The subject of this interview is Dr. Emanuel Libman.
     Dr. George L. Engel, Professor Emeritus of Psychiatry
     and Professor Emeritus of Medicine at the University of
     Rochester School of Medicine and Dentistry, is being
     interviewed by Dr. Manfred Waserman, of the History of
     Medicine Division, National Library of Medicine.        Dr.
     Engel is a nephew of Dr. Emanuel Libman.     The
     interviews took place in Dr. Engel's home, in
     Rochester, N.Y. on May 23-24, 1985.


Dr. Waserman:     I'm delighted to be here, Dr. Engel.     As you
     know, the Libman manuscripts collection at the National
     Library of Medicine is an exceptionally fine research
     collection, and it's because it is such a fine resource
     that I would like, if possible, to fill in some gaps.
     I would like to start with Dr. Libman, the man.        That
     is, his ancestry, his background, early education, the
     family, some of his personal traits, and who and what
     were the influences and factors that, more or less,
     shaped his adult personality and gave him direction.
     Could you tell me how Emanuel Libman and his parents
     interacted, and his relations with his immediate
     family?


Dr. Engel:     I lived and I was brought up in his house,
     which should make me a good source, but actually
     I see him from a very skewed point of view.        Let me go




                                      1
 {


back a little bit so I can tell you how it came about

that I lived in his house.    My mother, who was his

younger sister, and who was very devoted to him,

married late.    She kept house for her father, his

father, and for her bachelor brother, Emanuel.       My

father appeared on the scene, about 1903 or 04.

As her suitor -- in the language of the day -- the

arrangement ultimately was that if he wanted to marry

Esther he was to move into the house, and that's indeed

what happened.    Her father lived   there, I believe,

until 1919 or 192-0.   He moved to Atlantic City around

that time because he liked to walk and didn't like New

York traffic, being already in his late 70s.     In the

household were my uncle, my parents, and my two

brothers.   My twin brother and my older brother are now

deceased.



We lived in an old brownstone house, 180 East 64th

Street, that my grandfather had bought fairly new,

probably in the mid 1880s.    Grandma raised 9 of 11

children.   I think two died early in childhood; Libman

was somewhere in the middle, the fourth or fifth.         My

grandmother died probably about 1904-05.    Remarkably

little was ever said about her in my childhood.       And

that seems so astonishing to me, that I called my

cousin, who is now 88.    Her mother was one of my

mother's older sisters; I think she was second




                                2
oldest in the family.     And she also knew relatively
little about her although she knew her; she was 5 or 6
when her grandmother died.     My cousin promised to send
me some more material which she put down some years
ago.


Libman's     parents, Fajbush Libman, his father, and his
mother, Hulda Spivak (I learned her maiden name for the
first time last night -- I never knew it       the name
was never mentioned) were born in a town in Poland,
which the family believes, my cousin believes, is an
area which at one time was East Prussia.     She was older
than my grandfather, he was born probably in 1843, and
his wife maybe 1841.     She had no education, is said to
have been illiterate; she apparently never learned to
read or write, not even in Hebrew or Yiddish.


My grandfather had only what education there was
for a Jewish boy in a Shtetl, but (I only learned this
from my cousin last night) after he was bar mitzvahed
he succeeded in gaining entry, or made some connection
with monks in a monastery, where he got further
education.     He didn't live in the monastery, but for
several years, according to this account, he went there
and learned to speak German and Polish, both of which
he spoke fluently.     Afterwards he was employed by a
rich landowner to teach his children literature and




                                 3
foreign languages.   This is interesting because it's
consistent with my knowledge of my grandfather as a man
who was very ready to go beyond the confines of his
environment.    In the years that I knew him, which would
be in his 70s, 80s and 90s, he was already a man who
had on his own acquired tremendous scholarship, had
long since left any conventional kind of attitude
towards religion or politics, or arts.


Before he came to this country he married, and the
two of them left Poland in 1865, which is a time when
Jewish immigration to this country was still in its
infancy.   One figure I've heard is that the Jewish
pbpulation after the Civil War was about 60,000 for
the whole country.    So he came before the waves of
Central European immigration.       He established
himself in picture framing, mirrors and sold some art
objects, I gather in downtown New York and was modestly
successful.    He was never a man who made any sizeable
amount of money, but somewhere in the 1880s he was well
enough off to purchase the house on 64th Street, which
was built in 1879.    All the houses on that street were
built in '79 and '80, I'm told.       He gave up his
business when he was probably in his early 40s because
on an insurance examination he was told that he had
serious heart disease and probably would not survive
more than a few years.    on the strength of that




                                4
     prediction he sold his business, invested his money in
     real estate, only to outlive by some 50 years the
     physician who made the diagnosis.


     The rest of his life he devoted to scholarship.       He
     read extensively; all of the classics in English and
     German.   From my mother, rather than from my uncle, I
     know he maintained a rigorous intellectual atmosphere
     in the household.    For example, after dinner each
     evening, all the children were expected to sit around
     the dining room table, each to take a role in a
     Shakespearean play, or some other classic.    To her
     dying day my mother still could recite parts of
     Shakespeare that she had remembered from those dining
     room sessions.


Dr. W.:   So there's no doubt about it that the family and
     home influence had an effect on Dr. Libman's striving
     for education and learning.


Dr. E.:   Yes, indeed it did, but it didn't influence all the
     members of the family.    There's a very clear range in
     this family; my impression is that Emanuel was his
     father's favorite.    His mother is described by my
     cousin as a warm, affectionate woman who was very
     supportive to the children.    His father, my grandpa, as
     was usual in that period, was more the disciplinarian,




                                     5
     the teacher, the model, and the guide.        He was more

     stern, and maintained discipline and very high

     standards.     He was a man who placed tremendous emphasis

     on ethics, honesty, and integrity.        That did not

     necessarily reflect itself in how the children came

     out.     They ranged all the way from a younger brother

     who may be described as a wastrel, a sociopath who even

     got into trouble with the law.       Another older brother

     was married and divorced, a disgrace in those days, and

     was expelled by his father from the family; he

     disappeared for twenty years, went West.        Actually,

     Emanuel was the only one of the boys who really made

     good.     The other three just about got by.



Dr. W.:     That is a subject that we could devote a whole

     program to:     why some young people go one direction and

     others another direction.



Dr. E.:     Of the girls, my mother was the only one who got
     a college education.     She went to Hunter College and
     planned to become a teacher.     None of the other sisters

     went beyond high school.     Actually, she never did
     teach.



Dr. W.:     How many boys and how many girls were there?



Dr. E.:     I think there was five and four.     Let's see, Sam,




                                      6
     Abe, Charlie, and Emanuel.      Then there was . . .

     Elizabeth, the      oldest, whom I never knew, she died

     before I was born, and       Rachel, Rebecca, Esther and

     Sadie.



Dr. W.:   Your mother?



Dr. E.:   My mother was Esther.



Dr. W.    There is one brother that Emanuel kept sending

     money to and



Dr. E.:   That was Sam.



Dr. W.:   He was in the roofing business at one time . . .



Dr. E.:   Paint business, roofing business.       He settled in

     Pittsburgh after he came back from the West, and nobody

     knew what he did in the West.         It was in the pioneer

     days, and as children we imagined that he was a cowboy,

     or that he mined, or was looking for gold.         But he
     obviously was not a success in the West.         He was
     married, as I say, divorced and never married again,

     and he lived into his 90s.



Dr. W.:   So Esther went to Hunter College.




                                       7
Dr. E.:   My mother went to Hunter College and received a

     teacher's certificate.    None of the others did.     They

     married, with varying success.       Abe also divorced; that

     was a disgrace and a scandal in those days.       Abe was

     the youngest one.    It was the era in which the German

     Jews were the "superior" ones, the Polish and Eastern

     Jews were the "inferior" ones, and it was felt that the

     chances for marriage for the girls would be damaged if

     the two wastrel boys who divorced didn't get out of the

     scene.   So they were somewhat excluded from the family.

     My mother was a highly intelligent woman, and her

     relationship with her brother was a stormy one.       On the

     one hand she adored him, was in awe of him, on the

     other she feared and hated him.       They were constantly

     quarreling.



     My mother, in diagnostic terms, was a classical

     hysterical character.    I often say to the students that

     everything I know about hysteria I owe to my mother.

     When I   first read Freud~s case studies I was

     unimpressed because there was nothing that Freud

     reported in terms of behavior and symptoms, etc. that I

     hadn't seen with my mother.    Every possible symptom.

     And this was an intricate and comlicated situation in

     relationship to her brother, because he was the

     physician.    He didn't take care of her, but he

     regulated, and was responsible for, and oversaw the




                                      8
     medical care not just of Esther, but of every member of

     the family, without exception.       No one in the family

     every went to a physician without first getting

     Libman's advice, and if he even learned that a member

     of the family consulted a physician, he would be down

     on them like a tyrant.



Dr. W.:   What about his high school days.      Was he a good

     student?



Dr. E.:   I don't know anything about that.      I would gather

     that he was.   He was a very apt student, and learned

     well, and was bright and distinguished himself.       He won

     a medal in medical school.    I have the medal here, it's

     behind you on the shelf there -- the Harson medal.



Dr. W.:   Did he get along well with his siblings and with

     his parents?



Dr. E.:   I have no reason to believe that he got along
     well with anybody.    See, I have to say more about where

     I, from my vantage point, or maybe I should say

     disadvantage point, I saw this.       Some things I read,

     such as in the New Yorker article.       The Time article,

     make me chuckle to myself, because this is not the man

     I know.    I think, and I have to acknowledge I'm making

     assumptions here, I always had the feeling, from what




                                      9
little I heard, that he was his father's favorite,
that his father was very proud of him and very
disappointed in the other boys.       None of them matched
Manny, and I think they all suffered on that account,
in one way or another.     I think my grandfather looked
down on women, in the manner of the day, and was eager
for them to have good marriages.       Rebecca's marriage
and my mother's marriage were considered good marriages
in the sense that they both married German-type.       My
father wasn't German, he was Austro-Hungarian actually,
but he was a successful businessman when they married.
He was already 37 at the time, my mother 27, which was
late for a woman in those days.


I spent my whole childhood in the house on 64th Street.
You have to get a picture of the topography of the
house.   On the ground floor partially below street
level, were the dining room, kitchen and pantry.       There
were usually at least 2 or 3 servants, a cook and a
maid, and my uncle had a chauffeur as well.       On the
next floor, which was the floor up the front stoop,
was his waiting room, his examining room, his office,
and a little laboratory.     The next floor, up the next
flight of stairs, was my parent's bedroom in the back,
with a bathroom and the living room in the front which
looked out on 64th Street.     On the third floor, as you
got to the head of the stairs, was a large room, for my




                                 10
     twin and myself and a small room for my older brother;

     and a bathroom.    In the front was Libman's room and a

     bathroom, and next to it was the sleep-in maid's room,

     a very small room.    When Libman was in the house he was

     either in his bedroom, which included a large desk and

     floor to ceiling books, or in his office on the first

     floor.    He never used any of the other facilities, the

     living room or dining room, for example, never

     socialized or ate meals with us.     He saw his visitors in

     his bedroom or office.



Dr. W.:   What prompted your family, that is, your father and

     mother and brothers, to live in Dr. Libman's house?



Dr. E.:   I think it was the indissoluble and highly

     ambivalent bond between Libman and his sister, my

     mother.   My mother was the master of the situation, at

     least in respect to my father.     There was no way in

     which anyone could move her out of that house.     As a

     matter of fact, when Emanuel stipulated in his will

     that the house was to be sold two years after his

     death, that was probably the greatest blow my mother

     ever suffered.    Actually it made no sense for her to

     live in that house all by herself, which she had been

     doing since my father died (in 1928) and the three of

     us had left New York City.




                                  11
Dr. W.:    How did your father feel about the family living

     with your uncle?



Dr. E.:    He had no choice.   He submitted.     He apparently

     agreed as a condition of the marriage to this

     arrangement,' and he submitted.        In the family setting

     he was a passive man.



Dr. W.:    So you were raised in that house.



Dr. E.:    I was raised in that house.      Now -- I don't know if

     you can picture this, but you see here's this man . . .

      I forgot one more floor, the basement, important for my

     development for here were his pathological specimens,

      shelves with jars of livers, kidneys, and hearts.          I

      saw these as a small boy.    Now picture if you can this

      renowned man, on a par with the greats of medicine,

      living his entire life in a single bedroom, and his

     office.     Those were the only two places in the house he

     occupied.



Dr. W. :   Plus the basement where the specimens



Dr. E.:    Well, that was just storage.      When visitors came --

      the great figures that you hear about -- they came to

     his office or to his bedroom, where he had his records

     and record player.     He had a large music collection; he




                                       12
     was very involved in music.      He would occasionally go

     into the living room, to play the piano, but only if it

     was unoccupied.      But otherwise he never mingled with

     the rest of us.



Dr. W.:   What was your father's profession?



Dr. E.:   My father was in the fur business.        He was

     born in 1869.     He came over here in 1889.      He was a

     very fine, well-educated man.      I don't know what his

     education was but he was well-read.        He was raised in

     Hungary, what later became Czechoslovakia.         He was a

     quiet man, a man of very high standards, of great

     probity and integrity, that was his reputation.         He and

     his cousin established a retail and wholesale fur

     business, A&J Engel Furs, on 20 West 33rd Street.            He

     first worked for Lord and Taylor; that's where he

     learned the business.



Dr. W.:   Did your parents and Emanuel Libman ever do
     things together?



Dr. E.:   Never, never.     My father in his business was

     highly respected.      He was president of the Association

     of Fur Manufacturers.      He was known as the great

     negotiator, the great arbiter.         In all the disputes

     within the industry, between concerns, between




                                       13
     management and labor, my father was always the man who

     conciliated, who brought people together.         But he never

     could cope with the quarrels between my mother and her

     brother; there he was helpless.        He was very respected

     and loved.     My uncle was admired and feared.         I don't

     think anyone loved him in any sense.



Dr. W.:   Respected.



Dr. E.:    Not respected genuinely.    He was envied, and he was

     held in awe.      Family members would boast about him, but

     in all the family discussions I was ever involved in,

     the attitude was fear, awe, and not a little anger.



Dr. W:    Did you have meals together?



Dr. E:    He never ate with us.    As far as I knew as a child

          this is going to sound crazy -- Libman did not eat.

     (Laughter).     Actually he ate in his bedroom or office;

     his chauffeur brought a tray           or he ate out.      Other
     than that, we would occasionally meet on the stairs,

     that was our only contact . . . he would be coming up

     the stairs or down the stairs two steps at a time.            My

     brothers and I used to refer to it as the thundering

     herd.   We fled into our rooms when we heard his

     thundering steps.      It was strictly forbidden for anyone

     to leave doors open.      It was very strange for me to go




                                       14
     into anyone's house and discover that some people

     always left the door open.     Our doors were always to be

     shut.     He lived a separate life.     He had a chauffeur,

     and at one period he had a car, which belonged to the

     chauffeur.     I guess he didn't drive, he often used

      taxis.    It was as if life went on in this house in two

     separate spheres.



Dr. W.:    I know he was entertained a lot, but did he ever

     entertain in the house?



Dr. E.:    He never entertained in the sense that I think you

     mean.



Dr. W. :   Having people in



Dr. E.:    Having people in for a meal or for coffee or tea,

     or drinks, or whatever, never.         It was rare that it was

     anyone other than a professional visitor.         I am not

     aware of friends or social visitors.        Yet from the

      stories I heard, it was quite an experience to visit

     Libman.     Almost never did women visit.      I don't

     visualize married couples coming though I suppose some

     must have.     His chauffeur might bring up a tray, I'd

     see it out in the hall later.      Often he took people out

      to eat, or ate out by himself.        I know there were

     certain favorite restaurants he went to.         But as far as




                                       15
     entertaining, I could hear him call to the chauffeur to

     bring up some coffee and whatever the cook may have

     prepared.



Dr. W.:   Did he ever ask you how you were doing in school

     when you were growing up?



Dr. E.:   Never.   This kind of remote relationship began when

     I was a small boy.    The tale is told that Libman would

     have my older brother, Lew, come in to meet visitors.

     He liked to show him off.    When he was 8 or 9 Libman

     even took him to the Rockefeller Institute to look

     through the microscope to see the organisms that Harry

     Plotz claimed were the organisms of typhus fever ....

     But at one point Lew evidently revolted.     The tale --

     apocryphal or not, goes that Libman called him in while

     he was playing in the back yard.     He came in

     reluctantly and then threw himself on the floor and had

     a temper tantrum.    That was alleged to be the last

     time, according to this version of early life at 64th

     Street, that Libman ever had a child in his office.



     I have no memory as a small child of anything other

     than him shouting at us to keep quiet.     We learned

     to creep up the stairs, and to be quiet in the back

     yard.   As soon as we came into the house the question

     always was:    "Is Uncle Manny home?"   (Later on it




                                     16
     became "Libby").      If Uncle Manny was home, then you

     were very, very cautious.     If you met him, there was no

     greeting.    Mostly it was evasive action.    You looked

     down the hall, and if his door was open, or if there

     was some sign he was coming, you waited      until he went

     by.     In the New Yorker article, it was stated that he

     ignored us when visitors were present.       I can assure

     you it wasn't just when visitors were present

     (laughter), it was anytime.     Even when I was in college

     and getting ready for medical school, I didn't feel I

     could go see him for any reason.      My mother would say,

    "Now go see Uncle Manny, he can help you," and I would

     say "No," and Frank would say "No," and Lew would say

     "No."      But we had to, and then what did we do?    I had

     to call his secretary and make an appointment.       I would

     say there was maybe five occasions in my whole life

     that I felt I had any reason to speak to him.



Dr. W.:    And you lived in Libman's house until what age?



Dr. E.:    Well, I moved out of the house, as far as it being

     my residence, when I married and that was 1938.       Lew

     also lived there until 1938, during the years he was a

     graduate student at Columbia.     He also had virtually no

     contact with him.      Libman was the final arbiter of all

     family decisions.      Marriage, decisions to have

     children, career decisions, it was expected that you




                                      17
     would come down and meet with him and get his approval.



Dr. W.:   You mean the family, or only those people that were

     living in the house?



Dr. E.:   The whole family.    Every member of the family, that

     was expected.     You had to see Manny.   Evelyn and I met

     when I was a first year medical student.      She was a

     student in art as applied to medicine, with Max Brodel.

     We fell in love and that was a period when it was out

     of the question for a medical student to be married.

     You didn't get married until after you hung out your

     shingle.   This was a tremendous problem for me because

     it ended up that I did get married before I started my

     internship.     And I had to get help to work that out

     because not only was my mother dead set against it,

     Libman was dead set against it.     When push came to

     shove, there finally had bo be a meeting.      I had to

     bring Evelyn up, in my own house, up to the front room,

     on time, and she had to go in by herself to be

     inter~iewed.     It was like applying (laughter) for a

     position, or something.



Dr. W.:   Dr. Engel, I realize that some of the impressions

     you formed when you were a youngster may have been

     modified or changed since that time -- or maybe they do




                                  18
     remain the same.   But if we had to list some of Emanuel
     Libman's personal traits, what would they be as you
     look upon the whole person.    He was certainly in some
     ways charitable, wouldn't you say?


Dr. E.:   Well, I certainly can say a lot of very good things
     about him.    I have been giving an account, you see, of
     what it was like growing up in his house.    Certainly
     he had a very profound influence on me, much of which
     was for the good, and some of which I had to work my
     way out of.   It's interesting that at the very time I
     was personally feeling very angry, even hating him, I
     was also identifying with him, and for a long time I
     didn't realize this.    Long before I ever got to medical
     school I already, partly consciously, more I guess
     unconsciously, was very carefully attending to what it
     was he was doing that made him so effective.    I'm not
     going to use the word successful, because that gives
     the wrong impression, so effective as a physician.


     Very early in life, I already had a considerable
     interest and curiosity about nature, a development in
     which my grandfather was an influence, just as he must
     have been an influence on his son, on Libman.    When I
     was 7, 8, 9, years old I remember going out into the
     woods with my grandfather, who then was close to 80 or
     beyond, and he used to instruct us in nature.




                                     19
Collecting, paying attention to how leaves differed and

how plants grew, and getting us to read about nature,

etc.   So this kind of discipline, to be systematic and

orderly and make good observations, had begun even

before I knew exactly what it was that Uncle Manny did.

Lew     by the time he was ten years old -- had already

set for himself a career to be a chemist; he bought the

first Chem Craft set, as it was called, he had a little

laboratory, and he got his younger brothers to help

him.



This scientific atmosphere also was contributed to by

the fact that we knew that many of the people coming to

the house to visit Libman were scientists, many were

noted scientists of the day.     My grandfather was very

much a product of the latter part of the last century,

the struggle between religion, clericalism and science

and the Enlightenment.   My grandfather, even though he

had little formal education, was a great proponent of

logic and science and in his later years he became an

agnostic, and even an atheist.        So that atmosphere was

already there.   How it influenced Libman I don't know,

but certainly Libman became a sort of secret, admired

figure who actually was doing and exemplifying what

grandfather talked about.   There was my grandfather's

classical library and my uncle's medical library and

the pathology specimens in the basement.        And we, of




                                 20
     course, were objects of his clinical examination,

     because whenever we got sick he was always the first to

     examine us.     Later I suspected that it was on me as a

     child that Libman developed the pain sensitivity test.

     I don't think that's true, but that's how I experienced

     it.     I was very aware of these sorts of things, and I

     also was aware of the tremendous admiration and respect

     that people seemed to have for him.



Dr. W.:    He certainly had a very strong personality.



Dr. E.:    He had an overpowering personality, and he

     inculcated in me very high standards of clinical

     performance.     By the time I became a medical student,

     it was impossible for me not be be          I'll make that

     positive -- it became important to me never to miss an

     observation.     By the time I was a third or fourth year

     medical student I was having great satisfaction and

     pride in picking up physical signs or laboratory

     findings that others had missed.        That almost became a

     goal.



Dr. W.:    According to some biographers he had a large

     reservoir of humorous stories.        Did any of these



Dr. E.:    Those I never heard.   Almost to his dying day,

     and I was already in my 30s and established in academic




                                      21
     medicine, he never engaged with me, or my brothers, as
     a student or a colleague or even just as another adult.
     The pattern from my childhood persisted, at least in my
     mind.    I was not someone to whom he would tell a funny
     story.     I read about them, I heard about them.          I think
     in looking back and coming to understand the psychology
     of this man, I eventually came very much to peace with
     it because I've come to realize that this was a man who
     had very serious psychological problems.             Problems,
     which for the most part, he succeeded in compensating
     for in ways that were much more often constructive and
     creative than otherwise.        He was in fact, in many
     respects -- socially-maladjusted is not a good word for
     it -- I think he was basically a very shy, insecure man
     and he compensated for this by exploiting his superior
     knowledge and skills.        As a result some people would
     see him as a bully, and he was, and some people would
     see him as just so superior in his knowledge that they
     dared not oppose him.        He could overwhelm just about
     anybody.    When   I   was growing up    I   thought he could
     overwhelm me because I was a child, but by the time I
     was an intern and saw him in action, then I could see
     that he could overwhelm anybody.


Dr. W.:   There is an extensive correspondence in his
     manuscript collection, and there is abundant evidence
     that he had the respect of colleagues and scientists




                                         22
     everywhere.    In fact, it was more.than just respect,

     they seemed to have a personal . . . .



Dr. E.:    Awe, admiration . . .



Dr. W.:    Yes, and appreciation, because he seemed to be good

     to them.     He wrote to them, and he sent them gifts.        He

     certainly did not ignore them.        He tried to have them

     in for parties and he entertained and took them out

     frequently.     There must have been an element of

     sweetness about him somewhere along the line.



Dr. E.:    Yes, I think he was very effective at that, and

     it was genuine.     I don't think this was phony or a put

     on.    I think this occurred once he gained

     self-assurance professionally, and that happened very

     early in his life, maybe by the time he was in his

     early 30s.     By then, he had already established himself

     as a first rate clinical investigator, an investigator

     in pathology and bacteriology.        You have to remember

     this was an era in American medicine in which there

     wasn't all that much of quality going on.        Not only

     that, but he did this under the inauspicious

     circumstances of being Jewish and being at a small, or

     at least inconspicuous, Jewish hospital which he

     unquestionably, almost singlehandedly, elevated to the

     rank of a first class academic institution -- even in a




                                      23
     period in which it had no formal academic connection.

     And once he achieved this kind of self assurance, then

     it became increasingly possible for him to be a giving,

     generous person, and he was.



     He gave generously of himself and of his time.         He

     never coveted money.     He gave money away.   It was well

     known he didn't charge or charged a pittance to wealthy

     people in order to get them to give gifts to the

     hospital.     He succeeded -- and he did this I think

     perfectly honestly and honorably -- getting many people

     indebted to him.     I say honestly and honorably because

     it wasn't his intent to get them indebted, but a

     device that also helped him as well to feel      confident

     and secure.    Once in that position he could do things

     for people that nobody else could do.      He helped

     innumerable students, usually Jewish students, planned

     their programs for them, sent them abroad, gave them

     introductions.     There was no question that if you could

     become associated with and get in Libman's favor, that

     your career, if you had any capability, could be
     assured.



Dr. W.:   Did he go to synagogue?



Dr. E.:   He was not religious.     He had some interest in

     religion, and curiously, I think he probably attended




                                       24
     services at other churches maybe as much as a

     synagogue.     I don't know of him ever going to synagogue

     ritualistically.     I know he went on particular

     occasions.     But I also know he went to mass on

     Christmas Eve.



Dr. W.:   Did your mother observe the Sabbath on Friday

     night?



Dr. E.:   That wasn't part of the routine, not even with my

     grandfather.     Passover, Hannukah were observed

     occasionally.     I never went to a real Seder until

     sometime after I left the house.



Dr. W.:   I'd like to have you touch on two more subjects

     about Dr. Libman's life.     The first is:    do you have

     any insight as to why Dr. Libman never married.        And
     the second concerns his death.        I did quite a bit of

     searching to find something about his final illness,
     but was unable to locate very much.       First, why didn't
     he marry?


Dr. E.:   The issue of not marrying was for a long time one

     of the family secrets.     As far as anybody knows, Libman

     never went out with a woman, never dated, and at

     various points in time       and I can remember it from my

     fairly early childhood       there would be stormy




                                      25
outbursts by my mother or other family, outrage, tears,

angry accusations, etc. because someone -- and at that

point I didn't understand at all what was going on --

had apparently made the charge that he was homosexual.

I think the evidence that he was homosexual is

irrefutable.     It was the wrong era to be a homosexual;

it's still not the right era, but I certainly think the

evidence that dispositionally this was his bent was

strong. I think that's an important observation because

it tells an awful lot, and explains an awful lot, about

his behavior.



It isn't just that he didn't marry; it rather tells the

story, in a way, of a man who carried a tremendous

secret burden.    Without realizing it, I and my brothers

probably knew more about this than anybody else,

because we were in the room next to his.     I believe

that he had homosexual paramours who appeared under

strange guises.     I know that he had certain kinds of

rituals about his bowel activities.     I know that he had
men that came in to give colonic irrigations, at least

that's how it was presented.     There would be these

mysterious people who would appear.     I know that the

"scandalous" stories usually had to do with charges or

accusations that he had made approaches to, or allowed

himself to be approached by, other physicians or

something of that sort.     I took the trouble last night




                                 26
to call my cousin, who is 88, and knew him years before

I did because I knew this would come up.     If you didn't

bring it up, I was going to bring it up, because I

think its part of a human history.



It's something that nobody has really wanted to put on

record.   Actually I didn't have to ask my cousin, she

volunteered the information.     She said, "You know your

Uncle Manny was 'square,'" she got the wrong word

(laughter), she meant to say "queer."     I said, "What do

you mean?" and then she proceeded to confirm what I

already knew.   Included was his chauffeur, for example.

He was an effeminate man, and his constant companion.

So here you have this situation, you see, in a period

of time in which nothing could be more exluding, than

to be sexually deviant.   He carried the terrible secret




It was interesting that my cousin said that Libman used

to say to the family in his own defense when this

charge was raised:   "Well, just so I won't be accused,

my doors are always open."     They never were!   I never

saw into his room, the door was always closed when he

was there.   So, you see now a man in a prominent and

very conspicuous position, struggling with this threat

of exposure and literally obliged to hide himself in

his own household.   I now see the family around him as




                                 27
     a sort of shield.     I now see his activity, his social
     activities, as really -- and I'm saying this positively
     -- very effective devices that he worked out to
     maintain social relationships without being exposed and
     without getting involved.


     But I also know that this influenced what happened to
     some young people.     For example, he took the very
     strong position, for which he always buttressed himself
     with the authority of Osler, that medicine must be your
     mistress.     Physicians should have nothing to do with
     anything but medicine.     And I do know, personally, some
     very brilliant young men -- young at that period, they
     are all deceased now -- who got through all the steps
     of Libman's approval for being sent abroad, for
     training, etc., only to have everything withdrawn
     because they indicated, their intention to get married.
     That ended it.


Dr. W.:   Could you shed some light on the causes or
     circumstances surrounding his death?


Dr. E.:   Well, this is a fascinating story, and I've told it
     many times.     It's never gotten into the public domain
     as far as I know, even though I wrote it to Bill Bean
     who was very interested in premonitions of death, but I
     don't know that he ever published it anywhere.     I gave




                                      28
     him permission to publish it.



     In 1943, while on a trip to Mexico City, Libman

     suffered a stroke.     The story I got at the time was

     that he developed some difficulty with his vision and

     became confused, it was thought that maybe it was the

     high altitude.    In any event, it was a cardiology

     conference of some sort that he was attending.     He left

     the conference (this was in the middle of the war),

     came back to Brownsville, Texas, and a series of steps

     followed which aren't important.      He was obviously

     sick, confused, yet he still succeeded in bluffing

     everybody.   He was admitted to a hospital; I can't

     remember whether it was in Brownsville or Dallas, I

     think it was Dallas.     For the family, this was the

     impossible crisis.



Dr. W.:   When you say family . . . .



Dr. E.:   Everybody.   Not just the immediate family.   My

     mother, all his siblings, particularly his siblings.

     (His father died in 1937, so this is six years later).

     This is the impossible crisis, because in the family

     whenever health problems come up, you called Manny.

     That's just what you do, you pick up the phone and you

     call Manny, and he tells you who to get, and where to

     go, and what to do.     So the family collapses, and my




                                      29
mother, of course, being the closest, was the one who

then initiated action, which was to call me.        Lew, my

older brother, was in the military service at that

point, and Frank was in a sanitarium with tuberculosis.

I was the available one, and I was sent on the mission

to find Libman and bring him back to New York.        Without

going into details, it was a weird chase.



I finally established that someone had put him on a

train that was going to arrive in St. Louis.        And I

managed to get to St. Louis from Cincinnati before the

train arrived.     I met him coming off the train.     He was

disheveled, unshaven.     He had a homonomous hemianopsia,

couldn't see on the left side, and he was confused.

He was improperly dressed, his pants were not buttoned,

his shirt was hanging out, and so on.     I put him

together, as best I could, right on the train platform

and tried to get him on the New York train.        But before

I could accomplish this, there appeared a delegation

from the Washington     University, Department of

Medicine, to whom he had wired in advance that he was

going to come to St. Louis and would be prepared to

make rounds.     The people who met him, I can't

remember exactly who they were, but they were senior

members of the department.     At first they did not

recognize that anything was wrong.     He chatted away,

dropping pearls, as he was want to do, and everybody




                                 30
fell into the usual pattern of sopping up the words of
wisdom.     They were words of wisdom, they were just out
of context.     It took 15-20 minutes -- I felt like a
little gnat, you see, here I was just a young
instructor     and they were crowding around the great man
and I was trying to get through to the people that he
was sick.     Finally they realized he was confused, and
helped me get him on the train to New York.


It was a difficult trip; actually this was the most
intimate, in fact the only intimate time I ever had
with him.     I spent the whole night sharing a sleeper
with him, I on the upper, he on the lower berth.        I'd
never been that close to the man in my whole life, even
though we lived in the same house.     His speech was
garbled, he was confused; I thought it ironic that I,
who had started my career studying delerium, should be
taking Libman, delirious, back to New York.     He never
recovered from that stroke.     That was the beginning of
the downward path for him.     I think his visual deficit
compensated somewhat, but he had a major loss in his
cognitive ability, even though he was still able to
produce pearls.


Over the course of the next months or year his practice
fell off.     He was no longer called for referral, he no
longer got consultation calls, although patients called




                                 31
     him.     And he would respond.   He would go out to see the

     patients, just as he had always done, but the patients

     would not realize that there was anything wrong.           Some

     of the doctors didn't recognize his cognitive

     impairment, even though he would make recommendations

     which were obvious nonsense.      For example, he didn't

     know about penicillin.     It had come into use just about

     that point.     So if the doctor ordered penicillin, he

     would countermand the order.      He would not be able to

     acknowledge that he didn't know.       On the few occasions

     that I visited in New York over the next couple of

     years and dropped in to see him, he was a shadow of

     himself.     He was lonely, bitter.    He would cling to me,

     which I never experienced before, and talk endlessly,

     without sequence or connection.        These were painful

     scenes for me and it was quite clear that he was also

     depressed.     In the beginning of May, 1946 I had moved

     to Rochester, and I came down, as I had been for

     several years, to Atlantic City for the annual meetings

     of the American Society for Clinical Investigation and

     the Association of American Physicians.        He always

     attended the Association; he attended the Clinical
     Society too.



Dr. W.:     Was that part of the A.M.A.; did they meet at this

     time?




                                       32
Dr. E.:   No, these were the two generations of young turks.

     The Association of American Physicians was the young

     Turks of the early part of the century or the latter

     part of the last century, I guess it was.     And the

     Society for Clinical Investigation was the young Turks

     of the early part of this cenutry, the 20s perhaps.

     Libman was present at the Association meeting, and got

     up three or four or five times, as he had done

     throughout the history of his membership in the

     Association, to discuss papers.     But now he discussed

     them irrelevantly.   Once he struggled to the platform,

     or the mike to talk, people couldn't understand what he

     was saying, it was garbled and people were embarassed.

     The incident was so notable that Howard Means included

     it in the 75 year history of the Association.



     At that meeting, that same day, we happened to get on

     the same elevator.   He asked me to come to his hotel

     room, which again was something very exceptional.       He

     had never asked me to come to his hotel room.     He took

     off his jacket, rolled up his sleeves, and asked me to

     feel his elbow, which I did.   I could feel nothing that

     caught my attention, but he said this is an olecranon

     bursitis.   "In about six or seven weeks, I will be dead

     of a coronary thrombosis, a cerebral thrombosis, or a

     mesenteric thrombosis."   This was the old theory, going

     back a hundred years or more, of recrudescent gout,




                                    33
which had long since been abandoned, but which Libman

revived and firmly believed.   I listened to his

account, and in due course left.      And sure enough, five

or six weeks later, my mother calls and says, "Your

uncle has been taken ill with appendicitis and has been

brought up to Mt. Sinai hospital, please come down."



I took the night train down, went directly to the

hospital and found that he had been operated on~

Normal appendix.   He had had abdominal pain,

tenderness, a little elevation of temperature.      That

was the basis for the diagnosis.      He was operated on by

John Garlock who was the head of surgery.      When I

walked into the room Libman shouted "These damn fools,

they operated on an old man for appendicitis.      They

should know that it was mesenteric thrombosis."

Garlock came in just about that point, and I still have

this picture vividly in my mind.      He's standing behind

the bed where Libman can't see him and he's winking at
me.   And Libman is haranguing him:     "I taught them

everything I know, and look what they've done."         He

said, "Mark my word, in four or five days I will have a

bloody flux."   Those were his words.     "And then I will

develop a paralytic ileus, and in a week I will be
dead."



His post-operative course for the first day was




                               34
unremarkable, so I went back to Rochester.      But, on

the fourth day, mother called and said he'd taken a

turn for the worse, and to come down.     I came down, and

sure enough he'd had a passage of bloody stool, he'd

became distended, peristaltic activity had stopped.           He

clearly had a paralytic ileus, and he was drifting into

unconsciousness.    Over the next 24 hours it became

abundantly clear that he was dying.



The family gathered around.     This was the ultimate

crisis.     Frank came up from Durham, so there were two

family physicians in consultation now.     He was being

seen by everyone in the hospital, notes written, and so

on.   Finally the family said there must be a

consultation, for which we recommended Robert Loeb, who

was at that time chairman of medicine at Columbia.        I

called him up, and he was very gracious; it was already

after nine in the evening.     He came down and everybody

gathered around the bedside.     He listened to the story,

he examined him, and said, "This is clearly a case of

mesenteric thrombosis, and there is nothing that can be

done," which is as it was at that time; he died the
next day.



An autopsy was performed, and there was no mesenteric

thrombosis!    There was no appendicitis, that was

already established.     By a strange coincidence, the




                                 35
autopsy was done by a pathologist named Jack Adler, who

the following year appears in Rochester in the

Pathology department, and it is from him that I got the

facts.     He had a pedunculated tumor, benign tumor of

his sigmoid, and evidently this tumor had twisted on

its stalk, which probably accounted for the episode

that was called acute appendicitis, then it untwisted.

Then it twisted again, only this time the blood supply

was obstructed, the tumor infarcted and that was the

source of the bleeding, the bloody flux that he said

was going to happen the fourth or fifth day.     That was

followed     by the paralytic ileus, a not unexpected

reaction, and     that was the setting of his death.



Now, interestingly, after Loeb had made his

interpretation, various members of the attending group

surreptitiously wrote notes of the chart, saying

"I always thought it was mesenteric thrombosis."         I

always felt that this was Libman's revenge.     He had

been deserted and neglected by his students and his

colleagues and admirers, they fell away.     In his

characteristic way, he was going to end up showing

everybody up.    How he did this, how this took place,

you can speculate as you wish, but that was the end

result, and I couldn't help but think as I stood at the

autopsy table and saw the risus sardonicus that this

time it meant exactly what it looked like (laughter);




                                 36
     he was laughing.



Dr. W.:   Thank you, Dr. Engel.



Dr. W.:   Dr. Engel, perhaps we can now spend some time on

     Dr. Libman, the physician, and his contributions to

     medicine.   From the collection at the Library, it seems

     that Dr. Libman had a very fine relationship with his

     patients.   There are many letters from people who wrote

     to him and thanked him for his care.         And there are

     lots of letters from well known individuals expressing

     not only thanks for his professional services, but who

     seemed desirous of seeing him again as a friend.         What

     do you think made him so popular?        Why were so many

     distinguished people attracted to him?         For example,

     you once mentioned Queen Maria of Romania.         And, of

     course, there's Sarah Bernhardt and Fanny Brice.

     Surely, there were other well-known practitioners at

     this time, and none of these particular patients had

     cardiac problems, that I know of.



Dr. E.:   Well, he was a generalist.        He antedates the era
     of   specialization.   In the language of today, Libman

     was a walking CAT scanner -- I think the question has

     to be answered in the context of the times.         But I also

     have to give my own caveat; namely, that I know nothing

     first hand about his relationships with patients,




                                       37
other than as a little boy patient, and of course I
know about how family members and maybe a few people
outside the family spoke about him.         I think this
should be seen in the context of the time, but let me
digress a minute because I think this might throw some
light on this.


Lewis Thomas,     in his   book Medicine,     the Youngest
Science, wrote about his father who started as a
general practitioner, then became a general surgeon,
and practiced I think in Queens or Long Island.
Thomas, growing up in the physician's household, and
his father, like my uncle, saw his patients, had his
office in the house, and went out on call.         So in that
regard there was some similarity in our backgrounds.
Thomas gives a very dismal picture of what medicine was
like in the 20s and 30s.      Almost nothing could be done.
His father, as he described it, would come home tired
out and discouraged, there was so little he was able to
do for anybody.     And Thomas enters medical school
essentially with, as I sense it, no very great
excitement or zest, or curiosity.      It sounded to me
almost as though he went into medicine because it might
be interesting, but not much more beyond that.         Then he
contasts what medicine was like in those days, with
the exciting advances, developments, treatments,
techniques, of today.      As I read that what struck me




                                  38
deeply, was how completely different was my impression
of medicine growing up in Libman's house.


My impression of medicine, in the 1920s and 30s,
was like Thomas' impression of medicine in the
1970s.   To me all kinds of exciting things seemed to be
going on.   Science seemed to be in high gear.    I would
see all the books and journals and reprints coming in
the mail, even occasionally sneak into his room or
office to leaf through books.    I'd see the specimen
jars in the basement, then there were all the visitors
who came to consult.    I would hear stories, not from
him, but from family, about his diagnostic exploits or
about patients who were rescued from the brink of
death, by the correct diagnosis or a skillfully timed
surgical procedure.    But even more than that, I would
be hearing about the advances and new discoveries being
made.    From early childhood it was constantly impressed
on me that I was somehow in the presence of greatness,
that his totally preoccupied behavior reflected his
complete absorption in new discoveries, that we
literally were witnessing medicine's future.     As a
little boy I imagined these discoveries were being made
in the little chemical laboratory on the second floor,
or in the basement. There was always an air of mystery
and excitement about his comings and goings and about
who was coming to call.    He was portrayed, in the




                                39
family at least, as forever being called to solve the
insolvable and do the undoable, and never failing.
Called by the great and near great, all over the
country, even abraod.   As a small boy those provided
grounds for me to be quiet and not disturb him and then
later for curiosity as to just what he did.     By high
school I was beginning to get some sense of a man
single-mindedly engaged in discovery, whether at the
bedside or in the laboratory. Along with my fear and
dislike was also awe and admiration.   Medicine as he
exemplified it in my eyes was surely the most exciting
thing in the world.


When I went to Hopkins as a medical student in 1934, I
was actually disappointed because I didn't encounter
the brilliant, exciting, productive people I had
somehow or other been led to believe would be there
no bee hive of activity like 64th Street was.     Also,
I had spent the two preceding summers while a college
student doing research at the Marine Biological
Laboratory, where I was exposed to a veritable galaxy
of stars in biology from all over the world that
further enhanced the    impression of exciting frontiers
in medicine.   Now what that says to me now is, that in
contrast to today, there were stars      like Osler (I
read Cushing's biography) or like Libman -- who were
magnets and who stood out, as individuals don't stand




                                40
     out today.    As I travel around the country nowadays,

     from one medical school to another, I am impressed that

     in every medical school you find half a dozen or a

     dozen people with splendid ability and accomplishments

     and competence.     They're all around.   In contrast, in

     Libman's time such people were rare.      Hence they had on

     their patients more the impact of the magician, the

     god, the final authority; Libman was a master performer

     in these roles.



Dr. W.:   He must have had a decent bedside manner.



Dr. E.:   Not by my standards (laughter), and I say that

     without hesitation.     He could get away with behaviors

     that today would be totally unacceptable.      It not only

     was that he was the authority, even at times the court

     of last appeal, it was extremely difficult to get to

     see him.     You had to have special connections.   That

     very fact enhanced his effectiveness with some

     patients, especially those who do best if they are

     handled in an authoritarian, controlling, even harsh

     fashion.     As you read the accounts, such as in- the New

     Yorker article, and as I heard accounts when I was

     growing up -- and this was more characteristic of those

     times, patients were not that central in the regard of

     most physicians.     Of course, you realize I had no first

     hand experience with how he actually was with patients.




                                      41
     I do know, however, that he exploited some patients,

     particularly wealthy patients, but he did this for a

     good cause.



Dr. W.:   That was going to be my next question, about his

     fees, did he sock it to the wealthy people for a good

     cause?



Dr. E.:   He didn't sock it to them.        Some he didn't charge

     at all or he charged them very modest fees.         He was

     very good about that.     See, he had very few needs of

     his own in terms of accumulating wealth or possessions.

     My childhood memory, particularly around Christmas

     time, was limousine after limousine pulling up to the

     door, and the door bell ringing, and the chauffeur

     coming in.     And there was always a question, what is it

     this time:     a brace of pheasant, or a rare French wine?

     For a wedding present Libman gave us a bottle of

     original Napolean brandy, 1805.         That was a gift that

     he had received from someone, I don't know who it was.



     But to come back to his actual behavior with patients,
     he -- and this is clearly described in the New Yorker

     article, and I think accurately so -- he was not a

     listener.     He was a superb observer, and he could make

     more out of less than most people could.         More out of

     less meaning that he cultivated this skill -- I think




                                       42
     skill is the right word, not style -- of learning the
     significance of small signs; so much so that he could
     bypass examinations and inquiries that other people
     would have to go through to reach the same conclusion.
     He would notice a single sign which was so distinctive
     that he could indeed walk in and say, that's it.     That
     had marvelous, magical impact on patients.    He could
     also be very kind, very attentive and devoted to
     patients in the sense of following through.    But he had
     the advantage of being the ultimate consultant, which
     is a very different role than the ordinary, primary
     care physician, the person taking care of the patient.
     His skill was such that he was correct often enough
     that he could get away with behavior which some people
     were affronted by.    Some patients would never go back
     to him unless at death's door.




Dr. W.:   So he was not only a fine clinician, but also
     superior in research.


Dr. E.:   Yes.   I think those two dimensions should not be
     considered separately.    His first devotion, his first
     identity, actually was as a scientist.    He had high
     standards with respect to the application of the
     scientific method to clinical practice, which means
     meticulous attention to accurate observation and to the




                                      43
development of hypotheses and the testing thereof.         And

he was masterful doing this at the bedside.    To some

extent he belonged to a generation that had not yet

been contaminated by the laboratory model of the

application of science.    The laboratory model of

science does not involve nearly to the same degree as

does clinical work the necessity to process, to reason

on the run.



In the laboratory you design experiments, you carry

them out, and you analyze the results, and then you do

something else.    At the bedside you can't do that.       You

have to devise ways of testing your hypotheses as you

go along, and the material is changing under you eye,

under your hand, so you can't wait.     Libman was very

good at that.     He would know -- at a time when

diagnostic procedures and laboratory procedures were

barely developed -- what procedures to use.     His

development of the technique of the blood culture was
an early example of correlating a clinical expression
of disease with laboratory findings; one of the

earliest ones, and he perfected that elegantly.       So

he came to know what would be the circumstances in

which a blood culture was likely to be definitive.         He

also developed ways of recognizing false positives and

false negatives, and how to deal with that.     There was

very little of that in the beginning of the century




                                 44
     when he began.     In those days most of the doctors
     didn't even know these procedures existed, and even if
     they knew they existed they didn't know how to apply
     them or how to interpret them.        And here comes Libman,
     called to see a patient with indolent fever; he notes a
     spot on the tip of the finger or cafe au lait
     coloration of the skin, takes a sample of blood for
     culture, which he does himself from beginning to end.
     That was magic!     You see, he didn't send it off
     somewhere, he didn't read a printout.        In a few days he
     would pronounce the diagnosis to be SBE, or whatever.
     What a magical element that would be in the doctor-
     patient relationship!


Dr. W.:   What about Dr. Libman and his colleagues at Mt.
     Sinai, or his students?     Do you have any insights about
     that?     Do you recall any stories?


Dr. E.:   Well, that, I think is perhaps the most critical
     dimension of his life, because in contrast to his
     relationships with patients where his authority and
     their needs made his patients highly dependent on him,
     his relationships with colleagues were more tenuous and
     stormy.    He repeatedly got into difficulties, most of
     which I know very little about -- what I do know is
     partly hearsay and partly anecdote.        Of course younger
     men began in a very dependent relationship.




                                      45
To be able to work in Libman's office as his associate
was the ticket to success in New York.       This was also a
period in which physicians had difficulty establishing
themselves in practice.     If you could get into Libman's
office and get known as having been Libman's associate,
your success was assured.    The same was true for people
who had been known to have worked with him in the
laboratory, although I think that was less of a ticket.


If you look at the people who were his associates, I
think some of them maintained relationships with him
afterwards, which on the surface, as far as I could
tell, remained cordial and reasonably friendly.        I
don't know any of them who wouldn't say that he was a
very difficult man to work with, but they still admired
and respected him enough that they either kept their
discontent to themselves, or they played it down.           Then
there were the people who worked with him, got out, but
were cautious enough not to be critical of him because
they knew their practice to some extent depended on
their ability to refer, to call him in on consultation.
Not everyone could call Libman in on consultation.
There were those who frankly broke with him.        Often
times they didn't last very long in his office either,
and it would not necessarily have anything to do with
their professional competence.        There were personal
incompatibilities of one sort or another.




                                 46
Dr. W.:     Do you know any of these names?   Can you recall any

     of these names?



Dr. E.:     Well, . . . George Baehr is one figure where

     there's always shadow, and this involved scientific

     priority more than, I think, issues of practice.



Dr. W.:     Are you aware of the Baehr-Louis Gross controversy?

     There's quite a group of materials in the manuscript

     collection on Louis Gross, who as you know was killed

     in that airplane crash.     It seemed that Dr. Libman was

     a good friend of Dr. Gross.



Dr. E.:     Yes, he was a great supporter and admirer of Louis

     Gross.     Gross was one of the people who remained very,

     very loyal to him, intensely loyal, and if he had any

     criticism, he kept them to himself.      Eli Moschkowitz --

     whom I greatly admired -- I never got the feeling that

     Libman particularly admired or thought very well of

     him.     But I thought very highly of him.   Moschkowitz

     was a gentleman to the core and never was going to say

     anything negative about Libman.       These names have

     begun to slip away from me, but I know there were these

     figures and I know Libman got into intense conflict

     with some of these people.     There were fights, and

     Libman resigned, it was 1925 or 26.      I just remember

     that people were making charges and counter-charges; he




                                      47
     was being attacked and being forced out, but I don't

     know whether he was fired or whether he resigned.



Dr. W.:   After that he became a consulting physician at Mt.

     Sinai.



Dr. E.:   Right.



Dr. W.:   Did he have an office on 64th Street before . . .



Dr. E.:   He always practiced from there.       He never had an

     office at the hospital.      Nobody had offices at the

     hospital in those days.      The few full time people for

     whom he was responsible for getting the money were in

     pathology and bacteriology, in the laboratory.         Even

     that was a significant advance.        Nobody practiced from

     within the hospital.      They all had their outside

     offices.



Dr. W.:   Was that true in the 1930s and 40s?



Dr. E.:   Yes.     The full time system only gained prominence
     after World War II.



Dr. W.:   William Welch said that Libman founded the school

     of Cardiology at Mt. Sinai, which of course he did, and

     trained all of the people who followed him.        And you




                                       48
     had mentioned that he raised its standards to that of a

     university hospital.    Do you think there was anyone

     else at Mt. Sinai at the time that comes anywhere

     close to Libman in achieving this for Mt. Sinai?



Dr. E.:   You mean in general, not . . . .



Dr. W.:   At Mt. Sinai.   Or do you think that Libman just

     dominated?



Dr. E.:   No, there were other figures.



Dr. W.:   George Baehr?



Dr. E.:   No, I don't see George Baehr as of the same

     caliber.     In my contacts with Baehr on the wards and

     grand rounds, etc., I thought him a good, reasonably

     competent physician, but a lightweight.     He was a very

     dignified, impressive man; he lived well into his 90s.



Dr. W.:   Had you heard of Moses Swick?



Dr. E.:   Moses Swick, I knew.   He was a urologist and he

     introduced the contrast media for pyelography, which

     was a great advance at that time, intervenous

     pyelography.




                                      49
Dr. W.:   I'd like to bring up one related subject, Dr.

     Engel, and that is Dr. Libman's interest in the history

     of medicine.     He seemed quite interested in the history

     of medicine.     He knew Fielding H. Garrison, and of

     course you know of his interest in Thomas Hodgkin.

     And he was a good friend of William Welch.      To the best

     of your knowledge, did this interest ever surface when

     you were living in his house?



Dr. E.:   I don't know the background of that.     It hardly

     surprises me that he should have gotten interested in

     the history of medicine because he really bridged the

     period between the great clinicians of the end of the

     last century and the new generation of clinicians who

     were evolving.     It was an era in which the great

     physicians of the time were primarily clinicians, and

     were progressing by correlating clinical expression

     with pathological changes, with bacterial infections

     being the main etiologic category.



Dr. W.:   Of course, a lot of the physicians he knew were

     interested in the history of medicine.      Jacobi was,

     Osler was.     So it was bound to . . .



Dr. E.:   It comes naturally, it seems to me, if one is

     oneself involved in developing new ideas.      I doubt

     whether many people got interested in the history of




                                      50
     medicine in the abstract.



Dr. W.:   There were two fields that Dr. Libman was very

     much interested in, at least as revealed from the

     collection.    One was gout, and the other was pain.     He

     collected lots of reprints on both of these subjects.

     On the subject of gout, there wasn't anything else in

     the collection other than these reprints.     Can you shed

     any more light on that subject?



Dr. E.:   Well, I'll add one more, namely his interest in

     altering of the bacterial flora of the colon, which

     was originally proposed by Metchnekoff I think

     somewhere in the 1890s.     Now I put those three areas in

     a spectrum.    The gout business never came to anything,

     and he was almost alone, if not actually alone, in

     adhering to this view.     This was one of those

     fascinating things to me because here was this man --

     such an extraordinary authority in so many areas --

     everybody was in awe of his knowledge, very, very few

     dared or cared to dispute him, yet you had only to

     mention recrudescent gout and it would be met with

     ridicule.     It was almost as if there was a shared

     agreement, unspoken, that here was something you could

     make fun of Libman about.    He had this crazy notion,

     that went back to the last century, and which he then

     proceeded to duplicate in his own death.     You see his




                                      51
     statement at the time of his prediction of his death

     with respect to the bursitis    was "this is gout, and it

     will be followed by thrombosis in six weeks.''



Dr. W.:   Did he have any other symptoms of the gout?



Dr~ E.:   I didn't find that!    I could find no evidence

     of an olecranon bursitis.    He said it was there, but I

     felt nothing nor saw nothing, and he didn't permit me

     to quiz him about the symptoms.       He just said,   "This

     is olecranon bursitis."     I just felt, in my insecurity:

     "Well, I'm probably not sure where the olecranon bursa

     is, I'll have to look it up."     I thought I knew where

     it was, but his allegedly afflicted elbow didn't look

     any different to me than the non-afflicted one.        So

     that was that.   But here his dying gesture was to use

     the same old theory.



     But I remember -- I suppose peddling would be an

     appropriate word because I was only a medical student;

     I remember being able to peddle Libman's ideas at

     Hopkins and get away with it -- I never could peddle

     recrudescent gout, though.     Occasionally I would bring

     some idea that they had never heard of.       For example,

     that phagocytizing macrophages could be obtained from

     blood from the earlobe, but not from the fingertip in

     subacute bacterial endocarditis.       I remember being




                                      52
     laughed at for that.     And then I proceeded to do it and

     pulled smears on blood from both sites.      And sure

     enough -- just as Libman had said -- there were these

     unusual cells from the earlobe, but not from the

     fingertip.     So people backed away.



     Now the colonic irrigations, the infusion of cultures,

     which were supposed to have come from healthy, older

     men.     His father was a healthy old man in his 80s and

     into his 90s.     This was a treatment he gave everybody,

     he must have used it on thousands of patients.       He

     addicted people to this.     My mother was addicted to

     enemas and colonic irrigations, and from time to time

     implants.     I was addicted to it as a small boy.      So

     were my brothers.     Everybody in the family got enemas

     and irrigations.     As a child, I just assumed that was

     part of life.




Dr. W.:     Was this not common, generally, in medicine at the

     time?



Dr. E.:     This was an era in which there was a lot of

     attention to bowel movement.     Auto-intoxication was a

     popular theory for a while, but the notable thing is

     that it is not something he ever wrote or lectured

     about.    People who worked with him knew.   There were




                                      53
sodium bicarbonate enemas, and I know, because I had to
administer them to my mother.     I know because they were
administered to me from as far back as I can remember.
I know because I had to take calomel once a month,
irrespective, or castor oil.     There was some use of
such procedures in the general of medicine, but my
point was that it deviated from what otherwise was
Libman's very exacting, high standard of scientific
probity.     It was not something he ever tested or
examined, it was almost as if it was from another part
of his life.    He even took them himself.      And I can
attest to that because I can recount any number of
times in which he and I met, so to speak, at the door
of the john; I had to retreat, he was getting in there
just in time, shouting at me, and there were not a few
accidents.


Now the pain business is another story, which is of a
completely different order.     That intrigued me in
particular because I later on got involved in studying
pain and writing about pain.     And, incidentally, it was
an interesting and gratifying coincidence that we both
got the same award, the Modern Medicine Award, some 35
years apart, he for his studies on pain and I for my
psychosomatic studies which included pain.        The
organization that gave us the award had no idea there
was any connection between us.        His observation was a




                                 54
very good one, and valid.     I used it, in my work with

patients.    But this has interesting relavance in

respect to the question that you raised earlier about

his reputation being very good with patients.      I

abandoned it not because it wasn't valid and useful,

but because I no longer could allow myself to do this

to patients.



The test depends on catching the patient by surprise,

and I just don't feel that is something one should be

doing with patients unless there is a very, very good

reason.     I used to teach it to all the students.     And

I satisfied myself that his observation that people who

are hyposensitive to pain are more likely to report

symptoms other than pain in situations in which        pain

was the usual situation.



I couldn't help think of that in a recent report of

people who are now demonstrated with 24 hour

monitoring to have had "painless" episodes of cardiac

ischemia.    My experience is that those are not

painless, or more correctly, they are not symptomless.

If you talk with those people you will discover that

they are having other sensations, fullness, pressure,

but not pain.     If the physician asks if the patient is

having pain, the patient will say no.     But if you ask

the patient what he is feeling, then he may say:       Well,




                                 55
     I'm feeling a little fullness; a little aching in my

     throat; or something else, or some other sensation, or

     pain in some area other than where it's expected to be.

     Most of these patients are not in fact symptom free,

     but they are pain free.



     Were Libman on the scene now, I could just see him

     getting up at a meeting where this is being reported

     and asking       "How many of these people were

     hyposensitive to pain?"     And then proceeding to

     demonstrate the styloid pressure test on the man

     reading the paper, right on the spot.



Dr. W.:   Dr. Engel, may I submit one more subject in this

     general field, and that is Dr. Libman and cocaine.

     Would you like to comment on that?



Dr. E.:   Yes.    I think it's accurate to say that Libman was

     a cocaine addict, but not quite in the sense that we
     think of cocaine addicts today.       In that era many

     people became cocaine addicts in the course of the use

     of cocaine to treat sinus disease. This was before

     antibiotics.    Hence, sinus infections were much more

     common than they are now.     Further, sinus infections

     and sinus disease were often incorrectly diagnosed.          I

     think what was then called sinus disease now would be

     recognized as one or another form of allergy.        These




                                      56
were for the most part allergically sensitive people,
and because at that time there were not the harmless
vasoconstrictors available to open up the sinuses for
drainage, and there were no antibiotics, there were
lots and lots of patients who then were refered to ENT
people who used cocaine to shrink the mucus membranes.


And it worked beautifully.    My mother was addicted,
although I think not as severely as Libman was.     But
there were any number of times I went with her to the
ENT office and there would be literally lines of people
who were just given cocaine with a pledget on a probe,
up into the sinus orifices.    Then they were put on a
suction apparatus to suck the "pus" out, which__; was a
great way of traumatizing the mucosa and continuing the
infection.    I don't know when Libman started using
cocaine on his own sinuses, everybody in the family was
alledged to have sinus trouble including myself, and
somehow or other I escaped surgery.    I don't know how I
escaped it, but I did.


But Libman began using it as far back as I can
remember.    To this day I can vividly see him coming
up the stairs, three steps at a time, with a probe up
his nostril, usually in his shirtsleeves or his sleeves
rolled up.




                                57
     That raises interesting questions for me, in light
     of what we know about cocaine, as to what this has to
     do with his energy, the fact that he worked such long
     hours and seemed inexaustable, some of his mood
     changes, I don't know . . . .   But it did not seem as
     if it did him any harm, I can't say.


Dr. W.:   Dr. Engel, tell us something about Dr. Libman as a
     teacher, and then what your views are on his medical
     contributions.


Dr. E.:   There certainly is no question that he was a
     premier teacher, and I think in many respects that his
     most impressive reputation was as a teacher.     He was
     sought worldwide.    It is worth noting that Libman did
     not work in an academic setting.     He was working
     essentially out of a hospital and out of his office.


     A good commentary on his reputation as a teacher
     appears in the 75 year history of the Association of
     American Physicians, by Howard Means.     Libman's
     presence at meetings always was a great drawing card.
     People came to hear what he had to say.     The record is
     an interesting one because there was by no means
     uniformity of opinion, if you look at that material as
     to how sound and solid was what he had to say.        Most
     people listened very attentively, but there were some




                                     58
who would pronounce that what he had to say was of

little or no importance.     I think there was some

agreement that he was rather self-referential.        There's

the famous report -- the one Herrick gave in 1912 --

his first report on the antemortem diagnosis of acute

coronary thrombosis.     No one commented but Libman.     And

the comments about Libman's comments later on were that

Libman was trying to show that he already knew how to

diagnose myocardial infarction, which may well be

so.



He was a teacher of an era, in which the style was

dramatic, and showmanship was a prominent aspect of

teaching.   He was a showman.    He mounted a performance,

he created an atmosphere of excitement and an

atmosphere of awe.     I know this chiefly from when I

was an intern on the few occasions when he came to Mt.

Sinai on rounds.     This was in the late 30s, early 40s,

when that style of rounding had already begun to fade

away.   But when Libman came on board, the visit was

anticipated long in advance.     Everybody was very sure

that they had everything prepared.     They knew that he

was going to be attentive to detail.     They anticipated

that he would come up with some unexpected or

surprising, sometimes astonishing, statement or

observation.   They knew that part of the game was to

show everybody up, and more often than not, he did.




                                 59
The whole ambience was one of awe, admiration, and no

little fear, even from among the more mature people.

He was full of surprises.     He also bluffed.    And he

also swayed by the power of his style and the

impression that he gave that he had to be right.



The examples I'm going to give are, I'm sure

exceptional, but nonetheless they're revealing of his

influence and personality.     I remember he examined a

man, I can still see the bed and the patient -- a man

with a large spleen.     He announced, after a very

careful and typically quick examination, that the

spleen had three infarcts.     Person after person then

came over and felt the spleen, nodded their heads in

agreement, and wondered how they could have missed the

infarcts.    A few days later the patient had a

spleenectomy.     I was present at the surgery.   There

were no infarcts.     Exactly what he felt I don't know,

but the next time I saw him I plucked up my courage as

best I could and told him of the findings of the

surgery.    To which he responded with a mischievous
glint:     "They all felt them too."



I think that for the era he was probably one of the

people who developed very considerable skill at

exhibits.    Exhibits were fairly popular in those days

-- they no longer are.     That was perhaps partially




                                 60
because pathology was so prominent and specimens could

be demonstrated.     But I think Libman seemed to have

developed this to a really fine art.       Quite a few of

his exhibits won awards and prizes, and he became

known as a person who was able to document and

demonstrate through what nowadays would be called

multi media:   charts and tables, oral materials,

demonstrations, specimens, drawings and diagrams, and

put them together.     He had this capacity to put

together major topics, major areas.       The New York

Academy of Medicine Graduate Fortnightly on heart

disease, from everything I've ever heard, was

apparently an amazing exhibit, which people talked

about for years and years.     I was very aware of'his

working on these things because I would hear about

exhibits when I was growing up.       That Uncle Manny was

having another exhibit in Chicago, or Atlantic City, or

someplace in New York.     Also, when the exhibits were in

process he would be bringing people to the house, and

to the basement to show materials and specimens, and so

on.   Most of the specimens were saved.      I'm not sure

where they went; I think they went to NYU.       One would

have thought he would bequeath them to Mt. Sinai.



 This is changing the subject a bit, but to       come back

 to the complexities of this man.      Because of his

 situation at Mt. Sinai after he resigned in the mid




                                 61
      20s, 1927 I think it was, his position at Mt. Sinai

      became increasingly antagonistic.



Dr. W.: Why?



Dr. E.:     That's what I've never known.   There were rumors of

     conflict with other members of the staff.      Questions of

     priority and questions of favoritism, and the

     homosexual charges got into the picture somehow or

     other.     That was always very obscure; I would only hear

     about it -- people were jealous, it was unfair, etc.

     In looking back, I see this as a stormy period in his

     life.     A period in which he was really having great

     difficulty in maintaining his secret.       A terribly

     burdensome secret in that period of time, and as I look

     back I'm amazed that he succeeded as well as he did.

     But there were many charges of favoritism and jealousy

     that I would hear from one side or another, and

     controversies about the priority of work and that sort
     of thing.     But the net effect was that he left Mt.

     Sinai out of his heritage, his will, etc.

     completely.     I never could figure out why he gave his

     specimens, and his pictures, and the furniture of his

     office, to NYU.     He didn't have any connection with

     NYU.     I don't know the answer to that.   Someone maybe

     knows.




                                      62
Dr. W.:   I think NYU was going to recreate his office.



Dr. E.:   I don't think they ever did, and I've often

     wondered what ever happened to the furniture.      I have

     photographs, I wonder what ever happened to these

     items.    I can't imagine that they are at NYU.    At one

     point I made an inquiry and nobody had the slightest

     notion.    Some things must have just disappeared.    Then

     he gave some of his material to Hebrew University in.

     Jerusalem.    That made perfectly good sense; he gave his

     books and so on.    But he didn't leave anything to Mt.

     Sinai.    Here is this curious situation where all his

     major work was done at Mt. Sinai.     The material you now

     have in the Library he gave to Sorkin.     It's a puzzle.

     You see, Sorkin was one of his less conspicuous, or

     less well known associates.    I think he was his last

     associate in the office, or maybe next to last (I

     wasn't around anymore) but not a man, I think, with any

     clear perspective of the value of this.



Dr. W.:   Did he give them to Dr. Sorkin, or was Dr. Sorkin
     just there at the time?



Dr. E.:   It's in the will, and I only discovered this in

     1959 when Myron Prinzmetal wrote to me saying that he

     had many, many letters from Libman.    But now he didn't

     have his letters to Libman for which these were




                                     63
     answers, and he was working over his old material.

     Then I found that Sorkin had been given the material

     and so I wrote to Prinzmetal.     I don't know if there

     was any follow up of that, whether he ever tried to get

     the material.    But the net effect was that the teaching

     material, specimens -- valuable material that had to do

     with the whole history of the development of subacute

     bacterial endocarditis, and the lupus non-bacterial

     endocarditis, -- all that material, which really I

     think should have been in the archives of the pathology

     laboratory of Mt. Sinai, never went there.



     It's not surprising, therefore, that the few loyal

     friends that he had in later years would try to get

     some acknowledgement for him.     A plaque was put in the

     pathology building eventually, I think that was in

     1959.   I went to that occasion and there were very few

     peope there.     I've never seen the plaque.   The last

     time I was at Mt. Sinai I asked where the plaque was,
     and nobody knew.     Eventually I got a letter and a
     photograph of it.     It's in Hans Popper's office.



Dr. W.:   What are your views on Dr. Libman's scientific

     contributions?



Dr. E.:   Yes, let me say something else about his

     educational role.    There was one role of Libman as a




                                      64
sort of public educator, but I think there was a much
more powerful role of Libman as a mentor with young
people.    He identified, and had people around the
country who would identify, young men.    I don't know
that he ever selected a woman -- there weren't all that
many women in medicine to begin with, and I don't even
remember him talking about any women in medicine
besides Maude Abbott; I think that was the only figure.
People would write to him and describe so and so, a
young man, a medical student, and maybe someone who
seemed to have exceptional talent, and ultimately some
arrangement would be made for this young man to meet
Libman.   Maybe at a meeting, more often it was at the
house.    Usually, it was after the person had finished
medical school or finished his internship, and it was
really on the basis of a session or two that Libman,
all by himself, would make the decision that this
person should get further training.


Libman would then arrange the training in every detail.
With whom he would work, where he would go, what
laboratory.   Very often it was abroad.   And in the
early days he would just pick up the phone and call
this wealthy patient or that wealthy patient and say I
need three thousand dollars or two thousand dollars, or
five thousand dollars, and so on, for his training and
the check would arrive and that was that.    Later on two




                                65
foundations were established.    First of all the Dazian,
and then later the Emanuel Libman Foundation.     The
funding was done through foundations.     Seen in the
context of the resources and the support for education
and research in those days, this was really monumental,
and it was especially monumental for Jewish boys, most
of whom had great difficulty getting posts in the few
institutions where work was going on in this country.


Then as now, it's not at all difficult to get a
training situation if the home institution doesn't have
to pay for it.   We love to have fellows come from
abroad; they bring their own money. Or from some other
institution, and they're likely to be good people
because they were already well selected before anybody
thought it was worthwhile to support them financially.


I've often thought about the psychology of this process
because often time these were people who didn't know
Libman.   But the intermediary, like Gross or Segall, or
others, would describe him.     And I've talked to and met
some of these people years later.     They would get a
description of what Libman was like.     Then there would
be anticipation of the visit.     And then the profound
impact of having this man give his sole, complete
attention -- maybe it would be just a matter of hours
-- and it was a combination of education,




                                 66
entertainment, and examination.     He would pull down

books, or pull down papers, or pull out specimens.        I'd

hear them running up and down stairs -- they would

describe this to me.   He had a tremendous fund of

knowledge, and the people who were really good          the

one I got the best story was from the late Arthur

Mirsky, who was a brilliant, productive scientist; he

was the one who didn't get the support because nobody

had warned him not to say anything about getting

married, that was the end of it.     But Arthur had

already been doing research at McGill as a medical

student.   He described how incisively Libman challenged

and questioned what he was doing and involved him very

quickly in new ideas, or new ways of looking at things.



And other people have told me this.     It was almost as

if it was an internalization process that went on

within a matter of hours.   These people would carry it

with them, because they knew whatever they did abroad
they would have to give an accounting when they got

back.   Although I'm projecting here, I know that if I

were in this situation this would have an enormous

impact on me, and I dare say it did on others.        Always

a feeling that this incisive, critical mind was over

your shoulder.   The interesting thing was that it was

not just over the shoulder of the fellow, it was also

over the shoulder of his mentor abroad, so that Libman




                               67
     would be equally incisively questioning them when they

     came back for a visit.    You know, "Well, how did

     Lichtwitz do with this?    Oh doesn't he know about.

     ?"   These kinds of questions.    This style, and this

     manner, Libman was also displaying in other teaching

     situations, I think had a very lasting effect on

     people.



Dr. W.:   Dr. Engel, what are your views on his scientific

     contributions?



Dr. E.:   Well, I got involved in doing research very early

     myself, under the impact of this atmosphere, and as my

     own career developed I looked back, and felt I got into

     the era      just fortunate by date of birth -- of great

     support of research.     All kinds of funding and

     laboratories and opportunities, etc., which began in

     the post World War II period.     I'm absolutely

     astonished at what Libman was able to do, and I don't
     know how many figures there are who have a comparable

     career.    All the great clinicians of the past, of the

     19th century, were practitioners.     They had to be

     practitioners and all of them did their little bit,

     or their great bit in the laboratory, which was mostly

     pathological anatomy and a fairly limited sort of

     thing.    The bacteriologists for the most part, at the

     end of the 19th century, most of them I think moved




                                      68
away from clinical work, they were not practitioners.


Here was a man who not only was a practitioner and
earned his living in the practice of medicine, but he
also didn't have any academic connections.     Mt. Sinai
was not a teaching hospital, had no academic
connections.   Here is an instance perhaps in which
his personal peculiarities facilitated things.     Libman
was a loner, he was not married, did not have family
nor family responsibilities, and he did not have very
great needs in terms of finances simply because he was
living in the same house and under the same roof where
he had lived when he was growing up.     It was as if he
almost didn't move away from home.     So he was able to
do things, I think, which many people of that era maybe
of comparable ability couldn't do.     He was also able to
devote his attention to it and persevere.     He really
represents in a way -- exemplifies -- the transition
from the 19th century focus on pathology as morbid
anatomy to what was the beginning of pathophysiology.
He doesn't quite get to pathophysiology and the
correlation with clinical findings, the clinical
expression of disease.   That, of course, was the main
thrust of the 19th century.   He begins with a single
observation in Escherich's laboratory, which astonished
me because it was only three weeks that he was there, I
never realized until I read his letters that he never




                               69
     spent more than a short time with any of these people.

     I can't remember whether it was a year or two that he

     spent abroad.



Dr. W.:   He went abroad twice, I believe.       First, for a

     year, then he went back.



Dr. E.:   That's what I'm not clear about.       But it was a

     short trip and very different from what we think of as

     someone going abroad to study.        He visited here and he

     visited there a few weeks, and evidently Escherich had

     him do an Arbeit.   An Arbeit consisted of something

     that would be regarded as some really elementary

     nonsense.   He evidently had never cultured organisms;

     he had never had any occasion to do these kinds of

     things until he got there.   First, he went from

     identifying the enterococcus, the streptococcus in

     stool, to a concentrated attention on that class of

     organisms, and then he asked the question:        "If the

     organisms are normally in the throat and in the bowel,

     how do they get anywhere else?"



     I think it's hard to appreciate now what a monumental,

     challenging question that had to be.        Most people were

     thinking of pathogens as bad organisms that were out

     there, hiding in the water, typhoid bacillus and so on,

     malaria, and what not, which got into you.        And here he




                                      70
was, at this very early phase, looking at organisms

which were in the nose and throat to begin with, some

of which turned out to be highly pathogenic, but only

once they got past the mucus membrane barriers.      I have

no idea how he got to, and where he got the idea, to

look at the culture of the blood.    I remember the very

first time I drew a blood culture; I was an intern

before I drew my first blood culture and I had no idea

then that Libman had been responsible for the

development of the technique.    I knew he had done lots

of blood cultures.



Learning how to do a blood culture in those days, I had

to stop to think about it, and wonder how the first

person figured out all these details.     It seemed to me

every time I did a blood culture I was getting

contaminants, and that sort of problem.    And here he

works out the technique. And evidently for a period of

time, he was one of the few, maybe the only

person, who knew how to do this properly -- and this

was in the early 1900s.    So much so, that if the

question came up of a need for a blood culture --

that's how he got to be widely known      he could be

called to come a great distance just to draw the blood

for culture.   And it wasn't just the matter of drawing

the blood specimen, but having the proper media upon

which to grow it.    He had an incubator in his office




                                71
and he had incubators at the hospital.    And then to
think through the whole question of the dissemination
of infections.   Questions such as do bacteria grow in
the blood; they grow in the blood in the laboratory --
do they grow in the blood in the person -- and where do
they go?   And then work out the pathways of
distribution of bloodstream infections and make
correlations with clinical manifestations and
variations of organisms.


Of course, many people began to do this very quickly
with varieties of bloodstream infections.      It was
partly for that reason that he was saved from becoming
a specialist.    I know he is described as the founder of
the Mt. Sinai school of cardiology, but actually he
never became a specialist.    He was always a generalist,
and that was particularly logical in that in the
pre-antibiotic days, when knowledge of the mode of
acquisition and the course of dissemination in the body
of infections was a major part of what doctors had to
do.   So he became an expert, for example, in middle ear
infections and sinus infections, even though he strayed
from that in later years.


The complete working out of bacterial endocarditis as a
a defined syndrome was, I think, largely his
contribution.    Then to look at other forms of




                                72
endocarditis; there was a certain amount of
serendipitous discovery here. If you look through his
papers you'll find that later on he begins to pull
together clinical observations, and some of these
continue to be useful. Many of his observations had to
do, not surprisingly, with unusual manifestations of
infections.     But he expanded and became very skillful
and very helpful in his teaching in differential'
diagnosis.    I don't think he wrote as much about some
of these things, or in as orderly a fashion, as he
might have.     They were little vignettes, little
excerpts, that this is a useful sign or that is a
useful sign. In his later years he didn't document that
all too well.


His observations on pain were a major contribution
which I think were never really appreciated, largely
because there was a major flaw in the basic concept of
pain as it was being taught in those days. I think
Libman's views were part of the breakaway from that.
Most people were so embedded in the telephone concept
of pain that it's hard for people to deal with this.
It's interesting to me because Libman's concept of
hypo- and hypersensitive was beginning to touch on the
appreciation that there were psychological determinants
that were responsible for these differences.     He didn't
develop that, but it obviously was going in that




                                 73
     direction.


Dr. W.:   Dr. Engel, maybe we can spend a little time on Dr.
     Libman's interest in Jewish affairs.     Even though the
     family did not practice religious Judaism at home,
     Libman was very involved with Jewish students in the
     United States and with helping Jewish physicians in
     World War II, as well as things relating to Palestine.
     Do you have any ideas or comments about this general
     subject?


Dr. E.:   I know very little about that and how that came
     about.     I can speculate from some of the influences,
     and I suspect that some of it was chance.     Some of it
     was the influence of his father, who while not a
     religious man, was identified with Jewish causes.      I
     don't think of him as being involved in any
     organizations, but he was certainly a man who had an
     enormous knowledge of, and scholarly interest in, the
     problems of Judaism, the history of the Jews,
     comparative religion, and the problems of immigrants,
     and so on.    He had lived through it himself.   Having
     gotten part of his education as a young man in a
     monastery in Poland probably set him apart in a way
     from many of the same origin in Poland in those days.
     He was always inquisitive.     I just don't have any
     information, though, on what actually transpired.




                                      74
     My hunch is that it was a byproduct of Libman's rapidly
     developing prominence, and the fact that he became a
     conspicuous figure very, very early in his life in the
     community.     In other words, he became a Jewish
     physician who more than most became known, sought
     after, and highly regarded, and who may have been
     approached originally for medical problems.     Well known
     people around the world were refered to him -- people
     who were not Jewish -- first he acquired them as
     patients, and then as admirers or friends or patrons,
     wealthy Jewish figures in the financial world and the
     business world, and also in the arts, theater, and so
     on.    My hunch is that he probably just began to be put
     forward, or introduced into roles of social,
     quasi-political activity, because he could make
     contact.     I think this maybe makes a connection with
     his power as a physician, and the role of the physician
     in that era.


Dr. W.:    Did you know that he was invited to come to the
     Hebrew University, and head the department . . . .


Dr. E.:    Yes, yes, and Rachmilewitz, who became the first
     head of medicine and later the dean of the medical
     school, came over here to work with Libman in the
     middle 20s, and I knew Rachmilewitz; I met him as a
     little boy.    We used to have a summer place in Lake




                                      75
     Placid in the Adirondacks, and Libman would sometimes
     send one of these younger men up to vacation.     I
     remember seeing Rachmilewitz in Lake Placid, but I
     can't remember whether he just passed through or
     whether he stayed with us.    Sometimes they would stay a
     day or two; we had a rented house.    Sometimes they were
     coming up to look at the TB cases.    Some of them had
     tuberculosis, Benjamin Sachs had tuberculosis.        Then
     Rachmilewitz went back and I know that was a sustained
     connection.   I suspect that there were persons like --
     and I say like, but I don't know that these were the
     figures -- Eugene Meyer, or Kuhn, or Loeb, who had
     connections with the Zionist movement and with the
     Palestine movement, who just began to involve Libman.
     I can see them saying:     "Hey, this would be a good
     person for us, why don't you approach him."     And I can
     also see, and this fits with what I was saying
     yesterday, how I see him as an anachronism in one
     sense, of being in some ways a shy man with a deep,
     dark secret who as he becomes successful is able to
     compensate in a very effective way.     So the paradox
     is that he becomes very socially acceptable, not just
     socially acceptable, socially sought after in many
     different circles.


Dr. W.:   That's interesting.   You mentioned earlier that he
     gave his book collection to the Hebrew University.




                                     76
Dr. E.:   He gave his books to the Hebrew University, his

     library, that's in his will.



Dr. W.:   Perhaps I can get a copy of that will.



Dr. E.:   Yes.    I thought that we might go through it and

     identify things that are not in the collection and

     might be useful.



Dr. W.:   Very good.    And then, of course, he did take a

     lot of initiative and was very much involved in trying

     to save Jewish refugees.



Dr. E.:   Yes.    It occurs to me that a significant figure,

     maybe the most significant figure in this activity, was

     Rabbi Stephen Wise.     Wise was his classmate at CCNY and

     they were friends.     Wise, of course, was in the center

     of all of this activity in the first part of the

     century.     But I strongly suspect Wise was probably the

     central figure in getting him moving.



Dr. W.:   Is there anything else you'd like to add about . .




Dr. E.:   Yes, the rescue and the support of refugees from

     Hitler.     That was probably his major preoccupation

     beginning in 1932-33 and to his illness in 1943.        And




                                      77
there's no question there he made a monumental
contribution. He was able to make a monumental
contribution because he probably had more extensive
connections with, and knowledge of, the Jewish medical
and scientific community in Europe than anybody.     He
knew all these people, and he knew them personally, and
therefore could work and make connections with them.
The people that I knew that came by this route -- it
would be somebody at the university or the hospital, or
someone else -- said, "Get to Libman."     It was almost a
code word.


There was this committee, and he was the chairman at
various times, or held various important positions. But
it was not only the connections at the European end, it
was his connections at this end.     Again, this has to be
seen in the context of a time when it was very
difficult for anyone, not to mention foreign Jews to
get positions, certainly difficult to get positions on
faculties, or medical schools, or hospitals.     It was
very difficult for these people to get licensed. There
were all kinds of obstacles, but he had connections,
and some were exceedingly helpful.


There are people I know personally who were helped in
this process.   He got them internships, he got them
posts with very distinguished people.     I think of one




                               78
     Rochester man, Andres Roodenberg, (who is actually just

     retiring from practice next week; he is 75 years old) a

     Dutchman, a concert violinist of premier status who

     became a physician.   Libman got him to New York, got

     him an internship, and then got him out to the Mayo

     Clinic from where he eventually came to Rochester.



     The Mayo Clinic was in a way a paradoxical area,

     because he knew the Mayo people, and he could get

     people there.   And yet this was an area in which there

     was very little opportunity for Jews.     I think there

     were two or three Jewish people out there and yet

     Libman could manage to get people in.     Tinsley Harrison

     took people and got them arrangements.     He got people

     settled at Hopkins and at Sinai in Baltimore.     At

     Hopkins that was no easy thing to do, and yet he could

     influence people, you see, to take these young men.



Dr. W.:   That's certainly a significant contribution.



Dr. E.:   And some never knew that Libman was involved, or
     never even met him.



Dr. W.:   Dr. Engel, we are coming to the end of this very

     interesting discussion.   I'd like to ask you one

     question which occurred to me recently.    You grew up in

     Emanuel Libman's house, and from what you said, there




                                    79
     existed some very odd situations there.   And yet there
     can be no doubt in my mind that he was this very
     important influence in your life.   What are your
     feelings toward your uncle?   How do you feel that his
     behavior toward you while you were growing up, as well
     as his influence on your career, affect you emotionally
     and psychologically.   And, in addition, the fact that
     he did not, as you commented, leave his materials and
     his papers to you -- at a time when you already had
     your medical degree and already had a position -- but
     rather to a younger associate of his.


Dr. E.:   Well, it was not just to me, it was to the three of
     us -- my two brothers, Frank and Lewis -- and it wasn't
     even a question of leaving the papers to us.   I don't
     think we necessarily thought in those terms, but as the
     only medical members of the family, I always felt that
     it would have been appropriate for us to be in some way
     involved in the ultimate disposition or supervision.


     Your question actually is a very difficult one to
     answer, because there are many different answers.     I
     can tell you that the largest part of my psychoanalysis
     was involved in working through my relationship with
     Libman.   He, incidentally, helped to support my
     analysis, which was an interesting fact in and of
     itself, and which in a way expresses the contradictions




                                    80
in this relationship.   I'll say a word about my
feelings about Libman now, which are very, very
different.


It is only in recent years -- I can't tell you how many
years, maybe the last 20 years; he's been dead almost
40 years -- that I have come to peace in my mind about
Libman, and I would say now I'm proud of that.      I feel
indebted to him in many, many ways.   I feel what I
would now have to describe as an almost affectionate
understanding for the man.   I now see him as a tortured
person, who struggled with very serious, deep problems,
and I stand now in admiration of how well he coped.         At
the time I was involved in this scene, I had no way of
knowing what lay behind much of his behavior.


Certainly while growing up my feelings about him were
of fear and hatred, coupled with awe, respect and
admiration.   It was a very difficult kind of
relationship to have, and it was one about which the
three of us talked a great deal -- certainly my twin
brother and I talked a great deal about it.     He was the
villain, he was the enemy, he was the figure that
imposed all kinds of threats and fears on us.      He was
so remote and it was so difficult to relate with him.
And yet, at the very same time -- I think I'm repeating
myself a bit here -- I was identifying with him.      But




                               81
there was always this struggle on my part to
disassociate myself from him.     I suppose in a way these
behaviors and feelings were mutual, because he equally
was exhibiting these ambivalent attitudes toward me and
toward my brothers.   That is, on the one hand, of
leaning over backwards not to appear in any way to
foster our development or even influence our
development; yet on the other hand, I could sense that
he was concerned that it not turn out well.


I remember maybe the first decision he made to help
when I applied to Dartmouth, and one of the board of
trustees was a patient of his, a Judge Cohen.     To this
day, I don't really know who Judge Cohen was, but I
know I very reluctantly, at his suggestion, went to see
him.   I got into Dartmouth.    I don't know if that had
anything to do with it -- probably not -- but there is
this subtle conflict. I guess I would have to
acknowledge that my feelings were very, very mixed
about that.   At the time of application to Hopkins he
had me see a man named Murphy at Rockefeller Institute
who had some connection with Hopkins.     It was Libman
who urged me to attend Hopkins at one of the few
counseling experiences I had with him.     He thought
Hopkins was the best school, when comparing Harvard,
Hopkins, and Cornell; those were the three schools I
considered.   Actually I applied to Cornell and Hopkins.




                                 82
     I was rejected by Cornell and was accepted by Hopkins;
     I couldn't help but wonder if Libman had any impact
     there.


Dr. W.:   What year was that?


Dr. E.:   1934.   When we went down to Hopkins we were
     given the name of Charles Austrian, who was another one
     of Libman's admirers, although never worked with him.
     The Austrians invited us out for dinner a few times and
     I always felt very awkward about that.     Here is this
     contradiction now, on the one hand I didn't want
     anybody to know that I was related to Libman, and I was
     connected with Libman, that there was any influence.


     I should say that a very important experience for me
     was getting a job on my own at Wood's Hole, the Marine
     Biological Laboratory.     I wrote to the director, I got
     his name from someone at college -- at Dartmouth
     Jacobs his name was.     My brother and I both wrote and
     inquired whether there were any opportunities for
     student volunteers, and he wrote back with names of
     four or five people who indicated interest in having a
     student volunteer.     Ralph Gerard was the person I wrote
     to and Amberson was the person Frank wrote to, and it
     was very important for both of us that Libman was not
     involved in this in any way; that we got these jobs,




                                      83
and that we pursued research without his having
anything to do with it and, even more importantly, that
the research turned out successfully, and so on.
Thereafter Gerard became the person to whom I turned by
preference, not Libman.     Libman -- this is a very
subtle and complicated process -- I would feel
embarassed by Libman at times because I would hear all
these charges and attacks and accusations and I would
have very mixed feelings.     But mostly I carried this
image of this man, who seemed to me as a child to be so
unreasonable, and so demanding, and so.         eccentric
is the word I'm using now, but it wasn't the concept I
had at the time.     And that I was terrified of him when
I was sick, because he seemed to me to be so harsh and
rough in his examinations -- which other patients
talked about too.


As my own career developed I couldn't help but
acknowledge that I was trying very hard to follow in
his footsteps, and my fantasy was that I had acquired
all of the desirable attributes of Libman and none of
his negative ones.     I will never forget when one of my
young colleagues, a young woman who had been a resident
at Cincinnati and whom we invited to come with us to
Rochester, one day said to me -- and this was maybe
1950 -- ''George, do you know the students are scared to
death of you?"     And I was absolutely astonished.    I had




                                 84
no idea they were scared to death, and I was embarassed

and awkward, and I said, "For heaven's sake, Myrtle,

what do you mean scared to death?"     I thought of myself

as absolutely opposite from Libman, in no way

frightening to students.     She said, "Oh, yes, way back

even in Cincinnati, when they heard you were going to

be on rounds, they would start trembling."     I asked,

what was the trouble?     ''You were so exacting and

demanding," and she described all the features of

Libman that I was so critical of.     This was true of

Frank as well.    As a matter of fact, one time on rounds

he turned to ask a student a question and the student

fainted.   And the students then took off on the play --

the Al Capp figure of evil-eye Fleegle -- they called

him evil-eye Flengel, who had only to look at someone

and they fainted dead away.



So this is a very complicated kind of ambivalent

identification.    It was only slowly that I could begin

to disassociate myself from these feelings and come to

see this man in a reasonable perspective and come more

and more to admire him.    To talk about him and talk

about his work.   Whereas in my earlier days I used to

almost secretly do kinds of things that I knew Libman

did, which is, you might say, clinical one-upsmanship.

When I was a medical student, for example, I would be

looking for opportunities to pull Libman pearls on




                                 85
     Longcope, or on whoever was the attending physician,

     and show him up the way I knew Libman would show up

     people.     Libman was quite intolerant of anything but

     the best.



Dr. W.:   How do you feel about these exacting, thorough,

     demanding traits?     Certainly they are not bad in

     themselves, are they?



Dr. E.:   It becomes an even more interesting question in

     terms of the changes that took place in educational

     patterns in the mid-60s.     I went through a period in

     which -- this was after I had already gotten over and

     learned how to exact high standards without being mean,

     to put it very crudely       I became demanding without

     hurting people.     But I still carried with me the old

     view that the physician had to know, that the physician

     was responsible for his knowledge, that the appropriate

     technique of teaching was to pick out what people did

     wrong, to be critical.     For a long time it was very

     difficult for me to give praise, extremely difficult if

     performance did not warrant it.       It was impossible, I

     think, for Libman to praise directly.



Dr. W.:   Thank you very much, Dr. Engel.




                                      86