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Q: Were there further contacts between the academic work in physiology and the work at Deaconess?
Ross: No. There was not much basic research work other than what I just mentioned going on at the Deaconess at that time. At that time, the relationship between the Deaconess and the Medical School was not terribly close except for the professors who held appointments on the hospital staff. That's all changed now. The Deaconess is now one of the major teaching institutions for Harvard University Medical School, but then it really wasn't used much for clinical teaching. The research that was there, as I said, was primarily related to clinical observation.
Q: There's another question that's raised--has been raised--in the history of biology I wonder if you might be able to comment on. One, there's an argument that at Harvard, in the medical school, there's a development toward biochemistry because of new sources of funding and because of the political savvy of people such as David Edsall. There's another argument that says that the developments, the combination of analytic and scientific approach with clinical studies developed because of the new types of approaches introduced by people such as Walter Cannon and L.J. Henderson. I was wondering if as a medical student you became aware of either one or the other of these sorts of questions?
Ross: No, I didn't. As a medical student working very hard academically and also responsible for trying to support myself, I confess I was more or less isolated from the political impact of what went on in the medical school or the world as a whole. I didn't read newspapers. I didn't read journals, except for The New England Journal of Medicine. I tended to my last and worked like hell at what I was doing. So what went on in the higher echelons of the medical school, I didn't know about. It would be my interpretation, from what I've said, that the impact of people like Walter R. Cannon, I in terms of trying to explain what went on in human beings as a consequence of knowing something about basic physiology, had a tremendous impact upon the orientation of Harvard Medical School. The biochemical aspects of medicine under predecessor Otto Folin certainly were important, but I was not aware and I'm not aware now that this had any tremendous formative affect upon modifying the curriculum at Harvard Medical School or the training that we received. I could be wrong in this because I'm talking in an area which I didn't know about at the time.
Q: Were there discussions about other scientific breakthroughs or developments through seminars or conferences at that time?
Ross: Yes. Harvard had a marvelous system in which visiting professors and lecturers of great distinction were brought to present lectures and seminars. These lectureships were open to medical students, house staff, faculty, and all interested scientists. These lectures were superb, and they were greatly stimulating to everybody who heard them, medical students on up. I mention some of these: Professor Loewi, Professor Dale, Professor Starling and others of great distinction. This had a tremendous beneficial effect on the whole educational process. These, I believe, are now continued at Harvard. One of them is called the Dunham Lectureship. Very distinguished people present these. I can't remember the names of the others, but these were most advantageous, and I think it's unfortunate that this is not implemented very vigorously in certain other medical schools. Not that other schools don't have seminars and so forth in their own areas, but they don't really open up the opportunity for the whole medical community, everybody, to come and listen to one man talking on his contributions.
Q: You mentioned earlier talks by other people such as Alfred Whitehead, the philosopher. Were these discussed among medical students or was that just at the time, or was it mostly just--
Ross: We learned from the faculty that these distinguished faculty members were presenting their final lectures. Our professors would say, "Look, you ought to go and hear this, or go and hear Henderson for the last time, or Whitehead for the last time.” Again, I think probably the reason I went and many others did so was because of the distinction of these individuals and the fact that we were students encouraged to listen to what a great mind was saying! That's why I went and, as I said, Professor Henderson was talking in social terms which were more comprehendible than Professor Whitehead who was really a very esoteric philosopher. I couldn't understand some of the things he was saying, maybe most of it, I can't remember now. Again, this had a tremendous impact upon the whole milieu of the educational process, and of the research process in the medical school. I can't fail to recognize the tremendous impact that great minds have on younger people in terms of stimulating their interest, their concern, and their volition to continue and perhaps, to some extent, emulate what was done by these great men.
Q: In the period following your physiological tutorial, you had already decided that you did not want to follow either physiology or you made--
Ross: Well, as I say, I got mesmerized by watching a Kymograph lever go up and down and I decided I didn't want to do that the rest of my life. I didn't want to spend my life dealing with cats. So after graduation I opted for pathology which was a step in a different direction. Then I thought for a while I might want to be a pathologist. I had, again, a wonderful experience in the Mallory Institute of Pathology at the Boston City Hospital [BCH]. F.B. Mallory was still around. His son Kenneth F. Parker, Jr., was there and a lot of younger people. We had very close ties and contact with the clinical services. Harvard had two medical services and a surgical service there at the BCH. There was continual interchange of activities, and conferences held between the Pathology Department and the Clinical Services. The Thorndike laboratory had a very great interest in what went on in the Mallory Institute and vice versa. So, again this was cross-fertilization of different disciplines trying to advance human knowledge relative to disease. That was a tremendous opportunity. I don't know whether that still happens at the BCH or not. The Thorndike has been moved out of the Boston City Hospital to the Beth Israel Hospital. The Mallory Institute is still there but I confess I don't really know what they're doing. The bed population of the Boston City Hospital has fallen. However, at that time I was there it was a tremendous ferment of research. Clinical bacteriology was tremendously important because the only way we had, for example, to treat lobar pneumonia was to characterize the pneumococcus bacteria in terms of what were called its types. You "typed" the bacteria, and there were anti-serums that, depending on the type of pneumococcus recovered from the sputum, could be given to the patient that produced a radical improvement almost immediately in the patients who got it. All this development occurred while I was at either the Mallory Institute or an intern on the clinical service there at the BCH. Again, there was an intimate interchange of information and of ideas in the bacteriological aspects of disease between the Mallory Institute and the Clinical Services.
Q: Could you say something about the Mallorys, father and son?
Ross: Old F.B. Mallory, Frank Burr Mallory--he was a wonderful, old, crotchety man when I knew him. He was tall, still rigidly erect. He had a bristly white mustache and anybody who saw him knew he was still the boss, although Frederick Parker, Jr. really was the boss. Dr. "FB" had his own laboratories. He had his own continuing technicians and he was a stickler. He was interested in the possible causation of cirrhosis by copper, which he thought was contained in alcoholic beverages, because as a consequence of being distilled in copper stills. He had a colony of monkeys there in which he was trying to produce copper poisoning to see if this would cause cirrhosis. He also was interested in the tissues that came from anybody who had cirrhosis. He certainly was a stickler! He wanted each of these tissues to be cut precisely in two centimeter squares, and they had to be no more than four millimeters thick. If they weren't that way, he'd give the resident who provided them hell. Well, one of my colleagues figured he'd finesse old F.B. It's very hard to cut liver to those particular specifications when it's fresh tissue, so my fellow resident fixed them over night in formalin, and then cut them precisely to Dr. FB's specifications. They were cut beautifully to fit the exact dimensions Dr. FB wanted, but it was obvious that the tissue hadn't been cut to those dimensions when they were fresh, and the old man came around, and gave my fellow resident holy hell, and told him he was a cheat and a liar and he didn't want anything more to do with him. He cast him into outer darkness! Dr. FB's real concern, of course, was that the penetration of the fixative, in a certain period of time, didn't go more than a few millimeters deep and if the section was too thick when he put in the fixative, the fixation of the central part of the tissue would not have been adequate, and consequently what Dr. FB was trying to do was frustrated.
He had two sons. One was Tracy Mallory who was the pathologist at the Massachusetts General Hospital and the other was Kenneth Mallory, who was the pathologist who succeeded Frederick Parker at the Mallory Institute. Both of them were extremely fine pathologists and gentlemen. Tracy, at M.G.H., was involved in what were called the "Cabot Cases," the Clinical Pathological Conferences still are published in The New England Journal of Medicine. He gave a great impetus to all of us to correlate the pathological changes with the clinical condition of the patient before death. Kenneth was not so much involved in the clinical aspects; he was more concerned with the morphological changes that went along with the morbid state. Old F.B. ran them both. When he was around, they would both sort of sink down and become self effacing and take a back seat, Kenneth perhaps more than Tracy. I think Tracy was a little bit more independent. Kenneth was right there under the old man's eagle eye all the time, so that sort of kept him in line. He just died fairly recently. Tracy died of a stroke many years ago. He had a terrible stroke, and was partially paralyzed for the last years of his life. The Mallorys were a great family of pathologists.
Q: I was wondering if you could comment on some of the other people who were at the Mallory. There was William Castle.
Ross: Dr. Castle was actually at the Thorndike Laboratory which was a clinical research institute. Of the people who were in the Mallory--there was a fellow named Dr. Leo Alexander, Viennese neuropathologist, who sang as a Vienna choir boy in his youth. He was great fat fellow when I was there, and bald as he could be. He was interested in the central nervous system, particularly in a disease called Wernicke's disease: posterior inferior hemorrhagic encephalopathy which occurred in alcoholics also and in people who had a profound deprivation of vitamin B. He was able to reproduce this disease in pigeons with a specific low vitamin B diet and alcohol. The pigeons would get this disease clinically and pathologically. When I followed my pathology residency with a clinical residency I was able to recognize some of these peculiar central nervous system diseases in alcoholics and he was always right on hand to see them clinically and then to autopsy them when the autopsy time came and to demonstrate the characteristic changes. Interestingly, Dr. Alexander became involved in the investigation of the Nazi war crimes. He was a medical historian of those trials and wrote extensively about the trials and the observations on people who had been savaged by the Nazis.
Also, there was a very fine gentleman at the Mallory named Dr. Robert Nye. He was a microbiologist and associate director of the Mallory Institute, and became the editor of The New England Journal of Medicine [NEJM]. He was the man who first made the NEJM a world-wide recognized medical publication of the finest caliber. He developed a horrible disease known as multiple myeloma, which rapidly killed him in about two months. He was a very fine gentleman! He encouraged me to write a couple of review articles for The New England Journal. He was a very great physician scholar and scientist!!
Then there were younger people at the Mallory. Many of these people become professors of pathology at one place or another. Examples are Dr. Don Nickerson, Dr. John Sheeher, Dr. Jesse Edwards and his brother whose I first name I can't remember, but who authored the widely used test door of pathology. It was a tremendously stimulating environment.
Q: Were there more frequent discussions on hematology at Mallory?
Ross: Yes, because of Dr. Parker's interest in the hematopoietic system, and the lymphopoietic system. Dr. Henry Jackson was around, meeting with Dr. Parker frequently, and, of course, the great hematologists at the Thorndike, Dr. Minot and Dr. Castle, were around. Also a gentleman named Dr. Hale Ham, who was quite distinguished in the area of hematology. These all had frequent stimulating interchanges with the people in the pathology department. Joint clinics, conferences, clinical pathological conferences, and consultations relative to research were continually on-going affairs--
Q: Do you know when these were established?
Ross: I beg your pardon, sir?
Q: Do you know when they were established? Were they already in progress when you first came to the Mallory?
Ross: Certainly! Bill Castle's work on delineating the role of the intrinsic and extrinsic factors of pernicious anemia had occurred before I got there. Hale Ham's studies of paroxysmal nocturnal hemoglobinuria were going on while I was there as were his classic studies of the sedimentation rate. Also, the professor Soma Weiss, who later became professor chief of medicine at the Peter Brigham Hospital was there. He and Kenneth Mallory were actively cooperating on such diseases as the Mallory-Weiss syndrome, which is the rupture of the wall of the esophagus in alcoholics as a consequence of violent vomiting which ruptures the esophagus and leads to fatal bleeding. Also they studied the effect of vitamin B deprivation in alcoholics which caused Beri Beri Heart disease. Weiss and Mallory collaborated on the definition of that disease. During that same period of time, there was the first recognition of intercapillary glomerular sclerosis, a very common degenerative disease of the kidney.
Q: And this research was all the subject of various conferences and seminars?
Ross: Yes. It benefited everybody including the most junior resident and the many medical students that usually were around. It's a tremendously inspiring environment which isn't duplicated in many other medical schools.
Q: Do you think these conferences and seminars helped to define a later field of hematology?
Ross: I certainly do! There was tremendous emphasis on hematology with Minot, Castle, Parker, Jackson, Ham, Taylor, and others around. This really led to recognition of this field as a very important and unique specialty area in medicine. Dr. Castle, to my belief, didn't really believe that hematology should be segmented off as a separate specialty because he thought it still should continue to be part of general internal medicine. Obviously, hematology has changed. Hematology developed in the way he thought it should. However, the work at the Thorndike, at the Mallory of Dr. W. Dameshek at Tufts Medical School certainly laid the groundwork for initiating the publication of Blood the Journal of Hematology and also led to the establishment of training programs in hematology. Drs. Castle and Minot always had research fellows associated with them who were working in hematology. There was a man at the Thorndike named Laskey Taylor, a biochemist who was interested in the proteins involved in blood coagulation. The discoveries he made with another gentleman named Fredrick Pohle, became tremendously important in understanding the coagulation in hemostatic mechanisms. Their work recently has come to the fore, again, because of recognition that the coagulation mechanisms occasioned by factors in the plasma are probably related to the causation of arteriosclerosis and myocardial infraction and other troubles.
Q: Could you say something more about Castle's work at that time?
Ross: At that time he'd already done the work in which he would ingest raw hamburger and let it digest for an hour or two and then aspirate the stomach contents and give them to a patient with pernicious anemia. This made him even more slender and haggard than his usual appearance. That work was completed by the time I worked at the Mallory Institute. Dr. Castle was still trying to delineate precisely the chemical nature of the intrinsic and the extrinsic factors. I don't believe that Dr. Castle was the investigator who ultimately did this. There were other investigators who determined that vitamin B12 was the extrinsic factor and the intrinsic factor was a binding protein elaborated by cells of the gastric mucosa. Dr. Castle was an absolutely superb teacher in all areas, not only hematology, but also all the rest of clinical medicine.
[end of side one, tape two; beginning side two]
Q: Could you perhaps comment on Hale Ham?
Ross: Hale Ham, I believe, was an associate professor working at the Thorndike when I was at the Boston City Hospital. He was a very stimulating, handsome, lively, dapper gentleman. When I first went to the BCH he was working on the sedimentation rate. He published the definitive and classical articles relative to what it was that made red blood cells sediment at certain rates in clinical conditions and what modified this rate. Then he began his classical studies of paroxysmal nocturnal hemoglobinuria [PNH], a very fascinating type of hemalytic anemia. He developed methods of recognizing cells that were subject to the lesion characteristic of this disease. He developed the test for this disease which is called the Ham test. It's to test the hemolysis sensitivity of red blood cells to an acid environment. PNH cells hemolize if the ph of the suspending medium is lowered to a certain level in the presence of complement. Hale Ham subsequently became president of the Society of Clinical Investigation and of the American Society of Hematology. Subsequent to his time at the Thorndike he undertook the revision of the curriculum at Western Reserve University. Then he moved to Hanover, N.H. There he had a stroke. He wrote a history of the American Society of Hematology. I don't know if it was ever completed. I think he became ill before he got that finished. He was the historian for the Society of Hematology for quite a while. I believe it important that you interview him!! He's a fascinating, wonderful gentleman!!
Q: At this time in the conferences and seminars other people perhaps expressing interest in hematology--Soma Weiss. Is there anything else you could add about the work done by Weiss?
Ross: Soma Weiss was primarily interested in the heart, and in cardiovascular disease, and in clinical pharmacology. He was a Hungarian and he had a very heavy Hungarian accent, except when he became very excited and then his accent disappeared, which was a cause of considerable amusement to most of the students and house officers. It was believed that some of his accent was maintained for certain purposes. He was strongly oriented towards the study of the dynamics and causation of disease. I mentioned that he described beri-beri heart disease. He had a very major activity going on in terms of the mechanisms of heart function. He described the Veso-vagal syndrome of syncope and many things that control heart function. He was not specifically, as far as I know, particularly involved in the field of hematology. He was the chief of the Harvard medical services at the Boston City Hospital. In that role, he was involved in some trouble I got into as an intern at the Boston City Hospital. I was sort of a stiff necked fellow in certain ways and, as I told you, I worked very hard at the hospital. There were times when I wasn't out of the hospital for maybe five or six weeks at a time. I worked day and night. On one of the rotations I worked in the out-patient department. When I got to the out-patient department I was supposed to punch a time clock indicating when I came in and when I went out. As a budding young physician that was an insult to me. There I was working like hell, and I had to punch a time clock like a janitor? So I refused to punch the time clock. I was suspended as a house officer by the superintendent of the BCE and he said, "Until you're willing to cooperate with the rest of us, you're no longer a house officer", and he reported this to Soma Weiss. So I went to see Soma and Soma said, "What the hell are you trying to do around here", he said, "What's the matter with you?" he said. I explained to him that I was working as hard as I could and always spent the required time in the OPD. It was beneath my dignity to punch the goddamn time clock. He said, "Don't be a this and that and the other, don't be a damned fool. Punch the damn time clock and don't pay any more attention to it," which was a good lesson to me. So I went back and punched the time clock so hard it knocked it off the wall. [laughs] That didn't get me in trouble that time. I guess they figured the clock was kind of loose anyhow, but from then on I punched the time clock when I was supposed to, and didn't pay any more attention to it. It was a worthwhile lesson in life. Soma was a very fine mentor and teacher. He went to the Peter Brent Brigham Hospital as Chief of medicine and then had a ruptured berry aneurism in his brain. He meticulously described his symptoms. It killed him. It was a terrible loss!
Q: Chester Keefer was someone?
Ross: Chester Keefer was my chief after I left Boston City Hospital. I left the Boston City Hospital and went to the University of Rochester to work in the laboratory of Dr. George Whipple, one of the Noble Laureates in hematology. Then when I came back to Boston again thought of staying in the field of pathology, but Chester Keefer, who formerly was an infectious disease expert at the Thorndike had moved across the street to Evans Memorial at Boston University School of Medicine, offered me a position as an assistant professor of medicine at Boston University. He had just started to revise and rejuvenate the services there. He was the director of the Robert Dawson Evans Memorial, a heavily endowed research institute, and he brought in a very interesting group of young physicians. There was Francis Cabot Lowell, who was interested in immunology and allergy; Franz Ingelfinger, a gastroenterologist; Robert Wilkins, a cardiovascular specialist; Stanley Bradley, who later became chief of medicine at Columbia University was interested in renal functions; Charles Rammelkamp, who became a distinguished infectious disease doctor and professor at Western Reserve; Arnold Relman later chief of medicine at the University of Pennsylvania and editor of the New England Journal of Medicine; Louis Weinstein, later professor of medicine at Tufts. This was a very exciting group of colleagues. While I was at the BCH there was nothing more stimulating than participating in general grand rounds in which all six of the medical services participated. The presiding physicians were Soma Weiss and Chester Keefer. Each had a different approach, each was a brilliant man, and each had a different kind of memory that liked nothing better than to get into arguments with the other about the case being presented and discussed. Keefer had an encyclopedic memory, was extremely widely read, and one of the most stimulating teachers that I ever had. When he offered me a position back in Boston I deserted pathology for clinical medicine. He established one of the most exciting and stimulating groups of physicians that I've ever been associated with! He provided them all with everything they needed in terms of equipment, technical support, and clinical opportunity! Absolutely magnificent!! He built a big, new institute replacing the old Robert Dawson Evans Memorial which had become pretty decrepit. Keefer was a tremendously stimulating individual and he knew a great deal about the history of hematology. He knew a great deal about the history of everything, and the mechanisms that went on in the pathogenesis of disease. He taught me the word "meddlesome medicine," and that you shouldn't be doing things to patients unless there was a very good indication for doing them!! He really adhered to that. He thought there was an awful lot of meddlesome medicine going on then. If he lived now he'd probably lose his hair because of all the meddlesome medicine that goes on now!
Q: There was another individual who was a participant in the seminars at the Mallory, Maxwell Finland?
Ross: Dr. Maxwell Finland was a specialist in infectious disease. He was involved with the development of the anti-serum for the therapy of pneumococcal pneumonia. He was among the first to use sulfanilamide when it became available. He was among the first to use antibiotic agents when they became available. He and Chester Keefer both were involved in infectious diseases but each had a different approach. Maxwell Finland, again, was a tremendously advantageous influence on the people with whom he came in contact. He carries on to this day! He's still around writing books at Harvard. I didn't see him last week when I was back there but I'm sure he's someplace around inspiring young people!!| 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 |