ASH Oral History: Joseph Ross
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 interview with Dr. Joseph Ross, conducted by Eric Hoffman on June 11-12, 1986 at the University of California, Los Angeles. Dr. Ross has reviewed the transcript and made corrections and emendations. The reader should bear in mind that following oral history is a verbatim transcript of spoken, rather than written prose.
Q: Dr. Ross, I wonder if you could say something about your childhood in California. You were born in 1910. I wondered if you could especially point to the various influences that would have led you into a career of medicine and science.
Ross: Gladly. I was born in Azusa which was a small community with nothing but jack rabbits, rattlesnakes and sage brush. My father and mother had come from Illinois and my father was a science teacher at the local high school. He was very much interested in natural history and things that were living. He was very kind and took me on camping trips from my earliest recollection. We went to the desert, the mountains, and saw lizards and snakes, jack rabbits and road runners, etc. This initiated my interest in things of science.
Then, as I progressed in age, I was encouraged to participate in science fairs. I remember I had one exhibit, at a relatively early age, of the maturation of frogs. I got the eggs out of a pond and had exhibits of the eggs as they matured and the tadpoles and the development of a tadpole into an adult frog. I was gratified because it won the first prize, which was a blue ribbon. That was a great stimulus to my interest in science.
When I reached high school, there was a very excellent biology teacher named Kate Blocet, who was married to a gentleman who ultimately became a very distinguished professor of chemistry at UCLA. She was very stimulating and encouraged me to go into medicine as did my father.
My father was a quite gifted teacher and he got the local physician to sponsor an essay contest on scientific subjects. I wrote an essay about citrus by-products which was awarded that prize. It was then entered into the national Garvin chemical essay contest, which was a competition for college scholarships. It won the gold medal in California, but unfortunately only reached second place at the national level, so I didn't get the scholarship. And this was repeated in my senior year at high school: again the gold medal in California, but it placed but didn't win the national contest.
At an early age, I had scrofula and tuberculosis, which was acquired as a consequence of drinking unpasteurized Jersey milk from the local dairy. I had a neck dissection for removal of the scrofulous nodes from my cervical area and then spent some ten months in bed. Prior to that I had been a scrawny kid but my parents fed me up and ever since then I've been fat. But during that period of ten months in bed, again my parents were very kind in setting up plants and other things which interested me. Also, I was brought forcibly into contact with physicians at that point in my life.
The doctor who operated on my neck and who took care of me during that time was a colorful character. He had the biggest house, and the biggest automobile in the community and he drove faster than anybody else and considered traffic tickets as part of his professional expense. He'd pay the fine and go off at the same rate and the cops usually let him go. But he also stimulated my interest because he was a very kind gentleman and he appreciated the fact that I had interest in living things and started telling me about aspects of medicine. After I was able to get up and about, he used to invite me to go on patient visits with him and that also was very stimulating.
So I would say that when I was a freshman or a junior in high school, I decided I wanted to be a physician. And it's of most interest that most physicians have decided they wish to be physicians at the age of fourteen or fifteen, which is in marked contrast to some of the other professions where they sort of drift into it because they can't find much else to do, I guess. Incidentally, have three sons-in-law who are lawyers. I discussed this with them and all of them decided to be lawyers after they completed their college educations. Anyhow, I decided I wanted to be a doctor when I was fifteen years old.
When I finished high school--I had made a good academic record. My father was a high school teacher who by that time had become a principal in the school. I think his salary was twenty-six hundred dollars a year or something like that. I had a sister who had had a very severe mastoiditis, which depleted the family coffers which never were very great. So, in order to go to college, I needed scholarship support. I was awarded the Cranston scholarship, a very good scholarship at Stanford University.
Q: Can I ask some questions about the high school education before we go on?
Q: Okay. Do you recollect any of what the curriculum was like? Were there actual courses in chemistry and biology?
Ross: Oh, certainly. My father taught the courses in chemistry and in physics, which were fascinating courses. He was an excellent teacher. He stimulated interest even in the dumbest kids, and in those that were blasé. He was able to do this with certain tricks of the trade which was very interesting. For example, he told about urinalysis, I remember, in a chemistry course. And he told about the development of urinalysis and he said it used to be that people would taste the urine to see if it was sweet, to see if it was sugared. So he dipped his finger in a urine sample and, of course, put another in his mouth, but the kids were profoundly impressed that he was dipping his finger into a pot of pee and then putting it in his mouth, and he said, "This person hasn't got any sugar in his urine." That's the kind of thing he did, and it stimulated their interest greatly.
He also took people on trips to industry. I remember going to a soap making factory which smelled awful, but it demonstrated the chemical processes involved from taking offal and tallow and making them into soap.
That was very stimulating not only to me but also to the other people that he taught. No less than three of his students became distinguished professors of chemistry, and two distinguished professors of physics in very prestigious universities. One was at Stanford, another was at Pomona College.
Q: Do you remember their names?
Ross: The names of the professor at Stanford was Philip Leighton and his brother Wesley Leighton was a professor of chemistry at Pomona College. There were a quite a number of his students who went into the field of medicine, all the way from internal medicine to surgery. He had a very formative influence on these people. Also, he was able to promote a competition in this field which, as I said, was subsidized by the local physician. The winners of these contests received a gold medal, which was very nice. It was awarded publicly in an assembly in a high school. It was esteemed and that brought peer interest and peer esteem, which is very valuable in trying to formatively influence young people in what field they're going to enter. This was a very strong influence and also the lady, Mrs. Blocet, was very helpful in stimulating interest in children in the biological sciences. I'm undyingly grateful to these people for their enthusiasm, inspiration and guidance!!
Q: Do you remember anything of the content of the biology courses themselves?
Ross: Yes, I remember we had to draw pictures of twigs and leaves and animals. I was unable to draw even a crooked line, let alone a straight line. I had a terrible time making the pictures, but interestingly I've kept them. They're not all that bad. Also, the lady set up experiments. She repeated some of the things about the maturation of amphibians. She had demonstrations about fish. And, as I recollect it, we even did a dissection, I believe, of a frog, which was quite interesting and again stimulated the children. It presumably repulsed many of the girls in the class, but I think this was a show put on to influence the boys about how effete they (the girls were) and how turned off by things biological. I would say that this culture in which I grew up encouraged boys far more than women to go into scientific careers. I suppose that again was a reflection of the upbringing of these children in their homes. Women weren't supposed to go into professional activities such as medicine. They were supposed to do other things, which were equally important but they were not stimulated to go into scientific endeavor.
Q: Was there ever any mention made of the fairly new advances in genetics?
Ross: Genetics, at that time--you must remember I graduated from high school in 1929 and genetics really hadn't become generally recognized as being very important at that time. Subsequently, when I was in college, I took a course in genetics. I was considered to be sort of a kook for taking such a course, but it also was very stimulating. It was taught by a wonderful old man named Danforth. He was a very gentle, kind fellow. Unfortunately, the course came at one o'clock in the afternoon after lunch. You may know it's warm at Stanford after lunch and most of the class became somnolent, but it was quite effective at stimulating interest in the area of genetics. But in high school and grammar school, I don't think many people knew about genetics--some of them didn't even know the meaning of the word.
Q: So the main emphasis in the high school would be towards areas of either natural history or descriptive kinds of science?
Ross: Yes, except for the industrial chemistry in which my father encouraged interest by taking people on those expeditions, not only to a soap factory, to a steel foundry and to a dry lake bed north of Los Angeles where they were extracting brine out of the dry lake and fractionating this into certain chemical compounds. That was also very interesting. But I would say that the major emphasis to which I was exposed primarily was biological science rather than physical science, although there was a very good education in chemistry, which I guess you would call a non-biological science, but it has great bearing upon biological science. So I was blessed by having a family that was interested in encouraging such interest, an academic environment which encouraged such interest, not only in myself but to other children in the school. I think it was a great education!! I think much of that's gone aside now. People teaching school now, most of them aren't going to put forth the extra effort to develop little kids with interest in nature, take them on trips and encourage them to read papers and write papers after school.
Q: You entered Stanford University in 1929?
Ross: I graduated from high school in 1929. I was awarded the Cranston scholarship at Stanford. This was established by the parents of Senator Alan Cranston in memory of his brother who had been killed in World War I. This made it possible for me to attend Stanford. Interestingly, the tuition at Stanford when I was there was three hundred dollars a year. This completely subsidized all of the tuition costs and I was fortunate enough to have a little money and be able to pay for my room the first year, which also didn't cost much. I waited tables in the dormitory dining room--the food was unbelievably awful--but it sustained me.
The scholarship was extremely helpful, and interestingly I kept in touch with Mrs. Cranston until she died at the age of ninety. Every year I would write to her and she would respond. That also was a very, very helpful. I have not maintained, unfortunately, the contacts with the Senator. I should try maybe to stimulate those interests because I think it would be interesting to contact the people who held that scholarship and ask them if they would contribute some money to increase the support from the scholarship because from a tuition of three hundred dollars a year in 1929, to fifteen thousand today--subsidized scholarships, fall far behind in providing adequate support. Because Stanford, as well as Harvard, although the donor money is there its accrued value does not keep up with inflation.
Q: Yes. Okay. At Stanford, did you major in biology?
Ross: I was what was called a pre-medical biological sciences major. The whole drive that I had when I was there was to get into medical school, so there was very strong emphasis on scientific courses and a minimal emphasis on humanities, which I regret very much. I did take medieval history. I took some other such courses, but they were very few, which was probably a mistake.
When I was at Stanford, I played football and I had a rude awakening in the autumn quarter when I had a course in analytic geometry which I just couldn't understand. I didn't know what the hell was going on! I used to go on football trips on the weekend and have an examination on Monday and I flunked a couple of them and I was summoned by the dean who said, "Look, you came up here with a very good record. You've got a scholarship. If you don't shape up and do better, you're going to lose your scholarship." Well, that put the fear of God in me and I worked like hell and passed the course, but I didn't take any more mathematics. That was enough of a warning, so I didn't want to sacrifice what else I might do to try to learn mathematics. That again was a terrible mistake. I should have had more mathematics.
But again at Stanford I had an excellent education. I had superb teachers in chemistry, physics and biology and that was a very great blessing.
At Stanford, although my scholarship paid my tuition, I had to work most of the time to support the other costs. After the first year, I joined a fraternity and had the great privilege of earning my room by making all the damn beds. I had to make about thirty-five beds every day and change all the sheets on the weekend. That was a terrible, terrible job, particularly because the beds were double deckers and I had to get up on the damn bed to make the top bed and lean over and it usually gave me a stomach ache from all the pressure on my belly. Also, I waited tables for my food. The work didn't hurt me. It was probably good for me, and taught me how to work to get along.
I studied very hard at Stanford and made a very good academic record. I had anticipated going to Stanford medical school, and had enrolled and paid the initial fee, but a friend of mine got the idea of why don't we go to Harvard? So I applied to Harvard and was accepted at Harvard and the dean of students at Stanford was a very wise and understanding gentleman and he refunded the deposit I had made on the Stanford medical school tuition, an act of great kindness.
My time at Stanford really was very fine. I worked very hard, played football and had many friends. I didn't have a car or anything like that, but that was probably a good thing too.
At the end of my third year at Stanford when I was going to go to Harvard, I needed just one more quarter of credit at Stanford to accumulate credits to receive an A.B. degree, so I spent an extra summer at Stanford, when I took the course in genetics from Dr. Danforth and also took a course laboratory techniques, where I learned to make microscope slides. I also had a course in microbiology where one of the main things I remember was that there was epidemic equine encephalitis, which was killing horses. So I went with a very fine scientist name Gephart and we went out and did autopsies on a couple of horses to get the brains out. That was quite a major job. It's a lot harder to get out a horse's brain than it is to get out a man's brain. That was a very stimulating experience!
Q: Do you remember anything about the content of the genetics that was taught at that time?
Ross: Well, it was primarily classical genetics based on Mendel's theories and how that applied to inheritance in mankind. I remember a discussion about the distribution of hair on the dorsum of fingers. This is a characteristic which is genetically related, as is also a certain tendon in the wrist. I remember Dr. Danforth presenting this information and everybody look in at their fingers to see what kind of heredity he had. But interestingly, he also pointed out that there was a very interesting genetic relationship between the shape and size of the human ear and the incidence of certain human diseases, namely pernicious anemia, which was the first time I'd ever heard of pernicious anemia. That also was really very fascinating and very exciting, but it was primarily classical genetics in the Mendelian sense.
Q: Was there any discussion on biometry or statistics in genetics at that time?
Ross: No, none.
Q: Do you remember the text book that was used?
Ross: We had a text book that I probably still have someplace. I can't remember the name of it. Again, it was classical mixed with drawings of how the distribution of chromosomes and genes took place. I can't remember the name of that book.
Q: No, it's just a particular interest of mine because it fits into the research I'm doing. Were there labs connected with the genetics course?
Ross: No, there was no laboratory with this course.
Q: You also had courses in embryology at that time?
Ross: Interestingly, to go to Stanford School of Medicine, it was possible to fulfill all your biological science requirements by going to the Hopkins Marine Station in Pacific Grove for the spring quarter of the year. This was an absolutely marvelous experience! There were superb teachers there! We had a course in marine zoology taught by a fellow named McGinnty who was a colorful character; a course in comparative anatomy that was taught by a Swedish gentleman named Skogsberg, who drank quite heavily but he was a superb teacher and very colorful.
Q: Do you remember how to spell his name?
Q: We can edit it.
Ross: Those were excellent courses and the Hopkins Marine Station was a lovely environment! We used to have field trips out along the tide pools, an absolutely magnificent way to learn about nature!! Incidentally, Professor McGinnty subsequently became the director of the Cal Tech Marine Biology Laboratory. He's the man that discovered a peculiar new species of animal that he called the "uricho caupo," which meant "the keeper of the inn." This is a creature that looks like a disconnected penis with a hollow body cavity open at each end--a kind of tunnel. In this tunnel lives a little crab--the crab lives inside the body cavity in a symbiotic relationship with the crab--the "keeper" which passes water through one end and out the other, and the uricho get their nourishment out of this stream of water. I saw one of these creatures up in the aquarium in Monterey a couple of weeks ago when I was up there. Tribute was paid to Professor McGinnty who discovered and named it! He called it "keeper of the inn" because of the little crabs that lived inside it.
This was a wonderful experience. We were blessed by being able to go to school three full days a week and three half days a week. The students rented houses in Carmel, which at that time was an idyllic spot without all the inundation of people that exist there now. We had three half days a week and Sunday off to enjoy life, which was the first time most of us had ever had such an opportunity. It was wonderful! We could swim and surf. There was no snorkeling at that time, unfortunately, so we didn't do that. We had a splendid time both educationally and recreationally! It was one of the greatest experiences I ever had. Unfortunately, Stanford doesn't provide that opportunity to pre-medical students anymore, which is a great pity!! I learned very good biological science, which was subsequently of great use in my medical education, particularly the courses in embryology and comparative anatomy.
The comparative anatomy text that we used was written by a woman named Libby Hyman. I still have that book, which is a descriptive comparative anatomy which is just wonderful! We also dissected creatures starting with very low life levels and working up to fish and frogs and turtles. Turtles have got the most complex internal anatomy of anything I've ever seen. Have you ever seen the anatomy of a turtle? Everything's wrapped around everything else. A wonderful, wonderful experience! I'm very pleased I was able to participate!
Q: Were there any courses that you took at that time in biochemistry? Because I understand Stanford was one of the first places where they were actually trying to establish biochemical studies.
Ross: Yes, there was a professor named Murray Luck. He taught the course in biochemistry which I took. I also had courses in organic chemistry, physical chemistry, and a terribly difficult course in quantitative analysis, which really taught us precision to the nth degree. Everything had to be absolutely clean and, interestingly, we were given "unknown" specimens and we had to analyze. One guy thought he'd pull a fast one and he got the results on somebody else's sample and reported them. The professor knew something wrong was going on so they substituted a different sample in his locker and then caught him red handed and expelled him, by God. That served him right, it seemed to me. They should do that more often. If somebody cheats in a chemistry class, he'll cheat when he gets to be a doctor, and that is intolerable. But we did have laboratory courses and Murray Luck was an excellent biochemistry professor. Eventually, interestingly enough, he married a girl who came from my home town, who was the same age that I was and I think he was about twice her age.
Q: There is probably at Stanford University, perhaps a number of years before you arrived, an attempt to establish a separate research institute for biochemistry. I was wondering if you were aware of it. It was an attempt to negotiate a compromise between the academic departments and the medical school.
Ross: I didn't know about that. I think that might have occurred subsequently. I'm not sure. At that time, the medical school was located in San Francisco. The first year of medicine was taken on the Stanford campus, so there was a separation of about forty miles between the basic science and the clinical science.
Q: This was the Cooper Medical College? Did it start then?
Ross: Well, I think the Cooper Medical College--I can't remember whether Cooper Medical College ultimately became Stanford or became the University of California at San Francisco.
Q: It became Stanford.
Ross: That was long before my time. Interestingly, another course that I took was taught by a very fine gentleman, Joseph Hinsey. He was an anatomy professor at Stanford. He subsequently became dean at Cornell medical school. He encouraged me to go east. He said, "Young man go east. That's what people from California need to do to complement their education." So he encouraged me to go east and to go to Harvard rather than to go to Stanford. But I didn't know about the biochemical institute at Stanford.
Q: It wasn't established. Apparently a number of people both in the biological department and in the chemistry department opposed it in the end. Perhaps you recall some of their names: Charles Taylor, a zoologist?
Ross: I don't remember him.
Q: Okay, Lawrence Irving?
Ross: I don't remember that one either. What was the year of that?
Q: These were during the 1920s. I don't have exact dates, but I know they were involved in this.
Ross: No, I didn't know them.
Q: Robert Swain?
Ross: How do you spell that?
Ross: He became president of Stanford for a time.
Q: He was chairman of chemistry.
Ross: He had been chairman of chemistry, but I never had a course with him.
Q: Did you have any ties to the Hoover Food Research Institute?
Ross: No, not at that time. Mr. Hoover was elected President during the time that I was at Stanford and that was great jubilation, and the president of Stanford, Ray Lyman Wilbur, went back to Washington to be Mr. Hoover's Secretary of the Interior. He had a son, Ray Lyman Wilbur, Jr. who was in my class at Stanford. He was a very nice gentleman. He's still living and around the area. I don't know what he does. I didn't know the professors with the other names that you mentioned. May I ask, is this the kind of stuff you want, or am I being too--
Q: No, no. This is fine.
Q: No, it's the combination of the personal anecdote along with the technical skills accumulated and the research done. That's fine.
Ross: I was also privileged to play football for Pop Warner, the football coach, when I was at Stanford. He was quite a distinguished man. This was his last job. He was pretty old and kind of irascible. He used to get a little "high" in the afternoons before football practice and he liked to hear people really smack into each other and get bloody noses. If they weren't doing that, he'd give 'em hell. That was a different kind of education than I got elsewhere, but it was worthwhile also.
Q: In 1932, you entered Harvard Medical?
Ross: I completed enough units to get my A.B. degree from Stanford at three years plus one quarter and I decided to go to Harvard Medical School because that seemed like a wonderful place. Also it was very discouraging to go to visit the Stanford Medical School in San Francisco. I went up there late one afternoon. It was an antiquated building and the light was terrible and it was just such a depressing place that I decided that I would rather go to Harvard.
Q: Did they also have a requirement of having an A.B. degree at Stanford?
Ross: No, you could get into medical school after three years, and get your A.B. degree at the completion of your first year of medical school. Harvard also did not require an A.B. degree although it advised the degree. So I got my A.B. degree after my first year of medical school. I didn't need the units, but there were a couple of required courses that Stanford allowed me to complete at Harvard medical school and gave me credit for my Stanford A.B. I can't remember what the courses were. They were very kind to me at Stanford to let me transfer those three or four units--to make up the requirements for an A.B. degree at Stanford after I had been gone for a year.
Q: And at Harvard you also received a scholarship?
Ross: I again was very blessed. I was awarded the Cheever scholarship, which was funded in 1889 by Dr. David Cheever, the grandfather of Sergeant Cheever, a member of my Harvard class. David Cheever was a Harvard professor of surgery at the Boston City Hospital. He established the Cheever scholarship to provide tuition costs for students, one each year, who needed such support, and I sure needed it! I'm also going to try to contact the recipients of that scholarship and try to encourage them to make contributions to the Cheever scholarship fund hopefully to improve its ability to help students go to Harvard.
I just returned from my fiftieth medical school class reunion in Boston and, as I said, my classmate, Francis Sergeant Cheever is the grandson of the founder, and he pointed out that his father, who was also a Harvard professor of surgery, David W. Cheever, also had contributed significant additional funds to try to keep up the scholarship and Sergeant Cheever, my classmate, also had contributed additional funds. On the other hand, there's a Cheever professorship of surgery established in memory of Professor David W. Cheever. Sergeant allowed as to how he had to put what money he could into support of his father's memorial professorship, and probably not much more into the Cheever scholarship fund. I hope to be able to express my appreciation by encouraging my fellow recipients of the Cheever scholarship during the past fifty years to contribute funds to the support of the Cheever scholarship at Harvard.
Also, at Harvard, I waited on tables in the medical school dining room, which was one of the worst jobs I ever had! I had to get up at five-thirty in the morning, go down to the dining room and wait on tables. I waited on tables three times a day, for a year, and for all that glorious work, all I got was my food. I figured if I was going to get my food, I ought to have a lot of it, so that contributed to my obesity, unfortunately. But that was a very rigorous job, and after that first year I didn't do it any more, thank God.
It was quite a difficult situation, working like hell. I used to sleep through most of the lectures I attended as a consequence of working and then studying late at night. I think there was scarcely a lecture in medical school that I didn't go to sleep in. I remember on one occasion, we had a distinguished professor whose name was--Hans Zinsser. He got tired of seeing me asleep and he finally said, "Mr. Ross, it doesn't hurt my feelings, but I think you'd better wake up from your long winter nap and listen to what's going on around here." That embarrassed me so I stayed awake for about a week after that. On another occasion, Professor Bill Green, an orthopedic surgeon wasn't quite so gentle and he threw an eraser and hit me on the forehead when I was asleep. He commented, "Look, if you're that sleepy, I've got a nice soft sofa in my office on the second floor. Why don't you go up there and take your nap?"
Anyhow, it was a grand experience at Harvard medical school, and again I had very distinguished professors who were very stimulating as well as excellent teachers of the factual subjects. There was a professor of histology named Bremmer who was a very great gentleman and he was the immediate instructor in the particular section of the laboratory in which I worked. He stimulated interest by showing things that a novice medical student wouldn't ordinarily be able to see through a microscope.
There was another old guy named Duffy Lewis who had studied the structure of cells. He was a very peculiar looking guy with a great big long drooping gray mustache. He gave lectures which at the time we couldn't see why he was giving, but he talked about the number of sides on a cell and how they interacted with each other, which was tremendously important. He was a very stimulating teacher.
In anatomy, we also had very brilliant teachers. David W. Cheever, the professor of surgery, used to come and give initial lectures about the importance of the anatomy that we were learning as it related to surgery. I remember he fascinated all the students because he could draw simultaneously with both hands at the same time. That, of course, turned people on and kept them awake and it also indicated the relevance of what we were trying to learn to what we subsequently might be doing.
We had another very distinguished man named Wislocki, who was an anatomist. He taught the relevance of what we were doing in terms of anatomy also to what it might ultimately mean to one's subsequent career in medicine.
Also, we had a very distinguished professor whose name was Walter R. Cannon, who again was a superb teacher. He ran a magnificent course in physiology and stimulated great interest, to the point where I subsequently took a special tutorial in my last year of medical school in his department of physiology. Walter B. Cannon was the first man to study the gastrointestinal tract with X-ray. He did this in geese, and in the process of doing this, he got severe radiation exposure. He had multiple skin cancers all over the dorsum of his hand and he subsequently developed a neoplastic generalized disease. When he used to teach us, he had terrible pruritis (itch). So he used to be twitching his shoulders and scratching his arms and his back all the time. At the end of the lecture, half the class also would be itching and scratching their arms and their backs. He ultimately died as a consequence of this disease, which was believed to he caused by his overexposure to ionizing radiation.
Q: These courses were courses taken in your first year at Harvard?
Ross: These were my first year courses. There was another distinguished gentleman who taught biochemistry named Otto Folin, Scandinavian who didn't have much use for doctors because he had had an operation on his ear and it had given him a facial paralysis so that half his face was paralyzed. He was a very precise technician. He established the basic levels of concentration of many different items in the blood stream and developed techniques for analyzing these, which were the real basis for and forerunners of clinical chemistry.
He was sort of a colorful old guy. He'd come around and look at you when you were working in the laboratory. We had to do Kjeldahl analyses for nitrogen, and if you don't do it just right, the damn thing would suck everything back into the flask and ruin the experiment. He was looking over the shoulder of one of my classmates, David Weir, one day and he said, "You better be careful. It's going to suck back." And my classmate says, "Sure, you old fool, if you keep blowing on it like that!" I saw Dave Weir last week. He's still kind of a curmudgeon in the same way!
But these were very great teachers, very great inspiration to students. Also, there was a wonderful lecture series that was sponsored by the university, not just for freshman medical students, but for everybody. There was a very distinguished gentleman named Loewi, who I believe was either a Viennese or German. He had determined some of the mechanisms of the transmission of the nerve impulse. He gave a lecture which even a first year medical students could comprehend. These lectures inspired interest in students in research and how research related to the practice of medicine.
Q: You've remarked that when you first came to Harvard there was--if I have quote right--"remarkable difference in the ambience, culture and philosophy," comparing Harvard and Stanford. Would you expand on that a bit?
Ross: It was a completely new world. Here I was, a boy from the rural, agricultural area of California who'd been to Stanford, a school that was referred to as "the farm." There were still people at Stanford when I was there who paid no tuition, who wore sombreros, hob nail boots and wore cords [corduroy trousers] that they never washed. If they took them off the "cords" would stand up in the corner without support. And there were only five hundred women in the whole university and their absence didn't provide any particular stimulus for good grooming or much of anything else in the way of good manners. It was a pretty natural place and emphasis was placed on physical prowess as well as intellectual prowess. Things were extremely informal.
To be transferred from that to one of the oldest universities and medical schools in the United States with traditions going back for three hundred years--[I remember the three hundredth anniversary of the university occurred while I was a freshman]. I guess it also was the hundred and fiftieth of the medical school. The people who were on the Harvard faculty were much different, much more reserved, much more observant of propriety than the faculty I'd encountered at Stanford. This had a great impact on me as did the Boston climate. When I ran into the first blizzard--I thought I was ready to go back to California. It took me two years to learn to tolerate the Massachusetts climate and four years before I began to like it, and then I enjoyed it very much. But it was sort of a rude shock at first!
Also, it was a challenge to be suddenly interjected into a community of students who derive literally from all over the United States. Harvard made an attempt, I believe, to have some geographic distribution in their selection of students, and some geographic distribution of the schools from which they derived. These different students had different attributes. The boys from Princeton were gentlemen. They usually had a great big automobile and they purported to be more superior than anybody else. The Harvard students were more relaxed, but, nonetheless, they had a special accent that was quite different from the rest of us and they were sort of a coherent group. And the boys who came from Yale again were different. They wore white shoes and high water pants. This was something quite surprising to a boy from California to be among all these different people. But in the course of four years, they were all melded together. It's amazing how uniform they seem now when I went to my fiftieth medical school graduation anniversary.
They've all been through the same mill, they have the same philosophies, they have major respect for the same things. They more or less attire themselves in the same fashion.
But for me in 1932 it was a very different culture and again it led to great studiousness and it put a great premium on accomplishing intellectually and academically. Although this had to some extent been true at Stanford, I don't think it was as greatly emphasized as it was at Harvard Medical School. The fact that at Harvard, all the people that lived in the medical school dormitory were all going to be physicians, and, interestingly enough, many faculty who also lived in the medical school dormitory, this had a very stimulating effect on students and it convinced them of the humanity of some of these professors who otherwise would have seemed to be somewhat crusty, remote gentlemen. That was all a very marked change in ambience from what I had encountered at Stanford.
[end of side one; beginning of side two of tape one]
Ross: I've just recalled the name of the professor who invited me to wake up from the long winter nap. His name was Hans Zinsser a very distinguished microbiologist who had devoted a great deal of effort to learning about typhus and its relationship to ticks. He had wrote a book called titled Rats, Lice and History. He also wrote other magnificent books, one of which As I Remember Him, by RS, [which stood for Romantic Self] is his recollection of his life as he was dying. He developed leukemia from which he died. This is one of my favorite books. He was a very colorful gentleman. He wore bright neckties and usually had a flamboyant red handkerchief in his jacket pocket. He paced around and around and around the front table, and how anybody really could go to sleep on a fellow like that I've never been able to understand. He was a superb teacher. This was a course in microbiology, which stimulated a great deal of continuing interest in that discipline. What more would you like me to talk about?
Q: There's one question, perhaps, that you could comment on in terms of the difference in philosophy between Stanford and Harvard is this: there's a debate among historians of biology which suggests that there either was or was not a transformation from earlier emphasis on natural history to experimental biology. In other words, some historians of biology say that a basic shift took place--especially by 1920--which established experimental biology, and it displaced an earlier emphasis on natural history and morphology. There are others who continue to say that both disciplines and approaches existed side by side. So I was wondering if the change from Stanford to Harvard could be placed in that light also. Stanford seems to have placed more emphasis--at least in your courses--on the morphological and natural historical side of biology, whereas at Harvard, you have a heavy dose of quantitative and experimental approaches, such as Walter Cannon, Folin and others.
Ross: Yes, you may know that the first president of Stanford University was a gentleman named David Starr Jordan. He was an ichthyologist. He was interested in morphology and classification. I think that sort of set the pattern at Stanford. These were the things that we primarily learned, the--if you wish--morphological, the classical categorical approach to science, not only biology but also, I would say in chemistry and the other sciences to which I was exposed. That really was quite different from Harvard. At Harvard, although they were anatomists, the gentlemen, Bremmer and Duffy Lewis, that I told you about, they really were morphologists. On the other hand, Wislocki, his particular interest was in regard to reproductive biology. He had done experiments, which he described to the class--which at the time seemed absolutely amazing to us--about experiments relating to gestation, to the menstrual cycle in women, and how they could be correlated with endocrine changes, and hormonal changes in the blood. This was so different from the structural, classical approach to which I had been exposed as a college student. As a medical student at Harvard we learned of the experimental attempt to look forward to find out what made things work in addition to the morphological approach.
Otto Folin, as I told you, was a categorizer and an analytical person. He was succeeded by a man named H. Baird Hastings, a professor of biochemistry, who had a completely different approach. I also was privileged to have a lot of contact with Baird Hastings, who incidentally is still alive in La Jolla. Harvard is taking him back to Cambridge a special celebration this autumn in commemoration of the 350th anniversary of the founding of the university and the development of the medical school. Baird Hastings was a perfectly wonderful gentleman who was at the forefront trying to look for and analyze the mechanics and the dynamic aspects of biochemistry as it related to human behavior. Professor Cannon in physiology also certainly was an experimentalist, who was not satisfied just to repeat what had been taught, but he did wonderful experiments in terms of the alarm reaction in animals that also prevail in mankind and he explained it endocrinologically and hormonally.
There was another very fine gentleman in physiology named Phillip Bard who became professor of physiology at Johns Hopkins. As a freshman medical student, he invited some of us to participate in tutorial discussion sessions and to participate with professors in experimental endeavors. There was one of the members of the physiology department named "Curly" Brooks. He was called Curly because he was absolutely bald. He was interested in the location of brain functions which he studied by operating on the brains of cats. I remember one vacation period he invited me to help him do some of these brain operations. The dormitory dining room where I worked wasn't open at that time so I didn't eat very much. This was my first exposure to an operation, ether, and standing still holding a retractor and I fainted, to my everlasting embarrassment! He was very kind and I lay down for a while and got up and finished helping him with his operation.
Also, as a student at Harvard, I was a tutorial student in physiology in my senior year. I worked for Professor Arturo Rosenblueth, who became head of the cardiologic institution in Mexico City. We developed a plan. I was interested in what would be affected in pregnancy by a removal or modification of the sympathetic nervous system. My project was to obtain cats that were female, that one subsequently could get impregnated, and to remove certain portions of the sympathetic nervous system. I performed a complete unilateral hemi-sympathectomy on some of them, and on others I took out the sympathetic nervous system on both sides of the abdomen below the diaphragm, and on others removed the sympathetic nervous system above the diaphragm. Then I succeeded in getting the cats pregnant and observed what happened to the breast development under the stimulus of pregnancy. It was a sort of novel, probably inconsequential experiment, but it was interesting to me. Amazingly the breasts did not develop where the sympathetic nervous system had been removed. I reported this in a paper which I wrote during my senior year and published in the American Journal of Physiology with documentation, both histological and physiologically.
By the time the paper got finished, I had graduated and gone into a pathology residence. The gentleman who stimulated me to finish it was named Simeone, who became a professor of surgery, in Cleveland. It was a great association!
There really was a great emphasis at Harvard on looking at mechanisms and to what's going to happen in the future, trying to find out about what's going to happen in medicine, and trying to move it forward. So that was really quite different from my experience at Stanford. But I think one must remember that at Stanford I was an undergraduate college student and at Harvard I was a medical student and it may be that the environment for medical students at Stanford was different. I don't really think so because my friends who went to Stanford Medical School, to the best of my recollection, did not have the stimulus to look forward to the dynamic aspects of biology and medicine and what would happen in terms of how you might approach such studies. Most of the people who were my college classmates who went to Stanford Medical School became rich surgeons or rich practitioners and none of my immediate colleagues at Stanford became any kind of an investigator. Some of them became professors, but again, it was classical medicine, not forward looking and dynamic approaches to medicine.
That's at least my interpretation. Other people might disagree. I don't know. It was very different, really. That continued all the way through medical school. The emphasis in the clinical years also was "look into the future. Don't just accept all these categories about this and that and the other, but question them. See if it's right. Check it out. Look at something else. See what you can find out." Again, it was very stimulating. I was blessed to have very stimulating clinical professors.
Do you want me to talk about that?
Q: Okay, I was going to ask you about your first year experience with Dr. William Murphy who was a Nobel laureate.
Ross: That was very interesting. I was a poor boy at Harvard and I learned that you could earn money by serving as a blood donor. Medical school had just opened and there was an opportunity to give blood at the Beth Israel hospital, which I did, and they were kind enough to let me watch the operation on the subject that I was to give the blood for. That also was quite stimulating, and then I gave blood and got fifty dollars for it. Fifty dollars in that time was worth much more than fifty dollars is now. The increase in the consumer price index since then find out what the inflation has been, but God, it must be the indicates that in 1986 fifty dollars was equivalent to four hundred dollars, about eight fold increase in purchasing power.
And then I became a so-called walking donor for Professor William Murphy, a professor of internal medicine at the Peter Bent Brigham Hospital. He had worked with George Minot in studying the possible treatment of pernicious anemia. This was, I think, stimulated to some extent by George Whipple, who was studying hemorrhagic anemia in dogs. I subsequently went to work at Dr. Whipple's department in Rochester, New York. In regards to Dr. Murphy: he had a whole "stable" of people with anemia up in Vermont and New Hampshire. He used to pay periodic visits to these people to give them transfusions. I think this really was just at the beginning of the liver extract era of therapy for pernicious anemia, and it had not yet really become greatly accepted. But Professor Murphy would take me along as the donor. That was wonderful. He was a very fine gentleman and very kind to me, and I'd ride with him in his car and he'd talk about his research in hematology. Then I'd give my blood and he'd take me to lunch and we'd come home. I'd get fifty dollars plus a good lunch and a nice time with Dr. Murphy.
He told me about the way that they were assessing whether or not a compound was really effective in trying to treat pernicious anemia. He pointed out one way to tell about this was to follow the reticulocyte. I believe that it was he who made the contribution of using the reticulocyte response to see if a therapeutic agent truly was effective in the treatment of pernicious anemia. He told me how if the medication or the substance being given was effective, there would be a sudden burst of reticulocytes in the patient's blood. That was very interesting. This was really the way in which Minot and Murphy were able at an early time to identify liver as the material which was effective in the treatment of pernicious anemia.
He also told me lots else about hematology and how it was a quantitative science and there weren't many areas in clinical medicine at that particular time that really were very quantitative. Clinical chemistry was just coming into being, but hematology rapidly became pretty much a quantitative, clinical discipline. So that was a great privilege and also it was very formative in my decision ultimately to become a hematologist.
Q: Could you talk more about the relationship between Murphy and Minot?
Ross: Dr. Minot, at the time that he did these studies, was at the Peter Bent Brigham Hospital as was Dr. Murphy. Dr. Murphy continued working at Peter Bent Brigham Hospital, but Dr. Minot moved to become the director of the Thorndyke Memorial Laboratory at Boston City Hospital. I believe they cooperated and worked very closely together, but actually I didn't know either of these gentlemen well enough to know just what role each played. They both had relationships to the Huntington Memorial Hospital, which was the Harvard Cancer Commission Hospital in which I later became a student house officer in my third year of medical school. Many important publications were published with the imprimature of the Huntington Hospital. I have those reprints and I esteem them very highly. But I think Minot and Murphy cooperated very well. Whether there was friction or whether they disagreed, I just don't know. It would be nice to know, but I believe they're both dead. Maybe Dr. Bill Castle, professor of medicine Emeritus at Harvard, could tell you about that. He worked for Dr. Minot subsequently at the Thorndyke, but I don't think he worked for him when he was at the Peter Bent Brigham Hospital. You might ask him about that. That would be very interesting to know.
Q: Do you know anything more about the nature of the work they were carrying out on pernicious anemia?
Ross: They were trying to evaluate compounds that I believe were given orally to see if they could induce a remission in pernicious anemia. Again, I think this work was prompted by the work of George Whipple, who showed that in hemorrhagic anemia the response of a dog to therapy varied with the substance which was given. He had evidence that it was not only the iron contained in the substance that was given, but that there was probably something else in some substance which accelerated the regeneration of blood even in hemorrhagic anemia, over and above the influence of iron. For example, one of the interesting things that he found was that dried apricots given to his dogs led to a more rapid regeneration of blood than could be accounted for just by the iron contained in the apricots. So far as I know, nobody's ever followed up on that to try to explain that, nor am I sure it's ever been corroborated. But one of the most effective agents in his dogs was liver. Of course, liver had a very high content of iron, but he also thought there was something additional to this which stimulated the formation of blood.
Interestingly, historically pernicious anemia was greatly benefited in the foothills of the Alps by giving what was called liver soup. People who had anemia all got liver soup and it helped some because of the iron, but others apparently were cured of their disease and these probably were people who had pernicious anemia. How much Minot and Murphy knew about the liver soup story in the Alps, I don't know. Ask Bill Castle about that when you talk to him. I've always been curious whether they knew about that when they were doing their studies on liver extract. Certainly the ability to determine within a week whether or not an agent was really effective was of tremendous importance because then you didn't have to give the patient the stuff for a month to be certain whether it was going to have any effect.
Q: Did Murphy and Minot work in the same departments?
Ross: They were in the same department of medicine at the Peter Bent Brigham Hospital initially. What their relative rank was, I don't know. I would imagine that Minot certainly was a professor. Murphy was a professor when I knew him. What he was at the time he was working with George Minot, I don't know.
Q: Do you know anything about the interdisciplinary approach that was taken, for example, the work that was done with Edwin Cohn in trying to identify the factor within liver?
Ross: Edwin Cohn was a very colorful gentleman. I had some contact with him. I was not aware of the fact that he was really working with Minot and Murphy, although he may well have been. When I was with him, he was interested in protein fractionation. It was in that connection that I was trying to do some studies in his department.
Q: Did you have contact with him as a medical student?
Ross: Not as a medical student. This was afterwards when I was an assistant professor, at which time I was trying to crystallize hemoglobin. He was a protein chemist and he welcomed me into his department to try to crystallize hemoglobin. This necessitated working in terribly frigid, cold rooms with warm clothing and at one point I thought actually I had gotten crystallized radioactive iron labeled hemoglobin, but I think the material was merely so cold that it was frozen. So I never succeeded in really crystallizing radio iron labeled hemoglobin. But the president of Harvard College, James Bryant Connant--when he was professor of chemistry he did crystallize hemoglobin and did tremendously important studies on hemoglobin. But I never had any contact with him when I was in medical school.
Q: In your discussions with William Murphy on the state of hematology, did he discuss it in terms of developing a budding discipline, or as an interdisciplinary approach?
Ross: I got the impression that he thought it was a special discipline all of its own. I believe that the work that Minot and Murphy did really was investigative clinical hematology. They did not, the best that I know of, work on the concentration of liver to develop of what was known as injectable liver extract. But their work certainly led to that. I think Dr. Murphy would considered himself really as a hematologist, and I believe that Dr. Minot also considered himself as such, although they were internists and very
Again, you ask Bill Castle because Bill Castle, as you know, did absolutely tremendous investigative studies isolating the so-called intrinsic and extrinsic factors. He did this with considerable self discomfiture, as he will tell you, by ingesting raw meat and then pumping it out with a stomach tube and giving the product to pernicious anemia patients. It's absolutely tremendous research!! Bill Castle certainly should have been given the Nobel prize. Why it was never awarded, I don't know. I suppose it's the fact that Minot and Murphy and Whipple had received the award in this area. I suppose that was an inhibition to awarding it to another man in the same field, but Bill Castle's work really was fundamental, actually clinical investigation of the highest possible caliber. Minot and Murphy employed an empirical approach to solve a problem. It worked! Most of medicine, still is empirical, although it's not as empirical as it used to be. It was giving a patient a substance and finding out what happened and being astute enough to tell whether it worked or didn't work. But Castle' work really was a planned and expertly executed elegant investigation.
Q: Were there any departments of hematology at this time? Is there anybody that called themselves a hematologist?
Ross: There were no departments of hematology. Hematology was part of the department of medicine. There were emphases on the study of hematologic disease, but this was part of the department of medicine. However, Dr. Minot used to give us a series of lectures at the Thorndyke Memorial Laboratory at the Boston City Hospital, usually late in the afternoon. It was a voluntary course in which he discussed various aspects of hematology. This course was pretty much unique! I don't recollect that there were similar courses in endocrinology or nephrology or anything else. So I think the emphasis was really on a developing field, which became a coherent, recognized specialty. There were no departments in hematology. I think still, as far as I know, hematology is a division of internal medicine in most cases. That's of interest because there was great opposition to the establishment of a separate society of hematology by the people who came from Thorndyke Memorial, primarily George Minot and Bill Castle. They thought it was an error to try to segregate this specialty from the general field of medicine.
Q: Dr. Tullis apparently also opposed it.
Ross: Yes, I think he did. They were not enthusiastic about this. On the other hand, there was another fine gentleman in Boston named William Dameshek. Unfortunately he's now dead. He had a traumatic end. However, Bill Dameshek was a sort of a flamboyant guy and he thought hematology ought to be a separate activity, and he worked to accomplish this. As a consequence of his interests and also the interests of Castle and several other people, there was established what was called the Blood Club. It used to meet in Atlantic City in conjunction with the Society of Clinical Investigation and the Association of American Physicians.
Q: Perhaps we could talk about that a little later on just to try to keep chronological order here.
Q: Dr. Ross, I was wondering if you could add any more about the course work and experience you had as a Harvard medical student?
Ross: It was interesting that during the first two years of medical school the lectures were complemented by the laboratory work to a very large degree. For example, in physiology, we were stimulated to have ideas about what was going on in the body. I remember we used to make these smoked Kymograph drums to record physiological events and we'd burn our fingers and get soot all over us, which was sort of annoying, but it was the encouragement that you had an idea rather than just a recording of the contraction of nictitating membrane. If there was something you could do extra, this was encouraged and it also was stimulating, and ultimately led me to study and to write and publish a paper in the American Journal of Physiology about the influence of certain drugs on the nictitating membrane of the cat when I was a tutorial student in my senior year. Those interests and those approaches really began as a freshman medical student in the laboratory course in physiology.
Q: Your laboratory course itself was taught by Cannon?
Ross: It was under the jurisdiction of Professor Cannon and there were other distinguished people who were in the laboratory, but he was around all the time. And he'd visit the laboratory when the boys were burning their fingers smoking the Kymograph drums etc. and lending encouragement and telling them he used to that himself, which made it a little bit more tolerable.
There were other distinguished people. There was a man named William Forbes, Will Forbes, who was a distinguished physiologist who was there also to help. Rosenblueth I've already mentioned, participated in laboratory instruction. Then there was a man named Hallowell Davis, who was a very distinguished physiologist, and became chairman in Philadelphia who also was there. It was a very great stimulus for medical students to work under the direction of these people who we recognized as scientists and physicians of great distinction. This was very advantageous.
Also, in anatomy, in my second year, I became what was called a prosecutor. In essence, we did the dissection for the professor to use in the demonstrations to the class. That again was conducive to scientific concern. You could look for things that you wouldn't ordinarily see in the ordinary class dissection. There was every encouragement to proceed in that direction.
My chemistry course under Professor Otto Folin was pretty classical. We didn't do anything other than what had to be done and that was hard enough to do correctly, goodness knows.
The pathology that we studied was primarily histological pathology, although we saw some autopsies. They were pretty shocking to young medical students, particularly the way that they were presented. The first one we saw was done by a very distinguished lady pathologist who I think was out to shock the boys and she was pulling out the intestines and cutting them off and she broke them. The man had been dead in the refrigerator for a month and the intestinal contents sprayed all over the medical students and a couple of them got very ill. That was quite a lesson! Subsequently, I became a pathologist for a while. I never wanted to do anything like that. That was a good learning experience. However our instruction was just classical pathology at that point. It did stimulate a lot of interest in pathology and the morphological aspects of disease.
You asked something about the balance between lectures and laboratory work. I say that the major emphasis really was on the lecture aspects of our courses, although the laboratory work certainly was emphasized, too. But the amount of time that we dedicated really to laboratory work at that point was not the equivalent to what was dedicated to lecture courses. But in my first year in medical school, there was a tutorial group in physiology in which various things were discussed at an advanced level in an informal seminar type of procedure with Professor Cannon, Professor Bard. Professor Bard was a man who was chiefly responsible for the seminar activity. As I remember it, there were only eight or ten students involved in this. How they selected them I have no idea, but this certainly was very stimulating to advanced thought. I remember that one of the students subsequently became a quite distinguished molecular geneticist in the seminar. He was talking about the things that determine the function of organisms on a hormonal basis. I cannot remember his name, unfortunately. I think he left our class and went to some other school where he continued his work. Rut that type of discussion also stimulated people to think, to look forward, to look at other approaches and how we might do something more than just accept the rote learning which many schools at that time prescribed.
We had rote learning, too. We had a course in physical diagnosis. I remember this was taught by Professor Henry Jackson, Jr., who also was a very colorful character. It was a very interesting course. I remember I made outlines of what he had told us about physical symptoms, etc., etc., and put them on the back of my closet door and memorized them in the morning when I was getting ready to go to work. That also was a part of learning which I think was really quite valuable. Henry Jackson, Jr., his primary interest was in the white cell, not the red cell, and he and Professor of Pathology Henry Parker, Jr., became very distinguished for laying the foundations for the classification of the lymphomatous diseases by relating the clinical symptomatology to the anatomical findings. This classification was advanced by a gentleman named Gall, who worked at the Massachusetts General Hospital, but almost simultaneously Parker and Jackson developed this classification at the Boston City Hospital [an affiliate of Harvard].
Q: How do you spell Gall?
Ross: G-A-L-L. He subsequently became dean and Vice Chancellor at the University of Cincinnati's School of Medicine. He was a pathologist who worked at the Massachusetts General and I think he had the first publication attempting to make a classification of lymphomatous diseases. Except for Hodgkins' disease, they have been considered pretty much all similar when they're really vastly different. Rut, again, this impact of knowing that people were advancing the field of knowledge and not just being satisfied to learn what had gone on in the past was a very beneficial stimulus to medical students.
Q: The tutorial system itself was apparently established first by Lawrence J. Henderson? Did you have any dealings with--
Ross: Lawrence J. Henderson is extremely distinguished. He, when I was there, was working primarily at Harvard College, across the river at Cambridge. He gave tremendously elegant lectures. I heard just one of them which was wonderful. Also there was a gentleman named Alfred Whitehead who gave his final lecture at Harvard, when I was a student, I went to hear that! That also was tremendously stimulating. But I confess I couldn't really understand some of the things he was talking about. He was far too advanced intellectually and philosophically for me to completely grasp what it was he was talking about.
But the tutorial system existed at Harvard Medical School and I was privileged to participate in this as a freshman medical student and then again as a fourth year medical student, I opted to take four months as a tutorial student in the physiology department. I think there were at least two others in my class that also did this. That was tremendously stimulating to thought and to trying to advance knowledge by learning new things. That had existed before I went to Harvard, for how long I don't know, and whether Professor Henderson had a hand in establishing that or not, I do not know. It was emphasized primarily by the physiologists, although the biochemists also had a similar program, and I don't know whether microbiology and pathology had that or not. I wouldn't be surprised, but I cannot remember that.
Q: Apparently David Edsall, who's headed Harvard Medical School had wanted to establish a tutorial in biochemistry.
Ross: Dr. Edsall was the dean of the medical school when I was there. He had two sons, Geoffrey and John. They both became extremely distinguished physicians. One in the field of immunology and the other in physical chemistry. They both were splendid gentlemen. I had the very unfortunate experience of providing medical care to former Dean Edsall at the time he died. He had a neoplastic disease and developed torula meningitis for which there was no curative agent at that time. He expired. It was a very, very sad experience having known him as a dean and then seeing him pass away. There wasn't anything that could be done except take care of him. Nothing seemed to help him much.
Q: Were you aware of the various attempts of reforming the different disciplines in the medical school at that time under Dean Edsall?
Ross: Not really. Medical education undergoes an attempt at revolution at least once every ten years and usually it ends up about the same as it was before with a different name. No, I did not know about Edsall's attempts to modify this except that the whole tutorial system was extremely valuable and if he initiated that, why, God bless him some more!! I didn't know that. The tutorial system was very fruitful, and other people did tutorials in other areas. I was fortunate, I believe, in doing mine in physiology which eventuated in two publications as a medical student, which is not too bad. They both were based on experimental approaches rather than a review of literature, etc., etc. That was really very stimulating and every encouragement was given me to do that.
Q: Is there a reason why you chose physiology as opposed to perhaps biochemistry or some other field?
Ross: I confess that dealing with the organism as a whole and the Various things that it was doing were more attractive to me than dealing with test tubes, flasks, and bottles. I suppose that was probably the reason. Again, I would say that Professor Folin was a categorist whereas Professor Cannon's department was more dynamic and interested in the kinetics of life. They were just completely different. Professor Cannon's approach appealed to me more than did Professor Folin's.
Q: There was apparently some friction between Folin and Cannon over the question of establishing these different disciplines. Did you ever pick up on that?
Ross: That I didn't know about. Thank God, I didn't. There was enough dissension in the world without thinking about things that your respected professors were fighting about. Let them fight but don't tell the medical students about it. They never told us about it. I'm glad they didn't.
Q: This goes back a number of years, before you'd been there also. It dealt with the question, once again, if there's to be a program in biochemistry coming out of physiology or clinical biochemistry, who should have control over it.
Ross: Really? I didn't know that. Did Cannon want to control it?
Q: Cannon was friends with L.J. Henderson, who had ideas for developing it as a physical chemistry.
Ross: I see. I didn't know that.
Q: Folin was more, as you're saying, into the categorical approach.
Ross: That's very interesting. That sort of bears out what I was thinking but I hadn't known the facts.
Q: Is there anything more you'd like to add on the course work that you've gone through at this point?
Ross: I would say that we had magnificent texts. For physical diagnosis, there was a text called Norris and Landis, which has never been equaled. That would describe and illustrate in diagrams the physical findings that one would find and document it with cross sections of the body from the patient who had actually had those diseases. Again, this was structural and formal but to me it made realistic what it meant when you detected dullness in a certain area of the chest you could see a section of the lung that showed where the dullness was and what cause it and what it looked like. That was just wonderful. Gray's Anatomy was complemented by a handbook of anatomy by Professor Robert Montraville Green, who was our primary lecturer in anatomy. It had beautiful illustrations of anatomical structures and that was extremely valuable and complemented the dissections we were doing. The physiology text was pretty standard, by the Englishman Starling. It was a good text but nothing particularly striking. In pathology, we had a wonderful textbook written by a Canadian named Phillip Boyd. He had insomnia and he wrote his textbooks in the middle of the night when he couldn't sleep. He was an exquisite writer who had a style that attracted the attention of students. All the texts that we had were really valuable and I'm very appreciative of them!
Q: In 1936, you became Student House Officer at Huntington Memorial Hospital. I was wondering if you could describe--
Ross: No, I became Student House Officer at the Huntington Memorial Hospital in my junior year of medical school. I graduated from medical school in the class of 1936. So in 1934-35 I was the Student House Officer in the Harvard Cancer Commission's Hospital called the Huntington Memorial. Incidentally, it was endowed and named for the same Huntington who established the museum, library and hospital over in Pasadena, California. He contributed the money that made the hospital and laboratory possible.
The house officership at the Huntington Hospital at Harvard was a tremendous experience and it really changed my life remarkably, because up to that point in my education I really had been, I would say, a bookish person who learned from his lectures, text books, and laboratory instruction, but as a Student House Officer at the Huntington hospital, another third medical student and I were the only medical people in residence there at any time. There were about twenty to thirty beds. All the patients had cancer and the other student and I were "holding the fort" with the nurses. I remember I started work there on July the first, 1934, and on July fourth one of the patients who had had a radical electrocautery dissection of the tongue and cheek for cancer of the mouth "sprung a leak" at 2:00 a.m. He just bled like nothing I have seen before or afterwards. All over the place. All over me, the nurses, the floor, the roof and everything. I couldn't stop it. So I called a gentleman named Professor Charles Lund, who'd done the operation. He came in and ligated the carotid artery. I had never known that you could do that. But that is a sample of the type of serious illness that was hospitalized in the Huntingdon. The staffs of the hospital were all professors of surgery or medicine at Harvard and they encouraged the student house officers to assist at the operations. You're pretty young as a junior medical student to start assisting at a radical mastectomy, radical neck dissections, hysterectomies etc., etc. As a consequence of this "golden opportunity" to "practical" management of patients I didn't go to any more lectures. I stayed in the hospital and worked there rather than doing what I probably should have been doing and going to the lectures, but I didn't. I began dealing with actual, clinical medicine at a very practical level while I was still medical student, presumably still learning things from books and lectures. However, the instruction and supervision at the Huntington was superb!
To some extent, this experience may have been deleterious since I spent so much time at the Huntington rather than doing some of the things that medical students were supposed to do. I think the experience at the Huntington changed the course of my life from becoming what you might call a fundamental, scientific investigator to becoming a more or less clinical doctor trying to apply scientific methods to clinical medicine.
As part of my job at the Huntingdon, I was responsible for calibrating all the radon and the radium that was used for cancer therapy at Harvard Medical School. I was provided with great big, thick, heavy lead gloves and aprons for protection as I handled the radioactive material to calibrate it in an electrometer. But in the morning when it was early and I had something else to do, sometimes I didn't use the lead gloves. I got enough radiation exposure to the dorsum of my hands to cause skin carcinomas which have to be resected from time to time. I've got one right there now that's got to be taken off. That was also the beginning of the radiation exposure that lead to the development of radiation cataracts. I was exposed to much additional ionizing radiation over the subsequent years, but that's when and where the exposure began, and I think that's where the cancers of the skin of my hands began.
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.
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 elaborate
[end of side one, tape two; beginning side two]
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!!
Q: During this period, what were the sources of funds for both research, the clinical services, as well as traineeships?
Ross: There were no funds from the federal government at that time. The Thorndike, I think, supported its people with a private grant that had come with the establishment of the laboratory, and other grants from the pharmaceutical industry for the development of liver extract for the treatment of pernicious anemia. I think it was from Eli Lilly Company. The staff at the Thorndike Laboratory tested liver extract to insure its efficacy, and were provided some funding. Max Finland got support from the Lederle Laboratories and other agencies interested in the development of chemotherapeutic and antibiotic agents. Chester Keefer--I don't know where he got his support. It might have been that Dr. Minot paid his support from the funds of the Thorndike endowment. At the Evans Memorial, Dr. Keefer had funds to provide all the support for his staff. When the war came along the government became interested in funding research, and research grants became quite common. There was never any pressure to obtain grants brought by Chester Keefer, but most of us at the Evans felt it desirable to obtain a federal grant to support our research. My primary research support came from the National Science Research Development [NSRD] during World War II. After the war I received support from the NIH and the AEC. I don't know what's happened to the Evans' funds, I imagine they're still supporting research there in addition to establishing the laboratory at Boston University. The Robert Dawson Evans fortune also endowed the whole Evans Memorial wing of the Boston Museum of Fine Arts--the one that fronts on the muddy river.
Q: You had an eighteen and a half month internship at the Thorndike also?
Ross: My internship was served on the second Medical Service at the BCH, which was on of the two Harvard clinical services there. The Thorndike Laboratory was the Harvard research institute at the Boston City Hospital whose staff had surveillancy over the two clinical services. The visiting physicians on the clinical services were all Harvard professors some on the Thorndike staff and some on the Harvard clinical faculty. It was a wonderful system. On one day we would have a visiting physician who was a full-time academic at the Thorndike. The next day there'd be an excellent clinical professor from the community who'd make rounds on the same patients. This provided a wonderful opportunity to see the different ways in which these different kinds of physicians confronted the clinical problems that they were encountering. A very, very excellent system that I don't believe exists anymore.
Q: Did you carry out research at the time, while you were at the Thorndike?
Ross: I was in the second medical service. I was not a resident at the Thorndike. I was on the clinical service. No I did not. I had all I could do to provide medical care to the eighty patients on the service. Maybe I wasn't smart enough or vigorous enough to do any more than take care of the patients. That was a pretty full job.
Q: Seminars during that period also?
Ross: There were continuing seminars of all types at all times. We had excellent rounding physicians, there were clinical pathological conferences that we participated in. There were conferences on every subject that you could imagine, hemanologic conferences, infectious disease conferences, cardiovascular conferences, social service conferences. They kept life very full.
Q: You mentioned before during this period, that there was the introduction of sulphamid-
Ross: Yes. I was an intern on the second medical service when the drug "MB 67" [or something like that name] first was used. This was one of the first sulphanilamides used clinically and was obtained from England. The drug did absolutely magical things to people who had infections! We'd give them these little white pills and the disease would go away! I was working for Chester Reefer at the Evans when penicillin came in. During World War II there was a great limitation on the amounts of penicillin available and that was available was pre-empted by the military for the treatment of gonorrhea and syphilis. The military set up special clinics at the Mass. Memorial Hospital where Chester Keefer was the Chief just to treat people with syphilis! There were people in this country that believed that to do this was immoral. Here you were treating a disease--a social disease acquired by illegal "immoral" activity, and they believed it was too damn bad to use the medication to treat syphilis rather than to use it in taking care of some nice lady who had some other condition. At that time Dr. Keefer had six teletype machines installed at the Evans that were in continuous absolutely a thunderous communication from all the people seeking to get penicillin for other purposes. On one occasion some of the material was freed up by the military and used to treat a case of sub-acute bacterial endocarditis in an important patient. The disease was cured. It was absolutely amazing! It was the first time, as far as I know, that this disease had ever been cured! And the consequence of that--this got in the papers both medical publications and the lay press. The pressure to grow penicillin was even greater! There was a great stimulus to increase the production of penicillin and this was done. But Chester Keefer was responsible for a long time for allocating all the supplies of penicillin that became available in the United States. He did a very good job! He was a judicious gentleman and when a patient needed it as an absolute necessity he made the material available.
Q: Following you stay in Boston you made your way to Rochester to work with George Whipple.
Ross: I completed my internship on the Harvard Medical Service at the BCH, and I was still enamored with pathology. I knew that George Whipple had been one of the Nobel laureates in hematology, and in the meanwhile my mother had died of agranulocytic angina, a disease caused by the failure to form leukocytes and consequently the patient develops terrible and usually fatal infections. Incidentally, Dr. Jackson and Dr. Parker recognized that this disease was related to the use of a certain drug called pyramidon, a drug used to alleviate pain and suffering. This also was discovered at about the same time by a hematologist named Kracke, who was a professor at the University of Alabama. This was appropriately published in the medical literature but the doctor taking care of my mother in Covina, California didn't know about this. He spent all his time taking care of the sick. He gave my mother pyramidon for a broken leg every day for a month and wiped out her bone marrow and she died as a consequence. This was really quite hurtful and then again, made me want to go and continue a more intensive approach to the field of hematology. So I went to Rochester and worked for Dr. Whipple for a little over a year. While I was there I became enamored of the use of radioactive iron to study blood formation and worked there with a very fine biochemist Dr. Paul Hahn. We did lots of work in terms of the rates of hemoglobin formation in different circumstances and what factors would change the rate of hemoglobin production. While I was there I was also privileged to work with another biochemist Dr. Leon Miller. In this work we were interested in the toxic effects on the liver of toxins such as chloroform. It's of interest that if you starve a dog from the standpoint of protein nutrition and deplete his protein stores, a half an hour of chloroform anesthesia, would destroy the liver and he would die. We observed that if you fed the dog a pound of hamburger an hour before we gave him the anesthesia he survived. Then we showed that giving the dog methionine and sulphur containing amino acid in place of the hamburger the dog also survived the chloroform anesthetic. The dog didn't even get sick! This was a very fascinating field! One of my major jobs in this research was making up the protein free diets for the dogs, giving them anesthesia, administering the methionine and so forth. That was a very stimulating experience!
Dr. Whipple was on the board of trustees of the Rockefeller Foundation which funded the initial construction of the cyclotron at the University of California, Berkeley by E.0. Lawrence. He was a wise man who said, "Look, if you're going to make this instrument, how about making me some radioactive iron so that I can start an investigation of iron metabolism." So the first radioactive iron from the Berkeley cyclotron went to Dr. Whipple and Dr. Hahn, with whom I was studying the formation of hemoglobin. The radioactive iron was in such terribly short supply that we used to collect the feces of the dogs and recover the radioactive iron from the feces and use it again for experiments. I had a very menial task there. I didn't do the collection of feces, but took the collected feces and digested them chemically in a Kjeldah flask and then extracted the iron from the digestate with ether and alcohol. A terrible job!
Q: At this time were you aware of the work of Rudolph Schoenheimer and David Rittenberg at Columbia, using radio isotopes for labeling?
Ross: Yes, I was. They published a very fine book and one of them an expert--was it Schoenheimer or Rittenberg? I can't remember which who was that was interested in the porphyrins, a fascinating subject! They were among the first who were able effectively to use isotopic tracers to study the metabolism of these materials.
Q: Was also work being done in Baird Hastings labs at that time?
Ross: I don't know. They probably were using isotopic tracers but I wasn't aware of what they were doing. When I returned to Boston I was named a Welch fellow by the National Research Council. I held my Welch fellowship while I was an associate professor of medicine at Boston University School of Medicine as a research fellow in Baird Hastings department. I cannot remember whether or not isotopic tracer work was conducted in Dr. Hastings' department.
Q: Could you comment about George Whipple himself?
Ross: George Whipple was a wonderful old man. He was a sort of an elderly fellow when I was there. He wore half moon glasses so he would read through the glasses but did not need refraction in the upper part. He had trouble hearing, so these half moon glasses would sit on the end of his nose as he wandered around the laboratory. He was the Dean of the University of Rochester School of Medicine and he hated dirt! He had the corners of all the stairwells painted white so if there was any dirt in the corners he could see it. And then he'd make the janitors clean it up immediately! He walked around the hospital and the medical school--and if found any dirt he'd put in an emergency call to clean it up right then. He ran a very good department of pathology. His pathology activity, in terms of instruction, really was quite old fashioned. He used to have teaching sessions every week of collected anatomical specimens from autopsies that were of particular interest. He would stand up and demonstrate and talk about these. The bad aspect of this was that we did many autopsies at the County Tuberculosis Sanitarium. We were instructed to bring back slices of these T.B. lungs, kidneys, etc. I shudder to think of it, but students used to pick them up and squeeze them and look at them close to their faces and inhale the bugs!! Interestingly a very high percentage of the residents in pathology and also the faculty came down with tuberculosis. I'm sure it was acquired as a consequence of this exposure. I remember I did three autopsies at the T.B. Sanitarium one day and came back to the path department and had speckles of dried material all over my glasses. I scraped these specks off and did a tuberculosis stain. They were just loaded with tubercle bacilli!! I'd had tuberculosis as a child and conceivably that might have given me a little immunity to the disease, and I didn't catch it again, thank God! Dr. Whipple was a great fisherman. He used to take a month off every year and go up to Nova Scotia to fish for salmon. He also was an avid hunter. He'd go and shoot birds. Even up into his eighties he still could see well enough to hit a partridge on the wing. He was an experimentalist of profound astuteness. If you did an experiment in which one or two dogs that didn't come out the same way as the others, he'd always explain it by saying, "Well, some dogs can run farther and faster than other dogs." That was the explanation for the aberrancies that occurred in the experiments that he did. He made great contributions in terms of protein nutrition, the mechanisms of anemia, the regeneration of blood. He kept a special breed of dog that he used for his work. They were the ugliest looking mutts you ever saw! They were a cross between an English bull dog and something else, I don't know what. They had those pink rimmed eyelids, blue eyes, and white skin. Dr. Whipple had a whole animal house built to house these creatures. They were used very gently and humanely for the conduct of his experiments. Most of his experiments were related to rates of regeneration of protein and hemoglobin. He was a very stimulating and interesting man. He at one time was a professional baseball player. He debated whether he should become a continuing professional ball player or go to medical school, and of course he made the decision to go to medical school. He worked at the University of California Medical School in San Francisco at one time where he was the director of the Hooper Foundation, a well endowed research institution. As I recollect it, he became dean at [?] Medical School in San Francisco for a while and then was appointed dean to establish the new medical school at the University of Rochester, which was heavily subsidized by the Rockefeller Foundation. At one time during his career, he worked as a pathologist in the Canal Zone. He described certain tropical diseases and the consequences of these diseases. He was a very benign fellow, and used to entertain us at his home. He was a very great influence on those privileged to be associated with him!!
Q: In the conjuncture between Whipple's work in research and his role as Dean of the medical school, do you think he imparted a different path to development of biomedical sciences at Rochester as compared to what, maybe, was done at Harvard?
Ross: I think so. He selected all of the senior faculty and his faculty was uniquely concerned with fundamental experimental research at a laboratory level, not only in pathology but also in medicine, pediatrics, anatomy, physiology and chemistry. Dr. John R. Merlin, one of the professors working there probably had the explanation of diabetes and its relationship to insulin almost simultaneously with Banning and Best, but he hadn't published his results. This poor fellow was embittered the rest of his life because Banning and Best had beaten him out for recognition as the discoverers of insulin, when he'd actually had it first!
Dr. Whipple placed great emphasis on investigative endeavor and this lent a tremendous flavor to the whole institution. The University of Rochester medical school started with this emphasis, while Harvard started one hundred fifty years before basic research existed and when research was clinical observation and therapy. The impact of basic research came at a later date and was grafted on clinical research. Dr. Whipple started a school in which the emphasis was on fundamental research and clinical research followed.
Q: Whipple being a co-recipient of the Nobel Prize along with Minot and Murphy. Did they maintain contacts of any sort?
Ross: I don't really know. I don't think so. I don't think they had a very close relationship. I seldom heard them talk about each other. I just don't know about that.
Q: Did you decide more in favor of hematology while you were working under Whipple?
Ross: Yes. I would say that, although I had a very great interest in hematology as a consequence of my experience at Harvard. Some of the most exciting lecturers at Harvard were the people that talked about hematologic subjects. That gave me great interest and working in pathology stimulated and solidified this interest. Joining Dr. Whipple's group made it even more certain, and I decided that I would really like to be a hematologist, at that point and I continued in that specialty since. I would say that my idea of becoming a clinical hematologist was probably formulated when I was in Dr. Whipple's department. Then when I was appointed by Dr. Keefer I was head of the division of hematology. I expanded the clinical activities, and continued using radioactive tracers to study the kinetics of blood formation and destruction and used radioactive iron as a labeling tool to study the preservation of red blood cells during World War II. This was a fruitful endeavor. Using erythrocytes labeled with radioactive iron, I stored them under different circumstances and with different preservative solutions, and then transfused them into subjects to observe how long they survived in the recipients' circulating blood. This ultimately eventuated in the development of preservatives that were effective in maintaining erythrocyte viability for about three weeks. With slight modifications these preservatives are still used in blood banks all over the world. A few more items have been added to the solution and it now preserves satisfactory viability for four weeks. I'd rather transfuse fresher blood but stored blood is widely used at this time.
Q: We'll come back to that in a short while. Could you comment some about Paul Hahn?
Ross: Paul Hahn was really a wonderful gentleman! He came from a Rochester German family. His father had been responsible for developing the Crossman air rifle. I don't know if you knew anything about that or not. It was not an ordinary B.B. gun. It was an air rifle that propelled a pellet that was strong enough to kill a deer, and a man, and it was an analog of the rifles used by the Japanese in World War II. They were light. They were, in essence, almost noiseless. They were impelled by a charge of carbon dioxide gas in a tank or they could be pumped up by hand. His family had considerable financial resources and Paul had a large number of brothers and sisters. I think there were six or eight. Paul was interested in chemistry and after he got through college, he worked for Dr. Whipple. He wanted to go to medical school but Dr. Whipple told him it wasn't necessary, not necessary at all. He was a good biochemist and he should work in the field of biochemistry for George Whipple, which Paul Hahn did to his everlasting discomfiture, sadness, and sorrow, and ultimately to his death. He wanted to do clinical research on patients. Since he was not a physician, presumably he was not competent to do this, and he became a very unhappy man. So he went to Vanderbilt University where he pursued chemical studies using radioactive tracers. He had trouble there because he wanted to do experiments on humans, so he moved to Meharry Medical College where he carried out observations on humans. He never got in trouble for this. He was interested in trying to develop therapeutic applications of radioactive materials. He had various kinds of particular radioactive materials which he coated with gold which would stay where they were put in the lung. He had some effectiveness in treating people with carcinoma of the lung with this material. He was never really able to step out and become a clinical investigator. Although the work that he did was innovative and imaginative and potentially very fruitful, he could not use it clinically which is what he wanted to do. Consequently, he became a substance abuser for material known as whiskey and he drank large quantities of this material. He developed diabetes and ultimately expired as a consequence of alcoholism and diabetes which is heartbreaking! He had six children. He was such a bright and nice guy that it's too bad he had to do this and that he died as a consequence. He was very innovative, imaginative, a very good investigator, and a wonderful preceptor for me! I spent about a year and a half working with him. This again, was a great opportunity!!
Q: It seems that many of the personalities that we've discussed, even those that went in to do fundamental research actually began as M.D.s. You have Cannon, you have various other people that we talked about here. We have Whipple. Of course, Murphy, Minot. Was there a change that was going on at that time where people would leave medical practice to go into research, or did they seek a balance between these areas?
Ross: I don't think so. I think the individuals that you've mentioned and that I've mentioned became medical investigators as their role in academic medicine. I don't know, personally, of any people at that time who had been in practice, who abandoned practice to come back to do fundamental or even clinical research. Some of the professors that I had at Harvard were competent enough to write clinical papers analyzing four hundred cases of this or that or the other, which was a definite contribution, but this was distinctly a by-line to their practice. The people that I had contact with, primarily, had gone into investigative medicine as a continuum of their medical education. At that time, such occupation paid very poorly. At one time I as told by Soma Weiss that the most one could ever expect to make as a clinical investigator was about five thousand dollars a year. Of course, that was a long time ago. That might be worth about twenty five thousand in 1986 dollars, but some people get paid more than that and some don't, even to this day. These were people who were dedicated to trying to advance knowledge at the fundamental level and it was a fascinating opportunity because there were lots of things that hadn't been discovered then. If you were diligent you could find things and make contributions. Most of the people that I had contact with were clinicians. I mentioned Paul Hahn who was a Ph.D. biochemist. There was another gentleman at the Thorndike named Laskey Taylor. He was involved in the evaluation of different kinds of proteins. He was a Ph.D. He had the same problems as Paul Hahn. He wanted to do clinical research and he couldn't. He became an alcoholic which was a terrible tragedy. I think he died inadvertently at a relatively early age. However, not all the people that I know that are alcoholics are Ph.D.s! I also have very good M.D. clinical friends who are alcoholics as well. One of my best friends was a gentleman who studied blood volumes. He made great contributions! He had the misfortune to have two children who were criminally insane which drove him to drink. They were in an asylum outside of Boston and he'd have to booze up for a week before he went to see them, and it'd take him a week to taper off after he'd seen them. He was an innovative, very brilliant, wonderful man. His name was John G. Gibson III. He was a professor of medicine at the Peter Brigham Hospital who made his primary mark in studying blood volumes with dyes in disease states. He was an influence on my life, because I was studying blood volumes with radioisotopes.
Q: Are you aware of other groups that were beginning to use radioisotopes during this period? The Columbia group. The Rochester group.
Ross: The Columbia group, the Rochester group, and than there was also a group in Berkeley. They were using it therapeutically, and diagnostically. There was a man there named Low Beer who was I think a Viennese, who used radioactive phosphorous in the therapy of leukemia. He and Dr. John Lawrence used this agent.
Q: Do you know how to spell Low Beer's name?
Ross: L-0-W capital B-E-E-R. It's two words. Both the L and the R are capitalized. He probably got too much radiation exposure and he died of leukemia as a consequence of this. Also in San Francisco there was Mayo Soley who was investigating the use of radioactive iodine in the treatment of hyperthyroidism. He was a very nice guy! He went to the University of Iowa to become Dean. He [committed] suicide on a hillside with a rifle one sunny afternoon in autumn, which was, again, a terrible loss.
Q: Schoenheimer, himself, committed suicide also.
Ross: I did not know that. Did he really?
Q: Shortly after he won the Nobel Prize.
Ross: That seems so terrible, doesn't it?
Ross: Why did he commit suicide?
Q: He became almost reclusive, I understand, from comments by David Rittenberg and others. Nobody knows. There's no clear motive.
Ross: I've had several friends commit suicide. It's always terribly distressing! I always wonder why bright people who could have made so much more of a contribution and lived such a wonderful life could be so dumb! I knew a physician named Saul Hertz, in Boston, who used radioiodine on the East Coast. He was a nice man and very effective investigator. He [committed] suicide. His co-equal radioiodine investigator Mayo Soley on the West Coast [committed] suicide. So, suicide was not unique. It occurred in San Francisco, Iowa City, Boston, in Rochester, and New York.
Also Carl Moore, in St. Louis, began to use radioiron as a tracer. It was rapidly being recognized that radioactive tracers were an effective way to studying the physiology and the dynamics of biological processes.
Q: Do you know if the Rockefeller Foundation was behind the promotion of use of radio isotopes?
Ross: So far as I know, only in as much that they made isotopes available through the funding of the cyclotron in Berkeley initially, and they supported George Whipple's activities in Rochester, but I do not know that they specifically went out to enhance the use of these tracer materials. That's as far as I know.
Q: Could you comment some more about the research that you did in your period under Whipple in Rochester?
Ross: Yes, we were interested, as I say, in the rates of formation of hemoglobin and these studies were done on dogs that were made anemic by repeated phlebotomy and then we studied the rate at which they could regenerate blood under different circumstances and with different dietary supplements. For example, if a the dog was profoundly depleted of protein, he couldn't regenerate hemoglobin even if he had an adequate amount of iron and if he had plenty of protein but no iron he couldn't regenerate blood either. Studies were also made of the effect of certain types of amino acids in stimulating blood formation. All these studies were made on animals. In Dr. Whipple's laboratory no work was done on human beings, and when I came to Boston I began using radioactive iron in studies in humans of rates of hemoglobin synthesis, blood formation, and also in the preservation of red blood cells. I've already mentioned that labeled my own blood with radioactive iron. We'd bleed this out and store it with different preservatives for varying periods of time and transfuse these, my radioiron labeled erythrocytes into people and find out how long the cells lived. I developed a hemorrhagic anemia myself as a consequence of this work. The major product of my hemorrhagic anemia was that it made me unduly susceptible to the effects of alcoholic beverages. On one or two occasions a couple of drinks put me under, which is regrettable but I never really got hurt as a consequence. What was the question you asked?
Q: I was asking more about the research that you undertook at Rochester.
Ross: Oh. I told you about the work done with Leon Miller in terms of the protective effect of the protein and methionine in toxic hepatic disease. Subsequently, this was found to also have some beneficial effect in human beings who had various types of infectious, as well as toxic, hepatitis. For example, we saw some patients who were alcoholics who had knocked off the wall a carbon tetrachloride fire prevention suppresser device and developed toxic poisoned with carbon tetrachloride poisoning and hepatitis who when given methionine were greatly benefited and survived. It's not really as effective in patients who have infectious types of liver disease, although it does benefit them. So my work there was primarily tracer studies with Paul Hahn in terms of the kinetics of hemoglobin formation and the studies with Leon Miller of the protective effects of protein and methionine on toxic hepatitis. I also performed one hundred autopsies, and did surgical pathology in Rochester. Right now that's about all I can remember.
[recorder turned off and on]
Q: Doctor Ross, could you please comment about some of your activities in the clinical services dealing with hematology?
Ross: As I have stated, during the time I was working in Rochester I also had active involvement in the autopsy work of the institution. While I was there, there was a series of six patients who died of mismatched transfusions, which produces a hemolytic process with release of hemoglobin into the blood stream. This hemoglobinemia then blocks kidney function. This stimulated a great concern in regard to this subject. I did a great deal of work on this and recognized that the hemolytic processes that occurred as a consequence of mismatched blood transfusions eventuated in kidney failure. Also while I was there, I began to realize that people who were subjected to transurethral prostatectomy also developed hemogloginemia and hemoglobinuria the usual irrigating fluid that was used to fill up the bladder was water. Interestingly, there was a reflux of water from the bladder into the venous system with the production of acute hemoglobin release into the blood stream and renal failure. This bore a relationship to the field of hematology since hemolysis was caused by the introduction of water into the bloodstream. I think these observations were facilitated at Rochester because the clinical and laboratory services were in one building. The medical school, the pathology laboratories and autopsy room were only a few steps from the clinical areas where the patients were experiencing their problems. This was really more effective than the situation at Harvard where the great hospitals were physically separated from the basic fundamental laboratories. It wasn't quite so easy at Harvard fundamental research with the clinical activities that were going on in the hospitals. Although each of these great hospitals have their pathology laboratories, I think that the correlation of the clinical and the pathological observations was probably greater in Rochester when I was there than at Harvard, or as I subsequently experienced it at Boston University.
[end side two of cassette two; beginning side one of cassette three]
Q: Dr. Ross, in 1940, you moved back to Boston, and assumed a position at Boston University as Assistant Professor of Medicine and Head of the Division of Hematology. I was wondering if you could comment on this move.
Ross: Yes. When I was in Dr. Whipple's department at Rochester, I considered going into pathology; he offered me a job, but I decided I'd rather work with living rather than dead patients. At that time, Dr. Chester Kieffer, who had been at the BCH Thorndike Memorial Laboratory and professor of medicine at Harvard University, moved to Boston University medical school, which was across the street from the BCF and Thorndike, and became the Chairman of the Department of Medicine at Boston University. He recruited a number of young physicians. He was in the process, really, of revising not only the Department of Medicine but the whole school, which had been a homeopathic institution. Dr. Reginald Fitz anteceded Dr. Keefer at B.U. and started the change--from a homeopathic to an allopathic medical school--but Chester Keefer vigorously made it even more effective. He subsequently was effective in recruiting new professors of surgery, and of other departments and a new dean, Dr. James Faulkner. He brought a group of physicians at University medical school and salaried them with funds provided by the Robert Dawson Evans Memorial Fund which must have had a very sizable endowment. And all of financial support was paid from this endowment, of which Dr. Keefer was the director. I think he had some questions as to how he was to use these monies. We were housed in a quite old building, and it was very crowded, but we were very productive and had a very good time! He provided all of us with a laboratory, an office, a secretary, and technicians. I went there and began to use radioactive materials to investigate red cell kinetics, to treat leukemia, polycythemia with P32 and thyroid disease with 1131. At that time, there was no central supply of radioactive materials, so I made an arrangement with Harvard University, Dr. Kenneth Bainbridge, professor of physics to obtain radioactive materials from the Harvard cyclotron. I was provided with the cyclotron targets which were iron phosphide soldered on a copper block. It was my job to take these targets, dissolve them in aqua reglo, and ultimately to separate the iron, phosphorus and copper and other materials from the solution. As we received these from the Harvard cyclotron they were quite intensely radioactive, and the major part of the radioactivity was in the copper target to which the iron phosphide had been soldered. We really didn't have adequate facilities for processing this highly radioactive material. The technicians wouldn't come near it, so I was responsible for performing the chemical procedures for separating the various constituents. I wanted to use the radioiron. Dr. Shields Warren at the New England Deaconess wanted to use the radiophosphorus, which, by that time, was in the form of sodium phosphate, for treatment of various diseases. I also used some of the sodium phosphate for treatment of leukemia polycythemia rubro vero and other diseases. I used the radioiron for research work. It's of interest that the Harvard cyclotron didn't have very good safety regulations. When the individuals who ran the cyclotron would take out the targets and the parts of the cyclotron which were called, "dees," they would get a sunburn of their faces, from the intense radiation to which they were exposed. And I did some blood studies on a couple of these fellows and they had marked aberrations of their leukocytes, and I've never known what finally happened to those poor fellows; I sure wish I could track them down, sometime, maybe, I can. But they didn't have adequate protection, and the people in my laboratory including me didn't have adequate protection. Dr. Franz Ingelfinger who shared my lab had a technician who was a lady not in her greatest youth, who had a period of amenorrhea. She knew there was radioactivity there, and she got very disturbed, and went to Dr. Keefer complaining about the fact that this radioactive material was giving her amenorrhea. But then, in due course, it appeared that she was pregnant, and her amenorrhea was not occasioned by the ionizing radiation. This was sort of a catastrophe to this poor lady: she was not married, and she was not terribly young, and she resigned from her position. I never knew, really, what finally happened to her, but the ionizing radiation didn't cause her amenorrhea. The--
Q: When did--excuse me--when did discussion come up about the safety hazards due to radioactive isotopes?
Ross: There wasn't very much discussion of this. It had been recognized that X-ray caused health troubles, and there were attempts to control the use of X-ray, particularly fluoroscopy, because, when I was there, people were getting terribly burned from fluoroscopic procedures, particularly orthopedists. A young orthopedist who was setting bones under a fluoroscope got so badly burned that he had to have his hand cut off! Very tragic!! But the concern about the radioactive isotopes, radium, and radon was really not very great, which was unfortunate. The exposure which I received as a medical student calibrating radon and radium was supplemented by the exposure I got processing the cyclotron targets, and using radioactive materials. The radioactive material was hard to come by, although it was not terribly expensive, since Harvard gave it to me for free, as a gesture of good will. But we tried to recover the material by chemical processing of the stools that patients passed to recover the iron and use it again. And this, I think, produced a significant exposure. How much I don't know. We didn't have any personnel monitors to determine how much ionizing radiation exposure we had received, maybe that was just as well.
Anyway, this was very exciting for me, and lots of other people, and the use of these materials made it possible to label many substances and to study what happened to them in the body. In addition to studying hemoglobin formation, I also studied absorption of radioactive iron in order to determine from the gastrointestinal tract and also for direct measurement of the red cell mass. At that time, the red cell mass was determined indirectly by calonaling red cell mass from the plasma volume, which was measured using dyes. It became apparent that, under pathological conditions, the dye known as Evans Blue, was bound to plasma protein which did not really stay entirely in the vascular system, but leaked out into other places in the body. This gave an erroneously high indication of the plasma volume. Since the determination of the red cell mass was calculated from the measured plasma volume and the hematocrit, it was also too high, and a hematocrit measurement from blood, taken from the peripheral vessels, was an erroneous indicator of the total body hematocrit. We did studies trying to determine the relationship between the hematocrit [that is, the percentage of red cells] in the circulating blood as determined on a sample of venous blood and the total body hematocrit, in order more accurately to try to calculate the total red cell mass from the determined plasma volume. But then, we also realized that this was not really the best way to measure the total red cell mass. Therefore, working from information that had been provided by Dr. Von Hevesy, we developed techniques for labeling red blood cells and using them to determine the actual red cell mass. Initially, this was done using radioactive phosphorus as a label for red cells. However, it was not really very satisfactory, since the radioactive phosphorus leaked off the red cells and again caused inaccuracy. We were able to use erythrocytes tagged with radioiron that had been incorporated into the red cell hemoglobin. When the cells were made in the bone marrow this was a very accurate way to determine red cell mass but it necessitated administering radioiron to the donor of the labeled red cells. Subsequently, with others, we developed a technique for labeling red cells with radioactive sodium chromate. The radiochromate that entered the red cell left the red cell at a quite stable and a relatively slow rate. This made it possible to determine quite accurately the red cell mass. This is a technique which is still used clinically in quantitating the red cell mass in individuals who may have polycythemia, in determining whether the polycythemia is "spurious polycythemia" or polycythemia rubra Vera. There was a medical resident who worked with me, named Milan Chapin, who came from Maine. He was a wonderful gentleman, and a very industrious fellow. We worked very hard at this research. Neither of us was married, and we could dedicate nights, days and weekends to this work, which we did. This research eventuated in a series of publications, which, I think, would stand up even to this day; nobody's refuted the data that we presented. And then the war began. I was working on-
Q: Before we go on to talking about the war period, I was wondering if you could give some more information about the early use of these radio isotopes. At Harvard, you had connections with the Physics Department, is that who administered the cyclotron?
Ross: The Physics Department of Harvard College operated the cyclotron. My friend, Dr. Shields Warren, a Professor of Pathology at the Harvard Medical School, assisted me in my contacts with Professor Bainbridge of the Harvard Physics Department. When I began research with radioactive iodine, I developed contacts with scientists both at Massachusetts Institute of Technology [M.I.T.] and also at the Harvard Medical School's Massachusetts General Hospital. The use of radio iodine to study thyroid physiology developed almost simultaneously on the East and the West Coasts. There was a M.I.T. professor of chemistry named Roberts, who was very helpful to me in terms of the localization and the characterization of radio iodine in the thyroid. This was, again, an example of the free intercooperation of individuals from disparate disciplines, and from different institutions who really worked together very well. There was never any very great consideration of the financial aspects of this; there was money available for most of these endeavors without having to do an accurate cost-accounting. From the standpoint of a young physician and a scientist, this was wonderful, but I suppose from the standpoint of economics, as we would do it today, it was really very loose.
Q: Were there any other monies besides this Robert Dawson Evans Foundation?
Ross: Not that supported me. Shields Warren, I don't know where he got his money. He was salaried, I think, by the New England Deaconess Hospital, where he was the hospital pathologist. Whether he had other funds or not, I don't know. The gentlemen at M.I.T., were salaried from their professorial positions at M.I.T. As far as I know, there was no other subsidy provided. And, this was a very pleasant and a very good cooperation. I also was involved in studies of blood preservation with Dr. Robert Evans, Professor of Physics at M.I.T.
In those days there was no commercial source of equipment to accurately quantitate radioactivity or to do the measurements that we had to do. A very fine gentleman named Ivan Getting, who subsequently went into the space industry was very helpful! He arranged for a technician who was working at Radcliffe College to build for me a counter and scaling circuit, instruments to quantitate radioactivity. This young man was salaried by Radcliffe College. Ivan Getting was salaried as a Professor either of Physics or Engineering, and I think probably both, at Harvard. But he very kindly provided the diagrams of circuits, supervision, et cetera, et cetera, to make the scaling counter. However, the instrument that did the actual detection of radiation was made by my friend Dr. Bill Bale, of the University of Rochester, with whom I had worked when I was there: he very kindly prepared the Geiger Counters which I used. This was, in essence, a cooperative effort of five different universities!
Q: How do you spell Bale's name?
Ross: B-a-l-e. William Bale. B-a-l-e. He was a physicist at Rochester who had cooperated with Paul Hahn and George Whipple, when I was there as a resident. This very kind gentleman was able to provide assistance. When we got this equipment set up, we worked it around the clock, and learned about the problems that occur from fluctuating voltage in the electrical system. We learned this the hard way, and had to get voltage stabilizers because every time the elevator would go on in the building in which we did these studies, the voltage would drop so much that it would interfere with an accurate quantitation of the radioactivity. But we had lots of support from Dr. Keefer and lots of support from everybody and we were able to proceed.
We gave radioactive iron to individuals. We started out with patients who had iron deficiency anemia and pernicious anemia, and were able to show a markedly different rate of absorption of iron, and of uptake and disposition of iron in the erythrocytes of these individuals. I remember there was a little boy eight or nine years old, who had one of the most profound cases of iron deficiency anemia that I have ever seen, primarily because of bad diet. And, perhaps cruelly, I used to phlebotomise him after I had given him radioiron, in small amounts. Ultimately, I gave him a couple of transfusions and iron medication and cured his problem. I recollect that I became very attached to him; I took him to the circus and to ballgames, more or less as a walking cooperator in my research endeavors. Then, the war came along, and I was working in my laboratory on the fourth floor of the Evans Memorial Building on the afternoon of December the seventh, when news of the bombardment of Pearl Harbor came over the radio. This was very disturbing, not only to me, but to the rest of our group at the Evans. This interfered with our research for a while. The young man, Milan Chapin, who was working with me, immediately volunteered to go into the Army, and at that point, Dr. Keefer became concerned that the rest of his staff also was going to depart. He had connections in Washington, and he urged all of us to stay where we were, and he obtained deferment from military service to continue the teaching and research work that we were doing. At that point it became apparent that there was going to be need for blood transfusions on the battlefront.
Q: Just before we go on to that as a separate section of discussion, I was wondering if we could talk about some of the research investigators under Keefer who were present when you first arrived at Boston. We started to talk about Franz Ingelfinger before.
Ross: Franz Ingelfinger was in my class at Harvard Medical School. His father was a south German, a very jovial, large, wonderful gentleman who married an American lady who had gone to Germany to teach English. After they were married, they came back to the United States, and they had Franz Ingelfinger, who was a wonderful fellow, my best friend. We shared an apartment before we married our wives. He was interested in gastroenterology. After completion of internship at the Boston City Hospital, he went to Philadelphia to work with Osler Abbott who was studying the physiological aspects of gastroenterological function. I think he was there for two or three years. He was brought back to Boston by Chester Keefer to introduce these studies and to head the gastroenterological division at the Evans Memorial at Boston University. He had a very distinguished career; he made very excellent contributions in the field of gastrointestinal motility, particularly of the esophagus. Then, later on, he became the Editor of the New England Journal of Medicine. He filled this position with very great distinction for a number of years, and then, sadly, he developed carcinoma of the esophagus, one of the fields in which he had done a great deal of work. He had a resection of the esophagus, and replacement with a section of intestine, but this never was really very satisfactory. He continued to have great pain, and ultimately, the carcinoma killed him. Interestingly, a UCLA professor, Morton Grossman on the West Coast, who also was working in gastrointestinal physiology, also developed carcinoma of the esophagus and died within a few years of Franz Ingelfinger. That seems to be a peculiar coincidence to have two people on opposite coasts who worked on the same organ system to die of the same rather uncommon disease. It is sort of similar to the two people who had worked on thyroid disease in Boston and San Francisco, both of whom died of suicide. But Franz Ingelfinger and the gentleman out here did not suicide; they died of carcinoma.
Q: You mentioned also Robert Wilkins?
Ross: Robert Wilkins was a Harvard graduate who came from the South, and I think he had been working at the Thorndike, and Dr. Keefer brought him to Boston University to be the head of the cardiovascular division. Bob was very actively concerned with investigation of the function of the heart. He was one of the first people in Boston, at any rate, to use heart catheterization to study blood flow through the coronary vessels flow through the chambers of the heart. He was a very effective investigator, he also had great concern for the problem of pulmonary embolism; pulmonary embolism killed a huge number of patients following satisfactory completion of surgery. Bob and the Head of the Department of Surgery, Dr. Reginald Smithwick, conceived the idea that if they would compress the diameter of the veins in the leg with elastic stockings, it would accelerate blood flow and diminish the rate at which thrombosis might occur, and thus decrease the incidence of pulmonary embolism. This concept was developed by Wilkins and his associates, and it worked extremely well. It is used today in post-operative patients and in other people who are inactive and lying in bed. This appreciably has decreased the incidence of pulmonary embolism. And Bob Wilkins was married to the heiress of the Fisher Body Works, which at that time made all the bodies for General Motors autos. So he had a lovely wife, a wonderful person, and she was exceedingly well-to-do, and Bob didn't really have to work, so at a relatively early age, he retired, and went up to Newburyport, where he still lives. He has no contact with medicine, which seems sort of sad, because he was an innovative, brilliant investigator, and a very fine clinician, and took excellent care of patients. But he just went up there and, I heard some people talking about him last week: he's active in the town affairs in Newburyport, but he doesn't have any contact with medicine, which is kind of unusual. But he was a very good stimulus to the rest of us; he was older than we by a few years, and he sort of assumed a relatively significant role in representing the group to Dr. Keefer.
Another excellent colleague was Francis Cabot Lowell, who was a graduate of Harvard in my class, and he was interested in immunology, and allergy. He worked intensively on studies relating to antibodies that develop against insulin, in diabetic patients who were treated with insulin injections. He was busily involved in making insulin out of chicken pancreases. He determined the per unit value of insulin from the chicken pancreas, compared with that from pigs, porcine insulin. He developed antibodies against that insulin quite successfully. The work that he did, in terms of antibody formation to insulin has borne fruit and it's an extremely active area of concern, even at this time. He subsequently went to the Massachusetts General Hospital at Harvard, where he was head of clinical immunology activities. Unfortunately, he had a heart attack and died in his bathroom in the middle of the night five or six years ago. Very sad! He inherited his name, Cabot Lowell, from the Cabots and the Lowells. He occupied the Lowell mansion in Concord, which was a wonderful place. And he and Frank Ingelfinger married sisters, named Shurcliff. Both had wonderful children, and all of us and our children used to visit Frank Lowell's establishment in Concord, and had a wonderful time! It's tragic that he expired at a relatively early age!
Another very interesting gentleman who was at the Evans was Louis Weinstein, who came to Boston University with a Ph.D. in bacteriology from Yale. He arrived on the scene a little later than the rest of us, although I think he was about the same age. He considered himself Yale's gift to Boston, and Yale University's gift to Boston University. He was a very vigorous, very aggressive, very intelligent and very competent young gentleman! He worked under the jurisdiction of an infectious disease man named Charles Rammelkamp. Rammelkamp, Lowell, Ross, Ingelfinger and Wilkins served as an abrasive force to rub off some of his rough edges and to educate him in the ways of Boston medicine! He took it very well!! He has done very well. He was a wonderful fellow! He became Professor of Medicine at Tufts University, and when they retired him there, he went to the Peter Bent Brigham, at Harvard, and is continuing to pursue an active and a very productive career. He played the cello, and Ingelfinger played the piano. They used to play duets in a most excellent fashion. Another very pleasant activity at the Evans!!
Charles Rammelkamp was another of the people that were brought to the Evans by Dr. Keefer, and Charles was a very good comrade. He married Chester Keefer's secretary, which didn't please Chester Keefer very much, and when the lady got pregnant, and became obviously pregnant, he sacked her, which I always thought was a big mistake! There's nothing wrong with being pregnant, but her appearance embarrassed Chester Keefer. The Rammelkamps had several children. They went to Western Reserve, where he was a professor. He was in charge of infectious disease investigations for the Army at one point, and did extensive, crucial studies of the incidence of streptococcal infection in military personnel stationed in various parts of the world, particularly up on the Colorado plateau, where they had a terribly high incidence of streptococcal infection, with complicating nephritis. And now he's dead. I think he also died of a heart attack several years ago. Another individual who was there was Stanley Bradley, who was studying the kidney. Stanley and his wife worked together in the same laboratory. Stanley is still living, and his research has been very productive. He became the Bard Professor of Medicine at Columbia University, and on his retirement, he has carried on investigative activities in Switzerland. He also had an arrangement in the summer time in which he would go to Bar Harbor and study the kidney function of seals and sea lions: if you put a seal's nose under water, he immediately clamps down on the circulation through the kidney in order to circuit the blood from there to the heart and other places that were more vital to his under water activities. The Bradley's had a wonderful experience at Bar Harbor, and, in addition, did very good research work. He had a daughter, Jane, while he was at the Evans. Jane is a lovely lady! She worked here at U.C.L.A. as a resident in medicine, and subsequently went back to a faculty position in hematology at the University of Pennsylvania. She married a very nice Iranian gentleman, Abass Alavi who's director of nuclear medicine at Pennsylvania.
Additionally, at the Evans there was Arnold Relman, who was interested in endocrinology, he went to be chairman of the Department of Medicine at the University of Pennsylvania, and, after Ingelfinger's death, became Editor of the New England Journal of Medicine, which he now is doing. Do you want any more about these people? I don't know how much all of this is relevant, but--
Q: Sure. Well, the point of interest is that Keefer is coming into Boston U. to do over the University and, on the one hand, he apparently has a source of funding; on the other hand, he brings in a number of new investigators. So, the next question is, is there anything else, did he bring a particular philosophy of how a medical school should be established.
Ross: Chester Keefer was a top flight magnificent clinician. He had an encyclopedic memory. He read very extensively. He knew everything about everything, it seemed to us at the time, but his emphasis primarily was clinical medicine. He developed extremely excellent clinical services, both inpatient and ambulatory, and he was able to attract extremely good interns and residents who got a great deal of his philosophy in their training. But he also recognized the value of more basic, fundamental and laboratory research, which he supported very vigorously, and most of the people that he employed, in addition to being good clinicians, were interested in these various basic science approaches to medicine, Chester was very anxious to fund, and this work he did fund these researches extremely well! And he transformed this old homeopathic Boston University medical school into a top flight research and teaching institution!! When we arrived there, there was a homeopathic pharmacy that had a room filled with medications with titrations out to the five-power dilution. These were supposed to be effective in the homeopathic system of medicine in treating disease. Chester didn't cater for that very much. On the other hand, there were funds which had been given for homeopathic medicine, and he ran into trouble with this, and the physicians who were persuaded of the possible benefits of homeopathy, took all this money, and established a new hospital out in Washington Heights: a very elegant, small hospital with beautiful stainless-steel everything, et cetera, et cetera! That was a loss to the Boston University School of Medicine, but I guess there was no other way to solve the problem, since the money was given to the university with the stipulation that it was for homeopathic studies. They were unable to modify the bequest. Dr. Keefer made B.U. a really first-class medical school! It, as does Tufts University School of Medicine, suffers in the shade of Harvard Medical School, which is such a tremendous organization. Neither B.U. or Tufts medical schools achieve the recognition that they might if they were in another city. On the other hand, B.U., Tufts and Harvard get along, really, very well, and all three of them have thrived. Harvard Medical School has such success in raising money that it sort of out distances the other two institutions. But Chester Keefer really made a tremendous and vast change in the medical school! Unfortunately, he had a tragic and bad death. Just as I was leaving Boston, he had prostatectomy and the path report benign prostatic hyperpasia. Well, it's of considerable interest that twenty years later, he noticed a lump in his neck, which he thought was lymphoma; a biopsy showed it was carcinoma of the prostate. Review of the material that had been removed in 1954 revealed there was cancer in the prostatic tissue. In thinking about this, it maybe was a good thing that it had not been diagnosed originally, because, had it been recognized in 1954, they would have castrated him, they would have radiated him, and they would have given him chemotherapy. There's considerable question as to whether that really would have eradicated his disease or prolonged his life. He had twenty good years of good life, so, I think, maybe it was a good thing they hadn't recognized it. Chester had terrible pain at the end, which was excruciating and very difficult to control. It was considered desirable to give him radioactive phosphorus to see if this would control his pain. It didn't help his pain very much at all. He was a very great gentleman and a very great man physician!! He made great contributions to the field of medicine, medical education and to mankind!!!
Q: In coming to Boston University, did he place any particular emphasis on certain areas for basic research?
Ross: I think he was eclectic. He placed emphasis in all these areas: cardiovascular disease, hematology, gastroenterology, nephrology, endocrinology, infectious diseases, immunology and even psychiatry!! He brought good, aggressive, interested, young physician investigators in each of these areas; he gave them full support. Chester was an Infectious Disease man, and he figured that this was his area, but he hired Rammelkamp and Weinstein, who were in the same field, and they complemented his wisdom with laboratory investigation and a different approach. Chester was a very wise man, and he did a very great deal not only for his associates and B.U., but for the whole of medicine.
Q: Was there any attempt to set up more academic areas in conjunction with Boston University academic departments, such as biochemistry, or joint departments in physiology?
Ross: Well, he was quite successful in modifying the clinical departments of the school: surgery, obstetrics, psychiatry, and pediatrics. He didn't have the same success in the basic sciences, because the people who were there had tenure appointments, had been there for a long time, and they were set in their ways. They weren't going to take these changes from Dr. Keefer, or anybody else. So, unfortunately, the basic science departments really never progressed at that time, to the same extent that the clinical departments did. I would say it was not at all uncommon for the clinicians to work more closely with representatives of basic science departments at Harvard, and M.I.T., than it was with the basic science departments in their own school of medicine. That was unfortunate, but that's the way it worked out. This is not to say that the people who headed these departments were not fine people. They were fine people, but they were of a different era and a different concept, and they weren't going to change, and he couldn't change them.
Q: What was the status of hematology? There was a division of hematology created under Keefer with you as Head?
Ross: None of these subspecialties of medicine had existed at the B.U. medical school. When Chester went there, he created all these de novo, and brought people in to head them. There was a nice gentleman who was an old-style homeopathic clinician, who had taught the course in what was called clinical pathology. He was strictly a cytological hematologist, and he was a very good doctor, but he didn't do very much research, and wasn't very aggressive. He was superseded by me. There had not been a Division of Hematology before I came, and hematology at Boston University subsequently progressed, I think, quite satisfactorily. After I had been there several years we brought in another fine man named Charles Emerson, Jr., who also worked in the field of hematology. He made interesting contributions to make. He succeeded me when I left the Evans. When I went to Boston University there was a very small blood bank which had been started by a surgeon named Frank Barton. And I guess under Keefer's stimulus, I supplanted Dr. Barton as the head of this endeavor. I became very much concerned with the development of blood banking and transfusions. In the past, blood banking had not really developed to the point where large numbers of transfusions could be very appropriately carried out. And having seen a series of deaths from d mismatched transfusions in the institution from which I came, I thought it was tremendously important to have adequate controls, which we instituted. In the work that I subsequently did relative to blood preservation, it was very helpful to have available the blood bank to complement the more basic research that we were doing on storage of red blood cells. This was very helpful indeed! We developed a real good blood bank, and we never had any fatalities from transfusions when I was there; I don't suppose they've had any since.
Q: This is in terms of the work that developed after the start of World War II?
Ross: That's correct.
Q: Okay. Perhaps you could elaborate on that.
Ross: Well, you see, I came to the Evans in 1940, and the Japs bombed Pearl Harbor in December, 1941. That completely changed the whole direction of our research endeavor, because it became apparent from studies that I did on blood that had been stored in the usual fashion, just in saline solution, that erythrocytes and stored them in the usual blood-banking solutions, and transfused them into experimental subjects. The labeled cells all vanished within a matter of eight to ten hours after they were injected. At that time, along came a named Thalhimer who thought that if you put the blood into corn syrup solution, it would prevent red blood cells from aging. The reason this was believed was because the corn syrup solution prevented hemolysis of red cells, and the supernatant fluid did not become pink. Well, when we put blood with radioiron labeled red cells in that solution, they too vanished just as rapidly or more rapidly than if it had been stored just in salt solution. At that point, at the Battle of Casarine Pass, in North Africa, there was no blood for transfusion. They had plenty of plasma, but when a boy lost his leg, or his arm, or got shot through the lung, and lost blood, if he was just given plasma, that didn't help him very much. The physicians who were there recognized the need for whole blood. There was no real mechanism for taking blood for transfusions in the army hospitals. So they would draw blood from the medical people that were in the back lines, and since there was no citrate for anticoagulation or any way to preserve it, they would defibrinate the blood by stirring it in a flask with a glass rod and would use that definibrated blood for transfusion! And Dr. Elliot Cutler, chief surgeon there, sent back numerous communications to the War Department saying, "For God's sake, get us some blood for transfusions!" Because the plasma, which had been developed in large measure by Edwin Cohn at Harvard, just wasn't doing the job! Well, at that point, the use of corn syrup as a blood preservative, because it preserved the appearance of the mixture, was advocated. It was necessary to put 500 cc of corn syrup solution with every 500 cc of blood, which created a problem because it doubled the weight and the mass of the stuff that had to be shipped overseas. There was a considerable disputation about these various preservatives in the Surgeon General's office. The Surgeon General was a surgeon named Rankin, and he wasn't convinced that anything was necessary except the corn syrup blood mixture that was being sent. However, Dr. Conant, who, at that time, was the Director of the Office of Scientific Research and Development [OSRD], had recognized that there were problems, and a Dr. Newton Richards, a distinguished physician, was head of the medical branch of this organization, and got together a group of people and provided government funding from the OSRD to start studying blood preservation. I was one of the investigators who did these studies, working with me at the Evans was Dr. Clement Finch. This work was done in close cooperation with Dr. Robley Evans and a Dr. Wendell Peacock at the Massachusetts Institute of Technology--
Q: It's Wendell Peacock?
Ross: Wendell Peacock. Do you know him?
Q: I had his name down.
Ross: Wendell Peacock. He was a physicist. Also there was Dr. Jack Gibson III, and at Harvard and the Peter Bent Brigham Hospital. We all worked together in Boston, trying different ways of preserving red blood cells so they would survive longer in a bottle. There were other people working on the problem in other places, as, for example, Dr. Max Strummia in Philadelphia, and some people working in Canada. Together, over a fairly brief period of time, it was discovered that there were ways to keep blood cells happy in a bottle for a longer period of time. And, as frequently happens, there was a roundtable discussion as to what was going to be considered "satisfactory," in terms of percentage survival and duration of storage. It was decided that "satisfactory" would be 70% survival at the end of three weeks. That was accepted as the sort of standard, and we had a solution to do that which was adequate to store blood, so that 70% of the cells would survive at the end of three weeks. By that time, the necessity for whole blood for the treatment of battle casualties became readily apparent, particularly in the South Pacific, where there were no facilities for transfusion. It was necessary to devise a technique of delivery. This was done by getting a plywood box with six compartments constructed with an ice container in its center. This box with its stored blood could be dropped by parachute behind the battle lines. Hundreds of thousands of units of blood were taken from the civilians of this country, shipped to battle areas, and dropped by parachute to first aid casualty teams behind the lines. This saved the lives of lots of troops. This fact was recognized by General George Marshall who, in some of his writings, commented about the tremendous contribution that had been made to the war effort and to the medical care of troops with the use of this technique for preserving blood. As a consequence of this, the Medal for Merit Board recommended to President Truman that recognition should be given for this research. Robley Evans, and Jack Gibson, and I were given a special commendation by Harry Truman, the President of the United States! This was pretty exciting, and very gratifying! It was nice t 'know that what you did trying to help mankind was recognized by the president! Following this, my estimation of Harry Truman went up quite considerably. I now think he was a very great man and president! !!
Q: Was all this work funded under the O.S.R.D.?
Ross: All of this work was funded under the Office of Scientific Research and Development, through the Committee on Medical Research, headed by Dr. Newton Richards, who was a very good friend of Chester Keefer's and also a very fine and wise gentleman! The investment in this research paid off! This research was not funded by Chester and the Evans Memorial funds. All costs for this research were paid for by the government. This was the first government grant that anybody had gotten at the Evans. It made possible the employment of technicians, the acquisition of better radioactive detection devices, and the funds to pay subjects to whom we would give the blood that we had preserved. This transfusion procedure was a cause of problems at times; to find out if the stored blood was really any good, we had to transfuse it into somebody. We gave this to technicians and medical students, and, unfortunately, on one occasion, some of the blood wasn't all that good, and it made one of my technicians and one of the medical residents quite ill for a brief period of time.
[end of side one of tape three; beginning of side two of tape three]
Q: Tape three, side B, interview with Dr. Ross.
Ross: I commented that we transfused some of this preserved blood into a couple of individuals who got fever and got sick and scared the hell out of me!! But, fortunately, they got better without any other problems. One of my colleagues, however, was not so fortunate. He gave a transfusion to somebody and killed the boy, and that was a terrible, terrible tragedy.
This endeavor, as I say, was fruitful. In the pursuit of this, I would like to emphasize that there were other groups working on this. There was Dr. Max Strumia, working in Philadelphia. He was a pathologist. There was a Canadian named Orville--I can't remember his last name. And there were one or two others that I can't remember right now, but they all worked together, and corroborated the findings of the other investigators, a very wise idea! There were two people doing the same research and checking out what the other one did. This accelerated the solution of the problem! We also had some contact with Edwin Cohn, who was fractionating plasma. He thought we were blunderbusses, because we were doing most of our work on human subjects, and he didn't do that. I tried to crystallize radioiron labeled hemoglobin in his laboratory using some of his equipment, and facilities, in collaboration with some of the people who worked with Edwin Cohn. I wanted to find out how the hemoglobin released from destroyed red cells was re-utilized. I never succeeded in crystallizing hemoglobin; Dr. Conant had done this, but he was a far better chemist than I. But, again, this was an interesting example of intercooperation among scientists of different disciplines, working in different places who were trying to solve the same problem.
Q: It's been said that Cohn himself ran his labs and the plasma fractionation project almost as a business manager, that it was a combination of both scientific skills and management abilities that allowed the development of that fractionation process, and pilot plant. I was wondering if there were similar individuals who contributed to blood work in other groups.
Ross: Not to my knowledge. What you say about Edwin Cohn is certainly very true. He was an excellent manager; he was an excellent promoter, and he was able to attract good people to work with him. He stimulated them to do a lot of work, and he was able to get funding to support them to do the work. I would say there was a conflict between Edwin Cohn and A. Baird Hastings, professor of biochemistry at Harvard Medical School, and this, again, probably, was a good stimulus for each of them. There was a nice fellow named Pete Hughes who worked in the plasma fractionation process, and also a fine gentleman named John Ferry. They were able to tolerate Edwin Cohn's yoke and did extremely good work.
In the field of red cell preservation, there was nobody comparable. There was no industrial approach to this. This was all pretty much clinical research by people who were dedicated to trying to solve the problem of transfusions for military personnel. They each worked pretty much independently, although they all were supported by the Office of Scientific Research and Development, but they cooperated very well. But there was no industrial firm involved in the work relative to the preservation of red cells.
Q: There had been, however, a number of earlier attempts at building blood banks.
Ross: Blood banking really developed independently of the attempt to develop a method of preserving blood. A surgeon would recognize the importance of trying to have blood available to transfuse patients who had lost too much blood in the operating process. And many of these surgeons, as at Boston University, had started by surgeons, blood banks in their institutions. They were not particularly adept at trying to find out better ways to do it. At B.U. initially we had a refrigerator for the blood bank, that had been used to store meat, and it was quite all right, and we continued to use it for quite a while. The developments that I have described were supported by the O.S.R.D., although not oriented to blood banking really put blood banking on a firm foundation. [?] collection and storage of large amounts of blood and the ready availability of blood when needed. This was really made possible by the work that was done by the group supported by the O.S.R.D. This work made it possible to keep blood for a fairly prolonged period of time and to make it available for transfusion in every hospital in the country. The preservation process, which was developed during the war by the 0.S.F.D.-subsidized research groups with little modification, is still used to this day. The survival of stored red blood cells, has been extended to four weeks from three. Actually, I believe it's much better to give blood as fresh as possible rather than transfusing stored blood of which there is only a 70% or 60% survival at the end of three or four weeks. On the other hand, such blood is adequate to take care of problems, when it is the only blood available.
There's now a technique for freezing blood cells and keeping them for months, It's extremely expensive and, again, I think, except in cases of national emergency or unforeseen circumstances that fresh blood or blood not stored for more than a week is probably better than the frozen blood.
But blood banking in this country now is a tremendously important and a very large commercial endeavor. Most of this is done by the American Red Cross, which have excellent facilities for the collecting, storing and dispensing of blood to hospitals. There also are independent organizations that collect and dispense blood.
But the fear of God has been instilled in them as a consequence, of the possibility of transmitting hepatitis or AIDS. And I really believe that for most transfusion it would be best to obtain from people that are known to the prospective recipient who probably are free of hepatitis or AIDS. I don't know the actual total volume of blood transfusions in this country but except for antibiotics, and, possibly, analgesics, blood and blood products are the most frequently used therapeutic modality.
Q: Was there any interest shown by some of the pharmaceutical houses I or other commercial interests during this World War II period in the preservation of blood, in blood banking, or these other areas?
Ross: There was considerable interest in red blood cells! The production of plasma and plasma fractions by such companies as Squibb--and I think Parke-Davis--left huge amounts of red blood cells which were thrown down the sewer, which was a perfectly frightful waste! One of these companies developed a concept of saving these cells, drying them and using them as a powder to stimulate the healing of wounds. Interestingly, this was really quite effective. For example, if a patient had a huge ulcer on the shin, and this blood cell powder was applied to it healing was stimulated. But this therapy has not been pursued vigorously because of the possibility that the dried cells might transmit infections. However, industry was not particularly interested or concerned in the preservation, the storage and the marketing of whole blood products. This has been done primarily by the Red Cross and by physician-directed associations of blood banks and hospitals. So I would say that from the standpoint of whole blood, industry has not really gotten involved in this. Maybe that's just as well.
Q: Is there a reason why industry would be interested in the plasma fractionations as opposed to whole blood?
Ross: Sure. They can make money. It was possible to do this without attention so critically to time, the duration of storage. Since storage time was not so critical they were able to develop fractions of the plasma proteins, which are extremely valuable therapeutically and prophylactically: [?] anahemaphilic fraction, the fibrinogen fractions, the gammaglobulin fraction, and [?]. Plasmofractation lent itself much more advantageously to industrial exploitation than does the marketing of blood cellular elements that have a finite lifetime and are much more difficult to handle and process. I know that some commercial concerns were marketing whole blood, and cells, at one point, but I don't think this turned out to be particularly lucrative, and, as far as I know, they don't do it any more.
Q: Was there any problems with the development of quality-controlled blood products, whole blood products?
Ross: Oh, yes, indeed. They are a terrible problem! The quality control from a chemical standpoint was, I think, solved quite well, but the quality control from the standpoint of potential infections, still is not completely controlled, although it's greatly improved. It is possible to detect the presence of some hepatitis viruses in blood, and to exclude such blood from use. Presumably, it's possible to detect the presence of the AIDS virus. But most of these are only 95% to 98% accurate, and if you get a large quantity of blood that's contaminated with just a small quantity of virus that's slipped through, you can infect hundreds and, potentially, thousands of people. This is one of the ways in which children who have hemophilia have been given AIDS consequent to receiving anti-hemophilic concentrate from large volumes of serum. It is a very great problem and I think its solution depends, again, on fundamental developments and ways to detect the possible presence of disadvantageous agents.
Q: Was there any other work that you did under O.S.R.D. auspices during the World War II period?
Ross: My work under O.S.R.D. was related entirely to the preservation and transfusion techniques for the blood. I did not do other work under the O.S.R.D.
Q: Did funding continue from previous sources on other work during this World War II period?
Ross: The only sources that we had, as I say, were the Robert Dawson Evans Memorial Fund. That continued to provide support. At the conclusion of the war, it became apparent that the government was
going to provide support for medical research.
[recorder turned off and on]
Q: Dr. Ross, you were at Boston University Medical School for fourteen years. I would like now to talk about the developments of hematology as a specialty, subspecialty, at the Boston University Medical School. Could we, perhaps, start off by talking about the teaching of hematology?
Ross: Very good. The instruction in the field of hematology, except in laboratory procedures, really didn't exist at Boston University before Dr. Keefer came and brought me there. He developed a series of lectures for medical students on different types of medical, internal medicine subjects, and I was given the responsibility of developing and implementing a lecture series for medical students in hematology. These were quite fruitful, and interested many of the students into seeking subsequent work in hematology. From the clinical standpoint, the residents who were in the hospital were brought there specifically to work with one or another of these young investigators. There were two residents who were assigned to me, two to Ingelfinger, two to Rammelkamp, and so forth. Most of these residents came to work in these specialty fields because they were interested in the field. Additionally, they were doing general medicine as well as working in the specialty field of hematology, both in the laboratory and with hematology patients in the hospital.
Also, we developed for the first time at that institution an ambulatory clinic for patients with hematological disease. This was really quite successful. We started with one half day a week. We began to get so many patients that we had to have two full days of clinics a week to take care of the cases who came to B.U. These ambulatory cases provided many of the patients that subsequently were admitted and treated in the hospital. Many of them also participated as subjects in clinical investigations.
This also was of great value in teaching both medical students and residents. For example, the substance folic acid had been isolated and had been believed to be the essential extrinsic factor in the treatment of pernicious anemia. We had quite a few cases of pernicious anemia in our ambulatory clinic. I comment that in the ambulatory clinic we also had medical students working as well as residents and fellows. So we put these P.A. patients on folic acid, which produced a marked improvement in their hematological status, but pretty soon we noticed that a couple of them developed extremely profound neurological disturbances. It turned out that although the folic acid would rectify the problems with hematopoesis it didn't do anything for the central nervous system. One of these poor fellows had to be brought to the hospital because he couldn't move his arms or his legs. This eventuated in a report that folic acid might have some deleterious effect upon the central nervous system degeneration in pernicious anemia. We proposed a hypothesis as to how this might happen, which didn't prove to be correct. This caused great concern at Lederle Laboratories, the marketer of folic acid. They undertook to disprove what I have just reported to you about the development of civs deterioration, but they didn't succeed.
This experience was very informative as an instructional example to medical students and residents: that you had better be awful careful when you take care of people when you start to do various and sundry new things to them. Fortunately, the man who developed the profound paralysis subsequently recovered! We stopped his folic acid and gave him liver extract and at that point he greatly improved. It's now recognized that folic acid is not the best thing for the treatment of pernicious anemia! You really need to have cobalamine (vitamin B-12), which is the specific for P.A. as near as we can tell.
Also, clinically, we had several patients who had a profound aplasia of the red cell series of the bone marrow, and a tumor of the thymus gland, and thymoma. We were able to recognize and describe this as a definite clinical entity. We presented a report about the development of bone marrow aplasia in individuals who had tumors of the thymus gland. Subsequently, these have been recognized all over the world. It's a very peculiar disease which probably is related to abnormalities in the hematologic system.
These were very effective instructional case studies from the stand point of the teaching students and residents! We had full support for the in-patient hospitalization of cases for investigative studies. The funds in the Evans, and to some extent the funds that we had by that time from the Atomic Energy Commission, made possible hospitalization costs for patients who were hospitalized and couldn't afford the cost. This was extremely valuable!! It's extremely hard to obtain that kind of financial support today. It's going to be even worse in the future. These clinical activities were very helpful in the investigative and instructional endeavors.
Q: Okay. I was wondering if you could say something more about the development and your direct involvement in the outpatient clinics under hematology.
Ross: As I say, we went to two days a week. I was there at all times and we employed a technician to do the necessary laboratory. Now we can put blood samples into a machine and get the results in fifteen seconds. Then it used to take a technician a half an hour to an hour to do the studies that were essential for just one case, in which the results were critical for management of the patient. The clinics were staffed by me and another professor, Charles Emerson. We had two or three fellows who worked with us. Also, there were residents and medical students. It was very stimulating and a good show! But we felt it was imperative that somebody who was ultimately responsible be a participant in what was going on at all times and this was, I think, very advantageous from the standpoint of instruction as well as from the standpoint of patient care.
Q: The development of the hematology service in the hospital overall went through a surge in evolution in the period that you were there. Perhaps you could comment on that?
Ross: Well, it's of interest that the number of cases that were in the hematology sphere became really quite numerous, both in the clinics and also in the hospital, because at that time it became possible to modify certain hematologic neoplastic diseases with chemotherapy. The first of these agents was known as nitrogen mustard. So we began to have numerous patients that we brought into the hospital to treat with these new modalities. I can't give you the exact percentage number, but hematology patients comprised a very significant percentage of all hospital admissions. These patients were not isolated or localized in any specific area. They were distributed throughout the whole hospital medical service, which I think was most desirable.
We began using some of the newer agents and sometimes were confronted with very serious complications as a consequence, because not only do these agents interfere with the progression of the tumor, but they also interfere with the normal functioning of the body. We had a couple of cases that lost their entire enteric mucosa as a consequence of the drug they'd been given! Fortunately, we were able to carry them through and they regenerated their enteric mucosa and got better. Fortunately, also, their fundamental lymphomatous disease greatly improved as a consequence of all this treatment. However, that doesn't justify the terrible trouble that came from the side effects of the medication. However, that's the way we had to find out what these medications could do. Fortunately we were able to control the side effects and did not lose any patients from them! The whole hematology service prospered. At the time I left the Evans this was all turned over to Charles Emerson. It continued to grow and become an effective part of the Department of Medicine at Boston University.
Q: During the fourteen years that you spent at Boston University, did you see a change in the types of diseases that a hematologist would examine?
Ross: Yes, I think it's quite fair to say that during that period of time the capacity to modify the course of neoplastic hematologic disease, really began. Before that the only way to treat somebody who had lymphoma or leukemia was with radiation therapy, which wasn't terribly satisfactory. But with the advent of nitrogen mustard and the antifolic compounds, it was possible to modify things very quickly. Consequently, hematologists began to see and take care of more and more neoplastic disease. The advent of cyanacobalamine [Vitamin B-12] replaced liver extract as the therapeutic agent for P.A. and progressively diminished the referral of patients with pernicious anemia to hematologists because good physicians were able to take care of these patients without referring them to a specialist. Also, the recognition of iron deficiency anemia and the ways to treat this, decreased referrals. At one time iron deficiency anemia was a very common referral to hematologists. With the improved training and experience good physicians could recognize the cause of this type of anemia and could treat it. It no longer was necessary to send iron deficient patients to see a specialist. So, gradually over a period of time the hematologist's primary concern has become with neoplastic disease, with certain types of hemalytic anemia that cannot be easily modified, and with certain kinds of hemorrhagic disease which also could not be modified by the techniques used by most physicians.
This has led, unfortunately, to a specialty in hematology which increasingly is general oncology. This, unfortunately, as I say, is apt to be disappointing because usually you can't cure people with these diseases. You can take care of them, which is in marked contrast to pernicious anemia, iron deficiency anemia, and other illnesses which can be, in effect, controlled for a prolonged periods of time without the patient going ahead and dying. But it has changed the complexion of hematology. Unfortunately, hematologists years ago were not alert enough to recognize that they should expand their sphere of concern in neoplastic disease outside that of hematologic neoplasia. This then led to the development of what are now called oncologists, who use the same modalities of treatment in other tumors such as carcinoma of the breast, the colon, the liver, the lung, et cetera. The side effects that occur consequent to the treatment of these patients with oncolytic agents primarily are those related to the hematologic system involved and it's unfortunate that most of the current oncologists have not had a firm, basic education and experience in the field of hematology. Consequently, and not infrequently, we see very bad reactions in patients who have treated for carcinoma without sufficient attention having been paid to the effects of these agents on the bone marrow!
Q: Was there a similar change in the diagnostic equipment made available to clinical hematology during this period?
Ross: During the period that I was at Boston University everything still was done by hand--by technicians in a very laborious fashion. Subsequent to that time, the development of automated procedures on machines can perform these tests in a few seconds with greater accuracy than can be done by a technician looking through a microscope. At one point, we used to teach medical students how to do all the hematological procedures with a hemacytometer, hemoglobinometer, et cetera. Now, that's no longer necessary. When I directed the courses in hematology for medical students, I felt they ought to know how to be able to do a hemoglobin and a white blood count and differential in the middle of the night if they were out in a small hospital and didn't have a machine available, but even white counts are not taught any more to medical students. Those are all done by machine and most places now have technicians who are on call they have to be done. So doctors don't any longer know how to do all these technical procedures that once upon a time seemed so very important. They pretty much have been abandoned in terms of teaching.
Q: When did this change begin to take place?
Ross: This began to take place, in the 1970s--in the early 1970s when a couple of brothers named Coulter, working with Eugene Cronkite designed the so-called Coulter Counter, which initially was rather limited in what it would do, but now it's been expanded to the point at which it will do practically all hematologic studies very quickly in an absolutely magnificent fashion. The machine is not too expensive, and I believe it is probably present in most of the hospitals and laboratories in this country.
Also, it used to be that all of the white cell differential counts were done by eye and microscope but now, there are instruments that will do most of these automatically. This again has displaced technicians from doing the procedures. I'm not sure that these automated differentials always are as good as those done by technicians but if there's nothing really wrong, or expected to be wrong in the differential leukocyte count, I think the machine is quite adequate.
Q: Were there changes in blood banking following the World War II period, based on the experiences gained in the World War II period?
Ross: It expanded tremendously! It employed the preservation techniques that I've already discussed. Also the recognition of the numerous different types and groups of blood came to the fore, and explained some of the peculiar reactions that were observed that could not be accounted for on the ordinary [Landsteiner] four blood groups. I think that the major developments really have been in terms of matching and typing and the processing of the blood to ensure compatibility between the donor and the subject. The preservation procedures--that is, the actual places in which the blood is stored--demands a constant temperature in the refrigerator. These have been refined and made more elegant but they aren't much different from the refrigerators that used to be used.
The technique of taking blood, which used to be placed in a bottle with a liquid, has been supplanted now by the use of plastic devices, which are much less expensive, and safer. They can be disposed of after use. You don't have to wash them and worry about the bottles like we used to do. That was a great development which, interestingly, occurred as a consequence of the work of a physician named Carl Walter, a most interesting gentleman! While he was a surgical resident at Peter Bent Brigham Hospital there was a terrible series of fatal accidents consequent to the administration of intravenous fluids. It turned out that instead of having dextrose in some of the fluids, boric acid got into the solutions and killed the patients. Carl was assigned the problem of trying to solve this terrible situation and he solved it in one afternoon by insisting that a paper cup be put on top of every bottle of fluid that was going to be given to a patient and the nurse or the doctor had to take a drink out of the fluid before it was given to the patient. That stopped the trouble right away. He got interested in the subject, and went on to develop a very elegant series of bottles and systems for making intravenous fluids and taking blood for transfusion called the Fenwald system. In addition to being elegant it was quite expensive since the equipment was all Pyrex. Then when the war came along and it was necessary to ship blood from here to Timbuktu, he developed the plastic container which could be dropped from aircraft without rupturing or bursting. This was very wonderful.
He's an interesting gentleman. He was an engineer who had designed the valves that controlled the de-icing equipment used the in all military aircraft at one point. He was already an extremely wealthy man before he came to medical school and he subsequently continued with these innovative engineering developments in medicine. His work greatly expedited and improved the facility of blood transfusion and kept the costs down appreciably.
Other aspects of blood transfusion, haven't been particularly striking or different except for the capacity to precisely cross-match, and ensure that blood is properly used. An exception is the fractionation of blood elements. It's now becoming rather unusual that a patient is given a transfusion of whole blood. A patient more likely will be given a fraction. He may be given red cells. He may be given platelets, or leucocytes. He may be given plasma, but not often is he given the whole works together. This has been economically advantageous as well as improving the therapeutic use of blood.
[recorder turned off and on]
Q: Dr. Ross, I was wondering if you could say something about the development of consultation services in hematology at Boston University?
Ross: When Dr. Keefer recruited the members of the Department of Medicine, it was understood that they would be able to supplement their income--which was not very great from the University or from the Evans Memorial--with income from private practice and consultation. All of the members of our group engaged in consultation practices. It was part of the ground rules that the office space was provided gratis for this endeavor. All of the members of our group engaged very actively in consultation practice with certain limits in terms of the amount of time that was spent. Most of us spent one afternoon a week or maybe two afternoons a week doing this. We were able to supplement our salaries from this endeavor probably one hundred percent or even more. It wasn't very long before all of the members of our group were receiving very interesting referrals for consultation from all over New England, which led to the addition of fascinating cases to the patients admitted to Massachusetts Memorial Hospital of Boston University. These patients almost invariably were able to pay the cost of hospitalization as well as the cost of medical services. These patients were admitted to the teaching services of the hospital, and were a very valuable adjunct to the teaching, complementing the experience with the so-called ward charity patients. It was most advantageous for medical students and residents to deal with patients who were not impoverished and who usually were quite well educated and intelligent people. Although not all of our consultations were such, many of them were.
It used to be the usual practice that the consulting physician would charge each day the patient was in the hospital at the rate that the patient was paying for his hospital room, which was about fifty dollars. In retrospect, that was not too small a fee and probably not too large a fee. Now, with the cost of hospital rooms going up to four, five, or six hundred dollars a day, the consultation fees that the physicians charge are only a fraction of what the hospital charges.
The consultation practice was really very useful. To me, as a hematologist, many referrals came from other hematologists, such as Dr. William Castle of the Thorndike Memorial, who strictly limited the number of "private" patients that he wanted to see. He'd refer many of them to me, as also did Dr. George Minot and some of them from Dr. William Dameshek of Tufts Medical School. This was very much appreciated! This brought us very interesting cases and, interestingly, these were some of the best subjects for our clinical investigation. They were intelligent and we explained to them what was being done and, almost without exception, they were willing to cooperate completely.
Q: Are there any particular cases that stand out that you would care to comment on?
Ross: I remember one poor lady came to see me who had an anemia the cause of which the local physician couldn't figure out. She was studied and she had severe iron deficiency anemia. We did a barium enema on the lady and, at that point, I got lobar pneumonia and very, very ill. I did not review the X-rays of her colon. She was treated with iron, went home, got better and then she came back just as anemic as when she'd first been seen! At that point, I went and looked at the X-ray and she had a carcinoma of the cecum, which had been missed by the radiologist! Hers was a very good illustrative case not only for me but for the fellows, the residents, and the medical students that the doctor in charge of a patient has got to look and be familiar with everything that goes on relative to his patients!! This woman's cecum was resected and she is completely well, even at this time some twenty-five or thirty years later. That was a very educational and gratifying case!
I've mentioned the man that developed quadriplegia temporarily as a consequence of being treated with folic acid. And I had a very significant number of patients who had Hodgkins disease and we made an early attempt to eradicate this disease with radical dissection of the site of the tumor. I remember many of these cases. Unfortunately, we didn't cure any of them. That was a terrible ordeal for the patient to bear because the surgery was very disfiguring and it was very disillusioning because we didn't have any other therapy except X-ray and we didn't cure these patients. Now, the resection is implemented followed with and radiation and then chemotherapy, and we're able to cure about half of the cases with Hodgkins disease. Those are examples.
Q: Dr. Ross, I was wondering if you could review some of the major research efforts that you made while at Boston University as well as talk about the sources for funding for research in the post-World War II period.
Ross: Yes, in addition to the investigations that I carried out relative to blood preservation, iron metabolism, erythropoiesis, and blood destruction, I also was interested in applying radioactive iodine to the diagnosis and treatment of thyroid disease. This was a fruitful endeavor and as you may know, this modality of therapy and diagnosis of thyroid disease still is very widely utilized. In addition to this, I became interested in zinc, and we had radioactive zinc and were studying zinc metabolism. I had the idea that possibly polycythemia rubra Vera might be related to some abnormality of zinc metabolism. We did a great deal of work on that but zinc metabolism didn't seem to have any relationship to polycythemia. As a consequence of the use of these various isotopes, the Atomic Energy Commission expressed interest in subsidizing our investigative efforts and they took over the funding that had previously been granted by O.S.R.D. The AEC funded our investigations quite adequately for many years. This was extremely helpful since they were generous with their funding and we were frugal with our use of it. These are examples of the type of investigations that I did while I was there.
We were also interested in trying to study the mechanisms by which neoplastic disease produced anemia. It was always believed that anemia was caused by the bone marrow being crowded out by the cancer. We were sure that was not the case. We showed that the anemia in patients who have cancer is attributable to two factors. There's an increased rate of senescence of erythocytes, that is the red cells grow older more rapidly than they usually should, and the bone marrow is unable to compensate for this with an appropriate increase in the rate of formation of red blood cells. This was not related to any replacement of the bone marrow by neoplastic tissue. We tried very hard to find out what the actual mechanism of the increased rate of senescence of red cells was, but we never succeeded in clarifying what it really was that makes the erythocytes grow older more rapidly, except the fact that they circulate in a person who has cancer. To the best of my knowledge, this has never been explained. It's a fruitful field for future investigation.
Also I studied the blood volume in congestive heart failure in patients and in experimental animals with Dr. Clifford Berger, professor of physiology at Harvard. We proved that contrary to accepted belief there was no increase in circulating red blood cell mass in that condition.
Q: During this period you, no doubt, also had to develop new forms of instrumentation. For example, in following the use of radioactive iodine, I was wondering if you could comment on the development of some of this investigation.
Ross: At the time we began to apply radio-iodine in human subjects, the equipment was very crude and we designed an interesting thing that looked like a cannon. We got special kinds of lead and steel that didn't have any radioactive materials in them and fabricated them in to a very effective tool to localize the uptake of radio-iodine in the thyroid gland. This equipment was emulated elsewhere. There are more sophisticated techniques now available, but at the time it was a quite unique and a very useful instrument. Also, in our studies of radioactive iron, to quantitate the radio-iron in blood specimens we had to electroplate the iron derived from the blood onto a copper plate solution. That necessitated acid digestion in a Kjeldahl flask of red blood cells and then appropriately treating the digestate chemically, and electroplating the iron from the destroyed red cells onto a little copper disc. This made possible, really quite sensitive determination and quantification of the amounts of iron which were contained in the sample of blood. Also, we developed the technique of using radioactive chromium to determine the survival of red blood cells and not only the survival of these cells, but also using these labeled cells to determine the volume of red cell mass in the body. Interestingly enough, this again is a technique which is widely used even at this time. It is quite feasible to quantitate very accurately the length of time that red blood cells will survive. Take the individual's own cells, label them with radioactive sodium chromate, then puts his own labeled cells back in his body, so you're actually finding out what happens to his own cells in his own environment. It's interesting, you can compare that with what happens with the donor cells from some other individual in the transfusion into the same person who's got his own cells back and compare the two, which is an interesting approach to solving certain problems.
[end tape three; begin tape four, side one]
Q: Dr. Ross, I was wondering if you could say a few words about the contribution of your wife and the rest of your family during your medical career?
Ross: During the time that I was a young physician, it was the habit of people in my position to spend all their time, efforts, and concerns working on the medical problems at hand. And I confess I failed to spend an adequate amount of time in other pursuits. However, in December 1942, I married a lovely lady named Eileen Sullivan, who was a microbiologist head of the bacteriology lab at the Peter Bent Brigham Hospital of Harvard University. She always was a tremendous support and help to me in my endeavors. We had five children, and they were all born while I was in Boston. I confess, in retrospect, I feel guilty at not having spent more time with my wife and my children, but they never complained, and they made it possible for me to do things which otherwise I could not have done. I shall be everlastingly grateful for these facts. My wife died three months ago after a six year battle with carcinoma of the breast during which time she never complained. My children were a tremendous support to her and also to me subsequently. I am very glad that I was privileged to have such a marvelous wife and such wonderful children!
None of my children wanted to go into the field of medicine. They said you had to work too hard to be a doctor like I was and they could think of better ways to spend their lives. I'm sure being a physician takes a lot of work, but I'm not sure they'll find any better way to spend their time.
Q: Dr. Ross, during the World War II period, 1944 to be exact, an individual by the name of Henry Stratton met another person, Siegfried Tanhauser, and expressed an interest in beginning a journal in the field of hematology. It was Tanhauser, apparently, who introduced Stratton to William Dameshek in 1944. I was wondering if you could give some details first about Stratton, and then about Dameshek's role in founding the journal which was to he called Blood.
Ross: Yes. What's the name of the gentleman again?
Ross: Dr. Tanhauser was a very distinguished German physician who was expelled by the Nazis and came to the United States and became a professor of medicine at Tufts University. In that capacity he contributed greatly to mankind's knowledge in the United States. He was a very interesting man in relationship to certain types of pigment metabolism as it related to hematology. Dr. William Dameshek was the hematologist at Tufts and they became very close friends. There was another immigrant from Germany, a man named Henry Stratton, who had known Dr. Tanhauser in Europe. He had worked for Springer-Verlag, a publishing house which was, I believe, located in Munich. Everything that he had in Springer-Verlag was bombed out during the war, so he came to this country to start another publishing career. He, for some reason, wanted to start it in hematology. I don't know quite why, but he was a very astute gentleman. So he wanted to start a journal of hematology and Tanhauser, I guess, put him in contact with Bill Dameshek and between the two of them they decided to publish the journal, Blood. This was a joint ownership at that time. There was another gentleman named Grune, who I believe also was a refugee from Germany, but he had a significant amount of money and he provided the funding to start the journal, Blood. Subsequently, Mr. Grune, I think, was bought out by Doctor Dameshek and Henry Stratton, but Mr. Grune was tremendously effective in initiating the publishing activities of Henry Stratton. The company was known as Grune and Stratton. The journal Blood, I believe, was initiated in 1944. I can't be terribly sure about that--
Q: 1945, I believe, is its founding date.
Ross: --with Bill Dameshek as the editor. He got a group of associate editors and an assistant editor. I was the assistant editor and my job was to develop an abstract section of the publication, which I worked at for some years and which I think was very helpful to many hematologists. I became an associate editor along with Charlie Doan, Max Wintrobe, and two or three others--Carl Moore and some other distinguished individuals. At the time that the publication was begun Bill Dameshek used to put annotations at the foot of the articles which appeared in the journal saying that he disagreed with what was being said by the author or amplifying what the author had said. This was distinctly unusual in American scholarly journals and exception was taken to this activity both by Max Wintrobe and by Charlie Doan. At that point, we learned that Bill Dameshek owned a sizable portion of the journal Blood, and he allowed as now he was going to do what he saw fit as the editor and part owner of the journal. At which point all the associate editors resigned en mass. At that point, Bill decided maybe he'd better rethink the situation, which he did, and he agreed that that policy would be abandoned in the journal Blood, and that he was going to be much more amenable to the suggestions of his associate editors in the future, which he was. He was really a very great gentleman, scholar, and physician, and he had his way of doing things, but he was willing to modify it if other people thought he should.
Another interesting thing that he did--he was interested in international aspects of hematology and medicine and he was able to print the abstract of every article of the journal in Esperanto for a long period of time. I was never sure how really valuable this was since I always figured that anybody who was going to take the journal Blood could read it in English without having to resort to Esperanto. However, this was done for some years and then, I think because of the cost, it was abandoned. It no longer is done in the journal Blood. But the journal Blood was really a very successful publication. There are other publications in the field like Vox Sanguinis and other publications in Europe and also now in Japan, and they complement the activities of Blood: The Journal of Hematology. On the other hand, being biased, I would say that Blood: The Journal of Hematology, was one of the formative influences on the establishment of hematology as an effective discipline and brought coherence to the field.
Initially, the articles published in Blood, almost all of them, were clinically oriented. With the advent of new editors and new advisory boards, there is now much more basic science published in Blood than there used to be. I think that it probably outweighs the clinical articles at this time.
Interestingly, another journal has sprung up in an attempt to compensate for that. This new journal is called the American Journal of Hematology, and it concentrates on clinical presentations. I think that's good. There ought to be an opportunity for publication of any article which is good on any subject. It seems to me, unfortunate that good clinical articles are left out of Blood in order to publish basic science articles and vice versa in the American Journal of Hematology.
Both of these journals, I believe, are flourishing as are the journals published in Europe and also in Japan about hematology.
Q: Do you know if the European journals or the Japanese journals predated Blood?
Ross: I believe one of the European journals did. I can't tell you now which one, but I'm not even sure about that. I just don't know. Now there's a Scandinavian journal of hematology, there's VoxSanguinis, which I think originated in Switzerland and there's a European Journal of Hematology. I know that most of those came after Blood, but how many of them antedated it, I don't know.
Q: The American Journal of Hematology, do you know when that started?
Ross: This started four or five years ago, I believe, and I don't think it has the stature nor does it have the excellence of the journal Blood, but nevertheless it's a good publication.
Q: Were the early articles in Blood determined by Dameshek's own idiosyncratic feelings of how hematology should develop, or was there some other policy underlying that decision?
Ross: Dameshek selected the articles to be published and rejected the articles not to be published. Initially, he did this as a solo endeavor. Subsequently, with the encouragement of the advisory board, it was agreed that he would send these out for review to other people. Subsequently, each article was sent to two independent observers and to some extent Bill Dameshek was constrained in his selection by the opinions of the reviewers and of his associate editors. Initially, it was some what difficult to obtain enough articles to put out an every other monthly publication of the journal but this didn't last very long. I was on the editorial board for ten or twelve years, and at the time I left the board I think the acceptance rate was about forty percent of those that were submitted.
Q: I was wondering if we could go over some of the names that you mentioned who were among the early associate editors and assistant editors of Blood, and perhaps you could supply some background information. Along with yourself as assistant editor, there was a Steven Schwartz? Do you recall?
Ross: I think he came along a good bit later on.
Q: I had him as one of the original--[tape interrupted]
Ross: In the early days of the publication of the journal Blood, it is of interest that Bill Dameshek, the editor-in-chief and part owner of the journal, operated pretty much on his own in respect to editorial policy as I think I've already commented. He didn't necessarily see fit, originally, to refer articles to review by others but this was changed. He also used to put footnotes in the articles if he didn't agree with what the author was saying and that irritated some of the members of the board, as I commented, but he had a very distinguished group of individuals who assisted him in establishing this journal. For example, there was Dr. Charles Doan, a very distinguished hematologist in Columbus, Ohio, who had worked with Florence Sabin in delineating the reticulo-endotherial system and the vascular system of the bone marrow. He was an active participant and brought great wisdom to the board. There was Thomas Hale Ham, who was an excellent hematologic investigator and a very great stimulant and interested in large measure in improving education in the field of hematology. There was Roy Kracke of Alabama, who had been the individual who recognized the connection between medication with pyramadon and the cause of agranulocytic angina, and Maxwell Wintrobe of Salt Lake City, who authored the first definitive modern textbook of hematology, who was very interested in this journal and always was very critical about the advertisements which appeared in the journal. He was a very great stickler for propriety and he used to protest vigorously that the items which were being advertised in the journal weren't really up to the snuff to the extent that he thought they should be. Finally, it was agreed that any advertisement that was going to be put in the journal was going to be reviewed by Max Wintrobe from the standpoint of its appropriateness to appear in a journal.
Then, of course, George Minot, the Nobel laureate in hematology, initially was a consulting editor who provided great insight and wisdom in the initial stages of this journal. I played a role, initially, as an assistant editor, as also did Steven Schwartz, who at that time was in Chicago. My particular assignment was the development of the abstract section, and it might be that Steven Schwartz was involved with the book reviews. I can't really remember what his actual assignment was.
Then there was a very great group of advisory editorial people, among whom was Russell Hayden of Cleveland, a great hematologist; and Cyrus Sturgess of Ann Arbor, University of Michigan, who had a tremendous reputation and had published definitive textbooks in the field of hematology, prioriented toward clinical endeavor; Laskey Taylor, who as a coagulationist at the Thorndike; Oliver Jones in Buffalo, who was a cytologist; Cecil Watson of Minneapolis, who was interested in pigment metabolism; and Philip Levine, who had a great deal to do with recognizing Rh factors in blood and contributed very greatly to our knowledge about establishing compatibility of blood transfusions.
Every year there would be a luncheon, which was subsidized by Henry Stratton, at which all of these individuals would be assembled. We would have a nice luncheon and discuss things. As time went on, this group really had a considerable amount of persuasive effects on Bill Dameshek in operating this journal. It became, I think, the preeminent publication in the field of hematology in the world. It was extremely valuable to have a place for hematologists to publish their activities together in a coherent fashion. Henry Stratton insured that the publication was done in an excellent fashion. Having been a European, he was able to get absolutely magnificent photo reproductions of the drawings and the photographs of the various blood cells. He saw to it that the photographic and other illustrations in the journal were absolutely superb, as best they could be! The whole effect was of a really excellent publication which has continued since.
Q: Okay. I was wondering if you could comment on the purpose behind the publication of Blood in 1945. Were there differences of opinion about what its function should be? At this time, there was no society of hematologists in the United States. As you mentioned, the first major textbook in hematology had just been published in 1942 by Max Wintrobe. Was this seen as a push towards organizing it as a discipline?
Ross: At far as I'm aware, I don't think it was recognized that it was pushing toward an organization at that particular time. I think it was felt by the people we've just been discussing that it was a very appropriate thing to have a common site of publication of articles that dealt with the hematopoietic system. It certainly provided that. As a consequence of this interest, I think there was organized what was called the Blood Club, which met in Atlantic City in conjunction with the meeting of the Society of Clinical Investigation and the Association of American Physicians.
Q: Dr. Ross, I'd like to now talk about the International Society of Hematology. Its first organizing meeting was held in Dallas, Texas, and Mexico City in 1946. Could you perhaps talk about its early start and its purpose?
Ross: I believe that the spark plug in back of the creation of the International Society of Hematology was a hematologist in Dallas whose name was Joe Hill. He worked with another man name Haberman. They had interests in trying to establish an international organization. It's of interest that this antedated the American Society of Hematology by quite a few years. He was able to interest the Mexicans, as well as the Americans in doing this. It was agreed, after an initial sort of rump session, that there would be a planning meeting. I participated in the draft of the constitution and bylaws for the International Society of Hematology [ISH]. Subsequently, there was a meeting of the ISH. I think it was the first meeting, in Buffalo, New York. Is that correct?
Q: Yes. In 1948.
Ross: In 1948 under absolutely intolerable climatic conditions. I think the temperature was one hundred and ten, the humidity was two hundred and fifty, and it made everybody pretty limp. Anyway, in spite of that, the organization got under way and it became really a very successful organization. It led to meetings that were held in different parts of the world at different times.
I remember there was another early ISH meeting that was held in Mexico City in which some of the American participants got deathly ill. One of them was my friend Clement Finch. He got gastroenteritis so severely that he had to be taken to the hospital and given intravenous fluids to replenish what he had lost by rectum. Some people thought he wasn't going to make it. I remember we had a great big picnic in a park at which they served barbecued goat along with certain other delicacies. I was somewhat familiar with some of the problems that confront Americans when they eat too much Mexican food. I was very circumspect in what I ate at that picnic and I didn't get sick. There were an awful lot of the other ladies and gentlemen who were there, who did get very, very ill!
That was a fascinating conference. We met in one of the Mexican public buildings which was exquisitely wired for sound, for projection of slides, and time devices to limit the speaker. They had a very novel device and at the time that a speaker's time was up, not only did the warning light on the podium go on but the electric current was cut off from the loud speakers and from the microphone so the speaker had to stop talking because nobody could hear him. I've always thought that was a good thing to do!
Anyway, the ISH prospered and it still meets. It has representatives from all over the world. It, fortunately, is not a very expensive organization to belong to, and I think it serves a very useful purpose. It served a useful purpose in the United States in promoting the establishment of the American Society of Hematology.
Q: Can you recall any of the international hematologists who participated in some of the early meetings?
Ross: I confess my memory isn't quite up to doing that, Mr. Hoffman. I wish I could. I remember a few. There was Jan Waldenstrom from Sweden who had described an interesting syndrome known as Waldenstrom's disease, and had done studies of familial relationships in porphuria. He was an active participant in the ISH. Doctor Tanhauser, who had come from Germany, was an active participant, and there were others, I think, from Italy. I can't remember whether Dr. Guglielmo was at that time involved, but I believe that he was. There were other individuals from Italy who I cannot remember. There were active people from Japan and that's about as far as I can take it at this point.
Q: Okay. During the--as you pointed out yourself--during these meetings, Americans who were practicing in hematology would come together and yet they had no society of their own. It was by 1954, I believe, that an informal blood club was formed.
Ross: It was recognized that there was no really very convenient way for people interested particularly in hematology to get together and talk about things, so there was a group of us that decided that we might as well form what was called a Blood Club, which was highly informal. There were no dues, no by laws, no minutes, no elections. There was nothing except the annual meetings. The chairman for the next year's activities was, in essence, appointed by the chairman of the past year's activities. The chairman was responsible for putting together a program. In the interests of trying to diminish travel costs it was decided to hold this in conjunction with meetings of the Society of Clinical Investigation, and the Association of American Physicians, and the American Federation of Clinical Research, all of which met at the same time in Atlantic City. So, we decided to try to have a meeting there on one of the evenings which didn't have any other formal activity going on. This was extremely successful. There were hundreds of people who turned out to participate in this. The programs were usually very excellent! Each year the program was arranged by the chairman who invited people that he knew were dealing with current items of interest who were good speakers, and good communicators. They were very successful activities!! This perpetuated itself. I believe that it is still going, although I haven't gone to these meetings for the last several years. However, it still is informal. The only charge that is levied now is that they charge a dollar to fill out a postal card which will be mailed out the next year to the individual who fills it out to inform him about the Blood Club and what the program will be. That's a wonderful way to run a meeting. That has continued, and that, again, served to increase the interest in the field of hematology and sort of meld people together who wished to come together in a more formal organization than had existed previous to that time. It also was an anlage to the establishment of the Society of Hematology.
Q: Should the Blood Club be seen as a compromise between those American hematologists who would have liked to have formed a professional society as opposed to those who were not wanting to see such a society exist?
Ross: Yes. I well remember an initial discussion held in Atlantic City in--I believe in Carl Mooer's room--in which some of the representatives from the Thorndike, including Bill Castle, were present. They thought it was quite inappropriate to try to make a formal organization in the field of hematology. They thought hematology was a part of internal medicine and they felt that to establish a separate society of hematology would fragment the field of internal medicine. They had certain, very cogent arguments to support this. Indeed, what happened when the Society of Hematology and other specialty societies did get formed was precisely that. It led to the segmentation of the specialty of internal medicine in to many subspecialties.
That has gone on. There are specialty organizations not only in hematology but in cardiology, nephrology, endocrinology, all kinds of things, and it has led to a fractionation of the general specialty of internal medicine, but that's the way that human intellectual endeavor and human cultural endeavor develops. When something gets big enough and important enough, you make a new organization which is an offshoot of the preceding one which will be concerned specifically with the separate field. After all, this is the way that biochemistry sprung up out of physiology and physiology sprung up out of anatomy. Radiology, interestingly, developed out of surgery. There's nothing wrong with this to my way of thinking. Nobody can know everything about everything. Knowledge and competence is acquired as a consequence of these specialty organizations and concentration in certain more limited fields.
But what you say is quite true. There was considerable opposition to establishing a formal society and, possibly as a compromise to that, it was determined that we would try to have a Blood Club, which was to meet informally, as I said, in conjunction with other organizations.
Q: Who were some of the driving forces behind the Blood Club at that time?
Ross: I think you would say Dameshek, Carl Moore, Joe Ross, Charlie Doan. I think Hale Ham was supporting that and I confess that my recall is not much greater. I'm sure there were others but I can't really recall them.
Q: They seem to be some of the same people who were grouped around the journal Blood, it's editorial board.
Ross: That's correct.
Q: The members of the Blood Club also participated in the International Society of Hematology. It was at a meeting of this society in Boston that the suggestion came up, once again, to form an American Society of Hematology. Can you, perhaps, recount what went on there?
Ross: It was decided to hold a meeting of the International Society of Hematology in Boston. Invitations went out around the world and lo and behold, I think something like two thousand people showed up at that meeting, which was far greater than had been expected. Of those two thousand people, it's my recollection that twelve hundred or fifteen hundred of them were Americans. It was an excellent program and the enthusiasm and the scientific excellence of the presentations was really quite striking.
In the course of this meeting, there was a sort of an ad hoc group that got together for a dinner at the Harvard Club, which was immediately adjacent to where the ISH meetings were being held. I think this dinner was paid for by Shields Warren. Shields Warren was there, Charlie Doan, Bill Dameshek, Carl Moore, I was there, and there were other people there, too. I think Bill Castle didn't see fit to attend since he didn't think there should be a separate organization at that particular time. After a very good dinner, there was a concrete discussion about forming a Hematology Society, and it was decided that if 1200 Americans wanted to come to a meeting like this ISH meeting, there ought to be an opportunity for them to have their own organization and to schedule their own meetings.
That was the beginning of the American Society of Hematology. An ad hoc group was appointed to develop a constitution and bylaws which was accomplished. There was some confusion about that--as to how much expertise was going to be required for anybody to join the society. It ultimately was decided that it should be inclusive and not exclusive, and that we should welcome people to this organization who might be chemists, physicists, bacteriologists, as well as clinical hematologists, and it became an inclusive organization that welcomed anybody who had interest in the field.
[end of side one of tape four; beginning of side two]
Q: Dr. Ross, I was wondering if you could provide some background information on some of the people who participated in the ISH meeting in 1956 which finally called for the formation of the American Society of Hematology. Could you first begin with Dr. Berman?
Ross: Lawrence Berman came from Detroit. He was a professor of medicine in hematology and a very effective organizer. He had been designated as chairman of the bylaws committee. I remember he made a trip to Los Angeles to see me to try to obtain my views as to whether this should be an exclusive or inclusive organization. I urged that he right the bylaws to make it inclusive and I think he got a good deal of advice to that effect and it was done, which, as I commented, was a very wise and a very successful endeavor. The society, now, has all kinds of different specialists in it, although the preponderant membership is clinical hematologists.
Q: Doctor Tocantins, was it?
Ross: Doctor Tocantins. I believe he was of Brazilian national derivation. He was employed in Philadelphia, Pennsylvania and he was, I think, a pathologist fundamentally. He was interested in the dynamics of certain aspects of hematopoiesis. He brought an international flavor to the group. He strongly supported its establishment, too.
Q: Dr. Jacobson?
Ross: Dr. Leon Jacobson was the head of hematology at the University of Chicago--a very colorful gentleman. He ultimately became dean and he sold the medical school to the Pritzker family, so it's now the Pritzker Medical School at the University of Chicago. In the process of doing this, he raised some five million dollars for the school so I guess it was all right. But Jake was very interested in the hematopoietic effect of the kidney and hematopoietin. He exploited this very successfully. He, too, was a very astute gentleman and a very good clinical hematologist. He contributed a great deal to the concept of establishing the Society of Hematology. Jake is retired now. So far as know he's in good health but I don't know whether he does anything in relationship to hematology now or not. It might be worthwhile to contact him and find out.
Q: Dr. Crosby?
Ross: Bill Crosby worked with Bill Dameshek. He was a colonel in the Army--and an excellent hematologist and a very good organizer! He contributed a great deal of wisdom. He ultimately had very severe visual difficulties with cataracts, which were removed, so he was burdened with very thick lenses in his glasses, but this didn't dilute his interest and effectiveness in hematology. He was a good writer and he wrote a great many articles which contributed to our understanding of such diseases as paroxqsmal nocturnal hemaglobinuria and others. For a while, he was in San Diego. I confess I don't
know where he is now.
Q: Dr. Philip Levine?
Ross: Philip Levine--I think he pronounced it Levine--if I'm not incorrect, was a blood grouper. It was he who recognized the importance of the so-called lesser factors in blood grouping and compatibility, and discovered the Rh factor. He was a very interesting and a very dynamic person. I think he ultimately went to work for industry. He also was a very strong supporter of establishing an American Society of Hematology and contributed good ideas about it!
Q: Doctor Joe Hill we mentioned before. Doctor Jones?
Ross: Oliver P. Jones was an anatomist who came from Buffalo. He was a professor of anatomy in that school. His primary interest was the cytology of blood cells and the morphology of blood forming organs. A very stimulating gentleman! Because of his initials, he was usually referred to as Opie. I think he's still going strong. He's a charming gentleman with a very considerable interest in the history of medicine.
Q: Did Henry Stratton continue to play a central role in bringing together hematologists at this stage?
Ross: Yes, he did. He provided the funding to establish a Dameshek Memorial Award after the death of Bill Dameshek. He attended all of the meetings and he made appropriate comments at the time that they should be made. He was a very good advocate of the journal Blood, and wanted it to become the official journal of the society. Ultimately, he was awarded an honorary doctor of medicine degree. I'm not sure which institution it came from. He was made a member of the American Society of Hematology. I think if you had asked him, he would have considered himself as a parent of the American Society of Hematology. He was a very effective promoter and a very effective publisher. He just died fairly recently. In his memory, the Society of Hematology Stratton Award and lectureship were established. I believe that the funding for the Dameshek Award was provided by Henry Stratton--and I'm not sure, but I wouldn't be surprised but that he also provided the funding for the Stratton Award and lectureship.
Q: You've mentioned that numbers of people who participated in this meeting of the International Society of Hematology and gave the call for an American organization came from different disciplines. Were they generally connected to hospital services? Or was there any input also from academic departments?
Ross: I think the primary stimulus came from people who were academics. On the other hand, there were many, many people involved in this who were hospital pathologists and who worked in hospitals. I'm not sure that there were any of them that were solo practitioners and did nothing except practice hematology. I think most of them derived from institutions which salaried them and perhaps sponsored and fostered their interest in hematology. I can't give you a percentage breakdown, but I think roughly that's about the way it developed. But there were pathologists, anatomists, physiologists, biochemists, clinicians. There was a whole mix of all of these people together, which I think led to the development of this field, which is an eclectic field and also an inclusive field. I think is splendid!!
Q: Did programs develop at this time in other universities in terms of teaching at the postgraduate level or within the medical schools concerning hematology?
Ross: Yes, I think the stimulus of the creation of the American Society of Hematology, the publication of the journal Blood led to an increased interest in hematology in many institutions. All medical schools very shortly had divisions of hematology, most of them dedicated to research endeavor as well as to patient care. This, of course, was complemented with the establishment of the subspecialty of hematology as a certifiable subspecialty of the American Board of Internal Medicine, because this then made it possible to establish formally organized and recognized residencies in hematology in medical schools and hospitals with the opportunity for the graduates of these residencies to become Board certified hematologists. This developed very rapidly. There was a certain contention between the Society of Hematology and the American Board of Internal Medicine as to who was going to have the responsibility for this specialty certification, but there was a very strong gentleman named Jack Myers, who at that time was chairman of the American Board of Internal Medicine. I remember he made a visit to the Society of Hematology meeting and members of the Society were protesting what they considered to be the preemption of the field by the Board of Internal Medicine. Jack Myers had a short fuse. He got up and he said, "I don't care what your going to do, the Board of Internal Medicine is establishing this and if you have any sense you'll join in and support it to make it good because you're not in a position to offer accreditation of training programs or to really issue any special certificate in the special field of hematology!!" He said, "You'd better join up with us and we'll do it together and make it much better," and that occurred to the great advantage of hematology, the Society of Hematology, the American Board of Internal Medicine, and most importantly the citizens of the United States.
Q: In April of 1957, hematologists came together to carry out the first meeting of the American Society of Hematology. Could you recount some of the events during that?
Ross: I believe, although I'm not sure, that that meeting was held in St. Louis. Is that where it was held? I think so. At the time, Carl Moore was the President. I can't be too sure of that either. At the first meeting, it was planned that we should go ahead and make as good an organization of this specialty as possible and that we should rotate the meetings in different parts of the country to make it possible for people who couldn't afford transportation costs to attend some of the meetings. That has been done since. The meeting, I think a year or two later, was in Los Angeles, then it was in Columbus, Ohio. At one time it was in Canada. Usually, the meetings rotated to be held in the location of the city in which the president resided. I was president-elect when we met in Los Angeles and president when we met in Columbus, Ohio. This was really determined at the first meeting of the society and, again, it was an attempt to be all inclusive and make possible the participation of as many people as possible. That's continued and now the society meetings are very large and there are multiple sessions that provide an opportunity for anybody who has got anything worthwhile saying to say it. Initially, there was only one session for the whole duration of the meeting. When I was president at the time we met in Columbus, Ohio, for the first time I started dual sessions that were simultaneous. This provided an opportunity for twice as many people to present papers, but it also meant that there were conflicts in attending sessions. People who had an interest in a subject which would be presented here in Session A and also interest in a subject presented at the same time in Session B couldn't attend both presentations at the same time. It made it impossible for a person to hear all presentations, and this led to criticism. However, dual or multiple simultaneous sessions have continued. Now there may be many sessions held simultaneously.
Q: The meetings themselves were divided between scientific sessions and organizational sessions. How were the scientific sessions, themselves, decided upon? I believe the first sessions dealt mainly with bone marrow transplants and various items dealing with bone marrow problems.
Ross: The business of the organization was conducted at a business meeting which usually was held for an hour or hour and a half, in the middle of the meeting. The scientific sessions were based upon the selection of the program from submitted abstracts. When I was the president, I did this job. I created a committee with representatives from over the world. I had a representative from Greece, another from England, another from Japan and others from other countries, as well as the USA. Every abstract submitted I had photocopied and sent copies to committee members with a check-off ballot indicating their evaluations and recommendations for inclusion in the program. These were used to select the program. It was very interesting. There usually was a concurrence of opinion as to what ought to be included and what ought not to he included. The items which were not included for oral presentation were noted as "Read by Title," and the abstracts were published together with abstracts of the papers that were orally presented. This was a good idea. It gave everybody a chance to indicate what he was working on.
Q: Were there problems that still came up between those who had previously been against the organization of the American Society of Hematology? Or, had that more or less been done away with?
Ross: I don't think Bill Castle--I may be wrong about this--you can ask him. I don't want to speak for Bill Castle. He's quite able to speak for himself! I think he was not very enthusiastic about it the society in the early years. Whether he is now or not, I don't know. Initially, Max Wintrobe was not very enthusiastic about the society. In the hierarchy of the society, I always felt quite badly that Max wasn't a participant. Max was encouraged to become a participant. It was suggested that he apply for membership which I think offended him. He said, "God damn it. They can ask me to be a member. I don't have to apply." However, he finally filed an application. Of course, he was made a member and he became president of the society and that breach was healed. I think most of the opposition to this organization has vanished.
As I commented before, the segmentation of internal medicine into various specialties is occurring. I think it's essential. I think it's handwriting on the wall. That's the way knowledge is perpetuated and developed. I don't think anybody really resents the existence of the Society of Hematology anymore. It's a good organization. It holds fine meetings. It brings together people to exchange ideas. It promotes new ideas and that's highly desirable.
Q: It's been mentioned by a number of people that an area of contention came up between self conscious hematologists and people who became to define themselves as oncologists in the development of the new field of oncology. Could you perhaps comment on this?
Ross: Yes. Hematologists, I think in large measure, tried to adhere to the study of the hematopoietic and lymphopoietic systems in the body. They were really quite successful in blazing the way for chemotherapy of illnesses of these tissues and systems. Most of them weren't very enthusiastic about getting involved in what were called solid tumors, such a carcinoma of the breast, colon, liver, brain, and so forth. They pretty much stayed clear of this, which in retrospect was a mistake.
I remember when I was chief of the division of hematology here at UCLA, instead of going out and recruiting people who could be considered as general oncologists, I pretty much hued to concept that the division of hematology should be pure hematologists. That was a mistake. Consequently, the medical school brought in people who called themselves oncologists, who initially had been hematologists but had branched out into these other areas.
Then there were very effective proponents of a specialty of oncology itself, who were not and had never been hematologists. This was contributed to initially primarily by a Dr. Byrl James Kennedy, professor of medicine, at the University of Minnesota. But he was a very effective advocate of oncologic medicine and he was able to persuade the American Board of Internal Medicine to establish a subspecialty of oncology with training programs, certification examinations, and issuance of diplomas. This was initially opposed rather halfheartedly by the hematologists but later they oppose it much more vigorously. It's too bad that both subspecialties couldn't have all been combined into one, because today many physicians who have become certified in oncology take another year also to become certified in hematology and vice versa. I think that's probably the way it should be, because the oncologist uses agents which were developed and initially were most effective in hematology and the adverse effects of these agents given to patients with solid tumors usually relate to the hematopoietic system. So you have to know a great deal about the hematologic system to be very effective as a chemotherapist of "solid" tumors.
Q: I believe another area of contention that came up within ASH was between those who wanted to introduce accreditation standards for hematologists and those who opposed turning the society into an accrediting body.
Ross: Yes. I mentioned this briefly when I commented about the somewhat vigorous disagreement between the Board of Internal Medicine and the Society of Hematology. There were people in the Society of Hematology who did not really understand the mechanism of American specialty medicine. As I commented, the only real certification which has meaning in this country is one which is given by an accredited certifying board under the American Board of Medical Specialists. The hematologists didn't really understand about that. They thought they could do it themselves when, as a matter of fact, in the developing political milieu of the United States, it could not be done. The organizations who have attempted to establish independent certifying bodies in the main have fallen flat on their faces. Their certification is not recognized by the government, not recognized by the rest of organized medicine, and not infrequently is fraudulent--not that the ASH would have been fraudulent but many of these unaccredited boards are. There was a foregone conclusion that these people in the ASH were of good intent but were uninformed. They just couldn't do that. There was a good deal of hard feeling at one point but I hope that now that's all gone by! After all, the Society of Hematology is really not an accrediting body. They are not in a position to prescribe what has to be done, whereas the Board of Internal Medicine and the Board of Pediatrics are so qualified, and so recognized by organized medicine, the government, and the public. I don't know whether this still is a source of irritation among some of my brethren in the Society of Hematology or not. I hope not, but I don't really know.
Q: Dr. Ross, could you comment a bit about your personal involvement in the various stages of ASH? You served on the executive committee from 1957-1962.
Ross: If you say so, those are the dates. I was, I think, a member of the executive committee from the time of its institution and then I became president of the society in 1961. Then, subsequently, I was a chairman of the bylaws committee. We had quite a large rumble about that because the incumbent president didn't think there was any necessity for change in the bylaws, whereas the people on the bylaws committee and the society as a whole felt that there should be. This gentleman who was the president objected to one of the provisions in the bylaws that would have established a council of past presidents that had no authority but would have maintained the good will and the active participation of the past presidents who were in a position to be a considerable support and help to the organization. It was thought they might be helpful in such things as, for example, recommending where the meetings might be held in the future, establishment funding of lectureships; kinds of things like that, that then would be acted upon by the executive committee and the society as a whole. The president at that time was George Brecher. He didn't like that idea, so he was able to talk the membership of the society into voting that down, but all the rest of the bylaws revisions were voted into effect by the society as a whole.
Q: Dr. Ross, could you add a few more words on the journal Blood, and the development of ASH?
Ross: From the time of the inception of the journal Blood and the time of the creation of the Society of Hematology, it had been I believed by many people that this journal would become the official organ of the society. Well, that wasn't possible so long as Bill Dameshek and Henry Stratton owned the journal and were unwilling to transfer title to the ASH. It was repeatedly presented at the Editorial Board meetings, "Why can't we call this the official journal of the Society of Nuclear Medicine?'' As long as Dameshek was alive and Henry Stratton was around, this never came into being. When Henry, in essence, retired from Grume & Stratton he sold this journal, to Harper & Row who undertook its publication. Harper and Row were much more persuasive. They got the Society of Hematology to, in essence, put its imprimatur on the journal, which Harper and Row owned and published and controlled. The society, I think, had authority in terms of appointing the editor and the editorial board and it worked out all right. It is now the official organ of the American Society of Hematology, which is the way I think it should be and nobody's hurt too badly from this. It's too bad that the society can't cash in on some of the revenue from the journal, but that was not to be since it was initially privately held and Henry sold it to Harper & Row rather than giving it to the society, which was certainly his prerogative.
Q: Did the nature of the journal Blood change once it merged with ASH?
Ross: Yes, its nature has change. It initially was almost entirely a clinical article publication. As time has gone on, it very largely has become a publication of more or less fundamental articles dealing with laboratory research in the field of hematology with a decreased emphasis on the clinical aspect, although the clinical aspect certainly is very important. I don't know what the present circulation is because it went from a six issues per year up to twelve issues per year. The last time I was aware it was very successful in terms of distribution, circulation, and probably revenue.
Q: Did the change in the nature of Blood take place with the development of new techniques that could be applied in hematology, or did it take place with the change of personnel who were interested in hematology as a discipline, or for some other reason?
Ross: I think the change in the field has primarily been a reflection of the change in interest of people who were in the field. The approach to the genetic, biochemical, biophysical, and other aspects of hematology came about after the clinicians had established the organization and the journal. This is quite natural. Initially, in medicine, the clinicians are the people who introduce things and then subsequently the more scientifically inclined brethren come along and explain what things are and try to make advances. This has happened in the society and in the journal. If you look at the programs of the meetings now in comparison with those held twenty years ago, it's obvious that this change has occurred and the emphasis on the clinical aspects of hematology has diminished and emphasis on fundamental research has increased. That's quite appropriate and very valuable.
Q: Dr. Ross, I'd like to now talk about your association with the development of nuclear medicine, both in terms of the development of the Society of Nuclear Medicine as well as in the capacity you served at various missions and projects abroad.
Ross: All right. As I've already told you, my initial research involved the use of certain tracer radioisotopes in studying the kinetics of blood formation and destruction as well as the use of radioisotopes for therapy. Initially these were research tools but as time passed it became apparent that they could be adapted and used very advantageously in the diagnosis and therapy of human disease. My involvement in this was, as I think I detailed, not only related to hematology but also to certain aspects of cardiovascular physiology [?], and in endocrinology, specifically related to the thyroid gland. Again, at the very beginning, there was no recognized specialty field of nuclear medicine. These isotopes were used as research tools and they were not considered as anything particularly useful from a practical clinical aspect. As time went by and radioisotopes began to be used more widely in the practice of medicine, it became apparent that such use was becoming a clinical discipline and a clinical specialty. As a consequence a group of physicians in the northwestern part of the United States organized a society of nuclear medicine which initially was comprised primarily of physicians in Washington and Oregon, and a few from California. This served, again, as a focus for the development of the field and it rapidly expanded to include representatives from the entire United States. These were organized in chapters on the basis of state of location. This proved very effective and led to a marked expansion in the clinical application of radioisotopic tracers and their therapeutic uses.
At one time nuclear medicine--I believe this was in the 1960s--was the most rapidly developing specialty field in the whole area of medicine. Radioisotopes soon were in use in almost every hospital in the country and clinical uses soon were being taught by preceptorship in many teaching hospitals. Frequently this was done under the aegis of the radiology departments, although radiologists had not played much role in the research development of these materials nor in the applications of these materials to clinical medicine.
As time went by, it became apparent that in order for this use of radioisotopes in clinical medicine to prosper as a specialty there had to be some mechanism of training or any recognizing physicians who wanted to go into the field. As a consequence of this, it was thought desirable to establish a certifying board in nuclear medicine, which in this country is the only way in which an area of clinical practice can really get recognition as a clinical specialty. Up until the time that the American Board of Nuclear Medicine was created in 1971, the recognized specialties which used isotopes most were internal medicine, pathology, and radiology. Radiologists radioactive isotopes as a modality in imaging and this was pretty much the extent of their interest. The pathologists used them for in vitro testing. The internists used it as a modality for investigating physiological and pathological processes and for treating patients. The only reason that the Board of Nuclear Medicine ever got to be was because the pathologists and the radiologists were fighting about who was going to control the field. Every time one of them would move forward the other would block him. The internists were passive since they hadn't yet been convinced that this was really a clinical rather than a research discipline. However, we were successful in interesting all three of these groups in becoming sponsors of the Board of Nuclear Medicine. The Board was established as the first so-called conjoint board with these three other boards as our sponsors. This sounded fine, but in practicality it was terrible because the radiologists wanted to gobble us up, the pathologists wanted to gobble us up, and the internists didn't want anybody to gobble us up, so we had lots of troubles. But we prospered and established training programs--some ninety of them. The field of nuclear medicine became a recognized specialty as a consequence of the establishment of this board. We've certified thirty-five hundred candidates, and we give examinations each year to about one hundred and fifteen people. We certify about seventy percent of them and fail the rest, which is about par with the other twenty-two recognized specialty boards. The field has prospered!!
I emphasize that my involvement in nuclear medicine began as a consequence of using isotopes as tracers in the field of research hematology. That was true of most of the original people in the field. Now the people who go into the field go into it with the specific intent of becoming practitioners of nuclear medicine. Interestingly, most of these people work in large, major medical centers or major hospitals, although some practice in communities of smaller size, and in smaller hospitals.
Last year we were successful in getting "sprung" clear of the controlling influence of some of our sponsors and we are now an independent primary board and can determine our own destiny without being blocked by these other boards!!
Q: In 1953, President Eisenhower gave a speech in the United Nations where he said that atoms and atomic energy could be used for peaceful purposes. By 1955, you were participating in the first international conference on the peaceful uses of atomic energy. This was in Geneva, Switzerland. I wonder if you could comment on that?
Ross: That was a wonderful meeting. There were representatives from all over the world, including the Soviet Union, which was presenting recognizably spurious information and data. It provided an opportunity for interchange of opinions, ideas, and comments, and the establishment of friendships. I was very fortunate in being designated to represent the United States at this conference. Not only did I enjoy the scientific aspects but I also enjoyed the food, the booze and the opportunity to travel around Europe. That was the first time I'd ever been to Europe. This was, I think, the only general, international conference on nuclear and atomic energy, that's been held.
As a consequence of Mr. Eisenhower's comments and beliefs, there were certain scientific missions established to Latin America. They were called Atoms for Peace. There was one that went to the east coast of South America and one to the west coast. I went to the west coast with the mission that went there. I think it's fair to say that the intent of this was to try to interest the Latin American people in the United States as a source of information and possible nuclear power development, but the medical aspects of it were important, too. This was quite successful because the whole of Latin and South America now turns to the United States for its reliance on things relating to nuclear activities rather than the Soviet Union. Had these missions not been held, it might well have been the other way around.
Q: This was in 1956?
Ross: I believe that was the year. I can't be absolutely certain. I don't remember the dates so clearly, but I think it was in 1956, the year or two after the conference in Geneva, Switzerland. It was quite successful. We visited the capitols of each of these countries. We were under the auspices of the ambassador in each country. We had entree into the highest levels of the local government. They were fascinated and intrigued primarily from the standpoint of power development but also, possibly, from the stand- point of military exploitation. The medical aspects came along in third place, but we played a fairly significant role.
In these missions, we were able to interest very good physicians who came to the United States for education and training in the clinical applications of nuclear medicine. Latin Americans also came to the USA to learn nuclear engineering, and power development. What the military aspects of the interchange were, I don't know. But it was really a very successful enterprise and there were many young men who came here. Interestingly, many of them after going back to their country ultimately returned to the United States, which is somewhat unfortunate, but they had much better opportunities here than they would have had in their own country. But this was a very exciting and a very worthwhile scientific and political mission activity on the part of the United States.
Q: During the international conference in Geneva, and later during the mission to Latin America, were the issues of monopoly over atomic energy raised as points of contention?
Ross: There wasn't any question that there was some suspicion on the part of the local people. I remember a cartoon once that appeared in, a paper in Santiago, Chile, which showed Uncle Sam standing there saying, "Atoms for Peace," holding big bombs behind his back. That wasn't very good publicity. But I think our mission, which included many very personable people who were able to speak to some extent in Spanish and in Portuguese, was able to allay the fears of many of the Latin Americans, and maybe turned away the wrath that might have otherwise have occurred.
It was very evident that there was competition between the United States and the Soviet Union to enlist the cooperation of these Latin American and South American people in the use of nuclear energy.
Q: Did this competition come up in the international conference in Geneva, too? Since the United States and the Soviet Union were both there?
Ross: There was very keen competition in the presentation of papers and I would say that it was a competitive presentation all the way down the line between these two people, from medicine to power generation, et cetera, et cetera. That's all right. That's the way we live.
Q: At this time were the questions of safety and the hazards of nuclear energy raised?
Ross: Not very much, no.
Q: Was Herman Muller, the American geneticist, in Switzerland? Did he talk about mutation rates at that point?
Ross: I cannot remember that. He might well have been. I have heard him lecture, but I can't remember whether it was in Switzerland or someplace else. I just don't remember that.
Q: Did he have much impact being one of the first people to develop a theory of mutations in chromosomes at this point?
Ross: He had an impact on the research that was conducted under the auspices of the Atomic Energy Commission, particularly in Oak Ridge and also in the Soviet Union. They were very interested in this subject. The initial interest was the possibility of using ionizing radiation to improve agricultural genetics. In the Soviet Union, when I visited there, there was one huge building that was dedicated to an attempt to improve strains of plants by radiating seeds. In this country, there was considerable interest in this. I don't think it bore any very great fruit eventually.
I don't believe that Dr. Muller's presentation and comments had a great deal of influence on the medical aspects of radioisotopic use, though it might have had much more than I recognized.
Q: Were there other people there who raised the medical aspects besides yourself?
Ross: You mean about the safety aspects?
Q: The safety aspects.
Ross: Not very much. It wasn't emphasized and nobody really wanted to hear about it as I recollect. Scientists don't want to hear about it now particularly either. After this Chernobyl event in the Soviet Union, UCLA medical center was flooded with queries from people who had been tourists over there in the Soviet Union at the time of the accident. They were scared half to death, out of their wits! They wanted to find out about this and that and the other. It was apparent that they had received a minuscule amount of ionizing radiation exposure. And one can attempt to allay their fear on the telephone, but ultimately you have to say, "Well, if you don't want to believe what I tell you, we'd be glad to arrange to see you in consultation for such and such a fee, and for such and such a fee have measurements made." As a rule, that turned them off. They didn't call back again. We did arrange to have half a dozen of them quantitated in the total body counter at the V.A., and, indeed, the showed minuscule amounts of half a dozen isotopes that they had' picked up while they were in Kiev.
Q: One of the other issues that's raised along with discussions of Eisenhower's Atoms for Peace Program is the commercialization of the nuclear energy industry as well as the various forays the industry makes into the medical field. Did this come up for discussion at any point?
Ross: Certainly the industrialization of nuclear energy is a very important aspect. In this country, it has been left, really, primarily to private corporations to develop fundamentally, the power industry. In other countries, of course, it has been done by the government. In France, which generates most of its electricity by nuclear power, this all belongs to the government. It is possible that in this country nuclear power generation might not be fought with such a tremendous flack by people who are worried about everything under the sun without much basis for worry if nuclear power generation had been developed by the government, but that's not the way we really do business in this country. I think the development of nuclear power generation was much better done, in terms of scientific and engineering process, by private corporations in competition. Unfortunately, the alarm reaction of many of our citizens, complemented by the Chernobyl disaster, has set back the development of nuclear power generation by at least a generation. As long as gasoline and coal are cheap, I don't think it's going to go ahead very much. But if we get in the position in which France finds itself, then we're going to have to generate electricity with nuclear energy, which with proper precautions, I think, is quite all right. There have been a great many more people in this country killed as a consequence of fossil fuel power development and generation than have ever been damaged or hurt from nuclear power generation, if you consider the number of people who have been killed in mining accidents in getting out coal, the number who are damaged, many of them irreparably, in oil drilling activities, the number who suffer as a consequence of the smoke and the smog that's released, and the fact that the burning of fossil fuels releases far more radioactive material into the environment than does a well controlled nuclear reactor. These are things that people don't think about. Unfortunately, it's not been possible to present this information to make them comprehend that this is not all that dangerous and it probably is much less dangerous than using fossil fuel. I once started a crusade on that but I got discouraged and stopped.
Q: When did you start this? How was it started?
Ross: This was in 1956, or 1958, or something like that. That was a long time ago. It was, maybe, thirty years ago, but it didn't seem to have much impact. I had other things that were much more interesting than that, so I dropped it.
Q: Was this under the Atomic Energy Commission?
Ross: This was when I was director of the Laboratory of Nuclear Medicine and Radiation Biology at UCLA. I felt certain obligations to try to be sure that our citizens knew something about the risks and the hazards and the benefits and the cost-effect ratio, et cetera. There wasn't very much enthusiasm to hear about that kind of thing.
Q: What was the main emphasis that you placed on discussions of atomic energy at the Geneva conference in 1955?
Ross: I think we had three or four papers. We had one on the treatment of leukemia and polycythemia rubra Vera with radioactive phosphorus. We had another one on thyroid diagnosis and therapy with radioactive iodine. I presented some information about the kinetics of hematopoiesis, and we had a paper on potassium metabolism. We had detailed manuscripts that were submitted and published in English, French, Russian, and Chinese. They had, interestingly enough, translators that translated all these papers simultaneously into these other languages. The translators got along fine except the Soviets. They have to use so many more words to say what we say in a word or two, that the translators were always gasping for breath.
[end of tape four; beginning of side one of tape five]
Q: Dr. Ross, I was wondering if you could expand a bit upon the Atoms for Peace Mission in South America. Could you talk more about the particular programs that were suggested to the Latin American scientists that you approached?
Ross: As I mentioned, the primary interest of this government, I think, and of the other governments was in nuclear power development. There were engineers in our group, primarily heat exchange engineers who'd had experience with nuclear power generators. That's what the Latin Americans mostly were interested in.
As I commented, the medical activities, although they were fascinating to me and the physicians with whom we met, really weren't of any tremendous interest to the governments of those countries who didn't have a hell of a lot of money to spend on health things anyhow and probably should have used what money they had in more rudimentary and more fundamental things, such as cleaning UP their water supplies, than in nuclear medicine. However, we did attract considerable interest and support from the physicians with whom we met and considerable interest in young physicians who wanted to come to the USA and learn about nuclear medicine.
The nuclear power development--I don't know how many reactors were developed as a consequence of this mission. There was already one in Venezuela that was run by a dictator. There was already one under development in Argentina, which was also under the aegis of a dictator. They were much interested in this in Chile, because Chile had certain deficiencies in its available power; also interest in this in Columbia, but not so much in Venezuela, which really had a rather underdeveloped industrial activity, and in Peru, also, which is primarily an agricultural country. However, there was stimulation of interest and these countries all now have nuclear medicine activities and nuclear medicine physicians. How much they do, I confess, I don't know. I haven't been there for a long time. It would be interesting to have an assessment to see what came about as a consequence of these "Atomos para la Paz" missions!
As I say, I think the primary purpose of these missions was political. It kept the Soviets out, it got us in, and that is certainly worthwhile.
Q: Were you politically briefed before the trips to stress the political aspects of the mission itself?
Ross: Not in the one to South America, but certainly the one I made to the Soviet Union. We had a whole day's briefing before we went and a whole day's debriefing after we got back. This was not inappropriate. They warned us about such things as microphones and telephoto lenses in bedrooms. They warned against any involvement with people who might compromise us. I was amazed that, indeed, attempts were made to do this. I was awakened at two a.m. one morning by a knock on the door and there was a perfectly gorgeous lady outside who wanted to invite herself in. I don't think it was just, necessarily, the briefing I got not to accept her invitation, but I declined it. This happened to two others of our mission, too. They all declined this invitation. But we were told that undoubtedly there was a telephoto lens directed in the room and anything we did would be recorded and might be used disadvantageously, not only to us but to our government.
The other briefings that we got when we went on the mission to the Central Treaty Organization were nothing like this. We weren't subjected to that kind of surveillance there. They were very friendly to us. They were friendly to us in the Soviet Union, too, up to a point. I suppose you could consider that all of these missions, to some extent, were political, but they were political not in a bad sense because politics is the way that mankind lives with itself and each other. So there was nothing disadvantageous about this.
In this Latin America affair, as I say, we sort of sensed that this was a political endeavor to entrench us in South America, which we accepted, but there was nothing that was clandestine or any other adverse aspect of our visits there. The same applied to the mission that I made to the Central Treaty Organization nations, and also another mission that I made to Greece. There was no adverse political involvement.
Q: Do you recall any of the other doctors of scientists who were involved in the Atoms for Peace mission to Latin America?
Ross: There was one man named John Rouleau, R-0-U-L-E-A-U. I think that's the way he spelled his name. I believe that he was a representative of the State Department. The man who was chief of the mission also was a representative of the State Department. There also was a representative from the Atomic Energy Commission. I was the physician member. There were agricultural members. There was also, as I commented, a heat-exchange engineer who had had dealings with nuclear power generation. Also, there was a biochemist who had interest in this. I cannot, at this time, remember their names, except for John Rouleau, who I've maintained contact with. Over a period of time, I might be able to recall these. Some place I've got the report in which they're all listed. If we edit this thing, I might try to provide those, but right now I cannot remember these names.
Q: Were there any representatives of the commercial world who accompanied you on this?
Ross: No, this was strictly a non-commercial government activity, strongly tinged with science, esoteric medicine, and good will.
Q: On the side of the Latin Americans?
Ross: On the side of the Latin Americans. We didn't have any military people in our group, but the Latin American military were very much interested. They recognized what the atom bomb had done to Japan and it might be that they might like to do the same thing to some of their neighbors. There was no encouragement given to that prospect from our group! But the military were there listening and they had a very avid interest in everything that went on. They were very interesting people, a very competent people, and probably as competent as anybody in their nations from the standpoint of expertise, knowledge, information, and capacity to get things done. The whole atomic energy activity, for example, in Chile was under the direction of an admiral in the navy. In Ecuador, it was all under the direction of a general. In Peru, it was under the direction of politicians. In Columbia, again, it was under the direction of a military officer.
I remember we went to visit the dictator in Ecuador and we were ushered into this room and there was this guy sitting there in a general's uniform and I happened to look around over my shoulder. There was in the balcony in back of us three soldiers with machine guns trained on us. Well, this dictator didn't last a hell of a long time. They kicked him out subsequently and we were there on more or less the eve of a revolution which displaced him. We were in the embarrassing situation of being suspect that we might try to do something to this general. I'm sure if one of us had reached inside his shirt pocket he might well have been mowed down. That was kind of exciting.
Interestingly, this dictator indicated to us that he had the most wonderful brothel that was patronized only by the members of the military forces of very high rank and, if we would like, he would make arrangements that we could be entertained in that brothel that evening, with a wonderful dinner and the full facilities of the organization. I'm afraid we declined that one, too, but we weren't suspicious that we might be implicated and blackmailed.
Q: Were the discussions that were held in the Latin American countries on a one to one basis, or were there actual conferences or symposia held?
Ross: There were symposia held. There were also person to person dealings with, in my instance, with physicians in hospitals and medical schools in which we discussed nuclear medicine. We also gave lectures to the students and to the house staff and to the medical faculties. That was very interesting. They all spoke English. There were translators there but they weren't really necessary. I didn't know enough Spanish to give a lecture in Spanish. It would have been nice if I had. They are complimented if you can talk in their own language, but I'm not that well educated.
Q: Did you make note of the status of hematology or nuclear medicine at that point?
Ross: Nuclear medicine was rudimentary or non-existent. Hematology, with few exceptions in South America, was not well developed. The exceptions were in Peru, where there was a wonderful doctor named Hurtado, who was interested in the changes that occur as a consequence of transporting individuals to high elevations. He had done magnificent studies of the development of polycythemia in people who were mining copper at elevations of fifteen to twenty thousand feet. They developed very interesting changes. Also, in Brazil there was a very excellent hematologic institution developed by Oswaldo Cruz, who was the discoverer of certain of the parasitic diseases that cause mankind trouble. This was headed by his son, who I had known in the United States, Walter Oswaldo Cruz. He had delineated the role of iron deficiency in the causation of hookworm anemia. Other than that, I would say that hematology was not very well advanced.
Q: In 1961, you were part of a health science mission to Greece and Turkey. Could you comment on that?
Ross: Yes, the membership of this mission was comprised of a physician, a professor of agronomy, a research agricultural specialist, and an entomologist, and a zoologist from the AEC. Again I would say that the primary reason for the mission was an attempt to find some way to control the Dacus fly. The Dacus fly destroys probably about fifty percent of the olive crop in the Mediterranean countries and is a terrible economic scourge. They took me, a physician, along as sort of window dressing. We arrived in Greece and we found that we had been established in a dormitory up in the top floor of the hotel since we had been announced as the Dacus team and they thought we were an athletic group. This got rectified fairly promptly with rooms for us, but I thought that was sort of funny.
The Dacus activity developed as a consequence of the belief that they could breed large numbers of the larvae that subsequently turn into these flies and sterilize them with high level ionizing radiation and then release them into the environment and the sterile males would copulate with wild female flies and thus lead to the die-out of the species of fly. This actually was implemented by the entomologist. I think he came from the University of California in Berkeley. They did do this, and I think that the political situation got so bad that they couldn't really continue with the project, which was most unfortunate because, as you know, use of this technique eradicated the screw worm in Texas as a scourge to the cattle industry. There was a good reason to believe that this also could be accomplished with the Dacus fly. However, I don't think it ever came to very much, which is too bad.
Q: In 1963, you were a member of a science mission to Iran, Turkey, and Pakistan as part of CENTO?
Ross: This was part of the Central Treaty Organization and these were the three countries in Southeast Asia and in the Middle East who were part of the Central Treaty Organization. The others were the United States and Great Britain. We went there to see what might be done to improve the situation of science in these countries. This was very interesting because the chief deterrents to science in these countries were the governments. Anything that was shipped in, for example, radioactive material or equipment to count radioactive material, or anything else, e.g. chemistry supplies for a hospital laboratory, would be held up by the import authorities of the country until it had rotted or decayed so that it was no good anymore. They gave no credence and no support to scientists. The chief problem with their scientific development was their government structure, which didn't recognize the importance of science. We called this to their attention but I don't think it made any significant change. But we had a wonderful relationship with the physicians and the scientists in those countries but they didn't control the country; the country was controlled by politicians.
It was amazing--in Dakka, which is now Bangladesh--there was a whole hospital dedicated to nuclear medicine, with something like fifteen beds. They had the most modern equipment still in the packing cases, unpacked. The beds were empty. Nobody knew how to use any of it, which was a terrible, terrible problem. The chief problem was education and manpower to do these things and there was no capacity to train personnel to operate the equipment or to use it!!
Q: What was the source of the equipment?
Ross: The Central Treaty Organization, which bought it from Britain, and from the United States' manufacturing companies, and shipped it over there at great cost! But nobody knew how to use it!!!
Q: In 1966, you pointed out that you were part of a group that went to the Soviet Union to discuss tracer applications. Could you expand on that?
Ross: This was an interchange between the United States Atomic Energy Commission and the Soviet agency for Atomic Energy. Our interchange was part of the relationship and we were all physicians. There were four members of this group. One was Dr. Charles Dunham, director of the division of biology and medicine of the U.S. A.E.C. Another was a radiologist Hymer Friedel, a professor at Western Reserve, who spoke a little Russian because his father had been a translator in St. Petersburg once upon a time, and Hymer was born there. He fascinated the Soviets. Another one was Paul Harper, a professor of surgery at the University of Chicago who had developed the application of certain esoteric radiation sources for inserting into tumors. And I was the fourth member. We had a marvelous time. We met many, many Soviet citizens who treated us wonderfully on a one to one basis, but when they sat in a conference room with all their conferees around they were the most stony-faced, hard-nosed people that you'd ever expect to see. They wouldn't speak in English, although they could speak English perfectly between just the two of us. In formal conferences everything had to go through a translator. I remember at the conclusion of the conference, our leader, Chuck Dunham, said, "Well, I hope we can visit with you again," and the answer was, "Not until you stop bombing North Vietnam." They said, "We're not going to have anything to do with the United States until they stop this incursion of the poor peoples of the world.'' That was the end of our conference. It was completely uncalled for, which was very sad.
Q: Was the discussion on tracer applications?
Ross: Yes, and also from the standpoint of therapy. They had the most amazing therapeutic machines using radioactive materials that I have ever seen! They were a reflection of the engineering that went into the space enterprise. They were about the same size and the same massive construction, but they were really not very sophisticated. For example, they had a portable radiation source that they would pull into the operating room and radiate an organ that was still exposed by surgical procedure. Well, there wasn't really much indication for that, particularly in an operating room in which flies were circulating around the operating table! But that was the level of development that we saw when we went to the Soviet Union at that time. Our interrelationships with the doctors that did this were wonderful. They appreciated the fact that there were lots they needed to learn but they weren't really in a very good position to do so. We also went to Obinsk, which was their so-called atomic city, there they have built a whole great big hospital for nuclear medicine activities, elegantly equipped and maintained! As I remember, they had something like two hundred beds just for nuclear medicine. I don't remember how many of the beds were filled but quite a number were. They were treating thyroid disease, polycythemia, rubra vera, leukemia, and solid tumors. They also had a huge building that was dedicated to radiation biology--the effect of radiation on plants, on animals, on bacteria--and many of the people there were really very sophisticated. They were very anxious to establish contacts with us, very anxious to learn anything we had to contribute and to convey what information they had.
I remember one of these old gentlemen had a considerable reputation as a geneticist and he gave me a whole set of his hooks in the Russian language. When I came back I gave them to the UCLA library. He had been awarded a special recognition by the United States government and they wouldn't let him out of the country to collect it. I think it was the National Academy of Science wanted to honor him. They wouldn't let him receive it!!
Q: Do you recall his name?
Ross: Not right now. I'll have to think about that.
Q: Was there discussion at this point about problems of--once again, safety--the hazards of--
Ross: Not much, not much.
Q: Okay. In 1963, you participated in an International Atomic Energy Agency panel on erythrocyte survival in Vienna. I was wondering if you could comment on this.
Ross: Yes. This was relative to the work that we had done in World War II in the preservation of blood. The conference wasn't just limited to that, but it was felt that the development of blood banking, the capacity to collect and store blood for reasonable lengths of time in many of the countries of the world was subject to much improvement. That was considered, but there also was consideration of hemolytic types of anemia and what might be done to investigate these diseases and hopefully to find better ways of treating them with tracer approaches. It was an interesting conference. There were many physicians from the Third World countries. I don't think it ever eventuated in anything very concrete, unfortunately.
Q: You also participated in an International Conference on Nuclear Medicine, once again, in Vienna in 1974.
Ross: Yes, that was a more fruitful conference. It was dedicated to trying to improve the teaching of subjects relating to isotopes, nuclear medicine, and the protection against the adverse effects of ionizing radiation. Again, there were representatives from many, many nations, including the Soviet Union and Czechoslovakia. They were very nice gentlemen. They were very interested in what went on. They didn't say ever very much, but I think they learned a great deal. There the whole idea of curricula that might be used to educate medical students, college students, physicians, and so forth, was considered and developed and recommended.
That's a perfectly wonderful place to have a conference and a meeting. Eileen and I stayed in the Hotel in Palais Schwartzenburg, which is an absolutely marvelous hotel. Vienna is one of the best dining places in the world. It also has very good beer. Eileen and I had a marvelous time in addition, hopefully, to contributing something to the I.A.E.A. in its educational enterprises. We had opera tickets. We had tickets to the symphony. And it was just before Christmas, which is a wonderful time to visit Vienna. I can recommend it to you!!
Q: Did you find vast differences in approaches to nuclear medical education among the different countries that participated at this conference?
Ross: Yes. Most of them had no such education or training, no such concept, no such idea, and none of it was done. Anybody who used radioisotopes in many of these countries had learned to do so in England, or France, or the United States.
Again, in most of these countries their needs in medicine are at a basic level, far less sophisticated than nuclear medicine. They need to clean up their water supply, they need to improve their nutrition, and they need to do all kinds of things that don't require radioactive tracers and the elegant techniques that go along with it, but they all want to have those things. If they're not going to be provided by the West, they'll be provided by the East as a propaganda measure. So the West provides sophisticated equipment to these people, even though they aren't able to effectively employ them. But this was a stimulus to them. I have some correspondence with these people still from places like Iraq and Nigeria, who are very fine people. They recognize the limitations in their countries, and the fact that they have more important needs than nuclear medicine, but they would still like to have nuclear medicine available!
Q: I suppose we should also mention that a number of years earlier, in 1966, you were a participant in the World Health Organization and I.A.E.E.A. conference on the needs and availability of training in the medical uses of radioisotopes.
Ross: They conducted--the World Health Organization--a worldwide survey of facilities, opportunities, and education relative to the application of isotopes in nuclear medicine. My assignment was the new world, which was South America, North America, and Canada. Other people were assigned Africa. Somebody else had Asia. Somebody else had Europe. I made a whirlwind trip to the whole of South America, visiting all the countries and the people that I knew down there, discussing with them what they did about nuclear medicine education, which really wasn't very much, trying to provide opportunities for them to go elsewhere to learn what they needed to learn. We provided a report indicating, in essence, that there wasn't very much development or sophistication in these areas and suggesting that people who wanted to advance this discipline might go elsewhere to learn about it, and if they were provided with the proper equipment and tools when they returned home they could use them. I tried to emphasize that things should not be so sophisticated that they could not be applied in countries that didn't have the financial capacity to follow through.
That's a great problem in many of these countries. A doctor will come over to the USA, he will learn very sophisticated things, he then will go home, and because of his expertise, sophistication, and interest, he may be ostracized by his fellow physicians, who really will treat him as a pariah, and he doesn't have the opportunities to implement what he has learned which I think is most unfortunate.
Q: I'd like to now talk about your move from Boston University-- moving ourselves from the international plane--to UCLA in 1954.
Ross: This was really a terrible decision for me to make. I was offered an appointment at the new UCLA School of Medicine as a professor of medicine and an associate dean, also as professor of radiology in the field of radiation biology. I'm going to be very honest with you. We had five children. My salary as a professor at Boston University was not very great, nor was my revenue from practice very great. I had five children to educate. In Boston, this meant private schools from the time the children started high school until the time he finished college. I had come from California, which when I was a boy, had magnificent public educational facilities. It had the University of California system, which provided excellent education at very low cost. And my wife and I decided, in view of all these things, probably our children would be better off if we came here. So, we came out here and that was somewhat of a disillusionment. The land that I had remembered as a boy no longer existed. Los Angeles was a huge, sprawling metropolis. The school system wasn't up to what it used to be. The University of California was, in large measure, a huge, sprawled, rather inchoate mass of educational opportunity, and the barren cultural environment was sometimes disadvantageous to our children. Also this was the time of the beginning of the drug culture. That was very unfortunate.
However, we survived and my children have all done quite all right. I have five of them. I have eight grandchildren and they're doing splendidly! I believe implicitly in the statement of the Heidelberg confession of 1563, that "all things must fit God's plan for our salvation," and I'm sure that my salvation was coming out to Los Angeles.
Q: The medical school that you came to at UCLA was a newly formed medical school. Could you comment on something?
Ross: It was a newly formed medical school which had a very difficult birth. There was great contention as to whether the medical school should to on the UCLA campus, or be placed down by the big L.A. county hospital. The academics won their point and placed it on the UCLA campus, a decision which had been supported, in major degree, by the rest of the campus faculty until they found out that when they got the medical school here on the campus the capacity of the medical faculty to raise funds, to get research grant support, to appoint a large number of additional faculty, and the salaries that were going to be paid to these faculty members were a lot higher than the rest of the campus faculty were paid. At that point, all hell broke loose and there were invidious comparisons and designs made to limit the faculty of the school of medicine, and the salaries paid to them!
I came to UCLA as the associate dean and professor of medicine and radiology. Most of my endeavors were related to the deanship. We had terrible troubles trying to make medical faculty appointments because on every appointment committee there would be, maybe a professor of English, an astronomer, and a historian, and they didn't understand anything about medicine, but to get them convinced that somebody ought to be offered a professorship in a school of medicine at a salary higher than they were paid was almost impossible. It took a long time before we got that rectified, but it ultimately got rectified and then the appointments were made by medical school faculty committees and everything went all right.
I think it's a good idea to have the medical school on the campus. The interchange between the medical school faculty and the rest of the campus hasn't been as great as had been anticipated, but it is there and it's really very advantageous to have the hospital and the school right on the campus.
Q: Did you have any dealing with hematology at this point, when you first came to UCLA?
Ross: Yes. The chairman of the Department of Medicine was John Lawrence, who I had known in Rochester, where he was head of hematology. He was a friend of the founding dean, Stafford Warren, who brought John Lawrence out here. John brought with him Bill Valentine, and Bill Adams, who were hematologists. He brought the cardiologist, the nephrologist, and a lot of other people from Rochester. He protected these people and wanted them to thrive and prosper, which is all right. They weren't particularly enthusiastic to have me come out as a hematologist, and they didn't open any particular doors to doing hematology at UCLA.
But, my initial activities were those of an associate dean. That kept me very busy. It was the time that the hospital clinical services were being activated. I was chief of staff, as well as being the associate dean in charge of certain things, faculty relations, hospital development, and academic affairs. I worked very hard getting these things organized and I think the accomplishment of the school from the standpoints of a teaching hospital and good clinical services really have been very exemplary. Also, the school is very effective in developing research capability and I think it ranks among the best in this country from the standpoint of research, and clinical education, and patient care.
Q: Were you influenced in any way by Keefer's plans at reorganizing Boston University when you came here as Dean?
Ross: I had no say about that. That was in the hands of Stafford Warren and the chairmen of the departments that he had brought with him, primarily from Rochester. They were very jealous of their prerogatives. They didn't want anybody else interfering with them and Stafford Warren was one to hold to his guarantees that he'd made to these people when they came to UCLA. So I had nothing to do with the staffing of the school or the policies by which they made their selections of professors.
Q: Could you make any comparisons between the different developments that took place in the medical schools that you had been associated with at Harvard, Rochester, Boston, and Los Angeles?
Ross: Yes, one of the great virtues, benefits, and admirable aspects of the Harvard Medical School is the fact that they depended in large measure upon the great hospitals in the City of Boston. These were the Boston City Hospital, Peter Bent Brigham, the Beth Israel, the New England Deaconess, the Massachusetts General Hospital, the Faulkner Hospital, the Children's Hospital, the Good Samaritan, the Boston Lying In Hospital, and the VA Hospital. All of these combined to give a tremendous depth and a tremendous diversity of stimulus. In Rochester, there was none of that. The school was actively combated by the practitioners of the city who tried to keep the faculty off the staffs of many of the Rochester hospitals, so Rochester medical school was really sort of an ivory tower, an isolated activity. In Los Angeles, at UCLA, initially they attempted to have fairly close relationships with the big hospitals in Santa Monica, but the medical staff of these hospitals were very jealous of their prerogatives. One of the hospitals in Santa Monica kicked all the UCLA faculty off its visiting staff at one point. The Cedars of Lebanon and Mt. Sinai Hospital were more friendly to UCLA, since many of their staff had appointments on the UCLA clinical staff and that worked much better. But again, there was not the catholicity of approach to medical education, training, and clinical activity that existed at Harvard. This is being rectified now, and relations with the local hospitals are much better.
We had a chairman of the department of medicine named David Solomon, for ten years. He came from Harvard, and appreciated the value of the Harvard system. As a consequence, UCLA developed relationships with half a dozen hospitals, which have been very effective and very admirable. Each of these hospitals operates its medical service cooperating as a unit within the Department of Medicine. This provides some of the same stimulus that exists and existed at Harvard Medical School.
Q: Could you comment on the changes that took place within funding-- this is the post-World War II period now--with the development of the National Institute of Health, the National Science Foundation, and other funding agencies?
Ross: As I told you, when I started research work in 1940, all the funding usually came from private funds, which was very satisfactory and admirable. During World War II and subsequent to World War II, the United States government realized the tremendous importance of medical research and development, and the government began to support medical research very grandly and very elegantly! This contributed to the tremendous developments in scientific and clinical medicine in the United States! As you know, this government support for medical education and research now is being cut back. I think that that's unfortunate!! I believe that the United States government now is the major source of all medical research funds. It also is the primary source of the funds that subsidize graduate medical education by providing support for residents and interns from payments to hospitals for services to medicare and medicaid patients.
When I was an intern and resident, I never got paid except for my food, my room and four white uniforms a year. The sixth year of my residing in a hospital I got a hundred dollars for the whole year's work. Now, of course, residents after that length of time would probably be making thirty-five or forty thousand dollars at most of the hospitals in this country. Most of that money is derived from insurance payments for the provision of care of the patients, much of it from the Medicare and Medicaid. Now that's all going to be curtailed. It's already being cut back. Already we're seeing a diminution in the number of medical students, the number of residents, the number of opportunities for graduate medical education, and undoubtedly pretty soon, in the opportunities for these people to enter the field which is of most interest to them. Entry into these fields is going to be regulated by the federal government.
I think that's most unfortunate, but I don't know where else the funding is going to come from. The availability of private money to support medical research and education is any longer much of a research source in this country as a consequence of the tax structure. After four expensive years in medical school, most of these young men and young women don't have enough money to support themselves when they serve a residency and certainly not to pay any kind of a tuition charge. So I think it's going to shrink and shrivel. I hope it doesn't shrivel too far but it's certainly going to contract a great deal, which I think is very unfortunate!!!
Q: In 1958, you became chairman of the Department of Nuclear Medicine and Radiation Biology?
Ross: Yes, that was an interesting experience. This was done by Stafford Warren, the dean of the medical school. He said, "In essence, everything that you're doing running that A.E.C. supported research and educational activity is that of a department and I'm going to create a department." Well you should have heard the flack that arose as a consequence of that! My best friends would almost spit at me when they saw me in the corridor. They thought I was trying to steal their underpants and everything that went with them! This was a very troublesome and trying time. However, we were able to prevail to the point of building that building that you saw this morning and it was very adequately staffed. It was supported at that time with a budget of about--well, it was four million dollars in 1965 and 1966. In the 1958, when I became involved the budget was about one million dollars. In 1986 dollars that would be equivalent to three of four times that, and we had a very actively going facility.
However, this irritation on the part, primarily, of the Department of Radiology and, to a lesser extent, of the Departments of Internal Medicine and Pathology ultimately prevailed, and they fired me as the director of this AEC laboratory of nuclear medicine and radiation biology and chairman of the Department of Biophysics and Radiation Biology and markedly curtailed what was going on in that laboratory, which, as I told you, was completely funded both from a standpoint of construction and operation by the Atomic Energy Commission. So when they got rid of me, the day I walked out the AEC cut the budget by fifty percent. The budget and activities have continued to contract since. The place is now, unfortunately, very somnolent! Not a hell of a lot goes on there. The staff has dwindled, so there are not very many people around any more, which I think is most unfortunate. It's a great facility and the opportunities for research and education there are absolutely tremendous! However, all things but God's plan for our salvation; I'm sure it will come out all right in the end! The Department of Biophysics and Radiation Biology was abolished! I'm much better off doing what I do now than had I continued as director and chairman of that activity with the heartbreak that went along with trying to raise money and support people. I got along all right, and survived after some rough years!
Q: How long did you continue as chairman of the department?
Ross: Let's see. I spent four years as an associate dean. In 1954 when I came to UCLA they told me they'd make me dean in six months, but that never developed because Staff Warren fell into political trouble and they didn't promote him to vice chancellor of health affairs. He was supposed to become vice chancellor. So in 1958, I transferred from associate dean to be the director of the AEC laboratory and I continued in that activity, until 1965. At that point, although I had been successful in obtaining funding and getting the Atomic Energy Commission to agree to fund for their academic lifetimes eight full professorships in the for Labper-Bonnell in the Department of Biophysics and Radiation Biology this did not prevail and consequently everything fell apart. There's never been an opportunity subsequently to really attract top flight people into that laboratory in positions which would adequately recognize their expertise and their accomplishments. So this reality inhibited the appointment of people who could be leaders in the field of biophysics, nuclear medicine and radiation biology.
So in 1965, we had a showdown and they dismissed me from my position as director of the lab and dismissed me as chairman of the Department of Biophysics and Radiation Biology. I think this was one of the best things that ever happened to me. It was kind of hard in the way that it was done but I'm much better off having done what I have done since, than I would have been trying to sit there and promote the budget and the activities of the individuals on the staff! So I think it was probably a good idea that I got through that in 1965.
Then in 1969, after having sat in the outhouse for some three or four years, the chairman of the Department of Medicine, Bill Valentine, invited me to become chief of the Division of Hematology, which I did.
Q: Before going to that could we say something about what activities the Department of Nuclear Medicine was involved in?
Ross: The AEC laboratory had been established very soon after the so-called Manhattan District [which had developed the atom bomb] had been translated into the Atomic Energy Commission. The lab was awarded one of the first contracts that was let by the ARC. As a matter of fact, it was AEC contract number "Gen 12." So it had funding extending way back to the creation of the Atomic Energy Commission.
It was established, primarily, to study the effects of fallout, to study the effects of ionizing radiation on individual's organisms, organs and ecosystems. The lab carried on various activities. Probably the one that was most successful was concerned with environmental biology. Elegant studies were conducted of the characteristics of fallout following tests at the Nevada nuclear test site. There were fall out patterns traced all the way across the United States and the characteristics of the fall out material, which changes as time goes by and the material gets wafted around. These were really very important studies but they were classified at the time that they were made. Although they were reported in classified government documents, and they never really have been put out where people can see them and know what went on.
In addition to these environmental studies, we were interested in what radiation would do to certain organisms. We established a very large enclosure at the nuclear test site, which, as I recollect it, was around five acres in area. It was encircled with a fence with the metal going quite deep into the earth so that organisms couldn't get in and out, then a very large radiation source was elevated in the center of the area. It was designed to give a uniform radiation field over the five acres, and studies were conducted of the vegetation, of the rodents that lived in the area, of the insects, and of the lizards and the snakes that lived there. This was quite interesting. They showed a very definite progression as to what happened depending on their sensitivity to exposure to ionizing radiation. It almost wiped out some of the populations of lizards, but, interestingly, after a certain number of months and years they came back again in spite of the radiation. Some of the vegetation also initially got wiped out but some of it came back again. The same also applied to the rodents and the insects. It was very interesting to see how they were able to adapt to the presence of radiation and to survive in spite of these adverse conditions.
Then there was another program of considerable interest which related to biochemistry: the effects of radiation on lipids, and the effects on various other substances. We had an interesting project in which we were able to use radioactive carbon released--formed in the atmosphere as a consequence of the detonation of nuclear and thermonuclear weapons. By getting brain specimens back for a period of years prior to these detonations and subsequent to the detonations, we were able to show actual turnover of the proteins in the brain, over a period of time using this bomb produced environmentally occurring carbon, which so far as I know was the first time it was really shown that the protein material in the human brain was capable of metabolizing and turning over.
Then there were other studies, for example, the effect of ionizing radiation on the central nervous system, the use of radioactive materials in tracing the development of certain changes in the lung, certain changes in the heart, certain changes in the liver. These are the main things that come to my mind now. There were other studies, too, but these are probably the most important.
Q: Were these studies all classified?
Ross: Not all of them, but many of them were. Those that were related to fallout, and to some extent those that were related to the effects of ionizing radiation, were classified initially. They're not classified now.
Q: Why were they classified initially?
Ross: This was the effect of the government that felt that such information might be disadvantageous to the interests of the military, to the Atomic Energy Commission, and possibly to the interests of the American citizen. That's the best explanation I can give.
Q: Was there discussion during this period of nuclear hazards and the question of nuclear safety?
Ross: Yes, there was, and our group was concerned about the implications of fallout in terms of hazards to the population. We were very concerned about the fact that following some of the detonations the cattle and sheep up in Utah developed certain illnesses which undoubtedly were attributable to fallout. Subsequently, there have been claims that humans living in that area were very disadvantaged by this and I think it was a legal determination that one of these women--her leukemia was caused by fallout. I'm not sure anybody could prove that, but I would also say that fallout in significant amounts is not really advantageous to the human being. I'm not sure it's all that disadvantageous in small amounts but it's enough to give people pause for thought.
Q: Were there also studies done on the areas surrounding developing nuclear plants?
Ross: No, we did not get into that. I tried to encourage this being done at the San Onofre nuclear power generator south of here, but the Southern California Edison Company and the engineers running it were profoundly disinterested. I'm sure that they believed that what people don't know won't worry them, but it would have been an ideal place to have done environmental studies on the hill where the effluent from the plant blows, and in the waters and the costal area around the plant. This could have been funded through various agencies but they didn't want any of that done, so it was never done, which was a lost opportunity. I really believe it would have been supportive of what they were doing, since the amounts of radiation released are small. Probably the most important influence that existed was consequent to the release of large volumes of water into the sea, which increased the ambient temperature in that area by two or three degrees, and allowed lobsters, and fish and other things to grow much bigger and much quicker than otherwise might have happened. I don't think there's been any information, as far as I know, showing abnormality of these animals, consequent to exposure to radiation.
[end of side one of tape five; beginning of side two]
Q: Dr. Ross, in 1969, you became chief of the Division of Hematology at UCLA. I was wondering if you could recount some of the events that occurred.
Ross: Actually, when I came to UCLA from Boston, I initiated some investigative endeavors which were done in collaboration with a research fellow I brought to UCLA, Dr. Michael Quastel, a Canadian born physician. Mike was a very bright fellow whose father was a distinguished biochemist. In the studies that I had done in Boston, it was apparent that acute inflammatory diseases and neoplastic diseases led to to an arrest in the maturation and the formation of red blood cells, and to some extent white blood cells. I thought it would be appropriate to try to continue this investigation using experimental animals, namely rats. We attempted to study erythropoiesis and what went wrong by inducing turpentine abscesses in rats, then giving them radioactive iron and finding out what happened in terms of their capacity to use iron to form hemoglobin. It turned out that the same thing was observed in rats. If we produced an acute inflammation process, it turns off the formation of erythrocytes and certain other formed blood elements. We were able to trace this and concluded that the blockage occurred in the phagocytic cells, which are known as macrophages. The macrophages ingested and destroyed old red cells but they were unable to transmit the broken down iron products to the erythropoietic cells which resulted in a decrease in the formation of new cells. In essence, we thought that this had accounted for the failure of people with these illnesses to make blood in an adequate fashion. That's about as far as we got in this research. Doctor Quastel subsequently went to Israel where he heads the nuclear medicine activity. I think probably the most distinguished one in Israel, but we didn't follow up with any more of those studies.
When I became chief of the Division of Hematology, my activities were primarily administrative and clinical and I did not do any more laboratory investigation. However, we had a training program which was funded by the National Institutes of Health, which was a very successful! During the duration of this grant, which existed prior to my involvement with it, in its total time up to the time I completed my relationship to it, we had trained around sixty people in the field of hematology and something like three-quarters of them held high academic level jobs in hematologic investigation and clinical hematology! It was really a very distinguished program!! It was a privilege for me to come into the program and to be able to continue and expand it! At one point, at UCLA, the hematology division had responsibility for something like fifty percent of all the patients in the hospital. These patients had hematological related diseases. Our outpatient clinics were very large and had large numbers of patients. We had a very active teaching program and the clinical investigation that was done was fairly effective. This was done by research fellows and assistant professors. I wouldn't say that it was world shaking but it was good investigative endeavor in relationship to platelet function and to abnormalities of the leukocytes.
Then I reached the age at which the university mandated retirement from administrative responsibilities, which is at age sixty-five years. So I ceased being head of the division and this was turned over to Dr. Martin Cline who changed completely the emphasis of the educational and research activities. He was primarily interested in oncology and the treatment of solid tumors and he didn't have much sympathy or time for morphological or cytological education. This was pretty much all abandoned in the department and the main emphasis became the management of patients who had neoplastic disease and in bone marrow transplantation.
I was not at all enthusiastic about bone marrow transplantation. I've never participated in this endeavor. I'm not at all sure that this is a tremendously effective way to treat most hematologic diseases, but, again, that's just my opinion. Others have different ones, so that's fine.
The man that he put in charge of the transplant program, Dr. Robert Peter Gale, at the time of the Chernobyl accident, went to Armand Hammer, who's a consultant to the Soviet Union as well as the United States, and got Dr. Hammer to offer Dr. Gale's services to the Soviet Union. So he went over there and transplanted bone marrow and fetal liver into some twenty-nine of the patients who were victims of Chernobyl. The last I had heard, something like twenty-three or twenty-four of these subjects had died. I don't think the bone marrow transplants helped them very much.
That was my activity as chief of hematology. We were primarily engaged in clinical care of large numbers of private and clinic patients, both inpatient and outpatient, and the education of fellows and medical students. We ran the course in what was called the pathophysiology of disease. It's a new name for the department of clinical pathology. This course was very effective in orienting students to the field of hematology, and I'm very gratified that many of the students that I had in this course now express appreciation of their hematologic education! At the time they took the course they were cursing me for giving them the hardest course and the worst examinations they ever had had. I gave open book. I told them they could bring anything they wanted to the examination and one day a guy walked in with a footlocker full of books and notes and every other thing he could think of related to the [?]. If they'd been smart, they'd have realized that if they didn't know it they weren't going to find out then from books during the exam, but many of them would come in with indexes to all the pages of their hooks and they learned a hell of a lot just making the indexes as well as otherwise. Subsequently, quite a few of these students have gone into the field of hematology. I've seen them around the country and they come up to me and say, "We cursed you but we thank you now," which is very gratifying!
Q: The change that came to the department with Martin Cline's chairmanship, did this in any way mark a change from a morphological approach to hematology towards ones that face more on perhaps molecular, biological emphasis?
Ross: Yes, it certainly did, and this is a trend which I think is occurring all over the world. Cytology, and morphology, serve as a very useful basis and on this basis subsequently has been built the concept of genetics, molecular biology, molecular physics, and approaches to understand more fully the mechanisms of disease, particularly hematologic disease. It's very gratifying to see that now characterizations of oncogenes and other influences on the etiology of neoplastic disease have occurred. This is tremendously important! But I still feel it is unfortunate that the young hematologist today really doesn't know much about the morphology of cells. He couldn't recognize the difference between an acute leukemia and maybe an infectious mononucleosis, which from a clinical standpoint is tremendously important.
Q: Did this change also bring about changes in research styles, sources of funding, sources of students, and the development of different lab practices?
Ross: It certainly eventuated in a difference in teaching approaches. The emphasis that I had on clinical, morphological, and cytological aspects of hematological disease has now been quite completely abandoned. The performance of bone marrow studies is now completely left to the pathology department. The laboratories which in the past were usually used for these studies have been converted to laboratories for cell culture and for molecular biology, which certainly is very important. I'm afraid I must say that in my opinion, the overwhelming dedication to these more fundamental aspects of the etiology of disease has led to depreciation in the value and the virtue of intimate, personal care of sick people. I don't believe that the current physicians dedicate as much concern to trying to manage the emotional and the psychological and the physical distress of people who are sick. Yet, that is, in my opinion, the fundamental role of the physician. And when he begins to forget this, he no longer is filling the role of physician. He becomes like a Ph.D. who's involved in things other than patient care. I see this happening not only in relationship to hematology but in other specialties too. When the young physician is being oriented in the fundamental direction, I'm afraid it carries over into his subsequent practice when he becomes a practitioner. Both fundamental research and good practical clinical hematology is important!!!
The instrumentation has been vastly changed. Instead of using just microscopes, now chemical probes and other approaches are used which were not around and not used when I was working in hematological research. There's nothing wrong with that. I think it has to be done. But clinical expertise must not be abandoned.
Q: Have the sources of funding changed?
Ross: The sources of funding have continued to be largely from governmental sources and the National Institutes of Health, particularly the National Cancer Institute and also the National Institute for Pulmonary and Blood Diseases, are the primary sources of funding.
On the other hand, the introduction of oncology has introduced research money from the tobacco industry which is trying to prove that tobacco smoking doesn't have anything to do with cancer. One of the members of our department now receives his primary funding in an attempt to prove this. I don't think he's going to succeed, but he gets a big chunk of money. The money from the State of California to support research is minuscule. They don't really expect to provide that. They expect the faculty to obtain that elsewhere.
I don't think there's much private money that goes into the support of hematology at UCLA, or elsewhere in the county any more.
Q: Has there been any push from the private sector in the direction of hematology?
Ross: You mean private industry?
Q: Private industry, pharmaceutical houses--
Ross: Not that I'm aware of. There might be, but I don't know about it.
Q: Has there been cooperation between the academic departments, the clinical departments, and pharmaceutical houses' research departments?
Ross: Some of the independent members of the Division of Hematology cooperate quite closely with some of the commercial aspects to the point where they have been accused of conflict of interest between the stock that they own, their obligations as a professor in the university, and their obligations to do, shall we say, unbiased research. I think that's most unfortunate.
Q: Is there anything else you would like to add about the development of hematology at UCLA and your involvement in it?
Ross: I think it's following a normal progression which is being observed elsewhere in the country, with progression from cytology and morphology and anatomical pathology to genetics, molecular bio- chemistry, and other such fundamental approaches. I think that's a normal progression. I think that's very good. I just hope that the old time things don't be completely forgot. The education of medical students and house staff in the technical procedures of hematology I think has pretty much gone by now. There's no point in teaching a student how to do a hemoglobin analysis, or really I suppose to do a differential, if he's got good pathologists and technologists on whom he can rely. It wouldn't be gratifying to me personally, but other people look at it in a different way.
Q: Is there anything else you would like to add at this time, Dr. Ross?
Ross: Well, I'd like to thank you very much for your endeavors. It's been a great pleasure to meet and talk with you for the last two days. I'm amazed at your persistence and your perseverance, your patience, and your pertinacity. I admire you very much for all the work that you did before you got here and your patience with all the hot air you've put up with since you got here. I'll be interested to see what the hot air looks like in typescript!!
[End of interview.]