Berry, who was then dean of the Harvard Medical School, he said, “You don’t want to go there. They don’t want a dean.” Well, I thought I’d had great success, if I do say so, at Colorado pulling the place together. Stanford’s peculiar. It’s not a better place than this, although as a university it’s enormously strong. But it’s got a lot of people who don’t work well together, they really don’t. It’s no secret.
Prima donnas?
They’re prima donnas, yes. So the esprit – I’m always struck when I come back here – you’ve got a lot of very top-notch people. One of the great strengths of this place aside from everything else has been its succession of Professors of Medicine. That’s the key appointment in a medical school because it’s the biggest department. If you have a really good Professor of Medicine it not only makes for a good Department of Medicine, it makes for a very strong school. And this place has had it – Cori, Graham – that was an enormous strength. Stanford hasn’t had, since it moved down to the Palo Alto campus, people of that caliber as head of Medicine. They’ve had bright people, people with talent, but not the kind of medical statesmen that this place had.
So, it’s not easy to stay up there. It’s harder, probably, than it was because the competition is tougher. When I went to medical school for example, there weren’t many really top-notch medical schools in the country. There were Harvard, Yale, Hopkins, Columbia. This place was in that league but it didn’t have as much of a national reputation for the reasons I said. Everybody knew it was a good place but it didn’t attract the young people quite the same way as it does now. There were relatively few [top schools].
Now when I see young people, as I often do – kids in families I know who are going to medical school – I can tell them the number of really outstanding medical schools. But on the other hand, I have to say honestly that there are a lot of good medical schools in this country. If you just take the west coast – the University of Washington, the University of California-San Francisco, the University of California-Los Angeles, San Diego, the University of Colorado. There are an awful lot of very good medical schools around – the University of Texas-Southwestern Medical Center. Those places have all come up and they’re in the front rank. So the competition is a lot tougher.
Even in the lesser schools you can have outstanding departments – St. Louis U.—
Yes. Of course, it’s always suffered from sitting here with this great place. But it’s true – there are a lot of places that are pretty damn good and [where] a good person can go. After all, people come out of a place like this, like I did – from here to Colorado. I could have gone from here to six other places. They’ve all done well and so there’s a lot of strength that didn’t exist before. All I’m saying is that means the competition is— A lot of the reason that happened was because there was so much money around. You could go, as I did, to Colorado, and in the space of a few years increase the research program by orders of magnitude. You could attract bright, young people. We brought in a whole series of people, guys like Tom [E.] Starzl, a transplant artist from Pittsburgh. I don’t admire everything he’s doing now, but, I mean, Tom Starzl is a pioneer in transplantation. I brought him to Colorado. Don King is now the vice president for medical affairs at Chicago. I brought him in as Professor of Pathology. He was a young guy I turned up.
All I’m saying is that you could go after young people. There was money around to bring them in and you could build up a very strong group in a relatively short period of time. That’s much tougher to do now. But many of these places have a lot of strengths by now. They developed during the time when money was plentiful. So, there’s no question about the fact that the whole scene in terms of medical centers is different than it was. As I’ve said before, the problem of financing medical care – the university centers tend to be very expensive because they have a complicated bunch of patients. They get an abnormal load of patients who are not covered by insurance. The private hospitals, by and large, don’t want to take them. So it’s not an easy ball game.
When you left Colorado, a press clipping I read reported great regret on your part on leaving; great appreciation for the opportunity to be there. There was also an allusion to tensions among Colorado University faculty members and administrators. Did that have any specific relation?
It didn’t have to do with the medical school – I think that related to the Boulder campus. It was partly related to the very conservative, almost reactionary, bunch of people on the Board of Regents, as well as people in the community like Coors and the Coors brewery who thought the University was too liberal and so forth. Quigg Newton and I left at the same time. He went to become president of the Commonwealth Fund and I went to Harvard. In a way, going to Harvard was something I wouldn’t have done if it hadn’t been Harvard. The old school tie.
On paper a step down, right? You leave the vice presidency and become—
But you see, they had created this new setup of six hospitals. The concept was a very good one.
This is the president of the Affiliated Hospitals Center, Inc.?
Yes, the six Harvard hospitals. We developed a program, which was really ten years, at least, ahead of its time. What I didn’t realize, and what I should have, since I’d had a lot of years there, was that to move some of these old institutions is a very tough thing to do. I knew a lot of the people – by that time there were a lot of guys on the boards of those hospitals who I’d known back in college days. Boston being Boston, the families tend to perpetuate themselves. But it was a tough period because George Berry was in his last several years as dean. He was dying to stay on – he and Pusey, the president of the university, didn’t hit it off terribly well. I proposed that they start building this new institution on the Brigham Hospital parking lot. There was an old Catholic convent across from the Brigham and George Berry was sure they could get all this land by urban renewal. Well, I’d spent enough years in Boston to know if you’ve got to do anything with the Boston government you’d better have a long lifetime, because it just doesn’t work that way.
But they didn’t want to do it. So, I had a good time at Harvard – I visited at the Brigham, I visited on the Harvard service at the City, liked living there, but it was clear to me that things weren’t going to move ahead. One of the things they’d agreed to do when I took the job was to bring in some trustees. The way they set this up was they took two trustees from each of the six Harvard hospitals that were in this group and created a new super board of which I was the president. I’d suggested that they get some leading Boston citizens who weren’t hooked up with any of the hospitals to come on the board. And they said, “Yes, that was a good idea.” If they had done that, I think the whole course of the thing could have been quite different.
But what happened as we developed this new program – these hospitals, the Peter Bent Brigham was of course sort of dominant – all of the hospitals involved except the Children’s really needed new facilities. The Women’s Hospital was an anachronism – I mean the free hospital for women. I did succeed in bringing the free hospital for women and the Boston Lying-In into a new thing called the Women’s Hospital. And that was an important step forward. But every time we’d talk about changing things – [it was] “You mean change our hospital?” All these guys were wearing two hats. They were wearing their Affiliated Hospitals hat but they were also wearing their [individual] hospital hat. If we’d had three or four really top-notch people who didn’t have any long-term attachments, I think we could have done something.
The best thing I can tell you is that fifteen years later when they finally built a new Brigham and Women’s Hospital they built it exactly where I proposed they build it in 1964. If they’d done it [earlier], they would have built four times as much hospital for 1/4 the cost. Because between the time we proposed it and the time it finally got built, costs just escalated unbelievably. So, in a sense, I’d have to say again, if it hadn’t been Harvard I’m sure I wouldn’t have taken that job. On the other hand, it was an exciting concept and there was an opportunity to have created something there that would have been a real model for medical care in this particular era. It was going to be a one-class hospital, it was going to have an emphasis on ambulatory care – all the things that are going on today. But it became clear to me it wasn’t going to happen, although we loved living there and everything was fine from that point.
Did the Affiliated Hospitals include Mass General?
No. Mass General wasn’t in it. The Mass Eye and Ear Infirmary was going to be in it, although its base was going to be down at Mass General. But also, because of George Berry’s frantic last couple of years there were a lot of things that didn’t happen that might have happened otherwise. So I hadn’t been there more than a year when both Washington University and Stanford started coming after me.
You were Professor of Social Medicine. What did that mean?
Well, they created that chair. At that point people were just beginning to look at the whole question of how the care of patients and health care delivery systems ought to change. So they created a new chair – they’d never had one like that. My professional activities were in the Department of Medicine but I had this lofty title in recognition of the fact that there was going to be a program.
Since about that time you’ve been the editor of the Pharos, of Alpha Omega Alpha.
Yes, since 1962.
Can you tell me about the publication and its editorial philosophy as you’ve shaped it?
Well, as you know, it’s the journal of Alpha Omega Alpha. When I was elected to the board of Alpha Omega Alpha the Pharos, which had been published for quite a number of years, had really gotten decrepit. It had been edited by old Dr. Walter Biering of the University of Iowa who was about 90 years old. It had come on hard times and was sort of reduced to reprinting papers from the Iowa State Medical Journal. Jim Campbell, who was president of Rush Presbyterian-St. Luke’s Medical Center in Chicago, a classmate of mine, was on the board of AOA and secretary-treasurer of the society, realized that the thing as about to go belly-up. He talked to me about it once and said “Would you consider taking on the editorship?” I said, “I guess I would.” So, I agreed to take it on. It was hard going in the beginning because people didn’t want to publish in the Pharos – it wasn’t a terribly attractive place to publish. So we’d scrounge around and at times we’d have a tough time getting enough papers. It’s a quarterly journal. But with the passage of time we began to attract a different kind of paper. And my good wife, who’s a superb editor, came on as the first associate editor and then as managing editor. I give her an enormous amount of credit because she really does a terrific job of editing. You get a lot of papers from very distinguished people, but many of them are not well-written.
Are you still editor?
Oh yes, I’m still editor. And now, it’s gotten to the point that it has a circulation of 57,000. The editorial policy is just to include things that are not technical. We don’t publish any technical papers. We publish on a wide range of history, ethics, aspects of medical care, and if I do say so, it’s highly-regarded. One of the best evidences of that is that we get a tremendous number of requests from medical schools to reprint articles to be used in teaching programs. The only thing that’s vaguely like it is the thing called Perspectives in Biology and Medicine at the University of Chicago. It has a much smaller circulation. We take no advertising – I do it as a labor of love. I don’t get paid for it. And it has a very broad circulation now. So I’m very proud of it.
Stanford, now. You’ve told me already how you got there. You were there just at the stormiest days of student unrest in this country.
Yes, I was acting president during a little of that period. I went to Stanford, as I said to you, thinking that I could have a role in pulling the place together. The medical school had a good reputation, but it was in San Francisco. It was one of the old-line medical schools, primarily a clinical medical school; research was limited. The basic science departments were actually on the [Palo Alto] campus even then. The medical students would then move up to San Francisco for their clinical years. But it had a good reputation. Wally Sterling had the courage to move it down to the campus, and it wasn’t easy to do. The alumni didn’t like the idea of the Old School moving and they were worried about the emphasis on research, and so forth. But nonetheless, it was done.
They got into this unholy alliance with the city of Palo Alto when they built the hospital. Palo Alto had a city hospital – not like the St. Louis City Hospital or the Boston City [Hospital]. It was the only hospital in Palo Alto and was not for indigent patients, but the city owned it. So they joined up. They had two services, a community service and a university service, they had two staffs. If you wanted to design a lousy arrangement, you would have designed it that way. And they went through hospital administrators about every four days. So, before I came there I could see that was the real problem, and I told them. That’s why, as I said earlier, they created this vice presidency because I knew I was going to have to do a lot of negotiating.
The school has a great reputation for research. It doesn’t have the same reputation for clinical care. One of the great things about this place is despite its research eminence it also has a very strong tradition of patient care. So I went there and during the first two and a half years I spent an awful lot of my time negotiating the purchase of the hospital. The faculty worked pretty well on that one because they recognized they had to have that done.
About that time the Viet Nam War business and all the unrest came up. I got browbeaten into being acting president of the university when Wally Sterling retired. I’d gotten to know the trustees well and they liked me. I didn’t want to do that, because one of my aspirations wasn’t to be a university president. That period was particularly hard on me, personally. Because university means a lot to me – I mean “university” generic. I like the ceremonies of the university, the traditions of the university, and that was a terrible time. It was worse at Berkeley early in the game. It was a tough time. The students – a small group of them really – there were about 200 students at Stanford who, if you could have picked them up and dropped them in the ocean it probably would have been different. They started raising hell.
The university wasn’t responsible for the Viet Nam War. I didn’t know many people at the university who were for it – I certainly wasn’t for it. But they’d go around in this mindless way of breaking windows and raising hell. In my view, the faculty at Stanford and a lot of places was very weak. They were so anxious to be popular with the students that when the students decided they didn’t want to go to class, they’d say “Fine, don’t go to class.” At the medical school at Stanford, a lot of the people on the faculty were very bad in that regard. [If] they [the students] didn’t want to do this, the faculty said it was all right. I found that very tough, perhaps even more so than some, because I started here as dean of students. I had very warm relationships with students here at Washington University. One of the joys I have today, all these years later, is running into my old students and having a warm greeting from them. That was true at Colorado – even though I was dean I still did a lot of teaching and I got to know the students well.
At Stanford in that period, if you were an administrative officer you were a son of a bitch, period. Just because you were an administrative officer. I found that very painful and it really took most of the fun out of it. The only fun you get out of being an administrator, really, is having a chance to build something, to create something. And if that’s taken away, if all you’re doing is wondering who’s going to throw a brick through the window or blow up a building, then that’s not my cup of tea. So I didn’t enjoy the last couple of years one bit. Quigg Newton, who’d worked at Colorado had been wanting me to come to the Commonwealth Fund for a long time, so I finally decided I wasn’t going to stay on and do that.
I think it’s too bad. I also think, though, that at different periods of time you need different kinds of people. I grew up in the time when these places were smaller – there were only about 100 house officers in the whole of Barnes Hospital when I was a house officer. We all knew each other, knew the faculty. These places are gigantic now and they have a lot of things that we didn’t have. But they’ve also lost some things – they’ve lost some of the esprit. I don’t mean here particularly, but inevitably, if you’ve got 5,000 people around it’s not the same as having 1,000. That’s all right, I had my time of it and now you need different kinds of talents. I don’t think there’s any secret that people don’t find a lot of these jobs nearly as much fun as they did, because of the burdens and the problems and all the battles that go on, relating to finance and this, that and the other thing.
When I started out there were problems but they were of a different size. Even as a dean I was able to continue teaching. When I first went to Colorado I actually kept the lab going. Now, you can’t do any of those things. So, I think at a different time in history, you need different talents. But I don’t think there’s any question that late ‘60s, early ‘70s period was a terrible, terrible time. I don’t know anybody who really enjoyed it, primarily because so much of one’s time had to be given to extraneous things and worrying about all these controversies and battles, which isn’t what you ought to be doing in a university. What you ought to be doing in a university is creating.
So in 1971 your career as a foundation executive commenced.
September ‘70. And I’ve done that ever since. I spent two years at the Commonwealth Fund, one year of which we lived in New York. My wife wasn’t keen on living in New York. She was pursuing her psychiatric training. She started at Stanford and then she had a year at Columbia Presbyterian at the psychiatric institute and then finished her last two years when we came back to California when I took over the Kaiser Foundation. I did that for twelve years with an emphasis on health care delivery and they were big on the HMO business because of the Kaiser program. And I decided – I was going to be sixty-five in September 1983 – I had no intention of retiring in the true sense of the word, but I figured I’d done that for twelve years. I’ve done various things and I think there’s something to be said for, every so often, doing something new. So I had decided, my wife and I talked it over, that I was going to retire from the Kaiser Foundation and maybe do some consulting and so forth.
In February of ‘83 I told Edgar Kaiser, Jr. who was chairman of the board, that I was going to retire, that I’d stay on till the end of the year so they’d have time to get somebody else. There was some fear and trepidation only in the sense that I knew I wouldn’t be happy sitting at home. I really wanted an office, but it costs a lot of money to set up an office. As luck would have it, again, within a couple of weeks of my telling him, I think it was actually announced, I got a call from the chairman of the board of the Markey Trust, which was just about to come into being, saying Josh Lederberg at the Rockefeller, whom I’d encountered in Washington, had suggested he come out and talk with me. I think when he first came to talk with me he was just gathering information about what a medically-oriented foundation would do. But for better or worse we hit it off, and in matter of a few, six or eight, weeks—
You didn’t have to move this time?
Well, the Foundation is in Florida. But we had a discussion and then I met with him and the president – they’re both very distinguished lawyers, one in Chicago and one in Miami. They said, “We’d like you to run this.” This is a foundation that is going to concentrate completely on basic science, which of course is marvelous because one of my frustrations at Kaiser was we weren’t doing much in research. At any rate, I said to them, “I’d love to do it, but I won’t leave California.” Because we’d been uprooted enough and my wife has a career going very well and our daughter and grandchildren are there. So they said “Fine.” I got an office downstairs from where I was, I made a move of some twenty vertical feet, I’m 9/10 of a mile from where I live, and I have a wonderful setup. So I started that on the day after I retired from Kaiser.
We really haven’t talked about Kaiser at all or the philosophy of being a foundation executive. Did you enjoy it?
Well, you know, there’s an old saying that it’s more blessed to give than not to receive. Yes, I enjoyed it. I enjoyed the Commonwealth Fund – I’m still on the board of the Commonwealth Fund. I enjoyed the Kaiser Foundation, although there was this enormous interest in prepaid health care, which is an important thing; it was a very good system. But I thought it was a little narrow. The Kaiser family was very much dominant on the board. That’s a real problem in a lot of foundations – you have family. It wasn’t as much fun – I had a good time and I learned a lot and it all went quite well. But one of the things I like about the thing I’m doing now: first of all, they have quite a lot of money – and we had quite a lot at Kaiser – but research is just much more exciting and fun. The health care delivery business is important, but what I do now is spend all my time with people who are in the forefront of modern biological science. And that’s stimulating as the devil.
How did you deal with being bereft of your university functions?
Well, I haven’t been. When I was at Columbia they gave me a professorship there. I didn’t do anything there, really, because it wasn’t convenient geographically. But at Stanford – my office is in Menlo Park which is right next to Palo Alto. We kept the same house we had. I’ve been Consulting Professor of Medicine, whatever that means, at Stanford, and I’m only two or three miles from the Stanford Medical Center campus. So I go to grand rounds, and until a couple of years ago I used to take a tour of duty teaching general medical clinic. Being next to Stanford is a great asset. It’s a very stimulating, exciting place. So I have an attachment and I still have that appointment, so I’m not bereft of my university affiliation, although it’s an honorary title. And I spend a lot of time in universities – all our interest in the Foundation is there. I get invited to visit this, that or the other thing at various medical schools. So I really am not very far away – in some ways I see much more of medical schools. It’s a nice way. I have all the fun and none of the responsibility.
Well, our time is up.
You probably never interviewed anybody who talked so damn much as I do!
You’re very fluent. Let me thank you very much.
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