Interviewer: Paul Anderson
This is May 8, 1980. Our conversation this afternoon is with Dr. Israel Newmark, who is a general practitioner of Chester, Illinois, and Dr. Stanley Harrison who is a retired pediatrician, now of Southbury, Connecticut, formerly of St. Louis and Evanston, Illinois. Welcome, gentlemen. First of all, why did you choose to attend the School of Medicine here at Washington University?
IN: It had always been my desire to become a doctor since I had been a patient for years and been demonstrated as a clinical case at the dermatology clinic at Washington U. on Washington, when they had it in the old building. Dr. Weiss, the dermatologist, used to send me a card and ask my mother to bring me to the clinic so he could demonstrate dermatitis herpetiformis, which I really never had. He would get me there in front of the students and have me undress to show them places where I had scratched myself until I had sores on me, and then he’d expound on dermatology. From that time on, going through the clinic I had an idea [that] someday I’d try to be a doctor. And besides that, my mother didn’t want me to turn out to be a tailor like the rest of the Newmarks. (Laughter)
Where was this old building located?
IN: That was located on Jefferson and Washington. That was one of the first sites. It was not the first site, but it was one of the early sites of the medical school.
What year would that have been?
IN: Let’s see – we came over in 1910, and I was five. It must have been about 1912 or ’13.
You were born in England – is that right – in London?
IN: Yes.
Dr. Harrison, how did you choose Washington University?
SH: I had several reasons. One, my grandfather was a railroad surgeon, living in Pacific, Missouri, where my mother grew up. I used to hear all of her tales about how Grandfather took care of the casualties out there. And then in high school I worked in a drug store and there were two or three docs upstairs and I used to hang around up in their office when I wasn’t busy and I began to admire them and to try to figure out their prescriptions. I was imbued that way with the idea of becoming a physician. Of course, it was perfectly natural, living here in St. Louis – we lived in Maplewood, a little suburb out to the west – and it was perfectly natural to pick Washington University as the school to go to. Those were hard times back then.
Describe what were the hard times.
SH: In the first place, we graduated from medical school right in the middle of the Depression. The Depression hit in 1929 and when I graduated I didn’t have any money at all. My father’s income was reduced. He was with this big grocery company and he took a big cut; they couldn’t sell groceries. Business just wasn’t any good. We managed with the aid of a few loans from the University, which I paid off eventually, in my junior and senior years. I had to borrow money – of course all the students do that now, but then it wasn’t very common. It wasn’t as expensive to go to school then – the tuition wasn’t as high and living was reasonably cheap. I commuted back and forth; I didn’t have to board here. (To Dr. Newmark) You commuted to school, too, didn’t you?
IN: We walked to school for two miles every day.
SH: I had to come in on the street car from Maplewood.
Tell me a little about the preclinical facilities connected with your training. What were they like? Were they considered modern?
IN: We had what we thought was an intensive course in biochemistry, in which we were taught a number of early tests. We came in just as the gates of modern medicine were being opened and explored. There was tremendous research going on about the different tests in blood chemistry and so on. We were taught anatomy differently from what they are taught today. Two of us were assigned to a cadaver which had been kept in a vat of preservative carbolic acid.
SH: No, no – formaldehyde. We stunk like formaldehyde the whole year. We did anatomy the whole year.
Yes. I’ve looked at the schedule.
IN: We had very dry lectures in anatomy. Almost everybody had a chance to take a good nap.
Who was doing the dry lecturing?
Both: Dr. [Robert J.] Terry.
IN: He was a wonderful teacher, but his subject was of such a nature and so monotonous that we couldn’t help but fall asleep.
SH: I thought it was interesting that we did spend so much time in dissection, but I’m sure we learned anatomy better than some of the people do now who don’t do that. My interest of course, tended to get into the chemical side. I loved biochemistry and I made the highest grade in the class as I remember.
IN: Is that right?
SH: I became very much stimulated by Dr. [Philip] Shaffer. And then in the second year when we took physiology from “Ma” [Harvey Lester] White; you know Dr. White was a professor then. Well, he wasn’t the professor, [Joseph] Erlanger was the professor, but “Ma” [White] was the teacher, you remember.
IN: Yes. Is he still living?
SH: I think he is. (Voice in background contradicts him.) Did he die? I knew he was in very poor health the last time I was here.
Mrs. Harrison says that he’s no longer living.
SH: Anyway, we became very close friends during that time, and this is a little anecdote that you might want to hear. He was the regimental surgeon for the 138th Infantry National Guard and he would recruit two or three medical students to go down for three or four weeks prior to the time that the federal inspectors came to inspect his troops. At that time the quality of the enlisted men in the Guard was very poor. They paid a dollar a drill night and they’d drag these kids off the streets, you know. So we would go down and whip them into shape and teach them first aid. When the inspector came we would answer most of the questions. I stayed in the National Guard during my last two years in medical school because of Dr. White. As a result of that I accumulated twenty-one years of service, counting World War II, and I have a nice pension now. It paid off.
I was surprised to see that military science was on the curriculum.
SH: Yes.
IN: I took it, but I never had a chance to go to camp and so I never got qualified as a second lieutenant.
What was the rationale for including that in the medical school curriculum?
SH: They needed people for future medical officers and to give them basic training in the medical department regulations and practices, and when we went to camp we bivouacked and set up provisional aid stations and did all the things that they did back in those days. Of course, several of the people in our class, as a result of this, did make the military their career. The chap ahead of me, Sams, was our student cadet major.
Crawford Sams?
SH: Yes, and he became a full colonel and eventually a general. I served under him over in the Middle East theater. In fact, I spent five days sleeping in his villa in Cairo waiting to go to Asmara. So I ran into Sams again and we had a nice visit. He was a very fine guy.
IN: Several members of each class were [in] that way attracted to the military service. Several of our fellows went into it.
SH: It was a good internship because the pay was good. You got a first lieutenant’s pay. In those days internships and residencies paid—
IN: Ten dollars a month.
SH: My first year of internship at Oklahoma at the University Hospital, I got $20 a month. They gave us $10 of it at the beginning of each month and they kept the other $10 and put it away and we got it at the end. That was to keep us from leaving. At Children’s my first-year internship – I came back and took a straight internship in pediatrics – I got room, board and laundry. That was all. The second year, as what we called an assistant resident, I got $25 a month. And as chief resident, which I was for 18 months, I got the magnificent sum of $500 a year. That calculated out to $47.57 a month, I think it was.
How did that compare? I’m thinking of what people in other walks of life would be earning.
IN: No comparison. We were getting paid as if we were doing housework. People who were doing housework were getting more than $40 a month. And sales people were making a decent living, and we weren’t [being] paid anything commensurate. And on top of it, the type of work we did, compared to today – we did all our own laboratory work, we did our own blood counts, our own urinalysis, our own microscopic work. And we got paid $10 a month or $20 a month, or as we became residents at City Hospital, we got $87 a month, I think – as a third-year resident.
SH: You made more than I did over at Children’s. The pay at Children’s was very low because it was a very attractive internship. There were only five interns and three assistant residents and a resident.
But there was competition for these positions?
IN: That’s the reason we got such poor pay; the competition was very, very intense at all of these places.
SH: Do you know what the housestaff is over there now? It’s over fifty.
Yes. It’s a big place. No question about that.
IN: But how much do they pay? About $13,000 now, don’t they?
SH: I think the interns don’t quite make thirteen [thousand] now. The last time – in pediatrics – I can give you the figures. The last figures I saw, which was six years ago, the interns were averaging between eleven and twelve [thousand].
IN: Don’t you think that somewhere along the way they became organized? Is that the way this thing developed?
SH: No, I think it was a natural thing, because as the medical population grew and hospitals were built – this was not until really after World War II that the salaries went up because then there was an explosion in hospital construction. Hospitals were looking for service help, you see, and the interns and residents provided that care. They were forced then to begin to pay more – even university hospitals whose pay schedules were much lower. I know this because I did a fellowship program at the Academy and we had a committee and we helped these guys out when they got in trouble. As a result of that, the university hospitals had to keep raising their salary schedules to compete with the guys who were going out into the community hospitals and the other types of internships and residencies.
IN: Of course the university and big hospitals like Barnes they were desirable internships.
SH: Oh, sure. They always stayed lower.
IN: At Mayo’s, for instance, they gave nothing for an internship.
SH: That’s right.
Probably give you a milk pail up there.
SH: I don’t remember what the pay scale was here. I didn’t apply here. I could have and I probably would have gotten any service I wanted. But I was interested in pediatrics by that time, because I did an externship at the end of my senior year, in the spring of 1930; one of the guys got sick and I moved in the house.
This was at Children’s [St. Louis Children’s Hospital]?
SH: Yes, at Children’s. And that really set me off. This was where my career specialty was born – [in] those six months over there. I became very fond of Dr. [McKim] Marriott and Dr. [Alexis F.] Hartmann and Dr. [J. V.] Cooke. As a result, I told Dr. Marriott that I wanted to come back and he said, “Fine, we’ll take you.” But he recommended it – he wouldn’t take any people out of the class the first year. They do now, but they didn’t then. You had to have a rotating internship first.
IN: They don’t require that now, do they?
SH: No.
It was the opposite, wasn’t it, for a while? I’ve heard that they were discouraging right and left, very strongly, the rotating internship and wanted the straight internship only.
SH: [Joe] Jaudon, who became a very active pediatric practitioner—
Who is this?
SH: Joe Jaudon – he’s now retired. He’s about my age – he was an intern when I was chief resident. He was about three years behind me. Joe was the first guy that Dr. Marriott took right out of school. He was a top student. I didn’t know why they changed it then, but that was about 1933 or ’34. Dr. Marriott left in ’35. Hartmann became the professor and I think maybe then the departmental policies were changed. I wasn’t in on it, of course.
What kind of man was Dr. Marriott?
IN: Marvelous. He was a wonderful lecturer and he was a very gentle sort of a person. He was very sympathetic to his students and he’d answer questions [and] take time with his students. He seemed to be a very quiet person – otherwise he’d go about his business. You’d never know he was around.
SH: He was a very interesting professor because [when] he came out here in 1924, or in that period, he had had no clinical training in pediatrics except what he had picked up, as he was high in the biochemistry department at Hopkins. But he was researching then the problem of acidosis and infant feeding. He was interested in the chemical side of this. He came out here and he learned his pediatrics from the guys out here; this is fact. And he became an excellent clinician.
Did he come as dean?
SH: No. He came as chairman of the department. [Philip] Shaffer was dean of the medical school. But then Dr. Shaffer retired from deanship and they made Dr. Marriott dean then. But he worked with Shaffer and trained Dr. Hartmann in the acidosis and alkalosis and diarrhea problems of babies and popularized the feeding of evaporated milk with lactic acid added to it to make it more digestible so it could be fed stronger. Before that came out, physicians diluted the cows’ milk to make it easier for the baby – boiled it and diluted it. Many children were malnourished because they just weren’t getting enough protein with these very dilute formulas. He completely turned this whole thing around and docs from all over – he gave these postgraduate courses in infant feeding – and practitioners would come up and spend a month. I helped teach some of those later on. He became very famous for that here in the middle west.
I can’t help but ask [about] the fact that Pet Milk is located in St. Louis. Is there any connection?
SH: Yes there is.
IN: That used to be a popular formula.
SH: Pet was here and, of course, the local docs prescribed Pet Milk because it was a local evaporated milk. Of course, then we have to completely get away from Eagle Brand, this sweetened, condensed milk, because many people were feeding that and this was really low-protein. The kids got fat and sloppy and anemic and developed severe rickets. We’re getting into pediatrics too much here – let’s go ahead.
IN: I took a general internship for one year at Jewish Hospital and then I went from there to the City Hospital the second year. I stayed on another year for radiology at the City Hospital and then my funds got so low that I went out into practice and went into general practice in the town where I had once had a patient at the Jewish Hospital who had a store in Chester, Illinois. He came in to visit the circus on the last night. The _____(?) [ed. note: names circus] Circus. He fell through a platform where they were dismantling the place. They were dismantling it too fast [and] he fell through and fractured his transverse processes and ruptured a blood vessel in his stomach and fractured his radius. So I took care of him and when he got well he invited me to come down to see him at Chester. I went down there and they were short of qualified doctors. They had – what do you call these fellows that give titrate medicine?
SH: Homeopaths.
IN: They had four homeopaths there and none of them ever undressed a patient to examine them. It looked to me like they needed a doctor badly although it was in the middle of the Depression. So I went there to practice and developed a tremendous practice.
SH: How much did you charge your patients? What was your fee?
IN: A dollar.
SH: A dollar!
IN: (Laughs) For years. But I was so busy it didn’t make any difference. As long as I was making a living that didn’t matter to me about the fees or whether they paid or not. I never sent out bills. For twenty years or more I never sent out a bill because we had work to do all the time and we weren’t in need of anything. And we knew they’d pay if they had it – and if they didn’t they’d bring in produce. They’d bring us chickens or corn or tomatoes.
How big was Chester then?
IN: Five thousand people. It was a small shoe factory – International Shoe factory – town.
Did that company have branches in St. Louis, too?
IN: It had branches in St. Louis and all over southern Illinois and southern Missouri. Now, they’re all closed and the shoes are made in the foreign countries now. So we had no industries when they left. When I went there we started out making a living and didn’t have to go to CC camps like most doctors did. In those days there were CC camps. Roosevelt produced these CC camps for doctors to go to.
They included the doctors, too?
IN: Sure. They got [a] first lieutenancy.
SH: They needed medical care, you see, the boys that they had in these camps. So they hired physicians and paid them the Army scale of pay.
IN: Which was good, because physicians in the cities and in the country even, were starving to death. No matter what they charged they weren’t getting it because nobody had any money in those days.
So the Depression hit very hard and very fast, I take it. I had the impression that in St. Louis it wasn’t that way – that they had a balanced economy – not like Detroit.
SH: They used to be paid by the relief, as we called it.
IN: That’s right.
SH: They paid a dollar and a half for a house call. I would drive ten miles in town to make a house call for them. I remember I got picked up for going through a stop sign one night. It was raining. I paid a three dollar fine and I was getting a dollar and a half for the call. These early days—
What do you mean by “the relief”?
SH: This was welfare. They called it “the relief” then and it had another fancy name, but that’s what we used.
IN: “Public aid.”
SH: Public aid or welfare.
IN: People who got on that, they learned quickly that they could get earn a subsistence wage by just staying on relief. Then Aid to Dependent Children came in.
This included a kind of Medicaid, right?
Both: Yes.
But it was a temporary New Deal [program]?
IN: It was supposed to be temporary, but it’s persisted through all these years.
SH: Gradually it’s been converted over the time.
Didn’t it pass out of existence for a time after the Roosevelt administration?
IN: No, it never passed [out].
SH: No. The hard-core poor always had some sort of a program to provide some type of [health care].
IN: Now in the cities, for instance, they could go to the free dispensaries, but in the country there was no such thing. So they worked the system out so that the country people, all over the country, would get medical care. It worked pretty well until they started to abuse it. Doctors started to abuse it as well as the people. Doctors all over – they ordered lab work and had them come in time and time again when they didn’t have to and so they ran up huge bills.
But there wasn’t so much of this in the ’30s?
Both: Oh, no, no.
IN: That developed later.
At the time you were doing your clinical work as a student and in your intern years, what were hospitals like? How did the medical center hospitals here differ from today?
SH: Oh, it’s the difference between day and night. The hospital was a place to put a patient when they were sick. And if they didn’t need something cut out which improved them, the only drugs we had that were specific were arsenic for syphilis, quinine for malaria; we had aspirin to take to bring the fever down and some of the other antipyretic drugs. [We had] digitalis to strengthen the heart muscle and improve the heart beat. You could name just all these—
Morphine, maybe?
SH: And morphine for pain. But a diagnosis was the thing that was stressed in those days because it didn’t make much difference what the patient ended up with, the treatment was so limited – without any real specific treatment – that our professors were really stressing a clinical diagnosis. Dr. [Ernest] Sachs, particularly, the neurosurgeon, was one of our best teachers.
This is Ernest Sachs?
SH: Yes. His Thursday clinic was “The Pit.”
IN: That was a classic.
SH: We used to go over there in this old amphitheater and we called it “The Pit.” He’d have one student come down and examine the patient and then he’d quiz the hell out of him. He was very gruff and he acted very mean, but he was one of the nicest guys I ever knew in my life.
IN: That’s right. He was a fine fellow. You know, the explosion to us who graduated in ’30, came in about ’36 or ’37 when sulfa came out.
SH: Sulfa came out in ’36.
IN: And really the explosion came after World War II. In the middle of World War II when they discovered the antibiotics and the treatment of tuberculosis. That was where medicine really exploded. It was like we had learned nothing in medical school except physical diagnosis in clinical medicine.
SH: How to read symptoms and how to take care of a patient, sympathize in pain, make him comfortable, and treat the family, too. I mean – talk with the family.
IN: So we had to relearn medicine at the bedside.
SH: That’s right.
Can you relate any of this continuing education to the medical center here?
SH: Oh, yes.
Who was doing work in these areas?
SH: Actually, there were always continuing education courses offered here. But, frankly, it wasn’t until right after the war, when I got back, that people began to think more and more about this.
IN: They used to have medical rounds once a week, with the CPC once a week. At these medical rounds we could see the newer aspects of medicine developing, where they were using antibiotics; how they were using it, how they were treating bacterial endocarditis. And when [the] Salk vaccine came in, a whole session was devoted to [it] when they proved that it was of use – and measles vaccine and all the advances in medicine. For instance, the recent advances in x-rays of the brain and body scan and all that. All through these lectures you could keep up with your medical [training]. At the same time there were courses offered all over the country in all the universities for CME. Now there’s a tremendous explosion in CME. You get mail every day, almost that much mail everyday.
Tell me – what does “CME” mean?
Both: Continuing medical education.
IN: And now the states, like Illinois, require fifty hours a year of CME to get your license. For instance, at the end of two years you have to have 100 hours to show to them and then you can get your license; otherwise you’re denied a license.
SH: There are quite a few states are doing it that way.
IN: All the hospitals have been that way, too. To be on the staff you have to have a number of hours of CME. And they’re policing themselves, the medical profession is, without the government interfering. The interference that the government has produced has been lousy, but the hospitals themselves have been policing this business of CME. That way they can weed out the doctors that know what they’re doing and those that don’t know what they’re doing.
SH: I was involved a lot in this before I left the Academy [American Academy of Pediatrics] and I continued to watch it over my shoulder because I got all the mailings and things. There is a big push in the specialties, the societies, for re-certification, re-examination every five years. Many of the people don’t like the idea of having to go back every five years and take a written examination. Docs really fear this because if they flunk it they think that’s the end. We’ve had a big bit of flak about this from our membership in pediatrics – the 15,000 pediatric [diplomats].
IN: All the specialties are arguing.
SH: Yes. They’re all having this fight. What is going to happen, I think, is that it’s going to continue to be voluntary, but eventually the state licensing boards are going to say to the boys, “Come on now. You’ve got to do it. You’ve got to show us.” Whether they will insist on a formal examination or not will depend a lot on who gets on the state examining boards. [We don’t know] whether they will continue to accept intensive courses [or] continuing education by mail. We put out our self-assessment program – the guys like to do this – but they’re all afraid of an exam.
IN: About CME – there’s no way to make sure that anybody is learning anything through CME. It’s possible for people to go to lectures and sleep through them, or not go to the lectures and get credit for it. The only way they have of proving that they are a benefit is to see whether it benefits the population – whether their medical care in that particular area that these doctors are [in] is improved. Hospital records show that – whether it has or not. But CME being forced on the doctors, I think, is wrong.
SH: I think they’re going to have a big job.
IN: A lot of them are doing this to get money in their coffers – the schools – so they can use this money for other purposes.
Would this be true of this medical center?
IN: No. They give courses sparingly. They don’t keep this up all year round, one after another. Bang, bang, bang.
SH: What he’s saying is probably partially true. There certainly is just a complete explosion of these things. Every day in the mail I get three or four brochures for programs. He does, too. Certainly the schools derive an income from this and it increases the prestige of their teachers. How much of this is purposeful, or whether it’s still on the basis of their trying to do a good job of continuing medical education, I don’t know.
IN: Whether it’s laudable or not, there’s this about it: you don’t know whether you’re raising the price of medicine for the population through these things. I’m sure we are.
SH: Well, indirectly, yes.
IN: Increase of our fees, in order to make these trips, and so on. It’s very difficult to know whether it’s worthwhile or not. It sounds good. Those that wanted to learn always found a way to learn; to go away to take courses and so on.
SH: (Whispers) He’s right about that.
IN: Those who didn’t, they’re still that way. They’ll take the credit for the courses and [never show up].
Tell me something about the social characteristics of being a doctor, beginning with the medical student. Were you a particular kind of people? Conservative? More so than people the same age?
IN: I think you can see by looking at the medical students now how conservative they are. They dress as if they’re very independent; nobody seems to be bowing down. When we went to school we wore collars and shirts and ties, but you don’t see that nowadays. They wear overalls and their hair is long and you would never know they are medical students.
What kind of rules kept you in line?
IN: There were no rules. That was the way we thought we should behave. We were glad to be in medical school.
SH: I think what Dr. Newmark is saying is that because times were hard and this education that we were trying to get was coveted pretty much, that there were very few of us who didn’t walk the line and work hard and stay out of mischief and conform. I mean by that, in the hospital there were certain rules of dress. We weren’t told these things but we came trying to look respectable and also to look professional, because this is what we were all trying to do. I’m very unhappy with the way this has gone the other way.
IN: At the same time though, these students have been chosen because of their scholastic ability. It’s much harder to get into medical school today than it was in our day. There’s an oversupply of doctors now; in our day there was an undersupply. These people – they’re free-thinkers, they take up causes – like during the Vietnamese war they objected to this or that. You don’t see any of that now. We didn’t have any of that in our day. There was nobody that would burn down a barracks on the campus or something like that. Now, you don’t know what they’re going to do.
What about female medical students? What were they like? Were they treated any differently than males?
IN: They were a curiosity.
SH: By the time we came along we had five or six in our class, which was below the present percentage that they’re taking now. They all graduated and I think our gals were just as good and interested to become good physicians. But it is true that they were not looked upon in the same fashion as they are now. Since that time all the professions have had to accept more women, and this is the name of the game now. The same is true with marriage – we had three people in our class married. Now, by the time these guys finish medical school, 75 or 80 percent of them are married and they also have children. I don’t think we had one [student with a child when we were students].
IN: One of them, Mary Townsend, delivered a day or two after we graduated.
SH: Graduated. Now this is the number – this was the difference in lifestyle regarding families. We postponed – I courted her for five years. We didn’t have any money.
IN: That’s right.
How about members of minority groups? Were there any blacks in your class?
IN: There were no blacks in our class. There was no consideration of minority groups. For instance, I came from a minority group; no one questioned me about it. I came from a ghetto area and no one said anything to me about it.
SH: But blacks were not accepted. I don’t think we had any black students until after World War II. I don’t know about this for sure.
Were you expected to be at the medical library a lot when you were a student?
Both: Yes.
Did you find it adequate to your needs?
IN: Yes. We had a wonderful library.
SH: Yes, there was no question about that. All the journals that were being published then we had.
IN: Anything we needed.
SH: And the textbooks that we couldn’t buy – we could always come in and use them. Of course, very often you had to share them with somebody.
Was there a philosophy of Pediatrics that you could capsulize in the late ’20s? It strikes me that the attitude toward what a child is, for example, has changed, and this must affect how people treat children who are patients.
SH: I can answer that for you. I can answer that question for you. Children, up until right before World War II – up into the ’30s – were thought of too much as being little adults. (If you turn the tape off a second, I’ll make a remark that I shouldn’t make.)
Well, we’ll pick it up later, how’s that?
SH: The professor of medicine back in that time believed that we didn’t need a Department of Pediatrics; that it should be under the Medical Department and that he could train pediatricians just as well as a pediatrician.
You wouldn’t care to identify this man for the record?
SH: No, I won’t identify him. He was one of the professors and he was a good friend of mine. I shouldn’t really say this, but I’m using this to illustrate the attitude, of course. Now this is completely changed. Pediatrics as such has become a major specialty and has brought out so much in the way of improvement of care in the newborn, in the control of infectious diseases, in the study of handicapping conditions in children, of the chronic diseases, of growth and development, and – more recently – the care of the adolescent, who has been really neglected. You really had no adolescent medical programs in schools or hospitals until the last twenty-five years.
What did it mean to have the new Maternity Hospital open while you were students?
SH: Oh, this was fine.
IN: We learned a great deal by that. We were able to see how some practicing gynecologists and obstetrical professionals worked. Although we had to go out to deliver babies in the homes, this gave us good training for what to do when we ran into problems.
Did this in itself represent a change in the medical practice in obstetrics?
SH: I think having a department in a new hospital and having more deliveries that students could be involved in rather than to have them over at Barnes, scattered. My sister was delivered in Barnes Hospital back in the ’20s. But having a separate wing, a separate hospital for infants – yes. And the care of the newborn was better too, because the nurseries were improved and nursery techniques were improved – aseptic techniques – and nurses were better-trained. You weren’t having nurses come off of an infected surgical case and going in and taking care of a clean baby. That was the other reason for having a separate hospital.
IN: Now it’s gradually increased to where there are no more home deliveries.
SH: Oh, no.
What about birth control? I understand the first birth control clinic as such was opened in 1933. What was it like before that?
SH: There just wasn’t any. We had no courses in birth control. We were not taught anything, as far as I can recall – formally. Now we learned it from our professors in the clinic, in discussing this with women. Of course, back in those days the only methods that we had were – we didn’t have the pill – they were all mechanical: the condom and the diaphragm.
Was there a measure of scandal that was attached to birth control?
SH: No, I don’t think so.
Something that people tried to hush up?
SH: No, I don’t think so.
The pediatrician is sometimes the first person outside the family to detect child abuse. I realize this is a very serious and complex subject, but medical students now are trained to detect evidence of child abuse. Was this the case at all when you were students?
IN: We had no training in that at all.
SH: It’s true that over at Children’s we would pick up an obvious kid who would come in beat-up.
So you saw cases of child abuse in those days?
SH: Sure there were. But there wasn’t the emphasis, and it wasn’t until Henry Kemp gave his paper at the Academy meeting in the late ’50s or early ’60s and described the x-ray changes and coined the words “child abuse” and made the then-pediatric community familiar with it that this whole thing blew. I was working in the Academy when this all took place.
IN: In the country, as I can recall, we never saw any cases that we could label definitely as child abuse. We saw lots and lots of children and delivered lots of children – we have big families living in the country. I’m sure there was [abuse].
SH: You know there was abuse.
They did not spare the rod, as they say. Tell me about the homeopaths.
IN: People would call me up and say, “Doctor, my child [who is] six years old just swallowed a whole bottle of homeopathic medicine.” So I’d have them go back and get the bottle and read [the label to] me. And I told them to go ahead and give them another bottle.
They were little sugar pills, weren’t they? I had an aunt who’d swear by the homeopaths. How else did their practice differ from M.D.s?
IN: I can remember once I had a child way out in the country. [It was] snowing. The kid was about four years old and had lobar pneumonia which I diagnosed because I could hear the flatness and dullness and absence of breath sounds and the usual signs of a lobar pneumonia. The child didn’t get over it and went into an empyema – developed a temperature again.
I recommended to the family that they take him in to St. Louis Children’s Hospital, as I always did. They refused; they asked me to please have the homeopathic physician come out and consult with me. So they went after him in the horse and wagon and brought him out. He was an old gentleman. The window was open a little; he closed the window so as to keep the air from getting to the child. And he didn’t even take the kid’s clothes off or expose his chest. He put his ear to the clothing and said, “No, there’s nothing to worry about. He’ll be all right.” Meanwhile, I had told the people that if they don’t get him to the hospital soon he’s going to be dead. They decided to take the homeopath’s advice and in two or three days the child was dead.
But in other instances, the patient would enter their office, and before he was through telling him his story the homeopath was in the back room filling up little paper bags with sugar pills for him – [for] ingrown toenail; things like that. There was really no practice of medicine where they were concerned.
Weren’t they trying desperately to update their kind of medical training and practice to survive, by this time?
IN: No.
SH: No. The theory, of course, was all wrong. It was: you give the smallest dose of the medicine. Homeopath – that’s what the term means – minute doses would cure rather than the big doses that the allopaths gave. This was the difference. Of course it was a complete farce and actually, you know, 80 percent of patients get well whether you do anything at all.
IN: That’s right. That’s what I was going to say. We had no medicines to treat them with so the number of people that they got well was almost equal to the ones that we got well. Except for fractures or baby deliveries where they had some abnormality in the delivery, why they got well.
SH: Until the antibiotics came along, the practice of medicine, as such, was still pretty primitive, really – I mean the treatment side of it. The diagnostic side was building up because x-rays were being improved and laboratory techniques were being developed to diagnose. But the minute you got insulin for diabetes and then when the antibiotics came along, the whole ball game changed. Wonder drugs! I can recall the first kid I gave sulfa to. It was a miracle, absolute miracle. The kid was sicker than a dog with this horrible throat, membrane all over his throat and glands puffed out here, and [his] temperature was about 104. I hospitalized him. You had to hospitalize them because these kids would get peritonsillar abscesses and they’d block the airway and all this sort of thing. With ten or twelve sulfa pills that night, the next day I came back and he was sitting up in bed eating his breakfast!
IN: I can recall one case when a homeopath saw a patient after I’d seen him. The mayor of our town called me down to see one of his children. When I opened his mouth and looked in, I was pretty sure the child had diphtheria. Diphtheria was getting rather rare because we were using the vaccine. I told the parents that the child undoubtedly had diphtheria and I took a culture out, put it in the tube, put it under my pillow that night, and the next morning I looked at it under the microscope and the organism was there. I went down there and gave the child and everybody connected with him a shot of the vaccine.
Meanwhile, they called in the homeopath and he said, “Oh, no.” The kid got well and no one else developed it. But when he told them that, that was my ruination with that family. They never would believe anything that I [said]. This old fellow who was a homeopath was a tobacco chewer and heavy whiskey drinker. So that was the type of competition we had in those days.
How would you sum up the relationship between the medical school and Children’s Hospital over the years?
IN: It was a good relationship. Whenever we’d have a case that was in any way off the normal beat, or a case where complications developed, we’d always send them in to the Children’s Hospital.
SH: They always made room for them.
IN: They always made room; they always took them in. They’d never send a patient away that we [referred].
SH: Money didn’t make any difference to them.
IN: Money didn’t make a bit of difference.
SH: Of course it was cheap to take your kids in those days. The ward rate was $2.00 a day.
IN: Now relief pays for a lot of it and so the hospital doesn’t [waive the bill]. Prices have gone up so.
SH: Medicaid takes care of it.
IN: And we’re paying for it through taxes.
SH: Sure, sure.
Well, gentlemen, this is Alumni Reunion Day and I don’t want to take any more time. It’s been a great pleasure talking with you.
IN: (Refers to a document that he was given to prepare for the interview) You gave us these slips—
This was to remind you—
IN: We had some fine teachers. One person that they forgot to include on here was [Stephen Walter] Ranson.
SH: Yes, yes.
What was his first name?
SH: The neuroanatomist. Garnet worked in his department.
IN: Do you remember the classmate that we had who could recite that stuff backwards and forwards? Whatever happened to him? He never came to reunion.
SH: Was that Bill [William Howell] Ellett?
IN: Ellett. Yes.
SH: He was the Number 1 in the class.
IN: Yes.
Dr. Ranson was an effective teacher?
Both: Oh, yes.
IN: He wrote the book.
SH: Oh, yes. He wrote the book.
IN: It was a very detailed subject and very interesting but it took an awful lot of study and memorizing. We had one fellow in the class who had a photographic mind. What happened to him?
SH: Bill took a straight internship in surgery. When he was assistant resident he had an argument with somebody on the staff—
IN: [Evarts] Graham.
SH: —and got mad and quit and went out in general practice. And we never saw him again.
He argued with Dr. Evarts Graham?
IN: That’s what it was.
Was this a common occurrence?
SH: No, no, no. But we were so surprised because here this guy was the top man in our class. He was going to be the professor. He was going to be the academician.
IN: And he was a real farmer-looking type of guy.
SH: He was a nice fellow. I liked him.
IN: Oh, yes. We all liked him.
SH: The second man in the class, or maybe he was third – I never was sure whether I was second – he went into surgery and went down and had this excellent training with Barney Brooks.
Who was he?
SH: Bill [William Matthew, Jr.] Raymond. He went down and had this excellent training with Barney Brooks at Nashville at Vanderbilt – five years. He went out [and] he couldn’t make a living. He finally ended up as a company doctor down in the coal fields.
IN: Poor guy, he was a wonderful fellow. He got so depressed he shot himself. But I have an interesting story to tell you about Evarts Graham. I sent him a patient once that I had made a diagnosis of lung pathology and I thought maybe he had CA. Evarts Graham took him in and said he had CA. That was the time gold was popular and they aspirated the fluid and put gold in there. And the fellow got well – he was getting well anyhow, I suspect. He’s still living today. We just operated on him for a twisted stomach and he had a hepatic subphrenic abscess develop after this operation. But he’s perfectly well and drawing a pension from the state. (Dr. Harrison chuckles in background.)
Meanwhile, these fellows all used to talk about cigarettes being the cause of cancer of the lung. His [Dr. Graham’s] helper smoked more cigarettes! And he went around preaching – Graham said that cigarettes were one of the causes [of lung cancer].
By his helper you mean—
IN: Dr.— Who was that that came along? He was a funny fellow – he was a wonderful surgeon. The fellow who took over when Graham died. Anyhow, he went around making speeches telling that cigarettes didn’t do any harm. He died. He was a tremendous smoker.
SH: [Thomas] Burford?
IN: Not Burford, no.
SH: “Black Tom” – we called him.
IN: I can’t think of the guy’s name, really. Anyhow, we had wonderful teachers, all of these.
SH: One interesting anecdote that you probably have heard, but if you haven’t, it’s well worthwhile repeating. Mildred Trotter was studying growth of the beard and she would have us bring in the shaving soap after we had shaved. She was measuring the beards on all the guys and she wrote a paper on it.
IN: She was interested in the growth of the beard after death, too.
SH: Yes. After death.
IN: Was she one of your instructors?
SH: Yes.
IN: We never had her. [Alfred H.] Hathcock, I, or Jim never had her, but we’re having her to come to the reunion so you fellows that had her can toast her properly.
SH: Park J. White is still alive.
IN: No, Park is dead, isn’t he?
SH: No. If he is I should have heard of it. I had a note from him about six months ago. He’s in [his] 90s.
We have one of his interviews on tape.
IN: He was a marvelous teacher – tops.
SH: Oh, yes.
IN: Ernie Sachs – we had some good teachers.
SH: Yes, we sure did.
We appreciate your sharing your reminiscences with us and are glad you could come back for the reunion.
SH: We’re sure happy to be here – for the biggest reason – that we’re here.
IN: I asked them to interview [Willard C.] Scrivner, too. And Scrivvy is going to make an appointment with you.
Yes.
SH: Yes, he’d be interesting.
Thank you very much.
Both: You’re welcome. Thank you.
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