This is Oral History #49. It is April 28, 1981. I’m Paul Anderson and I’m speaking today with Dr. Richard W. Hudgens, M.D., Washington University School of Medicine [Class of] 1956. Let me begin by reviewing Dr. Hudgens’ career and then he can correct me if I make any gross errors.
You were born in 1931 in Greenville, South Carolina. You received your B.A. from Princeton in 1952 and your M.D., as I said, from Washington University in 1956. You were an intern at the University of Virginia Hospital in Charlottesville from 1956 to 1957 in Internal Medicine, and a resident in Medicine at the same hospital in 1957-58. This was followed by a residency in Psychiatry at Charlottesville [from] 1958 to 1959, followed by a residency in Psychiatry at the University of North Carolina at Chapel Hill, 1959 to 1961. From 1961 to 1963 you were a staff psychiatrist at the United States Air Force Hospital at Lackland Air Force Base in Texas. This lasted until 1963, whereupon you returned to Washington University and became an Instructor of Psychiatry and then were promoted up the academic ladder from there.
In 1965 you were a World Health Organization medical advisor (Dr. Hudgens gives corrected information) in Honduras, and from 1967 to 1974 you were also in the administration of the Washington University School of Medicine, first as Assistant Dean for Curriculum and then as Associate Dean. Now, since 1974, you are a professor on the clinical faculty, but in full-time practice in suburban St. Louis. Did I leave anything out?
No. That’s it.
Let us begin with an obvious question, since this is part of our alumni series. Why did you choose to attend the Washington University School of Medicine?
I wanted to get a school off the east coast. All my education had been on the east coast. I talked to an old friend of my father who worked for the Rockefeller brothers, and he said that the best school was Washington University – it was one of the best in the country. So I applied here and luckily got in.
The Rockefeller Institute, perhaps?
No, he was working for John, Nelson, and— in their overseas development enterprises.
What do you recall about the preclinical facilities of the medical school when you were a student?
Well, we had the two – the North and the South wing of the medical school and the Cancer Research Building in between had been recently completed. Those facilities were very much then as they are today. There have been a lot of changes in the curriculum since 1952 when we entered school. The core of the year really was the gross anatomy course then; it went all year [and] it no longer does. The whole emphasis now is much more on cell biology than it was then.
Do you recall that the medical school facilities were overcrowded or inadequate in major respects even then?
No, not that I remember. But I wasn’t paying too much attention to that back then.
When you began your clinical training, what were the facilities like?
City Hospital was probably where I spent more time than anywhere else. City Hospital was a real baptism of fire because the medical students functioned in the position very much of interns and also nurses and also, sometimes, of orderlies. We had to do everything – [be] lab technicians. We had a lot of clinical responsibility. The facilities at City have not changed very much in the last twenty-nine years. Homer Phillips [Homer G. Phillips Hospital] was then alive and well and was another baptism of fire.
So you had experience at Homer Phillips as well?
Both places. In three weeks at Homer Phillips I delivered sixty babies [including] four sets of twins in my three-week senior clerkship there.
Was Homer Phillips still more or less officially the St. Louis Hospital for Colored?
Yes. There was a segregated city hospital system. An interesting thing happened around about the time I was in school. I don’t know if this is an apocryphal story or not, but it’s said that a man collapsed on the street near Homer Phillips. He looked white so they took him to City No. 1 and they got him there and decided he was black so they sent him back to Homer Phillips, by which time he was dead. After that, a ruling was made that an emergency patient went to the nearest hospital. So by the time I was in school there were some black patients at City and some white patients at Homer Phillips. The facilities at Homer Phillips seemed to me to be inadequate, and even then there was talk about closing Homer G. But even then there was opposition in the black community for closing it because the chiefs of services were black, the housestaff was all black, and at that time black physicians and black physicians-in-training really had very few doors open to them. So Homer G. was a real training ground for some of our black physicians.
I heard on the radio this morning how strong the alumni group from Homer G. is.
Yes. It was interesting at Homer G. On OB – that was one of the few rotations that went through Homer G. then – the other fellow who was in my class rotating through OB on the same three-week slot as I was was Gene [Eugene B.] Feigelson, who’s also now a psychiatrist. I was born in South Carolina, Feigelson was from Birmingham, Alabama, so there we were with our southern accents. From the standpoint of the doctors there, the housestaff, we received a warm reception and felt like one of the gang. But the nurses and some of the other people who worked there were very hostile to us because we were white and Southerners. It was really our first experience with racial discrimination directed at us – us having been raised in the South and having observed it directed at blacks. It was a different story.
I imagine it was an interesting experience. What professors, looking at your medical training as a whole, did you consider to be the most influential on your career?
Ed [Edward W.] Dempsey was the most influential. Dempsey was the head of the Anatomy Department. He later became dean, after we graduated. I worked in Dempsey’s lab for two summers and we became friends. He was an extraordinarily good teacher in smaller groups and on a one-to-one basis. He really had a lot of influence in teaching me what the scientific method was all about and teaching me what the meaning of research was and why research had to be the foundation of all medical education. Dempsey was, I think, a much better researcher and department head than he was a dean. When he became dean I think he tended to try to run things more than the dean of this school can do overtly. The position of the dean in this school is how to run committees, it’s how to run the Executive Faculty. The department heads are quite powerful compared to department heads in other schools. The dean that we have now, Ken King [M. Kenton King], is probably one of the most successful deans this school has ever had because he knows how to work with the system, with the people. But Dempsey was the most influential to me.
After Dempsey, I think Carl Moore, who became head of the Department of Medicine in my senior year after Barry Wood left. Carl Moore, as Barry Wood had been, was an all-pervasive influence on the medical students because he had a way of approaching patients, a way of approaching clinical problems that gave you a tremendous respect for the patient and a tremendous respect for the spirit of inquiry into clinical problems. It was a serious matter with Carl Moore. So I would say Dempsey and Moore were the two major influences as faculty members. There were a lot of others, too, of course. [Like] Roy Peterson, who is running the gross anatomy course now – I guess he’s acting head of the Department of Anatomy now. Roy began as an instructor the year that we began as freshman medical students. Roy was my instructor in anatomy. I think he’s one of the best teachers that there has ever been at this school. He was tremendously influential – he made it fun, he made anatomy fun – and that was by far my most enjoyable course.
Other people I remember – well, Carl Moyer was a flamboyant head of the Surgery Department. Moyer was a very provocative man – provoked you to think. Moyer was not always careful with the truth; you couldn’t always tell if Moyer was kidding or not. He was the opposite from Carl Moore in that respect. But Moyer was a gifted teacher. His conferences were always fun. You had to pay attention because he might ask you some devastating question at any moment. They had a hell of a good faculty.
Were most of the medical students in your class from the St. Louis area?
They were from all over the place. I guess there were more from here than anywhere else, but they were from all over the place – mostly west of the Mississippi [River], though, as I recall.
Was it policy to recruit students from other parts of the country?
I don’t remember; I don’t know. [William B.] Parker was running the admissions procedure then. I wasn’t really in on how things were done back then.
Were there any foreign students in your class?
No, not any. And only two women in our entering class, and one [other] came in in the third year.
Where did you live when you were a medical student?
I lived on Belt Avenue, near St. Luke’s East Hospital. I used to walk to school, across Forest Park. It was an apartment – no air conditioning.
It must have been rather difficult in the St. Louis summer at times, although maybe people didn’t notice it quite as much.
Didn’t bother us too much.
Did you have any extracurricular social life? I’m referring to fraternities or anything like—
I was married – [I] married just before I started medical school. I didn’t belong to one of the fraternities – there were two – mainly because I felt that to belong, to really get the most out of the fraternity, you had to board there and there wasn’t much reason to belong. Extracurricularly, we had class parties; we had a lot of class parties. Every year we had a show, a skit of some sort, culminating in our third year when we put on a huge skit for the seniors in the old Machinists Hall on Olive just east of Grand. I think we had five or six hundred people there as an audience and about thirty members of the class took part in the show. It lasted two and one half hours. We even had some members of the faculty in it; we had Moore and Dempsey and Moyer, and Barry Wood was also in it.
What were they doing? Singing? Telling jokes?
We had them telling jokes, yes. We had them do a skit. We did that, and we had a softball team and played ball. That’s mainly what I remember about the extracurricular [activities]. We had a lot of fun.
Was it unusual to be married while a medical student in the fifties?
Not too much. I think there were about twenty-five of us who were married, out of an entering class of eighty-six – maybe twenty-five or thirty. A few had kids while we were in school.
Students of the 1950s are sometimes referred to as a docile, silent generation. Was this true for medical students?
I think we were pretty conventional, yes; [but] we weren’t docile or silent. There were some very bright guys in our class, of course, as in any class. There was a prevailing seriousness about the work, so the work took a large amount of time. There was a spirit of fun, really. We had a cohesive class and we still do. Claire said we’ll have the largest reunion class in history this next week – the 25th reunion. [There is] a lot of closeness.
Were there any rules that were noticeably different from those that affect medical students today – written or unwritten rules, codes of conduct?
Well, Robert A. Moore was the dean then. Moore was a stickler for dress. If you were going to see Bob Moore in his office you’d better have a jacket and a tie on. He used to conduct his pathology sessions in the sometimes-steaming pit of the old Pathology Amphitheatre in Barnes with a wool suit on, sometimes. This guy meant business when it came to dressing. So there was a formality – we dressed casually – but there was a formality then. Nobody had beards, nobody had long hair in those days. We were a rather sober-looking group. There was an honor system which was not as firm as the honor system I had been used to in college, but it governed the thing. There was just generally [in] your conduct on the wards – well, people like Carl Moore set the tone. Moore was a tremendously formal, dignified man around patients. You didn’t act in some other way; it wouldn’t have occurred to us to have acted in a silly or undignified manner around patients. It would have been impossible.
Were there any blacks or other members of minorities in your medical school class?
No, not any. Roy [Toshio R.] and Mitch [Michio] Kaku and Harold Nekonishi were Oriental; they’re from Hawaii. Nobody considered them minorities. There were no black students. There is an interesting tale about the process of how the wards – this is true – this really happened. About a year after I graduated, the wards in Barnes Hospital were integrated racially for the first time. Prior to that, there had been white women, white men, black women, black men in different places. 0300 was the ward for black men. It was in the basement of Barnes Hospital; it was called the Black Hole of Calcutta. The windows were up high; it had no cross ventilation. I think it was probably in late ’56 or ’57, there was a delegation of Russian doctors coming through. Somebody took a look at the wards and realized that, “Oh, my God. We’ve got racial segregation.” So they integrated the wards. Dempsey told me about this later when I visited him. He said it looked like a piano keyboard, black, white, black, white, black white. They had just inter-digitated the racial distribution.
And it was the pressure of that one visit that—?
It was a Communist plot. (Laughs) The Russians did it. And it was a very good thing they did it. It was really a terrible thing that we had inadequate facilities for black patients. It was a blessing, however it happened, that they got the medical services integrated.
Did you have any opportunity to do research while you were a medical student?
Yes. I did research in Dempsey’s lab. I worked with one of the first electron microscopes they had.
Yes. He was a pioneer in this facility.
They got the second ’scope while I was here and I used the old ’scope – the old original one. I did work with Dempsey on placenta and that was very helpful – not that anything came of it except it was part of my education in learning how to do research.
With regard to your eventual decision to specialize in psychiatry, did you go into medical school with that intention?
No. It didn’t occur to me to go into psychiatry until I was a resident in medicine at the University of Virginia Hospital. At that time I was interested in internal medicine and in taking care of patients, but I was realizing that the ones with psychiatric problems were more interesting to me. I should say that the internal medicine patients were just as interesting as the psychiatric patients, but the problems of psychiatry interested me more than the problems of internal medicine. I knew that I wanted to go into academic medicine and I knew I wanted to teach. I knew that in order to do that, I needed to be in an area where I had an academic interest in the subject matter and not only just [in] the patients. So, that was for me, psychiatry. It was a hard decision to make because psychiatry at the University of Virginia, and, at that time here, too, was not highly regarded as a specialty. So I sort of went against the flow. I remember I didn’t even talk it over with my wife; I just decided to do it. She was irritated with me that I hadn’t told her – she heard it about it from somebody else.
Even though you didn’t have the intention while you were a medical student here, you must have strong retrospective thoughts about Renard Hospital, which I think was built not too long before you were a medical student.
It was built while I was there. The psych patients were in McMillan at the time I was there. The only psych we had were lectures. Let me take that back – the only inpatient psychiatry we saw was at Malcolm Bliss [Hospital], which was really a snake pit at the time.
Can you elaborate on that.
It was a city hospital; it was not a part of the state system yet. They took everybody from the city, acute and chronic patients were in there. I remember helping to tube feed a woman who had been there for twenty years that was catatonic. The way they gave shock treatment at that time was very different from what they do now. It looked more like something out of One Flew Over the Cuckoo’s Nest. It worked, but it was a little harsher to watch.
The biggest influences on me in psychiatry – and I should have mentioned this when you asked me about influential teachers – were George Saslow and Sam Guze. Saslow was an extraordinarily good teacher; a gifted teacher and a gifted interviewer, and he had an outpatient psychiatry experience in the clinic. It went for twelve weeks. We took other things; we took psychiatry one or one and a half days a week. That was a very good experience. He taught us how to interview patients, he taught us something about psychiatric illness, he taught us something about treating outpatients.
Guze was at that time an internist who had also been trained in psychiatry. Guze got into psychiatry through the door of internal medicine, also.
He’s your senior—
Guze, of course is now the Vice Chancellor [for Medical Affairs]. Sam was a young assistant professor of something at that time and taught our class a great deal. When I left here and went to Virginia, what I remembered of psychiatry was what I had learned from Saslow and Guze. Those were the dominant influences, really. I guess in the long run they turned out to be more influential than anybody else.
Even though you didn’t have immediate personal experiences with Renard Hospital, can you describe what it meant to have this facility added to the medical center?
Yes. I can only say it in retrospect because when I came back – I was away from ’56 to ’63 – Renard was there. It was a very modern facility in the 1950s and early sixties. The whole way patients were dealt with in the hospital was different then. The idea then, both in psychiatry and in internal medicine, was to have a big room with all the beds in it. It concentrated everybody – you could watch people more closely. Now the trend is to have more space and private rooms or two-bed rooms. It’s just a totally different attitude. The patients began to mind that kind of thing in the last few years. The sixth floor of Renard was always a problem because it looked terrible. No matter what they did to it, it always looked bad because it seemed crowded.
Was this one big ward?
It had room for about thirty-two patients, and some four-bed rooms and some single-bed padded rooms in the back, and a couple of day room areas which always seemed too small because it was often filled with agitated patients wandering around. So old Renard was a place that was very tense to be in. It had some advantages, though. You could see everybody; you didn’t lose a patient. A guy jumped out of Barnes Hospital’s new division about a month ago. In 6 Renard it was easier to keep track of everybody because there was not as much space to cover. But it was less pleasant for the patients; it was more crowded. The other thing was that for a while in the sixties we had problems with the nurses in that we had changes of head nurses and the nursing staffs were not as well organized and the personnel kept turning over. [In] the last five or six years we’ve had real stability in the staffing in psychiatric services and even 6 Renard got to be an excellent place to take care of psychotic patients.
Is this because of advances in specialization in psychiatric nursing, or what has meant a change in this regard?
It was the individual people, the personnel, and the fact that they got rid of some of the people who didn’t do as well and they hired people who were good and they kept them. Barnes developed an enlightened way of dealing with the nursing personnel, I think, compared to what it had been. I think they’ve treated them better and paid them better than they used to.
Was it controversial at all in those days to have a psychiatric unit as part of a general hospital complex?
No, not by then. Not by that time.
When had that started?
I think probably – I’m not sure of this – really [that] before World War II it had already begun to be thought of as a good thing to have. Well before World War II it was already thought that psychiatric patients would be more likely to receive optimum care if they were in a medical center where they could get other services if they needed it. You have to have the wards separate. You have to have psych patients on the same floor because of the type of nursing. The whole flow of things is different than it is on a medical floor. But they should be in a general hospital, ideally, I think.
Moving to a substantially different subject: when you moved on to the University of Virginia Hospital, from this experience you wrote an article about students there. That may have been your first article – the earliest one I could find. Can you make comparisons between students there and students here?
Well, Virginia was a more easy-going atmosphere. I would say, on the whole, it was an easier medical school to get into probably. The median student at Washington University was probably a better student than the median student at Virginia. The top students at one place and the top students at the other place were probably just about the same. But it was a smaller place. It was a hospital of 350 beds in contrast to Barnes which has about a thousand. It was an extremely friendly atmosphere; I knew everybody on the housestaff. It was a warm, friendly place. That was a big difference. The faculty was not as strong or as deep as the faculty here. I’m glad I did it the way I did; I’m glad I had medical school here and the housestaff experience at Virginia because it was, I think, probably a more fun housestaff experience there. I worked very hard but there was more warmth at Virginia than at Barnes.
Were their facilities proper for switching to psychiatry as a specialty there?
Oh, yes. They had a psych service. They had a separate division just like Renard was here.
Why did you move on to North Carolina?
It was a better residency program than Virginia. The real question is why did I stay in Virginia for my first year in psychiatry That was an artifact entirely. That was because my wife and I were adopting our first child and we had to maintain residence in the state of Virginia for one more year in order to qualify. So, as soon as I could, I switched to Carolina.
You’re a native Southerner. Are there any differences which you can cite in attitude toward mental patients. Having lived in the South and having experienced both points of view, I think the northern point of view is that the southern temperament tolerates mental disorder.
No. I can’t generalize about that. I think medicine is pretty much uniform in different parts of the country. I should say that the South and the Midwest are pretty much alike in terms of their basic attitudes toward medicine. Medicine is more international than local – they look more out toward what’s going on in the whole field rather than what’s going on [in the] locality, at least in medical schools they do.
Did you have any really strong experiences that you could relate at either Virginia or North Carolina in psychiatry? Any crucial points in your development?
Honestly, I think that most of what I learned at Virginia and North Carolina I taught myself through experience with patients. With a few exceptions, I don’t think the faculties in the Departments of Psychiatry there were particularly strong. They taught us a lot about how to do psychotherapy but they didn’t teach us a whole lot else. It wasn’t anything like what I learned after I got back here. Most of what I learned, I learned from taking care of patients, the hard way.
I remember, for example, a young woman who was admitted to the medical ward when I was assistant resident on Medicine at Virginia. She was quite psychotic, delusional, thought her brain was rotting, and wanted to die. She should never have been on the medical ward; they took an overflow bed from Psychiatry. She jumped out the bathroom window and committed suicide the night after she was admitted. The psychiatrist who had seen her had no business putting her there – they should have put her over there [in the psychiatric area]. I remember another guy that they had – I just think that they didn’t really know enough about treating people with severe psychiatric disorders. They knew a lot about treating people who had problems and needed psychotherapy, but the real psychotic patients and the real suicidal patients, I think, weren’t treated as vigorously there. And I learned that the hard way. I knew when something was wrong that it was wrong. I never forget those things.
What were your experiences like at Lackland Air Force Base?
That was interesting. I was only there two years and that’s just about enough. You spend a lot of time getting rid of people whom the Air Force considers unadaptable. Lackland was their main training base; all new recruits come into Lackland. At that time, somewhere between three and ten percent were being processed out through administrative channels as unfit by virtue of personality problems or psychiatric illness. So we saw a lot of seventeen- and eighteen-year-olds. The Air Force is there to fight a war, so you get rid of people that you don’t think are going to be able to make it. A psychiatrist feels kind of used in that mission; they don’t really feel like they’re treating the personnel. Now, we saw their wives and children, also, and that was very much like a civilian practice of psychiatry because you did treat them. But it was good experience.
You wrote an article with a title that I looked at because it had a lurid character to it – I probably shouldn’t characterize it as that, but it was called “Murder by a Manic Depressive.” Was this one of the experiences?
Yes. This fellow had recurrent depressions and when he’d get depressed he’d believe that his wife was unfaithful to him, and he murdered her. He used to threaten her sometimes. I got him a medical discharge from the Air Force and actually after I’d come back to St. Louis and he’d gone on his way to Virginia where he lived, he went back and reunited with this woman, who for some reason, took him back. He had treated her terribly. About two weeks later he killed her. I was called down to testify at his trial. The defense told me that if I could say he didn’t know right from wrong he’d get off and I said, “Well, I can’t say that.” The defense had another psychiatrist who did say that, but I’d been the treating doctor and I said, “I know he was terribly sick, but I don’t know whether he knew right from wrong or not.” He didn’t remember anything about it. That was very distressing because I could have kept him out of jail by just saying that. But anyway I didn’t feel it would have been the right thing to do. He was found guilty and he spent about five or seven years in the State Hospital for the Criminally Insane in Texas. They gave him EST there and he recovered and he remarried. For a long time after that I got Christmas cards from him. He never held it against me that I didn’t get him off.
You allude briefly to the fact that you were not giving him treatment at the time of the murder. Is there any real regret that you have sometimes when your own career necessitates breaking off the treatment of a patient.
In his case, he was well by the time he left the Air Force and I left the Air Force, so I felt all right about that. It was a year later that he killed his wife, during another episode of illness. But, yes, [I’ve had] three or four patients over the last twenty years that committed suicide. I can think in each case of something that I wished I had done different. One of them was a physician in his sixties that I saw in the office and did not admit to the hospital because I thought he wasn’t that sick. He drowned himself in his swimming pool that night – I should have admitted him to the hospital. This kind of thing you never forget, but, hopefully, you learn from it.
I’ll tell you a story, if you’re interested in anecdotes about this kind of [thing]. When I was an intern there was a man at the University of Virginia on the surgical service who went into renal failure and died. At that time they had no dialysis. Nobody knew what had happened to him – it was postoperatively – he died of renal failure. The chief resident on Medicine, who was an extremely bright guy named Les Adams, who’s now in Florida, investigated and found that this fellow had gotten mismatched blood at his operation. The patient’s name was an unusual name, but it happened that there was another patient with the same unusual name in the hospital with blood typed and cross-matched in the refrigerator – the same damn name – and it was not a common name. So the intern, grabbing the blood out of the blood bank refrigerator, checked the name – which was natural enough – and not the number, and gave the patient the wrong blood and he died.
[Dr.] Tom Hunter, who is another influential person in my [career] – Hunter had been Dean of Students at Washington U. and he went on to become Professor of Medicine at Virginia while I was at Virginia. Hunter said, “The thing to remember about this is that we all make mistakes that cause people to lose their lives. Sooner or later you’re going to do this. The thing is not to hide from it, but to learn from it. Don’t let yourself off the hook and say, ‘Oh, I didn’t do that.’ Admit it to yourself, learn to live with it, but learn from it so you don’t kill somebody else.” I’ve never forgotten that and that’s been a great comfort to me in subsequent years when I’ve made mistakes that have cost people their lives. One time I gave a guy with asthma a sedative – not a large amount of sedative – during an asthma attack and he died. If I hadn’t given him the sedative I don’t whether he would have died or not. But I’m going on the assumption that what I did— I can live with that, but I’ll never make that mistake again. The main thing is not to make the same mistake twice.
Why did you return to Wash U?
This place, by that time, had such a strong faculty in Psychiatry – this was an absolutely tremendous place. [Eli] Robins was about to become head of the department. [Samuel B.] Guze, [George] Winokur, and a number of others [were faculty members]. Exciting research was going on both in the clinical line and in the laboratory. There was a spirit of adventure here in research, and a real iconoclastic approach to the usual idols of psychiatry such as Freud and others. It was a very exciting place to be; you could learn a lot.
There was a lot I didn’t know, of course, and I wanted to go to a place where I could learn. I had a choice of going to a place where they would already think I knew a lot and where I could have a higher salary and maybe a higher position sooner, and be thought of as kind of a hot shot, or to come here where I really didn’t know anything – felt real dumb – and where there were people that could teach me something. I didn’t realize it then, eighteen years ago when I came, but I still feel that way. I still feel as if I don’t know anything. Obviously, that’s an exaggeration, but relative to what I should know I don’t know anything. That’s what you get at Washington University in psychiatry – you get the feeling that there’s more and more and more to learn. You never get the feeling you’ve got all the answers. That spirit has remained even though Robins is no longer head of the department; Guze is. The same spirit is there. It’s a tremendous place to be.
Could you tell me briefly about your experience in Honduras?
I went there briefly in 1965, for three weeks, because I saw a notice in the American Psychiatric Association Newsletter, put in there by a Peace Corps social worker who said he wanted a North American psychiatrist to come down and consult on certain problems in a mental hospital there. They had a 500-bed mental hospital. I went down there then – I learned Spanish kind of in a crash course before I went. I’d had Spanish in school. Two years later I went back for three months in the summer of ’67, this time as a consultant for the World Health Organization, having to do with building a hospital down there. I also did research down there on the psychiatric patients in the hospital. They were going to build a new mental hospital out of town, outside the capital city of Tegucigalpa. I advised them not to do that because they were going to put them out in the sticks like in the nineteenth century. I said, “No, you’ve got to build a new hospital in conjunction with a general medical center. Otherwise, these psychiatric patients are going to be just isolated [and] you’re not going to have proper services.”
For reasons that we’ve already discussed in connection with American general hospitals?
Yes. I said, “There’s no need to repeat the mistakes of the United States.” They did, in fact, do that – they didn’t build the hospital out of town. They had a big problem in Honduras; there were only four psychiatrists in the country and these guys didn’t get paid very much. They had to teach and do private practice and run the hospital, too. It was really something. The Americans had a lot of Peace Corps volunteers in Honduras at the time. Some of them were working in the psychiatric hospital – very dedicated kids. The Peace Corps was really something back then; I don’t know what it’s like now.
It was in those days a very positive contribution to Honduran development?
Yes, it really was.
You mentioned the World Health Organization. Was the Pan-American Health Organization the branch—?
Yes. That’s the branch in the Americas: PAHO, Pan-American Health Organization.
We’ve had conversations in this series with Dr. [Robert E.] Shank of the Preventive Medicine Department about a nutrition study. Did you have any—?
No, I wasn’t involved with that. I talked with Shank about that after I got back. And I’ve talked with medical students who’ve been down in Central America, I think in El Salvador and Guatemala, too.
They wrote a survey concerning all the Central American republics, as well as many other countries around the globe.
You see, the problems down there, at least when I was there – this was fifteen years ago practically – the problems that are striking down there aren’t psychiatric problems. They’re bad enough. But it is the basic problems of nutrition and the most fundamental kinds of medical care, so psychiatry is kind of small potatoes down there. There's so much else wrong, that the psychiatric patients get swallowed up in the mess.
Let’s talk briefly about your work with the reform of the medical school curriculum as Assistant and then Associate Dean. How did this come about, first of all?
In ’66, I believe, the Executive Faculty [of the medical school] and the Committee on Medical Education began to realize that the curriculum needed to be changed because there needed to be a better coordination among different courses. There needed to be more time to give students a chance to pick what they wanted to do in their senior year. There was so much ground to cover; you couldn’t cover it all in one curriculum. So there were major changes of time allotment to different courses, creation of a new course in the second year which provided better coordination of the basic sciences and the clinical sciences, and the creation of an elective senior year where students could take whatever they wanted.
They had to get somebody to administer this program and it was an area I knew that I was interested in. So I really volunteered for that job. I went to Ken King, who was Dean, and said, “I really think that I should have that because I’m interested in that.” And he said, “The best sign that somebody can do a job is if he wants to do it.” Also, I wanted to be on the Executive Faculty because I thought that I had to be in touch with the faculty even more than with the students in this. So I got a non-voting position on the Executive Faculty. We got it organized and really got the bugs out in a couple of years and had a lot of fun with it. It was really fun. I did it for seven years. At the end of that time, just before I went into private practice, I told the Dean I didn’t think the position needed to be on the Executive Faculty any more. I thought that the Committee on Medical Education really should be the major policy-making body. It was already becoming that and the Associate Dean for Curriculum was already a sort of function, just sort of a member of the Committee on Medical Education. The pioneer work took two or three years to do.
Did anybody feel like their ox was being gored with these major changes?
Oh, yes. There was a lot of complaining about that. It took a lot of diplomacy. One of the things that I always did was that I would never have somebody come to my office, I would always go to his office. First of all, I was young – I was younger than most of the people that I was dealing with. So I would go with the position of “What do you think about this?” and never try to impose anything on anybody, using persuasion. I don’t even remember all the conversations I had with faculty members trying to talk them into this, that or the other flexibility. It was a major diplomatic effort on my part and I had to learn to be very tactful. Yes, there were problems. One of them [was] cutting out the clinical clerkship, the outpatient clerkships in the senior year. [It] had been required – twelve weeks of clerkship. That bothered Dr. Shank a great deal, I know, and he didn’t like it. There were a number of things like that. Psychiatry got more time and Surgery got less time and that made the surgeons unhappy – that kind of thing.
Do you think these reforms have stood the test of time?
Yes. And there’ve been a lot of changes since then. Yes, I think they’ve stood the test of time. One of the other things we did – we had a lot students going away to other schools for electives and we had to get some kind of quality control of that sort of experience. Some people spent the whole senior year away and then would get a diploma from Washington U – that kind of thing. We had to sell that to the Executive Faculty.
Why have you now gone into private practice?
I had, in the last three or four years of my full-time faculty experience – I left there when I was forty-three – [I learned that] in your late 30s and early 40s you get a lot of feelers for jobs as chairman of departments of psychiatry or deanships. I’ve probably had two serious feelers for deanships and three or four for department chairmanships, none of which did I ever pursue to the point where I was made an offer. Because when I looked into each of these jobs I realized that I didn’t want to be a dean and I didn’t want to be head of a department of psychiatry. I felt that I wanted to treat patients more and I was feeling that you can’t treat patients when you’re spending a third of your time administering and you don’t have continuity in patient treatment. So I was getting away from what I loved to do best. I was doing a lot of teaching and I enjoyed that a lot, but I could still teach and see patients. But research was not ever something that I did as avidly as I treated patients. I did it okay; my research was workmanlike, but was never brilliant. I didn’t have that “lunge-ahead” feeling that you need to be a top-flight investigator. A lot of my colleagues did have that in the department. So I didn’t feel that I was missing anything by that.
At that time, also, I remarried. I had been divorced, and when I remarried I had to increase my income, too. All this happened at the same time. About a year after I got married I went into private practice, because when you divorce and remarry everything gets divided up. So all of it happened and I really feel good about the way it’s worked out. I still have my associations at the medical school and now I’m doing what I love. I’m busier, I work harder than I used to. I guess I always will.
This sounds like a good point to end the interview, but there are [still] so many things I could ask you. You wrote a letter about Abraham Lincoln which raises the whole question about what one thinks about psychohistory, the point of view of a psychiatrist. But I won’t ask that, I’ll just thank you, Dr. Richard Hudgens.
Well, thank you. [I] enjoyed it. Thanks a lot.
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