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This oral history is one in a series of interviews conducted by the Columbia University Oral History Research Office in the late 1980s to early 1990s documenting the history of ASH and the development of the profession of hematology in the United States. Columbia University holds the copyright to this oral history, and anyone interested in quoting this transcript must first contact the University for permission.
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 one tape-recorded interview with Dr. Clement A. Finch, conducted by Keith Wailoo on November 16, 1990, in Seattle, Washington. Dr. Finch has reviewed the transcript, and has made corrections and emendations (both in 1991 and again in 2009). The reader should bear in mind that the following oral history is a verbatim transcript of spoken, rather than written, prose.
November 16, 1990
Q: My name is Keith Wailoo and this is the first part of the interview with Dr. Clement Finch.
I wonder if you can speak a little bit about your early childhood, your early educational experience and how that might have influenced your choice of career.
Finch: My childhood education was in a small town for the first few years. I went to Mercersberg Academy the last two years of what would have been high school and to Union College. At that time, finances were limited, and I had a scholarship there which made it possible, then to Rochester Medical School. I guess that was really when I had a purposeful life. I didn't have much of an idea of what I wanted to do, except that my father and grandfather were doctors, and it seemed natural to go on. But once in medical school, education became a meaningful thing. One of the most important things came after my second year of medical school when I was offered a fellowship. It was called the Dean's Fellowship. Dr. [George] Whipple, at Rochester, who had an unusual influence on the school and on the students, had two fellowships. I think largely because I had been very interested in pathology and had done some special work in that area, I was offered a fellowship. I took a year out, living in the staff house, associating closely with the pathology department members. It was a very important environment in expressing the-- perhaps the idealism that goes with medicine. I remember collecting information about other fellows that had gone through that position. One of them who was in practice, for example, would say, "When I had a very tough decision to make, I'd look at Dr. Whipple's picture and say, 'What would he have done?'" which exemplifies the influence he had on people. The things that came out of that--I don't think that we accomplished anything particular, other than to be a link in a series of studies--the thing that came out of it for me was a contact with Paul Hahn, who was working in iron metabolism, and more limited contact with Joe [Joseph F.] Ross, whom I later worked with in Boston, and a feeling that academic life was fun. Going on from Rochester, I had an internship and residency at the Peter Bent Brigham Hospital in Boston. That was an exciting experience. Remarkable people on the faculty.
Q: Going back to Rochester for a second, what kind of reputation did Rochester have at the time?
Finch: At that time I had little perspective of other schools and perhaps reputation. We thought it was great because the class was 42 students, I believe. We had very intimate relations with our professors. It was our impression that the professors that had been picked by Whipple were many of them outstanding people. On the other hand, we were very self-contained in Rochester. We thought it was traumatic, but a great experience going through the school. I don't think we could pass judgment then. Later on, I could see things, looking back or looking at a course at Rochester after that. I think that we felt that it was characterized by very close and very good community associations. Very inbred, to the extent that perhaps there wasn't as much active science going on. That would be my impression from ten years later.
Q: When you say, inbred, what exactly do you mean?
Finch: I mean that the faculty was inbred. They really weren't looking as much for outsiders as I thought they should, and in later years I think that was particularly true the next 20, 30 years.
Q: So, as a result of that science wasn't as heavily emphasized as it might have been?
Finch: I think that's reasonable.
Q: Was that Dr. Whipple's design?
Finch: That's very hard to say. I think probably in the early years of any school, there's a tendency to take the new graduates and breed them back into the system as faculty. I think perhaps we're doing it to some extent here now at the University of Washington.
Q: Was your interest in hematology first sparked there at Rochester?
Finch: Probably later. I didn't actually have any strong contact with hematology.
Q: Was it possible to have a strong contact with hematology at the time?
Finch: Yes, it was.
Q: I see.
Finch: The person who was the head of hematology at Rochester, who went to UCLA as the head of medicine, had a very active program at the time.
So, we're now in Boston. I had actually gone there with the idea that I wanted to be a surgeon. Before I left Rochester, I took a rotation through surgical pathology and felt I had a base for surgery, but I wanted to get a year of internal medicine before I went into surgery. Once in Boston, internal medicine became very exciting, with the faculty that was there, very unusual faculty at the time. Soma Weiss was the professor of medicine at the Brigham, and a number of people under him went to important posts in the country later on. Unfortunately he died, two or three years after I went to the Brigham, of a cerebral aneurysm. I had unusual clinical opportunities because at that time, the Harvard unit went off to war and it stripped the institution--Brigham included--of some of their key people. Those of us left behind were exposed to a lot more direct responsibility than would have been true otherwise. Just before I finished my two or three years of house staff at the Brigham, I got what was called atypical pneumonia. Now it's mycoplasma infection. That was followed by a period of bronchospasm that lasted several weeks. Because of that, I was rejected by the army. I'd been planning to go in the military. Now I had to look around for something to do. I got a fellowship with Dr. Joseph Ross, who was a hematologist at Boston University. At the Brigham, I'd become sort of a mini-hematologist because at that time they didn't have anyone very active in hematology. There was the Nobel Prize winner, [William P.] Murphy, but he had gone into practice and wasn't too active in teaching on the wards and wasn't entirely contemporary in hematology. So, I began doing bone marrow aspirations, which, to my knowledge, hadn't been done before at the Brigham, and other things relating to hematology, but in a very limited way. So, I spent a very good year with Joe in hematology. He included me in studies on blood preservation and took me to meetings at the National Research council in Washington, at which blood preservation was discussed. There was a lot of pressure from the military at that time to develop a better blood preservative, one that could be kept longer since the military use of blood required that. And I did a couple of other studies on my own. One dealing with complements levels in a variety of diseases, another dealing with high-dose aspirin therapy in rheumatic fever. In retrospect, the complement studies were rather interesting, but neither of these was ever published. The next year, George Thorn wanted me to come back as chief resident at the Brigham. One of the things that George did was to set me up with a laboratory at that time so I could do hematologic research. He wanted me to be responsible for the routine hematology at the same time that I was resident. I managed to attract two volunteer Junior League women as technicians. After the residency I stayed on as hematologist at the Brigham and took on the responsibility of running the clinical laboratories in hematology through the hospital, which were not entirely efficient, since there were labs in the outpatient, surgical service and on the medical service, all independently operating. But it did provide me with another technician's help in my research activity.
Q: You mentioned that in your first year as a resident, you were doing bone marrow. What was the significance of that?
Finch: For the hematologist, for a long a time, looking at the peripheral blood was very important. Making blood smears. As hematology developed, it became evident that you could also look at the blood formation in the bone marrow by aspirating the marrow. It was just another step in developing hematology-- a better look at what was going on in that particular organ. Red cell production, white cell production, white platelet production.
Q: At the time, I suppose it was a relatively novel--
Finch: I didn't originate it by any means. It was just being done. At that time, we did them all in the sternum, which is a little bit intimidating to have a physician get up and push a needle into your chest. Of course, it became a very routine procedure and I think was, in many places at that time, developing.
I got involved in several research activities while at the Brigham. The first few didn't have much to do with hematology, but as time went on, when I was a hematologist there, one of the important links that developed was with Jack Gibson and Robly Evans. Jack Gibson was at Harvard Medical School, working on iron metabolism and other projects. Robly Evans was at MIT and he was working with isotopes--radioactivity. So, we at this time--actually, this went back a little further because when I was with Joe Ross, we were working with radioiron as a tool to study red cell survival. Moving to the Brigham, that continued, but then the objective was to find out more about iron metabolism--internal kinetics of iron. I was at the Brigham from '41 to '49 with a year out when I was with Dr. Ross. There were a number of research studies that were interesting to us to at Brigham in hematology. In the area of iron, Charlie [Charles E.] Rath and I looked at the stainable iron in bone marrow aspirates. That was a way of evaluating iron stores in the body. Stuart Finch, Don Haskins, and I began looking at iron stores more directly by bleeding people. The use of phlebotomy proved to be a very important tool for many studies on iron metabolism from then on. One of the things that came out of it immediately, when we found that iron could be effectively mobilized by phlebotomy and iron stores could be measured, was the application of this to the disease hemochromatosis, where there is massive iron over-load. Really, Paul Hahn, who I knew at Rochester before--I think at the time I was at Rochester had the idea that maybe you could bleed the iron out of a patient with hemochromatosis. He started that on a patient, but the patient became more anemic and didn't do well and it was discontinued. We had done a little more experimental work where we loaded dogs with iron and took it out again. We thought that we were seeing a number of features that would be comparable to hemochromatosis in the very heavily loaded animal. At any rate, about that time, a patient came along with the disease. We bled him and found that the iron came out easily. So that started the series of studies of treatment of hemochromatosis by phlebotomy. Later on, I went back to Rochester and got out the patient's history that Paul Hahn had bled--a patient where it didn't work. I found that the underlying trouble in that patient was a hepatoma--cancer of the liver--and that, really, this was the reason for the failure.
Q: Was that a controversial kind of therapy?
Finch: Not really. It hadn't been done successfully at the time, to our knowledge, although later on, through another publication, the same observation was independently made.
Q: It's interesting because it harkens back to much older forms of medical practice.
Finch: Yes, this was one really useful form of phlebotomy therapy. Of course, later on it was evident that this would reverse a number of the features of hemochromatosis. Not all, but some of the very worst problems, such as liver failure, heart failure are reversed almost completely by phlebotomy therapy. That would have been the one great use of it, whereas some of the uses phlebotomy was put to were quite improper.
Q: The relationship between animal experimentation and clinical practice, was that unusual at the time?
Finch: Whipple had been pretty much bound to animal experimentation in his work. One of my jobs when I was with him was to bleed dogs. We were bleeding them, taking off the red cells, and giving them back to our experimental dog that we were bleeding. So the net effect was we were taking plasma off. Plasmapheresis was the name of it. But maybe that was in the back of my mind when I got into doing phlebotomies. Through my experimental work, whenever possible, when there's been a good animal model, it has taken precedence over doing things on a person. We've done quite a bit of experimental work on animals.
Q: Did Brigham have a well-equipped animal experimentation facility as part of their institution?
Finch: No, but Brigham is right next to Harvard Medical School, and there were animal facilities there.
Q: Maybe we can talk about that later on?
Finch: Perhaps. There were other things, too. I became interested in methemoglobinemia--that's when the hemoglobin molecule becomes oxidized and can no longer carry oxygen. Just by chance, we had a patient come in with congenital methemoglobinemia. It was a problem of an enzyme defect. I don't know how with--your medical background--should I go into details about things with--I mean technically or semi- technically?
Q: I’ll follow where I can.
Finch: This was a defect where about 30 or 40 percent of his hemoglobin was methemoglobinemia. At first everyone thought he had congenital heart disease, was cyanotic. But later on, with studies it became apparent that it was an enzyme defect. This got us into a lot of studies of what was going on; the therapeutic efficacy of ascorbic acid, which is a reducing agent for methylene blue which allows the cell bypass the defect and reducing methemoglobin to hemoglobin. We studied other kinds of methemoglobinemia: enterogenous, drug-induced. We ended up with a series of studies related to that.
Another interesting study was--occurred because a patient having a transurethral prosthetectomy developed hemoglobinemia and renal shutdown. They irrigate with distilled water--or did at that time. So, the water got into the circulation and hemolyzed the red cells. I had previously had worked with salicylate. It was a very good label, a good sensitive method for finding out how much there was in the blood. So, we were able to tell how much water got in; how much hemolysis was produced. We were continuing studies of iron metabolism and had developed a method for evaluating iron stores in the bone marrow, which I mentioned before. We also worked with the plasma iron-binding protein, which E.J. Cohn in the chemistry lab at Harvard had isolated through his fractionation of proteins. We developed a simple method of measuring it, depending on the development of a salmon-pink color when iron binds to the protein--transferrin, it's now called. We in fact injected this protein intravenously and tried to study its effect. However, the major thing that came out of it was the appreciation of the pro[thrombin] time, the plasmatransport of iron. However, about that time, we ran across a very beautiful study by Lorell in Sweden, which went beyond and was far more complete than the studies we'd done.
There are other things in my curriculum vitae that have to do with research--how much do you want me to go into all of these studies?
Q: Whatever you feel comfortable doing. I do have a couple of questions, though. Generally, if you'd like to talk for a while, what I do is I pick up on something. A more specific question. One of the questions I have concerns-- there seems to have been quite a community of people who would call themselves hematologists in that time period, in the northeast. That seems to be sort of extraordinary. Was that a particular rich community in which to work?
Q: I think so, It always surprised me that, in Boston at that time, there didn’t appear to be the communication between individuals who were very outstanding in hematology the way one would hope. In fact, that was an important item in my mind when I went West and we started up a new school. That there be more communication, at least within the city. I think there's always the likelihood, at least in those days, that after you have been doing things for a while, you get burned by someone who seems to be taking advantage of your open confidence in your work. I have the feeling that perhaps that had been true of some of the people in Boston and therefore that the cross-fertilization wasn't what it might have been. But there wasn't any question but that the Thorndike, with [William] Castle, [Hale] Ham, [James] Jandl, and Victor Herbert at that time, was a wonderful place for hematology. Then there were Joe Ross at the Evans and [William] Dameshek at Tufts. I misspoke before. So that there was a lot of hematology going on. I think I was in the neutral position and didn't have any ax to grind and was just a young man. So, when I was at Brigham as hematologist, we had association with all of those people. It was very productive.
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