WARD DARLEY Volume I ~i.~, Harlan B. Phillips April 2, 1969 NATIONAL LIBRARY OF MEDICINE BETHESDA, MARYLAND 1969 TABLE OF CONTENTS PREFACE ii CURRICULUM VITAE iii TRANSCRIPTS Tape #1' side #1 [Monday, April 8, 1 968] 1 - 47 Tape #1' side #2 [Tuesday, April 9' 1 968] 48 - 93 Tape #2, side #1 [Tuesday, April 9' 1968] 93 - 11 9 Tape #2, side #1 [Wednesday, April 1D, 1968] 1 20 - 139 Tape #2, side #2 [Wednesday, April 1 D, 1 968] 140 - 172 Tape #3, side #1 [Thursday, April 11 , 1 968] 1 73 - 212 Tape #3, side #2 [Thursday, April 11 , 1 968] 212 - 254 Tape #4, side #1 [Friday, April 12, 1968] 255 - 290 Tape #4, side #2 [Friday, April 1 2, 1 968] 290 - 303 INDEX 304 - 329 ll PREFACE This series of interviews between Harlan B. Phillips and Dr. Ward Darley were conducted in April 1968. Dr. Darley was presented the final typed and bound copy in April 1969. Dr. Darley had not had the opportunity to edit the transcript prior to final typing and binding and noted numerous errors and areas requiring editing. Therefore, in April and July 1970 Dr. Darley and Dr. Olch reviewed the entire transcript and numerous editorial changes were made. Those pages requiring editorial changes were removed and retyped. The reader will notice some pages are only partially filled, a necessary compromise in order to retain the original pagination. Peter D. Dlch, M.D. Deputy Chief History of Medicine Division National Library of Medicine lll CURRICULUM VITAE WARD DARLEY b October 30, 1903, Denver, Colorado s Ward and Mary Bolles Darley 1919 - 1922--Denver High School, North Side 1922 - 1926--B.A. University of Colorado 1926 - 1929--M.D. University of Colorado School of Medicine 1929--Licensed, Colorado State Board of Medical Examiners 1929 - 1930--Intern, Colorado General Hospital April 29, 1930--m Pauline Braiden; ch Donna Jean Braiden; Ward Braiden 1930 - 1931--Resident Physician, Colorado General Hospital 1931--Diplomate, National Board of Medical Examiners 1931 - --American Medical Association 1931 - 1954--Denver County Medical Society 1931 - --Colorado State Medical Society 1931 - 1944--Private Practice, Internal Medicine, Denver, Colorado 1931 - 1951--Active Staff Appointments Porter Sanitarium and Hospital; St. Luke's Hospital; Mercy Hospital; St. Josephs' Hos­ pital; Childrens' Hospital; and National Jewish Hospi­ tal 1931 - 1936--Instructor of Medicine, University of Colorado School of Medicine 1936 - 1944--Assistant Professor of Medicine, University of Colorado School of Medicine 1936 - 1950--Central Society for Clinical Research 1936 - 1956--American Heart Association 1937 - -- Denver Clinical and Pathological Society 1938 - 1956--American Rheumatism Association 1944 - 1946--Associate Professor of Medicine, University of Colorado School of Medicine 1944 - 1952--American College of Physicians: Governor for Colorado 1945 - 1948--Dean, University of Colorado School of Medicine 1945 - --Association of American Medical Colleges 1945 - 1957--Board of Control, Child Research Council, University of Colorado 1946 - 1956--Professor of Medicine, University of Colorado School of Medicine 1946 - 1947--Member, Post-War Planning Committee (Health) 1947 - 1953--Member, Colorado State Advisory Hospital Council 1947 - 1950--Member, Sabin Health Committees 1947 - 1949--Member, Advisory Committee, Colorado State Board of Nurse Examiners 1947 - 1951--Committee on Education and Publication, National Foundation for Infantile Paralysis 1947 - 1951--Training Committee, National Advisory Mental Health Council 1947 - 1951--Executive Council, AAMC iv 1947 - 1952--Committee on Financing Medical Education, AAMC 1947 - 1952--Consultant, Internal Medicine, Veteran's Administration 1947 - 1952--Consultant, Internal Medicine, Fitzsimons General Hospital U.S. Army 1947 - 1953--Director, Denver Area Rheumatic Fever Diagnostic Service 1948--Committee on Cardiovascular Disease Control, National Heart Advisory Council 1948--Chairman, Subcommittee on basic support of personnel and fluid funds to support general research, Steering Com­ mittee, Research Section, National Health Assembly, Washington, D.C. 1948 - 1955--American Clinical and Climatological Association 1948 - 1949--Advisory Committee for Maternal and Child Care Training Emily Griffith Opportunity School, Denver 1949--Colorado State Conference on Care of Mental Defectives 1949--Chairman, Committee of Denver Hospital Administrators to Survey Fiscal and Professional Situation of General Rose Memorial Hospital 1948 - 1953--Advisory Committee, Division of Medicine and Public Health, WK Kellogg Foundation 1949 - 1953--Vice President in charge of Health Sciences, University of Colorado 1949--Alumni Recognition Award, University of Colorado 1949 - 1950--Chairman, Subcommittee on Medical Education, Western Gover­ nor's Conference 1949 - 1953--Board of Trustees, Lovelace Foundation and Clinic, Albuquer­ que, New Mexico 1949 - 1953--Commission on Chronic Illness 1950--Chairman, Section on Physician Education, First National Conference on Cardiovascular Diseases, Washington, D.C. 1950--Member, Colorado Children's Code Commission 1950--Advisory Committee: Commission on Chronic Illness and Reha­ bilitation, State of Colorado 1950 - 1951--Survey Committee, Heart Disease in Colorado School Children 1950 - 1951--Chairman, Subcommittee on Curriculum, Advisory Committee on Educational Standards, American Board of Certification: Prosthetic and Orthopedic Appliances Industry, Inc 1950 - 1953--Medical and Science Advisory Committee, National Arthritis and Rheumatism Foundation 1951--Chairman, Committee on Education of Physicians and Dentists, National Conference on Chronic Illness, Chicago, Illi­ nois 1951--Steering Committee and Chairman, Section on Curriculum Struc­ ture, Integration and Administration, Conference on Teaching Undergraduate Psychiatry, Ithaca, New York 1951 - 1952--Chairman, Committee on Chronic Illness, Colorado State Medi­ cal Society 1951 - 1952--Committee on Postgraduate Courses, American College of Phys­ icians 1951 - 1953--National Mental Health Council, National Institutes of Health 1951 - 1956--Western Interstate Commission for Higher Education, Commis­ sioner for Colorado; Chairman, 1955 - 1956 1952--Award of Honor for Humane Service, General Rose Memorial Hospital, Denver, Colorado V 1952--President's Commission on the Health Needs of the Nation 1952 - 1953--Board of Consultants, Division of Medicine and Public Health, Rockefeller Foundation 1952 - 1953--Institutional Research Grant Policy Committee, American Can­ cer Society 1952 - 1953--Committee on Medicine, Division of Medical Sciences, National Research Council 1952 - 1953--President, AAMC 1953--Conference on Professional Education: The Fund for the Ad­ vancement of Education, Princeton, New Jersey 1953 - 1956--President, University of Colorado 1954--Golden Heart Award, Colorado Heart Association 1954--Honorary D.Sc., Colorado College 1955--Norlin Recognition Medal, University of Colorado 1955 - 1956--Board of Visitors, Air University, United States Air Force 1955 - 1956--Medical Education and Scientific Advisory Council, National Fund for Medical Education 1955 - 1957--Commission on Utilization of College Training Program, Fund for the Advancement of Education 1955 - 1963--Board of Trustees, National Merit Scholarship Corporation 1956--Honorary D.Sc., University of Nebraska 1956--Member, Advisory Committee on Medical School Grants, Ford Foundation 1956 - 1959--Member and Chairman, Advisory Committee on Personnel for Re- search, American Cancer Society 1957 - 1964--Executive Director, AAMC 1957 - 1964--Lecturer in Medicine, Northwestern University Medical School 1957 - 1967--Executive Secretary, National Intern Matching Program, Inc. 1958--Distinguished Citizen's Award, City of Denver 1958--Honorary LLD, University of Colorado 1958 - 1959--Surgeon General's Consultant Group on Medical Education 1960--Recognition for Distinguished Service, One Hundredth Anni­ versary, New York Medical College 1960--Chairman, Section on Medical Education, Annual Meeting, Pan American Medical Association, Mexico City 1960 - 1964--Board of Directors, National Society for Medical Research; Vice President, 1962 - 1964 1962 - 1963--Steering Committee, Biological Sciences Curriculum Study, American Institute of Biological Science 1962 - 1964--Member, Scientific Advisory Committee, United Heart Founda­ tion, Inc. 1964--Abraham Flexner Award for Distinguished Service to Medical Education, AAMC 1964 - --Board of Directors, Interuniversity Communications Council (EDUCOM) 1965--AAMC Award of Merit 1965--Markle Scholar, John M Russell Award for Advancement of Knowledge in Medicine 1965--University Recognition Medal, University of Colorado 1965--Honorary D.Sc., New York Medical College 1965--Honorary D.Sc., University of Illinois 1965--Honorary LLD, Loyola University (Chicago) 1965--Honorary LLD, Northwestern University vi 1965--Moderator: Economics Education of Health Professions; White House Conference on Health 1965--The Clinical Research Wing of the Colorado General Hospital exhibits the following plaque: "The Ward Darley Labor­ atories of the Department of Medicine. Made possible by the generous bequest of one of the country's great scientists, Dr. Florence R Sabin." 1965 - 1966--Moderator: Four Conferences between Medical Educators (AAMC) and representatives of Family Health Foundation of America (AAGP) 1965 - 1967--Consultant to the Executive Director, AAMC 1965 - --Visiting Professor of Medicine, University of Colorado School of Medicine 1965 - --Consultant, Presbyterian-St. Luke's Hospital, Chicago, Illi- nois 1966--Honorary D.Sc., Brown University 1966--Honorary LLD, University of New Mexico 1967--Moderator Symposium on Medical and Allied Health Education in Sparsely-Settled States, Western Interstate Commis­ sion for Higher Education 1967--Award for Distinguished Achievement, Board of Editors of Modern Medicine 35 Modern Medicine 82 - 83 [January 2, 1967 j 1967 - --Consultant, Western Interstate Commission for Higher Educa­ tion, Boulder, Colorado 1967 - --Executive Vice President, National Intern Matching Program, Inc. 1967 - --Visiting Professor of Preventive Medicine, University of Colorado School of Medicine 1968--John C Leonard Memorial Award, Association of Hospital Directors of Medical Education 1968--Moderator: "think tank" conference, National Association of Hearing and Speech Agencies, Denver, Colorado 1150 Grape Street, Denver, Colorado 80220 l Monday, April 8, 1968, 7002 University of Colorado Medical Center. Well, first I'll tell you a little bit about my--the family back­ ground. On my father's side my knowledge begins with Nebraska City. My grandfather, my father's father, was a very fine cabinetmaker. He had a family--three children. He had a brother who was a Presbyterian min­ ister and who had influenced him a great deal. For some reason or oth­ er he dropped his cabinetmaking business--grandmother agreed to this. I don't know where he went to study for the ministry, but he did, and he was ordained. Then he came out to this country in the middle seven­ ties. His brother was an Alexander Darley. My grandfather was a George Sinclair--no, George Marshall Darley. His brother, Alexander Darley, had been commissioned by the Presbyterian Church to come out here and establish Presbyterian churches all through the south, central, and the southwest part of the state. His headquarters was at Pueblo, and his primary focus of concern was the Spanish-American. He spoke Spanish himself. He ran a Spanish-English newspaper down in Pueblo, and that was his base of operations. My grandfather came out here and took his family first into the San Luis Valley, the country which provides the headwaters for the Rio Grande River in the south central part of Colorado. The southern part of the San Luis Valley extends on into New Mexico. The railroad went as far as Pueblo, so my grandfather and his family went into the valley by stage, and settled in a little community known as Del Norte which is located just where the Rio Grande River comes out of the mountains on 2 the west side of the valley. Well, I'm kind of hazy as to the sequence from here on, but my grandfather established a church in Del Norte. They followed the min­ ing booms. He went to Creede, Colorado, which is way up one branch of the Rio Grande River, and as an aside, in Creede he came into close contact with my wife's father, William A. Braiden, who was up there run­ ning a hardware store and a stage which ran between Creede and some point down in the valley, and I don't know which. Grandfather went over to Ouray, and established a little church there. He established another church in what was known as Lake City which is almost a ghost town now. He'd preach one Sunday in Ouray, and then he'd go across the mountains and preach the other Sunday in Lake City. In the course of all this he returned to the town of Del Norte, and the Presbyterian Church authorized him to start a little college in Del Norte, Colorado, which he did. It operated for two or three years and then burned down. Instead of reestablishing the college there, it was moved up here to Denver to a community a little north and west of here known as Westminster, and there's a big red building out there that is quite a landmark now, but the college only ran three or four years and then folded up. My grandfather located in Walsenburg, Colorado, which is on this side of the mountains, down in the coal mining area, and he preached there until he retired. Now--my father--well, there were four brothers and sisters. My father's older brother, George S. Darley, was also a Presbyterian min­ ister, and the area of his activity was the San Luis Valley, Alamosa, La Jara, down in the southern part of the valley where my wife's people came from, and he also preached in Walsenburg for a long time. Then he went over to the town of Rifle, Colorado on the western slope where he died. There was just a year's difference between this preacher brother and my father. Their boyhood was largely spent in this town of Del Norte, and they roamed the mountains all around that area. They both went to the University of Colorado. My father's brother graduated, and my father didn't. He came down here and went to the Denver University Law School where he graduated. He didn't practice law, however. He spent most of his life--well, he took a homestead down in the San Luis Valley, and he spent most of his life promoting independent sugar factories. The sugar beet industry had moved into Colorado--oh, when I was--well, I was born in 1903, and the sugar industry moved in here shortly after that. The sugar industry was sponsored by large compan­ ies, and my father wanted the farmers in a given community to develop the sugar raising industry and to have their own factories. This wasn't a very successful venture, but he worked at it for a good many years. It was a novel idea for 1903. We moved around with him over the state as he found a Colorado community where he thought he could make things go. The ones I remem­ ber particularly were Greeley, north of here about fifty miles, and a little town of Delta over on the western slope. He did succeed in building a factory in the San Luis Valley near the little town of Monte Vista. I went around with him as a little boy. He had one of the first automobiles to come into the San Luis Valley, and I remember 4 going with him when he would visit farmers and get them to sign up to raise so many acres of sugar beets. These farmers wouldn't know how to do this, so my father would have to make arrangements for people to come in and teach them how to raise sugar beets, water them, cultivate them, and all that sort of thing. In order to get the sugar beets to the Monte Vista factory he had to get a railroad that began down in the central part of the valley and would haul the sugar beets into this factory which was right on the main Rio Grande Railroad that ran through the valley. This little railroad still is in operation. The factory ran for about a year--just one season, I guess--and then the whole thing folded. Of course my father lost his shirt in this kind of an operation so when I was about eight or nine years old, he changed what had been a hundred and sixty acres of desert claim, owned by my grandfather, the preacher, his father--this hundred and sixty acres of desert claim was changed over to homestead, and we moved out there. Fortunately an Ir­ rigation District had been developed down there. This homestead was under water, which hadn't been the case when my grandfather had filed this desert claim. We lived there for about five years. This desert claim was located on the west side of the valley right up against the mountains in what was called Conejos County, just a half a mile south of the Conejos County-Rio Grande County line where the county line ran into the mountains. My father did--we did--in order to get title to this land we had to build a house and make other improvements. You had to break up twenty acres of land that had never been cultivated. This had to be cultivated. My father spent the rest of his time being the superintendent for this Irrigation District--the "ditch rider" really 5 for this irrigation company which was supposed to supply water to a very large area. They brought far too much land into the Irrigation District, so that there wasn't enough water to go around, but at any rate, we stuck it out until we got title to this place. In the meantime my father had patented a farm gate that was built along the same principles as the bicycle wheel, and he began to manu­ facture this gate in the town of Monte Vista, and we'd drive back and forth. We had an automobile by that time. This business outgrew the San Luis Valley so my father moved to Denver, formed a company, and be­ gan to manufacture the gate in Denver with the idea of developing a statewide market. We moved to Denver from the homestead when I was in the seventh grade, and I've lived in Denver ever since. Incidentally, I was born in Denver, and I don't remember anything about leaving Denver. All I remember is beginning to follow my father around in connection with this sugar business. When he'd be hard up--he was a very fine machin­ ist--he'd go to work for the railroad, running a lathe. Most of these periods when he'd work for the railroad would be as a strikebreaker. This would mean that if the strikers were causing any trouble, he'd always have to live in the shop, but we followed him down to Winslow, Arizona in connection with one of these episodes, and while he was shut up in the shop we moved to Flagstaff where it was cool, and I can re­ member a few things down there, but my childhood up to the point of moving to Denver was a very busy one. I had two brothers. I was the oldest, and there were approximately four years between each of my brothers, so they were staggered pretty well. We didn't have too much in common as brothers because of this 6 difference in age. I always managed to keep busy, and probably you'd like to spend some time at home--I'll have a lot of stuff laid out where you can see what you want to see. Some of it you may be interested in, and some you may not. On this homestead--up to the seventh grade must have been about ten, eleven. Well, we moved out there when I was about seven. I was ready for the third or fourth grade when we went there. Well, I didn't go to school at all for the first year or two on that homestead because there wasn't any school to go to. My folks helped organize a school district and started this one school. It was a community dominated by Spanish­ Americans and Mormons in Conejos County. This community where we lived had been unsettled, relatively, until about the time we moved out there. This Irrigation District was responsible for quite a community develop­ ment. Our little school board would hire a girl right out of high school to teach for six months. It was an unapproved school district, of course. We held school for two years in a couple of vacant farm houses, and then they did build a little school house; in fact, my father and I built the school house, and I went there. I was always the biggest kid in the school--this was a one room school house. I quit school in the mid­ dle of the seventh grade in order to help my father build these gates. Then we moved to Denver, and I tried to go to school there--! mean we went to Monte Vista, and I tried to finish the seventh grade there, but I didn't get along with the teacher, or any of my schoolmates, so my father just took me out of school, and we forgot the whole business un­ til we moved to Denver. 7 We arrived in Denver on July 4th, I remember, and I went to summer school in a special school that Denver operated for children who had to make up work, or children like myself that needed special work. The idea was that I would go to school, finish the summer out, and then I would take a general examination that the school board would give me. Then they would tell me what grade I would be in. I made the eighth grade according to that examination which meant that I had caught up one of the two, or three years of schooling that I had missed. I went to the school they told me to when school started, and there was no word there about me so the principal sent me down to this special school to get a letter which I did. The principal of the special school was a very famous woman by the name of Miss Emily Griffith. She started this "opportunity school", as it was called. It is still a famous school. She was murdered after she retired. She tried to live with a sister up in a little cottage in the mountains. Well, anyhow, in the confusion of her starting school, she asked me how I'd like to go to this junior high school that Denver was starting. I told her, "That would be fine." Of course, the junior high school had the seventh, eighth and ninth grades, and when I got over there with her letter, she'd made it out for the ninth grade instead of the eighth. I decided that they couldn't do any more than put me back, so I made up another year that I had lost. I got along fine. Then I went to North Denver High School for the sophomore, junior and senior years of high school. I got a little scholarship from there to the University of Boulder. When I graduated from North Denver High my father was again working as a strikebreaker this time up in Laramie, 8 Wyoming. The gate business had failed, so my mother went to Boulder with me and rented a big house with the idea of taking in some roomers and boarders to help me get started in college. We were very fortunate because a new fraternity was starting up there, and she made a deal with the fraternity to take care of the fraternity and be the house mother. I joined the fraternity so that's how we got through the first year-­ really very comfortable. After that my father came back to Denver and went on the regular work force with the Union Pacific Railroad as a machinist, and he worked there until the crash came. He got laid off. Then he began to develop arthritis, and he was never able to work after that. At any rate, we were living in Denver, out near the Union Pacific shops. I was always able to get me a job during the summers, and living right here in Denver I was able to go to medical school. I was able to get through medical school, and I was only in debt two, or three hundred dollars, except the debt to my parents for providing me with a home through all this period. What's the legacy of this skipping stone kind of existence from place to place to place? Is it a rootless, itchy-footed one? No. I think it gave me very deep roots as far as the statewide community of Colorado is concerned. My family was extremely well-known in the state, and I cashed in on this later when I became Dean of the Medical School, Vice President of the University in charge of the Medi­ cal Center, and President of the University. The name was well-known particularly in the rural areas, and the legislature was always under rural control. Then my wife's people were--her father, William A. 9 Braiden, came out here in the seventies as a young man with a little herd of cattle, and he settled in the San Luis Valley also. He had one of the most impressive cattle spreads the state has ever seen, the T­ Bone Ranch at Antonito, and he was very active in Republican politics all the time. The fact that my wife's family and my family were well­ known made a world of difference in my dealings with the legislature and the statewide community so far as the university was concerned. But as a kid growing up in this--what's the sense of security with this kind of existence? Well, there were lots of times when I know my parents weren't sure where the next week's meals were coming from. I don't recall that I was particularly disturbed. I was busy. I had work to do. There was al­ ways something to do, and I was always made to feel that what I did was important to the existence of the family. Of course, after we moved on this homestead I was "Mr. Big" as far as being important to the family-­ the overall family effort was concerned. I was given great leeway by my parents. I took all kinds of responsibility as a young lad. I could get on a horse and go back in the mountains. All they wanted to know was the general direction in which I was going, and I always got home all right. They never seemed to be disturbed. I suppose my mother worried some, but she knew that it wouldn't do any good. By the time I was ten years old I could drive a four horse team. I could work as a man out in the field as far as driving a team hooked onto farm equip­ ment is concerned. You mentioned earlier that your grandfather was a cabinetmaker with skills, tools and so on, and you also indicated that your Dad, though he studied law, never practiced law, was also •••• He should have been an engineer. His father insisted that he go to law school. Oh, dear. The father insisted that the older brother, George S. Darley, pre­ pare for the ministry. Then there was a third brother, William Darley, who was much younger than the other two who was supposed to be the en­ gineer. He went to the engineering school down at Colorado College. It was just a two year course in those days. He went from that engin­ eering school into the Forest Service--just as the Forest Service was being formed, and he stayed in the service all his life. He never would leave the woods. He turned down many opportunities for promo­ tion. Whenever it meant leaving the woods he wouldn't take it, and his district, except for the early years when he worked up around Steamboat Springs, was always the mountains on the west side of this San Luis Valley. All of the Darley tribe--their point of reference for the ma­ jor part of three generations--my grandfather, his children and myself and brothers was the San Luis Valley. As far as my father's mechanical skills were concerned these were self-taught. He just bought the books and learned how to use the tools. He was a good mathematician and a precision machinist. He had the num­ ber one lathe when he was laid off, as far as he was concerned. He was laid off just because there were other people there with more seniority than he had, but he was the one who made the small delicate parts for 11 thb locomotives. He loved this kind of work. After he began to get on his feet a little bit, after he was laid off, he bought five acres of ground out here which is now part of the Denver suburbs and built a very nice home. I was in a position then to support them in any way they needed, fortunately. Then when my father wasn't able to do the outside work there he had a little place built in the north part of Denver, and he stayed there until he died which was in 1942. My mother stayed on there for a while, and then as she got too old to handle a house, she moved into a little apartment and died in her mid-eighties. I had her in a nursing home. She had a cancer, and it took quite a while to run its course. She died in this hospital. Did you know your grandfather at all? Yes, I knew him very well. He sounds like a dominant fellow. He was. He was a man about six feet three, a big handle bar mus­ tache. My wife's father and he looked like brothers--tall, angular men with mustaches peculiar to the times. Grandfather Darley was a very strong character. Everybody--of course in those days as far as I could see, if the man was so inclin~d, he was the head of the house without much question. His wife, my grandmother, was four feet eleven. They were really the long and the short of it. My grandmother was a strong character. My grandfather thought he was running things. She went along with him though, and she had a lot to do with his success, and he was very successful, provided you used the environment in which he was interested as your point of reference. 12 I should say that for a while he preached out at Fort Morgan, out on the Platte River. He had a church in Salt Lake City for a few years. He started the First Avenue Presbyterian Church here in Denver. How I would put all this together in terms of sequence by years--it would take some doing for me to do it. I've got some of his sermons, and particu­ larly the sermon he used to dedicate this First Avenue Presbyterian Church here in town. I have a couple of trunks of stuff like this that I just haven't had time to go through. This younger uncle, William Darley, kept all of this. When his wife died--he has arthritis--we had to break up his household about four years ago. My wife went down to this town of Monte Vista where he'd lived for years. He had a barn with a hay loft. The old family books and papers and stuff--he had just been a pack rat. Stuff was stuck in every· conceivable place. Marvelous! All I could do was throw stuff out that hurried examination indi­ cated wasn't of much value, and the rest of it just went into trunks and boxes. I just have never had time to go through it. Now the State His­ torical Society wants it, the University Library at Boulder wants it-- I don't know what I'll do with it, but it will go one place or another. Your grandfather was an articulate fellow. Yes, and he wrote a book about his early life called Pioneering in the San Juin [Revell, New York, 1899] 226, a collector's item now. I have five or six copies, and he wrote a couple of novels about the wild, wild west that are very odd, little books. 13 I wondered about the effect of his being articulate, a kind of a many sided person, had on his children--your father. Was your father arti­ culate? Yes. He was a promoter at heart. Well, so am I. My father pat­ ented a lot of gimmicks, and he was always going to make money out of them. Well, he spent a lot of money in these kinds of promotions, but he never was able to make the grade. My mother was a very insecure per­ son. She wanted everything one, two, three, and whenever he had a job where he came home with a paycheck every week, she was perfectly happy, but it was awful hard for her to go along with all of this uncertainty connected with the sugar business and these patents. Later on the home­ stead when he had a regular job with this irrigation company--this suited her all right. She was a good manager just so she knew what she had to manage with. There was--well, I remember very clearly all the tension between them as far as this insecure business was concerned. It bothered me some, but on the other hand I think that what saved me was that I was busy. I had business of my own that I cooked up, if it wasn't anything but making cardboard soldiers. I was always having projects--if you spend some time in my basement, you will see what I mean. If there was work to do, of course that came first. The brother that was next to me, William Earl Darley--! pushed him around something awful in connection with all of this activity. He was just as different from me and the rest of us as daylight and dark. He was a very sensitive and imaginative, highly intellectual kid--a rebel. He just wouldn't go for any of this. My folks were very religious, and 14 he'd have none of it. I went along with it just because it was the easy thing to do, I suppose. Well, I was sold on it until I got older. Then the younger brother came along, Ellis F. Darley. He was born out on this homestead, and I think all of this lack of security bothered him more than anybody else because he was trapped in it until he got through college at Fort Collins--the land grant college there. He was trapped in it really until he got his Ph.D. degree and was in a position to make his own living, but he's come out of it pretty well. He's a full professor at the University of California, at Riverside. He has his ten­ ure. He's Mr. Big now in smog research--that is, the University's part of it. The other brother was within three months of finishing his college work at the State College at Greeley, which was a normal school, when he got into an altercation with the administration, and they kicked him out of school. This didn't bother him any. He just lived a sort of a beatnik existence, got married, two children--he married the same kind of a woman, and they lived a hand to mouth existence. They were both artists and good--they were both sculptors, and as far as my brother is concerned, he didn't go to art school--this is just a natural talent. They finally divorced, and he married a woman, a psychiatric social work­ er who is also an artist. They've been married now about six or eight years. He's worked up an excellent business teaching art in San Jose, California. His main field is teaching art to emotionally disturbed children. He has been working with a group of psychiatrists and psychol­ ogists out there. He's doing very well by himself now. This was a com­ fort to my mother. They never had much use for each other, but he got well established before she died. They made their peace, and it meant 15 a lot to both of them, I think. My father died in 1942, and he was a very philosophical turn of mind. Was he. Things never worried him. He always felt that things would work out all right, and part of this was a very deep religious faith that he had as a result of his childhood. All of the children--there were five brothers and sisters--the two girls died, one when she was just a baby and the other when she reached twenties. There was a big typhoid epi­ demic over in this mining town where they were living, and she got trapped in that. Father was just like his mother. Boy, he was used to making the best of things. He'd keep busy, and he always had great faith in his own future. He was a wonderful guy to be around. Hope blooms eternal. Yes. He never--my mother would be given to fits of despondency, weeping and all this--not him. He was always on top of things as far as his own emotional situation was concerned. Now this younger uncle, my father's younger brother, William Darley, was just like my father. I can go down and see him--he's in a nursing home down in the San Luis Valley, and considering everything he's very happy. From the window in his room, he can see his mountains. Other people that are in this home are old timers down there, and his friends come to see him. It doesn't bother him whether we get down very often or not. I was never a very important part of his life until his wife died, and I've had to manage his affairs for him. I write him a couple 16 of times a week, and i f I'm a little slow, I get a telephone call be­ cause I'm his tie today, of course, but he's a sweet old guy. When I go down there, it's just like being with my father--they look alike, are so alike in temperament, and he's in his mid-eighties. As far as his vital organs are concerned, he's in pretty good shape. The other Darley men--sixty-nine is the age of death--my father's older brother, my grand­ father, and my father. Grandmother died of cancer--now she was a Ward, and boy! This Ward family are a bunch of bigots as far as the Ward name is concerned. That's why my first name is Ward. This is your grandmother's family. Yes, and I have a lot on the Ward family genealogy. My younger brother--he started to pick this up. I've never been very excited about it. He wants a lot of this stuff that I have in these trunks, and I'm going to tell him that he shouldn't have it. It should go to the State Historical Society here. My mother's family I don't know too much about. Her father-- This is the Bolles. Her father--! can't even tell you his first name, but for his day he was quite an intellectual. He was an educator. He organized the public school system in Dallas, Texas. Well, that didn't last very long because he wanted the Negro teachers and the white teachers to go to the same teachers' meetings. He started a private school down there in Texas, and I don't know how successful that was. Then there were many children, and this was a very religious family-- 17 fundamentalist oriented. He ran the roost, and when I saw the play "The Barretts of Wimpole Street," that play represented exactly the en­ vironment that my mother was raised in, where the head of the house really ran everything and everybody. My mother was the youngest, and she was a rebel. She ran away from home when she was in her late teens. Well, they made up, but I don't think she ever went back home to live. She got a job teaching school. One of her brothers was an osteopath--Alden Bolles. He moved to Denver, and his wife was an osteopath. My mother lived with them. He started a school of osteopathy here in Denver, and my mother went to that school. I think the course was six months--maybe not that long. Anyhow, she set up as an osteopath up in the town of Greeley for a while, and then she quit when she got married. This osteopathic pair got a divorce--! remember this in connection with this sugar beet business. After the divorce Alden Bolles left here and just sort of wandered around. He finally died down in San Diego. His wife stayed on as a practicing osteopath, Dr. Jeannette Bolles, and she was some pumpkin here. They had one child, a daughter, who is an osteopath and who is married to the principal osteopath in town, a man by the name of Starks, Robert C. Starks, and she's retired now. We're friendly, but we don't-­ well, if you were to see this woman, my cousin, and myself side by side, you would think we were brother and sister. My mother was the last survivor of the family. I don't know what happened to her brothers and sisters, except that they were all very strong-minded people, always in conflict with their environment and the people around them. I picked up a lot of this too. I've been a noncon­ formist. Turmoil has always centered itself around me as I have gone 18 through, particularly after I began to get into administrative work as Dean of the Medical School, as Vice President and President of the Uni­ versity, and after I went to Evanston--well, not so much, but still enough to keep me •••• Functioning. Yes, functioning, able to function in that area, and I'm still at it in lots of ways except I'm not an activist anymore. I just work at it from the sidelines and sort of shift around in the other fellow's backfield. I've had a lot of fun at it. Your Dad sounds as though he was something of a rebel too. Yes, he was, but everybody liked him. He was a rebel, but he handled himself without being in open conflict with people. Now his preacher brother, like his father, was different. Of course, if my father had been a minister, he'd have made the fur fly, I'm sure. In this sugar beet business, of course, he was in open conflict with the organized sugar beet interests, and in this trunk there is one little pamphlet that he wrote--! haven't read it for years, but there is just the one in existence called "Sugar--The Tariff, The Trust, and The Truth." What distribution this had, or what impact it had I don't know. I don't think it resulted in his being sued. I don't remember anything like that, but anyhow he gave the organized sugar interests the devil. That's in a sense typical of Nebraska, Iowa, this area- the Populist 19 Revolt against •••• You see, in Nebraska City--when my grandfather went there, it was quite a community at the end of the Civil War because rumor had it that Nebraska City was going to be the point where the Union Pacific Rail­ road was going to originate. All of a sudden it originated from Omaha, 50 Nebraska City almost passed out of existence. Grandfather went there with the idea that with his carpentry and all he'd be a big part of this railroad development, or so my father said. Well, that's sort of a thumbnail sketch. I know nothing about my mother's mother's family at all. I remem­ ber my mother's mother very well. She lived to be almost a hundred, and as a little boy we had her in our home for a while, and she and !--boy, we had nothing to do with each other because if she could get her hands on me, I was going to sit down and memorize Bible verses. She just had to run real fast to catch me. She spent the last thirty years, or so, of her life in an old folks home here in Denver. Just as a matter of routine I had to go see her about once a month. Well, after I'd got old enough to handle myself, I didn't mind it, but I never enjoyed it because I was always going to hear sermons. She was a perfect mate for my mother's father because the two of them--and I think they got along all right--oh boy, were they rigid! This "Barretts of Wimpole 5treet"--this didn't apply to her. She wasn't any vassal of her husband at all. They agreed on everything so, as far as I know, they got along all right. They made quite a team. They were a pretty formidable pair as far as their children were con­ cerned, I think. 20 When you have your conclusions reached and all you have to do is apply them, but you ran fast and escaped this. Well, I was--in this little country school I was always in trouble with the teacher. I was trying to outguess this poor high school gal we had for a teacher. For a couple of years we had a real qualified teacher, and I learned a lot and got along fine. Then we went to Monte Vista where, as I said, I just didn't get along with these town kids in this seventh grade, and my father took me out. Then I came up here, and the same thing started in this jumior high school. I wasn't going to give up my five gallon hat! It was the kind of a hat I was used to wearing. I wasn't going to quit wearing boots, and I wasn't going to quit wearing Levis! Well, I was just easy meat for these city kids. I started having trouble right off the bat. Fortunately a teacher who stayed very close to me until she died a few years ago, took hold of me, got me straightened out in a hurry, and saw to it that I began to learn something. I learned how to study. Do you remember her? Very well. Her name was Brown--I'll think of her first name, but I kept in close touch with her. [Amy Brown] She died a good many years ago. Did you have much time for play? I wouldn't think so. I had a good time, I think. I enjoyed my work. I never had any close friends until we moved to Denver, and part of the success this teacher in Denver had with me was because she put me in touch with a kid that was just like I was as far as background was concerned--! 21 mean interest in cattle ranching, hunting, fishing, mountain life. He and I--we were real buddies, I'm telling you. His family were important people here in Denver, so he took me into not the social group here in Denver, but into an important group, and through him I made lots of friends with prominent business people here in Denver. He took me into DeMolay which is sort of a junior Masonic order--his father was a Mason. This was wonderful for me. Right off the bat because of this kid, this buddy of mine, I was an officer in DeMolay. You see, every kid has to feel that he has some status, and this status implied that I was important to this group, and gee, I hated to leave it when it came time to go to college. These contacts paid off, of course, later on. Well, when I went into practice here in Denver-­ I graduated in 1929, took a year's internship here, a year's residency in internal medicine, and then went into practice with Charles N. Meader, the Professor of Medicine, a man who had been Dean of the School of Medi­ cine. We didn't get along worth two hoots, but he got sick after I'd been with him for about six months, and never came back to practice. Except for a very few weeks, I was working for him about three and a half years, and it wasn't his practice that was the source of my patients for very long. It was the people who came to me because of my own con­ tacts here in Denver and also because I was a pretty good doctor. I just built up a practice in a hurry on the basis of my own reputation, so that by the time I left him--oh, I don't think that there were more than two dozen patients that were coming to me that were holdovers from that old practice. How about your early years before you reached Denver? Was there much sickness? What about experiences with doctors? 22 Yes, there was--I wasn't sick. Both my parents were healthy, but both my brothers were what were called marasmic children. They just didn't assimilate nutrition. My mother wasn't able to nurse either one of them. Now, I don't remember anything about the babyhood of the brother closest to me except that for about a year there they didn't expect him to make the grade. There was a doctor named Frank P. Gengenbach here in Denver who was one of the first doctors to stand out as a specialist in pediatrics, and he took this kid on. We didn't have any money. I know that. Dr. Gen­ genbach didn't get anything out of it, but he got this child straightened out as a patient. I mean my mother--we were living here in Denver--and she took the baby to see Dr. Gengenbach. This youngest brother who was born on this homestead, we never ex­ pected him to live from the day he was born. Working with Dr. Gengenbach through the mail--he tried to advise mother as to what to do. Artificial baby foods were just beginning to be developed, and they weren't much good. In desperation my grandfather put my mother and this baby on the train in the San Luis Valley, and she brought the baby up here to Dr. Gengenbach. He put the baby in the Children's Hospital, which was just a little affair in an old residence here in Denver. He had my mother go out and live with them--she did the cooking and the housework. This boy was in Children's Hospital pretty near a year before he was enough on his feet to leave. Well, of course, this experience did have a profound effect on me, and undoubtedly this doctor relationship to our family had a lot to do with my studying medicine. I'm sure of it, and the minute I went into practice--well, I began to take care of the Gengenbach family. Of course, 23 this helped to set me up in the medical community no end. Well, the faculty here--gee whiz, I started taking care of an awful lot of this faculty the minute I went into practice. In the mountains--fishing, hunting. No broken bones? No. My Dad saw to it that I learned to take care of myself and that I learned to be careful. He was a skilled mountaineer himself be­ cause he was raised in the same mountains. I learned to ride. He wouldn't let me have a saddle for a year. He taught me to take care of horses. The worst--the last licking I got from my father was for running a horse. That was a beating too, because he took the bridle of that horse, and he just let me have it--I'm telling you! My uncle, William Darley, was a forest ranger, and I used to spend a lot of my time summers with him. In those days a forest ranger took a pack horse and went out into the mountains for the rest of the summer. I used to spend a lot of time with him, and I can't even remember any close calls as far as mountaineering, if you want to call it that, is concerned. I much preferred going off by myself. I didn't want any kids going with me. I didn't want anybody to be responsible for. I'd been taught that. Roll your own. Yes. There wasn't any question whether you could go or not. No. I was reasonable. If there was work to do, I didn't go, but i f there wasn't work to do and I felt like it, I took off. I never 24 went out and stayed overnight by myself. I could have, if I had wanted to, but the mountains were close enough so that I could do all I wanted to without staying overnight. Neither of my brothers got into any of this because they were too young. I used to take my younger brother with me once in a while. We depended on the fishing and hunting for fresh meat. We had no refrigeration. We didn't bother going into town but three or four times a year for supplies, although we were only fourteen or fifteen miles away. With a team and a wagon that was quite a distance. On the homestead--was there a distinction drawn between Sunday and the rest of the week? We went to church every Sunday. There was a little Methodist Com­ munity Church seven or eight miles away, and we were a very active part of that. I enjoyed all that. They had a social center. We were too young really to be accepted by the young people in the church. There wasn't anybody just my age, but I tagged along anyhow on picnics, stuff like that. I'd ride a horse down there to roller-skate Saturday evening. I had a happy childhood. Once in a while I'd ride a horse into town and go to a movie. It would take me most of the night to get back home, but that was all right. Then I got to ride my bicycle when the roads got good enough so I could get into town and back in a day without too much of an effort. What about reading--were there books around of any kind? The Bible? There were not many books. I wasn't a Bible reader very much. I'd memorize the verses when I had to. Youth's Companion, Country Gen- 25 tleman, Zane Grey, Horatio Alger, Jr.--I didn't do much serious reading as a kid. You were behaving more like a man. Horatio Alger, Jr. was kind of verboten for a while. I can remem­ ber Sunday afternoons slipping out to the shady side of a haystack to read Horatio Alger. My folks soon gave up on that censorship, but after getting started here in Denver, in junior high the right way, I was a very serious student. Learning, school, was a pretty important exer­ cise for me, and I can remember many times this buddy wanting me to spend the weekend, or evenings going to shows and things, why I wouldn't go if I had very much school work to do. I liked it. Learning was easy-­ well, studying never was a difficult task for me. I probably today-­ well, I probably wasn't studying up to my capacity very much of the time until after I got into medical school. I was always taking extra hours at Boulder, the wrong hours, and I had to go an extra summer or two to get a bachelor's degree. That was one reason I was able to quit private practice because the demands on me were such that I just couldn't begin to keep up with the literature that was important to practice. There were other trigger mechanisms involved in that change. I had a group of four physicians counting myself, and when the war started these other three--they were gone overnight almost, and here I had a four man practice on my hands, and one of these was a psychiatrist. Of course, a lot of his patients I couldn't handle, but his patients that were also my patients I had to handle. This kind of patient takes time, and I learned a lot of psychiatry from this guy--thank goodness. Then we had no fulltime faculty out here. All the teaching was 26 done by volunteers--teaching by men in practice. Well, they were going to the Army, and Dean Maurice H. Rees, who was a patient of mine--we were very close--kept saying. "Well, there's just nobody but you to take this class. Can you possibly squeeze it in?" Well, after three or four months of trying to cope with both of these situations, I got a fellow to take the practice who wasn't very good, but he was the best I could do, and I came out here to the medical school full time. I had two wonderful years of teaching, just fulltime teaching, and all of my teaching practically was being in charge of the juniors who were on the wards. I practically lived with those people. I'd take them on eight at a time for six weeks. Dean Rees wasn't well. He had a coronary problem. Well, even be­ fore I came out to the Medical School full time, he didn't take any trips that he absolutely didn't have to take. I was going with him some on trips because he just didn't want to be alone. Then when I was here full time I went with him, and it reached the point where, I'm told, the Regents just had to give this man a leave of absence. The Regents did this, and he died the day of the Regent's Meeting. When I called the President of the University to tell him that Dean Rees was dead, of course, he expressed sadness and all that, as he should, but then he said, "The Regents met today and gave him six months leave of absence with pay, sick leave, and you're Acting Dean now. They've appointed you Acting Dean already." Well, there I was. I fully intended to go back to private practice when the war ended, but in the interval as Acting Dean, I'd gotten so many projects started here that I took the Deanship and never did go back to practice. 27 I did a lot of consulting work, and then the demands of the job as Dean here reached the point where I couldn't keep up enough to do con­ sulting, or any teaching, so I finally quit trying and gave myself over altogether to making things run along here. Back in junior high school when you got started with some continuity in school and Miss Brown, or Mrs. Brown, who helped orient you toward school and gave you what--an opportunity to see that preparation was re­ lated to performance--did you find all subjects intriguing? Yes, I liked everything, strangely enough, but English. Oh how I hated English and any other language--Spanish. I just hated it, and I never got over that, except for the English part of it. No compensation by the teacher, or was this just •••• I just didn't--! don't think I had that kind of mind. I don't know. German was just plain hell when I got to Boulder. I had to have two years of German to get into medical school. Now, I didn't mind Latin--I should say that. There was some sense to Latin--you know. There is order to it. Mathematics--I liked mathematics. Latin and math kind of go to­ gether. I had good teachers in Latin. I hated the grammar part of English. I should say I hated spelling--! can't spell to this day. Neither can I. Now, I could handle high school English all right, but when I got to Boulder, freshman English--it was the spelling more than anything 28 else. Well, I was lucky. I got a young gal as a teacher (Mable Van Duzee). This was her first job. She'd just finished her masters, a pretty little blonde girl. If I'd had the nerve, I would have dated her, but I didn't. I wish now that I had, because we were fast friends until she died just a few months ago, and she told me, "You're just going to have to pass .these spelling tests!" They had a very strict requirement at Boulder. Then, before you could go from the lower to the upper division you had to pass what they called a "Sophomore English" test, and I flunked it the first time. I flunked it the second time. Then I had to take a special course in Eng­ lish without credit before I could take it the third time, and I finally made it--oh, I know this little English teacher. You could only mis­ spell twenty words a quarter--maybe it was fifty--and this meant count­ ing the spelling tests, the compositions and everything, and I know darn well I misspelled more words than that. I accused her of raising the ropes so I could get by. She would never admit it, of course. She probably looked upon you as a hopeless case. Now, this course I took without credit was a course in English Composition, and I really pulled a teacher for this course. She did wonders for me, but other subjects, the science subjects and all--col­ lege was a breeze. I'll have to admit that. When I came down here I was cocky--oh, boy, I thought medical school was going to be a pipe. Boy, I soon found out different! I never--the first exam in anatomy-­ a red A never looked any better to me than that seventy-one did, I'm telling you! Well, I decided I'd better find out how to lick that, 29 and I didn't have anymore low grades at medical school. What was science training in high school--Denver High School like? Oh, it wasn't very good--well, no, golly, I had a good course in chemistry with a very good teacher, and I just took the one course. There were no advanced science courses in any high school in those days, so I had--well, I kept in touch with that teacher for a good many years; in fact, his son works here just as a diener, and I see him every once in a while. Then there was a course in biology. I didn't take physics in high school. I wish I had. I had trouble with physics in college. It was hard. Those were the only two science courses I took in high school, I guess. I majored in biology at the University; in fact, in freshman biol­ ogy they gave a placement examination which was just an English test. I know I got a low grade on the test because they put me in the dumb section. I wish they had left me there, but after a couple of weeks they moved me back into the other section. I had a little trouble with the first examination in this other section because I was used to easier exams than they were giving. Lucky for me when I found myself not doing too well, I learned to sit down and find out why and changed my tactics. You could re-examine what you'd done? Oh yes, sure. I even found it didn't pay to be cocky; in fact, it paid to appear to be the opposite. Self-criticism as a technique is hard to come by. Yes. Well, my wife has been a big help here. She remembers me-- 30 well, we didn't know each other down in the San Luis Valley. Our fam­ ilies had been good friends, but we didn't meet until after both our families had moved up here to Denver, and she says that she remembered me as a cocky, insufferable sort of a guy, and I suppose I was. They're the best kind. Well, when I began to get interested in her--we went together for a long time before we got married, or even before we got engaged--! had learned to use her as a weather vane. She doesn't hesitate to speak her mind. She's been a real factor in whatever success I've had, and there's no getting around that, and this goes way back, beginning with the first years of medical school. Out at Boulder--what about the faculty out there? Did anyone kick open a window for you? Oh yes--there were lots of windows open to me. I made lots of close friends up there. I took care of a lot of those people. I took care of the President of the University very shortly after I opened my office. He'd been my president up there--George Norlin. I mean as a student when you were going through the school--sometimes professors make a difference. Well, I can't say that there was any one I went to for advice, that served as a counselor all through--now there was no counseling system up there, of course. I was a pretty self-sufficient guy. I made a good friend out of a young instructor in economics--! never had him for a course. He was later Dean of the School of Arts and Sciences. 31 I used to go to their house for a meal. They'd come to the fraternity house, but I never used anybody up there as a counselor. Neither did I down here as a medical student. This Dr. Gengenbach I talk about was still head of the Department of Pediatrics at the medical school. Well, we'd see them socially a lot. He'd want to know how I was doing, but I never asked him for his advice as near as I can remember. Did you take botany? Hated it. Did you? Oh, I hated it! I liked the physiology part of it, but the class­ ical botany where you had to classify and identify plant life and stuff like that, I didn't like it. Remember the professor--a Professor Cockerell? Yes, I had him for an advanced course or two, liked him. He was in genetics wasn't he? Yes, he was a geneticist and an entomologist, and he was an odd sort of an old guy. His wife was also odd. Everybody thought the world of him, though, but I didn't get to know him very well. I took a course in the history of biology from him and enjoyed it very, very much. He'd been working with the evening primrose, but botany you didn't like. The old teacher who was my major professor--he was a grouchy, grumpy old guy. He's the one who put me in this lower division in 32 zoology. Well, I certainly didn't go out of my way to get to know him while I had him as a professor, but later on we became very close friends. I didn't use him as an advisor. There was just one fellow who was just there the freshman year, Arnold J. Lien. He left here and went to Washington University in St. Louis as head of the Department of American Government. That was his field. Boy, he gave a tough course! If anybody got a seventy-five to eighty, they were doing well in his course. For some reason--I don't know why. I didn't make the advances. He did--he just sort of took a shine to me and this guy who had been my buddy all through high school, the two of us. I don't know why--Lien was a bachelor. He was lonesome, and at first he'd stop us on the campus and chat with us, and then we'd walk with him to his office, and he'd have us come in. I don't even remember what we talked about. He went out of his way to keep track of me. He used to write me. I used to hear from him up to--oh, I don't know, I lost sight of him ten years or so after I finished medical school, I guess. He was a long, gangling guy, and quite a well-known person in his field. The only time I went to him--I was on the debating team, and soph­ omore year I had to support the German reoccupation of the Ruhr in de­ bate, and this was a bitter pill to me. I had no choice in the matter-­ you know. If he hadn't helped, I never would have been steered to any substantial literature to support this side of the argument, and he was a big help. How I got on that debating team--I had no yen to do public speaking. I had tried out for an oratorical contest that the DeMolay had, got a gold Eversharp out of it. 33 When I was in Boulder I spent the summers in Estes Park, a moun­ tain resort back in the mountains, working for an outfit that ran a truck line, grocery store, and a creamery, and I got going that summer, the first summer, with a very nice little girl from the University of Oklahoma. I just happened to catch my eye on the bulletin board at the university that they were going to have tryouts for the debating team, and I noticed that one of the debates was going to be with the Univer­ sity of Oklahoma down at Norman, Oklahoma, so I was interested enough in this girl at that time to decide, "Well, it will be just real fun to get on that team." I went to the tryouts, and I was the last one to get on the team. There were two of us trying out at the very end for the final place on the team. I got on the team. I never asked this fellow who managed the debating team why. He put me on the Oklahoma team. The reason I didn't ask him was because by that time it didn't make any difference to me where I went. We went down to Norman, Oklahoma, and we didn't win any debates with that subject--I'll tell you that! I saw the girl. She had other interests by that time too, but we went together that first summer in Estes Park. We saw quite a bit of each other. It just shows how--well, of course that was a terrific experience for me! Oh boy--debating, yes! I never was much good, I don't think, but just the same it was a terrific experience for me. The next year we had to defend--Congress had just changed the immigration laws to keep the Orientals out, and I had to oppose the congressional action. Old Dr. Lien helped me with that one too, believe me. It really--well, unless I think of something 34 later, that's about the only time I ever turned to anybody on the fa­ culty for any help. You spent time in the library. Did you get a chance to just browse, or was it all related to course work? I always had some specific objective in mind. In this debate work, I used the Denver Public Library more than the University Library be­ cause the University Library didn't have bound volumes to amount to any­ thing of the current periodicals--Literary Digest, things like this that we used--editorials, articles written by columnists, or the equivalent of columnists today. Of course, we'd pick up some quote from some big name, and we'd never worry about defending that quote. Maybe that's why we lost our debates--I don't know. Did some professor run the debating team? Yes, a fellow named--well, I don't remember his name. He didn't stay there very long. I dated one of my biology teachers a lot, and she was a dandy gal. We had a debate in Denver--I have forgotten who we were debating, but at any rate, it was this biology teacher's Alma Mater, so she invited the two teams to her apartment after the debate for a snack. She also invited my competition who was a guy on the faculty, a fellow named Joseph Cohen, a young instructor in philosophy and that was all right with me, but on the other hand, it finally boiled down to whether he or I were going to be the last one to leave. Well, by golly, I finally had to give up! You mean you met your match in a philosopher? 35 This young guy stayed on, and he's a very famous academician in the philosophical area. He's responsible for the superior student hon­ ors program. Colorado was one of the first institutions to start this program. That's where he made his name--not in philosophy. Well, we later became very fast friends. I've never said anything about this to him though--old Joe Cohen. How did you work out in the fraternity? Really, after the DeMolay experience I joined every fraternity I guess that I was ever eligible for, but none of them meant anything to me. The fraternity at Boulder was important because that was where I earned my board and room for two or three years, and the fellows--with the exception of this buddy of mine who went into Sigma Chi, the whole crew from my class in high school that went to Boulder joined this lit­ tle local fraternity that my mother took care of. Any close friends-­ with one or two exceptions--that appeared to come out of this frater­ nity situation involved these kids who were friends in high school. I wasn't hostile particularly to fraternities until I became Pres­ ident of the University, and then that was the thing that as much as anything else, I think, soured me on being a university president. We had a knock down and drag out when I was president up there over this fraternity discrimination business, and that's quite a story. The ten­ sion and the strain that resulted from that for both Mrs. Darley and myself was really something! We didn't start it. I didn't get into it until one of the Regents started it, and I didn't get into it until the Regents wanted me to find out--poll each fraternity, contact each fraternity president, and obtain a written statement as to whether or 36 not the fraternity had anything in its by-laws, or its constitution, that compelled it to discriminate as to race, religion, etc. I inter­ viewed each of these and the presidents of the sororities too, but I didn't get into it until it developed that one of the sorority gals had lied to me. That made me mad, so I got into it then in a big way. As an undergraduate, it was board and keep--pretty much. Yes--there were fraternity meetings and the ritual--no ritual ever meant a darn to me after the DeMolay business. I didn't go on into Masonry as most of the DeMolay do. You pick up relatively little from fraternity brothers--in the sense of close friends. The fraternity had no influence on my sense of social values one way or the other, I'm sure. Now I can point to kids that came into the fraternity where the fraternity did for them what DeMolay did for me, I suppose. It was very important to some of these kids. Of course, it ruined others too, I'm telling you, believe me, but as far as I per­ sonally was concerned, it was board and room. When you graduated from high school, there wasn't any question as to whether you'd go on to college? No. Neither father nor mother objected. They encouraged it. They wanted all their three boys to go to college. When my brother got kicked out of Greeley, this was a very 37 bitter pill to them, particularly when all he had left was another quar­ ter. I tried to get him to go back and finish later. I told him I'd pay for it, but he would have none of it. The other boy--gee, getting through college was a terrible task for him because his struggle there was while I was in medical school, and nobody in the family was in a position to help him. He earned his own way through. He just worked like a dog. But don't you have the sense that when you actively participate in pay­ ing your own way, it tends to sharpen interest in what you're doing? Your motivation has to be strengthened, or you wouldn't do it. He still works as if his life depended on it. Oh, he's a tense, strong-willed fellow--much more so than I ever was. My middle brother-­ he's relaxed. He's like my father. Nothing ever bothered him, and he's still that way. What went into the decision to become a doctor? Was there such a thing? Yes. Any alternatives? Yes. There was a time in high school--! don't know why--that I thought I might take a look at engineering until I took the course in mechanical drawing. Well, I'll tell you--my grandfather, the preacher, George M. Dar­ ley, was bound and determined that I was going to study for the minis- 38 try, but he never pushed me on this. He just let me know that that was what he wanted me to do. I never said that I would do it, or I wouldn't do it, but in deference to my religious background and my family feel­ ings, when I first talked about medicine, I was going to be a medical missionary in South America. I started to take Spanish in high school, but deep down inside myself I knew that this was mostly talk, particu­ larly after I began to try to learn Spanish and found out that it was going to be too much work. It wasn't long until medicine was it without any question. I even tried to carry my buddy along with me, get him to study medicine, but he wanted to study law. This course in mechanical engineering was a sophomore course in high school. I finished the course. I didn't get a very good grade. I could make the drawings look good, but they weren't very accurate. I had quite a flair for art. I can copy, things like that--I'm not like my middle brother by any means, but from that point on everything I took in high school and college either had relevance to what was going to be required for graduation, or was my idea as to what was going to be relevant to medicine. The requirements for medical school so far as this university is concerned were no problem, and practically everybody in those days who applied to this medical school got in. As a consequence, the mortality rate, the drop out rate was pretty high. We started out, I think, with about fifty, and by the end of the first quarter we were down to about forty. We had quite a few people transfer into the school from some other schools along the way. I think there were forty in the graduat­ ing class. Now I made no big friends in the graduating class. I was friendly. 39 I just didn't seem to require friends. I belonged to a medical frater­ nity, but I never went to any of the meetings after joining, and when the fraternity folded, I didn't lift a finger to prevent it, and I wouldn't lift a finger to bring it back to the campus. Phi Chi is the largest national medical fraternity there is. I had friends, but I never and to this day I have never become dependent on any one friend, or any small group of friends. This buddy that I talk about, William Houston, got killed in a hunting episode several years ago. We kept in close touch with each other. We used to go on long pack trips together up to the time I was about ready to quit practice, up until the war started. My wife had just one brother, Wade Graham Eraiden. He died of tuberculosis while he was a sophomore at the land grant school at Fort Collins. Here was this big cattle spread, and my wife's father--it broke his heart--because there wasn't going to be anybody in the family that would be interested in keeping this beautiful spread going. I say "beautiful spread" because he had enough land--enough hay meadow so that he could cut enough grass, and have enough 4U pasture to keep a nucleus herd of a thousand cows going ad infinitum without having to buy feed in the winter. Buying feed in the winter is what kills the cattle producers. He never had to buy a blade of grass. He wouldn't sell any feed either un­ til it was at least two years old--I mean hay. He always wanted to have a good big supply in reserve. This particular spread was in the south­ ern part of the state, just near the New Mexico line, close to where the Rio Grande crossed into New Mexico, and then he had a great big summer range about fifty miles across the line in New Mexico which was wonder­ ful summer pasture, and this would give his meadow land at home a chance to grow--you see, so I used to go along with that drive. (phone call interruption] This was the summer drive. Yes--well, let's take a little break here. I said that this operation of my father-in-law's involved a nu­ cleus herd of a thousand cows--that's the way they speak of a spread. Then when you add to this the bulls you need, the actual count of the herd depends on how good your calf crop is and how many of this year's calves you're going to hold over until the next year, heifers particu­ larly, to keep your herd young. We'd be driving around two thousand animals from southern Colorado into northern New Mexico every--oh, this would take place late in May. My father-in-law would wait until the grass was in pretty good shape in New Mexico. Of course, you had to pay taxes to New Mexico as well as to Colo­ rado, and the amount of taxes that you'd pay to each state would depend upon the number of months out of the year that the herd was in each 41 state and the size of the herd. The cattle had to be counted at some check point on this drive. It was just plain good business to count the herd, and so the excuse that I would use to make these drives would be to sit with the foreman and help count these animals. The foreman and I would almost always be the only non-Mexican members of the crew. This drive would take about five days from start to finish. There would be two overnight stops on this fifty, sixty mile drive. This was all semi-arid country, and you didn't want these animals to lose anymore weight than necessary. My father-in-law was smart enough to buy up two nice pieces of land strategically placed between the two end points of this drive where he had water and could fence it off so that there would be some pasture. We always had a place to put these cattle at night be­ hind wires, but it was--it was a lot of fun--a beautiful drive in beau­ tiful country. A day and a half of it was across the desert. I would go right out of the office and go down there. I knew enough about riding a horse so I could really do a day's work right off the bat with the rest of these fellows. Of course, it was important to have chaps and all the things like that, a leather coat, with which to protect yourself. It would be going down in the spring and coming back in the fall. This kept up for me until after I reached the point where I knew when I'd been on my last round up, believe me, and at any rate, Pauline's father was getting older, and it was getting more and more difficult for him to keep the spread going. I'd been making movies of this operation. I began way back when colored motion picture film was first available. When it became appar­ ent that my father-in-law was going to have to sell this place, I took these accumulation movies, edited them carefully, labelled them and 42 everything so as to give the uninformed a real good idea as to what the production end of the cattle business was like from beginning to end. These films were used to advertise this range so my father-in-law got a pretty good buyer for it. Then he moved up here to Denver and stayed until he died. Up until the time I was unable to enter into the mountains, I was always able to indulge that particular interest. These movies--I don't know just what to do with them. They're still pretty good. I've got to go up--you know, these things you keep putting off, but they've named a dormitory after my wife's brother up at the Colorado State University--we call it now. Of course, my brother graduated there, and the president's a very close friend of ours. These movies ought to be in the film library up there. I should take them up and show them to the president before they're put away. They should have a duplicate set made because these films are getting old and dry and brittle. They aren't going to last too much longer. I just question whether there is anything like this in the librar­ ies of the country. I haven't any idea. You used to leave the office and go on this drive? Yes, sir, and I guess I'd ride forty, or fifty miles a day because it's back and forth. The secret is just letting yourself go with the horse. That's what comes from my father making me learn to ride bare­ back a long time ago before he'd even let me have a saddle. With this Mexican crew any sign of being any different and you lose your rapport with them immediately. You have to live just the way they do, get up before daylight. Those buzzards--they'd always have 43 mouthharps with them. They'd sit around a campfire, and one guy would play a mouthharp. Then he'd pass it to the next one, and it was pretty hard to take that mouthharp when it reached me. I could play a mouth­ harp, still can, and they were watching me to see what I would do--you know. That was funny. In any event, your interest in things medical began as a sort of off­ shoot from the religious background, the desire to be a medical mission- ary, in a way. Yes, in a way, and the influence of this doctor who went miles out of his way to befriend us, taking my mother in. We were very, very close personal friends after that, of course. You majored in biology. I had a major in chemistry too, but I would have had to go another summer to have finished up chemistry, I guess. A biology major in those days was a far cry from what it is now. I really realized that when I was a consultant to this special study of the biology curriculum that the National Science Foundation financed and sponsored. It is still lo­ cated at Boulder, and it was really quite an experience to see these high school texts, the new biology develop, and gee whiz, those texts, any one of them, are better than most college texts today. The colleges 44 have been pretty slow catching up to what's been done to high school biology, math, physics, and chemistry. - Yes. The medical schools are slower yet. It's one of our big problems in medical education. Most of biology in those days was a descriptive course, courses in the classification of biological forms and forms of life. Botany--they didn't know much about the physiology of plant life in those days. It was pretty elemental compared to what we know now. I was wondering about the lab work--what the labs were like? Description, keeping a fancy notebook--! could make them real fancy. In chemistry, too. Yes, in chemistry we kept a notebook--the cook book laboratory courses. Of course, we're getting away from this now. Most medical schools, not all. We're just beginning to get away from it here. But you learn technique. Manual skills--well, the emphasis, of course, was on the chemical concepts that were involved in these cook books, the experiments that you'd do in the laboratory. It wasn't very exciting or interesting. Medical school was the same way, and you didn't see anything of your professors to speak of in the laboratory. They were either graduate students, assistants, young instructors who were just starting out. That's how I began going around with one of these biology teachers-- 45 she was just a master's degree. It was her first job, and I suppose she was a couple of years older than I was, but that didn't make any difference. She was a mighty nice gal to be with. I kept track of her for quite a while through my young English teacher (Elizabeth Peabody). Where did you learn how to dance? Oh, I just danced like most kids. It was in the air. Just attend dances--high school dances, two step and so forth-­ there was nothing to that stuff. I didn't do a lot of dancing, except to be dancing it was always because there was a school prom, or some special event. When I was in school at Boulder, it was just get a date and go to one of the dance halls where you'd pay a couple of dollars for an evening. I did some of that, but I didn't have the kind of dol­ lars I was willing to invest that way very often. I went to lots of movies. Oh boy, I was a great movie fan--just to get away. A change of pace. During final week--I'd see three or four movies. You'd just reach the point where you'd get tired cramming and take off for the evening. You did a lot better on the examination the next day than staying up try­ ing to bone some more. Even in medical school--we lived within a short distance of a little neighborhood movie, and my mother and I used to get over there maybe a couple of times a week, and during final week, every night maybe. 46 I hated to msnorize--oh, boy! Is that what it mostly was? Yes. There was really no break from Boulder into medical school. No, I went back to summer school a couple of times. I drove a city sprinkler summers a couple of years I was in medi­ cal school, and that was my good paying job, again a job that the father of this high school buddy of mine got for me. The city government was Democratic, and my family was Republican. In medical school, after I finished the course in physiology, I was made a student assistant in physiology for two years, and that paid me about fifty a month. I helped the janitor down at one of the big churches, took care of the Sunday School part of the plant. I got about fifty a month there. Well, with that and with a summer job I was doing pretty well. Tuition was about a hundred and twenty dollars a year, as I remem­ ber. Books were--! used my uncle's old microscope. I never did buy a microscope. It was an antique, and I sent it into the Bausch and Lomb factory. They put all new lenses on it, so it was just as good as any. We got married close to the end of my internship, lived in a lit­ tle house across the street, and in my residency year here--there were just two residents in the hospital; one in medicine and one in surgery, and the pay was a little apartment for ourselves and our wives, and board and room for us both, and a hundred dollars a month. My wife was a social worker, and she worked part time. The depression was on, and 47 I had to help my parents even then, but with a board and room job for us both--why, we made out pretty good. A dollar was worth about four of today's dollars. I think we ought to stop for now and come back to the school of medicine tomorrow. All right. Now, tell me a little more just how you'd like to do this. 48 1uesday, April 9, 1968, 7002 University of Colorado Medical Center I left here about twenty minutes after eight. With nothing to eat all day long. No, and I read through a number of those bound volumes. They're tre­ mendous collections, particularly the background of the Preventive Medi­ cine Conference and the other one--the first one, the one on psychiatric education. That's a tremendous collection of material. Golly, I haven't looked at it since the day I put it all together, I guess. I was wondering since yesterday whether you had any observations about what you said yesterday. You might. I have a couple of things I want to go back to, but I wonder whether you had any additions, or altera­ tions that you might want to make in thinking over what you said yes­ terday. I really don't. I've thought quite a bit about it. I realized I was completely uninhibited, but that's the only way to run an interview. So why don't you just back up any way you want. I wondered about an emerging sense of justice--! don't know exactly how this forms, but I did wonder whether you had one and what it was related to--a sense of justice. Can you tell me what you mean by "a sense of justice"? Well, it's probably related to a capacity for outrage, anger--! felt 49 the sense of discipline yesterday in our talk which is the consequence, I guess, of having lived a life, but I wonder as you look back at a gowing boy whether there was a capacity for outrage, anger, a sense of injustice, or justice. You moved around a good bit, and I think it's so that your sense of roots transcend a given time and place and move into a community at large. That's so, but--well, for example, going to school, junior high school, being tormented and taunted by one's fellow students, being the end of a game that kids and people play is bound to generate both outrage and anger. I think I did have a sense of outrage and a capacity for anger. As a youngster I don't think I suffered in silence particularly--like I have learned to do since. Junior high--when I hit junior high school here and ran into the situation that I told you about, that didn't last more than once, and sure I had a sense of outrage! There was more to this than physical combat. I guess I told you--yes, I think I did-­ that the two boys in high school who were the cause of most of my diffi­ culties I had lived next door to previously here in Denver. Did I men­ tion that? Well, during this moving from place to place in order to keep up with my father, we rented a little house in Denver. These two brothers lived next door, and they were the sons of the British Consul here. This would be when I was third gradish. One of these boys was just my age, and the other was a year or so older. This junior high school dif­ ficulty got started back there. Now, we got bloody noses every few 50 days--this other boy and myself, and we had some real battles, so it was very easy for him to pick up the situation years later when I came back to town. All the while I was trained in my school situation, starting school and getting into junior high school--when I felt like getting in a scrap, I got into a scrap. I didn't brood. I didn't have any inhibitions at all, and as a consequence I didn't like school very much, except for the two years out in the country when we had this well trained teacher who substituted learning, or who directed my aggressions toward study instead of letting them just run wild, and I wasn't wild. I don't think I ever started a scrap unless I felt that it was justi­ fied, or else it was in self defense. I've always been aggressive. You see that, I'm sure. But really a background of outrage stimulating the kind of activism you see today in young people--that wasn't a part of my pattern of be­ havior, I don't think. I would think not. I never was--even now, I never brooded over injustice that I felt might be directed toward me. My difficulties here when I was dean of the medical school were part of the natural history of the development of the medical school. I don't think there's a medical school in this country that has amounted to anything that didn't have to go through a period of conflict with the immediate environment. Usually the conflict involves the effort of the medical school to change in the face of oppo­ sition on the part of the practicing medical profession--at least that 51 was our situation. As a boy ...• I felt I was on top enough of the time so I got enough satisfac­ tion out of that development to keep me from giving way to frustrations, or feeling of anger just for the sake of anger. I keep myself pretty well decompressed as a result of doing something about a situation that is bothering me, or trying to find somebody to talk to about it. I don't think I am a burden to anybody because I need some psychotherapy, or somebody to share difficulties with. I don't take my troubles-­ these things home any more than I have to because Mrs. Darley does get upset, and I just don't want her to go through any needless suffering. Lots of time she knows something is bothering me, I suppose, and I will talk it over with her when I think the time has come for it, so that she doesn't get upset because she can be frustrated. She isn't in a posi­ tion to do anything about this, except to tell me that she wished I was in a different kind of a situation so that I wasn't under these kinds of tensions. The worst time she had of all, I think, was when I started out in practice with this older doctor, Charles N. Meader, and he was sick. As a consequence, my sense of loyalty kept me tied to the salary situa­ tion. I was under his thumb because it was his business I was operating, and my wife says that we had him for breakfast, lunch and dinner, and in bed with us every night, and this was awfully tough for her. I should have left at the end of the first year, or year and a half, but I kept thinking, "Well, he'll get back on the job. He'll get back on the job." 52 He never did get back on the job. He died in this hospital a couple of years ago and except for two or three months late in the war, about the time the war was over, he never did come back to practice. I finally had to break away and leave him to get along the best way he could because I just couldn't submerge myself in his situation any long­ er. When it was over, it was over. I never let that situation bother me since. I think that was about as tough a period mentally and emo­ tionally that we had, and what makes me say that is because I was so helpless in the face of it. There was just one thing I could do about it, and that was get out. I just had to wait for the time wien I could get out without carrying away too much sense of guilt for leaving a situation. Well, that probably struck a balance--didn't it? Yes. There was a subjective deposit about it though. My friends in the profession urged me to clear out of there long before I did. Sure, I'm a tense disposition. That's one reason why I have arthri­ tis. I took care of a lot of arthritic patients, and I don't think I ever had a patient with severe arthritis where the emotional and psycho­ genic component wasn't very considerable. You had one close buddy as a boy. I may be wrong, but I get the im­ Qression that for a long period of time because of this skipping stone life, people gua people, while they existed, didn't mean very much. 53 That's quite true, except my parents and my father's father and mother. My mother's parents just never were in evidence. In spite of what I may have implied yesterday in the way of conflict within the family setting, we were a very closely knit family and loyalties were very strong. Father and mother--mother particularly, a very aggressive, strong-minded sort of a person. My father was too, but he was slow to anger. These are the kinds of tensions you'd expect from that kind of a family constellation. I don't think that with the exception of the members of my family, this buddy, Bill Houston, and my wife, I ever be­ came involved very deeply with anybody until I got through school here and began to take care of a lot of my former teachers. My practice was a family oriented type of practice. I had learned enough in my work in psychiatry to avoid any emotional involvement with patients. Just the same I was motivated by a very deep sense of con­ cern for their welfare and as a consequence, I thought a lot about pa­ tient's problems. If there was any benefit of the doubt as to whether I should go to see a patient in the middle of the night or not, I gave the patient the benefit of the doubt. Well, this involved tension. I'd get two or three phone calls at night, and if I had any residual uneas­ iness about the patient after the phone call, I might as well get up and get dressed because I wouldn't go back to sleep--at least for a long time. That sort of thing is wearing--you know. It's the kind of wear that doesn't erode the situation either. No. I enjoyed practice. The satisfactions of practice were very con- siderable. Many of the patients turned into be rather close personal friends. When I quit practice and came out here, I had to make all these people emancipate, and it was difficult. I retained consulting privileges when I first came out here, and many of these patients in­ sisted that I keep in touch with them through the doctor I left my prac­ tice with under the name of consultation, although it wasn't very long until neither that doctor nor I could accept this approach, keeping these patient-physician relationships alive. It kept him from •••• Functioning. Yes, functioning--see, and we finally just got together and sort of mutually--both of us realizing that this situation just shouldn't go on. I explained to each patient the situation, and I broke a lot of very close friendships off. This was harder on the patients than on me. I was relieved to get out of this pained situation. As a boy was it possible for you to develop a sense of hero? Did you have a hero? Or a collection of heroes? I just don't believe so. I don't think you did either. This would account, in part, for the sense of being a loner that's not what I mean, self-reliant. Out on the homestead you had the kind of responsibility as a young fellow that an older person would have. The only way I can answer this is that all my life I've been a very self-sufficient sort of a person. I don't mean that in the way it might sound. I don't mean it in any egotistical sense. I've been 55 tty much a loner really. I never had to run to a preacher, or a doc­ pre or any--I've never had the "blanket syndrome", I don't think. tor, Do you know what a "blanket syndrome" is? Every child has the equivalent of a "blanket syndrome". I remem­ ber my grandson when he was two to five--he spent a part of a summer with us in Estes Park while his parents got some vacation, and he had 8 little blanket, and he 1ruGuldn't go to sleep in that bed, or take a nap without this blanket. He'd wad one corner of it up and stick it up his nose, and he'd quiet down under these circumstances. Well, every single time during the day when this child would be upset about some­ thing, when I'd seem to scold him, or anything, he'd run like a streak for that blanket--just hang onto it. Girls use their dolls this way, or their teddy bears. Boys will use a teddy bear more often than other things, but the psychiatrists call it the "blanket syndrome", and they use the term when they talk about certain adult problems, and we all know what they mean. Well, I didn't have any "blanket syndrome" I don't think. You had no one to whom you wanted to go, or could go, with one excep­ tion maybe--that family doctor. This was a long distance deal until we moved to Denver. I had hardly met the man, had never met any of his family, but I was aware of what he'd done for us--that was about as close to having a hero as I ever came, I think. When you got into high school, did you have a sense of being in competi­ tion with other students? Did you recognize this? Oh yes. y_ou were competitive. Yes, I was. The teacher I'm talking about--all she did was redir­ ect my aggressions. Turn them on. In school at Boulder, medical school--part of my goal was to be as good at least as this guy, or that guy, or better, by golly! Maybe I never quite made the grade, but I think I had a pretty high level of satisfaction, or maintained a high level of satisfaction. These are the kind of people that study medicine by and large-- the paranoid personality type, and these are the kind of people that re­ spond to competition. I think it's fair to call these people the para­ noid personality type. Paranoia is a well-known psychosis, where an individual feels that he's being plotted against. The system is all against him. His bed springs are bugged and all this sort of thing, but on the other hand the kind of people that study medicine by and large are highly individualistic, competitive--they like the sense of power of authority. They like to be authority figures in the community. They like to be adored--all that sort of thing. Well, I don't want to be adored, but I do want to be respected, thought well of--all that sort of thing. This has been a motivating factor, one of my motivations. I can't point to any successful doctor that hasn't had the same sort of mechanism behind his aggression. Did you ever have the sense of making up for lost time--for example, the spotty nature of your education before arrival in Denver. Maybe 57 that's unfair. I knew I had lost time in school. I don't think this worried me particularly. But to discover school with continuity and to do well at it. That summer I spent going to "Opportunity School'' I knew what the score was. I knew that I was going to have to do well in that examina­ tion. I knew I could do well. I wasn't afraid. I just buckled down, went to classes. I don't even remember the classes I took because most of the work--well, I knew that I was going to have to dig out most of this at home. Geography was one thing they told me I was going to have to dig out all by myself. Well, I knew that geography book from cover to cover. They gave me a course in arithmetic, or an examination in arithmetic--! suppose English. Well, I don't remember. I guess I did have a course in grammar that summer. I knew when I finished that day of examinations that at least I was in the eighth grade. Was there much discussion of content with your mother, or your father? You said yesterday that you didn't like--well, these aren't your words, but you conveyed a sense of displeasure at memorization, but to talk a thing out, discuss a thing. Not too much. Mother and father both had a mathematical turn of mind. Mother was a good grammarian. She knew her Latin pretty well, and she used to help me with English and Latin. Dad would help me with algebra, if I needed it, but I don't remember being any burden to them. How about the political currents of the day? 58 I don't recall any very great sense of interest. You know, in those days, 1903 to 1912--well, up through the war, our isolation pre­ vented my taking much interest, or feeling a very great sense of concern. World War I had been under way for a couple of weeks before we knew that the war had started, I think. Prohibition was an issue that my parents were very hot about, of course, and I remember hearing my father's jubi­ lation when the Prohibition Amendment was built into the Constitution, but as far as I personally was concerned, I don't think this was very important. How about the local strike in the copper mines about--what was it-- 1911, 1912, 1913? Coal mines down in the southern part of the state--the Ludlow Mas- sacre. Well, it just happens my grandfather had the Presbyterian Church in Walsenburg, and my mother and two brothers spent six months with him while my father was--this was when he was making his last effort to sal­ vage something out of this sugar factory business, and he wasn't there. While the strike was a very real thing to me, what did impress me and what I was interested in were these soldiers going around in uniform and carrying guns. This intrigued me. I don't remember that the strike bothered me very much. Grandfather used to take me down to see the Na­ tional Guard, I guess it was--they finally had federal troops, I guess, in too--and he'd take me down to watch the mustering, the roll call pro­ cedure. Gee, I thought that was wonderful! 59 I used to hang around the town jail a lot because the guards march­ ing around the jail interested me. I remember the Ludlow Massacre and thought that was terrible, of course. That's when the federal troops came in. After we left there, the miners got on one of the high hills around the town--this was in response to the massacre, I guess--and they pretty well shot the town up. There are buildings down there yet where they can show you bullets imbedded in the wall, but the social injustice that this represented--gee, I'm afraid that it didn't disturb me particularly. I don't know whether there was any IWW agitation in Colorado? Oh yes, it was all involved. A doctor down there who was the son of a close friend of my grandfather's was killed in one of these pitched battles. This was after we left, I think--he went out between the lines to pick up somebody that was wounded, and the miners let him have it. This was bad business down there, and the community has never recovered from it--never. The coal business just never really paid after that, and I'm afraid the only reason it paid before was because of the exploi­ tation of the miners, company stores, script, all this living in company owned houses--you can't hardly call them houses. All the substance of involuntary servitude. Well, I didn't appreciate this--you see. How old was I--I was seven, eight--along in there. Did you learn for you study habits? Other than memorization. Problem solving--you know, the educational system; primary, secon- 60 dary, college, and medical school--! just came along quite a bit ahead of any of the changes, any of the teaching educational methods that in­ volved anything but parroting, memorizing--! didn't get any of the ex­ citement out of education that I want young people to get today. Did you get--you know, well, for example, did you and Tom Sawyer, Huck Finn get together? Oh, I read all those things, was fascinated with them. There was quite a bit of self identity between myself and Huck Finn and Horatio Alger, Jr. characters. Every kid who reads those things experiences that, I'm sure, but when it came to putting what I say now, putting the wet towel around my head and getting going with any really serious scholarly effort that I'd call a scholarly effort--none of this really began to hit me until I went into practice. My internship and resi­ dency here--the service load was so tremendous, the demands were so tremendous that the use of the library was pretty much limited to a quick search for information that was highly important and highly rele­ vant to some immediate situation over on the ward. Now I took the National Board Examinations, and these examinations are given--this is a private corporation that was set up in the early twenties with the idea that it would develop an examination that would be used across the country in place of the State Boards, and the State Boards, most of them, did accept this examination for a certificate. There has never been a time when they all have accepted it. I decided that I would take those examinations. Part I is given at the end of the sophomore year, Part II at the end of your senior year, and Part III at the end of your intern year. Part I and Part II is all written, 61 and Part III was all oral--you examine patients under observation and submit to testing and so forth. I didn't start these examinations until I started my intern year. I took Part I, II, and III all during my intern year. That was the year when I really buckled down to the business of studying, even though I was busy as the devil over on the wards taking care of patients. That studying did me more good probably than any other single year's effort. I had to review my gross anatomy, bacteriology, all of the pre-clinical subjects. Then I took that examination. Then I had to review all of the clinical subjects, and I took that examination, and then--well, I didn't go through any particular preparation for the third part. I just took it as it came. I did very well on all three parts. That made my residency year very profitable for me because I had gone through all this recent review. The residency year was such that there just wasn't time for intensive study of any particular questions in depth, and when I got into practice--why, I had to keep up with the literature in internal medicine in order to be effective, and here again as the practice load developed and particularly when the war started and I hit this situation of taking on extra teaching and extra patient load--well, I had to choose one or the other. One of the main reasons I chose to come out here was that I knew I had gotten behind in the lit­ erature, and I wanted in a situation where I could study in peace. That's one of the reasons I had those two good years, and it was just at the end of the second year that I was beginning to feel comfortable as a teacher that Dean Rees died, and then I got sidetracked very rapidly. 62 Int □ administration. Yes, and then when I began to realize that I was losing out so far as keeping up with medicine is concerned, why then I had to choose again--you see, between administration and medicine as a scholarly, or an intellectual pursuit, and I chose the other partly because I had be­ gun to see what a terrific job needed to be done in education. This is why you find these volumes down there that had to do with these early conferences--those conferences had a terrific impact on me and the con­ tacts I made. Gee whiz, the people I met there that I thought I'd never see again have turned out to be very important people to me since. I haven't regretted any of these decisions. To live is to function--! understand that. Even now--you're putting me through a ringer that I'm not ready for because I have not reached the period in life when I reflect about the past, dwell on the past. I haven't reached the age of reminiscence yet--spontaneous reminiscence. I know. It's an effort. To live is to function--what's up ahead, to­ morrow and today. Well, when that time of spontaneous reminiscence comes I'm ready to quit. I see this in my older friends. You reach the period in old age when your memory is failing you, and as a mnsequence you go back to talking about things that have transpired years before, and this is Your chief preoccupation. This is one of the horrors of growing old, as far as I am concerned. 63 ~t the time you were in Boulder, was the medical school located there -19 □, or had it just moved down here? The medical school moved down here ••.• In 1924. The first two years had been down here--well, the last two years had been down here for several years, and the first two years were at Boulder, and they were moved down here. I started down here in 1926-­ no, I started down here in the fall of 1925,- so the school had moved down here in 1924, and I was in the second freshman class down here. I didn't see much of the school of medicine up there while I was up there in Boulder; in fact, I didn't see any of it. I knew it was going to move and knew how badly it was housed and equipped and all that. I knew a lot of the medical students. I had fraternity brothers who were medical students, so I was interested down here because I knew this was where I was going to start. I had a lot going for me up at Boulder--this debating business I told you about. I was in the band. I had no business being in the band. I played the piccolo, but I couldn't read notes. I would just learn the main theme and then play it by ear. I never used the piccolo music. Well, in those days they were so desperate for a man with an instrument in the band--there were no tryouts. The band leader never came around to see how I was doing. You had the illusion of being a member of the band. I had no illusions at all. I had that piccolo from back on the ranch. This is just an example 64 of how I kept busy. You remember the Youth's Companion Magazine? Each year you'd renew your subscription and get a prize. I got a flageolet as a prize one year with an instruction book. It showed the pictures of the position of your fingers for certain letters, and "Home Sweet Home" was just a bunch of letters lined up. Then all of a sudden I real­ ized that these letters corresponded to the notes on the music scale, and I learned to play some simple things. The Montgomery Ward Catalogue was a very important piece of liter­ ature out on this homestead. I'd brood over that by hours--going through the toy pages. After I got the flageolet I looked the piccolo and flute situation over. Here was a piccolo that they had for five bucks. I saved up and got it. I found that this was the old Bane System which was the same as the flageolet, except that it had some keys so that you could introduce some sharps and flats into the performance of the pic­ colo, I never learned to use those. I stuck to the straight key of c business. When I got to Denver and high school, they wanted a band. It was no trick to getting in the band. I was in the high school band for three years. When I got to Boulder, some fraternity brothers were in the band, and they said, "Bring your piccolo and come on over. We need you." I got a big kick out of it. There were a couple of other piccolo players. They didn't come to practice very often. I never missed a practice so that when it came to the football trip I'd get to go, and they'd be left behind, but this was all a great lark to me. My conscience should have bothered me, I suppose, but it didn't. Did you get into sports at all? 65 No. NfJ time. That and interest. I did go out for wrestling. This arthritis was getting started even then, and I hurt my back right off the bat and quit. I learned some good holds that I wished I'd known about years be­ fore. The fellow who was the wrestling coach on the faculty has just retired. I don't know why, but he acts as if he thought I was on the wrestling team, but I never got that far. I really hurt my back, I'm telling you. As I look back on it--why the reason I hurt my back was because of the arthritis. This kind of arthritis usually involves males mostly and starts in their late teens, or their early twenties. I've had it, and it's come and gone ever since. I don't think that I have ever had a serious flare up unless it was pre­ ceded by a period of tension and fatigue. The worst spell of it that I ever had was after an unusually tense session with the state legislature when we had about fourteen pieces of legislation that were important to the university. That was the year that we got the legislation through that put Colorado into the Western Interstate Commission for Higher Education. I had no big hassles with the legislature. It was just a terrific job to educate them and make the case for each piece of legis­ lation and put it through. Did you get medical care in Boulder when this happened to your back on the wrestling team? I came down to Denver, and I told you my mother had been an osteo­ path, and she took care of my back, and she did too. It probably would 66 have gotten on just as well--the massage and relaxation that went with it. Medical care for this condition never did me much good. Toward the end of my period in Chicago, the arthritis had gotten in my knees and neck due to the fatigue, I think, and just plain hard work. Then this heart block started and cardiac irregularity began to go with the fatigue, and that's when I decided to retire. I had hoped to stay with that job for ten years. I had financing in sight for ten years, but at the end of eight I just knew that I would never make it the next two. Well, I was on big doses of cortisone. I tried that two years be­ fore I retired, and then I had two big stomach hemorrhages from the cor­ tisone and was in the hospital for a couple of months. Then all my joints flared up. I didn't have a joint in my body except my jaw that wasn't involved. I had a foot infection. I went to Mayo's for part of this time and the physiotherapy at Mayo's did me a lot of good. They got me off the cortisone which was difficult because you get addicted to it. Since then I have kept under the observation of a good internist. There isn't anything that anybody can do for it. I just refuse to make a business, a full time job of having arthritis. That's what it amounts to. I could have been going for physiotherapy every day all these years--! don't think it would have made much difference. I kept active enough so I think I've given myself physiotherapy, a big dose of aspirin and beyond that whatever I've needed to take care of symptoms. I'm not going to make a fulltime job of being sick. When I get to that point, I don't know what I'll do. I'm not worrying about it. But it precluded your being athletic at Boulder. 67 Yes. Well, on the other hand I never was interested. 1.9u said something about not a little mountaineering. That was different from playing football--you know, there's a lot of other kinds of sensations that go with dry fly fishing, for example, or riding a horse across the mountains above the timber line trailing a bunch of cattle. I just wasn't interested in exercise for exercise's sake. I enjoyed athletics and football. I belonged to the C Club which is the athlete's very exclusive organization in Colorado. I got into that because I was president of the university, so again here am I in a company of people where I have no place being, but I've enjoyed it nevertheless. It's like playing the piccolo in the band really. When you came to the school of medicine here in Denver--I was interested in reading some of the early notes about the school in the light of what has happened since. Some of the comments are of interest--"the entire group of buildings is situated on the site of eighteen acres affording ample room for such future expansion as is likely to prove necessary." I don't know what the school was when you were a student. I don't know how much of this you want, but here's--these are the mountains behind you. This is 8th Avenue. This is a diagram of the original plot of ground which is three blocks, eighteen acres--the eighteen acres they're talking about. This was given to the state by Fred G. Bonfils, of Denver Post fame. [See Ward Darley Catalogue, and, more particularly, Colorado University Medical School; i.e., "The Plot Plan of the Land Acquisitions That Make Up the Present Medical Center" (May 5, 1964)] 68 Have you ever read Timber Line? -- Yes. If you ever want to read anything that will give you the flavor of the early days in Colorado, it's one of the best books. It's by Gene Fowler. The university had an option on a piece of ground north here, out near the Union Pacific Railroad tracks, out near where I was living at the time I was in medical school. This would be two miles north and a mile toward the mountains, and this was in a very depressed part of Den- ver. There was a lot of industrial development out there--the stock­ yards wasn't far away, that sort of thing. This was the space where the circuses would put their tents up. Well, Bonfils thought that that was going to be a terrible place to locate the medical school, and really to counteract this is the reason he gave the university this piece of ground. The piece of ground was way out in the country at the time. Now there was a little--see, this would be Eighth Avenue, and this would be Colfax where you get off the bus. This would be Birch Street about like this. This is Colfax and Birch--the end of the street car line, the Colfax Street Car Line. Then if you wanted to keep on going, you'd get off the street car, get a transfer and you'd catch a little narrow gauge street car that would come out here, turn here right where the big air conditioning unit of the medical center now is and head on east. There were some houses and some small farms out here. There were streets across Colorado Boulevard for three or four blocks, an area we're buying up now. There were some houses, a store, but this was country. 69 This was a slough really--it was a big cherry orchard out here and below the cherry orchard was this low piece of ground and water seeped int □ it enough so that there were cattails. When I was a kid back fight­ ing with these English Consul kids, some of us would come out here and hunt frogs, start a fire, roast their hind legs and have ourselves a real treat. This was the kind of place it was. This place was located on an underground stream really, and I can show you places in the basement where the basement has heaved up as a result of the water pressure underneath the building. The original foundations are on old-fashioned piling that were driven. Now there has been enough construction around here to lower the water table. The water table has been lowered, and this water problem isn't as great as it used to be, but in any of these buildings around here they now sink caissons down to shale. There's a layer of shale under this sand when you get down about eighty feet. They have to go down into the shale about twenty feet though because the shale shifts, swells, and shrinks. One of the buildings over here sits on a floating mass of cement, and they put the pillars on these cement blocks twenty feet square--some­ thing like that. That worked pretty well. Now this is the eighteen acres that they're talking about. Then a Dr. Horace G. Wetherill died. He was a graduate of this place--let's forget this street car line for the time being, though that was pretty important to me. Dr. Weatherill died, and he left an­ other block further east, and it's on this block that this Mental Retar­ dation Center has been built. They're going to move into this in a couple of months. There are some temporary old wooden barracks here, and the rest of 70 this is parking lot. There was a filling station here that Weatherill didn't have. I could have bought that piece and was a fool not to--I mean I could have had the university buy it for four, or five thousand dollars during the war because it didn't get gas enough to operate, and after the war--I think the university paid a hundred thousand plus dollars for this one corner. All right, here was another big plot of ground. The depression made this piece of ground available to anybody who would buy up the back taxes. The university acquired this piece by paying these back taxes, and here was forty acres, I'd guess, a pretty good tract of land, and this stayed vacant. We leased this for a driving range, and the lease money eventually paid off the purchase price. We got this for fifty thousand dollars or less--I forget which. It paid for itself, and there was a constant barrage of offers after the war to buy this. We owned another piece of ground over here on the other side of this Main Avenue which we foolishly sold for fifteen, or twenty thousand. It would be worth a hundred thousand now, if it would be worth a dime. Now the Veterans Hospital--here's where this gymnasium I showed you was located. Right after the war the V.A. announced its intention of affiliating new hospitals with medical schools. I heard General Paul Hawley talk about this at a meeting in connection with one of these na­ tional conferences that we were talking about. I spoke to him after the meeting. He came right out here. I said, "Look, I think we can be all set to go, if you'll come out and help get things started." He and I became very close personal friends--General Omar Bradley and all these people. Well, the V.A. in order to come, wanted that much (1 ground. Here's this Hale Boulevard over here, and this land was vacant, but a bunch of speculators had just gotten an option on it and were go­ ing to build apartments, or something. I went to the Chamber of Com­ merce--see, here's where this aggression comes out. We had a Board of Regents and a president of the university, Bob Stearns--the whole setup was just perfect for a guy like Bob Stearns and myself--we were two of a kind, and we got along wonderfully well together. I went to the Chamber of Commerce and told them what was cooking, and I said, "We've got to be sure that the university has the money to buy this ground. The government won't get in any hassle over a piece of property like this. The university is going to have to acquire all of the ground and have title to all of the ground that the V.A. wants before the V.A. will do anything." Well, the Chamber of Commerce didn't dare--it couldn't buy this ground, and it didn't dare get in a hassle with this bunch of specula­ tors many of whom were members of the Chamber of Commerce, I suppose. Well, a group of about ten or twelve individuals in the Chamber promised me that if the university would try to get this ground and there came a time when the university had to put some money up, they, as indivi­ duals, would see that the university wasn't hurt. None of this could be in writing, or anything like that. The Re­ gents said "All right, we'll just announce that our future plans are such that we're going to need this piece of property, that we're going to buy it and exercise the right of eminent domain, if necessary, in or­ der to acquire it." This area was all built up here. A patient of mine had put in a lot of apartments out here. He was making a million at it too, and so 72 these people, these speculators, the minute that announcement was made said, "Well, if the university will buy our option which will only cost a few hundred dollars, we'll be glad to get out of this." The university acquired title to this piece of ground through the option, and the V.A.--I don't think any money ever changed hands. We had the option. In order for the government to be sure of its title then, the government entered some kind of suit against the university so that the court arrived at a decision that would satisfy the government as to the price, the amount, and the location of the land. Then we went to town rapidly from that point on. We have the V.A. here. Then this General Rose Memorial Hospital set up business over here because the new mayor, Quigg Newton, whom you've heard of I'm sure. He is now president of the Commonwealth Fund, and he followed me as presi­ dent of the university. He and I were the same kind of guy too. He was a tremendous help in all of the developments that you read about, so we got the General Rose Memorial people to put in their hospital here. I had nothing to do with this development, but the osteopaths have located over here. We tried years ago to get the public health, the State Health De­ partment to have a building here. They never got that through the legis­ lature until later, but here was all this ground. This was given to us, and this was given to us. This we got for practically nothing, and the amount we got from the Veterans Administration for this more than cov­ ered this. The state has for the first time now allowed that it is buying pro­ perty over here across the street. We had to pay through the nose for 73 f that little filling station. The state didn't have a red cent in any of this really, and when I left here, this land here was still all va­ cant and in my mind there was--well here are the buildings. I would have located the new Colorado General Hospital over here as a real high rise building tying in the three ends of these hospital wings out here so that there would have been a good, free circulation. I still would have saved this land for other purposes. As it is now--the present re­ modeling is extending these buildings out, and it is doing much the same thing I had in mind, except that these extensions will be new basic sci­ ence departments of the school of medicine. Now, if my idea had gone through, here would have been the medical school wings here. This would have all gone to hospital, and the new medical school would have probably had to go over here along with the dental school. This might have made for a more economic and more func­ tional use of space than what happened. We still have this much space to grow on, and there's talk of Children's Hospital moving out from way downtown. I have no idea what location they have in mind for the Child­ ren's Hospital, but I imagine--it could be some of this parking lot area here with the idea that they would buy this area up across the street and use that for parking. I don't know. The one--well, the biggest administrative error I think I ever made in my life I made right after I took the deanship. All during the war we had a very close affiliation with the Children's Hospital. You could only get interns in those days. You could not get residents unless they were people who were disabled, or women, so we supplied Children's Hos­ pital--we rotated our interns through the Children's Hospital. The su­ perintendent of the hospital and I--we had big ideas about a real affil- 74 iation. Right after I was dean--this shows how chain reactions develop--we started this Rheumatic Fever Diagnostic Service out here because there was so much rheumatic fever here among the Air Force troops during the war. We knew that we were having lots of rheumatic fever among our children. Not much was known about rheumatic fever then and particu­ larly the subclinical variety where heart lesions had developed without the other parts of the syndrome, so we set up this Rheumatic Fever Diag­ nostic Service which was financed by the Community Chest. Well, there was a big hassle over the location of this diagnostic service--was it going to be out here at the medical school, or was it going to be at Denver General Hospital, or was it going to be at Child­ ren's Hospital--well, it was located out here. The superintendent of Children's Hospital was furious about this, so he began to de-escalate the affiliation between the Children's Hospital and the medical school. Like a fool I wrote a letter--the president; he was just following my lead--to the Chairman of the Board of Trustees of the Children's Hospi­ tal. I wanted a showdown right now--see. We sure had it. You put your thumbs on his eye balls. Of course, the Board backed him up to the hilt. Then there was no relationship whatsoever between us and the Child­ ren's Hospital until the time when Dr. C. Henry Kempe came here as head of the Department of Pediatrics. This would be--well, I arranged for Kempe to come just as I left the presidency, so he came here in 1956, or 1957. He's really one of the principal international figures in this 75 field of pediatrics and virology, small pox vaccination. He was so good that the medical community here in Denver just had to accept him with considerable pride. This did a lot to do away with the hard feel­ ings between the medical school and the practicing profession. He be­ gan to help out down at Children's, but only after he'd been approached by Children's. Well, the relationship has grown. Dur graduates now--they had to go to a full time medical director down there at Children's Hospital, and they took one of our good graduates. The situation is such now that even if Children's Hospital stays down there, the kind of affiliation I had in mind--which was broken off because of this rheumatic fever busi­ ness and my mismanaging things--will pertain now. I don't know whether the Children's Hospital will move or not, but it is going to be dis­ cussed. There was a lot of bloodshed over this rheumatic fever business. I started it--well, I should say first that we had a Dr. Arnold G. Wedum on the faculty. He was a bacteriologist, and his wife, Bernice L. Wedum, was a pediatrician interested in rheumatic fever. I say "I started this," but I started it because I knew I had a well qualified person to run it. She ran it, and she was a controversial person which didn't help this situation. I had to support her, of course. She was worth supporting, backing up. I worked in the clinic, however, worked just as hard as she did because competence in this area was pretty hard to come by in those days. Rheumatology and cardiology had been my main specialty in­ terests, although I was doing general internal medicine. This Rheumatic Fever Diagnostic Clinic has been a great thing for the community. It's still operating, and the doctors really use it as 76 a consulting service. A lot of the kids who come in there have a heart murmur, and I guess they're referred out here to the clinic because the doctor knows that they will get a good general examination.• Then he takes the patient back with that report and carries on from there. I suppose we did more good--the most good we did was because we identified kids with functional heart murmurs that had been considered as rheumatic. Of course we began to pick up a lot of congenital heart conditions. We soon equipped ourselves to adequately study those condi­ tions, or as adequately as they could be studied considering the times, and this paved the way for the subsequent developments here in cardi­ ology and the bringing in of good people in cardiology. I leafed through one volume last night •••• I've got to take a little walk for a minute. The people we had around us with this Rheumatic Fever Diagnostic Service--we picked the ball up right away when a report came out of Red­ lands, California, or some place in California, that there was a higher incidence of rheumatic fever in high altitudes than there was in low. [J.J. Sampson, P.T. Hahman, W.L. Halverson, & N.C. Shearer "Incidence of Heart Disease and Rheumatic Fever in School Children in Three Climati­ cally Different California Communities" 29 American Heart Journal 178- 204 (February 1945)] We arranged right away to examine every kid in every grade in high school in our high altitude area; in fact, nine thou­ sand feet or above. We examined fourteen, fifteen hundred children, I guess, and we found that rheumatic heart disease incidence--prevalence is a better word--was no greater than it was at ordinary altitudes. As far as the literature was concerned, we concluded that there was nothing 77 to this claim. [Bernice G. Wedum, Ward Darley & Paul H. Rhodes "Pre­ valence of Rheumatic Heart Disease at High Altitudes" 79 American Jour­ nal of Diseases of Children 205-210 (February 1950)] Then we went further--we'd gotten the Colorado Heart Association started, and we did a survey. We tried to examine every other sixth grade child in the whole state, and we really covered that pretty well. I was only on the Advisory Committee--! didn't have time really to be a part of this study. Anyhow, we found incidences that were just the same as the incidences in Texas, or any place else. [G.J. Maresh, H.J. Dodge, and John A. Lichty "Incidence of Heart Disease Among Colorado School Children: A State-wide Study" 149 JAMA 802-805 (June 28, 1952)] This was terribly important because of the effort Colorado was mak­ ing to get the Air Academy located out here. I had an all day session with the site committee--this was after I moved to Boulder--and as a consequence of that all day session I was told, the Air Force lost its concern over the rheumatic fever question. If that had not happened, Colorado would have never gotten the Air Force Academy. Well, I can't prove that because people who told it to me are dead now. I know how concerned they were, and I think the fact that we had this data did have a lot to do with eliminating this question from their consideration. I tried to make it clear to the site committee that there was no health situation any place in the United States that should in­ fluence where the academy was located, or where it shouldn't be located, that indicated whether it should or should not be located in any parti­ cular place, if it was a well run establishment. I think the lack of that Chamber of Commerce approach--at least it gave me a rapport with members of the site committee that the Chamber of Commerce people would 78 not have had. !:f.ps there a relationship with the public health in this survey of school children? Oh yes--the Public Health Department--Dr. John A. Lichty who was half time here and half time with the Public Health Department--he was the principal individual as far as organizing and executing this state survey was concerned. It was really more a straight Health Department project than a medical school project. The relationship between the university and the State Health Department has always been very close. Then when Dr. Florence R. Sabin retired and came out here, took it on herself to revamp the public health laws--why she worked very closely with the State Health Department. There was a man--he wasn't an M.D.-­ and I don't even know whether he had a master's degree, but anyhow the State Health Department just turned him over almost full time to Dr. Sabin. He worked right along with her, drove her around over the moun­ tains as she met with different people in the state in the high school auditoriums. She put on a terrific campaign to undermine the status quo as far as the state health laws were concerned. She was a whirling dervish. Yes. I went with her a lot, and she just was tireless. There was just no end to her energy and to see her operate--she just knew how to pitch things to the kind of audience she had. She just had them right with her from the start--never talked very long so there was lots of time for questions and answers. She just knew how to operate. She could tie into the Civil Service Commission, or the State Board of 79 Health, or anybody else. - She exuded a kind of competence that was hard to put down. She had nothing to gain. She'd won her race--you know. Sure. This was an added attraction. Yes, and you just couldn't go against motherhood, and she was the mother type. She never married, or had a family--too bad she didn't, because she was a wonderful, wonderful woman. When you came to this school, it was all out here in the country? Yes. You must have had some trip to get here because you didn't live on the campus did you? Well, this built up very rapidly after the construction began. This patient of mine--he knew that there was going to be a need for apartment buildings and so on and so forth. In this ground breaking ceremony and this little paper--! don't know whether you read that one or not or whether I sent it to you, but I reminisced about my knowledge of this area as a boy. ["University of Colorado Medical Center, 1925- 2000" University of Colorado School of Medicine Quarterly 1-4 (Summer 1965)] When I was in high school, I lived way over in North Denver, and summers I worked at Fairmount Cemetery way out here in those days. I'd get up at six in the morning and for a nickel I would ride ten, or twelve miles from where I'd catch the street car to the end of this line. Well, 80 I'd transfer downtown, and then I'd come to the end of the line, and then I'd transfer to this little narrow gauge street car which was about twenty-five feet long, I think, and it would turn here right where the big air conditioning unit of the Medical Center now is, and then it would wander around and eventually wind up at Fairmount Cemetery, and I got off. Then for a nickel--we'd quit at five o'clock, and I'd get home about--well, it was about a two hour street car ride. Now then when !--well about 1936, we bought a great big old house about here on this street, Birch Street. The street car line had been discontinued, and the tracks had been covered up with asphalt, so that street had a very high center. It still has a high center. I'd just walk down Birch Street to school. I only had--well, I had about the same length walk that you have from where you get off the bus. Well, this part of town--this was well built up. This house that we bought was built the year I was born. I found the inspector's tag when we re­ built the whole place inside and out. We made a lovely place out of it. This is all built up now even beyond Fairmount Cemetery. Did you commute when you attended school as a student? I lived way out here by the Union Pacific Shops. I took the street car, transferred downtown, transferred this side of--we had what we called the loop in those days, and all street car lines ended there, but I'd make a transfer along here someplace. It was a number 13 street car which came within two blocks of the school, out in here someplace. Well, I'd walk that. That hour's ride on the street car was my time to do some studying. When it was nice weather I'd take the street car to school in the mornings and I always walked home, a two and a half mile Bl walk, part of the walk through this very nice city park. Then, of course, when I got into the clinical years and had to have a car, I bought an old jalopy, and I used it to go to school. We were doing home deliveries in those days. I guess during my junior, senior, and intern year I must have delivered a hundred babies in homes. This writing indicated that the medical school building was "designed to accommodate fifty in each class, with adequate staff and research rooms." Yes, it was adequate according to the concepts in those days. All of the clinical teaching except the psychopathic--the Psychopathic Hospi­ tal was the first unit that was completed, and that had a good nucleus of fulltime people in it, but all of the other clinical teaching was done by volunteers, men in practice, until 1936, when Dr. James J. War­ ing came on full time as Professor of Medicine. I was the second full­ time person to come on in the clinical faculty. This was six years later, or five years later and after the war had started. The only pro­ vision that had to be made in this building for clinical teachers was a place to hang their hat and a toilet. The basic science buildings are what you'll see when you go through-­ these two wings that point toward Colorado Boulevard, and the free end of these wings were the large laboratories built to accommodate fifty students. Anatomy had one wing upstairs, and the other wing was path­ ology. Below pathology was biochemistry, and below anatomy was just physiology and pharmacology. Below that were the preparation rooms where we prepared the cadavers and stored them for anatomy. On the other side below biochemistry we had what we called clinical pathology. 82 That was the Dr. James C. Todd operation, and this was the first Depart­ ment of Clinical Pathology to start in any medical school and below that was pathology's mortuary. Of course, in order to get autopsy consent, we had to promise to do the embalming so as to avoid a hassle with the undertakers. We had one of the best anatomical laws in the United States in Colorado. We've never had trouble getting enough anatomical, human anatomical materials. In these wing ends there were offices, and with each office there was a little laboratory on each side for the basic science people. This is what they meant by "adequate". It was adequate because there was no money to use to finance research except what little dabbling most of them were able to do out of departmental funds. There was no line item for research. Shortly after I took the deanship--I'll never forget this--Dr. Maxwell M. Wintrobe, the Professor of Medicine from Utah, arrived. I wasn't looking for him. He just arrived. He said, "I'd like to see your medical school and talk to your people that are doing research." I said, "Doctor, I'm afraid you're going to be disappointed because there aren't a half a dozen doing research. I'll be glad to introduce you to them, but we have no research budget, and we have no research grants." He was amazed. He'd gone to Utah because of the very considerable research support. He went there from Johns Hopkins, and he was one of the country's leading hematologists, and, of course, the research pro­ gram at Utah was financed by the federal government. He had five, or ten thousand, I think, in research grants. Of course, you may have caught this in the book--! don't know 83 which one you went through, but there are some graphs to show how the research program had grown dollarwise, but none of this really got go­ ing until after the war. What we were calling research that I did with Dr. Richard W. Whitehead, Dr. William B. Draper, and a radiologist whose name I forget--this was just done on an opportunistic basis, squeeze out time and some departmental funds. We had no financial problem in­ volved in doing the kind of research we were doing. Yes--the nucleus here was quite good, the "State General Hospital of one hundred and fifty beds, capable of future expansion." This was the Colorado General Hospital which had two wings at that time. It was like this. Here's Eighth Avenue over here--the mountains again. Roughly here is the diagram of the hospital medical school com­ plex. This was hospital. This was medical school. This was sort of a fusion between with the operating rooms clear up on top, a pathological museum, classrooms, and clinical amphitheater. The outpatient was here as a separate building. Then it had the Psychopathic •••• Yes, then the Psychopathic Hospital was over here--just a building with that shape. The school of nursing. The school of nursing was here. That was a nursing home. There were no classrooms, or academic facilities there. In those days the nursing students--Colorado General Hospital supported the school of nursing completely. The students paid no tuition. The hospital budgeted 84 funds to pay the nursing school for the nursing services that the stu­ dents gave in the hospital. We budgeted a junior nursing student as be­ ing worth half as much as a registered nurse and a senior student at seventy-five percent. So the Colorado General Hospital was paying the school of nursing about a hundred and fifty thousand dollars a year, and that paid for what faculty there was, paid the director's salary. We didn't have a dean in those days. It paid the director's salary, and the ward supervisors were women that were paid half by the hospital and half by the school of nursing--that kind of arrangement. A lot of the registered nurses we had, even in those days, were women that had gotten their diploma from a hospital school of nursing and were working for a master's degree, or a baccalaureate degree in nursing. We switched from a diploma school to a collegiate school early in the war. I had--when I came out here full time on the faculty, I did not have to deal with this old director of nursing. There was a dean of the school. No, there wasn't a dean of the school. There was a director of the school, and the School of Arts and Sciences at Boulder was giving the degree. That's the way it was. We made this director a dean--that's one of the first things that happened when I took the vice-presidency. We made the director of the school of nursing a dean. We quit this hanky-panky about paying the school of nursing for the services of the student nurses. We put the student nurses on a tuition basis with vacations like other students, and we really hired a faculty for the school of nursing. The nursing students got their nursing experience on a clerkship basis just like the medical students got their clinical experience, and this still 85 pertains. Now the school of nursing wants to change it again to some degree so that these girls will be getting more of the responsible clinical experience in caring for patients than they get under this clerkship arrangement, and I'm all for it. I don't know whether they've made the switch or not, but I think they're going to. Now the medical faculty were very upset over these changes in the school of nursing because the appropriation from the legislature was to the school of medicine and nursing. The appropriation isn't to the uni­ versity as such. Fortunately too, the appropriation is to the Colorado General Hospital. There is a separate appropriation to the Psychopathic Hospital, so the university, or did then, went into the legislature with four separate, seemingly unrelated appropriations; the appropriation to run the Boulder campus, the appropriation for the school of medicine and nursing, and an appropriation, a separate one, for each of the hospitals. This gave a measure of independence to each of these units down here that was a godsend to us. The university people, the Boulder people, thought they got shortchanged a lot on our account, and I think they probably did, as did every other institution of higher education in the state because this medical setup has always had the inside track with the state legislature--still does, I think. You indicated the medical faculty •••• The medical faculty were upset because some real money was coming out of this appropriation to the school of nursing. I didn't consult with the faculty on this decision--! knew better than that--this was just the way it was going to be. Fortunately the legislature upped the 86 appropriation not as much as I wanted, but enough so that the switch was possible without the medical school being particularly hurt. The first year's budget for this revamped school of nursing, if I remember it, was two hundred thousand dollars at least, and I think more, whereas only about twenty or thirty thousand dollars was coming to the school of nurs­ ing from this appropriation to the school of medicine and nursing. We came out of it with a pretty good school and a good strong grad­ uate program. The graduate program is really the main part of it-­ master's degree. There were so many graduate nurses, or graduates of diploma schools that would come here when we began to give a baccalaur­ eate degree. They would work eight hours over in the hospital as nurses, and they'd also be fulltime students in this baccalaureate school of nursing. Then they'd stay with us to get a master's degree, and in this you'll see--you've seen that--! give the nursing school its due in there. This change put them in business, put them on their feet. But now they're having the same sort of a hassle because of the dental school. Commitment has been made. The medical faculty, I know, are very unhappy about this. Fortunately the dental school is going to get its own separate appropriation though, We had a dental school al­ ready to go when I left the presidency. The legislature in two conse­ cutive sessions appropriated fifty thousand dollars each year toward the salary of the dean and a secretary and gave him travel funds and funds for consultants so that he could build up a curriculLm. We were about to make an appointment. The minute I was out of the way--why then the new president and the faculty went to the Regents, and the whole dental business was called off, so it had to start all over again. 87 -•here is something mentioned in the catalogue for 1928, called "the - ,teele Contagious Hospital". That was part of Denver General Hospital. 1,t was part of that hospital. Yes, it was a bunch of old residences which had been linked together, and that's where the patients with scarlet fever, diphtheria and small pox--! was sorry for anybody that ever went down there. We had a case of diphtheria develop here during the freshman year in one of our classmates, and he had to go down there. They cultured all of us. I got pulled out of school two or three days while they ran a virulence test on my culture. Then they let me back, but two or three of the boys where they did have a virulent infection, though they never developed diphtheria, had to go down there to the Steele Contagious Hos­ pital until their cultures were negative. The poor guy with diphtheria-­ he had to go down there! Then we'd go down to see him, and they had a room fixed up with a glass between and a hole way up at the top so that if you talked loud enough, he could hear--you could visit with somebody. Well, we went down there for some of our instruction, but the in­ struction could just as well have been given out here because we never got that close to any of these patients. The guy that was running the place talked to us about scarlet fever, and we'd see a patient the other side of the glass. I don't think they ever had a case of small pox down there while I was a student. Of course, I haven't seen scarlet fever since sulfa began to be used. There was also something called the National Jewish Hospital. 88 The affiliation there was always and still is of considerable sig­ nificance. That's where this Dr. Henry Sewell had his research labora­ tory, and for the times he had a very imposing research setup down there. This hospital has been supported very liberally by the national Jewish community ever since it was established. At the time it was established there was a terrific need for this kind of facility--a tuberculosis hos­ pital. It says above the door there, "None can enter here who are able to pay, and none who enter can pay"--something like that. That hospital was really for the people who didn't have the finances to cope with an active case of tuberculosis, and it was full. Gee, we had our clerkship down there in tuberculosis, and honestly, as I look back on it, it was the only honest to God clerkship in today's terms that we had. We really had to work our patients up. The doctors on the staff went over the patients with us with a fine tooth comb. The exercise in the examination of the chest that we got down there--well, we heard every kind of a chest sign there ever was. They had no trouble showing us everything that was in the book, and then the conferences as to how to best handle the patient and all--these fellows down there really worked. This didn't cost the university a red cent, and we were down there full time for a month or so. This old Dr. Sewell and the other man who ran that place--we saw quite a bit of these people. I tried to take care of Mrs. Sewell after Dr. Sewell died. He was an old-fashioned type--he had a goatee, and he practiced in the best tradition. I stopped to see her, and all she wanted to do, it seemed to me, was sit and chat and reminisce about her husband. I had quite a time--! never did get her to disrobe so that I could examine her. She 89 wouldn't permit that, and after three or four visits, Dr. Waring called me- He is the one who got her to have me come in. He said, "Well, I guess you'd better just quit trying to take care of Mrs. Sewell. She wants me to send somebody else. Do you want to know why she doesn't want you to take care of her?" "Sure." "You never looked at her tongue. Every morning Dr. Sewell would look at her tongue and tell her how much water she should drink, what she should eat and what laxative she should take. I'm sorry I didn't think to tell you about that." She was a dear old soul, wasn't she? Yes, she was. This National Jewish Hospital was guite a setup in those days. Yes, it always has been--well financed. They have a fulltime direc­ tor of research and always have had and a very active research program. One of my--well, he wasn't a classmate of mine. He was a year behind me, Dr. Abe Ravin, a very fine cardiologist, has had a very good research setup down there. Still has--he has had a coronary himself and has re­ tired, but he still works away. Then after I was dean, we began to share departments. They couldn't get pathologists, and we could, so there began to be some exchange of money, or at least the paying of part of people's salaries, but the stu­ dents--of course that National Jewish Hospital is much more than a TE place down there now. It's chest and everything inside the chest because there just isn't much TE anymore. 90 We still operate a TB ward here at Colorado General. Again this was Dr. Sabin--WPA money came along after the war, and funds were ob­ tained to add a third wing to the Colorado General Hospital out here. We moved into that third wing. Then the legislature wouldn't give us enough money to run all three wings, so we always had a vacant ward over here--famous ward A. We used it to start the blood bank, for example. That's where the blood bank was housed for a while. Now, Dr. Sabin--one of her projects was a decent TB hospital, par­ ticularly a surgical hospital because surgery was beginning to be used in the treatment of tuberculosis, particularly with the advent of strep­ tomycin. She almost pushed through a measure to give the university money to build a separate building. Well, this ward was vacant, and the legislature in order to get off the hot seat asked me how much it would take to remodel this ward and operate it in the interest of surgical tuberculosis. I had to give them an off-the-cuff figure immediately be­ cause this was right at the end of the session of the legislature. I said, "A hundred thousand dollars for the first year." Well, it turned out that that was about half enough by the time we did the remodeling and had to provide for this special nursing setup and all, but at any rate--we still operate this. This turned out to be thirty beds--completely adequate to the state's needs. This had a big impact on the population of the other sanitariums because we had a commission screen all the hospitalized TB patients in the state, and those that could benefit by a lobectomy, or having a lung out, were sent in here, and this turned out to be most of them eventually. The average patient stay here was about two months, so the TB facilities, what were left of them, began to close pretty fast. 91 The only facility that was left was Craigmoor down at Colorado Springs which had beautiful grounds, nice buildings and was pretty well endowed for those days. Craigmoor has been given to the university for an extension center, and in order to satisfy the conditions of the endow­ ment down there, this endowment was turned over to the university with the understanding that the income from the endowment would be used to support a TB facility as long as it was needed. Well, we only get about twenty-five, or thirty thousand dollars a year from the endowment, but it is used to help finance what still is the tuberculosis ward. I don't know what the census in this ward is. I think probably the ward is pretty well filled. They have five, or six patients that can't be benefited by surgery that will have to stay there until they die, and they were moved up here from Colorado Springs. Colorado General Hospital through legislation was constructed for the purpose of teaching medicine. It had other limitations--caring for per­ sons of limited means. Yes, this provision was responsible for a lot of our trouble. This was written into the legislation in order to appease the medical profes­ sion; namely, neither a physician nor the state could collect for any professional services that were rendered in that hospital. This meant that we were totally dependent on the appropriations to support patient care. We could charge a county up to fifty percent of the cost of patient care, for the care of patients that would come into the hospital from the surrounding counties, and early in the game the outlying counties did send quite a few patients in. Many patients were taken in from the clinic as teaching patients with the understanding that the state appropriation 92 would bear all of their cost, but we were always behind the eight ball for enough money to run the hospital. We were always going to the legis­ lature for deficiency appropriations. The polio epidemic was a life saver! It hit right after I became dean. Everybody was scared to death of polio. We had several thousand cases in the state over a two year period, and the outlying hospitals wouldn't take them so these poor people would be thrown in an automobile, or an ambulance and be brought here. Denver General took the polio cases that originated in Denver, and Children's took a lot of the children from both Denver and the state. Between the three hospitals we took care of every case of polio in the state that was hospitalized--! think it's safe to say that. Well, it meant that we very rapidly filled one ward after the other with polio cases, and the Polio Foundation which was ac­ tively raising funds did like Red Cross. Just right off the bat it would say, "Well, take them in. We'll pay for their care." The Polio Foundation by the time this whole deal came to an end paid millions of dollars to the Children's and Colorado General certainly. I don't know whether the Denver General got any of it, or not, but we had to charge the Polio Foundation for the difference between what we got from the state and what it cost us to take care of these patients. I was always going to the legislature for deficiency appropriations, and the gimmick was that the Regents would adopt a budget that would call for more than the appropriation, and in adopting it their minutes would always show that the idea would be to run the hospital full blast until the money was gone. Then we'd close. Running full blast would always carry us into February, and the legislature would start early in January, so we would confront the legislature with a ••.• 93 - Crisis. With an appropriation bill--yes, with a crisis, saying, "Now, we need this money to keep open for the rest of the year," and we'd usually get it. The legislature--a lot of the people down there would say and tell me, "We shudder to think of all the things you're putting in this deficit appropriation in the name of a deficit." I could say, "Well, I'll go over it with you." Another problem we had was that we had no bank balance. We didn't use the state treasury as our bank. We banked with private banks, and lots of times our balance was a negative balance. The poor bank was just advancing money to meet a payroll knowing that in the course of the next thirty days the state treasurer would give us our quarterly share of our appropriation. I had this trouble in Boulder too with the rest of the university. We finally got the legislature to set aside a half million dollars. As a revolving fund? Yes, as a revolving fund, but we always had to show in our financial statement that this revolving fund--its integrity had not been invaded, or compromised. Let me put on a new tape. Dealing with the legislature just about killed Dr. Rees. As an intern and resident I can remember an admission problem, or there would come an emergency, or an automobile with a sick person in it, and we had to take him. We didn't have any choice in the matter. We were trying to run this place, Colorado General Hospital, for three 94 dollars a day per patient. We had a rule that if the patient didn't have county papers, we wouldn't let them in the hospital unless we collected a week's hospital bill in advance. Sometimes you'd get twenty-one bucks, and sometimes you wouldn't, and as a rule when we got the twenty-one dollars, that's all we got. The patient never paid another cent after he got in the hospital. Our patient stays were always long because these people were awful sick. We were depending upon volunteer, practicing doctors to take care of them, and it might be a week, lots of times, before a volunteer could get to see the patient and go over them carefully. The volunteer, practicing doctor would only come out for a half hour at a time. Lots of time they'd only come one day a week for that half hour at a time. County papers really didn't mean much. There were plenty of the counties from which we couldn't collect a red cent, so the legislature was always shaking its head over Colorado General. Now Psychopathic Hospital got along fine--fulltime faculty, every­ thing clicked, and they knew really what it was going to cost them to operate, what their patient stays were going to be and so forth, but poor old Colorado General was always behind the eight ball. It reached a point--oh, let me see, when I took the deanship, I was also the superin­ tendent of the two hospitals. The first morning in the Dean's Office there were between twenty and thirty people lined up in the hall to see me. Dr. Rees had that many people reporting directly to him every day in his effort to keep communications and coordination going. Well, I was able to get the money for a trained hospital adminis­ trator. We got a chap in who was fairly good. He lasted a year, and then I really got a good one who could qualify to take on an administra- 95 tive intern, and we got a graduate, Robert Denholm, from the school at Northwestern to come in for an internship. During this internship he had to do a piece of research and write a thesis in order to get his master's degree back at Northwestern. He was a real mathematician, and he studied several hundred patients from the socio-economic standpoint. He turned up with a graph. He'd list all the patient's assets up here and all their liabilities down here. Then he had this gimmick worked up so that given this, knowing this and this and this about a patient, he could come down here and spot what this patient theoretically ought to pay a day for a period of hospitalization. The patients liked this. They knew, the family did, when they went in what it was going to cost them a day. As soon as he finished his internship, why, we took him on to make this thing work. He got a machine from the National Cash Register people, and for the first time the hospital, so far as I know, could give the pa­ tient an itemized statement as to their account. He'd worked up what it cost per prescription, what it would cost for just board and room and so he'd show an item here--the cost connected with the operation of the hospital bed, drugs, surgery, operating room and so forth. Then down at the bottom he'd show by agreement the patient will pay so much of this bill, the county will pay so much of this bill, and this and that health agency will pay--the Colorado Tuberculosis Society, for example, will pay so much of this bill--and then at the bottom the state will make up the difference. When the patient was discharged, this cash register machine business let us always sit down with the relatives to be sure that they would feel that the balance due was going to be within the grasp of their means. The counties liked this, and the collections of this Colorado Gen- 96 eral Hospital went up like this. We were running way behind, but I'll come back to that in a minute. The chairman of the finance committee of the two houses was a certified accountant, and I got him to agree to come out here and spend a couple of weeks and review all of this, go over our books. I said, "I want somebody from the legislature to know all about the insides of this, how we do our accounting, and our finan- ces." He did come. Unfortunately at that time, however, his party wasn't in control of the legislature. The legislature was--well, I'm a little hazy here as to relationships, but anyhow, we were in trouble financially. From the old polio days we had six, or eight holdovers that were in res­ pirators. We've still got, I think, one. We had a polio ward manned by respirators. We had started a new fiscal year short of funds. We were going to run the hospital until April, and then have to close, but even to run until April we were going to have to cut our nursing service to the bone and all that. The polio ward got cut a nurse, a night nurse. There was just one night nurse on that ward. Well, the power went off, and here she was screaming for help with seven people depending upon manual operation of their respirators if they were going to keep alive. Well, she got the help in, but this must have been a horrible experience for these people. Well, one of the patients insisted on having his family called imme­ diately, and there was nothing to do but call them. The family insisted immediately on calling the Denver Post and calling one Steve McNichols who was in the minority party in the legislature, a Senator from Denver. All of these people came out. Here was a big expose--you see, in the making. I didn't try to defend ourselves at all. I just admitted right 97 off that we were just darn lucky to get by this thing without losing four or five of these patients. I said, "Take all the pictures you want. Talk to anybody you want. This is just the way it is." Then I explained the conditions under which the budget was adjusted. The next day Steve McNichols, the Senator, a reporter, head of our nurs­ ing service, the superintendent, myself, and several members of the legis­ lature met in the Governor's office with the head of the then finance committee of the legislature, the guy who was really responsible for cutting us off--well, we had them trapped. The Governor could only say, "You folks, please put back your nurses the way they should be." The Regents met right then and there. They called a meeting in the Governor's office, and they passed a resolution authorizing the staff out here to restore the complete personnel throughout the entire insti­ tution to take care of patients who ought to be taken care of. The Gover­ nor and these other guys had to say, "We'll take the responsibility to see that the appropriation is what it ought to be." This certified accountant fellow then had seen that we were keeping honest books, that we were doing an unusually good job for a hospital, and really from that time on things just went a lot better with the legis­ lature. This fellow that did this, that set up this hospital billing-- he went around the state wherever there was a welfare meeting, or a meet­ ing of boards of commissioners--he saw to it that the people out in the sticks knew what we were doing, and this helped with our collections like everything. lhe Colorado General Hospital is the only one of its kind in the state, l,sn't it? 98 Yes • .8.Pd its doors are open to anyone in this state •••• The law was changed. It was changed. Yes, it was changed so that the Regents now have the complete say­ so as to who is admitted to the hospital. The Regents have the complete say-so as to what the hospital will charge and what the charges for pro­ fessional service shall be. It collects the professional fees, puts the fees in a separate fund called the "faculty salary account" and it uses this money to pay the fulltime salary. This "faculty salary account" is what has let us go to absolute full time with the understanding that tax money will be used for a full professor up to the average salary for a fulltime professor at Boulder. Then whatever is needed beyond that this "faculty salary account" will supplement so a professor can be paid thir­ ty-five thousand a year--whatever it takes. This isn't just for clini­ cal faculty--this is any faculty. In most institutions that do this, these excess funds are under the control of the department and are used in the interest of the department. Maybe the point is reached where there is some spillover into general funds. In other places this has to go for clinical faculty. This "fac­ ulty salary account" lets us pay a professor of anatomy whatever was ne­ cessary to get him. I think this is fair enough. A good Department of Anatomy adds just as much to the reputation of a teaching medical center as the professor of surgery. The surgeons won't admit this, but I know it's so--that is, if you've got a good all-around educational program. 99 Well, gee, there was plenty of trouble over this "faculty salary account" before--we went into this in stages. When I was dean I got the--well, I couldn't recruit fulltime faculty at the end of the war. The Regents had decided that we'd have to have a good nucleus of full­ time clinical faculty. I came out here fulltime faculty for forty-two hundred dollars a year in 1943. The dean was only getting--I took the deanship, and I was only getting seventy-two hundred. That's all Dean Rees was getting. Here were these fellows over in the Psychopathic Hospital able to hospitalize their private patients in the Psychopathic Hospital and charge them anything they wanted to. How come they had that separate deal? That's the way the statute was set up. That was the deal that Dr. Franklin G. Ebaugh had set up at the time he came here. He recruited to this. On that basis. Yes. That's 1919. No, no, that's 1925, when they moved in. The Psychopathic Hospital was authorized in 1919, the enabling act. The appropriation for construction was 1923. The fat didn't hit the fire until the hospital was open. The men downtown were opposed to fulltime clinical teaching people out here. I'd get a good prospect in--a pediatrician I remember. He 100 went down and called on two or three pediatricians downtown, and he said, "I wouldn't come up here for anything. These fellows tell me that they will have nothing to do with me. I'd be crazy to move into this kind of situation." The boys downtown interfered with recruitment like everything for a long time. We were able to do some recruiting because here were bright young fellows coming out of the Army who were willing to take a chance on us, if we were willing to take a chance on them. Our fulltime pro­ fessor of ob and gyn who is now the dean of ob and gyn men in the country, Edward Stewart Taylor--he didn't have any reputation in ob and gyn, but we knew he was well trained. He was willing to take the chance, and he just skyrocketed, and so did the professor of surgery. I got the medical profession to agree that it would be all right if we would pay our clinical faculty on a five-sixth basis, that our clini­ cal faculty would have a full day to practice and see private patients, provided they maintained an off canpus office, and provided they took care of these private patients in a private hospital. Well, by law they couldn't take care of them here in Colorado Gen­ eral and collect a fee. Well, this five-sixth basis helped us recruit. We did pretty well for awhile until it became apparent that we would just have to have the Colorado General Law changed. The first effort that was made in this regard resulted in a real hassle. I remember a full day--the legislature had an open hearing where both houses acted as a committee of the I.J,ole, and here were the medical school people. The medical profession paraded their grievances before a pretty well packed balcony--people there as well as people from both hruses of the legis­ lature. 101 This was a terrible experience. I was president, and I had a man named Francis R. Manlove here as Director of the Medical Center. We'd been heading into this difficulty for a long time. Well a committee of the Senate, I guess it was--I'd gotten a doctor, a member of the Senate, to introduce this bill. He was sore at the medical society for some rea­ son, so he was happy to introduce the bill and helped to stir things up. The committee called the head man or two from the medical society, my­ self, and my Director of the Medical Center to talk about this. The chairman of the committee said, "Now, listen here, has the medical soci­ ety and the university ever really arranged to talk this whole proposi­ tion out under conditions where you could talk without getting mad at each other?" Well, we had to admit that we hadn't. We'd had a joint committee working on it, and those committee min­ utes are in one of those volumes down there in the library. If you ever want to read about an exercise in futility, read some of those. They were mad at us because we were developing a research program at federal expense. This was an unforgivable sin among many others that we were committing. The legislative committee said, "Well, we've talked about this prob­ lem a lot. We feel that Colorado General Hospital has to be put on some kind of a different financial basis, but we'll give you a year. A year from now if you people don't come in with a proposal that is acceptable to both the university and the medical society, we'll see that this is taken care of and in such a way that probably neither one of you will like it." That's when we kicked the discussion up to the level of the Regents and the Board of Trustees of the Medical Society. They met regularly 102 for a dinner meeting, once a month, six or eight times. The matter was taken out of my hands, everybody's hands, except the people that were responsible for policy on both sides. After several months of this the Regents took a look at the University of Chicago plan which is essen­ tially what we have now, and they drew up the proposition that they thought the university should support, and right off the bat, the peo­ ple on the committee from the Medical Society Board of Trustees said, "We'll buy this." I know that a lot of stuff had gone on behind the scene. This pro­ position went through the legislature--well, the next meeting of the House of Delegates of the Medical Society this proposition went through unanimously so that there was no trouble with the legislature. This more than any one thing has made it possible for this institution to compete with other institutions for faculty. These one-sixth time boys were given two years, I think, to make their mind up whether they wanted to come into clinical teaching full time--they were either going to have to come in, or get out in private practice, so that we had nobody any­ more on this one-sixth plan. There is a Regent who is a doctor who really represents the conser­ vative viewpoint of the medical society. The first thing he did when he was put on the Board of Regents was to call for an investigation of this faculty practice thing. Everybody cooperated with him, and he was com­ pletely satisfied with the way it was being operated. Now, I came back, you see, after being away--! left here for all Practical purposes in 1953, when I took the presidency because the direc­ tor here--I had to let him be director, or I tried to. Well, I came back, and there's no antagonism between the university and the medical 103 society anymore--oh, little rumblings here and there, but the fellows downtown are proud as punch of this place now. D7ey were very much afraid that with the increase in federal support for research, somehow or other the federal government would run the show out here. This is a label as distinct from content. Well, in a sense the federal government did there was so much re­ search money coming in. They wouldnrt--the people here wouldn't let this relationship be studied, but I say that in a sense the federal government did run the show because I say that this is true of every medical school in the country. Here's Columbia University in 1964-1965, with total ex­ penditures of twenty million bucks, thirteen million of which came with federal money for research. We all know that these federal funds don't pay the full bill. Columbia, I'd guess, was putting two and three mil­ lion of its own, particularly if you count the research going on that was being paid for out of departmental funds to help some young fellow get started. The places I know that studied this question found that they were putting a lot of their own money into research, but there's no fight now even though they're in the red because the AMA, as you know, at its last meeting completely turned around. I'm frightened because I know what will happen i f the schools become completely dependent on federal money. You can't guarantee what one Congress is going to do as compared to the next, and I'm advocating that all medical schools should be doing what the University of Chicago is doing, what this place is doing--each teach­ ing medical center should be making patient care pay its own way both from the standpoint of hospitalization and professional care, and parti- 104 cularly now that third parties are coming into the picture. I think I sent you that paper. I thought all hell would break loose after I read that paper at the AMA. Never a thing was said about it. I think the AMA deliberately wanted to bury it just as fast as it could be buried. I didn't get any letters objecting to that, and if anybody should have been read out of church, I should have been at that time. That's when I was--and the Association of Medical Schools passed a resolution in line with that paper right away, but a lot of medical schools in one way or another have been utilizing professional fees to help support their educational program, but it needs to be done in an open, business like fashion. The local medical society even got upset about the premature baby •••• They were scared to death of everything we tried to do out here that deviated in any way, shape, or form from the old, long-established status ~ , and I mean status quo before the Colorado General, or Psychopathic opened even, because the minute Psychopathic opened, the fat was in the fire, and the medical society--! remember going to the medical society meeting along in 1934, 1935. They were acting on a resolution to kick Franklin P. Ebaugh out of the medical society. It got that bad. The re­ solution didn't pass, but the feeling was that strong just because he was charging for patients that he was seeing in the Psychopathic Hospi­ tal. To me that was fine--I mean I was all for him. I didn't change my attitude until I got out here and saw that one half of the house was op­ erating under one set of rules that was favorable to full time, and I was supposed to run this house here under an entirely different set of rules-- I just couldn't continue that. Well, Ebaugh didn't like it, and I don't blame him. He finally pitched in, and he went on this sixth time busi­ ness. Although the statute made it possible, we put a stop to his put­ ting private patients over there in the Psychopathic Hospital where any­ body on the staff could collect a professional fee. Now lots of people that could have paid a private fee, or a physi­ cian's private fee, and were perfectly willing to do so, got taken care of for nothing over there. Making this change gave this Mount Airy San­ itarium, a private sanitarium just three or four blocks away--it helped that institution along because these fellows who were full time in the Psychopathic Hospital began to take patients over there. This furor is all over now. There was objection to Ebaugh's idea of community health clinics. He was the first one to propose this concept way back. Of course nobody went for it, and when I took the presidency at Boulder, one of the first things I got embroiled in up there was a community mental health clinic. Every place you try to do something like this--this was a local squabble up there at Boulder, and the best thing that ever happened in Boulder County--really it's a tremendous operation now. The medical profession would be the first to squawk if anything was done to impair the community mental health clinic's effectiveness. Now this polio thing--this premature baby business, this was unbe­ lievable. Harry H. Gordon who is now the Dean of Einstein came out, and he got the razzmatazz downtown that the pediatricians had been giving other 106 people we were trying to recruit. When Gordon saw Dr. Sabin, she made a hit with him because she said, "Dr. Gordon, do you like a good fight?" I don't remember what Gordon said. I think he said that he wasn't afraid of a fight, or something like that. Well, anyhow, she said, "You're just the guy to take that job out there!" Believe me the fat was in the fire the minute he hit town because he had ideas. He had research ideas, and this premature baby business-­ this had been his special interest. If anybody was qualified to set up a center, he was. The Children's Bureau was willing to finance it from scratch through the State Health Department. The medical society appointed a committee to consider this with us, and I remember the last meeting of the committee, and I told Harry Gordon, "We'll have no more meetings. We're just going ahead!" One of the fellows on the committee said, "Now listen here. Every­ body knows that you can't do anything about prematurity"--the reason was that they had been talking about doing research to study the causes of prematurity so that we could prevent it--"You can't do anything to pre­ vent it so that there's no use in having this center. It's a bunch of hogwash you fellows are putting out!" Another fellow there said, "You put in this center and sure, it will mean that you can do a better job taking care of premature babies than we can in the private hospitals simply because we don't have such a center, and this is unfair competition!" That's what he said. We'd say, "Well, we'd be glad to help any hos­ pital to establish a center. One purpose of this center is to train per­ sonnel so that they can go out and start centers in other places." "Aw, it's still unfair competition!" 107 Well, we went ahead and put the center in. From the moment it opened, it was jammed full. From the minute it opened, we began to have people come in from all over the United States for training--nurses and doctors particularly, and dietitians, and it's still operating full blast on this basis. We've helped every hospital in this state set up these centers, but you have to get over the hump, you see, and have a little period to show what you can do. It was tough going! Reading last night the minutes of one of these committee meetings, a handwritten note in the margin indicated that a Dr. George R. Buck didn't give a damn whether there was a school out here or not. Lots of times these graduates would say, "If the school"--and this would be after they'd been out of school twenty years--"If the school operated today exactly as it was operating when I went to school, that's just the way I'd like to see it." Now, this was common. This guy Buck--he's a close friend of mine, a classmate of mine, but in this rheumatic fever business, we almost got the Masons in Colo­ rado to establish a good research fund for research in rheumatic fever. We had an idea that we could study it from the tissue culture standpoint, and I still think this could be developed. The plan reached the point where a little letter outlining what was proposed was sent to every Mason in the state with a return self-addressed postcard for each member to indicate whether he was in favor, or against. Well, three or four of the good Masons, physician Masons, sent a competing letter around pointing out how this was going to be part of a move in the direction of socialized medicine. Well sure, the plan got 108 turned down by the rank and file of the Masons. Well, I told Lloyd J. Florio who was carrying the ball for this development that it would never go through. If the Masons were going to be democratic about it, it wouldn't have a chance. We got the money for his research laboratory--the Public Health Ser­ vice, I guess--and we set up quite a deal and then Lloyd--! had to make him go down to Denver General Hospital because you've probably uncovered the hostility between the Denver General and the medical school, where they wouldn't even let the students in the door down there. Quigg New­ ton--one of the platforms in his campaign to get elected was to make a university teaching hospital out of Denver General, and the day after he was elected, he and his assistant and Dr. James J. Waring, came out to my home--election was on a Tuesday, I suppose--"What's the quickest way now that we can get ahold of this situation at Denver General?" "We've got to get a hospital director in." I got Jim Dixon, James P. Dixon, Jr., through one of my men here, a fellow I had brought in under the Kellogg grant, this Frode Jensen, postgraduate education--he knew him. Jim had just finished an adminis­ trative internship, and we had him on the job in a matter of days. This is the guy who is now President of Antioch. He did the leg work to get the clinical center going under Norman Topping. A brilliant man. Well, Dr. Solomon S. Kauvar, a fellow in practice, a Jewish man whose father was a rabbi--we got him to quit practice right now and be­ come the Manager of Health and Hospitals--whatever you call it. He moved in down there at the Denver General, and boy--well, every member of the medical staff got a letter thanking him for his services to the 109 Denver General Hospital and saying that he was being relieved of hisser­ vices nonetheless. This just raised cane! It let us pick and choose who we put down there. A lot of these fellows, physicians, who got these letters were reappointed the next day, or even before they got the letters, but we had a hand-picked group at the Denver General Hospital. The residents and interns that were in the jobs there we had to live with until their appointments ran out. They did everything they could to sabotage this change. It was real tough. Then Jim Dixon got on the job. He is just like an old pro. He got things rolling. We worked out a very permissive sort of agreement. The city was willing to pay for the fulltime salaries at Denver General and meet our scale. Then when our scale got beyond the amount the city could pay, we provided the fulltime clinical faculty on a contract basis--we paid the people, and they worked down there. Denver General became a real teaching hospital. The Commonwealth grant came in with this Comprehensive Care Clinic, and if the politicians would just let it alone! Mayor Quigg Newton got the City Charter changed to set up the City Board of Health in such a way that we thought that the conditions that had developed down there prior to Quigg's election would never be possible again. Quigg didn't make an appointment to that board without checking with me. He wanted to be sure that they were going to be people that would be in favor of the university working down there, but gradually at the board level things began to change. The institution here, I'm sure, could have handled itself differ­ ently when the split came. I got a lot of the blame for it because I'm 110 running the National Intern Matching Program. Denver General didn't get anY interns the next time around, so they accused me of being in with the IBM machines so that they wouldn't get any interns. I was sick at the time. The Board of Health issued a public statement that gave me good cause for a libel suit, if I had wanted to start something. If it wouldn't have served to heat the situation up, I would have loved to have sued them, but I was sick and I just let this cause for a libel suit ride. I said at the time that the Denver General survived this difficulty because people liked to go there. One reason they used to like to go there was that they could do what they wanted to with patients practi­ cally because the supervision was so inadequate. Well, the City never let things get that bad again. They just began to put in fulltime peo­ ple, and it was just a couple, or three years when Denver General was again one of the most popular internships in the country and that's true now. Denver General probably gets more applications per intern place than any other hospital in the country. What did the local medical society have against Jensen? Well, chiefly because he came in as a fulltime person and a member of the department of medicine. Frode was a brilliant boy. He was ob­ viously a very sophisticated individual. He had a high pitched voice-­ if he had had a low pitched, husky voice, it would have helped him. The medical society made a lot of fun of his voice--the medical students did too. Frode knew what he wanted. Before he came here he had been working for the AMA inspecting internships, and he'd gone over to Utah, to Salt 111 Lake City, and he disapproved of a couple of internship programs over there and this infuriated the medical profession there. The minute it was known that Frode was coming here, why the boys over there in Salt Lake City saw to it that the people here knew what a heel he was. That was the kiss of death. I remember one medical society meeting when they had special hear­ ings on the medical school and apparently--! guess maybe we'd made peace. It looked like it on the surface, and at the end of that meeting of the House of Delegates there was a chap there from Utah and as a courtesy to him the chairman of the House of Delegates called on him for a few re­ marks. He got to his feet, and he said something to the effect that he'd noticed all of this consideration being given to the medical school/medi­ cal profession relationships, and he'd noticed that steps had been taken to heal the breach, but he said, "I want to warn you. You can't trust those university guys. They'll take advantage of this situation, and be­ fore you know it they'll be one up on you." This action at that particular time really didn't do any good. This Frode Jensen deal was partly the reason, but the people here learned to respect Frode. He's the fellow who set up the residency/intern pro­ gram at Denver General. He's the one that set up the community intern­ ship that was so important to this community. This was where a second set of interns were appointed, and they would be used to fill slots in private hospitals that needed filling. Then these interns would get the rest of their work at the Denver General, or here. This meant a full com­ plement of interns for the city hospitals that joined in the plan. Frode brought the city hospitals together, chaired the committee that worked 11 2 the program out. They ran it themselves. We didn't run it ostensibly. Frode organized the residency programs at the Fitzsimmons, and these fellows in the medical society did their best--I can prove this. They went directly to the Surgeon General to tell him what a scalawag Frode Jensen was. It got so bad that I sent Dr. Robert S. Liggett, the Asso­ ciate Dean, to Washington. Frode was a consultant to the Surgeon General, and we just wanted to be sure that the Surgeon General knew about all this. They said, yes, that they'd been hearing all about it, that they knew different. The Executive Council of the AAMC wanted Frode to take the secre­ taryship of the AAMC, just as he was really getting rolling out here. I was on the Executive Council, and Frode wanted to take the job chiefly because he thought he could do something with the Journal of Medical Edu­ cation. I had to admit that we needed a good journal in this area, but I said, "Frode, you've just gotten things started here, and if you leave, this is all going to fold." We had the Veterans Administration residency program on our hands too, and he had this basic science course for residents. We had the resi­ dents from Fitzsimmons, the V.A.--we jumped from two residents up to eighty. We had the Denver General residents. The private hospitals had stepped up their residency program. They all wanted the school to put on a good basic science review course which Frode organized, and a lot of it was centered down at Denver General. I thought, "Oh, this is all going to fall on its face," and I talked Frode out of taking this AAMC job. I should have let him go because the national need was much greater than the need here, I'm sure, but I talked him out of it. Had he taken 113 that job he wouldn't have stayed there more than two or three years, and the story might have been a lot different as far as the national develop­ ment of medical education was concerned because he had the ideas. He had the energy and he had the ability to carry people along with him even when they objected to him, or what he wanted to do. In the early days the medical society kept talking about an investiga­ tion of him--one fellow in particular, Sawyer. That was this communist business. There's a transcript downstairs of a meeting, or a discussion, and it gets kind of warm, but you can see why. Well, it's there--that's the reason I wanted to pull all this to­ gether. There's a lot of stuff that should be in there. Well, each House of Delegates meeting--before the meeting each dele­ gate gets a handbook with all the committee reports and things in it. The handbook for the meeting in Estes Park in--well, I forget the year, but this particular handbook had all the nasty resolutions in it that this bunch wanted to pass. I talked them out of every single one of them. That section of nasty resolutions has been lifted out of that handbook. I don't know--I've tried to get another one, but the medical society wouldn't let me have it. I think I could get it now. I should try again, but there's one place there where you can see that something was glued to a page, and it's gone, and that's the meeting. I can't find these remarks which I know are in the minutes some place. I once had my secretary look. I was usually a member of the House of Delegates. I Was a member of the House of Delegates when I took the deanship, and 114 at this meeting I arose, and I said, "I want the floor, but I don't want the floor as a member of the House of Delegates. I want the floor as the Dean of the Medical School." They had to put that to a vote, and believe me there was some argu­ ing as to whether I was going to have the floor or not. They gave it to me, and I made a short speech--the sense of which was that I was going to take over the administrative responsibilities for the Medical Center, and I just wanted them to know that they could expect an aggressive ad­ ministration because, I said, "Things have got to change. I would be willing to let you know what I'm going to do. I'd rather you'd be mad at me for that than for the way I'm going to do things." That's all I had to say. I read that last night. Did you find that? I'm glad to know it's there. Now through all of this--honestly, through all of this, sure I got mad, but there was so much cooking that the cooking got my energy, and I just knew we'd win, that there might be some delays and so forth, but I didn't brood. I didn't waste any time on that. Ken Sawyer--has been a good friend of mine ever since we were fresh­ men together at Boulder, and he'd do all these things. I'd do all these things, and yet we'd get together at cocktail parties, and we just felt as comfortable with each other as we do now. I kept him off the AMA Council--they came to me the first time he was going to run and asked, "What about all this trouble between you and Ken Sawyer?" I said, "There was plenty of it." Maybe that's the reason they delayed putting him on the council for 115 a term or two. I don't know. Even now we don't agree on lots of things. We've never really been enemies. He was on the Board of Health when all this happened over the intern business, and his name is on that statement. He would have been sued, if I had wanted to go after the Board of Health. I wasn't mad at him. He's such a darn sweet guy naturally that you can't stay mad at a guy like that. You did indicate at this meeting that you didn't want to attend any more meetings, that this was really, in effect, a distraction, but that you would let them know what you were going to do and they could do as they pleased, but you were going to do it anyway. I probably didn't go to any more--no I did. I don't think this was a meeting of the House of Delegates, but a com­ mittee meeting--a policy committee. If I didn't go to a House of Delegates meeting, I let the chairman know that I would always be available, if they wanted me. This was a much smaller group. Well, you'll see plenty of evidence of shooting from the hip as you go through those books, I think. Did the local medical society ever come around to the value of having a center? They do now--they're really proud of the place, and I realize this. The medical profession is the most peripatetic group that we have in the 116 country and in the last ten years as I have shifted around the country in connection with the Association's work I constantly would run into people who would say, "Well, I had a long visit with so-and-so from Colo­ rado." This was said and this--they wanted me to know that the medical profession really thought well of the place. I was in the early days helping President Thomas L. Popejoy of the University of New Mexico get a medical school started and you know, the beginnings of a development like this always go way back in time. I met with the Regents first on this matter. This probably was one of the first things I did when I went to the association. I was staying in Estes Park for the summer, and I met with the Regents of New Mexico. This was six, seven years before any consideration of the medical school got into the open down there. Well, I remember that when it first broke into the open I was down there at dinner sitting beside a doctor who was on the Board of Regents of the University of New Mexico, and he said, "You know, I was in Denver yesterday talking to a doctor, and I told him you were down here helping us. I'm going to tell you what that doctor said. He said, 'You listen to every word Darley says, and then you do just the opposite, and you'll be just right!'" I said to the Regent, "You can quote me on this. I know I've got lots of enemies up there, and I'm proud of every single one of them." I think he brought the word back from little things I heard from him later. I never asked him. Well, all this is childish. _It' s growing · · pains. 117 Sure. - When you work on the fringes of things and try to develop something ,iliat moves. Of course Ken Sawyer--he's "Mr. Big" now. He's vice chairman of the AMA Council of Medical Education, and he goes out on medical school accreditation inspection trips. At the meeting of the medical alumni not long ago, and he had no business saying this in this very responsi- ble position he's in and it wasn't true anyhow, but the senior class had been invited to this alumni function, and he said, "You might as well know that it's generally conceded that Colorado is considered number four across the country. If you forget all of the private institutions, it's number two." Then he sat down. Well, there's no way of arriving at a value judg­ ment like this in the first place, and he shouldn't have said it even if there is that kind of consensus which there isn't, but he's a great one. He was a football player and a good one, and he stayed an extra year--he dropped a year behind me when he was in school. He stayed on to get all the football in that he could. He's a great big husky fellow. He's got two sons that are graduates of this place that are doing fine. It's interesting--a big fellow, football--that's the language that comes out of him, a bruiser type. So many times in the course of trouble he's played a role. I re­ member when I was carrying the battle on this sixth time business, all the boys downtown were opposed to it at first. I shut the opposition off. I brought the matter to a head as far as working with them is con- 118 cerned by having a meeting out here one afternoon. I invited the full­ time faculty because there weren't very many of them. I invited the Board of Trustees of the Medical Society and the Board of Directors of the Denver Society--we had about forty people here. I read the memoran­ dum that I was going to submit to the Regents at the next meeting. At first it was pretty tough talk that came from these fellows. Then two or three of the fulltime people that were well respected--a psychiatrist particularly--they said something very reasonable. The discussion wound up with Ken Sawyer making the motion that all of the people there repre­ senting organized medicine approve this memorandum, and it passed unani­ mously. Now, I've seen Ken do that three or four times, and yet up to that point he was all against us. He'll be there tonight, and he'll be very active at the meeting probably. [The Denver Clinical Pathological Society] It's not the bread of life, some of its spice maybe, but you always said that it's hard to get a new idea borne apart from a certain conflict. It has to run its course like a case of measles. There's just no way that you can interfere and say--knock it off! It has to just run its course. What I'm looking for in this book must be some place else--anyhow, I'll try to find it. It's a statement that I made at a commencement talk at the University of Nebraska. I really--! won't say that I haven't had the nerve to use it since, but every time I have considered using it I have thought that it would be poor judgment. It has to do with the kind of explanation that you've just offered. I had it in the commencement address for the University of Illinois but took it out the last minute 119 and chiefly because I had to cut two or three minutes out of the speech. l think we'd better stop for today. All right. 120 - Wednesday, April 10, 1968, 7002 University of Colorado Medical Center This is pretty much in the order in which medical school courses were given--exactly in the order. For 1928, this was the typical stand­ ardized curriculum that had come out of the Flexner influence. I sound critical when I say that, but when Flexner made his study, as I see it, things were so bad that the only way they could be improved was to sug­ gest a level of standardization, a standardized approach to medical edu­ cation, but with the standards of this standardization far beyond the level that had been achieved by any of the medical schools at that time with the possible exception of Johns Hopkins and maybe two or three other institutions. This list of courses, the sequence in which the courses were given, the content of the courses and so forth were fairly representative, I think, of the average medical school in 1928. Anatomy, as a consequence got the same overemphasis here that it was getting every place else--still being overemphasized. I'll never forget the first day in medical school because we started out in Anatomy. I had gone to autopsies, and I was pretty well desensitized to cadavers. We first met with the Professor of Anatomy, Dr. Ivan E. Wallin who at that time, for those days, was very well-known in the field of gross anatomy. He'd done experimental work trying to understand the nature of mitochondria which were little bodies inside the single cell. I think they understand what they are today, but if so, I don't know what the understanding is. He was well-known for his interest in these little bodies in the cell. Professor Wallin was quite a character. When he met with us, one of the first things he talked about was that we were going to have to 121 keep ourselves neat and clean, and one thing he wasn't going to stand for was smelly feet. Then he said, "I want you to look around. Here are fifty of you, or whatever the number is. Look around because about twenty percent of you won't be here three months from now." He was just scaring the living daylights out of us as he could. Then we went to the little clinical amphitheater in the anatomy lab­ oratory which you'll see, if you go through the school, and we were sit­ ting there in great expectation. All of a sudden the swinging doors were banged open by a cart on which a cadaver was stretched with the diener pushing the cart in, but the impressive sight was the man who followed the diener. His name was Kehar 5. Chouke. He was an Indian--an East Indian, a Sikh, a member of the Sikh cult. Here was this big man walk­ ing in in very ceremonial fashion with a beautiful, white, silk turban on his head, big, bushy, grey eyebrows with these big piercing black eyes staring straight ahead, an enormous moustache, this full beard, and then this white coat that came down below his knees. This brought an aura of the occult into this situation--you see, and two students that I knew very well--they were pre-med students who had been with me at Boulder. They got up and left the room immediately, and you could hear them in the lavatory across the hall losing their breakfast, and they never came back. So we lost two of the twenty percent right off the bat. One of them--well, they both went back to Boulder, one in Law School and one in the School of Journalism. Well, we got started with our dissection, and this faculty were tough! They made us dissect out every little nerve as far as the eye could see. We just wasted hour after hour plowing through fatty tissue and fibrous tissue working out these minute dissections. The quizzes and 122 the examinations went into great detail even to the extent in osteology where we'd stand with our hands behind our back, and this Dr. Chouke--he was the task master--would lay a little wrist bone in our hand, and he expected us to identify that bone. Well, these wrist bones all looked alike and felt alike as far as we were concerned, and they weren't very much different from the bones in the ankle, so you can see how this went. Well, we were scared--everybody--and this interfered with our effec­ tiveness as far as learning is concerned, and when they gave the first examination on the arm, the upper extremity, anybody who passed it at all felt extremely fortunate. I got a seventy, or seventy-one, and that looked better to me than any hundred I ever got on any other examination. We got--at least I got used to this process. When I knew what was expected of us, I wound up with the two quarters in Anatomy, half a day every day five days a week, with a very respectable final grade. Now we started biochemistry at the same time in the afternoons. This was under Dr. Robert C. Lewis who was a very good biochemist--really a very good teacher, and he had a pretty good staff. This Dr. Robert M. Hill that is down there on the list--this was his first year in the de­ partment, and he spent a lot of time with the students. Lewis was a good lecturer, and it was the lecture notes that spelled out for me, I soon found out, what was going to be expected of us. If I could get down good notes and really knew those notes, I had no trouble with the examinations. The laboratory was pure Cook Book laboratory exercise, the sort of thing that we had in chemistry at Boulder. I'd gone through chemistry at Boul­ der up to the point of physical chemistry, so that chemistry was not a difficult subject at all. ].id you have qualitative analysis? .LLv No. I guess I should say that I had gone to quantitative analysis. Biochemistry was a two quarter course, and your grade was largely dependent in anatomy and biochemistry on how well you did in the oral examination, or practical examination they gave you at the end of the course. Was Wallin a reasonable lecturer, or was there no lecture in anatomy? There was no lecture in anatomy to speak of. Was Wallin available to the students? Oh yes--there were just the two of them--Wallin and Chouke, and they were in the laboratory most of the time going from booth to booth. There were four of us on one cadaver, and we used to have to come over quite a bit evenings and Saturday mornings in order to keep up with the work. These fellows made a business of teaching, and none of them had any re- searching going that I know of. Chouke as with many of these, Lewis, Hill and Wallin--! had them all for patients as soon as I went into prac- tice. I'll never forget Chouke a couple of years after I finished the course. I got on a street car downtown, and in another block a man got on the car that looked vaguely familiar, but I didn't give it too much throught. He and I both got off at the end of the car line out here, and then I knew, by golly, I really knew that fellow, and he started to laugh. What had happened was that he'd gone back to India, and he'd gotten his business affairs back there in shape so that he could leave the country and go western without creating any difficulties as far as getting his property and things settled, I guess, in India, and it was Dr. Chouke--he was bald, clean shaven, and from that point on he lost all his glamour as far as I was concerned. He was just another person. He was a difficult patient. He had asthma, and everything I wanted to prescribe for him he wanted a bibliography. He wanted to go look it up to be sure I was on the right track. I don't remember how I handled that. He stayed with me as a patient until he finally married. He got married here, and I saw his wife as a patient as well, until he retired. He left here and went to a postgraduate school of medicine at the Univer­ sity of Pennsylvania as Professor of Anatomy and stayed there for a long time. The last I heard from him he wanted to use my name as a reference. He was trying to get something else to do, and I never heard anything more on it, except that I saw a notice of his death not too long ago. Dr. Wallin is still alive--he's very old. I used to go fishing with him quite a bit because he belonged to a club up above Boulder, and he used to take me fishing a great deal. He was a lot of fun to be with. He had all kinds of hobbies, was very artistic--he did copper metal work, and he painted. He did carpenter work, and he's still busy with this sort of thing. He lives down in Phoenix--I haven't seen him for a long time. He had to quit corning up here in the high altitude I know. Dr. Lewis is still alive. He later was Dean when I became--you see, my first title was Dean and Superintendent. Then to make it a little more dignified they changed it to Dean in charge of Health Sciences. I still had the hospitals, but then I had a hospital director to work with. Then I was Vice-President in charge of Medical Affairs--this was when we made the director of the school of nursing a dean and so I ceased being dean of the medical school, and Dr. Lewis was made dean of the medical school. Then that meant the hospital director, the dean of the medical 125 school and the dean of the nursing school--! just had those three people reporting directly to me. Well, I had a business manager, I guess you'd call him, for the whole medical center. I put the Psychopathic Hospital under the hospital director--this made Dr. Ebaugh--well, it upset him a great deal, but he accepted it. He was the medical director then of the Psychopathic Hospital instead of the superintendent. All I took away from him was the administrative business affairs. I didn't interfere with his management of patients at all. I let the nursing director over there report to him. The nursing director over here reported to the superintendent of the hospital. This arrangement worked very well until I went to Boulder as president. Dean Lewis was very influential when it came to--as I look at it now, it really was a pretty minor affair, but to us we really had made a tremendous change in the curriculum and in order to make these changes, it was necessary to take away about ten percent of the time from the basic science departments, and Dr. Lewis was a big help in lining up the basic science teachers behind this curriculum, so he made a pretty good dean. The other thing about the curriculum--and this is getting off the subject a little bit--was the integration of the clinical teaching. We gave just one integrated set of lectures in human diseases, I think we call it, and this did away with each little department giving a group of a dozen to twenty, or thirty lectures--it cut the number of lectures by half or more, and really put the students on the wards and in the clinics so they could work with patients. Prior to that time the clerkships here were pretty perfunctory exercises. There was very little supervision, and the work of the students in the Outpatient Department also went with very little supervision. We didn't take advantage of the bedside, or the ambulatory patients the way in which we should as the focal point of teaching. Everything was lectures, quizzes, grading of quizzes. We cut down--we tried to cut down on the emphasis on examinations in the new curriculum too. This change didn't work too well; in fact, there are very few medi­ cal schools, I think, that have made any real substantial progress here. Things are still so that the primary reason for studying is to pass your examinations. The students learn what is expected of them, and this places limits on their learning efforts. I see a big change in the works as a result of these departments of research in medical education getting started in a dozen or so places. Well, to get back to this--that's about all I have to say about anatomy and biochemistry. How was Dr. Lewis as a biochemist, teacher? Very good--he was a good teacher. The teaching in anatomy was pretty good because the two people on the faculty were in the laboratory most of the time so they were avail­ able for questioning. They were quizzing us constantly as they went from cadaver to cadaver. Now neither one of them was any good at lecturing. What little lectures we had--well, we had lots of quiz sections, and here when it was apparent that the whole class, or a substantial part of the class had missed getting something--why, we'd get ten or fifteen minute lectures, but neither of these people liked to lecture. This was all very informal, and it was pretty effective teaching. We had to learn osteology all by ourselves. We just took bones-- 127 we checked bones out, took them home, and it was a straight memory situa­ tion, and we'd drill each other because we knew that we were always going to get questions on osteology in the examination. Physiology and pharmacology--it's a little difficult for me to talk about them because neither Dr. Richard W. Whitehead, nor Dr. Ernest H. Brunquist were particularly good teachers. I was extremely fond of both of them. I worked for Dr. Brunquist as a student assistant in physiology. My job was to be in the laboratory during the laboratory sessions, and I graded notebooks and graded quiz papers--that was my job, and I got fifty dollars a month for it which in those days was a pretty good salary, and I was expected to put in quite a bit of time. On top of that I helped Dr. Brunquist with a little research project he had under way, but this wasn't anything very arduous. It was just a chore. Dr. Brunquist was a very compulsive person, and as a consequence he showered us with mimeograph--well, what he did, he had big sheets of cardboard. I forget what they called them. They were about four feet square, and he had a clothes line strung across the front of the lecture room, and each class section we would find a dozen to two dozen of these cards hanging from this clothes line and on each card were diagrams and tables, and in his lectures Dr. Brunquist would go from card to card. Really, in order to keep up with this, we had to copy most of these cards because we knew if we could reproduce these cards we could answer most of the quiz questions coming up. This was a ponderous type of presenta­ tion that just overwhelmed the average student. Nobody got very good grades in physiology, but this was the only way a compulsive teacher could cover the waterfront in a fashion that was acceptable to this way of doing business. 128 As I got to know Dr. Erunquist this compulsive business just charac­ terized everything he did. He was a perfectionist. I often said to my­ self that if he could find a word that meant everything he'd use it. For example, one compulsion of his was he didn't want to touch door knobs. He'd always catch his coat between his hand and the door knob. He was constantly washing his hands, of course, as a consequence, but as an in­ dividual, a sweeter fellow never lived. I had him for a patient, his wife for a patient, and I saw him through some very, very serious ill­ nesses. Physiology was a very difficult experience for all the students. Now, pharmacology--Dr. Whitehead also was very thorough. He wasn't compulsive, but he kept his lecture notes--well, he had notebook after notebook of lecture notes, so his course consisted of his going through these notes very slowly and very thoroughly. We had ample time to take notes. They weren't always last year's lecture notes because he went over them carefully ahead of time and if changes could be made and should be made, he'd write them in. His notes were for the most part in his own handwriting, and if we took good notes--why, we got good grades in pharmacology because it was a memory proposition. At this time this course in pharmacology was a hard subject to teach because we were in this period of transition between a pharmacopoeia that was full of a lot of stuff that any modern doctor wouldn't use but the old boys in practice were still using a lot of this. They were still writing prescriptions that made the pharmacist buckle down to work and do compounding. The pre-compounded medication was just beginning to come into the picture. Aspirin, of course, had been put out in pill form by the pharmaceutical manufacturers for a long time, and there were things like this, but the pharmacists were still doing lots of compound- 129 ing. Prescriptions, by and large, were still written in Latin, and we had to learn to write prescriptions in Latin, and we knew damn well when we got out we weren't going to write prescriptions in Latin! The doses! The medications--Dr. Whitehead had a mimeographed list of I think five hundred, four hundred--a tremendous number of drugs where we were responsible for those doses--drugs that I've never heard of since. My younger brother can to this day--he sat and heard my mother drill me on these dosages--and to this day when he wants to tease me, he'll start out with "podophyllin" which was a laxative which nobody ever used even then, and he remembers the dose of that. I don't. He can reel off a dozen or so of these old drugs and their doses still. We were examined on these, and you had to buckle down and learn them. By the time I was writing prescriptions, or orders on the wards, everybody was writing the prescriptions in English. I wrote prescrip­ tions in the early days of practice, simple ones to be sure that required compounding--capsules, mixtures of oil of effederin for example, and I'd put in some phenobarbital to neutralize the exciting effect of the effe­ derin, some milk sugar to give some substance to the medication so that you could find it--you had a capsule big enough to see--this sort of thing. Now, of course, there's no compounding done at all, except some­ thing very simple--say, here's a cough medicine that is liquid and com­ pounded, and you want some extra codeine put in it--things like that. That's about all the compounding there is. Well, we had all of this because we were in this transition period. We had a lecture course in therapeutics that was given during our senior year, an old Dr. Moses Kleiner who had been a pharmacist before he'd studied medicine, and his teaching gimmick was to write these pre- 130 scriptions on the board that he wanted us to learn, and these were the old time prescriptions, written in Latin, and he'd go into great detail as to why each of these ingredients was necessary, and these things-­ some of them would have as many as a dozen, it seems to me, ingredients. We had another neurologist--two neurologists, and I'll tell you why we had two neurologists in a minute--who insisted on teaching a lot of drug therapy, and they were past masters at this old prescription busi­ ness. When we finished medical school, our concept of drug therapy was pretty darn confused, I'll tell you. Now then--why two professors of everything. In this catalogue I think there's a short history of the school and back in 1920--shortly after the Flexner Report came out the Denver and Gross Medical College which was a free standing medical school, a proprietary school--no, by golly, it was tied to Denver University, I guess, and then there was the University of Colorado School of Medicine, and the University of Colorado absorbed the Denver and Gross Medical College, but in order to handle the faculty reaction to this amalgamation, we had to have two heads of surgery, two heads of medicine--each one having been a head of his respec­ tive discipline in each of these schools. A lot of the clinical teaching here--this wasn't so true, or at least we weren't aware of it in the ba­ sic sciences, but our clinical work was all garbled up in order to satisfy the status requirements of these two sets of clinical faculty, and this persisted until I was in practice. We had two people in surgery. We had two people in obstetrics and gynecology, two in neurology, and this really garbled things up because they were obviously in competition for student attention and so forth. They'd make contradictory statements-- I mean statements where, as far as we were concerned, one would contra- 131 diet the other. The last one in surgery died after I went into practice, so it took quite a while for the effects of this amalgamation to wash out. Now then, Whitehead had some research interests that appealed to me so that while I was working for Dr. Brunquist in physiology, I began to spend evenings and week-ends with Dr. Whitehead with pharmacological re­ search. I was just helping him out because I was interested. I don't even remember what we were doing, and then this one thing led to another, so that we got interested in this urinary protease in connection with allergic conditions. There was another man with Dr. Whitehead by the name of Dr. William B. Draper who was really an anesthesiologist. He was in charge of anes­ thesiology over in the hospital, but he did a lot of the teaching, and later he gave us a course in anesthesiology. It was just a lecture course, but it was a pretty good set of lectures. We got to give some anesthe­ tics later on with Dr. Draper sticking right at our elbow. He was a good lecturer. I did a lot of my research with him. Well, again, he and his wife were patients the minute I went into practice. The Whitehead family were patients--! just couldn't get away from these personal ties--you see--that had me involved. As far as social relationships were concerned, Pauline and I saw a lot of the Lewises, a lot of the Wallins, the Hills--the Hills are still very close friends. He's retired. We saw quite a bit of the Drapers, a little bit of the Brunquists. It was to me a very pleasant, satisfying experience with considerable continuum to it--as student of these people, personal phys­ ician to these people, and then when I came in as dean, of course, the whole thing had completely turned around, and there were many, many very 132 difficult times for me as dean of the faculty in which these people served. For example, the Dr. Erunquist situation--we had to bring in another person as head of the department. It was easy to get people then because they were coming out of the Army, young men looking for positions, and we finally just had to tell Dr. Erunquist--we kept him on salary--that he'd do fulltime research, and we relieved him of teaching medical stu­ dents. We put him in charge of the student loan fund. He was a very kindly sort of an individual. He took on the student loan fund, and then he sort of served as a counselor to students. He did this plus his research. I think he finished up through retirement quite happy. Now Dr. Erunquist has a position over in the Museum of Natural His­ tory wiich incidentally is a very fine museum. Dr. Erunquist is over there in botany work, doing his work just the way he has to do work to get any satisfaction out of it. I suppose he's classifying specimens and things like that. Well, I don't know just what he's doing. Anatomy--! had no difficulties there handling these people as dean. I had trouble later on with people I brought in. The trouble was that troubles surrounded people I brought in. Whenever there's change in personnel, of course, in an academic situation you've just got to expect trouble. There's something the matter, I think, if trouble doesn't deve­ lop. Well, that takes me up to bacteriology, I guess, and boy was this a problem! The man who was Professor of Bacteriology, a Dr. Ivan C. Hall, was not a medical bacteriologist. He was a general bacteriologist who had had a lot to do though with the early understanding of the anaer­ obic bacteria, the kind of bacteria that grew in the absence of oxygen, 133 and he had done some good work on the pathogenic anaerobic bacteriology, gas gangrene, I think, particularly the Welch Bacillus, and he was a hard task master. He gave detailed lectures. He was easy to follow with the lectures. He gave a real Cook Book course as far as the laboratory was concerned. He required a weekly paper, the first effort up to that time that any faculty person had made to inject a teaching exercise that com­ pelled us to use the library, and the students didn't like this. I did­ n't like it, and I did it in a pretty slipshod fashion, I'm afraid. Well, Dr. Hall just stirred up antagonisms with the students and other people on the faculty. This happened after I was out in practice. He and the dean never got along. The situation was such that Dean Rees told the president that a change would have to be made in this depart­ ment. In the meantime, I was taking care of, was the physician of Dr. Hall and his fanily. As a result of this demand by Dean Rees that a change be made, this had to go through the General Senate machinery of the faculty. A committee had to be appointed and conduct an investiga­ tion, and it was such that Dr. Hall had an attorney. The attorney was always with Dr. Hall whenever Dr. Hall was being interviewed in connec­ tion with this investigation. Dr. Hall insisted that I appear before this committee, and I told the committee when I got their subpoena that I simply was not going to appear, and I explained the situation. This Was a hell of a spot for me, but I finally appeared. I tried to be as fair as I could, but I had to indicate that here was this situation where incompatibilities were such that it interfered with the students' learning. A deal was made whereby Hall resigned, and I don't know how many Years advanced salary he received, but he was bought off. He left town, and I completely lost track of him. I don't recall whether I saw him 134 professionally after this hearing episode or not. He was a rigid, old­ fashioned sort of a person as far as dress, friends, and social life was concerned. I was very, very sorry for him because he was able in his field. He just didn't understand bacteriology as the basic science for medicine, and it was taught as straight bacteriology. None of these subjects were really taught as parts of medicine. No relevance. Well, in pharmacology you couldn't help it, but in anatomy--well, radiology wasn't brought into anatomy. There were no correlation clin­ ics involving clinical people. Physiology was physiology. It wasn't even all human physiology. There was very little relevance to medicine and bacteriology. Now there's public health. Dr. Hall tried to give us an idea of what public health was about, public health as a function, but he didn't know anything about public health. He had an old fellow named Dr. Sever­ ance Burrage whom everybody loved and who was a public health man, and he handled public health. He was in the laboratory all the time. Hall was always accessible. You couldn't say that there was any lack of con­ frontation between the two. Dr. Hall had a lot of research going, and most of his research, how­ ever, centered around specimens that were sent over from the clinical wards. He'd get hold of an interesting case, and he'd go ahead, write the case up, and publish it without checking in with any of the clinical people--this was another thing that got him in trouble. He published quite a bit of this type of thing while he was here. Old Burrage would take us to slaughterhouses, to filter plants--he 135 did this ffirt of thing as an introduction to public health. I did not have Burrage as a patient. He was a favorite of the students, so every­ body kept in close touch with him. Pathology was a hectic experience. We started out with a man who had just been made head of the department by the name of Elliott, Chester Elliott, and he died shortly after the course started. A man named Dr. Frederick E. Becker was the other member of the department, so he fin­ ished the course for Dr. Elliott--no, he carried on until we got a Dr. William C. Johnson in to head the department who was an excellent path­ ologist. I think Dr. Johnson came from Columbia, or Cornell, and he came because he had asthma severely, and his asthma was· better out here than any place else he'd found to live. He was a hard task master. We had a hard time understanding him. We thought he was an old grouch. He never smiled. Well, I found out why he never smiled after I began to take care of him or after I got to know him, and I got to know him quite well before the course ended, and saw a lot of him as a junior and senior because we had to witness so many autopsies. There were a group of us--we brought our lunch and we ate in one of the seminar rooms--two or three students, four or five faculty people. William Johnson was one. Dr. Lewis was another--well, I forget who the others were. There was enough for a cou­ ple of hands of bridge for twenty minutes or so after lunch. Johnson would come down and eat lunch with us. He wouldn't play bridge. That fellow didn't dare laugh because it would throw him into an asthmatic paroxysm, if he did. He--you just knew that here was a very grim person and, by golly, he had reason to be grim. He was a hard one to take care of when I got out in practice because 136 he was so sick. He insisted on coming over here to the medical school, i f it was at all possible. He was a bachelor, and he figured he might as well be alone by himself over here as in an apartment down near Chees­ man Park. He had very high blood pressure, and we were fooling with that, and then he began to have strokes. He had terrific headaches with his hypertension, and then he began to have strokes. I had a partner with me by the time he died named Dr. Robert Gordon, and Johnson accepted Gor­ don very well. I wasn't on call this night. He called Gordon and said, "Come over. I'm having a cerebral hemorrhage. The door's unlocked." Bob Gordon got in and called me to tell me that Johnson was dying, and he was dead by the time I got there. Well, the autopsy showed four, or five cavities in his brain the size of a hen's egg. These were areas where there had been cerebral hemorrhages where the blood had been ab­ sorbed and left these cavities behind. How the fellow functioned, none of us could understand. Johnson gave us a good course by the then standards in pathology. It was a memorizing deal, but he made us spend a lot of time with freshly removed, pathological specimens, and we had to learn our slides. He gave unknowns that were stinkers. What he'd do is crowd organs, pathol­ ogical specimens, into a sausage--make a sausage out of specimens and run this sausage through the microscope and here'd be a little piece of a cross section of five, or six different organs, and we were to make a microscopic diagnosis. Well, none of us did too well at it. Now, clinical pathology--this Dr. James C. Todd was a tubercular pa­ tient and bed ridden. I never knew him. Dr. Edward R. Mugrage was deaf-- 137 quite deaf. He'd had scarlet fever when he was a child. Dr. Mugrage gave the course, or rather Dr. Todd gave the course from his bedside through Dr. Mugrage, and this textbook of Dr. Todd's--! think that by the time I was down here that was in its third edition. I'm not sure. All we had to do to pass this course was memorize the textbook. It covered a lot of ground. Mugrage would lecture, and the lecture was at one o'clock every day. Like a lot of lectures of deaf people--old Dr. Mugrage spoke in a monotone--and we were sleepy enough after lunch any­ how so that this lecture was a real ordeal. Now the laboratory course, while it was Cook Book, a lot of it was well done, and he had a Mabel D. Olsen who had a master's degree in sci­ ence--! don't know what field, but at any rate she was a qualified medi­ cal technologist, a good one, and a good teacher. ,Old Mugrage was al­ ways in the laboratory, and they gave us a lot of unknowns. We knew quite a bit about clinical pathology before we were through. Again Dr. Mugrage was a patient the minute I started out in prac­ tice, and he didn't like any of this new curriculum business. While he was friendly and all, and we used to see them socially, I knew that on the side he and his wife were grumbling like the very devil about the changes that were taking place in the medical school. He was doing a lot of his grumbling with the practicing people downtown, and without intending to, he fed this fire pretty briskly. These people depended on him as an information source. Well, he's dead. His wife is still alive, but she's still grumbling, I guess, as near as I can tell. The man who was president of the university, acting president-­ Rueben G. Gustavson, a very famous biochemist, endocrinologist, and he did a lot of the original work on steroids. I'd known him for years. 138 He was a very close friend of Dr. Mugrage. He knew about all this cur­ riculum business. Mugrage would grumble to him until he finally told Dr. Mugrage, "Ed, I know exactly how you feel. I'm all for what's going on down at the school, and I want you to quit talking to me about the medical school because it just interferes with our enjoying each other's company." Now then, we come up to medicine--this that we've been talking about was the first two years. There was just an iron curtain between the first two years and the second two years. We saw nothing of the clini­ cal people up to that point because, as I said, all the clinical teaching, except in psychiatry, was done by volunteer teachers. It might be that in pathology we saw something of the people from psychiatry, but I frank­ ly don't remember any of it. Everything was taught under the basic sci­ ences, and this is my big quarrel now. It's being corrected slowly, but it has been a long time coming. These basic sciences were taught with very little relevance to medicine. There was no integration between the basic science courses. We weren't conscious of any effort being made to provide a sense of continuum between anatomy and pathology, for example. Oh, one thing I forgot was a course in microscopic anatomy given by a man named Dr. Hugh M. Kingery. This was a part of anatomy, and there was some overlap with gross anatomy, but it was a separate course. In addition to human histology this course was supposed to cover embryology, and this was done largely through lectures and the models that were given. This Kingery was a tough teacher, gave lots of examinations, unknowns, and we just had to know our stuff in order to pass the course. Now the bad thing about this course from my standpoint was that while I could master the science side of it very well, you could write 139 a perfect paper, a perfect examination, and if you misspelled three or four words, he flunked you. This was plain hell for me because as I told you, I was a poor speller, and I always misspelled just enough words so at least if I passed, I didn't get a very good grade. The only thing that saved my neck in that course was a very tough, oral, and practical comprehensive. When we finished the course, he gave each one of us an hour's examination. - Oral? Yes--he had a bunch of microscopes around and, "What's this? What's this? What's this?" Well, after a lot of suffering over this spelling situation, since your overall grade depended more on what you did in this comprehensive oral examination, at the end I came out of it pretty good. In the mean­ time he and I--he was a cantankerous guy! He was one of these lunch fel­ lows, and he was a whiz of a bridge player, so that by the time I fin­ ished his course, I had already been assisting in physiology--I'd had a chance to figure him out and get to know him. Here again I began taking care of him and his family the minute I went into practice, took care of him up until the time he died, with em­ physema. He was a chain smoker--Wallin's wife died with emphysema, and she was a chain smoker. Draper died with emphysema, and he was a chain smoker. Well, I'm going to have to take a little break. When I come back I must make another try at this phone call. 140 - All right. These two clinical years--gee, I hope this is what you want--it's going to take some time. Incidentally I have to have the surgeon see my toe at one-thirty, so I have to get in a taxi about one. All right. The man I started out in practice with, Dr. Charles N. Meader, was the Professor of Medicine. He had been the dean before Dr. Rees. He was a graduate of Harvard, and he had all the Boston accent. He was a man who took himself very seriously, no sense of humor so far as I ever was concerned, a brilliant man. He'd come in, and our course in medicine consisted of a series of lectures. He gave the lectures on infectious disease. We were using the Osler McCrae textbook, and Dr. Meader would come in with a little piece of paper in his hand like this. These were his lecture notes, and this was a tremendous demonstration almost of a verbatim recital of Dsler's textbook. He was just amazing. He talked fast, and his sentence structure was perfect. He hardly stopped to breathe. He just would--the amount of stuff he'd cover in an hour was just out of this world. The minute the hour was up he turned on his heel, and he scooted just as fast as he could. Nobody ever had a chance to ask any questions. Why, we had three hours on typhoid fever alone, and typhoid was almost a thing of the past in those days. I think during my student, intern and resident days I might have seen two or three cases of typhoid over on the ward. I had one case of typhoid all the while I was in practice. The lecturing in medicine was divided among the four clinical pro­ fessors--another professor was Dr. Rudolph W. Arndt who sat and used a 141 textbook which was really a published outline of Osler's work. He would plow through these notes for his lectures. I've forgotten what fields he covered in his lectures. It doesn't make any difference. We'll say gastroenterology, for instance. He just plowed on, and you could see him run his finger on this page as he went from line item to line item. Now, once in a while he would stop and digress to give his idea of some humor­ ous experience he'd had with this condition, or a patient with this con­ dition. He had a funny way of smiling quietly to himself. He enjoyed these reminiscences a lot more than we did, I'll tell you that, because what he was doing going through this outline was telling us that we also had to memorize Osler, you see, to cover his course. The other man was Dr. James J. Waring. He later became Professor of Medicine. He was a sophisticated southern gentleman type, a very in­ tellectual type who had a wide range of interests. He was quite a bib­ liophile, and his lectures were a delight. I mean he came in without any notes. He covered pulmonary diseases, and when his time was up, we just wondered where the time had gone. We didn't take many notes--I don't remember taking notes. You just liked to sit and listen--he had a great sense of humor, and I don't remember studying very hard for his examinations. He must have given them. I don't remember any problems in connection with this. He was a superb teacher and physician. He was a TB and all during the period of years I knew him, I think he had at least two breakdowns when he had to drop everything and go to bed for a period of months. This would always be at home. Then the other clinical professor was a Dr. Clough T. Burnett who had been head of the Department of Bacteriology up at Boulder and then in 1922, when cardiology suddenly began to amount to something because 142 of the development of the electrocardiograph and the syndrome of myocar­ dial infarction had just been described--why Dr. Burnett dropped bacter­ iology and I don't know where he went, but he spent a couple of years qualifying himself in cardiology. He was the first one to come to Denver as a cardiologist. I don't remember Dr. Burnett particularly as a good lecturer. I think he skipped around a lot with what he had to say during the lecture period. It wasn't a very well organized business. He told us that he expected us to do quite a bit of reading, and he didn't say to read Osler. The first examination he gave us really caught us short because he asked things in this examination that he certainly hadn't said anything about in his lectures. That just told me--"Well, if you're going to pass these examinations, you're going to have to map out a sort of a study program on your own." I've forgotten now what I did, but it took some doing to catch up with him, and I'll have more to say about him later. We didn't like Dr. Burnett's course--the students didn't--because this was a threat. We weren't comfortable in anything but the highly structured teaching/learning situation, you see. The main subject of medicine was covered with lots of substitutions when these four fellows couldn't appear. Lots of times we just had a cut. Nobody came, and other times, why somebody would come and fill in. Sometimes it would be--let's see, the resident in medicine. I don't think they had any resident in medicine. A fellow named Clyde J. Cooper was a resident in medicine when I 143 was an intern, and I think he was the first resident in medicine--yes, he was the first resident in medicine that I remember anything about. We had a resident in ophthalmology. There was a resident in otolaryn­ gology, and this was a reflection of Dr. Edward Jackson and Dr. William c. Finnoff who were really powerhouses in the early days of opththalmol­ ogy on the one hand and a reflection of an old Dr. Robert Levy who was one of the nation's outstanding early specialists in otolaryngology. There were a lot of good men here in otolaryngology and in ophthalmology, and this was all the influence of these two people. We had a resident in otolaryngology. That man that sat in front of me last night with the completely bald head, Dr. Rex L. Murphy--you didn't meet him--he was the resident I remember. Then there was a Dr. Lyman W. Mason--I guess we had a resident--and he covered the whole ball of wax. This Mason turned out to be an ob and gyn man--I took care of the Masons and I took care of the Murphys. Now the rest of medicine was covered by these little special courses-­ I guess they're listed here, courses representing the subspecialities. All this theory and practice--the clerkships I'll talk about later--these clin­ ics and these demonstrations--they were really pretty perfunctory. You'd spend lots of time in the operating room watching--we didn't get down there. Senior year maybe we scrubbed a time or two--I don't recall. I don't recall getting down on the surgical floor until I was an intern to amount to anything, and the clinics--they'd bring patients into the clin­ ical amphitheatre. We had a clinic a day under the auspices of the medi­ cal department, and we never knew who was going to present a case. We learned quite a bit from this, I suspect. You never knew what the case Was going to be until they wheeled it in. 144 Our clerkships on the wards where we worked up patients and wrote histories, physicals, and progress notes--frankly, it was unusual for either a resident, or an intern, or a member of the faculty to take these histories and physicals we'd done and go to the bedside and check the ac­ curacy of our work, or discuss the case with us. We simply worked these cases up. We put the product of this work, or handed it in at the nurses' station. Then Dr. Edward R. Mugrage in clinical pathology--he was not seeing patients, and he knew nothing about these patients we worked up because he never had any occasion to see them unless once in a while be­ cause laboratory work he was responsible for was done in relationship to an interesting case--he'd grade these things. We'd get a grade on them. They'd come back to us, and most of us would get A's and B's. There was very little bedside teaching--honestly. Medicine in a vacuum. Yes, medicine in theory. In the Outpatient Department we wouldn't know whether a staff man would put in an appearance or not. The nurse in charge of the Outpatient Department would always be calling and asking for interns to come down and help, and the interns would never come, if they could avoid it. I know that when I was an intern I sure didn't go if I could get out of it. I didn't even want to go as a resident simply because the volume of work to do down there was such that you couldn't even give it a lick and a promise. You couldn't clear out all the pa­ tients that were waiting to be seen no matter how slipshod you were. As I look back on it from the standpoint of these patients, it just Was a disgrace, but this wasn't much different here from most of the Places. Outpatient teaching in the average medical school center is 145 still woefully inadequate to the possibilities as far as teaching and learning is concerned and certainly woefully inadequate as far as meeting the patient's need is concerned. These charts--patients that have been there, coming and going, are that long, installments, chart after chart, or microfilm of charts--you can't go through them. Of course you turn to the last entry and try to see what has been done. Entries are so mea­ ger, so incomplete--you just can't get much out of them. Of course, the supervision down there in the Outpatient Department is much better now. There are residents now, and this is part of their job. There's an excellent man in charge of the ambulatory service who is just killing himself trying to improve the situation, and the students tell me that it is improving, but they know too that in terms of the con­ tinuing care of patients--the continuity element in terms of one student following a patient for any decent period of time, or any one attendant following a patient, or a resident following a patient--the individual professional following a patient gets no feeling of continuity of care so far as the patient's problem is concerned. The woman, a Negress that works for us--arthritis. She's going to die. She has a fatal form of arthritis. I just know that her experience down there at the Outpatient Department is thoroughly typical. She does­ n't know who she is going to see, and she's in a specialty clinic, and it's in the specialty clinics where there is continuity, if there ever is. She's found that the best way for her to get taken care of here is to come to the emergency room in the evenings. She comes in--I was talk­ ing to the rheumatologist the other day about her. I was just telling him about her. I wanted him to get on the ball and see her the next time she comes in. Her last entry here was because of severe pain, and she 146 went into the emergency room. That coincided with about the time that she called us and said that she just didn't feel like corning in that day to work for us. Here's a big problem facing all teaching medical centers, all big metropolitan hospitals. If you've been following the New York Times at all in connection with the metropolitan hospital situation--there you get a feeling for this difficulty and how we're going to cope with it. Unless we really buckle down to the idea of setting up patient care teams where every member of the team knows what his responsibilities are in re­ lationship to the patient, and this is made meaningful in terms of unity by the team keeping each other informed and seeing the patient occasion­ ally together--all this sort of thing--I don't see any answer to this problem. Most of the people who come to a place like this they're good and sick or they don't come--you know. Decentralization of clinic care is part of the answer too. We're seeing decentralization now as the result of the OED program--economic opportunity, the poverty program. I tried to get Denver General to spot outpatient departments over the city. We needed in those days about five of them, so that a poor devil who needs to come to an outpatient depart­ ment in the dead of winter--he'd have to get up in the days of the street car at five in the morning and transfer three or four times to get here, and there were no appointments. It was first come first served. Patients who need to come would try to get over here by seven to be early in line, and nine times out of ten they wouldn't be seen at all. This was terri­ ble. Things are better, but they're still not better enough to justify anybody pounding their chest because of any great accomplishment. Under the OEO--they've got one good clinic down in the Negro area, 147 and they're putting another one out in the Mexican area, and they need several more. Something should be done like this so the outpatient load here, except for a rather small general clinic, is really limited to specialty clinics. There is no use trying to teach and demonstrate the concept of continuing comprehensive care in a medical center like this. I just don't think it's possible. You can talk about it, and you can do it within some limit, but you can't give students an idea of the natural history of illness, or the natural history of health in a place like this because the patients have to come in here. If you're going to give and teach the kind of care that patients need, you've got to take patient care to where the patients are--see, and that's why I'm excited about that deal between the little yellow covers that I sent you just before you left, and I' 11 come back to th at. [ "Medical Education: A Proposal for Inter­ state Planning and Programming" (March 26, 1968)] As a student who taught you the taking of histories? We had a fellow named Dr. W. B. Yegge give us a series of lectures on history taking, and he took a history, demonstrated the taking of a history a couple of times! Dr. Yegge assigned a couple of patients to us, and we went out and took a history and turned it in to him for a grade. We had a course in physical diagnosis by an old boy named Dr. John M. Barney and was he a character! He was really--well, he was a phenomenon. I'll never forget him. He was--even as a young man--do you know Lowell T. Coggeshall at all? 148 Well, Dr. Barney had the wrinkles like Lowell has, and he was a nice looking fellow, a chain smoker. He'd smoke wherever he was--on the ward, or in the classroom. It made no difference. He taught us physical diag­ nosis, but he spent most of his time reminiscing about patients. I remem­ ber this, and we loved it. He was interesting, and we learned a little bit about physical diagnosis from him. I didn't learn anything about examining patients really until I was an intern and really had to do it then in order to get into the swim of patient care, but there was no one coordinating clinical teaching with lecture assignments. I suppose the resident and Dr. Meader spent some time on an outline as to what should be covered for the students, and he'd get this and that practitioner to take the responsibility for this and that segment. We had an awful lot of time to play blackjack in the junior and senior year just because of no show on the part of faculty. If it hadn't been for Goepp, which is the book published that made a busi­ ness [telephone call interruption] ..•• Goepp was a book about that thick that was a compilation of all of the examinations asked by state boards of medical examiners, and that was the "Bible" we used when we prepared ourselves to take the state board exam­ ination. Questions were in there from anatomy--the whole business. There were no duplications. This was a safe thing to do in those days because practically all of the examinations the state board gave were questions taken out of that book, and on our state board here I recognized over hald the questions as having been taken verbatim from out of Goepp, so studying for state boards probably did more in the way of making us integrate our information than any other one thing. Of course you had to begin to study this--the boards were given in June, and we had to start getting ready 149 for them--well, we worked on it all senior year. It was a tremendous re­ view that was involved. Now coming back to these clinics--! think I probably learned really more there than any place. One fellow, and he gave quite a few clinics, was very good named Dr. Thomas D. Cunningham. He's retired. He's still alive. He was an excellent teacher, and these were completely unstruc­ tured sessions. Then there was a Dr. Thaddeus P. Sears. He's dead now. He was always good at this presentation of cases in the clinical amphi­ theatre. Drs. Burnett, Arndt, Waring, and Meader would do some of this, but offhand I don't recall any--well, there are no other names that stand out in connection with the teaching of medicine. Pediatrics was a lecture course, and we memorized the lectures. I don't recall whether we had a clerkship in pediatrics or not--I mean in the hospital. We were in the pediatric clinics some. Psychiatry was emphasized right from scratch. The teaching was good, and we were seeing patients, and we were working patients up--of course this all took place over in the Psychopathic Hospital. I think we were over there three months, I guess it was senior year--! forget, but we were over there enough. Of course they had a good fulltime staff, and they had an active fellowship program going, and the teaching was good. The teaching centered around a really psychotic inpatient. We saw a lot of institutionalized paresis and severe depression, dementia praecox, schizophrenia. We saw a lot of organic psychosis. These were the early days of giving patients with paresis malaria. Then the hot box came along, and they did a lot of the original clinical work for the fever cabinet over there in the Psychopathic Hospital. These patients had a lot of organic pathology, and particularly the 150 paretics would always have a cardiac complication with tertiary syphilis. We had to work these cases up completely, and as a consequence of this-­ this is the main reason that such a large percentage of our graduates went into psychiatry. The place was on its toes. Yes, and a lot of our graduates took the fellowship over there. Ebaugh tried to get me. He gave such a good course in psychiatry that I knew I didn't want to be a psychiatrist, I guess. I was always inter­ ested in it, but I just didn't want to be a psychiatrist. Surgery I just don't remember very much about. I wasn't interested in surgery, except the diagnostic part of it, the management of the sur­ gical illness part of it--that I was interested in. I knew that I would never be a surgeon--at least I had no intentions of being a surgeon. I used to get sick in the operating room, and if I'd go up there today and watch an operation I know I would get--well, if I had something to do in the operating room, I was fine, but to just sit and watch a bloody opera­ tion--the students used to bet among themselves how long I'd sit around up there in the amphitheatre watching surgery, particularly if something would seem to be going wrong. I just don't like to see people hurt, and this was part--well, this was deliberately inducing the illness lots of time, although when I finished medicine, I started a year of surgical residency because I thought I'd do general practice. After I had been trying to run the surgical service for a month or so, I told them that it just wasn't for me, and I pulled out. We had a lot of lectures in surgery, and most of these had to do with surgical diagnosis and the broad outline of the surgical technique. 1 1 51 We had a course in cadaver surgery and a course in dog surgery--Dr. Joseph F. Prinzing taught both--no, Dr. Prinzing taught dog surgery and then Dr. Carbon Gillaspie from Boulder gave us a course in cadaver surg­ ery. Dr. Leonard Freeman was--we called him the king. He was a very famous surgeon, a great big man, six feet two, or three, rather heavy, but very pontifical in his bearing. He was the old school--he was used to having people treat him with great deference. He'd make these pro­ nouncements in such a way that nobody would challenge him, or ask any questions. Underneath it all, as I learned to know him well later, he was really an old softie and had quite a sense of humor, but he saw to it that none of this ever showed through in the course of his professional contacts either with patients, or other physicians. Now Dr. Freeman's son was a classmate--he was in our class, and here was a man, very intellectual, very sensitive, interested in music, those kinds of things--he went to Mayo's and finished a certification in thor­ acic surgery, came back here, and practiced and did all right, but he didn't like it. He quit practicing, and I haven't seen him for a good many years. I don't know what he does, but his father, Dr. Leonard Free- man, dominated the surgery business. There was a team--a pair of partners, Dr. Edward F. Dean and Dr. Frank E. Rogers that did a lot of the surgery treatment. Old Dr. Dean was a holdover from the Gross College of Medicine side of things. He was a very aggressive man--I think he had quite a military career, as I remember, and he certainly conducted himself in a military manner. George B. Packard was probably the best teacher amongst the surgi­ cal people, and he was a very kindly, deliberate person. When he came out here to the Colorado General to make rounds--I'm speaking now as I 152 remember him as an intern and a resident--he gave us all the time we wanted. He did lots of teaching at the bedside, and he was a good teach­ er in the operating room. He's still alive, and he's still practicing. I took care of his wife's mother--that's as close as I became involved. I don't recall taking care of any of the surgical people who were my teachers. Well, Dr. Harold L. Hickey--I took care of him when he died. He was a nose and throat man. The senior year--here the clerkships were all supposed to be in the junior year. Well, we sat on our tails listening to lectures all but a couple of hours a day. We began lectures at eight o'clock, and we didn't quit them until five, and we had this little two hour period in the day for clerkship work, and this continued on into the senior year, but our work then was in the Outpatient Department. We were supposed to have a lecture from eight to nine, and then we had three hours in the Outpatient Department. We spent from one to four or five in lectures in senior year, and we learned the lectures where they took roll and those where they didn't, and the attendance was pretty spotty. We usually managed--four of us--to get away for a game of handball in place of the last lecture or two. We'd go down to the YMCA, but there was--this is true everyplace, I'm sure--there was just nothing very inspiring about the last two years of medical school. How about neurology? Dr. George A. Moleen and a Dr.--let's see, Pershing. There were two Drs. Pershing in neurology; Cyrus L. and Howell T. Moleen and the two Pershings pretty well split up the lecturing in neurology. Moleen had been a pharmacist, and he liked to lecture and went into a lot of detail. 153 The two Pershings were great drug therapists, and they spent most of their time writing these prescriptions on the board that we were supposed to use. Howell Pershing's brother--he took the position that there was really no danger in using small doses of powdered opium. He had powdered opium in a lot of his prescriptions, and I learned later that he had a lot of addicts to his credit, but it did make the patients feel better. Howell died, and the other Pershing's son went into practice with his father without even taking an internship. He didn't last very long. He died along the way. Moleen--I took care of him and his wife right away when I went into practice. He died. He was a cardiovascular problem. He died by inches over a long period of time. He was a hard guy to take care of, took a lot of time. We didn't learn much neurology. There was a good textbook in neurology--W. Russell Brain, I think. Well, I've forgotten, but I knew whatever textbook it was pretty cold from cover to cover. Neurology was a self-study proposition as far as I was concerned. We had a course in neuroanatomy. I don't even remember who pretended to teach it. I believe the histology professor, Hugh M. Kingery, was re­ sponsible for it, and we had to know our tracks. Neurology was and still would be a very difficult subject to get much out of and remember unless it could be built around teaching patients. It's a very precise science--you know, and it's interesting that in the new curriculum at Western Reserve neuroanatomy and neurophysiology are the two courses they start the students out with because the curriculum there is built around the regulating mechanisms of the body. Of course the most important regulatory mechanism is the central nervous system, so that it is reasonable to do as Western Reserve has done. The anatomy those stu- 154 dents get is spread out over three years at least and maybe four years of medical school. Then in this consortium of medical schools I'm promoting for these four states [Idaho, Montana, Nevada, and Wyoming] anatomy will be soft­ pedaled right from the start, except as it has relevance to other course work that will be going on, and they'll use the Western Reserve curricu­ lum, a great deal of it, probably. We'll teach anatomy from the autopsy table as much as from cadavers in these four states. An awful lot can be done with this medical curriculum. Now then, there are two things that people are excited about with the curriculum. In the first place I don't think as a primary considera­ tion the structure of the curriculum is so important. I think you can teach good medicine around any old curriculum, if you'll subscribe to the idea of integrated teaching and teaching that has relevance to problem solving. Undergirding all of this is a tremendous effort to develop the intellectual skills that are necessary to self-study and self-learning. Continuing. Yes. This undergirding we still don't know too much about, but we know enough so that we can develop a teaching program that is much better than you see in most places. The self-study and self-learning without access to the top people on the faculty is still being emphasized too much. Faculty availability is still centered around the residents too much. Sure they should do teaching, but there should be much more con­ frontation between medical student and the senior people on the faculty than there is. The students by and large are pretty bitter about this. To me, it means the development of team teaching. If we're going to talk 155 about team care, let's have some team teaching, and the student, the resi­ dent, the faculty person, the senior person, maybe a junior person, should be on this team, and they should be working together in the area of con­ tinuing care of the same patient so that these people who are on the team really get to know each other, and this means the nurse on the team, the social worker on the team so the idea of comprehensiveness can be brought in. You certainly didn't get much of this in your training. No, oh no. Sense of relevance, except in psychiatry. Psychiatry. They had the material. They had the fulltime faculty that had the interest--you see. How about obstetrics? Memorized readings--Dr. Clarence B. Ingraham and another doctor, and I can't think of his name. This was one of the two headed deals that we inherited from the amalgamation of the two schools. Now both these two people were good practitioners and by our standards in those days were good lecturers, but what they did was memorize the text--we knew that if we knew that text cold, we had it made. We made a business of knowing the text pretty cold, and this went on for a full year. Now there was a lot of delivering babies in the homes in those days. We as junior students would go out with an intern and a visiting nurse 156 ! I I to deliver babies, and lots of times the interns wouldn't make it. It would be the nurse and the junior student. When we were seniors--! don't remember whether we had to do some more home deliveries or not. I kind of liked it so I did a lot of deliveries my senior year, and there was a visiting nurse, Mrs. Taylor--boy, she knew a lot of obstetrics, and it was really fun to go with her on a delivery! Lots of times she'd get there before we would, and the delivery would be all over. Then as an intern I went out on lots of deliveries, taking students with me. Well, it wasn't long after this until they began to hospitalize these patients and the home delivery business stopped, but I kind of counted up and al- together counting junior, senior, and intern years I would guess I was involved in a hundred home deliveries probably. That's at least some practical •••• Yes, and I very closely considered going into obstetrics at one time. The intern year did a lot to point me. I was going to be a pedia­ trician, and Dr. Rees--and again the Gengenbach influence, but my pedia- tric service as an intern was a grim one. We had an epidemic of menin- gitis, and it was a bad one. Of course antimeningococcus serum was just coming into the picture, and Dr. W.W. Barber was the one we leaned on as a staff man, and he was good and he worked hard with us. We also had scarlet fever. As interns we were doing cisternal punctures, drawing spinal fluid and injecting this serum. Well, not much was known about this method of treatment. It was pretty crude as I look back on it. Some of these babies--it was miraculous the way they would snap out of it. On the other hand there were lots of instances where adhesions would form, and we couldn't--the serum wouldn't circulate, and we'd lose our L 157 children. We had scarlet fever. Well, the thing that kept me from going into pediatrics was the parents of these sick children. I just decided that to treat sick children was one thing. To treat frantic or sick parents was another, and I decided that at least I'd not go into pediatrics. I liked my service in medicine enough--there was a Dr. Constantine F. Kemper that I should mention. He was an excellent teacher. Diabetes was his field. He was a good lecturer, and he was a good man on the wards. We didn't get to see these people on the wards until our intern year, you see, and Dr. Kemper gave us a lot of time. He, Dr. Waring, and this Dr. Burnett were the ones that stimulated me to go into internal medicine. They were good doctors. Now, I said that I would come back to Burnett because I didn't like him as a student--at least I didn't like his teaching. Those areas that had special gualities--the whirling dervish Dr. Levy. We saw very little of him except on the lecture platform. Subspe­ cialties we saw very little of on the clinic. Genitourinary was a part of the overall clerkship in surgery. Nose and throat was a part of this, and all we cared about there was taking out tonsils, and as interns we'd take out tonsils without any staff man being there. If he came, fine, and if he didn't, we went ahead. We gave anesthetics for tonsillectomies without any supervision, except an older intern maybe. I didn't get to know Dr. Levy really until I was taken into the Clinical and Pathological Society that met last night. Everything sort of revolved around him for a long while with that particular society. I used him as a consultant quite a bit, and he was a good consultant when I was in practice. 158 But as a student, the sense of relevance between what it was you were learning in terms of idea was not related to teaching material at all, or very little. It was light--pretty thin. The time devoted to it was so inadequate, even if the supervision had been there. Two hours a day out of a whole senior year--that's inadequate. When I came on here full time, my only responsibility was the junior clerks on the ward, and I had them for a half a day. I had six of them for six weeks. That was hard work because we went to the bedside, and I checked every history and physical with the student. We had a little classroom over there where I had some models and things, and we'd seesaw between the bedside and the little classroom where I wanted a blackboard. I taught history taking and physical diagnosis, and these kids knew how to interview a patient. I carried this on until they were comfortable in their relationship with patients. This is terribly important. We al­ ways felt strange with patients as students. Of course we did. Those two years of fulltime teaching--! often wish that I had stuck with it because, as I told you, at the end of the two years from the time the dean died I just had enough time to catch up with myself as far as study was concerned where I was comfortable from the clinical standpoint in confronting students with a patient between us. You've got to be pretty much on your toes in these situations. You can't be on your toes if you're unsure of your own data bank, information bank, but students loved it-- oh, boy, they just went after it. They worked like the devil. Two of them I talked with last night at the end of the evening indicated that but for you, the sense of history taking and its relevance as well 159 2-5 the bedside approach, being a clinician •••• This just means being with the student long enough so that they see that this is the way a professional operates, and there is no substitute for it, and there never will be. You can go into the computer room with this and program instruction. You can do away with all these lectures, do away with a lot of this rou­ tine in teaching, so that the faculty will have time for student confron­ tations. Then teaching can be made to amount to something. I don't care what the organization of your curriculum is because all the students need to do is to learn to feel comfortable with patients, realize the impor­ tance of self-study, disciplined self-study and feel comfortable in that situation, the use of the library, the use of consultants. I should have stayed with the teaching game, I guess, although what I've done since, I guess is still teaching. After four years of alleged education, exposure to memory, and a memory bank, what were the alternatives in terms of internship? Did you have any that you thought about? I knew that I was going to intern here. You knew this? I don't know why. It would have been good for me to have cleared out. I've gotten none of my formal education any place except here in this state, except for the postgraduate courses the American College of Physicians gave. I managed to get in a couple of these a year most of the time. David P. Barr--he was then at Washington University in St. 160 Louis. I used to go and spend a week or two with him each year, just following him around. I spent a summer with Paul D. White which was the smartest single thing I ever did. Howard B. Sprague, Edward F. Bland, Dr. T. Duckett Jones--gee, I made some wonderful friends up there, and I learned a lot. I spent two weeks with Robert Cook at the Presbyterian Hospital in New York on allergy, and I leaned enough about allergy there to quit thinking that I was qualified to take care of real allergic problems. I passed these on to somebody else here that knew what he was doing because I found out that I couldn't know what I was doing without really making a big special effort. I stayed on here through residency. This is the group that were interns--! gather they came out of the class, though about that I'm not sure. Not all of them. Now, I did talk with Dr. Kemper about going to Mayo's, and he had me all lined up up there without my even applying. Well, the depression had hit. I wondered about that. I had to help my parents. Pauline and I--she had a job here in the Social Service Department. We knew that we could stay here and feel se­ cure, and that's what we elected to do. I got a lot out of the internship and residency. This William H. Mast who was a classmate, and he took the surgical residency. I took the medical residency, and that meant being on every other night and every other weekend, and we worked--I'm telling you, this hospital was full, and we didn't know whether a staff man was going to turn up or not. 161 I kept my part of the show going, even answering requests for consulta­ tion at Psychopathic Hospital. As I look back on it, I realize that I was learning by trial and er­ ror, of course, and that this meant unnecessary suffering on the part of patients in many instances. Kemper, Burnett, and Waring when he was well were the three teachers on the medical service, and I would estimate that about half the days I was supposed to have a staff man, I'd have a staff man. Other than that, why I had the whole responsibility for the patients and the interns, and I did quite a bit of teaching of students too. I'd take the clinic for Dr. Waring, if he wasn't well enough to come, and I would do the best I could with it. Now these interns--Hugh H. Awtrey came from some other school, and I've forgotten where. He went into otolaryngology. Kenneth H. Beebe was a classmate, and he went into pediatrics. He's in the northeastern cor­ ner of the state. I think he's still practicing. Richmond E. Bennett went into general practice out in Kansas. I don't know whether he's still alive or not. I stayed here in internal medicine. Andrew G. Finlay went into surgery, and then he went down to Alabama, The Tennessee Valley Auth­ ority. He began to work with a man that contracted for the medical care of the construction workers down there, and he married that guy's daughter and stayed on. Samuel Goodman was a classmate. He went into diabetes, and he died out in California. William Mast went into surgery, and he has a big clinic in Cleveland. John L. Swigert stayed here as a resident in ophthalmology, and he got a Ph.D. in ophthalmology and is still in practice. He takes care of me. Clyde J. Cooper--! don't think he went here to school, but he was a resident in surgerye He stayed on two years. Then he went to work with 162 one of the big packing companies and is still doing industrial surgery. Paul A. Dickman, resident in medicine is still in practice as an intern­ ist. The next year of interns was a good crop--Robert H. Felix was good. Wray R. Gardner was good, and he went into psychiatry. Frank C. Golding-­ I don't know what happened to him. Paul R. Hildebrand went into practice out in the northwest corner of the state, and he's now the coordinator for our regional medical program in this state. He didn't go beyond the intern year as far as formal training is concerned. His military exper­ ience was a terrific one from an educational standpoint, and he did a real superb job of family general practice out in the northwestern part of the state. He married the supervisor of the operating room. Samuel B. Potter was one of our graduates and he stayed on here for surgery and had a big practice, though he's dead now. Edna M. Reynolds who is an older woman, a graduate here, went into ophthalmology. I took care of her until she went into a mental institution in the southern part of the state. Charles Smith--he's the one that I got to take my practice when I came out here to the medical school full time, and he still holds forth and still has some of the old patients. Tinsley Smith went into medical missionary work in Africa. He and his wife were on the "Zamzam", an Egyptian ship that a German raider sank during the war. The raider took all the passengers off and then sank the ship. We weren't in the war yet so these people were unloaded at a port in France. He got back to this country shortly after that and never did go back to Africa, I don't think. He's in charge of student health at Baylor University wherever the main university is, a small town in Texas. Eugene L. Walsh came from the University of Northwestern, and he was a 163 protege of Andrew C. Ivy--did some work with Ivy before he came here and went back to Ivy from here, and he's the medical director now, or research director for one of the big pharmaceutical companies--! don't remember which one. This is a period when you get to see patients. Yes, and it was--now this Burnett. I keep coming back to him be­ cause when I was an intern Burnett was on service three months out of the year. Seven days of the week he was here at seven-thirty sharp, and we were supposed to be ready for him, and we were. He was a tough customer! He was. He would stay all day, if we needed him. He would go from patient to patient, and he went over things with a fine tooth comb. He quizzed us to death. He'd say, "You go up to the library and you read this, read that," and before he'd leave he'd always say, "Now, are you sure there isn't something more that needs to be taken care of?" Well, if he was here at seven-thirty, we were generally through by eleven, certainly by twelve. If we needed him, we could always call him no matter what time of day it was, or night. I wind up putting him down as probably the most influential teacher I had. Now Dr. Waring--also gave us all the time we wanted. He'd come about ten and he'd stay until--well, he was usually here for a couple of hours, and he probably only worked with one or two patients with us. His was the scholarly approach. He knew the literature. He knew medi­ cal history, and he knew--he just knew, and he just loved to maybe wind up talking about fishing, or something else, but he just made it inter- 164 esting. You always felt when he left that you'd been on the mountain top--you know. He and I became very close. Kemper was another one like Dr. Waring, but except for these three fellows there was relatively little. There would be others that would come and gallop through the wards. How much insight and aid do you get from the other interns? Do you work in a group? Were you a group? Yes, I worked closely with them. As an intern? Oh, when I was an intern. Well, there were four services, and there were supposed to be nine interns. We were divided up, and there was a senior and a junior on each service, and we didn't work too much together. We had our own patients, and there was a lot of work to do. We were all pretty buddy buddy. We had nice quarters upstairs. We all lived in, and there was lots of horse play. We got along well together. Who effectively administered the intern program? Was it Rees? It was entirely up to the resident. Entirely up to the resident--Cooper, or •••• I mean our assignments and all that was entirely up to the resident. He may have done this in conjunction with Dr. Meader some, and Dr. Meader was Professor of Medicine, and Rees, but he had to depend on the two resi­ dents. Rees, while he had an M.D., was basically a physiologist. He had a Ph.D., and he was Professor of Physiology, and he leaned very, very 165 heavily on the residents to keep things rolling. Who he worked with on the faculty in medicine, if anybody, I don't know. Rees was half Indian, or quarter Indian, I guess, and showed it--I mean in his appearance. He was very stolid on the surface--you'd hate to play poker with him, but that was all just front because he was an in­ secure person. They treated him terribly--the people downtown. They made it tough for him, and a lot of the faculty that came down here from Boul­ der. He was the most lonesome person I think I ever knew, really, and when he would go to the legislature, he got a tough going over there--he and the president of the university didn't get along, and he had this trouble with Ivan C. Hall, and during the residency--well, I used to take care of his lawn when I was a student and when they'd leave town in the winter, which they did around Christmas time, I'd watch the furnace. I got to know him and his wife pretty early in the game. One reason I took the internship here was because Dr. Rees wanted me to, and I saw a lot of him as a resident, of course. After I was mar­ ried--why we were in their home frequently and after we had our own home, they were in our home frequently. As I said, I took care of him--I was his wailing wall, if he had any. Do you remember the first patient you had as an intern? No. No particular patient with maybe one or two exceptions stands out during either my internship, or residency. There was just so much to do, and while I said I would duck the Outpatient Department, if I could, when I was a resident I couldn't duck it. We didn't have a direc­ tor. We had a nurse who was the director of the Outpatient Department, and doggone, if the staff didn't turn up down there, it was up to me to 166 try to get somebody down there, or go myself. Now I don't say that things were very well covered. I'd go to Rees and I'd say, "Goodness sakes, let's get some more men from downtown to come out here to help take care of this!" The hospital service was the status building set up as far as being on the faculty is concerned, and the people who worked in the Outpatient Department would only do it because they realized that this was a step­ ping stone to an appointment on the first service inside the hospital, and when the stepping stone kept stretching out year after year after year, and these people wouldn't get advanced in this fashion, why they'd quit. It was hard to get practitioners to take an assignment in the Out­ patient Department. Now there was a Welshman who was a paraplegic who was brought in the hospital and stayed here for years as a ward of the state. He wasn't a citizen. He was a very nice fellow. I remember him because he was one of my subjects when we were studying the effect of pituitary extract on the emptying out of the kidney pelvis. He didn't care whether we killed him or not, and he let me give him pituitrin intravenously which took a lot of guts and took guts on my part to do it. It was a blessing to him because he was having pyelitis as all of these patients did in those days because the bladder was paralyzed, and the retrograde infection to the kidney was the rule. We didn't have any effective urinary antiseptics in those days, so he'd have these attacks of chills and fever. When we found that a shot of subcutaneous pituitary would empty out his kidneys for him this meant keeping his infection under control, and he was our prize patient when we wrote that clinical paper on this. [Ward Darley, William B. Draper, and Joseph L. Harvey "The Effect of Pituitary Ex- 167 tract upon the Tonus of the Human Pelvis and Ureter and Its Possible Ap­ plication in the Therapeutics of Pyelitis and Related Conditions" 26 - Journal of Urology 1 - 11 (July, 1931)] Then later his family in Wales--this was when I was in practice-­ found the money to have him brought home, and they wanted me to take him and I wanted to take him, but this old guy I was working for was home with a cold, so Samuel B. Potter took him. That would have been--in those days a tremendous opportunity to get to Wales and back. The other patient was a woman from a little town of Castle Rock south of here who had a great big abdominal cyst. We were afraid to operate it. I remember her just because she was such a nice gal and was such a good patient. She was in and out and in and out of the hospital. Finally we got the courage to take the cyst out, and she died postopera­ tively. We should have let her alone, but she'd reached the point where she said, "I'd rather be dead than keep on this way," and her family agreed. I think that paper is written up, isn't it? I didn't write that paper up. There was a case--of course, most of my so-called scientific writing was case reports. We wrote up a case of diabetes. [Ward Darley and Richard W. Whitehead "A Case of Diabetes In­ sipidus Occuring as a Sequel to Epidemic Encephalitis" 15 Endocrinology 286 - 296 (July - August, 1931)] I wrote up a case with Dr. C. A. Doan of pulmonary hypertension. We called it Halophagia. ["Primary Pulmonary Arteriosclerosis with Polycythemia: Associated with the Chronic Inges­ tion of Abnormally Large Quantities of Sodium Chloride (Halophagia)" 191 American Journal of the Medical Sciences 633 - 647 (May, 1936)] That 168 was the case you mean. That's the one. I thought "Halophagia" was a pretty clever name, but what happened was that it buried the case in the index where nobody ever found it. Yes, that's the one I have in mind. That was written really as a thesis. That's what got me in the Amer­ ican College of Physicians without doing something, or other--I've for­ gotten what now. Did you ever get disenchanted with medicine during the intern and resi­ dent years? No. Despite the seeming disorganization? No, I think one reason was what has always motivated young people-­ they think they can do better than their elders. It's the function of people to create a greater degree of order out of the chaos they find. I guess you're right, and there was chaos. I wasn't aware of--! didn't feel that things were necessarily chao­ tic at the time. You know, medicine wasn't very effective in 1929. We didn't have very many specifics to play with. We had insulin. We had digitalis and quinidine. We had the salversans. Then as a real, power­ ful drug to use as necessary, we had morphine and codeine. We had sur­ gery, but we couldn't go into the cranial cavity and do very much good 169 j'11 t ever. We couldn't go into the thoracic cavity and do any good ever. We'd take out some ribs for empyema. There was lots of surgery done for the treatment of infection. That's what an awful lot of surgery here was--just dirty surgery. Terrible infections, burns, and things like this would come in. A simple appendectomy in those days was a dangerous operation, so when things went wrong, or the patients didn't do well--it was sort of par for the course, in a way. The internship at Denver General wasn't any better than here, if as good. The private hospitals--! had no idea what private practice was like until I left here and went with Dr. Meader. I was compulsive enough and this fellow Mast was the same way, so that we just extended ourselves sufficiently so that the standards of our performance were thoroughly ac­ ceptable to us. Well, you had to work hard to meet those kind of standards under conditions that pertained here. This was a brand new hospital with everything modern in it. It sure was. The nursing service was pretty good. We had no shortage of nurses. In those days when a staff man would come on the ward, the nurses would stand at attention--you know, wherever they were. If the nurse was work­ ing with a patient, and the staff man came on the ward, she beat it to the foot of the bed and stood at attention--all the women in the nursing station would stand at attention. I thought that was great for a while. There is a change in 1930 7 and that's your marriage. Yes--well, that changed things, of course. I got married about three months before the end of the intern year. We'd been engaged for 170 four, or five years. Well, we began to go together my freshman year, and we'd known about each other long before that. We first met each other in 1918, or 1919, right after her family moved up here to Denver. My family went to call on her family and took me along, and I didn't want to go. She was very aware of that fact, and she likes to tell about watch­ ing through the window--my father grabbing me and kicking me into the rear seat of the automobile and driving on. He did. He just gave me hell be­ cause I must have acted terrible. Well, then along came DeMolay and De­ Malay dances, and I didn't know any girls to take to dances, and mother would say, "Why don't you let me call that little Braiden girl's mother-­ see if they won't let her go?" I'd have none of that because I remembered all the visiting busi- ness. Well, we didn't see anything of each other to amount to anything until the two families joined together in a reception for all the old timers from the San Luis Valley that had moved up here. This reception was quite a deal, and after that--why, we saw enough of each other so that getting married was something we'd thought about. We felt we ought to have been married lots sooner. We've always gotten along extremely well. She was part of this way of life. It was quite a shock to her, even though she'd been in social work, to begin to sit at meals down in the dining room with other interns, re­ sidents, and medical students and listen to the shop talk, a lot of which was deliberately contrived to shock her when people found that she could be aroused. Well, she soon got used to all of that. She thought that she was used to it just having been with me so much. This Bob Felix, for example--he just delighted in getting her fussed. He was pretty good at 171 it. This Bill Mast--he had a mind like a sewer, and he didn't hesitate, and she just had to get used to it--well, these fellows, these nine in­ terns--we'd lived, most of us had gone through school together. We were all good friends, and on the other hand they were the kind of friendships that didn't last beyond the point of close contact. Swigerts we see some, but not very much. Masts we kept track of as long as they were in this neck of the woods, but the war took care of that. None of the others. Now the boys that were interns when I was a resident--there was Felix. Hildebrand was a whale of a good intern. He just worked. Potter, Edna Reynolds, Charles Smith, Tinsley Smith--that crew I kept in fairly close touch with until they either died, or moved away. At the end of residency--what alternatives did you see then? [Telephone interruption] Let's develop just briefly the post-residency year because if you want to go and leave at one, you ought to get a bite before you go. Well, during the residency I talked to Dr. Kemper, or he talked to me rather about the idea of going to Mayo's on a fellowship. That's where he'd taken his fellowship, and really unknown to me--he thought I had committed myself at least to applying up there--he'd gone ahead and talked to David Balfour who was in charge of things, a man I came to know later, and the whole thing was set to go, if I had applied. I didn't know that until Dr. Meader had asked me to come down with him and with the depression under way and all, two hundred a month looked like a lot of money at that time. It probably was then because we got along on it very well and still let my folks have some help. I'd been with Dr. Meader about two months or so--he was one of those fellows that when anybody got a little cold, he put them right to bed, 172 and they stayed there a week or two. My goodness. He was an autogenous vaccine fellow, and everybody that came to him he cultured their stools, their nose and throat. Of course, he'd recover a streptococcus, or a staphylococcus, and he'd make these vaccines and give them in various small doses. He'd keep patients coming week in and week out, and I knew pretty quick that this wasn't for me, but after about two months he was home in bed giving himself his own bed rest treatment, and so I just stuck with it for three and a half years getting two hun­ dred and fifty a month when I quit. As I said, in the meantime I had cured most of his patients because these people who were coming in every week for a shot of vaccine--I weaned them as fast as I could. He didn't like it, but there was nothing he could do about it, and patients of my own took their places very fast--people like that man I. W. Philpott who picked us up last night. [Telephone interruption] 173 Thursday, April 11, 1968, 1150 Grape Street, Denver, Colorado Yesterday we went to school and while there were digressions which are the sunshine of conversation--! like conversation when it flows where in- terest takes it--1 was wondering, listening to you yesterday, whether the school in general, or any member of the faculty in particular, made the students feel part of the institution, gave them a voice='= sampled their - views--any standing at all? There was no formal arrangement for faculty student communication. Each class elected a president. We had the honor system. This was put in at the medical school--at least it was in operation by the time I got there, and it worked extremely well and has always worked--the students have policed their own monitoring of examinations. I was on the honor commission representing my class for all the while I was in school, and in the four years of school we only had one questionable case, and that turned out not to be of any particular consequence. Now there was no faculty person on the commission. This was entirely a student affair. As far as I know the faculty organization, if there had been any facts that should be brought to the attention of the faculty, I'm pretty sure the faculty would have approached it by having the dean appoint an ad hoc committee. I don't think there was any standing com- mittee of the faculty. The class was small enough, and the faculty was small enough. For the first two years, of course, the faculty had no particular responsi­ bility except teaching. The research was minimal so that there was plenty of informal communication. I remember that the beginning of the sophomore 174 year we had a brilliant man in class and early in the sophomore year when he saw what the demands were going to be in terms of notebook work in memorizing, he dropped out of class in protest. There was no faculty re­ sponse to this, or particular concern, as near as I could tell. This man went to Denver University and graduate school and later got a Ph.D. under Dr. Gustavson in biochemistry. I don't know what's happened to him since, but there was no formal structure for communication. I don't know much about the faculty structure as far as· its doing business is concerned, except that the executive committee which repre­ sented the department heads had a luncheon once a month, and I'm sure that there were some faculty committees, but I was not aware of them. We as students weren't aware of faculty committees at the time as students. Now we weren't aware of the need for this. At least I wasn't. The other day walking in the hospital down one of the corridors, you de­ scribed, or intoned the voice of a surgeon describing what he was doing in surgery, but sitting where you were sitting you couldn't see. You might just as well not have been there. Was there any way to voice that need for some examination of approach? There was no set up opportunity for such dialogue. If any of us felt strongly enough about it, I don't think anybody would have been afraid to object to it. As I look back on it, I suppose I should have voiced my objections, but you know, in terms of educational methods 1926 to 1929, my experience of student protest of any kind was something quite rare. Now in Boulder just before I got there as a freshman, a group of seniors had been kicked out of school the year before--just within three 175 months of examinations for putting out a pink sheet, an anonymous little newspaper with a lot of uncomplimentary stuff in it about the faculty, the teaching, and the university in general. One of these was a very close friend of mine who was in the School of Journalism, and after two or three years, they were invited back by the administration to complete the quarter and get their degree. Most of them took advantage of this invitation except this one man, Gene Lindbergh with the Denver Post, and I think the main reason he didn't go back was because he was firmly intrenched in a good reporting job with the Denver Post. He, for my money, and that man Robert Perkin you met the other day have been the two outstanding newspaper reporters in the state. They are both very, very excellent. There was no organized student protest that I was a part of, or knew very much about. Now I led a revolt against the student government which was centered at Boulder, and the reason was that we were paying the stu­ dent association dues which included football tickets, basketball tickets and so forth. They included receiving the student newspaper. There was no community of interest between the medical student body here and the student body at Boulder. The work at the medical school was demanding enough so that very few of us went to football games. We just couldn't take the time. We certainly couldn't go up there week nights for basket­ ball games. We just saw no need of being a part of the student associa­ tion. Mrs. Darley: Long distance for you. [Telephone interruption] You were talking about the student body as a social force in the school, and I didn't yesterday get any sense of a social force at all. 176 I couldn't say that the student body was a social force except inad­ vertently due to the presence of the student body and the fact that the student body had to be the principal focal point of faculty concern. There were no fireside chats. There were no annual dinners. During sen­ ior year we had a senior week, and the students had a dinner and the fa­ culty were invited, or the faculty had a dinner and the students invited. I don't remember which way it was, but most of the senior week celebra­ tion was a faculty student baseball game. That's the only time anything like that happened, a picnic which was a beer bust back in the mountains. The answer is that there was no identifiable evidence, as near as I can tell, of the student body serving as a social force in the institution. To go back to this revolt--we were just going to refuse to pay our dues. I wrote an editorial, and it's in these papers somewhere here. There was a student election, and Boulder officials came down with the ballot box. As a means of registering our protest, we flipped a nickel and we all voted for the same guy. This was just enough votes to switch the election up there at Boulder. If we'd stayed out of it altogether, or if we had voted as we usually would have, with any distribution at all of our votes between two candidates--why, one man would have gotten it, but because there were a hundred and twenty-five, or a hundred and fifty votes at the medical school all for the same fellow it tipped the scales so that they were glad to get us out of the student government organiza­ tion. One of my jobs along the way after I got into the job of being dean was to get the student body back in because they wanted the football tickets then. T+ m~,, hP rPlritP.rl to the fact that when you went to school as a student 177 in the medical school there was no dormitory. No, there wasn't. And therefore no collection of students •••. Now, there were three fraternities that maintained houses, and there were four medical, professional fraternities, and I guess all of them leased a house. Quite a few of the students lived in, but there was no university supervision of these houses. They didn't even have house mothers, I don't think. It was a board and room proposition more than anything else. When it came to electing class officers--why, the four fraternities were vying with each other. There were combines, but being a class pres­ ident didn't mean very much because there was nothing for him to do that I can recall, and there was nothing for the representative of the honor commission to do unless there was a case brought to the attention of the commission, so out of the four years I just remember two or three meet­ ings in connection with this one case. I don't know whether the faculty even knew about this--I don't know. Was there any--well, let me use a word that comes to mind, and I don't mean it in harsh terms, but was there any "radical" thinking person on the faculty with reference to the students? No. This may be because most of them weren't full time. Well, we had no fulltime clinical faculty, except in psychiatry. Of course we had the small fulltime basic science faculty--they were in 178 constant touch with the students in the classroom and in the laboratory. The faculty had to work hard because, as I say, on the average there were two men in a department with a graduate student assistant or two. This was the pattern. This just wasn't a day across the nation for student unrest and student concern, it seems to me. Now, the sociologist and behavioral science literature might record otherwise, I don't know. It's during this period of economic unrest that you enter the practice of medicine. Yes, you see, on the day I graduated, everything was fine--as far as the national economic picture was concerned. The depression hit in the fall of my residency year. I started my residency in September, and the bank holiday and all was very soon after that. I remember it so well because Pauline--well, my wife's father owned a little bank down in the San Luis Valley. Of course, the banks were shut, and nobody knew what was going to happen when they opened. We were all concerned. He walked the floor, walked the floor, and walked the floor. His bank was in very good shape; in fact, it was one of the first banks--it was the first bank to be sold after the depression, as I remember, and the national newswires made quite a thing of this sale as evidence of an improving economy when it was possible to sell a bank. I don't know whether we have those newspaper clippings kicking around or not. You entered practice as an assistant to Dr. Charles N. Meader. Yes. Where was this? What kind of facility did you have? 179 He had an office downtown in an old building that catered to doctors. He had a room about this size, 14' x 12', for a reception room with a desk for a receptionist and a secretary. He had another room about this size with a roll top desk and an examining table behind a screen that stood between the desk and the examining table, and at the end of the examining table there was a little chair with a stand lamp so he could put on a head mirror and examine a nose and throat. There were three or four chairs in the room. It was carpeted. That was the extent of that room. Then behind that room was a laboratory. It was quite well equipped because Dr. Meader did all this bacteriological work, and he had a well qualified technician who was one of my instructors in bacteriology as a master's degree candidate, or she'd just gotten a degree, and she did blood chemistries, routine urinalysis, and blood counts, and we did gas­ tric analysis. We did quite a lot of laboratory work then. We ran our own--she did Wassermans which not very many private laboratories were equipped to do. She was busy, very busy handling cultures and isolating pure strains of bacteria and making vaccines, and then these vaccines were diluted. The patient would come in, and Dr. Meader would feel that there was a reaction to the last dose of vaccine, so he'd have the technician right then and there dilute the vaccine a hundred times, make a new bottle-­ take a hundredth of a cc., or a tenth of a cc. and make up a new bottle of ten cc.'s of diluent. This dilution process went on until Dr. Richard W. Whitehead and I sat down--he knew how to do it--and we figured the last molecule of bacterial protein must have been diluted out of this a long time before. This technician was busy. Now, then, when I was there I was with him, only he was in the office 180 just a short time, but there was no place for me to work separate from him. There was a little room between the laboratory and this room with the examining table, and all this little room had in it was a desk and a couple of chairs. I had no patients of my own that first year to speak of until Dr. Meader was absent for some time. I'd take his histories for him. I'd do the first physical lots of time, and then he'd check this over with me. Then we'd have patients coming in for short appointments, and I would sit there just as an observer. He'd examine these patients and once in a while he'd want me to listen to a chest with him, or a heart with him. I had the honor of administering the vaccine most of the time. We were in the office from about eleven until four, or four-thirty. I went with him on hospital rounds, and I went with him on house calls. It wasn't very often he would have me see patients in the home for him, if he was unable to go along, so that it was a very unstimulating kind of work. I remember my first patient--you asked me the other day--who was re­ ferred by Dr. Ralph W. Danielson who was the man that I asked to speak at the meeting the other night and tell about this voice library at Boulder. He sent me a man who was having some eye troubles that he felt represented some systemic condition, and I examined this fellow. Dr. Meader wouldn't let that stay at that. He was going to examine the man to check me. A phone call came in, and Dr. Meader wanted me to leave the office and take care of this matter, whatever it was. I said, ''Dr. Meader I have examined. this man. I haven't done a rectal yet, and I haven't checked his prostate. I think he has a very active focus of infection. It must be his prostate because I haven't found any evidence any place else." 181 Dr. Meader really took the patient away from me, and he did not do a rectal. He never did a rectal as part of a routine examination. He just decided that it was a sinus infection. This was his diagnosis on everybody, and subsequently it developed that this man's eye difficulties were due to his prostate, a prostatic infection. I got no more patients from Dr. Danielson. When he confronted me with the final situation, I told him what had happened, of course, but this sort of thing wasn't a problem very long because Dr. Meader went to bed, and I took over. I brought this protease business as a possible method of treating allergic conditions into practice with me, and I gave that quite a run for a while. I quit it because it just wasn't working, although we had written quite a few papers about it. Theoretically, it sounded great. The idea came from Guy's Hospital in London and the people at Guy's Hos­ pital stayed with this quite a while because I got reprints of the things they were publishing. Dr. Whitehead still thinks that there is something excreted in the urine during an active allergic reaction which is a fac­ tor in the causation of symptoms, that might be developed if it be con­ centrated enough and used as an antigen, but we were unable to follow the matter any further. It would have begun to cost money because it would have meant complicated chemical procedures requiring technicians, so we just quit. That big paper that we prepared for the Annals of Internal Medicine is a paper that I wished we had never published frankly, because some of the ideas in there were really unscientific, but for those days, as a piece of clinical research, it was pretty well thought of. [Ward Darley and Richard W. Whitehead "Studies on a Urinary Protease - II. Skin Reactions and Therapeutic Applications in Hay Fever" 6 Annals of Inter- 182 nal Medicine 389 - 399 (1932)] I think the papers--I've read them recently--are not one hundred percent black and white. It still continues to be a problem with insufficient evidence really to warrant conclusions drawn from the limited study that was done. You said "not scientific". I thought that in this sense they showed imposed limitations--you know, over a man who will, let's say, and I don't mean this critically, continuously dilute a serum. Well, now Dr. Meader gave a paper on this vaccine business at the AMA shortly after I joined him. I joined him in September, and the AMA meeting--well, I don't know. He gave the paper. He thought this was wonderful, and the journal turned his paper down for publication. This just broke his heart. He considered it a rejection of what he felt was a good scientific piece of work and, of course, his ideas. This technique was a holdover from the focal infection era in medi­ cine, started by a man named Dr. Frank Billings, as I remember, who felt that practically all illness was due to focal infections some place. Meader was a member of this school, and he was just trying to follow through with the ideology of the times and do things to justify the ideas. He was using a method whereby the patient's own blood was put in the bac­ terial medium. This was supposed to help the non culprit bacteria grow and inhibit the bacteria that were culprits. This was part of the screen­ ing procedure to help identify the truly offending bacterium. It was this screening method as well as his therapeutic follow-through with the autogenous vaccine that the Journal of the American Medical Association rejected. He carried on quite a correspondence, as I remember, trying to justify the idea that this paper should be published. Now who the 183 people were at the AMA that were doing the screening of papers I don't know. This was when Morris Fishbein was editor, but he wasn't making these kinds of decisions, I'm sure. ,tjgw long did this arrangement obtain? I stayed on his payroll for three and a half years. He was in the office--I'm estimating, but it couldn't have been more than six months. It was a difficult decision to make to pull out at a time when here was a fellow home flat on his back. It was a self-imposed flat on the back business, as far as I was concerned. I had taken a vaca­ tion maybe a year before I left, but he didn't ever want me to be away. I just told him that I was going to take a vacation. I took a week off. I came back and he said, "Now, I want you to examine me. I want you to take over the management of my case, just as if you'd never heard of me before. You just start from scratch, and I'll do everything you tell me to. I won't raise any objection to anything. I'll do exactly as you say." Well, I gave him the works. I put him in the hospital. This his­ tory--with all of this preoccupation with symptoms and illness that he had was quite a chore, you know. I came up with quite a document. I did a careful physical, and when I finished he said, "You did a pretty good job on that physical, except when you percussed my chest your percussion blows were not light enough." Well, I didn't go back and re-examine his chest. I had all the laboratory work done. He was a tape recorder as far as having symptoms 184 are concerned. He submitted to everything I wanted--a GI series and all that. Then I wanted to X-ray his gallbladder. Well, a gallbladder X-ray in those days was no joke--let me tell you. We were giving an intraven­ ous dye, and in about half the time the patients would have chills and a fever reaction to the dye, and they'd vomit--well, Dr. Meader said, "You know, I'm sure there's nothing wrong with my gallbladder. With your permission we'll skip the gallbladder X-ray." We didn't X-ray his gallbladder. I found that he was either taking, or doing about twenty some dif­ ferent therapeutic items, we'll call them, and I cut all this out. I put him on two or three drugs. I wanted to stop the vaccine because he knew by then that I didn't think much of this vaccine business. He said, "I'll cut all these things out, and I'll limit my medication as you re­ quest but with your permission we'll keep the vaccine going." I came to see him after that, but I never again asked him how he was. I never asked him at all, and he never volunteered any information. He carried on again from that point on. Then after I left--he had a lot of insurance. He was doing fine with this insurance bit with a waver of premiums, disability insurance. The insurance companies--! guess they got together, and they told him that he had to go to the hospital again, that they were going to pick the doctors and see that he really had an examination. They made him take a gallbladder dye because if he'd refused anything, they would have had a handle to take hold of to cut him off with his insurance, and here was a gallbladder full of stones. He let them go ahead and take it out. Well, the funny thing is--and here's one on me--when we went back and got out the old X-rays that were taken when I had him in the hospital-- 185 we'd taken just a plain flat picture of the abdomen--it was easy to see this gallbladder full of stones. The stones had enough calcium in them so that they were casting faint shadows. The X-ray man was embarrassed to death over this. Dr. Meader went on, and his insurance ran out. When antibiotics came out, I guess he quit the vaccine and kept these expensive antibio­ tics going. His wife had been tubercular and she caught cold. She was in bed most of the time just because he was afraid to let her up, and they had nurses around the clock, housekeepers, and then they finally sold their home. They moved into an apartment, and Mrs. Meader did all the housework and took care of him. Finally this doctor who drove us to the meeting the other night-­ it wound up that the Meaders wouldn't let anybody in to see them. Dr. Philpott just insisted on going and would drop around once a week. He finally found that Mrs. Meader was sick and that things were so bad he just finally called an ambulance and put them both in the hospital over here. She died very shortly after that. Dr. Meader stayed there for a long time. Then they put him in a nursing home and tried to get him off the antibiotics, but he had no natural resistance at all, so he finally came in with a pneumonia and died, completely impoverished as far as anybody knew. It sounds very much, and I may be wrong, that he really needed psychia­ tric help. Yes, and this was the last thing. The insurance people insisted on a psychiatric examination, and he blamed all this on me. This was a dis­ grace to him, to have anybody even intimate that his was a psychiatric 186 condition. Isn't that one of the symptoms--where resistance is monumental? Of course--well, when he was in the hospital, I had my little office over there, and I knew the doctor who was taking care of him, and I asked him, "Do you think I ought to go see the old gentlemen? Do you think it would do any good, to try and make peace with him?" The doctor said, "Gosh, no! Don't go near him. You can't make your peace with him." I let it go. For three years you had run the office, in effect, did you not? Yes, and he didn't interfere with my management of any patients. I would tell him about any interesting cases, or something--he occasionally asked about a patient, but he never interfered with my work. At first I kept on doing things his way pretty much. These vaccine cases--I would cut them from one week to two weeks and then to three and four, and a lot of patients by that time would quit coming in anyhow. I wasn't giving any vaccine according to his lights for a long time. Did he make adjustment in financial terms? No, I worked two years at two hundred dollars a month, and then he raised me fifty dollars. When I quit I was getting two hundred and fifty a month. As I say, a dollar was worth a lot more then, of course, and we were doing all right. We were even saving a little bit. What brings a patient to you, brand-new, unconnected with Dr. Meader? 187 When people knew that I was running my own patients, doctors like this man who took us to the meeting the other night would send patients. Of course I was taking care of a lot of doctors and a lot of faculty peo­ ple, and that's where my patients came from. The patients and I got along very well. I was being a family doctor, and many times people would come in, and the reason I'd start taking care of them was our agree­ ment that I would take care of everybody--children and everybody else, with the understanding always, that if I needed consultation, it was my responsibility to get it. This feeling on my part was part of their rea­ son for feeling secure with me. I used consultants a lot particularly with children because these kids with any infection can seem to be awfully sick with high fever and things that go with high fever. The same thing is true today that was true then. All you need is your first patient, and if you're really sincerely interested and they sense this, why they tell their friends and you've got it made. This is probably more true today than it was then because it is so hard to get doctors now when you want them under the conditions that you want them, but I was busy. After I opened my own office, I figured I wasn't going to be so busy, as I rented a little cubbyhole in another building, and Dr. George B. Packard came over with some flowers--this was our professor of surgery--to start me off, and he hadn't seen this office. He said, "Ward, it won't be three weeks till you'll outgrow this place." Well, within two months I was looking for somebody to come in and help me. We were able to get additional space right next to us, and we set ourselves up differently. We still didn't have enough room. When we left this first place we went all out. We rented the whole end of one of the wings in this building. It was very functional, very useful, and 188 that's where eventually four of us practiced. That space took care of us very nicely. It wasn't luxurious, but it was functional, clean and business-like. What period of time--let's see, at what point in time did you leave Dr. Meader, 1935--roughly? Yes--roughly. Let's see, I started with him in September of 1931. 1932, 1933, 1934, and I left him the 1st of February 1935. My wife and I went to old Mexico by train for two weeks. Did you really? I was almost down with arthritis at the time. I was having a lot of trouble. I was dead tired, and the tension and all with this decision to leave. Of course I picked right up the minute I dropped all this and got down there where it was warm, nice weather, and we had a nice lei­ surely vacation. I came back feeling fine. My wife's mother had died, and we moved in the old home. Her father was with us. We'd gotten a fulltime woman who did everything. She stayed with us for a good many years, and as we moved, she moved with us. There were lots of periods when I would go through the motions of not taking new patients and trying to keep the incoming patient load under control. Well, it didn't do any good. Most of my patients came from other doctors. All you have to do is turn down one of these patients--you know. This meant less reading, less leisure, more shooting from the hip with snap judgments. When the war came and these three fellows practicing with me had to leave, I couldn't practice medicine under those conditions. In a speech you give, you indicate that your practice included children 189 .§lld you said, "For these pains I nearly died with the mumps." I was on my way to a meeting of this Clinical and Pathological Soci­ ety and these people called--these were older people, and they had their granddaughter with them. She was two, or three years old, running a fever, and they wanted me to stop and see her which I did. I had never seen the child before. I went over the kid, but I had a knockdown and drag out to take a look at the kid's throat. Of course, she was crying and yelling and just spewed this virus all over me. When I got to the meeting, the pediatrician who was responsible for this child--well, I told these grandparents that I would be seeing this child's doctor in a few minutes and that I would send him out. I missed the mumps diagnosis. He came to the meeting, but, he went right out to see her. He came back laughing, and he said, "Ward, about all you did was miss a diagnosis on a case of mumps!" Ten days to the minute almost I came down with the mumps, and was I sick! High fever, delirious, and then they went down on me. Jesus! The toxemia with testicular mumps is always severe. I stayed home, and we had help come in at night two or three nights. I was out of my head part of the time. It was six weeks before I got back in the office. I didn't come anywhere near dying, but I felt like dying. I'm sure that I had some meningismus with it which isn't unusual for adults to have-­ low grade encephalitis with any of these virus infections--measles and mumps particularly. Some of the sickest adults I've seen have been adults with childhood infections--mumps, measles, and chickenpox. This classmate of mine, Dr. 190 Swigert, who takes care of my eyes, almost died with the chickenpox. He had lesions in his mouth and on his windpipe, and he had pneumonia with the chickenpox. There was nothing you could do in those days about it, except support it symptomatically. He finally came out of it. When you look for a partner, what do you think in terms of? I didn't look. I had this boy, Robert Gordon who had been a student. Even when I was in practice, right from the word go, I was active on the faculty out here. I didn't have a--well, I took one of these appoint­ ments as an assistant outpatient physician. That was my title. Then you were an outpatient physician, and then you were an assistant in medi­ cine. Then you were an instructor, and then an assistant professor, and then an associate professor--there were a lot of rungs in the ladder. I took over the little course in history taking right away, so I had seen a lot of this fellow Gordon. He was a handsome, smart fellow. He'd taken his internship there at Colorado General and his residency. Then he was medical director down at Denver General Hospital for a while. I got him to come with me. He was delighted. We got along fine. Then I took another vacation--the second one, and he and his wife moved into our house. We were gone a month, and when we came back--why, he got his own home, and he was right in there pitching until the war started. The patients accepted him extremely well. Of course, he had patients of his own. There were always a few of my people that didn't want him, and there were a few of his people that didn't want me, but we started out, and I worked him up to a full partner. We didn't have any written agreement of any kind, but I worked him up to a full partnership within a year, if not less, because he was obviously carrying his weight 191 right from the beginning. Then the third fellow that we took on--I found the third man didn't fit in too well. We tried one fellow that had finished a fellowship at Mayo's, and he was a depressive--he was in a depression, and we had to let him go. He went into practice at Fort Collins and committed suicide rather soon. Then we took a graduate of Washington University, a fellow named Terry, and he got along well with us until the war started. He was the first one to leave, and then Gordon left. This psychiatrist was the fourth one. We didn't have any partner­ ship arrangement with him •. He paid us rent for being in the suite. He used all of our facilities and our receptionist--no, he had his own re­ ceptionist, but having him there meant that it was easy to refer patients back and forth. He referred us lots of work. Then we always had lunch together, the four of us, and this was a dry clinic sort of thing. We were talking over our mutual patients, and then if Gordon or I had a pro­ blem that we weren't sure about--why we'd chat, and this fellow was a good psychiatrist. Was he. Yes, and particularly for ambulatory patients, the kind of patients we were having about half of whom always had some psychological, or emo­ tional, or personality determined factor to contend with. When he came back--well, of course everybody went their separate ways after the war. I had already gone. Gordon when he reopened his office, the man that had taken over the practice gave every single patient the option of going back to Dr. Gordon, if they wanted to, and a lot of them did, an awful lot of them. He just picked up the old records--Gordon then took on a 192 partner who was a good man. Gordon is dead. He developed emphysema. He was a chain smoker. Following the war this emphysema started, and Gor­ don was a sick guy. Well, he took on a partner, and his partner still has a lot of these patients and still has the original old records that were started in our office downtown. Later in a speech--maybe it's not in a speech. It's in a discussion for the Commonwealth Fund? You found this in the curriculum book. No, the books on the general clinic. There's a statement that you make in there--"psychiatry and public health are basic sciences to clinical medicine." This relates to what you've just been saying, the need for that kind of insight. Public health--that was--well, that was a term we used. For example, we used the Visiting Nurses Association a lot for patients, particularly home bound patients, where the nurse would go in once or twice a week for an hour, and we--I'm afraid that's just about as close to making use of the public health facility, or service that we came to. We ran our own laboratory. We kept a couple of qualified technicians busy running our own Wassermans, blood chemistries, and everything. We did quite a bit of vaccine work with our allergies and our arthritis cases, but we weren't diluting vaccines. We were using them intrader­ mally and trying to find ways of handling what we thought were important focal infections. We did our own bacteriological work. The State Health Department by then wouldn't accept the Wasserman from just any old laboratory. You had to prove that you could do this 193 work reliably, and once a month would come five or six unknowns from the State Health Department that we would have to run. We never had any pro­ blems because we always passed our homework. A technician learned to do electrocardiagraphs. Of course, in those days there were lots of basal metabolic rates made, and she learned to do that too. We never did any laboratory work for other doctors. We were frequently asked to, but I just told the doctors that we just couldn't handle it. Besides, it was only fair and proper that they should refer this work to a commercial laboratory. That kept us from getting into trouble with the clinical pathologists in town that were in business as clinical pathologists. Was Dr. C.H. Barnacle a graduate of the school? No, he graduated from the University of Minnesota, and he took his internship with the Army, and he was always interested in the military establishment. Then he took his fellowship in psychiatry with Dr. Ebaugh which is when I first got to know him. When he was getting close to fin­ ishing t~e fellowship, Ebaugh called me, and he said, "I've got this man that wants to go into private practice, and I think it would be terrific if you and he could team up in some fashion." Well, we got together. He went into the Army as a major because he had had this internship--! think he'd had two years at Fitzsimmons. He came out a first lieutenant instead of a second. They jumped him a grade, and shortly after he'd been in, he was made a full colonel, made a con­ sultant, a psychiatric consultant for one of the theaters, the Pacific. Ebaugh went in too right off the bat as a colonel, and he was--I've for­ gotten now the score, but the psychiatrists that were theater consultants, taking the whole ball of wax--and considering every place we had troops 194 in the war, and I think I'm right in this, that around sixty percent of them were Ebaugh's past fellows. That shows how important Ebaugh's con­ tribution was. You know, continuing education being what it has become, you had it all during this period. Oh yes. Dr. Barnacle was not a little responsible for illuminating areas? Oh yes, and between us--if I had a patient I'd just keep a patient waiting in the examining room if I wanted Barney. If he wasn't tied up with a patient, and I knew I couldn't interrupt a patient interview, I could always get him for a few minutes. During this time is when shock therapy first came out, and Barney wouldn't--Porter Sanitarium out here was the first private hospital to put in a closed psychiatric wing, and they set themselves up for shock therapy. Earney wouldn't do this therapy to any patient unless Gordon, or I could be with him at the time. We weren't sure when we'd get a case of cardiac standstill, or some unexpected complication and gee, we hated to be a witness to this thing from the start because this was intraven- ous metrazol that was the first convulsant that was used. This was given-­ just so many cc.'s per hundred pounds of patient, and the patient would go into this terrific convulsion. Of course the chest--the patients wouldn't breath. They'd turn black, and I'd have to hold them on the table. Then they began to use curare to prevent the convulsive seizure. They found that a patient didn't have to have the convulsion to have the beneficial effect, so that we'd give a dose of curare slowly in one arm. 195 The curare induces a generalized paralysis, and the minute the patient couldn't lift his head another fellow over here on the other arm with the metrazol needle in a vein would shoot the metrazol in. This procedure made it much better. We were lucky, we didn't have any--lots of patients convulsed hard enough so that they dislocated shoulders, hips, or fractured bones. We were fortunate in that we didn't have any complications. Having this psychiatrist in the office was a very satisfactory ar­ rangement all the way around. How was it looked upon by the medical fraternity? They thought it was great. I'm sure they did, or they wouldn't have referred patients to us the way they did. We were taking care of doctors and their families. We were doctors' doctors really and recognized as such. You talk to any of these fellows--like that guy in the car the other night. We were taking care of doctors' families where we had had no prior connection with them as far as something like previous associa­ tion at the medical school. One reason we got these people was because we took good care of them. A doctor is always--I've always felt awkward in turning to physicians for medical care because they wouldn't charge. A lot of these doctors' wives particularly, felt because they weren't paying, the doctor wasn't very interested in them. We'd get them and ad­ mittedly a lot of these people--they sure needed help, but the problems were psychological, or emotional, and we found it rather easy to get pa­ tients willing to see Dr. Barnacle particularly if we didn't broach the idea until the patients felt that we'd worked with them long enough so we really knew what was indicated and what wasn't. Occasionally we 196 couldn't engineer a transfer. Occasionally a patient would get furious at the idea and quit coming in. That suited us all right because we had reached the point where we couldn't do anything. Psychiatric practice in those days was pretty much limited to the serious psychiatric condition. Barnacle came back after the war, and he was very athletic--short man, very muscular. His son who is just fin­ ishing medical school over here is just like him, only a little taller. Barney was a great swimmer. His son is a great swimmer. At Minnesota, Barney was the swimmer on the team. He came back after the war, and he, like most doctors, didn't hesitate to use alcohol, and when he came back he just gradually became quite a problem. Himself. Yes, himself. He finally died while he was shaving himself one morning. We weren't here, and then two or three years later his wife died with a carcinoma of the lungs. She'd been a terrific smoker all the time we knew her. So there are these three children now--the boy's the oldest. He finishes school this year. I don't know what he's going to do. I've offered to visit with him anytime he felt so inclined. He came up once to get a list of the good hospitals that he might apply to for an internship. That's the only time he's--well, he's a pretty self­ sufficient kid, I think. Did you get time during this practice to really see patients? We took time. A new patient we'd take in the mornings. We would set up an hour or an hour and a half for a new patient. It was generally known that we didn't want just patients who were going to come in for a 197 casual examination. It was generally known that we were interested in continuing general care of patients, so most of the people who came to see us under office conditions were patients that wanted a thorough going over and then wanted to be followed. The acute conditions we saw--pneu­ rnonias, hearts, and so forth--were in our own patient population. As a consequence, when they called in the middle of the night with something new like pain in the chest, we knew enough about that patient to know we'd better damn well get on the job. On the other hand, new patients would call at night. If we were go­ ing to take them--if any patient called at night, we'd give them the bene­ fit of the doubt. We'd make a call, if there was any doubt at all, and many times I'd go back to bed, having told the patient that I'd see her in the morning--well, I couldn't go to sleep so I'd get up, and get dressed, and go to see her. There was just enough times when it was a damn good thing I did that--at least we felt that it paid. We felt that in practice it's all or none, and I still feel that way. There's no forty, sixty percent division. Well, did you get a chance not only to use the school library, but the medical society library? The medical society library was right in the building with us. I was the kind of a fellow that as far as being active in organized medicine in the county, or the state society affairs, I always rated the library committee, or the publications committee, or the program committee. I didn't get on any of the political action committees, or stuff like that. I never was active in any of the medical politics even before I went out to school. We subscribed to the JAMA--that a gal! [Mrs. Darley brought in 198 coffee and cookies]--and the Annals of Internal Medicine. As far as the library is concerned, Dr. Gordon and I were pretty self-sufficient. We had good working libraries. But did the organization of the office allow time in the library? Not during the day. If we had anything we wanted out of the library, we'd get it and take it home. Libraries--neither the society nor at the medical school--were open evenings to any great extent. I can certainly recommend my wife's cookies. She's a great cookie maker, and I've always been a great cookie eater. Maybe what I'm thinking about in terms of the libraries is a question •••• Of quick reference? No, recognition of one's own limitations which requires reading, or con­ sultation with someone else who knows a little bit more. You make a great deal later on of the awareness on the part of a physician who knows when the problem in front of him is beyond him. As I told you, we used consultants quite a bit, and we had a big consulting practice in our own right. At least to us it was big, and when I went to the medical school I retained the consulting privilege, but I soon found that I couldn't mix that up with teaching because when a fellow calls you for consultation he usually wants you right now--you see, and you've got to respond and this meant cancelling a class, or leaving a class. It was just interfering with getting ready for class assignments, so I finally told the Dean, "I can't afford to stay out here and not do consultation work." 199 I was getting forty-two hundred dollars a year. That was my salary which was a far cry from any net I was making out of practice. We had saved a lot. We were never insecure financially. We lived within our means, of course, right from the minute we started private practice. Well, the medical school doubled my salary and--well, they paid me seven­ ty-two hundred, I remember, and it was agreed that I would discontinue practically all the consulting work. I let it be known that I wasn't going to do consultation. It was just about this time too, that the man who had taken my prac­ tice, Dr. Charles Smith, and I realized that using a consulting gimmick as a means of avoiding the emancipation of this small group of private patients had to stop too. I was able to get out of everyone of those situations, except one woman who was quite wealthy. That wasn't the rea­ son why I stayed with her, but like many wealthy people--certainly wealthy patients, and I had lots of them, I found that they were extremely lone­ some individuals. This particular patient was a wonderful woman, and she simply said that she didn't care whether I came by professionally or not. She just simply was not going to let me drop her. She was difficult. I guess I'd get a doctor for her and something would happen. She wanted a change, and I had to engineer quite a few changes for her. I was with her when she died. I just had to stay. I know that this meant a great deal to her. Medicine isn't a limited thing--it is the human story. She was a beautiful woman, had been a widow for years--Verner Z. Reed. Well, you know, these people always have to be isolated, or every promoter in the country tries to get at them. Everybody's got a scheme. 200 She had her friends, and they were good friends, but so far as the world at large is concerned, a lot of these people have to be pretty defensive. I saw this quite often, I think. The more recent idea is the--the recognized limitation of the individual Beneral practitioner and the need for a kind of team, organized effort to take advantage of roads, travel and time and to extend whatever exper­ tise one has to a greater number of patients. There's more to this than I have put here, but did you get this sense--the germ of this later idea from your practice? Yes, I think--well, I was very conscious of the needs of patients and their families when I was in practice, and I don't think my apprecia­ tion of this need has ever diminished. It may have increased because-­ well, take my own relatives, my children, my close friends. It's been increasingly difficult for these people whom I know all about to get a satisfying kind of medical care. People complain to me that I don't know so well, and I have to tell myself that I realize that I'm only going to hear about the bad instances. They don't come to me all hot and bothered about a satisfactory relationship. My two children--even when I'd throw my weight around, and I'm used to being able to throw quite a bit of weight, if I feel it's necessary-­ I wasn't able to get them what I call satisfactory care. Now, here's a good example. They were living in Boulder, and they had what was consid­ ered to be the best--well, a good pediatrician, and I don't deny but what he is, or at least he could be a good one--and my daughter had this older boy. He was two, or a little older, and she called the doctor and she said, "Leigh has a high fever. He has had a sore throat. The glands in 201 the back of his neck are swollen," and then she went on to say, "The child across the street has got the mumps." The kid's temperature was 103, 104. The doctor said, "There's a lot of mumps around. From what you tell me I'm sure it's mumps. You just keep the kid in the house, lots of water, drink, stuff like that." We were in Estes Park--this was when we were in Chicago and we were spending the summer in our cottage up in Estes Park. I knew the kid was sick. Donna called early the next morning and said, "This baby is real bad, Daddy. I wish you'd drive down and see him." I did. Well, this chain of glands in the back of the neck were so swollen that they were almost meeting in the mid-line, and his tempera­ ture was high. He was dehydrated, and his tonsils were covered with exu­ date. Well, I call the pediatrician, and I told him what I had found. I said, "This child needs some penicillin, and he needs it badly." He said, "Bring the child right down." We took him down. I wasn't going to argue about it. Of course, he got a shot of penicillin, and he was all right. Now then--number one-­ this doctor should have found out more about this over the phone. The kid was sick enough so that any doctor should have arranged to see the child. Number two--if the doctor thought the kid had mumps, he had no business having that child brought to his office and go into the waiting room where there were ten, or twelve other kids. He didn't contaminate anybody because he didn't have mumps. I was just talking to myself all the while. Now this is the kind of thing that I'm kicking about. There is a group in town here, a clinic, that gives excellent ser­ vice to patients. A friend of ours was up in Minneapolis and had a coro­ nary, almost died. Finally he got well enough to come home--they didn't 202 have a doctor here. They were Christian Scientist, in fact--he was, but the wife said, "I want a doctor for Creed, and I want the arrangements to all be made before we leave here." I said, "All right. I'll make the arrangements, and I'll let you know what they are. I want you to call this doctor "--whoever it is--" the minute you and Creed get home." I called this doctor down at the clinic that I usually start with and explained the situation to him. He was to make arrangements to see to it that this man was taken care of immediately when they called in. Well, they arrived home. They didn't call in until this man had had the hiccoughs for thirty-six or more hours--just completely worn out. Well, hiccoughs intractable in a case like this usually means that you're in serious trouble. She called in on a weekend and the doctor who is a good internist but was on call told her, and this was in the evening, "Try some hot packs on his abdomen and bring him down to the clinic in the morning." I didn't know about this until the next evening. She called me, and Creed was still having the hiccoughs and this was still the weekend. I said, "I'll have to call the doctor, and I'm going to see to it that he comes and sees you." I got ahold of this internist, and he went to see the man. He wouldn't have gone, I don't think, if I hadn't insisted on it. He moved him right into the hospital--intensive care, and Creed made the grade, but he was an awful sick man. Well, now to take a phone call from a patient that you'd never seen before, that you knew had had a coronary, that had the hiccoughs and tell him to take an aspirin, or put some hot packs--not go see patient, or put 203 him in the hospital just on the strength of the phone conversation--this is what I object to. This is what I call having trouble getting into the system of patient care. This patient wanted in and couldn't get in. Ad­ mittedly he should have tried to get in three days before he did, but you can't expect the patient to use these kinds of judgments. You have to take the patient the way he is, and when he tries to get in the system of care--! don't care what time of day, or night it is, or what the complaint, or anything else--the system of patient care should be such that that pa­ tient receives the immediate judgment that his condition may call for. This is the reason for the kinds of papers I have been writing the last couple of years or so because the patient gets in the system and if he gets in, he's kicked out right away. He comes into an emergency room in the hospital and he's seen in a cursory fashion. Most of them, unless they really are a broken bone, or something are told to go home and take some aspirin, or are given a prescription, or given a shot. Then they're let leave, and they're out of the system because they are not told to come back. They're not told--no arrangements are made for any follow-up on them. Now nine times out of ten this does no harm to the patient, may­ be, but that one time out of ten when the patient comes in with a belly­ ache and is told to go home and take a laxative, or told to go home and put hot packs on his belly and dies before he gets home, even with a coro­ nary, it's that one case in ten that justifies the kind of organization of patient services that we people are talking about when we're complain­ ing about the existing medical establishment. Were you on call when you were in practice? Yes--well, one of us was on call. 204 The organization allowed flexibility. Yes, and if we--well, we each took off a month for post graduate study. I want to come to that. We could do this--it was agreed that we could do this. We usually did it twice a year, two weeks at a time, took these courses that the College of Physicians offered which were darn good courses, still are. Then we had a--well I don't remember any set rule on the vacations, but we'd take enough time off for vacation purposes during the year so that we were off the job a month on the average. Of course we had every other night. We had switches on ocr phones, had to, and then we had the phone set up so that each of us could get the other. Each of us knew all about the other guy's patients. In the office it was the rule that if a patient came in and one of us got hung up, we'd see the other's patient. We stuck to an appointment system pretty close with our patients. Patients usually didn't have to wait. If we got emergency calls, why we'd bounce out, and the other fellow would clean up the work at the office before he left. These were continuing patients. Practically all of them. Now, we made house calls, and believe me, this was a big part of our work. We had lots of nurses working out in the homes. We had four or five that practically didn't work for anybody but us. We just kept them going from patient to patient. We were on every hospital staff, except way over in North Denver, and we usually had patients in most of the hospitals. It wasn't unusual at all to go over tn PT"cch\/+c,-.; :::in - s+ . . lnsP.nhs. Mercv. St. Lukes and out south to Porter 205 Sanitarium, and we usually had to hit the hospitals again at night. We'd trade off on this a lot of times, and the fellow who was going to be on call at night would take care of these second hospital calls. I learned, and I guess Bob did too because we had small children, and we were dead tired by the end of the day at the office--we would come home for dinner and then make our second calls. We at least got to see the family at dinner time, and this gave us a little break before dinner. There was a telephone right at the table, of course. We never charged for telephone calls. Lots of patients told us we ought to. Rich people we charged at the same rate we did everybody else, unless they made us stay or stick around unnecessarily. If we were charging extra for a call--we itemized our bills always and i f we were going to charge more than five dollars for a call, we'd say, call plus whatever it was, and we rarely had any argument over a bill. Occasionally there would be one. Did you have any argument over care? I'm sure--we had patients leave us because they weren't satisfied with our care. Usually we were glad of it. They were difficult patients as a rule. Background, environment is so important--! mean the total picture. You just fall heir to an ongoing stream in a way. We took care--in that paper you notice when we gave those pair of papers at the state society meeting on the care of the aged--that was the dumbest thing we ever did. [Ward Darley, "Old Age As a Physiological State"; Robert W. Gordon, "The Medical Care of the Aged"; William H. Mast, "Surgery in the Aged" 35 Rocky Mountain Medical Journal 456 - 465 206 (June, 1938)]. It's an early paper on the care of the aged. Yes, it was a philosophical bit that I tossed in, and that made it worse because that convinced these doctors that care of the aged was built into the system. That really made geriatricians out of us. Oh we--it was a nice kind of practice. We found out that it was sure a lot differ­ ent from taking care of the average adult. These old folks--there is jus­ tification really for a specialty in geriatrics. If you want to carry the idea of specialism to its ultimate, at least there's a special body of knowledge, a special approach to old people that you just have to know about i f you're going to function the way you should. You had a paper somewhat later, I think, on the psychological thinking with respect to old people as patients. [Ward Darley and 5. 5. Kauvar, "Emphysema and Chronic Bronchitis in the Aged" 4 Clinics 1143 - 1156 (February, 1946)]. I don't remember any specific writing about old age except in that one paper. The secret is seeing them often enough so that they feel se­ cure in the system, and it is a system. Every guy's practice is a system of some sort. He has to have some structure to it. Our rule was to go in once a week to see these old folks, if they weren't able to come to the office. Some of them we saw less frequently. Some of them were really agitated people, people who maybe didn't know it but they were just los­ ing their capacity to be in contact with the environment and so there was a nameless feeling of apprehension they were under all the time. It's just one of those things you sense, and you can do quite a bit for these 207 folks, if you'll just listen to them; change this a little bit, that a little bit. You make a crutch out of yourself. You have to admit that to yourself. Their conditions reflect a multiplicity of causes always. On the other hand, there's no use in making them miserable with a lot of fancy examinations. Here's where the use of judgment is extremely important--to subject these folks to a lot of fancy X-ray procedures and stuff. Even if you find what you're X-raying for, what you're looking for, you're not going to modify how you handle the patient very much, so if you miss a diagnosis here and there, you miss it. Well, what accounts for the papers you gave at the state medical society, those papers? Was this the topic? No, this Dr. Mast in Pueblo who was the surgical resident when I was the medical resident--! don't know what made me cook up the idea that it would be a good idea if we three fellows could give three papers on the care of the aged. Maybe I was just looking for an excuse to give a paper-­ I don't remember. Three of you--Gordon, yourself, and Dr. Mast gave these papers. Yours was the physiological state. Yes--I just don't recall. I was status conscious back there. I was on the make. We were on the make--I'll put it that way, and we talked about it. We wanted stuff going for us, and we were concerned about our professional reputation. We did some research at the office. We let the expense of that come out of the business, and one year we got the prize at the state medical society for the best scientific exhibit. That's when we were interested in brucellosis, and again while I think we were 208 probably barking up the wrong tree, at least it was a darn interesting bunch of ideas we were working with. I didn't see this paper--how did this come about? There are several papers--these were later. ["Latent Brucellosis: Its Importance in Association with Joint, Muscle, and Nerve Pain" 115 .=!M'.!.8, 2115 - 2116, Part 2 (1940); "Brucella Sensitization: An Attempt to Evaluate Its Clinical Significance" 16 Proceedings Central Society for Clinical Research 68 - 69 (1943)]. I wound up with a big paper at the American College of Physicians. That's the last thing we published on it--a meeting in Philadelphia. [Ward Darley and Robert W. Gordon "Brucella Sensitization: A Clinical Evaluation" 26 Annals of Internal Medicine 528 - 541 (April, 1947)]. At the time I know we were certainly convinced that we had something. As I look back on it, I still think we had something. But pasteurization of milk and so on and so forth quickly did away with any concern over this question we were trying to work with. Nobody will ever be able to say whether--they'll never be able to work out the situation now where they can prove us right or wrong, I don't think, because the clinical material doesn't exist. How does an interest like this grow in practice? Well--the protease business got started because when I was a resi­ dent, Dick Whitehead picked up this report out of Guy's Hospital. That's Barber and •••• I've forgotten their names. The brucellosis business--well, I'd have to do some cogitating. I don't know whether I can reconstruct how 209 we got started in that, or not. Just offhand--I'm not sure. You did indicate that the way the office was organized you had time to Bo to important meetings, attend meetings and to do some concentrated postgraduate work should you desire to, or it could be so arranged. It's the postgraduate work that you thought you needed--that's what I'd like you to comment about. Well, we just knew that it was exciting, stimulating to go and take one of these courses as much because of the other people that were taking the courses as anything else, and we usually went to places where we knew the man that was organizing the course, or some of the people that were working with him on it. These courses that we were interested in--prac­ tically all the courses the College of Physicians gave were aimed at pre­ senting a pretty comprehensive review of a certain condition, or related groups of conditions. It was something that gave the whole course a con­ tinuity so that the beginning of the course would deal with fundamentals, and we saw lots of patients. They were demonstrated to us. We examined lots of patients. There was ample time for questioning and discussion, and we made some close friends along the way out of the faculty people that did this work. It was just the best way of keeping up that there was, and we would split up these courses so that Gordon would take one that we thought was particularly important to us. Gordon went and spent a summer at Dr. El­ liott P. Joslin's setup in Boston in diabetes. Gordon came back, and he took care of all our diabetics and most of our endocrine problems after that. I'd gone to work a summer with Paul D. White. I was interested in cardiology, the cardiovascular type of things. 210 How does this develop? Is this a recognized idea that you didn't have this? This was a response to an inadequacy on the one hand--I knew I was­ n't performing the way I should--and a real interest on the other hand. I was really interested in this area, and Bob Gordon's work--his situa­ tion was the same. I don't think we made any serious postgraduate effort except through the resources offered by the American College of Physicians. I'd cooked up this little arrangement at Washington University be­ cause I was interested in arthritis, and the man who did most of the early work in gold was there. He was an orthopedist. I can't even give you his name. A very good friend of mine was in radiology there at the Wash­ ington University. I got him to make the arrangements for me to go back and spend a week or so with this chap. While I was there--it didn't take long to wring all there was about gold out of him--I began to be inter­ ested--well, I went on grand rounds with this Professor of Medicine. I said it was Dr. Barr, but it really was the man who preceded him, Harry L. Alexander, and then when Alexander left, Barr came. I had learned to know Barr someplace else, so I just kept on going. I probably went to Washington University three times for a week or so at a time, just hang­ ing around really. Absorbing the air. That was a real way to learn in that place because there was always something going on. I got to know Dr. Evarts A. Graham in connection with this. I heard his first paper on the correlation of cigarette smok­ ing with lung cancer. That's when the College of Physicians met there, and it was interesting after one of these courses there would always be 211 a flurry of correspondence between ourselves and people who helped with these courses after we'd get back as we'd try to apply what we'd learned to the problems of our own patients. I never was emancipated from Paul D. White when it came to getting help with difficult electrocardiograms particularly. Howard B. Sprague--! guess I depended on him more than on Paul. I didn't have to use them a lot, but most of the time I'd just get a damn interesting cardiogram, and I'd just send it to him for the hell of it. It was probably useful to him. How long did you spend with Dr. White? I was there about six weeks. This was regular summer course he put on for twenty, or twenty-five students. I applied too late to really get in, and I got a wire the day before the course was to start saying that a vacancy had turned up, and I could fill it if I wanted to, so I picked up right then and left. You never cease going to school when you're in practice, I gather. No, I don't think so. There's some legislation introduced in the thirties particularly on the national level--the Social Security Act, old age and survivors benefits, and then there were maternity benefits, early thirties, some crash pro­ gram with respect to maternity benefits--not benefits, but health, wel­ fare of mothers and children. I don't recall that I was either knowledgable, or concerned about any of that. I remember the Murray, Wagner, Dingle hassle, of course. What year was that? That was in the mid-thirties, wasn't it? 212 That was later in the forties, fifties, but in the late twenties there was a group partly out of Chicago, partly out of Yale, New Haven, econo­ mists and so on--the Committee on the Cost of Medical Care. That study was chaired by--the father of the president-elect of the AMA--I can never think of his name. [Dr. Ray L. Wilbur] I wasn't aware of that report at the time it was published. I was far removed from these socio-economic problems in medicine. My only concern was when the doctors here in practice would get put out because they thought patients were get­ ting into the clinic at the medical school, or into the hospital that were able to pay fees. You'd better shut that off a minute. I think that whenever this question of patients getting into clinics able to pay fees amounted to much Dr. Rees--! always knew of it through Dr. Rees, the dean. They set up an arrangement at Colorado General where­ by if any patient was trying to get admitted to the clinic where there was a question about paying a fee, such patients were to be referred to physicians in practice. I took a few of these patients. They would have sent them all to me, it seems to me, and I finally told them not to send anymore. There were two or three reasons--first, there was none of them who could afford to pay a fee, but more than that they made very poor patients from our standpoint because they wouldn't keep appointments. They wouldn't do what we told them to do. You just couldn't do anything for most of them. They just were--you know, it takes--and we still have this kind of trouble from people in this station in life. They just don't understand. Maybe it's our fault that we don't communicate with them at their level so that medical care means anything to them, or their conditions at home are such that they couldn't do what 213 you tell them to do no matter what. I would defend the school at a county society meeting and just say, "Well, they've referred a lot of these patients to me, and I told them to quit sending them because these people can't pay private fees. I don't see what you fellows are worried about." About twenty-five percent of our work didn't go on the books. A lot of this was doctor's families, but a lot of it was people that just didn't have any money. Most of these patients were referred to us by other practitioners in town, and there was usually a good clinical rea­ son for a referral. These people, a lot of them, had conditions that were real challenging, real interesting, and they made good patients. I had quite a few charts of patients flagged to write up, if I ever got around to it, but I never did. Some of these charity cases, no charge cases, were people with all kinds of interesting conditions. The case of "Halophagia" we wrote up was referred by a man upstairs-­ this woman, of course, had too much blood. She was cyanotic, and she had hemorrhoids, and he foolishly opened a hemorrhoid in his office, and she bled like a stuck pig. He brought her down himself scared to death that she was going to bleed to death. He stayed there in my office. We got the hemorrhage stopped, and I checked her over--well, I didn't have to go very far until I knew we had a case for the books, of course. She didn't have any money; in fact, the radiologist downstairs helped us take care of her. I frequently had to give her money so that she would have something to eat. That was one reason we told her that she would have to go back to Columbus, Ohio, where her home was--we couldn't afford to keep her going. She'd run away from home years before anyhow, and she was sick enough so that she just had to be where there was somebody to 214 help look after her. The reason I mentioned national legislation was--you took the "Rocky Mountain Medical Journal", didn't you? Yes. It was the Colorado Medicine then. Every state out here had its own little journal, and it became the Rocky Mountain Medical Journal in the mid-thirties, I suppose. It had--part of its editorial comment was relevant to the legislative acts by the State of Colorado, and positions that physicians should, or should not take with respect to what was before the legislature. Could you keep up with this kind of thing? I don't believe I did. I don't recall any sense of concern over either national legislation, or state legislation until I went out to the medical school full time. I gave some money at the very beginning of the equivalent of the political action committee of the American Medi­ cal Association. That was Murray, Wagner, Dingle. I don't know why the hell I did it. This was the insurance scheme. Yes, some foundation people that know me real well, like Lester Evans, always kid me about helping to support the political arm of the AMA. That's why I asked you about the Committee on the Cost of Medical Care. 215 Ibey came up with an insurance scheme in the late twenties, and this be­ came part of President Roosevelt's Committee on Economic Security out of which the Social Security Act came. The Social Security Act, however, did not contain the insurance scheme because there was some behind the scenes--you know, "We'll allow certain things to go through if you won't put that through." I helped this, and I did for two years for I remember writing two checks, I just did it because I was one of the pack, one of these fellows I was writing about in that paper on professional responsibility because I sure wasn't thinking very hard, or I wouldn't have done it, I'm sure of that. ["The Professional Responsibility of the Physician" 174 JAMA 878 - 881 (October 15, 196 □)] The thirties were a period of great growth in organization--not medicine, but the recognition of the right to strike is 1937, and not too long ago in the big Steel Case argued before the Supreme Court. There were a lot of other things that are first in the thirties to give a kind of then equalized balance to the social forces that were operative in our society, but all of this is submerged ultimately in the European situation. Well, any interest I had in all that, if I had any--right now I'm looking through pretty dense fog--really. I was concerned with taking care of patients and my own domestic tranquility. But then suddenly you're forced to confront an issue; namely, that what has transpired in Europe is going to shape and configure what goes on in America. This being so, you suddenly are left with a practice which had kept four people reasonably busy, busy. 216 I don't think I'd developed any interest or feeling of concern for any of this business, really, until I began to be involved in things like the National Health Assembly, these conferences on Chronic Illness and Heart Disease and Old Age, and then the President's Commission on the Health Needs of the Nation. You may have noticed that I tried to duck that. I was--well Leonard A. Scheele wanted--! know he wanted me to go on the commission, but he asked me if I would be willing to be considered, and I told him no. I told him who to put on and he put on Dr. Joseph C. Hinsey representing medical education. The main reason I didn't want on was because in those days getting from here to Washington and back was really quite a chore. I thought Joe being in New York, a short train ride, he'd better do it, but I still was heavily involved in part of the commission work as you may have noticed from some of the things that I wrote. I practically spent a summer writing up the output of a panel on education that was chaired by Arthur C. Bachmeyer, superintendent of Bil­ lings Hospital in Chicago. I just took over for him practically, and a lot of the things I wrote for that commission are in these bound books. They are not at school--! don't think. I didn't find that. I found Hackmeyer and Hinsey with a statement, a conclusion issued, in a sense, before this committee was to meet, rather strange doings. I did a twenty-five to fifty page typewritten manuscript pretty well covering the whole ball of wax as far as financial problems in med­ ical education were concerned and the setting in which the medical schools found themselves. I've got it here. I don't know whether it's over there or not. 217 I think it's in two places over there--one, it's in the Executive Faculty Minutes. It's appended to one of the minutes--this rather long mimeo­ Eraphed history of the developments leading to this, a rather long title. I think that's it. It begins, for example, with a quote from the American Association of Medical Schools. This thing I'm talking about--! have had occasion to reread it a few times, and each time I have, I've thought, "Boy, this is pretty good! I didn't know it was that good." Paul Magnuson came into the picture; in fact, this was Magnuson's idea to begin with, and this development out here and the development at the University of Minnesota were two of the first affiliation arrange­ ments that the Veterans Administration tried to develop. Paul was out here frequently in connection with that because we made a hospital out of the old Fort Logan, a lot of old buildings. There was a little sta­ tion hospital there. We developed quite a hospital out there that ran while they were building this new one, and then this stuff here, this written material--! don't know whether it's over there in the library or not; I'm pretty sure it is--why, you'll see lots of long letters that I have written to Paul in response to requests from him, questions that he'd pose in a letter to me. I wound up pouring a lot of time and energy into that commission, and I enjoyed it. It was interesting. Why did the practice of medicine cease to have satisfaction? Too much? Overwhelming? There was just too much of it--sure. As I say, with me, it was all 218 or none, and I couldn't keep up with the "all" part of it. Now, as I said, I probably intended to go back into practice at the end of the war because I liked practice. Then by the time the war had ended, I was dean of the medical school. You never dropped your connection with the medical school. Except when I was in Chicago. I meant from the time you graduated. No, I started right in right off the bat. This course on history taking. Yes, and working in the clinic. Now, Dr. Meader himself interfered with the time I needed to work in that clinic. He just wasn't going to have me out there in the morning. He wanted me to tag him around. Be­ side working in the clinic was very unsatisfactory, and still is, unless you're in one of the specialty clinics. You were to be Dr. Meader's special slave. Yes, I ought to have pulled out, of course, long before I did, but it's probably just as well that I stayed with it. At least I wasn't be­ ing criticized by anybody on the outside for leaving a fellow sick in bed. When war came and the practice became too much for you to handle, and your associates went into the war, you went back to the school full time. You made some arrangement for the holdover practice. This Charles Smith who was an intern when I was a resident, and then he followed me in the medical residency, still has the practice. The same secretary that was with me way back at the beginning is still working for him (Katherine Barnes). Her husband is blind, and he runs this little coffee shop in the lobby of the Colorado General. This organization of these blind people have these concessions in all public buildings here. They get there in this coffee shop about six in the morn­ ing. She goes and checks over his cash and his inventory and gets him all set up in business, and then that gets her down to the office about eight­ thirty, or nine o'clock. She was a real important part of the team. She's a wonderful, a very attractive gal. She is as good a shorthand and typist as I have ever seen, or was then, and she knew how to keep books, and patients always liked her. She just knew how to use good judgment. She did some screening for us, I suspect, but I never knew anybody unhappy if she made them late for an appointment. Many times she'd come in and say, "So-and-so is out there without an appointment, and I think you'd better see him." Was it 1942, that you went back to the school full time? When was Pearl Harbor? December 7, 1941. Yes, it was in 1942. I stuck it out for a year, I think. The reason I say this is because I tracked you back to 1936, as an in­ structor in medicine, and in 1942 you become an assistant professor of medicine. 220 I was made an assistant professor a little bit before I went out there full time. I think being an associate professor of medicine was part of the deal of going out there. When was I made an associate pro­ fessor? 1943--the following year. That finally came through as part of the deal, I think. At least that's when the--well, the two went together. Rees at the time was dean. Yes. You said yesterday, I think it was yesterday, that you had two uninter­ rupted years of teaching and learning to catch up on a whole host of things. These students--we had some pretty good students. During the war--Navy V-12. I don't know what you called it, but most of the students were screened by the Armed Services and came to us from the Anned Services. Of course, the students who were freshmen were taken right into the Armed Services. There were two students particularly, one is a psychia­ trist now, and the other is a pediatrician--! know they stayed up late nights cooking up questions to see if they could embarrass me, and i t wasn't too hard to do. I had sense enough when a question came my way I couldn't field to tell them that I didn't know the answer, or I knew that, or that I'd have to look it up, or I'd make them go look it up. 221 _&::tually you look for that kind of student, don't you? Yes--these two were quite a pair. They worked together at this business. This psychiatrist is the son of the man who was later my vice­ president at Boulder. His name is Dr. James F. Dyde--he's got big brown, saucy eyes, and he still looks at me as though he'd like to •••• You're on his list! We're very good friends. At least you buckle on a sword. That's great! The more the merrier, if you had two years like that! My specified work was a half a day with the junior clerks and the other half day was never enough. I spent a lot of time with Selective Service--about the time I went out there full time the Armed Services had decided to recall all of the men that had been deferred for any cardiovascular question. Paul White had decided that this ought to be done. I don't know how many doctors here in Denver, or Colorado, helped reexamine this group, but I gave two afternoons a week to it for quite a while, and I think most of them were sent to me. I had them go to the medical division of the Outpatient Department where there was a fluoroscope. I'd get up there at one-thirty, and there would always be fifteen, twenty, or even more men waiting to be examined. Well, the bare requirements of this examination would have let me get rid of the whole shebang in an hour or so. I wasn't going to sign my name on any slips that represented that kind of a check over. It took me all afternoon, as a rule, to go through this bunch. I'd fluoroscope 222 most of them, and I'd have them wait--you see, until I could get in the dark room and do them all one right after the other. I found this work very interesting. I found some terribly interest­ ing conditions. Of course, by that time I knew my way around in the car­ diovascular field. I had some phone calls and a visit or two from some pretty angry parents, because most of these men who had murmurs that were purely functional and of no clinical significance at all. These men were picked up right away by the draft. About half of them were that way. The other helf, or twenty-five percent of the other half had real ad­ vanced pathology, and the rest presented a real interesting study. What effect did the needs of war have on the medical school--the speedup? We started school the year around with three weeks vacation a year-­ that is, we continued the academic program of nine months, but we just kept right on going, and that meant that we graduated one extra class during the war, and this added tremendously to the work of the faculty. This was one reason I was kept so busy because there was no letup to it at all, and gee, we were glad to get off of that accelerated program! This was when we started building up for this new curriculum that you got into over there in those books in the library. Yes, what about--he's a fascinating fellow--Dr. Alfred H. Washburn and the small committee involved with this curriculum change? Well, that's a long story, an interesting one, an important one, and a sad one. The Child Research Council was started back really, I think, before the medical school moved down to Denver by three, or four men in private practice who were very active on the faculty--Dr. Clough 223 T. Burnett, the cardiologist, Dr. W. Walter Wasson, the radiologist, Dr. T. D. Cunningham, and Dr. Thomas E. Carmody, a nose and throat man--Cun­ ningham was an internist. There were one or two others whose names I don't remember. It was their idea to take newborn children and examine them periodically until they reached adulthood so that they could estab­ lish the natural history of human growth and development. This first started out and most of the emphasis, I think, was on the development of the skeleton--the human skeleton, and they began to appre­ ciate the difference between boys and girls. I know Dr. Wasson was inter­ ested in the development of the paranasal sinuses. They had a little money from the Phipps family here, and they got the Commonwealth Fund in­ terested early and reached the point where they needed a fulltime direc­ tor. It's about this time that the medical school moved down to Denver, and it was decided that the medical school would house this operation. Washburn came, and he was a good scientist. He went over all the old data and published papers, and he felt that the data was inadequate and that the papers that had been published therefore were not justified. The men who had started this Child Research Council took this as unjust criticism of them, and the fat was in the fire. Dean Rees was blamed for a lot of this, and I think unjustly. He was on the Board of Trustees. Dr. Atha Thomas, an orthopedist, was on the board and Mrs. Lawrence C. Phipps was on the board. The board decided to really conduct an investi­ gation to see who was right because these doctors who had started the Child Research Council wanted Washburn to be fired. The committee came up backing up Dr. Washburn. Then the financing came mostly from the Commonwealth Fund and the Rockefeller Foundation. They raised quite a bit of money locally here, 224 but the medical school got the blame for the trouble, and this was really at the root of a very, very vicious feeling between the medical school and the practitioners because all of the men downtown, or enough of them, took the side of these doctors against Washburn. The upshot was the school could do nothing right from that point on, and Dean Rees was the target when they were looking for somebody to attack. Washburn wasn't in private practice, and he sort of went merrily on his way building up the work and program of the Child Research Council. Dr. R. G. Gustavson was acting president of the university--no, I guess this investigation took place way back. This is all kind of foggy as far as timetable is concerned. Well, when the war was over, and we began to talk new curriculum, I felt that this Child Research Council and the kind of people that were associated with it had a lot to offer the new curriculum. That's why you see in that material so much reference to human biology and medicine as human biology. We made the Child Research Council a Department of Child Health and Development, and Washburn, as a consequence, was on the execu­ tive faculty. The medical school along the way some place--well, it never put any money into this Child Research Council. I think the medical school did pick up Washburn's salary, or part of it. We housed the Coun­ cil and made no charge. As the Council grew we had to finance quite a bit of remodeling, and I think we purchased some equipment for the Coun­ cil--the Department of Anatomy and the Child Research Council. This new curriculum--they made it very interesting for the freshmen students, I think. That's when we started, I think, with the dissection of the newborn baby to give the students a quick overall appreciation of the structure of the human body. Dissections of the newborn baby are 225 very easy, and you can particularly appreciate the relationships of the nervous system to the surrounding structures and the circulatory systems. They started these correlation clinics with Dr. Ernst A. Scharrer and Dr. Washburn. They'd bring a mother and a newborn baby in, and this was quite exciting at that time and for that time. Washburn was a tactless sort of a fellow. He was a New Englander who had a lot of the abrasive qualities that some of these New England people seem to have, and wherever he went there was always a certain amount of turmoil. He began to have difficulty getting support for the Council. He was getting old, and he knew that he had to get a replacement. He brought in this Dr. Robert McCammon who is head of the Council now and who wasn't the able acientist that Washburn was, and yet Washburn defended him from that standpoint. Well, the medical faculty wouldn't accept him as a really top flight scientific person. In the meantime the Rockefeller Foundation and the Commonwealth Fund felt that they had been putting money into this long enough, and in spite of tremendous efforts on Washburn's part--he always had to make a tremen­ dous effort to get financial support--why, the support began to run down, and then they turned to the newly formed National Institute of Child Health and Development, or whatever they call this institute that Dr. Robert A. Aldrich took charge of. The Child Research Council got some money for a while, and then the site committees began to be critical of the Council because they accumu­ lated a lot of data without doing any publishing, without the benefit of a study of data to modify their research approach. This was a justifi­ able criticism, and it was a reflection of Washburn's feeling that noth­ ing should be published until it could be canpletely wrapped up as far as [Additional statement by Dr. Darley in March, 1971.] "Financed by a contract with the National Institute of Child Health and Human Development, Dr. McCanunon and his associates have published a book, Human Growth and Development (Charles C. Thomas, 1970), that negates many of the questions that have been raised here. This book, along with other Council publi­ cations of the past, covers the most important work of the Council. I am sure that investigators all over the world will have occasion to tap the Council's data, unpublished as well as published, for points of reference that will have relevance to research that will be done for a long time to come." support data is concerned. Well, in this kind of research that day will never come, and when McCammon began to come into the picture I think the criticism was justified because he just simply didn't write and publish. He just had limitations as to what he could do in terms of analyzing data, interpreting it, and writing it up. Then when the site people came here, they would ask why there hadn't been the adoption of new methods, new labora~ory procedures and so forth--why, it was obvious that these sugges­ tions were not acceptable. The Council began to lose out. It ceased being an important part of the teaching program in the medical school along the way--I don't know when, and I don't think there is now a Department of Child Health and De­ velopment. Our contract with the National Institutes of Health--this isn't a grant. It's a contract, and under the contract the Child Research Council no longer follow any of this patient load. It's a contract to analyze and write up the data that they have accumulated. This is a crime, that this Child Research Council has failed. Every similar development over the country has been terminated. I don't think there is a single one now going on. This should have been kept up for the next hundred years following as many of these patients as possible from birth to death. Here's where you have your opportunity to really study the natural history of health, and if you're on the ball and can follow these patients from birth to death, you're going to learn a lot about the natural history of illness. You're going to have a chance-­ say, here's a fellow that turns up with some arteriosclerosis, you can go back through your data and maybe identify when this arteriosclerosis began because of abnormal findings in the blood cholesterol, or the bio­ chemistry patterns--who knows? But this is not the dramatic kind of re- 227 search that is going to yield any dramatic result, and most individuals and foundations support results. They want something they can point to with pride during the term of office of this person on the board of trus­ tees--this kind of thing, and I never could get the legislature to pick up any of this tab which was the only thing that would have given the Child Research Council mortality. Reading last night about the curriculum problem, there was a small com­ mittee that was set up, not in a formal way, but in the sense of see what you can do--go ahead, make the assumption that you have everything you need, and they wrote up this report about changes and alteration so that when the curriculum is changed, it's not changed for just the freshmen class, it's changed right through the school without so much as an argu- 228 - ment. This went through. It was an incredible performance. The faculty bought it. This com m ittee was made up of Archie Buchan­ nan, in anatomy, who at that time was a real hot shot. He just published a book on neuroanatomy, and it was a good book, Atha Thomas who had been on through this Child Research Council fiasco, an orthopedist, but very loyal to the school and very loyal to me personally because I had taken care of his family a good many years. He liked to teach and so forth. Then there was Henry Swan, the new Professor of Surgery who came out of the Army full of beans, and came on full time. We just took a chance on him. He was a member of the Denison family that had given us the library, and I forget the others--! think there were two others. They met, I think, two nights a week--they decided to do that and let nothing inter­ fere with the meetings until they finished their job. They just assumed-­ they were told to assume that there would be no limitations whatsoever as to what could be done. They weren't to say, "Well, we can't do this be- cause we don't have the money, or the people, or the facilities, or be- cause so and so is going to object." They just plugged along, and they came up with this report. Well, they came up with a preliminary report, and the faculty went over it. We had a meeting of all the faculty, and the faculty voted to tell them to work toward a final report, and it came out. We gave a copy to each of the students, and the question was put to everybody--well, first the idea was that this would start with the freshman class. We'd keep the old cur­ riculum aoinq and let the old curriculum phase itself out, but we gave 229 the students the option, did they want to work hard enough to make it possible to put the new curriculum into effect for everybody overnight, and the vote was unanimous as far as I am concerned. That's why there was that special curriculum for the senior class where they had to come nights and do extra work weekends and so forth so that they could finish, so that the objectives of the curriculum could be satisfied for them. The Juniors wanted the change made, and the faculty were willing to do the extra work. We had it made. Now unfortunately we didn't set up machinery to keep the curriculum under constant review. We didn't set up any machinery for any particular evaluation. I think any such effort would probably have fallen on its face because we didn't know anything about how to evaluate these kinds of things, but it would have kept up the morale and the interest. I think we could have done more. We just thought we had it made. Every­ body settled back, and it wasn't long before this department was euchring extra time and then because this department got a few extra hours, why this department was given--well, the first thing we knew we were pretty much back in the old rut. The old lecture system, of course, was never reestablished, and the bedside teaching came into its own under the new curriculum, and in one of those talks--it was my presidential address at the AAMC--I let them know that we met with a group of students, two from each class, to ask them how they felt about the new curriculum, teaching, and so forth, and we found out that all wasn't as happy as we thought. Well, we'd had ink­ ling of this because we set up this joint faculty student committee pretty early in my career. I think that was set up before Dean Rees died, in 230 fact, and so we were aware of student attitudes well ahead of my presi­ dential address to the association. ["Medical Education and the Poten­ tial of the Student to Learn" 29 Journal of Medical Education 11 - 19 (February, 1954)] You saw in that book--you probably saw lots of committee reports, the reports of committees that had been set up paving the way for this kind of change as soon as the war was over. Well, I was behind a lot of that as was Dr. Waring. One of the reasons I was glad to go out to the school was because of him, because he and I had a lot--we were interested in this kind of thing. He made me take a lot of responsibility. I knew that would happen when I went out there to the medical school and that made his offer attractive, and yet he was always there to give me support when I needed it We--our offices were side by side. We had a lot of time together, and he began to promote me nationally--the American Clinical and Climato­ logical Association, the Association of American Physicians. I could have had a full blown career in the American College of Physicians, if I had wanted to put in the time and energy. Dr. Waring was quite a promoter and a manipulator, and as I have often said in talking about him, if he was here and he wanted to get over there and there was some disturbance between here and there, he'd start out in this direction. You just never knew where he was really headed for until he was almost there. A lot of the changes in the medical school had their basic beginnings with Ebaugh and Waring. Then I came into the picture really on ground that had been fertilized a little bit. I started out today by asking you whether you, as a student, felt part of th~e~insti tution. Later on with Washburn and others during this curri- 231 culum period the students are made a part of the school. You see, Washburn and he resented this--he was never brought into the academic family. He was not. No, he was not until the end of the war--I brought him in really. You saw that you could use his mind. Now, as soon as we started the Rheumatic Fever Diagnostic Service we began to be concerned because a lot of these children between the ages of five and eight seemed to have a large heart. They were sent to us be­ cause they had large hearts. Well, we knew before very long that these must be healthy kids, healthy hearts. All we had to do was go to the Child Research Council and review their chest X-ray of a couple of dozen of their kids, reviewing them from birth on through thirteen, and see that between the ages of five and ten the hearts were large. It was normal. They appeared large for one thing, larger than they were, because the de­ velopment of the thoracic cage hadn't kept up with the development of the circulatory system. The way kids that age run and never get out of breathe and tumble around. Another time a report came out, a paper about some peculiar abnormal­ ity in the electrocardiogram that was taken to be evidence of a myocardial involvement in rheumatic fever, and we turned to our records in the diag­ nostic service. We found this to be a rather common finding, a minor enough one so that we hadn't picked it up, or we'd go over to the Child Research Council and start going through that stuff, and we'd find that _.~ ---.--.m ,.,:::::ic:: nnrmal for kids for certain 232 ages, and it shows the utility of the kind of data that they were devel­ oping. Of course, the most important thing was the mental and emotional per­ sonality development that John D. Benjamin did, and I don't know whether any of this has been written up with the idea that the applicable parts of that study were going to be emphasized. I doubt if it has been written up. John Benjamin is dead, and I doubt if there is anybody around quali­ fied enough to take his records and make anything out of them. It illustrates that there had been changes in the faculty. Oh my! Washburn and Benjamin alone are whirling dervishes with idea and despite the personality clash of Washburn •••• These people--the reason they're the way they are is because they are just the kind of people who are going to clash. That's part of it. Now Benjamin--one of the most brilliant minds in psychiatry that we've ever had in this country--he and Ebaugh couldn't hit it off at all early in their relationship, and Benjamin didn't have an appointment in psy­ chiatry because he just didn't want to have anything compete with his in­ terest in the Child Research Council. Later they got together, and he was a very important man in the department. That's a great study of his, or the ideas that have come out of it, and it makes a difference in developing this new curriculum. Oh yes. Now Washburn was on this committee. I don't know whether I mentioned that or not. I think he met with Benjamin. 233 You mean Benjamin was on the committee? Was it Benjamin or Washburn? Washburn, I thought, chaired the committee. Yes--well, my wife says that she's got a little lunch ready for us. [Break for lunch.] Well, we talked about Dr. Washburn who was a member of this committee and I pointed out what I thought was a great contribution, and then he's gradually gotten on the shelf and bitter. Well, every other member of that committee--I'll tell you about them because it just shows the irony of fate. Dr. Swan who is still hale and hearty, and the curriculum committee met at his house always, went zooming up the ladder of status as soon as he became the Professor of Surgery at the end of the war. He did a lot of the early research in arterial grafts and open heart surgery, and he and our Professor of Anesthesiology developed this freezing technique to slow the heart rate down so you could do surgery on the heart. Of course this is no longer necessary, but at that time it was very important, and Dr. Swan was in great demand. Everything was going for him, and then we went to this fulltime practice deal. He had a sixth time, and he insisted on hospitalizing his patients over there in the Colorado General, and then he insisted on billing them and collecting which he wasn't supposed to do. He made such a point out of it, and the whole atmosphere there was so electric with the hostility he was generating that he resigned as head of the department, and nobody knows what he's doing. I see him occasion­ ally. Dr. Swan was there last night in the Denver Country Club. He should 234 have been at our meeting, but he didn't come. That was his father I spoke to down in the cloak room, and I had seen Henry go on through into the lavatory, and I thought that he'd be there at the meeting. Dr. Buchannan built this department up, and this Dr. Ernst Scharrer-­ he and Dr. Washburn were the ones who developed this course in medicine as human biology. He is a Bavarian, a neuroanatomist and a neurophysiol­ ogist, a very good teacher and very popular with the students. He and Dr. Buchannan just didn't get along at all. Dr. Scharrer thought it was time for him to be promoted to full professorship, and I think he was right. The rules and regulations were such that whenever a person on the faculty felt this way, he could ask for a committee to say whether he was qualified for promotion or not. Nobody--well, the committee couldn't do a thing to push through a promotion, and there was great heat over this situation. This transpired after I went to Boulder, and the committee said he was qualified but neither Buchannan, head of the department, nor Dean Lewis would do anything about the promotion so Dr. Scharrer left and went to Einstein where he played a big role in the development of the school, was drowned--he was a great boatsman. Dr. Atha Thomas continued very loyal to the school. He unfortunately was alcoholic later in life, and he was on the Board of Health and Hospi­ tals at the time the university and the Denver General split up and there was this hassle over Denver General not getting any interns. I told you about the news release that came from the board. Atha was the only one on the board that objected to this news release. He's the only one in this whole community that stood up for me at that time--none of the news­ papers did, nor the doctors here that knew that I wouldn't be connected with a thing like that. A couple of medical students stood up for me. They wrote a letter to the newspaper complaining about this charge being unjustified. Atha went on and finally died. I don't think there is any­ one on that committee that contributed so mightily to what was accomplished with the curriculum at that time that continued in activistic fashion for very long, and it's just kind of sad to me. It may be that this whole transformation was too sudden--too much. It did take place rapidly, and left everybody kind of breathless. It's just too bad that we didn't set up the machinery to keep the momen­ tum going. Do you remember what it was with respect to students that led to the de­ velopment of this student assembly--this period from eleven to twelve in which the students were given some kind of orientation? I'd have to look at the curriculum report. I just vaguely remember that there was something special from eleven to twelve one day a week. In the first place you got them altogether in one little bunch. It's also my memory that the enthusiasm on the part of students didn't last too long. I don't think we planned far enough ahead to main­ tain that any more than we had for the other parts of the curriculum. I look upon this as a period in which the school did recognize the stu- I 236 I i dent body as one of the social forces that were operative. Very definitely. Whether there was background or not, or sufficient thinking to make that social force an effective one, and a developmental one within the school is another problem, but just to recognize them over what you had had ear- lier as a student--and I don't mean any criticism of that period--it's just by comparison. This is a new day really. This squabble over the Scharrer promotion had lots of ramifications. This was a very bitter pill to me to have this develop so quickly after I left the campus and went to Boulder, and I think it had a lot to do with slowing the momentum down at the medical school because the faculty did choose sides over the question. Prior to that there was just one side for the most part, and then--well, maybe I'm stressing this too much because what really happened was that as research money became available and we began to draw in faculty qualified to build up a research program and the graduate program really began to zoom for the basic science de­ partments and residency and fellowship and post doctoral programs and all that--this built up cravings for empire and withdrawal of too many of the faculty from the kind of an atmosphere that prevailed at the time of this curricular development and the emphasis on teaching that followed. I think this was probably more responsible for slowing down the momentum under the new curriculum than anything else, and I say this because I have seen the same thing happen to other medical schools. I'm going to fumble with something, but the war had put great emphasis on research itself. It had reached into universities and identified 237 ~eople with skills which were useful at least to the war effort. These became the fair haired boys during the war. They were the recipients of funds for specific purposes, and it was almost like the needs of the mo­ ment creating little barons in a much larger setting. I'm not sure why this continued after the war--you see, because the stake in education also involved research but it would appear that research was used because it was on the boards to shape and configure other aspects of education rather than having a faculty alive and in tune to the needs and requirements of its student body knowing that research was necessary, but putting it in its proper place. The war with its accelerated program didn't give peo­ ple at the medical schools time to think about postwar situations in which education would either fall back, revert, or somehow or other ad­ just to the postwar period, and johnnies on the spot seem to have been the research people. Well, of course there was no research done in the medical school can­ pus here that had any relevance to the war effort. There just wasn't any research being done here during the war, and of course the war was no sooner over than the National Institutes of Health, the Public Health Ser- vice, for some reason or other began to provide funds for research, and since most medical schools, or a lot of them were like this one, had no laboratory facilities to speak of for research, it was important that funds for construction be provided, and we were fortunate here. We ap­ pointed this long range planning committee. The thinking of the commit­ tee had to do with architecture primarily, but we were in the position to be among the first to submit applications for construction funds for cancer and heart facilities. These were construction funds provided right after the war ended. There were only a few million dollars pro- 238 vided, and then the "Program" was shut off for a while. Then the Research Facility Construction Act came into being when we had to match funds. We didn't have to match funds in those early days. Wasn't the cancer wing a grant from the National Cancer Association-­ four hundred thousand dollars, something like that? We got an appropriation from the legislature for half of that can­ cer building, and the balance was provided by the Public Health Service, and the Public Health Service paid for all of the addition to what is now the Outpatient Department, the third story. We put in a very nice labora­ tory setup for cardiovascular research so we were able to get the facil­ ities and have the facilities as well as the money and the people to get this research deal under way. Biophysics was one of my principal efforts because I had come to know Leo Szilard. I went to him at the University of Chicago and said, "We need to get going in biophysics." He referred me to Dr. Theodore T. Puck who had just finished his graduate degree under his tutelage, and Ted wanted to come, but he went and spent a year with Dr. George W. Beadle in genetics and then came. That was just at the time I needed to find the money to set him up in the basement. He had some very nice laboratories down there. That money came from the Atomic Energy Commission and from the Boettcher Foundation here in Colorado, and then when we got the Sabin Cancer Research Building-­ why, Puck had a whole floor there. He kept the research space in the base­ ment also. Now, he still has the floor he had in the cancer building plus the floor I'm on. Yes--he's an exciting guy. Has his point of view enriched the curricu­ lum? 239 It did for a while until his research interest bent him completely away from very much interest in undergraduate teaching. He likes his graduate students, and he has postdoctoral fellows in all the time. Now he has one, or two members of his department, however, who carry on the teaching tradition in excellent fashion. He attracted a Dr. Arthur Robin­ son who was a practicing pediatrician here years ago, and Robinson began to come out and on his own time because of some research interest he had that coincided with Puck's. Well, the next thing we knew, Dr. Robinson was on halftime salary, and it wasn't very long before he was full time and he's a self-made biophysicist really--! mean he had no identifiable fellowship of any kind. He just got interested in learning biophysics because of his research interest and his increasing association with Dr. Puck and Dr. John R. Cann, and he's acting head of the department now. He's a terrific teacher, likes to teach, and he's real fine because he uses patient care in medicine as necessary, as a point of reference for his teaching. The students like what he does very, very much. Dr. Cann is a good teacher. He's a real scientist. Blood proteins are his field. Puck's still an exciting fellow. He's always got ideas that he is headed for, and he's smart enough to know that there comes a time when, if he's going to go any further toward wrapping up an original research idea, he's going to begin to fall by the wayside, he'll drop a project just about the time when this work is ready to be picked up by other peo­ ple other places, and he goes on and starts something new. Now this will keep him from being a Nobel Prize winner probably, but I think as far as his overall production is concerned, because of the way he's gone about it, he will have had his finger in very significant fashion in more sig- 240 nificant research than many, many other scientists. I'm hoping that he'll wrap something up enough some time so that he will get a Nobel Prize be­ cause he is that caliber. Yes, he makes a difference. He's retired as head of the department, and he has lifetime support now from the American Cancer Society, and under this arrangement with the American Cancer Society he can do research, but he can't be an adminis­ trator. He's a different individual since he's gotten rid of the admin­ istrative responsibility of that big department--completely different, like he was when he first came. He's lost this chronic look of concern. He was always unhappy because the demands of administration had to come first before he could do anything else, and it was hard for him to dele­ gate any administrative authority to anybody. He finally learned to do that, but he is doing just what he wants to now--just at the pace he wants to do it, and his research productivity is very, very considerable. Does this filter down to the medical students, or just the graduates? There is no direct link to speak of between him any longer and the medical student. I'm sure he occasionally gives a lecture. Dr. Robin­ son may ask him to. I'm not close enough to the detail operation of the place to know, but I just know that he's glad not to be responsible for a course in biophysics for medical students. He could have left here many, many times, and I think it's best that he did not leave. There are individuals who should have moved. Salk was after Puck--has really pressed him to go out to La Jolla, and I'm sure by now, and I haven't talked to Ted about it, that the way things are going out there he should 241 be very thankful that he didn't pull up stakes and go because the insti­ tute there is not going the way in which it was conceived and chiefly be­ cause the National Foundation hasn't been able to raise the money. I was told by the vice-chancellor of the San Diego campus that he was pretty sure that the time wasn't far away when the university would have to take the institute over lock stock and barrel to keep the thing afloat. What you've said as far as the University of Colorado Medical School is concerned is that during the war research efforts were minimal, if at all, and the university was in a position to alter its program, I suspect, be­ cause of the emphasis on full time after the war and fish for good people with a view to both research and teaching and fulltime teaching. That's right. So that its development is really a postwar thing. That's right. And its commitment in terms of facilities as far as laboratories are con­ cerned is also a postwar thing. Yes. During the war, it was largely a Navy V-12 program, or Army--some Army too. The thing that was basic to getting started was money--the availa­ bility of money, and of course right after the war any available money had to come from within the constellation of our own resources. Now dur­ ing the war the government paid--! forget what the rate was, but they 242 paid a very adequate tuition for all of the students that were in school that came there from the Armed Services, or that were in uniform, and this money went into the bank. The faculty kept trying to get Dr. Rees and the Board of Regents to spend this money as it accumulated in the interest of raising salaries primarily and also in the interest of adding to the size of faculty, as faculty would become available, and the Regents wouldn't let them spend a red cent of it. I was just as mad about it as anybody else because I started in at such a ridiculously low salary, but the Re­ gents just would not approve its expenditure. That's all there was to it. When the war ended, we had about a two hundred thousand dollar kitty in the bank--just under that. There's a diagram in one of those reports that shows this. Of course, we raised tuition, and the legislature for some reason or other--my first effort with the legislature was very suc­ cessful. The legislature had been meeting only every two years, and I think the legislative appropriations for the first year I was there was about eighteen, or twenty thousand dollars, and that's all. Now this isn't as bad as it looks because back in 1922, the taxpayers had voted a property mill levy all of which was to be earmarked to support our insti­ tutions of higher education with the idea that property values would ap­ preciate in such a fashion that never again would the legislature have to appropriate funds for colleges, or universities. Well, it didn't work out that way. Property values didn't go up as anticipated but this money from the mill levy had substituted for an appropriation to the point where these ridiculously low appropriations pertained. That first legislature I was able to get around, and that's when they went to an annual session. For the first year I think I got several hundred thousand dollars. It was a phenomenal jump from the standpoint 243 I' of people in the legislature and also from the standpoint of the other institutions of higher education. None of these other institutions got anything approaching that kind of an increase, but we got it because we were able to sell the legislature on the fact that if we were going to be a good medical school, we had to have a good fulltime faculty, and we had to have this and that and the other thing. In anticipation of what : l the legislature would do, the Regents right at the end of the war had let us begin to spend all this kitty that had accumulated, the kitty out , . I of the tuition money. The Regents were terrific in those days! They I I just kept pushing all the chips out on the table all the time to make ! I this development possible. How do you explain that? Just the quality of people? Just the nature of the times, the interest in medicine, the quality of the people, and part of it was because I was dealing with people that I knew, or who knew me and knew my wife's family. I had had my foot in the furrow, as some of them used to like to say. The fellow largely re- sponsible for it is a rancher out here on the Platte River, and he's now-- he gave up ranching, and he wanted to run for governor. He went to Wash­ ington as head of the Rural Electrification Program, and he's now the Ad­ ministrator of Institutions here in the state. He has all of the insti- tutions except the educational institutions under his supervision, and he's a wonderful fellow--David A. Hamil. He was chairman of the Finance Committee. He gave me a lot of time, and he came out to the school. He was thoroughly familiar with all of the reasons. He was for this request, and he was familiar with the resources we already had and with what we needed. 244 You loaded his gun. We really went to town. The next year was a little different. We got the same appropriation, and we had two or three pretty lean years there when the appropriation wasn't reduced, but it was not increased ex­ cept very little, and this was for the medical school. It was the con­ tract we made with the universities of New Mexico and Wyoming under which we'd take ten students a year from each university, and we'd charge them the usual resident tuition, but in addition to that each university would pay us two thousand dollars a year for each student. This two thousand dollars a year per student was the increment that kept us in business, because, you see, there were some dropouts, but not many. The first year we had twenty students at two thousand dollars apiece, and the next year it was forty, and the next year sixty and the next year eighty, and that's where we got the money to modernize the basic science laboratories and equip them to handle radioactive isotopes, particularly. There was no other place to get that kind of money. We used some of it for faculty raises, and we got the one sixth privilege in, and this did away with the need for paying big salaries as compared to what we're paying now. If I ever find the time to sit down and just reconstruct how the med­ ical school was financed from the day it was moved down here until today, it would make some very interesting reading. We were really flying by the seat of our pants and taking lots of chances. Another thing that saved our hide came out of an effort I made to put some faculty on the payroll of the Colorado General Hospital. You see, we had no items for psychiatry in the medical school budget. Only Ebaugh and his people were on the budget of the Psychopathic Hospital, and that institution never had any problem at all getting money from the 245 legislature. In Colorado General we had radiology on the hospital budget and physical medicine. I went to the governor and the legislature with figures to show how much time and how many dollars this time represented that were spent in patient care by the fulltime clinical faculty that were on the medical school budget. I wanted them to transfer that expense to the hospital. Then given the amount of money that we were getting from the legislature in tuition, we'd be in pretty good shape over in the medi­ cal school. I had this presentation worked up very carefully. I had interviewed each member of the faculty. I had a table which showed the percentage of their effort that went into patient care, teaching undergraduate medical students, and fortunately teaching interns and teaching residents. This was just guess work on their part. They were estimating, and it was the only way you could do it. Well, we got turned down by the governor and the legislature, but by that time we had taken on a hundred, or so residents who had been dis­ charged from the Army, and they were under the G.I. Bill of Rights. If it could be shown that these residents were really students and we could show that, as students, they were costing us x number of dollars to edu­ cate, we could get five hundred dollars a year per student from the govern­ ment. There was no argument about this with your medical student, or your nursing students, or your students at Boulder, but I wanted to claim these residents as fulltime students, and as justification for this, of course, I could show that we had set up this curriculum in basic science, that these students were studying there, and that the faculty were putting money into it, the fulltime, basic science faculty. I approached the Veterans Administration to pay us five hundred 246 dollars a year for each of these residents, and the Veterans Administra­ tion sent an investigator out, and he started off the session by saying, "Why you sure are wasting my time because there are many, many medical schools that have tried to get away with what you're trying to do, and they can't establish the facts that justify the paying of tuition." I said, "Look at the data." I was able to pull out these long accountant sheets that showed all these calculations. I could account in terms of the percentage of salary. I could account for everything that every single fulltime clinical member of the faculty had done, and when we got through this investigator said, "I have no choice but to approve your request. You've got the facts here to substantiate your request." This increased our income--you see--in terms of purchasing power for those days very substantially. It's these gimmicks that gave us the money to zoom that medical school budget up from a very small figure to a very respectable one. Then when the research money began to come in, the fa­ culty fortuitously, or those who were on tenure at least said, "We do not want any of our salary to come from research grants. If we're going to feel secure, we want to know that the university is going to assume the responsibility for our salary, and we don't want any hanky-panky in con­ nection with making money seem to be coming from the university when it's really coming f ram research." As time went on--even now particularly, it's a requirement that the institution getting research grants from the government show the extent to which it is participating in the support of this research, and there's a minimum participation required. Well, there's nothing to it over here because of the fact that the university has kept these faculty people on 247 funds that are strictly the property of the university. This adds up to way more than the minimum requirements under the grant procedure. Well, there are quite a few schools that are in this fortunate position, but there are an awful lot that aren't. In order to have money to spend for other purposes, they've taken grant money to pay a faculty salaries, or parts of faculty salaries, and they're having difficulty meeting the min­ imum requirement because they don't have the funds. Our budgets that went to the Regents always showed--here's a man on the faculty and the budget through footnotes showed the exact source of his salary and if there was money from a grant being used in this salary, it appeared, but the budget only showed the university money that was involved. Younger faculty that came in primarily to serve research purposes, they didn't mind going on the grant money. It was the only way we could have made room for them, but the core teaching tenure members of the faculty particularly have al­ ways been kept on university funds. It is this period in which adjustments were made at the university level, medical school level, which increased its funds and which enable it to compete for more personnel, and it was the local adjustments which made funds available--put it that way. Yes, and of course the most important single thing that ultimately happened was changing the Colorado General law so that we could institute the present faculty practice fund and utilize all the moneys that the uni­ versity collects in the name of the physicians responsible. This money goes into the faculty fund, and there's--well, several hundred thousand dollars surplus there. They keep more than they need. They're in good shape. 248 Yes, they're in pretty good shape, and the legislature doesn't give them all they ask for, but it sure comes a lot closer to it, and it does­ n't make much difference what party is in power. It doesn't matter. Now, this isn't true with higher education in general. The thing that saves our neck is this separate appropriation--you see. Now they're talking about putting all the institutions on higher education under one board and making one single appropriation to be administered by this one board, and naturally the people down here are scared to death of it. There were efforts like that in 1949. Yes, when we had an Attorney General Metzger. He was going to fix the university. He kept us on pins and needles the two years he was in. I'm wrong. The problem here was the state's efforts to remove hospitals from under the Board of Regents and the university and place them under Civil Service. That was Metzger. That's the one. Yes, that was the attorney general. He claimed that we were vio­ lating the law. Yes, the statute--that the two hospitals were established by statute and were not under the constitution of the state. That's right. 249 It was legal for them to establish the hospitals by statute and then give them to the university to operate. I don't think that went to court. It may have. Now, such suits have been threatened before. Some of our friends in the medical profession--way back--felt that the answer to all the town and gown problems was to take the hospitals away from the uni­ versity. You did succeed, didn't you, in getting the hospital on a separate line in the budget, the medical school on another and Psychopathic on still another. That's the way it was from the very start--always. Now the nursing school, as I said, was in with the medical school. Now, as I understood, the dental school--it's going to have its separate appropriation. I hope it stays that way. Wasn't the dental school tied in with the multi-state, 1948--the gover­ nors and state university presidents of Colorado, Montana, Wyoming, New Mexico, Arizona, Nevada, Utah and Idaho? There was no dental school here then. Back in 1947 or so, we got the legislature to appropriate--! think they started out with a hundred thousand dollars a year to the university to be used to help pay the tui­ tion charges for Colorado residents in dental schools in the United States irrespective of what school they were attending, and this was to repre­ sent Colorado's contribution to dental education, a financial contribu­ tion in lieu of starting a dental school, or until such time as we started a dental school, and this still pertains. But when this dental school opens, then automatically this program will be shut off except for those 250 students--well, they'll shut it off for students who are freshman and the next year when we have a freshman class, they'll let this phase out. Students who are in other schools at the time this dental school opens, they'll continue to receive this support until they graduate. The effort here was for the ten states that I mentioned to unite--does that still obtain? No--this you're referring to, I think, must be a study that was financed by the National Institutes of Health and the Kellogg Foundation of the need for dental education in the western Rocky Mountain area. Joseph F. Volker, the University of Alabama, I got to do that survey, and this is still a very important point of reference for any state out here that wants to take a fresh look at dental education. Then the Kel­ logg Foundation gave the university here a grant to do a feasibility study, and the legislature made two appropriations of fifty thousand dol­ lars each for two years because of the recommendations of the feasibil­ ity study. We were all ready to start a dental school back in 1956, and they had a couple of men lined up either one of whom would have accepted the deanship and then carried on with the detailed planning. Well, of course, the medical faculty here were opposed to this. They're still un­ happy about the idea of a dental school corning into the picture because they look upon it as another thing that dilutes the financial support of the medical school and so when the new president came and the new dean of the medical school, why it was easy to talk the Regents out of pushing this item. The whole thing was called off, and the dentists were really put out because they had worked hard as an association to put this thing 251 across. They pushed the dental school again. This drive originated again with the dentists, and this time they were smart enough to develop a Dental School Committee and everybody that is anybody in the state was put on that committee. The dentists used these people as sources of in­ fluence, and it took some doing. It really took some doing. We didn't know up to the last, the very last legislature, or up to a year ago whe- ther this drive for a dental school was going to make it or not because the Commission on Higher Education had recommended against it, and the governor was opposed to it, had made no provision for it in his finan- cial message. The people that wanted the dental school just decided, "We're going to buck this right down the line." They came out all right, and they did all right this time. The thing's passed the point of return now unless the legislature wants to really dislocate a pretty well developed program. Now we're not sure where the school is going to be located. It depends upon how much ground they can accumulate by the time the specifications for the construction-­ they have to start preparing those. They've got a brilliant young man in as dean. He was the secretary of the American Dental Association's Council on Dental Education for awhile--he's both Ph.D. in biochemistry and a dentist. He's very good looking, very articulate and knows how to adjust himself to points of view that he knows ahead of time that he's going to have to deal with (Dr. Leslie Burrows). That's a rare combination. He's very sensitive to people--! mean, and this is a very important gift, I think, and as a rule I think I adjust as I go along in this same fashion--just sort of sense how far to go and what to say lots of time. 252 You said initially that in order to develop postwar, it required avail­ able funds, but was the faculty--well, you brought in virtually a new faculty--but from where did the ideas for growth come? At no point was there any faculty opposition. Now, I worked with the faculty, and we used committees when I thought committees were going to work. I'm afraid sometimes if I didn't think a committee was going to do a job, I handled it some other way. For instance, when the nurs- ing school came in divorced from its support from Colorado General Hospi­ tal, I knew there was no use going to any faculty committee with that busi­ ness. I would just wear myself out uselessly. The president and I with the dean of the school of nursing--we just got this ready for the Board of Regents and that was it. There are many times when things just have to be done that way--at least so it seemed to me. When you're fingered for responsibility, you've got to sniff the wind-­ that's for sure! The President of the University has to make a big decision now. Dean John J. Conger has said, "After July, you're going to have to have a Dean of the Medical School that is separate from the Vice-President for Medical Affairs. I'm not going to be willing to wear these two hats any longer." The faculty of the medical school, of course, they don't want this separation and that's it, so far as the faculty of the medical school is concerned. There's no use asking their opinion anymore, and the president and the Regents by gum, they'd better decide one way or the other, or I don't know what Dr. Conger will do, except I know he means what he says. There's been no answer yet, and I think it's about time that they came up with an answer. Now they have the man picked who would be the dean of the medical school, and the faculty, I know, feel that if there has to be a dean, this is the person they want, so the way is paved to this extent, but even this fellow they've got pegged as being the dean, he doesn't want this change, but he will be dean if he has to as I under­ stand it. Now, this is one of those times that I would just see to it that the thing was settled so Conger khows and can begin to plan his time and energy accordingly. When I was Vice President in charge of Medical Affairs and had a dean of the medical school this worked all right, but when I went to Boulder as President, and we put another man down here--well, we didn't call him Vice President. We called him Director of the Medical Center, but the administrative organization and structure was all the same. This didn't work at all which is probably my fault. I say this just to point out that I don't care what your table of organization is--it isn't going to work unless you've got the right people. The minute I left there was a struggle for power down here, and this Dr. Scharrer and Buchannan scrap was a part of it and a big part of it. The gun was cocked, and this Scharrer Buchannan scrap pulled the trigger. There were other people that wanted to be Vice-President. The faculty chose up sides on that one pretty much. One man--the man who was in charge of postgraduate education was involved, and he finally-­ well, if he hadn't resigned, he would have been removed from the post. He had tenure as a faculty person. He's still over there, but it took a long time for the heat to come out of this situation. The medical school internally was hurt by this, and I was helpless. I just didn't know what to do. I felt I had to deal through the director. 254 I should have done something though administratively, I'm sure--well, I wasn't ready to be a university president. I moved into a completely foreign environment. It did me a world of good. It was an experience that really paid off as far as I personally was concerned, and I was able to do a lot for the university--! know that. It would have been better if we could have gotten a president who really had background in overall higher education administration. Well, I was on the selection committee, and we did our best. We thought we were going to get John Gardner for awhile. That shows how high we were shooting, and then we went after Nathan Pusey, and we went after another man and he's just taken the presidency up at Pullman, Washington University. We were going after the right people, but all through it the selection committee were trying to talk me into doing it, and finally when we just couldn't get one of these three people, why I agreed to do it. We can talk about that some other time. We're just about at the end here, and I think perhaps I'd better go. 255 Friday, April 12, 1968, 7002 University of Colorado Medical Center I kept a diary for a couple of years when I was President of the University, and once or twice when I was particularly disturbed I would write a half of page or so, and while I was reading some of this to Paul­ ine reminding her of this and that, all we could do was shake our heads-­ what an adventure that was! Now, let's see--progressively the documentation of this and that since leaving the campus here is more and more mixed up. I've got it, but I've just never put it together such as represented by these books. Some of it is at home, and you saw some of the books yesterday, but they aren't complete the way they ought to be. I'll probably kick the bucket before I ever get around to organizing it. I'm realist enough to know that this heart block can snuff me out at any time without any warning whatsoever. I don't think it will for a long time yet. Things happen fast. I brought this volume along--this is the Joint Committee for the Study of Medical Care of the Indigent, and it represents social forces that were loose in the City of Denver with which one had to deal and--you know, when you're in private practice you don't have the sense of social forces, but boy, when you have to deal with this kind of sensitive thing! This is the study, and there's a fellow who figures again and again ..•. Gee, I had forgotten all about this. My gosh--oh, this is what we called "the Lembcke study." And this material goes into this book of documents which is the material for the Commonwealth Fund on home care. 256 What's the date? 1951, and what was the ..•• That's a marvelous document, that first one--that's 1948, and this is a whole book on home care with the Commonwealth Fund. Frode Jensen was here then. That's 1947. In our application to the Commonwealth Fund they fiddled along two or three years making this grant. You had to make surveys. I was out of patience with them. They knew what they were doing, and they gave us a small grant for two or three of us to visit these places--Richmond, Baltimore, New York, and Boston. Yes. They said that we didn't have to make any reports. This was a trip for our own benefit--well, if it was going to be any benefit to us, we had to keep notes, and if the notes were going to have any viability they couldn't just stand as bare bones. I had to put some meat on them. I forget how long it took me to write this. I think that is a transcript of a conference that you had--just marvelous reading. I don't remember--well, this document goes back further yet. This was when Bob Stearns and I went into the Commonwealth Fund office, and 257 the staff of Commonwealth wanted to just sit around and we spent two whole days. Right. They did have a stenographer there, and they did take everything down. That's what this is. Is there something here about going to Bal­ timore and all that? No. The next volume is a collection of materials as a consequence of that survey. Yes. There is correspondence and at the very end there is material on the pro­ gram for home care that is developed here. This was our application as we sent it in. Well, now, is there something in here about the trip to Baltimore? No. Those reports and material are in another volume, and I didn't bring it along. It's all there. It isn't fair to you--gee, I should have gotten down and decided the order in which these things took place. Let's just begin by talking about the President of the University--Robert L. Stearns. A great deal that happens in any university is related to the kind and quality of the fellow who heads it. I think he's a pretty important figure. Yes, he was. 258 So some notion of the substance and quality of this man--the nimbleness of his mind, the directness of his mind too. Are you--have you got your question on? You have that question on. Well, I count it a real privilege to have known this man and worked with him. He's about ten years older than I am. He's a member of a long established family here, and his wife's father was one of the early gover­ nors, Governor Pitkin, so he had all the kinds of contacts that were ne­ cessary to make him a very effective person, and on top of this he was an attorney. He graduated from this school--the liberal arts college; in fact, Floyd Ddlum was a classmate of his. Odlum was famous later be­ cause of uranium development--the Atlas Corporation. You don't hear much of him anymore. Bob Stearns was in practice here in Denver, and then he went to Boul­ der as Professor of Law. This was when Dr. George Norlin was President of the University, and when Norlin retired--why, they made Bob Stearns Presi­ dent, and he'd been President just a year or so when the war started, and immediately he went into service as a consultant, a civilian consultant, the head of a team of consultants, and he had complete say-so as to who he got to help him deal with a specific problem the Air Force had given him to study and solve. He flew all over the Pacific Theater, and of course nobody knows a lot of the things he did, but the most important thing he did was to set up a statistical study of the best format~ons the bombing planes could fly and protect themselves at the same time, the most effective fire power that they could generate and not shoot at each other, and all this sort of thing. This apparently was quite an achievement. He accomplished all of this with civilian consultants, technical people, mathematics people and so forth. 259 While Bob Stearns was in the service, this Dr. Reubin G. Gustavson was acting President. He had been a Professor of Chemistry at Denver Uni­ versity, had gone to Boulder as head of the Chemistry Department about the same time that Bob Stearns went there as President, and as I told you yesterday, Gustavson was quite a man in his own right, a very fine chemist, did a lot of the early work on the female sex hormone, a very nimble mind, a very articulate person, a very forceful, dominating type of an indivi­ dual, fearless. He stirred up people very easily. He was very liberal, and he'd been a patient of mine. I knew him very well, and he and the dean of the medical school here didn't get along, as I told you, and I was kind of caught in the middle because of my relationship to Dean Rees on the one hand and to acting President Gustavson on the other. Well, Gustavson was the one that I called to tell of Dean Rees's death, and he was the one that had engineered my appointment as acting dean of the medical school, and of course he and I got along fine. The Board of Regents were a wonderful group of men at that time so everything went very smoothly in my dealings with the power structure within the University. When it came to taking the deanship, Stearns was still away, and I wouldn't take it unless on a permanent basis with the approval of Presi­ dent Stearns, so my acceptance later on of the offer of the deanship was delayed until they could communicate with Stearns. This was fine with him. Had you known him before? I hadn't known him except casually. He went to Boulder as Professor of Law, and then he was made the Dean of the Law School, and he hadn't 260 been in that job very long until he was made President. Then he hadn't been President very long before we were in the war and he was off, so when he came back everything was all set for the continuation of this ef­ fective working relationship. He leaned on me very heavily as far as the operation of this medical center is concerned, and he went along with everything I wanted to pro­ pose, as I told you yesterday, even this showdown that I called for with the Board of Trustees of Children's Hospital. He must have had some men­ tal reservations about what I was proposing just from the standpoint of good administration--you know. He went right along with it, and that was really the only bonehead between us that I think we pulled while we were working together. Well, just to show how he worked, I have forgotten about what this was about, but I had a session with Bob Stearns and was describing a pro­ blem I was facing down here. I asked him what I should do about it, and he said, "What do you think should be done about it?" I said, "That's why I wanted to see you. I wanted to know what you thought I ought to do about it." He said, "We'll terminate this conference right now. When we talk about it again, we'll start out by you telling me what you think should be done. Don't you ever come to me again with a problem unless you've got a damn good idea as to what you think ought to be done." [Telephone interruptionJ Pretty shrewd wasn't he? I think this was the most important rule that could be made under circumstances like this. That sure told me where I stood, and so after 261 that we talked some more about our relationship. The understanding was that at least once a month, and oftener if I thought necessary, he and I would have at least a conference that would last as long as necessary, where I would keep him informed of the important things going on down here, the progress of projects that he knew about, and I would also let him know what I was thinking about as far as the next x number of weeks, or months were concerned because he said, "I don't want to ever be caught uninformed. If a member of the legislature, or somebody steps up to me and says, 'What about this and that at the medical center?', I don't want anybody catching me without my knowing what's going on." From then on most of our contacts--I'd keep a special clip board for him and as things would occur to me that I thought he ought to know about, I would set them down. Of course there was give and take, and he'd react and tell me what he thought, etc., etc. I don't think he ever got caught short--at least in any significant fashion. The biggest hazard was a newspaper reporter getting hold of him. Well, I'd get caught short by these babies, because there were many times, both here in Denver and up there in Boulder that newspaper people would get wind of something before we would, and this was always very disconcerting, of course. The news­ paper boys just loved to catch us under circumstances like this. Bob Stearns and I became--well, close personal friends. We didn't see a lot of each other socially during that time and haven't since, but he was a wonderful man to work with, and everything that went on down here we had his support, and we had the unanimous support of the regents. I don't remember a hassle in the Board of Regents while he was president that concerned the developments down here. Now, because of the way Bob Stearns and I were working together, it was easy to keep the Regents 262 informed. I attended all the Regent's meetings. I was right there from the beginning of every meeting unless they went into executive session which was, of course, frequent, and even then I knew what was going on. I knew what transpired in those meetings, or most of what transpired because Bob Stearns wanted me to be in a position to function against a background of pretty thorough familiarity with the total university operation. Every time I wanted him to go with me east or on a trip around the state, why he'd go, and once in awhile there would be something going on east of here that he'd want me to go to with him. I know we took a whole week, and we met with, or tried to meet with every single county medical society in the state. I don't think there's anything in those books about that, but this was real early, soon after he came back from the war. We combined this with his talking to luncheon clubs and meeting alumni groups and when we finished that week's jaunt, we knew that we'd been places. [Telephone interruption] The death of this fellow [Augustus J. Carroll] the day before yester­ day has really--this is big stuff. We don't know anything about program cost accounting in hospitals when it comes to getting educational costs from service costs. [Telephone interruption] This study is under the direction of the steering committee of the American Medical Association, the American Hospital Association, and the Americal Association of Medical Colleges, and the study was to be done at the Grace New Haven Hospital where Dr. Albert W. Snoke was Superintendent. * Of course this study involved the Yale University also. This was an excellent hospital to start with because it is a very complex institu­ tion. Grace New Haven Hospital is involved in every conceivable kind of * Program Cost Estimating in a Teaching Hospital: A Pilot Study." 11 Carroll, Campbell, and Littlemeyer. Association of American Medical Colleges, 1969. 263 educational activity, but a poor place to go because Dr. Snoke is an ex­ tremely aggressive sort of man who gets divisive. He is just hard to work with. Gus had an awful time with him, not trouble, but Gus would have an appointment, and he'd go all the way from Evanston, Illinois, to New Haven and Snoke would be off some place else without letting Gus know that he wasn't going to be there. Gus would go to work a week where the week's work depended upon a long conference with Snoke, and Snoke couldn't see him until the end of the week which meant the week which Gus did spend was not nearly as effective as it should have been. It was just frustration after frustration. The Dean of the Yale Medical School suddenly decided that the pro­ gram cost study should include the medical school. We tried to get him to do this originally. Well, the university keeps the medical school books, and the university controller and bookkeeping accountants weren't interested in this program cost study. We finally got the data we needed from the medical school, but the school had yet to put the data together, and that's where that matter stands. I don't know what shape the stuff is in now. This is two years ago. In the meantime Health Education and Welfare is insisting that the medical schools and hospitals that have research grants account for the expenditure of these funds in terms of the time and effort that the fa­ culty puts in on each grant, and the auditors aren't going to accept time effort reports from these faculty people unless they tie this in with an accounting of how they spend all their time--not just time they put in on the grants, so we now have a big contract with Health Education and Welfare under the direction of a joint committee representing the AAMC, and HEW, and they put on a good staff man to study six medical centers. 264 Gus has been helping this man develop the expertise necessary to do this study, and this study has been leaning heavily on the New Haven study, and here Gus dies just as he's ready to develop the schedules necessary to this effort. Fortunately this man that joined the staff in January is pretty hep. He's been with Gus long enough so that he's pretty hep to what's needed and how to proceed to finish this. Well, we're tied to the American Medi­ cal Association and tied to the American Hospital Association so that we just can't move in ourselves, and here this Dr. Snoke who is no longer Superintendent at New Haven and a man who is head of the AAMC Council of Teaching Hospitals--they're already talking between them how they're going to take this study over ignoring the fact that this is the respon­ sibility of this three headed committee, so it's kind of a mess. I should have moved in on it yesterday immediately when I knew Gus was dead, but I never dreamed that Snoke would not even let old Gus get cold before he'd start to try to take over. Now, I'll move in on it this af­ ternoon. Do you want to make those phone calls now? No, i t ' l l take--well, I kind of want to ruminate a little bit. The damage has been done--they said that Snake's next move would be to get hold of Mrs. Carroll to get hold of Gus's files--well, he's surely gentle­ man enough to leave the woman alone until after the funeral, and that's tomorrow. This is administration--see, and administration is all or none, and I've got no business hanging on to any more administrative responsibili­ ties because I just don't have the energy to keep up with these things 265 the way I should. Successful administration means keeping ahead of things like this. Yes--it's avoiding certain endings by avoiding certain beginnings. Well, did President Stearns exercise a veto over the medical school at any time? Did he have that power? He had the power--oh absolutely, but he never exercised it as far as I know. I think situations could very easily have developed so that he would have, if we hadn't had this ideal communication between us and empathy--we knew how each other thought about things. I always knew ahead of time what his reaction was going to be; in fact, I knew him well enough to know what he'd go along with and what he wouldn't too, I think. You indicated that you had taken this trip around the state talking to I medical societies, among other things. Part of the function, assume, was a kind of orientation and public relations bit. I would This trip was revealing to him. This was the first time he'd ever rubbed elbows with medical politics in this state. He was highly re­ spected by the medical profession. He's a man that is still held in very high public esteem, and he is a forceful, very articulate--well, he was considered the best trial lawyer in the state at the time he was in prac­ tice, best performer in the court room, a trial lawyer. He was the one who did the examining and ran the trial from the floor of the court room. They tell me this--! never saw him function--that he was superb at it, and I'm sure he was. Gee, he could pick up a flaw in anybody's reason­ ing just like that. Was he a quick study? Did he absorb easily? 266 Yes--I know his reading time was very rapid, and he was a master at scanning, and he was a bibliophile. He had, still has, a tremendous li- brary with everything under the sun in it. It was his family's library and his wife's family's library, and he was fast enough at reading so that he got a big kick out of using this library. I never built up such a library, and I just was always so busy with operational activities that I never developed myself along the bibliophile lines. All the studying I've always done has had a direct relevance to things I was doing at the time, or thinking about doing in the future. I used to read a lot of detective stories and things like that just to make myself sleep, but I have even quit doing that. Did he have any views, or express any views about medical politics? I don't think he had any line of philosophy that had very much to do with how he conducted himself. He depended on me pretty much. Later on there were situations where he had--well, we were just getting into t the business of direct communication between the president and the regents and the medical interests in the state. Then when I became president this communication grew in frequency and complexity. It was good that these people did come into the Board of Regents and present their problems dir­ I' ectly because it was just impossible for a long time for the leadership in the medical school and the leadership in the medical society to commun- icate in any productive fashion. You saw that as a result of the minutes of some of these meetings. Things just got so bad, and I'm the one that realized this and saw to it that the level of conversation was raised to the level of the Board of Regents and the Board of Directors of the Medical Society. This was after I was president. Now sometimes I was in on those sessions as was the Director of the Medical Center here, and sometimes we weren't. We weren't there unless they wanted us there to answer questions, or to pro­ vide background. No minutes were kept of any of these sessions. Well, it's good that minutes weren't kept because there would not have been this free exchange. The only thing that came out of these meet­ ings was the proposition that the Regents made to the Board of Directors of the Medical Society, and I don't have a copy of that. We can get it, if you want it--we can get it from the minutes. The relationship that the medical school had, or certainly the Colorado General Hospital was fixed by statute, wasn't it? Yes. But the relationship between the medical school and the city of Denver and more particularly the Denver General Hospital was not fixed by law. That's right. This required agreement. Yes--just an agreement, and there's a copy of the agreement in some of this stuff, and it was a very permissive agreement. 1 The first agreement I ran into was one that dealt with nursing education. Yes. Part of the problem that you saw of reorganizing the school as a school of nursing with a dean of nursing. Yes. and this transition of the diploma program at Denver General 268 into a baccalaureate program took place very quickly and under the old city administration, as I remember. Mayor Stapleton--yes. There wasn't any problem about the nurses--inci­ dentally, the agreement is fine. Did Stearns draw part of this agree­ ment? Yes. It's clear. That agreement survived the Denver General-Medical School break, and that unit of the nursing school is still active. That's good. That survived all of this. It was the first agreement. Nursing aside--what was in the air was the alteration of the curriculum here at the medical school, new thinking after the war about the possibility of new personnel--competing with oth­ er institutions for personnel with reference to specific programs, and one of the things was teaching material for students in this new curri­ culum. Now, I'm not sure, and it wasn't clear in the material that I looked at, whether the curriculum was changed freshman through the senior year immediately, whether that curriculum was designed toward general practice? Was the commitment of the school then toward general practice? That's right, and at the time the new curriculum was instituted, and the change actually began to take place, I think we had access to the Denver General. I don't remember for sure, but I think we did have access, maybe not. I think not. I don't recall that the thinking that went into the curricular change was dependent upon getting more clinical material because they were told not to let limitations such as this hamper their thinking. Right, and I don't believe they did so, but getting an idea to get up and walk is different from having the idea, and I wondered whether the commit­ ment of the program was toward general practice, or whether that commit­ ment waited until the residency program was offered? No the commitment to general practice was stated in the introduc­ tory statement of the final committee report. Now I have to say immedi­ ately that that commitment to general practice didn't survive any test of time. We began to add faculty here, and we did not recruit against that commitment--see. It wasn't self-activating. This was just window dressing as far as actual practice is concerned. On the other hand, the development of the residency program here in gen­ eral practice, as you saw, was an early development. This began immedi­ ately when we began to expand the residency program, and we had no trouble getting takers for this program. That program was full--well, all pro­ grams were full, but the residency program was under the control of the Director of Graduate and Postgraduate Education, Dr. Frode Jensen. It wasn't under the control of this new professor, the head of this new Divi­ sion of General Practice in the Department of Medicine. 270 Archie C. Sudan. Yes--Sudan. Now this department of General Practice never did function as a de­ partment. It never has, although it's still in our table of organization, and there are some people that still hold appointments. For example, the man who headed the RMP was a general practitioner. Well, we had to give him a faculty appointment, so he's an assistant professor of general prac­ tice. Now, we tried for awhile--we entertained the idea of putting this comprehensive clinic at the Denver General, sort of under the administra­ tion of this Division of General Practice, and we tried to get general practitioners in the city to accept faculty appointments and work in this clinic. We went to one or two of the particularly active people in gen­ eral practice, and we offered one a faculty appointment and told him what we wanted him to do. He said, "Yes, I'll do that, but in addition to working in this general clinic, I insist on a service on the surgical service. I want to have my own operative privileges, and unless you'll let me practice the surgical part of general practice, I'll have nothing to do with this." We didn't get a single general practitioner to accept an appointment in this general clinic that I can remember, and Dr. Sudan--well, after he was appointed, he moved into Denver from up back in the mountains, and he began to run out of gas right away. A few of his patients would still come into Denver to see him, but he didn't succeed in building up a prac­ tice here, and he retired fairly soon after he came. We all lost sight of him. At least I did, and whether his name still appears on the faculty list, or not, I don't know. 271 You notice the present faculty catalogue has a long list of inactive faculty. Rather than fire these volunteer people that had been on the active faculty we just put them on an inactive list so as not to stir things up by discharging these people, or relieving them. This seemed to be acceptable to everybody. Did President Stearns--how did he get into the picture as a kind of peace movement between the medical school and its needs and the City of Denver and Denver General Hospital? There had been a break, I think. Oh, way back--well, it began. Well, even when I was a student, we didn't have real access to the Denver General. The medical director down there, the Manager of Health and Charities, was a Dr. Bertram E. Jaffa who showed us around Steele Memorial Hospital which was the contagious hospital. I remember going down there to watch the back of a surgeon's neck while he did a few operations. This was this Dr. Edward F. Dean, and he made us go down there during our clerkship in surgery. This was ' up to him. It wasn't an arrangement between the two institutions. We as medical students didn't have any clerkship experience--this did not develop. Clerkship experience did not development down there at Denver General until after Mayor Stapleton ceased to be mayor, and Mayor Newton took over. Then the students were down at the Denver General all the time, and they liked it at Denver General much better than at Colo­ rado General because they were seeing the run-of-the-mill kind of ill­ nesses that didn't come in to the Colorado General. Colorado General was a referral hospital more than anything else right from the day it opened. Then too, there was more work for the students to do down at the Denver • General. The students were consciously a more--well, they were necessary ► 272 down there because it was their histories and physicals that were a work­ ing part of the patient records. We made them a working part of the pa­ tient's records here at the Colorado General after we started the new cur­ riculum. Prior to that this was not the case, so the students felt a lot more important at the Denver General than they did up here at the Colorado General. Getting them in down there at Denver General was not an easy task. Immediately when the staff was discharged by Dr. Kauvar, and a new staff was established down there, why then the commitment--the appoint­ ments to staff were made with the understanding that they were going to have students for grand rounds, and they were going to be teaching, that teaching was their principal responsibility and things--well, it was dif­ ficult to get started because the interns and residents were loyal to the old regime, and we had to wait for them. Of course we expanded the resi­ dency staff immediately so that we began to dilute that attitude out of the picture pretty fast. We ought to have some indication of the substance of Solomon 5. Kauvar. He seems to have been an important cog in this operation. Yes, he was a terrific fellow, and he and I--he wasn't a graduate J of this medical school. His father was a very prominent rabbi and this was--I forget which division of the Jewish faith he was member of, but I think it was an in between group. Saul was very active on the faculty always and very loyal to the faculty. If he had an assignment, you could count on it, that it was going to be taken care of. [Telephone interrup­ tionJ 273 Kauvar was very active in the politics of the State Medical Society and the County Medical Society. He enjoyed universal general respect be­ cause there was nothing phony about him. He wasn't in the least bit divi­ sive. He said exactly what he thought when he felt like saying it. He never went back on his word, and all this sort of thing. He was always in the House of Delegates in the medical society, and he was frequently on ad hoc committees that were making an effort to make it possible for the medical school to work better with the medical society, and he was sort of an in between. He was a natural born medical statesman and a big help. Well, when the new mayor was elected, we decided that Solomon 5. Kauvar was an ideal person to take over the job of being the Commissioner of Health and Charities, or whatever they called it, and he did just that. He had two other partners to take his part of their practice over, and he moved in immediately full time as Commissioner of Health and Char­ ities. He was the one who wrote the first agreement, or agreements, and he's the one that decided that the only way to clean out Denver General was to fire the fat staff and appoint a new staff. Then we began to seek some fulltime people to go down there, and he found money in his budget for it. We were slow in getting people down there because it was getting hard to recruit for situations like this. We couldn't offer these people anything, but consulting privileges. Well, they were on a sixth time, I guess. Recruiting was difficult because the Professor of Pathology out here, Dr. James B. McNaught was not--incidentally he would have none of this curriculum; he would have none of it. He didn't cooperate one iota with it, and we had to build our teaching around his established course. He 274 would have nothing to do with any responsibility for the pathological services down at Denver General. That had been one of the problems. They had no pathologists at Denver General, and when one of the residents down there made arrangements on the sly, really, for one of our people in pathology to give the residents and interns a night a week going over their slides that represented their own autopsy work in surgical path­ ology, why, when the head of Health and Charities heard about this, he stopped it right quick, I'll tell you. I don't know how we handled the pathology down there at the Denver General until we got a fulltime man, and it was quite awhile before we got a fulltime man, and he was never friendly toward the medical school. He was a constant source of difficulty. He stayed with it until the break came, and he had a lot to do with the break, working from the in­ side at his end. He didn't leave down there until rather recently. There was a study--we talked about these things •..• Well, Kauvar stayed with that job for six months, and then Dr. Flo­ rence R. Sabin took over, and she took over with the understanding that she would be down there a couple of hours a day and that she would sit in on conferences and help with decisions, but that the footwork was go­ ing to have to be done by Dr. James P. Dixon and Dr. Lloyd J. Florie. She and I were in constant communication, and anything she contributed down there was in the light of conversations she and I had, I'm sure of that. We were together two or three times a week, I suppose. How effective was the Lembcke study? The Lembcke study fell on pretty barren ground for awhile. The 275 medical society reacted unfavorably to the major recommendations of the Lembcke Report. It was the Lembcke study that I hoped would result in closing down the Denver General and in the state and the city joining in adding the equivalent of whatever beds were needed here at the Colorado General. Then Denver would pay Colorado General for the care of Denver County patients on the same basis that the other counties did. It would have saved Denver County a lot of money. Well, the power structure--well, this was when the board of health began to draw away from the medical school, from the relationship as it had existed up to that time, because the board decided that it would not make a recommendation to this effect. The decision, however, was a long time coming, and there was a lot of hassle. In this book of material you'll see a report from the Denver County Society. I wrote a statement because the County Society was proposing even that the Colorado General might close and that we would farm our students out to private hospital staffs for their clinical instruction. I have a statement in this material someplace pointing out how this was contrary to the whole philosophy of medical education as it had developed since the days of Flexner and because of the Flexner Report, and that statement put the quietus on all this. The medical society never pushed this thing after I circulated this statement. I never heard anything more about it. The next hassle with the County Society came after Howard Rusk pub­ lished his big dream about rehabilitation centers. Howard and I had known each other for years. His wife was related to some close friends of ours here in Denver. He was interested in brucellosis, and when I'd C go into Washington University to spend some time, I'd spend a lot of time 276 with Howard. I brought all of the architect's plans and all, the Rusk concept, back here, and I tried to sell the medical society on it. We brought Howard here to speak at a meeting attended by a lot of lay people, and if you've ever heard Howard speak, he's a spellbinder and boy, these people in the Chamber of Commerce--they wanted to get going right now! The medical society was not going to get going right now. The medi­ cal society developed a statement that is in here that they would approve the establishment of a rehabilitation center provided it wasn't located at the Medical Center and provided that no matter where it was located-­ admittedly it should be used for teaching--but the medical society was going to have veto power over all staff appointments in the rehabilita­ tion center, and you'll find that in this book of material. Well, this delayed things enough so that the flush of excitement over Howard's hav­ ing been here subsided. We put in a good rehabilitation setup here under Dr. Harold Dinken. Dinken came in at the time when the polio situation was at its very worst, and Dinken was a godsend to this polio situation. He could take over the rehabilitation of these people and take it over in the light of having seen them in the acute phases of their polio and having had some appre­ ciation of what these people had gone through, but the orthopedic people in town never accepted Dinken. He had a hard time making his way with them, and one reason was that he was Jewish, and the anti-semitic situa­ tion here among the medical profession and at the Medical Center was a problem. There was objection to Dr. Harry H. Gordon, and I was told in noun­ certain terms one time on the train between Chicago and Denver. The C secretary of the State Medical Society and another man, and I forget 277 what position he held, but they sat with me in the diner, and they said, "You'd better quit appointing so many Jews to that fulltime faculty out there, or you'll never have the support of the medical society!" I said, "I'll appoint as many Jews as I want to. It's because they're Jews that I think they're interested in academic medicine. For a long time there were a lot of Jews on our faculty, and there always will be because they are some of our best people." Those boys had some real indigestion, I hope, after that breakfast because when I get mad--well, I learned not to get mad because I always came out at the little end of the horn. This is kind of hard--Solomon Kauvar. He was an exception. They respected him--they'd take things off of him and Dr. Levy--this nose and throat man--and Dr. Herman I. Laff who was with Dr. Levy there was some of these people that they •••• Tolerated? And respected. I'm not now conscious of any of this problem either downtown or out here, or as between downtown and out here. This is one of the things that I noticed right after we came back to Denver, that there didn't seem to be this problem any longer, and I think the quiet­ ing down of the medical school/medical society relationships had a lot to do with this. As I understand it, there's an agreement between the medical school, the university, and Denver General Hospital. C You mean an element in this. 278 A written agreement. Well, any written agreement between this place and any outside agency had to be approved by the Regents and had to carry the president's signa­ ture, or my signature as vice-president where it was generally ceded that I was his agent. Now, to come back to this Darley Stearns Regent situation--right off the bat, even before Bob Stearns returned, I began to attend all the Re­ gents meetings with Dr. R. G. Gustavson. By the provisions of the consti­ tution of this state the president is a member of the Board of Regents. He's the chairman, and he votes in case of a tie. Gustavson had me at all the Regent meetings, and when it came to a presentation of medical j center matters for Regent consideration, Gustavson turned to me, and had me always make the presentation. That presentation may have been in a memorandum, and if I ever did write such a memorandum, they are in this business some place, I'm sure. I did my own presenting which is unusual, of course. Gus just presided. He controlled the discussion. He put the motions and all that, but he'd pass any questions regarding the medical center on to me. Stearns continued that same approach, and all the while that Stearns was here I'd be darn sure that he was thoroughly briefed on all medical center matters that were going to come before the Board. He'd decide which matters needed to go to the Board and which didn't. He was good because he didn't want anything going to the Board unless it had to go. Anything that he and I could take care of administratively within the framework of established Regent policy we took care of, and we were darn sure of that because every time you put an item to the Board that could 279 ation of previous policy. The Board would forget what the policy was, and the first thing you knew you had a contradictory policy established. This is where his legal training came in, of course, and I learned from him so that when I became president, I followed the same approach. Sometimes, I'm sure, things were taken care of administratively that the Regents felt they should have passed on, and of course the Regents changed all the time. We were never able--Eob Stearns tried and I tried to fin­ ish it up--to codify the Regent's minutes and pull out all the policy items and have these carefully indexed. I just wonder if that has ever been done. Each time this was attempted we'd pay a member of the law school faculty to do it. They didn't buckle down to it on a fulltime basis. We would pay them five hundred dollars, and they'd do it at odd moments, and of course it never got done. Out of this--this theme of curriculum and curriculum change and then this reorganization of agencies--there is this home care program which develops, and this brings up the Commonwealth Fund and Dr. Lester J. Evans. You might set the stage somewhat with him. Let me take a little trip. You're proving that hypnosis can really be an anesthetic, I think. My toe was hurting like hell when we sat down and got started. It's quit . • That's great. I brought up Lester Evans particularly to give some sub­ stance to the Commonwealth Fund. He's important in his own right, and then there's a fellow named Roderick Heffron. This is Lester Evans here. My rogues gallery is limited to the peo­ ple that have had particular influence on my career, and this begins really with my medical education career. Well, my first meeting was as an acting dean. The meeting of the Association of American Medical Schools was in Pittsburgh, and Lester Evans attended that meeting. I didn't know who he was from "Adam's off ox." I didn't even know that there was a Commonwealth Fund. He sought me out, and we had a breakfast together. He began to just visit with me, said that he just wanted to meet me because I was a new dean. Before I knew it he was asking questions that were drawing me out as to what my ideas about medical education were and what my plans were for the University of Colorado Medical Center. I had been here as associate professor for two years and been around here long enough so that I was beginning to think in these terms. He was a past master--just the way he would ask questions he'd put ideas in your head. He's a pediatrician, and he was gung ho on this comprehensive, con­ tinuing care idea way back there, and he was gung ho on the general prac­ titioner being prepared to be the general physician. He felt that the general practitioner had no business doing surgery, and so this idea of the comprehensive care clinic was--well, the germination of the idea was pretty much due to his seduction. He really had a lot to do with molding my thinking, and I saw him rather frequently after that. I don't know-well, I know that it was his suggestion that the Commonwealth Fund would be interested in financing an educational effort in the field of continuing comprehensive care of patients. ' This Roderick Heffron was a minor member of the Commonwealth staff, and he contributed really nothing to this development. He came into the picture as a substitute for Dr. Evans. I remember that he came out to Denver once when Evans should have come, and he really threw a lot of roadblocks at us, and he left here without--well, I knew he was going to 281 go back and say that the Commonwealth Fund would have to slow down on its interest in this development at Colorado. I know he told them that we weren't far enough along, and maybe he was right--! don't know, but he was a very literal-minded sort of a guy that didn't do much for me cer­ tainly. I liked him, and we could visit, but visiting with him wasn't productive in any way, shape, or form as compared with visiting with Lester. Lester Evans did have a fellow with him by the name of Geddes Smith, and Geddes was really the power on that Commonwealth Fund staff. They just didn't do much of anything without getting Geddes' reaction, and Geddes was a hard one to convince. He did all the writing, the prepara­ tion of agenda materials for the Board of Directors, and so he was fre- quently out here. I knew he was much more critical of us than Lester Evans was--at least I was conscious of this. Smith was. Yes, and his death was a real blow to medical education, and this was a sudden affair that hit Lester Evans and hit us just at the wrong time. We knew that we were missing his help in the development of this home care program, and we put in more than one application to Commonwealth-­ I don't think I included any of the applications in this record except the final one. I brought Charley J. Smyth out here from Michigan with the idea that he'd carry the ball in preparing the memoranda and so forth for the Commonwealth Fund, and he didn't really capture the flavor of what we were trying to do. Harry H. Gordon, who we brought in as Professor of Pediatrics, was more of a help than any other one individual, more of a help to me in getting this application to the Commonwealth Fund and get- 282 ting it approved. This development had an uphill battle here in Denver all the way. Really? It's an exciting idea. I don't know whether you caught that or not. We had trouble re­ cruiting fulltime staff to this. This is the home care program. We had trouble recruiting. We brought in Dr. Fred Kern, Jr. and this was a compromise appointment. We brought many people here who would have none of it. Fred Kern was trained as a gastroenterologist at Cor­ nell, and he said that he was committed to this, was all for it, but he really never was. We had--well, Dr. Jacob Horowitz came in as Director of the Denver General Hospital, and he was never really committed to this. Fortunately Dr. Lloyd J. Florio was down there then as manager of health and charities, or whatever the title had been changed to, and Jim Dixon was for it. The committee of people here were really never for it-- there was Henry Swan in surgery and Gordon Meiklejohn in medicine. Harry Gordon, of course, was for it. We had to do lots of remodeling down at Denver General Hospital. The Board of Health felt that this clinic should be the point of entry for all patients into the Denver General service situation. We knew that that would kill this home care clinic program--this home care clinic had to have the number of patients that it could take responsibil­ ity for limited. We had trouble protecting the clinic from this stand point, and in order to protect the clinic we had to help plan for a com­ plete revamping of the entire outpatient operation down there at the Den- 283 ver General. The Commonwealth Fund let us have some money to do the remodeling necessary for this general clinic to have a nest of its own, and I had to promise to get volunteer doctors to commit themselves to man this gen­ eral outpatient operation so as to protect this home care clinic, and we had a hard time keeping these fellows on the job. Fortunately we had enough residents there at the Denver General. When a resident took an appointment at the Denver General--well, at the Colorado General too--they knew that outpatient work was going to be part of their responsibility, the outpatient services in both places. Well, matters reached the point where Florio, as head man for Denver, and Darley, as the head man for the university, brought Fred Kern and Horowitz in--they weren't getting along personally, and a lot of the trouble we were in was because the one was trying to see how mad he could make the other. We just knocked their heads together right there in the meeting. We told them, "You fellows will buckle down and make this thing work, or you're going to be fired. We put a big investment in you fel­ lows, and it's certainly not going to do you any good if you leave this place with the failure of this clinic hanging over your heads. Now, you just get together!" They did, and that's the only reason it went as well as it did, but nobody's heart was ever in it, except the pediatrician who worked down there, Dr. John H. Githens who is now the Associate Dean here at the Uni­ versity of Colorado School of Medicine. His heart was really in it. Kenneth Hammond was a psychologist from Boulder who was to head the evaluation side of this home care clinic. He was interested, .and he brought in quite a crew to work up these evaluation proce- 284 dures. Kern was very much interested in the evaluation of this home care clinic, and he made some real contributions to it. Of course, this was the first time any effort had ever been made to conduct a controlled experiment in medical education. We spent a lot of the Commonwealth Fund money in taking movies of patient interviews at the Denver General and of patients because we were going to use the student reaction to what they saw in this movie as a way of evaluating their at­ titude toward patients. The idea was that the same movies would be viewed individually by an equal number of students in the program and by the same number of students in the ordinary Colorado General outpatient situation. We wound up not using the movies, as I recall, but the fact that we had done this and had had some experience with it was a big factor in George Miller's development of this same idea at the University of Buffa­ lo and later on at the University of Illinois. This now has been trans­ lated into standard procedure for part of part three of the National Board of Medical Examiners. Some of the American boards are using this proce­ dure too, and it had its beginnings here at the University of Colorado Medical School. We tried hard enough with it so that people on the fa­ culty and the evaluation team could contribute something to the further development of this procedure later, but the minute the money ran out, why, everybody was all for stopping this clinic. I had left the situation here so this report on Teaching Comprehen­ sive Medical Care [Harvard, 1959J 642 just stands as an oasis of effort in a very barren desert. I think the result was worth every cent the Commonwealth people put in it because the experience is now a very impor­ tant point of reference for people working in the field of research in medical education, and I assume you have read my forward, that I prepared 285 for the book. To me that forward is a very fair capsule of the method­ ology and what we learned from it. What about the students .•.• They were really interested--yes, they were really interested, even the students here at the Colorado General that were subjected to the same observations and so forth, and yet this experience in methodology did not really result in creating any very great interest on the part of these students in patients as people. The conclusion of the study was that the group that went through the clinic left the clinic with about the same degree of interest in continuing comprehensive care that they brought to the clinic with them. In the Colorado General control group, there was less interest in patients as people than there was when they started this period of observation; in fact, the investigators sensed some pretty strong hostility on the part of the students toward patients as people that didn't exist to that extent when they first entered the observation, or came under observation. Well, the Teaching Institute for 1959--the main conclusion of that institute was the fact that comparing graduation with entry to medical school we had entirely different people. The degree of cynicism that de­ veloped in the medical students during their four years of medical school was appreciated very keenly way back then, and we jokingly referred to the two cynical years in medical school. We talked about the first two years as the pre-clinical years, and we also referred to them as the pre­ cynical years, and you still hear this crack. Boys in White [Chicago, 1961] 486--the study that Everett C. Hughes headed up at the University of Kansas was pretty informing--well, as far 286 as a contribution to the literature is concerned it was in much the same fix that the report from here was because the faculty there at the Univer­ sity of Kansas didn't want that study done in the first place, and when it was finished, they damn well knew that they wished it hadn't been done. This situation interfered with faculty participation in the first faculty seminar that Paul J. Sanazaro and George E. Miller organized and helped to get going. The faculty were hostile to this whole operation, and the Everett Hughes experience was part of this hostility, or was partly re­ sponsible for it. Well, I gather that the home care program just subsided. What does this do to the objectives of medical education here as designed by that curri­ culum; namely general practice? Well, that had gone by the board as a conscious objective--this statement, this objective as stated never got beyond the point of window dressing. This is true of every fancy statement of objectives I know anything about that any medical school has developed. You look at the statement of objectives in the catalogue of any medical school and then look at the curriculum, and I defy anybody to show me that this statement of objectives is in the minds of the faculty as they do their teaching. The University of Kentucky might be an exception, but their beautiful statement of objectives is being lost sight of, so people tell me. Dr. Githens left here and went down there as Professor of Pediatrics. Well, he didn't like the climate, so he came back here, and he and others have told me that. This losing sight of objectives happened in Florida. It's certainly happened at Stanford with the new curriculum that was moved from San 287 Francisco to Palo Alto. You've got to build in the machinery for the evaluation of the degree of objective accomplishment, and this has to get going right at the start and be kept constantly in motion, or the faculty are going to lose sight of any statement of objectives. This is the preacher in me coming out. I just don't think there is any use in trying to change things in medical education unless you build in a method of evaluation so that you know how you're doing as you go along and you modify how you do it on the basis of honest data and information that has relevance to the effort that is being made to accomplish objectives. This is--I can't point to any school where a built in method of evaluation is any outstanding suc­ cess yet. I can point to plenty of schools that are building evaluation methods into their teaching program now. This is spreading rapidly. The demands for the kind of people who can provide leadership for these kinds of programs far exceeds the supply. George Miller is the first to deliberately set up training programs for faculty people who want to develop this kind of competence, and he's taking on--he's got quite a student body. A man from the University of Colorado is spending a year with George Miller, and he's committed to come back here and set up a division of research in medical education. Well, this is quite a commitment for this faculty to make. I don't know how it is going to go. Nobody does, but the young fel­ low who is going to show you through the medical school part is heading a three part department of which this research in education is a part. Knowing this fellow Cooper, as I'm learning to know, I think research in medical education is going to go because he's the kind of a guy who is going to see to it that things do go. Then too, there's enough unrest here among the good, younger people on the faculty, so that I think what I told you the other day is justified; namely, I think we're on the brink of another period of rapid change in this institution. How much of the difficulty that you ran into with respect to the devel­ opment of programs like this do you trace to the influx of new people grafted into this older thinking faculty that took you as a Dean? It's hard to balance, I suppose. The exciting young people we brought in are today's conservatives, if they are still here--honest. Harry Gordon left. If he had stayed on, he would have always continued to change. I say this, that the ex­ citing young people we brought in are today's conservatives, and I still respect the people I'm talking about--Dr. Theodore T. Puck, Dr. E. Stew­ art Taylor, and Dr. Gordon Meiklejohn. Dr. Henry Swan has dropped by the wayside and in basic science, physiology, Dr. Clarence A. Maaske. Dr. Cosmo G. McKenzie has done the same in Biochemistry. These are the islands of inertia now as far as change is concerned. All of these peo­ ple have become very important people in their own right, in their field of interest. Puck--if he were still teaching, I wouldn't worry about him, but he's handled the situation by withdrawing from teaching. Now Meiklejohn--when I first came back after my work with the AAMC I thought it wasn't fair to people, like to Meiklejohn, not to know what my interests were without my bringing them together and telling them what they were because I hadn't--I don't think I'd moved in here yet. I know I hadn't. I wasn't going to move in if there was overt evidence of objec- tion to my coming back because the old man of the mountain is coming back on the mountain again. That's pretty dangerous doings, and I have done 289 my best to keep out of things. I had this meeting, and Meiklejohn was the main one I was concerned !,! I I I' I about because he's the Professor of Medicine, and I'm in his department. I He told me at the end--he said, "Ward, I'm not interested"--well, maybe I that isn't quite fair. He said, "The way this medical center is set up, the sort of things you're talking about can't be done here. Part of it is because we don't have access to the right kind of teaching material, but also part of it is because the faculty just won't be interested." I had another big session with Meiklejohn after the papers with Anne R. Somers came out, and we talked about a couple of hours. I wanted him to know some of the things I was doing, and he said, "Well, I'm beginning to realize that medical education has got to do something about this pro- blem of continuing comprehensive care. I'm beginning to realize that part . I of the education of professional people for this kind of care is going to 11. have to take place in the community setting in which the care is going to Ii I' be given. I think you and I can get together on a residency where I'd I have these people for the first year, and then they'd go out to a commun­ ity hospital for a year and then come back to me for the final year." Well, that would turn out people that are a lot better qualified for continuing comprehensive care than any we're turning out now, and I fully anticipate that under the regional medical program influence, plus the head of steam this movement is beginning to get over the nation, and it's really getting up a head of steam, it isn't going to be long until medi­ cal students will be assigned to community hospitals for a significantly long clerkship so that they can soak up some of this experience in com- munity oriented continuing comprehensive care. If this kind of clerkship is going to be successful, it will mean 290 that the medical students will have to be assigned to a member of the staff who will serve as a preceptor so medical students are getting con­ tinuity of supervision as well as continuity of experience with patients. I think this will mean bringing the preceptors into the Medical Center so that they will know what is expected of them and what their job is. They are going to know that evaluation of educational effort is going to be built into this program which will mean an evaluation of them. This is all going to come, and the way for the community hospitals to get started for this day is to begin to get ready now, and that's why I said what I did in the John C. Leonard Memorial Address, "The Continuing Edu­ cation of the Physician 'Lets You Do This"', a month ago in Chicago. How much of a roadblock to the development of this approach is the heavy emphasis--for ten years--on research? It's a real roadblock--a real roadblock. Now look .... Let me turn this over. Research is a terrific roadblock. Here's an institution, this one, and the total budget last year in just round figures was eight million dollars. Five million of this was represented by research grants. That means that this three million that wasn't going into research was still making a big dollar contribution to the five million of research that was being done. Now, let's jump from this institution to a place where the clinical faculty are pretty largely what we call geographic full time. They were geographic full time before these research funds became available so there was a roadblock to good teaching there. This geographic full time busi- 291 ness meant that these faculty people were more interested in taking care of private patients and supervising the residents as the residents helped take care of these private patients than they were in teaching medical students, and these medical students by and large--their educational ex­ perience did not involve exposure to private patients to amount to any­ thing. They were still getting their responsible patient experience on the charity wards supervised by the residents and minor faculty people, so in those institutions where geographic full time still persists, and research has been added to that, the medical student is getting short­ changed worse than ever. There are a lot of people screaming about this situation, and I think the time has come that the medical, clinical faculty should be ab­ solute full time, on strict salary, like they are here at the University of Colorado where the university is collecting the professional fees and using the fees to help support the teaching program, the clinical teach­ ing program. This is called the corporate practice of medicine, of course, in lots of states, and I say such laws should be changed. I don't think we have any. The changing of the Colorado General Law would have in­ volved changing some other statutes, and I know that wasn't necessary when we changed the Colorado General Law. Now then, if the Medical Center is going to be centralized and begin to get out into the communities and use the communities as frameworks within which teaching takes place, this is more reason than ever for the fulltime faculty to be full time. It's more reason than ever for the ad- ministration of the Medical Center of the university to build program cost accounting into its operation as an administrative tool so that it knows how many dollars are going into research and how much faculty effort 292 is going into research. It must know this so that there can be a reason­ able balance between the three major activities that have to go on in the medical center; namely, education, research and patient care. Sure there should be a lot of research, but research shouldn't be it all. Here we're in a situation where twenty-five, maybe thirty percent of our faculties are full time on federal research grants, and the condi­ tions under which the grants are given forbid that faculty person to do any teaching of medical students. The only teaching they can do is teaching in research. They can teach some graduate students and research fellows. That's all right. That's why faculty/student ratios don't mean a doggone thing, and yet you hear this all the time--this school being compared with that school from the standpoint of student/faculty ratio and the ratio, if it's going to be made meaningful, has to be based on the relationship of the actual amount of teaching as related to the stu­ dents who are being taught. You can't dig this out without doing pro­ gram cost accounting, and faculties are objecting to this because it means coming across once a month with a time and effort report where they account for all of their time and effort. This interferes with academic freedom. This last paper of Carroll's and myself published a year ago in Jan­ uary, or February, ["Medical College Costs" 42 Journal of Medical Edu­ cation l - 16 (January, 1967)J, at the end of that paper we discussed this question of academic freedom and tried to make a case for accounting for time and effort as a part of academic responsibility. You can't do this without faculty cooperation. Well, if the faculty are going to coop­ erate, sure they're entitled to see the results of the cooperation and 293 sit in on the discussion of what these results mean. This would make a better faculty out of them anyhow, so research has got to be kept in the picture, but, more importantly for my money, we've got to develop research in education, research in patient care and its effectiveness, and research in the efficiency of the delivery of patient care service. Here's an area of research for the guy that isn't interested in lab­ oratory research. The guy that just wants to teach complains because he can't get his promotion and salary raises because he isn't involved in research, and this is true. Well, here's a guy that ought to be doing research in education, and this kind of research should have the same status as any other kind of research. This day is corning. There's plenty going to begin to happen, if we can keep out of a big war, or a holocaust that is going to wreck things like this. The other war did just that. If it hadn't been for World War II, all of this would have happened because enough islands of innovation were sufficiently underway before the war so that if the war hadn't taken place, I'm confident that in medical education we'd be miles ahead of where we are today. Now the thing that got all the emphasis after the war was research, and this has delayed progress, the kind of progress we need if medicine is going to reach the ultimate as far as its effective­ ness is concerned because the big pay-off in the future effectiveness of medicine is going to be because the professionals are going to be effec­ tive in the areas of preventive medicine, health protection, and the con­ tinuing care of illness so that the guy with a chronic disability isn't going to be cut so short. You can spend millions of dollars on heart transplant research, and maybe we will ultimately help a hundredth of one percent of our 294 population, but if we'd spend that same amount of money, or even a tenth of that amount of money, in the direction of developing professionals that are going to be concerned with preventive medicine and health protec­ tion, continuing care of people as they live and work in their grass roots communities, then we're going to have a change in our morbidity and our mortality rates, or at least a shift of the mortality rate in the right direction. This heart transplant business, as far as our overall vital statistics is concerned, isn't going to have any effect at all, any appre­ ciable effect, I don't think. There is a certain pyrotechnical display to it. Oh yes. Didn't we enact--1946--a Hospital Survey and Construction Act? What did this do in Colorado? That was great. I was on the original council that was required by law before Colorado could get any of this money. I wrote the plan, and it was a good plan, and again we weren't able to activate it because it meant a lot of these little towns getting together and sharing in a hospi- tal that would be centrally located. I've got a good story in connection with that plan, but at any rate we began to improve our hospital facil­ ities. This is just one of the things that the government did that went just part of the way, that in the long run gave added visibility to the inade­ quacy of our system of patient care. We began to build up these facili­ ties, and patients as a consequence of Blue Cross came along and hospital utilization just went up like that. The patients got better care, and 295 there was more demand for care. Anything that increases the demand for care increases the need for doctors and nurses. The government didn't lift its hand to help us increase the number of doctors, or strengthen our system of physician education. We tried-­ the schools did, Mike Gorman and some other people notwithstanding, and we pretty near made it. We would have made it back in 1947, or 1948 if the American Medical Association hadn't all of a sudden moved in on us in the House of Representatives. We got through the Senate almost the same bill that was put through in the Health Education Assistance Act of 1963, and if things could have begun to get going back there in 1948-­ you see, it takes fifteen years before a doctor is really a sophisticated performer--we'd just be having the increase in the number of the kind of people we need now. Then the next thing was the support of research which increased medi­ cine's effectiveness, and demand again skyrocketed, but still nothing was done to strengthen the schools, or strengthen education, or help the schools increase their enrollments and then came 1963, and the passage of the Health Education Assistance Act, but did they provide any money? No. It took two years before they made an appropriation, and in the mean­ time Luther Terry, the Surgeon General, had spent some money tooling up to get ready to dispense funds. He set up his council. He wrote the rules and the regulations. Do you know that the people in the Congress when they passed the appropriations gave Luther Terry hell for jumping the gun. That shows how interested the Congress was in all of this pro­ blem. At the White House Conference on Health, if you went through that material, you'll see a little exchange between Mike Gorman and myself 296 on this-well, I didn't put in a lot of the stuff Mike said because the recording equipment wasn't working and--well, there just was no point in making too much of this part of the record. He wasn't very disciplined. At that meeting he had Senator Maurine Neuberger sitting behind him. Gorman is one of these chest pounders, as far as I'm concerned, so he got up and said, "The Congress isn't getting its due credit for exer­ cising vision in strengthening our medical schools", and then he went on to laud Congress for this Health Professions Education Assistance Act. He didn't quit there. He said, "If it hadn't been for the objection on the part of the medical schools and the AMA, this legislation would have been passed long ago. I remember a committee meeting years ago set up by Mrs. Lasker and you, Dr. Darley, were there. You had an opportunity to stand up and be counted on this question." I was with Mrs. Lasker frequently in committee meetings, but I don't remember anything like this ever coming up in any meeting she attended, and it would have been my word against his and hers. There was no point in getting down to his level and saying that no such committee ever met. I do remember sitting with Mrs. Lasker on this Ford Foundation Com­ mittee that was to help dish out this ninety million dollars to the medi­ cal schools, and I spent a summer helping with the staff work getting ready for that first meeting. They wanted me to come in with a review of the innovations that were going on in medical education with the idea that the schools that were willing to innovate would get the bigger grants so I came in with this review. I had a blackboard. I put a lot of stuff on the blackboard showing a big table, and I'd given this kind of innova- 297 tion a weight of four and a less significant kind of innovation a weight of one. I had the schools lined up, but I put the weaker schools at the top, the schools with the less innovation, and the schools with the most innovation I put at the bottom. I made a plea for the bigger grants going to the weaker schools. The Chairman of the committee was the President of California Tech whose name escapes me right now. [Dr. Lee DuBridgeJ He was furious. He said, "Do you mean to tell me that you expect the Ford Foundation to put ninety million dollars into the kind of rat holes you're suggesting?" Then one committee person after another joined in until they got down to Mr. Woodward, the head of this fou nda ti□ n in Georgia that "Beau" Jones is President of, and he said, "I think this is a good idea." Franklin Murphy, the Chancellor then at the University of Kansas, he thought it was a good idea. That was the only meeting I ever attended, but anyhow, the committee was so split over this question that they never came up with a set of committee recommendations to the Board of Trustees of the Ford Foundation. The Ford Foundation Trustees had to settle this question themselves. Maybe in this book of material you saw the letter that Henry Heald sent. He put out a letter to every committee member saying that since the committee was unable to agree on a set of recommendations he would appreciate hearing from each committee member by letter so that he could take these letters and perhaps develop a set of staff recommendations for the board. One of the best letters I ever wrote~ I think, is the letter I wrote on this occasion. I'm sure--well, nobody told me. Yes, sure-­ Dr. Jacobson whom the Ford Foundation got to .head the staff work told me that the weaker medical schools got half a mil~ion dollars, or so that 298 they would not have gotten otherwise. Carlyle Jacobson? Yes. A tough boy. Albany? Syracuse? He was in charge of both the development--well, when New York State took over Long Island Medical College and Syracuse, he was in charge of both developments. He's a smart one. A tough boy--he worked with Yerkes and the chimpanzee. He's the one who really developed the medical college admissions test when he was Assis~ant Dean at Washington University. You know--I gather that the •.•. We sure have been digressing this morning. I want to try to pull it back to the time when you were Dean here and subsequently when you were Vice-President in charge of Medical Affairs. We changed the title every few months. It was quite a joke. In fact, when we took the name Medical Center and made the announcement there was a scream from downtown. You went on a trip with Dr. Lyon~. That's what I thought this was a summary of when it was really a report of this conference. What about John Lyon$? 299 He was a Professor of Psychiatry. His and my interests in patient care were identical. We officed together. He was a young fellow who was I in charge of what we call the Psychiatric Liaison Department. Ebaugh got I this thing set up before I came out here, I guess. It was set up before the war, and Dr. Edward G. Billings was brought in to head it up. Now this was a psychiatric service for the general wards of the hospital, Colorado General Hospital, and it was intended that Dr. Billings would take the residents on, the fellows at the psychopathic hospital, for a year and he would also keep the medical students, interns, and residents in medicine at least under his wing with the idea that everybody would learn an every day kind of psychiatry, or the kind of psychiatry that could be used in everyday practice. That was what he was for, and Ed did a terrific job of setting this up. Then he went to war, Dr. Lyon! took his place, and had just finished his fellowship with Dr. Ebaugh. Both of these fellows, Billings and Lyonf, were superb teachers particu­ larly where a patient's problem was being used as a point of reference to teaching. In consequence Lyon, was a big help in conceptualizing this general care idea. This trip that he and I took was made at the suggestion of the Commonwealth Fund, and the Commonwealth Fund provided the money. They just wanted us to see what--admittedly there wasn't very much, but they wanted us to see what was being done that could be considered in line with our interests, and they also wanted us to go to one or two places where this general home care was still a gleam in people's eyes. Well, we spent most of our time in Maryland because the legislature there had sort of passed a Title 19 type of legislation, and the University of Maryland contracted with the state to set up a service just similar to 300 these OED arrangements that are being made with medical schools now. We spent a lot of time at the Medical College of Virginia. Virginia had established a similar service, and there is a report of that trip in this volume some place. Neither Lyonj nor I felt that we got an awful lot out of this trip. We took two weeks for the job; in fact, John Lyons let me finish up alone. I've forgotten where I went. We were in New York. Cornell had actually started a clinic similar to this, or had just gotten a grant. I think Cornell's grant preceded ours--I'm not sure, and we met a couple of times with the Cornell staff to talk about evaluation-­ how under the sun could we decide whether what we were doing was worth doing? The student physician by George Reader [Comprehensive Medical Care and Teaching: A Report on the New York Hospital-Cornell Medical Center Program (Ithaca, Cornell U. Press, 1967) 391] was the only book I know of that came out of the Cornell effort. Columbia's Institute of Behav­ ioral Science [Bureau of Applied Social Research] took on some of that evaluation and how much of that was published I don't know. Some of it was, I know. Robert K. Merton et al did some publishing. The sociological approach to evaluation is a very ponderous procedure because the approach is to go in depth and involve a small sample as a consequence. Approach here was from the psychologist's standpoint which was a broader approach, more shallow, but with the idea of getting enough data so that we could come out with something that would stand statisti­ cal analysis, and in this Colorado report you saw a lot of tables and things. Really that was one criticism that people had of the report, the sample was still too small to permit statistical analysis. The reason I brought up John Lyon' was the fact that the home care program, if it involved anvthinq, involved the environment too. 301 John didn't go down to the clinic. He didn't play a big role in its development at Denver General. He went into private practice--gee, this upset me, to lose him. He went into private practice pretty early in the game, and Ewald W. Busse took his place. Well, this was our gang really because Ewald was a real--Lyons was doctor, not an investigator, and he for my money is the best practicing psychiatrist this community has ever had with all due respect to everybody else. He was the most ef­ fective psychiatrist, I think, that I had anything to do with. He was more effective than my man Barnacle, and my man Barnacle was good. Now, Ewald Busse was a studious type, and he did a terrific job with this psychiatric service, and then we lost him because he left to head the department down at Duke. I wanted to make him--after Ebaugh resigned-- I wanted Busse to get that appointment, but the faculty wouldn't go along with it, and it took some doing, but that's when we got hold of Dr. Her­ bert S. Gaskill. I never grieved about this because Gaskill brought in a powerhouse with him. Dr. John J. Conger was one of them and boy, he really made things--he just changed things. Gaskill brought the analytical component in. His was an analyti­ cally oriented department, and of course Ebaugh's department wasn't. Bud Busse took analysis while he was here. We didn't bring him in. There was an analyst that settled here, and we made a deal with her to give our residents training in analysis, and Bud probably was the first one she took on. Ebaugh had brought Dr. Jules V. Coleman in here who was an anal­ yst, and Jules started the Children's Mental Hygiene Clinic. Cotter Hirschberg was one of our fellows, and he went into this with Jules, car­ ried it on after Jules left, and then he went on to Menninger's to head the Mental Hygiene Unit down there. These are the kind of high powered 302 people Ebaugh turned out--you see. Busse going down to Duke is the best thing that ever happened to him and Duke, and it was a terrific thing for psychiatry in general because he started this geriatric program study down there picking up people when they were fifty-five, or sixty and really doing for them from then on out what our Child Research Council was trying to do from birth on out. This deal of Busse's has gotten good support, has gone along in good shape and is still going. He has a terrific department down there. Did Ebaugh come into the home care program? No, he didn't. We got a fulltime psychiatrist down there, a woman and I forget her name. She had had her fellowship out here, and she was pretty good. A woman in that job down there had two strikes on her to start with--Emma M. Kent was her name, and she tried. She was all for it, and she did all right. It was more than she could do. We put in a closed ward down there. [Telephone interruptionJ I'm sorry to have to cut today short. I'm getting a little tired a little earlier chiefly because--well, last night I had to go over some NIMP, and it kept me up late. In the night I woke up, and I had another traumatic blow the day before yesterday. One of my best friends who took over the presidency of the Chicago Medical College--he took it because of the commitment to this thing that we're talking about of the total col­ lege set up including the teaching hospital. He's had some kind of a men­ tal break and has been relieved of his responsibilities for three months. I don't know what that means. He's paranoid along with it so that he's mad at everybody. I got to thinking about him. It's silly to be so vul­ nerable to insomnia. 303 A friend's a friend. You have a luncheon date today. Why don't you go, and I'll see you tomorrow. You stay here if you want--pull that door shut. The little girl will be here at one, or one-thirty. I'm going to come back after lunch. You're coming back after lunch? Yes, I've got to. We've got to get some things in the mail today. I'll work over at the other room--I've got all of that material, and I think tomorrow, if it's all right .•.• I can work as long as you want tomorrow, I'm sure, provided I can sleep in Sunday morning. I'll give you Sunday in return for tomorrow. You may want to take this book with you, and you can leave it over there; in fact, I can bring all that stuff from home over here if you want it. When it comes to the point where you want to browse the things that I have at home, I have a nice desk and set up in the basement where most of this stuff would be; in fact, there's a good bed down there-­ you can just sleep down there if you want to work late in the evenings, and there's a separate thermostat for heat control down there so you can have it as warm as you want it. It's dry and comfortable. I would like to browse. I don't have any reason why I can't stay with you until I get tired enough to quit at least. That's tomorrow. 304 INDEX TO VOLUME I Academic freedom 292, 293 Air Force Academy 77 Alamosa, Colorado 2 Albert Einstein College of Medi­ 105,234 cine of Yeshiva University ALDRICH, ROBERT A 225 ALEXANDER, HARRY L 210 American Association of Medical 104, 112, 113, 116, 229, 262, 263, 280 Colleges AAMC Executive Council 11 2 American Cancer Society 238 American Clinical and Climatolo­ 230 gical Association American College of Physicians 159, 168, 204, 208, 209, 210, 230 American Dental Association 251 Council on Dental Education American Hospital Association 262, 264 American Medical Association 103, 104, 110, 182, 183, 212, 214, 262, 264, 295 American Medical Association 114, 115 Council AMA Council on Medical Education 11 7 Anatomy 28, 120, 121, 122, 123, 126, 134, 138, 1 54 Anesthesiology 1 31 Annals of Internal Medicine 181, 198 AntiSemitism 276, 277 Antonito, Colorado 9 305 Armed Services 220, 221 , 242 ARNDT, RUDOLPH W 140, 149 Arthritis 8, 12, 52, 65, 66, 145, 1 88 Atomic Energy Commission 238 Autogenous vaccine 171 , 172, 178 Autopsies 120, 135, 1 36 AWTRAY, HUGH H 161 BACHMEYER, ARTHUR C 216 Bacteriology 61 , 1 32, 1 34 BALFOUR, DAVID 1 71 BARKER, ww 156 BARNES, KATHERINE 219 BARNACLE, CLARKE H 1 91 , 1 93, 194, 195, 196, 301 EARNEY, JOHN M 14 7, 148 BARR, DAVID P 1 59, 210 Baylor University 162 BEADLE, GEORGE W 238 BECKER, FREDERICK E 135 BEEBE, KENNETH H 161 BENJAMIN, JOHN D 232, 233 BENNETT, RICHMOND E 1 61 BILLINGS, EDWARD G 299 BILLINGS, FRANK 1 82 Billings Hospital, Chicago 216 Biochemistry 1 22, 1 23, 1 26, 1 74 Biology 29, 43, 44 Biophysics 238, 239, 240, 241 BLAND, EDWARD F 160 "Blanket syndrome" 55 Blood bank 90 Blue Cross 294 Board of Regents, University of 26, 35, 71, 86, 92, 97, 98, 99, 101, 102, Colorado 118, 242, 243, 247, 248, 250, 252, 259, 261, 262, 266, 267, 278, 279 Board of Regents, University of 11 6 New Mexico Boettcher Foundation 238 BOLLES, ALDEN 17 BOLLES, JEANNETTE 17 BONFILS, FRED G 67, 68 Botany 31, 44, 132 Boulder, Colorado 7, 8, 12, 25, 27, 28, 33, 35, 43, 45, 46, 56, 63, 65, 77, 84, 93, 105, 114, 122, 124, 141, 151, 165, 174, 175, 176, 200, 221, 234, 236, 245, 258 Boys in White [(Chicago, 1969) 285 486] BRADLEY, GENERAL OMAR 70 BRAIDEN, WADE GRAHAM 39 BRAIDEN, WILLIAM A 2, B' 9, 39, 40, 41, 42, 178 BROWN, AMY 20, 27 BROWN, W RUSSELL 153 Brucellosis 207, 208, 275 BRUNQUIST, ERNEST H 127, 128, 131 , 1 32 BUCHANNAN, ARCHIBALD R 228, 234, 253 BUCK, GEORGE R 107 Bureau of Applied Sociel Re­ 300 search Columbia University 307 BURNETT, CLOUGH T 141, 142, 149, 157, 161, 163, 222, 223 BURRAGE, SEVERANCE 1 34, 1 3 5 BURROWS, LESLIE 251 BUSSE, EWALD W 301 , 302 CANN, JOHN R 239 Cardiac irregularity 66 Cardiology 75, 76, 141 CARMODY, THOMAS E 223 CARROLL, AUGUSTUS J 262, 263, 264, 292 Cattle business 39 - 43 Chemistry 29, 43, 44, 122, 123 Chicken pox 190 Child Research Council 222, 223, 224, 225, 226, 227, 228, 231, 232, 302 Children's Hospital, Denver 22, 73, 74, 75, 92, 260 Children's Mental Hygiene Clinic 301 CHDUKE, KEHAR S 121, 122, 123, 124 Civil Service Commission 78 Clerkship in tuberculosis 88 Clerkships 157, 158, 271, 289 Clinical pathology 136, 137 Clinical teaching 87, 138, 148 CDCKERALL, THEODORE DA 31 COGGESHALL, LOWELL T 147 COHEN, JOSEPH 34, 35 COLEMAN, JULES V 301 Colorado College 10 308 Colorado Dental Education 249, 250, 251 Colorado General Hospital 73, 83, 84, 85, 90, 91, 92, 93, 94, 95 96, 97, 100, 101, 104, 151, 190, 212 219, 233, 244, 252, 267, 271, 272, 275, 283, 284, 285, 299 Colorado Heart Association 77 Colorado Homestead 3, 5, 6, 9, 22 Colorado Medical Societies 101, 102, 103, 104, 105, 106, 110, 111, 113, 114, 115, 118, 207, 267, 273, 275, 276, 277 Colorado Medicine 214 Colorado State Board of Health 72, 78, 79, 106, 192, 193 Colorado State Historical Society 12, 16 Colorado State Legislature 8, 9, 63, 85, 86, 90, 91, 92, 93, 95, 96, 100, 101, 102, 242, 243, 244, 245, 250, 251 Colorado State University 42 Colorado Tuberculosis Society 95 Columbia University 103 Committee on Economic Security 215 Committee on the Cost of Medical 212, 214 Care Commonwealth Fund 72, 109, 192, 223, 225, 255, 256, 257, 279, 280, 281, 283, 284, 299 Community hospitals 289, 290 Community internship 111 Community Mental Health Clinics 105 Comprehensive Care Clinic 109, 270, 280, 282, 283, 284, 285, 289 Comprehensive Medical Care and 300 Teaching: A Report on the New York Hos ital-Cornell Medical Center Program (Ithaca, Cor­ nell University Press, 1967) 391] 309 Comprehensive oral examination 1 39 Conejos County 4, 6 Congenital heart conditions 76 CONGER, JOHN J 252, 253, 301 Consortium of Medical Schools 154 [Idaho, Wyoming, Montana & Nevada] Consulting practice 1 98, 1 99 Continuing comprehensive care 147 Continuing education 280 COOK, ROBERT 160 COOPER, CLYDE J 142, 1 61 , 164 Country Gentleman 24 Creede, Colorado 2 CUNNINGHAM, THOMAS D 149, 223 DANIELSON, RALPH W 180, 181 DARLEY, ALEXANDER 1 , 4 , 19 DARLEY, ELLIS F 14, 24 DARLEY, EMMA JEAN ELLIS 11 DARLEY, GEORGE MARSHALL 1, 2, 11, 37 DARLEY, GEORGE SINCLAIR 2, 1 0 DARLEY, MARY BOLLES 13, 14, 15, 16, 17, 36, 37, 45, 53, 57, 65 DARLEY, PAULINE BRAIDEN 29, 30, 35, 39, 41, 46, 51, 131, 160, 169, 178,255 DARLEY, WARD (father) 3, 4, 13, 15, 16, 18, 23, 37, 42, 53, 57, 58 DARLEY, WILLIAM EARL 1 3, 1 6, 24 DARLEY, WILLIAM MARSHALL 10, 1 2, 1 5, 1 6, 23 310 DARLEY "Brucella sensitization: 208 an attempt to evaluate its clinical significance" [16 Proceedings, Central Society for Clinical Research 68-69 (1943)j DARLEY "Latent brucellosis: its 208 importance in association with Joint, muscle, and nerve pain" L115 JAMA 2115-2116 Part 2 (1940)j DARLEY "Medical education: a 147 proposal for interstate plan- ning and programming" [March 26, 1968j DARLEY "Medical education and 230 the potential of the student to learn" [29 Journal of Medical Education 11-19 (February, 1954)] DARLEY "Old age as a physiolo- 205, 206 gical state"; GORDON "The medical care of the aged"; MAST "Surgery in the aged" [35 Rocky Mountain Medical Journal 456-465 (June, 1938)] DARLEY "The professional re- 215 sponsibility of the physician" [174 JAMA 878-881 (October 15, 1960T} DARLEY "University of Colorado 79 Medical Center, 1925-2000" [University of Colorado School of Medicine 1-4 (Summer, 196 DARLEY and DOAN "Primary pulmon- 167 ary arteriosclerosis with poly­ cythemia" [191 American Jour- nal of Medical Science 633 (May, 1936)J DARLEY and GORDON "Brucella sen- 208 sitization: a clinical eval­ uation" [26 Annals Internal Medicine 528-541 (April, J 194 7) "1111111 .JII DARLEY and KAUVAR "Emphysema and 206 chronic bronchitis in the aged" [4 Clinics 1143-1154 (Febru- ary, 1946)] DARLEY and WHITEHEAD "A case of 167 diabetes insipidus occurring as a sequel to epidemic en­ cephalitis" [15 Endocrinolojy 286-296 (July-August, 1931) DARLEY and WHITEHEAD "Studies on 181 a urinary protease. II. Skin reactions and therapeutic ap­ plications in hay fever" [6 Annals of Internal Medicine 389-399 (September, 1932)] DEAN, EDWARD F 1 51 , 271 Debating 32, 33 Decentralization of clinic care 146 Del Norte, Colorado 1, 2 Delta, Colorado 3 DeMolay 21 , 32, 35, 36, 1 70 DENHOLM, ROBERT 95 Dental School Committee 251 Denver and Gross Medical College 130, 131 Denver Board of Health 109, 11 0, 11 5, 234, 282 Denver Chamber of Commerce 71 , 77, 276 Denver Clinic 201 , 202 Denver Clinical and Pathologi­ 11 8, 137, 1 89 cal Society Denver Country Club 233 Denver General Hospital 74, 87, 92, 108, 109, 110, 111, 146, 169, 190, 234, 267, 268, 270, 271, 272, 273, 274, 275, 277, 282, 283, 284, 301 Denver Museum of Natural History 132 Denver "Opportunity School" 7, 87 312 Denver Post 67, 96, 175 Denver Presbyterian Hospital 204 Denver Public Library 34 Denver University 130, 174, 259 Denver University Law School 3 Denver YMCA 152 Department of Anatomy 98 Department of Bacteriology 141 Department of Child Health and 224, 226 Development Department of Clinical Pathology 82 Department of Pediatrics 74 Desert claim 4 DICKMAN, PAUL A 162 DI NKEN, HAROLD 276 Division of General Practice 269, 270 DIXON, JAMES P 108, 109, 274, 282 DRAPER, WILLIAM B 83, 131, 139 DRAPER, DARLEY and HARVEY "The 166, 167 effect of pituitary extract upon the tonus of the human pelvis and ureter and its pos­ sible application in the ther­ apeutics of pyelitis and re­ lated conditions" [26 Jour­ nal of Urology 1-11 (July, 1931)] Drug therapy 130, 153 DUER IDGE, LEE 297 Duke University 301, 302 DYDE, JAMES F 221 313 EBAUGH, FRANKLIN G 99, 104, 105, 125, 150, 193, 194, 230, 232, 299, 301, 302 ELLIOTT, CHESTER 135 Embryology 138 Eminent domain 71 Emphysema 139, 192 Entomology 31 Estes Park, Colorado 33, 55, 113, 116, 201 EVANS, LESTER 214, 279, 280, 281 "Faculty salary account" 98, 99, 100, 125 Fairmount Cemetery 79, 80 Family background 1 - 24 Farm gate business 5, 6, 8 FELIX, ROBERT H 162, 17 □, 171 Fever cabinet 149 FINLAY, ANDREW G 161 FINNOFF, WILLIAM C 143 First Avenue Presbyterian 12 Church, Denver FISHBEIN, MORRIS 183 Fitzsimmons General Hospital 112, 193 Flagstaff, Arizona 5 FLEXNER, ABRAHAM, Medical Edu­ 120, 130, 275 cation in the United States and Canada, a report to the Carnegie Foundation for the Advancement of Teaching [(New York, 1910) 346] FLORIO, LLOYD J 108, 274, 282, 283 314 Ford Foundation Committee 296, 297 Forest Service 10 Fort Collins, Colorado 14, 39, 191 Fort Logan 217 Fort Morgan, Colorado 12 Fraternity discrimination, Uni­ 35 - 36 versity of Colorado FREEMAN, LEONARD 151 Fulltime faculty 25, 98, 99, 100, 102, 104, 105, 109, 118, 158, 177, 233, 243, 245, 246, 273, 277, 291 GARDNER, JOHN 254 GARDNER, WRAY R 162 GASKILL, HERBERT S 301 General practice 268, 269, 280 General Rose Memorial Hospital 72 Genetics 31, 238 GENGENBACH, FRANK P 22, 31, 43, 55, 156 Geographic fulltime 290, 291 G.I. Bill of Rights 245 GILLASPIE, CARBON 151 GITHENS, JOHN H 283, 286 GOLDING, FRANK C 162 GOODMAN, SAMUEL 161 GORDON, HARRY H 105, 106, 276, 281, 288 I I, GORDON, ROBERT W 136, 190, 191, 192, 194, 198, 205, 209, 210 GORMAN, MIKE 295, 296 315 Grace New Haven Hospital 262, 263 GRAHAM, EVARTS A 210 Greeley, Colorado 3, 14, 17, 36 GRIFFITH, EMILY 7 Gross anatomy 61 GUSTAVSON, RUEBEN G 137, 138, 174, 224, 259, 278 Guy's Hospital 1 81 , 208 HALL, IVAN C 1 32, 133, 134, 1 65 Halophagia 167, 1 68 HAMIL, DAVID A 243 HAMMOND, KENNETH 283 HAWLEY, GENERAL PAUL 70 HEALD, HENRY 297 Health Education Assistance 295 Act of 1963 Heart block 66 HEFFRON, RODERICK 279, 280 HILDEBRAND, PAUL R 162, 171 HINSEY, JOSEPH C 216 HIRSCHBERG, COTTER 301 History taking 158 Home care clinic program 281 , 282, 283, 286, 299, 300 Home deliveries 81 , 155, 156 HICKEY, HOWARD L 1 52 HILL, ROBERT M 122, 1 23, 131 Homestead 4,5,6,9,22,64 HOROWITZ, JACOB 282, 283 - j_Lb j,II' Hospital Survey and Construction 294 Act HOUSTON, WILLIAM 39, 53 HUGHES, EVERETT C 285, 286 Human histology 138 INGRAHAM, CLARENCE E 155 Internships 60, 61, 110, 125, 126, 142, 143, 144, 148, 155, 156, 157, 159, 164, 165, 169 Intravenous metrazol 194 Irrigation district 4, 5, 6, 13 IVY, ANDREW C 163 JACKSON, EDWARD 143 JACOBSON, CARLYLE 297 JAFFA, EETRAM E 271 JENSEN, FRDDE 108, 110, 111, 112, 113, 256, 269 Johns Hopkins 82, 120 JOHNSON, WILLIAM C 135, 136 Joint Committee for the Study 255, 274 of Medical Care of the Indi- gent, Denver JONES, E □ ISFEUILLET 297 JONES, T DUCKETT 160 JOSLIN, ELLIOTT P 209 Journal of Medical Education 112 KAUVAR, SOLOMONS 108, 272, 273, 274, 277 317 Kellogg Foundation 1 08, 250 KEMPE, C HENRY 74, 75 KEMPER, CONSTANTINE F 15 7, 1 60, 1 61 , 1 64, 1 71 KENT, EMMA M 302 KERN, FRED 282, 283, 284 KINGERY, HUGH M 138, 1 39, 1 53 KLEINER, MOSES 129, 130 LAFF, HERMAN I 277 Lake City, Colorado 2 Laramie, Wyoming 7, 8 LASKER, MARY 296 LEIN, ARNOLD J 32, 33, 34 "Lembcke Study" 255, 274, 275 LEVY, ROBERT 143, 157, 277 LEWIS, ROBERT C 122, 1 23, 1 24, 125, 1 26, 1 31 , 1 35, 234 LICHTY, JOHN A 78 LIGGETT, ROBERT s 11 2 LINDBERGH, GENE 1 75 Literary Digest 34 Ludlow Massacre 58, 59 LY □ Nj, JOHN 298, 300, 301 MCCAMMON, ROBERT 225, 226 MCKENZIE, COSMO G 288 MCNAUGHT, JAMES B 273, 274 MCNICHOLS, STEVE 96, 97 It 318 MAASKE, CLARENCE A 288 Machinist 5, 7, 8 MAGNUSON, PAUL 217 Manager of Health and Charities, 108, 271, 273, 274, 282 Denver MANLOVE, FRANCIS R 101 Marasmic children 22 MARESH, DODGE, and LICHTY "In­ 77 cidence of heart disease among Colorado school children: a statewide study" [149 JAMA 802-805 (June 28, 1952)j MASON, LYMAN W 143 Masonic order 21, 36 MAST WILLIAM H 160, 161, 169, 171, 206, 207 Mayo Clinic 66, 151, 160, 171, 191 MEADER, CHARLES N 21, 51, 52, 140, 148, 149, 164, 169, 171, 178, 186, 218 Mechanical drawing 37, 38 Medical College of Virginia 300 Medical School Curriculum 125, 126, 137, 154, 222, 223, 224, 225, 227, 228, 229, 230, 231 - 235 Medicine 37, 38, 39, 138 - 142, 144 - 149 Medicine as human biology 224, 234 MEIKLEJOHN, GORDON 282, 288, 289 Meningitis epidemic 156 Mental Retardation Center 69, 70 Mercy Hospital, Denver 204 MERTON, ROBERT K 300 Methodist Community Church 24 319 METZGER, Attorney General (Colo- 248 rad □) Microscopic anatomy 138 MILLER, GEORGE E 284, 287 MOLEEN, GEORGE A 1 52 Monte Vista, Colorado 3, 4, 6, 12, 20 Montgomery Ward Catalogue 64 Mount Airy Sanitarium 105 Mountaineering 67 MUGRAGE, EDWARD R 1 36, 137, 138, 144 Mumps 1 89 MURPHY, FRANKLIN 297 MURPHY, REX L 143 National Board Examinations 60, 61 , 284 National Cancer Association 238 National Cash Register 95 National Foundation 92, 241 National Health Assembly 216 National Institute of Child 225 Health and Development National Institutes of Health 226, 237, 250 National Intern Matching Program 11 0, 302 National Jewish Hospital, Denver 87, 89, 90 National Science Foundation 43 NEUBERGER, SENATOR MAURINE 296 Neuroanatomy 1 53 Neurology 1 52, 153 320 Neurophysiology 1 53 NEWTON, QUIGG 72, 108, 1 09, 271 NORLIN, GEORGE 30, 258 Norlin Library at Boulder 1 2, 34 North Denver High School 7, 29 Objectives 286, 287 Obstetrics 155 Deharo, Colorado 3 DDLUM, FLOYD 258 Office of Economic Opportunity 146, 147, 300 Program OLSEN, MABEL D 137 Ophthalmology 143, 161, 162 Osteology 122, 126, 127 Dtolaryngology 143, 161 Ouray, Colorado 2 Outpatient Department, Colorado 144, 145, 146, 152, 165, 166, 221 General Hospital PACKARD, GEORGE B 151, 187 Paranoid personality type 56 Pathology 135, 136, 138, 273, 274 Patient care 93, 94, 95, 96, 97, 103, 104, 145 - 147, 148, 154, 155, 200 - 209, 212, 213, 293, 294, 295, 299 Patient care teams 146, 155, 200 Patient histories 144, 145 Patients 165, 166, 212, 213 PEABODY. ELIZABETH 45 - Pediatrics 22, 31, 156, 157, 161, 200, 201 321 PERKIN, ROBERT 1 75 PERSHING, CYRUS L 152 PERSHING, HOWELL T 152 Pharmacology 127, 128, 134 PH ILPDTT, I W 172, 185 PHIPPS, MRS LAWRENCE C 223 Physical diagnosis 147, 148, 158 Physics 29 Physiology 41, 127, 128, 134, 139 Physiotherapy 66 Piccolo 63, 64 Pioneering in the San Juin 12 [(Revell, New York, 1899) 226] PITKIN, Governor 258 Pituitrin 166 Polio epidemic 92, 93 POPEJOY, THOMAS L 11 6 Porter Sanitarium, Denver 1 94, 204, 20 5 POTTER, SAMUEL B 162, 167, 171 Poverty program 146, 147 Practice 22, 23, 26, 53, 54, 178 - 198, 200 - 213, 217, 218 Pre-clinical subjects 61 Premature Baby Clinic 105, 106 Presbyterian College of the 2 Southwest Presbyterian Hospital in New 160 York Prescription writing 128, 129, 130 322 President's Commission on the 216 Health Needs of the Nation PRINZING, JOSEPH F 151 Program Cost Accounting 262, 263, 291, 292 Prohibition 58 Protease 181, 208 Psychiatry 25, 138, 149, 150, 155, 162, 177, 299 Psychopathic Hospital Bl, 83, 85, 94, 99, 104, 105, 125, 149, 161, 244 Public heal th 134 PUCK, THEODORE T 238, 239, 240, 288 Pueblo, Colorado l PUSEY, NATHAN 254 Pyelitis 166 Radiology 134 RAVIN, ABE 89 READER, GEORGE 300 Red Cross 92 REED, VERNER Z 199, 200 REES, MAURICE H 26, 61, 93, 94, 99, 133, 140, 156, 164, 165, 166, 199, 212, 220, 223, 224, 229, 242, 259 Research 82, 83, 236, 237, 246, 290, 291, 292, 293 Research Facility Construction 238 Act Research grants 246, 247, 263 Residency programs 46, 60, 61, 112, 142, 143, 145, 148, 150, 160, 161, 164, 165, 171, 178, 207, 245, 269, 272, 289 323 REYNOLDS, EDNA M 162-171 Rheumatic Fever Diagnostic 74, 75, 76, 107, 231 Service Rheumatology 75 Rio Grande County 4 Rio Grande Railroad 4 Rio Grande River 1 ' 2, 40 Riverside, California 14 ROBINSON, ARTHUR 239 Rockefeller Foundation 223, 225 Rocky Mountain Medical Journal 214 ROGERS, FRANK E 1 51 ROOSEVELT, FRANKLIN D 215 Rural Electrification Program 243 RUSK, HOWARD 275, 276 Sabin Cancer Research Building 238 SABIN, FLORENCE R 78, 90, 106, 274 'SALK, JONAS 240 Salt Lake City, Utah 12, 110, 111 San Diego, California 17 SANAZARO, PAUL J 286 San Jose, California 14 San Luis Valley, Colorado 1, 2, 3, 9, 10, 15, 22, 30, 170, 178 SAWYER, KEN 113, 114, 115, 117, 118 Scarlet fever 87, 137, 156 SCHARRER, ERNST A 225, 234, 236, 253 324 SCHEELE, LEONARD A 216 School of Nursing, University 83 - 86, passim of Colorado SEARS, THADDEUS P 149 Selective Service 221, 222 Sense of Justice 48 - 51 SEWELL, HENRY 88, 89 SEWELL, MRS HENRY 88, 89 Shock therapy 194 SIMPSON, HAHMAN, HALVERSON and 76 - 77 SHEARER "Incidence of Heart Disease and Rheumatic Fever in School Children in Three Climatically Different Calif­ ornia Communities" 29 Ameri­ can Heart Journal 178 - 204 (February, 1945) Small pox 87 Small pox vaccination 75 SMITH, CHARLES 162, 171, 199, 219 SMITH, GEDDES 281 SMITH, TINSLEY 162, 171 Smog research 14 SMYTH, CHARLEY J 281 SNOKE, ALBERT W 262, 263, 264 Social Security Act 211, 215 Social Service Department, Colo­ 160 rado General Hospital "Socialized medicine" 107 SOMERS, ANNE R 289 Specialization 206 - 325 Spelling 27, 28 SPRAGUE, HOWARD B 160, 211 Staphylococcus 172 STARKS, ROBERT C 17 State Board Examination 148, 149 State College at Greeley, Colo­ 14 rado STEARNS, ROBERT L 71, 256, 257, 258, 259, 260, 261, 262, 265, 268, 271, 278, 279 Steele Memorial Hospital, Denver 87, 271 Steroids 137 St. Josephs Hospital, Denver 204 St. Lukes Hospital, Denver 204 Streptococcus 172 Streptomycin 90 Strikebreaker 5, 7 Student Honor Commission, Uni­ 173, 177 versity of Colorado Medical School Student Loan Fund, University 132 of Colorado Medical School Study habits 59 SUDAN, ARCHIE C 270 Sugar Beet Industry 3, 4 "Sugar--The Tariff, The Trust, 18 and The Truth" Superior Student Honors Program 35 University of Colorado Surgery 150, 151 SWAN, HENRY 228, 233, 234, 282, 288 • 326 SWIGERT, JOHN L 1 61 , 1 71 , 1 90 Syndrome of myocardial infarc­ 142 tion SZILARD, LED 238 TAYLOR, EDWARD STEWART 100, 288 T-Bone Ranch 9, 39, 40 Teachin Com rehensive Medical 284 Care (Harvard, 1959) 642 Tennessee Valley Authority 1 61 TERRY, LUTHER 295 TERRY, ROBERT T 1 91 Therapeutics 1 29, 130 THOMAS, ATHA 223, 228, 234, 235 TODD, JAMES C 82, 136 TOPPING, NORMAN 108 Tuberculosis 90, 91 Tuberculosis Ward, Colorado 90, 91 General Hospital Typhoid fever 140 Union Pacific Railroad 8' 1 9, 68, 83 United States Air Force 258 United States Public Health 1 06, 1 08, 237, 238 Service United States Public Health 106 Service, Children's Bureau University of Alabama 250 University of Buffalo 284 University of California, 14 - - - - .. 327 University of Chicago 102,103,238 University of Colorado Band 63, 64 University of Colorado, Boulder 3, 7-9, 12, 25, 27-28, 33, 35, passim University of Colorado Medical passim Center University of Colorado Medical passim School University of Colorado School 86, 249, 250, 251 of Dentistry University of Illinois 11 8, 284 University of Kansas 285, 286, 287 University of Kentucky 286 University of Maryland 299 University of Minnesota 1 93, 217 University of Nebraska 11 8 University of New Mexico 11 6, 244 University of Northwestern 95, 162 University of Oklahoma 33 University of Pennsylvania 124 University of Wyoming 244 Urinary protease 1 31 VAN DUZEE, MABLE 28 Veterans Administration 217, 245, 246 Veterans Administration Hospital 70, 71 , 72 Veterans Administration Residency 11 2 Program Virology 75 Visiting Nurses Association, 192 Denver 328 VOLKER, JOSEPH F 250 WALLIN, IVAN E 120, 121, 123, 124, 131, 139 Walsenburg, Colorado 3, 58 WALSH, EUGENE L 162 Ward clerkships 143, 144, 152 WAR ING, JAMES J 81, 89, 108, 141, 149, 157, 161, 163, 164, 230 WASHBURN, ALFRED H 222, 223, 224, 225, 230, 231 , 232, 233, 234 Washington University in St. 32, 159, 191, 210, 275 Louis, Missouri WASSON, W WALTER 223 WEDUM, ARNOLD G 75 WEDUM, BERNICE L 75 WEDUM, DARLEY and RHODES "Preva- 77 lance of rheumatic heart dis­ ease at high altitudes" [79 American Journal of Diseases of Children 205-210 (Febru­ ary, 195 □)] Welch bacillus 1 33 Western Interstate Commission 65 for Higher Education Western Reserve curriculum 153, 154 Westminster, Colorado 2 WETHERILL, HORACE G 69 White House Conference on Health 295 WHITE, PAUL D 160, 209, 211, 221 WHITEHEAD, RICHARD W 83, 127, 128, 129, 131, 179, 181, 208 WILBUR, RAYL 212 r 329 Winslow, Arizona 5 WINTRDBE, MAXWELL M 82 World War I 58 Wrestling 65 Yale Medical School 263 YEGGE, W B 147 Youth's Companion 24, 64 Zoology 32 WARD DARLEY Volume II '/ .~ j_; ~~~~\> ~arlan B. Phi~ips October 15, 1969 NATIONAL LIBRARY OF MEDICINE BETHESDA, MARYLAND 1969 I TABLE OF CONTENTS TRANSCRIPTS Tape #4, side #2 [Saturday, April 1 3, 1 968] 330 - 360 Tape #5, side #1 [Saturday, April 13, 1 968] 360 - 401 Tape #5' side #2 [Saturday, April 1 3, 1968] 401 - 440 Tape #6, side #1 [Monday, April 1 5, 1968] 441 - 485 Tape #6, side #2 [Monday, April 1 5, 1968] 485 - 517 Tape #7, side #1 [Tuesday, April 1 6, 1968] 518 - 544 Tape #7, side #2 [Tuesday, April 1 6, 1 968] 544 - 572 Tape #8, side #1 [Tuesday, April 1 6, 1968] 573 - 609 Tape #8, side #2 [Wednesday, April 17, 1 968] 610 - 637 INDEX 638 - 658 Saturday, April 13, 1968, 7002 University of Colorado Medical Center. I know that Bob Stearns would really enjoy meeting you, and would you like to have me get him out here sometime for lunch next week? Yes--1 sure would. He and I have lunch together every once in a while just for the hell of it. Well, you're in the Deanship, and there is a marvelous series of papers published in the Rocky Mountain Medical Journal on the distribution of physicians and physician services in Colorado, an early study and unique of its kind, and it has a background. You might want to comment about Dodge and Clapper who worked on it with you. Well, it was my idea, but Dr. Horace J. Dodge did the writing and Merle M. Clapper did the statistical work, and in those days statistical work wasn't easy. We didn't have computers. She did have kind of an IBM punch card system. I don't know where she got it. Dodge was in the De­ partment of Preventive Medicine and Public Health. He had been a resi­ dent when Waring and I were running the medical service here--a resident in medicine. He took a year off at the University of Michigan, and got his Master's degree, and then came back here in public health. He was a Colorado boy, had had tuberculosis and had to be fairly careful of him­ self. His wife worked with Dr. Mugrage in the Department of Clinical 331 Pathology, and he was a very fine fellow to work with. He worked in the Rheumatic Fever Diagnostic Clinic quite a bit, and he helped a lot-­ would just sort of steer me whenever I got mixed up with the chronic ill­ ness business here. To just sit down and visit with him helped give me a sense of direction I would not have had otherwise about some of these community situations. This paper I did--! forget the title of it--which was published in GP. I quoted Dodge at length because he wrote down for me the concepts, or a set of assumptions that were important if we were going to think about medical services for the disadvantaged. I think this was the first paper that I published that revealed any particular interest in these kinds of social problems. ["Medical Care for the Needy: A Problem for Governmental or Nongovernmental Agencies" 2 General Practice 77-80 (Sep­ tember, 195 □)] This was a paper I developed for a meeting here of the Colorado State Welfare Association. That isn't the name of it, but it was a state meeting of all the welfare people--the social workers, the professional do-gooders, and at that time the medical profession were looking at this group with very jaundiced eyes so that the fact that I gave a paper to this group didn't win me any souls among the medical pro- fession. Then the state society had a committee on medical education. The chairman of the committee stopped in to see me one morning just to let me know that I didn't help the medical school's relations any by giving this paper. Well, it was well received by the group, and then GP is the official organ of the Academy of General Practice. It's a dandy magazine. It doesn't publish research papers. It publishes articles that represent a review of a specific problem area, and it's couched in terms for the 332 general practitioner to understand. They pay authors to prepare things for this publication. They had asked me if I wanted to be considered for the editor of this publication when it first started, and I didn't. I looked into it, but I didn't want to be considered as editor. That was my first introduction to the Academy of General Practice, and the man I interviewed is still Mac F. Cahal--the executive director, and he's a lawyer incidentally, and Walter C. Alvarez is the one that took the editor's job finally. Well, to help get this publication off to a start they wanted me to do a paper on socio-economics. I told them that I had this speech that I gave, and I said that I would be willing to rewrite it. It wasn't written to be published, but I could change it around easily enough so they took it, and I hear these people refer to that paper not infrequently. Now how did I get on that? I wanted the background and thinking out of which this series of papers .•.. Well, Dr. Atha Thomas--as soon as I went into practice I began to take care of him and his family. His wife was quite ill, and she died maybe a year before these papers were published. Dr. Thomas wanted to do something in deference to my interest in her, so he gave me five hun­ dred dollars to use any way I wanted to. I could have pocketed it, if I had wanted to. It didn't make any difference to him. Well, Dr. Dodge and I decided that it was just time to know how many licensed physicians we had, what their various specialties were, and where they practiced. We wanted to know how many of them were graduates of the University of Colorado; in fact, that was the original idea of the whole thing, and then as we talked about it we said, "Well, we ought to know this. We ought to know that. We ought to know this, that and the 333 other thing." Dr. Dodge developed a questionnaire, and we got the medical society to cooperate and mail the questionnaire out for us. Then Dr. Clapper and Dr. Dodge put this together. Dodge did most of the writing, and we of­ fered it to the Rocky Mountain Medical Journal as a series of papers, and they published most of the chapters--not all of them. You've found this bound volume down there I guess that contained the whole study. They didn't publish the chapter on the History of the Medical School, and they didn't publish the chapter that had to do with osteopaths and chiropractors. I had left a stack of that publication, the mimeographed copies, with my papers and files, but somebody threw it out--that copy down there in the library and the one I have at home is all that is left of the pub­ lication that came out as a Bulletin of the University of Colorado; in fact, they hadn't even accessioned it in the library. I had quite a time finding it. I wanted it for a man here who was doing a study of the dis­ tribution of the graduates of the University of Colorado, and he wanted to see that Bulletin. I also wanted the regional medical program people to know of it because this study should be repeated as part of the statis­ tical work of the regional medical program, but so far they haven't shown any interest in doing it. Well, that little series of papers--there was quite a bit of interest in them among the doctors of the state for a lit­ tle while. If you put this back in the context of 1946 and 1947, if the school was soing to aim in the direction of general practice, best it know what 334 general practice was in the state of Colorado. Where physicians were and what they were doing. What the limitations were and I think the study went into hospitals too. I have forgotten now--did we work this out according to the distrib­ ution of hospital beds? .liospital beds, size of hospitals, concentration of population, income of consumers of medical service. You see, I haven't looked at this since the day it was bound, and as I tell you, I just know that i f anybody wants a good point of refer­ ence for a similar study, why they've got it. Dodge was the brains behind this. It must have played some part in the development of the school. I didn't even want to put my name on it, but he and Dr. Clapper said that they wouldn't do the work unless it was that way, so I said, "All right. Put me down last." I did the forward. I earned my way--from the standpoint of editing. I was thinking that as Dean, if you had the point of view that you did have and were pressing toward curriculum reorganization, it ought to be relevant to the context in which this school was functioning. I think that's been a point that you've carried right along, even beyond Colorado, that guesswork is for other people. If you're going to sit down and plan, iou need the harsh and intractable facts that make a difference in the kind of plans you make. I thought that this study was a step in that 335 direction where there had been no information. It was a step, but the potential impact was never developed. I'm sure it's safe to say that. It didn't play the role in state-wide plan­ ning, or medical school planning that it should have played. It did come into being--! don't know whether the publication preceded the publication of the curriculum report, or not, but this was all going on at the same time. It was a cooperative undertaking--the school of medicine and the state medical society. I wonder if it made any difference in their thinking? Probably not. No, we put them down because they circulated the questionnaire and didn't make us pay the postage. They printed it too, and then they pub­ lished the report of course in their journal, but there was no steering committee, for example, from the medical society. It would have been smart if I had set something like that up, but I didn't. Roped them in? Yes. How about the Colorado State Board of Medical Examiners? They are listed also as a sponsor. They helped because we wanted the mailing lists of the osteopaths and the chiropractorso We had to get that information from the state board. No mailing list. We didn't send any questionnaires to osteopaths and chiropractors, I don't think. I think we just got their names and addresses from the state board. The medical society didn't have that 336 information. Was this also true of the State Board of Basic Science Examiners? Yes. Mailing lists? Names and addresses. They won't put out any such information, but they gave us the--well, whatever information is in that study relevant to the Basic Science Board except its existence came from Esther B. Starks, the secretary of the Board. You see, the people who take this basic science examination take it under conditions so that the individual giving the examination and grading the papers has no idea as to whether they are M.D.'s, osteopaths, or chiropractors. This is very secret in­ formation, and the grades that are put on the examinations are not tied to any names until the secretary gets ready to notify the individuals as to whether they passed or not, the individual taking the examination, but I think she told us how many osteopaths had been licensed over a period of time and had been given basic science certificates and how many chiropractors--was that information in that? She gave it to us then. What came out of it was the increase in the number of doctors who had taken the examination and the decrease in the number of osteopaths and, by seventy some percent the chiropractors. Now then it would be awfully interesting, you know, to get those 337 figures now--to see what the ultimate impact of the Basic Science Board was. It was passed frankly to keep the chiropractors from getting li­ censed. The osteopaths have had no trouble passing it; in fact, the os­ teopaths teamed up with the physicians to get that piece of legislation through. The study did indicate the number who passed on the first examination, those who received licenses on a basis of reciprocity, other states, the re-examination and those who received certification on waver. We could get that same data now, I'm sure. This had not been collected in one place for the State of Colorado. No. It might have proved very helpful in the development of, or in talking about what general practice was. I don't remember the questionnaire, or whether it was included in the study as published. I'm not sure. There was no effort in the study to determine what doctors did. The only basis for any classification was whether they classified themselves as general practitioners, or specialists and if they were specialists, what specialty, and I don't remember in there whether we asked the GP's to indicate what their special interests were, or special competences were--! don't think so. I don't think so either. I think we found out the number that were certified and the number that called themselves specialists without being certified. I don't re- 338 call. It could well be that we weren't hep enough to this situation to ask it. I think in a sense that's so, but this is a beginning. Oh, yes. It was a good study, if I do say so. It's just about this time that the need to make a state-wide survey and develop a plan for the construction of hospitals •••• This preceded that. Yes, by several years. This came ahead of that Hill-Burton. Working with that Hill-Burton business was sort of an exercise in futility, an exasperating experience. Even to make a state-wide plan? The state-wide plan wasn't hard to make. I said I wrote it, but there was a Dr. Wagner here who was in the United Stated Public Health Service. He was in the regional office, or the equivalent of the regional office, and he understood the ins and outs of this legislation very, very well, so that as I outlined my concept of this, and the reason I did this was because I knew the community and he didn't, he was a tremendous help in developing this plan. This was one of the first state plans to go to Washington for approval, and it was a good plan, but we weren't able to get the communities to follow along with the main concepts in the propo­ sal because these little communities wouldn't share a hospital. They each wanted a hospital of their own. The most vivid experience involved the towns of Loveland and Fort 339 Collins. The town of Loveland is about eight miles this side of Fort Collins. Fort Collins is where the state agricultural college is, the land grant college, and it is a good sized community and had a good com­ munity hospital--really a county hospital, a county community hospital. This is where Dr. Frode Jensen put his first residents in general prac­ tice. The staff up there in the community hospital were very cooperative with this project. Well, Loveland had an application in for a hospital and so did Fort Collins. To me it made sense for Fort Collins to build enough extra beds to take care of Loveland. The committee approved this plan, and the pro­ posal went to the State Board of Health. Of course the State Board of Health then had to find out whether Fort Collins and Loveland were will­ ing to get together on this. Well, Fort Collins was, but Loveland wasn't. Loveland people asked for a hearing, and it was apparent that I was the one responsible for this proposal. The matter reached the point where Loveland was getting attorneys and was going to go to court on this busi­ ness. Well, the State Board of Health always had the final word. The State Board of Health gave in, and the hospital for Loveland was approved. Well, there were other instances where small hospitals just had to be approved, and the reason I began to go along with this was because the community clinic idea had been built into the legislation. The com­ munity clinic was supposed to be a building where the doctors would have their offices and share laboratory and X-ray facilities. There would be four, or five emergency beds in this little clinic building, and Hill­ Burton funds would pay fifty percent of this kind of facility. I fig­ ured that if these little hospitals didn't make a go of it, why it would be an easy matter to turn them into these community clinics, and I think 340 there were a couple of instances where this happened eventually. Well later on when I was president of the university, I sent the director of alumni relations into Loveland to arrange for me to speak to the Rotary Club, or speak to a joint meeting of all the luncheon clubs which was a very common thing. The alumni director came back, and he said, "What did you do to those people over there? They don't want you over there under any circumstances. It had something to do with their hospital." This was several years later, but they just hadn't forgotten, so he arranged for an evening meeting with just the alumni of the university that lived in Loveland. I don't think that I was ever given an oppor­ tunity to go over and speak in Loveland under conditions that involved a total community permission. But they got their hospital. Oh yes, and they've added to it since. I don't think any communi­ ties--well, I'm not familiar with developments since then to know whether any of these small communities out here in the eastern part of the state finally shared hospitals or not. Most of them got a little twenty bed hospital out of the Hill-Burton money, and the way things are now, of course, you could never operate a twenty bed hospital and make it pay for itself out of operating funds. It would always have to be subsidized by county government, or community chest. Did you see the development of these rural hospitals--you wrote a paper about the general practitioner and rural practice [139 JAMA 934 935 (April, 1949)]--as an added arm for education? p 341 As I remember that little paper was given at a meeting that the AMA had in Chicago, and the American Medical Association sponsors organiza­ tions. I forget what it's called, but they have a Council on Rural Medi­ cal Care. That isn't quite the name of it, but that's what it means, and this council had a meeting every February in Chicago, a meeting that pre­ ceded the Annual Congress on Medical Education that the AMA has. The rural people piled into Chicago to this meeting, and I always attended it and it was a meeting--it wasn't too big. It was small enough so that there was some pretty stimulating discussion after each paper from the floor. People could ask questions, or come to the microphone and say things. Frode Jensen and I were interested in this, and we'd frequently go to the microphone with something to say, so one of these papers was one that I gave on invitation. The AMA never published the whole thing. They published a synopsis of it. There was a lot of discussion--! have forgotten what I said. The only thing I remember about it was that Dean A. Clark who was then the director, or superintendent of the Massachu­ setts General Hospital--! said something in that paper he disagreed with, and he wanted to talk about it, so we had lunch the next morning, and we were pretty good friends ever since. I have forgotten what it was he disagreed about. I think the discussion that had to do with that problem didn't last very long because we began to talk about the overall concept of patient care, and we found plenty of common ground there. It's Dean Clark's wife who wrote the Report of the Institute on Preventive Medicine--! don't know whether you noticed that. Yes, I did. p 342 Annette Clark who did that writing was his wife. Now he's at the University of Pittsburgh, and he helped Cecil G. Sheps with the study of medical school hospital affiliation agreements--I don't know whether you've come across that episode yet--and Cecil Sheps left Pitts­ burgh a couple of years ago, and Dean Clark is now head of the program in hospital administration at the University of Pittsburgh. But did you think, in terms of Colorado, that these little community hos­ pitals could be used in the educational program of the school of medicine? No, I always opposed the preceptor business where you assign medical students for a period of weeks to a practicing physician, and it took me a long time--it's rather recent that I have begun to realize that this could have been developed as a very important gimmick in medical educa­ tion. The reason was that these people in my estimation weren't keeping up. They weren't keeping up. They weren't practicing medicine. Their level of practice wasn't good enough for medical students. This has been a very controversial thing over the years in the area of medical education, and as I had seen general practice it was a shoot­ ing-from-the-hip type of thing. I had done quite a bit of consulting work for doctors in rural practice, and there was some foundation for my ideas, my feeling in this matter. Of course these men--the educational base for most of them was pre-Flexnerian. Well--it took the Flexner Re­ port ten years to really develop any universal impact on the educational process. Just because a couple of medical schools merged, or medical p 343 schools seemed to be taken over by a university didn't mean that that medical school improved its education program overnight. It took quite a while before medical schools really responded as far as their internal attitudes and methods of education are concerned. I was willing to put medical students, particularly interns and resi­ dents, into well developed community hospitals where the hospital staff structure was such that there were some recognized standards in patient care that the staff were attempting to enforce. That's why we turned to places like Fort Collins and Grand Junction. Those were the two hospi­ tals that we directed most of our attention to. We developed this pro­ gram where if a hospital requested it, we would send two to three faculty people out to spend the day with the hospital staff. The morning theoret­ ically would be spent in sort of grand rounds in the hospital, and the afternoon would be a situation where the members of the staff would bring in some interesting problem cases, ambulatory cases, and these would be presented and discussed by these consultants. Then the evening they would have dinner together, and one or two of these faculty people would give a little paper, conduct the discussion. This program was quite popu- lar. There was a little hospital down in Lamar. The only other place I remember was Alamosa, Colorado, which is in the center of the San Luis Valley where I was raised and where my wife was raised. This is a very isolated area completely surrounded by high mountains. In geological times it was a lake, so the valley floor was perfectly flat, a depressed area always, and Dr. Jensen, I remember, went down there to make arrange­ ments. It was Alamosa Hospital making the request, and Dr. Jensen said, "We'd like for you to invite the doctors from the other towns in this pt valley so we could make this as productive for as many people as possi­ ble." The doctors of Alamosa said, "Well, we won't invite any other doc- tors in. This is going to be for us, and we're just not going to have these sub-standard practitioners"--that's what they meant--"come in and dilute the student body that is going to partake of these goodies that you are going to bring in here." Jensen came back and said, "What shall we do about this?" I said, "We won't go unless this can be made an all San Luis Valley business." It took two or three months but they finally agreed, and we sent teams down I don't know how many times. We even went into Raton, New Mexico, and we went up to Cheyenne with this kind of program. I don't recall whether we went across the line into eastern Kansas, or not. Right from the beginning we had it arranged so that the faculty that went out on these programs got an honorarium of fifty dollars out of which they paid their expenses and then kept whatever was left--well, we wanted the hospitals to feel that this was worth a fee, and there was never any ob­ jection to this on the part of the hospitals. They were glad to do it. Under this arrangement we put on a basic sciences course in, I think Greeley which is up close to the state line, and this ran one night a week over a period of several weeks, and doctors came in for that basic science course from western Nebraska and northwestern Kansas, well up into Wyoming, and quite a few took it in the northern part of Colorado. I don't think we repeated it--maybe we did--but it was a very successful venture, we thought. It was just a series of lectures and demonstrations, and it was a reflection of the need of ~ 345 doctors to improve their scientific base for medical practice, but this appreciation came out of the early emphasis on research that followed the end of the war. Frode Jensen--he cooked up all this stuff. He was just busting with ideas all the time, and that's why I liked him, and that's one of the main reasons he wasn't liked by the doctors in the community. Where they ever got any idea that he was a dangerous, subversive radical I'll never know. I think it was something just cooked up out of whole cloth to interfere with Frode's effectiveness. He was a Dane. He ran away from home when he was in his middle teens, and he shipped on a Danish ship as a cabin boy. He jumped ship in New York City, and how he got along I'll never know. This story is written up. Frode eventually came under the attention of Elihu Root, and he went to Hamilton College. Elihu Root made it possible for him to work his way. Along here he had to make his peace with the immigration authorities, and Mr. Root took care of that. Then Frode became a protege of Alexander Woollcott, the actor, and it was Alexander Woollcott's auto­ biography that has a lot to say about Frode Jensen. It's really interest­ ing reading. Frode knew all tre Broadway celebrities. When he left here he went back to practice on Fifth Avenue with a well established cardiologist who died six months or so later, so Frode-­ his practice is made up largely of these theatrical people, and his office is in the Carlton Hotel there. He has a lot of the counsellor people for patients. I see him once in a great while. He's connected with a fam­ ily foundation back there that's interested in medicine, a small founda­ tion, and I've seen him in connection with the program of this foundation. Is he still involved in graduate and postgraduate education? 346 When he went back from here he was Associate Dean of the School of Post Graduate Medicine that Cornell Medical School had started. I could be wrong. It could have been Columbia. This school was started because of the interest of Kress, or Kresge, and I forget which one gave the medical school several million dollars to set up a school of post graduate medicine with the idea that this would be an organized educa­ tional opportunity for practitioners to come in and spend six months, or a year. Frode was half time at that and half time at practicing. The foundation money ran out after a couple of years so this School of Post Graduate Medicine folded up and of course Frode moved on. He still may have a faculty appointment, and I'm sure it's Cornell the more I think about it. It would have been terrific if Frode Jensen could have been held in medical education. He's a brilliant man. But the general practitioner out in a little town in Colorado is the name of the game for this school isn't it? Yes. And our program here in continuing post graduate education still shows the finger of Frode Jensen. Now unfortunately this circuit riding post graduate effort--! don't know when that ran down, but it ran down. The effort here primarily is to give good courses, at least one a month, that are beamed on practicing physicians. Now at first it was all beamed on general practitioners, and then as our clinical departments grew and the subspecialty people began to come into the fulltime orbit, why each of these departments wanted to give something for its own prac­ titioners, so a lot of the courses now are in ophthalmology, obstetrics and gynecology, and so forth, but there's one big course a year for gen­ eral practitioners. 347 General practitioners come in from all over the country for this one course. It's oversubscribed every year. They have to limit the num- ber who come in. The lectures are all outlined, and these outlines are printed up and put into a book that is given each individual as he regis­ ters, and there's room at the appropriate places for notes. All of the slides that are used in this course are reproduced in this book so that the people that want to really don't have to take notes. Their notes are much more meaningful with this book in their lap than they would be other­ wise. It's a very popular course, and in the summer they move to Estes Park with their courses, and they give about four. They take over the Stanley Hotel for all but one of these courses when they take over the YMCA conference grounds, and this is the October staff conference each year which is very popular--five or six hundred people turn up for that. Is this for practitioners in the state of Colorado? No, these courses all have an appeal beyond the state borders, and all of them--they draw more heavily from Colorado than any other state. For this staff conference every state in the union is usually represented there. The general practitioner course is given, and the tabulation for the year of the number of physician registrations--that isn't the number of physicians, but the number of physician registrations because there are a lot of fellows that come in and take more than one course, but this general practitioner course, and I'm just talking off the top of my head, but I'd wager half the states are usually represented when that's given. The specialty courses that are given in Estes Park--there is always one in pediatrics, and there's always one in ophthalmology, and these are well attended--several hundred. They pay a good stiff registration fee. 348 One reason the attendance is so good in Estes Park is because they are capitalizing on the fact that Estes Park is a popular vacation area. These people put their families in the car, and they get to Estes Park early, or they stay in Estes Park after the course. You'd think there would be a lot of them come and just register so that they could charge part of this off on their income tax, but the attendance is good enough so that we don't think that very much of this goes on. The courses are good enough so that it's worth their while to stick around and take them. This fellow, Dr. Wesley C. Eisele, who came here as Frode Jensen's assistant has done extremely well--gee, he's full time and in a sense al­ most he's away full time. He's on national committees. He's kept this program rolling in good shape. He's still in charge of the general prac­ y tice residents, and this general practice residency, I think, without any question is as popular as it can be because it's always filled and most of the general practitioner residency programs around the country are not filled, and they're not good residencies. This isn't a particu­ larly good residency, and it can't be made a good residency because these residents never get beyond the stage of being under the thumb of the resi­ dent above them on each service. They rotate from service to service, and they're under the thumb of the resident above them on each service-­ you see. They don't get to take any independent responsibility. Originally the residency was a year of surgery and a year of medi­ cine, or the medical specialties, mostly medicine and pediatrics, and to keep the thing going all the time--why, we'd start half of them in the surgical year and the other half in the medical year. The bunch that got into the surgical year would quit at the end of the surgical year and go out and hold themselves up as surgeons, so we had to get hold of this. ► 349 They started them all in the medical year, and the residents couldn't get to the surgical year without taking the medical year first. Then we found, and we still find, that these people come into this residency--we don't give them the surgical year any more. They can get a little surgical emphasis, if they want it, but this residency is given now primarily with the idea that these people will be general physicians and use qualified surgeons for their major surgery at least. Right from the start though, after we cut out letting any of them start in the sur­ gical year, most of the people have done darn good family medicine. The residency is just two years in length~ They have to have a rotating in­ ternship first, and I'm anxious for them to add the other year. They still put these people into Fort Collins for a while. They don't go any place else. Now at the start the Armed Services assigned officers, medical offi­ cers, to this general practice residency, and there are two or three peo­ ple rather high up now in a couple of the services who were these resi­ dents. As you can see, the Armed Services could have real use for fel­ lows who had had a graduate year in medicine and another one in surgery-­ these are the kind of people the navy want to put on destroyers, for example. As an aim, or an objective of the medical school, so far as the student body is concerned, is part of the aim and objective the notion of incul­ cating in the students that they are not educated when they get their de sree, but what is required of them is continuing education? That has gradually grown into the philosophy of the educational pro­ gram here, and this is acknowledged nationwide; that we are turning out-- 350 all medical schools--undifferentiated physicians, and these are fighting to the general practitioners. In other words, when a man graduates wor ds today, it's generally conceded even when he's finished his internship, that he's only educated up to the point where he can be trained to be a physician, and I subscribe to this. We just can't turn out an individual who can practice as a solo practitioner as a result of four years and an internship. I just don't think it's possible. There's still a few that do go into practice at the end of their intern year. I daresay that if we had the figures, most of these men, as soon as they've got a big enough savings account, quit practice and take a residency someplace. t Osler Pe,ersen at Harvard who did the famous North Carolina study of general practitioners, what they do, and how well they do, has done another study now. I don't know whether it's been published or not, but I think he has some data on this point. I read the manuscript for the Harvard Press a couple of years ago, and I urged them to publish it, and Osler told me that they were going to. I don't think it's out yet. I gave the manuscript I had to somebody and I've forgotten now who has it. It's lost, I'm afraid, because I've tried to think whom under the sun I gave that manuscript to, and I haven't been able to remember. I have a poor memory, as you can see, for names. I wish Frode Jensen could have been held. I wish now very much that I had told him to get the hell out of here and go to the Association of American Medical Colleges when he sort of wanted to go. We would have found some way of keeping his show going here that he had started. This may sound like a radical thought--but where does the burden lie, on a student that graduates from a medical school, the notion that he 351 ·res continuing education, or is it on the medical school and the regu J.. faculty to put continuing education out there where it's available in the State of Colorado, for example, even though, as in Alamosa, people don't want to share. Where's the burden of raising their sights. I really don't know. That's--to be trite about it--that's a good question. I don't know whether you want to get way off into what I would want to say about con­ tinuing education, or not. If it's relevant--sure. Let's take this up some other time so I can have a little time to think about it as far as the beginnings are concerned. You said the other day that one of the things that you might have done was to remain Dean and Vice President of the Medical School, that you might have generated more heat than becoming President of the University because that sort of cut you up in other areas, as well, or it was a different stream to swim in. I just wondered in terms of the developing idea and ideas that you've had since in terms of continuing education how it fitted in during that period. Well, let me tell you this. When I went to Boulder as President, this Dr. Alan Gregg over here [referring to a picture on the wall]--he just had a fit when he knew I was considering going to Boulder as President. Wasn't he originally from Denver? He was born in Colorado Springs. That's it. 352 I don't know at what age he left out here--I think he had some of his early schooling down there. This guy sought me out. I never went after him. He's like Lester Evans. He was just coming through shortly after I was Dean, and I think he would have come out here no matter who was Dean. That's the way he did. We just gradually established a nice relationship, and I didn't even know where he heard that I was talking, or thinking about making this change. I have forgotten whether he called me up, or wrote me--if he wrote me I didn't save the letter, I'm pretty sure, but he just thought that my taking the Presidency of the University was a mistake, and he's about the only friend I had in this walk of life who didn't encourage me. This fellow over there [referring to a picture on the wall], Emory W. Morris, the President of the Kellogg Foundation--he twisted my elbow pretty hard to take the presidency. Well, anyhow I went up there with the idea that I was going to do just like Franklin Murphy had done when he took the Chancellorship at the University of Kansas because he really pulled out of medicine. I figured that I would have to pull out of medicine, so I resigned from the American Clinical and Climatological Association and the Association of American Physicians. I cut off a lot. I burnt some other bridges just because I didn't want to continue to hold down a spot in an organization that was hard to get into and keep somebody else from getting it. Now I'd give anything if I had kept those bridges intact. I had been there as President of the University about three years, short of three years, when the Kellogg people got in touch with me be­ cause they felt that the time had come when the Kellogg Foundation should review the philosophy of all of its existing programs and be certain that if any of these interests were kept in the picture, there was good reason ~ 353 for doing it, that there was a real need for it. They wanted to consider ew areas, and they had this three day conference and wanted me to some n do the working paper for what I'll call their section on medicine and public health. I agreed to do it. I don't know whether I sent you a copy of that paper, or not--mimeographed. I never read the paper up there because by the time the conference was held I had a lot more I wanted to say, so I just let the paper stand as a piece of background for the conference. In this stuff you'll see at home, I think, I saved the notes I used in connection with what I said in a formal way at the conference. To make a long story short, of course, I had had a stormy time of it up at the university, and my wife and I knew very well that we weren't going to spend the rest of our days living in a gold fish bowl trying to be a husband and wife team to be president of a university. She was president too. Your wife can't avoid this, and she did a lot better, took it in stride a lot better than I did. Well, anyhow we knew that we weren't going to continue, but we didn't have any set time. I so thor­ oughly enjoyed writing that paper for the Kellogg conference and rees­ tablishing a lot of old contacts at the conference that as we talked things over afterwards, we just decided that some way somehow when the time came, I wanted to get back into medical education. This was fine with Mrs. Darley. Well, then out of the blue the Association of American Medical Col­ leges--the president was then Dean of the Medical School at Yale, Dr. Vernon W. Lippard. He stopped by to see me and wanted to know by any chance if I would be interested in taking the executive directorship of th e Association of American Medical Colleges, and it just so happened 354-3 55 that I was interested in giving it consideration, of course. It just seem ed like a natural to us--having been in practice, on the faculty, Dean with a good experience in the administration of hospitals, and then finally president of the university, to let the executive directorship of the Association of American Medical Colleges be the next step. I was quite a while letting them know I'd do it. I told them not to wait for me because I was having a lot of difficulties at the university, and I wasn't going to walk out in the middle of difficulties. In confusion and defeat. They waited for me, and the first time things got quiet and looked to me like they were going to stay quiet for a while, I announced my re­ signation. I gave them six months lead time, and if the whole previous three years could have been like the last six months, we probably would have been there yet because I got more done during the last six months than I did in the previous three years, and I suppose part of it was that the Regents knew that I was going to leave and so the conflict between myself and the Regents subsided pretty quick. I did enjoy those last six months, and then Quigg Newton came in the day I left so that the uni­ versity wasn't without a president at any time. What was the source of difficulty, just a variety of experiences that one can have? Part of it was that. I just got off to a bad start right at the beginning. ,.,.- 356 There was this squabble between Dr. Archivald R. Buchanan in Anat- nd Dr. Ernst A. Scharrer who wanted to know whether he was eligible omy a for promotion to a full professorship. This matter came up right after I had gone up to Boulder, and the fellow who had come in here to take my place as vice president, although he was called director, he never had a chance to take hold of this center because of rivalries in the fa­ culty that immediately came to light after I left, and in fairness to him I thought he should be made to appear to carry the ball, so all the ramifications of this scrap appeared. This matter was handled fortunate­ ly finally, but too late by the executive faculty down here, by demand­ ing the resignation of the fellow that had--well, I said Eisele took frode's place. This man came in between--Charley J. Smyth. I brought him in to be an assistant to Frode, and then when Frode left he was the Director of Postgraduate Education, and he was mixed up in this Buchanan- 357 f Scharrer squabble. The executive committee demanded he resign as an ad- . ·strative officer of the Medical Center which he did, and then things mini gradually quieted down, but it was a long time before the situation was really quiet. Then the first atomic bomb went off down in New Mexico. It was the last atomic bomb, and the winds were such that a lot of the fall-out came in this direction, and Dr. Puck and Dr. Raymond R. Lanier--Lanier was the radiologist, and he was quite a physicist too, and Dr. Puck, a biophysicist also was quite a physicist. Just by happenstance they had held a seminar with their own graduate students and any other graduate student that wanted to attend on the effects of radiation on biological systems, and this Gene Lindberg I told you about, who got kicked out of school because of this pink sheet and had gone to work for the Denver f2.21, had turned into the science editor to the Denver Post, and he was doing lots of writing about atomic energy matters. As a courtesy to him, Puck and Lanier thought he might get quite a bit out of this seminar, some background for the writing he was doing, so he came. After this seminar was all set up, why then the atomic blast took place. The radiation came this way, and the Public Health Service indi­ cated that even so the level of radiation was way below the dosage neces­ sary to have any effect on biological systems, particularly human beings, and this was discussed. This set the stage for this seminar, let me tell you, and these two scientists giving the seminar stated at the sem­ inar that the Public Health Service, or nobody else had any business mak- ing such an announcement because we really didn't know what the minimum tolerance dose was , so poor old Gene Lindberg--he gets back to the Post, and the .!:2§.i people had him call our Senator in Washington and people on 358 the Atomic Energy Commission--what did they think about anybody disagree­ ·th the authority of the Public Health Service on this question? ing Wl. Our governor then was old Edwin C. Johnson who had been our Senator and had been on the Atomic Energy Committee of the Senate, or Armed Forces Committee--he, boy! He was really mad about this! These guys--anybody that would say things like this was subversive, and all hell broke loose about this! The Denver Post, and again I didn't know what to do about •t • 1 I J·ust kept my head down. The legislature was in session, and we had a lot of legislation before them. Puck and Lanier didn't want the university to take a stand. They just stuck to their guns, and Linus C. Pauling and big named scientists all over the country came to their de­ fense--you see, and further infuriated Governor Johnson, and the Denver ~ kept playing one viewpoint against the other and got some real news­ print out of this. Yes, and selling papers up a storm. Finally I went down to the Denver Post--we'd been in there several times telling them for godsakes, to pull out of this. Finally the man at the Denver Post who was then, had been, and still is a good friend said, "Yes, I agree. This has gone on long enough." He went to the governor, and the governor agreed that this had gone on long enough, so just all of a sudden everybody quit talking about it. It was just this kind of thing, and along in there--oh, dear! Five years before, the Regents had passed a motion to the effect that all honorary and professional fraternities would have five years to do away with all the clauses in their charters, their constitutions, and their rituals that had anything to do with discrimination for race, color or 359 Of course, as a point of reference at that time, why each profes- creed. sional and honorary fraternity had filed a statement to the university as to whether or not any such clauses existed. Come the five years and ·t wa 8 time to investigate, and we found that a chemical professional fra- 1. ternity still required, or had a discriminatory clause in its constitu- tion. In line with pre-established Regents policy I notified this frater­ nity that it would no longer be recognized by the university. Well, the fraternity raised hell, and appeals were made that came up to the Board of Regents through channels. Of course, the Regents were confronted with this decision, and again I had a three Republican, three Democrat set up. The plea of the frater­ nity was based on the fact that we didn't require social fraternities to demonstrate that they didn't have any discriminatory clauses, and "it just so happens", said these fraternity people--the national officers were there--"that this fraternity is more social than it is professional. On many campuses this fraternity has a house and a housemother, and is a member of the Interfraternity Council and functions as a social frater­ nity." Well, I had five Regents--three Republicans and two Democrats, so the three Republicans voted to reinstate this fraternity because it was more social than professional. At the next meeting when this absent Demo­ cratic member was present, he announced that he was going to introduce a motion that all social fraternities in the next five years should do away with their discriminatory clauses. Of course, the fat was really in the fire, and I had to interview the representatives from each fraternity th en. Well, this hadn't passed, but I was instructed to interview each, fi nd out how many and also identify the social fraternities and sorori- - 360 . that had discriminatory clauses, and they all, except two or three, ties and down that there were no such clauses. They made no bones swore Up about this. This was a matter of record. This was smoldering along, flaring up and coming down, and all of a sudden i·t developed that one of the sororities had its initiation and a girl had gone through the initiation. There was nothing in the constitu- tion and there was nothing in the ritual that had to do with discrimina­ tion, but after this girl had been initiated and everything was supposedly all over, she was given a little card to sign which, if she had signed, would have meant that she would never permit, I suppose, a Negro, a Jew, etc., etc. to be pledged. This was a little deal all off to one side. That made me mad, to have been lied to, so I issued an open letter on this business, and I went further than the intent of the motion. I wanted all pressure taken away from the fraternities and the sororities. I did­ n't even want the alumni--! didn't even want the fraternities or the soror- ities to require a letter from an alumnus to be rushed. Let me put on another side. When I went so far as to want to deny the alumni having anything to say about who could be rushed and who couldn't--why I widened the range of hostility and the intensity of feeling very greatly. Then to be sure that everybody had a chance to get mad I said this in another open let­ ter; that I thought the local fraternity should have the complete says □ about its membership and if a local fraternity elects to not rush, or in­ vite Negroes to join, the local fraternity should have that option, but shouldn't be forced--well, you see what I mean. Then I had all of the antidiscrimination people mad at me as well as the people in favor of b: 361 . •nation but I looked on a fraternity, as I said, as a home, and discr1m1 ' I felt that anybody, as far as the home situation is concerned, should e complete say-so as to who is invited in. have th I don't know whether I would want to stick to that position today, or not in a public supported institution, but irrespective of that, the fat was really in the fire, and I was invited to meet on a Sunday morning with a selected group of representatives from the state-wide organization of all the fraternities and the Pan-Hellenic of all sororities--I don't know what the fraternities called their organization. This was a big house, and there were a couple of hundred people there. I made my state­ ment. I would have been there yet, if everybody hadn't gotten tired. I also went to talk to another meeting of the Pan-Hellenic--well, as long as I was into this--you see, I had to make myself available to everybody, and these sessions were interesting to me. I got so I didn't mind them so much. It ran on, and one thing led to another until I told the Regents that I didn't think they ought to vote on this proposition without every­ body being made to feel that they'd had a chance to have their say, and I said, "By everybody I mean everybody--anybody." I said that I thought we ought to have a public hearing. The vote was--I think, the Regents voted unanimously on that one, so this public hearing was set up, and we had it in a great big ballroom of the Student Union. There were a thousand chairs out--the Regents and I were on a little platform, and I'm telling you every chair was taken. There were people sitting on the floor, and as people came in, I had it fixed so th ey had to go through a single door, and everybody that had anything to say would write down their names. Then I announced several times during 362 the day as people went in and went out that that sheet of paper was there and if they decided that they wanted to speak, they should put their names t when the time came I would call them, read those names off down an d tha in order and give everybody a chance. Once or twice during the morning I thought a riot might start be­ cause the applause from both sides got pretty vigorous. These people had questions to put to the Regents and questions to put to me--most of the questions went to the Regent that started all this, and at noon it was obvious that the crowd was such that we moved over to the auditorium where we could seat around twenty-five hundred people. Around two thou­ sand could sit on the main floor. That contained the afternoon audience, and then we broke up for dinner. That evening at seven o'clock after dinner we took up again, and there were still--well, the main floor of the auditorium was still full and when that hearing broke up at one o'clock the next morning, there were still six or eight hundred people present. At the end I started reading this list of names off. This was about eleven l'clock, and I had eight or nine pages of legal size sheets. Well, a lot of the people had left and others had decided that they didn't want to talk. Others had already talked, but I gave them a chance to talk again if they wanted to. When that meeting broke up, there were still six, or eight hundred people in that audience, and I'd give anything if we could have taped it. It was an exercise in the democratic process, if I ever saw one. The Regents went right into executive session after the meeting, a nd by then there were four Democra t s an d t wo Repu bl·i cans, an d th ey passe d th is motion simply giving the social fraternities and sororities five years to eliminate their discriminatory clauses from their constitutions. ► 363 Now then--I've forgotten the history of the thing since then. I hough that when--well, the Democrats stayed in control of the Re­ know t ll through Quigg Newton's term as president, and two years ago t a gens . oming January, the situation changed. There were four Republicans this c and two Democrats. In the meantime Sigma Chi had been kicked out, and been told that it could not rush and couldn't initiate new members. That's what pertained instead of just saying, "We kicked you off the campus." It gave them another spell of time. As long as they could stay vi- able with a diminishing membership, they had another four years theoreti­ cally to make a change. Sigma Chi had gotten booted off because the chap­ ter at Stanford had been kicked out of the national organization because it had initiated a Negro boy, and there was a big law suit over this ac­ tion, the case in point being that the Regents here had no business tak­ ing such action against a chapter here because that hadn't happened here. It had happened in Stanford. Well, the courts upheld the decision of the Regents, but the very first Regents' action--l'm sure it was the first when there were four Republicans on that board--was to reinstate Sigma Chi, and that's where things stand--! guess. I don't know, but--well, it was just one thing after another like this that kept us stirred up. Mrs. Darley, of course, was in on this last one because she went to Denver University and graduated. She was in a sorority, and her sorority meant a lot to her and with good reason. These girls and their husbands still form the principal nucleus of our closest friends here in town, and it just happened the year before any of this started, the State Pan-Hel- lenic have a big banquet once a year, and she wasn't invited. The last •inute somebody woke up to the fact that she hadn't been invited, so they 364 delayed invitation, very apologetic, and she went. She ac­ sent her a invitation, but when the Pan-Hellenic met in the middle of cepted t h e she still didn't get invited to the luncheon, and about two this scrap, efore the luncheon, why they suddenly realized that she hadn't been days b invited, and they got a delayed invitation to her and wanted to be sure that she realized that this was an oversight and didn't reflect any of the turmoil that was going on at the time--well, she chose not to accept that explanation and she said that she wouldn't be caught dead down there, and she meant it. □ h, dear, the president of the Pan-Hellenic had gone through high school with me. My daughter was in the sorority that she was a member of, and she had been the girl of this buddy of mine in high school, and throughout all this campus business she had been particularly active in opposition to all this business. After this matter was over, the next day she came up with beautiful orchids for Pauline. Pauline went to the door and accepted these orchids almost through the screen. This poor girl was crying--oh, God--what a life! As a matter of power--was the President a creature of the Regents? What's the relationship between the two? Well, Bob Stearns had his struggles with the Regents too, but this was before I came on to the scene. He was a rough, tough operator, and he handled the situations just right, and during his term--all this com­ •unist business came up and oh, boy, he took a beating, but he sure did th e right thing at the right time as far as I'm concerned. This commun­ iat business was all quieted down before I took the presidency, and he deliberately hung on until this was out of the way. He wasn't going to ► 365 have his successor move into any hangover from this, and I can honestly say that I didn't have to contend with any of the overflow of this situa­ tion. The AAUP were out here, and there were riots, and Bob Stearns had the guts to go to a big rally of students, and he knew that there were guns in the crowd, but he knew that if he didn't go, there would be a riot. They threw stones at him. Paul Robeson came out here to give a concert, and he lived in Stearns' home for a week. He was using this home as his headquarters, and these students belonging to the American Youth for Democracy, or whatever it was--Robeson was just using the Stearns' home. It was dis­ graceful, if you want to look at this from the standpoint of his being a host in somebody's home. Bob Stearns and his wife took it. They never squawked. They lived upstairs, and they just simply let this run its course, and the Regents kicked this organization off the campus, with­ drew any recognition of it. I think I had a rough time of it. Bob and his wife--they had three years of this, just the worst kind of a deal. Is the president the executive officer? Yes, and the setup is such that he is a very influential person. The Regents, you see, are set up by the constitution. They are elected by the people, and the table of organization in the constitution shows the executive, the judiciary, the legislative, and the University of Colorado. The Regents are responsible to the people, not to these other branches of government. The president is chairman of the board, and he votes in case of a tie. He decides what goes on the agenda and what does­ n't go on the agenda, and the legislature and the people in the state really look to him, and the Regents too. When trouble brews, it's usually 366 because some Regent wants to stand out in the eyes of the public, or he wants to use this in a political way to further his own career. You're caught between swinging doors. I don't know how often Bob had to break ties. I had to break lots of them, and most of the time it was a different combination of indivi­ duals involved in the tie, so I didn't have to vote very many times until I had made the rounds, and this came out so clearly over the dormitory situation. We were--the university enrollment was growing rapidly, and the Re­ gents were trying to keep the dormitory development going, and this meant bond issues. I had been instructed by the Regents to work up a proposition where we would throw all the dormitory financing into a com­ mon pool. Prior to this we had arranged the financing for this dormitory and that dormitory with separate bond issues for each and so forth. The Regents wanted it worked out so that all of the dormitories were--all of the income from all of the dormitories could be used to pay off indebted­ ness. This would give us quite a bit of extra money to hurry along the dormitory development. I went ahead as per authorization, and we had a pretty good proposi­ tion. The Regents had discussed this off and on during the development of the consideration, and when it came up to the Regents for final appro­ val, one of them said, "Well, before Dr. Darley presents this, I want the board to know that I'm going to vote against it, and one of the reasons I'm going to vote against it is because Dr. Darley has done a lot of this without authorization from the Regents." Another Regent said, "I'm going to vote against it for the same rea- 367 son." He made a motion that no further consideration be given to this proposition, and that passed the Regents five to one. That was the straw that broke the camel's back. I should have resigned right then and there which I didn't do. In­ stead I had my staff put together a brochure, put it together in nice shape, starting out with the original motion adopted by the Regents and reviewing this by Regents meeting and showing what it did on the agenda, the agenda materials, the action of the Regents, and I expected that at the next Regents meeting at least they would have to admit that I was not acting contrary to my authority. Nothing was ever said about that. I didn't put it on the agenda again. Not one word was ever said to me by any Regents. The thing was done. Five to one? Five to one. Is there continuity of Regents, or had they changed? There had been some changes. Of course, this meant that there were--the one who voted in favor was a Democrat. He was the one man on the Board of Regents from beginning to end while I was president who was consistent in keeping himself from being sucked in by the consideration of any of these questions from a political party standpoint. The only other Regent who was on all the way through was an attorney who had been a wonderful Regent by my yardstick up to the point of this fraternity scrap, and then he and I ceased to get along. He died just recently. He was still on the board, and he had gotten elected to the board just 368 prior to--well, eight months ahead of Quigg Newton's leaving because he ran for election on the platform that he was going to compel the presi­ dent to resign. Quigg Newton was a well-known Democrat, and when he was mayor he was supposedly nonpartisan, but his whole family, his whole background was Democrat. After he ceased being mayor, he tried in the primaries for the nomination for Senator as a Democrat, and he got beat. He was beat because when he was mayor he succeeded in getting some water from the western slope. The idea of putting these tunnels through the mountains and bringing western slope water over here, which has made Denver, was his, but that western slope--he stole their water--see, so they saw to it that he was defeated. Being mayor of this city is the kiss of death politically--I don't care who you are--if you want to go for state or national office because you can't be a good mayor of this city without bucking the rest of the state. Well, Quigg is a fearless guy. He didn't care where the chips might fall. He came in as president when there were four Democrats and two Republicans on the board. The vote was four to two. He shouldn't have come under those conditions. The stage was all set for him to have a difficult time of it, and he did, and he's pretty bitter. He could have left here long before he did, and he had the presidency of the Com­ monwealth Fund in his pocket even before the election. I was told by a member of the Board of the Commonwealth Fund that he was going to be the next president of the Commonwealth Fund. He could have walked out of here and saved himself a lot of this hassle, if he had wanted to. He could have fallen upstairs to the presidency of the fourth largest foun­ dation in the country. 369 Well, going through this--maybe you'll turn the pages faster at home when you see some of this stuff I put in books at home because I've got all the memoranda, and of course anybody that goes into this really in depth would have to go through the Regents' minutes, page by page. The secretary (Miss Louise McAllister) up there came into the job shortly after Bob Stearns took the job. Then she was there through Gustavson and through the rest of Bob Stearns. While I was there she was still there, and she went all through this Quigg Newton business, and she'll dig up anything we want, or try to find anything we want, if you want it. Boy, she knows plenty! She's a sphinx--I'm telling you. Nobody gets anything out of her. She's the only woman I've known that can run a big office with an iron hand and get away with it. It's great to have that to rely on. Yes, and without any fuss, or feathers. They just know that she means business, and there's no monkey business. Well, now throughout this period--you see--! was just completely re­ moved from medicine. After this business quieted down here over the Scharrer affair, and of course, Scharrer got his appointment finally, and then he left immediately for Einstein. Then, except during this atomic energy fallout business, things went pretty well down here at the Medical Center. The thing that pulled the faculty together here finally was the squabble over the change in the Colorado General Statute. You know, there's nothing to pull a nation together, or a community together like fear, or hate, or anger. Love doesn't hold communities together in my experience. It's always got to be some crisis. Was this revision in the Colorado General Statute a crisis? 370 No, I couldn't call it a crisis, but it was one of those situations that forces everybody to stand up and be counted, and of course everybody down here was in favor of it. When you open up any statute, I would think, for revision, you open up the possibility of mischief too. You're inviting trouble, and this one year of the fallout business, I think that's the year I had some fourteen pieces of legislation that I was interested in. We were trying to get authorization from the legisla­ ture to pool our endowment funds into one fund. I don't know why we had to go to the legislature for that authorization. I don't think we really did, but that was the decision. Then we wanted some special legislation for our retired faculty whose retirement income that was coming from the university was so small that they couldn't live on it, and we wanted a supplement. We wanted them to get the same as the old age pensioners were getting. There was a lot of little pieces of legislation like that. We wanted it fixed so that the faculty could go on Social Security. The set up here was such, since the university had its own retirement plan, that you couldn't go on Social Security without enabling legislation from the legislature. We got all the legislation through that we wanted, and we got a good appropriation, but it was hard work. Two things--in designing legislation, was it the function of the Regents to do this, or the president and his staff to design ••• ? The Regents would authorize the preparation of a legislative propo­ sal, and then it was up to the president of the university to go to the 371 right place in the legislature where bills are written, or get somebody to sponsor a bill, and then you had the staff of the legislature prepare this bill. We never had trouble getting these representatives of Boulder County to introduce legislation for us, but the President of the Univer­ sity in those days was accepted as a very powerful individual with lots of influence. The present governor came in on a platform that the income taxes would immediately be reduced by some twenty percent, and he followed a man by the name of McNichols who happened to be the Senator that the fam­ ily called as a result of the power going off here when we had this close call with these polio patients. He was a Senator at that time, and this turned out really to be a blessing in disguise as far as the university is concerned. I didn't know Steve before this polio episode, but since we didn't try to whitewash ourselves, and we gave him a chance to spear­ head the effort to get a decent appropriation for the hospital, when he became governor, we had--I had a friend in court that was a real friend, and old Steve--he really went after the support of education. Now, old Ed Johnson returned here as governor from the United States Senate, and incidentally he had been governor of the state before he went to the Senate. He and my father-in-law were very, very close friends even though one was a Democrat and my father-in-law was a Republican, but they were both ranchers, and in those days this was quite a tight frater­ nity. Well, old Steve--the only time this state has taken care of its obligations--! mean adequately taken care of its obligations was when Steve was governor. He had a special study made of our tax situation, and somehow or other he got the legislature to follow the recommendations ,.-- 372 of this study which meant a high income tax. Some other taxes were re­ moved in lieu of this, or diminished, and the legislature was doing very well by its institutions of higher education, but the minute Governor John A. Love came in--this was the year of the Republican landslide, everything went Republican--why the taxes were reduced before these peo­ ple in the legislature had any idea what it took to run this state and how it was supported. It was pretty tough going for the legislature, and the governor put through a bill that created this Commission on Higher Education. Which governor? This present governor. Yes, Love, and this meant that before any institution of higher edu­ cation could present a budget, it theoretically had to be approved by this commission. Well, the legislature could make this stick except for the University of Colorado, and they couldn't make it stick because of the constitutional provisions for the university. Just the same the uni­ versity people elected to go through the Commission on Higher Education and a year ago, the commission's recommendations would have cut the uni­ versity so short that the university people at the behest of the Regents went directly to the legislature over the head of the commission and did this particularly for the dental school because the governor wasn't going to approve the dental school and neither was this commission. The uni­ versity got away with it, got more money than would have otherwise been the case and got the dental school through. 373 Now this last time I don't think that happened. I think the Regents were able to get through as good an appropriation as they had any right to expect without this, and the dental school was certainly kept in the picture this year without any difficulty. The Medical Center again, while it didn't get what it asked for, it came out with a better appro­ priation than the other institutions of higher education. Well, this has always been the case. Now the present president Dr. Joseph R. Smiley has gotten along ex­ tremely well. He's a different type than Stearns, or Darley, or Newton. He's a--he keeps his head down and doesn't get out in the public eye any more than he absolutely has to, but when he does, he makes it count. At the drop of a hat he doesn't start swinging like Stearns, and Darley and Quigg Newton did. He's a gentle person, but firm. Now he's got a bad situation on his hands. Seven hundred students or so--you may have no­ ticed that they marched on the president's office last week. They made these five demands, and he must acquiesce by Monday, or something terri­ ble is going to happen. Well, he said that he'd see a representative of the group on Wednes­ day. This doesn't suit them, but he'll stick by this Wednesday deal. What he'll do I have no idea, but nobody pushes him around, and when he comes out with a statement, it's obviously well considered, and it's a statement that everybody knows he's going to stand behind. Of course there's some faculty behind this student unrest up there just as is the case every place. Lots of outsiders have moved into Boulder to keep things stirred up as they had at Berkeley. They've taken over a lot of what ought to be good student housing around the campus--the university is having its problems, but they've handled things so far--the president 374 has done very well. The current scene made me want to ask you about the dormitory proposition you ran into. Were dormitories constructed on some other basis? Not for a long time. If the Regents had followed through, I feel this would have been a very wise move because construction costs were down. These bond issues that the university has issued--they've taken their own funds that could be invested, and they've bought up their own bonds to advantage, at a discount. This bond business up there has been a very profitable operation resulting in saving the taxpayers millions and millions of dollars, and a lot of these dormitories have been able to recall the bonds long before they were due. Many times I think they wound up buying back most of the outstanding bonds at a discount. A lot of the other building was done on the basis of a building mill levy on real estate. These mill levy periods would go for ten years, and the legislation was passed so that you could borrow against it. You could issue anticipation warrants against the expected collections of the mill levy. This would let the university--the other institutions are in on this too, all of them, the insane asylum, all of them could lay their plans for that ten year period, but could contract for the construc­ tion all at once if it wanted to and borrow against these anticipated col­ lections. Well, obviously during that ten year period, as you look back, building costs went up and this was mighty good economyo The year we were pushing through these fourteen bills the building mill levy had two more years to run and we got the legislature to put through a new mill levy for ten years. This nullified the two outstanding years of the prior building mill levy legislation, but gave us the money to start construe- 375 tion which made it possible for all of the institutions to be well ahead of this increase in student enrollment. The legislature won't do this anymore. The building funds--you have to ask for them and you get special appropriations, and with federal matching money available, before the federal government will earmark any money for you, you've got to show that you've got matching money. It takes you two years after your plans are made to get any money out of the legislature. Then you get the money from the federal government, and then you go to the architects. By the time you get your bids out, build­ ing costs have gone up so much that you can't do anything with the money you've already got. Then you have to go back to the legislature to get some more money, and it's back and forth. This new construction over here on 9th Avenue has been held up at least three years because of this situation. In the meantime the tax­ payers have had to meet these increased costs. All we had to do in order to spend any of this building mill levy money, anybody had to do, was to go to the State Planning Commission and get approval. Well, the State Planning Commission was just as much interested in saving money and build­ ing to advantage as anybody else. In the early days of the building mill levy, we had our matching money. The cyclotron up there which was the last thing I put through--we got the Atomic Energy Commission to agree on so much money, and we got the State Planning Commission to approve several times more money than the Atomic Energy Commission gave us with the understanding that this would be repaid, the money would be repaid from some other income the university had. We could do all of this be~ cause of the constitutional privileges of the Regents. How about the non-scientific parts of the university? 376 The scientific development got the high priority, of course. We did establish an institute up there for research in the behavioral sci­ ences. We did this because somewhere there was twenty thousand dollars to be used for behavioral science research. This twenty thousand dollars served as seed money, and this has slowly grown now until it has reached the point that it is of considerable consequence. At least they have the administrative setup there now so it's easy to go to the federal govern­ ment as the government has provided funds to be used for things like this, but it was the science business that got started. Physics was in bad shape when I went up there to Boulder, and it was because the department head and the Dean of Arts and Sciences--here was all this red tape, established tradition, so that you couldn't crack any­ thing. We were losing good faculty people in physics. The graduate stu­ dent group that they had were not good. Finally the Regents gave me the authorization--they created three professorships in physics, and I was to make the appointments if I wanted to without consideration of the Dean of the College of Liberal Arts, or the head of the Physics Department. George Gamow was the first appointment, one of the big guys in the atomic bomb from George Washington University. Of course, the head of the department--the minute the Regents took this action the head of the department resigned, and the department elected its own chairman. That was the rule at the time, still is, I guess. I don't like the system, and you'll find memoranda to that effect in this stuff, but they made a good choice, and the department that was left--boy, they revamped things in a hurry. The other two people we brought in were cyclotron boys-­ just finished graduate school, but in the process I think it was part of their doctoral thesis, one of them at least, a design for a new kind of 377 cyclotron, a cyclotron that would do something that hadn't been done be­ fore, not a great big cyclotron, but big enough and expensive, so we brought them on. This has been quite a deal--this cyclotron. We had the High Altitude Observatory. This was established jointly by the University of Colorado and Harvard. Walter Orr Roberts was brought here fresh out of graduate school to run the coronagraph up at Climax. Well, it was obvious--he was an unusual person, and he was really going strong when I came on as president. Stearns had promoted him, but one of the first things that happened when I was president was this visit from McGeorge Bundy from Harvard saying that Harvard no longer wanted to be associated with the University of Colorado in this High Altitude Observa­ tory venture. He said, "This isn't anything and mustn't be taken as dero­ gatory of the University of Colorado, but Harvard has just decided that it does not want to be involved in any enterprise that isn't under its complete control." I said, "All right. The University of Colorado will assume Harvard's responsibility." The Regents bought this immediately, and the Board of Directors of the High Altitude Observatory approved, and there was just nothing to it. But Walter Orr Roberts was not an intimate part of the university. He couldn't even get a faculty appointment because the head of the Department of Physics wasn't willing to recommend an appointment for him. Take the Bureau of Standards--Bob Stearns got the Bureau of Stand­ ards out here with the understanding that the scientific people that came on the staff of the Bureau of Standards, if they were qualified, would be given faculty appointments, and we would develop a big joint research ef­ fort and a program in graduate education. These people couldn't make it. 378 The Physics Department, the Mathematics Department--they were just on the outside. That's all there was to it. They knew that they weren't even welcome to seminars and things like that over on the campus. The people at the Bureau of Standards invited our faculty to their seminars, and very, very few of our faculty went. Some of the graduate students went. It wasn't until after I left that Q~igg Newton straightened this one out and now, of course, everything is like it is here with the Veterans Hospital. This Institute for Atmospheric Research wouldn't have had a prayer up there at Boulder, if this deal hadn't been straightened out properly. With Walter Roberts pushing the geophysical year--you remem­ ber that--well, we got Boulder, or the university designated as the re­ pository for all of the data that had to do with geography, or the sur­ face of the earth. We got the designation. Whether anything really came of the whole geophysical year effort, I don't know, but at any rate, this looked important at the time to everybody. Tell me this--as president did you get opportunity and time to develop an educational philosophy for the school and the State? Or were you •••• Frustrated right down the line. To begin with--! thought it was a pretty good speech, and I haven't looked at it since I originally thought it was good, but my first pronouncement before the Faculty Senate was the proposition that the Senate would appoint the necessary committees so that we could develop an official statement of the university's objectives. I have forgotten now how I made the case for this. As I look back on it, I didn't do very well because the faculty just wasn't interested. They appointed a committee, and I met with them. They wanted to know what I meant about objectives, and I don't know what I told them. They fumbled 379 around and came in with a statement. I went over it, and then it went back. I think I remember two statements, and then I think I became so involved in this sort of stuff we've been talking about that I ceased to make an issue out of it. I was all hot for a good counselling system and got frustrated on that. We didn't have the money to put in a good counselling system. They had a counselling service, of course, where they would give all the tests and have a quick interview with the students that came in for the test. My son went through it, and from what he told me I would have to say that it didn't sound very impressive. As far as educational philo­ sophy is concerned, I talked about it--you see, I had just been made president a little while when my term of office as President of the AAMC started, and I gave that paper with that diagram.* Well, I got quite a bit of mileage out of that speech after I came back to the campus. I was asked to meet with groups of faculty and talk about education, and I would draw these diagrams on the board and these formulas. I have a paper about half written on the subject of academic free­ dom--well, I was never able to feel comfortable with really the sorts of things that a university president should do. If I was going to do in Boulder the kinds of things that I had tried to do down here at the Medical Center, I was dealing with a different breed of cats. I'd never had anybody down here do anything, or say anything that indicated there was any problem about academic freedom. The moti~ation down here was pretty much on a single track. These people all had a lot in common. They liked each other. They liked me. My wife was a part of this. The student body--we had no--well, we were just sort of one big happy family. * Darley, Ward, "Medical Education and the Potential of the Student to Learn," JME 29: 11-19. February, 1 954. 380 I didn't know how lucky I was until I left, but it wasn't that way up there at Boulder. Here were eight or nine schools each with faculties that had different objectives. There was not very good communication be­ tween them. The Faculty Senate meetings--I'd made my mind up, and this was a mistake--I'd made my mind up as presiding officer of the Faculty Senate that I would never become involved in any of the debate, that I would never do anything to direct what should be the spontaneous flow of faculty opinion and faculty decision. This seemed to work all right until one time the legislature didn't pass the big appropriation that we'd gone in for. I worked hard on this, and the Regents worked hard on this. The Regents authorized me to go in after the finance committee had made its report, even after the appropri­ ation had been acted upon. Well, to begin with we'd worked out an arrangement whereby we had a president's association, or an Association of Presidents of State Sup­ ported Universities. Bob Stearns had set this up, but it had never worked too well because the land grant college at Fort Collins wasn't going to play ball this way. I was able to get the Fort Collins institution to play ball. I went up and met with the Board of Agriculture. This was early in my career. Here we were San Luis Valley rural cattle people-­ this was where I could really make this background go. I could cash in on it. I knew most of these people. There was no question about their letting their president come into this association and forget his suspi­ cions and so forth. This association paid off in getting better appropriations for all of these schools. If I had anything special to offer the university, it was in this area and in working with the legislature really, so this group 381 of presidents agreed that the Fort Collins and the Boulder Institution should go in and make an effort to get a couple of extra hundred thousand dollars. We were able to get a hearing on it, and we were able to per­ suade the house committee to report this bill out, and it got before the legislature, and it was assigned to the rule's committee, and there it stopped. Then the Regents and I were not getting along. This question of ap­ propriations happened to be one of the few things we agreed on, and the Faculty Senate passed a motion expressing appreciation of me for making the effort and criticizing the Regents for not doing its share, and I didn't have sense enough to tell them not to pass that motion. I could have kept them from putting that motion through. That's why I say I just never was cut out for this big time stuff in higher education. I suppose I could say that the last six months went well after I had announced my resignation. I had six months to go. Well, things had been going pretty well for six months before that, or I would never have announced my resig­ nation, or resigned because I wasn't going to leave the university and leave any big hassle behind me. I'm sure if I had stayed on, by then I had learned enough maybe to cope with this kind of a job. Another factor was going back to the Harvard Business School for this week's course that the Harvard Business School offered newly appointed presidents of colleges and universities. This was a Carnegie venture, and we went back there--you were supposed to have been in office no less than two years, but this was the first time the course was given so they let me go back having been in office longer than two years. This course was built around the idea of case studies, case histories. 382 This has built up the graduate curriculum of the Harvard Graduate School of Business. Here was this book that represented actual situations that presidents, or university people had been willing to write up. Of course no names were involved in these case studies, and there was every conceiv­ able kind of a problem that could confront a university president. I don't think there was a problem, including murder, that was outlined in that book that I hadn't had here at Colorado to contend with in some way, or other. The trick was that we were to read pages so and so and be prepared to discuss cases such and such. The men presiding at these sessions were not educators. They were just experienced chairmen--Robert's Rules of Order authorities, people who were supposed to draw other people out and keep the discussion going. We discussed these things, and nobody had any idea really as to what to do about any of them. When we'd finish a dis­ cussion, nothing was wrapped up. There was no concensus. There was no sense of feeling that these problems even had a solution, and this went on day in and day out. They were having similar sessions for the wives. My wife and I would get together in the eveni~g. All this experience did was to open up old sores and leave them raw. They didn't bring in any old heads and have somebody discuss this particular case and say, "Having been in uni­ versity administration for thirty years, this is what I would do, or at least this is the procedure I'd suggest you follow." We came away from this, all of us, very frustrated. I didn't feel that I got a thing out of that course, and I told them so. You'll find letters to this effect in some of these books. They didn't like what I had to say. What I wanted out of the course was exactly the thing that 383 the course intended not to give--you see. I was looking for a structured educational situation, I guess. I didn't want to be stimulated. I was stimulated all right, and this had quite a bit to do with our decision to resign; if this was an example of what being a president of an insti­ tution was going to mean no matter where you were, we just didn't want to go to the graveside early with this kind of an experience behind us. My arthritis flared up during this period as university president. I was wearing an orthopedic collar. It was all I could do to keep going. I was having migraine headaches before each Regents meeting and diarrhea went with this. I knew what was causing all of this--you know, and I wasn't about to go to a psychiatrist when I knew all I had to do is get out of the situation. This took an awful lot out of the two of us. Now Bob Stearns and his wife were entirely different people. Sure, it was hard for them too, but they took this in their stride a lot better than Pauline and I did in ours. Old Gustavson--he'd have loved this. He had plenty going against him when he was president. Well, he was a very, very--he'd learned to think. He was a scientist and a real one, and he was articulate. You don't ever want to go at him with the idea that he's got any papers for you to read because he just didn't publish anything except scientific papers. He wouldn't write a speech for anybody. He'd give a good speech, and his notes would all go on a piece of paper about that big, and he'd always give a good speech. Whenever anybody wanted to start an argument with him--! don't care what the subject was--! have seen him time and time again handle himself superbly, just superbly. He went to Nebraska from here as Chancellor. That's where he got his hard knocks. ].id the president have access to legal counsel? 384 Oh yes, you had the law school. The Attorney General was supposed to be the attorney for the university. He was the attorney for all state agencies, and this old Duke W. Dunbar who is still there, was a doggone good attorney general. Of course Bob Stearns was an attorney, but I found Duke Dunbar more than satisfactory, and I'd go down long--well he told me the first time he met me, "When you see even the remote chance of trouble coming up, feel free to come and see me. Let's keep ahead of things." He was always a good wailing wall for me. I mean sense of procedure, the variations in procedure that one can use. I had no--while I was president the university was never involved in any litigation. Now then under Bob's--this fellow who was on the Board of Regents, Charles D. Bromley, was a graduate of the university. He was a Regent way back, and then there was a period of six years when he wasn't on the board and during those years there was lots of litiga­ tion, and the Regents hired him as the university's attorney. In order to do this and give Bromley any stature, the attorney general had to ap­ point him a deputy which he was perfectly willing to do. Now, this Brom­ ley was as good a lawyer as this state has ever seen for my money, and he served the university very well as its attorney, but I never--! just can't think of any time when there was any, even remote, chance of any­ thing happening involving litigation. One amusing time was when a bunch of retired preachers filed a suit against the university because we were teaching evolution, and the basis of the suit was that evolution was really a religious rather than a sci­ entific concept, and therefore the university was violating the princi­ ple of the separation of church and state. Well, there was a lot--the ,., 385 newspapers had a lot of fun with this one. We gave this old man a hear­ ing, and I had a letter already for the Regents to approve. They heard the plea, and they authorized this letter which I signed right then and there and gave to this old gentleman, and that was the end of that. Well, that would never have got into the courts, of course. Don't you have the sense that having been Dean of the Medical School and Vice President in charge of Medical Affairs, the experience you had here wasn't nearly an adequate preparation for the kind of peas and carrots you got involved in up there at Boulder? That was really big league compared to this. Now I don't mean to belittle the job of a fellow who is head of a place like this because in its way it's just as tough. Oh yes, I didn't mean •••• But it's a different way. It's an entirely different set of circum­ stances, and it still is. Now this guy Conger could go into a situation up there at Boulder, I think--! think he's too smart to. I liked him very much. He's good. He's a member of the President's Cabinet, and the president has told me that this fellow Conger is a real resource when it comes to the point in a cabinet meeting where problems are being considered that are just as important to that part of the university as this, and I'm sure that's true. He's a good practicing psychologist, and he's an authority on juvenile delinquency and adolescent problems. Accident proneness has been another one of his special fields of competence, and he's chairman 386 of the President's Commission on Accident Prevention, and he gives this a lot of time. He has to. He sounded like a fellow who could be disinterestedly interested. Bob Stearns was this way. It really took a situation when the sit- uation would keep him from getting his sleep. It really did. Now his wife was a different matter, but old Bob--of course being trained in law, and he'd had enough experience in law. Even today when he's retired--he left the presidency to take over the presidency of the Boettcher Founda­ tion. He's retired from that, and since then he takes on civic jobs. He led the movement to revamp the state's court system, and he was very successful with that. Well, he gave that everything he had for three or four years, I suppose, but if anybody wants to get in a rough and tumble fight, he's not the one to pick. I've seen him. I've seen him in action, and I know. That's him right there. A sense of humor--boy, has he got a sense of humor! That's what saves him. Even the worst of the experi­ ences he had at Boulder are things that he can walk away from. He can laugh at--at himself too? Well, he takes himself pretty seriously. I've been fishing with him, and he's a wonderful guy to go out with, and we've travelled a lot between here and Washington and around Washington, New York, and around the state--he's a wonderful companion. Did you have to stump the state too as president? Oh yes, that--I liked it. It was terribly fatiguing because when we went out, when we went through a wide place in the road, and there was 387 any alumnus there--we knew who were alumni in all these places. It did more good to stop in a little town with three or four hundred people and have lunch with a group of alumni and maybe include the guy who ran the newspaper and if there was a broadcasting station there, or a superinten­ dent of schools, or a principal of a high school. I said it then, and I'll still say it, that it does more good to spend an hour there than to spend five days getting ready for a big speech to the Chamber of Commerce at Pueblo or here. We always sought out any members of the legislature as we went through these towns. I'll never forget one time--I got a sense of humor. I can laugh at myself after I'd cool off. This episode was funny from the start. I had the Dean of the School of Business, Delbert J. Duncan, and John W. Bartram who was my public relations man, and the Dean of the College of Arts and Sciences, Jacob Van Ek, and incidentally he and I were good friends always even though we had these difficulties at Boulder. He and I and his wife were good friends when we were in school at Boulder. Well, we were going to see this man in the legislature who had a sheep ranch out at the town of Delta. It was raining, and we called him and wanted to come out and see him. He wouldn't hear of that. He was going to come in and see us right away, so here he came. He was a small man, and he was really dressed to the teeth in a western outfit. He had a nicely tailored western suit and a great big hat, and he sat down, and we visited along, and the Dean of the School of Business said, "What do the people over here think about the University of Colorado? How do they feel about it?" This man was sitting with his knees crossed, and he was smoking a cigar about that long and with great deliberation he wound up to answer 388 this question, taking several puffs on this cigar, and he said, "I've never heard the university spoken of except in terms of the highest con­ demnation." How under the sun the four of us sitting in that room did not change expression I'll never know. As far as he was concerned that was the nic­ est thing he could have said honestly. Beautiful. That's precious. That's one of the funniest experiences I ever had in my whole life. It makes me think of the "Tug Boat" Annie stories. My wife's step mother's housekeeper is a "Tug Boat" Annie type. She makes cracks like this, misusing words in the same fashion. A neighbor is a construction man, and she always speaks of him as an "obstructionist", and we can't get her to change. The faculty--we got along well with the faculty up there at Boulder by and large. There were these islands of trouble such as the Department of Physics. The fact that we got along so well is as much my wife's fault as mine. She clicked wonderfully well with the faculty up there, and we hated--we felt sorry. The faculty was really sorry to see us leave. We know that. What about the nonscientific--history, political science, English-­ _g_roup? I did very well with them. There wasn't much available for them by way of support. We were doing the best we could. They felt that. The school of 389 engineering and law--of course we didn't dare get chummy with anybody. You'd have to keep yourself so that you could say no to everybody, and even down here we were careful to avoid being identified socially with any particular--well, the situation here was such that you could be real friendly with everybody because there weren't too many people involved. Being president of a university is a lonesome business. Fortunately we had our friends down here. The 5tearnses were friendly with everybody. They had their intimates down here, I'm sure, and the same with the Newtons. Did the budget of the medical school come before the president for review? Oh, yes, and that came before the Regents for review, but, as I said, each of these units received a separate appropriation so the university campus as a whole was never fighting for budget position in front of the Regents. They were never fighting with the medical campus. Now they did­ n't like the fact up there that it was easier for the Medical Center to get the legislature's money. They didn't like the fact that salaries were higher down here at the Medical Center than they were up there. They knew that getting salaries up down here helped to get their salaries up in the long run. Of course, getting this faculty salary practice fund established down here took a little more of the curse off of this high salary deal in the medical school because the faculty at Boulder realized that part of the high salary the faculty were really earning themselves. Then you have a counterpart of this up there at Boulder. There are people in the Physics Department whose consulting fees amount to a whole lot more than the salary they get from the university--chemistry, educa­ tion, the way things have gone most of the people in economics, sociology-- 390 this consulting business has opened up for all of them. ,, I .b9oking at it from the point of view of the president of the university §§ a whole, it was apparent, I would think, that federal funds from what­ ever source were shaping the policy of the school without the school real- izing where it was going. Now, that's a conclusion in support of which I can't risk anything specific, but I thought maybe you could. This did shape your policy. It was--time after time because you knew you could get money for something, it was because of that fact that you did this and you did that. You just can't deny that this is true. I think--well, I know we never said no. A good example is this money that the Physics Department spends up there to investigate unidentified flying objects. The Air Force says, "Here's some money, if the universities can take it on and carry on these investigations." The Physics Department up there at Boulder took some of it. I don't know what they're finding out, or whether this has competed for time that ought to be going for other things. I don't know anything about that, but on the other hand down here at the Medical Center, at least while I was here, I think everything we went after was closely related to the kind of things we should be doing anyhow. In an ongoing thing like this, you don't have a chance to •••• A good example is the Mental Retardation Center that every medical center has taken on. Now as far as teaching undergraduate medical stu­ dents is concerned, you need a Mental Retardation Center like you need a hole in the head, and you don't need it for your interns, or your resi­ dents either. You don't need it for your residents in psychiatry to any 391 very great extent. It's a wonderful place for postdoctoral fellows, and it will probably result in a real service to the state. It's going to compete for funds. I don't know whether it will be on a separate appropriation or not. I think there's a good chance it will, and the reason is that this was a year that the legislature was under the control of the Republicans, and there was a Democrat, a woman from the western slope (Elizabeth Pellet), who was concerned--! forget what had happened to make it apparent that what this state had to offer in the interest of disadvantaged emotionally disturbed children was pretty inadequate. She tried to get the legisla­ ture--she introduced a bill that would have established a separate institution for the evaluation and management of emotionally disturbed children. Whether she had mental retardation in the thing or not--! expect it was in there. Well, it was obvious that a Republican legisla­ ture wasn't going to pick up a Democrat proposition, so she came to me-- I know her very well. She was quite a gal, had been a well known actress on Broadway when she was young. Now she was old. You wouldn't have dreamed that she had been a star on Broadway, but she was sharp. She said, "Would you go along if I would put a bill in that would set up an evalua­ tion center for children at the medical center?" I said, "Yes." She put in a bill for fifty thousand dollars to establish a center out here at the Psychopathic Hospital to which judges, or police officers, or courts could refer children for a thorough evaluation before they were committed to a foster home, or to one of the homes for disadvantaged children, or even one of the correctional institutions for young children. Well, the legislature bought this immediately, and the psychiatry people 392 were glad to set this up. That was an example of the sort of thing you're talking about, and the legislature has never failed to keep supporting this thing, and this was one of the reasons why over here you've got this original Psychopathic Hospital shaped like that. This deal here was one of the reasons we were able to get this addition that is lined up for Eighth Avenue over here, and of course it's one of the reasons they were able to sell the legisla­ ture on approving in principle at least, this Mental Retardation Center. This shows how you yield to temptation once and you get yourself in a rut that you can't get out of, and some good things come out of these deals-­ you know it. I didn't mean to imply--you know, that this was a bad situation. I meant to indicate that in many instances the initiation, or the manipu­ lation of forces is out of the president's hands. Yes, you just take hold of the bandwagon as it goes by. You ride it hopefully for purposes of the schoolz I'm sure, but whether it accords with an objective that the school might have--there's no way to measure for a long period of time. That's right. These were exciting times. I had written up once--l'm afraid I don't have it because it was part of another paper, and I have discarded it. I wished I saved it. I can write it up again not without too much difficulty, but a fellow by the name of Joseph Murtaugh who is James A. Shannon's right-hand man is 393 now with--he's the fulltime secretary for this new committee on--well, it will be with the National Academy of Sciences. Walsh McDermott's the chairman of it. Well, Joe Murtaugh was out here telling me about this development a long time ago. He wanted to know what I thought about it. Of course, I'm all for it, and I was particularly for it when he told that Walsh McDermott would come in and that he, Murtaugh, would change over, because this Murtaugh is--well, he's got plenty going for him, and Jim Shannon is missing him, I'll bet you. Joe said, "We have got to identify the core responsibility of the medical school, or a university medical center, and will you write your idea of this up for me?" I promised to do it, and I haven't done it yet, but the core respon­ sibility would be your undergraduate school of medicine. Let's say you'd have fifty in a class. Then to support two hundred students you've got to have clinical facilities, and your ideal clinical facility would be no larger than that necessary to satisfy the teaching needs of these two hundred students. Then your pre-clinical faculty would be no larger than was necessary to satisfy the needs of these two hundred students. The clinical faculty would be no larger than that needed to satisfy these two hundred students but also to take care of the clinical patients, the clin­ ical load which, in turn, would be held to the size just needed to take care of the needs of those students. This would put certain limitations on the size of this faculty and the makeup of this faculty. Then the number of interns and residents you'd have would be no larger than that necessary to permit this faculty of specified size to take care of this limited number of patients--you see. Then the research that you would bring in would be no more than the cl·inical · research necessary to serve as the continuing education stimulus 394 for this faculty which would be of limited size, said size being deter­ mined by the size of your clinical facility that would be just barely big enough to take care of the needs of these two hundred students. Over here your basic science research program would be no larger than that ne­ cessary to serve as the continuing education gimmick for your basic sci­ ence faculty and the number of graduate students that would come in to this situation would be no larger than this research program could accom­ modate. Well, you get this all down, and you think that you're going to start a medical school up someplace that is going to be surrounded by all these limitations, and you're not going to have any takers, unless this philosophy can be made to pertain for a while in these four states that I keep coming back to that don't have medical schools. This is exactly what I have got in mind, but I'm not saying anything about it. Already you can't do it because these community hospitals that will be accommo­ dating these medical students are already going to have service loads that are geared to meet the community need, not the needs of these stu­ dents, but I say that the selection of patients that these students will be involved with as far as patient care is concerned, the number of pa­ tients, or families that are selected and made an intimate part of this teaching program will be no greater than that necessary to meet these stu­ dents' needs because these students are not going to be exploited in the name of patient care out here in these community hospitals, and if we don't watch out, that will be the first thing that will happen. I've said nothing about this yet, but this is the kind of thing that they'll have to agree to, and the interns and residents--if this is going to be truly an educational experience beyond graduation for family physi- 395 cians, they cannot expect these residents to be involved in the care of any more patients than the number and the kind necessary to really make this a worthwhile educational experience. If this can be made to pertain, I think that you'll think about a complete education for these people as a function of demonstrated educational accomplishment rather than a func­ tion of time. These fellows can be trained in a lot less than the pre­ scribed three, four, five years that now is insisted on by these various specialty boards. In these changes, things that I have added to this in the document that you haven't seen, I take a real fast pass at education as a function of demonstrated accomplishment than a function of time because i f the academy people go to this meeting at the end of this month, I don't want them to be selling themselves out by agreeing to a specified number of years. I want them to get more than two years--! want them to be willing to support programs that are more than two years, but I don't want them to sell themselves out for five years. Well, Joe and I talked about this--you see. We drew these pictures, and he can write this up as well, or better than I can because he's a superb writer in his own right, and he can turn out a finished product ten times faster than I can. How did we get on this--! don't know. This is just the way with conversation--as a president seeing development from the president's chair you don't get the chance to develop this kind of program. You really don't. The shape of the program here is related to existing funds which are available, and you're a fool not to try to _g_et them because they are available, but it already shapes your program, enriches the stream which was already swollen when you jump in. 396 The Regents when I was down here--up there too--many times I have seen them approve a program with only limited financial support in sight really basing their decision on the philosophy that "the Lord will pro­ vide, blessed be the loan of the Lord," and we moved in on the basis of faith, and there's no getting around it. That's not a very strong reed on which to rely, but you can see--put it this way, did you ever have the sense of identification with other uni­ versity presidents as voices in the capitals where the sources of funds were coming from? No, I really never became active in the Association of State Univer­ sities. I went to two meetings. I should have gone to two more. I just didn't find these meetings very interesting, and I can't tell you why. One reason was that they were talking about things that were completely irrelevant to any of my actual experience. They were talking about some of these things that made me unhappy about this experience at the Harvard Business School. I think I kind of got frightened at some of the things I heard there--concerned. I didn't feel comfortable with these fellows. I honestly didn't. There were some good friends in there. I didn't like to travel. I didn't like to fly and you had to fly. Flying was very tiresome in those days even if you did like to fly. I didn't let my fear keep me from flying because I went on the Board of Visitors of the Air University for three years when I had to do with the Air Force, where I had to do plenty of flying in all kinds of equipment, but the main reason I didn't go was that if I could find a good excuse not to go, I was glad. I don't mean to smoke the background for this, but later on the Coggeshall Report involved the university as distinct from the medical school, or a 397 ygment of the university--to involve the university which would seem Well, in the first place, that was Coggeshall's original idea, and I sure went along with it because by then I could see how important these other areas of health education were, and I knew that we needed a differ­ ent definition of medical education which I put in the early part of one of the final chapters I wrote for one of the institutes. Now then I had met with the Association of American Universities when I was with the AAMC because the Deans had often talked about feeling isolated from their pres­ idents, and they were always talking about the president's grumbling about what a cross the medical school was. This was a common thing the presi­ dents talked about and at one of the meetings of the Association of Amer­ ican Universities this was the principal thing they talked about appar­ ently so the AAU--this was when Lawrence A. Kimpton was the President of the AAU and of the University of Chicago, and I'd gotten to know him pretty well. I got him to invite us to come and have lunch with the AAU people, and we spent an afternoon talking about medical education. I don't remem­ ber much about this except that this was a lively discussion. I don't think that anything came of it. One of the first things I did as executive director was present the executive council with a proposition for improving, even compelling com­ munication between the deans and the presidents, and I can get this docu­ ment--! don't know whether I saved a copy of it or not. I cleared it with Frank Murphy of Kansas who had been dean of a medical school before, and he said, "This sounds fine to me." I was really going to suggest a separate organization of presidents where they would appoint task forces to investigate certain problems be- 398 cause there is no organization of universities that forms an umbrella over medical education. The AAU--the membership there represents about half the medical schools. The other half aren't represented there, and they weren't all represented in the Association of State Universities be­ cause there were two organizations--the land grant universities and the non-land grant universities. I think we could have gotten money to sup­ port an organization like this. Well, the AAMC Council put it off until the next meeting. Then at the next meeting, it was put off until the next, and they obviously weren't interested, so in the meantime I began getting thoroughly involved in other things. This was dropped by the way­ side, but this suggested organization might have been able to work--! don't know. When you were president there was no place for sharing, or if you had a place for sharing, there was no sense of sharing. I didn't feel the need for it when I was president. This place was going along all right--with this Medical Center here things had developed so that it was in good communication with the world of medical science. All these fulltime people were constantly bringing visitors in. It was easy to get people to stop when they were flying over here to go to San Francisco, or Los Angeles. We could get a Nobel Prizer to stop and pay him twenty-five bucks to cover the extra fare involved in a three hour layover here on his way going one way or the other. These people were bringing in visiting professors, the clinical people--they were building their own bridges to the outside world. This isolation--the airplane did away with that in a hurry. lhey say that the history of medical care is somewhat related to the 399 .!2.,_uilding of roads, the construction of roads, the automobile, shortening the distance between places, and it may well be that in an intellectual sense the University of Colorado--its boundaries are now the United States, intellectual in that sense. It's always been a national institution. The enrollment at Boulder as to the non-resident has been as high as fifty-five percent of the to­ tal student body. That's the way we got our money to run with--the legis­ lature would cut us short, and the Regents would say, " □ .K. Maybe we'll raise tuition on the residents, but we'll raise tuition on the non-resi­ dents, and you'll admit enough extra non-residents to make up what we need to jibe with this budget." Under Quigg Newton that would have happened anyhow. The legislature decided that this would have to stop, that we should aim at a twenty-five percent non-resident enrollment. The legislature began to approve really a line item budget. This has crippled the university a great deal. "Colo­ rado General can spend x million dollars next year. We'll appropriate x over two million dollars. We'll appropriate half of it with the idea that the hospital will earn the other half in patient fees and hospital bills it will collect, but if the earnings exceed this estimation, the amount that will come to the Colorado General from the State Treasury will be diminished by that amount. You cannot spend one red cent over this auth­ orized amount no matter where the money comes from." Now so far they haven't let this interfere with the amount of re­ search money that's accepted, and they haven't let it interfere with the size of this faculty fund. I've been scared to death they would. Now the Regents have the constitutional authority to say, "No. No you can't do this to us." 400 f l!7ey can say that to the legislature? They could say that, but they know darn well that if they do, the next legislature will offer no appropriation at all maybe, so even though the constitution appears to protect the university, it really doesn't work that way because of the way the legislature can handle appropriations. Way back I think I told you that the taxpayers voted a mill levy that was supposed to take care of all the needs of all of the institu­ tions of higher education for public money, and there would be none of this going to the legislature. If that pertained today, the legislature couldn't threaten it in any fashion. Now there was time back in 1924 to 1926--I think these are the years--when the Ku Klux Klan had complete control of this state--governor, legislature, everything, and this build­ ing mill levy was there, but the university had to go back to the legis- lature for appropriations. (see Empire Magazine of Denver Post, Sept. 21 and 28, 1969) The appropriations were rather small, and this year ••.. [Telephone interruption]. As I said, the Ku Klux Klan really had this state. Well, there were two or three people on the faculty up there at Boulder that the Ku Klux Klan didn't like, so Dr. Norlin was told that he'd have to fire those three people if he got any appropriation from the legislature. Well, Norlin said, "We'll get along without any appropriation", and they did. The faculty had to take a little salary cut in order to make up the sit­ uation. Good for Norlin! He was quite a fellow. Oh, he was--he was a Greek scholar • .Yl,Jite a man. 401 He was a tough customer too. He was president probably longer than anybody else. Did this blow over? Yes, the next year--this governor was sent to the pen not for some­ thing he did as governor. I've forgotten what it was, and this Dr. John G. Locke, the M.D., he was the head of this Ku Klux Klan. He--I don't remember what happened to him, but everybody has forgotten about this pretty near. Well, it was the building will levy that saved the situa­ tion. That came in automatically. The legislature couldn't touch that. Let's go get a sandwich. Let me put my sweater on--the blanket syndrome. We're not going to be able to continue because you can't find your sweater. It looks as though we're out of luck. Well, I think one of the consequences of beirg a Dean and then the Vice President of the university is the fact that one gets pulled beyond one's immediate task; the Deanship of the Medical School, and into other areas. I'm not saying that this dilutes effort, but a thing like this item--a whole series of studies in 1950, 1951, and 1952. You're a member of the Council of the Association of American Medical Colleges, and one picks up vicariously a lot of ideas in this context too, but as a member of the Council you're pressed into service with the Rockefeller Foundation on its Board of Consultanta--put it this way, the demands on the person be- 402 ~nd the administrative matters with which he is confronted become large. n,ere are two ways of treating this, I think. One of the developments which I find refreshing really is the regional approach to these problems in your Western Interstate Commission on Higher Education. We talked about this before with respect to the way in which funds accrued to the University of Colorado Medical School, but beyond that you set in motion means whereby you can be of service beyond the state and within perhaps a reasonable distance from the state with sister states that are close by. I think this is good. I don't know how you feel about it. I agree. I think the regional effort is a step toward the future whereas trying to handle things perhaps on the national scene--I'm not sure that that is possible to the same degree in terms of satisfaction. For example, as an agency the AAMC competes with the American Medical Association, and there are other groups, articulate groups, with their own--! was about to say petty interests, or their narrow interests, and if the AAMC wants to raise the sights of medical schools, it becomes--well, the number of areas from which one can be shot at is multiplied on the national scene. It might not be so on a regional basis--! don't know. I think your re­ gional experience is an important one. Then we can get into the begin­ ning studies and the preliminary studies of the American Association of Medical Colleges. You may want to comment in a wholly different vein than I have sketched. I think that's a very valid observation. It's easier--! don't know whether I want to stay with this thought or not. Let's see how it sounds, but I think it's easier to produce change centrifugally than it is centri- 403 petally--at least you can see the evidence of change. Change is easier to induce i f you work from the inside out than i f you try to do it from the outside in--that's the way I'd put it. You're playing in different ball leagues. You're in the sandlot when you're talking about inside out; whereas, you're in the big league when you talk about the outside in. The regional approach--I'd never thought about this, but my experi­ ence with the Western Interstate Commission on Higher Education and my observation of it when I ceased to be a part of it, really make me think that there's a lot about the regional approach that makes for change that would be very slow in coming if you waited for a coalescence of islands of change, or what is taking place from the inside out basis in a region. Of course, there was a lot of common ground upon which these original eleven states could work--not all of them. California probably didn't get much out of the Western Interstate Commission on Higher Education compared to Colorado because it's such a self-sufficient community it­ self. The philosophy of the Western Interstate Commission was limited to the conduct of studies and the conduct of conferences in which the re­ sults of studies played an important role so that the need for change to me became self-evident in this kind of process. Then the representatives of each state would go back and depending upon the strength of their mo­ tivations set up islands of change that are pretty independent of the Western Interstate Commission on Higher Education. They've gotten their stimulus, their ideas and enough information to support their ideas so that they feel like getting something started. The compact that each state adopted when it joined the Western Inter- 404 state Commission--one reason we could get the compact adopted was that in the compact operating programs is forbidden. WICHE cannot operate a program. Now WICHE may be stretching things a little bit because the re­ gional medical program for the states of Idaho, Montana, Nevada, and Wyoming is one program, and it is coordinated by a Dr. Alfred Popma who lives in Boise, Idaho, and then there is a state coordinator from each of the states so that these five people compare with the Board of Direc­ tors of an institution, and all WICHE does is administer the funds. WICHE submits the application to Washington, and WICHE accepts the money, does the banking, and does the bookkeeping, but so far as I know, there's nothing going on that indicates that WICHE as WICHE is taking any pro­ gram responsibility in any of these states. Now then this consortium of medical schools that I'm talking about-­ if this would go through, I would like to see WICHE continue to adminis­ ter the funds and house the staff that will represent the core activity of the consortium. Here again, this is just as far as WICHE would dare go. WICHE's long suit, therefore, is the conduct of studies, the prepar­ ation of reports, the conduct of conferences, and the publication of conference reports. Isn't the compact designed in the sense that four states are better than one with respect to a specific problem. Yes, all states together can do better than a single state can do alone. And this compact was an enabling piece of legislation? WICHE has arranged for exchanges of one kind or another between 405 states. I guess you could call this operating a program. It really serves as a door opener for opportunity, and WICHE's total program goes far beyond the field of health, although the health field is still pro­ bably the biggest single element in the WICHE deal--if you take nursing, medicine, dentistry, the student exchange programs, the conferences and studies and things that WICHE has done. WICHE runs a big program in con­ tinuing education for practicing physicians. The National Institute of Mental Health--Bob Felix's old partner, his associate director, Dr. Ray Feldman, came out here to heed this part of the program up. They built an evaluation of educational effectiveness into the operation that I hope is going to prove to be interesting and worthwhile. This is a new development. Higher education--was it aimed toward students--that is to say, students of one state who could be supported in another state where a facility existed? That was part of it. Or was it toward the creation of new facilities that could be shared? Well, the creation of new programs that could be shared. Ideally, as we promoted this thing, we'd say--"Here's Montana with an unusual pro­ gram in mining engineering. Let's set things up so that this resource can be shared by individuals from other states." Now, the construction of facilities is expressly forbidden by each state constitution. I mean Colorado can't contribute to the construction of a facility in Utah • .fuit Colorado can grant funds to the University of Colorado for support 406 .E.f students for a program in Utah. Or Colorado could build facilities that would enable it to accept students from Utah and then the capital outlay--if you want to do it for purposes of the record, you can say, "Well, this is prorated in the con­ tract arrangement that has been made between the University of Colorado and the University of New Mexico." Our arrangements with the University of New Mexico and Wyoming-­ this figure of two thousand dollars, or whatever it was, was arrived at on the basis of a formula suggested by Dr. Gregg. He said, "A fair price would be to take the total expenditures of the medical school plus a tenth of the expenditures of the teaching hospital plus two percent of the value of your physical plant and divide this by the total enrollment and this will give you a fair figure to charge a neighboring state for the educational service that you render that state." There never was any argument over this at all, and the minutes of the Regents would show this. In order to get the Regents to approve this I would put my memorandum out so that it looked something like an algebraic equation. Was there any effort to use this Western Interstate Commission with hos­ pital facilities, resident training programs? No. There's no prohibition, however. Now the precedent for this con­ tract we had with these two universities was a contract between the States of Colorado and Wyoming under which the Colorado State Peniten- 407 tiary would accept women prisoners from Wyoming because Wyoming didn't have enough women prisoners to pay it to set up a separate penitentiary for women, or a separate facility for women within an existing institu­ tion. This arrangement may still be in effect for all I know. They're exchanging students, or they have provided for student ex­ change in a great many areas. I can't give you any examples though. I've just gotten the last Annual Report of WICHE, and if I can put my hand on it quickly I'll try to remember to give it to you so that you can leaf it through and get an idea as to just what the total program is. I'm interested in whether an existing conduit of energy like this could be used as an adjunct of the medical school, or an extension of the medi­ cal school in medical education. Did these thoughts ever come, except in training other state's students. I don't know, but other states might have diseases peculiar to it, or conditions, environmental conditions pe­ culiar to itself which might be useful as a focus of study. The only way I can answer that is that WICHE is set up to render this kind of service. Now the extent to which they've gone beyond the area of medicine I don't know. One study was done of these four states I'm talk­ ing about by Dr. James M. Faulkner of Boston with the idea that some way might be found where the four states could join in the establishment and operation of a regional medical school. Well, we soon found out, of course, that you couldn't build a separate institution where the construc­ tion would be financed, or contributed to equally by these four states. Legally any state could have built a medical school with its own funds, and then under contract have accepted students from other states. Any state could build into this contract a way of recovering its investment 408 in the construction, but no state would be willing to do this. Weser­ iously--! say "we"--1 was serving as a consultant in the background. I'm not even mentioned as a consultant in the report, and I worked with the University of Utah with the idea that the university there would double the size, the amount of its floor space and then accept students in large numbers from each of the four states. Legally there is no reason why this couldn't be done, but we soon found out that there was no interest in doing this on Utah's part, either on the part of the university, or the state legislature, so the Faulkner study came out with an up-to-date analysis of the socio-economic situa­ tion in these four states and compared them with the national average, and the only recommendation it could come out with was that the present contract program for medical students be expanded. Well, this meant that there was nothing in the report that was going to contribute to any new thinking, or any new program. At the time when this report was developed-­ it was published about four years ago--everybody including myself was con­ vinced that these states just didn't have the resources to do anything more than they were doing. This idea that they're excited about now--the reason I suggested it was because of what I'd been through with the EDUCOM--the Interuniversity Communications Council. I have been exposed to all this business about networks, community communications, and working various aspects of the computer into this, and so now the report coming out of WICHE, a copy of which I shall have tomorrow--well, Monday probably, a report on the con­ ference in Estes Park--represents just the next natural sort of a proce­ dure to be considered. !!.,hen a student came for medicine from the State of Wyoming, was it with 409 - the understanding that he would return to Wyoming to practice? Wyoming had a clause in its arrangement that these students had to sign, a pledge that they would go back to Wyoming to practice, and Nevada too. Well, Wyoming found that occasionally a boy would go back there to practice, but more often than not soon after he graduated he was returning the Wyoming investment. He just paid Wyoming back the money so he could be free of that pledge, or that promise. Nevada was finding the same thing. I apologize to the Faulkner Report--the one thing that report urged was that these states take these clauses out of their agreements, and they have all taken them out. I don't know the extent to which these states did, but they must have participated in Hill-Eurton Hospital construction, and I wonder whether-- was it possible to conceive of having a residency, a student from Wyoming, as a resident in a Wyoming hospital? I'm sure that this would be thought about and possibly talked about, but the residency system is such that if a hospital in Wyoming was going to attract residents, there would have to be some real reason behind that attraction, and none of these hospitals in these areas have been able to get interns or residents. This was brought out in the Faulkner Report. The reason they couldn't get interns or residents was because they just weren't good enough to compete with other hospitals in the country offer­ ing these programs. This whole residency system--the way it stands now is based entirely on the principle of competition between individual hos­ pitals. This means that the hospitals associated with universities get interns and residents much more easily than those that are not so asso­ ciated. There are some non-university hospitals that get residents be- 410 cause they are just good enough so they can do it. Stipend is another basis of competition, of course. Early in the game the hospitals that offered the high stipends to residents were not the university hospitals. They were the less popular hospitals, and the high stipend standing alone did not get any interns. The situation before and after the high stipend area wasn't very much different. Now the sit­ uation is such that the stipends have gone high enough so that the hospi­ tal can get interns if it's willing to pay enough irrespective of the quality of the educational offering it might have. I have an unanswered letter from an attorney in New York City asking me for a bibliography relative to the development of the residency system in this country. He's particularly interested in the history that will portray the sequential development of stipends for residents, and the reasons he wants this information is because the interns and residents in the New York City Municipal Hospitals have formed an organization-­ they call it a committee, and this committee is about to start negotia­ tions with the municipal hospital system for an increase in stipends. The current stipend begins at about six thousand dollars a year for in­ terns which is high--it's the upper level of all the stipend hospitals to as high as eighteen thousand for a fifth year resident. The current level for an intern is six thousand, and the current level for a resident is twelve. They're going to negotiate to twelve thousand for interns and up to eighteen thousand, or more for residents. Well, I haven't answered this request from the lawyer yet. I am getting the references together because I want the bibliography for my own use. I don't know yet how I'm going to answer that letter because I don't want to get involved in this scrap, and I don't want my name to be 411 bandied around there. One of the papers that Anne Somers and I have pro­ mised to write for the New England Journal of Medicine will have to deal with this question because I think it's morally wrong for these charges to come out of what the hospital bed does for people. I think it's mor­ ally wrong to charge these kind of stipends to those beds. These sti­ pends should be charged against the professional services that the patient in the bed receives. Think what this will do to hospital costs, and yet the medicare law states that the stipends of interns and residents can be charged as hospital expense. This is the AMA influence because a long time ago the Association of American Medical Colleges passed a resolution stating that intern and re­ sident stipends should come out of patient care fees, or income earmarked for professional care of patients. This made the AMA furious, and this has been under consideration at every meeting of the AMA since. The AMA have got themselves in a spot now where the AMA says these people should be reimbursed according to the amount of responsibility they take and the reimbursement should be ample to the living needs, but these funds should not be a part of the professional care of patients. Well, there's a lot of places that are collecting these fees, third party payme~t fees partic­ ularly, and using them to reimburse their house staff, but the point I'm making is that it is still the law of the jungle that controls whether a hospital gets interns and residents. If you're willing to accept fairly good reputation as far as the offering of an educational program is con­ cerned, it is the names of the chiefs of staff that tell a student, in part, whether a service is going to be worthwhile, or it's the name Johns Hopkins, or the name of the Massachusetts General Hospital. This is what they compete with. 412 The armed services have no trouble getting all the interns they want through the matching program. Here you've got another kind of motivation. It's--they do a pretty good job as far as organizing an educational pro­ gram is concerned, but you're a first lieutenant, and you get a first lieu­ tenant's pay, and you have the privileges of the commissary and all this. Many students who take these internships are people who are thinking ser­ iously at least of careers in the Armed Services, and today a career in medicine in the Armed Services isn't a half bad career--the opportunities aren't half bad, if you want to be sure you have your weekends off, your nights off. Your living security is adequate, and the retirement provi­ sions are good. You have your time off for vacations, and you get a month off once a year for postgraduate study, but the answer is that WICHE has not had any influence as far as helping hospitals get interns and residents is concerned. The reason I say that is because the situa­ tion in these hospitals in these four states are no different than it was before WICHE was even thought of. Now then, if these four states would get into this medical school consortium, this situation would have to change. If it didn't, it would mean that we were failing in our effort. I'm taking advantage of hindsight. I read the report with the yellow covers, and I was just thinking as this regional business came along, did anyone thinking about it •••• These unhappy states, these have not states, keep thinking and hop­ ing that through WICHE something should be done, might be done to help them solve their problem. Well, the regional medical program legislation has done more to create a climate that is favorable to this between the Yellow page consideration than anything WICHE's done, and next to that 413 are the developments in communication and the realization of what can be done with networks, sharing in programmed instruction, and so forth. Oh, yes--1 think so too. Times are different now than they were when the Faulkner Report came out. Not only that, but this Interstate Commission was in response to a de- mand at the time and within the limits of that demand it did a marvelous job. The fact that it is now limited and can't go beyond the limits im­ posed was written into the very nature of the state identification; namely, it cannot use its funds in another state to help that other state build a facility even if a study, a survey showed such a facility to be neces­ sary. They would have to come out with a new piece of legislation to enable them to do this. While I was active with WICHE we did a total regional study in nurs­ ing. We did a total regional study in dentistry. We did a mental health study and then shortly after I went to Chicago, they got the Commonwealth Fund to do the physician manpower study. The next thing that followed was the Faulkner Study. The grant from Commonwealth that supported the Faulkner Study--funds were left which have permitted WICHE to keep the embers on a little by almost once a year having some kind of a special conference to which these states would send representatives. I attended a couple of these conferences, and at these meetings the representatives would tell about any new developments, or any new thinking in their state. They would have a chance, and I attended these meetings as a consultant so that these people would have somebody to ask questions. These confer- 414 ences have helped to keep idea going, and this grant now, the last of it, is being used to publish this report that will be out next week. The next move is to go to Commonwealth to see if it will continue to be financially interested in helping this consortium go. Commonwealth would take care of the costs involved for say the first two years opera­ tion of the core office, the director and his staff, travel, etc. I'm sure that the states will pay for the participation of their representa­ tives on the core committee and then, as I told you, another foundation, I think, would come through with some very substantial support to each state as it would try to get its own medical school underway under the conditions of the proposal. It's exciting. Now, there's no federal money being depended upon. The regional medical program would save this effort money--! mean things the regional medical program would do would represent items of activity that would fit right into this consortium--they would already be being done so that the schools wouldn't have to do them, and the new community health planning legislation, 749, undoubtedly would be important to this effort. We don't know yet what this legislation is going to do because the money is just becoming available, and the funds have been cut so. Now is the logi­ cal time for this sort of a consideration to come to a head, and undoubt­ edly there would be many programs in the several states that would appeal to various bureaus of Health Education and Welfare for program support, but I would hope that the guts of this four state consortium could be fi­ nanced so that the whole thing would not be dependent upon federal funds. These people from these four states--they like this idea, and then they 415 go ahead and say, "Well, we know that we can't get the legislature to put any money into this until it's a well established program." "How do you know that you can't get the legislators to do it if you've got something that you're pretty sure is going to work?" Well, I can't go around and do a lot of traveling in the interest of this consortium idea if they pick it up, but I got the legislature here to pick up lots of things on the strength of promise. If it can produce locally, the legislature has an investment too in idea. WICHE too, you see, could get at this now by putting on a legisla­ tive workshop at the right time on the financing of medical schools. I think these legislatures would put some real money into this if you can show two things; that it is going to raise the level of medical care in their state-wide communities, that it's going to increase the availabil­ ity of medical care to more people, and that it's going to provide edu­ cational opportunity for their own people and then conversely, add to the pool of health manpower that they need. They'll take a chance on that-­ I'm sure they would. This just came to a head when you were Dean and Vice President--this kind of need, and it served a useful function here at the University of Colorado because you had funds that you might not otherwise have had. We would have had three or four awful lean years there. Some of those years just raising everybody--a salary four hundred dollars a year meant a lot. It meant that you were at least recognizing that they were worth more than they had been getting. What did it mean to you, in terms of the school, to sit on the Board of 416 Consultants in the Division of Medicine and Public Health of the Rocke­ feller Foundation? This is 1952-1953. This was really just for the last year of the life of that board, and the principal benefit to me was meeting the people that were on the board. Rockefeller was beginning to pull away from the support of medi­ cal education in this country. I got to know Dean Rusk fairly well, and if I'd have followed through on this, I would have gotten lots of support for the association to support a program in international medical educa­ tion. At one of these meetings I had talked to him about this. After I got with the association, he said, "Come in with a proposal." Well, I just kept putting it off and putting it off until the last two years, or at the most the last three years I was there when I got around to it, and Rockefeller gave us a good grant. Kellogg gave us a grant too, and I got Henry van Zile Hyde from the United States Public Health Service who was eligible to retire. He had been a career officer and always associated with the federal government's international health programs. He'd been loaned to other agencies by the Public Health Ser­ vice. When the World Health Organization started he was Tom Parran's right hand man in all of the development. For a good many years he was the United States representative on the executive committee of the World Health Organization, so when he moved in, things began to hum. The only thing that made me get going on developing this proposal, I think, was when a Dr. E. Harold Hinman, Professor of Preventive Medi­ cine down at Puerto Rico, insisted that I agree to be the vice president in medical education to develop a program for the Pan-American Medical Association that was being held down in Mexico City. I didn't want to do this because I was having arthritis pretty bad. It was getting in my 417 knees then. Well, I went ahead and went down there. The experience-- the meeting was a fiasco, a complete flop, because nobody came to the meeting, except a mere handful. One fellow came, and I forget his name now, or where he was from. Anyhow, he wrote a letter. Apparently he was impressed, and he felt that something should be done to start a federation of associations, a Pan American Association of Medical Schools, and I think I got a grant from the Rockefeller to invite all the medical school deans from South and Central America to the next meeting of the association. Henry van Zile Hyde had just come aboard. The invited medical school deans came. * I proposed this federation, giving this South American credit for this idea. That was the politic thing to do, if you wanted to get anything done, and we had this little program for them. We said, "We have a good sized room for you where you can meet by yourselves. If you have any proposals to make and if in order to give some life to this pro­ posal there's anything you want the AAMC to do, you feel free to say so." They came up with their own proposition, you see, and on the strength of that we got these grants from Kellogg and Rockefeller, and then AID came along with a big contract. I just turned van Zile Hyde loose on this. He knew what he wanted to do and what could be done. He still is going strong, but my interest in international medicine kind of got in through the back door. I just was never willing to set aside a lot of time and effort for it, and any pleasure that I got out of it has been had vicariously because of what van Zile Hyde and John A. D. Cooper, the editor of the Journal of Medical Education, have told me. South America had been Cooper's bailiwick for awhile. He was at Northwestern--he's a biochemist, and he got in on the *Proceedings AAMC, 1960, Darley, Ward. Remarks regarding meeting with medical school deans of Central and South America • .:d,t1I 36:440-442. May, 1961 • 418 isotope business early. He's been used by the Atomic Energy Commission in that connection and the Rockefeller Foundation and the Kellogg Founda­ tion in connection with atomic energy developments down there in South America from the very start. This Division of Medicine and Public Health--was this a granting agency of the Rockefeller Foundation? Yes. The function of the board of consultants was either to □ .K. a grant, or study a proposition? And also to talk over fresh program possibilities. They only held two, or three meetings. I really--well, I almost wish that I had never put that down in my curriculum vitae because it's gotten a lot more play than it deserves. I only meant that when you get to be a dean, somehow or other the assump­ tion is that you have the time. That's right. By God--you don't have the timeo The assumption is that you have the educational and intellectual capacities and resources at the end of your nose too, and part of the choice here was geographical. The government activities particularly were conscious of the need for geographic distribution of people on these boards and committees, and this was true in case of some of the founda­ tions. Utah was just barely coming to life after being spanked real hard 419 as far as the medical school is concerned, so there was really nothing between Kansas City and the Pacific Coast, nothing north and nothing south, so--and I think I was taken advantage of. 1t1ere you were--well, once you're in this position you have to confront !11ether to accept, or not to accept. Alan Gregg--that association may have been looked upon as a change of pace--! don't know. This was Alan Gregg's Division of the Rockefeller Foundation--see. I never felt I was a representative of a geographic area on there. I was down there because Alan Gregg suggested it. He's worth a word association with him, the kind and quality of fellow he was. As I say, he went out of his way to stop by and see us. He was a not infrequent visitor in our home--! mean this would be a couple of times a year. He and Dr. Sabin were buddies, and so he wanted to see her. I had him come out before the war ended to give a commencement ad­ dress when we still had a separate commencement down here. Gregg was just a person who kind of entranced you, a lot like this Waring guy--you just felt like you'd been up on the mountain after you'd talked with Gregg for awhile. He did all the talking. He loved to talk. That was­ n't true of Waring. Waring would draw you out, but you put a question to Alan, and he was on. What he had to say was worth listening to. The thing he said that always impressed me more than anything else was the story that he told at the first Conference on Preventive Medi- cine, and I used it in the introduction of my commencement address in South Carolina! He was differentiating between virtue and morality, and 420 he told the story of the fellow driving on the highway a speed car that had bad tires on in front. The fellow driving the car went along at twenty miles an hour because he was afraid of his tires. The traffic was passing him, and everybody was bawling him out because he wasn't going faster. Alan Gregg said, "Now, he was virtuous. He could have done the moral thing and gone sixty miles an hour, had an accident and killed a lot of people. He wouldn't have been criticized because he was operating within the norms of accepted morality, but he was virtuous. He didn't want to be a threat to the people on the highway. Of course he was look­ ing out for himself on the side maybe, but he was going slow because his car wasn't fit to go any faster." I got a lot of mileage out of that commencement speech. * I developed it first as a commencement talk at the university, and that's the only commencement speech I ever gave that I think ever made any kind of an im­ pression. I got quite a few requests from students for copies of it. That little nursing journal asked for it to publish in its first number. I let them have it just the way it was. I finally published it as that paper "The professional responsibility of the physician" in the Journal of the AMA. Of course, that's kept me from using it anymore since. He's quite a fellow just the same. I saw him begin to slip long before--! pleaded with him when I first knew him to retire and write because he had so much to give, and it was something that he was always going to do, but by the time he retired he was beginning to show this cerebral sclerosis. I have gone through his bibliography, and I think I have read everything he's written. It's quite a chore at that. There's an awful lot of repetition in it. The *Darley, Ward. A Message to the Graduating Classes: The Personal Responsibility of the Health Professional. Medical Colleges of South Carolina bulletin. Summer issue, 1957. 421 1ast time I went through it was when I was giving the Alan Gregg Memorial Lecture for the association. I used just a little bit, and I had to kind of stretch things a bit to work that in. You see, I was going to make that lecture, * and I often wish now that I had been able to do it--I was going to make that subject revolve around the objectives of physician education, and I was going to get in a lot of the ideas that I have written piecemeal here and there and the other place since. Then they asked me to take over the section in this White House Conference on Health, on the Economics of the Education of Health and Medical Personnel. I don't know why I felt I had to do it. Well, I couldn't do that and carry through with the original idea on the Alan Gregg lecture because there just wasn't time, so I switched to the finan­ cing of medical schools and used the same talk both places. In a way that was a timely thing for me to do because that Alan Gregg lecture--! can say to everybody, "I told you so!" The government now is forcing the schools to do exactly what I was advocating in that lecture. Yes. You spent some time also on an Advisory Council for the National Fund for Medical Education. Yes. This was an agency the origins of which center around the medi- cal school effort to get federal aid. The AMA really boxed us in good on two counts--and I know this was the original idea of Frank H. Lahey in Boston. He was president of the AMA. I can't prove this. I can't go to the record and prove it. The people that get the credit for start­ ing the National Fund for Medical Education are the presidents of Harvard, Hopkins, and the University of Pennsylvania--Milton Eisenhower. * Darley, Ward. The Alan Gregg Memorial Lecture, 1965: Medical School Financing and National and Institutional Planning. JME 41 :97-109. Feb., 1966. 422 James Conant, who was president at Harvard, and this perennial candidate for the Presidency of the United States. Stassen. Harold E. Stassen was President of the University of Pennsylvania. The idea was that a corporation would be formed that would solicit funds from big business on an annual giving basis that would be passed on to the medical schools for unrestricted use, and in order to make this look real good, after Eisenhower became President he pushed a resolution through the Senate giving this organization a federal charter. It wasn't necessary, but it looked good on paper. Then the AMA picked up this or­ ganization right away, and we had a big meeting in the University Club there in New York City. Alan Gregg was there. Well, this idea was put out. Of course, everybody spoke favorable to the idea, and the fund got started. The history of the fund has been written up. The total amount raised for the medical schools through industry never amounted to more than a million and a half dollars, two million at the most. The AMA at the same time came up with its Foundation for Medi­ cal Education, the idea being that the private practitioners would rally to the aid of suffocating medical education, and the AMA would make unre­ stricted gifts. These would be passed on to the medical schools. Well, as far as raising enough money to solve the problems are con­ cerned, both of these efforts were pretty much a flop. The money was passed out on a formula basis--each school would get x numbers of dollars, and then it would get another increment based on the number of students er.rolled. The AMA was giving its money to the National Fund so that this made the National Fund look pretty good for the first two or three years. 423 The thing leveled off pretty quick. This did give the medical school deans money that, provided the Board of Trustees, or the Legislatures were willing, he could use for anything he wanted to. It was to be used to strengthen education so the deans theoretically would use it for faculty travel, or visiting professors, or to get a young researcher started, or some loan funds--he could use it for anything he wanted to. If a research grant was taken away, he could use the money to continue the support of the investigator. What this really did was--this was pushed in the Congress behind the scenes as a substitute for federal aid--these two ideas, and enough mem­ bers of the Congress bought them so that serious consideration of federal aid didn't get very far. On our first effort in the Congress in 1947, or 1948, we almost made it. The AMA did not interfere with the effort to get federal aid through the Senate, but it did come in in opposition in the House, and I don't think the House even held hearings--maybe it did. The next year we got the idea going through the Senate, and they changed it so that the only money the medical schools were going to get was a couple of thousand dollars for every student that was enrolled over and above the average enrollment for the past four years. This was a grant of twenty-five hundred dollars. Well, George P. Berry pulled the thing out then without consulting with any of us; on the other hand, it was all right with most of us because this was a very unrealistic way to go at providing federal aid, but these two tricks--these two tricks accom- plished quite a bit for the AMA. It was mischief. You sat on a committee representative of the AAMC and the AMA almost from the beginning, 1946--a committee on policy, something like that. 424 Well, back there there were frequent stabs made at setting up liai­ son committees. The only one that amounted to anything, and this was in existence before I came into the picture, was this joint effort, the joining together in the accreditation effort, and that may be what you saw. This was a committee on which you served for a long time, and they never did agree--well, I'll have to go back and refresh my notes. There may have been a committee on medical school financing--I don't remember. The AMA had taken a position with the AAMC with respect to this early effort at federal support. They were not against it. From the very beginning--right. In fact, the AAMC Council sat down with the AMA Council to draw up that bill, and I remember the morning we were to meet to do that. We were meeting in a hotel. Harvey B. Stone of Johns Hop kins said, 11 I'm sorry, but we can't join in th is effort be­ cause we've been instructed to oppose it." I spoke up. I said, "Do you mean to say that you're going to oppose something that you haven't even seen. You don't know what you're going to be opposing. At least why don't you sit with us today and see what kind of a bill could be drawn up. You might be surprised." They did sit with us. Oscar R. Ewing was there--this was in his of­ fice--and that bill was the joint effort of the two councils, and it went through the Senate without any ifs, or ands within the very next few weeks, maybe two or three, but you don't ring any very loud bell yet. Maybe this is the thing that "Mike" Gorman was talking about--something 425 I had forgotten about. ll7e House of Representatives and whoever was chairman of the committee-­ Percy Priest I think--thought that in view of the change in attitude, and I guess this change in attitude was communicated to him in such fashion that it made him say, in effect, well you've joined together, and some­ how or other you've had a falling out, and with this dichotomy in support, we can't see our way clear at the moment. They watered it down to the point where you did have this twenty-five hundred dollar grant per stu­ dent beyond an average. Well, if we worked directly with the AMA, and I'm beginning to re­ member now, Donald G. Anderson and Joseph C. Hinsey were the two main protagonists. Anderson is a name in the records. I first knew him when he was executive secretary of the AMA Council, and then when he left there, he took the deanship at Rochester, and he soon changed his tune after he got to Rochester because he needed federal money. It depended on whose ox was being gored. Also another factor in the problem was the long history of the AMA and its public relations counsel. They would somehow or other absorb a good idea, to the point of diluting it ultimately, from any other agency that came into existence, or spon­ sored a new idea, or a helpful idea. This is certainly true. It was apparent the AMA was beginning to weaken a little bit when it approved the idea of the federal government making one time grants to 426 medical schools for construction purposes. The AMA can say that back in 1 956, or 1957, whenever the Health Research Facilities Construction Act passed--why, it began to be in favor of federal support of medical schools. The Association of American Medical Schools tried hard to get that bill amended to include educational facilities, not just research facilities, and the AMA fought that, of course. There's a piece of writing that needs to be done on all this, and I'm the guy to do it. I've got most of the research, most of the bibliog­ raphy together--not all of it. Part of it is in one of those Somers' papers, and I sent part of it to Joe Hinsey that he used in the Vernon Lippard honor issue of the Yale Journal of Medicine and Biology (Vol. 39, June, 1967). The article by Joe Hinsey, ahead of the paper I wrote-- the first two pages is pretty much what I sent Joe. What got you into the AAMC--it was pretty early--1946, 1947. Yes, I hadn't been a dean very, very long. My first meeting was as acting dean in Pittsburgh, and the next meeting I was a full-fledged dean, and that was in Mississippi. The Sun Valley meeting was my third meeting, and nobody could have been more surprised than I when I saw that I was nominated for the Executive Council. This was Frode Jensen's do­ ing--I'm pretty sure--because we'd been working hard with George Arm­ strong who was deputy Surgeon General and getting the Fitzsimmons set up as a teaching hospital. George and Frode, I think, set this up together, and I took my election to the Executive Council real seriously, of course. It was a great honor, as far as I was concerned. The first meeting of the association I ever attended was in 1941, when it met here in the Colorado General Hospital. Dean Rees asked me 427 to sit with him, and at that time there were only about sixty or seventy people in attendance--that is, the deans of the then existing medical schools, and then the next meeting was the one before the meeting in Pittsburgh. Dean Rees was having this coronary insufficiency and wanted to go to the meeting, but he didn't want to go unless I would go with him, and I sat through that. He wanted me to write a report for him on my impressions of the meeting. You haven't found it yet, but I did--I sort of layed myself out. I should have known better because that pin­ pointed me in the eyes of the Executive Faculty as somebody to make chair­ man of key committees, etc., etc., etc. That was really what set things in motion for me to be acting dean. Dean Rees was talking assistant dean. I never told him that I would take the assistant deanship. I kept putting that off, and then he died, and the president made me acting dean. Now then the thing that attracted my interest at the Detroit meeting was all of the discussion about an integrated curriculum, and what right any of them had to talk about an integrated curriculum was more than I can see because none of them were a party to any such activity, and this is what I wrote up in this report to the Executive Faculty. Then they had these two, or three committees of faculty to study faculty privilege-­ I have forgotten what these committee reports are all about now. The meeting in Pittsburgh--Lester Evans gave a paper promoting this comprehensive idea--! don't know what he called it, and I got up, quite excited, in the discussion of the paper and had something to say--I've forgotten what. Lester Evans thought it was pretty good, still seems to think so. Then the next meeting was in Sun Valley and this was the first meet­ ing after the war ended, so there was a lot of talk about change, and it 428 was at this meeting that the AAMC agreed to join with the AMA in the sur­ vey of medical education that's now known as the John E. Deitrick, Robert c. Berson Report--Medical Schools in the United States at Mid-Century [McGraw-Hill, N.Y. 1953]. I remember the Board of Trustees changed the rules on the AMA and told the council to tell us that this joint survey of medical education was all fine provided the AMA could have veto power on what was written into the report. We told poor old Herman G. Weis­ kotten who was then chairman to tell the AMA Board of Trustees that there wasn't going to be any survey. Well, the word came back, "We'll do the survey without you." We sent word back that we'd see to it that the schools didn't coop­ erate, so then they came back, "All right. We'll not do it that way." The reason the AMA--the justification for the AMA taking this posi­ tion was because it was all AMA money that was being put in, and this fellow said, 11 I' 11 fix th at." Dr. Hinsey got the Markle Foundation to give the AMA a hundred thou­ sand dollars to contribute to this effort, and this didn't make the AMA Board of Trustees notice any more either. They wanted the foundation to give the money directly to the AMA instead of giving it to the AAMC to turn over to the AMA. Bob Stearns was on the advisory committee of that study. To go back a little bit though--I have forgotten about this almost. They were having trouble finding somebody to do this study, and then Don Anderson representing the joint committee came out to Denver to try to get me to conduct this study. Bob Stearns was in Boston, and I said, "Well, I can't even think about it until I talk with President Stearns." Don and I got on the train, and we went to Boston to see Bob. Bob 429 gave permission for me to do it, said that he would support a leave of absence for this. I met with the AMA Council on Medical Education on that same trip--they were meeting in Boston, and everybody on the council urged me to do it. Well, I got back to Denver and began to talk it over with Pauline. There was so much just beginning to get going here that I decided that it just wouldn't be fair to my own situation to leave. Furthermore, I felt that I wasn't ready for a deal like that. I hadn't had a chance to develop any real background in medical education to label me as a person qualified to do a survey. Well, I could have done it just as well as Deitrick and Berson did--I'm sure of that, and Pauline and I often wonder what would have happened to me had I taken it on, like we talk and wonder what would have happened to us had we gone to the Mayo Clinic. Well, that's natural, but Bob Stearns was on the committee, and he said these meetings were terrible. The squabbling over the use of a little word, any idea that had any cutting edge to it at all--a squabble over that. The AMA wanted everything blunted, and Deitrick wanted to use fighting words. Deitrick likes to scrap, and this interfered with his doing the sur­ vey. He was supposed to listen and find out what was going on. Instead of that, people here were very angry at him. He asked us a question, and we would start to answer, and he would start to challenge what we said. They said, "We don't see how he could write any kind of a report about Colorado because he didn't find out what was going on. He just objected to what was going on." He's still that way. Well, this is a stimulating approach. That report of Deitrick and Berson had mighty little impact, and it 430 have been as much because the country, the world of medical educa­ rna Y tion, just wasn't ready for it, or ready to react to any report. They didn't examine all the schools. They ran out of money. They did about forty schools, but the AMA--well, during my days on the council the AMA was always in our hair over something, or we were in the AMA's hair. When I retired as Executive Director of the Association, the AMA gave me a couple of framed placques which expressed sentiments that really amazed me. I think they were so glad to see me leave that they had a little extra inspiration in connection with these sentiments. I always had things so that I could communicate down there. They knew that I would always say what I thought. The nearest to a personal fight that I had was with Dr. Wiggins-­ this was after Dr. Turner died. This was just on the eve of the Health Professions Educational Assistance Act starting favorably through the Senate when all of a sudden here came a news release from the AMA announc­ ing that the physician population ratio had been steadily increasing and there was nothing to worry about. The size of the future pool of physi­ cian manpower was nothing to worry about. Of course, this AMA news release came out, and the AMA was supposed to have been in support of the construction features of this bill--they opposed everything else--and we took this news release as being deliber­ ately timed in an effort to snag things up in the Congress as far as this bill getting through was concerned. The reason the AMA could claim that there had been an improvement in physician manpower was because the AMA had suddenly added to the various categories of physicians it was counting. I have forgotten now what these categories were except the foreign students that were taking internships. They were suddenly added 431 for some reason or other. - It was phony. It was phony right from the start. ll7eV were wrong. We got out a letter directed to the then National Advisory Committee on Health Resources. This was the committee to which the Selective Ser­ vice looked for advice, the same committee that had been set up when Howard Rusk was head of it, and we suggested that in order to avoid confu­ sion that committee count the AMA, AAMC, and the osteopathic association. The AMA would never count the osteopaths. The Public Health Service had already issued a news release blasting this physician population ratio news release from the AMA. Our idea was that there should be a definite spelling out of the various categories of physicians that were going to be counted as belonging to the national manpower pool of physicians. All the AMA could do was to agree to this. That's when the AMA was in the position where osteopaths, for example, had to be counted. Well, according to the new count, the physician population ratio is not much higher than it was in 1959, when the Surgeon General's Committee on Medical Education ran these determinations. It stayed just the same. There hasn't been any upward swing. Of course, the AMA neglected to say that any upward swing was due to the foreign graduates coming into our manpower pool. This was a pretty sorry source of manpower, i f we were going to count on this indefinitely. I promised to write an editorial, but never did, that would have 432 shown that the significant thing was the ratio of graduates to popula­ tion, not the ratio of physicians to population, and the ratio of gradu­ ates to population shows that the ratio is steadily declining. Now no­ body has bothered to point this out. We mentioned it in the Somer's papers. We point this out, although we didn't give any figures. You take the percentage increase of population and the percentage increase of physicians, if you go back far enough, why there's quite an increase in physicians as compared to population, but it's this increment of the for­ eign graduate that accounts for it. Did you get any insight as to why the AMA changed its mind in midstream in 1946, 1947, and 1948? You mean in relationship to .•.. Federal legislation. You mean their opposing it. This little burst of apparent support was as a result of the AMA Council meeting with us in Oscar Ewing's office, and it was viable for a very short time. The AMA was really opposed to this going way back. The record shows that the AMA was opposed to increasing the number of practicing physicians. Howard Rusk gave a paper right at the end of the war estimating the physician need for the next fifteen, twenty, fifty years. Well, he had some astronomical figures at the far end of this, and the AMA Council went into action right away to shoot that down. The AMA had this economist--I can't think of his name now--who was always 433 writing papers in which he tried to make a case for there being no con­ cern over the rate at which we were producing physicians. He said that it was only a matter of distribution--if the physicians that New York City didn't need could be transplanted to Mississippi, we'd have no problem. That was his approach. He didn't include any means whereby one was going to transplant these £hysicians. Or support them, and--well, the AMA always kept saying that we've never said that we didn't need more doctors, or they said, "We've never opposed increasing the number of students in our medical schools." Well, way back there you can't point to any policy statement in the record that says in black and white that there is such opposition--at least I have never been able to find such a policy statement. It's al­ ways been behind the scene stuff. There was a fellow from California who was president of the AMA about 1958, 1957. He had a "president's page" in the AMA Journal every week, and he was always in this hammering away claiming that there was nothing to this concern. The AMA never has come out frankly and boldly in favor of increas­ ing the physicians until a year ago this coming June. That's the first time the AMA, to my knowledge, has ever come out with any kind of a force­ ful statement saying that we need more doctors. Now this fellow Ed Tur­ ner in his Report of the Council on Education of the AMA House of Dele­ gates along about 1958, or 1959, when he was referring to the AAMC's in­ terest in increasing enrollments, he indicated that there was agreement on the part of the AMA Council on Medical Education, and the AMA House of Delegates didn't kick this item out of that report. Well, they use 434 this as evidence of the AMA's support of increasing the number of doctors, but they never came out flat-footed and said so. Of course, coming out flat-footed for federal support, financial support--that is extremely recent, and the boys got trapped a few weeks ago when the AMA Board of Trustees and the AAMC Executive Council had a joint meeting and released this statement urging that there be an increase in the number of physicians. I say "they got trapped" because on the same day that that statement was released to the press, the AMA released notice of its opposition to most of the items in the President's Health Message. The newspapers lumped these two offerings together in the same column. There's an AMA editorial I can dig out for you that is three weeks old or so, where the AMA includes both actions in the same article. The AAMC boys sh □ uld have said, "Well, th is is all fine. We' re in agree­ ment on this, but we'll each put out our own release." They should have done this instead of putting out a joint release. This is better than nothing from the AMA. Yes, but the burden of carrying that organization--I'm not sure how much they knew about medical schools. The individuals in the power structure can't know anything to speak of. The AMA Council on Medical Education is about half practicing physi­ cians and about half deans. The AMA House of Delegates was pretty un­ happy about this situation three or four years ago, and I think they cut down on one dean and added a practitioner in his place. They are on there for terms of four years, I think, and they can serve two terms, so that by the time the practitioners go off, some of them begin to develop some understanding of medical education. Dr. Sawyer here when he was put on 435 the council--four years ago, well, he was in a position to know about this place, and he learned pretty fast. He's been a real addition on the AMA Council as far as the contributions the council makes. Most of the council contributions are in the area of accreditation. The council passes on lots of ideas and things to the House of Delegates that are shot down more often than they are approved, I think. Also the council's real business, where it carries real responsibilities, is in the area of interns and residencies. The AMA has got this tied up with the specialty boards, of course, and it's a three way deal. The learned societies like the College of Physicians, the Section on Internal Medi­ cine of the AMA, and the AMA Council on Medical Education and Hospitals jointly set up the Residency Review Board in internal medicine, and it's this review board that has the say-so about the details of residency training in internal medicine. The AMA Council inspects the hospitals offering these programs to see to it that the programs there are func­ tioning within the framework of the essentials as prescribed by these Re­ sidency Review Boards. Now there is one of these boards for every spe­ cialty. The one in surgery--it's the American College of Surgeons, the Section on Surgery, and the AMA Council. The AAMC has no in on any of this, has no in on the internship busi­ ness, except the AMA invites the AAMC to appoint a member to its intern review committee. The AMA doesn't have to do that. Dur representative is James A. Campbell, the President of Presbyterian-St. Luke's Hospital in Chicago, and he's made it tough for this committee. They have quit approving programs just because the director's a good fellow. He really has been able to carry enough votes always so that an obviously poor program can be dealt with properly. 436 Now the Millis Commission report which you've seen, I'm sure, repre­ sents the first major positive contribution that the AMA has made to this area of intern and resident education. I doubt if the AMA will ever adopt any of those recommendations officially. I don't think they'll take any action that will mean opposition to a place like this Colorado Medical Center that wants to adopt some of the recommendations, and I think, and Dr. John S. Millis thinks, that if the Millis Report has any impact at all, it will be because of the response of medical center by medical cen­ ter. Now the AMA will oppose, I'm sure, any national commission that would be set up to control graduate medical education. I don't think the AMA or the Specialty Boards, either one, would give up this review author­ ity. That's part of the facts of life with which one must deal though--the existence of these ongoing forces. How do you make change in what that implies? It will have to be institution by institution, I think, and that's one reason I'm attracted to this idea of this four state consortium be­ cause we'll have to measure up to the minimal standards as they are laid down by these residency review committees, but these essentials, those standards are minimal. Any real educational enterprise that's going to be satisfied with those as standards ought to have no business getting into the business. That's my feeling. Do you have a sense that it is also quite unreal--given the potentiali­ ties and the opportunities. Oh, yes. 437 - from their point of view it's more important to sit astride this than it - is to release, to free action. Be a part of it. Yes. It's a curious situation. I think graduate education--that's the internship and residency to­ day, certainly continuing education, is about where undergraduate educa­ tion was before Flexner swung into action. I think it's that bad. It may make for variation from school to school. You take a school, a set up like Grace New Haven Hospital. I would have to say that the offerings at Yale to residents are as good as there are in the country, and in this survey that Gus Carroll did and the re- sults of that survey have been reviewed by the steering committee, and there were some hardheaded clinicians on that steering committee that know what the score is, and only about five percent of the time, or ef­ fort of these people went into activities that were primarily educa­ tional. Dr. Leland S. McKittrick whom I can't get hold of in Boston, a sur- geon--he was on the AMA Council on Medical Education, chairman for a long time, the most progressive practitioner I've ever run into, and he's on the steering committee that is supposed to be running this study of pro­ gram costs in teaching hospitals. This is officially a joint effort of the American Hospital Association, the AMA, and the AAMC, and when he went over this with us and in connection with American College of Sur- geon's activities, he'd say, "Well, this is par for the course. I have to admit that there isn't a lot going on in internships and residencies 438 that can be called primarily educational. If you want to call osmosis a primary method of learning--why, I'd have to backtrack, but osmosis when it's your only educational medium is not a very solid reed to tie to." The fact of this high failure rate in the boards--if anybody wants any evidence that something's wrong here, I think the high failure rate is all you need look at, and these examinations are based largely, until very recently, on a regurgitation of content. Maybe that's why they fail. M2ybe these people are a lot better than the scores they make on the boards indicate. I hope they are, and I suspect that most of them are. There has been no effort to evaluate their capacity with surgical tech­ niques until lately--! mean the evaluation method hasn't been anything very satisfactory, but to me, of course, the important thing is the eval­ uation of capacities for good solid judgments. If you're just going to have one educational objective, I think that's the main one to tie to, the development of a capacity for judgment, safe judgment. It's a little different--if I go on a desert island with only one medicine to take with me, all I'd want is a great big bottle of morphine. I wouldn't want anything else. I'd leave the encyclopedias, the great books and everything else out on the sinking ship--if I was thinking in terms of comfort, or survival that is comfortable. This AMA/AAMC business, except for the area of accreditation, has been just an awful lot of talk, a lot of hard work and plenty of talk. We had some meetings set up with the board of trustees way back at the time that van Zile Hyde joined us. I remember it because we interviewed him on the same day. We were to get ready for a meeting with this AMA board, and I knocked myself out developing a document that would portray 439 the difficult position, the financial position that the medical schools were in--hours and hours and hours, and I went into some expense in printing the stuff up. Well, we had the meeting, and the fellows who were supposed to be there from the AMA--most of them wouldn't come, and the ones that were there would say, "Well, I can stay an hour," or "I can stay two hours", and on top of that it was perfectly evident that none of them had read this background stuff. I should have known, of course-­ learned that years ago, that nobody ever reads the backup for an agenda. I remember that we finally kept at it, and we had one pretty good meeting in Chicago. The reason it was a good meeting was because W. Clarke Wescoe, the Chancellor of Kansas, was chairman of the council. He'd come on the council originally because he was dean of the medical school, and Clarke Wescoe is a very forceful character. He's very arti­ culate, and he compells attention. He was familiar with all this backup data, and he really made them get down to cases and get into some real conversation. Maybe this action of the AMA to finally support federal financing of medical education--the beginnings of it might stem back to some meetings like that. You never know. In terms of the problem nationally for all medical schools, the question isn't to get ahead of the national needs, but to try to catch up. Yes--we're not even catching up. For every step ahead we're falling behind. Well, in this stuff at home I think I have saved a set of these agenda materials. It's kind of difficult to feel the necessity of working with and through an organization like the AMA where its philosophical--well, if the facts disagree with its theory, they hang on to the theory and forget the facts, 440 - throw away the facts, or bury them somehow. This is common--the curse of bigness is common to every big complex organization, and the AAMC's getting into this now. When I first was on the council, it was very simple. The agendas were short. The problems then compared with now were extremely simple--it seemed to me. We just didn't know what we were doing, or we wouldn't have felt that way. The secretary was only hired to be a secretary. He wasn't hired to provide or develop any leadership as a staff person. He was hired to do what the council told him to do, and he did a good job. He worked hard. [Telephone interruption] She's waiting. I guess I told her three o'clock. I was thinking it was three-thirty. I think we're kind of losing steam anyhow. 441 - Monday, April 15, 1968, 7002 University of Colorado Medical Center. Incidentally the Reverend Charles Petet, if it's all right with you, he's coming by to pick us up at one o'clock. That couldn't be better. There will be just the three of us, and we'll go down to the Foun­ tain Inn so we can talk. I'm very anxious for him to meet you. I told him, irrespective of which way the pendulum may swing for him in the next two years, I just think he ought to be aware of this technique that you use and why you think it is important. That's fine. Now then I want you to tell me if you want any of this material that's in these cellophane pages reorganized. Some of it is well-organ- ized as far as sequence is concerned, and some of it is organized as far as having pertinence maybe to a given year is concerned, but within that year no particular effort has been made to organize the material in any sequential fashion, and there's a lot of this stuff--say, one year will be something I thought important, and two or three years later something will turn up that is really related--like these documents I have in the Sabin book. I don't know after you leave, if you want me to make any par­ ticular effort to reorganize some of this material. Then there's a whole box of stuff that I didn't get into last night which needs to be sorted out and put on those six, or eight piles that are up on that bed that I was using last night. Of course, that has yet to be--a lot of it thrown away and a lot of it put together. 442 1.,was going over there today to dig away at that. I looked through some gf the material last night. I wouldn't want you to put any more effort into a reorganization of already organized material. I think it's there, and that it speaks for itself. What is missing and what I can provide when I get my hands on it all and I'm in my shop is a catalogue of every­ thing that is there and not merely listing it, but substantively listing it too. Where there's some question of date and time, I'll have to get in touch with you. If I leave on Wednesday, I plan to come back with the manuscript because I want you to see what the manuscript is. There may be some questions which are not clear and which I will have to check with you as to what you did mean. I want to do that. There will be a period of going over the manuscript. In that interval then--now this •••• I'd like a collection of all your published papers. I'd like a collec­ tion of all the miscellaneous papers that were not published, and there might be some tie, some putting them in a context as to how they emerged, what they were, and how they related. There were a lot of things we saw the other day which were miscellaneous. In addition, the bound volumes I have seen are just marvelous. Now did you look at some of those volumes last night where the var­ ious items haven't been put between celophane covers7 My old secretary--! alerted her to help us, if necessary, because she's the only one who could find anything in that set of files, for example. 443 - Right here in the office. Yes. She put it up. l/7at's since you returned from Chicago? Yes. I wouldn't do anything to that--leave it just as is. If it's your view that that ultimately should come to the National Library of Medicine-- j us t as it is • Now there is some stuff there in a separate file that I brought in boxes from Chicago, and she wanted me to go over it and make it fit her file titles. Well, I knew that if I did that, I wouldn't get anything else done for the next two or three weeks, so I had her just take that and make a separate file of it. Is that the stuff that's home in boxes? No, that's in here. The stuff that is home is •••• Some correspondence with Dr. Berson, for example, over a period of time, I think. I can't call it correspondence. They were letters I sent to Berson. Some of them he acknowledged, and some he didn't, and when he did answer me, what he had to say was really inconsequential as far as reacting to my letter is concerned. Now, I've got to go over this bunch of Markle letters that you got to be sure that there aren't some things in there that just mustn't be in the record. I was so disturbed after awhile that I was writing Dr. William N. Hubbard who was then the president, or presi- 444 dent-elect with the hope that as president-elect he would get this execu­ tive council on the ballo I talked to him on the phone. I sent these letters always to his home, and they were the reflections of a very angry man. This you would like. You sent me seven volumes of material. I hope none of these Hubbard letters were included in that. I told my secretary not to include them. This I can't tell you. There is reflected feeling with respect to the necessity to reorganize the association, or the apparent either unwilling­ ness or the tepid attitude toward the necessity of reorganization. There were a lot of letters to Berson that reflected the same thoughts I was expressing to Hubbard, but my language was much more tem­ perate. I shouldn't have written these letters to Hubbard, but--you know, the guy that followed me. The Coggeshall report had just come out. As far as I'm concerned, there was the greatest opportunity to do good in medical education that ever confronted anybody because the Coggeshall report was a good point of reference for a fresh start, a fresh look at everything, and they completely ignored it. The whole council practi­ cally ignored it. They couldn't get anybody to take my job. Hubbard should have taken it. Dr. William R. Willard, the Dean at Kentucky who is a national figure in medical education, he should have been willing to take it. I told Hub­ bard, and I told Coggeshall that the greatest disappointment in my life Was that--! told Hubbard this, "The greatest disappointment in my life was that you didn't think this job was important enough for you to take 445 it-" He'd been at Michigan long enough. He had accomplished his objec­ tives there. He's a brilliant man. He's articulate, and he could have moved right in, and things would have sailed right along. Everybody would have accepted his leadership, but no--he wouldn't do it, and Dr. Berson wound up being the only candidate. Now there was a time back when Berson was particularly effective in Washington, when I honestly thought Beraon could handle the job, but this one forte he has of dealing with the political situation in Washington has been his principal contribution to medical education. He knows how to handle these congressmen and congressional committees. He can come into a hearing, and he doesn't do a snow job with a bunch of figures and a bunch of tables, charts, and things. He doesn't even have any notes with him, and he just talks their language. They like the way he responds to questions. He gives a short answer. When they ask me a question, they're in for the full treatment, and they don't like that--you see. A lot of questions raised are just not answerable yes or no. I know what you mean, though. A lot of the writing that I'd like to do is going to involve dig­ ging into the old files of this House Committee on Foreign and Inter­ state Commerce, and I'd like to do this while Mr. Borchardt is there. He is the secretary, or the chief of staff of this committee. He knows where everything is that I want, and he to me would be like I am to you-­ his recall of the circumstances under which certain pieces of testimony were developed and so forth are important to the history of the efforts to get federal legislation through for medical education. [Telephone 446 interruption] I don't know whether you've ever seen this or not. Well, it's this sort of stuff that I don't want to give to the library. Here's something out of print. [ "Medical School Inquiry" Staff Report to the Committee on Interstate and Foreign Commerce, House of Representatives, Eighty-fifth Congress, first session containing back­ ground information relating to schools of medicine, dentistry, osteopathy and public health (GPO, Washington, 1957) 479 pp.] Now this--Borchardt put this together in anticipation that Congress might do something. Is that the old Fogarty Committee? Yes, that was for the old Fogarty Committee, and this was put out in memory of Percy Priest, dedicated to Percy Priest. He'd died, and the staff at the AMA and the AAMC did a lot of work pulling the information together that was used in this publication, and this is still a very use­ ful document to me. Of course, nothing ever came of the effort until years later. Then there are things like this. I have a full set of that. It isn't all there, but this is all out of print and everybody has forgotten about it. This is a study that was financed by the government, chaired by the then dean at the Johns Hopkins School of Hygiene--! forget his name. Yes, Lowell Reed--thanks, Margaret--and this was the first serious 447 effort to develop an understanding of the financing of medical education. The four volumes representing the Report of the Commission on Chronic Illness--well, all this sort of stuff I'd just as soon send to you and put it in this collection. I have a very good working library on medical education, and I've got every government report, like the Bayne-Jones Study, the Jones Study--"Beau" Jones, DeBakey, and all this. If all this were in one place, it seems to me that it would be valuable. Now a lot of these books and monographs are still working documents for me. It would be hard for me to get along without them for a while, but as I say they're out of print, and they're hard to come by now. A lot of them-­ even the DeBakey report, I think, is out of print by now. That's in two volumes. Well, the reason I'm rambling here--! just want to know whether this is the kind of thing you'd like to have me turn over. Very much so--you know, your working library has been purposeful--there are threads that run through it that are related both to you and to the problems you've confronted and where you've raised the hue and cry. I think that that is what the AAMC essentially is; the hue and cry--it can't compel compliance. Now, the association office--I didn't do the snow job I did when I was dean and vice-president here, but at the office I did make an effort to gather things together that I considered archives of the association. Now some of that--a little bit of that was bound. A lot of it was laying in a book case with glass doors. What's happened to it since I have left I don't know. The files there were in excellent condition when I left and were well maintained up until, I guess, six, or eight months ago when the file clerk became ill (Mrs. Louise McGinn). She died, and I've been told nobody has made any effort to keep the files up and by now with every 448 Tom, Dick, and Harry dipping into them, trying to find things, I imagine that they are in a state of complete chaos. This Mary Littlemeyer was one of the best secretaries, administra­ tive assistants that anybody ever had. She supervised the secretaries that were working for me and this file clerk, and she did a lot of index­ ing of the council minutes and the AAMC proceedings. These indexes are invaluable now, but she hasn't been in a position to keep them up. They are complete up to--well, the time I left, and I think very shortly after that no effort has been made to keep them up to date, but it was very easy, the last two or three years while I was there because of the work Miss Littlemeyer had done. She could find stuff for me without any effort at all. I couldn't find it myself. I just never learned to use these instruments that she developed, but she knew how to use them. Of course, this is the way it always is. Miss Littlemeyer has moved on up now. She's still there, but she's now in charge of a project to start training programs for new deans, and this is all she's doing. When she wraps this one up, they'll give her another project to do probably. She's the kind of a person who can do this kind of work. Now the stuff at home that I started to get into in these trunks goes way back. I can lay this out for you so that you can just barely get an idea what is there, if you want to take even that kind of time. That I would have to organize for you--the cellophane envelope cover kind of thing. The newspaper clippings--we were going to start a scrap book, but we never did, and there is manila envelope after manila envelope of these clippings. 449 - presidency, deanship? All the way back. Some of them have gone into these books, but by no means all of them. The old librarian here at Denison did a wonderful job at keeping a scrapbook, and she left just before Brad Rogers (Frank B. Rogers) came, and I don't know whether anybody's kept the scrapbook rela­ tive to the whole medical center up to date or not. Now then, one thing that I have just thought I could do--if I get a lot of these books in front of me, I can run a self interview. I can turn the pages, and I can elaborate into a tape recorder the circum- stances responsible for the development of this and that memorandum and so forth, and I could have this typed up and attached. I still have enough money left in a grant from the Markle Foundation to pay for the secretarial work, this kind of secretarial work, and I'm positive that if I need more money to do this, the Kellogg Foundation would underwrite any necessary expense. I wouldn't want a memorandum to just hang without the humus that makes all the difference. The memorandum would be attached to each document, and I think I can get the money to do the necessary typing, if you think it's worth­ while. Now, don't kid me on this! I'm not--if somebody comes to this. If you've worked through papers be- fore, and you come on some memorandum which exists all by itself, unop- pressed by any other detail, and no one is around with whom you can square it, it's a guessing game at best as to what it is and the social context of which it is a consequence. You don't know this. 450 You know, last night as we were standing there in my study, I started elaborating on this application to the Commonwealth Fund, for example, and i f that just stands as an application, I don't think it's as meaning­ ful as it would be as i f I could add some of the comments I made about it as we just went through. I think it's a good idea myself--you think about the fellow who stumbles into the library seventy years from now. Neither one of us is going to be there. How can we now help him with reference to the things that ~ou've seen grow and develop both in terms of idea and in organization? One difficulty is that this sort of thing is old man stuff, when a man's reached the point when he's all through working. I'm not at that point yet. I've still got lots of things I want to do, particularly in the writing line. If this Western Interstate Commission four state con- sortium goes through, I'm very apt--! could even close up shop here, rent an apartment in Boulder, and help give some direction to that development because I'm tired of writing about the sort of thing I think ought to be done. If the setup could be such that I could keep rested and not have too many demands on me--why, I would be willing to move into an action situation again like that, i f it really got an opportunity to make a go. I would expect you to. My wife--well, she hasn't said no to it. It would mean keeping our home here. I'd have to rent a little apartment up there in Boulder so that we wouldn't have to chase back and forth all the time. If I move into something like that, I'm not going to have time to work this sort of stuff up that I'm talking about now. That will just have to wait, and 451 85 I told you this heart block could move in and take me right now--at anY time. I have to recognize that, but I'm not going to sit around waiting for it. This is a progressive condition, and I don't think any­ thing will happen that will take me out of the vineyard for several years, but it could. I don't want to do a lot of things that are going to aggra­ vate this condition because I still get a kick out of life. I've always got that as a limitation that I don't want to disregard too much. Now the published papers are the only thing that is in tiptop shape. I've just got the one set, and they're over there in the corner in chrono­ logical order, the order in which they've appeared, and there are a lot of things in there that I have counted as published that have also been put with unpublished things such as this. This--well, this hasn't been put in yet. I don't think it's in there. That's the paper I gave at the White House Conference and following that there's the edited record of the discussion. Well, about two thirds of the discussion was edited out, I expect, or half of it. That was Gorman. Well, everybody said too much. The editor, the man who did the overall editing--you take the complete Report of the White House Confer­ ence which is another volume I'd turn in with this collection, if you want to call it a collection--it will be elsewhere in the library, maybe several other places in the library, but if anybody is going through this collec­ tion and wants the context within which this was given, why it will be there, if that's what you think would be worthwhile. That's how I think about documents--unoppressed by their context, they're nothing. They're very hard to use and evaluate. 452 In the future if I have my way, I'll do a lot more writing, and I suppose periodically that should go into the library. I'll keep on sav­ ing stuff just like I've been doing probably. If I could go into the AAMC having had this experience with you--you're going to find that I'm going to be aping your techniques as I can because I think in a lot of the things I'll be doing in the future, I'm going to be carrying a tape recorder around. This has been quite an eye opener to me, this experi­ ence with you. I could go into the AAMC office, if I had a couple of weeks, and dig out a lot of the stuff that I think ought to be in the National Library of Medicine. There's nobody else who could go in there and know what was there. As long as Mary Littlemeyer is still there, the two of us could dig an awful lot out that ought to be part of the archives of the overall field of medical education. I'm sure that the powers that be in the AAMC would like to have this happen. Of course there is an awful lot at the AMA that is relevant to medi­ cal education particularly the annual educational number of the Journal of the AMA which I'm sure you've seen. Shortly after I went to the AAMC with Ed Turner--if he'd have lived and stayed down there with the AMA the story of the relationship between the two organizations would have been entirely different, of course. He was becoming terribly unhappy down there. He knew that he just couldn't live in that situation much longer, and he came to me one day because he'd been offered a fancy job with one of the drug houses, and he wanted to know if I thought he ought to take the job. I knew how disturbed he was. He was a very conscientious, sen­ sitive, imaginative person, and he just couldn't take the Madison Avenue way of doing things. He reflected this unhappiness, and he was clashing with everybody down there. Well, I told Ed, "I've got to think about this 453 for two or three days." Then we got together again, and I told him that I thought it would be the worst thing that had ever happened to medical education if he would bury himself in a pharmaceutical company someplace, and I said, "Why don't you come out here with me?" I sprang this idea on him that what we needed in medical education was a living survey of medical education, that with his background in the hospital field and medical education field, and that with the very high esteem in which he was held in all quarters, he could talk to anybody about anything and really milk the individuals completely dry of anything they had to offer. They would always talk to him because they would know that what went into the record would give adequate consideration as a privileged communication. He and his wife talked it over and decided that that was what they'd like to do. I told him, "I don't have the money for it, but I'm pretty sure I can get it." Then I told you about the Rockefeller interest in this. Ed went back and spent a weekend with Dr. Robert S. Morison who left the founda­ tion--he's up at Cornell now, at Ithacao Things had to rock along for several months with a lot of talk particularly because the Foundation al­ ready had decided that it wasn't going to support medical education in this country any longer and Dr. Virgil C. Scott--the one to whom I ad­ dressed these letters--he was willing to make an effort to get at least this one more grant through which he did. Ed Turner died the day the grant was to be announced, and the grant was really to Ed. I was selling this to Rockefeller because this was Ed Turner not because this was anything I wanted, or the AAMC wanted, and so when word of Ed's death got through--why, the grant wasn't made. 454 - You used the word "living survey"--yesterday you told me he liked to yavel, and I think you ought to amplify that. He literally was going 19 travel. Yes, he and his wife loved to motor together, and this was under- stood, that she was going to go with him. It was understood that taking her with him would be a part of the travel expense. They were just going to leisurely go from place to place. He was going to carry a dictaphone, dictating equipment with him, and this was to be a collection of his reac­ tion to what he found in the most interesting places in the medical schools and the most interesting people he would meet. One of the main things he was to do was to identify the horses that the future of medical education was to need, and no one individual today is able to point to very many people in the schools that could be doing things different now than they are doing just because of the limited contacts that people have. I'm out of it, as far as identifying exciting young people anymore, unless they happen to just come to my attention here and there. I would like to see the Archives of the Association in the National Library someplace. It would probably mean that they would have to be duplicated. They're locked up in the association in a fire proof vault, at least they were the last I knew. There should be a complete file of the Journal of Medical Education in the library of medicine. Whether it is there, or not I don't know. The early journals are hard to come by. They were called Bulletins in the early days--Bulletin of the Association of American Medical Colleges, and there is one complete set at the AAMC. Now this history of the AAMC that is up there--is just an outline, and stuck in some of those celophane pages are some notes of things that I Was going to add if I ever got around to it, notes to remind me of things 455 to add if I ever got around to it, but this was put together as you can see there--! picked eight or nine •... .B,_ybrics, headings. Developments that I thought ought to be followed from beginning to end. That's why you see these, and out in the corner I indicated the things that other agencies were doing and when they were done that were related to this history of the AAMC. Most of those notes have to do with the AMA, but I think that I put down National Fund for Medical Education, and things like ECFMG--things like that. You sent me a volume called a History of the Association. Well, you may already have one. Mrs. Renfree may have made a dupli­ cate of that--! don't know. She sent the--! may have sent that--that may have been among the stuff that came from the Markle Foundation--! don't know. That's the one I received--the Markle Foundation. This, you see--you had a copy of this. That's the reorganization. Yes. I sent this into the president--my file copy. I don't have a copy of this. He never even acknowledged receiving it, and two or three people that I had told about it and where it was, people that were asking me what might be done about this, that, and the other thing--! told about it and where it was, people that were asking me what might be done about this, that, and the other thing--! told them to write the president and 456 get the copy because there were things in it relevant to the questions they were asking and as far as I am concerned no use was being made of 1·t • When I knew you were corning, I called him and asked him to return it which he did. Well, the letter of transrnittal--he indicated that he'd had a copy made for his own use, so maybe it will do some good. I don't know. They like to say they're following a lot of the suggestions there, and maybe the suggestions made there have helped them, but what they're actually doing is a far cry from what I suggested. They had already taken too rnany--well, gone past the point of return in too many ways to permit them to backtrack and begin from scratch. You see, these sugges­ tions were largely patterned after the way the old land grant college association used to do business, and these suggestions came from this John Russell. He published a paper in the Journal of Medical Education making these suggestions, and this was way back before the Coggeshall Report, before anything was done about getting the Coggeshall Report started. I wouldn't be surprised if what--this guy Russell was and still is a real mustard plaster, and he just keeps needling people here and there. He used to needle me. He's a lot like Lester· Evans, except Les- ter was more subtle about it than John Russell, and a lot of my ideas, I'm sure, came out of casual conversations with these two fellows just as they did with my conversations with Alan Gregg. Dr. Sabin, of course, was very stimulating. The Western Interstate Commission idea came from Dr. Sabin. She first made the suggestion at a meeting of the western division of the American Public Health Association when it met over in Salt Lake City. I tried to run down the actual record of this suggestion, but I haven't 457 been able to. I was never able to find it, and of course these reports that you've seen of things like the Cardiovascular Conference and all that--these experiences all came early enough to have a lot to do at least with getting me excited about medical education. I would have probably gone back to practice if these things hadn't have happened. What I'd like to know is at the time they approached you to take what they referred to as the executive director's job--what was the establish­ ment? What was in existence? This was a new job. It hadn't been created. The secretary, and the job of secretary--Dr. Dean F. Smiley was the secretary--was to stay in the table of organization. For the first year or two Dr. Smiley was on the job, and I didn't interfere with any of the things he was used to doing. He organized the annual meeting, and he did all of the arrange­ ments for the AMA for medical school visitations, and he cooked up the budget. I didn't even bother with that, except he'd show me the budget as he was setting it up for my office. I wasn't even getting too con­ cerned about starting new programs just because I had to have a period of getting used to the new environment. Then he was offered the job of being the executive secretary of the ECFMG which really was one of his babies. He was the one who came up with the idea of the ECFMG, and it was reasonable that they would ask him to take it on. When Dr. Smiley left, I did not replace him. We made the secretary really--we elected a member of the council as secretary, and this was really a constitutional secretary. The other thing I had to do away with was the Division of Audio Visual Education. This was the baby of the old dean down at George Washington University. [Walter A. Bloedorn] 458 No, J. Edwin Foster was the staff person. This is all covered in this outline of the history, I'm sure. Well, I should have kept that Division of Audio Visual Education going because here was the premature beginning of all of this communications stuff, and the AAMC should have kept its finger in this so as to be in on the ground floor of all this programmed instruction, the real use of movies, audio visual tapes, and all of this sort of thing, but we couldn't find support for it. The foundations lost interest in supporting this, and when Ed Foster had a chance to go to the American Heart Association as director of their Divi­ sion of Education, I had to tell him to go because I felt that there were other things more important at that time, and I couldn't have gotten the money for that Division of Audio Visual Education, if I had tried. Who discussed with you taking a position called the executive director? The first one was Dr. Vernon W. Lippard at the time he was president of the AAMC. Maybe he was the immediate past president. There was a committee set up. Lippard was chairman, and then there was Robert A. Moore, the Dean at Downstate Medical Center of the State University of New York--! don't know who else was on the committee. They came at me with the idea first when I was in all this constellation of hassles at Boulder, and I told them that my taking this position was unthinkable at first. Then they came at me again, and I said, "Well, I might do it, but things have to quiet down here. If you want to wait six months, I'll talk to you again, but I don't think it's fair to you people to wait six months." Well, they waited, or at least they couldn't find anybody else inter- 459 88 ted so at the end of six months they came at me again--well, along there someplace, I told them that if I could give the University six months notice, I would take it. Did the committee function as a committee? I think the only function of the committee was as far as gathering names is concerned. They didn't come at me with a job description. They did not. No. Were they dissatisfied with the ongoing program? They just knew that the AAMC couldn't meet its future responsibili­ ties with the organization it had and the budget it had. They were very frank in telling me when I took the job, "It's up to you to develop your program. We don't have any specific program for the future in mind. We just know that there is a hell of a lot of things that have got to be done, and we want to get an executive director that can start out and provide the leadership that is necessary if the medical schools collec­ tively are going to do the things that are needed." That's about the sense of it. I don't recall the existence of any correspondence except the letter of agreement that came from the presi­ dent making me the offer. Was this John B. Youmans? I think it was Bob Moore that sent the letter. The immediate past president. 460 It's in some of this stuff someplace, or it's in some of my personal papers. ~re you well received when you took the offer and joined? Oh, yes. This wasn't a palace revolution of any kind. Oh, no. No, frankly the council and the institutional membership which are deans--they rubber-stamped everything I wanted for a long time; in fact, they never refused to do anything I wanted. There were plenty of things I suggested that were just sort of tabled--"Well, we'll get to this at the next meeting." This situation became a pattern that sort of grew with the council. My agendas were too long for them. They were used to a meeting where they would come in the night before and leave at four, or five the next day, and I frequently set up meetings that were to be two days in length, or even three. I pleaded with them to plan their time so that we could have a long meeting where greater deliberation could be given to things. They would let me set such meetings up, and then they'd begin to come late, and others would leave early so that it was very unsatisfactory. It was obvious that these long agendas weren't being looked at until they got on the plane to come to the meeting, and I just didn't feel that I was getting the kind of deliberation out of the council that the ser­ iousness of these questions required. I'd tell the council so, and it's at this time that I began to come up with the suggestions for something like the Coggeshall study. The only reason, I think, they agreed to the Coggeshall study was because I told them that the time would come when I 461 was going to have to retire, and I thought the Coggeshall study should be gotten underway so that its release would about coincide with the time when they would be looking for a new executive director, or they would have employed a new executive director. Your first report is made not on a basis of a year because I don't be­ lieve that you were there a year at the time the report was made. No. It does sketch in some detail the plan of operations that you're going to create which involves people, a staff. Where did you find Leland Powers? They authorized an associate director early in the game. "They" being the council? Yes, and I must have interviewed twenty-five, or thirty people. I couldn't get anybody to take any interest. They wouldn't take a chance. They would not leave the security of a good job and move in. Also I think a lot of the people--well, maybe I was trying people that were too senior as compared with me. Nobody ever said so, but I sensed frequently the feeling--this guy says to himself, "I'm not going to move in under Darley's shadow. I won't have a chance. Darley's too agressive to suit me." I think this was a factor in getting turned down. Nobody ever told me this, although I sensed it many times. Well, Lee Powers was at Beirut-­ he'd gone over there to establish a school of public health, and he was one of Ed Turner's proteges. He was with Ed when Ed started the medical 462 school at Washington University, and Lee took over Turner's Department of Preventive Medicine. I didn't know Lee at all, but on the strength of Ed Turner's recommendation I took him. He was looking for a job be­ cause he wanted to come back to this country from Beirut. Lee Powers was all right as long as I would spell out in detail just what he was to do, so he really functioned in a staff capacity more than he did as an associate director. Now, he handled an awful lot of the visitation, the accreditation business. I made him head of this Divi­ sion of Operational Studies and until that got to be a pretty complex operation, he did all right. Then Gus Carroll came in as the assistant director. Well, Gus came in as a person who would really develop data, put it together, and write it up. Lee Powers helped him with it. Lee was pretty good at developing questionnaires such as was necessary for this study of construction needs, and we based our statement of construc­ tion needs on the history of the availability of construction funds. Powers developed all of that, and then we decided on this series of in­ stitutes on administration. I turned that whole thing over to him, and he did very well with it, but Lee was not a creative sort of a person. Not a stem-winder. Not a stem-winder, and there were times when it was a little diffi­ cult for me to find really enough to keep him busy. The big disappoint­ ment, and I have told him this, was when Gus Carroll came. I told Lee, "I wish you'd work closely with Gus and learn his skills so that you can become Mr. Medical School Financing Authority." Gus was doing this real well, and Lee just didn't see why he should­ n't do other things, so Lee really never developed a working knowledge 463 of the methodologies that Gus had developed, and nobody else has developed such a knowledge. Fortunately the AAMC six or eight months ago made this contract with HEW to do a program cost study in six selected medical cen­ ters. Gus was not well enough to take the responsibility for this study, so they had to find somebody else, and they got a chap by the name of Campbell who had worked with Gus at Syracuse years ago and who after leav­ ing Syracuse had gone to Minnesota and taken a master's degree in hospi­ tal administration. His last job was to take charge of this Kansas City Medical Center in Kansas City, Kansas, part of which was the University of Kansas City Dental School. There was a hospital there--it's in Mis­ souri--Kansas City, Missouri. The University of Missouri was going to take this medical center over. Maybe they're still going to do it, but at any rate, this fellow Campbell went there with the idea that this amalgama­ tion would take place, so he became much more than a director of a hospi­ tal. The AAMC got him to come in under this contract, and he's worked closely enough with Gus in these past three, or four months so that Camp­ bell is pretty well qualified to move into Gus's shoes, and they're going to set things up so that he can do it. We have to finish this study of the New Haven Hospital, and Campbell says that he and Gus spent enough time together on this study so that Campbell is qualified. What was be­ ing done in the study is relevant to the hospital part of the studies in these six medical centers that Campbell has to do under this HEW contract. As soon as Mrs. Carroll comes back and it's proper--why, I'll have to go to Chicago with Mr. Campbell. I'm still chairman of this committee doing this New Haven study, and we'll have to see if we can't salvage enough out of Gus's notes and things, plus what Mr. Campbell knows, so that this New Haven study can be finished up. It will be a book of two or three hundred pages when it's done. Gus was going to re-edit all of the preliminary reports that he's made. Well, they'll have to be used as is without a lot of editing, except possibly to improve on the language and do away with some unnecessary duplication, but this study is going to be a gold mine. It is going to be an absolute gold mine of background thinking and philosophy and detailed procedure, much of which will be unnecessary to any final instrument that will be developed for approaching the question of the costs of education programs as they are conducted in hospitals. It will be a lot like this volume that was published in 1958, which was Gus's study of medical college costs. It will be that kind of a production. Since Carroll has come into the picture, I think you ought to include the basis upon which you and he got together originally. Yes, I'd never heard of him until he came to me with the typewritten manuscript of this book, A Study of Medical College Costs. This was one of the things I recognized was needed in the field of medical education, so I had this meeting. Fairly early it was. Yes. I had this meeting in New York to which Gus was invited, and I brought my old administrative assistant from here at the University of Colorado because he'd tried to do much the same thing that Gus had done, except he'd built his schedules around an estimate of various amounts of time that the faculty spend in a given year in connection with teaching medical students, research, patient care, and so on and so forth. 465 What was this fellow's name? This fellow's name was Robert Denholm, and he still has all of these old working papers, and if you want them, I'm sure he'd be glad to turn them in. His study was on the basis of time. Yes, time. Now Gus's was on the basis of energy estimates--effort outputs, and Denholm realized when we finished this initial study here, that if he'd redo it on the basis of effort, faculty effort instead of faculty time--why, he'd have it made. Eighty percent of what goes on in a medical center like this is tied to what the faculty do, the fulltime faculty. Now unfortunately in Gus's book and Gus's studies there's been no effort made to make an allowance for the contributions of the volunteer faculty, the part-time, volunteer faculty. Of course, this is a tremen­ dous part of the total effort of most teaching medical centers. All we have been concerned with has been dollars and costs as represented by dollars transferred from the legislature to the pocket of a member of the faculty, but we haven't worried about the contributions of the volunteer faculty because we knew that this would be easy to build into a system of cost accounting any time we were ready to do it. Did Carroll come to you with a view to having his study published? Yes. This was his purpose. Yes. Now, he didn't have any idea of joining our staff, but when 466 we took the publication of this manuscript on, we knew the whole proce­ dure needed to be refined. I paid him out of this Kellogg grant to do this, and he was really giving the equivalent of half time to the asso­ ciation--almost from the time he and I met. He was doing this weekends and nights. He'd spend his vacations on these projects. When something had to be finished up, and he didn't have any vacation, or weekend time to give to it, or couldn't do it on that basis, he would go off the pay­ roll of the upstate medical center, and we'd use Kellogg money to reim­ burse the upstate medical center for the time that Gus would spend on finishing up some of these things. He has quite a collection of publications to his own credit. Oh, yes--was his background medical economics? His background was high school education--fantastic! I'm getting the material together because I have never done it. I wished I had it. After high school he went to the equivalent of a junior college in some little town in northern New York. He had a fulltime job, but he took ac­ counting and mathematics, and I know he took correspondence courses. He entered the New York State Civil Service System and was running the busi­ ness office at one of the penitentiaries of the state. He revamped the whole system of accounting in that penitentiary and budgeting. He re­ vamped, I think, the personnel policies, and then they moved him to the Forestry School. I have forgotten where this was. It was operated by the state. Syracuse. Syracuse--yes. Syracuse is a combination land grant and private 467 institution, and he did this at the School of Forestry. Then when the state took the medical school over, why Carlyle Jacobson got Gus to move over and be his business manager, and old Gus was always figuring out a better way to do things. A creative guy. He revamped the whole code of accounting for the state university and the personnel policies and the budgeting methods--boy, the state uni­ versity really got some mileage out of the stinking, little salary he was getting from the state. I wanted Gus full time right from the start, but he had too big a stake in his retirement, so he didn't join us full time until he was eligible to retire. Gus was never too well, he had diabetes, and until late he didn't take too good care of this, although I don't think it was ever out of control but he developed complications, and these are what took him finally. Dr. Julius B. Richmond, the dean at upstate medical center has a big file on Gus, and he's going to send it to me. Miss Littlemeyer is get­ ting what there is at the office. I've got to put this together and at least have a record of everything in it that I can get. I'll have to go to Mrs. Carroll, and I'll give her much the same treatment that you're giving me with a tape recorder. Out of fairness to Gus this record has to be established. You know--your constituency as executive director were the deans of the medical schools. How receptive were they to the development of a secre­ tariat that put such emphasis on cost accounting? They had none of it, most of them, and they're still that way. 468 And the reason is the faculties. The faculties are violently op­ posed to this effort reportingo We got--Gus got several schools to go through this schedule and do this program cost estimating. Twelve of the schools were willing for us to use their data, but only when the data was several years old. This is the data that was the basis for this big paper of his and mine that was published a year ago last January, but there's fear of questions that a Legislative Committee might ask, or a Board of Trustees when program cost data is presented. They are afraid that they won't know the answers, and Gus says that this is natural be­ cause figures standing alone don't mean anything. You've got to have the information--the facts behind the figures, and the deans just don't de­ velop these facts. You can get the schedules filled in, but the trick is for the dean and his people to sit down and to decide what these fig- ures mean. Say here are two schools sitting down together comparing figures. Let's say one of those schools had a direct undergraduate per student cost that was less than the tuition that was being charged. That kind of information can't stand the light of day unless you can explain it. Here's another school with the direct cost of three thousand dollars per student per year. What's the reason? The reason is that in the school with the low cost all of the clinical teaching is being done by volunteer practitioners. It's easy to explain, and the explanation gives you the ammunition you need to begin to get a fulltime clinical faculty on the job. Well, you can't get the deans to see how this information can be used, and it's this sort of thing that I tried to wring into this Alan 469 Gregg Memorial Lecture I gave--you see, to build up the case for program cost estimating. I don't think any dean ever read that paper, or any faculty, because I can't see to this day that that paper had any impact anyplace. The only reason this study is being done in these six schools is be­ cause the government has made it tough through the medium of the govern­ ment auditors coming in and demanding an accurate accounting of the ex­ penditure of federal funds. That's the only reason that schools are be­ ginning to do this, and in one of my annual reports--that speech where I announced the Kellogg grant--! pointed out the inevitability of this day unless they got to work then, but they wouldn't permit this program cost accounting to get to work. We set up a Steering Committee on Operational Studies. I had one meeting and the hostility to all this business came out. We called another meeting, and only one or two people would come so the meeting was cancelled. I said, "To hell with the Steering Committee on Opera­ tional Studies!" We just went ahead with the studies as best we could because this committee would have put us out of business, if we'd have kept it going, I'm quite sure. They were so critical and picayunish in the way they considered the agenda that we presented that the meeting was of little value. Now on the other side of the coin, I should have insisted that this steering committee be kept underway as an educational experience for the deans that were on the committee, and maybe we would have come out with acceptance of this type of thing, this program cost accounting. Now the faculty salary study--that has been a very important ad­ ministrative tool to the schools--we never could get all of the schools 470 to contribute data to this study. About half of them, or maybe two-thirds would play ball, but the deans that wanted the study before we were ready to publish it were always the ones that wouldn't give us any of their data. That's just the sort of deal you were up against. It seems to me that the office of executive director and the plans that you had in mind were not reflective of what the deans were thinking at - all. No. It was something that was being done to spike hearsay, speculation, and replace that at least with facts that were hard and intractable. Most of this was generated in the office--you see. And then the council would be presented with an accomplished fact almost. There were instances of this. They could do nothing but approve. The establishment of the teaching hospital section is a good example. The director of the hospital at the University of Nebraska and my public relations man, Tom Coleman, came with the idea of just letting the hospi­ tal directors come together for a meeting on an ad hoc basis at the time of the AAMC annual meeting. This looked like a good idea, so I said, "Go ahead and arrange it." It was the best part of the annual meeting, and so they wanted to do it the next year. In the meantime these hospital people had gotten together and wanted an organization set up that would be approved by the council and the council--! don't remember whether--yes, it must have ap- 471 proved it. Then I knew we would have to get the approval of the deans as they met in their annual business meeting. Now the proceedings--un­ fortunately I didn't have a stenotypist recording everything that was said at a meeting. I'd give anything for a verbatim record of that dis­ cussion because it was hot and heavy, and this organization didn't pass unanimously by any means, and what I said in the proceedings about the discussion was really very kind to the institutional membership and that motion, that resolution they passed establishing the section, passed as I presented it, and many of the people that voted for it did so because they knew--"We've had it. We can't turn this down now. It's gone too far." Even more important--! hate to say this, but money talks, and people with funds were willing to support the kind of program which the secre- tariat had envisaged, even if the deans didn't care. This section didn't have any money. The indirect costs were buried in the general budget. They didn't have their own money until after the Coggeshall Report was out, and the organization was set up as a dues pay­ ing Council of Teaching Hospitals. That's when they began to have their own money. I mean you brought funds with you, and the secretariat grew in terms of the development of a program even if the deans didn't like it, or didn't share in its vision, or didn't want its substance, or preferred to deal with hearsay. You had funds to support the studies. I'd get these grants. 472 I'd get these grants and tell the council, "I've got the grant. Will you pass a resolution accepting the grant?" The foundations didn't pull the trick of saying that your applica­ tion should carry a resolution approving this. I don't think any founda­ tion ever approached me that way, but here would be a grant and a program that the grant would support, so the council were happy to approve it. That's the way a lot of this got started. The most successful data gathering instrument was set up by Ed Turner and myself which is referred to as the joint AMA/AAMC annual questionnaire, and this is the questionnaire that goes out from the AMA--it's out now, and it's responsible for most of the data in the annual educational number of the Journal of the AMA. This is a joint questionnaire now and has been ever since I took this job, and what burns me up is that the AMA gets the credit always because when any of this is referred to in the literature, the reference is always to the Journal of the AMA. Gus Carroll is the one who developed the questionnaire for this ex­ penditure data which is in this journal and which is the most important single item in the issue always, and if you go back through the early re­ ports on expenditures, you'll see where it took Carroll about three years to get a fairly good instrument. Now then, the turnover in the schools in the last few years is such that it's been like pulling teeth for Gus to get this expenditure material from the schools. I'll be damned. They don't turn it in--a lot of them. A lot of them that do turn them in don't understand the questionnaire. They don't fill it in pro­ perly, so beginning about the end of May, Gus has to get on the telephone. 473 He knows these schools well enough so that he'll call them up, or he'll start writing, and he'll ask questions. He'll send them new forms to fill out. Then the schools that don't send in anything--he starts after them, and it's all he can do to make the publisher's deadline with this report on expenditures always, and he tells me each year that it's get­ ting harder and harder to get this information due to the turnover of people in the schools, lack of interest in the schools. He has wound up with fairly accurate information. The expenditure data is just part of it. It's important to know where your money comes from and with this you have to put what the money is spent for--see, and that's what we don't have. It's a matter of rou­ tine. A lot of schools I know go through this cost study and use it as an internal administrative tool. The Dean of Washington University in St. Louis--he isn't there anymore, and I don't know what the present dean does--this was Edward W. Dempsey. He told me, "That's the most important single thing we've done when it comes to just building up a budget and understanding really what the budget is all about in terms of our objec­ tives and our programs and in terms of getting things approved by the Board of Trustees, but more importantly going to the business community of St. Louis and getting money that we use to operate the school." Some of the schools when they did this cost study found that they were making money on their research--this was told Gus and me in confi­ dence, and this was one reason they weren't about to release this infor­ mation. That knowledge made them buckle down and use these grant funds the way the government intended that they be used, and if they hadn't done this, they would have been in real trouble. Shannon has talked to me about this. He's known how important these 474 procedures have been, and Gus is the guy--they got the whole concept from Gus, the HEW NIH--the whole concept of time effort reporting came from Gus because he spent hours and hours and hours with Shannon's staff on this business, and if the schools only knew it, they're just damn lucky that the government auditors are willing to accept these time effort re­ ports in lieu of classical cost accounting procedures. I'll say. You mean it's actually getting worse--your constituents. It has been getting worse. Now then I'm quite sure that the worm has turned as a result of this six school study that has been financed by HEW. The schools know that they're going to have to get into the busi­ ness of program cost estimating. So far they think it's going to be a limited effort, however. All of them think "All WE need to do is carry this far enough to show how we spend government money." Well, now, cost sharing has developed as a government policy, and the auditors are going to audit the institution's books to the extent that they'll be satisfied with the extent of cost sharing. Well, you can't do all of this unless at the same time you account in terms of dol­ lars spent for everything else that the medical center does, so the audi­ tors can see here's an honest effort being made to do a job of program cost accounting, but if they come in and see the effort limited to a single research grant, or to just government money, or not foundation money, or money that comes from the legislature, they'll say, "This is just cooked up to satisfy the government, but we can't be satisfied unless we can see the rest of the expenditure and cost picture." This will have to go. This will have to go, and in one of those un­ published papers--! think I sent you the talk I gave at Creighton. 475 Medical educators--I still stick to the idea expressed in that paper--they don't do anything until they have to, and I don't think organ­ ized medicine has ever done anything until it has had to, and if I had the time, I think I could make a case for that, but it would take some digging. lI1 terms of the public interest they have no place to hide. Yes now, some tables you haven't seen that I have developed for this next paper that Somers and I are to write are just based on expenditure material (never published). I have worked out the average amount of money that has come from a given source for the tax supported schools, for the private supported schools, and then a group in between that are private schools that receive a great deal of public subsidy, particularly the Pennsylvania schools, and the patterns of income differ for each of these groups of schools. I mean the average number of dollars received from each source differs. I compared 1958-1959, with 1963-1964 in these tables. Well, the dean here took those tables to the legislative hearing because he could show just where his income stood in relationship to the averages for all of the state supported schools. He said, "This made all the dif­ ference in the world in the way that hearing went." It's a stick, a club. Sure. Well, let's backtrack once again--there was another person who was already there, I believe, in terms of director of research--Helen H. Gee. Well, shut it off a minute, and let me take a little walk. 476 Now you asked about Dr. Gee, and she is an extremely important figure in the development. I have to go back now and give you some background. This last report of mine, AAMC milestones in raising the standards of medi­ cal education--in that paper I tried to review the beginnings of research in medical education, particularly the more strictly education aspects, medical education as medical education, and this goes back to the begin­ nings of the medical college aptitude test and the medical college admis­ sions test. Carlyle Jacobson when he was Assistant Dean at Washington University in St. Louis was chairman of the committee that did the first real development here on this admissions test, and then we got a man to come in as the director of research, or director of education, and this was John M. Stalnaker. Now his name doesn't appear in any of this because he left just about the time--well, quite awhile before I went in. He never was full time with the AAMC. Stalnaker brought Dr. Gee in full time to help him with this medical college admission test business, and this was under the jurisdiction really of a committee on--well, I forget what we called it, but it was this com­ mittee chaired by George P. Berry at Harvard, and George Berry is a fel­ low that is always looking ahead. His committee took on the responsibil­ ity for developing a lot of research chiefly around this medical college admissions test, and then they got the idea of investigating the non-in­ tellectual characteristics of early medical students. All of this went into the first institute, the teaching institute on medical student selec­ tion. This would be the fourth institute. The first one was on biochem­ istry and physiology, the next one was on anatomy and pathology, the third one was on basic science, and then we had two institutes--one on the ad­ mission procedures, the selection of medical students, and the other on 477 the ecology of the medical school. Now these two institutes were the outcome of this interest of George P. Berry and his committee and John Stalnaker and Helen Gee. They cooked up the idea of this longitudinal study where they ap­ plied this battery of psychological tests to the entering classes of some thirty medical schools. I can't tell you who should get the credit for the birth of that idea, but these three people between them--it came out of their interests. Carlyle Jacobson was mixed up in this also. Is this the continuing group on student affairs? The group on student affairs was a spontaneous development that came out of the first institute on the admission and selection of students. The admission officers had a meeting--John L. Caughey at Case Western Reserve, I think, is the one who on his own brought the group together at an annual meeting of the association, and maybe they met up in his room, or someplace, I don't know. They just found that here was a big problem area in which there was no communication as between schools, and the group asked the deans each to appoint an official representative to this group on student affairs. There was no difficulty over this because the deans looked on this as an arm of their own deans' club. This group on student affairs have always been unhappy because they didn't get enough recognition in the proceedings, for example, and at the annual meetings for the work they did. One reason was that their meetings were always closed. The things they talked about they wanted to talk about among themselves. They got into some very sensitive areas, and they didn't want any newspaper people horning in on this. I told Caughey that this was terribly important and maybe their organization and its 4(0 work wasn't having the visibility that it was entitled to, and then was when they began to have an annual meeting with a bunch of papers and things, but they still have a full day at least in executive session. They've done a tremendous job for medical education. Then Davis G. Johnson came on to the staff full time--I'm skipping Paul J. Sanazaro's coming into the picture, and Davis Johnson came to me originally with the idea for this study of attrition. I helped him get the money from a foundation in Pittsburgh for this study. Edwin E. Hutchins is another one. Helen Gee found Ed, brought him in to help her, and Ed is a real research psychologist, an excellent scientist. He helped Davis Johnson get going with this dropout study, and then we brought Davis into the association full time. Johnson brought his unexpended grant with him, and he and Ed Hutchins finished the study up, and it was pub­ lished as an AAMC project. I'm rambling now--let's go back to this longitudinal study. This has to do with the number of areas that were not treated seriously from a research point of view when you first set up that operational studies. Let me finish with the operational study business because the Kel­ logg grant made that possible. This was a half million dollars over a five year period. Well, I had already come to know Emory Morris very well--President of the Foundation. I'd been on his advisory committee when I was here, and we were able to get grants from the Kellogg people while I was here. That's how Frode Jensen happened to come into the pic­ ture. Emory was one of the consultants to the Surgeon General on medical education, and prior to the first meeting of this consultant group, I 479 had been dickering with Jim Shannon for a grant to start this operational study program, and someplace in these documents you'll find the applica­ tion I submitted to the NIH. Well, I'd go in and we'd talk about this, and Jim would say, "Well, I'm sorry, but the government can't support this aspect of your program, or this. The total amount that you're re­ questing is more than we can give you." Well, he finally told me to come in with a watered down program that would have cost about fifty thousand dollars a year for two or three years. Also part of the deal was that all the raw data, or duplicates of it would go to NIH. I just became more and more uncomfortable over the prospect of trying to satisfy Jim Shannon and his crew, as much as I thought of them. There just were certain things that Jim could and couldn't do, cer­ tain limitations within which he had to work. This was all very much alive--this consideration, and I saw Emory the day before this first meet­ ing of the consultant group, and I told Emory what my troubles were and what I wanted to do, and I said, "Gee, whiz, Emory if Kellogg could pick up this whole ball of wax as it was originally put together for NIH, I think it would be the greatest thing that ever happened." Well, within a month I had that money in the bank. I had the pro­ gram approved and money in the bank for the first year's operation, so I forgot all this dealing with NIH on this program. The Kellogg Foundation can't support research. That's in their charter. You can't call any­ thing research. That's why we called it operational studies instead of operational research. I had to draw a statement of objectives up very carefully so that nobody could even read the common concept of research into this statement of objectives. This made this activity of John Stalnaker, Helen Gee, and George 480 Berry all the more important because this was research--see, and they tried out the measurement of the non-intellectual characteristics on one senior class so that we could have that data to use in that institute on the ecology of the medical student, and this stimulated such a productive discussion at the institute that the idea was born of starting with a freshman class in a good sample of medical schools and using this instru­ ment each year--! mean continuing the study throughout the entire period of the four years of medical school and then carrying it on into the in­ tern years, the residency years, and eventually studying the professional performance of these individuals after they'd had a chance to become es­ tablished in practice. The students were very much interested in this study, and most of the schools were. Just one school dropped out of the study, and this data that accumulated as a result of this study occupied file drawer after file drawer and became increasingly ponderous and difficult to use because we didn't have the money to really build it into a data bank as we went along. Each time Dr. Gee, or Ed Hutchins, or anybody wanted to write a paper--why, the cards would be organized in such a way as to just pull out a segment of data. The cards then would be left just the way they were so the next time anybody wanted to get anything out of this it was more difficult. In the meantime Dr. Gee had tried to get some data out of the schools, particularly data that had to do with an individual faculty's estimate of individual personality characteristics of individual students. This ques­ tionnaire that was developed in an effort to get this kind of information and along with it grades and so forth, was a very ponderous questionnaire and angered a lot of the faculty people that got it, so we found ourselves 481 with a revolution on our hands. Fortunately, however, enough faculty people filled this questionnaire out, tried to, and sent it in so that we still had a valuable body of data. Now, Dr. Gee had charge of all the institutes. This was her responsibility. The data gathering, the exercise that the schools went through in answering the questionnaires that these committees would send out was out of this world. The work books that would be developed for each institute would be about three inches thick, and there's a world of data in there that has never been used, but it could be used, and these have all been preserved. There's just one file set, I'm afraid, of all of these working documents at the association, but here's a body of information that has never been tapped, that could be tapped when a point of reference is needed for a piece of work that might be done tomorrow, or fifty years from now, and this has been well preserved. Now Dr. Gee was supposed to get this data organized on a longitu­ dinal study and get it into a data bank so that it could be really used, and she never could get around to it. She always had too many other pro­ jects. She was doing lots of consulting work. She was always on demand for papers for meetings. She wanted to keep her identity as a clinical psychologist and keep active in that field, so a lot of the things she did had to do with working with people in her own discipline, and in the process she was introducing these people to medical data and work in edu­ cation that hadn't been done in any other field, so it was good that she was doing this. It was one thing after another. She was very good looking, but also a very aggressive person, and she struck sparks everyplace she went. She finally resigned with the understanding that she'd have two years to get 482 this data organized. I kept her on the payroll for two years. She went and set herself up in an office Northwestern University gave her over near the computer center so that she could be close to the computer cen­ ter. Then she took a year as Visiting Professor of Psychology at the University of Oregon, and we shipped all of this stuff to her out there, but she never did get this done. Then it was Ed Hutchins' job to do this. Well, he never got it done because he had too many irons in the fire, partly because he was helping us with other things and partly because he was working with his own dis­ cipline. We finally gave him the year off, and he went to the University of Iowa at Ames--! guess that's Iowa State University. At any rate, he finally got this material organized, so that it is now available, and it has been worked into the computerized data bank the way it ought to be. Thank goodness that's taken care of! Now after Dr. Gee left, I went after the Carnegie Foundation for a grant to set up this Division of Medical Education which we'd never had before. I think we called it research in medical education under Dr. Gee. Carnegie people were interested, but they wanted to know who was going to be the head of the division. I really have forgotten what made Dr. Paul J. Sanazaro's and my paths cross--it was like meeting another Gus Carroll, except in another field. They boy Sanazaro was out at the University of California Depart­ ment of Medicine in the Outpatient Department. When I got to know him and could see what his interests were, what his competencies were, and what his potential was--the minute the Carnegie people met him, why, we had the grant. He came in, and from the minute he hit the place, there was better direction to what we were doing, and he had his own interests. 483 In these dccuments you find where he had his research in education, his core program which were his own projects he wanted to develop, the MCAT program, and there was a fourth one, and I forget now which it was. I presented him to the executive council with the approval of the grant from Carnegie. That got to the council almost as an accomplished fact. They didn't have much choice in the matter but to go along with it. Paul Sanazaro is leaving to become Director, National Center for Health Services Research and Development. The 1st of May is his last day with the association. His interests switched from research in medical education to research in patient care, and you'll see in my last report to the as­ sociation, that I wound up indicating that research in patient care should now be recognized as an important part of research in education because it would be the effectiveness of a physician's professional per­ formance that would be the ultimate measuring stick as far as measuring the effectiveness of his education is concerned. Research in patient care has to become a part of research in education, and the tools that we work with in evaluating the effectiveness of the physician in his re­ lationship to the patient are non-existent, or practically so. Paul has finished up the first leg--that is, the identification of criteria that can be used in describing at least what goes on between the patient and the physician in relationship to the care of the patient. Paul is going to NIH and will be in a position to stimulate and evaluate islands of research activity in this area. He's aiming to the day though when he can come back to these students that were in the fresh­ man class in 1969. These babies will have finished their residencies and their military duty and will have been established in practice long enough so that we can wind up this longitudinal study as we call it, and Paul has every intention of seeing to it that this study is finished, and if he 484 can't do it at the AAMC, he's going to do it at NIH. Now, he's like all these research people in this area--they have a one track mind, or so it seems to outsiders, and they aren't the easiest people in the world to get along with. This goes for Stalnaker, Gee, 5anazaro, Ed Hutchins, and everybody else I've ever met in this area, but the development of this area has been a godsend to medical education and even to higher education. Now the fellow who went to the National Board of Medical Examiners-­ I can't think of his name again, but it begins with S. Schumacher. Charles F. Schumacher--he got his start with us under Helen Gee, and he went to the National Board and organized their whole research pro­ gram. That's been his baby, and if you ever want to hear about some ex­ citing things, why, drop in on the National Board sometime. They took Richard H. Saunders on, the fellow that did our study of the university internship. He left Rochester as a Professor of Pediatrics to be Assis­ tant Dean at Cornell, and he's been in on a lot of this research because he's been active in the group on student affairs. Now he's gone to the National Board as associate director. If he hadn't been pulled out of a little assistant professorship up at the University of Rochester, he'd still be there, I think, so some horses that the national scene has needed have come out of this. There are other instances that are really impor­ tant. Helen Gee left Oregon and went to the National Institutes of Health. I don't know what she's doing now, but I know that she's in the data pro­ cessing business someplace, and this experience she had with us is a na- 485 tural preparation for whatever it is she is doing. - I 8 sh e down at NIH ? The last I knew. I know she's still in HEW. Whether she's gone out of NIH in connection with a lot of this reshuffling, I don't know. Ed Hutchins is a member of the permanent faculty at the University of Iowa, or Iowa State University, and I forget which, and his interests are such that he'll always be identified with this longitudinal study concept at least, and he'll always be available to anybody that needs help from him as to questions to ask the computer. He'll always be available, i f he's alive. Now, then the AAMC is •• oo Let me turn this over~ I'm going to have to run this by hand. You go ahead. Has something blown out? Something has happened, and I'm not sure just what it is. The recorder is functioning. What do you mean--you have to run it by hand? The reel on which the tape •••• I've got some reels over here. The reel is all right--it's just that something has happened underneath, and it doesn't go around. It doesn't take up the tape. I have to hand feed the reel. I'll show you how it works. 486 This is Dr. Darley. I guess Dr. Cooper's secretary told you that I'm in a real trouble up here. I have this man here from Washington, and we're tapeing a discussion, and if you have a recorder of one and a half, or three and three quarters speed, I would sure appreciate it if you could send somebody up with it right away. That's 7002. I'm on the bridge on the Colorado General and facing the mountains. Now fortunately the AAMC has found the money to set up a very sophis­ ticated data bank with everything except its own computer. Arrangements have been made under contract with an outfit to supply this need, and Davis Johnson has been put in charge of this operation. Then all of the data coming out of the longitudinal study, a great deal of data that Dr. Sanazaro has developed in connection with his special studies in educa­ tion programs, NIMP data, MCAT data, and all of the data that could con­ ceivably be important to correlations of data will be readily available. Then they've replaced Dr. Hutchins with a qualified clinical psy­ chologist who will continue with the development of the Medical College Admissions Test and other research that has to do with characteristics-­ intellectual and non-intellectual characteristics. All of this is to be continued in good fashion. Also--and I don't know what the program is going to be like--much of this research in education will be continued particularly in cooperation with medical schools, or groups of schools that will want to join in on special studies, so that I'm not too unhappy at the developments in the AAMC that will keep this research in education going. [Question here is indistinct, but in substance the question was whether the problem for the secretariat isn't its ability to bypass its consti­ tuency, the deans, and reach the faculties directly as a whole.] 487 Well, that is just what is a necessary next step. [Again the question was indistinct, but in substance the question was ![lether Dr. Sanazaro's workshops weren't a key to reaching the faculties.] Yes--Sanazaro has worked out the mechanics for getting to the facul­ ties, and this is done through what he calls these intramural seminars. The intramural seminar involves a single medical school faculty and re­ presents an effort on the part of the faculty to go into detail regarding the study of its whole operations, its whole functions. Many of these tests came out of the longitudinal study plus others that have been picked up here and there from people working in, or doing research in psychology and sociology. Dr. Sanazaro and his staff have adapted these tests to the medical school situation so that a medical faculty can sit down--it takes about a year to get ready for one of these intramural seminars-- and study all of the intellectual and non-intellectual characteristics of medical students, study the methods of evaluating student learning and methods of evaluating teaching. Dr. Hutchins developed what he called the test that let you evaluate--well, it was called "the medical school environment inventory." The first one of these studies, these intramural seminars, was done at the University of Kansas. Then one was done at the University of Mary­ land, Ohio State University, and the last one was done at Tulane Univer­ sity. I have a copy of the manual that Dr. Sanazaro has prepared which is based on the experience with these four studies and which any faculty could pick up. Provided a faculty is willing to do the work and provided it is willing to have its own performance looked at critically, or it is willing to look at its own performance critically, and faculty can develop 488 the data necessary to run one of these institutes. Then the idea is that the faculty, helped by appropriate consultants in medical education, or consultants in research in medical education, can hold a retreat for a week or two and discuss the findings and decide for itself what its find­ ings mean. The idea then is that out of this discussion the faculty would set up the machinery that would keep its own educational program under constant review. This is really big business--medical education, and I mention this in this final report I gave to the AAMC admittedly taking some fast passes at it because I was merely trying to paint the broad picture as far as re­ search in medical education is concerned, its importance is concerned, and its potential for good is concerned. Here I've got just a file copy of this manual ["Educational Self­ Study by Schools of Medicine" (AAMC, 1967)]--it's out of print, but this is a terrific thing! Now then--! don't know of any medical school that has picked this up since the manual was prepared. Six copies of it went to every medical school. I got five or six copies. I gave them away. A faculty member here was interested in it, and I told him to find out what had happened to these copies. Well, we found all six of them laying around the Dean's Office. I'm afraid this is what happened to this manual in most places. Well, this faculty member picked a copy up, and I know that if he has any­ thing to say about it, and I think he'll have a lot to say, why, eventu­ ally he's going to build this self-examination into the program here. I think that from here on the major impact of what Dr. Sanazaro has done will be what happens medical school by medical school with just a natural coming together of schools as they develop on their own initia- 489 tive how they function. Now the AAMC has set up a Council of Academic Societies, and I know that the staff hopes that the Council of Academic Societies will begin to represent the faculty in the work of the association. Here will be a meet­ ing place, a forum in which curricular problems will be discussed by fac­ ulty. Now, I'm very skeptical that this is what's going to happen for the simple reason that the Council of Academic Societies represents people who, in turn, represent an organized, vested interest as a specialty group. The Association of Teachers of Psychiatry will designate two or three individ­ uals to come into this Council of Academic Societies and represent psychia­ try. By the same token the anatomists will have a representative in the Council. Well, there must be thirty different organizations now of teach­ ers. These are organizations set up for specialties, each with a repre­ sentative in this Council, and I think these people are going to think and act as vested interests, their own specialties, their own disciplines, rather than the vested interest in a good education. [At the time he edited this memoir in April 1970, Dr. Darley stated, "I think I was wrong".] I made no bones about making my views known about this Council of Academic Societies development. I got a letter in the pile there that I will dig out and give you that reflects this concern. I just cannot believe that this will work. These people are going to think and act like doctors. They are not going to think and act like faculty unless the whole statement of purpose changes, or unless these people are in a posi- tion to forget that they represent a specialized field of practice. It's going to be like a meeting of the curriculum committee of a medical school where everybody is thinking about getting more hours for their department, and trying to get something in the interest of their department instead of in the interest of good teaching. They can try to make the case by 490 saying this helps teaching for this and this reason, but the faculties of the medical schools are by and large serving their purposes, not the purposes of the school. These are fighting words, but I think they're true. This is one of the evils of specialties in the national outlook. We've got to try to find some way of breaking its back, and I come back to things like this four state consortium of medical schools, a setup which will not be set up to be controlled by specialized faculties. fguestion here is indistinct, but in substance how the AAMC's teaching institutes fitted into the picture as Dr. Darley was describing it.] These were good forums at which these teaching problems were dis­ cussed, and they were discussed intelligently because the discussion was based on data, factual information. The theory was that each school had just one representative attending these institutes, and the theory was that this one representative would be so stimulated that he would get back to his school, and he'd organize things, hold a little institute within the school. Well, it never worked that way as far as I know. Some of them would give reports at faculty meetings, but by and large these institute reports which we usually issued a year after they were held, and sometimes as long as two years after they were held--they just went up on the book shelveso Every individual member would get a copy because i t was pub­ lished as a supplement to the Journal of Medical Education, and each medi­ cal school gets about twenty-five free copies of the journal, and that means that when there is a supplement, they get twenty-five free copies of it. The dean has a list of faculty to whom these copies are sent, and 491 these are usually departmental heads. As far as I've been able to observe there just has been no overall impact. Of course there have been islands of innovation here and there, where I think these reports have had some influence. As I said before, there is beginning to be a pretty well recognized movement in the medical schools toward innovation. Most of the innovation is in the direction of bringing some appreciation of health problems as they exist in commun­ ities, medical problems, and the educational importance of improving the delivery of medical patient care services. It's still pretty minor. It's being done in such a way as to underscore the departmental structure of the medical schools. Some of the schools are handling this through their department of preventive medicine, or they're calling their department of preventive medicine community medicine, but these departments of com­ munity medicine are not given any practical frame of reference within which they can develop an educational program, actively and responsibly allowing students to experience the kind of service they're going to have to establish--this is going to be off campus--in the little surrounding community hospitals. This is probably going to be a good way to do it. In other words, they're going to have to take the education out to where the patients are instead of taking the patients where the faculty is, and it will take a lot of doing to make this good education. [Question here is indistinct, but in substance the question was related to the changing character of the Journal of Medical Education as a con­ duit for new ideas.] Yes, there's been a tremendous improvement in the journal, and yet I'll sit and talk to a dean or a faculty person, and more often than not 492 it will be here in this faculty. A person will come in and will want to talk about an idea, and I'll mention that this idea was touched on and that there is a reference to this issue of the journal which isn't very old, and the guy sitting where you are begins to get a faraway look in his eyes. This journal isn't being read by teachers, and it ought to be--I'm convinced of it. Now some of these articles reflect research in education. They are couched in language and concepts, that are difficult for the average faculty member to understand. One of the good things that came out of Sanazaro's work was this annual conference on research in medical education. Now, a special issue of the journal is given over to the presentation of those papers, and each issue of this journal--no, somewhere along the line there's an issue of the journal in which there is published all of the abstracts of all of the papers and articles on the subject that have appeared that year. This means that there is such a wealth of research data beginning to come into the field of medical education that it would be worthwhile for a faculty like this one to have a person who doesn't do anything else but keep up with the literature, abstracts of the literature, and use this at faculty meetings, or at least meetings within the faculty. This kind of communication is beginning. The deans, the institu­ tional membership, have finally organized themselves into regions, and considering the agendas that come out for their meetings, they are begin­ ning to talk about the kind of things in small enough groups that we've been discussing, and they are bringing faculty people and other adminis­ trative people with them to these meetings, and the situation is such that a dean can't sit there and not say anything. In this smaller con­ frontation a man has to speak up, and this is beginning to make meetings 493 of deans, business meetings for deans, more frequent. They are having about four of these a year now instead of just one or two, and this can't help but do good. Something should happen to do away with the short terms--the average short term of a dean. The average short term is about three and a half to four years. This is no good for medical education. A fellow is in the deanship just long enough to find out what a hell of a job it is and quit. "Let somebody else do it." It is a hell of a job. That's why Miss Littlemeyer's program can be important--the AAMC really getting the right kind of adult education program going for those people who are going to be assistant and associ­ ate deans. Maybe this kind of program can develop a pool of leaders which will be available for overall medical school use. The most important single pool now is the outgrowth of the scholar program of the Markle Foundation. This is one of the greatest things that has ever happened to medical education. It's been going on now about forty years, and the Markle Foundation makes about thirty scholar awards each year. Up to a period of five years an award helps to support a care­ fully selected person who is committed, who has completed his formal edu­ cation necessary to a lifetime of teaching, or administration in the field of medical education, or in medical research. These people have formed the Markle Scholars Association. They meet in certain years. Most of them are outstanding people in medical education now, or a good percentage of them in medical education are out of this Markle Scholar group. These people are still being selected. This Group on Student Affairs has developed into an organization within which many of our leaders have gotten their start. The Teaching 494 Hospital Section is getting to the point where they can identify people who are active and able in its field. Hospital Administration needs to come into this field of medical education. This Council of Academic Societies--maybe some good people can come out of that. Now I'm assured by Dr. Robert Berson and Dr. Cheves Smythe that my fears about this Council of Academic Societies are ill-founded, but, as I told you, I have fears about the way it will function. They don't share my fears. They say it won't happen, but I've got to be shown. [Question here is indistinct, but in substance the question was how AAMC responds to its constituents] Requests for help come in from individual schools and/or indivi­ duals--it's immaterial. Requests from either source greatly interfered with homework--that is, homework like Gus Carroll's. Gus, Dr. 5anazaro, and Dr. Hutchins--they've gone miles out of their way to respond to these requests. One thing I want to look into right away when I get to Gus Carroll's files--each year he has been asked to submit a list, a short memorandum, regarding each consultation contact which has involved very much of his time and energy, and sometimes this has occurred at the schools, and sometimes it has occurred at his office, a visiting dean, or a faculty member, and sometimes it has occasioned some correspondence. Gus was a great one to carry on correspondence with the idea of helping someone, and in his files I'll find hundreds of pages of this kind of correspondence. This summary from Gus--this has always been part of the annual report to the Kellogg Foundation. I know that a year ago he sent me a copy, and he'd had a significant contact with over fifty medical schools in that one year. 495 Now Sanazaro didn't keep a record of his consultancies, or a sum­ mary of them, but people were always asking him for help--you know, "Come to a meeting," and he's been available and he's made himself available-­ he's been out here twice on curriculum matters, and some of the curricu­ lum committee members have told me that his visits at these meetings have always been stimulating. Well, if there is any impact here as the result of his two visits, or any visibility, it's just barely beginning to sur­ face. One of our faculty people here, Dr. Raymond Helfer, is now getting his master's degree at Illinois in George E. Miller's course in research in medical education. He is to come back and head an Office of Resources in Health Science Education. I think this is going to help the situation here and make for some changes around here. Administratively the Office will combine three Departments: Unit Teaching Laboratories, Audio-Visual Education in the Health Sciences, and Research in Health Science Educa­ tion, and when this gets into full swing, why I think things will begin to really move. The announcement has just been made of this administra­ tive change, and Dr. William Cooper who is going to head this three­ headed division will be reporting to the Vice President in charge of Medical Affairs and not to the Dean of the Medical School, so this whole operation, therefore, will be medical center wide, instead of just med­ ical school, and that helps. Here's this letter I've been saving for you that I wrote my concern about this Council of Faculties, and you'll hear more about that. IQuestion here is indistinct, but based on editorial 39 Journal of Medi­ cal Education 1049 (November, 1964) and, more particularly, as follows: " ... The twelve new medical schools under construction, or in the planning 496 - stage are a monument to his perseverance and determination. for the new schools was clear. The need Committee after committee had established ,:tlie point with facts and figures and predictions. But nothing much hap­ £,ened until Ward Darley took to the road and used his prestige and strength .i!J convince college presidents and civic leaders and legislators that ac­ tion, not another study was urgently needed •.•• " Now in the first place that statement is highly flattering, but on the other hand that's the way I used the time when I first went to the association. I was glad to leave all of the internal office administra- tion to Dr. Dean F. Smiley, the Secretary. I did take to the raod--just on my own. Give me that list. I had already been to New Mexico. I went to Connecticut, to Delaware, to Rhode Island--Brown. If I had any influ­ ence in Ohio, it was indirect. The same for California. South Dakota was indirect. Tennessee--! spent a lot of time down there. I went to Buffalo because that's where George E. Miller was, and he was teaching me--! wasn't teaching him. I went to Mississippi, and there were other places. I did use my prestige as an ex-university president, as a door opener, a device. I went on my own. I didn't make any reports to any- body. Finally this got so bad that the AMA Council objected to my doing this alone. They wanted me to start taking somebody from the AMA with me, so I said, "Fine!" I took Dr. Walter 5. Wiggins with me--a trip of a couple of weeks, and this time we included MIT and Rutgers. We went to Delaware, but I had already been to Delaware once, and I forget where else we went, but most of these developments would probably have taken place anyhow. I went to several places where there was no follow through. I had several presidents stop to see me in Evanston. I had a finger in most of these 497 developments. I went to see John A. Hannah at Michigan State long before anything really happened there. Most of these places I was there way ahead of any actual development. lquestion indistinct, but in substance, how did you come to go to Texas?] I didn't go to Texas. lQuestion here indistinct, but, in substance, what was the process, say, in Connecticut?] Connecticut--the old president. Well, I forget his name, [predeces­ sor to Homer D. Babbidge, Jr.], but I knew him. I would stop and see him at Storrs, and he'd ask me back. My getting in there, I think, had a lot to do with the timing of the start. They wanted me to come up and talk to a legislative committee--they called me out of a meeting in Chicago and wanted me to catch a plane immediately. Well, I didn't go, but they got along all right without me. Delaware--! worked real hard on that one, but I didn't get it started. The reason?--well, I did get them to run a feasibility study that showed that Delaware had about as high a percentage of their students of college age getting into medical schools as any place, and they didn't see the necessity of building a medical school. Brown started a very unique program, having students in the freshman year in liberal arts carrying through to a master's degree in what is called medical sciences, and they're finishing their first master's de- gree candidates this next June. I was up there many times. Barnaby C. Keeney, the president up there, and I became very close friends in the course of this development. I was anxious to see this tried. The accred- 498 iting people really shook their heads over that concept of a medical school under the direction of the Division of Biological Sciences-­ they've changed the name now to medical and biological sciences. There is nobody they call a dean up there. There is no identifiable, fulltime medical faculty. They are all integrated in the various departments of the university. They've never had separate schools. They've always had divisions, or departments of the university. There is just the one fac­ ulty. This has been a full faculty effort. Practically the total fac­ ulty has worked together on this, a very satisfying experien~e. We've tried to get the same thing started at Brandeis. The dean of the graduate school up there who worked on this--it finally failed to pass. He left because of this failure, but Brandeis will do it someday. We wanted MIT to do the same thing. MIT has the faculty right there right now. They could give this degree, a master's degree in medical sci­ ences, and they could do this within the framework of existing personnel, departments and curriculum, if they wanted to. Well, MIT and Harvard work so closely together that this MIT effort with this medical visibil­ ity would probably be Harvard's loss. [Question indistinct, but in substance, the question was what the pros­ pects were for those who were graduating from this new development at Brown] These people who have finished this master's degree are ready to go either their junior year of medical school, or on into graduate work for a Ph.D. Now, I thought that when they first instituted the program--it is a pretty highly structured program, and these are hard courses. Brown University is a tough school to get into. The free time at Brown goes 499 to research. You have to get into research. I've talked to a lot of these students. They think the program is terrific. The ones I have ll talked to up to two years ago said with few exceptions that they were going to go on into medical school some place. They were not going to take the Ph.D. route. I thought that with this research influence, the research influence would be such that most of them would want to go on to the Ph.D. What they finally do--now that they're beginning to gradu­ ate this first group--I will be interested to see. I expect Brown to come on and offer the second two years of medical school before very long. The medical commission up there wants it, and the general community wants it. It's a private institution. If they do, there's no need for them to construct a hospital. There are hospitals there in Rhode Island that with very little change could qualify as a teaching hospital in a medical school--Rhode Island General Hospital is one now, has been for years. The other big hospitals in Providence-­ they want in on it too. I went up there a couple of years ago and met along with the hospitals urging them to set up what would amount to a school of graduate medicine where they would all join together in one educational program for interns and residents that would be evaluating the effectiveness of this institutional experience. I don't know whether anything's come of this, or not, but Glidden L. Brooks who is sort of the natural man behind the scenes in this medical school development-­ well, he's gone down to Toledo, Ohio. He's gone down there to start a new medical school. When Barnaby C. Keeney who is president at Brown retires, he will be replaced by Dr. Ray Heffner, of Indiana University. On the basis of his experience in Indiana I expect that he will not be opposed to developing the last two years of medical school at Brown. 500 I have been turning down these consultation requests that I receive. I just come out of one of these three, or four day sessions just beat. This kind of an effort is too exhausting. lQuestion indistinct, but in substance, the question was whether original contacts with schools related to prior knowledge of developments, or shooting blind.] Most of them were going in where, as far as I knew, really there wasn't any demonstrated interest. I may have heard rumors. I know I heard some rumors at Connecticut, or I may have met someone who said that they were interested in starting a school and would I plan to come up there. Delaware--! just picked that place cold. I just thought I'd go out there, and I was invited back a second time. Texas--you asked me if I went down there, and I said, "No." Well, the first new development in Texas will be at San Antonio. Here's the University of Texas at Austin--forty miles away, and I wanted any new medical school in Texas to go on the campus of the University. People at San Antonio wanted this free standing medical school made a part of the university system instead. Well, San Antonio politically is stronger than Austin, and they've made great progress. When I was on the Board of Visitors for the Air University, of course, the Air Force School of Medicine was at San Antonio. I'd go down there, and the Commanding Gen- eral would have a dinner for me and whoever else was with me. Twice somebody next to me, an official of the medical school at San Antonio, wculd tell me that the Air University wanted the medical school in San Antonio with the idea there would be a tie-in with the Air Force and the 501 Medical School. They got pretty sore at me down there because they knew I was opposed to a medical school being tied in with the Air University. I never was invited to Texas. [_g_uestion here indistinct] Well, Idaho, Arizona and New Mexico--well, Arizona and New Mexico were both medical school developments and I was in on those very early, talked with the people in New Mexico, the Board of Regents, years before it actually got started. f~uestion here indistinct, but in substance, the question was how success­ ful were you in getting existing schools to increase enrollments?] I didn't get any of these schools anyplace to increase enrollment. Now they said, "If you will find the money to support increased enroll­ ments, we'll be interested." Of course, they all got together in the effort to get money out of Congress. They really supported that movement. The increase in enroll­ ment was the main argument. There was this general idea that you can't have more than a hundred in a class and have a good educational program. Originally I'm afraid I probably went along with that general idea-­ really, it was in my work with the AAMC that I got initiated; that the schools with large enrollments like Illinois--those graduates stood up as well as the graduates from Harvard, or the University of Chicago. Actu­ ally getting these people from schools with the large enrollments out into practice after they've had an internship and residency--you don't see much difference in their capacities. They're going to compensate for not having had a real exciting period of medical education. I think this 502 is because of the kind of people who study medicine. They are going to compete. They are going to be concerned with quality service as well as in terms of size of practice and annual income. Now then, Paul Sanazaro picked the ball up and really made a study of this. He got all the relevant data together and then published it. It took him a year almost, and this publication is now a very important point of reference in the literature when it comes to shooting down ideas associated with the size of a medical school. (~uestion indistinct, but in substance, the question was relevant to the place of research empires in directing and shaping medical schools.] The research empires--the bigger the name the bigger the empire. Look at your research projects in a place like Columbia which does a tre­ mendous business in research, a school with the highest expenditure, total expenditure almost always, and in spite of having two-thirds of its expen­ ditures mainly in research, still adds five and six million dollars that it might have for other purposes. I don't get as excited about that as I do about a school that has a four million dollar total expenditure and claims that it is doing three million dollars in research. What is left isn't enough. Here's this educational self-study that Dr. Sanazaro developed. That's the workbook. I've forgotten about the University of Georgia. You know one interesting thing to me in this self-study idea is that the whole thing started with the tax supported institutions. There was Kan­ sas, Maryland, Georgia, Ohio, and I think South Carolina before Tulane came in. You would think that this would start with private schools. Tulane was the first private institution. 503 Most innovations have started in the non-tax supported medical schools. As I look innovations over now--RMP, this general physician development, and all that, most of this--well, the early development was more in publicly supported schools than in private. Now, in a big way-­ here comes Harvard, Yale and Johns Hopkins. They can get the money that the public schools couldn't get. The Commonwealth Fund has made big grants to each of them for the development of educational programs in the general area of patient care, to develop community centered, plus medical school related services in education. This is great. Funny that it has come so late. I think this educational self-study is probably the most important single way for a medical faculty to begin to act like a faculty instead of like a bunch of individualists. [Question here indistinct, but was related to continuing education.] This is still another--of course, on this issue I think I have be­ come more angry than I have over anything. You saw the paper about the National Academy of Continuing Education [ 11 A Proposal for a National Acad­ emy of Continuing Medical Education" 36 Journal of Medical Education 33- 37 (January, 1961 )]--that article came out as part of a package deal in that issue of the Journal, the first article of which was by this Charles D. May of Cornell, a pediatrician. ["Selling Drugs by 'Educating' Physi­ cians" Ibid 1-23] He was attacking the advertising of the pharmaceutical companies showing how asinine it was to have the same drug represented by a half a dozen different names and the problems that this created in a medical school where you had to teach a medical student four, or five names for one drug. He also showed in his article how misleading the 504 advertising was, and he gave example after example. This was a very well documented article. We accepted it for publication knowing full well that this would make the drug houses very unhappy. Now there was reason for not making the drug houses unhappy. I'd come to know E. Gifford Upjohn up in Kalamazoo, George R. Cain of Abbott, and Mr. John D. Searle of Searle Manufacturing Company. One year with the association Searle asked me if I thought there would be any chance of the pharmaceutical houses subscribing to what I wanted to call sus­ taining memberships, or contributing memberships. Sustaining memberships would be a thousand dollars; contributing memberships would be five hun­ dred dollars, or less. E. Gifford Upjohn, Mr. J. D. Searle, and Mr. George Cain got together and went after every single drug house, and all of a sudden, almost overnight, here was fifty or sixty thousand dollars. We were having meetings with the representatives of the pharmaceuti­ cal houses because we objected to the way in which they were subsidizing postgraduate courses in medical schools, the way they were approaching medical students, giving them free this and free that to gain their atten­ tion, and we wanted all this to stop. We ultimately referred them to the code of ethics, and for some reason they did stop, but it's started again now. With the May's article accepted, I thought, "Well, we'd better let Mr. Searle see this May's article ahead of time. This will give the phar­ maceutical manufacturers a chance to get some space in the journal. [Jo~n D. Searle, L. D. Barney, Francis Boyer, George R. Cain, Lyman C. Duncan, Robert A. Hardt, D. Mead Johnson, and E. Gifford Upjohn "The Pharmaceu­ tical Industry" Ibid 24-32] Then Dr. Cain who was with us a short time-­ we got him to do a rough draft on this National Academy idea, and we 505 thought that here would be a good packet of three articles. Then out of the proposal of Cain and myself in this article there came this development. The AMA picked the idea up, appointed a committee, got its budget started with sixteen thousand dollars given to it right away. So I got the AAMC to put up sixteen thousand. The AMA didn't like this. They wanted all the participating agencies to turn their money over to the AMA, and the AMA would dole this out. This would clearly make this an AMA controlled operation. The AMA worked out a contract, an agreement with Dr. Bernard V. Dryer so I used the same letter to an­ nounce to the AMA that we were willing to put our money in, and actually put money into this enterprise three months before any money came from the AMA which let Dryer get started. Dryer wouldn't have waited any three months for the AMA to make actual payment. Then these other agencies fol­ lowed the position of the Academy of General Practice. They were all willing to give their money to the AMA. All credit to the AMA they put in as chairman of this steering com­ mittee Sam Newman, a man who had been intimately involved in all of this hassle over the Colorado medical school--well, when I heard who they had appointed to head this committee I thought it was horrible. Well, you know, this guy was one hundred percent perfect. This committee just clicked like that. There was never any hassle involving territoriality. There was never any hesitancy to approve anything that Dr. Dryer wanted to do. There was no difficulty whatsoever. When that report was completed and tendered at a joint meeting at­ tended by representatives of all the sponsoring agencies the enthusiasm was tremendous--"Oh, let's get going! Let's get going!" That was the spirit. Somebody then made a motion that the report 506 be accepted and in accordance with the enthusiasm that the AMA be asked to provide the leadership necessary for the establishment of a national academy in continuing medical education. Also things were so set up that the steering committee could make a report to the AMA Board of Trustees with recommendations for the steps to be taken for the establishment of this national academy. Well, I wasn't invited to this meeting. All I know is that at the meeting Dr. Dryer was there. A question was asked, and when he started to answer it, he got shut off. He's quite verbose, and it takes him a little while to answer questions, as far as I know, but he usually comes out with the answers. The recommendations that this steering committee made were never made, and nothing has happened at the AMA about this, so our annual meeting out in Baltimore--and I was in a wheel chair. In the meantime the Public Health Service had brought in--his name escapes me, but the husband of the woman in the Food and Drug Administra­ tion who got on to the tranquilizer given to pregnant women that produced deformed children--well, anyhow, he'd been employed by the Public Health Service to move in on this developing area of communications, programed instruction--the works. The Public Health Service called a workshop to which about fifty carefully selected people were to be invited where this business of communications development could be considered in detail with the view of pointing out areas where government might work on this and where private enterprise, the parts where private enterprise might play a role. The AMA hadn't done anything, and of course questions were going to be asked, "What about your National Academy?" I left the AAMC meeting in Baltimore, flew to Washington and got hold of Hugh H. Hussey, then Dean of Georgetown University School of Medi- 507 cine who was chairman of the AMA Board of Trustees, and I pleaded with him, "At least allow the AMA representatives that would be attending this public Health sponsored meeting to say the AMA is going to do something." He called Dr. F. J. L. Blasingame, and they set up a special meeting of the scientific committee of the Board of Trustees. I attended this meeting, and we discussed this whole thing. This committee adopted the report that they would get on the ball, that they would get the AMA Board of Trustees on the ball. The AMA representatives at this Public Health Service sponsored meeting announced that the AMA was going to move in this area, but still nothing happened. I have a file on this. Finally after about three years--four years after the publication of that paper; two years after the Dryer Report--the AMA announced that it was going to start a program in a very exploratory fashion, a very low gauge program. Out of this came the appointment of Patrick E. Storey who came on full time to develop this program. The AMA put him at the Uni­ versity of Utah where he developed this study that was supposed to involve the doctors in Utah in such a way that the content of a program in contin­ uing education would be identified. One of my people, Frank Whiting, who had been with us a long time, went to the AMA to develop the questionnaire, "The Physician Inventory". It's a good one, and this has been released to the doctors. Very shortly after it had been released the whole enter­ prise was called off without any explanation whatsoever, except what was put out in an AMA editorial. Well, after boring away on the development of this program, Pat Storey went ahead and prepared a report on his study--as far as it went. I thought that the AMA would suppress his report, but he has finally gotten 508 the AMA to publish this. It should be out before very long. I have a copy of it in manuscript--right there. We have referred to this report in the Somers-Darley papers. Here is a good instrument which can be used by doctors in connection with identifying the gaps in their knowledge which could be filled by competent and effective teaching, but there's still no National Academy of Continuing Education. Dr. James G. Miller, a psychiatrist at the University of Michigan, talked about problems of communication. [Telephone interruption] I want to get the rest of this off my chest. This Dr. Miller is a communications expert in psychiatry, and he's also thoroughly familiar with all the hardware that has been developed and the new hardware that can be used in communications. He knows the place of each of these pieces of hardware and is familiar with the impor­ tance of the right kind of programs to be used with this hardware. He gave a tremendous talk down in Florida--the first institute was on admin­ istration. I'd never even met the ITBn before. He was head of the re­ search institute at Ann Arbor that was concerned with all of this commun­ ications business. He kept hammering away at me to get something going through the AAMC to sponsor this national academy. I just knew there was no use to go into the council to get any AAMC money because I'd talked enough about this to know that this was one thing the council wasn't in­ terested in--this national academy. Such a national center might vie in leadership with the AAMC in a national effort. Miller kept at me until finally--! wasn't feeling at all well--I agreed that I would call together those deans that I knew were interested, so we got together about eight deans--William N. Hubbard of Michigan, Thomas H. Hunter of Virginia, and others. We decided that three individ- 509 uals would form a corporation. We decided to call the corporation the Interuniversity Communications Council, the whole idea being that back when the idea of the National Academy of Continuing Education was started, it would have been better, instead of bringing together professional or­ ganizations of doctors, to pitch this idea to the universities in the interest of all areas of continuing education, particularly for all the professions--if we cut across all of the professions, maybe we could get something started. We went to the Kellogg Foundation--Bill Hubbard, Jim Miller and my­ self--and we met for a day with the staff at Kellogg. You've seen the letters that preceded this. When we finished we were asking for seventy­ five thousand dollars a year for five years, but Emory W. Morris--this idea to him was very exciting, ahd he indicated, "The only trouble with your proposal is that you're not asking for enough money." When the grant was made, it was for one hundred and fifty thousand dollars a year instead of the seventy-five thousand. This was their doing--not ours. This development has just gradually gone along now. Medical education is the one thing that we really haven't gotten to yet-­ there are so many other big problems, and Mr. Jordan Baruch who is iden­ tified more with MIT than any other group, has just been made president. He's gone through a series, a combination of programs, techniques and ob­ jectives--a lot of our efforts have been wasted. This development has now reached the point where I hope I can get off the Board of Directors. It's very time consuming. Still the AMA hasn't done anything. Now there is a corporation starting up called Media Medica that has gotten capitalized with about four million dollars--they're going to sell 510 stock. They're getting a board of directors made up of the most compe­ tent people in the cGuntry. Bernard Dryer is on their board. Dr. Hubbard and the President of the National Board of Medical Examiners, John Perry Hubbard, are very close, and this agency, Media Medica, is going to do all of the things that Dr. Dryer recommended in his report--sell educa­ tional services. They're going to develop curricula just exactly the same way Dr. Dryer recommended with teaching materials to help supple­ ment this curriculum. They're going to develop programs in computerized instruction--the whole ball of wax. I think this Media Medica will go. Media Medica absorbed a company known as Basic Systems that sold programmed instruction--tailormade pro­ grams for the Academy of General Practice. The Academy bought a lot of their programs. It's going to be a high level operation. The other agency that is going to get into this communications edu­ cation area, of course, is the National Library of Medicine. I've talked to Martin M. Cummings, and if the Library of Medicine can get the money and go ahead with the development of his dream, the National Library of Medicine will be in the picture too. Now then this development in the four states--you see, is tied to this whole concept, the concept that we're talking about--these new devel­ opments in communication, the possibilities inherent in the network idea of programmed instruction coming out of a center. A shortwave network for these four states in this setup can serve many purposes in these four states other than medical education. If they put a satellite up there, it will answer the problems of communication in these mountain states. :I .L.L (g_uestion here is indistinct, but the question related to a role here fgr the regional medical program.] Except as the medical schools individually are- joining together and pooling their efforts--the regional medical program has been a tremendous stimulus. It has created a climate for communication, provided the schools are going to be a part of it. The AAMC is in favor of the regional medi­ cal program. As far as any--well, maybe I'm doing somebody an injustice, but if there has been any original impetus, or any original contribution from the AAMC to this regional medical program, except that which has in- advertently come out of the teaching institutes, and Paul Sanazaro's pro­ gram, I fail to see it. Now part of this failure is my fault. I was in a position of impact there. I was counting on this AMA thing--it just seemed so reasonable, that the National Academy of Continuing Education would be the thing the AMA would pick up that would justify its existence for all time. The AMA bragged about this center for continuing education in the committee hear­ ings when the AMA was opposing the regional medical program. They said, "There's no need for the regional medical program if you're going to use continuing education as a justification for it. The AMA is already doing this." Well, here's a full page of testimony building up this national pro­ gram the AMA was operating. Three months later they shut the whole thing off. I've got a lot of editorials to write here if I wanted to take the time to buckle down and do them. fguestion here indistinct, but, in substance, the question was why the 512 _§[lut down?] The only reason I think they shut this program off--I can't prove this. The reason I think they shut off this program in Utah was because there were objections to having anything happen that would indicate that there were gaps as far as the quality of basic care and the knowledge necessary to good patient care is concerned. That's the only reason that I can think of. Now I know that doctors have objected to being looked at from this standpoint. In my John C. Leonard paper I decided that if the dcctors weren't going to do this, it will have to be done community hospital by community hospital, and this is happening, and chiefly because of the work being done by this outfit, Professional Ad~inistration Service. Charles Wesley Eisele, our director of postgraduate education here at Colorado is the fellow who started this whole business. Years ago when he was at the University of Michigan, he got a Kellogg grant which enabled him to go out and work for two or three hospitals where the hospi­ tal staffs were willing. He began to develop the questionnaires, and all that wound up being this internal audit. This has just gradually grown and grown. Then the computer came along so that this audit could become more and more detailed and more and more flexible and put to more and more usage--you see. He's still on the board of directors of this outfit, and he came out here with the idea that he'd do the same thing in a few hospi- tals. I said, "Wes, you' re nuts! None of these hospital staffs are go- ing to let you do it." Well, I underestimated him. He's a kind of a guy with a personality-- well, before I knew it he had a little grant from Kellogg, and he'd got­ ten a couple of hospitals here to work with him on this. Now then, continuing education is getting underway. The American 513 College of Physicians has this self-audit. I paid my ten bucks so that I could get the sets of examinations. I didn't try to fill any of it in because I might have answered five percent of the questions. I've been away from things for so long, but I wanted to know the sort of approach the American College of Physicians has developed, and it's good. The doc­ tors that get these results back--nobody knows about these results but themselves. Out of this material I know that there will be some publica­ tion which will indicate how the total group did. Here's another step in the mechanism of self-evaluation, and I think all of this will grow. Wes Eisele is going to do more than any other single thing to bring all of this down to the grass roots level. If EDUCOM get into it, it's going to be to sponsor research that will answer the question as to how adults learn, particularly professional adults who are completely boxed in as far as having any spare time, or energy is concerned. How these people are going to be brought into a self-education situation that really is significant and how self-evalua­ tion is going to be built into the program so that these professional peo­ ple will stay on the ball as long as they're in practice--this is the kind of thing that is needed. It is moving. But, gee whiz, i f the AMA had moved along rapidly! I know I could have raised all kinds of money to start an Academy. If this could have started way back then, we would have worked out methods of education and all that needs to go with it, methods of identifying content, and the effectiveness of medicine as far as continuing education is concerned would be years ahead of where it is now. That's the way I feel about it. 514 J. - What I don't quite understand--and I've got it down here--is the rela- _:tionship with the well organized vested interests like the AMA. If it ~re possible to create an Academy and get sponsorship and support for ~kind of continuing development, I don't understand why that wasn't seized upon rather than trying to work with and through the vested in- terests. I just didn't think hard enough about it. I think the only alterna­ tive that would have been a good one--instead of working with the vested interests would have been to go immediately to the university world. That's the implication in the Coggeshall Report. Yes. I'm sure that this could have been sold to the university world in the same way that EDUCOM started. My idea to get this national academy started was to forget the AMA and everybody else--just a group of individ­ uals set up a corporation that could legally receive grants and make con­ tracts, et cetera, et cetera. Maybe I should have done it, but I didn't. I could have quit the AAMC way back there and just started this thing on the same basis this private corporation, Media Medica, is starting now and made it go. It would not have been a stock selling scheme and a for profit operation. See, here's where you're getting into where it's evident that in my own development I was reaching the point of very crippling frustrations in part because I had bitten off more than I could chew, and I don't mean to make this sound pathetic, but in part because I was sick. I was in a wheel chair through a lot of this, and my wife wanted me to quit and get the heck out of it way back. The people at Mayo's told me to quit. I'm 515 glad I didn't quit, even though I did do a lot of funbling around for awhile. Was there a tug of war between the staff established in Chicago and the leadership in terms of •••• No. Not while I was there. Between the executive and the council? You use the word "rubber stamp." Did the stamp become more powerful that •••• The council the last couple of years became more and more conscious of the need for it to dig into things a little more deeply. Take the development of the Division of International Medical Education, for exam­ ple. I was reaching the point where I had to work a lot harder with the council to get things approved for Dr. Hyde. Hyde was a big operator. The council was beginning to dig into things a little more deeply. I was beginning to think that the AAMC would get behind something like the Coggeshall Report. I'd made efforts before to get the council to foster a move to take a hard look at the association and particularly in the whole field of medical education in general, but there wasn't any open warfare, or any difficulty. The minutes--! knew ahead of time how every member on the council would feel, and I would deliberately move along, taking this into consideration. Sometimes with the staff, Henry van Zile Hyde and Paul Sanazaro particularly, on the way to a council meeting, I would go over the agenda with them, and I'd say, "Here's where I expect there might be some difficulty. I don't want you two fellows to sit there like bumps on a log. If you can think of something to say in support of this, I want you to speak up." 516 They were familiar with their particular field and could verbalize as a consequence much better than I. The main reason I anticipated some difficulties was because the budget was getting bigger every year, and we were skating on thinner ice all the time financially. I had a hard time raising enough money to keep me in business that final year without having to start cutting back. The Avalon Foundation gave me an extra fifty thousand dollars just so at least I wouldn't be confronted with the problem of cutting back program. I knew the honeymoon was about over as far as foundation support was concerned, and that was another reason for the Coggeshall study--see, to give something some visibility that would bring foundation interest back into the picture. If the council had lost no time in getting into this Coggeshall Report business with the idea of following the recommendations, foundation support would have been available all over the lot. Again there would have been another honeymoon. They weren't unaware of this. Oh, no. They just didn't like the implications of the report. The Commonwealth Fund, of course, picked up the tab to finance the Coggeshall Report. I had no trouble getting that, and Commonwealth gave me an extra twenty-five thousand to keep that last year going too. The hand writing was up there on the wall. Yes. Now, Carnegie had told me that medical education really wasn't Car­ negie's forte, that they would not renew that grant. They got as much 517 mileage out of that grant, dollar for dollar, as any other grant they ever made though, I think. I think time will show that, because it just brought Sanazaro into the picture. We'd better be--what time is it? We must get downstairs. I'm get­ ting tired and so are you. 518 n.iesday, April 16, 1968, 7002 University of Colorado Medical Center. lJiis morning I would like you to take a look at developments in the hos­ £._itals, particularly with respect to auxiliary and related medical per­ sonnel and to speculate on the need for the development of training pro­ _g_rams with respect to patient care. You've asked an awful big question. Now first--except as I have been involved with the education of aux­ iliary medical personnel right here, I have been out of the main stream of this development. The American Medical Association has complete con­ trol of accreditation programs for technicians, and this means the medi­ cal technicians--these girls who become X-ray technicians, the physiother­ apists, the occupational therapists, dietitians--well-recognized techni­ cal areas, all of which could involve a bachelor of science degree and all do not involve such. The AMA is in a position to handle this accred­ itation because a good percentage of these programs--well, they have these training programs in hospitals, and the hospitals are not related to uni­ versity medical schools, so the AMA accredits the whole ball of wax. Now then, at Colorado here, the education of this group--leaving the nurses out of it--has been a combination of a bachelor of science kind of program and a certificate kind of program. Medical technology has been a bachelor of science program here, and it's the College of Liberal Arts that gives the degree, not the School of Medicine. X-ray technology here is a certificate program under the complete control of the Department of Radiology. I don't know what the prerequisites are to enter this program, and I don't know how long this program in X-ray technology is--probably two years. In the case of medical technology--to come back to it--you 519 go to Boulder for three academic years. Then you come down here for a full calendar year, and then you get your degree. Occupational therapy here is worked out with the Land Grant Univer­ sity at Fort Collins, Colorado State University, and most of the occu­ pational therapy, at least as far as the collegiate work is concerned, is the primary responsibility of these land grant schools. The people in occupational therapy come down here from Fort Collins for a full calen­ dar year of work, and then Fort Collins gives them a degree. I think the same is true of dietitians--they come from a land grant college for a full calendar year, and then the university they come from gives them their degree. Physiotherapy here is a bachelor of science program, that has its home base in the College of Liberal Arts. I forget whether it's a one, or a two year program here, but the College of Liberal Arts gives the de­ gree. Now, there's a new area of inhalation therapy. This is formally recognized now as a new technical area, and none of these are degree pro­ grams. They are all certificate programs. These are the people who have learned to work in these cardiac pulmonary centers where oxygen has to be kept under positive pressure. For chronic emphysema, for example, these people are taught to carry these little oxygen kits with them and give themselves the oxygen under pressure. Sometimes various kinds of medications are put in, mixed with the oxygen--drugs that tend to assist the air in getting in and.out of the lungs. Now this technical school situation isn't going to change. This is all set. It's working very well, and so far about twenty or twenty-five percent of the places available in these technical schools are not filled. While they are establishing new schools all the time, there are still a 520 great many vacancies. This is like nursing in that most of these students are women. They get married, and their period of professional practice and service is cut short. Now a lot of them, like nurses, go out and have a family, and then they come back to work part time. There's a big reservoir of these people that come into the manpower pool. Of course they can be or­ ganized, and they have been organizedo The pay is attractive--they have really been underpaid, but the situation is improving, just as it is with nurses and just as it is with custodial and clerical help. Organized help in hospitals over the years have improved their positions. It is this effort on the part of organized help that is going to ac­ count for the skyrocketing of hospital costs. We haven't received yet the full impact of this effort. I heard Anne Somers say that the day isn't far away when the average cost--we don't say the average charge, but the average cost of hospitalization is going to be a hundred dollars a day. I think she's right. It's going to force our medical care es­ tablishment to go back to taking care of patients in their homes and do­ ing a better job of ambulatory care. It's going to force doctors to quit putting the patients in the hospital for evaluation and do this under am­ bulatory conditions. Motels will spring up around hospitals where the ambulatory patients can go, though I must say that the structure and func­ tion of society isn't ready to think seriously about any of this, to start the ball rolling here, and to give it directiono The idea of people, patients, when they leave the hospital remaining on the hospital census and having the hospital personnel taking care of them at home--they've got to teach the relatives how to take care of them and still be responsible. This has all got to come yet. The Montefiore 521 Hospital has done enough to show that this is very practical, that it really saves money, and it really makes for better patient care when these patients are managed in their homes. You see, illness--people that are ill by and large now are out of luck because it's part of our pattern of behavior to reject these people. If somebody gets sick, the family doesn't want them--"Get out of here! Go to a hospital!" The chronically ill individual--the family doesn't want you. They would rather put you in a nursing home, particularly if you're old and senile. You're rejected. This is just an indication that we have a lot of internal problems that aren't strictly medical that have to do with medical care just the same. It just burns me up to hear doctors complain because welfare is moving in as a part of the responsibility in the pic­ ture of medical care. You can't separate these things. Rich people have welfare problems too just as poor people do. These have to be con­ sidered by the medical establishment. This is all a philosophy which the average doctor ignores--he doesn't want to stop and think about it. If he did, his attitude about this might be different. This is just another reason why I come back to this four state propo­ sition--community centered activity is going to be essential to the suc­ cess of the whole venture. This attitude on the part of doctors can be anticipated and plans made to deal with it right from the beginning. Now there's a lot of talk coming, and this starts with people like Phil Lee, Bill Stewart, and John Gardner in HEW. There's been a lot of loose talk about this medical system business just as if there's going to be nothing to training these people on the one hand and finding a place for them in the medical establishment on the other hand. We don't know how to use medical assistants--! mean the corpsman 522 type of person. The prototype here that I think will obtain is being built up by the universities. They like to take the corpsmen essentially because of the background they've had, but eventually they'll be taking anybody, a high school graduate, and give them a junior college two year program and some work that can be counted as credit toward a bachelor's degree. The primary thing in these two years would be to give these peo­ ple the kind of an educational experience that will permit them to be taken into a hospital without having been trained yet to do anything specific. It's because of the educational experience that they've had in this two year program that a junior college can develop very easily, that they are ready to be trained for specific tasks and be classified as medical assistants. For the most part these people will know that they're always going to be in the assistant category. They should be trained and used in such a way that they're never going to want to be licensed by the state and then be independent to practice. I think they will be very important members of the team, and they should be paid what they're worth. Here's one of these individuals who comes into this hospital, and an operating room can find all kinds of use for this kind of person, train them for six months for a limited and very specific task. They could be in the central supply room of a hospital, or in the pharmacy, or they could be trained to do specific things on the wards, particularly in a coronary care setup. They could be trained as research assistants. There's a tremendous opportunity for them in a given research setup where they could be trained how to take care of animals, how to assist in surgery involv­ ing animals. Nobody--in general, this is not the way the people who are promoting 523 the medical assistant idea think. These junior colleges have got the idea that these medical assistants have to be trained for a specific task. Now it may be that in the course of this junior college training they can go into hospitals and fill a job like being an orderly just to get ac­ climated to the kind of environment in which they're going to be trained, and they're ultimately going to work. Now many universities are moving ahead, appointing a dean of a school of paramedical sciences. The university is putting all of this activity-­ some of them in the School of Nursing under a dean that coordinates •••• (Telephone interruption] I think the setting up of these programs is good. Now, this isn't an innovation because a university in Pennsylvania, and this was a long time ago when I was on a committee for the old polio foundation that went over applications for grants that had to do with education. The founda­ tion made a grant to Temple University just about two or three years ago, and I don't know how it has gone. This Dr. Lee Powers is leaving the Association of American Medical Colleges and is setting up one of these schools. These schools I hope will establish relationships with colleges of liberal arts and junior colleges so that the medical center will not be developing programs that will represent unnecessary duplications. There needs to be a common understanding as ta what a medical system is and how people should be trained to man it. How do doctors look upon this idea? This is all very vague in their minds. They realize that medical systems have to come into the picture. I have had one experience I have­ n't told you about, but it's been a very exciting experience. There's 524 the Denver Clinic here in town. About half the doctors are my former students. The two principle doctors are both personal friends of mine-­ Dr. Frank B. McGlone and Dr. George Curfman, and shortly after I returned to Denver, why Dro McGlone came out, and he said, "We think we have the kind of a patient load and the kind of setup that will let us begin to do some research in the area of patient care." We talked along. They have a little research foundation that they set up. They put some of the earnings of their clinic into this. They got some money from private sources, and at first the money was used for-­ here's a patient, a mother that has to go to the hospital. They were us­ ing this money to hire some woman to come in and take care of the kids while the mother was in the hospital. They were using it for orthopedic appliances when the patient didn't have money for such an appliance. Then they developed a real good continuing education program of their own. There are about thirty-five of these fellows, and they meet for breakfast once a week. They have lunch together once a week, and they have dinner meetings once a month. They put in a little art department and a pretty good working library. They have a cook, a dining facility, and they have an awfully nice room that can be used for a round table dis­ cussion and meals. The room's got all the gadgets any classroom would have, and their continuing education largely centers around somebody pre­ senting a case, or a series of cases. Quite a few publications come out of this. These boys are really on their toes, and they give good care to their patients. Finally they got a little grant from the Colorado State Wel­ fare Department to study three hundred patients over sixty-five years of age, ambulatory patients, just to determine the perceptions that these 525 patients have of their own patient care. They wanted to know the degree of satisfaction, and they wanted to know whether there were any areas of dissatisfaction. They hired this Frank Whiting who used to be with me at Evanston and is now the director of research of the American Psychia­ tric Associationo It took quite awhile to work this questionnaire up. It's a real thick one. Whiting analyzed this business. A couple of weeks ago they called me up, and I went to a meeting, and here was the head of the State Health Department, the head of the State Welfare Department, the head of Blue Shield and Blue Cross, a man from the regional office of HEW--well, the people who should have been there were there. Dr. Whiting had worked this material up very carefully, and he made a terrific presentation. I told him ahead of time, "For goodness sakes, don't use jargon that the psychologists use, but use simple, short sentences in a language that anybody can understand." He did a very good job. The whole crew there were excited, and prob­ ably this group of three hundred patients--more is known about this group of patients than any other group of patients in history. The main thing that came out of this study was that these old people to a patient when they'd call in with something worrying them right then and there and ask for a doctor, they were perfectly willing to talk to a nurse, or a social worker, or one of the people who helped with research work who wasn't a medical person, but just a person who was learning on the job. These people were perfectly willing to come in and talk to a nurse, or a social worker, or anybody else that represents the physician with the understand­ ing that if in their estimation, after they have had a chat, the doctor should see the patient right away, arrangements will be made. This takes place with the understanding that this patient is going to report to the 526 doctor about this chat and an understanding that a note will be made on the chart so that whoever represents the physician will have to consider this. An appointment will be made with the doctor right there. Just the demonstration of this was the basic team concept of patient care. I don't think that the public will show anything but enthusiasm for participating in an experiment involving their being taken care of by the right kind of patient care team where the members of the team would each have an area of responsibility as far as patient care is concerned and providing for this patient and this team getting together often enough, doctors and others, and sharing their views. That means that these peo­ ple on the team are going to be trained to work together. If we're going to make this mean anything, it's going to mean medical schools, nurses, social workers. I would like to see a major in medical sociology in the liberal arts college come out and be trained to work under the supervision of a social worker so that there is somebody always available to get out and assay at least the patient's environmental situation so that if there's anything the doctor should know about in the environment, it will be known. What this means, of course, is that the rapport between the doctor and these other team people has to be such that they know they are ex­ pected to speak up. They are not just going to speak up when they're spoken to. They're going to understand that it's their responsibility to introduce their findings, or their opinion in the discussion of these patients. There's quite a holdover of the military organization in nurses. The nurse doesn't tell an attending man, "Doctor you ought to know this about this patient." 527 She keeps still until she's spoken to. She doesn't feel free to communicate with the doctor, and this is the biggest problem throughout the whole system of patient care. Certainly the biggest, single problem, I think, is the lack of communication, the lack of that environment that makes people feel free to communicate--doctor to doctor, patient to doc­ tor, doctor to nurse, relative to doctor, nurse to patient--name any re­ lationship as end points in the communication system you want, and they should be communicating. To me this condition ought to be easy to correct, if everybody would just forget their own importance and focus on the patient as a person. I've seen that here, and this is a wonderful hospital. There was this old duffer who came in here sick, and he had a history of a prostatic condition. The interns and residents wanted to X-ray his kidneys with kidney dye, or his gall bladder. They wanted an X-ray series. I told Dr. Gordon Meiklejohn, "Here's a fellow over eighty years of age. Why can't you just limit your diagnostic studies to those areas where it is really important to have this information? Let's use our judgment. Let's guess about it. It's quite obvious that we can't do too much. Let's aim at keeping him comfortable and taking care of him through this per- iod." He agreed. Hell--they gave him the castor oil and all the other stuff, extra studies--they just wore that old man to a frazzle. He was deaf, and they couldn't explain things to him. I sat and listened to an explanation. I was sitting there, and this medical fellow delivered a junior lecture to this deaf old man (William M. Darley--my uncle). Every once in awhile he would pause, and he would say to the old man, "Do you understand?" 528 What could the old man do, except smile and shake his head and say, When this guy got through, I said, "Now, doctor, this fellow is go­ ing back to the San Luis Valley. He will be in his home, taking care of himself. You tell me one, two, three what I should write down so I can give him a note that I write, so he'll know exactly what he is to do at nine o'clock in the morning, at noon, at three o'clock, and at bed time." He did. This was a very simple schedule. The old man didn't give a tinker's damn about all this other yack yack. This represents a chronic situation--the doctor wasted the patient's time as well as his own time. This is a great show at an effort at com­ munication, but it falls right on its face, and I see this going on every place. You see this, and then you see just the opposite where there is no effort made at any kind of communication. All that has to be learned; how to use interpersonal relationships in the evaluation and management of not only illness, but the evaluation and management of health. This is the general feeling behind so much of the stuff I've been reading and talking about. I've talked to a bunch of doctors at one of these meetings--if I don't watch out, they go to sleep on me. I haven't found out how to com­ municate with these deans yet. I don't think you're going to get any­ where unless you do like this Denver Clinic does where the doctors them­ selves are willing to permit and take part in studies of their whole oper­ ations. Then when they begin to talk about the significance and the re­ sults of this effort at self-study, then they are willing to begin to take corrective steps. They're not going to take corrective steps be­ cause somebody is preaching at them. I don't think. 529 [_9.!:!estion here is indistinct, but it compared the Denver Clinic study - with the AAMC study of the student.] The other big element in this, and I'm very sympathetic to the aver­ age doctor, the one who is giving general care like this boy Niel Chisholm who just called--the demands on these fellows' time and energy are just unbelievable. Some way has to be found to free these hands, so that they can be more deliberate about their time and effort. Here we come to the discussion of organization. Start building an organization in anything that involves person to person relationships, and what you have to do to reach your objectives before you get started--you can't conserve the doctor's time, or the nurse's time and get the most out of these people in terms of patient care unless something is done along the lines of organization to help them out. This means these patients have to be willing to enter into this organization. I'm not worried about the patients being willing to do what is necessary. That's the general understanding of the system that you're trying to develop. It is going to take some time to educate the population to make the best possible system of patient care, whatever system you're trying to develop. [Question here is indistinct, but in substance the question was whether community centered patient care perhaps may be a refinement for the cur- rent care that seems as impersonal as a state highway.] Ten years ago I would have held up my hands in horror at the idea of a preceptorship, or the use of the community hospital, the average community hospital as the place to assign medical students, and that's because of the attitude I had toward the average practitioner. I hate for this to go into the record, but it's a fact, and I'm no different 530 from the average medical school faculty person in this resentment at the man in practice. The attitude of the fulltime academician is well justi­ fied. I've heard about the LMD--the last medical doctor's long years of service many times, and it is not unusual, but I am appalled at the un­ favorable attitude of the man on the faculty toward the man in practice. This has got to change, and they're not going to change until the fulltime academic man gets out into the community enough so that he really sees what life is all about. These academic people are busy with their research, training residents, reproducing their own kind--they're busy doing this. Well, I think we're on the threshold of change, and once this com- munity centered patient care gets going I'm afraid we'll fall on our face because we don't have the horses--we don't have the people to handle the demands of the public for service the way they're going to demand it. They're not going to be able to live with the kind of service we've been talking about. Psychiatry--going way back--oversold itself terribly. Overnight al­ most Franklin G. Ebaugh stirred up a tremendous amount of concern over education in psychiatry--his survey of medical schools, or his survey of psychiatric education in medical schools in a Flexner-type report. I have forgotten the details of that survey. I don't know just how many medical schools there were, or Departments of Psychiatry--there were mighty few, and as a consequence of this survey everyone at this school became an aca­ demic psychiatrist, and this still persists. The fellowship that the Com­ monwealth Fund set up is just one--there are four or five others--but the output from this program has been a tremendous advantage. Psychiatry is still oversold. The medical profession does not need psychiatric training. You're not going to meet the need in patients by r 531 training psychiatrists. You're going to meet it by setting up mental hygiene clinics over the state. Ebaugh advocated this years ago and al­ most got kicked out of the fraternity for daring to suggest it. You're not going to meet this need until every doctor has very considerable con­ fidence in what I call everyday psychiatry--that is, he should be able to identify most of the anxieties in patients, guilt complexes, psycho­ somatic conditions--he should be able to recognize and evaluate them, take care of them himself without giving a patient a bunch of suppositors, or tranquilizers, and stuff like that. When a doctor recognizes an irreversible psychosis and seeks to make a crutch out of himself for that patient, this should be done very delib­ erately and with the intention of recognizing that this is the only thing that can be done for this patient to help this patient. The average physician now can't do this. He just doesn't have time. He's got to develop the kind of relationships with the patients that are going to permit the formulation of those kinds of judgments. Here again, you must come to the conclusion that there must be some­ body on this team that can help the team meet this need in the patients. The need is present in all people at some time or other, and it means a close tie-in between the team and the other people--the community. Ef­ fectiveness depends upon the proper exploitation of, or use of the inter­ personal relationship. Teachers, judges, preachers, welfare workers-­ each will have their part in a full community effort as far as relation­ ship is concerned and particularly where these relationships call for some kind of health care. I think this can be done. I can't tell you any place where it's be­ ing done right now, but lots of places have been planning for this as r 532 these kinds of population laboratories are being made available to the medical schools. Doctors are responsible for the failure here because they wouldn't let a place like the University of Colorado Medical School do this. In the years when we wanted to, they wouldn't let us have ac­ cess to the kinds of patients we needed to train doctors who would be in­ terested in and qualified to prescribe this kind of care. This always involved getting the kinds of patients that would interfere with the prac­ ticing physician's domain. When HIP first started--that is, the Hospital Insurance Plan in New York, New York University, for example, wanted to form a unit that would contract for several thousand patients. The medical society raised so much hell that New York University gave up the idea. Washington University in St. Louis--they were going to build a build­ ing to house the staff to take care of private patients on a fee basis, and whether they were going to build insurance into this, or not, I don't recall, but the idea was to have a population of patients which would be part of the education of medical students. The hell that was raised was out of this world! Just now the medical profession isn't willing for medical students to have anything to do with these kinds of patients. OED clinics being set up under the antipoverty program in a way are going to be valuable classrooms. Here I s a highly selected group of pa­ tients. You can't say they're selected because the one criterion that pertains to their selection is poverty. These people in poverty don't have the same intellectual resources as an all around group of patients have that can satisfy this all around educational need. They're poor, they're illiterate, and so on. Doctors on these teams and each of these students have to be trained 533 I in these team situationso The students have to see this team service as really answering a need, or you are not going to sell them. You're not going to sell medical students, or nurses. They've got to know they're being trained to meet these needs. It's too easy for nurses to get good jobs in hospitals and in public health. The nurses are comfortable with the situation in which they find themselves. A practicing nurse, I think, will adjust herself more easily and more quickly, will play ball with the sort of situation I'm talking about more easily and more quickly than any other group, and I think it's because they're women, and women are more sensitive to human service and human needs than the average man. I don't know whether studies have been made that will indicate whether nurses will use their essential humanitarianism as a result of having been a student or not. If we have enough nurses--if we have twice the number of; I don't want to say "enough"--professional nurses as we have today, this whole community centered patient care would develop much easier than it's going to be able to develop because it's hard work to learn the social service techniques and concepts she's going to need in evaluating these environmental situations. She's going to learn this sort of stuff awfully fast. She already knows about it. Nurses can be taught quickly to perform specific tasks that the doc­ tors do today. We have this program here to train nurse pediatricians, nurse practitioners. The Commonwealth Fund supports this program. A year in this experience, and these women will be fully qualified to ren­ der well child care and exercise all of the judgments that are necessary and perform the services. The thing that makes this program and exper­ ience a safe situation is that one of the judgments she has learned to exercise is when the pediatrician should be called into the situation. 534 These nurses are finding stuff every day that the ordinary practitioner doesn't see. They are finding these things because they are not under the gun all the time as far as a crowded waiting room is concerned. They go at this deliberately, and they are service oriented. Pediatrics is a ready-made situation for such a relationship, and these girls are in great demand. Sooner or later there is going to be a clash because some joker is going to go after some state board of medi­ cal examiners and go after one of these gals for exceeding their authority. The traditions of the license, the whole licensing system is going to have to be revamped. I hope it's going to be kept simple. Now the State of Pennsylvania is licensing all these technicians not because they have to, but this is going to make it hard to develop well-rounded pro­ grams in Pennsylvania. A fellow named John Gerdes is finishing his doctor's degree at Pittsburgh, and I haven't got time to read it it is so thick, but his doctorate deals with the licensure procedure situation in the State of Pennsylvania. He's critical of it--it's just this free standing criticism. It's not limited to the psycho-social aspects of the problem. John Gerdes is one of our administrative interns here. Now he's turning to the regional medical program in these four states. I keep re­ turning to this four state consortium to talk about it. If it ever amounts to anything, this fellow Gerdes will be a very important part of it, if somebody doesn't take him away from here. He knows hospitals. He knows what's wrong. It's just inevitable that the community hospitals will develop substations out in the community where people can enter the system of care out where they live. It's these points of entry that represent the single weakest point. Everybody--well, the system has to be such that 535 anybody can enter the system at any time they elect. It must be under conditions where judgments are exercised that are completely adequate, and decisions are made at that time and place. The patient knows at that time, and it must be for defensible reasons if the patient does enter the system. This is a hard thing to get across. That's why these multiple screen­ ing developments are so terribly important. The trouble is that everybody is going to look at this screening process as an automated proposition, as though the judgments are going to automatically fall out of the machine the way xerox pages fall out of the xerox machine. This process will be automated, and the proper use of these printouts by the average doctor will require considered judgments just to formulate them. This is the use of data information. I think in most instances it will be necessary for a doctor on each of his patients to have a printout. When you add the impact that this printout represents a person to person confrontation, it's going to condition his final judgment. Here's a history that was taken. A patient has filled out a questionnaire. It's been added to a little bit by a nurse, or a resident, or a technician who asked some ques­ tions that can't be tabulated. Here there are going to be fifteen, or twenty laboratory determinations, some of which are borderline, one of which may be out of line. If there is nothing else wrong with this lab­ oratory profile that a researcher can say will contribute here--unless you have something other than this printout to go along with it, the doc­ tor has no business making a diagnosis without subjecting the patients to further study. These kinds of findings are going to stick out all over these print­ outs, and they are going to stand out all over these patients. Just be- 536 cause a printout sheet makes everything look hunky-dory, that doesn't mean that the patient doesn't have anything significantly wrong. The trick is going to be bringing the proper professional judgment into the operation of whatever system of patient care is set up. [~uestion here is indistinct, but, in substance, the question related to a balance sheet for the doctor.] How's he going to get personal satisfaction out of being a part of this? Is that what you mean? Well, he isn't going to get it--the source of his satisfaction isn't going to be the same as it is today. I can see where a patient who has to go into surgery--the doctors in surgery are going to get the same type of satisfaction they get now. There isn't go­ ing to be the romantics in this kind of operation that characterizes prac­ tice today. It is the romantic situation in medicine that appeals. It's one of the reasons men come into medicine, as far as I can see. They an­ ticipate the sense of power they are going to have, the authoritarian position they are going to play in society which comes out of being an entrepreneur, comes out of being in complete control of the situation. Well, most doctors are practicing the way they want to practice. They like to think that the way they're practicing medicine is best for the patient, the group as a whole, and they're sold on this. You can't talk them out of this--they'll always feel this way, unless they're part of a deliberate study of patient satisfaction, a study which will reveal real gaps in the quality of the service they give. Now then, I think it's this continuing study process, this continu­ ally being alert through the need to constantly improve the system as well as put the dot in the right place that will give doctors the satisfactions. 537 Then too, the doctors will receive the satisfactions out of picking up £"'symptomatic illness and seeing that it is taken care of years before -...,; the illness itself lets the doctor know that there is something wrong with this patient. The sense of values--! think they're going to have to introduce new value systems, and the satisfactions that now come out of being an entrepreneur aren't going to be there for everybody. This use of the word "entrepreneur" with doctors--that will be over. Like institutionalization and organization, these words--up until now the doc­ tors have objected to them. Now they're using them themselves. The medical profession--the practicing profession--! think are more nearly ready for this thing I'm talking about than the teaching profes- sion. It will mean that we're going to have to turn out a new kind of doctor, and to do this we're going to have to look for a new kind of teacher. Some of these teachers here will jump at the chance to be a part of this. Most all the youngsters I notice than the older people want change. The older group are so comfortable and secure with the way things are, but they are beginning to recognize that this kind of change is going to take time, and they're beginning to realize that they must not stand in the way. Now then, they're going to have to go further and be willing to go further, be willing to be a part of the change. The older people in medical schools--this is going to be the final stage of change through which some of them will have to go. Some of them will never change, of course, but enough will so that most university medical centers, I think, will measure up to what is needed. Now this four state proposition--the one group that we're going to have to get to right away are the other deans and a lot of the faculties in these other medical schools in the Western Interstate Commission area 538 because they mustn't feel that we're hiding this four state consortium idea from them. We're going to have to have their help. We've got to make them feel that we must have their help, so this idea mustn't go much further until they are made aware of the sort of thing that is being pro­ posed, and I mean something's got to be done to get to these people, the deans and faculties, within a week to ten days. This proposal is going to hit the fan later this month, or early next month. We're going to have to maybe delay this document from being used indiscriminately. Now this item here is a revision. This has gone to the printer. This is going to be the formal report. The part in this report that is related to this proposal is rather short. Well it begins--! can't see the page numbers. I don't think they numbered the pages. Well, here-­ that's all the reference there is in this overall report to this proposal. Perhaps I should have made some changes in this report that would be in line with the revisions I made in this proposal, but it's too late. It will have to go the way it is. This is going to be the document, the proposal, that will be distributed. This will just be in mimeograph, or lithograph, so people will fit the reference to this and this, and then they'll be in time for this proposal--you see? We've got to get •••• Ward, when you concentrate on patients and patient care in community cen­ ters for health care, aren't you changing the whole power balance? In the speech I gave at the University of California I suggested the community corporation, and this community corporation would be the ideal organizational gimmick under which this community centered patient care would work. All vested interests would be forced into an organized, re­ sponsible situation where they would be more careful about passing deroga- 539 tory resolutions, or throwing roadblocks in the way, particularly if this community corporation is incorporated by the real leadership within the community. I sent you that paper, didn't I? Now I should have polished that up for publication, but it would have taken time, and again I wanted to be free to change my ideas without being too embarrassed because of a prior publication, and I've changed a lot since then. In fact, this docu­ ment--it's that one there. There are changes in that document that I made that I wouldn't have been willing to listen to a couple of weeks ago. All of a sudden this thing hit me about this surgery hassle that's been going on all these years between the general practitioners and the non­ general practitioners. The Academy of General Practice and the Association of American Medi­ cal Schools would have trained everybody that wants it in this surgery business so that surgery would be among the competencies of the family physician. This may not be a good idea, but right now it looks like a good idea, and this is what I'm going to try out on these academy people that are going to be at the house at two, or two-thirty this afternoon. I still think that if they're smart, they're going to go into this meeting on the 26th and 27th of this month, this meeting with the specialty boards, and at least let it be known that they're willing to sit down, to listen and to talk over the ideas of setting up certifica­ tion for these people as a result of the collaboration of different sets of conbinations of four, or five principal certifying boards. [Telephone interruption] If they'll do this in one fell swoop, they're going to neutralize practically all the hostility that they've been deal­ ing with for a good many years, and a lot of this hostility is even going 540 to go further and turn into support, I think. Irrespective of what they do--if they don't do anything, as part of the development of this four state consortium we'll be going to these specialty boards ourselves to see what we will have to do for these resi­ dency programs in order to have programs that will turn out people who will be qualified to take the examination of this or that board, or this or that combination of boards. If the Academy of General Practice isn't willing to work it out, I think we can as far as our program is concerned. It wouldn't have been fair to the academy to have gone off on our own without at least letting them know. fguestion here indistinct.] Now these universities--John Millis of the Millis Commission Report recommends this supercommission to control the standards of all graduate education, all residency education, and he recommends a certification. He's kind of indefinite as to just how this certification would be accom­ plished, but he's been invited from university to university--you see, he's no longer tied to his office at Western Reserve. He's chairman of the board, so he's free to do anything he wants, and he's finding that quite a few of these universities are even thinking of putting these resi­ dency programs on a doctor of science basis, so that the doctor of science will be the status symbol, and there's no reason why we couldn't try that. The Canadian College of Family Medicine will certify these people. I found this auto Well, a Canadian certification would be looked at down here with some disfavor, I suppose. You know, the real thing that is different here, and this is a cli­ che now with me, is that the time has come to take the faculty and the 541 students where the patients are instead of taking the patients where the students and the faculty are. Now that's really the guts of the whole idea, and in this revision I underscored that. I hope they kept the un­ derscoring in--well, I didn't underscore that. I underscored something else. The chance here is that the four states with the kind and quality of popu­ lation that they have--! don't know what this would do, if you took it into Pennsylvania, New Jersey, and Delaware, let's say. In that document I take a fast pass at saying that the entrance re­ quirements of these medical schools must be such that students can be in­ put at the first year of the medical school, can come in from outside this four state area. At the end of the sophomore year, the program must be such that these students can transfer into the junior class someplace else, or can accept juniors from some other school. Now this may mean a summer of extra work, or something, but at the time of graduation they must be able to qualify for internships anyplace, and they must be able to pass Part II of the National Boards. I didn't put this idea in there yet. At the end of the sophomore year they ought to be able to pass Part I of the National Boards. At the end of graduation they must be able to pass Part II of the National Boards and qualify to take any state board. The intern programs must be such that graduates of other schools outside the area can come into the system at that point, and they can come into the residencies also. These in­ terns, when they finish, can go into another institution out of the area for a residency, and the final product must be qualified so that he or she can fit into a community situation anyplace, whether it's rural, 542 urban or suburban. It means they have to know how to use consultants no matter where they're going to be. Isn't the concept here traced back to your university without walls as far as these four states are concerned? Yes. I don't use that term, but the paper--well, we suggest here sort of a bibliography, a reading list at the end, and I told them to put in a paper by Grey Dimond, who has just gone to the regional medi­ cal program in Missouri, a paper entitled the "Open Medical Faculty". I hope it's in there. I don't see it offhand. His paper supports the whole ball of wax, the open medical faculty. The "University without walls" is a cliche that has kind of been overused. It's still a good expression though. In part, isn't the secret of this proposal the fact that there doesn't stand in the way the kind and quality of vested interests that one would find in Pennsylvania, New Jersey and Delaware? That's right. Where they would be more ready to scream in defense of whatever limited view they may have than they will in this four state complex? We'd be--this development, if we can get the money, there will be a minimum of expediencies and compromises to cope with, and there will be a minimum of commitments to the past. Sure, I'm making compromises al­ ready when I started to rewrite this thing last week, but through it all I think we can come out with essentially the thing that we're proposing. The hold we have on these hospitals that will participate is that the 543 intern and residency programs will have to be approvable. Now, admittedly in extending these approvals the AMA is going by a set of minimal stan­ dards, but these minimal standards when applied to the hospitals as they are today are so high that I'm not going to worry about any standardiza­ tion freezing the situation in these hospitals. In raising the quality of their service to date to meet the minimal standards that will be ap­ plied tomorrow, it's imperative that the physicians that make up the staffs of these hospitals become so used to keeping the quality of their own service under observation and so used to building improvement into the organization and the system, that they will be functioning far ahead of any set of minimal standards and be keeping ahead of it. If they don't build evaluation of the quality of patient care and the quality of educa­ tion into this right at the beginning and set up the machinery to keep it alive and going in perpetuity, there's no use starting this. As I read this report from the AAMC, almost from the start one of the great problems that you ran into was the absence of studies to evaluate-­ like student attitudes--you didn't have •••• You didn't have the tools. Yes, and fashioning the tools and making them relevant to change was the problem. We don't have ideal tools now, but we've got tools that are good enough to let us get started, and tools will be developed. That will be one of the big projects. I hope of the AAMC will keep its finger in this so as to develop tools. Now this medical school inventory Dr. Ed Hutchins has developed has , 544 turned into a very practical, important tool that a faculty can use to evaluate itself really. That's it right there. Paul Sanazaro and his crew have picked up tools here and there from industry, doctor's theses, I suppose, and so forth--they're just names to me. I don't know. I frankly don't understand the concepts that go into the reporting of these studies and these evaluation procedures. I couldn't and I wouldn't try because people are available to pick this up. I just know how impor­ tant they are. If you don't build the process of re-examination and evaluation of what one does into this four state business •••• We won't get a red cent from any foundation that really knows the score unless we can assure them that this is going to happen and then these two documents--this is referred to so much that it's almost--it's tiring to see the repetition. I think I'd better turn this over. I have a couple of more things to take up with you. I think I'll take a little walk. What I'd like you to do now is come back to the AAMC and the circumstances which gave rise to the Coggeshall Report. Well, we've talked some about the beginnings of the early changes in the climate necessary to convince the Executive Council that something like the Coggeshall Report needed to be done. I suppose 1959 was the first date in that outline of the AAMC program which occurs first in this book of documents that has the Rockefeller Foundation documents in it. 545 Well, that collection of materials sort of--if they didn't do anything ,I else, they sort of began to present some facts to the Executive Council on the idea of an overall study of the AAMC objectives and so forth. What brought the situation to a head was my decision to retire. The gun was cocked, I'll say, by the fact that I was going to quit, and I gave them a good year's notice. The main pitch I made when I told the council of my decision was that they use this year as an ideal time to do this kind of a report. At the same time I told them that for my money Coggeshall was the person to do this study. He had the time. He had the national stature. He'd done things like this before. He had chaired a commission, for exam­ ple, for the Pharmaceutical Manufacturers Association on drug safety, and he'd had experience with this sort of thing as a consultant for the govern­ ment, the universities, and so forth. He's a tremendous fellow, and he did it, took the job purely as a favor to me. He knew I was leaving. He didn't want to do it, but he did. A steering committee was set up as you noticed. DeBakey never came. We only had about three meetings. DeBakey prepared some preliminary mem­ oranda. He helped a little with the interviewing. Clark Kerr came to just one meeting, the first one. Then the people that turned up at the three meetings consistently were John E. Deitrick and Robert C. Berson-­ and, of course, Berson was executive director by the time this study was really rolling, or he knew he was going to be executive director--Bill Hubbard, Coggeshall--and Coggeshall used Boaz Allen and Hamilton for staff so that there was this staff person always meeting with us and I can't think of his name--and myself. We had a meeting here in Denver. We just never came to grips--the 546 committee never really ever came to grips with this study and report as a committee. At the meeting here in Denver we deferred some of the tight discussion for an after dinner meeting. We met all day. We were getting tired, and tempers were getting short. This was just Deitrick, Berson, Hubbard, Coggeshall, the Boaz Allen Hamilton man, and myself. We came back for the evening meeting, and Deitrick and Berson didn't come. They never showed at all. Well, this bothered Coggeshall of course. We got nothing done. The next meeting was in Florida in connection with either an annual meeting, or an institute. It was an institute, and Coggeshall didn't get there due to weather conditions, and at this Florida meeting the whole outline of the report was changed by the committee, and it was my job to get Coggeshall on the telephone and tell him. Well, Coggeshall--he was disgusted then. I finally--a few days later I finally told Coggeshall-­ I said, "You surely aren't surprised at what has happened." We had talked about the difficulty of doing a thing like this where a committee played very much of a role, unless the committee really gave the matter a lot of time. The people on the committee were not the kind of people that had the kind of time to give. I told Coggeshall, "Let's not have anymore meetings of the committee. I just wish that you'd take the couple of months that it's going to take, and you just sit down, and you write this report exactly the way you think it ought to be. It will be a lot better report, and it will get done a lot sooner." He said, "All right." That's exactly what he did, and the manuscript came out. We printed up a preliminary report using the same format as the final report, and we presented it to the Executive Council. We didn't call this steering 547 committee together again. The council decided that the report was all right the way it was, except for improving the English and doing anything more to it than Coggeshall wanted to do so we rushed the report through. We printed several thousand copies and distributed the report to the four corners of the country without anybody approving it. The council accepted it and authorized its wide distribution which was just what I wanted to happen so that the AAMC and the medical schools would be put on the spot. The council came very--! wasn't at this meeting. Of course I was no longer a member of the staff, and at this particular meeting the Exec­ utive Council had the votes to recommend the change in institutional mem­ bership--they had the votes to recommend this change to the institutional members--that is, the deans, but because the vote wasn't unanimous they decided to delay, and the delay really persisted for about two years. They did adopt a watered down statement of objectives. They didn't take the statement of objectives that would have really required that the deans begin to work with the nursing educators, the pharmacy educators, and dental educators--the Executive Council cut all that out. I wrote the statement, and they took the first sentence and the last sentence. This limited the interest of the Association to physician education. It was a nice statement, except for that limitation. I was asked to rewrite the bylaws though which, if adopted, would provide for the university to be the institutional member. I was a lit­ tle slow getting those revisions in. I guess they got in a couple of weeks before the council meeting. In the meantime, Berson had prepared a set of bylaws of his own that were strictly in line with the continua­ tion of the old type of institutional membership. The one thing the Exec­ utive Council did rather early in the game that was good was authorize 548 the establishment of the Council of Teaching Hospitals. Well, they al­ most had to do this because of the demand that was being made by the mem­ bership of what was called the Section on Teaching Hospitals, so this got the hospital group on the ball pretty fast. The regional meetings of the deans--this was not the result of a deliberate decision on the part of the council, or the institutional mem­ bership. This regional meeting business started because of the dissatis­ faction of a dean here and there with the AAMC, so he would call all of his buddies together in a region, and they began to have these spontane­ ous rump sessions. Small groups of deans began to spring up all over the country so because of this a motion was made and passed that there would be a regional organization, that there would be x number of regions, and that this and that school would be in this and that region. An agenda question would be developed that would be discussed at the same time by each region, and out of this organization is gradually emerging a new kind of AAMC. How far this is going to go in terms of satisfying the concepts and objectives expressed in the Coggeshall Report remains to be seen, but things are moving. I've stayed out of this. They still send me the agendas of council meetings, as you've noticed, and I go through them so I have an idea of the direction in which things are moving. These agenda items are ex­ pressed in pretty fuzzy terms, and the motions that are passed, a lot of them, are pretty fuzzy too, but maybe things will sharpen up as they move along. I don't know. What was in the air that led Coggeshall to write into this report the need for changes from deans as members to the universities? 549 Well, as I told you, this was really his idea, and it was because he felt that there should be an educational association that formed an umbrella over all the disciplines that were necessary to the proper oper­ ation of the medical establishment, and he wanted this to include parti­ cularly the nurses and the dentists, the pharmacists, the hospital admin­ istrators, public health. He wanted an umbrella that would caver all of these associations for schools of the health sciences. He wanted the university to be the institutional member because he felt that it was the university that in the last analysis should be in complete control of the setting of standards. He was willing for the non-university programs to come into this through the medium of task forces, or councils, or commis­ sions--I've forgotten what he called them now. Well, naturally the associations the schools of the health sciences didn't go for this any more than the deans of the medical schools because they didn't want to lose their identity. They didn't want anything to interfere with their own little power plant that they were running. At this meeting of the presidents of the AAU--they didn't want any of this. Well, here were presidents representing about half of the medical schools. I wasn't at this meeting, but I was told that the presentation of the Coggeshall Report at this meeting--well, there wasn't any presentation worthy of the name. It was obvious that the presidents, or very few of them, had read the Coggeshall Report, and this shouldn't have been sur­ prising. It should have been anticipated, and Coggeshall himself should have been invited there to present the gist of his recommendations. The president of the AAU just opened the matter up for discussion, and some­ body asked what the Coggeshall Report was all about. I don't know who made that presentation, but it was very short and brief, and then presi- 550 dents one by one said that they were satisfied with things the way they were. This was a short meeting, and this action was used by the Executive Council of the AAMC. It was taken to mean that the universities weren't interested in this kind of an approach to the medical education establish­ ment of this country. It would have taken some doing to sell this to the presidents, but I'm very sure it could have been done, if the right kind of an effort had been made. Weren't presidents experiencing the fact that their arms were being twisted financially by the fantastic growth in research funds? Yes, they were complaining about it, but the time had come, and it came some time ago when the universities, very few of them, were actually putting any money into the medical schools. The state appropriations were providing the income that balanced off the operation of the medical cen­ ter from the rest of the university. High tuition rates, income from en­ dowment, earned income from taking care of patients and these big grants-­ a lot of the private schools were getting grants for general purposes from foundations like the Commonwealth Fund. The Macy Foundation put quite a bit into the private schools. The universities--our studies show that the universities were putting a little bit in. There's one or two in­ stances where the universities were taking money out of the medical school--small amounts. At least you couldn't balance things up except to say, "Well, the university made a little bit of money out of the Medi­ cal Center for this particular year." They didn't have a stake in the medical schools, or didn't seem to? 551 As these presidents spoke, so I understand, they all expressed con­ fidence in their deans, or their vice presidents. There's a whole section in the papers which you sent me earlier on the need to reorganize for the future the AAMC, and to what extent is that need to reorganize related to the implications in the Coggeshall Report? What's taking place now is being done with the idea that the AAMC is preparing to meet the future. It's more in response to the objectives and concepts as expressed in the report than it is to specific recommen­ dations that have to do with tables of organization and so forth. At least that's the way it seems to me. Really they're gradually, so George A. Wolf told me, and he's the Dean and Vice President of the University of Kansas, and as he says, they're really moving more in the direction of the recommendations I made so far as organization is concerned than the recommendations that Coggeshall made. You see, I sent these recom­ mendations to Coggeshall well ahead--it was while he was writing his re­ port. He wanted to know what my ideas were as to organization, and I sent them in--well, Boaz Allen and Hamilton, that staff, had already made its mind up as to the kind of an organization that should pertain so that's what went into the report. Well, to me the question of organiza­ tion wasn't half as important as the question of objectives and concepts and commitment to those. Where are the stumbling blocks? From 1956 to the present moment the stature of the AAMC had grown precisely because it has had available data which it never had before, where a dean of a medical school who has discretion to exercise could use this material--a sense of control from the center is not there, but this material is available from the center-- 552 like a lunch counter. You want salad, here. You want cold cuts, here. We've got the data, and the means continue for the accumulation of that - data. I think the most basic stumbling block has been the tradition of self-sufficiency and self-determination that has characterized that whole system of higher education. Universities have never gotten together, I don't think in order to share resources. They have never done anything to amount to anything in the way of important studies. Now there's the American Council on Education there in Washington that has an institu­ tional membership of several thousand institutions, including junior col­ leges, and they have a research division that gets out lots of data, but no effort is made beyond that, so far as I know, for the right people to come together and decide what this data means and what other data is ne­ cessary to make this data meaningful. Nothing is done to use this data in the shaping of national policy. It's true that the American Council on Education expresses itself on matters of legislation. Witnesses for the Council appear at congressional hearings and so forth. Now the Land Grant College Association when it was a separate or­ ganization under Thackery--this was a very effective, well organized out­ fit, and the roots of this effectiveness were in the individual institu- tions. Let's say that the Land Grant College Association wanted to pre­ pare itself to develop a policy that concerned some aspect of federal col­ lege relationships. Back in the individual institutions a committee would be appointed representing the appropriate academic disciplines or colleges, we'll say, and agenda materials would come from Thackery's office in Washington to this committee that would give the committee all it really needed to begin to consider what the posture of this particular 553 institution was going to be regarding this particular question. The president of the particular Land Grant College would be brought into the deliberations of this committee at the right place, or the business offi- cers. Then the chairman of this committee when the institutional posture had been determined would become a member of a regional committee, maybe representing six or eight land grant colleges. These six or eight chair­ men would come together, and each would lay out the policy as determined by his institution. They would begin to work together to iron things out so that there would be a regional posture. Then the chairman of this regional committee would be a member of a national commission, we'll say, that would meet at the Washington head­ quarters, and the same procedure would be gone through. Then the Senate of the Land Grant College Association which was made up of the presidents of the colleges, or their representatives, plus some people elected to the Senate to represent the faculty, would meet. This Senate would de­ cide what the Association's posture was going to be, and as a rule all of this work was carefully enough done and the data necessary for a well considered determination was adequate enough so that when the Land Grant College Association was ready to speak at a congressional hearing, or be­ hind the scenes more often than not, this was a very authoritative voice. The Land Grant College Association always knew just where it stood in relation to questions of national policy. This method was what John Russell was trying to get the college association to adopt, and this was what I recommended in this stuff I sent to Coggeshall. Now this process is cumbersome, admittedly cumbersome. The expenses of this did not show up in the land grant college budget because the institutions carried 554 their fair share of the expense as far as the participation of their own people in this process was concerned right up to and including the expense involved in bringing this Senate together. There was only Thackery as a staff person and some dog-gone good secretarial people and administrative assistants. I don't know what the annual budget of the Land Grant College Association was. It was a hundred thousand dollars--maybe a little more, but my friends here, the President of the University of Nebraska and out here at Colorado State University, told me that their participation in the activities of the Land Grant College Association, including the dues they paid the association, was in the neighborhood of ten, or twelve thou­ sand dollars, and they were kind of guessing at this figure because the cost of this participation is just kind of buried--there were no line items necessarily in the budget, and they weren't doing program cost es­ timating so that they were really just guessing. They knew what the trav­ el bill was. I don't think they made any allowance for the time of their people--maybe they did--but this Land Grant College Association was very effective from way back after the first Morell Act was passed, and they had a lot to say about everything that went on in the Department of Agri­ culture. Do you see the AAMC altering its interest in counterpunching, or respond­ ing to idea, particularly government idea? I don't know--the trouble is that recognition of the fact that a re­ sponse is necessary comes too late to do much good, or to be very well directed. It's always facing up to a crisis. Now, Berson is good at this. When he gets in front of a committee, he knows how to say the right things in the way congressional committees like. Now whether there's any 555 reaction to this effort of Berson's on the part of the people who are staffing these committees whose job it is to gather data, interpret it, and present it to a congressman, or a committee in meaningful terms, I don't know. I don't know how they feel about this. I have no idea how the people in NIH, or in the Surgeon General's Office feel either because they're used to going before committees with ample data to back up their recommendation, and it's well organized and well presented. It's usually in a document that is turned over to a committee and referred to maybe casually in testimony. Now, there's a Committee on Federal Health Programs of the associa­ tion that still acts pretty much on its own in response to questions that come up where there isn't much time to get prepared. This committee more and more is trying to operate behind the scenes which is good. Its line of communication with Jim Shannon's office is pretty good, and Jim will frequently have somebody in to talk about a matter that is still in the ideation stage, but they don't buckle down to do anything in line with the kind of procedures that I suggested in the Alan Gregg Lecture yet. They have this salary data each year, and this is semi-confidential. Some of the salary levels that are revealed in those reports are pretty hard to justify. Now these high salaries represent really ceilings on what a faculty person can earn as a result of taking care of private pa­ tients. They don't necessarily represent institution funds. There isn't the process of putting data together today that is going to be used a year from now in making a case for medical education. There's never been the staff adequate to this. Now the AAMC has authorized for the institutional membership a tre­ mendous increase in support from the medical schools. The basic dues have 556 gone from fifteen hundred to two thousand dollars, but on top of this each school is supposed to pay a percentage of its total expenditures, maybe a tenth of one percent. It's small, but on the other hand, it's such that the dean here told me that it would cost the medical school about ten thousand a year to belong to the AAMC, and the difference be­ tween the dues and the maximum amount to be paid is supposed to be justi­ fied in terms of services, data gathering, reporting services, and con­ sulting services. The AAMC has in mind setting up a central clearing house for medical school admissions where everybody that applies to a medical school would fill out a form that would go to the central office, and the central of­ fice would take the responsibility for gathering together the grades, the letters of recommendation, the MCAT scores, and so forth. The AAMC would carry this up to a point, and then every student that wants to apply to Harvard--! mean Harvard then will ask this central office for the poop it has on this particular student, and then each institution will carry on from there. Well, this will cut down the red tape as far as each in­ stitution is concerned a great deal, and it would also give our data bank a lot of biographical information about the people applying to medical school that would be extremely useful over the years in analyzing the kind of people that are applying to school. For those that succeed in getting through school we'd have a lot of socio-economic information that could be used in developing correlations that in the years to come could be quite significant. Now then having--there was only one vote against this support idea I'm talking about. The trouble is going to be for a man like Dr. Conger here to justify this kind of support to the Board of Regents and the State 557 Legislature. Now this approach suggested by the Land Grant College Asso­ ciation would have meant very much the same kind of support and the same amount of support, but it would all be buried in the operational budget of the institutions. It wouldn't stand out as a dues business--you see? Well, maybe this is good because if the central organization at AAMC is going to justify this kind of support, it's going to have to perform in an entirely different fashion and on an entirely different basis under an entirely different kind of inside staff leadership than has ever been the case before. You make much in these reports on the need for better communication be­ tween the executive director and the AAMC as a central agency, whether it be a clearing house or whatever, and the firing line, the deans. Yes--you see, one of my biggest diasppointments was not being able to visit medical schools to any very great extent. The only time I vis­ ited the medical school almost was when I was on a program, or when I went as a member of accreditation teams. Now getting Ed Turner on the staff would have--! would have quit feeling guilty about this. In fact, I would have felt pleased because he would have been much better at this than I would have been. He would have been getting more out of the vis­ its to medical schools than would have been the case if I were doing it because this was all he was supposed to do. The only contacts that I had with deans to amount to anything, except those that were on the Executive Council, were those at an annual meeting. There were a lot of deans I didn't know. I couldn't even tell their names, and of course the turn­ over of deans was so fast that this interfered with communication. I just never had the staff. 558 Gus Carroll was the best contact, the most satisfactory contact be­ tween my office and the medical schools, and this was because he was in constant demand. There were people who wanted his help, and Sanazaro was under demand too, but not to compare with the way Carroll was. In your tenure--it would seem to me that during your tenure as executive director the executive director was not seen as somebody who was necessar­ ily in touch with the constituents at all. That's true. The executive director was somebody who was developing a program where there had not been one theretofore. That's right. Once set in motion there's a body of material you can use, or it's avail­ able. It comes out maybe in this form--maybe, but you know, here's where the evaluation comes in. How does one evaluate the AAMC and its executive director with reference to the service to the medical schools. The grass roots. Yes. This is what I didn't find. It wasn't there. This wasn't evaluated, I don't think. Now I got along well with the institutional membership. I know I was thought well of. I had no--maybe with one or two exceptions I felt very comfortable with all of the deans and they made me feel that they were with me. These programs that you talk about--as far as participation in them was con­ cerned, the schools could take it or leave it, and there was no program 559 in which there was universal participation except this collection of ex­ penditure information and the only reason it was a hundred percent--well, there were two reasons. One was that the AMA was in this effort with us, and everybody knew that this annual education number of the JAMA was the Bible that everybody turned to, the authority that everybody turned to for data about medical schools. The data in publications that we at the AAMC put out independently of this AMA business--this was just fortuitous. This was just gravy as far as the educational establishment was concerned. You take that study of dropouts by Davis Johnson and Ed Hutchins--if there's been any impact from that, I haven't been told about it. I think the group on student affairs are probably talking a lot about ways of reducing the number of dropouts and at least by improving the admission procedure so that they do a better job, they select more students that can make the grade, but this is all behind the scenes. I was surprised that the lay press didn't pay more attention to that publication. The medical press paid very little attention to it. The AMA newspaper gave it one story and practically--well, that story was almost verbatim the preface that I had written for it. World Medical News, Medical Tribune, Medical Economics--! don't recall seeing any refer­ ence to it in those things. There wasn't any editorial comment any place about it, except maybe one that the editor of the Journal of Medical Edu­ cation wrote, and he wrote that because I told him I thought it was im­ portant that he should. Things like this--by and large their impact has yet to be felt. Dr even assessed. 560 Now, Carroll's little book on medical college costs did have an im­ pact and still is in great demand. These two different publications that were developed by the Public Health Service about new medical school devel­ opment including architectural plans and a lot about class size and all that--well, the supply ran out, and any impact from that was short lived. Well, maybe I shouldn't be surprised at that because conditions have changed so that the help that is supposed to be in those two publications just isn't any longer relevant to the problems of developing a new school. This conference that the New York Academy of Sciences had on new medical schools--! don't see much evidence of that having had any impact, and that was a very good collection of papers. Of course unfortunately they didn't get it out until the conference was over a year old, and this delay in publication is a problem that we have to confront in getting out our teaching institute reports too. There still needs to be a common front of scholarly effort in the development of programs of physician edu­ cation in this country, and some of these things going on at the AAMC may be headed in that direction--! don't know. Now if anybody should have been able to develop this I should have, but I didn't. There is one theme that you do use in several articles, not infrequently-­ put it that way--and one is, and these are my words not yours, but it's silly to talk about money in the absence of something concrete in the way of proposal which requires thinking and data to condition judgment. Sure. This may happen incidentally in these schools. It's got to--it's going to be forced on them. The federal auditor 561 is going to force this on them. The federal auditor is going to demand data that the medical schools are not able to generate at the present time, and that's what this contract is all about involving these six medical centers. The thing is happening that I warned them about in that paper when I announced the original Kellogg grant; "If you don't do these things for yourself they're going to be done for you." That's what I said. Or you're going to do it for someone else and for their purposes. You're going to serve their purposes--right. That's what I meant by "counterpunching." Now the big thing that needs doing more than anything else in medi­ cal education is for the educators to get together and define the knowl­ edge but more importantly the concepts and the skills to be expected of every student that enters medical school, and this should be spelled auto What should the student be able to do with mathematics as a commun­ ications tool? What should he be able to do with the English language as a communications tool? What concepts in sociology, et cetera should he have mastered? This should be a three, or four page statement maybe, instead of so many hours in English, so many credit hours in this, or this course, that course and the other course. The same thing needs to be stated for the requirements for the MD degree--what are the concepts and the skills that should be shared by all graduates, all physicians at the time of graduation? Then you go on and define the extreme on the one hand, the knowledge necessary to develop these concepts and skills, and on the other end, at the other extreme, you've got to define what you 562 mean by skills--intellectual skills which I think are the most important at that stage of affairs; the professional skills, those that are neces­ sary for any person to perform at the professional level; and then the technical skills which would be rather minor, so far as the graduating senior is concerned. Then you do the same thing for the intern year, if you're going to keep the intern year in the picture as a free standing year of educa­ tional experience. The same thing needs to be done at the resident level, and again this should start with a definition of the concepts and skills that should be common to all physicians at the time they are certified for a specialty, as well as those that would be peculiar to each specialty, and this state­ ment of definitions should be set up in such a way that it represents a continuum of thinking, preferably beginning with the time when a student goes into a liberal arts college and ending up with the time he's certi­ fied for a specialty. This is going to take a lot of real skull work, but then you can make this statement of educational objectives mean some­ thing. One school might develop a curriculum to accomplish these objec­ tives that would represent one line of thought, one philosophy of educa­ tion, and another school might do it altogether differently, and then we'd know which school was the most successful. We'd know the kind of students that would be the most successful in this situation that would­ n't be rigidly structured the way it is now. You might obtain a variety of educational experience which might lead from this student to this attitude. And you'd have multiple tracks that the student would take depending 563 upon what his objectives were. You could even say, "If he's ready for the comprehensive examination for the MD degree--if the faculty thinks he's ready in three years instead of four, I don't see why they shouldn't let it go. If he's ready for his certification examination in two years of residency instead of five, and the institution is willing to certify him as ready, I don't see why the board can't keep its grimy little fin­ gers out of the content and time of the educational experience required for examination for certification. Just limit itself to the examination of candidates for certification. The only requirement being the institu­ tional certification that that student is ready. Now this is what I think the Association should begin to stand up to. I haven't written this up as well, or as forcefully as I should. I have probably said it better right here talking to you than I have ever said it before, and you often do say things under conditions like this better than you've ever said them before, or better than you'll ever say them again. That's one reason I like the tape recorder present for a committee meeting. Is it possible to chip away at this piecemeal? It's being chipped away at piecemeal. People like Dr. Daniel H. Funkenstein up at Harvard has made a wonderful case for this. Edmund D. Pellegrino who is developing the new school at Stony Brook has made a good case for this. George T. Harrell, the dean at the new school in Hershey, Pennsylvania is making a case for this. They have made a case for this at Kentucky, but I'm afraid that this is being watered down too much. I hope not. These are new schools--aren't they, except Harvard? 564 Yes, Harvard talks this way all the time, and Harvard has decom­ pressed the curricular structure a lot, I'm sure. This revolt of the students a couple of years ago at the idea of attending class--well, this is good, but you've got to remember that Harvard has its choice of the pick of the students of the nation, and Harvard couldn't do anything to hurt those kids, if it went out of its way to try. I agree. The same for Yale, or Johns Hopkins, but the students that come here aren't that good. Now things here should be such that the few students we have that are that good, and we do have quite a few, they should be able to do things in accordance with their capacities for work. The stu­ dents that can get along with a small amount of supervision, this condi­ tion should pertain, and those that are still good enough to take the re­ sponsibilities of professional practice are going to need guidance and support, and the situation should be such that they have it. Now in the second institute--the institute on the ecology of the medical school--all of this was brought out, but from the standpoint of the total student body. They were talking about schools that were dif­ ferent than other schools. There were certain schools in which these students that do well in the unsupervised situation represent the total student body. Then there were the other schools where all the students had to be spoonfed, and then there were the in between schools where part of the student body could handle the unstructured situation, and part couldn't. That's when they began to talk about the panic that developed in these students requiring the structured situation because these stu­ dents were expected to survive and compete with this other group. That's 565 the reason that institute report is a good one. It's the first time I know of that there was any evidence developed that explained why students responded the way they did to certain situations in the medical schools. Just to distinguish student from student was a step. Yes, and here I come along with a golden opportunity to emphasize this in my presidential address to the Association in 1952, and I just came up to this, and I stopped. I should have pointed out the structure and function of this medical school situation versus the kind of students that were involved that I had shown in graphic style. I should have done away with this line over here on the right which represented a situation that all students were confronting at the same time. There was absolutely no change in it. There was nothing done to make it possible for a stu­ dent to individualize the route he might follow through medical school. Well, the reason I didn't think of saying that was that I was holding this rigid structure up. I was at least implying criticism of this rigid situation that all students must face in common, but I dropped it at that. I didn't tear away the pillars that were holding this rigid situation up, so i f I ever would publish the best of my papers as a little monograph, this would be one of the papers where I would introduce considerable modi­ fication. Well--the proof of whatever pudding has been stewing since 1956, still rests with the discretion of the local dean and his faculty. Absolutely and this will always pertain, I think. Good, so if he had imagination, interest--the wherewithall is available to him if he wishes to turn it to local advantage. 566 This goal business that I'm talking about--these are goals that must be shared in common by all schools and can be shared in common without in­ terfering with the way a school wants to achieve these goals. These goals are necessary because the students are still going to have to pass their National Boards, their State Boards, and their certifying examination. All graduates of all schools some day are going to be evaluated in terms of their performance in professional practice, and the ultimate objectives of education in medicine are going to depend upon the outcome of this eval­ uation way out here in practice which will be a common procedure fifteen, or twenty years from now. You're going to know what the goals of educa­ tion should be in terms of how effective this physician is in meeting the problems of patient care. This is the dream. Is there much evaluation of goal achievement? We are just beginning to develop tools. That's tough isn't it? Yes, this is a tough one, but you can't develop tools to evaluate achievement unless you identify your goals first, and they haven't even been able to do this in a satisfactory manner. Now the introductory pages of every medical school catalogue, I'm sure, has a beautiful statement of goals. It's poetry. You could set it to music, but nobody pays any at­ tention to it. Just like the statement of goals we developed for our new curriculum. Those were lost sight of by the time the ink was dry. We just in general said that we were going to develop every student as if he were going to be a general practitioner, and this made the general practitioners very happy. To refer to our goals this way was all right 567 as long as we were talking to doctors here in Colorado, but everybody on the outside began to jump on it right away. Then we began to get our fulltime clinical faculty in, and they began to think in terms of repro­ ducing themselves, and they were all specialists. The new curriculum did not include means to evaluate its achievement. No. This was one of the drawbacks? Yes. While there might very well have been commitment to idea, there was no means to check on this. We probably in that some place--I haven't read it for years--but I wrote in, or took a fast pass at what I thought the objective of study should be; to do this and that and the other thing, instead of to pass examinations. Maybe that's in there. It was in my presidential talk in 1952, and that may be the first time I said it that way, but no matter what was said, or not said in the curriculum report that we're talking about, study to pass examinations persisted as the main motivation for study--! can tell you that. I can understand and even accept that from the point of each individual student. What is difficult to accept is for instruction, an educational experience not to relate itself to determined goals, or the committed goals. There was no evaluation. 568 Methods were young then. No evaluation was built into this, or even the need for evaluation from this standpoint. People weren't thinking that way. This paper that Ed Turner and I published which was a reflection of a panel discussion at one of the annual meetings of the AAMC down at Colorado Springs--! remem­ ber a sentence in there to the effect that it was the considered opinion of the discussants that the techniques of the so-called science of peda­ gogy had no application in the field of medicine. Did you catch that? ["Leadership in Curriculum Planning" 25 Journal of the Association of American Medical Colleges 12-20 (January, 195 □)] That's the worst thing I ever said, and Ed Turner. We often kicked ourselves for writing that into that paper. That statement was made by the dean of a college of education. Yes, I know. It seems to assert that ideas are self-activating, but it doesn't take long to destroy that notion. And it makes a difference how you present things and how you involve students. The reason I like this four state deal is because maybe here is a chance to quit grieving about the past, the past sins. Here's a chance maybe to shed this mantel of guilt which I say bothers me; it really doesn't, and make a fresh start--see, and under conditions where a fresh start might have a chance to pay off. It's one thing to be involved in action as you were here as a dean and as vice president; it's quite a different thing to get up on top of the 569 whole mountain--you get shooting rights over the whole of the mountain. You make pronouncements. Yes, instead of grabbing a small holding on the slope somewhere, and I think that's what this four state business •••• A reflection of what you just said is why I gave this John Leonard talk the subtitle t1 Let you do this t1. I think th at was a pretty good sub­ title. The editor of the Journal of the AMA didn't think so. After you get home I'll send you a copy of a report of the committee chaired by Ed Pellagrino that was to be a think document for the Executive Council of the AAMC, possibly a document for the consideration of the deans at regional meetings regarding this family practice concept. I wrote a very angry letter to Berson about this report because I was so terribly disappointed in Pellagrino. Well, I won't try to put my hands on the letter, and this is the only copy of the report I have, but I'll send it to you fairly soon because the first half of this report I thought, "Boy, we're really moving. This is like Ed Pellagrino." Then, as I said yesterday, the adjectives and the adverbs began to rob the nouns and the verbs of any significance, and they finally wound up, t1 It may not be appropriate for some medical schools to develop models of health care, or programs for the education of the generalist. Every school, however, must advert consciously to the question before making a decision. It would be disastrous to initiate such programs without fac­ ulty acceptance simply to satisfy the external pressures of the me-too spirit." It's the me-too business that bothered me. I probably over-reacted to this. 570 Now here's an exchange of correspondence responsible for that me­ too bit. [See Darley Correspondence with Fred A. Mettler in WDl X 9] I wanted to be sure that I was remembering the right incident. This is the paper I gave him--well what he was reacting to was the paper on the inevitables in the future of medicine that was in the JAMA, [196 JAMA 267-268 (April 18, 1966)] and here's his letter. His handwriting was so abominable that I had to translate it. Now then, you're disappointed because I don't have too many instances where there's been a real exchange of correspondence, and you're justified in having that disappointment because for some reason or other I just didn't carry correspondence on. There was my answer to that letter. Now then the paper that I enclosed was this University of California address, and boy, he gave it the works--let me tell you--just turned the pages. I could have had a correspondence still going. This is another thing--when you were executive director, it may well be that the deans were so bogged down in their local scene that a percentage of their time was just unavailable. I didn't have much correspondence with deans. I would have thought that they would have punched away at headquarters-­ I need such and such. What can you do? They'd either go to Lee Powers or Gus Carroll for data. Most of my correspondence was with people outside the medical schools, people trying to promote something. I used to get a lot of letters that weren't easy to answer--! know that. Of course I was still running the National Intern Matching Program. I was running that then too, and that always called, 571 as it does now, for heavy correspondence. Usually letters have to be written carefully because they are in response to some criticism, or some anger, or describing a situation that is difficult to react to. These fellows that get these letters are always going to read between the lines to see what isn't there. They don't make that part of the function, but yet that has had great utility--that intern matching program. Oh, yes, and the data. The data--we get down to the business of correlating the kind of internships students put down for their first choice and then correlate this with data that we have about these students as to the kind of people they are, the kind of students they were, and correlate this with the final evaluation of these people after they have been out in practice for awhile, correlate it with the specialties, the careers they chose, the kind of careers, and where they chose to go for training for these careers. If this is put together and analyzed proper­ ly, this can tell a school an awful lot about the kind of students to pick, and indirectly it will tell them how effective their educational program is. I tried to make this point in my last report to the association. The trouble is in that kind of a paper--well it's the way I've always written, as you may have noticed. It's a fast pass--I go from one thing to the other. I always want each sentence to be related to the sentence before it and the sentence after it, and I find if I try to elaborate on the main idea I'm trying to get across, I've broken into a chain of thought that I never can get back into. That comes through. 572 The way to do is to do a paper like this, and then stand up to some sort of an inquisition and let them try to shoot me down. Then I'm ready to substantiate, or try to substantiate my thinking. That's one thing. I haven't published a lot of these things lately. It just takes too much time to get these kind of things ready for publication. I had other dead­ lines coming up, and I wanted to be able to use some of this same stuff some more until I was really ready. Now then, this affair at the Univer­ sity of California, I thought, "Gee, I'm going to catch it because each of these papers was followed by an hour's period for questions and dis­ cussion. There wasn't--all the questions and all the discussion were very benign. We were tied into community hospitals in the bay area with television, and these people who were supposed to be taking this thing in by television were tied into us by telephone. Well, I thought these practitioners on the staffs of these community hospitals--I'm really go­ ing to catch it, but I didn't. It was just talking over their heads, my wife said. I don't know. I am surprised--these are revolutionary things, and I am surprised that you didn't get bombarded enough. The guy who wrote all that stuff--! looked him up, and he's some pumpkins. He's a neurologist, full time on the faculty at Columbia. Ac­ cording to his bibliography he's done a lot of real research, but he led me to believe, until I looked him up, that he was in general practice some place in New Jersey. He used a New Jersey address, and his hand­ writing was so lousy I couldn't make most of that out, but anyhow, that's where "lets you do this" gimmick came from. I want to read these notes when we come back. Let's go to lunch, shall r 573 You can take that with you, if you want to, because I'm through with it. Here's an item here--you probably know all about them, but talking about data ever since Lee Powers came to the Association we have been putting one of these little bulletins out every month. They also appear in the Journal of Medical Education. Yes. I have seen the ones in the Journal of Medical Education. This, I think, has been a very good way of getting information out in a hurry. How fruitful have these datagrams really been? So far as you can tell? I think they've been quite fruitful. They've been cited not infrequently. Yes, you see them referred to in the literature all the time. Un­ fortunately most of the time they are referred to as they are there, in­ stead of as they come out in the Journal, so that anybody running down a Datagram as a source, they don't realize that they are in the Journal. They used to come out in the Journal about two months, or even three months after they came out this way. Now I think they come out in the Journal--there isn't a lag of any more than a month, and most of the time I think the Journal keeps up with these Datagrams currently. Sometimes they're kind of late getting the Datagram out in which event the Journal may fall behind. 574 In one of the Parran letters I read you make some comment to him respect­ ing efforts which the AAMC might make toward the general public in the sense that the AAMC is best equipped to present the case for medical edu­ cation to the general public. That's a fantastic idea. Well we never really made it. I hired a public relations man. He was at the University of Pittsburgh, Tom Coleman, and he made an effort at getting out news releases and things, but it just didn't work. I frankly don't know any way to get the story of medical education to the public unless it can be through articles in publications like the Satur­ day Evening Post, the New York Times, a really good newspaper, Time Maga­ zine, and so forth. Sporadically publications like this have worked up articles--the Wall Street Journal has worked up a few things, but we haven't done anything--well, frankly for all practical purposes I don't think the AAMC has succeeded in reaching the public. We tried to hire a public relations outfit several years ago when I was just on the Executive Council, and this outfit came up with a proposed pamphlet that would be distributed widely. The council felt that the way in which this pamphlet was put together and all, it would be anything but good public relations, so they cancelled the whole thing out. How about the public school systems--junior high schools, high schools? No consideration has ever been given to getting into even the col­ leges--the pre-med groups in the colleges. Until very recently no organ­ ized efforts have been made to get them. Now the Group on Student Affairs for the past two years has been making a big effort to set up conferences with pre-medical advisers in colleges. This is being done on a regional basis, and an effort is being made to get at the college age people. I 575 don't know whether I can put my hand readily on any of these little bulle­ tins or not. They haven't been coming out very regularly--maybe one or two a year. There's stuff like this that has been widely distributed. We put out a little thing before that that was printed on cheap paper, and we distributed thousands and thousands of those. The AMA distributed a lot of them for us, but I can't put my hand right now on any of these publications that the Group on Student Affairs distributed. I'll make a note to send you some of them. There was not a little ferment going on in the public schools particularly in the basic science programs in this period--changes in mathematics, biology. This came from the National Science Foundation--the foundation financed these curricula studies in physics, in chemistry, in mathematics, and in biology, and I think this ferment was a result of that. It certainly wasn't a result of anything that either the AAMC, or the AMA did. Still an unimproved area. It really is. Get 'em young, or at the least with reference to their stake in health and health care. Of course the public schools--well, when I was in school out in this little one room country school, we had a course in physiology in the 4th grade. For those days it was a pretty sophisticated little textbook we used. Well, I think the schools have really been prevented from doing 576 ' too much in the name of medicine, or health because of the philosophy of the separation of the church and state. The Christian Scientists object. Teaching anything like medicine, or health education in the public schools has been objected to. Even the colleges have done a miserable job of putting on work in health education. When I was a freshman in Boulder, they had a course in personal hygiene that was required for graduation. They gave one course for women and one course for men. I remember the textbook--Fisher and Fisk, How to Live. Well, the student attitude toward this course was such that they just discontinued this course as a required subject after one year. You only got one hour's credit for the course. They gave it on Saturday morning, and this interfered with student activ­ ities. The Department of Physical Education gave the course, and none of these people were really qualified in this area to make the subject very interesting, so when I talk about health education as an area that needs to be developed I mean what I say. I felt that the best place to get this started was in the community hospitals as a responsibility of the medical staff where the staff would say to overweight patients--"Well, there's a series of lectures and demon­ strations going to begin next week, one night a week at the hospital, and I want you and your wife to attend this so that your wife and you to­ gether will know how to work together in managing this weight problem that you have." Or it could be a patient with diabetes, and, "There's going to be a series of lectures and demonstrations on the home management of diabetes" and then there could be lectures organized for the public on how to use this system, the community system, lectures on how to use the local medi­ cal establishment because the doctors and the public could work together 577 on this and help make the establishment more efficient. There could be lectures on how to prevent upper respiratory infections and lectures on venereal disease. Maybe this could be pitched so that the voluntary par­ ticipation of the public would be very considerable, and the staff--and I haven't mentioned this in any of the papers, but the staff effort could very well extend into the public schools. Maybe this would take. The staff effort could very well extend into the junior colleges, and the liberal arts colleges, if there were any close. The climate for health education is better now than it used to be. I'm sure of that--the public is becoming much more knowledgeable about questions of health and medi­ cine and is much more interested, and maybe they will be making demands before very long for health education programs that can't be put on just because there aren't the knowledgeable people to do it. It may be that the times will condition a much better effort, won't it. Yes. Now then I've taken part in several efforts at a high school here and there--to take part in what they call their "career day" when an engineer, a doctor, a nurse, and a banker on down the line will be at a certain place at a certain time to talk to students that are interested in exploring this, or that career. This has never impressed me as being a very fruitful experience. The kids come and listen and ask some asinine questions. I remember the last time I did it some kid wanted to know how long it would be before we would be grafting an extra head on dogs and maybe do this for human beings--well, what was the sense to that? Well he'd read some report that came out of Russia that they had grafted an extra head on a dog--so he said. The biology--the science work in high school and particularly biology 578 in high school and college has been of a very low order until this biology curriculum science study which is pitched at the high schools really be­ gan to have an impact and the textbooks that were developed were far bet­ ter than any textbook that I know of that was being used in college. The objective of this effort was to make it possible for most high schools not only to give a good beginning course in biology, but offer some ad­ vanced courses that would be worthwhile, and kids in high school are tak­ ing biology more to satisfy a science requirement for graduation. Of course these weren't very challenging--well, you couldn't teach biology in a very challenging fashion until the last fifteen years. Until the radioactive isotopes came into the picture and techniques where you could plant single living cells and develop a colony of cells from the single cell, and then the computer came along--you weren't able to introduce quantitative methodology into biology to any very great extent. The quan­ titative chemistry and quantitative biochemistry, the methodologies, were so difficult and so inaccurate really--they did not satisfy the need for quantitative methods in biology until these other developments came along. Now with the microchemistry and microbiology the ultra powerful micro­ scopes, the electronic microscopes, the ability to tag animals with radio­ active charges and follow them through biological systems and particular­ ly the single cell tissue culture technique--this is why biology is flow­ ering now as a science that can be studied from the quantitative stand­ point. Then, of course, the discovery of DNA and its role in genetics, the ability to tease chromosomes apart, and it won't be long before they will be really teasing genes out of chromosome systems. Did the medical schools in their curriculum respond to this change? 579 They were slow--awfully slow. This was brought out in our teaching institute for--well, Ted Puck here, his Borden Award lecture dealt with this whole business and at that time the biologists were very unhappy with the medical schools because they weren't getting people on their faculties that were qualified to back up interests that were being gener­ ated in high school, and I think they still have quite a ways to go many of the medical schools. Other medical schools are considered as having overdone this. The time that is being required in the duplication of ef­ forts in molecular biology has swung too far and is preventing the pre­ sentation of other work in the medical school, so the weakest point now, I think, is in the colleges. A lot of the liberal arts colleges, of ccurse, are catching up with this. There are a lot of them that haven't. They haven't had the money, and they haven't had the faculty. I should think that with the change on the public school level the expec­ tation of a student was enhanced. I don't know the extent to which that was satisfied in medical schools, but I think they would arrive with a better orientation toward biological systems. The speech I'm talking about--oh, it was the Borden Award lecture. Then Ted Puck gave very much the same talk at one of our teaching institutes. This is 1959, Ted Puck got the award for his development of a method for cultivation in vitro of colonies from single mammalian cells. He was the first to do this, and his investigations have derived from this method, so he's planting still single cells--say ten colonies on a plate, ' 580 and he'll expose half the plate to a certain dosage of radiation and the other half of the plate will get no radiation, and he's comparing the ef­ fects and is able really to contribute to an understanding of the levels of radiation that can produce abnormal mytosis. He's done a lot of ex­ tremely important, very fundamental work. What he does--like this single cell technique, he carried that along until it had been picked up as a methodology by many laboratories all over the country, so he quit fool­ ing with it. He turned to something else where he could be the first, and he's never followed through with any of his work beyond the point-­ well he's never exhausted all of the possible developments that could come out of things he's started. He likes to swing from one love to an­ other, and he thinks he's doing more of a service to the scientific world that way than if he tries to wring some one basic discovery completely dry. This may keep him from becoming famous because fame so often comes out of turning up with something that can be applied to some practical problem--like the atomic bomb. The boys that got all the credit, or all the blame, are the ones that just did the last things necessary to make the bomb possible. There were hundreds and hundreds of scientists way in the background who, of course, contributed to this effort without knowing what would come of it. I think Puck should have gotten more re­ cognition for this single cell technique than he's gotten. Maybe he'll get it some day, but he was the first to demonstrate how a virus enters a cell, how it's attracted to a cell and how it permeates the cell mem­ brane. He stopped short of finding out why it is that the virus multi­ plies so fast after it gets inside the cell. He thought, "Other people will do that. I'm going to do something else." You make much--well, the comment you make over the years from the AAMC 581 about the demand, or the pressure that is exerted on the medical estab­ lishment by the public for care. I wondered about this--how is this re­ flected in the medical school, the demand, the pressure for medical care? I wonder if I was speaking in the past--! think most of the time I've been speaking in future tense rather than present. I keep saying, "There's going to be the demand for care." We know the need. The needs have been demonstrated in studies that have been applied to many communities. Well, demand and need are two different things, and the time is coming when demand is going to get closer and closer to the need, and I'm urging people to get ready for this particular day. We know that demands are increasing. Evidence of this demand is apparent from studies the Academy of General Practice has done, for example, on the number of patients seen by the average general practitioner. The Public Health Service has done many surveys that de­ monstrate the increase in the number of patient/doctor contacts a year and all this sort of thing, so that you can demonstrate the increasing demand for care in these terms, the increasing demands on hospital uti­ lization and all this sort of thing. Until lately there hasn't been a lot of consideration given to the significance of these increased patient/doctor contacts,this increase in the utilization of hospital beds. In the case of the hospital a lot of this utilization has been due to false claims because these patients didn't really need to be hospitalized. They entered the hospital for diagnostic studies that should have been done on an outpatient basis, or an ambulatory patient basis. They represent hospitalization for condi­ tions that could just as well have been taken care of at home, but the doctor doesn't want to take care of patients at home. When I was in I 582 practice I have to admit that we were terribly busy and here in a home was a patient that needed to be watched. The family could afford hospi­ talization, so we put the patient in a hospital where we had other pa­ tients so we could keep an eye on them there with less effort than we could if we followed them in the home. We also responded to the patients' demand that they be hospitalized. We didn't have the guts to stand up to the patient and say, "You don't need to go to the hospital. We can handle this outside the hospital." This is still a factor in increasing hospital demands, and the time has come when hospital costs are such that we're going to have to go back to home care, and we're going to have to do more things in the office than used to be the case. Maybe the only reflection of this change will be that the curve that reflects increasing demands on the hospital will quit going up as steeply as it has been, or level off a little bit. From the relative standpoint I don't think we'll ever have enough hospital beds, but those beds will be used much more intelligently. The patients that fill them are going to really have some real reason for being in the hospital, and this is going to be a factor in driving up hospital costs because the needs of these patients are going to be such that it's going to require more equipment and more technical people on the hospital staff. The administrative costs are going to go up because of this, so I don't think that you're going to be able to say that because we did this today, the curve of hospital utilization all of a sudden is going to flatten out. I don't expect that. We'll just create more facilities and they will be full too--utilized. Come back to the patient team idea--there's a pharmacist at the 583 University of California I have to catch up with (Donald Brodie). He had worked out a real exciting proposition for an experiment in team care that he was in hopes he could move down to the University of North Caro­ lina, and the last I heard from him he was afraid that North Carolina people were not going to buy this. I don't mean to say that they weren't interested, and I can see why under the direction of a pharmacist there might be some objection to letting a deal under his direction move into a physician oriented, physician dominated situation. He had conceptualized the approach to the care of patients on a team basis. This was extremely well done, and in order to pass this on to you I'd have to draw a bunch of diagrams and things that wouldn't go with your tape recorder, but I must get hold of him. The last word I had from him-­ he had turned all of this over to an artist, and I hope the diagrams at least are ready to see the light of day. I have hesitated to try and ape what he's done because he's the one that should get the credit, and I hope that he's got it far enough along so that people like myself can make use of it and give him his due as far as credit is concerned. Now, Joe Becker and Tad Mayeda at EDUCOM, the Washington Office, have been in touch with this man in California--his name is Donald C. Brodie, because Joe and Tad are trying to develop a visual method of presenting their ideas regarding the application of medical care to the community and to patients in the community, and these diagrams that Dr. Brodie has developed are just the thing that Joe and Tad need, so they called on him. I haven't seen that they've made any use of this yet, but they know about it, and it is something that I know they'll use eventually. You must have a session with Joe and Tad. Anything they give you should be a part of this EDUCOM development, if you're going to consider 584 this as important in the history of medical education. The implications for medicine in the EDUCOM program are very great--admitting that we've really pretty well given up the idea that EDUCOM is going to bring any­ thing like the recommendations of the Dryer Report into being. The times have changed--as I told you, here's this Mediyi~dica corporation, and it's really going to pick this up and go into business and sell these services that "the University without walls" that Dr. Dryer had would develop on a non profit basis. I wonder from the beginning when you joined the AAMC and over the period that you were associated with it whether the old feeling in America that competition made for progress was true of medical education. I'm reminding myself of something. Long before I went--well, even after I came out here from practice I think I probably subscribed to the theory that the effectiveness of medicine was really pretty dependent upon the private enterprise approach. I think I just gradually began to change, and I can't say just when. I'd have to think about it. As I told you there were two years when I made this financial contribution to this AMA political action committee--they didn't call it that then, but that's what it was--and if I began to change, the first visibility of this was probably about the time that we did this study here with Jack Dodge and Marion Clapper on the distribution of phy­ sician services in the state. I'm just using that study as about the time because that's when I gave this paper to this Colorado Welfare Associa­ tion that was eventually rewritten and published in .§f., and I told you that I had worked into this paper a pretty extensive quote from Dr. Dodge. I think that paper probably marked a change. Then, of course, there was 585 my working paper that I developed for the Kellogg Foundation--I had a lot to say about prepaid voluntary health insurance programs as a way of meet­ ing the total health and medical care needs of a given population, and that was preceded by a little editorial I did by several years--that I have forgotten all about--a little editorial I did for a little magazine that Colorado Blue Shield Blue Cross was publishing. You may have come across that editorial. I picked up part of it in that Kellogg paper--! lifted most of this little editorial in this Blue Shield and Blue Cross publication and used it in this working paper for the Kellogg Foundation. That goes back to when I was Dean here. I forget the year on that. Now, then--! don't hold any brief any longer at all for the--! don't think an effective patient/physician relationship is dependent on this exchange of money between the patient and the physician. There are too many examples of effective medical care where this exchange doesn't take place and still within the framework of private enterprise. You take the Russ Lee Palo Alto Clinic--the father of these Lee boys, and I can't think of his first name. He's in HEW now. Phil Lee. Phil Lee--yes, but I have friends that were on the faculty at Stan­ ford way back when Russ Lee first started this plan, and they said that they never had such satisfactory medical care since. Well, he took care of patients on a fee for service basis, but he also had a little pre-paid insurance plan to which people could subscribe, and his clinic would give total care. The last time I was there Russ said that he figured that within the corporate city limits of Palo Alto, he's sure that fifty per­ cent of the population depend upon the Palo Alto Clinic for medical care, 586 and I believe him. I have talked to many people who have used this setup for care, and I have yet to hear a complaint about it, and one reason is that he'll take care of these patients and their families on almost any basis they want. If they want a straight fee for service--fine. If they want to carry Blue Cross--well, I don't think there is any hospitalization worked into this, except that they use Blue Cross. Their patients that are hospitalized, if they are insured, it's usually a Blue Cross insurance. I think they're tied up with some labor unions also, though I'm not posi­ tive about this. Your Permanente Foundation--this Dr. Turner's son is with a similar pre­ paid health program in Seattle, Washington called Group Health, that's very successful. He's in obstetrics and gynecology, and he likes this way of practice because he has time--he's on duty. He has enough nights when he's not on duty so that he knows that he can get some sleep. He has enough weekends off so that he can have some family life. They make them take time off for postgraduate work, and they have a very adequate retire­ ment plan and a very adequate vacation arrangement. I don't know whether the setup has ever been studied to determine the degree of patient satis­ faction, or dissatisfaction. These kinds of studies should be made and probably have been made. You've heard of the Commission on Medical Care Plans that was chaired by Leonard Larson--! have the reports back there. The AMA was supposed to study the effectiveness and the degree of patient satisfaction with these various forms of medical care--solo practice on the one hand and prepaid volumtary health insurance on the other. This commission couldn't come up and prove that any of these methods, or any of these patterns of care weren't good, or that they needed to be bad because of the way 587 they were structured. That report has been pretty well swept under the carpet by the AMA. You never see the AMA refer to the conclusions of this study. You see people like myself referring to them some. People that make the most use of that report are the ones that want to start pre-paid voluntary health insurance plans, and there's a group talking about it here working with a group of unions. They wanted me to attend the meeting, and I wouldn't attend because they wouldn't invite anybody from the state medical society. I said, "I'm not suggesting that you invite them with the idea that if the state society objects, you won't develop such a plan, but the record should show that very early in your consideration of the plan the state medical society was invited in at least to hear about it, so the society can't get mad at you because of the way you do it. They might not like what you do, but have the record show that these representatives of the medical society have been invited in to listen to this deliberation." They did invite the medical society to send some people, and the medical society did. These fellows were very surprised that these people from this society didn't get up on their hind legs and scream. Well, I happened to know in talking to my friends in the medical society that the thinking people in the society know that this kind of thing is going to come, that there's no use fighting it, and that it isn't going to be too bad, if it does come. I wouldn't be surprised to see Denver doctors be­ gin to be a part of arrangements like this. I mean the leadership of the medical profession. The AMA of course--after they lost that suit in Washington, D.C., the AMA has kept pretty quiet as far as objecting to this kind of development is concerned. Connecticut has passed the enabling legislation necessary to estab- 588 lish the pre-paid voluntary total insurance plans, and the medical soci­ ety up there tried to keep the legislation from going through, but they didn't succeed. I.S. Falk who is on the faculty there at Yale is the one who carried the ball on this. I've had quite a bit of correspondence with him because in the course of these papers that I keep talking about that Anne Somers and I have yet to write--why, we've got to develop an­ other review of innovations that are really beginning to have some visi­ bility, and things like this we need to mention again. We didn't mention Yale in our paper. We mentioned Harvard and Johns Hopkins. Well, of the three institutions, the Yale one has got the best chance of developing fairly rapidly at least, and the Yale University Medical School is all set to make use of this population for teaching purposes. I.S. Falk has had a long continuity with this question. Oh yes, he goes way back--the Committee on the Cost of Medical Care, and then of course he was staff of one of the congressional committees when the Murray Wagner Dingle Bill was up, and his name is really "red" to a lot of doctors. Now there's been no objection, as far as I know, on the part of the Massachusetts Medical Society to the plan that Harvard is developing. Maybe there has been, and I've missed it. The development that Johns Hopkins was contemplating at Columbia-­ this new community between Washington, D.C., and Baltimore--after the whole plan was well out in the open and had been there for a long time the medical society finally came out in opposition, or disapproval I should to say to be fair. Whether this has amounted to any real action T on the part of the medical society, or not, I don't know. The faculty at Johns Hopkins is still, I think, on the fence about this development. That statement in the Darley-Somers papers though was cleared with Russ Nelson, and he cleared it with the Dean of the Medical School and the chairman of the board of trustees of the hospital. I haven't followed up on that. I will. Georgetown University--Dean Rose told me that Georgetown was figur­ ing on getting mixed up with things like this in one or two other brand new communities that were developing within a few miles of Washington, and I haven't heard whether anything has really come of this or not. Stanford, you know, was looking. When it was still in San Francisco it gave very serious consideration to working with a group of labor unions in San Francisco with the idea of developing this as its patient labora­ tory for teaching, and there was enough objection so that Stanford gave it up. That sort of cleared the way for Stanford to move the whole oper­ ation to the Palo Alto campus, and when Dr. Glaser went to Stanford as Dean--you know that hospital there is physically part of the University Medical Center and half of the hospital is open staff. It's a community hospital, and the other half is a closed staff--strictly university hos­ pital, and the two halves of the hospital have never gotten along. I wrote Bob a gratuitous letter urging him, before making any effort to break this up, to see if there was any way at all to harmonize the ar­ rangement so that the private patients in the hospital could really come into the situation as a teaching resource. In the back of my mind I hoped that this could tie in with the Palo Alto Clinic because most of the staff of the hospital are Palo Alto Clinic physicians. This was a--well, I don't know whether any effort was really made to follow in this direction, 590 or not. I know that they're trying now--if they haven't already--to buy the community out, and the community will set up its own hospital, but this could have been a deal that would have filled a great need in medi­ cal education. The feeling between the two groups was pretty strong. There's a limit to healing these wounds within a short enough span of time to do very much. I don't quite get the picture from 1956 through 1964, whether as between one medical school and another in idea, competition in this sense has made for progress in medical education itself. Is there this feeling of competition in program, competition for students--! don't know where it lies. There's competition for students, and that continues and will con­ tinue. There's going to be a matching program for admission to medical schools some day. I don't think--I honestly don't think there is any, and I certainly can't recall any competition between medical schools as a motivation for starting some innovation. The field is so wide open that there really was no call for any. There was no feeling among the schools that I could detect that, n □h we must do this because the Jones have done it. n All innovation I know about in medical schools, as far as its ori­ gins are concerned, came from a school itself, totally from within a school itself. Tailor-made. Yes, tailor-made to existing resources, or developed because all of a sudden a chunk of money was handed to the school provided the school 591 would do this, or that. There is no secrecy about this. The schools have always been very generous. Anybody who wants to come in, or see what's going on, or talk to the people who have been doing the thinking--they have always been very generous. Pete Lee, another son of Russ Lee, is the Associate Dean down at USC, and you saw the study he made of nine schools. He was wel­ comed with open arms, and I'm sure he'd tell you that he sensed no bitter­ ness any place on the part of any school because some other school had done something that had gotten too far ahead of the bandwagon. Except in one instance, or maybe two instances, I can't even recall any criti­ cism on the part of medical educators of an innovation that was being planned in a given medical school. Now the program at Brown was a radical program chiefly because it didn't make any provision for a dean, or a faculty where it could be said, "this is a medical faculty whose activity is limited to a school of medicine." There was a lot of head shaking over this diffusion of this program in medical education throughout the rest of the university. There's been criticism and head shaking at the deal up at Michigan State because Mich­ igan State has done something unique from the organizational standpoint by setting up this--! don't have the exact terms, but they set up a Divi­ sion, or a Department of Biological Sciences within which is the School of Human Medicine and the School of Animal Medicine, veterinary medicine. These various programs are not going to have separate faculties. The basic science faculty in biochemistry is going to serve all of these pro­ grams including the undergraduate program over in the university, I'm quite sure. 592 This arrangement has been the occasion for some criticism. There ~ I are individuals who think that George Harr~ljf at Penn State is getting too far off center with some of his plans, but even so the powers that be in the world of accreditation have not given any of these institu­ tions any problems. They don't dare because the statement of essentials, as it has been approved both by the AMA and the AAMC encourages innova- tion. They don't necessarily encourage such innovation. There's no warning in the statement of essentials that innovation can only go so far. In the essentials that apply to the two year schools, we even wrote in a paragraph saying that it wouldn't be necessary to have a dean whose only concern was the School of Medicine if the university wanted to ex­ periment with other forms of organization. Had it not been for that statement in the essentials the Brown fac- ulty would never have taken a chance with its program. I had to make a special trip up there to quiet down the fear of the faculty that they were thinking about a program that wouldn't be accredited. The president knew that i f he ever had any inkling that there was going to be trouble over accreditation, he was to let me know right away so that I could be- come thoroughly familiar with the reasons and identify the point of dif­ ficulty with the idea that i f anybody could overcome the objection, I could. But there wasn't any trouble. I knew where the criticism was coming from and I knew that it would never materialize in any obstacle. Was it possible for you either in going around, or through contact that you may have had to identify within a medical school, that fellow who in the presentation of his material was thinking in terms of skills instead of a body of knowledge that his students had to receive, creating a learn- ing process different from, say, the one which you had when you went to 593 medical school? Is there that kind of competitive sense? I know, for example, that articles begin to appear in the Journal of Medical Educa­ tion. There was never any criticism of this kind of thinking and planning and programming. I've heard--well, some school like Western Reserve was starting up with something exciting, really all I ever heard were expres­ sions of envy; "I just wish we could do this in our school." I don't know of any school that has combined a statement of objec­ tives similar to the one I outlined yesterday with the organization and content of a curriculum. Most medical school faculties are still preoc­ cupied with the content of curriculum and how to whack this up between departments. If anybody complains about duplication, why then they say "Repetition is a basic philosophy of good education. This is an example of reinforcement that George Miller talks about." Well, I don't think George Miller means to use the word "reinforce­ ment" in th at sense. He do es talk about repetition, but he doesn't talk about the duplication of big chunks of the curriculum as between depart­ ments. He's talking about exposing a student to a learning experience that may involve some repetition of the method of approaching problem solving--that's the kind of repetition George Miller's t~king about be­ cause it is going to take repetition in the use of intellectual tools to become proficient and feel comfortable in the field of problem solving. Part of the criticism is that the body of material that one might have to learn, in the sense that you learned it, is just too much for anyone to learn. Yes--that's just out of the question, and the subspecialties in most -- 594 medical schools are not getting the faculty time they used to have. New York University is the first school I know of to move all of the subspe­ cialty faculty into the graduate area--otolaryngology, ophthalmology. They did away with the departments of ophthalmology and otolaryngology in the undergraduate school of medicine and set these up in the graduate school and in the graduate program. Now this didn't mean that some of the members of these graduate departments didn't come in and do some teaching in the undergraduate school, but these subspecialties lost their identity as undergraduate departments. We've handled it here that way. Many schools have. How I got away with this I don't know because there was a lot of objection to it after it was an accomplished fact. We had a Department of Dermatology that was on a par with the Department of Medicine, and we had a Department of Dtolaryngology that had the same status. A Depart­ ment of Ophthalmology too. Well, in this reorganization I moved derma­ tology into medicine as a division of medicine, and I moved ophthalmology and otolaryngology into the Department of Surgery as divisions, so that the executive committee no longer has somebody representing otolaryngol­ ogy and/or ophthalmology. The head of surgery represents these interests. This form, or organization still pertains here. They've done away in clinical teaching with formal lectures, blocks of lectures that are given by any department, or division. They have this course in human disease--! guess they still call it that, where a committee of the clinical faculty decides what lectures will be given-­ and efforts are made to arrange these lectures in some sort of a reason­ able sequence--and decides who shall be asked, or at least decides what department, or what division will be responsible for which lectures. 595 Well, this was an improvement over the other system. At the same time they put in the block system of clerkships so that students would be full time during their clerkships. They'd be full time while they were taking their clerkships in medicine, and full time in surgery, and full time in Ob and Gyn, so these departments sort of got around what was in­ tended with this systematized group of lectures by giving a lot of lec­ tures to these small blocks of students. The departments took up a lot of their time with lectures, and this process would be repeated with each group of students as they came in. After awhile I think most of the departments recognized that this wasn't very effective, wasn't proving to be very effective. There are two or three departments here where I am close to the department heads, and they've cut this out. What they do now is what I did when I had charge of the junior clerks. We'd be at the bedside and be dealing with a patient with diabetes, we'll say, and it was apparent that none of the students had yet developed any working knowledge of how to prescribe a diet in diabetes. At the bedside we'd reach the point where it was per­ fectly apparent to me that we'd better move over to the classroom and talk about this because we were dealing with a patient where it was ne­ cessary to develop a prescription for a diet. I objected to using these diets that came out from the drug houses. They published little pamphlets-­ here's a diet for a patient of such and such a sex, age, and weight, and here's a selection of diets that the patient can set up for himself. I wanted the students to determine how many total calories this patient needed, how many of these calories should be carbohydrate, how many should be fat, and how many should be protein so that the students could learn how to use a table that, in turn, the patient's family could learn to use, 596 so that the students could learn how to give this patient some flexibil­ ity as his meals were planned. In cardiology frequently we'd find a murmur that the students could­ n't explain. I never wanted the students to get the idea that they were going to make a diagnosis of a heart condition because they could put to­ gether a bunch of symptoms and physical findings that they had memorized. It made it exciting to teach cardiology by teaching the students to iden­ tify a given murmur, time it properly, and so forth. Then, they could ask themselves and answer the questions as to why this murmur is pro­ duced--what's the physiology of this murmur, so we'd go high-tail it to the blackboard, and we'd work this out. This is why the students liked my teaching because I got them away from the idea that they were going to memorize the items which were in­ volved that had come together in a certain combination and then down here it would all add up to auricular fibrillation, or some other heart condi­ tion. It's easier to teach medicine this way now than it was then be­ cause we know more about the anatomy of illness--! mean the pathological physiology, et cetera, et cetera. There's less and less excuse now. I doubt if students, or faculty, either one, expects medical students to function on this basis of memorization anymore because the body of knowl­ edge that you would have to memorize and always keep at your finger tips is just recognized as an utter impossibility. This means learning to use the library. It means learning to tell when a paper that's published in a journal is based on inadequate data, or data that's been put together improperly, that is presenting conclusions that are not justified by the data. That's what I mean by intellectual skills, and if we can develop good, solid, intellectual skills in these students by the time they grad- 597 uate, and they've had enough experience studying concepts and knowledge so that they appreciate the importance of developing these skills--that's all I ask for. Does the accreditation process have to do with how a thing is presented in a medical school, or just what? These people come in--they're usually considered senior citizens in the field of medical education. A given team may have a neophyte along because we know we have to keep feeding fresh blood into this activity. These fellows really are just free to use their judgment. Now the books of information that these teams get a couple of weeks before they make a visit--there used to be about two books about that thick--each depart­ ment would fill out a questionnaire that would be fifty, sixty pages in length. Well, the accreditation team members were supposed to study all this before they'd make the visitation which was wishful thinking on any­ body's part that thought they were going to do this. Then the team splits up--two people will take on pharmacology while two other people take on anatomy, maybe. They have to split up. Until recently they tried to cover the waterfront in every school, visit all departments, all divi­ sions, talk to the heads of all departments, all divisions and then go over in the hospital and go through the wards, surgical and medical, and then look at the outpatient department, the library, and the animal quarters. The team would do this in a period of four days maximum, so these people on the team would ask the dean what his main problems were, and the dean was usually glad to talk about this. Then they would go to these department heads, "What are your main problems?" and they'd try to get a pretty vivid picture of what these problems were. 598 It was usually fairly obvious as to what was needed to cope with these problems--not enough fulltime people on the faculty, a faculty too small and therefore this discipline and that discipline couldn't be taught adequately. The report is written purely as an expression of a collection of judgments. They quit counting the microscopes and the bricks and the walls--well, they never did that though they counted micro­ scopes. They recognize if a library is completely inadequate to the edu­ cational programs that exist in a given school. A librarian can tell you all about it because the librarians are very much concerned when they don't have a library that measures up to the library in the next school. This might be an instance where there was some feeling about differences between the haves and the have-nots. Now then the accreditation teams quit this. The questionnaire that the schools fill out has been abbreviated, or is being abbreviated with the idea that what the school says about itself automatically is made an appendix in the report that is sent to the dean and the president. The concern of the accreditation team is limited primarily to the problems the school has, but they are also concerned about the goodies, the things the school is proud of, the innovations that are going on in the school. These are beginning to appear in a separate section of the accreditation report, and I think the reports are becoming more and more useful. The deans and presidents use these reports when it comes to putting pressure on the legislatures and on the boards of trustees. The reports are confidential as far as the AMA and the AAMC are concerned. The schools, the universities can do anything they want with them. Now in this stuff you read you saw the term "a living survey of medical educa­ tion," and the AMA people and the AAMC people frequently talked about the 599 desirability of identifying the areas that would be thoroughly surveyed over a period of two years. These areas would be gone into in depth. It might be a hard look at the way in which a medical care plan was fi­ nanced, the way in which patient care was financed, and the relationship of this to the fulltime salaries, or it might be a hard look at the salar­ ies of the fulltime faculty and the composition of the fulltime faculty and the way and the extent to which the volunteer faculty might be used. This would be a big area that would be studied exhaustively over a two year period in every school that was visited. Then attention would be given to a sample of schools that would be visited in this two year per­ iod to be sure that the study effort would be a fair assessment of the situation that pertained generally. Then this in-depth study would be published every year, or every two years. We always talked about this and never got around to it. It's still a good idea, I think, and maybe they're still talking about it and getting closer to it. I haven't discussed this with anyone, but this was men­ tioned, I'm sure, in some of these foundation applications and in some of these memoranda. It was talked about practically at every meeting of the liaison committee on medical education. This is a joint committee of the AMA and AAMC that is responsible for accreditation. This joint accreditation developed early in World War !--before my day, and the Armed Services really brought this to a head because there was an unapproved school near Boston--! guess maybe it was the only unap­ proved school; well, there were two or three unapproved schools. The graduates of these schools because they had graduated from unapproved schools weren't eligible for commissions in the medical corps of the Armed Services, and they were squawking about it, so the Armed Services 600 wanted a quick review of the existing non-accredited schools to see i f any of them really should be accredited. Since up to this time accredi­ tation was an isolated function of the AMA on the one hand and the AAMC on the other the school had to be accredited by both bodies and inspected by both bodies. For some time the inspection had been a joint effort, but the action had been separate, so it was decided then and there to set up this joint committee approach to accreditation where the committee would make the recommendation that still had to be acted upon separately by the two agencies. Then when the commission on accreditation came into being about 1956, and I've got quite a story about that, the commission decided that in each area, each academic discipline, they would only re­ cognize one accrediting agency. This accreditation business at that time was really a mess, parti­ cularly in the area of teacher education where there were three, or four different agencies accrediting the same program. It was at this time that the liaison committee on medical education officially became the ac­ crediting agency in medicine. Now then, if the time ever comes when the AMA will accept the recommendations of the liaison committee, that a given program be accredited, and the AAMC refuses to, nobody knows what's going to happen. It isn't apt to happen because this liaison committee has worked so well. We just know that if there was any open disagreement, or any trouble that resulted in a given institution getting accredited, why the two agencies would be in real trouble in the public eye. Really, the commission on accreditation has used the methods of accreditation in medicine and presented it as the one ideal approach to accreditation. Now while there may be many faults to the fact that we haven't a well considered statement of criteria that are applied when ws accredit a 601 school and all, the accreditation commission has always felt that we do the best job of any of the academic disciplines that have to be accred­ ited. This commission on accreditation came into being after Dr. Gustavson left here as acting president and went to the University of Nebraska as chancellor. Right at the end of the war--well, the University of Nebraska had closed its law school during the war and started it up again at the end of the war with a young faculty. The school had a curriculum that was way out in left field so far as the practicing lawyers were concerned, and the American Bar Association which still controls the accreditation of law schools, sent a team in to look at this school. The team didn't visit the school, didn't talk to any of the faculty, didn't talk to the dean, or to the president. It talked to the lawyers downtown and went home and discredited the school. The President of George Washington University had been concerned about accreditation matters, so he and Gustavson got together on this. About the same time the AAMC and the AMA sent a team to look the Univer- sity of Nebraska School of Medicine over. I went along because when I was president here, we knew the school was in bad shape, and we knew about this law school fiasco, so I went along to be in a position to be of any extra help possible because of my long association with Gustavson. We found things there at the medical school that just compelled us to put the school on probation. Gus took this fine when we talked with him. He wasn't surprised, I'm sure, and he immediately moved in on the recom­ mendations that were made. Nevertheless, he used this experience along with the law school episode as the reasons for his and Dr. Marvin's rea­ sons for recommending to the AAU the establishment of a commission, a 602 national commission on accreditation, so as to compel some order in this whole business. Then we met with the commission, after it was established. I went along to make darn sure that the commission understood what we were try­ ing to accomplish with our accreditation visits, and we never had any trouble with the commission. Now then, we made a big point of advertising that we were using ac­ creditation as a means of providing consulting services. We learned early in the game that when we knew a school was in trouble the thing to do was to have the executive director of the AAMC and the secretary of the AMA Council on Medical Education visit the school so that we would have advanced warning of what the weaknesses were and so that the dean and whoever he wanted in on this at the school had a good idea as to just what was going to come out of a visit. The staff came back with a first­ hand appreciation of how the dean wanted to correct these deficiencies, or how he thought they might be corrected, so that our visitation could jibe with what the dean hoped to do. The only place we had trouble was Seton Hall in New Jersey. We never should have accredited that school in the first place. This trouble always centered around the hot political situation in Jersey City and the relationships between the Jersey City Medical Center and Seton Hall Uni­ versity. Nobody ever was able to do what they promised to do. Things got so bad that Seton Hall gave up and sold its equipment and so forth to the State. Then the State took Seton Hall over, and it's now the New Jersey Medical College, or the Medical College of New Jersey. They're still having trouble because of the political hassle over the location of the school. Well, this prevents any satisfactory development of clini- .. cal facilities, you see, for the students. This Seton Hall business is about the only thing I watch in the agenda materials that come to me from the AAMC. This is really a toughie, and I don't know what will come of it. I know this--that in spite of all of this difficulty the graduates of Seton Hall Medical School--well nobody can say that they don't do well in their internships, or in their residencies. The school hasn't been in existence long enough for too many of them to be out in practice, but nobody can say that the contributions to the medical manpower pool that come out of Seton Hall haven't strengthered the manpower situation, and this shows how futile almost, in medicine at least, accreditation with a view of putting a school out of existence can be. Now they always go up to the Dakotas, and they come away unhappy about the two year schools that are there, the handicaps under which they operate, and the fact that a few of the students at the lower end of the grade spectrum have a little trouble getting into a junior class of a medical school someplace. They always get in someplace, and there's no evidence that shows that these transfers don't do well in medical school and well in their internships and their residencies, or that they don't make an important contribution to the total national effort in medi­ cine. The commission on accreditation never discredited the schools. They have put them on confidential probation from time to time, but the development that is really needed up there in the Dakotas is strictly in line with the proposal for the four states, and I'd like to see the two Dakotas invited to come into this four state consortium. They've already got two year schools, and this fact would mean that they'd bring a know­ how resource into this consortium effort maybe, but they would be years 604 ahead of the other four states. I know there's interest in South Dakota in moving into the four years using community hospitals as recommended in this proposition for Idaho and the other three states. Let me go back again to the theme--has there been progress in medical education as a consequence of competition between the national agencies like the AAMC, the AMA, the AHA, George Bugbee, the General Practitioners, or any other national agencies? I don't think that any of this competition has interferred with progress. Now then I have to qualify this. The AAMC, the AHA, the ADA, the dental association, and every other agency I can think of--I think the Academy of General Practice might be an exception--have never been at loggerheads over big socio-political issues. When the AAMC was in favor of federal support of medical schools, this wasn't fought by the AHA. The ADA went along--they wanted that kind of support for dental schools. The AMA and the AHA were on opposite sides of the fence on this question of federal aid. They're ~till on the opposite side of the fence regarding the manner in which residents should be reimbursed and the source of this reimbursement. The AMA does not want this reimbursement to come out of professional fees, and the AAMC feels that this is what should be done. They're still--! think they're on the opposite sides of the fence regarding federal loan funds for students. Other than that there is no real open conflict between the AMA and the AAMC. Now the Academy of General Practice and the AAMC--this has been a source of sorrow to me. The academy has asked for the establishment of a committee that would serve as a liaison function between the medical schools and the Academy of General Practice. They have asked for this 605 several times, and I have always recommended it, but the AAMC Council would never go along with it. The reason offered is that the liaison between the AMA and the AAMC is all that is necessary because the AMA is the professional organization that provides an umbrella over all prac­ ticing physicians and their interests. Well, this doesn't satisfy the Academy of General Practice and never has. 1 When I left the AAMC, the Academy of General Practice had established a foundation called--well, first it was just the Academy of General Prac­ tice Foundation. Now they've changed it to the Family Health Foundation of America, and it has its own board of directors. There is duplication in membership on the board as between the foundation and the regular academy. They came to me because they knew I was sympathetic to a lot of their problems even though we've argued over the years. They wanted to hire me as a consultant to the foundation on a retainer fee basis. I told them that I didn't want to do that; that I would serve as a consul­ tant, but that I didn't want to be obligated as to a certain amount of time and effort because I just didn't have that kind of time and effort to give. I just didn't want to be tied to any agency on that basis. Well, they accepted this, and I worked with them wholeheartedly. We set up a series of regional meetings, workshops to which medical school people would be invited. The Academy of General Practice leader­ ship would be invited, and some of the local practitioners would be in­ vited. We had four of these--two here, and one in Chicago, and I forget where the other one was. At my suggestion they had stenotypists there, and they got down all the discussion. The academy, or somebody paid to have all this indexed, and I had the index here for a long time. I in­ tended to write a review of these regional meetings, and I just never 606 could get around to it. I'm glad that I wasn't on their payroll because I would have had to write this review. At this meeting a year ago in February in Chicago that the foundation held--and you have the report of that meeting which came out as a special supplement of GP and which is really all of the printed visibility of this regional meeting effort. This index is going to be very valuable to somebody that really wants to dig the thinking out that went into these meetings. I have the transcripts here of the meetings and I'm sure that the academy would be delighted for me to turn these over to the National Library of Medicine, and I'm also sure that they would be delighted to turn this index over to the National Library of Medicine because if somebody wants to use this material for a master's or a doctor's thesis--here it's all set up for them. A lot of good ideas came out of this. I think you saw probably the series of questions I developed to be used as a basis for the discussions. I was never able to hold the participants to this series of questions at least in the order in which I had them. I had them in a pretty logical order. If I could have followed the logical order, I was in hopes of getting academic people at these meetings almost without knowing what they were doing to back into admitting that the medical schools had to take some responsibility in meeting the problems that we had under dis­ cussion. We were able to identify some schools where this concept of education for comprehensive continuing care had a chance. Now then, I got the Executive Council of the AAMC to agree to act as a co-sponsor with the foundation of these regional meetings. I knew their heart wasn't in the agreement to do this, but they did it because it was the easiest way to get rid of me and I'm glad for the record that 6U7 the AAMC's Executive Council did this. Referring to this participation I've never said that the AAMC did this; I have said that the Executive Council of the AAMC agreed to this. This Jim Bryan--do you know him? He's in Washington--he's prepared a report of these meetings that he wants the Academy of General Practice to publish, and as far as I know it's still on Mac Cahal's desk. I've talked to Mac about it, and somewhere along the line I think Bryan and Mac have had a falling out. I can't be sure. They paid Jim to come to these meetings, and the contract was satisfied when Jim read the paper at this meeting a year ago last February which was, I think, the second paper in that supplement. Now Jim has this other paper that uses these meetings as a point of reference, but it's still pretty much his own ex­ pression of his reaction to these meetings. He's used as source material a lot of things that were in the literature that had no direct relation to the meetings. In his letter to Mac when he sent this paper in, he in- dicated that he still considered it his privilege to use these transcripts in connection with writing a book that he has in mind writing. Whether he's doing anything about this, or not, I don't know. I don't think he's received either a letter of approval from the Academy, or a letter saying he can't do it. If I were he, I would go ahead and do it, i f that's what I wanted to do. Now these transcripts--there's quite a pile of them. They're down there, and as you went through that stuff you may have seen them, and they're worth putting in the National Library of Medicine, particularly if I can get hold of this index for you, or at least a duplicate of it. Certainly the AAMC generated a research program with reference to medical education, and the program had implications for hospitals, for general 608 practitioners, for the medical profession generally. I wondered whether the fact of establishing a research program guickened interest in research in these other agencies? I think it did. Now just to prove it. The AMA has hired Charles Hudson who was past president to come in and take charge of their divi­ sion of patient care, or medical care. Now here's a thoroughly broad­ gauged, liberal individual compared to anybody else that I know in the AMA, and he's tried to hire Paul Sanazaro to come in and take charge of a project in research in patient care. Paul gave this offer very ser­ ious consideration. It was a choice between this and a job I understand he's taken with Bob Marston in Washington. I'm sure he would have gone with the AMA, if this job with Marston hadn't materialized. Now Charlie Hudson--this isn't in writing anyplace. Yes, it is--I think I can find the letter. After he took the job, he wrote me saying that he wanted to see me because "after all, one of the reasons I've taken this job is because of the past conversations that you and I have had. " I went out of my way to see him the next time I was in Chicago, and he honestly believes that he can get the AMA to do something of a posi- tive nature in this field. I've got to be shown because they drove Pas- tore out and Charles Edwards, who was an old student of mine. Edwards was head for awhile of the division of socio-economics which has been taken over now by Charles Hudson under this new name. Charles Edwards left because things were too conservative for his blood. I know Walt Wiggins from time to time has been very unhappy at the AMA because things he wanted to do were just not possible, and I know how unhappy Ed Turner was there. The AMA gradually may come around to a more liberal viewpoint. My 609 goodness--look at its decision to support the idea of federal funds for medical schools! I never thought I'd live to see this day. The AMA lost its best opportunity to really improve its public image when it didn't move right ahead with this center for continuing education. That was the big thing that the AMA muffed, and I was fool enough to think for awhile that the AMA would pick this ball up. I think I could have gotten a dif­ ferent kind of motion through that meeting that the various agencies spon­ sored when that Dryer Report was presented, but it just seemed so reason­ able to me. The AMA up to that point, the men in the home office, seemed so enthusiastic about the report. The AMA had the funds and could have hired the staff. This was run under the foundation the AMA had set up, and the foundations would have gotten behind it, I'm sure. I didn't tell them that I would be willing to move over and be a part of this, but if they had really taken hold of it in decent fashion I think I would have. As I look back--that's when EDUCOM should have been started, or something like it. 610 Wednesday, April 17, 1968, 7002 University of Colorado Medical Center I want to take you back to June 5, 1964--I'm not sure of the place, but people like Henry C. Meadow, Thomas H. Hunter, William N. Hubbard, Wil­ liam G. Anlyan, Bob Howard, James G. Miller, Bill Maloney and yourself. All right--now, first this was the initial meeting that was respon­ sible for EDUC0M getting underway. It was first called the Interuniversity Council for the Advancement of Educational Methods. Yes--I've forgotten the fancy name. Where was this meeting held? Does it say? I'm not sure. It was in connection with some other meeting--well, I'm not dead sure. It will come to me, particularly if I can see the document from which you took those names. Tom Hunter .••. Well, Tom Hunter first--we knew ahead of time that these people, that these were the only deans in our own mind that we could identify as having any responsible sense of this idea about this centralized agency concerned with continuing education. Tom Hunter is one of the most intel­ lectual people I know. He's the Dean of the University of Virginia down in Charlottesville. He had polio after he was grown, so he's paralyzed from the waist down. He's on crutches. He can stand leaning on the crutches because of the braces he wears, and he's a shooter from the hip Alme 611 fellow. When he gives a paper, of course, he comes there without any notes, as near as I can tell, and unless you catch them with a stenotyp­ ist, you don't get them. He is willing to produce them again, but he grumbles about it. It's tremendous--the way he can proceed to talk about things he's thinking about. His ability to express himself is really something--a great sense of humor. For an able administrator, he's pretty casual. I've been in his office and his desk and everything in the office looks like the top of that bookcase, but everybody feels, "There is the kind of a guy"--well, the morale is always kind of good wherever he is, and the Medical Center there sort of runs itself. To have him interested in this development was a tremendous help because he's extremely well thought of. He's a graduate of Harvard. He was in the same class at college as John F. Kennedy. He's on the Board of Visi­ tors of the Harvard Medical School--he may still be for all I know. As President of the AAMC, he was terrific. He and I always kind of thought alike, and whatever I wanted was usually all right with him. On the other hand, if he ever disagreed with anybody, he didn't hesitate to put his thoughts out. Another one is Bill Hubbard who was the Dean of the University of Michigan. He'd been Assistant Dean at New York University and had been employed as a fulltime assistant secretary of the AAMC before the war started. Then along came the draft, and they needed him at New York Uni­ versity and anyhow, if you tried to make the switch, they would immediate­ ly draft you because in those days when you changed from one job to an­ other, the moment you left your home base job, you were available, so he never came to the AAMC as assistant secretary. That would have been a terrific thing for the future of the association if he could have come, 612 I think, because he's a natural born leader, very articulate, thinks 1, 2, 3 and expresses himself in that fashion. The medical school of the University of Michigan has really gone places under his leadership. I don't know how close he came to being selected president of the Univer­ sity of Michigan after his term expired, but I know his name was on the list and was being considered very seriously. He's the one I told in no uncertain terms how I felt about his being unwilling to take what I thought was the most important post in the world in medical education, the Executive Directorship of the AAMC. I told him that this really hurt, but he didn't think the job was that important. He--anyhow, he was all for this and contributed an awful lot. He was the Treasurer, and he dropped off the board a couple of years ago because he felt that he had done about all he could for EDUCOM. He'll still be heard from. He's quoted frequently. He writes a great deal, speaks a great deal. I don't know how long a bibliography he's got, but it must be a long one. Bill Anlyan--he was a newcomer to the dean's field. He's one of these Markle Scholars, a very active Markle Scholar too, and probably he's the one who prepared the citation when I was given the medal of the Markle Scholar. He was all steamed up about this EDUCOM idea right from the start. Part of this, in fact, a great deal of this, was getting un­ derway down at Duke University involving the hardware and the software upon which EDUCOM thinking and planning of programs was going to depend tied in with what was called the "Science Triangle" there--Duke, North Carolina, and the State University of North Carolina. He was active enough, and he was a fellow--if he's made up his mind that something should happen, he doesn't make any bones about starting the ball rolling. He's the guy who will make the motion to get the discussion off dead cen- T 613 ter, and he doesn't wait too long. Maybe he doesn't wait long enough. In any event, he's a pusher. He was a big help, and he was obviously the one to make the first president of EDUCOM--I mean the first chairman of the board. He's still chairman of the board, and things move right along whenever he's chairman. He doesn't let things ride. He doesn't let talk, talk, talk pile up too much. He's an old arthritic. He has a rigid spine. He's all bent over. It must be completely quiescent be­ cause he never rests, has got more things going on. Duke has become a very exciting place under his direction. There are lots of innovations going on. What's another name now? Bob Howard. Bob Howard--! wanted somebody in the family of deans to come out in the open and be the one guy responsible for getting this thing started. I didn't want that person to be me. I wanted it to be a worker in the vineyards, and I paid Bob Howard's way to Chicago to come down and talk to me about this well ahead of this meeting. I had quite a file made up for him to take home and study. For some reason or other--well, the University of Minnesota has that Kellogg Center up there in continuing education which has been a big deal with the medical school up there for a great many years. They have this fellow Al Sullivan in charge of it, and he does a superb job. He's still quite a young man, and somebody ought to be picking him up for a dean, or a director of a regional medi­ cal program. He's on my list to come down here for this four state deal when we get down to cases and start looking for a director. If I help with that, it can't be as director. It will have to be on a consultive 614 basis because I have got to keep myself so situated that when I'm get­ ting tired enough so that this heart starts acting up, I can stop. I can tell now ahead of time that it's going to begin to act up, and I find if I just quit and sit in my big chair at home and get some sleep, ! I relax, why, I can get ahead of this thing. I can't have a meeting sched­ j I I I uled and work scheduled for me in such a way that I just can't take care 11 of myself. Well, dog-gone--Howard hemmed and hawed over this for about a month, talked it over with his president whom I had known for years, Meredith Wilson, who was dean of Arts and Sciences at the University. Wilson and I were the ones who did all the dirty work to get WICHE started. We did the first draft of the by-laws, and we did the first draft of the com­ pact--by golly, old Meredith thought this idea of a continuing educational center--he just didn't think anything of it. I was counting on him to I 1 I back Howard up into pushing into this. Well, Howard said, "Nothing doing." Howard came to one more meeting. He dropped out, but he's an able fellow. He would have been a good one to do this, if he'd felt so in­ clined. Who else? James Miller. Jim Miller is a phenomenon. I don't know whether you know him, or have ever met him or not--James Miller. He's a psychiatrist, and he was at Michigan and head of a research institute not in the field of mental health as much as an institute for having to do with basic research in processes. I never understood just what all it's about, but it's a big deal. Hubbard was very unhappy when EDUCOM business began to wean Jim 615 Miller away from this thing. Jim has written extensively. He was our source of information, concepts, and ideas as to how to proceed with the development of EDUCOM from the standpoint of programs that might be pos­ sible to EDUCOM, the role that EDUCOM might play. Without Jim we would have been a one horse outfit from the standpoint of ideology right from the start because he made us see from the beginning that what we were thinking of was so much bigger than medicine and so different. He was the one that really made the thinking of EDUCOM move. Then--he wanted to be president, I'm sure, and the board felt he shouldn't be president. From the scientific standpoint he had too much to offer to be tied to a strictly administrative, promotional post, and moreover the board felt that he wasn't the administrative type. He would get diffuse in his--well, he'd cover too much ground too fast when he started to express himself on a certain topic. This fellow who took the presidency, Edison Montgomery--I've never seen anybody his equal--to listen for a little while, or to go through agenda material and quickly pick out the core thinking, the things that were really pertinent, to summarize this in succinct fashion, and to be ready for somebody to make a motion that could really be stated in get- going, meaningful, directional terms like he can. I can well understand why the Chancellor of the University of Pittsburgh wanted Montgomery to come back as vice chancellor because every chancellor, or president has to have somebody like this, or several people like this, if their office is going to function effectively. Jim Miller then became acquainted with Harold Enarson who had gone to Cleveland as president of the new Ohio State College. That isn't quite the name of it in Cleveland--Cleveland State College. This state 616 college took over a little, private institution there, so it didn't start completely from scratch, but as far as educational philosophy, ob­ jectives, and so forth were concerned, or commitments to any program were concerned, Harold Enarson was able to start right from scratch. Now Harold Enarson was the second executive director of WICHE, and I got him to take the job. He and I were always together at Boulder be­ cause the office of WICHE was moved out there when Harold took the job. Harold went from there to be vice president of the University of New Mex­ ico, and while he was down there, he was off on special assignment most of the time; one year for the Ford Foundation in South America, and anoth­ er year for AID doing a special study of education. I don't know how he and Jim Miller got together, but anyhow, Jim sold him on the idea of set­ ting up this Cleveland State University in such a way as to make exten­ sive use of the new developments in programmed instruction and data pro­ cessing, data banks, working this into programmed instruction, and all that sort of thing, and I don't know how things are going at Cleveland State University from this standpoint. This is going to cost a lot of money, but as I meet Jim--he seems very happy. He's academic vice presi­ dent down there, and he's pretty well withdrawn now from the detailed, short stroke kind of research he was involved in up at the University of Michigan. Now, he's our principal scientist. He's vice president of EDUCOM, and while he isn't on salary, he's giving an awfully lot of time to EDUCOM, and what arrangements are being made, except pay him for out of pocket expense, I don't know. He's reached the point where he's so involved with what he's doing that he doesn't want to join EDUCOM on a fulltime basis. He's found a fellow--! forget his name; he's associated with MIT--who is sort of filling the post of principal scientist for 617 EDUC □ M. This man Jordan Baruch--just in the short time he's been president he's pulled together a tremendous staff. I think things are going to move much faster and in a much more reasonable fashion than they have moved to date. We were diffuse in our interest, and a lot of the pro­ grams we were picking up were picked up because of the availability of funds. This fellow Baruch is not going to be subject to that kind of in­ fluence, and when you read his statement of what he considers the role of EDUCOM, I'm convinced that he's going to see to it that our programs stay consistent with that statement, provided the institutional members when they meet next month in Chicago will approve this as a statement of EDUCOM's objectives. Who else? Bill Maloney. Well, Bill Maloney I had brought in as a second associate director of the AAMC. He was down at the Medical College of Virginia as Dean of the Medical School, and he is the one who brought in most of the fulltime clinical faculty down there. Under his leadership they developed a rather exciting new curriculum down there patterned somewhat after the Western Reserve Curriculum but by no means identical. Then he began to have trouble--trouble was generated internally, partly because the state chap­ ter of general practice felt he wasn't cooperative enough as far as us­ ing the general practitioners who were on the faculty, or appointing new general practitioners. Finally the president of the college appointed a general practitioner as the professor of surgery without consulting Bill Maloney, so Maloney had no choice in the matter but to leave. He 61 8 made a good associate director because Lee Powers, as I told you, had settled down to the point where I was using him as a staff person. Mal­ oney I could turn loose, and he could go to meetings, make decisions on the spot. He was much more articulate, much more imaginative, and he made my last two years at the association much easier because I could use him in this way. I turned all of the accreditation business over to him, and this took an awful lot of his time. At first he found it inter- esting. I told him that he would tire of this job, and by the time he tired I hoped I'd be able to have worked out some other way of handling the accreditation business so he could be free for other things. He was there for just one year, not two, and then he stayed a year after I left and went up to Tufts, in Boston as dean. He dropped out of the EDUCOM business when I retired. He sort of just came in to be with me. He is up at Tufts, and since he's been up there I don't think he's even been in a position, or even had the inclina­ tion to become a part of a thing like EDUCOM. He's doing very well at Tufts. He took over an under-financed, under-organized institution. The medical school neither owns nor controls a hospital, so he has a mean job. Anybody in a medical school in Boston is going to have a hard time oper­ ating under the shadow of Harvard, and they all realize that. Now Robert H. Ebert, the new dean at Harvard has gone out of his way, or did for a while, to try and work out a nice working relationship up there, but I'm afraid that effort has kind of run down just because everybody--all of the deans of all three schools have just got too busy. Now the Board of Directors of EDUCOM--Hubbard is off, Tom Hunter is still very active, Anlyan is still very active, Howard has dropped, Maloney dropped, and Jim Miller, of course, is still very much in the --- 619 picture. We had all kinds of meetings after this. Just this group, or with others? We added the Pittsburgh people right away because they came to me independently, to try to get something started not knowing that this was underway. Montgomery? Yes, Montgomery and he brought Dryer with him because Dryer had been made a professor at large at Pittsburgh, and his job was to coordinate all of the communications development there. This didn't last very long. Right from the beginning the addition of Montgomery to this working group--well, that saved our necks. He was the finance man. He was the finance man, and he also conceptualized all of this be­ cause he was in charge of all of the computer communications development at Pittsburgh, and Pittsburgh is quite a center for this; in fact, he was responsible for getting a lot of this going at Pittsburgh, so he brought a lot of know-how as well as an administrative ability and organizational ability into this effort. He's treasurer now, and he'll still be contrib­ uting in a big way. The purpose of establishing the corporation was to become, or create a legal entity which could seek •••• Funds and make contracts, hire and fire. You wrote a letter to the Kellogg Foundation I believe on December 30, - 620 ~1_9_6_4_-_-_l_e_t_'_s_g_.o_ _b_a_c_k_.__Y_o_u_w_r_1_·_t_e_a_n_a_r_t_i_c_l_e_w_i_t_h_a_D_r_._A.;..;r_t;..;.h..;.;u::;;r=--.::::C:.::a:..::i=.!.n.!_t~h!..!.Sa.!:.t, in effect, said, or at least sketches, outlines .... Well, at least that article conditioned a lot of people to this kind of a development. Now the immediate impact of that article by Cain and myself was this Dryer study and then the Dryer--the impact from the Dryer study got misdirected to the AMA. EDUCOM came into the picture because Jim Miller personally just felt by golly something like that National Academy business had to get underway. Because of the Cain-Darley article he just wouldn't leave me alone. We'd become acquainted because of what he'd had to say at all of the teaching institutes. As I say, I was feel­ ing lousy at the time. I didn't want to do this. I just didn't feel like starting something new. Jim understood that if I'd call these peo­ ple together, he'd do most of the work. Well, you know how it goes. You get in the swim of the thing and we--Jim, Tom Hunter, Bill Anlyan, particularly Edison Montgomery, Bill Hubbard--he stayed with this in an intimate fashion--and myself--this was a team effort, and I just didn't sit to one side as I thought I would do and let·somebody else pick up the ball. The bunch wouldn't adhere to it. They wouldn't let me get out, and I began to feel better, and particu­ larly when I saw a chance of something really happening, but Jim Miller is the one that is responsible for it. The early--he provided the early push to EDUCOM, and that's why it isn't quite fair for Edison Montgomery to say that Ward Darley started it. I called these people together. This was the first visible effort, perhaps, but before anything has any visi­ bility in this business there's always a lot of things that have to go on first. 621 The funding is related to a letter which you wrote to the Kellogg Founda­ tion. I made the initial contact. Jim Miller, Bill Hubbard, and I went to Michigan, to Battle Creek, and we spent a whole day with Emory W. Morris and his staff. That meeting took place pretty quick after this first letter went to Morris. Maybe that was hand delivered at the time of this other meeting--l'm not just dead sure. It could be that we went up there without a document having proceded us--just to find out if there was enough interest for us to go to the trouble of preparing a document that would be an application. Well. there is a difference between •••• Now I can straighten this out by going to my diary. No, I don't have a diary on thiso This was before I started a diary. There is a difference between your letter of December 30th and their re­ ply. Their reply takes your request for a sum of money and multiplies it by five--giving you a five year grant to get this off the ground. In my letter, did I ask for a hundred and fifty thousand a year? I think so. Then this visit preceded the writing of that letter because we went up there and asked for seventy five thousand a year, and after our meet­ ing Emory said, "The only trouble with your thinking is that you aren't asking for enough money. I think you should ask for a hundred and fifty thousand a year." I went home, and that's the letter, and it's reasonable that we'd 622 go up there without being preceded by any written document. I know them all well enough, and they know me well enough that they would do this. You did send them four items appended to this letter--one was the Michi­ gan bylaws and incorporation papers; a reprint of this Cain-Darley arti­ cle which outlined a national agency; a study called Learning for Physi- cians. That was the Dryer Report. Then the foreword to Lifetime Learning for Physicians. That was repetition--the foreword was already in this book. What was this item again? The foreword to a Lifetime of Learning. The one ahead of that one? Learning for Physicians: Principles, Practices and Proposals. Yes--that's the Dryer Report, so they got the foreword in two dif­ ferent places. I included a reprint of the foreword because I wanted to be darn sure that they read it. That's one way of emphasizing it. Now Emory Morris wouldn't have had time to read the Dryer Report, I don't think. Matthew R. Kinde certainly did and at that time there was a man up there who was in charge of their Division on Education. He had just come there from Michigan State--Hollis A. Moore. He's still there. Now before the staff of the foundation presented this to the board of direc­ tors, this was subjected to study by the entire staff. They had four divisions--one in medicine and public health, one in nursing, one in 623 education and one in agriculture, and Morris felt that this would have implications, if it succeeded, for the whole range of Kellogg interests and particularly the Division of Education. I think this thing wound up going to the board as a recommendation primarily from the Division of Education rather than from the Division of Medicine and Public Health. The area was broadened from medicine even in the peti tion--"the contin­ uing education of professional people." Yes, this little group that had been meeting quickly realized that the pitch should be in the interest of all professional continuing edu­ cation. We began to realize that the pitch would be in the name of high­ er education in general because the ideology, all of the thinking had im­ plications for liberal arts education, even high school education--that's why I wish originally somebody would have tumbled to the idea of putting this up to the universities instead of a group of medical associations. What kind of pro grams come out of this effort, or is it still in the planning stage? Well, there's a lot of program, and I'll send you the minutes of the last council meeting. That is a meeting of the institutional repre­ sentatives. I won't take your time now for me to dig it out, but it's an excellent summary of the program as it existed when this fellow, Jordan Baruch, was made president, and it's program all over the lot--really too diffuse. You see a way in which this kind of thing can be used in this four state consortium. It's tailor made, isn't it? ~ 624-626 Yes, it's tailor made. Now, here's a--well, if this will go through for these four states, here's the demonstration area. This stuff that Baruch has written is exactly what we need in these four states. This is the place to put all of the Baruch ideas and try them out--the whole ball of wax is right there. I've got extra copies of these Bulletins, and these have been sent to everybody that counts in this four state area. I just say, "Instead of considering what I have to say about a network, a communications network and so forth in this write up, I want you to know what Baruch has written. Here's the thing I'm talking about." That Bulletin [March, 1968], the Leonard Memorial paper, and the item you have a rough draft of--those are the three key documents to this consideration as far as passing out homework to people in these four states are concerned. I don't think we need go any further. This should be enough for them to decide in these states whether they want to really move ahead and develop some serious plans . ....... (••~ DEPARTMENT OF HEALTH &. HUMAN SERVICES Public Health Service ~~~+~~~~ National Institutes of Health National Library of Medicine Bethesda, Maryland 20894 PAGE MISSING (••~ DEPARTMENT OF HEALTH &. HUMAN SERVICES Public Health Service ~~~+~~~~ National Institutes of Health National Library of Medicine Bethesda, Maryland 20894 PAGE MISSING , 627 Art Cain did a questionnaire that went to the residents of our hospitals. He covered a good sample of residents, even interns, and found that here were a large number of individuals that said if they could be trained for faculty posts--they didn't care whether they got a graduate degree, or not--and said that if said training adequately covered mathematics and the basic sciences, they would be interested in coming into fulltime faculty posts. Pointing to this survey* has always been my answer to these fellows who said, "You mustn't start new schools, or talk about expansion because there won't be any faculty available." Now then the files at the National Research Council, I'd assume, still contain these questionnaire returns, so that if it ever became necessary to get names in connection with seeing that here's a group still interested in joining faculties, this could be done, so that's how Art * Cain, . A.S. and Bowan, L.G. The Role of Postdoctoral Fellowships in American Medicine. J. Med. Educ. 36:Part II Oct., 1961. 628 Cain--! used to stop and see him and so did Ed Turner, whenever we were in Washington, because we felt that this was important, and Art needed that kind of moral support because the other people in the National Re­ search Council weren't giving him very much moral support. What's the attitude of the AAMC toward this development? They've been informed, but there's never been any official recogni­ tion of it, as far as I know, and I knew I couldn't interest them in it. That's why we went in the direction of calling these few deans whom we knew would be interested, but if I'd let this idea get tied up in the organizational maze of the AAMC, it would never have gotten anyplace. It's possible through experimentation for medical education to become something wholly apart from the AAMC, isn't it? Sure. How about the AMA? The AMA recognized this in an editorial in a special edition of con­ tinuing education that comes out every year, and there were two other editorials in this same issue of the JAMA, one bragging about the nation­ al program of the AMA and then three months later they chopped the whole thing off. I have these editorials plus the copy of the testimony that they gave in Washington when they were opposing the Regional Medical Pro­ gram. I'm just dying to write this into a review of continuing educa­ tion in medicine. Now the big problem with EDUCOM is going to be to switch from foun­ dation support and contract support to adequate support from the univer- 629 sities that belong to this. They are only charged two hundred and fifty dollars a year now, and we've talked to the institutional members about raising this, and they've discouraged us because they don't feel that we're ready to really offer the universities any service in return. Now the Kellogg people are aware of our problem, and we've tried other foun­ dations for support, and as so often happens when one major foundation is in a major deal like this providing major support, no other founda­ tion will touch it. At the suggestion of the Kellogg people themselves, we're in the process of getting another grant, and while this is being done the foundation has advanced us money out of future installments and is willing to take a chance that we'll eventually come up with some­ thing that Kellogg might have to give the backbone support to for quite a while. They were roped in early in this development. Yes--the Kellogg is the one foundation that is willing to put risk money out on the table more than any other foundation that I've ever dealt with. Commonwealth used to do it more than it does now, and Markle was always willing to do it, but Markle never had that much money to use. Avalon was interested in medical education largely because of the close friendship between Tom Parran and myself. Well, Charles Hamilton, who is his vice president, became president and in the meantime I got to know him quite well, and it was the Avalon that gave me the extra fifty thou­ sand dollars so that I wouldn't have to wreck my program for lack of sup­ port the last year I was with the AAMC. Theh Markle gave another fifty thousand to the AAMC with the hope that this would defray my activities as a staff person who would help the AAMC activate the Coggeshall Report. 630 When it turned out that that wasn't going to develop, I went to John and told him that this was bothering me, and he said, "Well, don't let it bother you. Just so long as you keep active in the interest of medical education and you feel that you're earning your money, it's all right with us just to let matters lie. I'm still using the tail end of that grant. I quit drawing any salary from it over a year ago, and I was drawing only enough so that I wouldn't have to dip into any of my reserve for retirement, so I've got a couple of thousand dollars there that I use for long distance calls. The NIMP is paying my secretary, and if I have to make any trips in the interest of medical education, or hire any printing done, or need any equipment or something like that, I'm using the tail end of this Markle grant for that. I figure that it will run me another year, probably a year from this July. Now not for the record, but if I need any money to help wrap this business up for you for the National Library of Medicine, I'd be amazed if I can't get it in a hurry from the Kellogg people. They've talked to me about getting some of my stuff out in a form where it is more ac­ cessible than it is now. They have a complete file, I think, of every­ thing I've written up there, and these people are all very close personal friends--well, Emory Morris is not well. He's no longer president. He's chairman of the board. Philip E. Blackerby is president and there's enough mileage out of my friendships up there to run for several years probably. You used the word "diffuse"--efforts here. Is it going to take a show case item, or two to get it on its feet with reference to service for the university? 631 Yes, and again I come back to these four states--you see, and this Joe Becker when he called last night before I turned him over to you. He'd been away. He said that he just couldn't get to reading this docu­ ment and that he'd just read it. Tad Mayeda has already taken care of my request--you see, and Joe said, "This is one of the most exciting and bold propositions I've ever seen." Well, that means quite a bit coming from him, and he said, "I think it can work." Well, he's already been out here and met with the staff up at WICHE and said that. He's interested. I can't give you the details of just what it is that he's done under this contract, but whatever it is, if we can get a commitment out of at least two of these states, we're going to lean awful heavy on Joe Becker and Tad Mayeda for the consulting help we're going to need in the planning. They can tell us what we can do and what we can't do within the limits of existing hardware and particularly hardware that is within our reach financially. That is within a reason­ able financial reach. They know just what's around the corner in the way of developments that will in themselves will come along in time, so I just hope--now, Commonwealth I don't have. They've got to be approached, but I'm not encouraging the people at WICHE to count too heavily on con­ tinued Commonwealth interest. It may be that we'll have to see if we can get Kellogg to not only support the states, help them get started, but to help the central planning get started. Avalon might be interested. I wouldn't hesitate to go to Charles Hamilton. Markle I don't think will. It's commitments are such that it can't branch out anymore. Now these doctors from these four states will tell you, "I know you can't get the legislatures interested in this for quite awhile." 632 I don't believe that. I think the record is going to have to show--if they are interested in doing something, the records have got to show that these legislators are confronted with these plans at the session coming up this January, and if I do any traveling in the interest of this proposal, serious traveling, I'd be willing to do it in the effort to persuade legislatures to get into this. Now traveling in a lot of these states in the dead of winter is not an easy thing. You fly. It's easier that way than any other, but these are little planes, and they only fly when the weather's clear. It's tough getting around Montana in the winter--let me tell you. The Frontier Airline? Yes, that's one. There are several. It's exciting--this whole thing, and you can trace the development of this idea all the way back into the AAMC. I want off of this EDUCOM board. My term runs out pretty soon. The traveling in connection with this is arduous. Then too the complexion of the staff now has changed because Baruch, while he is close with MIT, he's like a lot of other people at MIT, he's more identified with big business and industry than he is with the academic world. That's one rea­ son he's getting these good staff people because he knows where they are, and a lot of them, I think, are in industry. Baruch needs a different kind of board of directors than has been the case in the past, and I think I've done about all I can at the board level. The last few meet­ ings that I have attended they're way over my head--the language they use, the concepts they express, and I don't conceptualize in the mathe- 633 matics area very well anyhow. I'd like to get off the board, but--! stayed on because Kellogg said, "You promised you'd stay on." I don't dare even suggest about getting off until they are willing for me to. In terms of the possibilities that's a small price to pay. And I think this will happen. This is a nice compliment because four times, I guess, they've asked me to come to Battle Creek and spend all day with the board of directors just talking like I'm talking to you. "We want to talk about what's new, or what's exciting in medical education, or in medical care," so I go up there without any agenda, or anything. Old Emory starts the meeting out, and we talk about the things he wants the board to talk about--well, it's just no time at all before the board people are asking all the questions. I did go up there with a bunch of stuff once. This was all this business that involved the compilation of data up to that point that had to do with medical school financing. It was that meeting that resulted in a decision of the board to provide a million and a half dollars to four schools that really needed that kind of money. What the board did-­ this is the way they do business--they appropriated four times a million and a half dollars to a staff, and from that point on the staff made the decisions as to the schools that would be supported and the amount of the support knowing that when that four times a million and a half--six and a half million dollars--was all spent then they'd have to come back to the board for more money. Well, I worked with Matt Kinde and we picked up schools that we thought needed help the most, and then I engineered an application from these schools to the foundation--the foundation wasn't 634 going to go to a school and say, "Here. We're going to have an applica- tion." I did this so that each school did it in two stages--applied first for, say, ten thousand dollars to finance the use of consultants and so forth that would identify the weakest places in the school and the most important and the weak places so that the school is really asking for money that would be applied in the right way. Then they'd ask for a mil­ lion and a half dollars to help activate this. This is what let the school at Loyola move from the eastside medical center out to Skokie. This is what gave the new dean at Woman's Medical College a chance to get a decent library, for example. The only school that couldn't get beyond the ten thousand dollar deal was Meharry. We couldn't find enough imagination in that place to even develop a request for funds, and I was a part of two, or three different combinations of consultants to try to find a way to get Meharry started on a worthwhile track. Finally, and I don't know how--I had nothing to do with this and I don't know how it came to pass--but Commonwealth made a pretty good sized grant down there. In the meantime I think this million and a half that Kellogg had ear­ marked for Meharry probably went to some other school, was spent some­ place else, or reverted to the general funds of the foundation for reap­ propriation for some other program. Creighton got the other grant from Kellogg, and I had to work with the dean down there quite a bit to get him in a position where he could justify a grant. Things--he was brand new in his job, and we just had to wait for him to get a sense of direc­ tion. Even that possibility •••• 635 The other thing that Kellogg did was to provide a pretty good grant for the development of four new two year schools of medicine. At that time I had sold them on the importance of the two year school, and at that time it was still a good idea--well, they helped New Mexico. They helped Arizona, I think. They helped Brown. I have forgotten the other school. I might be wrong about Arizona too, and at New Mexico, for exam­ ple, after they'd gotten this money and spent most of it, the decision was made to go to four years and they were worried for fear that this would mean that they had misspent the Kellogg money. Well, Kellogg came right back and said, "Well, you can just change that. We're interested in helping start the first two years of the medical school. If they want to go to four years, that's all right. We'll help them with the first two, or a program that doesn't go any further than the first two years." Now they're confronted with an application that is based on the idea of starting a new two year school. Nevada has such an application in right now, and Kellogg has decided that they aren't going to help start anymore two year schools. Matt Kinde knows all about this four state project, and I sent him a copy of the letter that came to me from Nevada expressing enthusiasm for this four state compact. [Telephone interrup­ tion] I told Matt, "Don't turn them down. Let's just keep Nevada mark­ ing time until we see what's going to happen." Well, I don't want anybody to know that. You see, at this stage I don't want Nevada to think that I was keeping them from getting a grant from the Kellogg Foundation. They were there yesterday, and I want to call Matt Kinde later on today. I don't know whether he let them know he knows about this four state project, or not. I told him he could use his judgment, but Matt can't have me going around yet saying, "Kellogg 636 Foundation will help these states get started." That's just talk between Matt and myself. Matt would be interested in seeing if the foundation would be interested in corning into this on that basis. Well, because of past association he's open. Sure--the way is open right to the top, and Matt, the last time I talked with him said, "It's about time for you to come up to Battle Creek to meet with the board anyhow." I said, "I 'd love to do th at." I like it because they are wonderful hosts up there, and the board generally has a dinner in the evening. Whose on the board anymore that I know--! haven't looked on the composition of the board. They're all business men, local people--local as far as Michigan is concerned. Most of the Kellogg money is spent in Michigan and South America. I don't know what percentage of funds, but I know that the aim in the be­ ginning is to have this private funds to begin with, is it not? Then EDUCOM could branch out and earn funds through contracts. We don't want to be completely dependent upon federal rnoney--see. Kellogg wouldn't come in, nor any other foundation if we were going to say, "We can get a million dollars from the government. If you will give us a million, we can get going." It was my desire to stay out of the clutches of the federal govern­ ment that helped Kellogg give the AAMC the money for this operational study deal. Much better chance? 637 Yes. Well, I've got less than an hour to catch that plane. Do you want me to call a cab because they might come a little slow. II ! i I 638 INDEX TD VOLUME II Academic freedom 379 Academy of General Practice 331 , 332, 539, 540, 581 , 604, 605, 607 Accreditation 597, 598, 599, 600, 601 , 602, 603, 618 Air Force School of Medicine, 500 San Antonio, Texas Air University Board of Visitors 396, 500, 501 Alamosa, Colorado 343, 351 Alamosa Hospital 343, 344 Alan Gregg Memorial Lecture 421, 468, 469 Albert Einstein College of Medi­ 369 cine of Yeshiva University ALVAREZ, WALTER C. ,332 American Association of Univer­ 365, 397, 398 sity Professors American Bar Association 601 American Clinical and Clima­ 352 tological Association American College of Physicians 435, 513 American College of Surgeons 405, 437 American Council on Education 552 American Dental Association 604 American Heart Association 458 American Heart Association Divi­ 458 sion of Education American Hospital Association 437, 604 American Medical Association 341,411, 421-426, 428,430,431, 433- 436, 438, 446, 455, 457, 472, 505-508, 511-514, 518, 559, 575, 584, 586, 587, 592, 598-602, 604, 605, 608, 609, 628 639 American Medical Association 341 Annual Congress on Medical Education American Medical Association/ 472 Association of American Medi- cal Colleges Questionnaire American Medical Association 428, 434, 506, 507 Board of Trustees American Medical Association 424, 425, 429, 432, 433, 434, 435, 437 Council on Medical Education and Hospitals American Medical Association 341 Council of Rural Medical Care American Medical Association 422 Foundation for Medical Educa­ tion American Medical Association 433, 434, 435 House of Delegates American Medical Association 435 Section of Internal Medicine American Medical Association 435 Section on Surgery American Public Health Associa­ 456 tion ANLYAN, WILLIAM G. 610, 612, 613, 618, 620 ANDERSON, DONALD G. 425, 428, 429 ARMSTRONG, GEORGE 426 Association of American Medi­ passim cal Colleges Association of American 555 Medical Colleges Committee on Federal Health Programs Association of American Medi­ 398, 424, 434, 496, 515 cal Colleges Council Association of American 489, 490, 491, 492, 493, 494 Medical Colleges Council of Academic Societies 640 Association of American Medi- 471, 548 cal Colleges Council of Teaching Hospitals Association of American Medi- 457, 458 cal Colleges Division of Audio Visual Education Association of American Medi- 515 cal Colleges Division of Inter­ national Medical Education Association of American Medi- 482 cal Colleges Division of Medical Education Association of American Medi- 462, 475-483 cal Colleges Division of Operational Studies Association of American Medi- 469 cal Colleges Steering Commit- tee on Operational Studies Association of American Medi- 470, 471, 493 cal Colleges Teaching Hospi- tal Section Association of American Physi- 352 cians Association of American 396, 397, 549, 601 Universities Association of Presidents of 380, 398 State Supported Universities Association of Teachers of Psy­ 489 chiatry Auxiliary medical personnel 51 8-523, 526, 533, 534 Avalon Foundation 516, 629, 631 BABBIDGE, HOMER D. 497 BARNEY, L. D. 504 BARTRAM, JOHN W. 387 641 BARUCH, JORDAN 509, 617, 623, 624, 632 BECKER, JOSEPH 583, 631 BERRY, GEDR GE P. 423, 476, 477, 480 BERSON, ROBERT C. 428, 429, 443-445, 494, 545-547, 554, 555, 569 BLACKERBY, PHILIP E. 630 BLASINGAME, F. J. L. 507 BL □ EDDRN, WALTER A. 457 Blue Cross 585, 586 Boettcher Foundation 386 Boaz Allen and Hamilton 545, 546, 551 BORCHARDT, KURT 445, 446 Borden Award Lecture 579 BOYER, FRANCIS 504 Brandeis University 498 BRODIE, DONALD C. 582, 583 BROMLEY, CHARLES D. 384 BROOKS, GLIDDEN L. 499 Brown University 496, 497, 498, 499, 500, 591, 592 BRYAN, JAMES 607 BUCHANAN, ARCHIBALD R. 356, 357 BUNDY, MCGEORGE 377 CAHAL, MAC F. 332, 607 CAIN, ARTHUR 5. 504, 620, 627, 628 CAIN, GEORGE R. 504 CAMPBELL, 463 CAMPBELL, JAMES A. 435 642 Canadian College of Family Medi- 540 cine Carnegie Foundation 381, 482, 483, 516 CARROLL, AUGUSTUS J. 437, 462-468, 472-474, 482, 494, 558, 560, 570 CAUGHEY, JOHN L. 477, 478 CHISHOLM NIEL 529 CLAPPER, MERLE M. 330, 333, 334, 584 CLARK, ANNETTE 341, 342 CLARK, DEAN A. 341, 342 Cleveland State College 615. 616 COGGESHALL, LOWELL T. 444, 545, 546, 547, 548, 549, 551, 553 Coggeshall Report 396, 444, 460, 471, 515, 516, 544, 545, 546, 547, 548, 549, 551, 629 COLEMAN, THOMAS J. 4 70, 574 Colorado Commission on Higher 372 Education Colorado General Hospital 399, 426 Colorado General Statute 369 Colorado Psychopathic Hospital 391 , 392 Colorado State Board of Basic 336, 337 Science Examiners Colorado State Board of Health 339 Colorado State Board of Medical 335 Examiners Colorado State Legislature 399, 400, 557, 558 Colorado State Medical Society 335, 336, 587 Colorado State Planning 375 Commission Colorado State Welfare Associa­ 331, 584 tion 643 Colorado State Welfare Depart- 524 ment Columbia University 502 Commission on Medical Care 586 Plans Committee on the Cost of Medi­ 588 cal Care Commonwealth Fund 368, 413, 414, 450, 503, 516, 530, 533, 550, 629, 631 , 634 Community centered patient care 521 , 524, 530, 531 , 533, 534, 535, 536, 537, passim Community clinic idea 339, 340 Community health education 575, 576, 577 CONANT, JAMES B. 422 CONGER, JOHN J. 385, 386, 556 Continuing education passim COOPER, JOHN A. D. 417 COOPER, WILLIAM G. 495 Core responsibility of medical 393, 394, 395 school Cornell University 453, 484, 503 Creighton University 634 CUMMINGS, MARTIN M. 510 CURFMAN, GEORGE 524 DARLEY, MRS. PAULINE BRAIDEN 353, 363, 364, 429 DARLEY, WILLIAM M. 527 DARLEY "American medicine and 570 the inevitables in its future" [196 JAMA 267-268 (April 18, 1966)j 644 DARLEY "Medical care for the 331 needy: a problem for govern- mental agencies" [2 GP 78-80 (September, 195 □)] DARLEY "The professional re­ 420 sponsibility of the physician" [174 JAMA 878-881 (October 15, 196 □ )j DARLEY and CAIN "A proposal for 503, 504 a national academy of contin­ uing medical education" [36 Journal of Medical Education 33-37 {January, 1961 )J DARLEY and TURNER "Leadership 568 in curriculum planning" [25 Journal of the Association of American Medical Colleges 12-20 {January 1, 195 □)] DEBAKEY, MICHAELE. 545 DEITRICK, JOHN E. 428, 429, 545, 546 DEITRICK and BERSON Medical 428, 429 schools in the United States at mid-century [McGraw-Hill, New York, 1953] 380 pp. DEMPSEY, EDWARD W. 473 DENHOLM, ROBERT 465 Denver Clinic 524, 528 Denver Post 357, 358 Department of Health Education 463, 474 and Welfare DIMOND, GREY 542 DODGE, HORACE J. 330-334, 584 DRYER, BERNARD V. 505, 510, 584, 619-620, 622 Duke University 612, 613 DUNBAR, DUKE W. 384 DUNCAN, DELBERT J. 387 DUNCAN, LYMAN C. 504 645 EBAUGH, FRANKLIN G. 530, 531 EBERT, ROBERT H. 618 Economics of the education of 421 health and medical personnel EDUC OM 408, 513, 583, 584, 609-615, 617, 618, 620-624, 628, 632, 633, 636 EDWARDS, CHARLES 608 EISELE, WESLEY C. 348, 356, 512, 513 EISENHOWER, DWIGHT D. 422 EISENHOWER, MILTON 421 ENARSON, HAROLD 615, 616 Estes Park, Colorado 347, 348, 408 EVANS, LESTER 352, 427, 456 EWING, OSCAR R. 424, 432 FALK, I. S. 588 Family Health Foundation of 605, 606, 607 America FAULKNER, JAMES M. 407, 408, 409, 413 Federal aid, 1947, 1948 423 FELDMAN, RAY 405 FELIX, ROBERT H. 405 Fitzsimmons General Hospital 426 FLEXNER, ABRAHAM 437 Flexner Report 342 Ford Foundation 616 Fort Collins, Colorado 338, 339, 343, 349, 380, 381, 519 FOSTER, J. EDWIN 458 Four state consortium 521, 534, 537-543, 568, 603, 613, 623, 624, 631, 632 646 Fraternity and sorority exclu­ 359, 360, 361 , 362, 363, 364 sion clauses FUNKENSTEIN, DANIEL H. 563 GAMOW, GEORGE 376 GARDNER, JOHN 521 GEE, HELEN H. 475-485 General practitioner residency 348, 349 programs George Washington University 376, 457, 601 Georgetown University School 506 of Medicine GERDES, JOHN 534 GLASER, ROBERT J. 589 Goals 565, 566, 568 GORMAN, "MIKE" 424, 451 Grace New Haven Hospital 437, 463 Grand Junction, Colorado 343 Greeley, Colorado 344 GREGG, ALAN 351, 352, 406, 419, 420, 422, 455, 456, 555, 579 Group on student affairs 477, 493, 574, 575 GUSTAVSON, RUEBEN G. 369, 383, 601 HAMILTON, CHARLES 629, 631 Hamilton College 345 HANNAH, JOHN A. 497 HARDT, ROBERT A. 504 HARRELL, GEORGE T. 563, 592 Harvard Graduate School of 381 , 382, 396 Business 647 Harvard Medical School Board 611 of Visitors Harvard University 377, 421, 476, 498, 501, 503, 556, 563, 564, 588, 618 Harvard University Press 350 Health insurance 586-588 Health Professions Educational 430 Assistance Act Health Research Facilities Con- 426 struction Act HEFFNER, RAY L. 499 HELFER, RAYMOND 495 High Altitude Observatory 377 Hill-Burton Hospital Survey 338-340 and Construction Act HINMAN, E. HAROLD 416 HINSEY, JOSEPH C. 425, 426, 428 Hospital insurance plan 532 House Committee on Foreign 445 and Interstate Commerce HOWARD, ROBERT 610, 613, 614, 618 HUBBARD, JOHN PERRY 510 HUBBARD, WILLIAM N. 443-445, 508, 509, 545, 546, 610-612, 614, 618, 620, 621 HUDSON, CHARLES 608 HUNTER, THOMAS H. 508, 610, 611, 620 HUSSEY, HUGH H. 506, 507 HUTCHINS, EDWIN B. 478, 480, 482, 484-487, 494, 543, 559 Institute for Atmospheric Re­ 378 search Internal audit 512, 513, 543 648 Interuniversity Communications 408, 509, 513 Council Interuniversity Council for the 610 Advancement of Educational Methods Iowa State University 482, 485 JACOBSON, CARLYLE 467, 476, 477 JENSEN, FRDDE 339, 341, 343, 344, 345, 346, 348, 350, 356, 426, 478 Johns Hopkins 411, 421, 424, 564, 588, 589 Johns Hopkins School of Hygiene 446 JOHNSON, D. MEAD 504 JOHNSON, DAVIS G. 478, 486, 559 JOHNSON, EDWIN C. 358, 371 Journal of Medical Education 417, 490, 491, 492, 559, 573, 593 Kansas City Medical Center 463 KEENEY, BARNABY C. 497, 498, 499 Kellogg Foundation 352, 353, 416, 417, 418, 449, 478, 494, 509, 512, 561, 585, 619, 620, 621, 622, 623, 629, 630, 633, 634, 635, 636 Kellogg Foundation Division of 622, 623 Education KENNEDY, JOHN F. 611 KERR, CLARK 545 KIMPTON, LAWRENCE A. 397 KINDE, MATTHEW R. 622, 633, 635, 636 Ku Klux Klan 400, 401 649 LAHEY, FRANK H. 421 Lamar, Colorado 343 Land Grant College Association 552, 553, 554 LANIER, RAYMOND R. 357, 358 LARSON, LEONARD 586 LEE, PETE 591 LEE, PHILIP R. 521 , 585 LEE RUSSEL HEWLETT 585 LEONARD, JOHN C. 512, 569 LINDBERG, GENE 357 LIPPARD, VERNON w. 353, 426, 458 LITTLEMEYER, MARY H. 448, 452, 467, 493 LOCKE, JOHN G. 401 LOVE, JOHN A. 372 Loveland, Colorado 338, 339 Loyola University 634 MCALLISTER, LOUISE 369 MCDERMOTT, WALSH 393 MCGINN, LOUISE 447 MCGLONE, FRANK B. 524 MCKITTRICK, LELAND s. 437 MCNICHOLS, STEVE 371 Macy Foundation 550 MALONEY, WILLIAM 610, 617, 618 Markle Foundation 428, 443, 449, 455, 493, 612, 629-631 Markle Scholars Association 493, 612 MARSTON, ROBERT 608 650 Massachusetts General Hospital 341 , 411 MAY, CHARLES D. 503, 504 MAY "Selling Drugs by 'educat- 503 ing' physicians" [36 Journal of Medical Education 1-23 (January, 1961 )j MAYEDA, TAD 583, 631 Mayo Clinic 429 MEADOW, HENRY C . 610 Media Medica 509, 510, 584 Medical college admission test 476, 483, 486, 556 Medical College of New Jersey 602, 603 Medical College of Virginia 617 Medical Economics 559 "Medical School Inquiry" Staff 446 Re12ort to the Committee on Interstate and Foreign Com- mercez House of Re12resenta- tivesz 85th Congressz 1st session [G.P.O. Washington, 1957] 4 79 pp. Medical school inventory 543 Medical teaching 595, 596 Medical Tribune 559 Meharry Medical College School 634 of Medicine MEIKLEJOHN, GORDON 527 Mental Retardation Center 390, 391 METTLER, FRED A. 570 Michigan State University 591 MILLER, GEORGE E. 495, 496, 593 MILLER, JAMES G. 508, 509, 610, 614-616, 61 8, 620, 621 651 Millis Commission 436, 540 MILLIS, JOHNS. 436, 540 MIT 498, 509 Montefiore Hospital 520, 521 MONTGOMERY, EDISON 61 5, 61 9, 620 MOORE, HOLLIS A. 622 MOORE, ROBERT A. 458, 459 MORISON, ROBERT s. 453 Morrill Act 554 MORRIS, EMORY w. 352, 478, 479, 621-623, 630, 633 MUGRAGE, EDWARD R. 330 Multiple screening process 535 MURPHY, FRANKLIN 352, 397 MURTAUGH, JOSEPH 392, 393, 395 National Academy of Continuing 511, 513 Education National Academy of General 505, 510 Practice National Academy of Sciences 393 National Advisory Committee on 431 Health Resources National Board of Medical 484 Examiners National Fund for Medical 421 , 422, 423, 455 Education National Institute of Mental 405 Health National Institutes of Health 479, 483, 484, 555 National Intern Matching Program 486, 570, 571, 630 652 National Library of Medicine 510 National Research Council 627 National Science Foundation 575 NELSON, RUSSELL A. 589 New England Journal of Medicine 411 New York Academy of Sciences 560 New York Down State Medical 458 Center New York State Civil Service 466 System New York Times 524 New York University 594, 611 NEWMAN, SAM 505 NEWTON, QUIGG 354, 363, 368, 369, 373, 378, 389, 399 NORLIN, GEORGE 400 Northwestern University 482 Office of Economic Opportunity 532 Ohio State University 487, 502 Palo Alto Clinic 585, 586, 589 Pan-American Medical Associa­ 41 6, 417 tion PARRAN, THOMAS 41 6, 574, 629 Patient care 520, 521 , 524-529, 535, 536, 581-583, 585, ~assim PAULING, LINUS C. 358 T PE,ERSEN, OSLER 350 PELLEGRINO, EDMUND D. 563, 569 PELLET, ELIZABETH 391 ~ 653 Permanente Foundation 586 PETET, CHARLES 441 Physician population ratio 430-433 POPMA, ALFRED 404 Post graduate medical education 342-348 POWERS, LELAND 461-463, 523, 570, 573, 618 Presbyterian-St. Luke's Hospi­ 435 tal, Chicago President's Commission on Acci­ 386 dent Proneness PRIEST, PERCY 425, 446 Program cost accounting 468, 469 PUCK, THEODORE T. 357, 358, 579, 580 Pueblo, Colorado 387 Raton, New Mexico 344 REED, LOWELL T. 446 REES, MAURICE H. 426, 427 Regional Medical Program 413, 414, 511 Residency programs 409, 410, 540 Residency Review Board 435 Rheumatic Fever Diagnostic 331 Clinic Rhode Island General Hospital 499 RICHMOND, JULIUS B. 467 ROBERTS, WALTER ORR 377, 378 ROBESON, PAUL 365 Rockefeller Foundation 415-419, 453, 544 Rock:i Mountain Medical Journal 330, 333 654 ROGERS, FRANK B. 449 ROOT, ELIHU 345 ROSE, JOHN C. 589 RUSK, DEAN 416 RUSK, HOWARD 431, 432 RUSSELL, JOHN F. 456, 553, 630 SABIN, FLORENCE R. 419, 456 San Luis Valley, Colorado 343, 344, 380, 528 SANAZARO, PAUL J. 478, 482-484, 486-488, 492, 494, 495, 502, 515, 517, 544, 558, 608 SANAZARO "Educational self­ 488 study by schools of medicine" [AAMC, Evanston, 1967] Saturday Evening Post 574 SAUNDERS, RICHARD H. 484 SAWYER, KEN 434, 435 SCHARRER, ERNST A. 356, 357, 369 School of Post/Graduate Medi­ 346 cine, Cornell Medical School SCHUMACHER, CHARLES F. 484 SCOTT, VIRGIL C. 453 SEARLE, JOHN D. 504 SEARLE et al "The pharmaceuti­ 504 cal industry" 36 Journal of Medical Education 24-32 (Jan­ uary, 1961)] Selective Service 431 Seton Hall University 602, 603 SHANNON, JAMES A. 392, 473, 474, 479, 555 SHEPS, CECIL G. 342 655 SMILEY, DEAN F. 457, 496 SMILEY, JOSEPH R. 373, 385 SMYTH, CHARLEY J. 356, 357 SMYTHE, CHEVES 494 Social Security Act 370 SOMERS, ANNE R. 411 , 426, 432, 475, 520, 588 STALNAKER, JOHN M. 476, 477, 479, 484 Stanford University 363 STARKS, ESTHER B. 336 STASSEN, HAROLD E. 422 State University of North 612 Carolina STEARNS, ROBERT L. 330, 364-366, 369, 373, 377, 380, 383, 384, 386, 387, 389, 428, 429 STEWART, WILLIAM H. 521 STONE, HARVEY B. 424 STOREY, PATRICK B. 507, 508 SULLIVAN, ALFRED 613 Surgeon General's Committee on 431 Medical Education Syracuse Forestry School 466 Temple University 523 THACKERY, RUSSELL I. 552-554 THOMAS, ATHA 332 Time Magazine 574 Tulane University 487, 502 TURNER, EDWARD L. 430, 433, 452-454, 461 , 462, 557, 568, 586, 628 656 United States Air Force 390 United States Atomic Energy 356, 375, 418 Commission United States Bureau of Stan­ 377, 378 dards United States Public Health Ser­ 357, 358, 416, 431, 506, 507, 560, 581 vice University Club, New York City 422 University of California 482, 538, 570, 572, 583 University of Chicago 397, 501 University of Colorado 332, 333, 372, 425, 464, 512, 518, 532 University of Colorado Board 358, 359, 361, 362, 365-370, 373, 374, of Regents 376, 377, 380, 381, 383, 384, 396, 399 406, 556 University of Colorado Depart­ 377, 389, 390 ment of Physics University of Colorado Director 340 of Alumni Relations University of Colorado Faculty 378-380 Senate University of Colorado Office 495 of Resources in Health Science Education University of Colorado Presi- 351-354, 356-390 dency University of Delaware 497 University of Florida 508 University of Georgia 502 University of Iowa 482, 485 University of Kansas 352, 397, 487, 502, 551 University of Maryland 487, 502 University of Michigan 330, 508, 51 2, 611 , 61 2, 616 657 University of Minnesota 613 University of Missouri 463 University of Nebraska 470, 554, 601 University of New Mexico 406, 616 University of North Carolina 583, 612 University of Oregon 482, 484 University of Pennsylvania 421 University of Pittsburgh 342, 374, 61 5, 619 University of Rochester 425, 484 University of South Carolina 502 University of Utah 408, 41 8, 507 University of Virginia 508, 610 University of Wyoming 406 UPJDHN, E. GIFFORD 504 VAN EK, JACOB 387 VANZILE HYDE, HENRY 416, 417, 438, 515 WAGNER, 338 Wall Street Journal 574 WARING, JAMES J. 330, 419 Washington University in St. 473, 476, 532 Louis WEISKDTTEN, HERMAN G. 428 WESCDE, W. CLARKE 439 Western Interstate Commission 403-409, 412-415, 450, 456, 614, 616, on Higher Education 631 Western Reserve University 477, 540, 593, 617