[silence]

-Well, Bob, I had the idea,

which I still believe it's valid,that to be a stimulating teacher

in any field,one has to be doing some kind of research.

I think if you just teach,

and are not doing any kindof creative work at the cutting phase

of the subject of which you're working,you can't be an inspiring teacher.

I felt it was part of my duty as a teacherto be engaged in research.

It wasn't something that I found difficultto do, because I loved it.

I suppose this is a certain amountof rationalization is involved in this,

but I really do thinkthat the great teachers are the ones

who are involved in research,but at the same time,

are sufficiently involvedin clinical medicine

to be good clinicians.

This is one of the dilemmasthat the modern doctor is in,

in an academic setting.

How can you be good in research,particularly,

today when it's so complicated,and at the same time be a good clinician?

-I look at biomedical sciencesand technology as a great big pool,

or a bag, or library,shelf full of so many learned books.

It seems to me that what we do,

is to educate ourselvesand train ourselves to go to that pool,

and extract exactly those elements

that apply to a situation.That we do it in one of two ways.

One way the physician who takes careof one patient at a time,

extracts exactly those elementsthat are needed for the problem

of a particular person,at a particular moment in time.

That's what the public consider as beinga doctor.

Unfortunately,that's what the profession considered

the only doctor is that type of thing.

In reality,

there is another way, a way which,in the long run, has proven

more efficacious,in terms of at least extension

of life expectancy from birthand all the rest of that.

That is to take those same elements,

and apply them in some indirect wayfor people considered as a group.

During the first 35 years of this century,all the great advances were made

by that way.

The last 35, the great research advanceshave been made in the other.

-Now, the most dramatic eventsin our development as medical students was

when we first began to go to autopsies,

and I actually had the opportunityto assist in the performance

of an autopsy.

Does the autopsy still rank as suchan important teaching instrument today?

-I think there's been a tendency todowngrade it from the academic standpoint,

very unwisely,

because pathology is reallya key transitional subject

for the student.

Up until then, in his curriculum,

the student has been largely concerned

with what the normal structure is,what normal function is,

and has been viewing his subjects as,largely,

of a descriptive type.

If we take an analogyfrom English literature, let's say,

up until then,his studies have essentially been

from the essay standpoint,

and with pathology,

he begins not only to be concernedwith the apparent things,

but to move into the analytical side.

Think of the various disease processes,

the sorts of things that [?] used to callthe inevitable histology sequences.

Things of this sort.

The autopsy is not only

the soundest and best meansof quality control,

as far as the hospital is concerned,

but it is still a true gold mine

for the pathologist.

A source of great insight

for the successful menin the clinical fields

of medicine and surgery.

-There's one other subjectit might change,

and that is the question of examinations,which came up as a very important course.

The decision was made early in the dayto mark satisfactory or unsatisfactory,

with no identification in the beginning,unless the faculty felt

that they might help the studentby identifying the one in trouble.

Later, the students requestedthat honors be recognized,

so that came from them.

Now, you want to say a word or twoon the examinations?

-Still the most debated item we have,it's a very hot item right now,

because they're always are peopleon the faculty who would like the students

to be ranked in rank order.

That used to be what was done.

When I first came out to Cleveland,I found the graduating seniors

and juniors really disgusted,because they were ranked from 1

to whatever the class was, 60.

It was the four significant figuresthat is 82.24, 84.25,

competition was such that they usedto hide material from one another.

There were 30 some examsin the second year.

The changeover to the exams,which are given right back to the student,

but they're just satisfactoryor unsatisfactory,

made a whole different environment.

We've taken away the honors at the moment,

but this is oneof the boiling issues right now,

and I'm delighted that it's upon the table.

The only issues that frightened me arethose that are under the table.

Some schools have triedthe no-grading system,

have dropped it.Harvard has just dropped it.

I personally hope we'll keep it,because the warmth of friendship

in the first year class, this very year

of tutoring one another,is unbelievably great.

There is no competition for grades.

-I had contract read

that I would only teach one semester,and I would teach microbiology

and immunology to the medical students.

I barely had gotten off the train

at [?]when Frederick Parker Gay, said to me,

"I got some news for you."I said, "What are they?"

"Well, Academic Center has just decided

that since we are paying you $300 more,that you must give a course

in general microbiologyas a cultural course to anybody

in biology, in chemistry, in engineering,et cetera."

I said, "When this is going to happen?"

He said, "It's going to happenin January semester,

or spring semester of 1914."

Well, I said, "You know how many studentswill register?"

"I haven't the least idea."

When we did the registration,286 registered,

we had laboratory facilities for 65.

The laboratory was running

from seven o'clockin the morning till ten o'clock at night,

and I had to give the lectures

from 1:00 to 2:00.

Then, I made up my mind,since this is going to be my opportunity

to stimulate 286 students,there was no lecture room,

except in the College of Agriculture,housing this number of students,

that I would give them the best I could.

I always prepared detailed lectureswith all the references I could find,

all the interpretations.

I gave the lecture for 1:00 to 2:00,but when I hadn't finished my notes,

I said, "I seeyou again at seven o'clock tonight."

Let me frankly confess, they always came.

Sometimes it went from 7:00 to ten o'clockat night, because in the last two hours,

it became a colloquium,where I answered questions, et cetera.

The best proof is that it was, probably,most effective teaching

because over and over again,I meet students who look 10 times older

than I do, put their handson children and say,

"Do you remember when you said so and so?

Do you remember when you told me thatI should look this up in this and that."

That's a great satisfaction.

It was a tremendous effort.

-I remember that Osler was an earlyand strong advocate of clinical teaching

at the bedside,even to the point of protesting

the developmentof the full-time clinical academician,

whom he thought might not be the bestof clinical teachers.

You always advocated strongbedside teaching programs.

Why?

-Well, in order to providethe best medical care.

I didn't agree with Osler concept,as you expressed it just now,

in that I felt that,

the best clinical teachers were thosewho were not simply distributing

what others had learned,and using that to handle the patient with,

to treat the patient with.

People who themselves had questionsin their minds, and because of those,

their questions, they were critical.

They evaluated things as they came along.

They were constantly strivingfor the best,

and the most correct.

After all, as we well know, there's much

that is thought to be

the right answer one day,and a year or two or many years later,

that seems quite wrong.

We can't just accept

and then applywithout critically evaluating that.

One of the important thingsa doctor must learn,

is a critique,and the capacity to evaluate,

and how best can you do that,except by doing research yourself,

and seeing what the foundation

for those opinions is.

-I teach students, but they teach me,

and I recognize that.

We had our tea, and I provided the tea,

and a couple of English students cameto work with me.

What do you think they drank?They didn't drink tea.

They'd drank Coca-Colas.

Well, I said, that's whythe British empires disintegrating

when you quit drinking tea,nothing will work. I drank tea.

Well, of course,I would present these ideas

to these students.

They were not just beginning students.

They had finished their training.

They had been interns,some had been residents.

I would get their ideas,and I'd talk to them about it,

and they would, "Yes",and make some suggestions.

On that way, we worked out a programof experimentation.

They got interested in the game,and that was really well worthwhile.

In the years, John, that had gone by,I've met some of them down in Mexico,

and other countries that talkabout those teas.

-Well, many a brilliant experimentwas born in those discussions.

-That's right.

-Those afternoon teas hada very vital ingredient.

That was you, because we neededsomebody who had

the background and the experiencewho could say, "Well, no,

that's not right,because so-and-so did that in 1910

and found the opposite result."

-At the end of one month,

one of the classmates

just before the anatomy examination said,"Fellows, there's no need to study.

Were a highly select student group.

They wouldn't dare flunk us."

Anyway, we took the examinationand the next day,

Norman Elton was on his way home.

He was the one who saidit was not necessary to study.

-Did he ever get back in?

-What we had at that timewas a wonderful group of professors.

The mystique of Harvard Medical School

is rather simple.

They havethese five beautiful marble buildings

on the Longwood campus.

Second, at that time,they had wonderful professors

such as Cushing and Walter B. Cannonand Otto Folin and [?] .

Again and again, the professorwould come in to the lecture,

to lecture to the students,

and he would say,"This is a very great honor for me

to lecture to the students today."

This is the only medical schoolwhere I ever heard a professor introduce

a lecture to undergraduatemedical students in that way.

Everything at Harvard was designed,primarily,

first and foremost,with teaching of medical students in mind.

First, there will be great laboratoriesfor the students.

Then, if there's something leftover there,

there can be research laboratoriesfor the professors.

There, I became--I developed a great love affair

with medicine.

I thought medicine was just wonderful.

It was vocation, avocation,religion, profession.

It was a combination of sadness,

a chance to serve,

large amounts of comedy.

Dollar sign didn't enter into it.

We were all young priests of medicine.

We all felt great studyingin these marble buildings

with professors who considered itan honor to lecture to us.

-You remember, you cameto medical school learning

how to read.You knew how to read.

You know that manyof our college graduates today

will get in professional schoolnot knowing how to read.

It doesn't matter from what schoolthey come,

Harvard included.

The inanimate text was 1,500 pages.

You had a dissecting manual,and then you had atlas's.

Too many students would try to learnto read those things

like you will a novel, can't be done.

I tried to set this in a frameof reference,

simpler.

Primitive man made pictures beforehe invented any form of writing.

A Paleolithic man, old stone age man madethe first pictures.

We find them in the caves on the Bayof Bisque in southern France and Spain.

That shows he was a good artist.

We can recognize the elephant,the rhinoceros,

and these other animals.

They found,and you see the spear going in,

you see images of the heart.He was an anatomical artist.

I said, "Well, let's teach

these kids to draw."

Nowadays, I would saythese sophisticated adults,

and the first thing a studentwould tell you is that,

"Doctor, I can't draw."

Then, we disprove that.

Of course, in a school that gets money

from the government,you can't dare be innovative.

You are told to be innovative, but try it,and you'll be smacked down.

You're using somethingthat hasn't been approved.

I felt I was being very conservativewhen I said that I got the idea of drawing

from Paleolithic man.

If you have onlyan upper Paleolithic level

of intelligence, you can do this.

-I feel that if the entire contextof medicine,

from anatomy to zoology,were taught with reference

to some relationshipswith historical background, that would

have far better oriented medical studentsthan we have today.

At first, I thought it was disinterest,

but I'm inclined to believewith probing into it and so forth,

that many good scholars yet do not knowthe background of their discipline.

It's amazing how many thingsthis can teach.

As I look into the historyof some of my own interests,

I find that when questions have been posedand prized

are awarded, that today,the second and third prizes are the often

the better people.

The commission who adjudicatedthese things

are tradition-bound.

If those people making decisions,their knowledge had actually been broader,

I think that many innovations,and antisepsis and asepsis,

there were enough signs on the horizonto suggest that this

could have come much earlier,if the commissions making

the adjudications were wiser.

-We have felt here, I know even felt

that nutrition should be integratedin the teaching of biochemistry,

and the teachingof various clinical subjects

such as pediatrics medicine,obstetrics surgery,

and that some groupin each medical school ought

to have charge of the program,and that we should have

some one individual, or a committeeof individuals planning nutrition,

so that it could be integratedinto all of the medical teaching.

-It's been a challenging experienceto try to introduce

another perspective

than that which was traditional,and has been traditional.

It's been a long effortand struggle at times.

We've met all kinds of opposition.

I do think that now,after 27 or 28 years at Rochester,

that there is a certain flavor

to the Rochester ambience and curriculum,which I do think comes from the--

-Yes, people talk about a certain qualitythe Rochester graduates have.

-Yes.-Which, I think is fundamentally

a clinical orientation, and abilityto relate to patients, people.

-I think it's been important,too, that our research

has always been clinical.

It's always involved patients.

Not only has it always involved patients,but to a very large degree,

we've been able to involve it,and integrate it into our teaching.

-Actually, I happened to be Chairman

of the Curriculum Committeeat the same time,

and I had definite philosophiesabout how to teach.

The first place I wasagainst all those lectures,

because I think lectures were anythingbut showmanship for the lecturer.

I thought a student could learn betterby being guided and directed

to go read himself,and then come back and teach you.

I thought that the teacher was responsiblefor the student's success or failure.

I would tell my men all the time that,if a student fails,

the teacher also fails because it's upto the teacher to teach the students

such a way,or provide an atmosphere of learning

that was so importantto the students enough.

-I feel very strongly that medicinehas become too gadgetized,

and we are putting too much faithon laboratory tests.

This is not the fault of the students,it's the fault of the teachers

of the students.

Laboratory tests can tellyou an awful lot,

but as an example, perhaps extreme,

often, the students are being told

by the teachers nowadays to get hard data.

This is something you can measure,something you can express in milligrams,

or in milliliters, and so on.

This is the example they are setat practically all medical schools.

I often ask my students,"Do you have children?"

"Yes". "You have a daughter?""Yes".

"How old?""Two-years-old."

"Well, is the sound of that laugh

of that daughter somethingthat's very precious to you?"

"Oh, yes."

"Well, what is the vibration frequencyof that sound?

If you can't measure it,doesn't mean anything.

That's where you taught medicine.

You'll realize that about your daughter,or do you like a sunset?"

Well, it happens,I have very beautiful sunset

from my college at Lake Martin,and students who I invite,

they often admire it, and I say,"What's the spectral analysis

of that sunset?"

"Well, it doesn't make it pretty."Well.

How can I mount anythingif you can't measure it?

Because that's the wayyou're being taught,

and I try to use examples of this typeto illustrate

that the most important valuesin life are subjective, not objective.

This is why I believe that the history,what the patient tells you,

is by far the most important informationyou get.

[silence].