This is Oral History Interview number 20. Dr. Estelle Brodman, librarian and professor of Medical History, interviews Dr. Ruth Silberberg, professor emerita and lecturer in the department of Pathology.
We’re very happy to have you here, Dr. Silberberg. Dr. Silberberg was born in Kassel, Germany on March 20, 1906 and got her M.D. at Breslau in 1931, having in the meantime studied in a great many other universities in Europe, including Freiburg, Berlin, Goethe and Vienna as well as Breslau. She took her internship at the Department of Pathology at the University of Breslau in Municipal Hospital and then was an assistant at the pathological institute there from [19]30 to ’33, as well as in the Jewish Hospital in Breslau. In [19]34 she came to the United States (’33-’34) and was a volunteer research worker in Pathology at Dalhousie.
No. This was Canada.
In Canada. Yes. Not to the United States. She came to North America, to Canada, and was in Dalhousie from [19]34 to ’36, then spent one session of the time from [19]37 to ’41 here at Washington University School of Medicine before going back to New York to be assistant and H. G. Dean fellow at N.Y.U. from [19]41 to ’44. Since that time, since [19]45 she has gone through all the cursus honorum of the department here at Washington University, having become full professor in 1968. She has been acting pathologist at Jewish Hospital and pathologist at Barnard Hospital, and senior pathologist in the hospital division of the City of St. Louis as well as having been president of the St. Louis Pathological Society in 1950. You’re so distinguished I’m a little embarrassed! Her interests are in experimental pathology, particularly skeletal growth and aging and the pathogenesis of osteoarthritis, among other things.
It’s very good of you to come and talk to us. I’ve been reading some of your articles – Dr. Silberberg’s list of articles runs to almost thirty pages and they go right to the present [date]. She has continued her work both here and at the University of Zurich.
Could you tell us, Dr. Silberberg, what you think is the difference between medical education and medical practice in Europe and in the United States, since you’ve been involved in both.
To speak about medical education first, I think this really applies not only to the education in medicine but also to the education in all academic subjects. In this country we have a much stricter organization of the educational curriculum. In Europe they still have much more freedom as students. Although they are checked for attendance, they have a choice of taking courses [of] their choice, to a large extent at least. There is a certain number of courses that they have to take, but the order in which they take [them] is somewhat different from ours and also the stress is probably more on the academic lecture and the formal course than it is in this country.
Do you think that’s good or bad?
Well, I think it has its good aspects. I personally am in favor of the academic lecture because it helps the student to get an overall view and a view of correlations within different fields of medicine or pathology, [or] whatever it is. What they get when they learn a lot of detail, as they do under our system here – it has a bad aspect in sometimes becoming too academic and depending a little bit too much on the quality of the teacher. If you have, as is true for many universities in Europe now, the old professorial system, then there is a danger of the teacher getting stale.
Are the classes there larger than they are here or has that died out?
The classes are very much larger because you do not have to register as you [do] here. The number of students in medical schools is not limited, so anybody who wants to go into the study of medicine just registers and pays his dues and attends classes. From what I know from the University of Zurich, the courses are so crowded that certain courses have to be held twice or even three times, which is really very hard on the teaching staff.
Do the teaching staff then get to know any of the students if they have such large classes?
I suppose that depends on the individual teacher. I suppose there are people who make a special effort to get in close touch with the students. For instance, Dr. [name is inaudible] who was here the other day is one of those. The one who really is in charge of the course and who gives the lecture has very little individual contact with the students.
So the more important people rarely get to know the younger ones?
Right.
Do you think that’s an advantage or a disadvantage?
I think it’s a disadvantage, definitely. I think the better you know your students, the better teacher you are and vice versa.
Who pays for the education? If medical education here is considered so expensive that no student’s tuition could possibly pay for all of it, is this as true in Europe [where] they have such large numbers of students? Who pays for that education?
So far as the system in Switzerland, Germany, Austria and these countries is concerned – France, I suppose, would have to be included – the universities are all state-owned. The state pays the professors, [who] are at the same time officers of the state. They draw salaries which are comparatively low but they have all privileges of officials. They draw a pension later on in life and so on. Also, they are entitled to charge fees. Not to the individual student, but they get paid additional fees.
Per student.
Per student. For students that take the examination, not for students that attend the courses. They are so-called examination fees, which are considerable, [when] you think that 250 students may be taking the examination at one time, twice a year. Also, they are permitted private practice in medicine. The pathologists are entitled to act as consultants for private pathologists or, in some places, they are entitled to have some examinations carried out in the university laboratory. That depends on individual agreements between the school, the hospital, and the individual pathologist.
The universities on the Continent are so very different from the British universities, it’s hard to realize that they both evolved from the same medieval university system. We in the United States seem to have taken over more of the British system than of the Continental system. Do you think this has been good for us or do you think we should try to get closer to the Continental system?
I would imagine that there are disadvantages to both systems. Economically, certainly the European system is preferable in that the student has to pay a minimal amount of money as university fees. I don’t know exactly, but I know that it would be way, way below a thousand dollars per year. I understand that some people expect free tuition before very long in some of the European countries, too.
Yet, they probably don’t need as many physicians as they have students. How do they get around to winnowing out those who are not very good or keeping the number of physicians down so that there are not more than are needed?
I’m not too well-acquainted with details of this problem, but I don’t think there are any restrictions on anybody. They just go out and practice.
As soon as they pass their examinations. [Do] they have state examinations which license them to practice?
Yes, they do, certainly. And there are restrictions. Licenses for one country do not apply in [another] country unless there is a certain degree of reciprocity which may exist – I don’t know about that.
That’s the same thing we have in the States here. You have seen both the education and the practice of medicine on the two continents. Is there much difference in the way in which medicine is practiced?
Actually, I haven’t seen too much of the practice of medicine. I have seen some of the practice of pathology. I would say that there is a certain number of excellent physicians on both sides; there is a certain number of average physicians and there is a number of those that aren’t very good. Whether the percentage is different, I do not know. The problem is that medicine has made so much progress and there have been such changes within the last generation that it’s very hard to say what is due to the local differences and what is due to developmental differences. Certainly, it is true that some of the European hospitals practice excellent medicine. There is perhaps a little more attention paid to the patient as an individual.
In Europe or here?
In Europe.
Isn’t that just the opposite of what used to be? They used to say that Vienna was a wonderful place for Americans to study medicine but a terrible place to be a patient because they were treated so poorly.
I don’t know anything about Vienna, or Austria in particular. I would imagine that it is just a generalization, maybe arising from the experience of a few individuals which doesn’t apply generally. I don’t know, really.
Like Claude Bernard, you keep going back and forth from one culture to the other. Why is that; what do you get out of this?
This is really more or less a matter of personal, shall I say, convenience. I’m not functioning too well in the heat of St. Louis, and on the other hand, we did have a group of people who worked in the same field that we worked who had very similar interests in certain scientific problems. So, one day we received an invitation [saying] “Why don’t you come to Switzerland and work with us?” That was in the early [19]50s, when Professor [Ambrosius] von Albertini worked here with Dr. [E. V.] Cowdry. Then in 1959 it became possible for us to go over for a prolonged period of time and ever since then they have told us “Why don’t you come back next summer?” So we did.
You mentioned already that medicine and pathology have changed very greatly in your lifetime, or in the last decade or so. What are the main changes, do you think?
Do you mean in this particular department or in general?
Why don’t we start in general and then secondly in this department.
Well, pathology has really developed from a relatively uncomplicated part of medical science into a highly-sophisticated branch. The invention of the electron microscope, the study of disease with the help of radioactive tracers. On the whole, the development of molecular pathology has really boosted the development of pathology during the past twenty years to a point where it was unimaginable a generation ago.
The three things that you have mentioned include two methods – electron microscopy and radioactive tracers – and one theory – molecular pathology.
I was just trying to hurry it up. (Laughs)
Please go on as much as you want. We’re delighted to have as much time as you will give us.
Well, immunopathology has come into being as an exceedingly important branch that increases in significance from day to day, really. So, at my age one really feels kind of outdated at times with the methods that we were trained in.
Still, you have been using them. You wrote an article in ’73 on using electron microscopy on osteoarthrosis and the aging process. I read it yesterday with great interest. Obviously, you have taken the new methods in with your regular work, so I think you’re just being modest.
No. I have taken in electron microscopy because this is really one that is [most closely] related to the methods that were in vogue many years ago. Electron microscopy is morphology and I’m trained in morphology. But nowadays if you want to be an effective pathologist, I really think you have to have training in biochemistry and immunology as many of our young people have now.
It’s very interesting to me as a historian of medicine to see a theory or pattern like molecular medicine or molecular biology which has so many tentacles. It is beginning to bring the world together on a new axis in medical science. I wonder if you would like to say a few words on how it affects pathology.
Well, it really moves the search for knowledge on diseases onto a different level. At the time of [Rudolf] Virchow and the hundred years past him, we were concentrating on the cell. When electron microscopy came on we thought, “Well, we will find the essence of disease in the subcellular structures.” Now, we all have been a little bit disappointed in that because electron microscopy still is morphology and morphology has its limits. So has biochemistry, because if you match up your tissues you’re not able to localize disease processes. You may identify them but not localize them. I would imagine that the future really lies in those methods which combine the biochemical with the morphological aspects. So, the highly sophisticated technique of tracing [particles] in the electron microscope would help a great deal. Cell centrifugation with separation of cellular constituents and then exposing these constituents to biochemical and immunological tests, as is being done now, will certainly lead us farther. Where the final solutions will be, of course, nobody knows.
I would think that we are at a place where no one method or no one explanation is the right one and unification is what we’re looking for. One has to look at the world from different points of view.
This is very true. As you say, unification, well, that should be a final goal. But on the other hand, the possibility that it will really lead to greater diversification is also very great because you cannot possibly master all these methods that you would want for unification. So, the words “molecular biology” is a simplification of a great many things. How unification will ever be possible is really a very difficult thing today; it will take a great mind to put it all together.
[Perhaps] a generalist who takes all the specialists together and makes one thing out of it. In this particular medical school, how has pathology changed? Obviously, it must have changed the way pathology generally changed, but how about more personal things in the changes here?
It has changed enormously. When we [Silberberg and her husband, Martin Silberberg] came here in the late 1930s, Leo Loeb was head of pathology. Of course, he was a great scientist, really one of the basic researchers, especially in cancer, but also in endocrinology. His role as head of department can be questioned, but he was intelligent and unselfish enough to turn the administrative aspect and the teaching aspect over to his second man, who at the time was [Dr. Howard A.] McCordock, an excellent teacher and an excellent morphologic pathologist. Unfortunately, he died very shortly after we came. He died in 1939 or something like that [ed. note: Dr. McCordock died on November 13, 1938]. There was a brief interlude, then Robert Moore came and with him the whole attitude, the whole aspect of the department, changed completely. He has been quoted as saying “I am a simple doc,” which really characterized the whole outlook. The work of the department was concentrated toward practical pathology, autopsy pathology in particular.
Surgical pathology at that time, was still in the hands of the surgeons – Dr. [Nathan A.] Womack. Only many years later Dr. [Lauren V.] Ackerman, a pathologist [and] a member of our department, took over the direction of surgical pathology. So far as our own research was concerned, it certainly was difficult in the time of Robert Moore.
Was that why you left and came back?
No, no. We had an opportunity for salaried positions. Our financial situation with Leo Loeb was impossible, to say the least. We enjoyed the scientific work with him and that’s why we stuck it out as long as possible. Then, in 1940 (I believe) or 1941, he resigned even from his laboratory work. He retired completely and then that was the signal for us to get away, so we took these positions at New York University.
And what brought you back here?
The City Hospital of St. Louis’ Department of Pathology was reorganized. It was in a pretty unorganized state, with part-time people. For some reason or other (which I do not know) it was decided to reorganize the place. The head of the laboratory still was Sam Gray, who kept working as a part-time director, but the deputy director was John Saxton, a member of our department here, a very learned man and at the same time an excellent practical pathologist. Together with him, there was another senior position free at the City Hospital which my husband [Martin] took at that time. This was during the war [World War II]. Sam Gray was in the navy. Sam Gray was [also] chief pathologist to Jewish Hospital; [when he left for the navy] they had no chief pathologist. So, I took over the pathologist’s job at Jewish Hospital. That gave us a really a very good base for a start here in St. Louis, and we were glad to come back – very glad. At the time it was agreed with Dr. Moore that we would be part-time members of the faculty.
You said that Dr. Moore’s interests were not in research and yours were. Would that not have made it a little complicated and difficult to work here?
It was very difficult. I remember, to give you an example, we did get a small grant from the American Medical Association for our research. We had a laboratory at the City Hospital. There were certain problems of administration with the city because they just didn’t have a setup for administration of research grants in those days. So we asked Dr. Moore whether Washington University would take over the administration of the grant, and he refused.
So you lose the grant?
No, we got the grant with the help of the city administration. They set up this fund – it was a little bit unusual for them, it was a little unusual for us – but it worked out.
What was Dr. Moore’s objections? Personal?
I do not know. I have no idea. Later on, things became a little easier. He agreed to furnish our laboratory at City Hospital. We needed some equipment and there was the Gerentological Research Foundation, associated with the school. They had quite a bit of money and he gave us some money for equipment. So, I think he relented a little bit.
He has been said to be a politician more than a scientist. I suppose the fact that he was dean here and then went to be dean in several other places would bear that out. Was that your feeling about him, too?
Oh, yes. If I may quote something that I heard in New York which amused us very much. In our department was a man who was a classmate of Dr. Moore’s at, I think it was Cornell University. He quoted Dr. Moore as saying, during his first years in medical school, “I’m going to be a dean.”
That seems to have been his thrust all along. How long did he stay? I guess Paul Lacy was the next one [head of Pathology] or was there somebody in between?
Oh, no. There were a whole lot people in between. You know, he took over the deanship and he had both the deanship and the chairmanship of our department at the same time.
As most of the deans do.
Apparently that proved to be unworkable and there were other heads of the department. I probably will have a little difficulty in enumerating them in the right order. There was Gustave Dammin.
I haven’t even heard of him.
Oh, yes. He was a clinical pathologist and a member of our department. He is now in one of the Boston hospitals [ed. note: Dr. Dammin went to Peter Bent Brigham Hospital]. He was head of [the] department for some time; it may have been a year, it may have been a little less. Then – let me think – I think there was a short time that Dr. Moore came back as head of department. Then, of course, there was Stanley Hartroft, who came here [ed. note: in 1955]. With this really, the reversal of the changes instituted by Dr. Moore came about and the entire orientation of the department was back to research. Also, I would say autopsy pathology was not neglected, but the stress was on research. You know that Dr. Hartroft has really carried out a good deal of research, particularly on liver diseases. So, from then on things changed; they changed very much to the better for us, too.
At that time – Dr. Hartroft was here in the late ’50s – and in 1959 we received this pension from the German government and we decided that we would rather quit the routine work which had been our bread and butter at the City Hospital and go back for a time to research. In preparation for this we went to Switzerland for a year where we familiarized ourselves with electron microscopy. We came back in 1960 on a full-time basis.
That’s very interesting. Since Hartroft’s time, the whole emphasis here has been on research, and yet it can’t be entirely on research because it must have the ordinary routine hospital pathology [also].
Certainly. We have a very elaborate program of autopsy pathology and surgical pathology. I think these aspects of pathology are taken care of in a meticulous and exemplary fashion. I think the training that our young men get, especially under the guidance of John Kissane and the rest of the senior staff, is really excellent. It is not neglected by any means. At the present time, the time is divided about equally between training in routine pathology and in training in research, and that is satisfactory all the way around.
What made you enter pathology in the first place?
I was interested in biology. In those days, if you wanted to go into biology, you had two ways open. One was to become an academician and the other was to become a schoolteacher.
Was this true of everybody or just women?
No, that was really true of everybody. So, I didn’t want to become a schoolteacher, and of course, there was no guarantee that as a woman you could make a living in academia. So the next closest [discipline] was medicine. I studied medicine and as soon as I had a possibility to get into, looking into the different disciplines of medicine, I got into pathology and I got stuck right there as a medical student.
You got out of medical school just a year or so before Hitler came to power. Was that a very difficult time to be in Germany?
Yes. Of course, I was already [an] assistant in pathology. We saw it come gradually. The philosophy, if you can call it philosophy, of Nazism took root first among the lower employees, [who] were, in part, former soldiers. They always had grudges against the ruling group, so this is where it started. The second group to be affected, I think, were the laboratory technicians, and then it slowly crept into the academic staff, too. Our head of department was an old conservative who always used to say, “Don’t worry, we’ll take care of Hitler.” Well, everybody knows how the conservatives did take care of Hitler. During the last year, I would say, from 1932 on, it became clearer and clearer to us that we would have to leave. Dr. Martin Silberberg having been here with Leo Loeb in the late 1920s, immediately began negotiating to find a job to get in this country.
And there was no difficulty in your getting out of Germany?
No. We left in 1934 and we had no problems. Of course, we had our passports stamped with a “J,” we had to report our departure and so on, but we were not molested personally.
And you were able to take all your things with you?
I guess so. We left with just a suitcase and my husband’s cello. He wanted to show me his hometown in Upper Silesia, so we left on a cross-country bus which the peasants use for going to market. We were not molested at all; we made a little trip to Italy and France and then we came over to this country – to Canada.
Did your family leave at the same time or left later?
No. My family left later and certainly, my husband’s family left at the very last minute.
They were lucky to get out.
Right.
Do you think the position of educated women in Europe and in the United States is about the same or has it changed over the years?
It has changed. When I was a medical student we had a large number of women among the students. I would say that we were at least 20 percent women. Most of them graduated; there were very few dropouts, I would say. How they did in practice is hard to say. Now, I think, women are doing much better in this country than anywhere else. In the situations [that] I’m familiar with, certainly they’re doing better here than in Switzerland. In Switzerland, really, women have a hard fight.
Switzerland always was very conservative.
In Germany, during the Weimar Republic women made great strides. I had an opportunity to know some of the very prominent women who were in the Ministry of Education and other high spots in education. I suppose they’re doing as well today; I’m not too familiar with the situation in Germany.
Could you tell us now something about your own work – what you are trying to find out in your research and what you feel you did determine and what avenues you took that proved to be useless? Indeed, your future plans. That’s a whole long question, but I think you know what I mean.
We started out originally under the influence of Leo Loeb to study various aspects of growth and aging. Since Dr. Silberberg, my husband, was specialized in the pathology of bone diseases it was very obvious that we would apply the knowledge of aging processes, or growth processes, that were available in those days to the skeleton. Really, we had no particular theory in mind. So little was known about it all that you just had to look and see. So, it was very helpful that we could work in Leo Loeb’s laboratory because having as little money for our own research as we had in those days, we could use much of the material that he [Dr. Loeb] used for his investigation to apply [it] to skeletal research. We were in for a great many surprises. Very little, shall we say, was known about the effect of hormones on skeletal growth and aging. Acromegaly, of course, was known as a disease of the pituitary gland, but experimentally this had not been approached at all. So it was possible to examine the action of pituitary hormones and, subsequently, other hormones on skeletal growth and aging. We had a fight uphill because growth hormone, for instance, was considered to be a growth stimulant and nothing else. We thought that we had found that growth stimulation is associated with stimulation of aging. So, hormones that do stimulate growth – and it isn’t only growth hormone, it’s for instance a sex hormone – [that] do stimulate growth, at the same time stimulate aging. [This] was quite a shock, especially to the group in California – Evans(?) – who were really the promoter of the idea that pituitary stimulated growth and nothing else.
So we got involved in this problem. Again, in investigating this we came across things that had not been known before, namely that one disease of old age which was considered a typically human disease, occurred in small laboratory animals. It was osteoarthrosis, or osteoarthritis, as it is called by many people in this country. So we got involved in the pathogenesis of osteoarthrosis with which I am still concerned today.
Again, it is and was an uphill fight inasmuch as osteoarthrosis was considered a purely mechanically-caused disease. Abuse was considered to be the main thing. On the basis of what we have seen in animals we have concluded that metabolic conditions in the body in general, whether it’s hormonal balances or imbalances, or nutritional imbalances, will influence the condition of the joints [just] as these things influence the conditions of other connective tissues. Many conditions that were merely attributed to purely mechanical things are really related to metabolic states of the individual.
Another point that we were able to point out is the fact that these age-linked joint diseases are, to a large extent, genetically determined just as other chronic diseases of old age are genetically determined. So, in the course of these diseases I am now interested in the relation of diabetes and joint disease of old age. The coexistence of diabetes and osteoarthrosis is well-known but we really do not know whether this is coexistence or whether there is a cause and effect relationship. So this is where I stand today. I am working with diabetic hamsters. Chinese hamsters develop spontaneous diabetes at an early age so they are really a very good model for studying juvenile diabetes. I hope to go on studying age-onset diabetes in animals in which diabetes is produced experimentally.
You will be doing this in Israel?
Hopefully.
Do you have laboratory all set up or arrangements made for it?
I do not have a laboratory set up. I am going to work in a laboratory which is set up but which is being moved right now to a new location. The head of the group is taking over a division in the new Mount Scopus Hospital and I think I will probably be located up there. I hope to continue this. These people are chiefly interested in osteoporosis, which is also an age-linked bone disease. Again, there are certain correlations between diabetes and bone disease rather than joint disease. I hope that I can work in my interests together with theirs and work with material that is at their disposal and easily available over there.
This will be at the University of Jerusalem?
This will be in Jerusalem, yes.
You used to go to Switzerland for the summers. Maybe we can hope that you will find it necessary to come back to St. Louis in the winters and thus make a tripartite life for you. Could I end my questions by a very personal, for me, question? That is, you have been using this library since the 1940s. What do you think about the changes which have occurred here?
Well, I have only the highest praise for the library, and this is not because you are sitting here. It has been a great help, always, but the changes that have been made here in recent years have really been so helpful in my work that I really wouldn’t know how I could have done this without your help.
What changes are you referring to? It’s always pleasing to hear that it’s been helpful.
The greatest help to me has been the computerization of the reference library. The help that these people have given me, the amount of work that they have saved me, is just phenomenal. But I also want to stress a personal point of view. I have found that everybody in this library is so helpful and personally so accommodating that it is really a joy to work here. It isn’t embarrassing to ask questions. You really feel that these people make it their job to be helpful.
We would hope so, but I suspect it’s because you are so very nice to them. Don’t you feel the same way in the libraries in Europe, in Zurich and elsewhere?
They are very helpful, yes, and personally very, very nice. But, of course, the facilities are not what they are here. Switzerland is a very small country. Many journals are available only in one set of copies. They never tire [of getting] things for me, but of course it takes a little while and if somebody else happens to have a volume that you [want], you have to wait. So the conveniences here are just marvelous. The same thing has been said to me over and over again by visitors whom I had here.
We’re very pleased. The main library at the University of Jerusalem is a very, very good one. Dr. Wortman, who was the librarian – I knew him. His wife is a pediatrician. They used to come to Washington [D.C.] when I was there. The medical school library was just being settled when I was last in Mount Scopus so I really don’t know how that is doing. It was down in the main part of Jerusalem before they took back Scopus in the ’67 war. I’ll have to make that an excuse to come and visit.
You certainly have to, and I hope very soon.
That’s very kind of you. I have finished all the questions I had on my list, but you perhaps have something that you would like to say that I didn’t even think to ask.
Well, I don’t think so. At this moment I can’t think of anything, but I certainly want to thank you very much to give me this opportunity to talk to you.
We thank you. It’s been awfully good of you to give us this perspective and all this time. We’ll miss you when you go and we hope when you have need of us you’ll just write and we’ll send you the photocopies.
I certainly will do that. I’m very glad to have this possibility because I know there will be things that I may be looking for and not finding over there.
Thank you very much.
Thank you, Dr. Brodman.
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