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Q: Were the health problems connected to the handling of radioactive materials noted at that point?
Ross: Yes. There were poor old guys around Harvard medical school who had worked with radiation and X-rays from the very early days and because of cancer, had had sequential amputation of their upper extremities up to their shoulder joints. They didn't realize radiation was harmful in the early days. I mentioned Professor Cannon having developed cancer on his hands. I don't think the hazards of the calibration of radon and radium were appropriately emphasized to the medical student who was doing the procedure. I didn't really know it was that hazardous. Although, subsequently I saw these poor guys who had had their arms amputated and then I knew that I had to be more careful than I had been in the past. This was one of my experiences as a medical student.
Also, I worked in the Huntington medical clinic where Henry Jackson was in charge of the leukemia and the lymphomas and that stimulated quite a bit of interest in me. I found those diseases much more interesting than carcinoma of the breast and carcinoma of the cervix, etc. My experience in taking care of these poor ladies who had had radical mastectomies for carcinoma of the breast made a profound and everlasting depressing impression on me, because breast amputations in those days were really radical!! They removed everything right down to the rib cage. They all became infected. They all had to have what was called a scultitis binder put on as tight as you could cinch it so that the pus wouldn't accumulate. I just felt terrible. I had the job of doing the dressings on these poor creatures and I decided then I didn't want to have anything more to do with carcinoma of the breast, and I never did until my wife got it. The birds came home to roost at that point! However the Huntington house officership was a very interesting clinical experience! I think it was a valuable, formative part of my education. It taught me compassion, how to take care of the sick and how to take medical histories and do physical examinations without taking all day to do them. I had to do three or four every night. If you took an hour and a half to two hours on each one, you got in trouble, and if you didn't do it right--if it wasn't a good work up--the professors, all the staff were professors at Harvard, they told you about your deficiencies that and you had to do it over again. That was also good discipline. It was a very valuable experience. I'm everlastingly thankful I had an opportunity to do that.
The next year I was a Student House Officer at the New England Deaconess Hospital in the Palmer Memorial unit. The Palmer Memorial unit was primarily surgical, although there were many cases of medical illness too. The Deaconess Hospital primarily was occupied by the patients of the Joslin Clinic which specialized in diabetes. Patients would come in in the middle of the night in acidosis or coma, we Student House Officers were responsible for doing the preliminary work up and the laboratory work, this was very good discipline, both from the standpoint of getting up at two o'clock and learning how to do blood urine sugars and acid base balances in the middle of the night. We did a vast number of admission histories and physicals, and were able to dictate them, which also was very good experience.
[end of tape one; beginning of tape two]
Q: Dr. Ross, a couple more questions about the Huntington Memorial Hospital. Could you say something about what the Harvard Cancer Commission was?
Ross: This was established by Harvard University at a relatively early time. The exact date I don't know. It had representatives on the Commission both from the Schools of Medicine and from the collegiate departments in Cambridge. What the composition of the Commission was, I really didn't know, because when I went there I had just finished my second year as a medical student and I didn't know about those things. The director, that is the physician-in-chief, was a very distinguished physician named Professor Joseph Aub, who had studied calcium metabolism and also, quite interestingly, had studied poisoning with radium and what it did to people. He was an excellent clinician and a very fine teacher. He was very nice and very inspiring to the two student house officers who were third year medical students who were provided room and board and did the work that I've already described. The Chief of Surgery was a nice fine handsome Boston Brahmin named Channing Simmons. He did most of those radical mastectomies I talked about. He had a nickname among the surgeons of "Septic Simmy", because all of his patients got infected after the surgery. Since he did most of the mastectomies at this hospital, almost all of the patients were infected. He was really a very good clinical surgeon in the old style.
This was a very interesting institution. It had research endeavors. They had extensive research laboratories. Doctor Aub continued in his study of radiation poisoning from radium. Interestingly, the people with arthritis used to be given injections of radium water to try to treat their arthritis. This eventuated ultimately in bone necrosis and other complications. The Huntington Hospital the first place in which methods of sterilizing instruments in hot oil were developed. Also, the Huntington was the first place to implement very high voltage radiation therapy. This was initiated by Professor Trump of M.I.T. and the therapeutic Professor Richard Dresser. The first very high energy therapeutic radiation machine was installed at Huntington Hospital while I was there. This was pretty fascinating to a third year medical student! Rotating belts would pick up the electric charge at one electrode and convey it quickly to another so that it built up very high voltage. The cracking of electricity, and the rapidly spinning belts were very dramatic! I thought at that time, of trying to become a therapeutic radiologist. But after my exposure to patients with cancer of the breast, I decided that specialty really wasn't for me!
Also at the Huntington was a very fine physician and scientist named Justin Brues, who subsequently became director of the A.E.C. Argonne National laboratory of the University of Chicago. He was carrying out animal experiments in radiation biology, which I observed and found very interesting. The Huntington Hospital laboratories were of interest not only to the medical school but to the Harvard University administration, Dr. James Bryant Connant, the chemist who had become president of the university, periodically paid visits to see what was going on, and of course that was a great stimulus to the research that was in progress. I think I mentioned that a Professor Henry Jackson, Jr., lymphoma and leukemia conducted extensive clinical research on leukemia and lymphoma in the Huntington clinics. The hystological studies on tissues from these patients were all carried out at the BCH Mallory Institute by Professor of Pathology Dr. F. Parker, Jr.
Q: Theodore Parker?
Ross: No! His name was Frederick Parker, Jr. He worked at the Mallory Institute of Pathology at the Boston City Hospital. The contact with Henry Jackson and learning about the pathology studies and the correlation with clinical findings interested me so much that ultimately I took a residency in pathology under Doctor Parker. All of these activities sort of fit into a pattern related to hematology. There was a great deal of research in terms of the clinical medicine at the Huntington. There were classical reports written about the natural history of cancer. For example, in patients with certain kinds of cancer Minot wrote a series of articles about what happened or who were left alone and who were treated with radiation or anything else. There really wasn't much to be done about many of the cases. So they had very classically, considered now, these were classical studies that showed what happened with various kinds of tumors if nothing was done about them and they ran their course. These studies provided a "base line" to compare with what happens when attempts are made to modify the disease by surgery, or chemotherapy, or radiation. Those studies were still in progress while I was at the Huntington.
There was an associate professor of surgery Ira Nathanson, who conducted these studies on different kinds of cancer than those studied by Minot: endocrine cancers, cancer of the ovaries, cancer of the breast, showing the natural course of these tumors when nothing was done to modify the course of the disease. These are very important studies. They were clinical studies, oriented, toward statistics and longevity and not laboratory investigation, but I've always thought that clinical investigation like this is of equal, importance to looking at a Bunsen burner flame or viewing a test tube. But it was a tremendously stimulating environment for a medical student to be associated with fine physicians and excellent investigators with an interest in the student. Harvard, with the abandonment of the Huntington Hospital--
Q: When did that take place?
Ross: Let's see. I can't tell you precisely when. I think it was probably in the 1950s or 1960s. Harvard medical school wanted the space occupied by the hospital to build a new building, so they moved the Huntington Laboratories from the grounds of the Harvard Medical School to the Massachusetts General Hospital where it continued as an important research entity headed by a classmate of mine named Paul Zamesznick. This is a Czechoslovakian name. Paul is a very brilliant man who went into research chemistry and applied it to neoplastac disease. This shows, again, the influence of research applied to looking for new ways to do things in disease which had great impact not only the people who were of the Huntington but to the whole of our culture.
Q: Were there any dominant theories of cancer, its genesis, its origins, that were promoted at that time? Up in this--
Ross: Well, certainly recognition of the carcinogenic effects of (certain things that were irritants. There were lots of cases there that had carcinoma of the mouth and the lip consequent to smoking. There were also lots of cancers of the lip in fishermen who used to hold the tarred fish nets in their mouths as they mended them. There were significant numbers of these so-called "fisherman tar cancer" of the lips and the mouth that came into the Huntington. The environmental effects in causing neoplasia certainly were recognized. The more fundamental studies as to what really produced the fundamental change from the normal proliferating cell to the unregulated cell growth of cancer, was not being investigated while I was there. The Huntington Laboratories subsequently conducted such research in a very effective way.
Q: Were the laboratories solely under the administration of Huntington Hospital or did they have closer contacts with the Harvard College itself or any academic departments?
Ross: They primarily were the laboratories of the Harvard Cancer Commission at the Huntington Hospital, although the people who worked there had appointments in other departments, such as biochemistry, or medicine, or radiology. They certainly cooperated actively and participated in the teaching activities of the medical school in their particular field or discipline. As I recollect, there were not people at the Huntington, when I was there, that came from the departments of the college at large, such as chemistry, physics, or biology. Those were not represented there. It was too bad that they weren't but they weren't so far as I know.
Q: Was it a frequent occurrence to have somebody like Trump from M.I.T. working at Harvard?
Ross: They had very good cooperation with people at M.I.T. I don't know how widely this occurred in other parts of Harvard University and Harvard Medical School. It certainly applies now. There are coordinated courses of education between M.I.T. and Harvard Medical School, and certainly in there are extensive cooperative research activities. These are being strengthened and amplified at the present time. Certainly it was a very excellent influence on cancer research, that they interested Professor Trump in designing something that could be used to treat people who had cancer.
Q: Could you say something about the other types of research that went on at Huntington?
Ross: They were studying the effects of photons from ultraviolet light and from sunlight on the proliferation of cells. As I recollect it, I didn't know much about that. It was probably too esoteric for me at that time of my life, perhaps even at this time of my life, to know really very much about what those studies actually were. So I couldn't comment extensively on that.
Q: Is there anything you'd like to add on Channing Simmons?
Ross: He was a grand old man. As I say, everything he operated on seemed to get infected. He was a very great gentleman. He came from a distinguished line of Boston families. His family, part of it, was responsible for establishing the Channing Home, which was a treatment facility for women who had tuberculosis. It was in conjunction with Deaconess Hospital. More than that, I can't say very much. He was sort of an aloof fellow in many respects. He was not as gemutlich as Joe Aub was, but he was very kind to me and taught me a great deal about patient management. He used to enter a room or ward, sniff and say, "I smell cancer!"
Q: Is there anything you'd like to add on Aub himself? The connections he had, perhaps, with Harvard?
Ross: He participated very actively in research with M.I.T., with a professor of physics Robley Evans. They studied the residual radiation in those poor people who had been given radon water to treat their arthritis. They published extensively on studies of the radon content of the exhaled breath in individuals who had received radium, and they were able to accurately estimate the quantity of radium which must have been deposited in their body from how much radon was contained in the exhaled breath. Joe Aub also cooperated with M.I.T. in studies of the calcium metabolism of these patients. They did very elegant balance studies on these patients with quantitation of intake and output of calcium and what influences the things they were using to try to rid the body of the radium bad on the general calcium metabolism. As I say, it was in close collaboration with Robley Evans of M.I.T.
Q: Is there anything more to add on Jackson or Parker?
Ross: Henry Jackson, Jr., was the chief of the physical diagnosis education at Harvard Medical school. He did, again, a very superb job in teaching the young medical students how to examine a patient, and what to look for and what you talked to the patient about. As I say, his research interest, primarily, was in lymphomas, leukocytes and leukemia. He was a very good clinical investigator and, as I say, he collaborated closely with Frederick Parker, who was a superb histological pathologist in terms of interpreting the significance of cell modifications and morphological changes. Together they made a wonderful pair in trying to delineate the significance of the histological picture of disease with the clinical course of the patient, and that, in essence, ultimately led to the recognition that different types of diseases of leukemia and lymphomas had to be treated in different ways, which we now know to be terribly important in managing these diseases. These two gentlemen really laid the basis for the approach to the therapy of diseases!
Q: That was through their classification scheme?
Ross: As a consequence of their classification scheme and their recognition that different types of lymphomas and leukemia responded differently to different types of treatment.
Q: Would you like to comment at this point on the approach taken, being one of a more morphopological approach in the labs of Parker and Jackson as compared to, perhaps, the biochemical or biophysical approaches in other Harvard labs.
Ross: It may have been because of my interests and my contacts, and the fact that I was trained initially in pathology and histology but my impression at that time was that Harvard placed a major emphasis of the approaches not only in hematology but other aspects of medicine. This was before the really tremendous impact of the introduction of genetic studies, and of biochemical and kinetic studies in terms of body function and I believe the major emphasis was on morphological and clinical correlations. While I was there, it was believed that the best avenue to a future in academic and investigative medicine was that after a young physician finished medical school he should take a residency in pathology, which is what I did. That again, amplified the emphasis on morphological structure as it related to clinical disease and it was very valuable, but this has now been superseded. I'm sure that at Harvard now, as at many other schools, the emphasis on histology and morphology and cytology has been sort of soft-pedaled. For example, at my present school, U.C.L.A., the teaching and the training in cytology, and morphology, and hematology residencies and fellowships is markedly diminished. There isn't really an awful lot of attention paid to this any more! The attention now is on the genetic structure and cellular metabolism--immunology and the way that you can modify the genetic structure, metabolism and immunology of cells, either by chemotherapy or by some other route, and thereby change the characteristics of the disease. I think this is very advantageous, but had it not been for the cytological approach that showed that there were different cellular and morphological aspects of these diseases and that diseases with different cytology behaved differently, then the subsequent developments probably would not have occurred for a much longer period of time. So, this was a basis upon which other investigations and therapies subsequently were built. This is true, really, of all of medicine, I guess of all of mankind, to build on the basis of what your predecessors did. They had a different approach and you must devise a new approach and follow that.
Q: Could you possibly also talk about the links that existed between the New England Deaconess Hospital, their clinical services, and research labs?
Ross: Yes. The New England Deaconess is a very interesting institution. The chief influences there were Eliot Joslin, who was the diabetic specialist, Frank Lahey, who was a surgeon, and Shields Warren who was a pathologist. In the Joslin Clinic there were superb physicians who excelled in taking care of diabetic patients and in pursuing the disturbed metabolism and clinical chemistry that went along with the caring for these patients. Except for statistical studies and the studies of case management, there were not, to my knowledge, any great advances contributed in more fundamental research into the nature of diabetes during the time that I was there. Frank Lahey, the surgeon-in-chief, was instrumental in designing new types of operations and in excellent surgical treatment of illness, but, again, this research was clinical and so far as I know was not involved in probing the fundamental aspects of the disease or modifying this or that or the other. Shields Warren was somewhat different. Because of his involvement with a large number of neoplastic cases, he became interested in the dynamics of cell proliferation and how one might influence this. He became involved in radiation therapy of neoplasia and the changes that occurred histologically consequent to such therapy. He became an extremely important figure in the Atomic Energy Commission and in the investigation of individuals who had been exposed to ionizing radiation in the nuclear tests and also in the study of the Japanese who had been exposed to ionizing radiation at Hiroshima and Nagasaki. He wrote extremely important papers depicting the clinical aspects of what went on and relating these to the patholigical changes in the magnitude of exposure that these individuals received which was related to their distance from ground zero.
He was a very interesting and a very fine gentleman. He was the son of a former president of Boston University and he himself was for many years a trustee of Boston University. He was extremely effective in dealing with the Congress of the United States. He was a lean faced, lank guy who played the part of an old country doctor when he'd go before a congressional committee and fool around with his papers and so forth. The Congressmen sort of would develop empathy as a consequence of that. He didn't need to look at his papers. He didn't need to fumble. He was putting on an act, but then when he started to talk, these Congressmen were favorably disposed to him and he could present tremendous amounts of factual information and plead the case for funding for the Division of Biology and Medicine of the Atomic Energy Commission, et cetera, et cetera. He did a very great deal in initiating the research work that studied the effects of radiation exposure on human beings and how one might combat these effects and how to take care of patients so exposed. He was a truly very great gentleman and a very excellent scientist, and a very good advocate of the scientific approach.
Q: Was there a developing field at that time of Oncology? You have here Shields Warren looking into neoplasias. You have the work at Huntington Memorial Hospital.
Ross: It was not an integrated specialty when I was at Harvard. Many individuals were approaching the problems of neoplastic disease from their disciplines. There was no attempt, to the best of my knowledge, to amalgamate these into a specialty of Oncology or to develop oncologists. The surgeons might spend most of their time operating on neoplastic disease, hut they didn't consider themselves necessarily as oncologists. The medical people didn't like to get involved in diseases that you couldn't do very much about. If you couldn't cut it out and you couldn't radiate it, it was pretty hopeless and it was a depressing field, so most of them stayed clear of oncology with the exception of the hematologic neoplasias which during the war were recognized as being responsive to therapeutic administration of certain oncolytic agents. The first of which was nitrogen mustard. This was observed to be very effective in inducing remissions in patients with Hodgkins disease. But, again, I don't think physicians giving this therapy considered themselves, at that time, as oncologists. They were just hematologists who had this new modality of therapy.
Q: Was that work with nitrogen mustard done at Harvard?
Ross: I think the first clinical use of this was done by Bill Dameshek at Tufts University School of Medicine. He was, I think, among the first to publish this finding. The reason he got introduced into that was that Dr. David Karnovosky of S.K.I. recognized that animals that had been exposed to this toxic agent, which was one of by-products of the manufacture of war gases, their entire lymphatic system was eradicated. This suggested that this might be effective in getting rid of the illnesses associated with lymphatic proliferation, namely Hodgkins disease and leukemias. That, really, was the anlage of the whole area of the chemical treatment of neoplastic disease. Dave Karnovosky had worked in the army and he was associated with the chemical warfare service. He also began to use these materials at the Sloan Kettering Institute and he went on to make very significant contributions to the chemotherapy of neoplastic disease. Unfortunately, he died of carcinoma of the lung. The therapy that was available didn't help him.
Q: After you completed these services, or was it during the course of these services that you began your senior tutorial in physiology?
Ross: This was when I was a fourth year student and, a student house officer at the New England Deaconess Hospital. That provided me with room and board and camaraderie, but no money, which wasn't needed much, but it was during that period of time in my fourth year of medical school that I did my tutorial work in the department of physiology at Harvard. I worked under Professor Walter B. Cannon and Professor Arturo Rosenbleuth, studying the relationship of the sympathetic nervous system to certain bodily functions and the responsiveness of the sympathetic system to certain chemical agents. A very stimulating experience and one for which I'm very grateful! However, although at one time I thought I might want to become a physiologist involved in physiological investigation, after sitting for hours every day watching the cat nictitating membrane go up and down on the Kymograph or the catheters do this or that or the other, I decided I didn't want to continue as a physiologist. I then gave a whirl at being a pathologist, which was a different experience. However, it was interesting to combine the clinical aspects of my house officership at New England Deaconess with the basic research in the department of physiology.
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