D r , Sanford E. Leeds d i s c u s s e s t h e Vanderbilt Years of D r . A l f r e d Blalock Table of Contents Introduction i Transcript 1-31 Index 32-34 Introduction D r , Sanford E, Leeds, a t h o r a c i c and c a r d i o v a s c u l a r surgeon, was interviewed on January 29, 1973 i n h i s o f f i c e i n San Francisco',, Dr. Leeds was interviewed s p e c i f i c a l l y because of h i s e a r l y a s s o c i a - t i o n w i t h t h e l a t e D r , A l f r e d Blalock a t Vanderbilt U n i v e r s i t y , D r . Leeds was a r e s e a r c h a s s o c i a t e i n the s u r g i c a l l a b o r a t o r y a t Vanderbilt from 1936 t o 1938, T h i s appointment had been arranged by Df. Howard (3. N a f f z i g e r , t h e P r o f e s s o r of Surgery a t t h e U n i v e r s i t y o f C a l i f o r n i a , San Francisco,, T h i s c l o s e a s s o c i a t i o n w i t h Alfred Blalock gave Dr. Leeds ample o p p o r t u n i t y t o a s s e s s t h e q u a l i t i e s of t h e man a s a surgeon, t e a c h e r , and a s a n i n d i v i d u a l , He has provided a r e f r e s h i n g l y candid and honest commentary on h i s views of t h e s t r e n g t h s and weaknesses of D r , A l f r e d Blalock. This i n t e r v i e w i s a n e x c e l l e n t supplement t o t h e i n t e r v i e w h e l d w i t h M r , Vivien Thomas (OH 15), a s b o t h men worked w i t h Dr. Blalock a t V a n d e r b i l t , p r i o r t o h i s move t o t h e Johns Hopkins, P e t e r D, Olch, M O D , , Deputy Chief H i s t o r y of Medicine Division N a t i o n a l L i b r a r y of Medicine i 1 T h i s is D r , Olch, of t h e National L i b r a r y of Medicine, v i s i t i n g i n t h e o f f i c e of D r , Sanford Leeds, of San F r a n c i s c o , January 29, 1973, T h i s morning we p l a n t o d i s c u s s D r , Leeds' a s s o c i a t i o n and r e l a t i o n - s h i p w i t h Dr. Alfred Blalock, More o r l e s s t h e Vanderbilt years, D r , 0,: D r . Leeds, would you s t a r t by t e l l i n g us how it came about t h a t you went t o V a n d e r b i l t i n 1936, D r , L.: Well, i n 1936 I f i n i s h e d my i n t e r n s h i p and I had s e v e r a l i n t e r v i e w s w i t h Dr. Howard C, N a f f z i g e r t o s e e about t r a i n i n g i n t h e Department of Surgery a t t h e U n i v e r s i t y of C a l i f o r n i a , and D r , Naff- z i g e r , who was b u i l d i n g up a s t r o n g department i n s u r g e r y , had t h e concept t h a t h i s men should have a broad background i n some s p e c i a l f i e l d and he wanted me t o go i n t o b a c t e r i o l o g y , T h i s was about t h e time Dro Altemeier was s t a r t i n g o u t and had I chosen t o go i n t o b a c t e r i o l o g y I would have been i n tandem w i t h D r , Altemeier, But I never l i k e d b a c t e r i o l o g y and I d i d l i k e experimental work and I had had a l i t t l e w o r k w i t h D r , Joseph A, Long a s a n undergraduate i n Berkeley, H e is t h e z o o l o g i s t who t a u g h t embryology t o t h e under- g r a d u a t e s and h i s work i s well-known, e s p e c i a l l y i n a s s o c i a t i o n w i t h H e r b e r t Evans on t h e e s t r o u s c y c l e of t h e r a t , He was a g r e a t tech- n i c i a n , D r , Long. He made l i t t l e knives t o c r o s s - s e c t i o n embryos and I d i d some work w i t h him t o g e t t h e f e e l of i t , I never d i d anything w i t h D r , Long t h a t was published, Anyway, when I mentioned t h i s t o D r , N a f f z i g e r he thought of two people t h a t I might work w i t h , One was D r , Dragstedt, i n Chicago, and t h e o t h e r was "some young f e l l o w " t h a t he knew t h a t was coming along down i n N a s h v i l l e , I very 2 w i s e l y , f o r a change, s a i d t o D r , N a f f z i g e r t h a t I d i d n ' t know e i t h e r of t h e s e men and t h a t I would leave it up t o him, and he arranged f o r me t o go t o D r . B l a l o c k ' s l a b o r a t o r y , So I went i n about June, I g u e s s , i n 1936 and I s t a y e d u n t i l A p r i l 1938. D r , 0,: And you were t h e r e a s a r e s e a r c h a s s o c i a t e , D r . Lo: Yes, t h e t i t l e I had was Research A s s o c i a t e , Incidentally, a s f a r a s funds went, D r , N a f f z i g e r s a i d he could a r r a n g e f o r t h e p o s i - t i o n , but funds he c o u l d n ' t a r r a n g e , He suggested I go and s e e D r . Harold Brunn, Dr, Harold Brunn was v e r y n i c e and he arranged f o r funds f o r t h e f i r s t y e a r and I o n l y found o u t l a t e r t h a t he had asked M r s , Walter Haas f o r t h e funds and she gave him I t h i n k i t was f i v e o r s i x hundred d o l l a r s f o r me t o go. The second y e a r I was a b l e t o g e t a N a t i o n a l Research Council f e l l o w s h i p a f t e r a n i n t e r v i e w w i t h E v a r t s Graham i n St, Louis and t h a t c a r r i e d me through t h e second y e a r , D r , 0,: Well, your f u n c t i o n s t h e n were p r i m a r i l y a s D r , B l a l o c k ' s r i g h t hand i n t h e l a b o r a t o r y , D r , L.: D r , Blalock s t a r t e d me r i g h t o u t i n t h e l a b , I had v e r y l i t t l e c l i n i c a l worko I went t o some of Barney Brooks' l e c t u r e s and ward rounds once i n a w h i l e , but most of my t i m e - - p r a c t i c a l l y a hundred p e r c e n t - f o r t h e whole time was i n t h e l a b o r a t o r y , D r , Blalock would come i n t h e morning and p l a n o u t t h e d a y ' s work and Vivien would assist me--Vivien Thomas, who i s s t i l l a t Hopkins--and we s t a r t e d r i g h t o u t i n doing o p e r a t i o n s and I l e a r n e d a l o t of my t e c h n i c a l t h i n g s from Vivien, The f i r s t t h i n g t h a t I worked w i t h was something 3 D r . Blalock and D r . T i n s l e y Harrison and Morton Mason had developed, and t h a t was a method of measuring t h e blood flaw by passing a long b r a s s cannula w i t h a f e n e s t r a t e d end down t h e cava. L a t e r on I was given a p r o j e c t t o conduct with Vivien and D r , Blalock where I was doing t h e primary work. T h i s was t r a n s p l a n t a t i o n of t h e kidney, D r , 0,: Yes. You've o u t l i n e d your experimental work v e r y n i c e l y i n your paper, "Alfred Blalock a t Vanderbilt : Reminiscences of a r e s e a r c h a s s o c i a t e a f t e r 32 y e a r s , ' ' published i n Vole 9 , No, 6 , t h e November- December 1968 i s s u e of t h e J o u r n a l of Cardiovascular Surgery, One of t h e t h i n g s t h a t we comnented upon p r i o r t o t u r n i n g on t h e machine was t h a t you had seen t h e commentary t h a t Vivien Thomas had made about D r , Blalock i n t h e Vanderbilt y e a r s and subsequently. As we do have your aforementioned paper a s a b a s i c o u t l i n e , we might l e t you s t a r t expanding, a s i t were, on some of t h e s e t h i n g s , I know you f e l t t h a t V i v i e n ' s comments a t times were perhaps a l i t t l e a c i d and I ' m wondering what your f e e l i n g s a r e about Blalock t h e man and how t h e y were manifest i n t h e l a b o r a t o r y a t Vanderbilt and i n your exper- i e n c e i n subsequent y e a r s . Dr, Le: Well, t h a t ' s t h e s u b j e c t of t h e e n t i r e conference, I t h i n k , and t h e s e t h i n g s w i l l come o u t , Last n i g h t I r e r e a d D r , Longmire's l i t t l e speech and, although most of it was v e r y l a u d a t o r y , he d i d have a s e n t e n c e where he mentioned t h a t D r , Blalock was human and had some human f a u l t s . I have made a few n o t e s , but I ' v e mellowed a l o t , 1 had some v e r y bad t i m e s , but on balance i t was a v e r y p r o f i t a b l e two 4 years. Of c o u r s e , I was working v e r y hard and of course t h a t was t h e i d e a t h a t I had i n my mind when I went t h e r e . D r , Blalock was very k i n d i n many ways. He was v e r y f a t h e r l y i n many ways. H i s guidance was o f t e n i n d i r e c t . One t h i n g I remember i n t r y i n g t o r e c a l l some of t h e s e t h i n g s was t h a t I ' d g o t t e n up l a t e a couple of mornings and h a d n ' t shavedo Apparently D r . Blalock n o t i c e d t h i s and one day he came t o t h e l a b without having shaved and he d i d n ' t s a y one word, He d i d n ' t have much of a beard and he had t h e s e s p a r s e h a i r s s t i c k i n g o u t of h i s c h i n and he looked p r e t t y s i l l y , [Laughter] But I g o t t h e p o i n t , One of t h e t h i n g s a l s o t h a t I mentioned i n my papers t h a t D r , Longmire a l s o n o t i c e d was t h a t he t a l k e d t o a l o t of people, He t a l k e d t o Morton Mason, he t a l k e d t o T i n s l e y H a r r i s o n , I ' m s u r e he t a l k e d t o D r , Burwell a l o t when he was t h e r e (he had l e f t j u s t before I a r r i v e d ) and o t h e r people t h a t he admired and he would d i s t i l l i d e a s from them, He would use whatever was good o r u s e f u l t o him and d i s c a r d t h e r e s t . T h i s t r a i t was hard f o r me t o understand i n many ways. It was some- t h i n g c o n t r a r y t o my approach t o t h i n g s , As I s a y , I was a young man-- I t h i n k I was twenty-six--and I w a s s o r t of immature and unsophis- ticated, I thought i t took a p a r t i c u l a r kind of person who would have t h e a b i l i t y of doing t h i s , who was a b l e t o accept t h i n g s i n c l e a r conscience and use o t h e r p e o p l e ' s thoughts. D r . Blalock was always a b l e t o a c c e p t a s w e l l a s t o g i v e and I t h i n k t h i s was something v e r y important t h a t I l e a r n e d from him, t h a t although i t may be t h e B i b l e ' s s t a n d a r d q u o t a t i o n , "It's b e t t e r t o g i v e t h a n t o r e c e i v e , " I t h i n k human n a t u r e r e b e l s a t r e c e i v i n g and many c a s e s of bad blood a r e made 5 by people having t o r e c e i v e i f t h e y d o n ' t want t o , But D r . Blalock was a b l e t o do t h i s and I t h i n k t h i s r e p r e s e n t s h i s s t a t u r e , He was a b i g man and v e r y seldom p e t t y o T h i s r e c a l l s one time when he was p e t t y - - r e a l l y he was p e t t y . He had a feud going w i t h D r . Larson, D r , Larson was i n t h e Surgery Department and I t h i n k he was i n t e r e s t e d i n s u r g i c a l anatomy, i f I r e c a l l . He was a younger man, h i s o f f i c e was i n t h e experimental s i d e of t h e h o s p i t a l which was down t h e h a l l from t h e c l i n i c a l s i d e . I n c i d e n t a l l y , t h i s was a g r e a t arrangement a t Vanderbilt. D r , 0.: The c l o s e proximity t o t h e l a b s . Dr. Lo: Absolutely, and of course t h i s made i t p o s s i b l e f o r D r , Blalock t o t a l k t o everybody-Goodpasture was one of t h e people he l i k e d t o t a l k to--because they were a l l under t h e same r o o f , they a l l had meals i n t h e d i n i n g room and a l o t of c o n t a c t , But t h i s Larson, I d o n ' t know what i t was t h a t got him s t a r t e d , but D r , Blalock locked t h e door between t h e two l a b s and he would not t a l k t o D r , Larson f o r many months and I c o u l d n ' t understand i t . O f c o u r s e , D r , Blalock had q u i t e a temper t o o and he could g e t mad, He g o t mad a t me a couple of times, I t h i n k I mentioned one i n c i d e n t i n t h e paper when he g o t mad. I had gone t o h e a r I r v i n g Abell g i v e a t a l k , I r v i n g A b e l l w a s from L o u i s v i l l e and was P r e s i d e n t of t h e AMA, He gave a t a l k a t Vanderbilt and t h a t a f t e r n o o n I happened t o r u n i n t o D r , Blalock on t h e s t a i r w a y , He s a i d , "How'd you l i k e D r , Abell?" I answered t h a t I thought it was kind of a lousy t a l k , you know, pure p o l i t i c s - - j u s t what you'd expect from t h e P r e s i d e n t of t h e AMA. Well, he g o t f u r i o u s w i t h me. He j u s t g o t red i n t h e f a c e and he s a i d something and marched o f f and I was r e a l l y worried t h a t I had offended him badly. The next day e v e r y t h i n g was t h e same a s always and we went back t o work. Some of h i s g r e a t q u a l i t i e s I ' l l go through f i r s t , and t h e n I ' l l go through some t h a t were not q u i t e so charming, i f I can r e c a l l them, Some of t h e s e I r e c a l l from reading D r , Longmire, One of them was h i s great tenacity. D r , Longmire commented on i t i n r e l a t i o n t o h i s o p e r a t i o n s i n s u r g e r y where h e ' d keep p e r s i s t i n g t r y i n g t o make t h a t anastomosis, where o t h e r people might have given up. Of c o u r s e , D r , Longmire d o e s n ' t t e l l t h e whole t r u t h a t a l l . D r , Blalock was not a good t e c h n i c i a n , and D r , Longmire was a g r e a t t e c h n i c i a n , and w i t h Vivien s t a n d i n g behind them---- Vivien and I had done a l l t h e anas- tomoses i n t h e dogs and we published t h e paper i n t h e J o u r n a l of Thoracic Surgery, which I mentioned, where we connected t h e l e f t sub- c l a v i a n a r t e r y t o t h e l e f t pulmonary a r t e r y , Of c o u r s e , my experience w i t h s u t u r i n g had come from doing t h e kidney t r a n s p l a n t s . Of c o u r s e , I d i d n ' t r e a l i z e it a t t h e time, b u t n o t many people i n t h e country o r i n t h e world were doing v a s c u l a r anastomoses, although t h i s was i n the t h i r t i e s , A c t u a l l y , it may i n t e r e s t you t o know t h a t we had problems w i t h n e e d l e s and s u t u r e m a t e r i a l , The Deknetal No, 6-0 had j u s t come out--5-0, I guess i t w a s - - t h i s was a b e a u t i f u l b r a i d e d s i l k and i t was s t r o n g , b u t t h e r e were no needles t o go w i t h i t , So we found a needle i n t h e o l d Johnson and Johnson a r t e r i a l s i l k which was put up i n a f l u i d i n a g l a s s c a p s u l e , We had t o break t h e g l a s s open 7 and t a k e o u t t h e s u t u r e m a t e r i a l , The s u t u r e m a t e r i a l was r o t t e n , it would break i f you j u s t touched i t , b u t t h e needle was a s t r a i g h t needle w i t h a n eye. When we, t h a t i s , Vivien and I, f i r s t looked a t t h i s needle we c o u l d n ' t s e e t h e e y e ; we had t o put it under a micro- s c o p e o But l a t e r on we could t h r e a d i t , maybe because we knew t h e eye was t h e r e and we d i d a l l our anastomoses t h e whole time I was a t Vanderbilt w i t h a s t r a i g h t n e e d l e o I b e l i e v e t h a t ' s what C a r r e l used t o o - - s t r a i g h t needles When I l e f t Vanderbilt I met my younger b r o t h e r i n New York and we went t o Europe f o r seven weeks and i n Florence I was a b l e t o f i n d some l i t t l e curved round needles which I took home and I used a t UC when I d i d my f i r s t work t h e r e on p a t e n t ductus a r t e r i o s u s , This tenacity of D r . B l a l o c k ' s i n t h e o p e r a t i n g room i s one t h i n g , b u t he a l s o had i t i n o t h e r ways, t o o , I f he had a problem, something he was t h i n k i n g about, he would come down t o t h e l a b , not o f t e n , o c c a s i o n a l l y h e ' d come down t o t h e l a b , and h e ' d b r i n g a l e t t e r t h a t he had t o answer o r some kind of problem and he'd t a l k about i t , T h i s was v e r y f l a t t e r i n g t o me, o f c o u r s e , because I was j u s t a young person, but I t h i n k he d i d it p a r t l y t o show me how t o t h i n k about t h i n g s b u t he never l a b e l e d i t a s sucho Of c o u r s e , I g o t a g r e a t d e a l o u t of h e a r i n g t h e s e d i s c u s s i o n s , He would ask my o p i n i o n and of course I ' d be a l i t t l e embarrassed because I d i d n ' t know why he was a s k i n g me. I d i d n ' t know a n y t h i n g o So he would t o y w i t h v a r i o u s answers and t h i n k and s t r u g g l e w i t h what he was going t o s a y u n t i l he got it r i g h t and he would answer t h e l e t t e r o r make a d e c i s i o n , He was a g r e a t one f o r making d e c i s i o n s , H i s desk was nothing l i k e t h i s , It was a b s o l u t e l y c l e a n and he'd do h i s correspondence everyday and he was a v e r y , well-organized person, He d i d n ' t waste a minute, I n c i d e n t a l l y , he had a l o t of energy, The two y e a r s I was a t Vanderbilt he had p r a c t i c a l l y no sickness. He'd have a c o l d once i n awhile, I understand s h o r t l y a f t e r I l e f t Vanderbilt he had h i s g a l l b l a d d e r out and I t h i n k he was a i l i n g q u i t e a b i t and b e f o r e , of c o u r s e , h e ' d had t u b e r c u l o s i s and l o s t a kidney, D r . Longmire, i n a l e t t e r t o me (I c o u l d n ' t f i n d t h e l e t t e r l a s t night) s a i d , and I t h i n k I quoted it i n t h e paper, t h a t t h e two y e a r s t h a t I happened t o be t h e r e were v e r y , v e r y productive years i n h i s career. I t h i n k p a r t of i t was because I was v e r y dedi- c a t e d t o working and I wanted t o produce a s I f e l t I awed a l o t t o D r , Brunn f o r digging up t h e f i n a n c e s f o r me t o go and t o my b o s s , D r , N a f f z i g e r , and of course I w a n t e d t o g e t a r e s i d e n c y i n s u r g e r y after I left, I n c i d e n t a l l y , D r , Blalock i n s i s t e d t o me, every time t h e q u e s t i o n came up, t h a t I must go back and t a k e my residency. This i s what I meant e a r l i e r t h a t he took a p a t e r n a l i n t e r e s t and r e a l l y guided me and was a v e r y good person t o t a l k t o i f you had a problem, As f a r a s t a l k i n g t o him about h i s p e r s o n a l problems, g e t t i n g c l o s e t o him i n any way, it w a s n ' t . He was t h e boss and I was t h e s l a v e , b u t i t worked o u t f o r me and I t h i n k i t worked o u t f o r him. Although when he wanted t o be, o f c o u r s e , he could be a b s o l u t e l y charming t o me o r t o anyone e l s e , He was v e r y warm. Another t h i n g t h a t always s t r u c k me when I was t h e r e and i n r e t r o s p e c t , he always knew t h e r i g h t word t o say t o t h e r i g h t person-a master a t t h i s , D r . N a f f z i g e r was a v e r y good p o l i t i c i a n , a very powerful man and a v e r y a s t u t e mano When you were on D r , N a f f z i g e r ' s s e r v i c e i n neurosurgery we a l l worked very hard, One of my c o l l e a g u e s , s e n i o r t o me and a r e s i d e n t , always c a l l e d D r , N a f f z i g e r ' s s e r v i c e t h e "six-month t r i a l by f i r e , " I'm s u r e you, having been through s u r g i c a l t r a i n i n g , know what I mean. We used t o have t o g e t up e a r l y and shave t h e p a t i e n t s ' heads f o r him and woe be unto us i f we were l a t e o r anything. I n comparison t o D r , N a f f z i g e r , D r , Blalock r e a l l y could outcharm and o u t p o l i t i c D r , N a f f z i g e r and I t h i n k t h a t ' s saying a g r e a t d e a l . Now my t h i r d p r e c e p t o r , D r , Brunn, was a d i f f e r e n t kind of personc He was a v e r y warm, j o l l y , f r i e n d l y fellow. Somebody ought t o w r i t e a biography of him sometime, because he helped a l l t h e young men i n town, p a r t i c u l a r l y t h o s e a s s o c i a t e d w i t h t h e Mount Zion H o s p i t a l where he was c h i e f , He was a l s o c h i e f a t t h e San F r a n c i s c o County H o s p i t a l , and you may know t h a t he v e r y badly wanted t o be t h e p r o f e s s o r a t UC and D r , Naffziger got t h e j o b i n s t e a d of D r , Brunn, But D r , Brunn was l o y a l t o D r , N a f f z i g e r and he worked w i t h him f o r many years. D r , Brunn was a v e r y powerful man. Had a b i g p r a c t i c e , He was a pioneer i n t h o r a c i c s u r g e r y and he d i d t h e f i r s t lobectomy, I b e l i e v e , and D r , Graham d i d t h e f i r s t pneumonectomy, Another t h i n g about D r , Blalock, on t h e p l u s s i d e , was t h a t he always gave c r e d i t when he g o t i d e a s from people. He always remembered where he got h i s i d e a s , He had a fabulous memory and a fabulous mind, He was v e r y q u i c k and he always gave c r e d i t , Maybe t h i s i s why he was 10 a b l e t o t a k e i d e a s and use them because he f e l t t h a t i t was f i f t y - f i f t y o Another one of h i s t r a i t s t h a t I came on v e r y e a r l y t h e r e - - - - i f he d i d a f a v o r f o r you, you had t o do a f a v o r f o r him, r i g h t away quick. He always thought of something. I f I did something f o r him, you know l i k e doing t h e l a b work, my name always went on t h e paper, and v e r y o f t e n f i r s t which was v e r y generous i n a way, b u t not r e a l l y , because i f somebody r e a d t h a t paper t h e y ' d s a y , "Oh, D r , Blalock wrote a paper." T o t h i s day although I ' m s u r e I c o n t r i b u t e d more t h a n a l i t t l e , people l i k e D r , Ochsner who quote t h e e a r l y o p e r a t i o n , "Who d i d t h e l e f t s u b c l a v i a n and l e f t pulmonary?'' h e ' d s a y Blalock, My name i s f i r s t on t h a t paper and i t was f i r s t f o r a v e r y good reason. I d i d a l l t h e l a b work. Now i t ' s t r u e , t h e idea came from D r . Blalock. He walked i n t h e l a b one day and he s a i d , " L e t ' s do t h i s , " Now one t h i n g about D r , Blalock t h a t ' s n o t a s complimentary is t h i s - - - - - - I am v e r y s u r e t h a t he knew who d i d t h e f i r s t o p e r a t i o n o f s u t u r i n g t h e l e f t s u b c l a v i a n t o t h e l e f t pulmonary a r t e r y . It was a German L gentleman named J e g e r because J e g e r ' s book on v a s c u l a r s u r g e r y was i n t h e l i b r a r y a t Vanderbilt. I had been t r y i n g f o r y e a r s t o g e t a copy--I c o l l e c t o l d medical books and I had t r i e d through S p r i n g e r , and Old Hickory, and Argosy, and Steckert-Hafner, and I ' v e never been a b l e t o g e t a copy, I imagine a l o t of t h e books i n Germany were destroyed during t h e War, I ' v e been d i c k e r i n g w i t h one of t h e - - 1 t h i n k i t ' s Springer--who a r e coming o u t w i t h a r e p r i n t of t h i s book and 1 have it on o r d e r f o r over a year and I keep g e t t i n g l e t t e r s , t h e y ' r e going t o have it come out v e r y soon, This was a n important book, I t h i n k G u t h r i e ' s book on v a s c u l a r s u r g e r y and C a r r e l and t h i s J e g e r which was 1912 o r 1914 were r e a l l y b a s i c books on v a s c u l a r s u r g e r y o A s you know, t h e Germans were doing e v e r y conceivable exper- i m e n t a l procedure i n t h e whole world p r i o r t o World War I. I ' m sure D r , Blalock g o t i t from t h e r e and he never mentioned i t t o me and he never quoted Jeger, He d i d n ' t have t o , so he d i d n ' t , Dr. 0.: I t ' s an i n t e r e s t i n g m a n i f e e t a t i o n t h a t comes along l a t e r , I t h i n k , t o o , a t t h e time of t h e Blalock-Taussig procedure, D r , Le: Well, you know a l o t more about some of t h e s e t h i n g s t h a t happened a f t e r . A f t e r t h e War, I put i n f i v e y e a r s i n t h e s e r v i c e , and when I g o t o u t D r , Blalock was n i c e enough t o i n v i t e me back t o Hopkins. That was v e r y decent of him. A f t e r I got o u t , I d i d n ' t r e a l i z e i t but I ' m s u r e many of t h e people who were i n t h e s e r v i c e found o u t t h a t t h e y had a hard time a d j u s t i n g t o a d i f f e r e n t l i f e a f t e r f i v e y e a r s o There were a l o t of things--we'd only operated on h e a l t h y young men and we d i d n ' t s e e any cancer work o r any female s u r g e r y o r any c h i l d r e n ' s work, s o t h a t t h e r e was a l o t of c a t c h i n g up t o do and a l s o a l o t of r e a d j u s t i n g t o do, D r , N a f f z i g e r was n i c e enough t o l e t me go back t o UC f o r t h r e e months where I a c t e d a s a r e s i d e n t because I had l e f t a r e s i d e n c y , and t h e n D r , Blalock. I went back t h e r e , I t h i n k , a month and s p e n t t h e time w i t h Richard Bing l e a r n i n g h e a r t c a t h e t e r i z a t i o n which I brought back h e r e and I was t h e f i r s t one t o do i t h e r e on t h e West Coast, I d i d a l l t h e c a t h e t e r i z a t i o n s a t Mount Zion H o s p i t a l f o r s i x y e a r s and a l l t h e c a r d i a c s u r g e r y f o r t e n y e a r s u n t i l t h e pumps came i n . 12 When I was back w i t h Richard Bing he t o l d me some t h i n g s about t h e Blalock-Taussig c o n t r o v e r s y a s t o whose name was t o be f i r s t on t h e i r paper and a l s o a t some l a t e r t i m e , I had d i n n e r w i t h him i n Chicago once and he t o l d me how badly D r . Blalock wanted t o r e c e i v e a Nobel P r i z e . Well, D r . Blalock---- Are you aware of some of t h i s ? Dr. 0.: No, I h a d n ' t r e a l i z e d t h a t , b u t I'm not s u r p r i s e d . D r . Lo: Yes, w e l l , D r . Blalock was n o t a shy v i o l e t , He was v e r y a g g r e s s i v e when i t came t o something he wanted and he p u l l e d every s t r i n g imaginable, and t h i s time he d i d n ' t succeed i n g e t t i n g i t , But t h i s i s a n o t h e r s i d e l i g h t i n t o D r , Blalock, T h i s s i d e of him, o f c o u r s e , I d i d n ' t s e e t o o much a t V a n d e r b i l t , I was i n a j u n i o r p o s i t i o n and my j o b t h e r e was t o work hard and do a l o t of experimental work, We published s i x t e e n papers when I was t h e r e and t h i s was a p r e t t y good output f o r two people i n two y e a r s , I t h i n k . An example of h i s kindness and how warm and f r i e n d l y he could be i s t h i s - -=- he came t o San F r a n c i s c o w i t h t h e American College and D r , Brunn e n t e r t a i n e d him and took him t o M r s , Haas' home f o r cock- t a i l s , and D r . B l a l o c k , without even mentioning i t t o me a t any time, c a l l e d up my mother, and t h i s was a v e r y n i c e t h i n g , He t a l k e d t o h e r ) f o r a l i t t l e while and she was v e r y p l e a s e d t o h e a r from him. I had t h e impression when I was down a t Vanderbilt t h a t D r , Blalock never d i d anything w i t h o u t c a l c u l a t i n g i t o u t f i r s t , He planned every s t e p , every move, and you could j u s t s e e him doing i t f o r h i s whole l i f e , planning h i s g o a l s and t h e n going o u t and making them come t r u e o f 13 Of c o u r s e , t h i s i s a kind of a c h a r a c t e r i z a t i o n which many people would f i n d r e p u l s i v e because i t reduces t h e man t o some kind of machine and t a k e s away a l o t of t h e human v a l u e s t h a t a person could have. Of c o u r s e , i n my r e l a t i o n s h i p t o him, although t h e r e were human v a l u e s , I sometimes had t h e f e e l i n g t h a t when he t a l k e d t o me i t was a c a l - c u l a t e d t h i n g and t h a t he was t e l l i n g me what I wanted t o h e a r r a t h e r than---- i n o t h e r words, he was manipulating me r a t h e r t h a n i t coming from t h e h e a r t , T h i s was D r , Blalock, D r . 0.: I g a t h e r , a t one time he and Barney Brooks had some s o r t o f a n out. I d o n ' t know whether i t was a l l i e d t o h i s being asked o r going t o Hopkins without c o n s u l t i n g w i t h h i s c h i e f o r what, but I g a t h e r t h e i r r e l a t i o n s h i p was one8of r e s p e c t but n o t a g r e a t d e a l of warmth. D r . Lo: I d o n ' t know i f you e v e r read h i s o b i t on Barney Brooks, D r , 0,: I don't think I dJd. D r . Le: I t h i n k i t ' s i n t h e SG&O, I ' m n o t s u r e , Wait a minute. It's i n h i s bound volumes, The Papers of Alfred Blalock, D r , 0.: Then I probably have read i t but t h a t was some w h i l e ago. D r , Lo: T h i s %s s o m t h i n g t h a t I read y e a r s l a t e r and t h i s was n o t t h e Blalock 1 knewo D r , 0.: It d i d not r i n g t r u e , i n o t h e r words, D r . Lo: Oh, he was v i c i o u s , almost v i n d i c t i v e . D r . 0,: Of Brooks o r v i c e v e r s a ? Dr. Lo: Yes, t h e y asked him t o w r i t e i t and he could be honest a t times when i t p l e a s e d him, He was a l i t t l e t o o h o n e s t , I thought, But he d i d it i n a s u b t l e way f o r anybody who d i d n ' t know him o r know Barney Brooks. And i t probably read a l l r i g h t t o M r . Jones o r D r , Jones--John Jones o r John Doe--but I t h i n k i f you read i t y o u ' l l be a l i t t l e shocked t h a t he would w r i t e something l i k e t h a t , I think he was something l i k e Richard Nixon and he was u s u a l l y concerned about h i s image i n h i s t o r y and t h i s i s nothing t o g i v e him a very n i c e image. I t ' s a v e r y i n t e r e s t i n g document i n r e l a t i o n t o D r . B l a l o c k ' s c h a r a c t e r . A s I mentioned e a r l i e r , Barney Brooks could not be a warm person, His house s t a f f were never c l o s e t o him, He was n i c e enough t o me, I went and asked him f o r a photograph b e f o r e I l e f t and he g r u f f l y s a i d something about how I ' d done some good work t h e r e o r something l i k e that, He was a r e a l s t i n k e r t o a f r i e n d of mine a t Vanderbilt named Bernard Weinstein. D r . Brooks would n o t have a Jewish r e s i d e n t and t h e r e a r e two s t o r i e s about t h a t , One i s Bernie Weinstein was i n l i n e f o r t h e r e s i d e n c y and D r , Brooks arranged f o r him t o have i t with C u t l e r i n Chicago i n s t e a d of a t Vanderbilt. Another s t o r y i s from a f r i e n d of mine from h e r e named M i l t o n Rosenberg, who i s a v e r y f i n e u r o l o g i s t h e r e i n town. Milton Rosenberg i s from North Carolina o r South Caro- l i n a and he went t o s e e h i s p r o f e s s o r about a y e a r i n g e n e r a l s u r g e r y b e f o r e going i n t o urology, He'd had a y e a r o r two of t r a i n i n g t h e r e and t h e chairman of t h e department thought he might b e n e f i t from a y e a r i n g e n e r a l s u r g e r y somewhere. So M i l t o n , w i t h naivete', s a i d , "What 15 about going down t o V a n d e r b i l t ? " because he'd heard t h a t was a good s c h o o l , and t h e f e l l o w looked a t him and s a i d , "Don't you know Barney Brooks i s p r o f e s s o r t h e r e ? " So t h a t was o u t f o r Milton. D r , 0,: I g a t h e r u n t i l v e r y r e c e n t l y i t was extremely d i f f i c u l t i n many p l a c e s t o be a c h i e f r e s i d e n t a s a Jew. Certainly t h e profes- s o r s h i p s were s c a r c e a s could be. D r , Lo: We had t h e problem a t UC, and Leon Goldman, Jake Smith, and I were t h e only Jewish r e s i d e n t s e v e r a t UC f o r many, many years,, Another t h i n g t h a t I f e l t when I was working w i t h D r . B l a l o c k , and t h i s is p a r t of h i s t e n a c i t y because he r e a l l y was t e n a c i o u s , He was l i k e a bulldog when i t came t o a problem; he'd f i n a l l y work e v e r y t h i n g out. There was t h e f e e l i n g t h a t he was a competitor. I had t h e f e e l - i n g t h a t he was pacing me; t h a t he was running ahead of me and I was t r y i n g t o keep up w i t h him and it was t h e dog with t h e s t i c k and t h e c a r r o t idea, T h i s was of course a g r e a t means of s t i m u l a t i n g me. I guess everybody l i k e s t o t a k e i t e a s y a t times and I ' m not a w e l l - organized person and through h i s i n f l u e n c e I r e a l l y accomplished a g r e a t d e a l and d i d a n awful l o t of work, As I s a y , my i n t e n t i o n s were good; I intended t o work, Having j u s t f i n i s h e d a n i n t e r n s h i p a t t h e San F r a n c i s c o County H o s p i t a l , which i s now San F r a n c i s c o General H o s p i t a l , and working s i x t e e n and e i g h t e e n hours a day; I was used t o working, But w r i t i n g papers was something t h a t I s t i l l d o n ' t do w e l l and f i n d i t v e r y h a r d t o do, I ' l l come t o D r , B l a l o c k ' s w r i t i n g i n a minute, But t h i s i d e a of being a competitor was s t i m u l a t i n g but a l s o 16 s o r t of f r u s t r a t i n g because I never d i d c a t c h up t o him, P a r t of t h i s was t h a t he would never ask you t o do something t h a t he wouldn't do. I f you were supposed t o g e t t h e r e e a r l y i n t h e morning, he was t h e r e t o o , and e a r l i e r , T h i s reminds me of a s t o r y I heard when I was t h e r g about him and Barney Brooks. I t h i n k he o f t e n i r r i t a t e d Barney Brooks because h i s mind was v e r y f a s t and Barney's was not a s fast. He would make remarks sometimes t h a t would embarrass Barney Brooks, One s t o r y I heard-and w e ' l l go i n t o t h i s more when we t a l k about h i s drinking--was t h a t he came t o rounds on a Sunday morning which were h e l d v e r y e a r l y , t h e r e ' d been a b i g p a r t y t h e n i g h t b e f o r e and he had g o t t e n home v e r y l a t e and he could h a r d l y s t a n d up on h i s f e e t , but he was a t t h o s e rounds. He was s o r t of r e e l i n g around but s t i l l having t r o u b l e w i t h h i s e q u i l i b r i u m , As f a r a s Barney Brooks goes, I d o n ' t know t h e whole s t o r y of t h e i r r e l a t i o n s h i p , b u t he d i d want t o be promoted and he became f u l l p r o f e s s o r a t t h e age of t h i r t y - seven, I g u e s s , when I was t h e r e , D r , 0.: Yes, but not chairman, D r . Lo: Not chairman. Oh no, Barney Brooks was Chairman, So I guess he was i n t e r e s t e d i n looking, While I was t h e r e , f o r s u r e , he went t o Ford H o s p i t a l because when he came back he t o l d me about v i s i t i n g w i t h Henry F o r d - - t h i s was s e n i o r , I ' m p r e t t y sure-and t h a t Henry Ford had given him a watch, Henry Ford l i k e d t o do watchmaking a s a hobby and gave D r , Blalock a p r e s e n t of a watch which D r . Blalock was v e r y pleased about, I had w r i t t e n t o my b o s s , D r . N a f f z i g e r , a t t h e time 17 about i t (I saw i n my l e t t e r s ) and D r , Naffziger wrote back t h a t he was s u r e t h a t he wouldn't t a k e t h e j o b t h e r e because i t w a s n ' t a u n i v e r s i t y setup. D r , Blalock was a l s o c o n s i d e r i n g L o u i s v i l l e ; maybe t h a t ' s why he got s o mad a t me when I t o l d him about Abell, But D r , N a f f z i g e r d i d n ' t t h i n k L o u i s v i l l e was t h e proper place f o r him either, He considered i t s o r t of a second-class s i t t a t i o n , There's one o t h e r s t o r y I r e c a l l : when D r . Blalock was a t Hopkins he was t r y i n g t o g e t an i n c r e a s e i n h i s s a l a r y , As you know, D r . Graham was t h e h i g h e s t paid p r o f e s s o r o f s u r g e r y a t one time; i n t h e t h i r t i e s he was g e t t i n g $35,000 I t h i n k . D r , Blalock was working f o r what he thought was peanuts a t Hopkins, s o h e was o f f e r e d a j o b a t P6S which Humphreys l a t e r g o t and D r , Blalock manipulated t h i n g s - - t h i s was D r . Blalock a s a p o l i t i c i a n , i n h i s c h a r a c t e r a s a p o l i t i c i a n - - a n d he manipulated t h i n g s and waved t h i s appointment and t h r e a t e n e d t o leave and go up t o New York, u n t i l he got h i s r a i s e . D r , 0.: He a l i e n a t e d a few people w i t h t h a t maneuver, I t h i n k , i n Baltimore. D r , Le: Well, he must have made somebody f u r i o u s , b u t he got what he wanted. I heard t h a t , I t h i n k , from Richard Bing, too. Do you want t o t a l k about a l c o h o l i s m ? D r , 0,: Yes, I t h i n k t h a t ' s a s e r i o u s problem t h a t he was a p p a r e n t l y faced w i t h f o r p a r t of h i s c a r e e r . C e r t a i n l y i n my day he had a problem e D r . Lo: I n my day it w a s n ' t a problem, He l i k e d t o d r i n k and he got smashed a few t i m e s , I understand, a t p a r t i e s , but I w a s n ' t a t any of t h e p a r t i e s where he got smashed, N a s h v i l l e was a g r e a t place f o r parties. I was a n o u t s i d e r ; I was a s t r a n g e r i n a f o r e i g n land, N a s h v i l l e was more f o r e i g n t o me t h a n many c o u n t r i e s i n Europe I ' v e since visited, I came from t h e West where people thought about t h i n g s differently. The f i r s t time I rode on a J i m Crow c a r , I s a t i n t h e back where I l i k e t o s i t and found t h a t I was s i t t i n g among a l l t h e b l a c k people, I d i d n ' t r e a l i z e what I had done u n t i l l a t e r . I was shocked one morning when a black man was walking dawn t h e s t r e e t toward me and t h e b l a c k man walked i n t o t h e g u t t e r and he took o f f h i s h a t - - a n o l d darkie--and he s a i d , "Good morning, s u h , how a r e you suh?'' I j u s t f e l t s i c k about i t , So t h e s e were t h i n g s t h a t I---- and a l s o t h e Jewish people t h e r e . I remember Bernard Weinstein bragged t o me about how t h e y had t h e i r own g o l f course and t h e i r own country c l u b and t h e i r own p a r t of town where they l i v e d i n t h e i r n i c e homes and of course t h i s d i d n ' t s t r i k e me a s being anything t o be v e r y proud about, The p a r t i e s were g r e a t , Everybody went t o them and everybody had a good time. T h i s was r e a l s o u t h e r n h o s p i t a l i t y , The s c h o o l had p a r t i e s , t h e undergraduate s c h o o l , t h e medical s c h o o l , and everybody r e a l l y g o t together, A s f a r as alcoholism, it w a s n ' t a problem e i t h e r with him o r w i t h Mary Blalock when 1 was t h e r e , H i s c h i l d r e n were young. Mrs. Blalock used t o come t o t h e l a b once i n awhile w i t h t h e k i d s and s a y h e l l o , and I was a t t h e i r home a few times. He l i k e d t o d r i n k and I remember he i n v i t e d me o v e r New Year's Day t o watch t h e Rose B o w l game 19 because i t was o u t on t h e Coast and he knew I ' d l i k e t o watch i t , and h e ' d pour me t h e s e s t r o n g d r i n k s and I ' m not a d r i n k e r , I can d r i n k a d r i n k o r two, b u t when he poured them, wow: and I ' d j u s t have t o l e a v e them t h e r e . I f e l t t h a t I w a s n ' t a v e r y good s p o r t , t h a t he would p r e f e r t h a t I d r i n k w i t h him b u t I j u s t c o u l d n ' t keep up, Then of course l a t e r on i t ' s a l l heresay about Mary becoming v e r y s i c k and having l i v e r t r o u b l e and t h e n A 1 having a problem, t o o o Vivien t o l d me about t h a t when I v i s i t e d back t h e r e . He'd lock h i m s e l f up a f t e r d i n n e r w i t h a b i g d r i n k and a p p a r e n t l y he worked i n t h e evening i n t h i s way, But of c o u r s e a l o t of b r i l l i a n t people have been a b l e t o work and d r i n k , l i k e Edgar A l l e n Poe and s o on, but i n N a s h v i l l e i t wasn't evident. One of t h e v e r y n i c e people i n N a s h v i l l e was Cobb P i l c h e r . He w a s a neurosurgeon. He was r e l a t i v e l y young, and I d i d n ' t know i t b u t a p p a r e n t l y he had a d r i n k i n g problem and committed s u i c i d e . D r , 0.: Is t h a t , I d i d n ' t r e a l i z e he committed s u i c i d e . I know he d i e d around t h e age o f f o r t y - f i v e , D r . Le: Yes, Gee, h e was a n i c e guy, He was a neurosurgeon w i t h a tremor, b u t h i s tremor always stopped a t t h e r i g h t moment when he was operating. D r . Blalock always used t o s a y t h a t every neurosurgeon he knew was c r a z y except Cobb P i l c h e r and D r . N a f f z i g e r , But D r , P i l c h e r was a v e r y , v e r y n i c e mano Very k i n d , D r , N a f f z i g e r became disenchanted w i t h D r , Blalock, He was i n love 20 w i t h him when he s e n t me t o Vandcrbilt and he thought a g r e a t d e a l of him; admired him a l o t ; thought he was a f i n e young man coming on, I n h i s l e t t e r s when I was a t V a n d e r b i l t , D r , N a f f z i g e r mentioned t h a t he would l i k e o r was c o n s i d e r i n g having D r , Blalock come o u t a s p r o f e s s o r on t h e West Coast but I doubt i f t h e i n v i t a t i o n e v e r be- came formulated; i t j u s t d i d n ' t come t o f r u i t i o n . A f t e r t h e War when 1 was i n p r a c t i c e h e r e a t home, D r , B l a l o c k ' s name came up and D r , N a f f z i g e r made some c r a c k about him, The o t h e r n i g h t I was t a l k i n g t o D r , John B o deC, M, Saunders about i t . I n c i d e n t a l l y , I mentioned t h a t you were coming o u t and he had met D r , Blalock during t h e War, D r , Blalock and D r , N a f f z i g e r went t o P e a r l Harbor t o s e e how t h e wounded were cared f o r . D r , Saunders and D r , Abbott--Abbott was an o r t h o p e d i s t , p r o f e s s o r a t UC--went t o Mare I s l a n d t o s e e how t h e wounded brought i n from P e a r l Harbor, p a r t i c u l a r l y o r t h o p e d i c c a s e s were cared f o r , and a p p a r e n t l y t h e wounded were v e r y w e l l cared f o r i n both p l a c e s , according t o t h e i r r e p o r t , A t t h a t time I guess D r , Blalock and D r . N a f f z i g e r were s t i l l q u i t e f r i e n d l y , But D r , N a f f z i g e r got turned o f f i n some wayo D r , Saunders s a i d t h a t although D r , N a f f z i g e r would t a k e a d r i n k , he was somewhat abstemious and I guess a l i t t l e p u r i t a n i c a l about i t , Another s t o r y t h a t I r e f e r r e d . . t o e a r l i e r about d r i n k i n g was w i t h D r , 0, T o C l a g g e t t o D r , 0,: Claggett of Mayo, 21 D r , L.: Mayo C l i n i c . Dr. Claggett was s i t t i n g next t o me a t a d i n n e r of t h e P a c i f i c Coast S u r g i c a l , I t h i n k it was, i n Palm Springs, M r s , Clark-A1 C l a r k ' s wife--was s i t t i n g between us and B i l l S i l e n was s i t t i n g a c r o s s from me ( B i l l is P r o f e s s o r a t Haward a t Beth I s r a e l ; he took F i n e ' s p l a c e and h e ' s from Cal) and B i l l s a i d t o me, "What's t h i s about D r . B l a l o c k ' s d r i n k i n g ? " I s a i d , "Well, he l i k e d h i s d r i n k , he drank s t r o n g d r i n k s and he drank q u i t e a b i t . " Of c o u r s e , I ' d heard s t o r i e s about h i s d r i n k i n g a f t e r he went up t o Hopkins, Claggett s a i d , I'We11, I knew A 1 Blalock and I s t a y e d a t h i s house and he s t a y e d a t my house and t h a t man never drank t o o much a t a l l ; I ' v e never s e e n him i n t o x i c a t e d , " and he was v e r y huffy. H e had t o defend D r . Blalock which was a s i n i n e , I thought. I guess i t i l l u s t r a t e s t h e c l o s e f e e l - i n g people sometimes develop f o r t h e i r f r i e n d s , Anyway, I was q u i t e s u r p r i s e d a t D r . C l a g g e t t because I f i g u r e d he was a n o u t s t a n d i n g man w i t h a tremendous background and t h a t he would be a l i t t l e more s o p h i s - ticated, But he was q u i t e offended t h a t we would even d i s c u s s i t , About h i s technique i n s u r g e r y , You know R a v i t c h ' s d e s c r i p t i o n about t h e whining. D r , 0,: Oh y e s , I experienced t h a t p e r s o n a l l y , D r . L.: Oh yese When I went back, Harry Muller was r e s i d e n t and he took a b e a t i n g f o r hour a f t e r hour. Not i n c h a r a c t e r because he had such c o n t r o l o u t of t h e o p e r a t i n g room, b u t i n t h e o p e r a t i n g room I guess not. Maybe, I d o n ' t know, he had t o l e a r n a l o t of g e n e r a l s u r g e r y a f t e r he l e f t V a n d e r b i l t , He d i d v e r y l i t t l e t h e r e , I remember he did a thoracotomy, I t h i n k I was i n t h e o p e r a t i n g room a t t h e time, The o p e r a t i n g room a t V a n d e r b i l t was s o r t of i n t e r e s t - i n g because i n t h e summer i t was h o t t e r t h a n h e l l and t h e y had a b i g bowl of i c e w i t h a f a n behind i t blowing toward t h e o p e r a t i n g t a b l e t o c o o l t h e O,R, off, The procedure w a s f i n i s h e d and D r , Blalock was going t o put i n a c h e s t tube f o r suction-an underwater s e a l s u c t i o n , He p u t t h e tube i n and h i t t h e i n t e r c o s t a l a r t e r y and t h e p a t i e n t began t o s p u r t blood, How could he do i t ? I guess he j u s t had capa- b i l i t i e s i n t h a t direction. I n t h e l a b he would do t h i n g s l i k e passing t h e cannula down, b u t a c t u a l l y a f t e r I g o t s t a r t e d t h e r e he did very l i t t l e operating. Once i n awhile he'd come i n j u s t t o show t h a t he w a s one of t h e boys and he could do anything we could do and t h a t he w a s n ' t going t o a s k us t o do something t h a t he wouldn't go. That w a s t h e f e e l i n g I g o t , but a s you know, he wasn't e x p e r t a s a technician, D r . 0.: I t h i n k Ravitch, i n h i s b i o g r a p h i c a l s k e t c h of Blalock, glosses over the s i t u a t i o n , He s a y s t h i s is h i s way o f t e a c h i n g , Having s t o o d next t o t h i s man many a time where h e ' s r e p e a t e d ques- tions t o the resident: "Is t h i s a b i g enough b i t e ? ' ' "Should 1 put t h e s u t u r e t h e r e ? " and n o t j u s t i n a q u i z z i c a l way b u t sometimes almost panicky and whining. It was q u i t e a n eye-opener, D r , Lo: I t h i n k y o u ' r e probably r i g h t , Now M r s , Grebel, when I was a t Hopkins working up some m a t e r i a l f o r t h a t paper, I t a l k e d t o h e r about D r , Blalock and she made a n i n t e r e s t i n g p o i n t , t h a t he could 23 never do anything. He c o u l d n ' t open a window,, He c o u l d n ' t t u r n on the heat, He c o u l d n ' t a d j u s t t h e t h e r m o s t a t , He was completely h e l p l e s s and she would have t o do everything. Well, t h i s was a device of D r . B l a l o c k ' s f o r o t h e r people. He t r a i n e d them t o look a f t e r him s o t h a t he wouldn't have t o do anything he d i d n ' t want t o o r anything time-consuming himself SO he was f r e e t o do a l l t h e many t h i n g s he d i d , Of c o u r s e , I was impressed w i t h h i s o u t p u t , He was a dynamo. A t Hopkins he would have lunch and t h e n go t o t h e Hunterian everyday. He had a tremendous number of l e t t e r s t o d i c t a t e , He would w r i t e papers which he would do a t n i g h t . I t h i n k t h i s i s t h e way he conducted t h i n g s s o people would do t h i n g s f o r him, As f a r a s h i s c o n s u l t i n g t h e r e s i d e n t , t h i s i s always f l a t t e r i n g t o t h e r e s i d e n t , t o o , and t h i s i s t h e way he handled t h e r e s i d e n t t o g e t t h e g r e a t e s t output from him, Of c o u r s e , &is was good f o r t h e r e s i d e n t , I guess, but i t was a l s o good f o r D r . Blalock. I had a l i t t l e remembrance i n connection w i t h h i s being f a i r and g i v i n g c r e d i t . I was g e t t i n g ready t o come home (I was going t o Europe w i t h my b r o t h e r f i r s t and t h e n come home), I was g e t t i n g ready t o l e a v e Nashville and t h i n g s were a l i t t l e s t r a i n e d w i t h D r . Blalock and me because, you know, I ' d put i n two y e a r s and worked v e r y h a r d and I was ready f o r a change. He was a l l r i g h t ; he had a d i n n e r f o r me a t h i s home w i t h t h e r e s i d e n t s . I n c i d e n t a l l y , he only put white meat on my p l a t e which I i n t e r p r e t e d a s being a l i t t l e p a t r o n i z i n g - t h a t was chicken o r t u r k e y , whatever i t was. I happen t o l i k e dark meat. [Laughter] Anyway, we had done a l o t of work with t h e G o l d b l a t t clamp and we had some dogs i n which 24 we had put G o l d b l a t t clamps, a t D r . B l a l o c k ' s s u g g e s t i o n , on t h e s u p e r i o r and i n f e r i o r mesenteric a r t e r y , Of c o u r s e , t h i s i s a demon- s t r a t i o n of how f a r r e a c h i n g h i s experiments took him and how modern some o f t h e s e experiments a r e because only i n r e c e n t y e a r s have people become aware of abdominal angina and p e r f o r a t i o n s from n e c r o s i s of bowel w a l l and SO on, But we were doing t h i s i n connection with hyper- t e n s i o n and t r y i n g t o produce h y p e r t e n s i o n and nothing happened, So I got a b r i g h t idea-I used t o brood about t h e s e t h i n g s t o o and s i t up and worry and wonder about t h i n g s t o do, p a r t l y because D r , Blalock had shown me t h e way and how t o t h i n k about problems,, T h i s was one o f t h e f u n t h i n g s about r e s e a r c h . You can be c r e a t i v e , you can do new t h i n g s , and t h i s was one of t h e p a r t s t h a t was most s t i m u l a t i n g , If you could b r i n g something i n and h e ' d g i v e you a p a t on t h e back t h i s was p r e t t y good f o r morale, So I g o t t h e i d e a maybe i f a f t e r produc- ing ischemia of t h e bowel, we should t h e n put t h e clamp on t h e kidney, By g o l l y , we got a h i g h e r h y p e r t e n s i o n t h a n we d i d without i t and t h i s i s something t h a t ' s i n t h e back of my head t o pursue sometime because t h e experiment stopped, t h e paper i s published, But D r , B l a l o c k , i n s t e a d of having no paper, had a paper now, I got f u l l c r e d i t because D r , Cressman had j u s t come and he f i n i s h e d o u t p a r t of t h e experiment but my name went on t h e paper, Also I g o t good b i l l i n g because t h i s was my i d e a , So t h e r e wouldn't be any confusion between myself and Cressman, D r , Blalock put h i s name f i r s t which was f i n e , t h e n my name and t h e n Cressman's, I t h i n k t h i s r e p r e s e n t e d h i s eminent f a i r n e s s i n giving c r e d i t f o r an idea, I f e l t t h a t he was always v e r y dominant; 25 always i n command. He dominated me o f t e n i n v e r y s u b t l e ways, but t h e r e i t was and t h i s i s hard t o t a k e month a f t e r month, but i t r e a l l y d i d n ' t b o t h e r me t o o much most of t h e time. Toward t h e end, b e f o r e I l e f t , I t h i n k i t g o t t o me. D r . 0,: You were ready f o r a change, D r . Lo: Yes, I s u r e was, but i t was a v e r y f r u i t f u l two y e a r s f o r me a s w e l l a s f o r D r . B l a l o c k - - s i x t e e n papers. My c h i e f was v e r y happy w i t h me--Dr, Naffziger--and he wrote it i n l e t t e r s and he was v e r y pleased, D r . Brunn was v e r y pleased w i t h me and it r e a l l y gave me a running s t a r t when I came back, I had awful problems g e t t i n g s t a r t e d doing any r e s e a r c h a t UC, b u t t h a t ' s n o t anything y o u ' r e e s p e c i a l l y interested in, Now i t ' s a b i g r e s e a r c h s c h o o l ; t h e n , nobody knew anything about r e s e a r c h , I c o u l d n ' t g e t a Van Slyke going f o r t h r e e months and s t u f f l i k e t h a t , Because he was s o dominant and I wanted t o t r y and t h i n k f o r myself and f e e l t h a t I was t h i n k i n g f o r myself, I d i d two papers w i t h a chap named, Tommy Diaz, They were two of t h e s i x t e e n papers, Tommy was from S t a n f o r d H o s p i t a l i n San F r a n c i s c o i n OBG and he went back w i t h John Burch, so we became f r i e n d s , We bought a Model A Ford t o g e t h e r , The f i r s t weekend I was t h e r e we drove t o Chattanooga; a f t e r t h a t I d i d n ' t have time f o r weekend t r i p s , Never went anyother weekend, So Tommy had an i d e a i t would be n i c e t o measure blood p r e s s u r e i n r a t s . So we developed a p r e s s u r e c u f f t o put on a r a t ' s t a i l and we c u t t h e t i p o f f and watched t h e a r t e r i a l bleeding and pumped up t h e p r e s s u r e w i t h 26 t h e pressure cuff. W e wrote a couple of papers on t h e method and what we found which were published i n t h e American J o u r n a l of Physiology. Well, D r . Blalock d i d n ' t g i v e m e any encouragement a t a l l f o r doing this. D r . 0.: It was independent work. Dr. L.: Yes. I was t a k i n g t i m e away from t h e lab. H e w a s possessive. I remember once T i n s l e y H a r r i s o n approached me and asked how would I l i k e t o work f o r him and I s a i d , " W e l l , I ' m working w i t h D r , Blalock." The i d e a of working f o r somebody else was one t h a t I knew would be disapproved of by D r . Blalock. So I n e v e r even thought about working w i t h D r . Harrison. Rudy Light worked w i t h u s i n t h e lab. Rudy was t h e s c i o n of t h e Light family. H i s f a t h e r was w i t h Upjohn and t h e y were v e r y wealthy. In f a c t , Rudy r e n t e d a g r e a t b i g house i n Bel A i r d i s t r i c t and h i r e d away Barney Brooks's b u t l e r who was v e r y good a t making mint j u l e p s . Rudy was a j o v i a l fellow. Kind o f a l i g h t w e i g h t i n o t h e r ways. He was a medical s t u d e n t and h e wanted t o do experimental work i n t h e lab. I had a l o t of fun w i t h Rudy. Rudy was j o v i a l and a n i c e guy and belonged t o t h e Bel A i r Country Club. W e used t o go o u t and p l a y t e n n i s i n t h e h o t sun a t noontime and t h e n go t o h i s house and d r i n k mint j u l e p s t i l l I was smashed--I c a n ' t d r i n k worth a damn anyway--and then have d i n n e r and go home v e r y lightheaded. But Rudy i s a n o t h e r s t o r y . Rudy f i n a l l y passed away and h e gave a l o t of money t o V a n d e r b i l t f o r an Experimental Surgery Laboratory. 27 Ralph Cressman followed me (and you may be i n t e r e s t e d i n i n t e r v i e w i n g him, I can h e l p you g e t h i s address). I have a n o t e h e r e he r e f e r r e d t o J o e Beard a l l t h e t i m e - - D r . Blalock did----- D r . 0,: He was one of h i s e a r l y a s s o c i a t e s ? D r . L.: He was b e f o r e me. Joe d i d some of t h e work, I t h i n k , on t h e chemistry of shock. Dr. Blalock c o n t i n u a l l y r e f e r r e d t o how hard J o e Beard worked, how e a r l y he got t o t h e l a b i n t h e morning and so forth. I d i d one paper on shock--blood flow i n shock. Of course, shock i s D r . B l a l o c k ' s opus a t t h e beginning t h a t r e a l l y got him on h i s f e e t i n the research f i e l d , Well, t h e r e i s something I wanted t o s a y about D r , Blalock. I could never understand h i s motivation. I never could understand why t h i s man wanted t o work s o hard, why he wanted t o p u b l i s h more papers than anybody e l s e . This was l i k e Cushing. Cushing was very compulsive and you know h e admired D r . Osler a l o t . T h e r e ' s a famous l e t t e r from O s l e r t o Cushing t e l l i n g Cushing i n c a r d s and spades j u s t what he thought about him f o r some of h i s a c t i o n s which O s l e r found o f f e n s i v e , such a s being p o s s e s s i v e and grabbing c a s e s , and mean t o t h e house s t a f f and everything. Cushing emulated D r , Osler a s a book c o l l e c t o r and he became q u i t e a b i b l i o p h i l e , H i s c o l l e c t i o n of books was 6,004, I t h i n k , because O s l e r ' s was 6,000 and D r . Blalock was something l i k e t h i s , too. He had t o have more papers, more degrees, more than anybody e l s e , dnd t h i s I never could fathom. Of course, t h i s i s from watching h i s c a r e e r 1a t e r on. We had t h r e e b l a c k men working i n t h e lab. Vivien was i n charge and he was t h e master t e c h n i c i a n and he t o l d t h e o t h e r two f e l l o w s what t o do. Sam s e t up t h e packs and d i d a11 t h e s t e r i l i z i n g . We d i d a l o t of s u r g e r y and he was v e r y busy every day. H e was a work horse, and d i d n ' t t a l k much; h e was always chewing tobacco. The t h i r d one--I have Aesop down--his name may have been Abel; I d o n ' t r e c a l l . A l l h e was good f o r was sweeping o u t , he was q u i t e an e l d e r l y man, and keeping u s s u p p l i e d with Coca Cola. D r . Blalock was a g r e a t Coca Cola d r i n k e r and a g r e a t c i g a r e t t e smoker--in between o p e r a t i o n s , w e l l , every time he came i n - - h e was always smoking a c i g a r e t t e and always h e l d t h e c i g a r e t t e a c e r t a i n way. I can s t i l l s e e him. They made a p l a c e f o r me t h e v e r y f i r s t day i n t h e l a b i n t h e b i g icebox where we put t h e dead dogs. There was a r a c k around i t and w e kept cokes i n t h e r e and Aesop made a l i t t l e p r o f i t on i t , I guess, and h e kept us supplied. It was v e r y hot i n t h e summer and t h e cokes were wonderful. Well, I ' m coming t o t h e end. T h e r e ' s another comment about D r . Blalock and h i s g r e a t s k i l l i n speaking, but b e f o r e t h a t I want t o t a l k about h i s s k i l l i n writing. W r i t i n g t o me i s v e r y hard. 1 w r i t e everything f i v e , s i x , t e n times and then i t ' s lousy, D r , Blalock, of course, you never knew f o r s u r e about what he was doing, but i t appeared t h a t what he would do was t a k e a c h a r t of experiments--when we'd f i n i s h t e n o r f i f t e e n experiments h e would make a c h a r t of t h e r e s u l t s and t h i s was t h e same c h a r t t h a t would be typed and go i n t h e paper. He'd t a k e i t home and h e ' d come back t h e n e x t day w i t h a paper. He would w r i t e an i n t r o d u c t i o n , method, r e s u l t s , d i s c u s s i o n , conclusion and v e r y seldom would a word o r two have t o be changed, I i n s i s t e d on w r i t i n g a paper-- one of t h e papers, H e w a s n ' t too anxious f o r me t o do t h i s , Dr. 0,: I n o t h e r words, he would l i s t you a s s e n i o r a u t h o r b u t h e would have w r i t t e n t h e paper? D r , L,: Yes. He would always show i t t o m e i n h i s s c r i p t b e f o r e i t was typed and I was welcome t o make c o r r e c t i o n s and changes which I would do b u t they were always very minor. We would t a l k about c e r t a i n t h i n g s b e f o r e he wrote i t up, too, W e would d i s c u s s because I would be r e a d i n g i n t h e l i b r a r y , They had a v e r y n i c e l i b r a r y t h e r e . Mrs. Cunningham was t h e L i b r a r i a n , t h e w i f e of t h e p r o f e s s o r oE Anatomy, I was always very impressed w i t h t h e f a c i l i t y w i t h which he could w r i t e , Of course, he spoke v e r y w e l l , too, [End of S i d e I, Reel 1 3 [Side 11, Reel 11 Dr. L,: A s I say, he was a very s k i l l f u l and f a c i l e w r i t e r and he used t o g e t a f t e r me t o w r i t e i n p e n c i l t h e way he d i d , I always wrote with a pen because t h a t ' s my h a b i t , I took n o t e s i n c o l l e g e f o r f o u r years--very f u l l notes-so I could u s e them a t f i n a l time and I was a good s t u d e n t a t c o l l e g e , I always wrote i n pen and t h e n I would c r o s s o u t and w r i t e over i t . H e wrote i n p e n c i l and then h e ' d u s e t h e end of t h e p e n c i l with t h e e r a s e r on i t and change a word o r two and he would p r e f e r m e t o do t h a t and I ' m kind of stubborn, o r else have bad h a b i t s . 30 In speaking, it was always interesting to watch him at the lunch table at Vanderbilt. A bunch of doctors would be sitting around--on the staff--there'd be a lull in the conversation. Dr, Blalock would have been quiet up to this point, Then in the lull he would start talking about something of interest to everybody. It would be local politics, what the county medical society was doing. He would bring up some topic of general interest and he would expound on it and give a couple of sides of it and then there'd be general discussion, It was very interesting to see him operate because he could do it and not many people can. I admired him for being able to do this. I mentioned that he was very ambitious and I understood that he wanted the Nobel Prize very badly and he tried very hard to get it. A s far as loyalties, he was a very loyal goutherner. My word, anything having to do with the South, with Georgia, Gone With the Wind came out when I was there and this was must reading. Everybody talked about it every noontime in the doctor's dining room. Dr. 0.: It must have been an experience coming from the West. Dr. L,: Well, there are a lot of contrasts. I lived in a boarding house and one of the fellows upstairs was an engineering student in II Knoxville--the University of Tennessee. He was working on the highways I for the state during the summer to make some money. I went up to his room and he was getting dressed to go out and he pulled open his sock drawer and there's a loaded . 3 8 caliber pistol: I got scared just looking at it, and this was typical, though, of southern households, 31 they a l l had weapons. He was very l o y a l t o e v e r y t h i n g southern and he was r e a l l y a l o y a l f r i e n d . You could count on him. When I worked t h e r e I knew I could go t o him i f I had any problems--I d i d n ' t have t o b o t h e r him o f t e n with problems. But I d i d have a problem t h a t I d i d d i s c u s s with him. I r e c a l l one and t h a t was whether t o s t a y a second year. I mulled t h i s over f o r a long time. I took t h e cue from him and mulled over t h i s problem. I t h i n k b e f o r e I went t h e r e and was exposed t o him I would have j u s t decided something, but having been exposed t o him and watched him mull, I mulled too. I wrote t o D r . Brunn and D r . N a f f z i g e r and asked them what t h e y thought and I t a l k e d t o D r . Bla- l o c k a t some l e n g t h about i t . O f course, he may have been a l i t t l e p r e j u d i c e d because h e wanted me t o s t a y a second year. Dr. 0.: He had a producer i n t h e lab. Dr. L.: I f i n a l l y decided t o s t a y and I t h i n k i t was a good d e c i s i o n . C e r t a i n l y i t was a d e l i b e r a t e d e c i s i o n . 32 Index Abbott, Leroy C., 20 Abell, Irving, 5 Altemeier, William Am , 1 Anti-Semitism, 14 , 15 Beard, J o e , 27 Bing, Richard, 11, 1 2 , 17 Blalock-Tauss ig c o n t r o v e r s y , 12 Brooks, Barney, 2 , 13-16, 26 Brunn, Harold, 2, 8, 9 , 12, 25 Burch, John, 25 Burwell, D r , , 4 C a l i f o r n i a , U n i v e r s i t y of ( H o s p i t a l ) , 15 r i C a l i f o r n i a , U n i v e r s i t y Medical Center, 25 C a r r e l , A l e x i s , 11 C l a g g e t t , 0. T., 20 Cressman, Ralph, 24, 27 Cushing, Harvey, 27 Diaz, Tom, 25 Dragstedt, Lester, 1 Ford, Henry, 16 Goodpasture, Ernest W., 5 I Graham, m a r t s A . , 9 , 17 Grebel, M r s . F r a n c i s , 22 Guthrie, Charles C., 11 Haas, M r s . Walter, 2 , 1 2 H a r r i s o n , T l n s l e y , 3 , 26 J e g e r , Emst, 10, 11 Larsen, Ralph M., 5 L i g h t , Rudy, 26 Long, Joseph A . , 1 Longmire, William, 3, 4 , 6 Mason, Morton, 3 Mount Z i o n H o s p i t a l , San F r a n c i s c o , 9 , 11 M u l l e r , Harry, 21 N a f f z i g e r , Howard C., 1, 2 , 8, 9 , 17, 19, 20, 25 Nixon, Richard, 14 O s l e r , W i l l i a m , 27 P i l c h e r , Cobb, 19 Rosenberg , Milton, 14 San F r a n c i s c o County Hospital, 15 Saunders, John B., 20 S i l e n , William, 2 1 34 Thomas, Vivien, 2, 3 , 6, 7, 19, 28 Weinstein, Bernard, 14, 18