The Reminiscences of

DR. ALAN GREGG

  

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Oral History Research Office

Columbia University
1958
Prefatory Note

In the spring of 1956 Dr. Alan Gregg decided to record his memoirs
vith the Oral History Research Office as part of a pilot study undertaken into
she history of contemporary American Medicine. In the beginning some 250 inter-
view hours were projected. It was felt that such intensive interviews would
eesult not only in a fascinating autobiographieal account but also in a vivid
vistory of medicine in most countries of the world during our own time, and
above all in a frank history of the division of medical sciences of the Rock-
sfeller Foundation. In all some 17 hours of interviews were held before Dr,
ireggs death last year. The resultant Ms. is but a fragment of what might have
oeen. Dr. Saul Benison who conducted the interviews has edited the Ms with a

view to making it a chronological narrative.The memoir lacks the questions
which Dr. Benison had put to Dr. Gregg.
PREFACE

This manuscript is the result of a series of tape-~
recorded interviews conducted by Saul Benison of the Oral
History Research Office with Dr. Alan Gregg during April,
May and June, 1956, at the Century Club, New York City.

The menuscript has been carefully edited and is there»
fore not a verbatim account of the interviews; however, the
reader should bear in mind that this is a transcript of the
spoken, rather than the written, word.

The manuscript may be read, quoted from and eited*by
serious research scholars accredited for purposes of research
by Columbia University in such place made available for pur-
poses of research by Columbia University.

No reproduction of this memoir, dither itn whole or in
part, may be made by microephoto, typewriter, photostat or

any other device except by Dr. Gregg's heirs, legal represene
tatives or assigns. .

# This doas not include those portions on pp. 226 and 227 which
have been blocked out according to the instructions of Mrs,

Gregg. . They will not be available to scholars until January
1, 1978,
My father was a Congregational minister, born in Medford,
Massachusetts. My mother was born in Louieville, Kentucky. She
went to the New England Conservatory of Mueic in Boston, and my
father met her when he was a theological etudent at the Andover
Theological Seminary. Originally Father was the Congregational
minister in Hartford. Later he weat out to Colorado Springs, then
a town of about ten thousand. it's an interesting fact that he decided to
ge out to Colorado largely because Hartford, Connecticut, at that time,
contained go much malaria that he didn't consider it a fit, healthy
place to bring up a family. He certeinly didn’t go for the money;
his top salary in Colorado wae three thousand dollars.

Father wae a man with one rather peculiar characteristic
which ie found frequently, 1 believe, in Scotch stock; namely, he was
a man of what I could call corporate loyalties. it is relative to clan
behavior and clan thinking and feeling. Anybody for Father who was
Scotch Irish, a graduate of Harvard, and a Congregationalist had
special access to his sympathy and presumptively Father considered
any one of those three groups as all right. He would lend thers
money without hesitating. Mother gave the contrast to that charact-
eristic by being completely realistic, by being completely practical,
completely without corporate loyalties. She wanted the cash on the
barrel head and proof when she was shown anything. But Father
was an absolute victirn of his loyalties, and they were very deep

loyalties.
I wae the laat of seven children, arriving, as I later
learned, a6 something of a mistake. Both Father and Mother
wanted to goto Europe, and 1 used to tease my mother by saying
that the enthusiasm she had for travel which was interrupted by
my appesrance on the scene had some prenatal influence, because
I've always enjoyed travel which wae doubtlese on her mind as
something she wasn't getting. There were three boys ahead of me
at convenient intervals of five years each, three sisters in between
the brothers,

Mother was the manager, and she managed extremely well,
because she got all four of the boys to college and one daughter to
Radcliffe and, though heavily in debt for a period, stayed solvent.

Raising seven children on a three thousand dollar salary
had ite aspects of modest expenditare. I think that the thing that
illustrates that as well ag any was the party that General William
J, Palmer, the head of the Denver Kio Grande and Western, and a
man of immense wealth, gave for the children of hie friends and
acquaintances in Colorado Springs. Once a year we were all taken
out te his country estate at Glen Eire to what became known as the
Palmer Party. To gothe Palmer Party meant that one was to walk
on polished floors, and while my shoes were not hob asiled, they did
have naile in them. The day before the Palmer Party i had to take
a file and file down the iron in my shoes eo that they wouldn't scratch

the floors of the Palmer house. That's complicated, because it means
that | was among those who went to the Palmer Party, but l also
went in a condition of epit and polish, plus the concern about
what my feet might do to the Palmer floors. That really surm-
marises it, We were poor ae the devil behind the ecenes but

we got asked to the parties just the same.

i aleo had, along with that status, the knowledge that i
would have to succeed intellectually. There was ne doubt about
that either, I didatt have a free choice. i wasn't going te etep and
be a prominent grocer or something like that. It would have to be
sorsewhere in teaching, learning or one of the professions~-that
was a set piece.

There was a good library in the house. The poison in
that situation, however, was fairly simple and is probably pain-
fully revealing. l had eix brothers and sisters who were on my
neck supervising my education because Mother wae too busy with
the general business. i got eo sick of being told what 1 should
read that it wae almost a guarantee that i would not read a book if
it was strongly recormmended to me. ican find traces of that even
at present--a resentment at having had my reading dictated by my
elder brothers and sisters. That sounds rather embittered. Ae
a matter of fact, I see now that it was inevitable.

l rermember among the book shelvea 1 once discovered

Spencer's Fairie Queene. Then the wonderful quality of that book
lay simply in the fact thet nobody told me to read it, and 1 ased to
read it on Sunday afternoons with real excitement and « real sense
of discovery. However, all of the reat of the books were clouded by
recommendation, “What? You haven't read that. Well, why don't
you get to work and read it?"

During one rather hectic July, my sister, Margery, read
aloud to me a good deal, because 1 got some powder in my eyes
on the Fourth of July and had photophobia and couldn't read. I lay
there and Margery took me through The Talisman and ivanhoe. i've
looked at them since and just don't understand how 1 could be in-
terested, but 1 was.

We had books of reference ae well ae standard good quality
booke almost uniformly. 1 remember we had the Jungle Books and
two or three English children's books like Castle Blair. i think
that 1 can perhaps describe the situation that obtained best by saying
thet absolutely the only time l ever heard my father and mother have
a falling out with criticiem and resentment (and all that goes with it)
wae when Father bought a book of reference that Mother didn't con-
aider completely necessary. She berated him for spending money
on books. When he came back at her rather annoyed, she fell on
him like a ton of bricke. She was a very forceful person. 1 remember
Yather's argument quite clearly. “How am I going to be the intellectual

leader of my church if 1 can't buy books ?"'
5.

Mother's anewer was, “It doean't matter what you think
you've gottode. There are two libraries in this town, and we've
got to make the grade.“

Mother was what one might call ultra-refined, 1 remember
that she objected to Mark Twain ae being vulgar. She wae the
daughter of a young Englishman who came to America to make his
fortune. He wae, I think, of real ability and quality. He was a
Northerner in sympathies in Louisville throughout the Civil War.
At the end of the War Lincoln appointed him as Collector of United
States Revenue for the State of Kentucky because he wae one of
the very few honest men who had been a Northern sympathizer,
Some of the flavor of life and real ability of my mother she got
direct from her father. He, for instance, sent her to Oxford
Seminary for Women over on the Ohle side of the river, which was
one of the first echools in that part of the country that went in for
woman'a higher education. Because my mother had musical ability,
my grandfather then sent her all the way to Boston to go te the New
England Conservatory of Music.

There were a great many taunte for the son of a minister.
“Oh, @ minister's son) Well, we cas't say anything!" And the
temptation was to outdo everybody in naughtiness so ae to prove
that 1 wasn't outside the fold, In actual fact, being a minister's aon
gave me a certain social status in that little town that I wae completely

unaware of when l was a kid. Now, it comes out more in contrast
6.

to other frienda of mine who remember a life that wasn't quite
ae fortunate as that. But the etuff had to be there. You had to
deliver the goods.

Long afterwards my mother told me that when I firet went
te achoal I delighted the teachers because when the name Michel-
angelo came up i knew roughly who he was simply from etuff picked
up in family conversation, I didn't suppose him to be a leading
catcher on the Brooklyn baseball team. We had as strong a contact
with Zurope in the form of culture and art and refinernent and real
quality as Mother could possibly manage. The boys did well at
Harvard scholastically and that was all she wanted.

i think I rnust have been somewhat independent because, al-
though my father was a conservative Republican, when the 1WW
struggles were at their livelicet in Colorado (or very near their
liveliest} 1 slipped out of the house one evening and I went to a
labor meeting downtown. I heard both the local people and John
OD, Rockefeller maligned te a point that one couldn't believe. My
introduction to the Rockefeller name wae euch that would have
shocked elther father or eon in thet family because the labor feel-
ing was so intense and so violent, The result was that 1 wae com-
pletely puazled by this formidable difference of interpretation of
human behavior.

There was a game that I played ae a kid that might have some

interest. One of my small boy friends, Dudley McClurg, had a mother
7.

who was very interested in the Mesa Verde indians, and one of the
firet in that pioneer society to show that interest in the Indians, His
house wae filled with various artifacts of the Mesa Verde Indians,

and without reasoning it out in #o many words, i became perfectly
accustomed to the idea that there could be people that you never saw
who left artifacts of one kind or another that you could see in quantity.
kL don't exactly knuw how the game grew up, but Dudley McClurg and
another boy, Eagene Preston, and | played a game consisting of as-
suring that we weze the representatives on carth of imaginary people
about eight or nine inches high. Our main occupation was producing
the artifacts of civilisation of these three imaginary peoples. We
never made representations of aur people. We only showed each other
what they did, Jt was wonderfully free to the imagination. We would,
ior example, make atamps of these people. We found that by teking
the thread out of Mother's sewing machine we could rua sheets of paper
up and dewn in the machine and perforate them perfectly well. After
we perforated the stampa we designed them.

My people's name was the Trobens and kugene Preston's people
were the Erogans, 1 rezaember that he was furious when he found that
Brogan was an actual word and mcant « large shoe. Dudley McClurg's
people were the Bibits. We'd spend every Saturday, year after year,
preoccupied with showing each other the way the Trobene did things as

contrasted with the Brogans and Bibits. We had one assumption which
peychologically wae perfectly delightful; namely, we'd get biscuit
ware, put on a glaze, and then fire them and make them into pot-
tery. If they turned out well. they were typical Troben or Brogan
producte. Lf they turned out badly, all we had to say was that this
was early Troben or Brogan that had just been discovered. CGon-
sequently all failures were covered by a halo of antiquity. It was

just ae beautiful and as easy for our consciences as it well could be.
We never had any failures. They were either early Troben or Brogan
or relatively recent Troben or Brogan.

il have ao map that i made of Trobania which shows curious
similarities to the map of the British isles because there is an
island alongside the mainland which plays the same lefthand re-
lationship that Ireland playe to the British isles. There was a little
bit of an island which was very much like the island of Man in posi-
tien. although it had the aingular distinction of being the earliest
point of origin of the Trobens. This Troben, Brogan, Bibit game
covered maps, histories of the country, the creation of royalty and
occasional shifte of sovereigns. it covered religious activities and
beliefs, The God of my people was Cash and, being completely
vinual-minded I spelled mine Kash. it didn't occur to me that
that was something very much like what sume Americans also wor-
shipped. 1 remember being quite annoyed whea Gene Preston teased
me by saying, "That's not an awful lot different from what goes on

in Colorado Springs. "
Fe

Heligion covered religious techniques, methods af worship,
prayers, hymns, anything we saw around us. We'd say, “Now l
wonder how the Trobens did this?" I think moat of what I know of
the useful arte like glass making, paper making, weaving, writing
histories, history iteelf--anything that I know about the ordinary arte,
i learned then. 1 aleo learned quite early that if 1 could get to Father's
copy of the Encyclopedia Sritannica, i could read up on any subject
pretty well.

Colorado Springs had a very dry climate, and when we came
on the worke of Flinders Petrie, the Egyptologict, it wae just en-
chanting because we would mummy a white rat (turn him into a mumray),
bury him some place out of town, forget about him « year, and then go
end doa Flinders Petrie reconstruction. We discovered from pretty
early that we could write pretty clearly with ink on manila paper, give
it a bath of hot melted wax, rub off the surplus wax, and have a dead
ringer for parchment, We invented languages with figures of any kind
to represent different letters, it waa good rainy dey stuff, Now, I've
never seen anybody who had a game just like that. We got refreshment
by seeing how the Brogans did it, or how the Bibite did it, and we ex-
changed ideas all the time. It wae wonderful, when we went out on an
expedition and discovered one of our parchment records. it was 60 long
ago that we couldn't remember what had been written, it was, ase
matter of fact, a praise, eulogy, and something of a biography of this

favorite white rat. ALL 1 know about eryptography | picked out of the
id.

dictionary and it helped us decipher the hieroglyphice we made up.

l can remember an interesting thing that happened to illustrate
the flavor of life in Colorads Springs. The town had been atarted, |
think, in 1870, lt was a pioneer country. When i wae in the company
of my eldersa and betters, I could frequently hear discussions on “is
El Paso County too big." or “Should the boundaries be changed," or
“Where will we have the water supplies,“ or "Where ought the roade —
to go?" Much later--in fact, yeare and years later when 1 was in
Lyons, France, at a dinner party--the conversation of my Freach
hostess aod host aad friends ran to modern French poets about whom
i knew virtually nothing. Consequently | said nothing end Listened. i
wae thinking, "Well, the leet time 1 Hetened 04 patiently and as long
te conversation that 1 didn’t understand at all was when | used to hear
Father and hie friends talking about the future of Colorado Springs
and where would we put the roads and so on.” This ie wonderfully
different.

At that instant Madame Lepine, my hostess, eaid, “Dr. Gregg,
I'm afraid we're talking ebout things that don't interest you. Juat for
fun, U'd Hke to ask you what were you thinking 7”

i said, "Well, 1 was thinking that the leat time I listened ao
much in the subjective and not participating at all was when I was a
bey and used to hear discussians on probleme that yon, Lyonnais,
had settled for you by the Romane in 60 A.D." Whereat there deve-

loped among the French at the party the moat amineing and interesting
il,

dispute on the question of whether they would like to take the whole
countryside around Lyon and do the roada, the bridges, the canalie
all over again, or whether the Romans after all had done a pretty
good job. I eay that to illustrate the point that in Colorads there
were all these primary questions being settled, and it waa the at-
mosphere, "Sure, we can do what we want. Now what's worth
doing?" We hed almost no heritage at all to conform to as most

of the people in Furope had. We had it to make, and the atmosphere
of freedom of choice, but necessity of action, was singularly vivid.

There was in Colorado Springs at that time a characteristic
effert. in 1874 a emall college was begun. When the town was
still in an extremely formative stage, that little college (Coloradc
College) had to have a preparatory shoool in order to have enough
students to run with. i went to Cutler Academy, as that ashool was
then called, for my secondary education.

The president of Colorado College in those days wae a fellow
named William ©. Slocum, and he had the wit to see that he could
get far better personnel in that Little college if he made a trip once
a year to the Eastern colleges. He usually went to the president
of the Eastern college and said, “i haven't got money enough to rob
you of some of your good teachers, but if tuberculosis develops in
any one of the members of your faculty or the members of their

family and they have to go to Colorado Springs. would you kindly
k2.

write me their names because I may have a place for them?” He
got some exceptionally qualified teachers in that way for that little
school. He had a man who certainly would have been headmaster
at Phillipe Andover, That person had “weak, weak lungs" but be-
cause he could live out in Colorado Springs perfectly comfortably,
he kept on teaching. He was one of the best teachers lever had. (i'd
almost say, that l ever could have.) His name was Clement Giles.
We had another thing in Colorado Springs that I aleo think
was important, and that was that Colorado Springs was the favored
resort for people with tuberculosis. it was known far and wide as
@ place where lots of people with tuberculosis got well instead of
dying. That brought to Colorado Springs a highly selected recruit-
ment of ite citizens. If somebody in the family had tuberculosis,
it wae the reason they came to Colorado Springs. Now if they came
to Colorado Springs, it ueually meant that they were (1) well ia-
formed and (2) fairly well supplied with money because people
couldn't take @ trip of that dimension unless they did have money,
The town therefore had a singularly Eastern and civilized flavor.
We had a ver; lively intellectual life granted the size of the
town, I think mainly because of that curious role of tuberculosis!
supplying a selected group who had to live there anyhow and simply
loved the idea of being a teacher and still have their health. The
13.

town did that for a living, relatively little else. We were near
mining and there were emelters in the adjoining city of Colorado
Gity three miles away. But the smelters were the only industrial
elersent in Colorado Springs aud the rest of it was what were

called "one lungere”’. The flavor was one of & pioneer town

with much to be done and everything to be arranged, but almost
nothing of making of money. Life wee singularly healthy, and there
was sunlight in quantity.

My mother was a very competent, very thoughtful and very
independent minded person, and she handled my education in a way
that I've always been grateful for and that Il have a great deal of
respect for under the circumstances. We didn't have eny money for
my primary education to supply anything in thst direction, and there
weren't any very good private schools. Aso matter of fact, 1 went
to the public schowls. However, Mother wae eo bored with what
President Lowell called the "convey eyatem of education’ (namely,
the performance of the classes wae at the rate of the slowest boat,
not of the fastest). that she compromised on my early education in
avery independent and original way. She kept me completely out
ef echool until il was ten years old. By then i was so reatlees for
the company of my contemporaries that when i got to school i was

determined to hold my place. Il was going to etay or else.
14.

Teo begin with she put me in the fourth grade, I was des-
perstely unprepared for it, but I was also desperately in carne st.
1 worked like hell. I don't know of another eachool year in which I
worked more consietently. I had difficulty with spelling for a
while. i used to get fifteen on a scale of one hundred, but 1 worked
at it. Inewer lost courage at all--why, I don't understand, but 1
never did. I skipped half of the fifth grade and then I ekipped half
of the sixth grade and landed in the seventh grade where I stayed for
the whole time. Then | skipped all of the eighth grade and went
inte the secondary achool at the age of twelve. At any rate, 1 know
that when I got to Harvard i had just passed my seventeenth birth-
day. What Mother did casentially wae whoop up the speed of per-
formance to a point where 1 kept busy. And i kept very busy. I'd
had up to my tenth year for being in pasture and I didn't mind being
busy. I got a good physique out of it. 1 think it wae very wise, and.
as lesay,. i'm very grateful for that element in my earlier existence.

My life in Colorado Springs toward my fifteenth and sixteenth
year ie roughly represented by the hymn that runs, “i'm bat e stranger
here. Heavens is my home.” i knew that in all probability 1 wae
going to go to Harvard College and that 1 was not going to have the
reet of my life in Colorade Springs. That knowledge lent a curious
flavor to my existence. I knew that the finances of the family were

narrow enough so that 1 would have to help put myself through college
iS.

and thet I would be on my own from pretty early on. Father told
me eventually that he'd give me « college education if 1 would
help some, but that he couldn't help me on the profeesional educa-
tion atall, That's what it proved to be.

i regarded Harvard College as probably if not the superior
at least the equal of Olympus. I wae sure that the people there
were going to be everything that wae wonderful, agreeable, stimu-
lating. |

Harvard College for me, I can now see, was a very curious
experience. I wae convinced when I arrived that although I couldn't
prove to myself that these people that I landed with were demigode.
they certainly were different from anything that 1 had known in Colo~
rado Springs, and 1 would have to wait for a long while before I saw the
magnitede of the excellence of their characters, Now, of course, they
weren't gode or even demigode but it took me a long time to find out
how to fit in that atmosphere. I did a piece on that for the Harvard
Bulletin once, and doing that sharpened my wite to the passionate
loyalty the whole family felt for a place they only began to see little
by little. When I finally got to. Harvard, three of my brothers had
already been through the mill, This was the Harvard of the elective
system, and my brothers gave me very sensible advice which wae,
"Den't bother about the consistency of your studies. Geo te the best

teachers,“
i6.

J had the pick of a remarkable group of teachers, and I
simply went tothe beat ones there were, There were « lot of therm.

The English Department had as much as any, but the beat ones were
aleo scattered around the lot.

it wae the firet time I had had exclusively male teachers, and
they were very active fellows. i remember I was simply dumbfounded
to see o highly competent fellow like Charles Haskins spending hie
time teaching. He had a course in European History, History 1, which
was wonderiul. The section men weren't anything completely remark-~
able, thoagh 1 thank God that 1 had a fellow named Sheppard in English A
(which wae the only required course in Harvard), who was sympathetic
and encouraging.

l ranged very widely. i went on # little further with Greek, but I
didn't take any more Latin in college. i took neither French aor Ger-
man in college. I got those later. 1 passed ray requirements in Freach
and German to get into college. in geclogy 1 juet missed Nathaniel
Shaler by one year, but i took Geology 4 with William M. Davis.

Pve come to make a rather doubtful generalization about geo-
logista. They are men with atrong bony facee, not very articulate,
but very firm on the ground that they stand on. Cavis wae not an articu-
late teacher, but he had an expression on hie face when he talked about
clines and anti-clines and sedimentary and volcanic structures that
seemed to me to be so completely content and so completely solid and

indisputable, that I got that flavor out of geology. I'm damn glad that
iv,

i took that course because it has rade the travels that I've had since
much more interesting, When I look out of the window going down
through the Pyrenees | know in « certain sense where | arm.

The great regret--and thie is not of the dimension to crush
me at all--wase that in entrance to college in my day you had to pase
examinations in certain courses #o that your total system of values
was twenty-six points for entrance. You also had tu present the sig-
nature of your teacher to the effect that you had had the instruction
requisite to enable you to pase the exanhination. What i regret is
quite simply thie. Harvard did not allow aay two pointe out of the
twenty-six where you hadn't had any teaching but you were just ia-
terested enough in « subject that you presented yourself tor examina~
tion. I would have presented myself in physiography and meteorology
which [had read up in because 1 was genuinely interested, if I had
gotten in to college even to the tune of two points out of twenty-six
for something which is sometimes called auto-didactic-~that is, seli-
taught~-1 would have learned at the age of seventeen a leason which I
dida‘t learn until | was twenty-six, it's a very important lessen: namely,
that you can instruct yourself about something, and be competent in it
without ever having received instructions given to you by somebody elae.
That was the one defect from my purposes in the elective system. For
the rest of it, it was just perfectly suited to my frame of mind, and the

time that 1 apent figuring out what courses I wae going to take wan
18.

considerable. 1 only made what l sow regard as one carding!

error and that is thet I didn't take biology with William M. Wheeler
who would have opened a world to me that I've only come slowly to
be able to open myself. I missed him. Lami very unhappy that 1
didn't have that, bat it ien't worth mourning over.

In coltege i deliberately wae ae C stadent eo that I could cover a
let of ground and fields of interest. I'm glad I did that. i diecovered
with something epproaching aversion the knowledge that in order to get
echolarships at Harvard, you had to dyin one field where one course
would help you with another course. 1 remember that Edward i, Hunt,
a year shead af me in college, wae very bitter about that. He could

pull down the A's casily enough providing he stayed in one field. My
feeling was, "Why I didn't come to college to stay in one field av early.“

Now, of course, lL heven't mentioned a thing that is and wae
very important, I think that probably thirty percent of what you get
out of college you get out of your contemporaries, and my contem-
poraries were in the welting crowd, In my senior year l was preai-
dent of the Harvard Lampoon, Louis Williams was my sidekick on
it. Jack Reed was one year ahead of me. Bob Kenchley was there
a year after me with Fred Allen. I remember many yeare later
when l went to Russia for the KRockefelloer Foundation the very firat
houre I was in Moscow I decided that 1 would go and see Jack's tomb

which wee right outside the Kremlin, about a hundred years from
i9,

Lenin's tomb. I hopped over a low fence and wae looking at this black
granite tombstone, when a Communist policeman came and shoved
te off, Ithought. “Well. thie ia the height of irony," because on
occasion when Jack and l were approached by policemen ia Cambridge
it never occurred to us that someday I would be shooed off looking
at hie tombstone by a policerman. I think he would have hooted and
thumbed his nose at that Communist policeman just as a challenge
to authority of any eort.

i don't know that I could illustrate whom I deflated on the
Lampoon. I tried to deflate anobbery, but from my present point
of vantage 1 was too near to @ snob myself to do a handsome job at
it. I've always been interested in worda and a lot of toy contributions
tothe Lampoon were plays on words. Some were poor puns and a
lot were in Biblical style. But what I got out of it wae realizing
the scope that the Lampoon offered. You could tackle anything
you wanted to and if you could get away with it, well and good.
Gn the Advocate, which was the literary magasine, i confined
myself to efforts at verse. 1 don't think 1 wrote a single essay.
The towers in those days were tn the Harvard monthly. Walter
Lippmann was the admitted chief of my generation in the way of
writing.

itosk a course--it waan't a large course-~but it was a very

popular, very eclectic and at the same time a very much talked
20.

about couree with Cepeland. That consisted in doing a long essay
every two weeks. You'd then let it lie fallow in Copey's hande

for two weeks and then you went te hie room and read the thing

aloud ta him. It was «terrible experieace, because by that time

it was ceually cold, clammy and dead. Copey used to be pretty
critical. You sat at a desk, and he'd sit in the corner aad listen

and make comments which you were to write in with red ink. 1
dida't have even an idea of what musical langaage was. My sen-
tences used to be pretty awful and | remember Copey once interrupting
me and saying, “Thie ie out-Gregging Gregg! Devil do thy worst!"
He preceded thie comment by saying, “Cacophonoue and rude. Write
that out!”

What I got out of that course wae just the beginnings of the
feeling for clear and forceful writing--the choice of the right word.
That's grown slowly with noe so that 1 really appreciate either spoken
or written excellent language and apposite words for what one wante
to say. il remember George Vincent, who was the president of the
Rockefeller Foundation, told me a thing that illustrates thie point
exactly. He gaid that he cnew of an Oxford don who was asked his
opinion of another don whom he disliked intensely and he replied,
answering the question of what he thought of this fellow, "What time he
can epare from the adornment of his person, he devotes te the neglect

of hie duties.” 1 just loved that, Because it was eo closely packed.
ai.

Every word was right and there it was, That's the thing that I picked
out traveling around with the fellows onthe Advocate and Lampoon.
icarefully watched the praise that they gave. When you got on the
Advocate you could look through the drawer of things that were being
submitted and sometimes by chance find some of your own that had-
n't beea published yet for very good reasons, The critical judgments
of your contemporaries were asually written on the outside of these
papers. I remember that Shorty Long, on a poem that I had submitted,
wrote out in avery emall, but in a very quiet and efective handwriting,
much like Tom Eliot's, "lam ill at these numbers," That put a
sufficient block on my “numbers” go that they weren't aa frequent

for awhile. The contemporary criticiem at Harvard wae very

lively, and there were some first rate boys there. Tom Eliot was

on the Advocate with us. About the beet I could do then was either

pay attention or in retaliation write parodies of thelr staff and put
them inthe Lampoon.

Coming from Colorado Springs to Boston wae a very stimulating
and strencous businese. I felt uncouth. 1 felt like a monkey at an
afternoon tea. I seemed to be doing the wrong things consistently.

I picked up, not by explicit statement, but by peaple'a behavior, a lot
of standards thet | tried deaperately to follow. Some of them were
good standards and some of them were fearfully superficial and trivial,

i was pretty largely at sea so far as values went because l had cnade a very
22.

big transition and I didn't want to remain.

Although I had a good constitution in the sense of surviving
iliness, 1 did not have strength and in particular muscular control
and agility. 1 rode like a madman and badly all the way through
eollege. But i didn't have the skill to play the hardy Westerner. 1
really wasn't. Colorado Springs ae a Western town wasn't a Western
town, excepting that it wae near Gripple Creek and we had a little of
the flavor of gold mining. Although | eaw cowboys in town many a
time, I never lived on a ranch. A great deal of what Owen Wister
immortalized or at least made better known was not the kind of thing
my family or most of my friends were interested in. They too aleo
lived the West at second hand.

i was a long way from the fone et crigo and 1 payed sharp atten
tien to it. 1 got te know. partly through my brothere and sisters,
the Lowelis and Cabote and their views of things. I got to know them
well, i went to their families oa Sunday for lunch and that sort of
thing, and I heard the fiavor that they had. To my very slow and
very reluctant disillusionment I realised that they didn't have the
flame in their hands anymore. They were talking about the Thomas
Wentworth Higginsons and the generation that wae going fast. Heary
Lee Higginson was alive, available, but the Longfellows and the Lowells

end 60 on existed as tribes. They didn't exist as remarkable individuale.
23.

Gnee Migs Mabel Lyman described somebody as, “I think he was
in the dase of '67". I knew it wae gin, 1 knew that it was a damn
upstart remark, but 1 wes dama certain that there wae something
in it for me to say, “What college?" She nearly fell over. She
sort of exalted, laughed « bit self-consciously and then said, “Why,
i suppose that that means that l have always thought of classes as
claeees in Harvard.” She had, and that wae, if anything, an ander-
statement. Exactly how I fitted in I don't know. Incidentally,
the proviatialism of Harvard College wae one of the things I did
put pretty substantially in the Lampoon.

ihave come to the conclusion that 1 wae very slow in devel-
opment (that I grew very slowly). I'd gone to college pretty young--
juat turned seventeen. What in a sense then troubled me wae that
i was so youthful, 1 knew it, but 1 couldn't do anything about it.
My life consisted of two thinge roughly. One wae my inner life,
which was pretty lively, and an outer life which, compared with
some of my contemporaries, had the effect of making me feel pretty
damm young and pretty damn immature. i should say that that wae
rmaodified a little bit in turn by the fact that during the summer va-
cations, in order to earn some extra money, I taught. I did that
by being tutor in families. it wae tremendously stimulating, be-
cause I saw the inside family life of four different families, and it

was in pretty sharp contrast to what I'd had at home. 1 saw marital
24.

quarrels. I saw an indifference to standarda te be set for children that
jast applied me. For instance, I wae once at the table of one of

the families i tutored in where there were eight kids under thirteen

(by the procesa of bringing in some of their friends and neighbors)
where the parents were all drunk three quarters through the meal. I
was the only sober person at the table. I'4 never seen anything ap-
proximating that at home, Talk about comparative literature, 1 got
comparative family life to an extent that made me very mature in some
directions and very iromature in others,

I used to feel (thie isn't a question ia my mind any longer of
racial generalities) fearfully immature when I compared myself with
Carl Binger who was the year shead of me in college and with Joe Aub
who was in my clase, I didn't understand why it was that they were so
far ahead cfmée in reading, interests and values. 1 think I've got the
answer now. but it's taken me @ long time. It's thie. The analogous
boys to Walter Lippmann, Carl Binger and Jee Aub are the children of
American miesionaries in China. These children have the extraordinary
task. duty, obligation or circurnstance of having to see life through the
eyes of two different cultures with quite different values. If you grow up
that way seeing life binocularly instead of monocularly, you get mature
in some ways pretty early along. | once described that situation to «
teecher down at Duke, and he looked almost uncomfortable. He anid,

“I've never had an explanation. My brother's a missionary in India
25.

and i'm looking after his son and daughter who are just exactly

the same age ase gon and daughter of mine. Or. Gregg. the com-
parison between the two children ls one to make me fearful of my
children's capacity to earn their livinge. These othere are eo much
more thoughtful and so much better prepared. They know the way the
indians think about things and aleo the way the American missionary
thinks about things.

| i felt very unhappy about the kind of loneliness that being an
uncouth and awkward Westerner brought me. My activity on the
college paper wae something of a protest against my insignificance
in the athletic sense. But still and all 1 had to decide what ! wanted
tedo. It was my decision, which it woulda't have been if 1 had been
a football hero, because then | would have been under the coaches
completely. i think, as a matter of fact, that | could stop any in-
ordinate interest in football even in a state university by three moves
if Ll were president, Each of these moves would be perfectly harm-
lese but in their summation they would finish football, The moves
would be these: Firat announce that since football is a splendid
developer of character as well as brown, it will be an obligatory
course of all students attending the university. Let that sink in and
then, about two weeks later, announce that in order to encourage--

wonderful motive--those who are doing not very well in football,
26.

marke will be given for performance in football just as they are
given in the course. Then let that sink in for two weeks. Then
announce that the coaches have been instructed to give most of thelr
time to men who are getting D's and E's in football. That would
finieh it. They are impeccable reasons and disastrous resulte.

1 still think that my tendency to let the courses take their
own pace, although it made going through « little bit harder finan~
elally, wes a wise move intuitively taken. It seams to me, higher
education in my time was very heavily tactical and not at all strat-
egic. The definitions that i have in mind in saying that are, that
strategy is the art of knowing when and on what you will engage your
Strength. After that decision has been made cames the question
of tactice which can be defined as the exill, economy and the adroit-
ness in reaching the ends already defined by strategy. Now, I
think that college ought to be a time when the strategic lseuce
come forward pretty pointedly. I don't mind it if secondary education
is largely teaching in the ways to do things, but what to do, I think,
ought to be much more on the horizon than it ordinarily ie in college.
As l anderstand the general phenomena of higher education. we have
too much tactics. We still haye too much of just learning ways and
means, We don't have enough freedom deciding just what does amuse

you. It's like the German slang phrase, “Ich gerecht''. It's a thing
27.

that I have a right to do just because I'm free aad i can choose,

Well, it seems to me that boys and girls at the college age intuit~
ively feel that something ie wrong. They make up for it by student
activities where you're not told how to do things. Yor example,

you're certainly not told how to write on a college paper. You write.
William A. Nieleon once told me that he thought being on any one

of the college papera was worth any two courses in English in Har-
vard College. And I think it was. You have ae critics contemporaries
whose criticien: you care about. There'a no mother to guide you.
There are no performance tests, You can write about what you please.
it's an intimate and searching experience in strategic values.

I've devised a game on pure chance which is both amusing and
revealing. Take « group of ten friends who are in their forties and
over, and ask them, “Looking back over your life, can you think of
any events, persons or booke which you now realize were turning
pointe in the business of growing up?" 1 have deliberately avoided
saying "education". lt is important just to eay the business of growing
up. Well, about a third of the people will say, after a little reflection,
“No.” But you always get, in a group as large as ten, three or four
fellows who look at the ceiling and then look at the floor and then they
suddenly smile and say, “Why, I never thought of it that way. Yes,

lcantell you." You get the most interesting stories on that basis.
28.

For myself, I think the must powerful turning point in
college was reading William James and in particular bis thoughts
on habit. But the dominating event was a thing that happened quite
by chance. 1 was nineteen years old, ani was up at a camp that
James Putnam, William James aad Professor Bowditch maintained
in the Adirondacks. Putnam was then professor of psychiatry at
Harvard. It wae September, 1909, and it was told to kids in the
Putnam family. Tracy on one side and Martha on the other (who
were contemporaries and friende of mine), that Dr. Jim was going
to have three foreign visitors. Sure enough they turned up and a
very foreign outfit they were. Their names were Freud, Ferencai
and Jung. They stayed at the camp for a week. After they had
left and partly while they were atill there, lasked Dr, Putnam who
they were, and he out of the sweetness of his heart gave a college
sophomore an explanation of Freudian theory, l saw Freud. He was
in the flesh. Ll saw Srence! and Jung, but | didn't talk with them
hardly at all and certainly aot on the subject of their primary interest.
That event dovetailed with my life ia a very interesting fashion.

i used to, in very suphomoric form, keep a journal of what 1 was
mos interested in aud what 1 wanted to say to myself. l had written
out a piece within two weeke oy thereaboute of the time that 1 had
met theee people, the burden of which was that scx had some curious

relationship with accomplishment, especially artistic accomplishment.
29.

The nearest anslogy that I could think of was Niagara, in the point

that the natural phenomena of o tremendous waterfall with e hell

of a lot of energy could be modified by taking some of that water

to run turbines and make electricity. I thought that the remendous
brute force of the sex drive could (i didn't know the word sublimated,
but I came at it in every conceivable fashion} do things, Well, then
came along this fellow who eaid it did which wae a terrific reinforce-
ment, I spent most of my sophomore year in college, taking my courses,
but also keeping track of my dreame and aeeing what happened, and
watching the slips of tongue thet people made. Without being analyzed

i great deal of the machinery. it wae a fearful load. because I couldn't
explain it to anybody witheut their thinking that I was sexually perhape
off the line, but 1 did a tremendous job of digestion that year, as well
ae in my junior and senior years. It wae a big turning point. However,
it was an intervet ec totally barbarian to most of my contem-

porasies, and certainly my seniors, that I didn't dare show it. I had
an inner life of my ows which I] didn't share with anybody or practically
not at all.

Towards the end of college, although 1 had known for a long
time that i wanted to go inte medicine, lote of my friende tried to
pereuade me te go inte writing. | was enthusiastic enough about it.

i found the writing crowd at Harvard much more congenital company

than asybody in chemistry. Asa matter of fact 1 just skipped biology
30.

because it seemed to me to be eo much the flavor of what now-~
adays we call scientific and that didn't regale me at all. The
desire to go into medicine, however, wae an old one deeply rooted
in my childhood.

I can remember that when | wae about ten yeare old, I had
@ severe sore throat, and the family doctor in Colorado Springs
wae called. I noticed immediately my mother's reaction to him
was one of respect, intense concern and great punctilic. 1 remem-
ber Dr, Lawrence came with a cigar which Mother allowed him to
pat on 8 marble covered table, and Or. Lawrence listened to my
heart by the old direct method. He smelled as nobody | ever
amelied before. There was an appalling smell of tobacco. He turned
to my mother and esid, "Did you hear the curlews laet night?" (The
curlews used to migrate over Colorado Springs.) She said, “No.”
“Well,” he said, “I was coming home from MeCaffrey's--eight pounds
and in good condition. Mre, MeCaffrey's doing very well.” Turning
to me he said. “Il heard those curlews, and it was a wonderful sound
about three o'clock in the morning." He then reached for hie medi-
cine bag, pulled out a bottle of little brownigh purple crystals, and asked
Mother to get a glaae of water, which she did. He put a few of the
erymale into the water and the water turned a gloricus purple. kt
Was permanganate. He said, “Now, make up some of these, Mre.
Gregg, a half « teaspoon to a pitcher of water, and lethim gargie

every hour, half hour firet and later an hour.”
3,

I noticed that he eaild “let, sad that impressed me. There
were no categorical orders, It wae “let him gargle". After he hed
gone, Il heard Mother say to Father, “llike Dr. Lewrence. You
can trust him.“ I'd never heard Mother make a comrendatery
remark about much of anybody, but she was all for Dr. Lawrence
because he gave her eo much confidence. It was almost a denial
in terms to think of giving my mother confidence because she had a
handsome sapply of it, to my mind, all the time. Yet, here was
somebody who gave her confidence.

About four days later after | was over my sore throat, 1 was
aitting in & swing that belonged to a neighbor, and it just came on me
like that, “I'm going to be a doctor". This was a revelation so in-
tense that, being a minister's son, I thought I ought to talk to God
about it. Out ine public swing where anybody could see me kneeling
down was not quite the place so 1 ran up to our bathroom which was
the only room in our house that had a key and knelt down under geome
paraphernalia, my father's back scratcher and an enema outfit, and
thanked God for showing me what | was going to be. 1 wae just as
sure of that ae 1 could be of anything. I went to college and took the
courses that interested me “in preparation for the medical echool,
it waen‘'t a preparation at all, but 1 wae absolutely certain that I
wanted to be a doctor. it was a set piece from the age of ten.

To my interest I found from Frank Boyden, who ia the headmaster
at Deerfield, that it's a characteristic thing nowadays that medicine is
$2.

the only career that boys know from very early on. It's bewilder-
ment for most of the rest of them. I think that's an interesting
fact, and 1 wish | could probe to my own satisfaction the various
motives that boys have for going inte medicine. Mine hae been,
ithink. a composite of a sensation of wonder, the wonder of living
tissue, a curiosity, plus an element of liking people's affection and
réspect. Ihave no competition in me at all. lt doesn't amuse me
to compete because I can't stand the reeults most of the time. I know
that was the difficulty with athletics, However, you can be nice to
people and have them grateful, if they're ill and you're the doctor,
in a fashion that passes belief. That's what I really like. 1 don't
think that's the motive for everybody in medicine, just the same as
3 don't think motives are shared uniformly in any field. 1 realised
getting into medicine was going to be different.

initially | considered going to Johne Hopkine Medical Schaol
very seriously, because the provincialiem of Harvard was deep in
me (although I hasten to add that I'm a loyal graduate thereof), Al-
theugh 1 knew that i had to earn eome money to get through medical
school and that through friends and acquaintances I could pick up
summer jobs in Boston much better than if | went down to Johns
Hopkins, 1 went down fust the same.

In the apring vacation of my senior year I left the tutoring job
that I had up in New York state and went down to Baltimore. On arrival
33.

at Hopkins | wandered into the Anatomy Building. 1 aaw a very
sharp locking person, with very intelligent eyes there in the hall, and
he came over to me and said, “le there anything you're looking for?"

Il eaid, “No,”

“Well, " he said, “you're looking around."

isaid, “I don't mean to bother you with my own affairs but
i'm trying te decide what medical school to gow."

This individual wae Franklin P. Mall, whom i didn't know
from @ hole ia the wall, He gave me about fifteen minutes of talic
about what Johne Hepkine wae. i left ina perfect storm. I wanted
to sign on #0 much. i went out into the street and lew as one of the
students at Hopkins a fellow 1 had been a counselor with up ina YMCA
camp in my freshman year. He looked at me with astonishment and
said, “Why, Alan Gregg, what the hell are you doing here ?"

lsaid, “Why I'm trying to make up my mind what medical
school to gate. I'm going te go to medical school next auturun. "

He gald, “You come here. You won't make any mistake, We
have wonderful professors. in physiology ther’ e Howell. Papey
Welch is in pathology. Then there is Thayer in medicine." He wae
all enthusiastic, and then he added, “All except one son of a bitch. "

leaid rather guardedly, thinking that it would be a good thing
to know early on, “And who is that?"

“He thinks he's our profeseor of anatomy. His name is Franklin

P. Mall. DM just tell you what he did to us. The tiret day he met ue
34.

in Anatomy, he said, ‘Gentlemen, the dissection room will be
open from nine in the morning until ten at night except on Saturday
afternoos when you ought te go out and get some exerciee anyhow.
Up untl six o'clock there'll always be somebody to get you out of
any tangles you get into. 1 can recommend the three following text-
books, and when you're ready to take the examination, let me know. '
Now,” said my young friend, “if you can beat that ae a aon of a bitch
of lasinese in a professor you're going some.

Weill, the whole thing just anfolded at that. I aaid, “Thie is
a place where I would like to go." However, financially 1 coulda's
manage it and I knew I couldn't get jobs in Baltimore for the summer.
So i said. “Any port in « storm I've got to atay where I can make
enough money to go.” Sol went te Harvard. 1 would have gone glad-
ly to Hopkin. Mall has stayed in my mind as « good example of
excellent teaching completely wasted on a badly prepared student mind.
This boy I spoke of just missed Franklin Mall by yards and yards and
yards, I privately think that Mall's teaching was designed for and ap-
preciated by A-number-one students, but that Mall had an appalling
mortality because #o many of his students thought, "Well, he muet
be interested in golf or something. He ien't teaching. “ Thie boy,
incidentally, wae 1908 at Yale and the level of Yale instruction then
col, pletely failed to fit him for Johns Hopkins and Mall's instruction,
35.

Mall was reroarkable, and he's far nearer to being the core
of Hopkins than many people realize.

One of the requiremente to get into Harvard medical acheool
was to say that you'd had chemistry and to explain that you had sot
bad soology, and that was all. It wae nothing like the competition
nowadays. 1 think the pre-requisite atuff now is on the whole probably
wise. Ithink it hae some very serious limitations because it throwe
the time of decision nearer to the sophomore year than the senior
year because you have to proceed to say, “Well, I've got to have
three years of chemistry and I've got to have a year of biology and
a year of physics.” That's putting it so that you can't decide to
go to medical school at long last which again is tantamount to say-
ing you've gotto be a little precocious. We gave a tremendous
reward to precogity although as part of our course in biology we
take it as a complete fact that man among the animale ts distinguished
and hae reason to be damn glad of the fact that he has a leng period
of childhood and adoleecence. Speaking in terms of pure sovlogy.
the only reason we can have education is because thie long period
existe in which we can teach. We procdly say, "Yes, the reason
& man can trasemit s culture is that he hae « long period of pre-
paration for it." Then we turn right around and we give admission
te the medical schools to those who are precocious in preference

to those who are « long way from being precocious.
36.

When 1 arrived at the Harvard Medical School it wae in
& transitibual stage of moving from a status where it was almost
entirely a local institution inte being part and parcel of the then
rather bewildered but slowly growing medical climate of the
United States, To put i¢ somewhat too sarcastically, a Boston
birth certificate wae no longer one of the requirements for «
profesecrship. Harvard was just #lipping out of tat.

in order to get a very good clinician at the Massachusetts
General, Richard Cabot, whe was the obvious inheriter and heir
apparent, after Fred Shattuck, gave out word that he'd get oat of
the way if they could get a good man from somewhere else. They
act David Edsall. That, under terme of the then prevailing morals,
wae a very handsome thing for Cabot to have done. i think it was some ~
what less handsome in a way because Cabot was preoccupied with perely
moralistic questions, He later became professor ef social morality,
or something fantastic lke that at Harvard, quite apart from medicine.
Aga matter of fact, later he offered me « position as his assistant
which at the time was a guarantee of an established posltion in Boston.
I wasn't interested in it because I'd gotten interested in preventive
medicine, but Richard Cabot did a very decent thing in getting out of
the way. As econ as Edsall came, the solid Boston front began to
waver a little, Cushing was put in at the Brigham--or better to
#ay, the Srigham was created. It was the firet real rivalry that
37.

Massachusetts General ever had. Christian had already been brought
into the Brigharn from Johus Hopkins, as a professor of medicine.
Fhe combination of Chrigtian from Hopkins, Cushing from Hopkins
and Edeall from Philadtlphia via Waehington University at Salat Louis
tipped the scales and Harvard became an interstate rather than a
one-atate inetitution. it fell in with President Eliot's educational
ideaa.

By 1909 Eliot was convinced that Harvard Usiversity had no
future at all ae a regional institution and that ite only future lay in ite
being above questions of region, and being a quality job and a national
university in the eense of support from everywhere. In Edeall'e regime
that became the fact for the Harvard Medical School and still rersains
eo. Ithink that Edsall wae a good deal more of the architect of the
medical school as it stands today than most people realize. 1 remem-
ber that once he aeked me, “Ke you think I ought te keep on my
position at the Massachusettea General Heapital in clinical work or
give myself entirely to the dean's Job at Harvard Medical School?”

i wae dumblounded when he avked me because given my age I didn't
think it wae any of my business. i know what he was doing now. He
wae trying to sample the opinion of the younger generation.

ieatd, “I think the latter ie the thing to do,"

He made ne comment, but he'd gotten hie sample and that wae
that.
38.

i came in to the Harvard Medical School with this Colorado
taint and so I saw the ecene a little bit from the grandstand in the
sense of not being committed to « desire to live in Boston forever
and forever, and knowing that probably it was going to be in other
fields thah Boston that my future was going to be thrown, 1 could
look in and the more I saw of the Medical School the surer I was
that exogamy wae what was needed. I'd cheer every time that they
brought in an outsider. The school went up just like that in quality.
It was a fantastic change.

i used to make my contemporarice mad as hell by saying,
“Look, the Boaten Red Sux don't require a birth certificate as ad-
mission for employment, They're looking for baseball players.
Why can't we draw « moral from a very unlikely place?" We
should have and to « certain extent we actually did. But in the
beginning Harvard wae not like Hopkins, Osler, Welch and
Halstead bullt up in Hopkina » tradition of excellence, of knowing
ite features fairly well, knowing ite food fairly well. of knowing the
animal called excellence. That hae since survived some very unfor-
tunate appeintments. (it ie interesting that that epirot of excellence
till can be evoked in Hopkins, and I think that Barry Woods can
evoke it.)
39.

At the Harvard Medical School I had Johnny Warren and
Robert N. Green, his assistant, in anatomy, Breemer and Councilman
in pathology, Cannon in physiology, aad old Folin in bio-chemistry,
Those five were easily the top. Physiology interested me partly be«
cauee of Cannon's quality, and partly because enatomy being so largely
taught at that time ae spacial relationships didn't amuse or interest
me immensely. Johnny Warren was a rather painful piece, in my
opinion, of nepstiem. He belonged to the Warren family and there
wasn't anything much better to do than to make him profesecr of
anatomy. He was avery second rate mind.

Dr. Bereemer had more of an interest in the student. Once he
asked me if I'd like to help him with a little piece of research. 1 wae eo flat-
tered and delighted that 1 said I would. Asa result Breemer set me to
making « reconstruction of a rabbit placenta. i did it only reasonably
well, but the relationship which Breemer maintained with me was very
stimulating. I alao had Councilman in pathology. Councilman was the
son of a Maryland farmer and the key to his interest and character was
that of a biologist, better to say a natural historian. The distinction
between an experimentalist and a natugal historian is that the nat-
ural historian observes and records the uniformitics of behavior.

He never tries to interfere with an experiment to eee what will happen,
Gouncy was much more of a natural historian than an experimen-

talist. He was rather conscious of the fact that when he left Johns
Hopkins to come to Boston he was leaving Mecca. He married

a capable Bostonian who changed hie point of view a bit bat not

very much. The thing that took Councy'a measure i think wee the
ability of Or. Mallory in the same department. There was a bitter
quarre] between the two, the inside of which 1 never knew, but |

knew it was on, Councy was the kind of a pereon who was #0 emotional
that he was far from being above trivial and nasty things that he'd say
or do, and Harvard pathology just went on the racks. He was on the
other hand a perfectly charming character and picturesque figure.

He loved teaching and did it pretty well, He loved the natural hiet-
orlan approach, but was, however, so narrow and small minded on
certain subjects relating to his department and hie relationships with
Mallory that he just tore things to pleces.

Mallory wae a firet class observer and scientist, not mag-
nificent as an experimenter, but very good. I remember a tale that
Ted Parker, who waes classmate of mine and an adherent of
Mallory’s, told me. He said that once Mallory came in to his gang
of agsiatante with what looked like « piece of tiseue in his hand. He
shoved it before therm and said, “What ie it?"

They looked at it and they were completely confused. It was
almost colorless, slightly blood stained, originally apparently a clear
transparent, but in the form of o big bag of something or other with a
perfectly definite covering to it. They'd never seen anything like it.
41,

One of them poked it with a match, looked at it, and finally Mallory
bellowed at them to tell hirn what it was. Gne of hie assistants,
smelling of the match, said, "Well, it looks like parrafin.

Mallory Just bellowed at the top of bie lungs, ‘It is parrafin. "

He wae just trying to reward an honest but incredulous
observer. Mallory stood for that sort of thing. He steod for good
observation. The alr at Harvard in pathology was cloudy all the
time that l was there. It came out rouch better later.

Phystology bad a better standing at Harvard than it had in
many other schools at that time. That was largely due to Cannon's
quality as a human being. ln a negative sense it was aleo largely due
to the fact that pathology was ic such a mess that physiology wae
beund te stand out even by contrast. Harvard gave much more of
& reward to on ambitious stadent to go inte physiology than it
ever afforded a peraon who might have gone into pathology. _ For
example, Alex Forbes, an assistant to Cannen, asked me if I would
like to do research on nerve action carrent, He did some of the pre-
liminary and pioneering work in that field in the United States. 1 liked
Alex Forbes and found out a grest deal of the flavor of reasearch from
him. When we were done Alex insisted on putting my neme on the paper.
in my opinion then and not far from it now, I felt that it wae « dishonest
thing to do because 1 didn't understand the etuff that i wae signing and
42.

Alex hada't the faintest idea of the depth of my ignorance. I know
now why he did it; it wae done to get me interested.

I may inadvertentiy have given the impression that there
were no firet rate etadents among the pathologists. That just waen't
oo. There were examples of first rate youngsters in the department
of pathology, and it seems to me that the medical school had about
as distinguished « product of pathologists as it had of physiologists,
but to « student and to myself as « receiving mechaniom they weren't
in the same clase. Cannon was way ahead, aud physiology was way
ahead. Cannon had an affection for hia stadentsa, There waen't any
spare affection to be had in the department of pathology. It just was-
n't one of the commedities that was on the shelf. Homer Wright, who
wae s pathologist dows at the Massachusetts General, wae a rather
embittered, retiring, emcompromisingly honest fellow who felt that
he hed been done down. i reomernber working late in his laboratory
one night, and I stepped on the staircase to look at a picture of Popsy
Welch. Homer Wright wae just going home and he saw me locking at
it, and he bellowed at me, "Do you know who that is?"

I gaid, “Why, that's Gr. Weich of Hopkine, isn't it?"

He said, "The only white man of my experience!" and stormed
eat of the laboratory. That described pretty well how he wae getting
along with Councy and with Mallory. There was no friendliness in the
department at all.
43.

Being taken from a college atmosphere where I had had
relatively little ecience aud plunged into the thick of it disturbed
me. It wae pretty disturbing because I didn't get better than C's
eo far aglknow. i had hoped to get A's and be given a scholer~
ship. ican remember that in chemistry where I had had a very
poor preparation end felt thoroughly incompetent, I think the
sweetest words l ever heard were at the end of the examination
in blo-chermistry. Folin wae staying by--it was a laboratory ex-
amination as well as a written examination--aed 1 was the last
one te lgave the laboratory. I was feeling very depressed, in-
adequate and low, lwae plugging along, and showing by tenacity
what } lacked in intelligence, Folia came over to me and in his
slow and sing-song Swedieh intonation he said tome, “Don't be
ahog. You have dons very well.”

#rom that moment the gordian knotwae cut for me. I wae
in the clear. I finished up the experiment hardly able to contain
myself for satiefaction and contentment.

Yet there is no gaineaying that | was pretty bewlldered
by my firet year in medical school. 1 didn't know a damn thing
about observation--perhaps that's why I'm etill interested in it.

i didn't do very well the first year because I'd stayed out a year
totutor in order to get money enough to at least atart in medical

achool, and I was profoundly teraubled. 1 remember in this
44.

connection 1 was ap at summer camp and Richard Cabot was
there as one of the owners of the camp during « part of the eum-
mer that he could spare. We were out canoeing together. He
was in the bow and | was in the stern. We were talking and he
said, “How did the medical school go?"

leaid, “it didn't go very well. *

Thea he did something that 1 wasn't prepared for. He
wal Gn awkward guy, and he almost tipped us over by turning
around suddenly, looking at me and saying, “Why, Alan, you
didn't think the medical echool was e hundred yard dash, did you?"

A little defiantly l answered, “Well, it dece have sume
elements of competition, Or. Cabot."

"Gh." be eaid, ‘if you've thinking of doing well in the
medical echool and settling your future that way, you're com-
pletely wrong. 1 aesure you you are completely wrong. The time
te draw the line and add up the pro's aad con's in medicine is on
your fortieth birthday, "

That wae a tremendous relief to me because i thought
to myseli, “Well, danm fool that lam aud a possessor of Gta
instead of A's, i know oné¢ thing. il can keep at it. if that's what's

required, 1 certainly can keep at it." It was a tremendous relief,
45.

Then something encouraging happened a little bit further
on. When I got into the clinical years my marke suddenly be-
gen to be A’e and B's, I couldn't underetand it, but of course I
waa cheered up by it, I did not get into AOA until thirty-five
yeare later when I was given aq honorary which, 1 think, le a
perfect exarnple of justice. Everything improved in the clinicel
yeare (the third and fourth years). 1 got along with patiente well,
and I got clear stories out of them. 1 think now that it wae in
the clinical relationshipe with people that the pay-off of having suited
myself in my college courses began, It hae never ceased,

i'm rather reluctant to Judge students at a time when the
most wonderful thing for them to be le precocious and awfully good
scientiets. However, that isn't what they'll need later on quite eo
much. I think that it's a salient aed significant fact of medical
education that we put boys under the guidance of and make them the
victime of ¢rticiem of nothing but doctors for four years. Perhaps
it's better to say seven years because during their internships their
critics and judges are doctors alea, We then turn ther loose into
e lay population and suddenly their critics and judges are laymen,
They don't know that the criteria have changed, or at least they feel
completely tewlldered by the change that there ia. 1 think thet it would be a
good thing--and 1 make the point when I talk to studente of warn-
ing thems--that the road is going to change and it's going to change
at right angles, and they'd better, insofar as they can, pick up

a little bit of something that might help them to see the way doc-
tore are regarded by laymen, 1 tell them to learn what qualities
they will have to show other than 8 clear and simple knowledge of
otidation processes.

Age medical student Il had a very definite ignorance of the
complexities and the elusiveness of psychosomatic conditions;
although. l had a very definite interest in psychiatry. From
Elmer Southard | had the moat intelligent treatment in terms of
what to aliow a fourth year student who elects an elective course
in paychiatry that l ever had from anybody. 1 simply met Southard
whe in his breezy way said, ‘What are you interested in? What
do you want to do ia thie time?"

i tald him that 1 wanted to read and look over histories of
the peycyopathic. He said, "That's fine, Ul meet you on the
last Wednesday of every month and we'll talk over your reading
and your impreasions. Goodbye,"

1 Juet reveled in complete freedom and with that amount
of freedom | got a major interest in psychiatry because | felt,
“Well, here ie a new field where practically nobody is at work."

Another important experience that 1 had in my clinical
47.

years asa medical student was exposure to CPC, or the clinical
pathological conference. Our CPC's were held at the Brigham.
Richard Gabot was the clinician and Bert Wolbach was the patho-
logiet. Usually Cabot sever enw the case before the conference.
One day Cabot gave his impressions of what the condition was
and l was sitting up in one of the back rows and wrote down my
impressions of what it wae going te turn out to be. Now, Cabot
was wrong and | wae right, aad i got « wonderful kick out of
being right. But that got me far enough into it that | kept a pretty
sarefal account. it won't surprise anyone to know that Cabot's
batting average wae a great deal better than mine. That's after
all something to learn. You have interest, the material is there,
and yet Il would add somewhat maliciously perhaps, that | was puzzled
by the pathologist's performance, in that in many an autopsy {and
ithink too many). the ond reesulte could be summarised that either
it was a case where you said, "Well, how the hell did he keep
alive with thie state of affaires in hie insides, or etill what did
he die of 7" That pointed my mind in the direction of saying,
“There's « lot more in function than in form. that uatil we know
the functions of an organ or a system of organs, we don't know
anything really.“

It was a wonderfully vivid form of teaching, and it allowed me the chance

to be right just enough to whet my appetite. i¢ was a creator of interest.
46.

i thank the Cabot brothers a great deal for introducing that at Harvard.
it representa by ite continuance and by its effectivences a measure of
magistral hurnility that ie not to be found in other parts of the world.
Ae it stands I have ecen it act as an absolute model of humility te
people who have been brought up where it is not practiced or used.
They don't have any hope of taking it back to their country because

it would ruin the prestige of the boys who are never wrong. It's an
admirable thing. i dida't know until recently that it wasn't the Cabots
who started CPC. in eesence it wae started by the Panama Canal
medical organization because too many people died in Panama from
diseases that couldn't be explained. For example, it became a mili-
tary ruling that the dectors had to have a written, signed diagnosis,

if surgery was involved, of what the pre-operative diagnosis was

and what the diagnosis was on death and then the pathologiat's report.
The same was true for medical casen.

Looking back I think the Harvard hospitals, both the Massa-~
chusetts General Hospital and the Brigham, were honest in keeping their
mortality figures. 1 ought to add that Aichard Cabot caused a hage
storm in Boston the time that I was there by announcing that he had
gone over the CPC records and the Massachusetts General doctors
had a acore of fifty-four percent correct. It was a terrifically dis-

turbing thing to think that the Maesachusette General was only fifty-
49,

four percent right. Yet that was not the right way to state it, and one
has to bring some clear statistical thinking te bear there. The Massea-
chusetts General Hospital, at that time, had a singularly large
number of exceedingly difficult diagnostic probleme who were speci~
fically brought to the hospital for that reason. Therefore, they were
playing in a field where expertese at best was very justifiably mod.
est. A great many people didn't realixe that. They didn't realine
that a hospital in those daye very much as now wae trying to crack
the hardest nuts. That doesn't mean that doctors had « little bit
above flipping a penny and being right. The thing that inter.
ested me along with that statistical approach and 1 still feel is
a grett field for development, is the study of the kind of thought
and clarity of thinking that is brought to a medical case. 1 can
sometimes iligetrate things by witticiame because the witticiam
hange on cloudy thinking. I happen to recall now a woman who
said to her dactor, “Doctor, is the pain in my right knee a sign
of getting very old, perhaps too old?" |

The doctor ssid, "No, madam, your left knee is just as
old ae your right."

There's cloudy thinking in there somewhere, She sounded
as though eke were putting the entire emphasis on the adjective,
and it wae an insignificant adjective and the doctor rightly caught

her inthe insignificance of the adjective. Now, all these thinge
59.

build up into a job that has to be done. We've got to bring better
thinking to bear on our cases,

Another thing in which Il took some role or part and which
subsequently had a good desl to do with my interests wae the intro-
duction of statistics inte the study of cases. +e had a society in the
medical school called the Boylaton Medical Society at which, in your
fourth year, you had to give a serious paper. You had to have pre-
sent on the evening of your paper one of the members of the faculty
whom you had invited te come and discuss the paper. Well, after
a certain amount of fiddling around, i made my) jwubject the contriba-
tion of mathematics to the study of medicine, 1 taught myself the
rudiments of statistics. 1 actually knew what a standard deviation
wae and what a coefficient of correlation was and so forth. However,
1 left to pretty late the business of finding a member of the faculty
who would come and discuss my paper. 1 couldn't find anybody.
There just waen't anybody on the faculty who was willing | te come,

Qn bended knee and because he was one of the few personel friends

i had on the faculty 1 got Richard Cabot to come and talk about it.

I don't think that he had the faintest ides of the importance of & stand«
ard deviation, or had any notign of the broad line of reasoning that
the statistician used. Althougt Cabot didn't under étand the neceseity

of making distinctions between) jmode, mean and average, he came
51.

anyway. Idon't remember the details of the evening but the die-
cussion reinforced my views that the eubject warranted attention.
Deeper 1 knew there was a lot for medicine coming in that field,
One important area in this field was and ie the problem of
the observer. For example, only a couple of days ago, 1 thought
that “Since I've got to talk at my college's forty-fifth reunion,
i think that I'l talk about something that everybody has had one
whack at in one way or another. That is, the general conclusion
eof a certain section of our class that ia now still living, that the
world is going whellin a hand basket and that people are not a¢
moral, responsible or decent as they used to be. Could that sup-
position by any chance be explained by thie line of reasoning 7"
Out of our whole class there was a fraction at least af sober, god-
fearing, moderation-at-all cost boys who were that way vary
largely because they were extremely sensitive to criticiem and
moralistic remarks. Te become convinced of moderation in all
thinga le something that makes it quite Likely that one will reach
the age of sixty-five. That is to say that when those who are
sixty~five meet together it'a practically inescapable that they
will come to the conclusion that in their youth people were a lot
more eober than they are now. Sure, what of it? They alwaye
bave been. They always will be. The boys that aren't paying any

attention at all to the expe rience of the past are going to be dead
52.

before the ones who do pay attention, So on the forty-fifth an~-
niversary of the clase of 1906 there will be those who are naturally
eagacious and who have learned the trick of surviving to an old
age pretty young ani they're going to say, “When we were young,
people didn't raise bell." But the truth is that those that did died
off, and that could explain the almost uniformly general feeling
that the world is going tohell. That particular thing ie being
celebrated by those who didn't have that tendency and are now
looking back on it or are now locking at the younger generation
that hae both kinds of people pretty severely and saying, “Not in
may day". Well, they ddn't in their day and that's why they are
still alive now, That touches on the problem of the observer.
There are theee intricacies. What does the observer bring to
the observation that in some way or other seema to either enter
the observation or enter the conclusions that are drawn from it?
it's one of the things that hae continued to fascinate me in medicine,
Speaking of observation and the quality of thinking reminds
me of an interesting experiment.1 engaged in when | was a student
at the medical school. In those daye I used to go occasionally to
dinner part.es in Boston Saturday aight and I would bear rather
frequently remarks from my elders and betters, or strangers,
that bore on the excellence of the Harvard Lew School. Ht piqued
me te find that the Harvard Medical School had ne such country~
53.

wide reputation, not be a long shot. It has sow, but in those days
it didn't.

With the brash directness of youth 1 said to myself, “Well,

i don't think I} be missed anywhere if i play hookey for » couple of
days, and I know what I'm going te do. I'm going over the law
school and see what it is they have that is so wonderful, it's « big
enough show so that 1 won't be put out of any classroom that 1 choose
to go ints, *

I went to the law school and 1 found out two things that were
interesting. One was that on the hoof and en masee the law echaol
students were very much better quality of animal than we had. They
looked far more intelligent and they behaved with a great deal more
apparent self control, knowledgeability and sericusnees of demeanor.
That rather shocied me because i dida't find it amusing to be ia
with a gang of cagual dolts which is a pretty poor description of the
Harvard Medical School et that time, but we had gome rather weak
brethren which i didn't see any evidence of in the law echool, The
other discovery at the law echool wae far more important aad made
far more of an impression on me. That was that 1 eaw whole
classes being led and encouraged and helped ia the business of
how to think and not what to know, That threw my mind very
sharply on the fact that the mental processes of the medical students

were being taken for granted. Medical students were not given any
54.

atieation to compare with the law school. Of course, it was ob-
vious that the law schvol boys had no laboratory to work in. they
had nothing to observe, they just concentrated on. “How do you

get that way? Why do you eay that?” The thinking process was
very sharply emphasized, That's come to my assistance many
times since; namely, the relative neglect of the processes by
which one arrives at a conclusion. I think that there is a thing

that would deserve this deacription if it weren't for the pun in-
volved. 1 know that there is a process called logic. i think there's
a process called biclogic-~that is, it's the thing that is in play whea
a doctor aays, "i don't know. 1 can't tell you how l arrived at that,
but i Just know that this is typhoid. *

Now what's going on? Why does he say it in that vague
fashion? Well, that relates to statistical experience and interpre-
tation. In the Harvard of my time it wae a little bit lonely beusiness
te be doing that. There was one other companion that 1 had in that
kind of thing--a bey samed Jake Wilbur, who later went into psycho-
analysis. Jske had an adventuresome and a pretty well experienced
type Of mind and on his own accouat and with no direction or prese-
uré on him at all he was very widely read. He was a good desl af s philo-
Gopher in the sease of being the onlooker abuut most of the things that
happened. Along with that, curiuusly enough, he had s timidity and
55.

a sense of reeponsibility that almost overwhelmed me because
@e One may realize responsibility is piled pretty heavily on the
young shoulders in the medical school. To be blunt about it,
you occasionally kill somebody. 1 remember the firat man that
i thought I had killed, and I probably had. It ien't a light load
atall. It contributes to your growing up considerably when it
happens.

Cushing 1 was told, but I never confirmed it by him,
spent the night walking up and down as « house officer when he'd
killed his firat mas. He was trying to decide whether to drop
medicine entirely and go into architecture, Well. vou have to
face thoee things, When I found that that was the case and that
nearly everobody and perhaps everyone had, inadvertently killed
eormeone it wae a great relief to me, However, untit, that moment
i dida't realize that that was the magnitude of the rekponsibitity.
it was and it sobered me. I can spot today among blologiats,
who have never had clinical responsibility, a streak of fanciful-
ness without responsibility which epells itself, “Wet, we might
give him some chloride instead of some bromide", "We might
give him some of this instead of that", that docen't have the
faintest relation to what would happen if they did give it to him.
it's a very solemn thing that happens to you when you find out

some of the things that can happen.
56.

You ace, in your third or foarth year perhaps ten or
fifteen of your teachers handle patiests, and they do it amazingly
differently. Most of them do it very conscientiously and your
wits are sharpened to that very fast. One of the amusing things--
although it would be hard to convey the amusement of it--of the
third year ia thet you see a lot of your clasemates whom you have
known as pretty rough end tamble tough guys develop their idea
of the perfect bedside manner. Some of the early and initial
essays in that direction were ludicrous, I won't name names but 1
can remember a boy whe put on a sing-song voice and began to
pat everybody that he came near not knowing what kind of people
you can pat and what kind of people it's very well to leave along.

i can remember that in 1926 when 1 came back from three years
in Europe I attended ward rounds of a professor of medicine

in an extremely well-known American medical achool. I was
thunderastruack at his culmination of rudenese and stupidity, 1

saw him come up to the bedside of eight successive bed patients
in the univeraity hospital and forget to say good morning to the
patients. it was much more, “Have the x-rays cone in yet?’ and
then onto the next bed if they hadn't~--there was no relationship

whatever with the patient and | was pretty troubled by it.
57.

After Harvard College the next big turning point in my
life came at the end of medical echool when I entered the Massa-
chusette General Hoapital to begia my internship. Almost im-
mediately I learned an important lesson. lhad as two visiting
men Dr. Richard Cabot and Dr. William H. Smith. I made the
none too pleasant discovery that they had very different interests
in medicine and thet If 1 wanted to make merit with either one of
them I could write a history designed to please them. Unfortunately,
however, l couldn't rell who was going to take up a given case. it
might be that Cabot was going to take op « history that I had written for
Smith and vice verea, and then in neither case would it succeed. But
if l had the good lack of having the man take up the case for whom i
had written the history it was all right. I felt like sort of an intell-
ectual prostitute. I could pleasethe patron maybe, but 1 wasn't heaving
any fun.

One night 1 stopped Bill Palmer, whe was then resident at the
Massachusetts General in the throughway in the hospital. The resident
at the Massachusetts General in those days was almost unattainable,
even the senior wasa't supposed to bother him much. But | got my courage
up and I stopped Bill Palmer and asked, "Or. Palmer, could 1 speak
tu you for a minute 7"

He looked a little surprised and said. "Yee."

Il eaid, “Could you give me any tips on writing a good history?"

He looked very cloudy and finally said something that was
58.

just perfect. He said, "No, | don't know of any tips about writing
histories." Then he looked at me quite pointedly and said, “But

I think that if you write a history that satisfies you, it will be a
good history,

i thought that was an absolutely sweeping remark, and |
thought with shame, "It never occurred to me to do that. lt hae
never occurred to me. By gosh, I'll go ap to the ward work to~
tmorrow,and I'll write a history that satisfies me and i don't care
how long it takes." 1 was then right at the stage where 1 could
write «a paseable history. i could take a passable history in forty
minutes, re-write it in half an hour. and it would conform with the
wiual tradition of a history. However, that history would be one done
to please my bosses.

lL went up, and by pure fortuitous circumstance, the woman in
bed that I was assigned to take the history of as an intern had migraine.
ihad only read about migraine very casually, but she had it. 1 said,
“This ie it. I'm going to take a history that will satiely me." Instead
of forty minutes 1 spent two houre with her and l asked her every dama
question I could think of. When I finished lhad a tremendous number
of notes and I found that it took me a whole hour to gettheee actes in order
and digested. Then two miracles occurred, and they really were.
They just knocked me for a loop. One of therm was that 1 realized that

I wanted to go to the library not to appear to know about things,
59.

but to find out how much anybody else had ever learned about
rnigraine. I really wae directly interested, and independent of
any other consideration 1 wanted to learn about migraine. That
astonished me because 1 had never gane to the lisrary ia any
other frame of mind than one of “Well, now, of course, 1 can't
be caught off base. I'd better read about this. This time that
wasn't what l went for. I went to find out as much as I could,

The other miracle was also completely fortuitous. We
hadn't had any migraines on the wards for a long time, and when
it was reported to both Dr, Smith and Dr. Cabot that a case of
migraine came in the day before, both of them wanted to take
up the case instead of only one. They usually wouldn't cross
each other's fences and repeat on the same patient, bat both of
them wanted to, and both of them read my history and both of
them said, “This in an anueually good history. Whe took it?"

Il manfully stepped forward and took the credit that 1 knew
or felt fairly certain was coming as credit, Then it suddenly
flashed over me, “You suit yourself, and by gee, you don't have
to worry about sulting anybody elee." That was a primary discovery
which I could have made on meteorology and physiography before
I got to Harvard College perfectly well if they had given credit
for my teaching myself. An intern taking a history is teaching
60.

himself. That was postponed until | got into the internship. How-
ever, it changed the entire face of medicine for me as being some-
thing you could say this way, “Thies has never happened before.
I who am a queer guy anyhow, meeting thie woman whe is an in-
dividual sick with migraine. Now what's going to come out of it?"
That gave me a freshness of interest in clinical material on patients
that 1 don't think I've ever lost. Since that day, I've never gone into
the pigeonholing dueiness, like, well, thie is manifestly a case of
Addison's disease and once you get it labeled you let it alone. I've
got corapletely out of what, and that was another first class turning point.
You learn your way. You see a lot of panful mistakes.
You stay afterwards when you're an intern to talk to the patient
because you're living with him and the visiting man is going home.
ican remember an incident of that kind that made a good deal of aa
impression on me. One day we had a young man who was an expert
accountant come in to the hospital with Bright's disease, acute. He
told me the reagon he had come to Massachusetts General was because
he had heard that Ur. Richard Cabot told the truth to patients, and he
had to know the truth about himself. We got all the laboratory work
finished and when he wae ready for presentation, he insisted on
seeing Dr. Cabot. It was natural enough, in my opinion. At
the end of Cabot's examination he was half-sitting up in bed and
61.

breathing rapidly because he wae pretty sick. but he said, “I've
come in, Dr. Cabot, because | understand you tell the truth to
patients who ask you to,"

Cabot said, “1 do."

The patient said, “Do you think I'm going to live, Boe 7”

Cabot eaid, "Nope, *

The patient sort of fell back and said, “Well, of course,
none of us are going to live forever, but how long do you think
I'm going to live 7"

Cabot said, “I should say somewhere between a week and
ten days.”

The patient eank back, very nearly fainting away, but quite
out of reach otherwise, and, as the phrase goes, the visit went on
the next bed. I was then a juntor, and the patient reached out
and caught me by the band before [left and he said, “Bend down."

i bent down to hear what he wanted to say, and again between
gacpa he said, “Jeaus, that's a handout. Can 1 ece another doctor?”

leaid, "Yes, UM bave Dr. Lee see you tomorrow. "

The next day Roger Lee came, went over the whole thing and
got the sare question, “Am 1 going to live ?"

Roger Lee said, "Mr. Nelson, you've got to realise that you're
an awfully buey man when you're sick, We're pretty busy too. You be

buey being sick, and we'll be doing the worrying. And 1 want to tell
62.

you aleo that I have known doctors who in their most honest opinion
were wrong.“

The visit went on, and the patient reached out again for me.
Between hiv gaepa he said, “That's what I call a good doctor."

Well, you see these things, and there isn't much doubt about
the choice of handling the patient on the question of telling the truth
after you've seen that. There are ways of admitting it, end Lee
aleo said, “Il think you're very eick and i think you're very busy.
Now, you be a good boy and keep busy. I'll do the worrying.” The
response to that was, “Jesus, that's what I call a good doctor."

You see those things played, and they're played is the raw
and with a great deal of feeling, You pick up things from time to
time.

A lot of education went on among the juniors and | remember
something that impreased me at the Massachusetts General. We
had an awfully good crowd of boys. Once we had a woman come in
with a question of tuberculosis. One of the boys whose job it was
to do the laboratory work as promptly ae possible examined her
sputum that afternoon, didn't find any tuberculosie, and recorded
it in the history. He'd done his work for that day. He'd done his
work but he was going to examine it again later. The senior in
charge of the service was Bill Kerr, who later became profess-

or of medicine at California. Bill came home from hie night
63.

off and read all the histories before he went to bed. When he
came to the extremely expressive NEG on the report on the sputum;
mamely, negative for tuberculosis, he sald, “Not de the history.
That woman's got tuberculosis. Where is Dirk?"

Dirk was the fellow in charge of the laboratory work and
leaid, “Heta gone to sleep.

Bill spat, “Sleep, hell! i'l! see him, and he went in and
work Dirken from a sound and much deserved sleep. He said,
“Dirk, you put on your pants and come up to the laboratory and
LL ‘show you that that woman up in 16 bas tuberculosis. I know damn
well she has and you ought to, too. Dirk couldntt refuse that chal-
lenge and he put on his pants and they went up te the laboratory. They
worked until three o'clock in the morning and Bill found the tubercu-
lovie all right. That's the kind of morale there was.) You didatt let
down the service by putting in a negative report when, within reason
you ehould have had a positive one. It was « tremendous stimulus.
in many ways it was like the sensitivences that a college freshinas has
for a college senior. That same paychology was in play on the surface,
and the surface morale and tone was such that the visiting doctors had to
keep ue away from work rather than urging oe to de it. That was lit-
erally true. I remember internes got so tired that they déme out with

boile and many a surgivel senior in my time had to get off'the service
64,

service for a while because he wae too tired or too sick to be
around to be safe for the patients. That etandard of performance
Was avery high standard and we were proud of it.

The chiefs of the service in my time were Roger Lee,
Bill Smith and Richard Cabot. We didn't see an awful lot of
Cabot because he had other interests and was trying togpen up
some opportunities for younger men, but 1 saw a grest deal of
Bill Smith and a fair amount of Roger Lee, though his services
were go timed that 1 missed him as e« senior, which i've bitterly
regretted,

The Massachusetts General at that time was, I think, fairly
clearly the best intern service in Boston. li was very much on its
good behavior because the Brigham had just come into the picure
and the Brigham was reaching out for the best men it could get.
The Boston City wae good of a very peculiar basis; namely, if one
took a city hospital interagship, one had an endless quantity of material
but not quite eo good and careful guidance through it, However,
if you were mature enough to take that. there was more actual ree-
ponsibility at the City than there was at the Massachusetta aad the
Brigham. Channing Frothingham, a little bit ahead of me, took the
city hospital appointment because he didn't get the Massachusetts
appointment asd because he knew that he wanted plent of res-

ponsibility, Well, he was so much better than the ordinary
65.

intern there that they gave him a tremendous responsibility.
He gained by that compensation phenemenon,

I recently wrote an account of what happens to a young
doctor in training and called it “Anabasie". Well, “anabaste"
meana the way up into, and Ihave long been convinced that one's
entry into medicine is net a spectacular plunge. It's much more
like « coming up from the eeacoast into the mountain range in that
it is accomplished at different speeds, subject to the different
kind of country that you go into. It's a slow, winding experience
such ae going up into the mountains would be from the seashore.
it's a long game and parte of it come at very different tempo
from what your friends and classmetes are going through.

The conteropoary influence that I felt the most came
through my relationship with George Bigelow. Tommy Goethale and
Joe Aub. Joe had more of an influence on me than he realised.

i didn't have any junior family life and 1 didn't have any immense
interest in them. As the youngest in the hospital family 1 alwaye
automatically pointed to those who were a little bit ahead of me
rather than my juniors. George Bigelow was a little ahead of me

at the heepital when Il was there. He was witty, shrewd and sens-
itive. He not only had the ability to suromarize situations; he had as

well a perfectly delightful sense of humor. He was also modest to
the point of abeolute agonized embarrasament when he did things
that were wrong. i found him awfully good company, and there were
an awful lot of things he made me see or enabled me to see which
were very useful. Tom Goethals wae an awfally hard worker

and bore the purple « little bit because his father was General
Goethals and he'd gone to medical school in -epite of his father's
wishes.

In spite of the fact that 1 wae the youngest in the family |
was not without proper regard for my eldera aod betters of the
hospital hierarchy. The senior on the service that 1 went into
when l entered the Massachusetts General was Bill Kerr. Arty
Bock and Harry Dirken were between the senior and mysaelf--~if
I'm not forgetting anybody. Arly Bock later became head of the
hygie ne department of Harvard College, and 1 don't think that i've
ever worked for anybody as hard ae | worked for Arly (partly be+
cause with mature judgment we both egree that he was passionate
for unnecessarily detailed repeated studies), He wanted total
urines done three times in a row on a new admission. He wanted
total bloods done every four days op five. The burden of work
on me was euch that lL have never had before and never eince.

But I was very fond of him and l worked my head off to make it go.
67.

Dirken was extremely original and fresh and capable, cepecially
in cases where neurosis complicated the picture. Dirken could
eit by an adolescent girl of fourteen or fifteen and come out with
a story of what her difficulty really was which simply amazed all
the rest of use because we didn't know how he did it. He was
aeually right.

We used to watch our seniors on the service very closely
and very sensitively, and we knew what kind of guys they were,
although we were all overworked by routine. The hospital was not
then in # position to have either the sense or the money to have
any technical work done by technicians, and we had to do all of it.
We had to do so much of it that again and again a patient would
come into the hospital and go out of the hospital and though in charge
of the laboratory work I wouldn't learn anything fromm the patient
at ali because I just had my nose to the grindstone, getting the stuff
out. When you get up in a hurry (and you're more in a dream than
awake) and you put on your clothes and go down and have a hurried
breakfast and get out to the leb about half past six and are faced
with eighty urines to teat and have ready for reporting at ten ofclock
you've got a job. We were ao preoccupied with moving fast and keeping
things accurate that thinking about cases was not in the picture. It
wae a real defect that stuff went at that speed.
68.

i did, however, see enough of the gauche and awkward
young intera to see that something was seriously wrong, 1 had
a brief service time on the surgical service. I won't mention
his name, but 1 had « surgical intern who thought that it was cor-
rect or et least a reasonable thing to do to come around in late
afternoon and say to a woman who had been operated on for an
abdominal tumor, "i had my hands in your blood this morning."

Well, that waen't calculated to restore a woman's fading
courage or her respect for a dottor. The amenities of civilised
existence of some of these boys just showed up in extraordinary
conspicuousness by their absence. You got that side of things.
However, there was one thing that I missed, and I didn't catch
it until much later when 1 was dows in Brasil. 1 used to have a lot
of coast-wise travel to do while I wae in Brazil. Often on these
little const-wise Brasilian steamers there were from one to five
American traveling salesmen. 1 used to naively introduce myself
as Dr. Gregg and I would be treated ae a doctor throughout the voyage
by all the Americans on board. One day it occurred to me that it
might be fun to justcome on as Mr. Gregg and spend my time in the
off houre talking about doctore to the other Americans. The did-
n't know I wae one. It was dishonest Lf you chocee to call it that,

but it revealed a wonderful lot of stuff tome that 1 didn't know
69,

before. it revealed for instance the fact that the majority of these
men fell into only two groups. One was the man who was 6¢ en-
thusiastic about his doctor that he would give you hie name and ad-
dress ao that in case you wore ever sick in Kokomo you'd call on
Dr, Joseph. The other group was those whe had been so embittered
by the doctors that they delivered themselves of a general tirade
against doctors. i didn't know that there was anywhere near es
much smothered, amoldering~-and to change the figure--unuttered
irritation on the part of laymen against doctors. I'd never heard

it when the stethoscope wae hanging around my neck. Of course,
ididn't, idid it partly because in public health work you have to
pay a good deal of attention to the perfectly well person. “What

do they think?" I learned a lot by that device. 1 learned how complete-
ly isolated a ductor is from honest opinion, right or wrong. He's
isclated because he has a stethoscope hanging around his neck, so
to speak. .

The relationship between doctor and patient that in my actual
experience came nearest to what 1 imagined it would be was on the
district delivering poor women of their children, The student in those
days came into the houses. He waa the docter. He came in at a moment
of terror, uncertainty, straight fear, concern and worry. He stayed

by and nature being what it is he stayed until the ueual conclueion
76.

wae a fat and healthy baby and a very much exhausted, but aleo
very much relieved, mother, Presumably he stayed long enough
for the husband to get sober again, though the Jews and the Negroes
always behaved themselves ae fathers. The Lrish never did, or
practically never did, and he got a flavor.

I got a flavor in those days in the metropolitan hospitals
service of different cultures and the way they reacted to events of
life. It was pretty vivid. You were the bringer of confidence,
of supporty:meoral and physical, relief, moral and physical, and
then happiness unalloyed, and it wae a lot of fun. That's what I
thought practicing medicine wasn all the way up and down the Line.
Seeing people at their worst in terms of behavior only lasted a
short time if it wae there at all, Sometimes it wae best from
start to finish, and I loved that part of it. It was a considerable
relief tome to have that experience in contrast to being in night
and day attendance on awfully sick people on the warde and then
discharging therm. 1 used to feel bitter about the latter. The
phrase was “discharge, relieved to the out patient". Well
dammit 1 knew that that wae a pretty funny description of what
really happened. That side of disease and disease experience
made a pretty strong impression on me. It made a strong im-
pression--perhaps better to say, it made a etronger impression

than I realised because I see now that getting your medical education
Fi.

by practicing in poor parte of town and with poor and bedraggled
individuals to whom injustice hae not infrequently occurred was

in a very marked contrast very different from the initial experiences
of a student of law who sees no occasion for employing the devices
of an intelligent mind to help the underprivileged (he doesn't sce
that unless he occasionally gets into Legal Aid Society work).

it seems to me that in contrast medical education is devised very
well to give one a broad sympathy. I'm ignorant about it--but 1
don't see much in legal education that wouldn't fall into the witty
definition of the Republican Party once given: namely, that what
the Republican Party does very well is to organize egotism. The
overtone flavor of working in a metropolitan hospital ie not in

that direction. It's far more humane; all come and are served

as far as possible.

Fo me tone of the important impressions that 1 derived at
the Massachusetts General Hospital was related to a ruling which
the hospital wisely held that when a patient came back for a second
or third or a fourth time, the beginning of his history was to be a
careful recapitulation of the facts recorded during his earlier stays
at the hospital. One afternoon we had an old cab driver in Boston
who came in for his eighth stay at the hospital with nephritis, It
wae in November. He had eight histories. I had to go over his entire
record and it took me the entire afternoon and well into the night.
92.

From the histories together with some questioning of him 1 knew
perfectly well that when discharged he wae going to go up to a
cold water walkup tenement room. It wae certainly no place
whatsoever in late Noverober for a man recovering from aephritis
to conduct a decent convalescence. I was profoundly disturbed by
the future of that man and by the futility and excess wasted effort
of hie coming into the hospital again when his convalescence was
ausgeschlossen (there wasn't e chance of it).

The next day after 1 had done that history and recapitulation,
and was still under the cloud of saying to myself, "1 just wonder
whether it'e worthwhile ?", I was in the male outpatient doing scut
work in the sense of finishing up with some patients, Luncheon had
already been available in the dining room for very near to an hour.
About ten minutes after the hour one couldn't get any lunch. One of
the young visiting men, Harry Forbes, and l were staying on to
finish the load and Harry said tome, "Sometimes | feel as though I
am running a little office in a lot about a hundred feet from the street.
Lam working all alone, and looking out 1 can see a line of people
reaching the street waiting to eee me. Most of them have sprained
ankles and very dubious questions of fractur of the ankle because
of something which | know very well; namely, that there is a hole in
the sidewalk outeide of my shop. However, 1 am so busy with patients
who are in pein that I never have a chance to get a shovel and go fill
up the hold."
73.

L enid to myself, “By god, that's exactly the way i feel.
Yesterday i tock in a man and | know that to do anything to prevent
his condition from occurring again is quite out of the question.

i don't want to go inte a field of work where I can't call the tune
and where I just take the line of staff that's loaded on me, What

i do for my patients ie wonderful in intent and perfectly miserable
in result. By gosh, i'm going late public health work. "

Now, ae | later learned, that decision was a little foolish
because | was not being exposed in the hospital of thase days to
being of use to any people secure enough to take my advice. 1
was working with psaupers who couldn't take my advice. I oaw it
right hand and left hand, and i thought, "Thanks very much. I'm
not interested in being forever after the fact, and i'm not good
enough with my hands to be a surgeon and to take some definite
action that way. I think that probably the thing to do is public
health work, “

i wish at that time--1 can make up all kinds of lovely things
that might have happened~~1 might have had a junior among the
instructors to whom I might be inclined to take my pusazlement and
aay, “How about it?” A little bit later, a young doctor named

£. Gorham Brigham said, "Oh, don't come to that conclusion,
74.

Alan. You can do an awful fot for peaple as their doctor by tell-
ing them bow to live aud what to avoid and when to coneult you."

That's an impression of medicine that is of a crowded
free clinic. It isn't medicine.

While | certainly had ideas aboutdisease they weren't
articulated. I had no feare at all. That was through ignorance,
ithink, 1 remember that we once had @ choice event at the Masea-
chusette General. A woman with diphtheria came in and had an
examination in a metaboliem machine in which a mouthpiece was
used first by one pergon and then by another, She apread diphtheria
over the hoepital like o thunder clap, and there were five house
officers and three nurses thet came down all at once. 1 was one
of those thet came down. 1 knew that 1 was hot, but 1 wasn't
bothered. We went and got shot with diphtheria lantietoxin and
then spent an extremely welcome two weeks anda half in the sta-
tue of convalescence. It never gave me two miputes of concern —
as to whether I had enything or whether there was anything seriode.
inever was sfraid of disease, but that was, es 1 think, because I
had very good health, and I just didn't know enough to be scared
of it. l remember reading with some amazement that in the old
daye whens a family doctor was called on a case of diphtheria he
usually left his wife and children crying in the hallway because
75.

how could she know that he wouldn't bring it back. It wag much
more of an adventure then then anytime since.

I wae very much impreesed by the whole discrepancy
between psychiatry, peychiatric disease, and other forme of
so-called somatic disorders. i was prepared to see that the great-
eet recent headway--in other words, the headway between 1696 and
1910--that had been made was the headway that concerned bacter-
ial or virus forms of disease. Apparently that was the place where
work paid of {the best, and it did pay off extremely well. Diseases
of nutrition were virtually unknown and unrecognined ap to my early
student days, which were 1912. Vitamin, the name wae coined in
1912 by Casper Funk, if | remember rightly, but the full force of
bad nutrition expressing itwelf ae it did in cur own South wae juat
diemisecd as, “It isn't the right food, However, apecific deficiencies
were unheard of so there wasn't very much emphasis on nutrition
or metabolism as it came into the picture. The big threat was
bacterial invasion. We just conquered typhoid fever--so that where
my brother who was five years ahead of me on the same service
at the Maseachusetts General as a house officer had had forty cases
of typhoid to tend to, on the same gexvice ten years later I only had
four, It was a pleasantly casy thing to remember. It was ten to

one,
76.

There wae nothing fatalistic in my attitude towards disease
excepting insofar as hereditary disease was concerned and there
the atmosphere that was in my mind was pretty largely fatalistic,
"Well, you were born with thie thing to come out some time and
now it's come out," There was a passionate desire to get in early
¢nough $0 a8 to make some difference, That took ite form in go-
ing into public health work for a while. There was nothing of the
daemonic in it, nothing of the emtanic, or malicious, very little af
the uncontrollable. J hadn't seen enough of it. My attitude towards
disease and death had more to do with violent deaths of war than the
general attitude towards the diseases of old age and death, To il.
lustrate that I'd like to jump ahead a bit and tell of an experience
ihed during World War i. When I got inte the war Il knew something
about transfusions and how to do them. Up to that time the Britieh
didn't use transfusions at all, Consequently I wae sent to the field
hoepitale up the line todo them. I felt very, very embittered by
that surgical experience in the war mostly on two counte. The
only cagualty clearing station that I worked in during a push which —
got the people that didn't die on the field wae because 1 could do
transfusions. I was put in charge of a receiving ward where the
men came right off the Lorrye and the tracks. 1 shouldn't have
been put there. They should have had an experienced surgeon there
v7.

becauge it was I who hed to decide who would be operated on and
who woulda't, and I thought that it was stupid as the devil,

The only casualty clearing station that had anything dif-
ferent was presided over by a Major Scrimminger, a Canadian,
who ae the best and most experienced surgeon spent all of his time
in the receiving ward deciding who and who wae sat going to be
operatedion, which wae a highly intelligent use of his #kill and
ability. fo put me in charge~-well, 1 can remember the moet
shattering experience that Lhad. One night we were working, as
anall night team. I was in charge of the receiving ward. We got
along until about five o'clock in the morning. All heavy casos had
been done practically speaking. Because | knew they were either
going to go to their quarters and go te bed or else finish out the
all night service, 1 sent in for operation a sergeant major of the
King's Royal Rifles who had the front of his abdomen just torn
to ribbons. His bowels were in his pants roughly speaking,

Well, it took three and a half hours to etitch him up. And
afterwards an awfully nice Londen surgeon named Barris
who did the lebor on this poor sergeant came to me in the most
deferentiol and kindly way and said, “Gregg, if you don's mind,

iknow that there was nothing else that wae better fo me to do,
78.

but in the case of a real emergency with lete of people waiting
for operation, you wouldn't send ina chap to me like the sergeant
major, would you?"

Taeaid, “Barris. leertainly wouldn't. It was a question
of giving him a break or giving you a little sleep. “

He anid, “Quite all right. I thought that was it. By the way
let's go over and see him.“

This was the day afterwards and there was the sergeant
major sitting up in bed and looking like a million dollars, thanking
us in the most cascal and innocent fashion imaginable. I said to
myself, "I know my judgment is bad. It's been demonstrated
after all in a very pleasant way, but everybody's Judgment was
that he was dead so why bother with him, and everybody was wrong. “

lt was an awful experience to have seen numbers that run
up into thousands of people go over to the other side while still in full
health and vigor and everything «lee. My attitude, so to speak,
about violent death, was that it was quite unnecessary, quite
meaningless and completely tragic. I was obseased by a lot of
these things that I saw. It was very rough going.

The hereditary diseases impressed me immensely. That

is the hereditary diseases that 1 eaw at the hospital more than in
795

the war. The discaves of old age were auch as te leave me with
grave sympathy for euthanasia. I did not see my ignorance as
being quite such as to validate the idea that you fight for every~
body no matter how much suffering they have and ao matter how
certain they are to die, I'm not in favor of that. Unnecessary
agony for weeke on 4nd doesa't amuse me and one of the beat
talke that I had from one of my teachers I got from Bill Sesith
who told me that one of hie first eselgnmenta as Fred Shattuck's:
nesistent was to take care of Dr. Arthur Cabot in his last bourse.
He said, “My instructions were that whenever a twinge of pain
came over Dr. Cabot'e face, I was to give him some more mor-
phia, We kept him without a twinge of pain for four weeks until
he died, Il said to myself, 'That's humane, and when I'm on the
pallet suffering I want to have somebody look after me who will
take care of that end of it,’ "

Speaking of detth there is one thing that I wish I could
make a dent on and that is the subject of autopsies, Autopesics
are regarded by the laymen usually in thie framework. They are
a concession on the part of grateful family ta the marbli curlosity
of adoctor. Now, in contrast I have an agreement with my wife
thet if Lam struck by appendicitis In Kokomo, Indiana, aed the
hotel physician te called, I will say tohim, “Now, Dr. Parson, I
89.

think 1 ought to tell you that I have a rather unusual arrangement
with Mrs. Gregg; namely, if thie illness comes rather slowly or
rather promptly to the worst conclusions, Mre. Gregg will ask
for an autopsy, and | think it's honest to let you know.

I do that because the autopsy really could, and when used,
does, play a role that nobody attaches to it, but everybody should.
It is practically a cost-free way of getting the best medical atten-
tion that you can demand, because it says to a highly intelligent
doctor, “Here's a patient who's thoughtful enough of my knowledge,
of my desire, to become a better doctor that his last gift in the
world is a gift to me because he lets me find out whether I've
been right or wrong.” That's what it does to a good doctor, which
is very welcome indeed, and improves your relationship with him.
To a cheap doctor it is the most inescapable threat that he'd damn
well better call a consultant as early as he can if he's in any doubt
because he's going to be shown up as incompetent if he doesn't.
Now, why people don't get on to that I don't know. 1 proposed that
idea at a talk that was fairly well limited in scope and also in interest
at a meeting of the American Physicians because the meeting was
scheduled for half past four in the afternoon, They'd been in con-
clave for two days and I said, "I've got to have just one idea and

have it clear because everybody's blood sugar is very low at half
Si.

past four in the afternoon and they can't pay attention to a wander-
ing piece." It went over very well, Curiously enough ithae come
out in the current sumber of the Reader's Digest, although they
picked it up the year after I gave it and ran one piece on it. Now

they're running it again but there's no mention of the autopsy as a

form of protection for the layman.
82.

My concern with World War I dates back to really earlier
than 1917. It dates back to 1914 when war had just broken out.

i went to a Boston gentleman named Mr. Arthur T. Lyman, who.
had more than kindly supplied me with funds to finish the medical
school and asked him what he would think of my going into the war,
He said, very aptly, “What would you do in the war?" 1 realized
that I couldn't say that 1 could be a doctor because I was only half
way through the medical school. I said, "Well, I could go up, and
for purely advertureceome reasons I'd like to get into the Canadian
Black Watch. The Scotch tradition runs reasonably strong in me
and I would like to do that. "

He said, "No. That isn't what you should do."

I thought to myself, "Well, after all, he's put up my hopes
in medicine and I ought to pay some attention to what he says.” I
asked him why and he said, “You'll be far more useful if you fin-
ieh your medical achool and then go into it,"

I realized that that made sense so 1 deferred and, hearing
about the formation of a Harvard medical unit, 1 deferred in the
sense that I went to them and said, ‘I'd like to go in when I'm
through. I can go right after | finish medical school, or, if I
get an appointment at a hospital, I'll come after my appointment,

They said, “We'd prefer that," so l was set for the year
1915 and 1916. I graduated in 1916 and 1 knew that I'd be free from
63.

my hospital in September, 1917, and 1 signed up for that date.
it wae getting into the war ina serviceable fashion, and it waen't
anything more than that. There was an element perhaps of ad-
venturesomeness, plus the fact that I wanted to be in whatever wae
going on that was important.

I went to London as seon ag I could be shipped in September,
1917, and to my surprise things happened that I just didn't expect.
I foand that I would be given what was known half facetiously as an
honorary, temporary commission in the Royal Army Medical Corps
and that I would have to have a British uniform for it. I picked up
what I could of it, I remember the firet day that Il had on my Britieh
uniform. I was still sightseeing and I went down to Whitehall and was
looking up at one of the mounted guard at Whitehall. He went into a
full military salute. Llhad clean forgotten that I wae an officer, and
i thought he was going to fall off his horse. It was the darmnedeat
thing lever saw. It was as though he had an epileptic convillsion
on horseback. 1 realized with immense embarrassment that he was
saluting me, so I took his salute as well as I could under the circum-
stances and escaped. 1 also had an amusing experience just before
my uniform was ready. One day as 1 was walking in the streets of
Londons an enthusiastic Englieh girl rushed up to me, seized my lapel
and pinned a white feather on me for being a coward. i had enough

detachment to realize that 1 waen't quite as bad as she thought, but
64.

i certainly underatood the position of somebody who was hiding
from service, being caught on the street by an anknown female,
and having a white ribbon pinned on for being a coward.

I got over to France and everything was new, including the
role of being a British officer. I tried to watch how the others be-
haved and learned with great relief that in a British hospital
medical unit when officers went to the mess for dinner they took
off their Sam Brown belts, which meaat that they no longer had
rank above or below anybody. The Officer of the Day, on the other
hand, had to keep on hie Sam Brown because he wae in command
of the situation--the Sam Brown in effect was his badge of office.
All the rest of it, however, was on a very civilized and informal
basis. We almost used to laugh. at the Americans who were next
door to us at the base hospital, because the second lieutenant had —
to salute the first lieutenant and the first lieutenant had to ealute
the captain, and the captain had to salute the major, and #0 on.

It was all so self-conscious, and there were no human beings

left, soto speak. I learned a lot of British technique or tradition,
like pronouncing it "leftenant” inetead of “lieutenant. The ways
in the meas were also different. The attitude toward enlisted men
was different. It was all very workable, and officers above field
rank, majors and better, didn't bother to salute each other at all,
That was humane. Certainly those below field rank didn't bother to

salute each other because it was ridiculous,
85.

lam glad that I went into the British Army, partly because
it gave me a sudden over-all view of the whole British Empire.
We had New Zealanders, Australians, Canadians, Imperials,
Tommies, North countrymen--we had every variety of dialect of
English and some very interesting people among them. I felt
for the first time in my life the stamp of feudaliem and class
distinctions. i used to think, “Really, if 1 hadimy choice of being
a gentleman and not being a gentleman, the obligations in England
of a gentleman's life are so considerable that it deserves some
reflection as to whether you care to be one, because you have a
very much harder life, For instance, as a lieutenant in charge
of ten soldiers, you can't possibly feed yourself before they're
looked out for. You must see that they are bedded and fed before
you touch anything." That whole line of obligation from above
downwards was a:pretty impressive thing, and the officers lived
up to it pretty well.

My first paychiatric case among British troops was a gal-
lant, wonderful sergeant who had been appointed a lieutenant on
the field of battle to take care of what was going to pieces. He
developed a neurosia that he wasn't a gentleman and it completely
unmanned him. This took the form of wae he properly dressed,
and had every button been buttoned, This poor unfortunate fellow
86.

would go over his uniform and appearance two and three hours at
a time trying to be a gentleman. i can't imagine any American
who is made a lieutenant on the field of battle who would go into
a tailspin on the question of whether he was a gentleman or not,

I also got a lot of the thing that has interested me almost
es much as anything and that's variety, not only variety of pheno-
mena, but variety of interpretation. Life in the British Army was
modified to some extent by the fact that all my fellow officers at
the base hospital clinic were Americans, and only a few of them
were Canadians, The nurses were in the majority ofases Boston
nurses, but the non-commissioned personnel--the sergeant and
the corporals of the hospital staff who carried patients around--
were ali British. (English as from England, not from Canada,
Australia or anywhere elec.) Hoepital life was a beautiful exam-
ple of the British capacity to compromise on the unimportant
things and keep the essentials running right. It was a life where
the biggest limitation was that Colonel Hugh Cabot, who was in
commend of the unit when i wae there, was extremely interested
in making a good impression with the British. That had limita-
tions because he wasn't entirely square with some of his young
Americans, He knowingly took youngsters who had not had intern-
shipe in the United States and were rawly plucked out of medical

schools, and never saw to it that they got any teaching in that
87.

hospital, although we had plenty of older officers who could have
taught us. I was resentful on that point, I was also resentful
about several other things that he did or failed to do, so that when
the whole show was over I never tried to have anything to do with
Cabot again. I was fed up to the teeth with him. However, he did
one thing for me that was very helpful. 1 knew about transfusions
end could give them. Because of this he sent me up to the base
hospitals and I did nothing bat transfusions in the receiving ward,
so that lwas busy. I felt that I was useful and now, almost forty
years later, still think so. However, lI really didn't have any
first line experience at all.

At the end of the war 1 had an offer to go on into Germany
with a British unit. It wae at a terribly andecided stage of affairs,
and then I discovered one thing that's since been helpful. That is,
nobody seems to recognize that in a war medical officers suddenly
have their future carved out. Their hearts are usually gone, because
they don't know where they're going to be, what they're going to do,
or whether they're going to live. All of us finished the war in 1919
in a fearfully uncertain frame of mind because we hadn't been able
to hold up to ourselves what our next five miles might be. I never
realized that we lived with potential hopes and that they somehow or
other stabilized our existence. If you live for six or eight months
88.

without them, you're a very lonely puppy, and you don't know
what the hell's coming. Now, 1 utilized this knowledge in the
second World War by getting the Rockefeller Foundation to say
to certain first rate teachers in our medical schools, “Would you
like eight thousand doliars to epend on somebody who will be your
assistant when the war is over and to whom you can write now,
saying, ‘When the war is over 1 will give you that residency that
I would have given to you anyway'?" We spent something on the
order of six hundred thousand dollars doing that. I know that it
meant an immense amount to the youngsters because it gave them
a fixed point which they could look at from time totime. It sta-
bilized them and kept them from being absolutely forlorn and
absolutely buffeted around by whatever happened.

The plans that | had were similarly affected. About all
that I knew at the end of the war and, curiously enough, thie was
almost enough, was that | wae going te go see the people et the
Rockefeller Foundation and find out whether they were doing any-
thing in public health that 1 might latch on to.

i think also that the experience in the British Army had paved
the way very considerably for me to realize that some very valuable
items and sides of medicine existed in the world and ia Western Europe

in forme and in conventions of behavior that Il had never even dreamed
89.

of before. I was the deep sea fish all over again. That is to say,
I discovered America by leaving it and by coming back to it. I
saw flavors in our life that 1 could not have seen if I hadn't had
this experience in a quite different medical environment. It
bowled me over, for instance, to be told bya young Britisher
that when one went to the medical school in London, "One lived
a6 near as one could to the playing fields. "

“Why do you do that?" I asked.

“Why do you ask?" he replied. ‘Why don't you see that
we want to live right next to the playing fields?"

I eaid, “By the time s fellow gets to medical school in the
United States, he's gotten all of that worked out of his system."
It wae a fearfully sarcastic thing for me to say.

He looked at me. “Do you have four yeare that you spend
between the secondary school and the medical school?"

i eaid, "Yea,"

"Well, what do you do in them?"

I realized then that we make up in college for a perfectly
outlandish system of secondary education where we get no cultural
stuff at all, practically epeaking. it's all routine and very cheap
and ordinary routine at that. i'm very far from the ordinary sym-
pathiser with what we've got in the way of secondary education in

the United States. I think that we throw two years of it away by not
90.

making it atiff enough and by dissipation of this and that. The
British, on the other hand, went right from secondary school

into medical school and,of course, they liked to play games.

They did play games, and the games at the London hospitals

were and are quite as important ae football, baseball and so on
are in our colleges. I got a lot of that. I got a lot of the idea

that things are much more comparative literature than they are
the Gospel of St. John. There's much more variety in there,

and that stood me in very good stead for the experiences that I
later had in other parts of the world.

I wasn't in Britain for any of the war in a professionel

capacity, and I did not see the British hospitals. On the other
hiand, I learned a good deal about the ordinary progression for

& young doctor in Britain purchasing a practice, what being a
locum meant--a whole set of things that really reflected the current
social structure and standards over inte the professional in a per-
fectly novel fashion. I think--to put it in the simplest form--what
i got out of the KAMC was almost infinite variety and nearly all of
it well controlled. There was awfully little of it that wae sloppy.
I saw what being the various kinds of a doctor was and it was a
very different thing from anything that 1 knew in the United States.
I liked it and furthermore I think that it broadened my point of view
91.

quite substantially.

Looking back I would say that Il also got a great deal out
of being in the different casualty clearing stations. I had no com-
panion at all from America and I never will forget the shock of
going into one of them up near Popry one morning. There was
a boy lying in bed. 1 said, "Good morning.“

Out of him came, "Good morning, sir."

I said, “Where do you come from?"

He esid, “I don't know exactly where | come from, but 1
used to live in North Carolina. *

I discovered that the Americans had taken over the sector
and Lhad a ward full of Tarheels.

It was here that I got a very eubstantial experience in
physical examination and general sizing up of “Is he sick or is
he only half sick?" 1 got to recognise what the illuess was without
the use of any words. Lawrence Henderson once put me on to one
awfully interesting thing; namely, the English language is deficient
in one way that ie rather deceptive. We have only one verb for the
idea “to know", French has "savoire" and "connaitre". German
has “wissen" and “kennen". We don't make a distinction between
what we mean when we say we know something. 1 say to you, "My

dog knows me." Lalso say a little bit leter when you tell me that
92.

Pasteur was born in 1822, "I know it." Those are two very dif-
ferent meanings. “My dog knows me" entirely evades, avoids

and raises no question about putting it into words. it's knowledge
without words. Whereas I say "I know" the Pasteur item because

i read it or heard it, I wasn't there when Pasteur was born, In

the latter case there no experience at all. Now, these various kinds
of knowing have tremendous advantages and tremendous limitations.
if you mean “mon chien me connait", "my dog knows me", you are
talking about the kind of knowledge the dog cannot transmit, It
grows within and it dies with him, and a lot of the knowledge that
the clinician hae he cannot communicate. He'll do his best, but he
can't tell you why he thinks so and so. Now it's a great defect that
that kind of knowledge can't be communicated, but one immense pay-
off is that that kind of knowledge, coming from experience, gives
you courage and guts. The other kind of knowledge--from reading,
or from Hatening to something--gives you only a secondary kind

of courage, Say you're at the top of your class, If that's courage,
I'm a plumber. You don't know things in the deep sense. However,
such knowledge can be spread and stored for indefinite periods.

The British lean more heavily than we do on the knowledge that
comes from experience~--at least so they impressed me when 1

wae among them. Along with that thezeis also a sort of horse sense.
93.

It's pretty impressive and aleo at times pretty depreesing be-
cauee itis so uncommunicable. You may have known at one time
or another men who could sail a boat damn well, but who couldn't
possibly tell you how todo it. Well, I thought there was a goed
deal of that in British medicine. There was aleo a good deal of
supereensitiveness to social position. | felt that fall time was
going to be quite a while coming to England because 1 thought that the
part timers would go te see the duchesses whether they liked to or
not and if necessary desert the classes that they were supposed to
lecture to. On the whole, the Londoners had, as boys, experienced
@ great deal more contact with excellence than most boys in this
country had. They had a tremendous sense of moral inter-per-
sonal responsibility, which was very impressive,

I think that technically I didn't get much. There was too
much rule of thumb and by the time I got into the war a gxeat many
British doctors were bored to tears and embittered. Some of them
were broken up in their family relationships. 1, on the other hand,
had a very good time because 1 was "quelquechose unique’. In terme
of my suppositions, I was something that they hadn't seen before,
and they put me over the jumps pretty steadily.

All during the war which, for me, begah in September, 1917,
and lasted until February, 1919, IL, in a certain sense, lay fallow.
94.

I knew that after the war J wanted to get inte public health work
and I decided that I would take a chance--the future wasn't very cer-
tain anyhow--and ask the Rockefeller Foundation if they had any job
for me, Ihadn't the faintest idea that they were frantic for doctors.
I remember going to see Wycliff Rose, who was then the head of the
international health division. He had an office that overlooked New
York harbor at 61 Broadway on the twenty-seventh floor. From his
window I could see the boats going back and forth in New York har-
bor, with the suggestion of a world that lay beyond. When I told
Rose I wanted a job he said, “Yes, Dr. Gregg, 1 think we can use
you. Now, I'd like to give you your choice of where to go and what
todo. We need two men in malaria and hookworm in the southern
states. Dr. Connor would like someone in the yellow fever field
in Ecuador, Or. Hackett would like someone in Brazil on hookworm
and some malaria work, We want to send someone to the south seas.
Dr. Sawyer would like someone in Australia. We're very anxious
to get a man to start in public health work at the echool in Peking,
and the government of Spain wants somebody for hookworm in the
mines, and Italy would like somebody in malaria. Would any of those
interest you?"

Well, I never felt so acutely being at the crossroad. My frame
of mind might be inferred from the fact that I thought, Which of
these do I know the least about?" I finally decided that | knew the
95.

least about Brazil, and I said, "i'd like to go to Brasil."

My die was cast--this was on the 23rd of February, 1919,
Rose then aeked me when I could leave.

1eaid, "Anytime,"

He said, “Could you make it by the 10th of March?"

Lenid, "Yea,"

He said, “"Wery good, we'll send you all the necessary
instructiona, *

Now I can't help but thinking what would have happened tf
Thad gone to two of the places that were mentioned (one was China
and the other was the south seas), However, Lhad « very valuable
time in Brasil, and that's how it started. It's the reason I left
clinical medicine,

Now the thing that I didn't know about public health work was
that one of the motivations that l had for medicine in general was
honeatly winning human gratitude. In public health you don't get
a great deal of gratitude out of improving the death rate from
malaria from point something or other to point something or other.
I can remember that I was very much impressed when | had been
in the little town called Florianopolis in Braxil very nearly a year,
and one of the citizens stopped me in the street to thank me for

making the area around the hoepitel so much more healthy than it
96.

used.to be. He said, “Malaria has disappeared. Frankly, I'm
able to rent two houses that i never could rent there. i can now
find people to take these houses. They were in #0 insalubrious
a place." .

ithought, "God, it's been very nearly eleven months. |
haven't had a word of gratitude {rom anybody. This is very nice,
But is public health always going to be like that, that the only sitla-
faction that you get is from your own technical knowledge, and that
everybody behaves in a way that my old melical school friend,
George Bigelow, summarised very neatly?" George, because he
was public health officer for the Sate of Massachusetts, once
went to a dinner of the Good Samaritan Hospital, given by dowagers
interested in social work. He was a very witty and amusing per-
sen. He stood up before these dowagers and said, "I'm sure 1
haven't any idea why a public health officer of the State of Macea-
chusetts should be not only admitted but invited to such fine company
as you people in this chronic sanitarium provide me with this evening,
unless of course there is some truth in the statement that has been
toade occasionally that a public health officer is like manure in
that in large quantities it's offensive to practically everybody, but

if it's spread thin, it's said to do seme good',"
97.

I can remember about the third day I was in Rio, getting
te know Louis Hackett, who was my chief, sitting out in the after-
noon at the time when all the boys and girls did a little bit of walking
around and looking at each other. The scene wae so exquisitely
peaceful and so amasingly different from northern France in the
winter of 1918 that I had a hell of a hard time not bursting into
tears, mostly from self pity, but partly {rom relief. Brasil was
new in practically every sense of the word. My boss, Louis
Hackett, told me later about a theory of his that concerned when
it was a good time to send a newly arrived Rockefeller Foundation
doctor out into the bush on his own. He'd come to the conclusion
that the best test of real capacity at communication was to find out
whether the unknown could tell a dialect story or not. After I'd
been there about a month boning up on helminthology and studies of
mosquitoes, Hackett said to me one night, “1 haven't asked you.

Do you know any good coon stories?"

My mother was a Kentuckian and we'd had Uncle Remus read
to us by the hour, by someone who knew how to pronounce it, and so
I obliged with a couple of coon stories. The next morning Louis
said, “I think it's time for you to go out inte the bush.”

Ihad spent the whole month of May in Sao Paulo, learning
about the helminths and hookworm principally, at the school that the

department maintained there in public health. Then Hackett, on
98.

the basia of thie story about the Negroes, decided that I was ready
for the hinterlands, and sent me to the state of Parana to make a
survey of the incidence of hookworm. in my party there were

five Brazilian youths of somewhere around the age of twenty.

One of them was a trained microscopist who had been at another
ene of our stations, and another was « guarde chafe, whose function
was to herd the party for me. Then there was a Little doctor named
Remisio, who could talk what he thought was French and what 1
thought was Eskimo. However we did manage to converse and in
the process I learned Portugese.

First we'd go to a Brazilian village that would be represent~
ative of the highland or the lowland, the interior or the coast, and
make contact with the mayor, With Remisio's help we'd explain
that we were sent by the state board of health--the latter was
largely a figurehead but had good writing paper. Usually the
mayor already had had a word from them that we were coming,
that everything wae being paid for by the etate and that all he had
to do was provide help in lodging ue momentarily. Then we'd an-
nounce that we'd examine anybody for nothing and tell them whether
they had hookworm and treat them if they did. We got very varied
receptions; however, the natives were friendly and trusting. By
the time we had examined at least six hundred people--men, women

and children--we'd say, "All right, we have a working idea of what
99.

infection is here, and it's time to move." We'd give them a
treatment and then move along. i did that for three months.

We gave them quinipodium and oil of quinipodium, one
dose in the morning at six while they were fasting, and then two
houre later a dose of magnesium sulphate to clean them out.
That was all. lt cleaned them out pretty well, and it was a
pretty good job in the sense that they all felt better. Frequently,
however, we didn't witness the results of the treatments and only
when we stayed as long as ten days could we notice a real differ-
eace, This in essence was the procedure we used in the survey,

The work I did later was to pick three places in the state
and start up what were called posts. There we rented a house.
The guardas lived in the house and early every morning they
went out on horseback and did a recensiamento, which is a
census of farmilies--that is, where they lived, how many were
in the family, ete. The guardas also collected fecal specimens
and brought them into the laboratory for examination. Later we
treated everybody who was infected, and in the lowlands of
Brazil that's everybody. I got rather fretted. We had an obiter
dictum from the United States that thorough treatment was to be
three doses of quinipodium per individual at ten day intervals.
There wouldn't have been any harm at all if it had been a week
100.

interval, It would have been ten times as easy to say, "This is
Monday, ien't it? All right, next Monday I'll give you the second
dose." But we'd have to say, "I'll have to give you the next dose
a week from this Thuraday."' That isn't easy administratively.
In fact, it's quite near to impossible.

Some of my college education came to my assistance in
Brasil, particularly a course in the history of the west by Fred~
erick J, Turner. It made me aware of geographic differences.

I saw, for example, that Portugese settlers coming from Esperits
Santos in the south first encountered a high range of mountains,
Way inside of that wae the Planalto, which was cool enough to be
free of some of the worst of the mosquito and worm infestation.
Life was healthy up in the Planalto. It waen't healthy in the low-
lands, Wealth, happiness and health were the reward of enter-
prise in the state of Sao Paulo, but in the state of Pernambuco
death was the reward of being too enterprising. There the settlers
simply got into more and more hot river valleys where there were
pests that they didn't know of and had never encountered before,
whether anakes, insects or diseases. Jl also saw that the character
of settlement was markedly different whea no racial lines were
drawn, The early Portugese married the native women to their —
bearte' desire, soto speak, and the resultant Brazilian caloce

is really a mestize. The pure bred European stock dwindled and
161,

changed very rapidly.

Brazil had a very different history {rom the United
States. The force that took people to Brazil wae the hope of
finding El Dorado in whatever money they wanted to count in.
it was not to practice their own religion or to live in freedom.
it was a very different atmosphere from the settlement of the
United States by the various European powers, like the English,
the French and later the Scandinavians.

I saw the historical development of the country halfway
before my eyes. Becanse in Brantl, es you go away frem the
railroad, you go back intime. I've seen children playing all
their games with Gregorian music because they had had no ad-
ditional music since the earliest Gregorian music which was
ased for children's games. In Parana and in Sante Catherine
& slightly acquainted pair of men who have widely separated
ranches and chance te meet on horseback find that the polite way
to finieh a conversation with an acquaintance from three weeks'
away isto ask, “How is your obligation?"

The other one says, “It goes well, thanks be to Ged, my
obligation proppers."' What does he mean? He means his
family. “Quantos familias tent?" or “How many families have

you?" relates to the old custom of the daughters marrying end
102.

living with their fathers and their husbands--~their families always
remain under the paternal roof, “How many families?" means
“How many daughters have yout" Usually they ali get married.
Ae you left the railroad you kept going back in time and
the human relationships you encountered reflected this, All of
that wae extraordinarily striking and interesting, and you got into
it by Just the measure of how well you knew the language. if you
knew the language reasonably well, you got way in deep. I reached
that peint in Pernambuco, where 1 lived with Brazilians for about
eleven months. When 1 was recalied from Pernambuco to Rio,
I went down by the royal mail steam packet line, the Almanzoa
Ora, an English boat. Here for the first time in eleven months
leaw my own race. Believe me it was impressive. We anglo-
saxons or western Europeans are interested in movement and in
muscles. We're not particularly interested in our glandular life,
but the Brasilians adore the glandular ‘life and they can't bear to
move. When I got on that boat 1 saw women walking up and down
restlessly, I sald to myself, "Why, these women have freedom.
Nobody's hanging on tothem. They're walking up and down all by
themselves, and they're prefering to exercise, which is incredible."
To be like the Brazilian women | was seeing they should have been
sitting in deck chaire and emoting, just having emotions--complicated,

delicate, forceful, anything you please, but not walking around.
103.

We're neuromuscular. In effect our cue is movement and action.
Previously l had never scen my own race from any other point of
wiew. The eubtle differences labserved were awfully stimulating. it
made the relative isolation cost me much less. It was exciting,
fresh and new. Much of it was undescribed.

it was said when | was in Brazil that on the mountain
Itatiya, which is not very far away from Rio, there's a biclogist's
reputation for every five hundred feet difference in altitude be-
cause there are forms of life there that have never been described,
The thing that I wish I'd had at college to make all of that exper-
lence worth more was a good course in soology. I hadn't had it
and etill was not alert to the fact-~as | should have been~~that 1
could learn a good deal on my own hook. That's been a constant
struggle and stimulus to me, to learn without teaching, but 1 did-
n't have it right at hand.

The contact with unsophisticated, unspoiled and uncitified
people was a very refreshing thing, and 1 got one or two things
that were quite good out of it. lcan remember dealing with a
chafe politico of a little bit of a municipio or wm little bit of a
county. I wanted terribly to convince him that there was such a
thing as hookworm disease and hookworms. I got some strongy-
loid larvae, which closely resembled worms, and since they're

easier to get and put under the microscope I said, "I'll show you
104.

these enakes that are sucking the blood in yomr belly. You come
and look at them."

He came and looked at them under the microscope and
broke out with, "Noces, Senor. By our lady."

I got too optimistic and said much too soon, “Well, now
you belleve that there are enakes in your belly sucking your blood,
don't you?”

In a very sing~song, reserved, but decided fashion, he said,
“No, Senor, I don't believe it.”

1 eaid, “Why not?”

He said, “Because 1 see lions and tigers in the cinema and
they're not there. "

That's a profound remark. I couldn't explain the theory of
the compound microscope. It wae obviously something the likes
of which he'd never seen before. Were the worms there? He'd
seen lions and tigers in the cinema and they weren't there. The
whole business of getting the confidence of these people and getting
therm to let you treat them was really quite an experience.

One of the vivid ones was in the state of Parana. 1 went
way into the interior to get to a Polish colony that had gone down
there in 1845 and settled and had lived in a Brazilian environment
fer eighty years. This was in the early twenties. They had lived

there all that time. We went to the place and were given rather
168.

formally a house to live in right acroas the street from the
Catholic church. All Friday we were there, but none of those
Poles came in to be examined. On Saturday afternoon | got very
worried. 1 remember that 1 was sitting on a keg of magnesium
sulphate that was awaiting consumption and I realized something
that has been of help te me ever since, and that is that these

people had absolutely checkmated me by réfusing to accept a

gift. There was no reason for them to be grateful. It was going

to help therm alot, But 1 could very wisely be extremely grateful
to them if they allowed me to give them a gift of great value to them.
That revised my view about the Foundation for all time. 1 can any,
“We're indebted to Woches when he lets us give him some money

to work with, He has no reason to be grateful because we won't
exist unless we find some people capable of receiving money and
using it wisely."

I got frantic in thie situation among the Poles. They were
all going to church and none of them were coming to us. Finally
I went to see the padre, a Polish Catholic, and said to him, “I'm
troubled becauee I've come all this distance to help your people
and they don't come. "

He said, "Well, what is thie man Rockfelice?" (Happy
Mr. Rockefeller, it means in Portugese.) “i don't anderstand

his motives. Now, if you could tell me that he had lived a life
106,

of considerable dubicusness aud he was giving all this away
asa peace offering to his God, then I'd understand, but you
haven't told me why he's giving it away."

Then I had the one happy inspiration that I've had in life--
I think awfully slowly usually, but it occurred to me to say this.
"if you walk down the street, Father, end you see a man starving
and so weak that he can't stand up, what would be the motive for
your helping him aad giving him a little to eat or a little money?“

He said, "Charity or a sense of guilt."

Il eaid, “Well"--1 was awfully tempted to say, ‘Same thing
here," but I dida't--"the Rockefeller Foundation has just spent
three million dollars in Poland for the starvation in Poland."

He said, "It has?"

Ieaid, “Yea.”

He said, “Oh, well then, how many people do you want to
treat?

I said, “By Sunday mi be ready for five hundred. Will
they be here?"

He said, "They certainly will."

He sent me seven hundred and the day after he sent nine
nundred. We were absolutely ewamped, but he wasa't going to

have anybody do anything for his flock unless he knew why. 1
107.

showed hic that he didn't have to have the motive if he was
still in the position te give somebody a little food on the street
without a reason for it, better than, or more cogent than,
Christian charity.

ln general, however, we dida't have any objection at all
from the Brasilians. They took it mildly, gently, and were friendly,
and it got very picturesque results. I know of one father who came
to me complaining a little bit. He said, “You've treated my son,
and it was all very well, He waa too weak to get up from the floor
and he'd been that way for six years, but you've treated my son and
he's run away from home, he's eo full of energy."

We used to have these bursts of strength come on young
people that would just carry them right out of the bax because they
were free from worms.

We had instructions from Johns Hopkins that the methods
that we were using for diagnosis of hookworm distase were about
three percent inaccurate in the sense that they missed detecting
the infection in three cases out of a hundred. When I was in the
lowlands we very rarely had an infection rate lower than ninety~
eight percent. In other words, the population wae one hundred and
one percent infected and 1 said, ‘What the hell is the use of exam-
ining these people as though you were finding one case in forty of
infection when they're all infected. In fact, they're one hundred. .

and one to one hundred and five percent infected."
108.

i got Hackett to let up a little bit, and, in areas where
& primary Survey had already shown something better than
ninety-five percent infection, we would just treat everybody.

The treatment wae picturesque in its efficacy and in ite promise,
and we had complete success with it. i shudder to think what
would have happened for any roughneck that came after our

fiest sweep through and said that he was also from the "Rock-
felice Foundation". He could have done anything with the people
because of some of the wiseacres who sald, "You don't get any-
thing for nothing. There's a string attached to this and i'm

not going to take the treatment.’ Well, when we leit town we
left them very disconsolate and bewildered. We hadn't asked
for anything.

The country wae lovely. It was picturesque physically
and it was a beautiful contrast to northern France during the war.
More important 1 had lots of fun with the language, learning more
and more of it, particularly the use of diminutives and augmentatives.
in Portugese you can stick an augmentative on any noun, which
transforms whatever you're talking about inte something big.
With thie device you can get the most delicate shades of meaning.
i remevober | heard a fellow get off his horse after a long ride.
His friends in the tavern said to him, “A big trip, wasn't it?"

His reply was, “lt was ao little bit of a great trip."
109.

That was combining the two to mean that "I'm a master of
anything that comes to me no matter how big it is." lt was a bag
of shelis.

Language came to my assistance in my Branilian experience.
I'd had a good preparation in Greek and Latin and although | was
capable in languages I knew no Portugese, I picked up Portugese
in Brasil in a way that I never thought of picking it up; namely,
entirely by hearing it. I did not do much reading, and I had prac-
tically no grammatical study. I had a miserable two months when
i couldn't express myself at all. However, that sitaation changed
and ina relatively short period 1 got to a point where I could begin
te exprese myself, The learning of Portugese made a profound
impression on me. Through it | found how inadequate, vague and
scrappy English was in certain ways. For example, I found
Portugese far richer than English in adjectives and adverbs, these
being subjective words and describing feelings with shades of
meanings that were quite beyond our common usage. On the other
hand, they were weak on verbs and weak on nouns because they
hadn't touched as many things in this world as the seafaring English
had. For delicate shades of meaning Portugese hae us all backed off
the map. The simplest illustration that occurs to me is our word
“corner”. We have the “corner” of the street or the “corner” that

you were sent to when you were a child for punishment. It simply
410.

bewildered Brazilians to be told that it was the same word. They
kept saying, “It's an exactly opposite condition." Well, | learned
that after all, all human thought didn't begin and end with English
and I learned that a statement made in Portugese was as inescapably
different from English ae any conversation I might have on the eame
subject with two different people. They're two different statements,
and it can't sensibly be otherwise. 1 learned that, and it helped me
a lot towards seeing, “Well, how does this other guy regard the
circumetance he's in? I can see what I think of it. How does he
regard it?" It was a tremendous pressure in the direction of
pluraiism. rather than monism. At present I'm not ready to take
the monistic view of anything. I like the sense of unity but | always
feel that it's spurious. That knowledge came to me at a particularly
iroportant time. I wae sot married and when my time was off, it
was completely off. I had plenty of time to think about things and
for three years I had a chance to puzzle out an awful lot of what
was confusing and bewildering me. Looking back it was an ex-
perience 1 wouldn't trade for anything.

ican hardly exaggerate beyond reality how completely
pioneering we were in Brasil. The decade between 1916 and 1920
was really the rensiseance period of public health work. We didn't
know where the ore lay. We didn't know what to put emphasis on.
All we feit (and I felt it pretty strongly) was, "Il spent all these
lll.

years learning to be a clinician and now this isa't clinician's work
atall, Where are the leads?" It was anybody's choice. There
wae no movement to guide us. There was no precedent. We would
be talked to about Lersuel Shattuck and “the great figures", but
what does one do in Brasil? Herman Biggs was still alive. There
were perhaps three or four figures of theBiggs dimensions, but the
questions were, "le it right for public health men to be full-time
public health men? Is that the wise thing to do?" All these were
unresolved puzzles and we reacted to this state of puzslement accord -
ing to our temperament.

it wae a little bit confusing except that we were all in the
same boat. We were doing public health work for a government
and at the game time maintaining our status as a supremely in-
dependent private organization in a foreign land where not only we
but our wives--if we had any-~had a great deal to learn about keep-~
ing house. Everything was new. It was enjoyable, and the contribu-
tione of each man were very different. Everybody tried to tackle
the problem in hie own way and then would rather laboriously
come to the point of admitting that George Strode's view of doing
it wae probably better than anything we had. We had plenty of
chance to contribute, but had very little consciousness of the fact
that we were contributing. We were just bewildered. I did write
two papera, but that wae sort of a repetition of an old habit.
112.

The fact is that we didn't know how te do public health work,
For example, take the problem of obtaining publicity for public
health and public health education. I had no precedent and I just
had to sit down on my tail and figure out what probably would be
the best way to do it. Fortunately | came upon something that I
etill feel can be used in other places. That is, the place to give
your public health demonstration is in the public market place on
public market day. One should never put a health exhibit in the
mayor's office because nobody goes there.

I Just let my fancy {ree in the business of conveying and
teaching Brasilians that it was well worth the effort to get rid of
their worms. I did anything that occurred to me and | had very
interesting and amusing payoffs. One day in @ little village 1
thought, "Well, when I was se kid in Colorado, the railroad com-
panies used to take pictures of fishermen holding all the trout
that they got in « stream lined out on a string. Why don't | take
one of these little kids, treat him for ascaris (which is the long
worm about the sise of a pencil that all the children had), retrieve
them and pin them to a board, and then have the kid hold it as
though it was his fishing catch to show passersby in the market
place what he'd harbored."

i did it and 1 had the full and delighted cooperation of a kid.
Hie arms could hardly stretch the length of a board that was long
413.

enough to pin all the ascaris he'd had inside him the night
before. Itook a picutre of it and stuck it in one of my reporte.
To my immense astonishment, in 1929, when I was talking
with a professor of parasitology in Leningrad, he showed me
that photograph in an effort to impress me with the importance
of parasitology. He said, “Look at that''.
i said, "Good God, where did you get this?"
He enid that he had put it is a Russian journal on parasitology
because that particular type of worm was known all through Russia.
I then told him that 1 took the picture in Brazil in 1921. I might
add that he disbelieved me.
The exhibition ] arranged was simply a way that occurred to
me to demonatrate te Brazilians the amount of worms that they
carried, and it wae a fantastic amount, One day in Santa Catherina,
one of my guardas came to me and asked for special permission
to treat a woman for worms. Outwardly she looked pregnant but after
I examined her thoroughly i couldn't see any reason not to treat her.
She filled three urinals with nothing but ascaria. The baby was
nothing but worms. It waa to be sure an extreme case, buat 1 think
it conveys my point; namely, that Brazilians had a good many worms.
i never tried to play the extremes with my prospective patients.
It was almost enough to tell them they were sick, because they were
114.

all sick. I brought home hookworm in the sense of a new name
for a very old condition. They used to call it the exhaustion. I established
with a lot of them that the exhaustion was related to hockworm and
that one could get a cure for it. Today you don't see the railroad
stations in Brasil filled with the pathetic, pale, inert, hardly living
people that you used to sce. It's gone. They know that if you have
hookworm and that if you take treatment you're finished with it. It's
all right. In thet way, thousands and thousands of people-~-and I say
that literally because in one post we treated a hundred thousand
patients for hookworm-~-are alive and doing well who before would
have been just hanging on to existence.

The other thing that I managed to do went back to my interest
in statistics. I had seen the International Business Machines and
it occurred to me that with nothing but an ordinary cardboard card
leould put notches up and down a Line so that when the cards were
stacked together, some would fall down and some would be held up
by the beedér. Louls Hackett improved on that substantially by
thinking of putting holes all the way slong the margin of a card and
making @ hole that was cut through eo that it fell out, We found
that we could run a skewer through a pack of these cards and in
this way sort a thousand people by their age, sex, type of work
and kind of infection for one or any one of a combination of six
415.

different types of intestinal worms. We got some fascinating stuff
out almost immediately. 1 brought that technique home and it has
been used in the Foundation ever since. There is one thing, how~-
ever, that I've always been sorry about. I kept a record of child-
ren's Reight, weight, age and verminosis (particularly the many
different kinds of worms they were host to). Il had over twelve
thousand children sorted in this way. However, before I returned
tothe United States I left those records with some people with
whom I stayed and they later threw them away. I was pretty un-
happy about that because it wae the one good payoff that I'd had
from the whole business, and I never got anywhere with it.

Public health was just coming into ite own in the United States-~
and in Brasil we were carrying a flag which had just been put to-
gether aga flag. We didn't know whet parte of it would rot and
drop out or what parts of it would hold fast in a fairly stiff breeze.
Public health was cur marching banner but what was it good for?
We didn't know.

Leould say rather promptly and rather forcefully that nobody
gathered this together. It was completely disjointed. The idea of
writing the history and trying te make a digest rather faltered
because of a very understandable thing. We were so busy that we
didn't have time to think on a centipede basis which leg went first.
116,

We just had to walk, do what we could, and watch for the major
successes and follow them as much as possible. It was much
more @ guerille warfare on disease than a planned campaign.
Although a planned campaign sounds perfectly wonderful in retros-
pect, it waa really guerilla warkhre.

When I later returned to New York I had a complete shift
because I decided to go into a new venture of medical education
which had never been stadied in a conspective fashion before.

I brought to the division of medical education simply a fairly
lively memory of what medicine was like when it was pat on a
preventive basis by complete novices in a foreign country. 1
don't think there's any doubt that in those purely empirical forays
that we made into a new subject, new at home and certainly new
abroad, that we got into what Mra, Wharton calle "The thick of
thin things", sometimes for six months or a year at a time.
What I wae very much impressed by was the great importance
of having a teating laboratory somewhere in the whole picture
so that the questions raised by experience in the field could be
clearly studied and explored, so as to get better and better field
operational procedures. Now, the safe interval between two
doses of quinipodium wae a case in point. We had thie obiter
dictum that ten daya had to elapse. Well, we would have been
ALT.

able to treat thirty to fifty thousand more people if we'd had it

a week because patients didn't forget if you told them to come
back in a week. We wanted a place to go back to and say, “Now
look, you tell us beyond a peradventure what the minimum period
ie because we need to know that." | saw very clearly the value of
a testing laboratory, a place where certain aspects (that nobody
could think of until they had it shown to them by experience) could
be explored, precisely defined and then be ready for application.
That was a tremendous lesson,

Incidence of disease was an area in which experience taught
me a great deal, in particular the importance of getting a general
conepective view by taking everything into account when dealing with
parasitical and intestinal worm infections. We were, for example,
concerned with problems of nutrition. Our guardas in Pernambuco
used to be asked rather revealing questions by their sick hookworm
patients. The question was, “Would you let me have a loan of your
rifle for a few days because my appetite is so enormously more than
it has ever been before that if 1 could go out and shoot a few birds
I'd be very grateful to you." What we noticed right away was an
enormous increase in the appetites of people who had been eating
miserably becawe they'd had no appetites. What was more im-

portant was some excellent work that was done in Puerto Rico by
118,

one of cur men whose name | forget for the moment, to the effect
that doge who also have similar types of parasites if fed (a really
good quality of meat and plenty of it) don't have hookworm, although
their conditions of living are exactly the same. In other words,
not only does food help the general nutrition but it protects the
animal against parasitical infections. The concept of an organism
run down by malnutrition being a safer harbor for a parasite if

it doesn't have good food and an organiem practically protected
from parasitical infection if it does have good food was a new idea.
We might have been able at a far greater cost to get rid of para-
sites in Brazil by feeding the population extremely well. There
was an extremely good example of that in Santa Catherina. A

very religious and pious German Brazilian Catholic established

a rest house or a cure sanitarium which was made more impressive
by his taking a perfectly lovely mountain side and putting very
expensive, imported stations of the cross on the hillside. The
technique was to take a poor--in terms of physical condition but
rich in terms of income--Braxilian gentleman who suffered a great
deal from thet tired feeling, make him do the stations of the cross
and then afterwards give him an astonishingly good meal. That
fellow had wonders to his credit, and people came from all over

Brasil to may, at his pension because they got well and came away
119.

feeling wonderful. The feeling wonderful was probably quite
ae much due to the quality of the midday meal as it wae the
restoration of the physique through prayer. lt wae also true
for the hemoglobin count. There is no doubt that the condition
improved greatly on s good diet,

lam perfectly willing to admit that I was almost fana-
tically interested in diet, and that the whole concept of vitamins
was then making © great impression on me, 1 watched it fair-
ly carefully, and I insisted that my guardas take food that they
hadn't been accustomed to, like liver and fresh orange juice.
The Brazilians did not have at that time a good understanding
of nutrition, |

The instructions that 1 had from the Foundation on leaving
New York for Brasil were mainly to the effect that in working with
the Brasilian public health officials, doctors and population
generally | was going to make merit in the New York office in
precise ratio to the extent to which 1 gave it away in Brazil, 1
was to take no credit. I was to seek or tolerate no publicity.
All my work was to be done in the name of the state health
department of whatever state I wae in, or in the name of the
federal health authorities. When I started out I thought that was
pretty high ground, I thought it was applying moral principles
120.

pretty literally and pretty forcefully. I did not see the Machia-
vellian cleverness of it and how well it would pay off. It paid

off in the following manner. In essence we did not attempt to
establish any working relationship with the Brazilians for any
long period of time. Our purpose was simply to go down and show
them the results they could get with a certain organization and
certain methods of detecting hookworm and treating it. We

made our contracts with definite time limite and they usually ran
for about three years. However, they could be renewed for a
comparable period of time,

When I went to the state of Santa Catherina it wae on &
three-year arrangement. Consequently the thing 1 wanted most
was to get the Brazilians interested in doing public health work,
and in particular work on hookworm. It wae a disease that was
very easily handled diowever, unless it was controlled it was
disastrous is ite results,

1 used to have lots of interviews with Brazilian laymen
who would come and beg me to start control work in their county
and lwould always sey, "lam sorry, I cannot give you an answer
on that. I'm only working under the direction and at the invitation
of Dr. Ferrera Lima, who is the head of the state health depart-
ment. You must go and talk tohim. He is the man who gives the

permission and he instructs me,"
121.

Well, they'd go and see Dr. Lima, and he just inhaled
the news that he was running the show. It was a very trivial
and subtle step for him to move over from the enjoyment of
being given full credit and full power for running the show into
believing that it was his work (which by insinuation and over~
tones he allowed to be the general inference). The cleverness
of that policy blossomed later. When I left, Dr. Lima for two
and a half years had taken it and let it be known that the hook-
worm project was his work, and he found later that he couldn't
stop, it simply guaranteed the permanence of the work that
the Foundation did.

Dr, Lima wasn't a cantankerous human being. I'd ask
him a question and he would say, "Tell me what you think be-
cause, frankly, I don't know." Under those circumatances I'd
tell him, but only under those circumstances, Everything be-
came Dr, Lima's decision. The policy of giving the credit all
away and completely refusing any credit for any resulte made
the work stick.

Now another aspect of the work was that being an Ameri- |
ean doctor exposed ms to an enormous number of requests for
just a little private advice on the side. i was offered bribes.

I was offered all kinds of kindness and consideration if 1 would
only see little Emilie after lunch and so on. If lL had strayed
122.

from the path, I could have established very lucrative relation-
ships because 1 went to places where a doctor never hed been
before, or had not been within the memory of anybody there.
We were awfully worried about setting a bad example to the
young Brazilian doctors whom we wanted to get into public health
work, We felt that if they saw the boss seeing people on the "qt"
and on the side they could not resist doing the same thing, We
were putting people in areas where no docter, to say nothing of
a public health man, had ever been. For example, at one point
I got a wonderful offer signed by a committee to aay in a municipio
of about twenty-five thousand people, financially guaranteeing me
anything that 1 could have sensibly wanted. There simply was
just a crying need for medical care. The experience of being
in the bush carried a funny little corollary. When I was in the
deep wilderness ag a doctor, 1 found that there were no other
doctors to talk to. Excepting very inferentially and very much
second hand, that meari that I didn't get a chance to find out what
kind of a knowledge, skill and approach Brazilian physicians brought
to problems in medicine,

Looking back, I think I found Brasilian medicine more to
be criticized on the sociological and moral plane than on any other.
That was a ruder surprise to me than the discrepancy, or the dif-

ference, or the step down in standards in technical procedures.
123.

Their technical procedures were not very good, but they were

far nearer passable, for example, than the regulations, customs
and legal provisions in Brasil cegarding the eatate of a man who
had just died. These laws were uniform throughout Brazil and as
I moved from state to state l always encbuntered them. Their
provisions stated that in case of death the doctor's bill had the first
claim on an estate and that the undertaker's bill had second claim
onan estate. If there was a difference of opinion about the size

of either of those bills, the law provided that it was to be settled
by & commiesion consisting of an undertaker, a doctor and a lay-
man. Well, hand washes hand, and those commission opiniones
were valucless because they were arranged, All the doctors would
vote for the doctors. All of the undertakers would vote for the
undertakers, and the undertakers would vote for the doctors if

it came to a quarrel with the third member of the commission,
who wae ae layman. He was always outvoted by two to ane. It was
a very immoral and very unwise provision to have those professional
bills take precedence, The people were horribly gouged again and
again and again, Lots of times | was asked to come and pronounce
aman dead because any Brazilian doctor that was called under

the circumstances would charge so atrociously that the dead man's

family was almost sure that I'd be cheaper. 1 never went, but

there it was.
124,

Now, the tradition of humane and free medical service
was very scant. lt was matched in some ways by a purely self-
seeking and endlessly hopeful activity on the part of laymen: in
Brazil to escape paying anything to a doctor. In the end these
moral relationships matched off and I think it was extremely
unfortunate. Once I was waked in the middle of the night way
out at the end of nowhere by a poor peasant whose wife was dying
inlabor. He had knocked on the door of three doctors in this
little village to come out and see if they couldn't save his wife,
and all of them demanded an atrocious fee paid in cash before
they started, He didn't have the moasy. When I learned that
that was the circumstance 1 was so angry that I went out with
him. We walked about nine miles through a mareh and, as luck
would have it, by the time we arrived the baby had been born.
There wae nothing for me to do, eo to speak, but wash up, and
that was that. I don't think many doctors in the United States
would survive if they refused to attend a woman who was dying
in labor or refused to go until a pretty big fee was paid. On that
side 1 waen't particularly drawn to the standards that obtained.
They were pretty primitive, I was told that a fourth or a fifth
of the students who went into medicine in the medical schools
in Brasil at the time I was there went in because the title of
125.

doctor and the statue of doctor served their political purposes
better than any other. They never had any intention of practicing.
And ae for practicing in the sense of the priesthood, jamais de le
vie, there was nothing of that at all. I used to hear numerous
stories of deceite in practice which recalled the atmosphere of
the tricketer in the middle ages.

One nice one that I remember concerns a little dector
in the country in southern Brazil who arranged things in the
following manner. His little consultoria, or room where he saw
patients, had a transom on the door that overlooked the next room.
The transom was always open. The doctor never stayed in his
consultoria, but in the room next door. Whea patients came to
see him, the doctor's wife would go to the door and invariably
tell the patient that the doctor was not in, but that he was expected
back soon. The patient would then be invited into the consultoria
to walt. Once in the consulturia, the doctor's wife would ask the
patient some intelligent and revealing queetions.

"What troubles you?"

"I have a pain in my bey."

“Where in your belly?"

if the patient pointed, the wife would say, "Oh, the lower
right hand side. Well, how long have you had it?"
i 26.

in effect she would make the patient state his history
in an audible voice. The doctor, listening in the other room,
would then run out, get on his horse and ride around a special
road that he had made. When the patient rather dejectedly was
about to leave the doctor would come back as if from a visit to
another patient, enter the house, and cry out to his wife, “Did
any patients call?" His wife would then anewer in a loud voice,
"You have a patient in the consultoria. ”

The doctor would appear in the door of the consultoria,
look at the patient, and very dramatically say, “Wait. 1 know
what's troubling you. You had a belly ache last night. I would-
n't be at all surprised if it was in the lower right hand quarter
of your abdomen, You haven't had any vomiting, but it is per-
haps a question when you're going to. I know the story, I can
see it written on your face iand in the way you're standing, “

That diagnosis made a tremendous impression on the
patient, and this particular doctor, by the device of listening
through the transom, never had any trouble gaining his patent's
confidence,

There were, however, some very good dottors. In the
toain, they had been to Paris, and had worked in the Paris clinics.
They had a wide reading knowledge, great influence, and were
skillful. However, their knowledge was more of the book than
127.

of the hand or the car. Although Brasiliane had very little
experience in scientific laboratory work, there were a few
that had and those were superb. One of them, Carlos Chagas,
wae a first rate intellect and character.

While French medical tradition was dominant in Brasil,
there was no Spanish medical tradition at all. Branilians
were enemies root and branch of everything Spanish. 1 suppose
that in large part it was because their own traditions werer
Portugese, Asa matter of fact, they weren't very much more
Joyal to the Portugese than we were to the English. The same
parent-child confusions existed in Brazil as well, When I firet
got to Brasil, Brazilians would ask me with great interest how
the Portugese had done in the World War. i made the simple
inference that they probably wanted to be told that they had done
wonderfully. When I obliged with what fragmentary evidence
there happened to be (and there wasn't an awful lot), 1 found that
it annoyed them. I learned that they wanted to be told that the
Portugese were the scum of the earth. iheirfeelings were much
worse towards the Spaniards and the Spanish tradition. Dr.
Ricardo Machado, a good friend of mine in Posie Alegre, once
told me that there were two factors responsible for the fine
character of the people in southern Brazil. He explained that one
was coal and that the other was the Spaniards or Argentines.
128.

The latter, according to Dr. Machado, obliged the Brazilians
to tee the line by being their major affliction.

The trick part of the situation that the Foundation found
iteelf in in Brazil was that it in fact wae offering prevention of
disease instead of a very lucrative cure. We were "Norte
Americanos" and not French. This is rather a circuitous state-
ment. Although circles of Brazilian medicine in the cities like
Sao Pauto and Rio seemed to tolerate us, I suspect a great many
ef the reet of the Brasilian medical profession wae somewhat
startled and somewhat bewildered by an American attitude to-
ward medicine which was not filled with the traditional sanctified
state of twenty to thirty French doctore that I could name. It
roust be remembered that at this time all of the Brazilian medical
students’ books were in French and the French tradition quite
clearly wae his pathway out into the medical world.

There was some conflict regarding my traditions of
service and the Brazilian climate of opinion. It was hard for
me to deny to be of any use because the condition involved was
something we weren't treating. That called on several occasions
for rather detailed explanation which was rather hard for the
Brazilians to understand, especially the ones who wanted some

consultation or some treatment. But it was extraordinarily
129,

important on two or three counts. It kept our attention on what

we were supposed to be doing. It smoothed the way enormously
for such cooperation as we might need from the Brazilian doc-
tors because they really saw that we meant what we said and

that we were not trying to take their practice away or planning

an invasion by American doctors. We were adhering to our side
of the agreement. Deeper, it showed something that I think in
social affairs is of greater importance than ie recognised; namely,
our conduct was predictable. You don't resent it if a fellow comes
up and says, “On Tuesday morning at 10:30, lam, if it's possible,
going to get at you and deliver the sharpest blow that I can on

your chin." His conduct in that is predictable. He's a fellow

who at bottom you respect and like far more than if he just sailed
up to you and hit you on the chin at 10:30 on Tuesday morning.

i think that predictability of other people's conduct is more im-
portant than the conduct itself, Well, in that way the Rockeféller
Foundation said to the Brazilian doctors, "We will do so-and-so.
We will not do so-and-so," When they found to their astonishment
that our conduct wae predictable, they liked us for it. They didn't
love us by any means, but they could at least tolerate us because
we'd kept our word, and the business of keeping our word after all
depended essentially on predictability.
130.

The salient thing for me being in Brazil wae that I
went through a constantly moving and changing experience.

I reached pointe where I began to feel that 1 understood the
Brasilians that | wae working with. I got quite confident about

it and then from time to time the earth suddenly opened in

front of my feet and I found myself before a chasm of unknown
depth, 1 found that 1 didn't know Brazilians as well as I thought
Ldid. That disillusionment or shock mended itself rather siow~-
ly. It was not & unique personal experience; others went through
it as well. Louis Hackett, my boss, wae no exception.

One day Hackett was driving in the city of Kio on the avenue
of Rio Branco when a presumably slightly intoxicated citizen
stepped off a safety island and was hit by hie car. When Hackett
saw that he hit the man, he turned off at the firat right hand
turn and came around the block to see if he could be of any use
to this poor fellow. He was of no help and for his pains he wae
hauled in and obliged to appear in court to explain how he was
driving and how fast he was going. Whea Hackett tried to ex-
plain hie actions to the judge the judge juat couldn't get the ides
that anybody who had hit citizen would do anything but run away.
He kept saying, "You say you turned. What did you turn for 7"
Hackett explained and the judge just didn't see thet that wes an un-
derstandable piece of human behavior. ‘What did you go back
131,

for, To see whether you'd done any harm? You say that's it?
Well, what the uee of that? All that meant was that you were
going to be arrested." Prior to the accident Hackett thought that
he knew Brasilian psychology pretty well, but found that he didn't
anderstend it at all because he couldn't explain to a judge why
he'd gone back and carry any conviction whatacever.

There are sides te the Brazilian character which are
quite notable and quite memorable. For example, they have an
almost oriental degree of stoicism on the subject of pain. That
stdciam ie particalarly accentuated in the case of Brasilian
women, and I saw it come out in a rather vigorous and impressive
form. When I was in Brazil a book about the state of Santa Cather-
ina wae published. The climax of eulogy and praise given to Sante
Catherina women in that volume was thie: "In short, the women
of Santa Catherina seem born to suffer." Meaning by that that
the women touk their suffering so well that they didn't do anything
elee as well as they suffered. Well, that isn't a climax of eulogy
that would go very far with us because some impious North Ameri-
can female would say, "Says you! You're in a nice place to say that
because you're a man",and go on. The Brazilian--and I'm told that
it is traditional in the Portugese as well--~is extremely stoical in

the face of suffering. It wae interesting to compare their stoicism
132.

with their attitude toward the hospital. Their attitude in this
area was completely negative and with good reason. The hoe-
pital was a place of last resort. lt was a place where one
usually died. Brasilians didn't want to go to the hospital and
there was more basis of reality in that than is comfortable to
think about. It was regarded as acceptance of defeat even to go
to a hospital. The usual name for a hospital in Brasil was
misericordia. Although misericordia meant pity, it didn't
mean any technical skill. Nursing, for example, was an act
of rather diluted piety (heavily diluted by the passage of time
and the loss of motivation of a really pious character), The
misericordia were places of extraordinary inefficiency, waste,
carelesencas and a good many human qualities that never should
be in a hospital.

lt wae interesting to observe the different values or con-
notations put on various diseases. 1 remember once when I
was up on a fazenda treating people, that | was asked to the
proprietor's house for lunch. Eighteen sat down at the lunch
table because there were three daughters and they were all married,
and living, ae the custom was, with their father. The wife of my
host got me to sit opposite a little girl of nine, In the most

curiously intense and emotional way imaginable, she begged
133,

for the privilege of having me lcok at the Little girl, just to
give a little word of counsel te her about what she should give
her for food and whether there was any medicine that seemed
good, In discussing her little girl's health, she said, “Of course,
she's very syphilitic, doctor, but what I'm worried about is whether
her lunge are atrong.” Which meant "Has she got tuberculosis or
not because that's the thing I'm afraid of." Tubercuylosia was the
terror that stalked by noonday, while syphilis wasn't a matter of
anything more than casual conversation, The other disease which
was terror-striking was leprosy, and leprosy in certain parte of
Brazil wae pretty awful. I'll never forget some of the leper patients
that I saw there and what it meant. Now #ome of the states in
Brazil were more intelligent than others and organized leper
colonies. The baffling thing was that it was very difficult to keep
a normally poor peagant from joining the colony because it was a
sure handout of food from the government. There was no difficulty
in keeping the lepers in the colony; that was foregone and easy. They'd
stay. The problem was to keep normal people out of the colony and
prevent them from getting leprosy and so adding to the total burden.
Brazil the twenties for me wae the quickest access to the
middle ages to nearly every form of life that | could have imagined.
lt introduced me to medieval Europe with a bang, and with a vividness
134,

that I could magnify if f chose by simply going back and looking
at it a third, a fifth and a twentieth time. It wae there, The date
was somewhere around 1680 and you could get it all up and down
the line. In medicine it wae somewhere in the center of the
Eighteenth Century, 1750 or thereabouts. For example, in
Ribram Prato in the state of Seo Paulo, on the dining table of the
inn there wae a combination cruet of vinegar, olive oil and patase-
ium iodide, because all the men were taking potassium iodide on
the assumption that they had syphilis, which wae frequently correct.
The medication was only as generous as that, and it was exactly
what 1 would have expected it te be about 1750.

i think the biggest impression that I got from working in
the field of public health wae that it's an absolute novelty to the
Brazilian mind. I remember the puzslement that I caused among
doctors with the concept that it might be better ‘oe one prevented
disease rather than go through it. "Aren't you a doctor ?'people
would say. "In that way you sacrifice your livelihood." i further
got the notion that every witnessed action and event had a muiti-
plicity of interpretations, In a foreign country one must continually
be on the alert to an event or an action having almost an infinity

of meanings. It helps define the social environment.
135,

The rest of my experience was partly the inestimable
thing which comes from associating with interesting people.
Louis Hackett was my boss, and a first rate one, He had a wonder~
fal sense of humor anda wonderfully alert and curious and wonder-
ing mind. I was very fond of Jack Hydrick. He wae a very
serious minded, hard working and admirable character. Sam
Darling was a very picturesque and brilliant person. When I
came to Brasil he was in Sac Paule as professor of hygiene, and
he just sparkled with ideas. Fred Soper, who succeeded me in
Porte Alegre, in the state of Rio Grande de Sol, was a very rough
and tumble Kansan with what used to be said of the Cabots in
Brookline: "They had customs but no manners." Soper is a good
friend but he's too domincering to suit my tastes. Il don't really
care for him a lot, but 1 had a lot of fon with him and he was
good company in Brazil. George Strode was first rate. He was
avery serious, careful and effective health officer. Jim Janney,
who followed me in northern Brazil, was a first rater, and he's
done perilectly beautifully since in Chile, as il was sure he would
do.
136.

While | was in Brazil, Dr. Richard Pierce came dowa
on a visit, One night he asked me to take dinner, and my questions
of him about what was happening in medical schools in the United
States gave him {1 didn't have the faintest idea what 1 was doing)
the idea that 1 was a fellow he could have for an assistant. i
was then coming to the end of my three year's service and Pierce
offered me a chance to go into the New York office when I got home
instead of returning to South America. I'd had what I thought was
the major return from Brasil and 1 wanted to get married, so 1
accepted. I went home on my leave, and after my leave was tech-
nically over. 1 went into the New York office for a year. In the
beginning Il was just a desk boy for Pierce.

One of the important people at the Foundation at that time

wae Dr. Abraham Flexner. Abe had earlier been a highly success-
ful owner and headmaster of a secondary school in Louiaville,
Kentucky. He told me once that his wife announced to him one
day that he was going to give up the school. He thought she wae
crazy and he didn't understand why she eaid it. She told him,
"} know what you're going todo. You're going to go to Harvard and
write a book on the American college. You can do it, and although
i can't tell you how to do it, that's what you're going to do, "

Abe went to Harvard with a flying start, because President

Elict, whe was a very shrewd citizen, had noticed that boys who
137.

came from Mr, Flexner's achool in Louisville were extremely
well prepared for Harvard College and did very well. They had
enough to make Elict believe that something of their capacities
was related to the type of teaching that they had had. and he made
® point of knowing Mr. Flexner. When Flexner's book, called
The American College, came out, Eliot, who was then on the
Carnegie board, mentioned Flexner's name to Dr, Pritchett
when that gentleman asked Eliot if he knew of anybody who could
make « survey of American medical education, Abe wae named
asthe person. He told me that he didn't know how to proceed, but
that he went down to Johne Hopkins and asked Popay Welch how to
go at it.

Welch thought the beat way to procesd was to take a leaf
out of Dun and Sradstrest and simply go to the medical schools
and gay, “i'm listing or aot listing your school among the Ameri-
can medical schools. if you want to be listed I'll have to see
what you've got in the way of equipment, see what your setup is
and talk to some of your principal people."

As with Dun and Bradstreet, it's wiser, although having
some defects, to be in than it is to be on record as "I can't report
on thie outfit because they don't allow anybody to learn anything
about them,” Abe went right at it but said that the thing that made
138,

it successful was the fact that he went down to Johna Hopkins
at the outset and spent upwards of two or.three months seeing
how it was put together. Hopkins was unique at that time and
Abe simply used Johns Hopkins as a foot rule to measure the
other medical schools in the United States.

Abe Flexner was and is a very able fellow. lhave con-
sidered for a long time that he was far shrewder and wiser as
an appraiser than as an administrator. He wae extraordinarily
bold and usually correct when it came to appraising and evaluating
a system of education. He was a man trained in the classics. He
kaew what good teaching wae. He knew how to get it and how to
give it. But he wasn't entirely at home in satisfactory cooperative
endeavor. He was terribly restless at the effort involved at see-
ing lote of people in his office. All the rest of us would be sceing
all and sundry and doing an awful lot of talking and some Listening.
However, Abe would be in his office virtually inaccessible for long
periods of time--weeks--writing books and putting things together
in & way that was extremely effective.

1 once went to a luncheon of Foundation officers when Dr.
Pierce was in Europe, and Abe did something that was quite character-
fetic. We used to have Little talke by various members of a group--

some eight or ten. Abe had the floor at one luncheon and he went
139.

right down the table and showed how completely unfit for his
present position every man at the table was. He left us all
gaeping. There was no mercy and nobody was spared.

The flavor of Abe Flexner in the group wae on the whole
simply excellent, but he had some rather troublesome traite of
character. Abe was terrifically jealous of his job and of any
apparent incursions or intrusions.

There was an interesting arrangement between Abe
Flexner and Richard Pierce on the subject of who was doing
what and where, which comes near to being important history
im the Foundation, According to that arrangement, Flexner
reserved the United States for his bailiwick in the field of med-
ical education, while Pierce staked out Europe and Canada.
That worked itself out to mean that although we were the division
of medical education and it was in the Foundation and located in
New York, 1, as an underling, was not supposed to go anywhere
in the United States or know anything about American medical
education except what | picked up on my own, 1 couldn't do that,
#0 to speak, on office time because our divis on wasn't supposed
to have any relationships with any of the medical achools in the
United States. That was Flexner's bailiwick and it was very

bluntly defended. It was an unfortunate thing because it meant
140,

that I really didn't know the central problems that we were having
in this country well enough to help me understand what was going
on when I went to other countries. That was that and there was

- Mo uncertainty about it.

Although Abe was supposed to keep out of Europe, he
went right ahead and broke his agreement. In 1923 he went over
to Europe and came back steaming about the condition of medical
education in Germany. The report was ao horrendous that Pierce
had to make a special visit there. This was really stepping over
the boundaries. Now I think that the essential fact was that Abe
didn't have a great deal of interest or reapect for Pierce's mind
or Pierce's ability, and I think that Abe did only a mediocre job
of hiding that low estimate.

Richard Pierce was my boss and he was my friend. He
was in charge of the medical education division, which had been
created because the International Health Division had come to the
conclusion that our relationships in the field of public health in
foreign countries were limited. and had «a ceiling placed upon
their growth, activity and effectiveness by the level of medical
education in the country that was involved. When Rose was con-
vinced of that he got the Foundation te create a division of medical

education that was going to do something about the education in
141.

medicine, especially in those countries where the public health
work had gone well and was beginning to produce something
roughly comparable to a miracle in the way of progress and im-
provement.

_ i remember the first time I met Pierce in Brasil, I had
come in from the hinterland and there he was. 1 put a note in
my diary that Pierce's exterior was about as inviting as a ceme-
tery wall. it wae, it was (as it is in lote of cases) the result of
shyness and not the result of superiority or aversion, Pierce
was a very shy person and, like a great many shy people, extreme-
ly sensitive. Pierce had lost hie mother when he was about nine
or ten years old, His father married again and the traditional
stepmother situation developed. The new wife poisoned the
father against the small boy and when he was twelve yeare old
Plerce ran away from his parents. He told me once that he
remembered in complete vividness earning his living in New
Haven driving a grocery truck and seeing hie father and hie
stepmother on the street hughing st him. That just cut him to
the quick, For years he went slong ae best he could. He wanted
to be a doctor and worked his way through Tufts medical school.
After graduation he went to Philadelphia. I don't know how he
got to Philadelphia, but he came there as an assistant to Simon
Flexner in pathology,
142.

Pierce worshipped Simon Flexner. He told me that
once he took a trip to Europe so that he wouldn't have to make
& speech about Flexaer at Flexner's anniversary at the Institute
because he coulds't trust his voice in any such speech about
Flexner. After a while he was given a research professor -
ship at Pennsylvania and was personally among those young
professora at Pennsylvania who wanted to get the University of
Pennsylvania pointed to the outside of the world inetead of
being in the hands of some squabbling clinicians. The fight
wae tough and Pierce consequently was a little more than ready
to leave Penneylvania when Simon Flexner put him up asa
possible candidate for heading the new education division at the
Rockefeller Foundation.

Pierce told me of an incident that occurred in these years
at Pennsylvania which later proved to be of considerable and actual
importance in the work of the Foundation.

When Pierce was with Flexner at Pennsylvania, Flexner
came to him one day and said, “Dick, I think you had better go
to Germany for a year."

This wae comething of a thunderclap because Pierce was
thea in the process of getting engaged to the present Mra. Pierce,

who was the daughter of Professor Musser. It wasn't a time when
i43.

Pierce wanted to leave that particular neighborhood. However,
he went and then a curious, fortuitous thing happened. He worked
with a German pathologist who in physical appearance as well as
manner bore so strong @ resemblance to Pierce's father that
they didn't get along from the start. Pierce stayed because the professor
was & person whom Pierce's boss and ideal had sent him to. A Little
later, Pierce, a lonely, lovesick student, contracted typhoid. His
convalescence was long and arduous and, to add to bis burden, he
developed an embolism in both legs. This limited him for the rest
of his life in the amount of exercise he could take because the cir-
culation in hia legs remained poor. He developed a hatred for Ger-
many and this German professor that knew no bounds, but he kept it
quiet. That hatred was reinforced during the first World War, when
Pierce, although a volunteer, was rejected for army service because
of his phiebitis. He bitterly resented the fact that he was not able
to serve as other men did in the war, It was simply another strike
againat the Germans,

The end result of that attitude wee that when I weat abroad
Pierce received my letters saying that 1 thought that I ought to go
to Germany very coolly, 1 finally avoided open warfare with Pierce
by simply devoting my vacation to being in Germany and learning

German and something of German medicine (which I never learned
144,

any too well). At the time I didn't know the German medical
school situation except fram what I could get from avid reading.
Reading didn't prove too helpful because there waen't anything
anybody cared to write about in post-war German medicine.

Although I had a reaponsibility for German medicine
l was severely discouraged from having anything to do with it,
it also meant thaé later when Pierce was in Japan he never.
warmed up much to the possibilities of Japanese medicine be~
cause it was so completely Germanified. We never did anything
either in Japan or in Germany to compare with what we could
have done.

Now that's what 1 call unofficial history and it came
about and showed itself deserving of that term by the fact that
when Raymond Fosdick was doing his book on the Foundation
Mra. Carson, who wae helping Dr. Foelick, said that she'd
encountered some great puszles and she'd be glad if 1 would
have lunch with her and explain some of these things. One of
the main questions from her was, “Dr. Gregg, I've looked
through all the records of the period 1922-1925. Why didn't
the Foundation do more in Germany 7"

I said, “Do you want the official explanation, because
I can give you that. I know what that ie. Or do you want what
i think is the real explanation?"
145.

She said that she'd like the real explanation. There it
was. That's the kind of thing that doean't get written in many
a formal history and | resent it. 1 am supported in my resent-
ment by reflecting on what the autopsy has meant in the develop-
ment of medicine. The autopsy tells the truth as it is understood,
records the attendant circumstances rather then ignores them
and comes out with some very useful information. it ie, however,
true that the autopsy is « privileged document. 1 think that history
might be a privileged document up to the time when nobody much
cares whether the situation is decorous or not. Although the
prejudice of an individual is not entirely decorous, admirable
or understandable, it actually explains a great deal more than
any other nominal facade of supposition and correctitudes. That's
what makes me interested in Professor Nevins' Oral History
Project. It enables some facts to be mentioned which either
carry their own conviction later on or don't, but if they do, it
ie the only place they will come out.

Pierce had so lively a memory of his own difficulties
and his own hardships that he was extremely tenderhearted and
solicitous with junior people. He was awfully afraid of himself.
i came at him in a funny way. 1 was so astonished and completely

bewildered by having @ position of assistant offered to me in
146,

Brasil by a man who didn't (as it seemed to me) have any idea

of my character or capacity, that when Pierce told me that we
were going to go back to New York on the same boat from Rio

I said to myself, “Well, when you go up in a balloon, it's wise

to take a parachute, I'm going to look around pretty lively and
fast to see what | can do when Pierce fires me because when he
discovers what kind of a guy lam he will fire me, It will be made
very decorous and everything, but it will be there, The best thing
I can do on this two weeks! trip to New York is to be perfectly
reckless in my comments, not try to curry favor and be just as
blunt and casual as 1 can be."

Although I did this it dida't seem to have any effect. It
wasn't that I wanted to have him break with me before we got to
New York. I Juet wanted him to know quite thoroughly what he
wae dealing with. 1 didn't want the humiliation of being fired.

i'd rather have gone back and made some other arrangement. We
got along beautifully, 1 can see now that he wae enchanted to have
perfectly frank, boid and daring comment from a young fellow who
apparently wasn't afraid of losing his job before he had gotten it.

i saw his relationship with other young men and it was outwardly
extremely formal, even to the point of being almost timid in its
correctness. Inwardly it was one of great sympathy and great
yearning. It wae quite touching.
147,

Pierce told me once that the role of a family country
practitioner was the kind of life that he thought was the finest
poseible--certainly not being a pathologist, or a foundation
executive. I think that he was disappointed ae nearly all men
who go into science are that he hadn't made a contribution of
greater significance. However, he was a well trained pathologist
and he had a very strong sense of good tearnwork without any
excess sentimentality. He was much too timid and self conscious
to dare to show hia feelings. He couldn't bear that but he was
awfully concerned about how things went.

in the office he was highly respetted for his complete
honesty, modesty, thoroughness of work, and his capacity to
get at the esgence of a proposal or a request from the outside.
There were people--Flexner was perhaps the most clear-cut
example--who resented the slowness of Pierce's mind and the
Spparent cloudiness of his acceptance of ideas expressed to hia.
He didn't have an instantaneous grasp of everything. He had one
or two funny attitudes. He cautioned me very explicitly against
writing or speaking because he said, “Ae soon as you explain
what you think is worthwhile, you'll be embarragsed by the number
of requests from people who had that same ides and come in and
say, ‘I've always wanted to do the very thing that you describe. '
Don't go in for that,"
148,

He did more than that. When I got to Kurope 1 started
& round robin letter, describing, in effect, what | saw and my
reactions to it. In essence it was more reflection than description,
Pierce wrote me a letter éaying that he thought that that kind of
correspondence was too far from the work in hand and that he
wished 1 would not spend teo much time on it. It really meant,
"Give up and stop that". I didn't get started again until the dean
in Louisville urged me to do some writing in 1936, In the period
from 1926 to 1936 1 did no writing at all. I have never felt Pierce's
worriment about being caught by somebody who says, "I've just
had the same idea you expressed in a speech at so-and-so." I
never have felt that to be a handicap. As a matter of fact, I have
had relatively few people say explicitly to me, “ What you have
described is just exactly what I always have wanted to do. Now
get the money for me." It is quite possible, however, that that
situation might net have obtained had I been in Pierce's position
ten years earlier.

Pierce had awfully little muscular movement in different
moods. His face wae impassive and didn't accompany him. It
sort of hung asa mask. Every once in a while when he was too
moved to speak or moved to tears he would pull out his handker-

chief and blow his nose very hard, It wae as far as he ever got
149.

inte an external expression of hig emotions, Aea mind he had
singularly accurate and tenacious and searching intelligence.

But he didn't particularly enjoy self expression and he wasn't
particularly good et it. He could approach conditions previously
completely unknown to him and seek out and find the kernel.
There were few reports that 1 submitted to hin that would not
get a four to five page memorandum pointing out the inaccuracies
and all the things that I had left out. I didn't obtain perfection

in his response ever, There was always something needing re-
pair and patchwork.

Although we had some pretty strenuous times, Pierce
stood by me later pretty intelligently, with one exception, and
that I won't go inte. He was extremely loyal.

Although Pierce was considered a little difficult of access,
hie status among pathologiste in the United States was much res~
pected, While many dids't feel particularly at home with him,
he came to the point of belag practically revered. He had a bad
heart, and after about a month of acute invalidism in February,
1930, he died suddenty in a hospital while under the care of Alfred
Cohn,
150,

I'd like to turn now and discuss the flavor of the Youndation
and the kind of work I did when I firet came to New York with
Pierce. In the early days work in the office consisted for me in
reading a good deal of the incoming mail in order to get an idea
of the requests or projects we were having thrown at us. It was
a heavy mail, although I asually saw only those elements which
Gr, Pierce's secretary, Miss Blake, decided De. Pierce cauld-
n't see for two or three days and needed an immediate reply.

I spent long hours reading letters coming in from various countries
and in a certain sense 1 began automatically or incidentally to
memorize names, identities and functions,

We had a valuable bipartite rule in the Foundation in
those days, One wae that we would never go to any country
where we weren't invited. In effect that meant that we had to
walt for quite a long while for invitations from some countries,
The second rule was that we never proposed to give money away
to @ country that we had not visited. That rule involved me in
making digests of the tons of material we were given whenever
we planned to visit a country. Usually we were given reports
of conditions in that country that nobody had ever read, The
habit of giving a visitor the reports that the local boys think
they know well enough so that they don't think they need to read
15l.

them was and still ia rather widespread throughout the world.
i did an enormous amount of report reading. 1 wanted to do it
because usually it was the only available descriptive material
of the medical setup in countries that we were quite likely to
visit or had just visited,

In addition in this early period Pierce gave me special
assignments which had the advantage of showing me the workings
of gorne American medical schools, although in « very different
role from what might have been expected, On several occasions
iwae used ae a guide for various visiting medical commissions
from foreign countries. In that I think a minor error was made.
For example, once l took seven Japanese doctors through the
United States for nine weeks. 1 was given the task of planning
their entire visit, With the enthusiasm of youth I plaaned the
visit in such a way that those poor doctors didn't have time to
see anything but medical education, The Japanese found it
pretty strenuous. It was a stupid mistake on my part, but I
was very loyal and hard working. A ehort time later 1 took
a group of four or five professors from Straesburg around the
United States for a much more limited visit.

i was impressed by the seriousness and the deliberate

precision of the way these foreign visitors, all of them profeseors
162,

and all of them men of forty and beyond, made statements. They
were very conscious of the importance of formulating their ideas
carefully and well. While at first £ thought it wae due to the very
definite handicap of speaking in a language with which they were
not completely at home, I later found that they were very care-
fal about their statemente even if they had facility in English.
On the whole they were very formal. They assumed a position
of being about halfway on the platform. They aleo showed pretty
definite evidence of feeling that they were the final authority on
anything they were talking about and didn't expect to be challenged
or didn't expect to be interrupted with a question, I noticed that
in contéast to the casualness with which an American counterpart
would break down and be very indirect and very informal in much
of his behavior after he'd stood, so to speak, on the platform for
a certain period of time. They didn't, Both the Japanese and
the French were much more on the platform and in a certain
sense much more on a formal good behavier.

thing came out with the Japanese and to a somewhat
lees extent with the French. They had quietly assumed that they
would be asked to lecture and that they wouldn't be entirely in the
position of receivers and listeners when they visited institutions,
Rugene Opie at St. Louie was the only one out of upwards of sixty
professors who had the adroitness, the kindness and the understanding
153.

ask the Japanese to give a lecture. They all had lectures with
them in their euitcases begging to be delivered. The only trouble
was that they usually weren't asked. I would like to give a plece
of advice to people taking foreigners around, By all means ask
them whether by any chance they would be willing to give a lecture.
Gogh, they are not only willing, they are expecting it and they're
very near to hurt feelinge if they are not asked to perform some-
where.

This discovery led me to another thing that has proved
very valuable in arranging visite of a similar kind; namely, if
one wants to teach a foreigner something without the faintest
trace of assuming that role recognizably, ask him about a year
in advance to come to the United States to give six lectures, He
will come and because he considers that hie main, and perhaps
his exclusive, role is to spread the light, he's actually in a
frame of mind which makes it perfectly eney for him to discover
something which one couldn't possibly lecture to him on. He
goes away having really profited from hie visit becauee he was
asked to teach and he was let alone to learn. If he had been
brought over to be lectured to there would be resentment from
the very start because one just doesn't lecture to a professor.

The only circumstance under which a professor from many of
154.

the foreign countries can learn is to be asked to teach and do
his learning in a hidden or concesled fashion. lt was on euch
« basis that the Kockefeller Foundation got the great German
clinician, Frederick Muller, to come and lectere ai Chicago.
Because Mulier was brought over to Chicago to spread the
light, he discovered some things that he couldn't possibly have
been convinced of if he'd been asked to come and receive;
samely, that at that particular time American bio-chemiastry
wae moving rapidly and was already well ahead of Germany in
certain fielde of bio~chemistry, It was on that basis that the
Germans invited Dr. Irving Page, who is new in Gleveland, te
go to the Kaiser Wilhelm Institute in Munich as ateacher. The
Germans quietly did the natural and needful thing to catch up
on certain phases of bie~chemistry. The Foundation couldn't
possibly have achieved those results by asking Frederick
Muller to come over and learn what the Americans were doing.
it le true that the method of asking people to teach and relying
on their picking ap something is the acme of indirection, but
it works extremely well. The Foundation used that a lot and
used it very effectively. it, however, ia an item in the inter~
change of ideas which is usually overlooked.

The French visitors we invited differed markedly from

the Japanese, The Japanese visit was put over by President
155.

Vincent. Plerce, I think, did not want it because he didn't
think that Japanese medicine was in « pesition to be given
money ona large scale. However, it was done for reasons
of international comity. The feeling about the Japanese on
the Weat Coast was such at the time that it wae both difficult
and necessary. 1 would say that the visit was almost purely
8 political gesture, a thing the Foundation usually doesn't go
in for mach,

The background of the Strassburg visit was entirely
different. Pierce's idea was that Strassburg professors with
a history of having worked in both the German and French
tradition might really profit from seeing how things were done in
the United States. He felt that such a visit would result in
closer relationships with American medicine. lt worked very
well, When the Foundation invited the French to visit us they
were enchanted and understandably so. We said quite bluntly,
"We think that it will be easier for us to deal with you in the
future if you understand the point of view that we have in making
certain offers and arrangements with you. You'll understand us
better if you see the background in which we have grown up."

For example, some time later, when we decided to aid the

medical school in Lyons to put up a perfectly new building, we
456,

insisted that they come over and see some of the medical schools
inthis country. We did this partly because we felt that they

could make better plana for « building if they saw what could be
done. The visit which the Foundation paid for wae not restricted
tothe United States. The Lyonnais went to Germany, England
and Scotland ae well. The trip had one half humorous result.
When the French architect, Balmain, who accompanied the Lyon-
mais on their visit, sew the construction of the hospital at Vander~
bilt, he was struck dumb by the fact that we ordered standard

size windows for the whole place. He had never thought of doing
anything like that. In hie experience all of the wondowe had to be
of different sizes and shapes so as to look nicely. We got across
rather perilously the idea that a medical school seen by the pase~
ing architectural eye might be made very beautiful at immense
cost but, because its function was that of a medical school and

not an object d' art, it might profitably be made « Little bit more
like a factory in order to save coats. Fortunately the architéct
was open minded enough to say, "Well, after all you are paying the
total bill and if you say that you are not fretted by something that
looks pretty much like a factory, I'll do it." The bill for a block
order of windows all the same size ‘was 60 much below what Balmain 's

original plan had been that the Foundation really saved the entire
157.

coat of the trip to the United States for the Lyonnais. The
results of that visit nut only carried advantages in terms of
economy but served to focus the attention of the Lyonnais on
the actual essential function of a structure. To look at the function
of anything was and is new for a great many people in thie be-
wildered world. |

1 spent all of one morning once talking to a Japanese
doctor. He asked me very bluntly what my impression was of
the Japanese physicians who had come to the United States and
whom I'd seen in Europe, With the proper appearance of defer-
ence and hesitation I told him that 1 thought beyond any question
that the Japanese that I had met were wonderfully couragebpua
aad meticulous in copying forme but that 1 hadn't yet seon a
Japanese who was interested in function. He didn't know what
i was talking about. 1 spent much time thereafter explaining
and he was, I think, quite honestly (and 1 know in form at least)
remarkably appreciative and understanding. If I remember
correctly, | asked him first about the function of a laboratory
in physiology. I got him around to see that it was teaching
physiology. "Well, then," I said, "what do you care about
form? It's the function that 1 want you te take. I want the form
to be as Japanese as it can be or it cares to be but first you've

got ¢o define the function. "
158.

That distinction between form and function came up
sharply for certain countries because again and again we were
interested in providing for the function of a laboratory, say,
of bio-chemiatry or embryology, If our visitors really pre-
ferred or insisted on having a building that had eome decora-~
tion in it, we would sometimes say, “Well, all right, if it
makes euch a glaring exception to the architecture of the reeset
of the medical school, go ahead and put on some curlycues. We
will put up with it, It's not what we care more about. It's what
we care less about," and we'd get by by weakly conceding the
point,

However, again and agaln these visits helped recrient
points of view all along the line. For instance, visitors would
talk with professore of embryology and, secing that the bio-
chemistry of embryology was developing quite rapidly in the
United States, would think, Gracious, here's somebody who
is doing something in embryology that we haven't realized the
significance of. It hasn't yet been published mach, and it
certainly hasn't been accepted, but today Ihave seen thet bio-
chemical methods as applied to embryology are quite significant

and very promising indeed."
159.

We made it perfectly clear at this time that it was
possible for us to take youngsters for a year or two and give
them a training which would enable them to see the horizons
of new and promising fields. We showed our visitors that it
would be worth their while for example to take a promising
young fellow and say te him, "Now, you read all you can about
the status of bio-chemistry applied to embryology, "and while
not promising him anything make it clear that if he did reason-
ably well and learned the alphabet of things that there was a
good prospect that he could be sent at Foundation expense to
a place where things were really moving in that field. Te
make a phrase, it wae a policy of investing in the horizons of
young men,

We did insist, however, that anybody who went on our
fellowship had to have an aseured paid position at the end of
the fellowship. That stipulation saved us from wasting a great
deal of money. If you offer a fellowship without asking at the
same time for a quid pro quo in the sense of an appointment to
your young man, he literally doesn't know what he's going to do
when the followship is over so he doean't know what to study.
it can be a great defect, Another and sometimes more serious
situation that we had to guard againet was offering « fellowship
to brilliant but cantankerous youngsters whom the schools really
160.

did not want. Many schools were very glad to get fellowships
for such youngsters in order to get them out of the way.

it ia hard to guess what impression the Rockefeller
Foundation's work and program made on some of our foreign
friends. One must remember that this early stage in which I
wae working at the Foundation was the mid-Twenties. People
in Europe generally, and people in the universities particularly,
were in some measure to be described as quietly licking their
wounds and trying to recover from the first World War. The
first World War had o far heavier mortality than the second
World War, The disastrous plan of sllowing volunteering made
it a literal fact that the English elite who volunteered in droves
in World War I took a fearful beating in the first battles of the
war, A friend of mine named Campbell who wae a professor,
Ithink, at Bart's, was one of a group of twenty young men
who came up to Oxford in 1913. In late August, 1914, they all
volunteered for service. In 1915 one of the group got a shrapnel
wound of the head and was invalided and never came back to any~
thing inthe Army. With hard work he later became one of the
leading barristers in London, Another of this group of twenty
had « heart failure in 1917, With very careful nursing and care
he became the headmaster of one of the English public echools.
161,

When l asked Dr. Campbell about the others, he replied, "They
are all gone." Looking at wer from a biological standpoint it is
not difficult to realise what an effect that has had. lt is self
evident that it stopped those particular individuals. However, it
algo made a very curious shift in the sex ratio and the sex relation-
ship. The real widows of World War I were not the girls who had
just gotten married, or who married during the war and lost
their husbands. The real widows were the girls who were just
coming out or who were just being exposed to the freedom of
getting married. They were not taken because the young widows
took their place. The istter, having had experience in getting
married and having their dead husbands' property plus their own,
were perfectly able to find another man. The young widows were
not the widows of the war because they got married again. The |
real widows were the girls who hadn't even got married.

it'a » little bit unfair to expect a very clear impression
to come to theese visitors because they were still getting over the
war, licking their wounds and trying to find successors. Still
there were some impressions. One, Il would say, wae a rapidly
developing realization on the part of Europeans that America and
Canada were both beginning to have things that were worth seeing.
I would say that their grand style provincialism was beginning to
desert them. You can be provincial if you're a Parisian and the
162.

trouble with that (s that your province happens to be the only

place in the world. Metropolitan provincialiam is almost a dis-
ease. In fact, it's the kind of provincialism that is pretty marked.
Today we've got the same thing in New York.

That did change considerably. it chenged on an em-
bittered basia, einbittered because they said, "Well, you've
got money #01 suppose you may have something. '' The essence
of this kind of thinking came out when I made a viait some years
later to the second medical clinic in Naples. My identity wae re-
vealed to the surrounding residents when the medical visit wae
in progress and 1 was being given a lecture on exophthalmic
goiter by a very curious, violent and rather vain professor. At
one stage of the game he interrupted himself to summarize what
wee obviously his opinion of my relationship te him. He shot both
hie arme into the air, assuming a position of crucifixion and bel-
lowed, "Sometimes 1 feel like Christ on the cross when 1 see all
the people with ideas having no money and all the people who have
no ideas having all the money."

It came awfully close to being an insult because it wae so
clearly directed. However, I think that wae an impassioned ex-
pression of what a great many of the Kuropean leaders felt. Later
I learned why this professor in Naples had gotten that way, He got
163.

that way because he had seen so many sick Italians coming

back from the United States with perfectly diagnosable con-
ditions, They had never been correctly diagnosed in certain
American cities becauee the ltalians didn't know whom to go to.
Asa result, on the basis of what he had seen of cur missed caces,
this Italian professor considered that we were absolute ignora-
muses and barbarians, Of course our good men never knew the
kind of a reputation they were acquiring. It was not their fault

at all,

I can't say that the impreesion that was made struck me as
being very favorable. in fact, it was relatively difficult for
Europeans to make a comparison with our teaching methods and
theire because they were dealing with highly trained young minds,
very explicitly an elite who quite frequently carried a great deal
of intellectual baggage from the family life they lived. They were
in fact a professional educated class. I should say that in Europe
a young man came to the university intellectually twice as well
prepared as the average young man here, so methods of procedure
were bound to be different. The biggest differencé was the fact
that the European assumed and still assumes that the young man
coming to the university will take a measure of responsibility for

his own education and be active about it, in fact, they thought he
164,

should not be bound down by the convoy system of education.
Giving Europeans our obligatory course structure gave them

the eame sense of incomprehensible futility that we would have
if we had a special officer in the army whose job it was to make
sure that everybody put his shoes on. Well, one could say,
“That's thelr problem and it's a waste of time to make sure that
everybody has hie shoes on. Let's not do thet." The Europeans
ased to feel that our educational system was not their problem.
They felt that in large measure everything depended on the in-
terest of the student. The French student had a phrase that
summarised that position rather nicely. It wae ‘debroulllard’.
"Debroulllard" means that you can find your way around any-
where even if you're tossed in, born yesterday. A debrouillard
can find the road, find the path and find what to do (and they do,
too} with an independence and freedom and resulting originality
of mind that I found new and in many ways admirable. Now, the
human tendency when one finds something perfectly new that
works weil is to euspect that it ie perhaps superior. 1 learned a
darn sight more from most of the Europeans that 1 met than I
could expect them to learn from me, especially if they had any
of the mentality of "Sometimes 1 feel like Christ on the cross,"
That kind of person just won't learn. Mostly | think one learns
when there is a challenge. Under such circumstances there is

almost an overwhelming obligation to learn.
165.

Our European visitors did learn some things, They knew
that full time as an idea wae quite inoperable in their countries because
moat of their governments in the Twenties were right in the middle
of a heavy inflation and could never pay the salaries that were nec-
essary in order to get the leadership that was desirable for such
a program. In most cases Europeans had inherited their buildings
in which to teach the pre-clinical sciences of physiology, anatomy
and pharmacology. Well, it was just nonsense to think that one
could build new laboratories at that atage of post-war reconstruction
in Europe. There was just no hope for that. The results of course
were well-nigh disastrous. In the University of Parie during the
Twenties there were only eighty benches in pathology for over eight
hundred students. What could a student do under those circum-~
stances? Well, he usually got busy in the hospitals and slid or
skinned through pathology as beat he could.

i don't want te present the next point as typical but it existed.
The chairs that were really valuable in most of the European
universities were not the chairs of the pre-clinical sciences, In-
stead they were the clinical chairs, If you were a real profeseor
the income was tremendous. The result of that wae that the
European schools (not so much the English) were absolutely

dominated by clinical criteria and interests. The dean of the
166.

medical school at the University of Strassburg told me the
story of a candidate who once got a job working in a clinic and
thumbed his nose at physiology, pathology and bacteriology.
When the time for examination came, the teacher in physiology,
who was hoping to get a clinical chair himself, got a note from
the clinical professor about the young candidate who had been
slighting his work. The note ran this way: "My dear colleague:"
(He might just ae well have said, "My dear inferior colleague:")
“Young so-and-so is, 1 understand, taking his examination in
physiology. Because he ie very intelligent I have loaded him
with heavy responsibilities in the clinic and 1 underatand that
he ia not quite ae brilliantly prepared as 1 know you would like
him to be. I would consider it a great favor if you would keep
these circumstances in mind when you examine him." In short
form, that letter meant, “Let this boy through and I'll feel in-
debted to you and so when your name comes up for a clinical
professorship, I'll aot forgetiit. "

lonce made a rule for myself that | would never criticize
what 1 saw in any foreign country until 1 had stayed long enough
to hear one of the native authorities make the criticism which I
wanted to make. I think that it is absolutely easential in working
abroad on cultaral matters never to bring in the atmosphere of a
i67.

judge who first invites himself to a trial and then proceeds to
pronounce sentence. I don't think one in a thousand of our cult-
ural representatives understand that, because there's a trick
in it. Sometimes one has to wait quite a long time for euch
criticism te present itself. If you wait four years instead of
four months, or four days, you get to see some exceptions to
your rule and you're not quite so eure of yourself. When you
at long last hear a native person who has lifelong familiarity
with local problems say the very thing that you think, you can
at least quote him. it's also a fair assumption that he's going
to know some additional facts which will make your primary
impressions just look foolish by their superficiality. I never
will forget when Pierre Marie came in to our Paris office and
i got him started anthe defects of French medical education.
He gave me an account of French medical education which in-
volved thinge I never even heard of, He truly showed me how
great the defecte were. Now any priest would know and any
doctor would know that you have to establish a certain relation-
ships with patients or penitents before they will tell you the
whole bad news, and you don't get that established very quickly
with persons who don't even have the advantage of being total
Strangers, They feel themselves partly known, and when you
ask therm to tell the whole dirty story they just don't.
168.

The visitors who came to America were always grateful
when I was critical of something we might have seen. However,
they were aleo always a little bit distrustful of a temperament
that would reveal the inadequacies of his colleagues. Sometimes
they were grateful on another ecore. They just didn't under stand
the atmosphere of the American high school, They didn't under-
stand the fantastic conception of giving a large number of stadents
a not very good education and finding it more worth while than
giving a very few a first rate education. They dida't understand
the extent to which the American teacher generically (and I mean
this up and down the line) was so concerned with the failing stu-
dent. The model in the European medical school and elsewhere
in the university followed a different outline.

First of all, there was no limit to the number of students,
In that case, the duty of a professor was to present the subject
as clearly and as effectively as possible in his lectures. He
didn't have any personal concern for the students. It wasn't
his problem. His problem was mainly to give good lectures.

l must say that the level of lectures in Europe was two to three
times as good as it was here. Nevertheless the professor was
overloaded with lots of things to attend to, eo he had to have some
competent help. How did he get it? Well, he picked out of, we'll
169.

say, six hundred listeners or men in the firat year clase, five to
eight youngsters of apparently real ability land devotion. In ex-
change for a perfectly incredible amount of stupid slave work, he
promised them special personal attention. In Italy they were
known as “ayluti" and in France as “eleves". In cesence, however,
the system was the same all over. It was a bargain in which both
sides were happy and there was a loyalty there that we rarely see
bere. That company of men, however, wasn't completely davish
because they realized that they never were going to get anywhere
except on a competitive basis. They just had to be better than
somebody clae's favorite. But they were marked men in their
class. They had it in the palm of their hand and they usually did
want to use thie distinction,

That reminds me of one other thing of European student
_ life and student attitudes which is pretty different from here,
in 1947 1 had occasion to make o Little bit of inquiry into student
life and ite effect on audents in Germany. Ll asked some eight or
ten medical studente at Tubingen how many of the men in their
claee they knew by name. Well, the low man said he knew the
bames of eight classmates, and the high man said he knew thirty-
one. Although these observations occurred after World War U,

it wasn't a post-war phenomenon. It wae, I think, characteristic.
170.

One knows perfectly well that you just can't go through an
American medical school without knowing more than thirty-one
persons at the end of four years. I tried to think of « comparison
to measure the social isolation and distance from fellow human
beings and contemporaries that that situation implied, ithink I
hit it fairly closely by saying, "You don't find a personal res
ponasibility to know the first or last names of everybody that gues
to a certain concert at Carnegie Hall with you. Why should you
know the names of everyone who site in your row and why should
you speak to them more than saying, ‘I bég your pardon’ when
you step on their toes?" 1 said to these students, “Well, who
do you care about and who do you get te know 7?"

They looked at me astonished and said, “Why, you care
about the instructor and the professor."

Every student makes an effort to impress an instructor
or a professor so that he will get a chance to get inte m special
relationship with him. I said, sort of laughing, "Yee, we have
a name for that in an American student and that's an apple polisher."

Of course they didn't know what that meant. Ten minutes
after I had explained what an apple polisher was | was amased to
have one of the students speaking partly German and partly English
say tome, "That Ido not quite understand, What is der apfel politique 7"
i771.

Well, I'd heard of Weltpolitique, Machtpolitique; aber
apfel politique I hadn't heard of. However, that was the name
they gave it, They immediately confused the word "polishing"
with politics.

In Europe the isolation of the student means the height-
ening of his personal responsibility. He hasn't anybody to com-
pare notes with to say, “Sure, I thought it was a rotten lecture
too," That problem becomes a question between him and his
future. He's darn well got to make the most of it and he does
the rest sitting in hie garret. The poverty of the student abroad
is @ pretty impressive thing, There are very few who aren't living
awfully close to the line, although I might say that I'm not making
that ataterment as a generality to cover all students in Europe
during all time, It ain't necessarily so. But ldo make it as
& Comment on post-war conditions, The post-war years follew-
ing World War 1 were difficult for planning and forward movement.
They were terribly unsettled years. There was, for example, a
perfectly frank and complete European depression which finally
reached our shores in the Thirties, They were sot perfectly
ideal years for constructive work. But nobody realized it.

The contradictions sean by those who came ae visitors to

the United States with what they had was tremendous, 6o tremendous
172.

that i don't recognize the stamp of the Rockefeller Foundation
on European medicine as being anything very significant. That
firat came to me when I was having dinner with a delightful
French friend of mine, Dr. Polical, in Lyons, We got a little
bit lit up but I was aober enough to want to take advantage of
Policai's expansiveness of mind, and I asked him to be perfectly
frank with me and tell me what he thought the Foundation had
done in France that was particularly new and valuable. He made
the proper amends at the outset by saying, "I think thie may
surprise you, I think it may disappoint you. I think it may annoy
you, but franchement, toute franchement, Gregg, the thing that
you've done that really has made a difference is your contribution
ta nursing."

It is true that | was surprised, but I had been interested
in nursing myself so that I waen't disappointed or angry. I
asked him further and he said, "Well, at bottom, you brought
in the idea of a doctor having a highly intelligent witness and
enlooker. You do it cleverly because you make the onlooker the
doctor's helper, but don't you realize that before we had anything
approaching trained and intelligent nurses the French physician
wae as alone and was ae unobserved as it pleased him to be, Now

we have an invaluable assistant, and she's alao somebody who knows
i73.

when we should have put on a bandage differently. Morally that
hae a formidable effect, and it's perfectly new."

Well, lhad a sister who was a trained nurse and who
had given me in casual inquiry similar accounts of times when
she forced the doctor to do something that he wouldn't otherwise
have done out of laziness or out of ignorance. 1 could therefore
appreciate Policai's frank steement.

My early work in the office also involved « great deal of
reading applications for grants. 1 often realized from the firat
reading that they weren't really very good applications. One of
the common things that 1 experienced was this: I would receive
an application for financial aid in putting more emphasis on
metaboliem and nutrition in a field like skin disease. Usually
the applicant described what he was going to do pretty clearly.
In addition he often described his project as a complete record-
breaking departure from the usual procedures, in fact, as an
idea in iteelf something epoch-making. Because our activities
had forced ua to see what was going on in a great many places,
I often felt like saying to the candidate, "You have described a
field of activity which is original, which ie good. which is valuable,
but 1 don't think that I can get the board to appropriate a aur of
money anything comparable to what you want because you really

don't know of the efforts that are being made in other places in
174,

this field. However, I think that 1 could get the board to give
you six hundred dollars to go to these places and see what they
are doing because then you could prepare a request to us that
would be firet clase and well covered. Your present request is
simply insular in its character because you don't know what ie
going on elsewhere. We can, however, give you some money to
go around and see what's going on, and make the acquaintance
of persons with comparable interests to yours. Remember what's
going on in university laboratories is a very different thing from
what is now available in the Literature. "

I think the fact that | have survived in the Foundation
without being asked to go somewhere elise depended on a point
that 1 realised early; namely, that communcation wae central to
my success and to my survival in the Foundation. 1 wae in essence
a middle man between highly skilled technological scientific workers
and a foundation board on which out of eighteen trustees there were
only two that could even know the jargon that I would want to talk,
lhad to, so to speak, put inte plain English a great many ideas which
usually survive in the form of a shorthand used by scientists who
are perfectly familiar with common phrases like oxidatian processes,
i had to put such thoughts into terms that, say, the president of the
XYZ bank could understand. My life depended on it. My position
certainly depended on ft, I alec had to know the meaning of certain
i75,

words in one language and put them over in another language

and etill be talking about the same thing. 1 became--and this

ie a lighthearted example~--something of a specialist in a field
that nobody knows much about, and that is understanding
Europeans who believe they are talking English but whe aren't
talking English at all. I remember once I was catled into
Preeident Vincent's room while he wae visiting the Paris office.
He wae interviewing a Russian lady biologist who was talking

a perfect spate of what she thought was English. Vincent called
me on the telephone and eaid that he wanted help in understanding
her English because it wae going to upset her terribly to tell her
that she waen't understandable. I came in and wae introduced.
She turned to me in a perfect uproar of words and said, “I am
just telling President Vincent that the ‘lake' must become the
necessary informations.

When a pause occurred, Vincent turned to me and said,
"What does she mean?"

iaaid, "Why, President Vincent, she means she thinks
that it's important that the general public be better informed. ”

i knew that the word “lake” wasn't what she really meant.
Casting around pretty quickly I guessed that ehe was saying “the
lake" because the French word for the laity is “laique, Europeans
often make the mistake of taking the English word become" for
176.

meaning “bekommen", so “the lake’ must become the necessary
informations" was quite clearly “the laity must secure better
information in some fashion, "

I found that my duties made me something of an old hand
in understanding English ae it was really spoken. Once while in
Japan I asked Dr. Fujinact what some very strange looking
creatures with wastebaskets and sticks for eyes were doing walk-
ing along the street. Dr. Fujinami's reply was, "ls this official
kind of traitor. He plays on flute and becomes gold.” Now, that
simply meant the pereon was a special kind of religious priest
who played a flute and got money for it.

i conatantly had to put into statements noises that were aot
Enaglieh with the heartening reflection that most of what I said in
the person's native language was probably going through the same
tortuous agony in being understood. Finding the essence of com-
munication wae ea steady and uneading task. I etudied it all the
time. I worked on that side of things far more than 1 eaw my col-
leagues working. Getting yourself understood and understanding
othere was far more difficult than learning what was going on.
The latter came fairly easily.

i discovered after about six months of roy time in Europe
(which was from the summer of 1924 to the summer of 4931) that
177.

although one could talk about the University of Strassburg it

wae a secondary generalization, because the University wasn't
like an individual. Gaying “University of Straseburg" was
merely calling » group of associations by a collective name.

ii, however, universities in that rather blunt and primary

sense didn't exist and they didn't, then what did exist? Well,
people exist, and as a result I rather tirmorously and at my ows
expense started up a card catalog of the people that 1 was deal-
ing with and that I heard about. 1 put their names, their ages,
and their academic pedigrees down. I included who they bad
worked with and for how long. 1 designated their particular
intereste in the field of science and their present interest in
contrast to their published record. I noted the languages they
could speak. In eum I put down what their long suits were as
Lestimated them. However, I made one rule very cautiously.

lL allowed no bad news, and no unhappy facts to appear on these
tarde, 1 ales allowed no symbol to indicate how | rated theen to
appear on the cards. It would have been perfectly disastrous

to have on those carde ae part of the Foundation’ s“secret record"
bad news about anybody. I could alwaye recall such information,
but I couldn't alwaye recall all the dates of birth, all of the lang-
wages anc the epecialized scientific interests that appeared on the

cards, That eyetem carried a very interesting and unexpected
i7é.

vesolt. As i added to the liet I got more and more familiar
with the names and identities of medical workers throughout
the world, and i got to the point where if an American from,
we'll say, Hopkins asked me, “Who are the high altitude phy~
slologista in Sweden?’ I could come up with much better than
fifty percent of the names right out of my head. Today [June,
4957] 1 can still do it.

it was an invaluable discovery for me to know that
ecience didn't exist in any primary sense but that people did
exist and that if l could get familiar with people i could do some-
thing for which no foundation ever gets any credit. Thinking on
it we don't want it, because in a certain sense it's too much
pewer. Although wo could introduce scientists to ecientiste
whe didn't know each other even though they worked in the same
field, I found there was always a fear on their part that we
might pase on some ideas they were working on and didn't care
to share. Ihave seen that happen with foundations and it - always
works badiy. It builds walls if you attempt to be the dispenser of
Professor X's ideas to Professor Y, etc. It's one of the reasons
that 1 am eo gour on the subject of patenting scientific discoveries
for revenue. I don't mind patenting as protection from somebody
elee's profiting from your discoveries, but sometimes a university

patents regularly as a matter of course and acientific communication
179.

is hampered thereby. I have ecen Professor A from the Univ-
erelty of Missouri goto the University of Wisconsin (which be-
lieves in patenting anything it can discover), see some work of

a graduate student there which, if coupled with what he had been
doing (but had not yet published), would have made a patentable
discovery. Asa result he didn't communicate because he would-
n't give away two or three hundred thousand dollars’ worth of

a patented chemical. The wall was put up and there wasn't the
interchange in science that acience practically lives by. lt meant
thet secrecy entered an area of human effort where it did not
wisely belong.

There were always specific problems involved in inviting
people and the work was arduous and demanding. Few realize
how demanding. Just today [June, 1957] I went to a meeting of the
Child Study Association and heard one of the executives say,

“Dr. Grimm hae just come back from a jaunt to the West, and
he will make a report on what he has seen." i felt Like saying,
“Jaunt, my hat!" When you go to atudy a function of a child
study organisation in Chicago, you are not on a jeunt. It is not
a jaunt because you have to be on your feet at nine o'clock. You
have to aay on your feet walking around the building and looking

at kp arrangement and the provisions that are made. You then
480.

have to talk all the afternoon with the director who tries to tell
you what he's trying to do. In the evening you have to go to

dinner and meet the pooh-bahe, pay attention to them and make
your eetimate of what kind of people they are. When you finally
get back to your hotel at eleven o'clock at night, you have to seit
down end make up a note of everything that you can remember
having seen since nine o'clock in the morning. Ii that's a pleasure
party or s jaunt, I'ma plumber, it's awfully tiring, and if you
don't take those notes you're sunk, juet aunk, because the truth

is you can't remember it all.

My boss Dr. Pierce had @ secretary who sorted the daily
mall and knew roughly whet was especially important and what
Ought to be attended to right away. Her guess wae a pretty good
guess. She also knew things that could wait a week if need be.
Well, I found that 1 was not getting to know the business because
the would take important letters and send them into Or, Pierce,
He'd anewer those lettere and that wae that,

I finally went to Pierce under my own steam and said,
“Dr. Pierce, I don't want to interfere with the speed of handling
any communications and I couldn't possibly handle the amount of
stuff that you handle now, but would you in the majority of cases
agree to a day's delay and have a great deal of your mail go over
él.

my desk? Wl read it and I'll aketch in a written note atached
to it how I would answer the letter without your, a0 to speak,
being involved. It doeen't matter a bit to me whether I do that
or not. I'd like to do that, but I'll tell you now I'm not going
to learn anything by having all of the quick and important stuff
handled by you and coming to me after it's dead. Once you
have given the final answer I don't think about them, "

Hie took that on quite promptly and aald, “I'd be glad
to,” whereet the stuff on my desk was all that 1 could attend to
in twenty-four hours. lt was formidable, but i had to write the
anewers for it. When it wae a right enewer or a good answer,
my anewer went. I'd write the letter in draft form, roughly
speaking, and it would be typed and Pierce would sign it. In
that way | burrowed into the actual reaponsibilities of the division
pretty rapidly.

We placed an immense emphasis in the office on the ekill
and the wiedom of our declinations, The declinations were all
listed and put ina special category, and if there wae a declination
in « field that some trustee thought we ought to be more active in,
he'd challenge it and we'd go back and reopen the discussion if
it seemed wise to. i've often thought Pierce's agreement to let

me go through the mail was an important policy decieion, and
LEZ.

later when i wae in Pierce's position I did the eame thing with
my assistants. 1 had a lot of stuff go over to them to draft
replies to. In thut way they learned what was going on pretty
quickly.

Leould exaggerate the importance of making one thing
quite clear and that is thie: In the earlier years of the Foundation
we hed sbeolutely nothing ta go by. We were doing something
new both in purpose and in methed. We dida't know exactly how
' ta do this or thet, When I say that eomething was the rule of the
Foundation, the stetement is true enough Lf rather sedulously
regarded. However, if | imply that that rule wae the fruit of
long experience, that it wae a tried and true Policy, it's com-
pletely wrong, Actually we were feeling our way, and if we
paid attention to our rules, it was largely to see how they would
werk, it was not because we had had enough experience to know
thet they would work ene way er the other,

The process of formulating rulea and making them oper-
ative wae very largely what one could call instinctive tact te-
gether with pretty sharp attention paid to just how the leat rule
we msde up worked out. It was trying to find the origin of dif-
ficulty, Lf there was difficulty, and looking at the nature and cause
of difficulties that didn't actually wreck ue but made things etiff,
463.

These act inherent but certainly varied difficulties shargly in-
creased in number when the Foundation went into a foreign
country. I remember that 1 once heard 2 story that really
reflected one of our vo-called rules, which was to the effect
that we had to limit ourselves to countries to which we were
invited. This wae a etory of a young Southerner who was asked
why he wasn't turning up at the dances any more and he remarked
rather languidly, "I don't go to dances any more because the
last time I went to « dance where lL waen't invited 7 didn't enjoy
myself.” That's almost a word for word statement of what would
have happened if we hadn't rather stead on ceremony in point of
being invited. Now, we didn't always get invitations when we
wanted them, An analogy to that situation is my favorite Umerick:

There wae « young lady from Siam

Who said to her lover named Piam,

To kiss me, of course,
You'll have to use force,

But God knows you're stronger than J am.
Although in some instances we waited for a long time for an in-
vitation, ae far as I know there weren't during my time any un<-
aseailable peaks to scale in terma of getting an invitation m do
things. i must emphasing that it wae alinoast an experimental pro-
cedure rather than a long established rule.

That firet rule led to ancsther so-called rule that we
adopted; namely, that the Foundation would never make any gifts
184.

in any countey antil it bad beea asked to make a survey, and
until the survey bad been finished and turned into the office for
the reading of all those who felt themecives interested or con-
cerned. The desire to do public health work and lraprove the
level of preventive medicine in any country anywhere ln the
world wae the motivation behind wanting to work in the field

ef medical education in foreign countries, We learned from
experience that you could only go about so far with the local
doctors to whom you wanted to devolve the entire responsibility
of preventive nieditine, Then you ran up against the stone wall
that their education diin't have any preventive medicine in it,
in other words, the quality of their medical education really
determined their fitness to do preventive medical work,

Since the Foundation had been in collaboration with the
public health departments in various South American countries,
it wae natural that they would aleo want te knew something
about the stete of medical education in these countries. The
stady of medical education tn Brazil wae one of the firet. There
the Foundation utilized the more er less vague but very real
friendly traditions that existed between the United States and
Brasil, On tavitation from the Brasilian government, my chief,
Dr. Plerce, made two visita to Brazil. The firet visit to Brasil

was made as part of a larger over-all view of South American
i865.

medical education. The second was part of a specific pro-
ject to help develop a good medical school in Sao Paulo. Fol-
lowing Brazil, Colombia asked the Foundation for a survey

in the hope of getting some aid for medical education.

in 1923, my second year in the division of medical
education, Dr. Pierce asked me to go down to South America
and make a survey of Colombia. Now, the Foundation already
had a keen glimpse of the obvious, and realised that an effect-
ive survey of medical education had to take « very considerable
and attentative view of the political, historical, demographic
and economic circumstances of that country. lt wae in other
words absolutely essential to study the milieu in which medical
education was going on.

I quickly turned te the job of studying Colambia, Asa
matter of fact, these orders to move when the moving wae good
were alwsys a little bit urgent. In this case I had to interrupt
what I had planned to be my honeymoon. 1 went down to Colombia
for, I think, about six weeks, and wrote the report when I got
back to the office and my very email, but very important, family.

in Auguet, 1923, 1 landed at Baranquilla in Colombis.
Since the Magdalena River was then low I decided to. take a
Scadta plane (which wae a German private flying company) and
166.

do in olx hours what used to be done by boat in six weeks and
which had been dene by the original Spanish invaders of Colombia
in six months; namely, to go up the Magdalena River to Girardo,
then go up from Girardo to Bogota, the capital, by rail.

1 can always understand most of the Spanieh that 1 hear
on the basis of my Portugese. When I got to Bogota I was im-
mediately, with a proper amount of ceremony and pomp, intro-
duced ta various worthies and shown the school in a way that
‘would have completely bewildered me if I hadn't been used to
that sort of thing in Brasil, Everyone wae very friendly and
kind, but | wae almost bewildered to know where the deadline
was. Where did thie picture, thie collection of impressions
that I got lead? What was it to be measured against? 1 mean~-
ie thie a cold day? The anewer to that queation depends on
whether it is asked in Quebec or in New Orleans. I didn't know
what guide lines or scale to use, i didn't have any ecale ex+
cepting the memories of Harvard University and the impressions
roughly speaking that came slong in the intellectual baggage of
any young man who had just finished what was for ite time a very
good education. I wae frankly bewildered. In evaluating a
laboratory, for example, I have since come to a rather good

formulation that the outside appearance of a really good laboratory
187,

is exactly the same as the outside appearance of « very bad
laboratory. In this point, I've seen laboratories in China where
the equipment was so meager that I couldn't tell what it was o
laboratory for--whether it was for bio-chemistry, physiology, patho-
logy or for anatomy. On the other hand, I've seen laboratories
#o beautifully equipped with every conceivable kind of instrument
that I couldn't tell what it was a laboratory for. it was so beau-
tifally equipped that one could do anything there. That's a sort
of specious distinction. The real distinction at bottom is "Are
there people working in the laboratory or is {¢ beautiful and clean
ae a pin with nobody working there at all?" At that stage of my
existence, how could I tell by the looks of a laboratory whether
any work was being done excepting on the day of my visit?
Frankly 1 didn't know how. 1 remember later that I asked that
question of Walter Jones, whe was professor of bio-chemistry
at Hopkins, thinking he was least likely to tell on me for the
stupidity of my question,

“How do you tell when a laboratory is really an honest-
ly active place excepting on the day of your visitation?" I asked.

Jone suggested an interesting device and I tried it and
found that it worked. He said, “You just pull a drawer Open and
run your finger along the edge of the drawer, Then if you look
168.

at your finger and it's covered with dust, you can make a fairly
sound conclusion.“ Later I got to the point of not needing this teat.

There were lote of that kind of drawer in the medical schools
in Colombia, and I learned o lot of thinge there. I learned, for
example, that an organization with money to give away cannat es-
cape from the inevitable corrollary of being « political tesue in
aud of itself, Whether Foundations Uke it or not, the power that
they have ls a power which foreigners can't actually take, although
they are always very pleased to have thelr name assoctated with
so-and-s0 as a Foundstion representative. In Bogota, I immediately
became @ sort of social football and people there were happiest when
they could run quite a distance with me under their arm, It became
necessary for me to be able to distinguish real friendliness from
aesumed friendliness, Because people in Bogota wanted to associate
themselves with the power that my visit implied, I had to steer
very carefully on what l accepted in the -way of invitations,

Well, Bogota wae a pretty friendly place, and there were
pretty lively afternoon teas, dinners and luncheons. I don't re-
menter that it ever got to breakfast ae a complication. Ido re-
member that all my life breakfast hae been my one unobligated

meal because that kind of entertainment is not often done at break-
fast,
189.

I saw pretty much all of what Colombia had to show in the
way of medical school facilities in three days, For purposes of
decorum and appearances I stayed at least another week or ten
days. During that period I filled in. Well, filled in with what?
Sometimes | filled in with picnice and sometimes with serious
talke with different individuals. The perpetual thing in the back of
my head was, "Who would it be safe, wise and profitable to play
ball with in the faculty?" “Who were the two or three really good
men who were respected locally and who would not, as the cliche
goes, get drank with power, Uf they received some substantial
aid?" ithought, “ls there the possibility of finding in Colombia
one or two clear-headed and dependable individuals who might
be brought together and made the nucleue on which the Foundation
can depend?" It meant that { had to watch people in Bogota like
hawke all the time in a language in which I wae not at home in
order to solve part at least of the eternal problem, ‘Who do I
want to go tiger hunting with?" “Who are the false alarms?"
"Who are the intrepid lads who promise anything but really can't
deliver anything Tt" In Colombia I discovered all that as a per~
fectly new set of probleme to face,

Originally the medical tradition in Colombia, like Brazil,
was largely French. Added to that was the larger problem of
190.

evaluating those individual Colombian doctors who in the pre-
vious fifty yeara had gotten to Paris, For example, how long

aid they stay? What did they pick up and what did they feel to

be appropriate and desirable to work in and for when thay got
back? The medical tradition in Colombia was so largely at the
fringe of the scientific world rather than at the center of {t that
Colombians developed a sort of colonial attitude toward the center
and toward their role at the fringe. Time and again { heard the
phrase, “I followed the course of Professor Vidal in Parie,"

and 1 used to say to myself almost bitterly and certainly with
some sarcastic Naver, "Oh, you follewed the course of Vidal.

i wonder at how many paces? Were you sixty feet from him or
were you a hundred and twenty feet from him?” (i've seen clinics
ia Paris where there were a hundred and fifty attendants at a
clinical ward round.) it was absurd to try to fool me by making
me think that they really were anywhere near the prafeasor.

The political instability of many South American countries
wae euch that medical faculties faced very serious questions
whenever there was revolution. Combined with profound politi-
cal instability was a concept of higher education as something
supplied by the state and professors reflected very sharply their
political appointment and political affiliations. Consequently when
191.

& government fell the government professors usually found
themselves in the streets and a new orowd came in. Now
that absolutely wrecked the steady tradition of any reedical
school or hospital, whether it had a good tradiion or not. It
waen't a very good state of affaire, and while I don't want to point
te Colombia as an exception, other Soath American countries
were no different. Colombia fell within that general rule of revol-
ution,

i think that 1 may have previously mentioned a comment
which is profoundly true. It was made by Sir Oliver Lodge in
the form of « statement from which one can draw his own con-
clusions; namely, the last thing in the world that a deep ses fish
could discover would be salt water. L learned a great deal about
the United States hy my constant visits to other countries. I
realized that we had something quite different from the country
i was visiting, or which l had just visited. 1 remember one of
the residual, strong impressions that I had from that firet visit
that I made to Colombia was that medical education was e function
of the etate of cultural and economic development in that country.
The other, equally strong and perhaps at that time even atronger
impression was that I realised the tremendous implications of

doing our level beat in the United States to keep government and
492.

politice out of universities, The fact that we in the United
States didn't have a federal department of education that really
told everybody where to get off by implication meant that, if we
had a change from Democrat to Republican, {t wasn't a change
that had to throw every professor out of his job. That was really
quite a eharp fact. in South America the general rule was that
it was problematical. I the new incoming political party that
had seised control (either by violence or aabterfuge) had no
extremely goad anatomiat, the current one might be kept on.
However, it certainly was awfully sensible on hie part to keep
out of politice and not to have any political affiliations, Yet
the controlling personality in a medical school in South America
had to be political whether he liked it or not. He usually was,
and he landed ba his ear whenever a change in government oc~
curred, At thet time it certainly was one of the traditions that
obtained in many South American countries, I think things ere
better now, but I'm not sure; one has only to look at the sitcation
in Argentine universities as 6 result of Peron's henchmen being
thrown out,

I found out, if you want to help medical education in a
country that you're not familiar with, that when you're having
your firet visit there it is important somewhere in the recesses

of your nature to be both critical and discriminating. Again and
193.

again I used to get the loopreesion that it was entirely unfair
to compare the state of affairs that I was looking at with what
i knew existed in another country, It wae entirely trrational
to make such compariaons. Yet that ralsed a very curious
and to me bothereome question when, say, the Rector of the
University leaned forward (after having looked around him to
tnake sure that no doors or windows were open and nobody
wae listening) and said, “Now, tell me honestly. How good
are we?" What's the path of wisdom? I came to a working
conclusion that the best thing under those circumatances was
to answer only in terme of things that you had seen that could
be improved. It docen't advance much of anything even if all
the doore and windows are closed and nobody ie in the room

to say, “Why you're perfectly awful! That's how good you are.
I'm doubting whether you as a president have got a glimmering
of what's going on elechwere if you have to ask that question.
Why, that's almost « self-confessed damnation, because as
the head of an institution you darn well ought te know how good
yoo are and you ought to be so much #0 that your question to
me might well be, 'What do you think is the most promising
area for obviously needed improvement?’ That's the way your

question should have been asked." Essentially it wae hard to
194,

answer the apirit of the original question. It was ke trying

te answer a poor ttle Brazilian rancher who asked me, "Tell
me, how richam1?" What was I going to use as a yardstick?
J.P. Morgan? John 0D, Rockefeller? While it was true that the
rancher was not very rich in the absolute of what 1 knew, he was

wonderfully rich compared to his neighbor,
495.

Before 1 went to Colombia in 1923, lL had from 1919
to 1922 been in Brasil. Brasil, in terms of ideae and stand-
ards of conduct, qualitatively amounted to either being deep
in the interlor or in the eighteenth century. The city life of
Rio de Janiero and Saco Paulo, which | knew very slightly, was
modern, evanescent, and transitory and very different frorm
the back country. For example, the streetcars found in Rio
or Sao Paulo weren't to be found in the smaller towns up country.
There no one had ever acen streetcars or anything like them.
At the time of the carnival in Rio I saw peasants at the end of
the first day sitting on the curb rubbing their feet becauee they
hurt them like the devil. The pessants, in order to dance and
be in the epirot of « big carnival in a great city, wore shoes,
and dancing for four hours in a new pair of shoes or in a pair
of shoea that they only used once a year hurt their feet. Well,
the city Brasilions smiled at (not to say laughed at) the poor,
benumbed, pained and suffering citizens of the back country,
There was in affect a collision between the twentieth century
and the eighteenth century, between the back country and the city.

After three years in Brazil I became accustomed to
life being shot through and through with all kinds of fantastic
contrasts. I waen't greatly surprieed when I found much the
same thing in Colombia. In Colombia | was constantly impressed
196,

by the anomalies of two different centuries as well as by the
anomalies caused by attempting to superimpose the modern on old,
well worn, tried and true custome. For example, one could ge
inte a hospital in Bogota and meet at the door an old and quite
definitely senile sister of charity. Although she didn't know

any modern medicine at all she admitted patients. All she
actually had wae a lingering memory of people whe used to know
pretty well. Although she had a range of discretion that wae
very narrow, within thet emall range it was extremely final in
point of its authority. She, for example, decided what the patient
who was lugged ta the door in a stretcher had and whether he was
to be admitted or not. Although she could bavely read the ac-
companying documents if she saw a familiar signature she'd let
the patient in. I saw that in contrast to the standards that ob-
tained for a competent modern hospital admitting officer at home.
it was a reality, but the point wae, was 1 going to kick against it
and critize it? I find, now, that even recalling these things pute
me ine curlous frame of mind, 1 don't want to go on record ae
criticising Colombia, because we can't get anything done for
Colombia if we criticine, To avoid that pitfall L transformed

one great big area of my mind, judgment and discrimination, It

was something like converting a very lively color picture of a
497.

very beautiful and very well stocked garden into a black and
white photograph. If one takes a black and white photograph
of @ garden none of the color comes out and nothing is left
excepting odd forme, Well, i just rabbed out the fine dis-
criminations that are analogous ta getting a cblack and white
reproduction af a color photograph. 1 was fearfully detached
and i got a fearfully unrealistic pictarc.

Curiously 1 find myself even now reluctant to tell how
awful many of the things were that I sae in medicine in South
America, awful in point of reality, awful in point of concept
atd awiul in philosophy of medicine, lf 1 had not made two
radically different scales of expectation and performance I
couldn't have stood it. I'm not sure that my willingness to come
back to the United States from Brazil wasn't the result of some
residual feeling such as, “Gee, I'd lke to go back where life
bas color. I can't live by this extremely sage writing off of
every form of fine discrimination in order to be of any use at
ell, I can't possibly live indefinitely where red, blue and green
are out of the picture and some meseure of fine discrimination
is not involved. *

Is part it was similar te the way I usdd to feel in the post-
war Europe of the Twenties. I often thought then, "What's the
198.

ust of my getting more and more familiar with poverty and
inadequate means in medical education, inflation and all ite
innumerable offapring? Laman American,” Little did I
realize that that experience in the Twenties in Zgrope was
preparing me for the Thirties in the United States. The fact
of that point was my feeling in 1932-1933, “Why, dammit, we
doa't know what trouble is. What's wrong with a twenty per-
cent fall or a fifty percent fall in purchasing power of money
inthe United S&tatee? That's not very much because in the
France in which I was living in the Twenties there was a seven
hundred percent fell, There you begin to be in some difficulty. "

There wae not much eelf-treatment in Colombia. Like
Brasil, it wae the standard of the capacity to euffer which was
held high.

This may disappoint the reader, but I thought that Gal-
ombian: a¢ well ae Sraailian physictans needed training up to the
age of perhaps fourteen years in honesty and decency. They’
didn't have that and I didn't know what course in a medica} school
could give it to them when they lived up te the age of twerty years
or thereaboute without any “semblance of it. I found them lack-
ing more than anything else on a moral and ethical level, That
was somewhat bewildering because my office wanted to know what

they needed. Well, my honest feeling was, "Why, hell; they need
199.

things that you don't even know aren't there.” I had to go
there to imagine it myself, but without morality and ethics
what can you do?

What 1 came back with wae essentially a eocial critique
of what li eaw. Now, at times some people make assumptions
that aren't in the least bit quaint, and no proviso is made for see-
ing the absence of things that one usually takes for granted. One
takes it for granted, for example, that if a company finds oil in
Colombia, there will be some reaponsibility towards the workers.
There ought to be, bat why in the world should anyone assume
there would be? In my experience companies would say, "1 pay
my workers a salary; why should i have to worry about thelr health?
That's not my problem." They didn't cealine that the money ex~
pended in training an untrained worker in order to make even a
paesable machinist out of him was so large a sum that in their
own self protection they ought to have been interested in the health
of their trained workers.

l ased to be impressed by etories which described situations
that had taken me off my guard and 1 used to tell them to my friends
in letters, or tell them to people when I got back in the hope of con~
veying what « tremendous ehift of major sasumptions occured as a
reault of my forelgn travel. My friends thought that they were merely

picturesque stories. They didn't realize that i was doing my level
260,

best to convey the strangeness of the environment that I found.

Let me illustrate the point. Soon after l arrived in
Brasil | found that I really ought to have an automobile in order
to cover my job. The arrangement then was that as a member of
the Foundation staff l could buy a car. Since it wae aa underlying
expense I found that I could charge a fraction of the cost for gas,
oll, depreciation and repairs to the Foundation. It was fixed up
very nicely eo that I got out from under that responsibility with
as unfair lose to myself.

Well, I'd had the cer for about a month and a half when
I discovered that all | was succeeding in doling was making myself
« chauffeur to the organization, instead of having the advantages
of a chauffeur. I decided it wae common sense to employ one. I
asked the chacffeur of a car that some American Electric Bond
and Share people had in Santa Catherina whether he knew of any~
body who wae a good chauffeur and who wanted a job becauce |
wanted to get a chauffeur. He replied that he'd like to think it
over. I eaid all right. The next day he gave me the answer. He
said that he knew one who was a very good chauffeur (because he
could drive very fast, which was the last thing | wanted } and he
eleo had the very rare quality that if there was a minor repair
or a blowout he actually could repair it himeelf. He wouldn't

have to send it toa garage. But he said, in a sort of burst of
201.

honesty, "He has a defect." i thought, “Now, dammit, if I
try to guess the defect he'll say yes to the first thing I guess
and get out from under.” We sparred for quite a long time for
him to tell me what the defect was instead of my supplying him
with a defect.

When I saw that I never would get it out of him I said,
“ALL right, youtell me. What is hia defect?" Well, in a burat of,
BO to epeak, great candor, honesty and regret be said that this
fellow!s major defect was that sometimes he sold the car without
authorisation, That wasn't in my major assumptions among the
defects of a chauffeur. It was something #o totally fresh and
unimaginative that I had to go right through my scheme of re-
lationships with all concerned on the basis that this fellow could
sell my car without authorisation,

it wan very much like the ceadjustment that I had to make
in Paris for the arrival of my third baby. The doctor whe looked
after the firet baby 1 had in France was a fashionable French
fellow who dida't arrive at the time of delivery, so 1 got a younger
obatetrician who wae then just making his way and has since done
very well. We made all the arrangements and 1 was perfectly
happy. Sut i found, when the time had come to let him know that
the birth was going to take place, that he didn't have a telephone.
202.

Now it hada't occurred to me that you could practice obstetrics
in a city aa great and ae modera ae Paria without having a tele-
phone. Well, as a result of that assumption of mine that there
would be a telephone, I was the obstetrician. Everything went
all right. i wae glad that 1 had had some experience in that gen-
eral area, but it wasn't satisfactory and it waen't satiefactary
for the simple reason that 1 imagined or aseumed one factor in
the equation and it waen't there.

Now, in foreign service when you had an objective that
was ae far ahead of the local conditions as what the Foundation,
eay, wanted in medical education in South America, it was nec-
seeary to look over your assumptions awfully carefully and yet
be almost certain that you would not be aware of some of the
factore in the equation and that your slip would come there. As
an example, the assumption that a doctor in Brasil had a good
background in ethice and morale went by the boards again and
again and again. Ilhad assumed that in Brazil a doctor was
not a epirit hovering at the bedside of a dying man whe would
take all the money that he could get hie hands on. You don't
practice medicine that way in the United States, except for rare
exceptions. It ien't a good working principle at the bottom, but
it was there and I found it true that no Brazilian doctor wae
203.

interested in public health work in the etate of Santa Catherina
except for the head of public health in the state, who had it as
& specific means of livelihood. There was acbody else.

That condition was also pretty largely true of Colombia.
Although they had an outline of public health work, their people
held office because it didn't look right to outside visitors to find
none of that in the government. However, the men who were in
it were passionately devoted. There were some very fine people.
i made the friendship of a very nice old doctor named Pepe Montoya
in Bogota who had the very picturesque history of having been sent
to Boston ase kid of elevan and living with the family of Fdward
Everett Hale as an odd specimen from Colorabia. Pepe Montoya
never left me a word of uncertainty as to what he had gotten from
living in Edward Everett Hale's household, He had gotten the
firat working concept of honesty and decency that had occurred in
hie life, He eaid that it just broke his heart when after talking to |
all his friends and relatives about what a high level of moral be-
havior you could expect from Americana, the Panama Canal wae
taken away from Colombia by a perfectly spurious revolution.
Pepe had everybody pointing « finger at him and saying, “You
said the Americanos were honest and decent," and Pepe's status

in Colombia for the rest of his life was e double sero because of

Panama.
204.

Colombia was a nice example of what geography does
to human existence, There is a tremendously interesting tra-
dition in Bogota that Bogota remained in the controlling epot
in Colombia because it wae situsted at an altitude of eight thou-
sand feet, an altitude in which the wives of the conquistadores
(whenever they brought them or if they brought them) or their
descendants could live without the serious ilinese which nearly
always attacked the women in the Bhaada, which is the lowland.
Ase result Bogota remained a center for purely spoken Spanish
and Spanish traditions. In the lowlands that tradition was com-
pletely diluted because the only women that could live there were
Indians or mestizos, and the men married them and the Spanish
traditions just melted away bit by bit. In and eround all of that
business of the kind of people and the kind of places that they
lived in wae the conquistadore philosophy--to make the money and
get back te Spain. Or at least make the money and. drag it out of
the innocent antions ae best you can. There wae no,idea of build-
ing up @ civilization for which you were responsible in the name
of religious freedom. The latter tradition was far ‘etronger in the
United States and one doesn't see how much stronger until they
have seen the opposite, absolute view of exploitation, eepecially

im the form of gold, or, as came to be the cage in Colombia, emeralds.
205.

The exploitive tradition builds that kind of society, and there it
ie. (“Why the devil don't you take it asd don't inject all these
abeurd questions of equity and justice and building a workable
civilization, That len't the problem. Take it.") They do take
it and then they fall to quarreling as to who hae the right to it

or even who can get it, which is a much more important question.
The politico regime or atmosphere of South Americe really
derives from circumstances in which nobody wanted to do sny~
thing moral or anything workable. They wanted to get theire
while the getting wae good and it's astonishing how that pervaded
everything. I used to get Looked at with the sort of half pitying
and half admiring glances. “Where hae this innocent little child
come from to be suggesting such things as he is suggesting?"

It wae a tremendous jag to all the things that I had taken for
granted and it was a little bit ae though someone had suspended

the law of gravity. It wae fantastic and it strained the imagination,
206.

i produced a report ae a result of my visit to Colombia,
and J think that I could write » headline to that by simply saying
it wae received by the Foundation with equanimity, composure
and a very satisfactory kind of gratitude. However that atete-
ment ormite a very important consideration and it was this, First
of all the general flavor of the report wae one of considerable
unfamillarity with the material 1 was reporting on. 1 was con-
fused and bewildered at the primitiveness of the conditions that
i saw and, except for recommending that fellowships were dea-
ivable and could do certain things that were well worth doing,

I couldn't say exactly how we were going to reform Colormbian
medical education, In other words | had the job of conveying
almost inconceivable detail to a fellow who in a sense coulda't
say, "Well, i know all about that sort of thing and 1 expected that.
You are not telling me anything new." It was more likely to be
thie; “Now, you eay here that they didn't have any hoapitals
for convalescence, “I don't understand how they can practice
mediciue,” and Il would have to reply, “Well, neither dol. it
{en't medicine that they practice, but i'm telling you that they
had an absence of that kind of &cility. in fact there wae such a
complete absence of the concept of its existence that it would be

completely new to any young fellow that we got up bere from there
267.

and they would have a problem to fit that into the local circum-
stances." The report was also raceived therefore with « certain
measure of bewilderment and realization that there wae much
mere than an occasional branch of medicine that needed some
attention in Colombia and that it wasn't sensible to try to reform
it all at once. _
Another quite different consideration which | should men-
tion wae that Pierce's division af medical education in the Found-
ation was at bottem an experimental procedure. Pierce had to
mend his fences from time to time in maintaining the general
argument that it wae a worthwhile thing to continue with a depart-
ment of medical education. He wae consequently harried for
purely internal reasons in the Foundation with the solicitudes,
the uncertainties and the problems of being anable to make plans
and being unable to get money te put them into operation. Ina
certain sense he had the same problem that Wordsworth referred
to in @ letter to Lady Beecham ia which Wordeworth's point was
expressed in something like the following phrase, “It is the duty of
all great and creative artists to produce the taste by which his works
are to be relished.” You've got to create the demand for the things
that you know you can do well at. Without that demand you can't

deliver it to anybody, or get any results. Pierce had to prove the
2068,

validity of maintaining a department of medical education which
was his life and his salary and mine at the same time as doing

the work, it was making sure that the work will be significant
because it is at least anderstood by sume of the trustees if not

all of them. i've gone through the same thing in my lifetime im
the Foundation. You have to create the taste by which your labors
are to be relished. At times that can get to be a pretty tight
question, pretty time-consuming and above all emotion-consuming.
i think it ie quite natural for me to say that a form of expressing
my disappointment with certain of the results that I did not obtein
ig to agree heartily with the remark of Solon who was asked,

“Did you give the Greeks the beat laws that you were capable of ?”
Solon made a very somber reply to that and a rather frightening
one. “‘No," he said, “not possibly. 1 simply gave them the laws
that they were capable of accepting. "

In Foundation work you net only have the job of Spotting
the good men and recognizing the validity of certain developments
in certain phases of medicine, you aleo have the additional res-
ponsibility of making the trustees sce that your point of view is
perhaps worth giving an experimental try to. Now 1 have on two
separate occasions been told to tell the trustees what psychiatry
is, Well, I did a fairly good Job the firet time. i thought, “Well,
they've been going at it for four years and it's about time that they
209,

make sure what they're doing under my recommendations.” The
second time I was @ little bit angered by it because they had been
going about fifteen years and i was then told ta address them on
what is psychiatry. Well, lL had a reaction to that which was in
rough terms, "My God, if you don't know what you've been doing
and spending a lot of money for for the last fifteen years, I think
that it's time for you to speak and not fer me to speak. Teil me
the extent of your ignorance.” You can't get any human being to
tell anybody the extent of his ignorance for the simple reason
that it's ignorance that he's talking about and he can't tell you.
But an officer of a foundation has thie secondary (not in importance,
but in time sequence) obligation to explain himeeclf to hie trustees
enough eo that they will stand behind him. That's a situation that
has made me peculiarly sensitive to the classical definition of
rhetoric, which wae, “Rhetoric is the art of conveying conviction
without resort to logic." Well, that definition has « singular
analogue in the present day because of advertising. How is
advertising described better than by the old definition of rhetoric;
namely, advertising is the art of conveying conviction without
resort to logic. A foundation officer's obligations are quite as
much in the field of rhetoric; that is, carrying conviction to his
trustees, such oa they are, ina wise and long headed underatanding
206.

of foreigners with whom he would like to stay in touch and have
that human relationship productive, There is no inherent reason
why it should be productive. I can give illustrations where it was
singularly enproductive and the responsibility wae mine and still
is, But emotionally speaking, for a man in the head office in
charge of a youngeter who is sent to Colombia, it is quite a job
to handle and to carry conviction. Pierce fortunately had, as 1
have had, the advantage of one criterion; namely, is this really
helping the werk of the Foundation in the field of preventive medi-
cine or isn't it? Now, Mr, Rose used to say an awfully wise thing.
People would come to him or quite ae often they would catch hirm
at dinner parties with thie question, “le it within the policy of the
Rockefeller Foundation to do this and that? 1 got it two days ago
in a clase reunion. The wife of my clasemate, Jake Wilbur, who
lives doen on the Cape, came up to me afterwards and asked very
nicely (that is, with the full realization that it wae a question that
might be segative or unanswerable), "Dr. Gregg, 1 am a member
of w little church down in Weat Dennis and we are approaching
our two hundredth anniversary, Dove the Rockefeller Foundation
help churches? We want to get « really good organ."

in that instance | could say, “Why, I'm awfully sorry,

Mre, Wilbur, but by a written part of our charter we cannot take
aki.

any responsibility for say local needs in the way of churches
or other organizations which are not directly connected with
education, so that 1 can say to you with a certainty that I don't
possess in many questions, No,

Me, Rose ueed to say, "I can tell you what the Reckefel-
ler Foundation hae done, bat I've ecen it change ite interests oo
often that 1 can't possibly tell you what the reaulte of sore new
proposal will be. In other words, what the Foundation will do
ang what it will act do I cannot tell you,"

Pierce ran the division of medical education and hia
guiding light was the importance of pre-clinical sciences to
the adequate training of cliniciane and public health men. He was
convinced that better Anatomy, better Pathology, better Bacter-
iology, better Physiology and better Bio-chemistry were the
horses that he wanted to bet on. He aleo wae very much con-~
cerned with the value of experiments in medicine as contrasted
with the reliability or value of putting anything whatecever on
authoritarianiem. He had stood for that in Pennsylvania. It
had come as a pretty direct inheritance, Spiritually speaking,
from hie chief, Bimon Flexner, While he didn't override or be~
little the great contributions that persons gone past had made,

in terme of arbitrary status of anybody's opinion or personality,
212.

Pierce was definitely among the revolutionaries, However,
he aleo had something which maaked this attitude a little bis;
namely, he had a pretty strong tendency to feel that the best
thing for me to do was to find out the raw realities myself and
HOt expect to be told what to do.

Pierce wae a very helpful boss in a point that I've never
seen anywhere equaled, and that wae that Pierce had a very
clear and working idea of what kind of relationships and what
kind of freedom of communcation he wanted to have with me.

He celled me to his office just before | went to Kurope
and he called me in in a way that was typically anamoleus. |
hadn't had asy euch message from him before. He used to come
inte my little office in the Foundation and sit on the desk and
talk to me and he'd bring up anything he wanted to talk to me about
that way, or sometimes I'd go into hie shop. But, I never hed
hie secretary go through the formality of coming in and saying~-~
ithink that she wae ecared, too-~"Dr, Pierce wants to speak to
you." I thought that 1 had done something pretty bad and that 1
was going to get teld off. 1 went in all alertness, He said,
“Everything is in order for you to leave next Friday, ien't i¢?”

lasid, "Yea.”

He said, “I want to say something to you very seriousty. *
213.

I eaid, “Yes.”

He said, “1 will promise you that aatil you hear from
me that I have lost confidence in you, you will be wrong in con-
cluding that Ihave. i have confidence in you and I will have it
until 1 find @ situation in which 1 will write you that I have lost
it.”

I thought, “God, that's « funny thing to say.” But i didn't
way anything. instead 1 said, “That's very helpful." 1 knew it wae
helpful. But i hadn't yet experienced the extent to which it was
helpful.

i went to Paris on the public health side of the Foundation's
work, I remember that in the Paris office, after"E * had gotten
three refusals of proposals that he had made and thought were
pretty good, he blew hie top. He came to the conclusion that
Colonel Russell didn't trust him. I used to see him through
constant tantrums on that basis and I didn't dare tell him what a
kice reletionship | had with Pierce, because 1 knew that 1 had
Pierce's confidence because I hada't heard differently. That wae
an A-number-one agreement to have at a time when you couldn't
fly over the next day to sce what wae wrong, and you had to wait
two weeks to get it cleared by correspondence. That was an srea

where Pierce wae very skillful, He was a very brutal guy at times,
Zi4.

not to me, but ia terms of facing up to sumething. He would
face up to it and I knew dama well that I'd get a letter that told
me that he los confidence; if he had, there wasn't going to be
any pussyfooting about it.

Now Pierce devised another thing which I could recom-
ment to all the world, including our State Department with its
ambassadors and its special emiesaries. We had three ways
of communicating. One was a formal office document. In
engence it was a memorandum recommending cdrtain action.
Since the purpose of that memorandum was to serve ae the
basis of an action by the trustees, it demanded campletenesa.
it therefore eet out things in detail, lt wae a docket iter.
That document stayed in the office permanently, available to
anybody who wanted to eee it. lt went all over the iilice and
wae a eubject of--well, if J were a newspaperman i would say
pitiless scrutiny. lt got a good going-over anyhow, certainly
that. That was one way that you could communicate with the
New York office and you were likely to have two oF three com-~
munications in that field because your firet one was not as
complete as it should be. The second method of cgmrounication
was to keep a diary, This let my bose in New York know where

hia man in Paris was, what the deuce he was doing, what he was
215,

saying and what he was being told. That diary enabled me to
convey & great deal to Pierce. i found that it gave me an op-
portunity for doling something almost unearthly, which was to
put down as sights seen and words spoken things that would
give my bose almost as raw and brutal, astonishing and thought-
provoking experience as I had had. 1 could tuck into my diary
almost anything that I wished to God Pierce knew, but that I
coulds't tell him as his representative. It wae just what hie
representative was going through that I could tell hico and he'd
catch some of it,

The third method of communication was the privilege
(not to be abused and quite so specifically denominated ag not
to be abused) of writing to hin: at bis home and hie writing to
me at my home about suck items ae did not belong ig the record
af the organization, These were hunches, not suggestions or
propositions, but plain hunches and, if it wae necessary, a
statement about the pereonnel in the Paria office or the kind
of visitor we got from the Foundation itself. Pierce warned
me not to go too far with this privilege, but I can say that it
same in damn handy when we hed a homosexual uproar caused
by one of our officers in the Paris office. 1 couldn't possibly
have put it in the records of the Foundation without causing 6
216.

far greater uproar, although it was wooly enough ae it atood.
Now when ve met ambassadore or whea I've met & andard
Oll or international capper representatives or other businesamen
who were in « business where communication with a man at a
distance was involved, I've made a harmless inquiry. “How
do you get along with your New York office?" or “How do you
get along in the field? What do you do?" None of them have
had as many notes on their plano as I had with Pierce on the
basie of definite formal memoranda, a running diary and pri-
vate letters. Now I still have the private letters to Dr, Pierce
in almost illegible handwriting, but I haven't put them into the
Foundation record. I haven't turned them in as foundation
papers. It may well be that they aught to be, bat they have a
range and an intimacy that | enormously valued at the time and
which 1 still value. I can look at them from time to time and
say, “Good God, how could it have been true that we were
thinking that way? What would have been the result if we had
done this thing that he spends thia whole letter on?” Thoee
lettere are not without their considerable fraction of tragic
regrdt that we didn't get something done that was then among
the roseate possibilities immediately before us; namely, our
attempt to help out the Paris faculty. That was a tragic fail-

ure on our part, partly my fault, partly the fault of the French
247,

faculty and Dean Rousy, but we could have done something just
incalculable and continual, and with great profit. But it fell
through.

in the Foundation we knew in these carly years with in-
creasing astonishment and certainty that the potentialities of the
growth of preventive medicine and scientific medicine were vir-
tually unlimited and that we hadn't yet scratched the surface. it
was felt that by aiding the development of the pre-clinical sciences
great things could be done. That thought was very etrongly im-
bedded in the mind of Mr, Rose, the head of the international
health division. Little by little he grew to see that in the per-
fecting of preventive medicine the basic sciences of physics,
chemistry and mathematics had equal potentialities that hada't
even been scratched. He came to see that the international ex-
change and the use of the oncoming world's well of talent possessed
in itself a fluidity, an excitement and a possibility which might be
hidden if you just said, “Oh, what's to come to medicine if you're
going to take physice as the fixed point of perfection?” We sud-
deoly turned around to see that, by gosh, these things that were
supposed to be fone et origo of things for medicine, by being
themscives better exploited, contained possibilities that we
hadn't even dreamed of when we were calling them uncle to medi-

eine.
218,

Rose went off into the International Education Board
with techniques that he had learned in public health work and
in medicine to start up a tremendous activity in the exchange
of international resources and talent in things apparently as
stable and fixed as physics or mathematics.' That in turn
had a lively effect on all of our work. In many ways it was a
remarkable period, 1 will say that ae result of Rose's work
in that field that Niele Bohr came to the Rockefeller Foundation
to talk about the diacoveries in the field of atomic energy, In
the final stages of development of atomic energy there were a
surprising nomber of people ali over the world to whom the
Rockefeller Foundation had already given followships or had
helped in their laboratories. Bohr is simply the firet name
that comes to my mind, That was one of the deep things that

was running at the time.

 

l. Although the Rockefeller Institute and the Rockefeller Foundation:
were two separate and distinct organizations, Simon Flexner was e
power in both. He had great influence in the division of medical
education not only becauee of his position as director of the Inetitute
but because he had been Pierce's teacher in Pennsylvania. Simon
was the mailed fist in the glove all the time. In fact it wae his in-
fluence that kept the Foundation ap to 1929 from going into fields
other than medicine. He was for keeping it right where it stood.

Finally they did make a division of humanities,
219.

In w sense Pierce's was the medical side of this tide,
but it was going on all along the line and the strong and golden
thread in that wae very much what Willkie later condensed in
the phrase, "One World", In the late twenties we were already
one world although we hada't waywhe re near touched the poa-
sibilities of that concept. I think it's fair to say, with what i
hope will be a reasonable amount of dispassionate discrimination,
that there was no organization at that time that was anywhere
near the Rockefeller Foundation in that kind of activity. 1
say thie largely because men that were capable of forming auch
an inetitution in their ows country gave me plenty of reason to
know that they were jealous or, better to say, envious of us,
They were awfully sorry that they couldn't go beyond their own
borders. Sir Walter Fletcher, now of the medical research
council in Great Britain, said, “Gregg, lL hope you realize how
lucky you are to be able to go to any country that you want te. I
know that that is an inaccurate phrase, and that you can ge only
to the countries that invite you.” Then sort of winking at me, he
continued, “You know that you're not an anwelcome visitor in moet
of the places where the Foundation has bean. it has a standing
tavitation and that goee for Britain, Scotland, Ireland and Wales."
I think it is justified to eny that in a certain sense many were en-

vious of the kind of opportunity that we had. Because of it we

were alone in our field.
220.

After the survey of Colombia | saw that I wasn't going
to be happy about being a desk boy for an indefinite period so
i went to Pierce and said, “i'm just not happy with having ao
direct contact with anything-~it's all by mail,

He said, “Do you mean that?

isaid, "Yes."

He said, "What are you going to do?* —

i said, “I think I'l apply for going back into the public
health division, “

He said, "I'll be very sorry to see you do that.”

He let me sweat on wy logical conclusion for ten days
and then he called me in and spid, “What would interest yout"

1 said, “What do you mean?”

He said, “I'd like to keep you with me, but what would
interest you?”

i said, "Going to get some raw experience--I don't want
to be handling correspondance a the time. Hee I am in New
York City talking about places I've never been té and dealing
with people in places I've never seen ,"

Fierce just bowled me over by saying, “Weoeld you be
willing to goto Europe and represent me there for an indefinite
long period 7?" .
221.

i said, “Yes--I'll have to wait until the baby is born,
but 1 could go in June."

He said, “All right. I'm going to send you. "

it is almost foolish to think that 1 did much preparation
for the trip abroad. One reason was that the daily pound of cor-
respondence to be anewered and trivia to be taken care of in the
office wae euch that | remember having very little time for read~
ing and discussion. It was perhape a mistake. However, it is
equally true to eay that I had a preparation that in a way was
deeper and larger than I then ¢ealised, (I can see it now with
the eyes of sinty~five instead of the eyes of twenty-five.) l was
born and brought up in circumstances that prepared me in a cer-
tain sense, et bottom, for almost any kind of an experience, It
was perfectly clear to me from the age of ten and perhaps ae
early as eight that 1 was going te go te another part of the country
for ty college training. 1 can remember evenas a kid how &
propos and neat if seemed to me to sing in church the hymn which
has this last line: “i'm but a stranger here. Heaven is my home.
It described my situation and Il knew it. I wae in a perpetual etate
of readiness ta go somewhere that was new, different and better.

Consequently 1 think that I can say that it hardly occurred to me
222.

that my work in the Paris office of the Foundation waa going
to be anything for which I could prepare for adequately. 1
had to be ready to experience it. There wasn't anything thet
i could substitute for getting on the boat and going. In « way,
one can say that that was very bold, imaginative and advent-
uresome--well, it waen't anything more than planning to leave
Colerado Springs to go to Harvard College. i'd done that and
ihad skinned by, { think that this is the important point--1
didn't in my impressionable years have any suggestion that I
would be at a serious disadvantage by cutting cables and going
somewhere elec,

That certainly was true of Paris. 1 had sufficient cash
resources, I knew that | wae going to be treated decently by the
Foundation and | waen't anywhere near the uncertainty that 1
would have had if | were going to Paris to become « recognised
world artiet. Hardly anyone te behind « fellow like that and he
has very real reason for being considerably concerned.

lL aleo knew from direct experience that the world and the
academic world in particular had been ao upset by World War |
that it was handicapping myself te know what Germany, France
or Italy used to be like, 1 knew i waen't going to encounter that
and I was quite right. It was a yew situation and it was almost
the same as saying, “1 think I wilt do more accurately and ef-

fectively in my job by peeking at the things that now are in
223,

disorder compared to what they used to be, looking at the flux
as compared with the stability and solidity of a previous decade,
i will just register what ie in front of my hands, feet and my
face, I'l face the things that are. i'll be able to pick ap as
much es 1 can of what used to be, I'm sure to have people talk
to me about what the past was Like, *

idon't think that it wae all as conscious as Ll make it
now in retrospect, but I know that wae in my mind. I didn't
try to get at the history of the countries that was going to
partly because on the invitation basis that the Foundation fol«
lowed I didn't know what order they'd come in. i was terribly
restiess and dominated by the feeling of, "Dammit, i'm ao sick
of other people's reports about themselves or sormmebody elec
that | want to get my hand in to the elbows on something that
is completely raw and new and see whether 1 can put it together.
ithought, “I will do one thorough survey, absurdly thorough for
the reason that it will let me find out what the guide lines are
and what the relative value of all the details is." Before I left
i specifically asked Pierce for plenty of time to do the Italian
survey, which was the firet survey that 1 wae going to do. I anid,
“Lem deliberately going to go inte « detail that may not ever
appear again ina survey, but I've got to go into the microscopic
side of this thing as well as the gross." He understood and to
my delight he said, “You've got plenty of time. “
224,

i did de a thorough job. it was around six hundred pages.
it was @ huge kind of thing with all manner of detail that I later
found didn't matter at all. i knew it didn't matter and after I'd
done it I felt sure-footed in leaving it out the next time, For
instance, the survey of Ireland and eepecially the survey of
Sweden, which wae the last one that I did, were selective jobs

in the sense of spending my time on what mattered moat,
| I'd like now to spenk of another factor that aficted my
preparation. The year I learned Ll wae going to Europe was
alsa the year that our firet baby was in the process of being
assembled. It wae a pretty grim introduction to the fact that
the person whom I loved the most of anybody and was simply
devoted to wae frightfully sick the whole time. She was very
ill and when I got home my care of her pereonally was partly
nursing and partly companionship. i had no freshness to do
any reading at oll aad preparation wae the last thing on my
mind.

i can certain eay that I didn't have the conscious set-
ting eaide of time to prepare for Furope that i might well have
made. 1 couldn't have done it anyhow and been in the least fair
to my family. In the end | left for Europe, thinking God that we
had got the baby and that at least the prenatal experiences were
finished.
225.

The situation in the Paris office was peculiar and pretty
vivid, Ouring the winter of 1923 Dr. Pierce had been in Europe.
When he departed from the New York office he appointed me as
the representative of the division with the perfectly clear under-
standing thet I waen't going to go off on any private, personal
and individual tangent. What i wae to do waa to hold the machi-
nery together, attend meetings and pro forma hold things in a
state of suspense for him. Well, that was « useful experience
too because I went in with my mach senior colleagaes to trustees!
toeetings and saw glimpses of what was really going on from the
inaide.

Pierce didn't know Europe. He waen't capable of effect-
ively speaking any foreign language for negotlation purposes,
It atruck me as a very queer. thing that in his absénce the Found-
ation employed a representative for the Paris office without
Pierce's seeing him. The person who was appointed happened to
be an extremely complicated character. He'd been: in Hoover's
war relief organization in Russia. In the year 1912: be had gotten
a zeugoies from the University of Vienna and he bad the spurious
finish thet they gave in those certification courses tn Vianna,
He had a very rich wife and « flavor of internationaliem that

made an impression on President Vincent. in retroepect \t
226.

scems more incredible than it did at the time. It was bad
enough at the time. 1 thought that either the Foundation had
an arrangement with Pierce about taking this fellow~-we'll
eall him "“H'~-or elee that it wae a very odd procedure, it
turned out to be a very odd procedure because when Pierce
saw him he didn't like him. Dr. © was in charge of tha Paris
office and although Dr. Pierce went throagh the formality of
saying that I was going to be in charge of fellowships in Europe
and take Dr, E's responsibility there, the real fact was that
in Plerce's raind (though act in mine) 1 was a substitute in
training to succeed Dr. E,

Well, Dr. E was a man fifteen or twenty years older
than I and he knew perfectly well what waa happening. His
problem was, “Shall I hunt with Gregg or shall l be wary of
him?" He tried both and | was resistant because | had enough
experience with peychiatry to know that Dr. E wae mostly s very:
subtle kind of facade. He had had a boyhood or a young manhood
in which he was very beautiful to lbok at by a lady's standarde
of theatrical beauty, He'd been an actor before he became a
doctor and most of his doctoring was acting. Later he was
iavolved in an unfortunate episode. He wae adchedd of being
h homonextial, It eas anonymous dnd we dlastt tnow where it

 
227.

came from, The situation was troublesome and very delicate
to manage because letters describing Z's character had come
te every member of the staff, The office was in an uproar, and
KE in desperation told one of the staff that he was going to shoot
himself on a bridge over the Seine, One Monday morning he
offered roe hie resignation and | had to tell him, “Look, that's |
the one thing you can't du because that will only éndoree the
tadictment, “

in many ways he was a very nice and helpful fellow, aad
i think that contact with him, because he wae devious and born
that way, sharpened my wits and eophistication. 1 worked with
him until Pierce finally called him back. He had a perfectly
obvious case of tuberculosis which furnished him with a very
nice back door, although one could never mention anything ex-
cept that he waen't very well.

My firet job for Pierce in Europe was making a survey
of medical education in italy. it was a September to May job,
and when I wae through I'd seen something different from any-~
thing I'd ever seen before. Although the Foundation's head-
quarters were in Paris, while | was on the Italian survey, 1
rented # little house for my wife and baby in Anacapri on the

Island of Gapri, ‘it wae quiet, ieolated and peaceful. Originally
226.

Anacapri had been the summer vacation residence of the Soman
Emperor Tiberias, and the peasante when 1 wae there atill re-
garded any piece of fragmented antiquity as "Tiberius’ stuff".
Ail that firet winter I'd have little vacations with my family and
then go plowing off to visit four or five universities at a time.

Now, my preparation came mostly in reading an occasion-
al book, Idida't try, for example, to cover the medical education
of italy. iy preparation for that was a timetable, a map and an
invitation from the Ktalian government to make the visit, so that
il came semi-announced wherever i went. 1 picked ap as much
of the history as 1 could by going along. 1 made up for that lose
in some measure by making the past an easy subject of conversa-
tion when I was visiting--hell, I could get an hour of lecture from
auy professor that | wanted to talk to, if 1 started him off on the
history of his department or the history of the university. 1 got
an awful lot of side information when 1 was actually visiting with
them, but that technically doesn't quite qualify as preparation.

I got a wierd character named Kaffolovich to be my sec-
retary, interpreter and guide. Haffolovich had an interesting
background, I think hie father originally came to Paris from
Rusela to arrange on international loan between French and

Russlan bankers in the late nineteenth century. He then stayed
229,

in Paris and married the daughter of a very intelligent and great
Frenchman named Chaptal. One of Chaptal's sons later became
Bishop of Paria. Well, “af” was the offepring of thie French
Buosian anion, Ref married an American girl and when I came
to know him he was dead broke because he had tried to start a
newepaper in italy that would compete with the Paris Herald.
All of the money he borrowed, and his wife's as well, went down
that rat hole, He was almost starving when 1 took him on as a
secretary, 1 really dids't know very much about his past but }
learned it acon enough, ins lot of ways he was really a very
admirable fellow, but he was also one of the queerest ducke I
had ever seen,

in the beginning Raf waa my interpreter, but 1 picked up
enough Italian in the first two monthe eo that I could do most of
the talking and question-posing in the second two months of the
four and one half monthe that 1 was in italy, I learned one lesson
which I would like to make a record of; that ie, when you go to a
country where you have to have an interpreter you are putting
your futere in the hands of the interpreter. I say this not because
ihad as bad a future or experience as that in Italy. But having
an interpreter was eo manifestly unsatisfactory in several things

that { had to learn Italian. The second wae that I'd found out later
230.

that Abe Slexner, on his survey of European medicine, had
taken a diegruntied Paris doctor, who happened to have the
obvious complication in Europe of having a Jewish name as

hie interpreter. This interpreter absolutely bitched Abe as

his comeback at the French medicine that had treated him the way
he had gotten treated. Abe lost all eympathy and trust for the
Rockefeller Foundation in medical education by means of that
roletake. He didn't have it and that made it hellishly difficult
for me to work out confidence enough, so that I could get a col-
iaboration in the Parie faculty that 1 wanted to have, but Il never
got. I got it in certain delayed forma but the jig was over before
Lbegan. i learned that an interpreter can queer the pitch every
time he wants to and sometimes even inadvertently.

The preparation that Il had was of a very superficial sort.
Looking back, Iam sot too disturbed that it wae, because ter-
ribly fluid conditions followed the war. I don't think that I could
have taken quite as good photographe figuratively speaking if I'd
known what used to be, or to be able to say where things were to
be in the photographs. All that had gone and all 1 could say was
“it wae war lose.” The preparation 1 had was very emall, except
that in a certain sense each school visited made me much shrewder

eboat the next school te come because | wae studying the functions,

not the forms. 1 begen to get clearer and clearer ideas about what
231.

the function of the medical school wae by seeing it violated or
absent. Every country | went te something was different. I'm
convinced that in work of this kind a sensitiveness to comparison
(and the mere function of comparing) is formidably influential

end valuable. I fink that ina way it was better to do just what

1 did because | assumed nothing. The questions | faced were,
“What's going en? What is the reality and how do these things
work?” That point of view wae in a certain sense the paradoxical
preparation that I bad.

Was I right in taking no guide and trying to do a photo-
grapher's job of recording what went on? Would it have been
better if I had hed a guide? 1 hed « somewhat potentially well
informed critic in Abe Flexner and l knew my staff was going to
be read by him, but Pierce was no guide at all, 1 was explaining
to Pierce a country that he'd never seen. I wanted to find who the
pewerfal local influences were and explain them. At each inetitu«
tion that I visited I tried particularly hard to find a really thought-
ful person who hdd influence locally but, above and beyond all,
who had honesty and perceptivensas. Actually there waen't any
standard, You couldn't have implied that there was a suggestion
of @ standard aoywhere else but the capital city in each country.
in effect that was where the leadership wae coming from. in France
232,

it was the University of Parie, with Lyon as a slightly defiant
but very weak competitor. In Germany it wae mainly Berlia
followed by Leipzig and Munich.

I was miserably ignorant of this whole field. There waen't
anybody excepting Flexner to tell me, and he didn't play in any
too closely in any responsibility for me. 1 aeed to be a Little
bit annoyed by the review of the New York office personnel.
They'd all been teachers. Pierce was the only one that cared
to do anything for me and that used to puzzle me. I think Pierce
went on an experimental try first and try it again basis, much
more than the scholarly preparation for the job. Of course, I
made the usual characteristic young Americac's assumption that
if he doesn't tel) me then of course there's nothing much that's
there. i didn’t feel the adventurer in the senve that I had to be
responsible for a great deal that I didn't make myself, or that
ihadn't got, I think the thing | ehould have felt a Little bit more
was, "You're the architect of your future. You're not juet the
carpenter under directions.‘' But l was the carpenter under
directions for a good deal of it,

i didn't have anything like the background that would have
made Italy both more exciting and more significant. For example,
ididn’t know the story of the Risorgimento with any real competence.
233.

i consequently was a total stranger to « lot of Italy although
my guide there, Saffolovich, helped me a lot because he
wae passionately interested in it.

I might say that I prepared in retrospect. I mean that
I did the preparation for the understanding of my experiences
through subsequent things, not that | was prepared to interpret
them then. I waan't. For instance, I didn't know what Rome
meant. I didn't know that the government of italy had very
deliberately been moved to Rome for peychological, traditional
and historical purposes, and under a great deal of explicit and
hidden opposition and ¢riticiam from the Fiorentines. When
the Fiorentines had to announce in their newapapers that the
government had decided to move to Rome they ran it in a
characteristically Florentine and clever way. It wae explained
in a two line slag at the very bottom of the front page of the
newapaper with no capitale at all. it simply read, "From to-
morrow onward the political government of Itely will be moved
to Rome.” Well, that wae as much to say by implication, “The
place that we give this announcement conveys quite clearly our
opinion of the significance of thie move. Everybody knows
that the heart of the government of Italy is in Florence and al-
ways will be. Well. it wae terribly close to reality to say that

because the sense of quality hae slwaye stayed in Florence.
234,

Gn the continent the capital city in many ways te ite
cost was the capital academically as well, For example, the
University of Vienna was in the Austrian capital. The Univ-
eraity of Paris wae in the French capital, The only exception
wae that rare queer place England, where the intellectual capi-
tel wae not at one and the same time the financial and political
capital. Curiously enough I can see that tradition in all of the
offshoots of the British Empire; namely, that the capital of
Genada is Ottawa. It's not Montreal. The capital of Australis
ie a fanny little synthetic place called Canberra. it's neither
Sydney, Brisbane nor Melbourne. The capital af the United
States, intellectually speaking with due obeisance to the emin-
ent intelligences that are therg, is not Washington,

By putting Rome up agile capital Italians wexe having a
good deal of a time to make the University of Rome a comparably
dominant place, say, to the Udiversity of Paris, When l was
in Italy in the Twenties Kome waa, by borrowing traditions from
other countries, expected and supposed to be the University of
Rome, but it wasn't. When you wanted really thp notch per-
formance you looked for it in Turin, Milan andiin Florence.

Or you could look for it in Bologna, which had disort of » rough

and tumble memory of the past, and was gaining in importance
235.

politically because i¢ wae the home of the Fasciste. At the
time Padua was also quite good, but it wae still living a the
Middle Ages. Althuugh one can live on the past, say, in Cali-
fornia, it is a very different thing than living on the past in
Padua. Living on the paet in California is juet repeating a
hardly exietant tradition, but that couldn't be said of Padua,
Floreace, nor in some sense even of Napoli, which was then
playing very hard the role of being the spiritual successor to Salerno.
i don't know that l can say for sure just where i started my
survey. i think i began in one of the hill towns south of Piea. 1
surveyed the medical echools in chunke of about four at a time.
After Pisa 1 made a southern awing down to Sicily and then later
croseed over to Sardinia. idid the Po Valley separately. 1
visited Rome and then on a trip to the north and northeast looked
at Turine and Genoa, I think I covered all the medical schools
in Italy save two Little bite of purely historic relics in the Ab-
ruczi, For the moment I can't remember their names,
Although i had a letter to the various medical echoole
from the minister of education, and it bad proceeded me and .
they expected me, i was nevertheless under a little bit of a
handicap. Iwas the only human being, including anybody on the

ministry of education, who hed ever made an attempt to ace all
236.

the medical schools of aly. No one on the various faculties

I visited had ever seen as many schools in italy as lhad. That
turned out to be a rather tricky advantage because some were
angry that no Italian had done what i had done,

The ministry of education was then an anamolous affair
of old and new. It was very uncertain and [ think that it was one
of the reasons that 1 dida't get an overwhelming measure of
support. If Museolini had taken an outsider's resentment at
having the Foundation in Italy we would have been nowhere at
all. At that time Mussolini had a preference for Bari,which
had been created ae a new Univeraity and was getting a good
deal of the spare cash. Mussolini chose as his minister of
education the great Italian philosopher, Croce. Unfortunately,
i never had any friendly mave from Groce. When | firet ar-
rived in Italy 1 had a formal visit with him in which I used my
interpreter most of the time because I wasn't capable of doing
@ damon thing in itelian. French would have helped the inter-
view considerably, but Croce wae observed by everbody. Siace
it didn't do for the minister of education to speak a foreign
language to a foreigner, Croce confined himself to beautiful
Italian. Italian is an interesting language in the sense that you

can recognize the beauty of it as a language even if you don't
237.

know the vocabulary fully. He was just formal, brusque and
pretty mechanical and I left certainly within tweaty minutes.
We never bad any real discussion. I think the feeling was,
“Well, there may be money in this business, so we won't turn
them out." Besides I don't think that any Italian would be
guilty, purely ae a matter of masners, of approaching any
request such as we made with an iron curtain, They'd say,
“Sure, come," and the amount of attention when you got there
wae the measure of your reception. There would never be
anything approaching formal discouragement.

The attitude in Italy toward the Fascist Party when i
was there wae one of outright fear aad circumepection and to
a certain extent closed doors, Italians were afraid that 1
Dace would turn out to be pretty conch what he did, a very con-
siderable figure of power. From 1922 until 1924, when the
murder of Mattectti occurred, Mussolini's power increased
vapidly. However at the time of the Matteotti affair it was a
terribly close thing in the general conversation and comment
as to whether Mussolini was going to get away with it or not.
There wae no one to turate. Gonsequently Mussolini was more
and more feared. The wiser, older, more sophisticated Italians

who could understand and did speak French~-especially in the
Z38.

north, in Turin--were very free and open with me. I could
talk French and 1 could eee that hatred was building up.

iam perfectly convinced that doctors are fairly good
observers, They're damn poor performers but they have one
advantage that other professions don't have. They are in ap-
proximately comparable contact with both the rich and the poor,
the powerless and the powerful. The doctor hae a rather wide
spectrum of acquaintances in society compared to anybody else.
Lecould see that I was asked to negotiate with very shaky citizen-
ry and one that was proud ae punch and just sbout as powerless
ae it was proud.

Of course, as isthe case again and again, the part of
history where you weren't alive ia just in an interminable flux
of anknowa things, I didn't realixe how near we were in italy
in 1924 to 1666, and we were near. There wore a thousand
examples of that. Italians don't form teams to get things done
much, They form armies and squads and they can be regimented,
but their natural tendency is not to form an association to do this
and that. Consequently Italy as a social phenomenon to look at
and live in was and is amazingly varied. Italians are amazingly
passionate about their convictions, but they are not distinguished
by the ability to get together or stay together.
239.

Medically the person who by all odde had the most
power was the pathologiet in Florence. 1 ought to be able to
remember his name but I don't. I remember that he had a
German name and that he was {rom the northeast of Italy.
However, he was God Almighty in pathology and because he was
avery powerful figure we played ball with him in the establich~-
ment of local fellowships. in addition what we did was pick out
all over Italy two very good professors in each of the pre~clini+
eal subjects and give them money to maintain four youngstere
on fellowships under conditions that would really attract. We
had a local fellowship program running in Italy for about ten
years after Lleft, it dids't produce very much becaure the
system of appointments was not really a very satisfactory one.
Local lnterests had to be served a Httle bit too much. But it
quickened the exchange of Haliane with other countries, We
had some very nice results in sending Italiane to Britain. How-
ever, they were too proud or too tense to goto France. We
didn't have many of those exchanges and only a negligible num-~
ber came to the United States. In addition a fair number went
to Germany and to Scandinavia.

I think it ie o little bit exaggerating but there's aleo a
grain of truth in the comment that during the Twenties the
240,

Foundation saved Italian medicine from a still deeper gloom
of isolation that would have otherwise been the case. That
was worthwhile. In recent years we have had, in point of
quality, an increasing crop of youngsters who have come on
fellowehips to the United States because it had at least been
done in the Twenties and they heard about it,

Most of the fellows concentrated quite clearly in the
fields of physiology, bio-chemistry, neurophysiology and ana-
tomy. There was « good tradition in anatomy because there was
an extremely good anatomist in Turin, a really modern and
first-rate fellow. One of our fellowa went to work with Cajal
in Spain. Actually there were more fellows in neuroanatomy
than I originally expected and the streak in neurcanstomy and
aeurophysiology has continued. The Italians have continued
to supply very good men in thia field. 1 remember that one
of the fellows who came and worked at Northwestern te now
professor of neurophysiology in Pica. He's first rate and I
have very friendly contact with him still, However, not much
work wae done in pathology or surgery. Surgery was just as
it was in Paris, in the sense that it was inbred and ae a result
suffered very severely, Gormpetition in surgery wae so bitter,

so relentless, so ever present and so self- renewing with sew
241,

competitors each year, that a young man could not possibly
afford the risk to absent himself from the competiteon for

even ae much aga year. We never had any fellows in surgery.
it's « sad fact bat a very important one. People talk to me

of overpopulation more nearly in terme of foodstuffs and calories
than anything else. Why to me that's only a part of the picture.
The type of human relationships that derive from a starving
mob, the politeness, the consideration, the fairness, the
general decency are just as important to me as the fluid or
solid intake by mouth. People think that the population problem
is principally one of calories. It's not that at all, lam re-
minded of Richelieu's advice to his secretary, "Pas de seel,
pas de seel.” “Don't you get too damn sealous and begin walk~
ing on somebody else's heel.” That's a significant thing.
Population struggles in Europe today or yesterday are the

vivid and realizable effect of too many people struggling at
bottom for food, but the human relationships o thousand times
more 6a,

In Europe I discovered the immense importance of knowing
hew personnel in the medical schools were chosen. In the beginning
i didn't think that wae of very fundamental importance. My Europ-
san visit was the firat time that | saw the significance of tradition.
242.

At that time tradition in the United States didn't amount to a
damn in point of recognition of real power. In Europe it
amounted to alot. In Europe, it was the guide line to find
out how things happened to be. Curiously enough, the European
concept of tradition is found in the motto of the Univerelty of
Pennsylvania, which ts, "Leges sine moribue vani." (Laws
without custome vain, }

The difficulty in Europe wae that the anewer that you
got to any question you asked was "We've alwaya done it that
way." Their real motto cought to have been “Moree eine legibus.”
Namely, custom without lews that define it clearly is cockeyed--
which is just a pum. The thing Europeans needed more than all
elee was to define and to deacribe to themselves what they were
doing, because the contradictions and the futilities appeared to
have escaped them. I didn't know much about mores when I
went to Europe, tat I found that they were damned important. 1
would ask questions and more than once I would get the response
from a local professor, “But how else could you do it?" Or a
little bit more intelligent, “We've always done% that way.”
That wae true for the smallest es well ae the largest questions
that lasked. 1 found that the historical background that I got

from Rashdall's volames on the medieval university opened the
243.

sky to me in a way nothing elee did. Not only for the reason that
it furnished me with very good explanations for the course and
development of Turopean education, but becauee it also threw light
on things in this country ae well. I realimed that the European
university began as a epontancous segregation of young men wha
were alert and curious, apart from the rest of the feudal society.
In many cases these universities were influenced and controlled
strongly by the church, in order to strengthen the church, because
the church didn't want to lose control of alert and curious young
men, By a system of Papal Bulls to make teachers and give them
authority, the church got its hand in and controlled. Educational
institetione in thie country eeers to me to have this in common
with their European counterparte. They too started with support
from religions groups. The Baptists, Methodists, Presbyterians
end Congregationaliste supported higher education in order to
produce preachere and teachers for a colonial society that wae
producing young people faster than it wae bringing religious and
and educational leaders over from the old country. For example,
the Congregationaliste carly said, “We can't provide ministers
for all the parishes that are developing in western Massachusetts
saless we have a college.” Aen reeult Harvard got started. ite

principal purpone was to: produce preachers: its secondary purpose
244,

to make teachers. The tricky thing was that this was not a
Spontantous Segregation of intelligent people. It was much

more & career opened to reasonably intelligent boys, not,
necessarily of any originality at all, to become ministera,

Who was the admitting committee? Well, if a young man

eaid that he felt called by God to go into the ministry, God

was the admitting committee. What was left for Harvard College
te do but to give as good an experience as it could manage to
somebody who had been admitted by God as a religious exper-
lence into the ministry, and needed geome polishing? Now that
in turn produced the attitude in the colleges (the sectarian ia~
stitutions in America from the east as far weet as you want

to go). "We must do our best by these who feel called to come

to Albion College, or Wiliam and Mary", or what have you. The
reason that Catholice did mot take a more active early role in
thie educational movement , 1 think, was largely due to the

fact that there was almost aa inexhaustable pool of prieete

that could and did still come from Europe and it raust be remem-
bered, of course, that Catholice were heavily in the minority

in the early decades in the United States. Ae a result, Catholic
educational institutions like Holy Croee and Boston College did
net develop until much later. Catholica could alwaye be eupplied
from a pool of missionaries and missionary orders that would

come and serve in the wild country known ae North America.
245,

That sectarian educet:onal situation in turn produced
one of the most conspicuous featuree of American medical
education. We limited the number of students to the facilities
because it was obviously cruel, anfair and indefensible to give
some student chosen by God e big advantage over other students
who also felt the call, We said in justice to these young elect
of God, “if God doesn't send us enough money to run thie show
on an entering clase of one hundred and fifty we'd better limit
it to seventy-five people go that we can give a desk to every one
of thers,

Saying that we're facing the Almighty bringe on an awful
lot of paternalism and protection. “Have we given this young
wan the proper balance in education? We can't leave him alone to
his own devices. He's hopelessly unprepared for what he really
should have, #o let's only take a8 many as we can give good op-
portunities to. Let us say with some satisfaction, 'God, they
have at least equal Gppertunities, and if it wasn't to be that we
were to have all the facilities we like, we will at least see that the
facilities that they do have ave equal.' “

Thad to adjust all that when i sew eight hundred students
in the firet clase each year in Paris, with only desks for eighty.
Qn that basis how could l assume that a graduate of Pavis was

well trained? The fact ie that 1 couldn't. The leadership that
246.

the European universities hed was an elite, self-chosen, self-
formed and going through a period of exposure of desperate
cornpetition for a chance to be close to a great teacher. A
great teacher had to have young men close to him because he
couldn't get hie work done unless he had some sesistante, in
return for: the help that his assistants gave him he provided
close association. Now close association with a very able mind
ie a singularly significant thing in the life of any young man and
that's how the young men in European universities' medical
schools got paid off. #or the rest of the fellows who were act
taken in ae being good enough to be really helpful to a professor,
devil take the hindmost. And he did.

One of the confusions that I had to face was that a country
that medically speaking was as fer shead ae Germany was alac
the country where I saw in drugstore windows cat skins tanned
and ready for their major use and significance, which was a
cure for rheumatism, i thought, "By God. this is an odd effect.
Here's a country which has the leadership in ecientific medicine
and where a¢ 4 matter of actual practice cat skins are the major
treatment for rkheumatiem. How can that be? Well, it can be
perfectly easily, because the medical education wae based on men
of great tested and proven ability taking as kammerere a very
small sumber of young men. While there was no doubt that the

chosen young men came out, there was every kind of doubt whether
247.

medicine was reaching the German people. it hadn't and, except

for some very intelligent government health measures, I think

that it is fair to say that many of the popular cures and the residuum of actual
hebites and usages stayed in the medical picture. I aaw some of theae
things immediately, and they made me think, “God, you've got to stick
around some time here before you know how to explain things that you
have seen and have been bewildered by.” lt wae really the reason why
I was rash enough when Pierce died and | was forty yeara old for me

to say, “Well, they've offered me the chance of succeeding him,
succeeding him at an age when in Europe nobody gets any real ree-
poasibility. I know that I haven't had enough experience. But what

is the alternative? The alternative is going to be to have asa chief

in New York sornebody who doesn't even know the little that 1 know
about Europe, and my main job will be convincing this stranger of
things that he's never seen and getting him to understand that cer-

tain measures must be followed that don't make senge, *
The story of how the Rockefeller Foundation got into
legal medicine in quite simple and amusing. | had noticed that
French schools had departments of legal medicine done with
& Seriouences, skill and experience that I had never heard of
before, Legsl medicine before the 1930's just didn't exiat in
the United States, except for some hurried lectures by frantic
medical examiners who did little more than throw the adject-~
ive legal medicine into the student's mind. I saw with increas-
ing clarity that we had simply forgotten about one area of
medicine which in the French system of civil goverament was
an important one. The French paid attention to legal medicine
(and toxicology, which went with it) in a way that put all that we
did into a very shameful fuss and gloom. At one point the
General Education Board woke up to legal medicine and pro-
duced a darn good study of it as a subject, but the study pro-
duced no reactions in the United States whatever, and the General
Education Board did nothing about it. Although legal medicine was
done rather badly in a number of countries it still had something
in ite own right because it wae the application of scientific know-
ledge to the administration of justice. it had therefore some
very serious and very extensive implications. Well, one day

(i don't remember now exactly when, but it wae in the ea dy
hi

thirties) my secretary came in and eaid, “There's a lady here,
Dr. Gregg. who wants to see you", and in a rather irritated
frame of voice she added, "She doeen't want to tell me what
she wante to see you about,”

Well, I've always been a little on the alert to things on-
known and to my secretary's disgust 1 said, “Bring her in, please."
la came a woman, well dreseed, and highly intelligent by the way
she spoke and developed her thought. Her thought was that legal
medicine in the United States wae a perfect disgrace. She had
gone to the Harvard Medical School, but the dean there gave her
& very discouraging, unsympathetic cold shoulder, She'd gone
to President Lowell and she'd gotten the brush-off there, too.
She knew about the General Education Board's report and won-
dered if we had any interest in it. I said to her, "Well, Mra.
Lee, what do you propose to de? Why are you interested?" it
tarned out that Mre. Lee's brother, who wae her ideal (thie was
a brother fixation for fair} had a great friend named Jake McGrath,
who was the legal examiner for Suffolk County, and Mre. Lee,
through her brother's friend, wanted to found a chair of legal
medicine in the Harvard Medical School. To this end she wanted
to give a capital sum of two hundred thousand dollars. 1 saw my
chance, and l said, "Mra. Lee, I don't believe that the board is
ikk

ready to make a capital gift te match youra, but I do believe

and ican almost promise you (we can't promiee anything be-
cauee it ie the board's decision) that we will undertake to train

a man for you and #o make it possible for you to go ahead with
your intention of contributing to a chair in legal medicine at
Harvard. it'e not quite the same thing. You can't do that quick-
ly in this country, but we cas, I think. find a man and train him
for the position.

She said, “That's exactly what I wanted. "

idid one other thing. When she told me this story of
being rebuffed at Harvard, l eaid, “Why, Mre. Lee, you know
there's a new president at Harvard and, although you may -not
know it, there'e also a new dean, and I would be rather inclined
to think that if you approached them again your reception would
be different.

That heartened her alot, When ehe left the office I got
Sidney Burwell on the long distance and I told him what wae up,
and 1 think that J also wrote a note to Conant, giving him the
substance of my conversations with Mra, Lee. Well, the end
result was that she came acrose with her side and we went ahead
and got Allen Moritz, who was a pathologist under Karsner at

Cleveland. Morits at my suggestion went abroad on a two year
iv

fellowship for training ia legal medicine. He was not an
adaptable type of human being so that he had a miserable time
in apote and was half reluctant to go ahead with the project.
On hie return the department was started,

The reception of legal medicine by the other professors
was not a brilliant one. There was no overt opposition, but
they didn't understand what was going on. They didn't under-
stand the field well enough to give Morits the kind of emotional
response thet he, in a perfectly new field to him and very dubious
about it, needed. To this day legal medicine haan't yet attained
its steture, the more oo because shortly after Morits took the
new chair at Harvard he wae asked to be Karener's successor
in pathology at Cleveland and left. We didn't have an awfully
well trained successor to Moritz and the department never got
wery far off the ground.

Leas of people is a constant generic limitation for
foundation work. If you're not going to get the kind of people
who are going to accept the gift in its potentialities as well as
ite realities, it is sometimes best not to start at all. I'm darn
glad in thie case that we did start. However, legal medicine at
Harvard hasn't been a screaming success, partly because of the

ignorance of what ite significance could be and partly becauee
people could not see what could be made out of it. Because I
knew Governor Galtonstall as a boyhood friend, things were
latex done to make the reception of legal medicine state-wise
what it ought to be, for a good profeseor of legal medicine in
a Masnachuactte University Medical School.

What etruck me ae one of the best arguments in present-
ing the cauee or the validity of legal medicine as a subject for
seriqua study aod experiment to students or laymen, was to say,
“Now, gentlemen, don't please think that having good legal medi-
cine in one American medical school ls designed to catch the
gailty man and punish him, because the fact of legal medicine
ie equally important in the administration of justice. It also
helps individuals who are unfairly accused of murder and saves
them from the electric chair and from life imprisonment." For-
tunately, in the firet two yeare of legal medicine at Harvard,
Morita dramatically helped a New Hampshire farmer unjustly
accused of murdering his son. The farmer, who didn't get
along well with hie Little boy, was left alone with him one after-
noon when the mother went is te town to do some shopping. When
ahe returned the little boy wae dead. The farmer insiated that he
hadn't touched the boy, and that he knew nothing of the circum-
stances of hie death.
vi

He was quickly brought to trial end seemed destined for life
imprisonment when somebody in New Hampshire very wisely
brought Morits into the case as an expert investigator. Morits
went up to New Hampshire, did an autopsy on the small boy and
found that a growth in the boy's traces had slipped into positian,
{one might say, just as a plug is a washbowl) and it had closed
hie lunge. The boy actually died of asphyxiation caused by a
polyp in hie windpige. Asa result of Morita’ investigation,

the farmer was saved from life imprisonment. | alwaya tell
that story of strangulation by a polyp because it illustrates the
function of legal medicine in the administration of justice, lt
goes better with a critical audience than any story of the vin-
dictive catching of culprit.

Mre. Lee continued her enthusiasm, although she was
frightfully disappointed at Morita' leaving. She was also some-
what embittered because Harvard University turned a cold
shoulder to s special course ohe had suggested for policemen
in legal medicine.

Mrs, Lee's actions in suggesting courses shows the
way certain relationships can come into something that you
would think would be far from it, Mre, Lee was the wife of «

very rich Chicago man who hai been in the International Harvester
wik

Company. She was a woman of Immense intelligence. 1 don't
know how we got into it, but one day she told me of the embit-
terment that she suffered as & young women when her own mother
interfered with her married life and her relations with ber hus-
band. She was, when | knew her, atill a smouldering volcano
on that subject. To my utter amazement | found that Mra. Lee
could not let the department which she had founded alone. She
waa interfering ell the time. 1 aaid to myself, “Here's a woman
who bitterly resented her own mother's interference with her
own life and now she's passing on the same line of goods to the
department of legal medicine which she hae created, ”

Taking my cace in my hands (a pretty rieky procedure),
i wrote her a long letter and accused her of passing on exactly
the dame treatment to the department of legal medicine that her
mother had dealt her. Well, there was an ominous silence that
continued for about fourteen months and then to my complete ae-
tonishment, because I thought that 1 had broken the whole thing
to pieces by that letter, i got e Christenae card from Mrs. Lee.
i thought I'd lost a colleague and practically co-plotter by being
blant with her, but she had to lick her wounde in silence and
separation. We now have a very friendly relationship that works

all right. She's never referred to it and God knows I never have
wii

either, That is an illustration of the fact that dealing with

the recipient of a gift is one of the least known and most valuable
aspects of foundation work. lam preparing a small book which
i hope | can get published, which will have the title, Notes on
Giving. Giving is « frightfally complicated relationship. If
you've had the length of experience that I've had, you can see

my riad complications arising in the relationship between a
foundstion that is making a gift and e recipient who iv receiving
a gift. ican assure you that they are not as simple as they seem.
You have to do certain things with certain values ia your mind
that don't appear, excepting after practice. All the new founda-
tiene don't need to be told how to do things. That is ruinous,

but they need to have certain roadblocks and holes in the road
and all kinds of things that are in their path pointed out to them.
How they solve them is their preblem. You can't interfere with
a burgeoning foundation and say, “You'd better do thie. We do it
thie way and you do it too and you'll save trouble.” You just have
to raise the problem in a perfectly dispassionate and objective
fashion. I don't knew whether 1 will ase medical illustrations in
the book. I could tell stories that would be extremely vivid but
they would interfere with my relationship with the recipients in
question. 1 think that 1 can make things up that will serve my
parpose just ag well as the identifiable ilustrations, but God
knows that there are plenty.

For instance, there ie a great deal of truth in the old
sarcastic remarks that gratitude is a lively sense of favore atill
to come. The Foundation has esedulously tried to avoid the creation
of dependenta on the past of a receiving agency. At the beginning
we naively thought that all we had to do was say, “We are giving
you a three year grant. The total that you asked for, yes, but
we toust tell you sow that after that period you've got to be on
your own." We found that doean't work anywhere near as well
aes it does to any, “Here is a grant of sixty thousand dollars to
be epent over a five year period. Because you can't have every-
bedy you want the fivat year, all bright and eager, ready for the
fray, it is possible you're going te waste a year looking around and
getting your etaff tegether. We're not going to go in af the level
of twelve thousand dollars 2 year for five years, which would be
elxty thousand dollare. We're going to say, ‘not over twenty
thousand dollars any year, ' and that means that the laet two years
of our grant will be a tapered gift. You can start off big because
you need new equipment or new quarters, You then bit a certain
level, but the year that you hit the optimum level is going to be
the last year at that level, The next year it will be a little bit
lees, and you have got to find money as of the fourth and fifth year.
We're going to move out of the picture gradually.” Mow, nothing
Speaks so clearly to a recipient as s tapering grant where he
has to find the money. He just can't bear to break off abruptly
at the high level of twenty thousand dellars. That sort of thing
is ont of the bite of technique in giving. To be euccessfal you've
get to give away the credit, end step slowly out of the picture.

I'l add enother illuetration. At one time we made a
grant for a pharmacology laboratory in Bucharest. 1t went along
ali right, aad then one bright morning | received a visit in the
Parise office fram the professor to whom we hed given that aid.
He came in with the most pathetic and troubled demeanor and
eaid that he had come into apologine. I thought, “What the hell
has gone wrong?” 1 eaid, "What do you mean ‘to apologize’ as

He said, "1 stopped off in Professor Pick's laboratory
and I learned that moment that he had received some sid fromm
the Aockefeller Foundation, He had a nice Httle sign put over
his door, ‘The Rockefeller Laboratary', because he got the money
from you. Il never did any such thing as that. 1 came in te apole-
gize, I'm going to have it done."

i eaid, “lbeg you nottso, We are aot in the position where
we want our name put up with every gift. in fact, Mr. Rockefeller

has always felt that it was better to keep in the background because
mi

we're happy when you do your work, Your work ie the acknowledg-
ment and the thanks we're looking for and not anything over the door, "
Phen I had the job of writing to the Viennese professor who had

done if without telling os or asking us if he could, explaining the
entire situation and asking hiro to take the sign down. What Pro-
fessor Pick was doing wae discharging hie feeling of gratitude to

ua, Bot it was also making every professor of pharmacelogy that
visited him feel, “Well, maybe I could get something if 1 was will-
ing to advertise the Rockefeller Foundation a Httle bit. That woold
be the end. I said frankly to Professor Pick, “lt will give me twenty
letters of application as long as that thing cores in. Because of
your sign I'L} get requests from all over, perhaps, is large amount,
from secoad rate people. It will increase my mail substantially

but it won't please me or the Foundation at all." Pick very quickly
teok the name out and called it « day,

The generation that I came into the Foundation with had a
similar attitude toward honorary degrees which | happen to per-
sonally honor myself. I like it. Some of my present colleagues
are not impressed by a refusal te take an honorary degree. i think
that it's much better taste and it suite my purposes better to have
refused every honorary degree that i have been offered (and I've
been offered a lot of them and under very odd circumetances). i
simply explained that it ie not my belief that that's the wise role
wii

for a “philanthropist” or for an officer in « philanthropic organi-
mation to occupy. They say, “Well, your colleague, so-and-so,
did." Iaeay, "That's hie problera, but I'm not doing that." Mr,
Rockefeller himeelf hae been offered I don't know how many
honorary degrees. He took an honorary LL.D. from Brown
because that wae hie college, but he hae refused all the others.

He haan't lost any respect by that, but it's a delicate business
refusing it. You're really put on the epot. tis, however, an
amusing plece of virtue, because once practiced, it ie possible
to practice it easier thereafter, because Uf you explain that you
have refused an honorary degree and name a distinguisbed in-
stitution that wae refased, the other people don't have any trouble
and they don't take the refusal as an insult. I simply mean to say
that we are always more interested in s performance with the

money we have given than anything elec.
INDEX

Advocate 19, 21
The American College 137
American Physicians 80

"Anabasis"
Aub, J. ah, 65
Balmain, -- 156
Barris, <«-

78
Bigelow, G. 5, 96
Biggs, H. lil

Binger, ©, 2k

Bock, A. 6

Bohr, N. 218

Boston City Hospital 6h
Bowditch, N, 28

Boyden, F, 31

Boylston Medical °ociety 50
Breemer, -- 39

Brigham, F.G. 73
British Army 8-6, 88
Burwell, S$. 444

Cabot, Ae ae
Cabot, H. 5 ne,

Cabot, R. 36, hk Be 48, 50, 57, 59-61, 6h
Campbell, Dr. «-

Cannon, -- 39, hi, 2

Carnegie Foundation 137

Catholic Church 2hk

Chagas, G. en

Christian, --

Civil War c

Cohn, A. 149

Golorado College 11

Conant, James Lii

Copeland, «- 20

Councilman, -- 39-lo, he

Croce, B. 236

Cushing, Hq, 36, 37, 55

Cutler Academy 11

Darling, SS. 135
Davia, WM. 17
Dirken, H. 53, 66, 6

RLiii
xiv

Duke University 2h

"E", Dr. 226 227
Edsall, R. 36, 3

Eliot, C.W. 37, 775627
Eliot, T.S. 21

Fascist Party 237
Ferensei, -- 28

Fletcher, Sir W,

Flexner, A. we 6-ho. 7yh7, 230-2
Flexner, 8. l, 2, 211, 218
Folin 39,

Forbes, A.

Forbes, H,

Fosdick, R. ohh

Freud, S. 28

Frothingham, CG. 6h

Fujinami, Dr. -- 176

Funk, CG. 75

General Education Board %, ii

Giles, C. 12

Goethals, G.w. 66

Goethals, T. 65, 66

Green, R.N. 9

Gregg, (father) +-- 1-2 6, 9, 10, 15
Gregg, (mother) “m 1- -7, i, ik, 30, 31, 97
Gregg, M. (sister)
Gregg, Mrs. A. (wife) 80

Hackett, L. 97, 108, 11h, 130, 131, 135

Halstead, W. 38 3

Harvard Lampoon 15, 19, uy 23

Harvard ae: 1, 14, 15, 17, 23, 27-9, 32, 3h, 37,
57, 59, 66 23 -7, 222, 243-h, vi

Haskins, C.

Henderson, L. an

Hoover, H. 225

Howell, -- 33

Hunt, E.I. 18

Hydrick, J. 135

rr

International Education Board 2138
International Health Division, Rockefeller Foundation 1ho

James, ¥. 28
Janney, J. 135
XV

Jones, W. 137, 187
Jung, C, 28

Karsener, -- 4414, iv
Keer, W. 62-3, 66

Lawrence, Dr, 30-1

Law School, Harvard University 52-3
Lee, Nrs. -- iil, 444, vi, vil

Lee, R. 61-2, 6h

Lima, F. 120~1

Lippman, W. 19, 2h

Lodge, 0. (Sir) 191

Lowell, A.L,. 13, id

Lyman, A.T. 82

Lygan, Me. 23

McClurg, D. 67

MoGrath, -- {i

Machado, R. 127, 128

Mall, F.P, 3345

Mallory, -- l0-2

Mark Twain 5S é h2, 48, 49, 5

Massachusetts General Hospital 30, 37, ha, » 49, 57,
60, 62, 6h, 65, 71, 7h, 75

Matteotti, -- 237

Medical School, Harfard University 35-1, 48, 52, ope {Lev

Medical School, Johns Hopkins University 32-5, 38-0, h2
107, 137, 138, 187

Medical School, Massachusetts University Vv

Montoya, P. 203

Moritz, A. iii-vi

Muller, PF. 15)

Mussolini, B. 236, 237

New England Sonservatory of Music 1, 5
Nielson, W.A. 27

Notes on Givin viil
Opie, &. 152

Osler, VW. 38

Oxford Seminary 5S

Page, I. 15h
Palmer, W. 57
Palmer, %.J. (Gen.) 2
Parker, T. 0
xvi

Peter Bent Brigham Hospital 36, 17, 8, 6)

Petrie, F, 9

Policai, Dr. <- 172, 173

Preston, E. 7, 8

Pritehett, H.S. 137

Putnam, J. 28

Putnam, M. 28

Putnam, T. 28

Pick, Prof. -- xox]

Pierce, R. 136, 138-51, 155, 180-2, 18h, 185, 207, 210-16,
218-20, 223, 226-7, 231, 232, 2h7

Radcliffe College 2

Raffolovich, ("Raf") 228, 229, 233

Readers Digest 81

Reed, Jd. 18-9

Remisio, Dr, 98

Republican Party 6, 71 ©

Rockefeller Foundation 20, 88, 9h, 105, 106, 115, 119,
121, 128, 129, 136, 138-ho, 142, ih, 150, 15h-6, 159,
160, 172, 171, 177, 182-5, 188, 189, 200, 202, 206.8,
210-3, 215, 216, 219, 222, 223, 225-7, 230, 236, 2ho,
1, ix, x, xi

Rockefeller Institute 218

Rose, W. 9h, 95, uso, 210, 211, 217, 218

Rockefeller, J.D. » X, xii

Rousy, Peah 217

Royal Army Medical Corps 83, 90

Scrinminger, Major 77
Shattuck, F. 36, 79
Shattuck, L. 111

Slocum, W.F. 11-2

Smith, WH. 57, 59, 6h, 79
Sovov, F. 135

Southard, E. h6

State Department 21)
Strode, G. lll, 135

Thayer, -- 33
Turner, F.d. 100

University of Pennsvivania 12, 22
University of Paris so 23h
University of Rome 23

University of Vienna 23k
Vidal, Prof, <- 190
Vincent, George 20, 175, 225

Warren, J. 39

Welch, W. 33, 38, h2, 137

Wilbur, J. sh, 210

Willke, . 219

wflitfeams, L. 18

“olbach, B. 7?

Woods, B. 38

World War I 76, 82, 113, 160, 161, 222
World War II 988, 160

Wright, H. :

Yale Univers'ty 3h
YMCA. 33

xvii