[National Library of Medicine HF1092 - This transfer made: 08/02/2004 - Length: 00:54:40]

[A National Medical Audiovisual Center Production]

[In cooperation with Alpha Omega Alpha National Honor Medical Society]

[Leaders in American Medicine]

[L. T. Coggeshall, M.D. Frederick H. Rawson Professorship of Medicine University of Chicago February 15, 1975]

[Interviewed by: John Z. Bowers, M.D. President, Alpha Omega Alpha National Honor Medical Society]

Bowers: The biographical memoir which you are about to see is part of a program 'Leaders of American Medicine.'

The program is sponsored by Alpha Omega Alpha, the National Honor Medical Society, the National Library of Medicine, and the National Medical Audiovisual Center.

It was inspired by Professor David Segal and his wife, Professor Beatrice Segal.

And they subsequently made a generous benefaction to continue the program.

The leader of American medicine who is the subject of our interview today is Lowell T. Coggeshall, Frederick H. Wasson Distinguished Professor at the University of Chicago.

Dr. Coggeshall is the only man in the history of that institution, save the president, to simultaneously hold the title professor, vice president, and trustee of the University of Chicago.

Coggeshall: Good Morning, John, pleasure to be here.

Bowers: Talking about the National Library of Medicine, I think you were sort of a founding father of that institution within its present form.

Coggeshall: In a way I was. It was during the period when I was a special assistant to Secretary Folsom, HEW.

Some of the friends of American medicine were concerned about the Surgeon General's Library, probably the best collection of medical periodicals in the world, [texts], etc.

We were faced with the dilemma of seeing them destroyed because there was neither adequate housing or budget.

So the late Alan Gregg, myself, went to the Senate before the late President Kennedy and induced him to have this activity, the library, changed to the HEW.

The main reason being that there would be insured adequate support.

And after we had obtained the late Senator Kennedy's support we went to Senator Lister Hill, who's been so important in American medicine

and indeed one of the founders, and the National Library of Medicine was established in that year.

And I had the pleasure of transferring the official title to the first director of the National Library, Dr. Rogers, Mr. Rogers.

And I'm gratified here today to see this satellite so active and engaged in such important activies.

Bowers: Well my first recollection of you goes back long before you pioneered the National Library of Medicine.

I think it was either 1939 or 1940, that a classmate of mine at medical school who was interning in Detroit,

drove out to Ann Arbor to attend grand rounds. And a man came in, of all things, to talk to them about malaria in the midst of a howling blizzard in Ann Arbor.

And the man was Lowell Coggeshall and he opened by saying, "I guess you fellows wonder what I'm doing coming out to Ann Arbor to talk to you about malaria," and I think you were the malariologist in those days.

Coggeshall: I remember that incident very well and and you indicate malaria at that time, even the entire study of tropical diseases had dropped to a very low ebb.

And there were a few of us interested in malaria, which was my primary interest. And incidentally this gives me an opportunity to say that I came into medicine largely through the study of malaria.

Malaria had been so important in my life, that I sort of hated to see it go, [    ] my medical education and furnished me one of the most exciting careers in medicine.

But I started out with the Rockefeller Foundation after graduating at Indiana University with a degree in medical zoology.

And from then on I obtained my medical degree at Indiana and was associated first in malaria research in South Carolina and in Georgia.

Here [    ] in Georgia where malaria was very rife at that time.

The director of the research project, who was Dr. Samuel Taylor Darling, came out of the Panama Canal Zone where he was chief pathologist,

one of the most inspirational and least published man in medicine I've ever met.

And it was largely through his influence that I obtained my medical degree and continued from then on to pursue a career of research

and teaching which I did until the outbreak of World War II.

And it was during this interlude when I was at the Rockefeller Institute as a member of the Rockefeller Foundation, studying malaria, immunology, and chemotherapy,

that I was invited to the university and I went out in this howling blizzard and the only thing I knew to talk about then was malaria.

I was gratified, though, that they seemed to appreciate the topic even though the setting seemed a little out of line.

Bowers: When I studied about malaria in medical school, of course, it was rampant in many parts of the world in those days

although I think that through the work of the international sanitary division, I think it was called, of the Rockefeller Foundation.

Coggeshall: International Health Division and International Health Board.

Bowers: They were working on malaria and on hookworm.

Coggeshall: And on hookworm.

Bowers: And cleaned it up.

And in those days we were taught that there were no immunological mechanisms associated with malaria.

My comment, my question then is, what did you find out about the immunology of malaria and how'd you do it?

Coggeshall: If I might step back just a step or two, John. After I completed my medical education, I was about to start an internship, at the United Fruit Company hospital in Honduras,

which [burned] down approximately two days before I was supposed to start.

So I returned to the Rockefeller Foundation offices and talked to Dr. F. F. Russell, who was very important in American public health, told him I needed an internship

and he introduced me then to Dr. Franklin McLean who said he had an internship in Chicago.

And so by that coincidence I went to the University of Chicago and was thrown in with Dr., I say thrown in, was invited by Dr. O. H. Robertson who was studying lobar pneumonia,

long before the antibiotics and sulfonamides. And through the laborious studies and through his great leadership, an anti-pneumococcic serum was developed.

Terribly expensive, terribly difficult to administer but it saved lives of a disease that claimed about half its victims at that time.

But about the time it was ready to be produced on a large scale, not just on an experimental scale, sulfonamides came on the market and this program was literally shot out of the saddle.

Now this is the introduction to the story because I was intending to return to tropical diseases and I was enthralled by the experiences of the man I had met in Georgia here

who had done so much to eradicate malaria and hookworm throughout the world, or at least taught the health people how to do it,

that I went back to the Rockefeller Institute with this intention of working for the Rockefeller Foundation, going to some parts of the world, and like many of your preconceived plans

I was assigned to a laboratory there and told that was the only immunology and trying to develop a vaccine for malaria and so forth,

so without any subject knowledge of malaria other than what I'd obtained in the field, I started the program literally almost identical along the lines of Dr. Robertson had used on lobar pneumonia.

And now to your question, up to that time there had never been anyone who could develop who had been able to develop any demonstration or protective antibodies that

protect the [action] of a malaria serum or glutination reaction and we were successful in demonstrating all of this largely because of two malaria parasites,

one that came from India [in   ] and another in Canaries, so I was very proud of that contribution which did not turn out to be of any practical importance as far as control of malariology but it was vary gratifying.

Bowers: My recollection of Dr. Robertson, who was certainly a very famous man, was that he worked in the laboratories of Peyton Rous at the Rockefeller Institute during World War I.

And through using Ringer-Locke's solution he did the first successful trans storage of blood

Coggeshall: Storage of blood

Bowers: took it to the western front and gave it on the battle lines in Belgium.

Coggeshall: That's correct.

Bowers: Then he went to PUMC and then the Pekingese alumni were congregating at the University of Chicago under Franklin McLean's recruitment.

But then you were with Peyton Rous, I think, weren't you

Coggeshall: At the Rockefeller Institute he was a member, of course, of the Rockefeller Institute staff and I was in the same building but a member of the Rockefeller Foundation and we were working primarily there were three groups,

Dr. Mike Connor attempting to develop a serum and a vaccine against yellow fever, which he did, and Frank Horsfall and Dr. Tommy Francis, both the late Dr. Horsfall and Francis working on influenza and I was responsible for the malaria program,

so that my connection to, my relationship with Dr. Rous you might say was a junior colleague, who was very very helpful to me.

And that's [something] I shall never forget.

My first paper I published was on preferential breeding habits of the anopheles mosquito which, as you know, carries malaria.

When I went to the Rockefeller Institute and published my, submitted my first paper to the Journal of Experimental Medicine, this Dr. Rous whom I consider one of the greatest medical editors in this country, that this country ever had,

I was doing a study on the immunology of malaria and one of the problems that I had tackled was what was the effect on the spleen.

And I could show that by removing the spleen the animals would invariably die of this experimental malaria,

so it was sort of a trick to get the spleen out and I exteriorized it and put a cup over it and measured its volume and it would go up and down with malaria, and

so in my paper I said I had very carefully dissected out the spleen, and I shall never forget Dr. Rous said, "Do you mean to imply that usually you're very sloppy about this,"  and then I said I dissected the spleen.

Bowers: Never give a paper to the editor of a journal.

Coggeshall: That's right.

Bowers: Well, you, did you go off to Ceylon and India to get the parasites that you worked on or

Coggeshall: No, that's, I think a very interesting story. Malaria, as I say, I'm very grateful to that disease because it did so much for me,

speaking facetiously, but at the outbreak of World War II as we've indicated earlier, as we've said earlier, we had practically no one in this country interested in the tropical diseases and malaria in particular.

When the Germans and the Japs got busy in their activities, all quinine and atabrine, a synthetic drug against malaria, was cut off from this country and there were not enough supplies to carry us but for a few weeks.

So it became very evident that a new drug to handle malaria, either control it or cure it, would be essential because by that time the war was being focused in the South Pacific.

So not having an adequate experimental animal, we began to search for parasites and unfortunately we couldn't find any, but Professor Brumpt at the Pasteur Institute in Paris found one in chickens,

plasmodium gallinaceum in Ceylon, and this was ideal because it was easily kept, it would invariably kill the baby chicks, which made an ideal experimental animal for the testing of drugs.

Unfortunately the Bureau of Animal Industry wouldn't let us bring it into this country.

And I practically was invited to leave the Rockefeller Foundation laboratories at the institute because I was so persistent in my request to get it, promising everything in the world to quarantine it.

And I was denied this. And I understand why because of its tremendous economic importance so when I'd drive [  ] to my home in Westchester county I'd pass the Bronz Zoo

and it occurred to me those there have a lot of animals that came from Southeast Asia and I asked the curator of birds if he would let me bleed a few and he said, "Yes, if you let us hold the animals,"

so the long story is that out of one of these animals that had [been] this parasite or first cousin to it at the Bronz Zoo literally there for years

and it became the parasite on which all the [anti] malaria research was conducted during World War II

which, as you know, eventually culminated in the discovery for the first time of cheap new drugs that would for the first time sterilize a patient on the infection,

which atabrine or quinine would not do previously.

Bowers: What did they name it, plasmodium coggeshall?

Coggeshall: No. Well, I was the discoverer so it was called plasmodium lophurae because it was obtained from the fireback pheasant of Borneo, which was known as gallinaceum lophurae lophurae.

So it's still, I think it's still being used experimentally.

Bowers: Well then your work in malaria came to the attention of the armed forces and off you went to another heroic phase in your career and a particularly fascinating one.

Coggeshall: Well it was to me and I was fortunate to be in World War II doing the things that I'd been, doing the thing I had been trained to do.

At the middle of '41 I think it was July President Roosevelt and Prime Minister Churchill met in the South Atlantic and set up a secret air route from Miami, Florida through to China

and the principal function of this air route was to carry vital supplies such as could be carried by air at that time which were not very heavy, of course - bomb sights, tracer bullets, important documents, and personnel.

And so since we had no air force at that time and neither the army nor navy were capable of flying over the oceans, Pan American was given a contract

and they quickly, this organization, threw together a force of about 5,000 young men and they scattered these men through [built] airports right through the heart of Africa,

through the Middle East, and over the hump and into the Philippines in the Far East.

This was before of course before the Jap attack on Pearl Harbor.

Unfortunately, there was not sufficient importance given to the control of disease along this route and within a year, less than a year, matter of fact,

they went over at the beginning of malaria season and about five months later almost fifty percent of those boys had malaria.

Not only the boys but the leaders were housed over there, so Mr. Juan Trippe, who was president of Pan Am, called me at Ann Arbor where I'd gone from the Rockefeller Institute to head up the Department of Tropical Diseases,

called and said "We have a serious problem with Pan American Airways and of importance to our national interest and would you come to New York?"

And I got on a plane that night, went to New York. The first thing I knew I was headed across Africa, across South America into Africa.

And what I found was that these young pilots that were in charge of the transport unit and all the backup forces were all sick with malaria.

So, because of the urgency of the situation, and so many of them sick with malaria, I got practically anything I needed to control the disease - something my predecessor didn't have.

Because he was told "Well go ahead and do all the sanitation you can but don't get in our way because we're about ready to fight a war."

This is an oversimplification, but when I went since most of them were ill, I was - netting was flown from Paris to us, Paris green from the states and so forth.

And we set up a very rigid control program where the troops are, where they built the airports, and where the personnel, this is all civilian, were housed,

so that we were able to lick malaria to a standstill fortunately because we could get adequate anti-malarial control implements and measures and of course we didn't have to control large areas,

we merely controlled [the] three miles. This was one of the great satisfactions of my medical life which I felt that I made a contribution and if I may be immodest,

Lord Moran who went with Churchill, [where when] you probably knew him, I'm sure you did,

said that the opening of, the maintenance of an open air route through middle Africa when the Germans were going rampant in North Africa

was one of things that made this successful and the [   ] of the Germans in World War II.

Bowers: Lord Moran, I had dinner with him, Cogg, in London where we - I had the honor, I should say, of sitting beside him at a dinner at the Royal College of Physicians in London in 1971.

He was quite old then. And he talked and I was asking him of course about his days with Churchill.

And also about the period when he was president of the Royal College of Physicians.

And after dinner one of my friends talked to me and said, "Say, John, did you enjoy Corkscrew Charlie?" And I said, "Is that what you call Lord Moran?"

He said, "That's what everybody calls him." I said, "Why?" He said, "Well, you know, when he was president of the Royal College of Physicians," he used the word,

"he conned us into joining the national health service." Into accepting it I should say, and joining it.

"for which we've never forgiven him and we thought that he was devious so henceforth he's been referred to as Corkscrew Charlie."

Well you didn't have DDT to spread around Africa which would have been the first thing today, and of course you would have defoliated Africa perhaps.

How did you do it?

Coggeshall: We had, primarily it was done by insisting that every member of the personnel responsible for flying the planes from

I'd say Miami across the hump had to be in bed before darkness when the malaria mosquitoes, you know, bit.

There were bed nets over each bed and around each camp there was a drainage program that eliminated all the breeding sites,

so it was really the very strict and meticulous carrying out of known anti-malaria measures - because, as you say, we had none of the modern methods or materials to whip malaria

and I think that it demonstrates that even today malaria is one of the most serious problems throughout the world in many areas

but it's largely an economic problem rather than a health problem because it can be done if you have the money.

We had control, of course, limited to very small areas which made it - it wasn't too easy but in comparison to eliminating malaria in Africa it was pretty simple.

Bowers: You had no chemo prophylactics.

Coggeshall: No chemo - we didn't use any. Matter of fact, I didn't believe in it and I wouldn't allow it to be used because in the first place if you use [then] chemotherapy agents, atabrine, and quinine -

all you did is subdue the infection and let it smolder, you see, and you never knew when you were coming down, so I wouldn't take any of it myself,

preparing to treat the disease, if it occurred, rigorously 
rather than to sort of subdue it, partially.

Bowers: I understand that malaria still is the number one scourge of the world, the most prevalent, disastrous communicable disease and it still infects large areas

although in some countries such as India, where two thirds of the population had the disease, it has been suppressed.

Coggeshall: I think that's true. And I think probably as unfortunately even with the World Health Organization the statistics on that are not readily available

but it primarily affects those areas where the population is the densest, where there are so many people, and the tools are there to whip it and I was glad to be a part of it.

Still I have a great interest in the disease.

Bowers: You sort of came to a - you didn't sort of - you came to a highly significant crossroads in your career then.

Coggeshall: I did. I [   ] my career as I said was starting out with the Rockefeller Foundation in the south here and field malaria

and then back to the University of Chicago where I took my internship and worked on pneumonia with Dr. Robertson

and then to the Rockefeller Institute where the fundamental studies on the immunology of malaria carried up to World War II.

And I was at the - shortly before the onset I went to Africa and carried out this public health and administrative program

and I was given a lot of administrative responsibility, incidentally, other than that applied to medicine.

When the Air Force was established our first contract was dissolved so I went into the U.S.Navy

and from then on my career was largely confined to medical education and government service in an advisory capacity

and development of facilities for medical research and teaching so my career was research and then administration.

And pretty widely dispersed, I'm afraid too widely dispersed to be effective.

Bowers: We're going to explore that. But you did come to a crossroads. You had done - you had demonstrated administrative managerial skill when you put that program together to control malaria.

And this drew you to the attention of universities looking for administrators.

I heard a rumor in Boston awhile ago that you had been awfully close to going there but somehow you ended up at Michigan instead [  ] straightened out.

Coggeshall: Just [was it] after World War II, I've forgotten what year it was, at this time. No, it was just before when I was still at the Rockefeller Institute.

I had been told that I would be offered the post of the professor Theobald Smith Professorship of Comparative Pathology and Tropical Diseases in one of the best departments in the United States,

one of the best financed and certainly one of the outstanding if not the outstanding medical university in this country.

And I was looking forward to being tapped on the shoulder, so to speak, but the wheels of the gods move slowly and so forth and I knew I didn't want to stay at the program at the Rockefeller Institute

because I wanted to be more actively engaged in teaching. So the late Dr. Francis had offered me the post heading up the section on tropical diseases at the New School of Public Health and I delayed answering for some time

until he called me one day and said,"Are you coming or are you not?"

And I'd told him previously about this potential offer at Harvard

which I would have loved to have accepted but I waited until Friday night and I called Dr. - I sent him a wire - I said I will be coming to Michigan.

The next morning I got a telephone call from President James Conant, said I have the honor to announce that you've been appointed the -

obviously I had accepted this other post and - but I'm not sure it wasn't good for Harvard that I went to Michigan.

Bowers: But in your early period in academic medicine you completed your house officership at the University of Chicago clinics

and then you stayed on as secretary to the department of medicine

and you rose to an assistant professorship, then you left the midway, then the midway wanted you back.

Coggeshall: After the experience in Africa I accepted a commission in the Navy and headed up, for the Surgeon General, a research unit and a care unit for marines and sailors coming out of the South Pacific.

We had a five thousand bed facility out there, most of the patients were ambulatory because, as you know, malaria patients are only incapacitated for short periods. And I ran that program.

I was responsible for its direction I should say with a very able staff of young doctors from Harvard, Michigan, Chicago

and we were given some citations for outstanding work in connection with curbing the problem.

At that time there was a good deal of speculation that filariasis in particular - we were going to sterilize a lot of our troops and ruin the lives of many of the boys

and this died down so that neither problem became as important as they thought it might be and indeed there was no spread of these infections to the people back in the states, here.

And I was returning to Michigan when I was intercepted on my way and offered the post of Chairman of the Department of Medicine,

Professor and Chairman Department of Medicine in Chicago and I'd always loved this institution [   ]

and I think this is interesting, historically interesting at least, that President Harper, who started this great institution, it is truly a great one, one of the great ones of the world or the country,

had from the beginning insisted that there be a - what he called an academic medical school on the campus,

as you know that very good medical school, Rush, was in the Presbyterian Hospital on the other side of town.

So his theory was that there should be a medical school whose professors spent their entire time in teaching and the care of patients and doing research

and they should be on a par academically with their colleagues in astronomy and physics and English and you name it.

So he had drawn up a design for a new medical school and later years when - what became - resources available which he did not have at the beginning. He had bled John D. Rockefeller almost annually from -

and his tactic was to get a certain sum to build a new department or building and then spend twice as much

and ask Mr. Rockefeller to pick up the check which he did and he didn't quite have the courage to start a medical school so -

this school started in 1928. [Though] first admitting patients in 1927 and admitting students and patients.

And it had three unique characteristics, which I thought was extremely important.

I think it is important today. I wouldn't advise, wouldn't recommend that this be the common pattern for a medical school.

He first insisted, as I say, that all the professional staff be on a full-time basis so that they are not distracted from the routine of practicing medicine.

Second that the clinical sciences and the non-clinical biological sciences be united in a single group

so that it was possible for the student to get his PhD in biochemistry and surgery both at the same time.

There was no conflict or abrasiveness that I've seen in some areas. At the outset it was proposed that there be sufficient funds to subsidize all the patients -

and you'd select patients exclusively on the basis of their interest as teaching material and so forth, but

the Great Depression of 1929 and so forth stopped that and since that time paying patients are utilized for teaching medicine

and I think the [of course] many of the other institutions - Hopkins, Columbia - had fulltime men for some time,

but this was the first and only institution where the entire staff is full-time.

Bowers: You had no practitioners who came in periodically to do some teaching?

Coggeshall: Well, yes, we had occasional ones, but they did not see the patients, they were largely conducting clinics and so forth, which -

it presented some problems but I think the strengths of the program overcome this weakness.

So I went, as you ask, I went there and headed up the department of medicine but since I'd been out of clinical medicine for so many years

and my interest while in clinical medicine was largely in the field of infectious diseases,

I thought that too much time had passed and the medical progress during World War II had been so phenomenal that it just took more energy and time than I had to go back and catch up.

So when the late - when the then president of the University, Robert Maynard Hutchins, offered me the deanship of this biological division, of which a medical school is an integral part, I became a dean.

And I served as a dean of that division for fourteen years and then was during this period that I changed my -

I tried to do research but unfortunately - my malaria - I was working on [lympho chorio] meningitis and still had some malaria

and my [animals] seemed to die whether I had a meeting or not. They were not very respectful of my time, so it just didn't work

and I was - the last twenty-five, thirty years of my life was entirely academic - medical education, government service.

Bowers: Well - to meant to go back to - we're not going back - President Robert M. Hutchins had

and continues to have a high reputation as an innovator - what we would say today, a mover and a shaker in education.

Did he make similar efforts in regard to medical education or was this more in other areas of the University?

Coggeshall: It was in the other areas of the university. The pattern had been laid out and Bob Hutchins was a great innovator, as you say,  in other disciplines.

But he could live with the scientists and so forth but he did not enter actively in that field. He did some very interesting -

institutes and very interesting developments in education at a lower level and college - in other words he developed colleges much on the English system

in which the students got some rather advanced material at a very early age but he was not an important factor in the medical school.

Bowers: Do you think he might have found it a little tougher to shape the medical school than he did some other [   ] in the University?

Coggeshall: I think it might have been, yes.

Bowers: But in general I think medical school faculties have a reputation, at least today, during your era, of being the most innovative and those that are most willing to -

I wouldn't say tinker with a curriculum but - to try to make major changes. And you observed some of these during your period at Chicago, such as integration, electives and so forth.

You were barely on the scene at Chicago, began to make trips to Washington, because in November 1947 when I went to work at the Division of Biology and Medicine at the Atomic Energy commission,

you were one of the first people whom I met and I continue to cherish and enjoy that friendship that we established then. But you were in and out of Washington quite a bit.

Coggeshall: Yes, after the war because of the importance of tropical diseases and a rather broad interest and activity in several fields relating to medicine and the care of troops

and how to handle the sick veteran and so forth, I was a frequent visitor to Washington largely in two areas. First as a National Research Council was 
attempting to consolidate some of the gains it made in medicine during World War II,

but more specificially I was for a few years chairman of Committee on Medical Sciences for the Department of Defense,

which required a group of civilians to oversee the research aspirations and programs of everything medical in the three armed services - the army, navy, and air force.

We, with the late Francis Blake and several others traveled to every medical institution in the armed service. So I kept interested in that program for two or three years

and I think this ultimately led to my interest in medical education and the internships and the residencies for the men who were in the armed services

or going back to try to recapture some of their earlier experience, led to my trips to Washington on a permanent basis when I was assistant secretary, or rather special advisor to Secretary of HEW.

Bowers: When I came out to Chicago and first visited you in your office when we were establishing a program to build the Argonne Cancer Research hospital which, incidentally,

I learned recently is now the Franklin McLean hospital but that was - when I got out there you were in the midst of a very major building program.

Coggeshall: Yes, what had happened there, briefly, was that at Chicago - there - really, was the headquarters of a basic program of fission and atomic energy and some great scientists had been assembled there from the -

not only physicists but all the related disciplines - and so in order to capitalize on this talent and make available to science the potential benefits of atomic energy we were

selected to have, as you know, being part of the Atomic Energy Commission, one of the first hospitals - this was the atomic energy hospital and devoted almost exclusively

to the study of radioactive materials and its effects on the normal and on the human body and it's a great institution and it's made many, many contributions.

Like you, I recall with affection, our early contacts to - that particular activity.

Bowers: Will you expand - I remember that in some departments you were coming to the end, as it were, of the first era of the faculty of medicine of the University of Chicago

and on some of your trips to the East you were recruiting, you were bringing in new talent and of course on other trips East you were recruiting funds.

And you did that very successfully in Chicago, Washington, New York and I don't know whether you went to California but you were everywhere else.

Coggeshall: Yes, we were rather successful in collecting funds for the development of this school which, incidentally, had utilized the University hospital on the campus exclusively, almost exclusively, for its teaching purposes.

And I think between surgery and medicine when I first went there there was less than one hundred and forty beds.

So we embarked on a major expansion program and money was more readily available because public, government, and private interests had been shown quite effectively the beneficial effects of medical research during World War II,

when all these marvelous developments of new measures to improve health plus sophisticated instrumentation and so it was, I wouldn't say easy, but it was much easier than it is today,

we created several new buildings that was essential - had several new buildings erected at the University, I think the total expenditures was something in the neighborhood of thirty million dollars during my tenure.

It's still going on. But I was particularly proud of the fact that, although the University was - had a reputation - had considerable restricted endowments

and indeed I think when I went there the restricted endowment for the biological sciences, which include the medical school, was twenty-five million, when I left it was fifty-six

so I think we were able to not only expand but to store up some more resources and during this period also there was, as you say, the initial group,

many of whom came from Peking Union Medical College all about the same time, they retired almost at the same time.

There was this problem of difficult recruiting when so many medical schools were being created and expanding. It was a very active and interesting and demanding program.

Bowers: I know that one of the qualities that you have which so many of us admire and benefit from is the capacity for warmth and also the quality that you have for people willing to tell you exactly what their problems are.

I've commented on this to several people and one of them who worked with you on malaria at the Rockefeller Institute said, "Yes," he said, "I remember that Cogg's door was closed a lot."

Because people from all over the institute would come to you with their troubles. I said, "Did he get much research done?"

He said, "Oh, sure, he got a lot of research done," but he said, "He was the chief counselor and confidant of people,"

and I think you, in recruitment, found this quality to be beneficial and many other of us have enjoyed it. But then your interests at Chicago were flourishing.

You were more and more in the public eye and you were more and more in the vortex of activities in Washington. On my way to Peru in 1956 I tried to contact you

and I discovered that you were in Washington in the office of the Secretary of Health, Education. and Welfare. What were you doing there?

Coggeshall: Well, when the Department of HEW was established, I think it was in '54 or '55, I don't want to be too dogmatic about that date because I'm uncertain.

President Eisenhower named to his cabinet Oveta Culp Hobby, who was the first secretary, I believe. She was the first prominent one.

And then, of course, one of the principal activities of the HEW Department was in the medical arena and she asked Dr. Chester Keefer of Boston to accept the post of special advisor to the secretary.

And he wanted to help and indeed did help, but he was unwilling and unable to give more than an occasional two or three days a week.

When she resigned Marion Folsom, who was on the board and treasurer of Eastman Kodak and the father, the principal architect of the social security system,

asked if I would assume the responsibility.This was at a time when I personally had problems that occupied a [good deal] part of my time. I had a major program at the University,

I was president of the American Cancer Society and trustee of the Rockefeller Foundation - I hope I don't sound immodest - but I was very busy and I was unwilling to accept this

even though I would have liked to have done it. But largely through the suggestions of the chairman of the board of the University of Chicago, Glen Lloyd,

and president Kimpton at that time I was more or less invited to accept the position. So I went there and accepted on a full-time basis

with the exception that I went back to Chicago each weekend and had my appointments on Saturday afternoon and all day Sunday.

And it was a very enjoyable experience because I felt I was a part of a new era in government-university relationships.

I'm not sure that's all been good, but it was essential and I would say the principal architects on the government side were non-partisan

but Senator Lister Hill, from Alabama, and Representative John Fogarty were very active and interested in promoting authorizations for research funds

to help the medical schools out. And at that time many of the medical schools were in a real quandary whether they should accept government money or not.

I think, to me, it was a good philosophical question but I'm sure that many of the institutions that we have today that are very strong would have gone down the drain without them.

So it was interesting to talk with the members of Congress about the programs and where the strengths and where the difficulties were and keep them under control.

And I enjoyed that experience very very much and I think this activity was possibly most important bringing my name out a little more widely

because the government has its public relations activities. They don't skimp them too much.

Bowers: When you went to Washington my recollection is that the controversy over whether or not federal funds should be used

to subsidize the construction of medical research facilities was red hot. There were organizations within medicine who opposed it.

And medical school people in general needed it and wanted it. And you were the key man, I think, in establishing the legislation which made the first government investments in facilities possible.

Coggeshall: I think that's true. There is a background to it with a lot of spade work being done previously. I might just encapsulate - the story really started out

in nineteen forty-nine or fifty-one when the late Senator Taft was very much interested in medical problems

and the supply of doctors to make them more readily available to the people of our country. Introduced a bill that called for support of medical research and medical teaching.

And one of the inducements to increase the class, the size of graduating classes of M.D.s was to provide a bonus of five hundred dollars per student.

At that time our - good - mutual friend Dr. George Berry, one of the great leaders in American medicine, particularly medical education,

thought that this might result in the deterioration of the quality of, particularly schools that were struggling and didn't have strong faculties.

So this was dropped. So then the program was renewed four or five - [  ] along until I went to Washington and at that time there was money available for certain research,

primarily categorical. [  ] all right for heart, cancer, and indeed the institutes were created at that time.

But there was still an element of distrust of the government supporting anything that can be related to medical education.

I recall, for example, that there were research institutes they would delete - the Senate and the House - would delete support for the libraries,

which is interesting in view of this today, because libraries were considered by some in Congress to be educational and they felt,

believed, that the government should not be identified with education. The federal government should not be identified with education.

But it was so obvious that the programs that were essential to carry on the vast amount of basic research that was engendered in World War II, that it just had to go on.

And so the research program was subsidized. I'm sorry to say I think it became too much a way of life and many, some individuals went into medical research

because they thought this was a new way to succeed. I think today we have plateaued in that area. Meaning that the problems are not just increasing each and every year,

but I think it is getting to the point that we should support, genuinely support, the real, the  good investigators but not make it a - to excess.

So this is a long answer to your question but this was a very interesting period in my life.

Bowers: Well I think we should spend our final few minutes talking about one of your most important contributions - there were several important ones we talked about today.

That is in medical education. You were president of the Association of American Medical Colleges and chairman of the editorial board of Journal of Medical Education

and the author of the Coggeshall Report, which I think is in its sixth printing.

Coggeshall: Sixth printing, yes.

Bowers: Did you - ?

Coggeshall: I just got a letter the other day.

Bowers: About the Coggeshall Report?

Coggeshall: After the enormous expansion of activities in medical education and research, it seemed that medical education was going in several different directions,

there was no cohesive opinion about how it should materialize and so Lloyd [Darley] who was then the, president, the executive director of the Association of American Medical Colleges,

asked me if I would assume responsibility of trying to assemble a knowledge of where we stood today and where we should go.

So out of this committee that I had the honor to chair, there came a report - progress of education, progress of medicine through education,

that I thought would be another report that would probably collect dust on the shelf. Apparently it was issued at the right time and instead of being in the archives,

I understand it's sold literally a hundred thousand copies have been made and it restructured the, it suggested the restructuring of the Association of American Medical Colleges

and diverting it from sort of an exclusive group of deans who were concerned, inwardly concerned with problems, to having the deans take a more directive role in working with the university as a whole,

looking outward to the community, and reorganizing itself so that it could get an input from other professional and learned societies.

And I think it's been a good thing by and large, although any report is not worth the paper it's written on unless somebody takes it and improves it,

but it has attracted a good deal of attention and I really am proud of it today, although I thought it would just be like many others I've written - should have been filed in the archives.

Bowers: Well, I suppose we certainly are going through a lot of wrenching changes in medical education today. A number of new medical schools, existing schools expanding.

People - so many feel a loss of emphasis in the basic sciences. So would you tell us finally how it looks to you today.

Coggeshall: Yes, I don't think there is any doubt that we must maintain our interest in the basic sciences and in the fundamentals.

There's no routinization of medical education that will tell us how good or bad we are. To me, I think the important thing, we've got to stick to a very solid core of, program of medical education

and expand where you will if you must but don't sacrifice quality. I know in 1837 I think it was Graves said the curriculum was too large to be absorbed

and [   ] and Osler said that you can't possibly teach the students what they had to teach, what was available to be taught at that time is a mere fraction today,

so I would say that I think unfortunately we may expand a little too far in creating medical schools that there should be a good sound basic reason.

I don't see that the influx of new programs to create the general practitioner is going to change that ratio very much. I'm somewhat disturbed to see the constant intrusion of external influence

on government and other activities in the medical arena. I'm sure, John, that you and I thought we had tough jobs when we were deans, 
but it was child's play compared to the responsibilities they have today,

but I know that the deans are doing an excellent job and our country is going to continue to lead and have medical leadership.

[L. T. Coggeshall, M.D. Frederick H. Rawson Professorship of Medicine University of Medicine University of Chicago February 15, 1975]

[Leaders in American Medicine]

[National Medical Audiovisual Center - U.S. Department of Health, Education, and Welfare - Public Health Service - National Institutes of Health - National Library of Medicine]