ASH Oral History: Louis K. Diamond (1/7)
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ASH provides the following oral history for historical purposes. The opinions expressed by the interviewees are not necessarily those of ASH, nor does ASH endorse or make claim as to the accuracy of any of the information included here. This oral history also is not intended as medical advice; you should always seek advice from a qualified health provider for your individual medical needs.
The following oral history memoir is the result of two tape-recorded interviews with Dr. Louis K. Diamond, conducted by Eric Hoffman on November 17 and November 18, 1986, in San Francisco, California. Dr. Diamond has reviewed the transcript and made corrections and emendations. In 2008, Dr. Diamond's daughter, Susan J. Diamond, reviewed the transcript and made additional minor corrections. The reader is asked to bear in mind that the following oral history is a verbatim transcript of spoken, rather than written, prose.
November 17, 1986
Q: Dr. Diamond, I have you as being born in New York City in 1902. I was wondering if you could supply some early biographical data--about your childhood, early education, and etcetera.
Diamond: No, I was born in Russia in 1902 and immigrated with my parents at age two to live on the lower east side of New York City. My father was a storekeeper. We remained there through the first five or six years of my life. I attended the New York public schools, starting there. Then as we moved around New York City, leaving the lower east side for the upper Manhattan, the area which is now Harlem, I continued in New York public schools. Various different areas. Because of the desire to live in a better neighborhood, we moved up to what was then, and now, known as Washington Heights, where I continued school from about my ninth year of age through graduation at about thirteen.
Q: Where did your family come from originally?
Diamond: Originally from what is now Russia -- the Ukraine area? Crimea, I guess. The Black Sea area. They, of course, ran away at the time of the pogroms there, and came across Europe and eventually sailed out of Hamburg, or one of the German ports, to New York City where they had relatives, and therefore settled there. Both my father's and my mother's families were fairly large, were settled in the New York area. They remain there. I attended this public school at Washington Heights, which I still remember because it was a very good school. We were very well taught there. In fact when I finished there sometime around my twelve-and-a-half or thirteenth year, I could easily enter Townsend Harris Hall, which is a branch really of City College of New York. Most of the graduates of Townsend Harris Hall go to City College. Townsend Harris Hall was a three year high school, but a very classical one. You had to take Latin, math, learn English well. The education was concentrated. They cover in three years what the ordinary high school takes four years to do.
Q: Was there any special training in the sciences at that time?
Diamond: Not that I can recall. It was a general program. I don't remember that any one subject interested me more than any other. I went on from there to City College for a year because most of the colleges to which I wanted to go demanded a four year high school course. So I had one year at a combination of Townsend Harris Hall and City College of New York.
Q: Did you during that one year at City College specialize in any area or take a particular interest in any area?
Diamond: No. Again, it was a general sort of course. My aim was to accumulate enough credits so that I could enter some other college, preferably out of town. Go away from home. I did in fact get to Harvard College. Entered in the class of 1923 at Harvard College.
Q: What were your impressions of Harvard coming in as class of 1923?
Diamond: Well this was 1919, 1920. I was thrilled at being able to go there, and immediately took as many courses as I could. I think I had five full courses instead of the usual four. But I didn't have any particular bent. At that time we didn't need to pick a field of concentration until our sophomore year at least. Sometimes you could delay even longer. I tended to aim toward science, even in my freshman year at Harvard. Became more and more interested in chemistry. We had a marvelous teacher in inorganic chemistry, under whose influence I rapidly became interested in this as my field of concentration. He happened to be James Bryant Conant, who eventually of course was the President of Harvard. Conant was the sort of lecturer who never used notes. He'd just stand up there and say, "Now in the last talk, here I ended at this." He could go on smoothly and make it very exciting. So I had one-and-a-half courses with Conant. Came to know him personally, too. I've forgotten what discussion led to his remembering me by name, because I used that later to my advantage. Being interested in chemistry I took as many courses as I could. I had to of course diversify a bit. One of the exciting courses -- and this would interest you--was with a man named James Lawrence Henderson. He had a reddish peak beard, and he talked in a high-pitched voice. But like Conant he could talk endlessly without notes. He was actually called the "Pink Jesus," because with his beard he looked somewhat clerical. He had just come back from a sabbatical in France. One of his pet subjects was food, how beautifully the French could prepare food which we butchered over here. But whatever he talked on, he made it interesting. The course in the history of science, which is what he taught, was fascinating. He also, as you probably know, was a great biochemist. He actually set up the bio-chemistry study of human fluids.
Q: Were you aware of the attempts to establish a biochemistry department at Harvard during that period?
Diamond: No. Not until afterward did I really get in to that. But with his exciting portrayal of the history of science, and particularly the biochemistry of human fluids. He was the first to show that human salts and human circulation were really a carry-over from our life in the ocean. So Lawrence Henderson is really a model scientist for everyone.
Q: Did you participate in any of his seminars on the history of science?
Diamond: No. I never got that far. At that time his first year back from sabbatical he took very few students and gave very few courses. Just the history of science, biochemistry, and so on. But under really his stimulation I became more and more interested in medicine, and medical aspects of chemistry. But not to the point where I was certain that I wanted to go to medical school. I was going to take a graduate course in chemistry. That's where I became more closely interested in Conant's courses, because I was going to take a course with him to get a master's degree in inorganic chemistry. But I never did get to that, because by my senior year in college I was pretty sure that I wanted to go into medicine. Also that if I went in to medicine I'd want to deal with children. The reason for that was that I supported myself to a great extent, in college and medical school. In college I earned money during the summer as a camp counselor dealing with children, and was very happy in that sort of work. In addition to that I did get a partial scholarship so that I could get through there. Also I had a part-time job at the Varsity Club. I was not an athlete, but I was a friend of a fair number of athletes including the student director of the training table at the Varsity Club. He was a great athlete -- he was a miler, and a half-miler. He won both in the Yale-Harvard meets, for example. We became quite friendly. We were in a course in chemistry laboratory together, and I helped him quite a bit. In return he helped me get a job at the Varsity Club which gave me privilege at eating my meals with the athletes at the varsity training table as long as I joined some squad. Of all things with my 145-pound weight I didn't qualify for anything like football, but I went out for the scrubs football team. Just being a member of the scrubs entitled me to eat at the training table.
So that helped pay my way through college also. In the summer I was a camp counselor, for three summers. That paid pretty well. But I was certain with that past experience that first, I wanted to go in to medicine; and second, that I liked dealing with children. That's what eventually turned out.
Q: Were there any particular problems--medical or scientific--that interested you in terms of pediatrics at that time? Were these questions that were discussed?
Diamond: No. Just the fact that I liked dealing with children; I seemed to be able to handle them fairly well as a camp counselor. In fact I -- well, we'll get to that. I became a camp doctor summers after I entered medical school. Even after my first year in medical school I was signed up as a "doctor" at a camp. All I could do was pick out these sick children and get a real doctor to see them. Otherwise I took care of cuts and bruises. But I applied to Harvard Medical School when I graduated from Harvard College in 1923, and was very fortunate, I felt, in being accepted there. Because although I had fairly good grades, had scholarship grades at the college in my senior year particularly, there were only 150 places at the medical school. I think they had over six, seven hundred applicants. Many of them were veterans who had just returned from the War, which ended of course in 1919.
Q: What sort of criteria were used at that time to choose medical applicants? Were you made aware of the needs to fulfill certain course requirements, or service requirements?
Diamond: Yes. Very definite course requirements in the sciences, and some spread to other areas. But I had a good letter -- oh! I forgot to tell you in my senior year in college, when I was thinking of getting a further degree in chemistry. After I was due to graduate college in 1923 I received an offer to act as a tutor and then an instructor in chemistry at some small college down south -- I've even forgotten the name of it. But that was due to Conant's giving me a strong recommendation, of course. He also gave me a strong letter of recommendation when I eventually told him I wanted to go to medical school. Now I think it was that, and also I got a letter of recommendation from Henderson, that got me in to medical school despite the large number of applicants.
Q: What was the attitude of first Conant and then Henderson toward undergraduates who seemed to be interested in chemistry then deciding on a career in medicine? Would they encourage that?
Diamond: Very much so. They both felt that medicine, medical students and doctors, needed more chemistry, more biochemistry particularly than they had been exposed to in colleges. So that they applauded, or backed, my wanting to go to medical school, and gave me strong letters of recommendation -- I guess, because I did get in without too much trouble.
Q: Do you think they almost saw you playing a vanguard role, and spreading the gospel of chemistry amongst medical profession?
Diamond: I can't say. They were very kind to other pre-medical students too. Lawrence Henderson was just fine in that respect. He did want the gospel of biochemistry to be part of the medical background of the students, and kept up his interest in biochemistry for medical students.
Q: Did you come in to contact during that time with some of the other chemist, for example [Otto] Folin?
Diamond: When I got to medical school.
Q: If you could remember at a later time that could be interesting. Because there's research going on now on the role that the relationship between biochemistry and the medical schools played in the development of the discipline of bio-chemistry itself. So it's interesting to know who the various characters are.
Diamond: I think another person that influenced me during medical school was the great Hans Zinsser, he was professor of bacteriology and head of the department at the medical school. I came over twice to listen with medical student friends of mine to listen to Zinsser teach. I know his son, as a matter of fact. When I was in Children's Hospital in pediatrics I was once called to see his son, who was known as W. Bradford Cannon to distinguish him from his father. He's still alive, still at Harvard. When I saw Brad as a consultant for some acute infection, I became friendly with Walter R.Cannon.
Q: Upon entering Harvard Medical School, did you notice any differences in terms of the type of education you were asked to under-go?
Diamond: No. It was a standard medical school curriculum. It's completely changed, or very much changed, now. There was practically no contact with clinical medicine in the first year, excepting for a few clinics given by outstanding teachers to stimulate the students. Like two lectures at the Peter Bent Brigham Hospital by Harvey Cushing, the great brain surgeon. I helped take care of some children that he operated on. We didn't have a children's neuro-surgeon at that time, so we when we had children with neuro-surgical problems we'd send them over to the Brigham for Harvey Cushing or one of his assistants to work on. I had one very interesting, difficult case -- neuritis -- that he operated on three times. I was in charge of medical care, so I came to know him quite well.
Q: Were the courses mainly of a theoretical bent during the first part of your undergraduate training?
Diamond: A regular course in anatomy, and bacteriology, and then biochemistry and physiology, through the first year and in the second year, when pathology and bacteriology were the basic courses. You didn't get in to any clinical contacts, except for the occasional clinic, until the latter part of the second year, when you took what they called "physical diagnosis"-- learning how to do a physical examination, listen to the heart and lungs, and palpate the abdomen and so on. That was usually given in the outpatient department at the Brigham Hospital or at the Children's or City Hospitals. We were assigned to different hospitals.
Q: Were you aware at that time of the various attempts to reform the medical school curriculum of people such as David Edsall?
Diamond: Yes. He was a great Dean, of course. Helped build up the school, and change the courses. I don't know whether there was resistance from the pre-clinical faculty to try keep the students in their own specialty rather than let them go toward clinical medicine. But we were not encouraged to do anything like that until the third year. Then, of course, we had to take clinical courses. In fact at that time we had to learn to handle obstetric problems and deliver twelve babies ourselves "on the district," so called, meaning outside the hospital in the homes. Usually the students would deliver six in their third year, and the second six either in the summer between the third and fourth year or in the fourth year, when you'd have a two-week stint of obstetrics and go to the homes of patients that were enrolled in the clinic to be delivered in the homes by medical students with the support of the resident in obstetrics when you needed help.
Q: Would you recall roughly what the proportion of home deliveries to hospital deliveries was at that period?
Diamond: Well, we'd have four students on at a time. No, I don't recall. But there were a small number of hospital deliveries. Most of them were home deliveries, enrolled through the lying-in Hospital outpatient department. Delivered by students or residents, and usually only brought in to the hospital if there was any problem.
Q: Is there anything more that you'd like to say about David Edsall? Apparently his view of the need for what he called "bedside research" did meet with some resistance from some of the older guard.
Diamond: I guess so. He, of course, was a disciple of Osler's. He wanted very much to have the students learn clinical medicine at the bedside of patients. By the time I got there he was full-time Dean and didn't give any ward rounds himself. But, he arranged special courses, elective courses, of which there were three or four -- and I took a few -- with great teachers like Francis Peabody and George Minot. Henry Christian met with them at Brigham Hospital. Howard Means at the Massachusetts General Hospital. I think Edsall very much favored contact with clinical medicine. I got to know -- both his sons went to medical school. John Edsall, and Jeffrey. Jeffrey is dead now. He was the younger son, and John was a classmate of mine at medical school. He never practiced medicine.
Q: He developed fairly early on an interest in protein chemistry.
Diamond: Oh yes. He went to England for a year, studied chemistry there and then came back to Harvard College as professor of biochemistry. He had an MD degree, but he's never used it.
Q: Could you say something more about Francis Peabody?
Diamond: He was a great bedside clinician. I did not get to see much of him. He developed cancer of the stomach and died in my senior year, or shortly after that. But I attended a few ward rounds with him. He emphasized the importance of patient care. He wrote a little book on the care of the patient. It's a classic. No more than about fifty pages. He wrote several papers on the bone marrow in pernicious anemia. He was one of George Minot's teachers and associates. He influenced George Minot to study pernicious anemia. But his own articles, his own research, were on the bone marrow changes in pernicious anemia. He recognized it as being a bone marrow disease, and not an infectious disease, which some people at that time believed. He was a tremendous teacher.
He set up what was called the Fourth Medical Service at the Boston City Hospital. The first belonged to Boston University; the second and fourth to Harvard. Francis Peabody was the physician-in-chief on the Fourth Medical Service, which was the outstanding one.
Q: Could you say something further about Henry Christian?
Diamond: He was the Chief at the Peter Rent Brigham Hospital. I did not have any contact with him. He was not only a great teacher, but the author of a fine textbook of medicine.
Q: This would be General Textbook in Internal Medicine?
Q: Howard Means was the other name that you mentioned.
Diamond: He was the Chief of Medicine at the Massachusetts General Hospital. I didn't have any contact with him. His interest was thyroid disease.
Q: You mentioned George Minot a number of times.
Diamond: I'll get to him in a moment, because I had a fellowship with him.
Q: Right. Were there any other personalities that you would like to mention, from your medical school period?
Diamond: Yes, in my third year, outside of the medical school in Cambridge, New York. It was close to the border of Vermont. Kenneth Blackfan was the son and grandson of the doctors who took care of patients in Cambridge -- he was the town doctor. Kenneth Blackfan, therefore, naturally entered medicine and went to Albany Medical School. When he finished there, and after a year's internship at Albany Hospital, he returned to practice medicine in the town of in medical school I had a pediatric course, standard pediatrics. The Chief of Pediatrics was a young man who had an interesting background. His name was Kenneth D. Blackfan. He came from a small town in upper New York, not far from Glens Falls, -- Cambridge, taking over his father's practice But, he was interested in doing more than just general practice, and came under the influence of a pathologist named Pearson, who was professor of pathology and bacteriology in Philadelphia -- the University of Pennsylvania. He summered in a little town in Vermont--I think it's called Dorset, Vermont--on the New York-Vermont border. He told Blackfan that he ought to go in to some specialty because Blackfan wasn't too happy with just taking care of all sorts of problems such as his father had taken care of. Because Blackfan enjoyed taking care of children, Pearson persuaded Blackfan to go in to pediatrics. He became the physician to a Foundling Home in Philadelphia, an orphanage where he, Blackfan, had charge of a hundred children. In his year there he made contact with pediatricians who used to come to the Home to take care of the children. They thought he did a remarkable job. When he was due to finish there, he was offered a residency in Philadelphia. The chief there was a prominent pediatrician named Howland. This must have been about 1912, 1913. Howland developed a very fine service with special interest in biochemistry as applied to medicine. Washington University of St. Louis under Edsall's stimulus -- Edsall, incidentally, had come from Pennsylvania. Been professor and dean at Pennsylvania --
Q: This is David Edsall.
Diamond: David -- before he went to Harvard as first, professor at Harvard and then, dean. The Brigham Hospital was just opening then -- newly built, and Harvard Medical School was newly built, around 1913. At any rate Howland was invited, they reorganized the Washington University Medical School in St. Louis. Got a lot of money I think, I don't know -- Rockefeller and other places. They invited Howland to set up the pediatric department at Washington in St. Louis.
Q: With an emphasis on biochemistry? He had a particular interest in biochemistry?
Diamond: Yes. In the feeding of children, and the digestion of children. He was a good pediatrician. In fact he and Emmett Holt wrote the first textbook. Holt wrote the first textbook of pediatrics, and Howland helped him write the second edition. Holt and Howland's textbook became the standard textbook. At any rate, Howland went to St. Louis as Chief of Pediatrics up at Children's Hospital, and at the Medical School. Washington University still ranks as one of the outstanding schools. Howland invited Blackfan to come to Saint Louis as resident at the Children's Hospital. Howland was there only two years, and then Johns Hopkins opened a new pediatric division called the Harriet Lane Home. When Howland transferred to Johns Hopkins as the professor of pediatrics and the head of the Harriet Lane Home, he persuaded Blackfan to come as his resident. At that time, or shortly after Blackfan got there in 1914, the war broke out. Everybody went off to the war. Blackfan wanted to go but he had a facial palsy, and therefore was excused, couldn't go. But Howland went, set up a hospital overseas, and left Blackfan in charge of Harriet Lane Home. So Blackfan as senior resident of pediatrics remained as resident for seven years, but actually ran the Harriet Lane Home and taught pediatrics to many medical students. When Howland came back, Blackfan of course was immediately upped to Associate Professor. Then shortly after that, interestingly, the school of medicine in Cincinnati -- Cincinnati University Medical School -- There was a pediatrician named Griffitts, I think -- as Chief of Pediatrics.
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