Title: Jape Taylor
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UFHC 37
Interviewee: Dr. W. Jape Taylor
Interviewer: Julian Pleasants
Date: July 26, 1999


P: This is Julian Pleasants on July 26, 1999, and I am speaking in my office at Yon
Hall at the University of Florida with Dr. W. Jape Taylor. When and where were
you born?

T: I was born ten miles out in the country, in a farmhouse out of Booneville,
Mississippi.

P: That was what year?

T: 1924.

P: What was your father's occupation and education?

T: My dad, when I was born, was a cotton farmer. He was not very good at it
because he held some cotton that was selling for fifty cents a pound until the
price dropped to nine cents a pound. At that time, my mother decided he
needed more education, and we went to Ole Miss, where he received his
bachelor's degree. Then he later got other graduate degrees in education. He
was always a school teacher and school administrator.

P: When did he go back to school? How old was he?

T: He was about twenty-four or twenty-five. I do not remember exactly. I was two
years old then.

P: Is that not rather unusual?

T: Oh yes, it was quite unusual. In fact, it was unusual for him to get a high school
education. He got his high school education, actually, after he was married
because the rural education in northeast Mississippi was not all that great, and it
was not easy for kids to get to school and all that. My mother was also a school
teacher, certified for many, many years and a great teacher, but she never had a
college degree.

P: So early on, you had a lot of strong influence toward getting a college degree?

T: Oh absolutely. Yes, there was no other thought. If I would have tried to make
another choice, I do not think it would have worked.


P: Where did your middle name come from?









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T: It came from my great-grandfather, Jape Holley. Actually, there is a family story
about that. I was named at birth William Smith Taylor, but my Grandmother
Smith-my mother's mother-looked at me the first day and said, oh, that is little
Jape, for her father who was Jape Holley. But, it was not his real name either; it
was a nickname. The family story was that he had dated a Dutchman's
daughter and that the Dutchman was named Jape. I am sure all of that was
malarkey because there were not many Dutchmen in northeast Mississippi and
Jape is an old English name. I am not going to tell you what it means, but you
are a scholar and you can find out.

P: What was it like growing up in a small Mississippi town in the 1920s?

T: Actually, I did not grow up there. After my father finished school at Ole Miss, he
taught most of his career in Tennessee. The first that I remember was a small
east Tennessee town named Oakdale. Oakdale was a junction town for
Roundhouse [Railroad]. So, they had railroad linked there, but it was a very small
town, probably less than 1,000 [people]. We stayed there for four years. When
the Depression was coming along, we moved to a town called McMinnville in
middle Tennessee. That is where I really say I was raised, although I was in the
seventh grade by the time we got there.

P: How did the Depression affect you and your family?

T: Very severely. As I told you, both of my parents were teachers, but they always
had to be penurious and also to work on the side. Now, they never had other
jobs, in the sense people are talking about two jobs now. My mother always had
a huge garden, canned, all that kind of stuff. My father got into the chicken
business and I can tell you, I washed so many eggs because at one point,
we had 1,200 white leghorn chickens--hens, that is, not both sexes. A lot of my
job throughout high school was looking after these chickens, and that meant
washing eggs because they did not have those automatic cages that they do now
where the eggs roll out and they are pristine. There were several hens fighting
over a nest, and you can imagine what all got on it. You had to use vinegar to
clean them off, so I had a rag and vinegar. Boy, for years, I did not eat eggs.

P: Did you have any other jobs?

T: Not official jobs. I always worked in the garden. In fact, my first pay was a
family job, picking bean beetles off of the beans. I got something like ten cents
for 100, and that was not very good pay. Then, I sold roasting ears (corn) on the
street. A couple of summers the folks let me keep the money that I made from
that.

P: In many cases during the Depression, these small towns would reduce the









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school year so that they, in many cases, did not go to school more than four or
five months. Did they have that problem?

T: That did not happen to my parents. On the other hand, wages were extremely
low. I think the combined income some of those years was $90 a month, [that]
kind of thing. Then, when Daddy went back to get a master's degree at
Peabody [Peabody College] in Nashville, we really had nothing. I remember a
couple of nights-more than a couple, probably, we and a number of other people
slept out in Centennial Park in Nashville. We did not have a fancy tent or
anything, but we had some quilts we could roll up and got along fine. We then
moved in to some kind of subsidized college housing for almost nothing.

P: Did you have any siblings?

T: One older sister who was five years older than I.

P: When you were in McMinnville, talk a little bit about the schools you went to and
how that influenced your later career.

T: Actually, I think the schools were pretty good, surprisingly. McMinnville, for
middle Tennessee, was relatively affluent. There was a lot of lumber there, and
several local people had made fortunes on timber. There was a public town
library given in part, I believe, by Carnegie funds as well as a local millionaire.
So, the schools were not bad. I went there for the seventh and eighth grade. I
was sort of young for my school years. I graduated from high school when I was
fifteen, for example.

P: Where did you graduate from high school?

T: There, from McMinnville. It was called Warren County Central High School.

P: How did you get so far ahead in your schooling?

T: Mother was teaching out there in Oakdale, and my father was the principal at
Oakdale in east Tennessee. That was rough mountain country and mountain
people, incidentally. There are things I still remember, although I was only four.
So, I started school when I was four and moved right on up and then skipped
third grade or something like that.

P: Who, other than your parents, would have influenced your life during your
formative years?


T: It depends on how far up you count formative years.









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P: Well, through high school.
T: I do not think of any one major person. I did have two or three schoolteachers
who I still remember from high school. One was a football coach who was
doubling as the history teacher, history and civics, which was not unusual at all
then. It probably still is not. I had a French teacher who was considered very
poor but [who] I thought was pretty good, and I still remember her. I had a
couple of math teachers who were good. I still remember them.

P: How did you get interested in science and medicine?

T: My mother was really a remarkable person. Her family in northeast Mississippi,
the Smiths and the Holleys, were all educated for the time, with two or three
doctors, a lawyer, and so on. My Grandfather Smith owned a cotton gin, a grist
mill, a sawmill, and farmed, with his nine children, about 1,000 acres of land. My
mother told me that she plowed in the field behind the mules when she was a
teenager, and I do not doubt it. But anyway, she was extremely interested in the
outdoors, not in the sense of camping and all that but in knowing what the plants
were. She managed to collect a whole variety of the native plants around
Tennessee, east and central, for the yard, which she was able to grow. She
was just great at this. She also knew the birds and encouraged me in
collections of insects and butterflies and so on. This brings back a thing I have
not thought about in years. As a school principal, my father was sent a variety
of kinds of publications, some from the federal government and some from the
state government. I remember that one was a national publication on genetics
when I was in the seventh grade. At that time, I was ten years old. I started
reading this and learned the fundamentals of [Johann Gregor] Mendel and
genetics and just thought it was absolutely mind-boggling. So, my memory of it
obviously shows that it had some either direct or subliminal kind of effect on me.

P: How else did your parents influence your life in terms of values and goals, not
just in terms of your desire for a better education?

T: My mother had a saying that if you take a horse to water and it does not want to
drink, you ought to make it drink. I do not ever remember getting a spanking or
anything, but she was a real believer in doing things and doing them well. My
father was too, but he did not take nearly as direct a hand, in part because he
was involved in the school administration but maybe for another reason. We are
talking about almost 100 years ago now. Fathers were not generally thought of
as taking as much of a role in looking at the kids and the family, as they are now.
I was, in a sense, never exposed to my father, although we never had any real
disagreements; you know, we felt warmly and proudly of each other. The other
thing was that his education was primarily in literature, as well as educational
theory and so on. Now, can you imagine a man teaching in a little boondock
town? McMinnville was 5,000 in population when I was growing up; the total









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county was about 10,000. His favorite book was Paradise Lost. How many
folks do you think he could talk with about that? So, my mother had more
influence on these things, but both of them encouraged me. Do not get me
wrong: I was good at math so they said, well, be a mathematician or [be] in
natural science. Mother, obviously, liked natural science. So, that was when I
went off to college. I probably thought I was going to be a mathematician.

P: What kind of student were you, in terms of your grades and commitment to work?

T: I did not have to work very hard in school, but I was the top student in my class
all the way along. I was also far and away the youngest. There were students
in my graduating high school class who were twenty-one when they graduated.
I was fifteen.

P: Was that a problem?

T: Yes, it was.

P: Did you get picked on a lot?

T: Yes, I felt it. Do not get me wrong. The other pupils were always good to me
and so on, but I was clearly emotionally and socially behind them. They started
dating a lot earlier than I did and all that kind of stuff. But I was accepted.
There was none of this business of, oh, he is just a book grind.

P: What about extracurricular activities?

T: We did not have an official tennis team, but I played tennis, I was the time keeper
for the high school basketball games, and I was in two or three school plays
every year.

P: How did you get from a small town to Yale University?

T: Well, that was fairly easy, as a matter of fact. I had a cousin named Myres
McDougal, who had lived with my parents at Ole Miss when he was getting his
degree. He went on to be a Rhodes scholar and a named professor at Yale Law
School. If I do say so, he has really been one of the leading theorists on human
rights and international relations of the twentieth century, and this is widely
acknowledged. There are two or three of his former pupils here in the University
of Florida Law faculty: Winston Nagen [Winston Percival Nagen, professor of law,
UF, 1975-present], for example, was one of his; Walter Weyrauch [Walter Otto
Weyrauch, Stephen C. O'Connell chair and professor of law, UF, 1957-present]
was. Walter Probert [professor of law, UF, 1959-present] was in school there,
[but] I do not know whether he was actually under my cousin. But anyway,









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Myres McDougal kept very strong ties to the northeast Mississippi community.
He would drive from New Haven to Booneville almost every summer. Because
he was so close to my mother, he would always stop by and see us, he and his
wife and their child. When I was on up in high school, Myres basically told them
that if I could get in (which he was not at all sure of) to Yale, that the financial
package that they could put together at Yale would be such that it would not cost
me any more than going to UT [University of Tennessee] or Ole Miss. So, I
applied and got a Southeastern U. S. regional scholarship to go to Yale, which
paid-I do not remember the exact amount now-the total cost to go to Yale for a
year then was probably $4,000 or $5,000. It was not a heck of a lot, but that
was a lot for my family. So I got a regional scholarship that paid tuition, and I
think that was about all for the first year. I actually then lived my first year with
Myres and then moved on campus the next year.

P: So, when you went to Yale, you were sixteen?

T: Yes. I took an extra year of high school because I was so young, and my
parents did not think it was wise for me to go up there. Although, I later found
when I got there that there were some that were as young, not many but a few,
as I.

P: Did you ever strongly consider going to local schools [such as] the University of
Tennessee?

T: No.

P: Why?

T: My parents were pretty attuned to higher education, and they recognized
different qualities in institutions. My dad really got incensed when schools like
Middle Tennessee State College started calling themselves a university. He
thought that was terrible. They really were not a university, and he was right, of
course. Vanderbilt was considered the best school in the state. If I had stayed
locally, I would have probably gone there. I never applied there, when I was
accepted to Yale.

P: So, you obviously understood the great opportunity you had at the time?

T: Oh yes. Sure, I considered myself extremely lucky.

P: Talk about your experience at Yale. Did you ever have a table at Morrie's?


T: No, no.









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P: Did you ever sing the Whippeupoof song?
T: No. Morrie's was far out of my class. See, that was basically a private club for,
primarily, the prep school guys and the wealthy ones. Yale has changed a lot
since I was there, for the better I think, although I got a tremendous education.
The first thing was that I was woefully unprepared, although I had to take an
exam to qualify for the scholarship. I went to Nashville, and it was something
equivalent, in the general sense, to the SAT now. I obviously did pretty well,
although I do not know how well, on that, and I had my high school marks. At
any rate, I was woefully unprepared. There were freshman students there at
Yale, in my class, who knew more than the graduates of many of the state
universities because they had come from Andover and Exeter. They really were
bright kids, and they had tremendous educational backgrounds]. So, I did not
do very well the first year, but I did better than most of the other Southeast U. S.
scholarship recipients, because four of them flunked out. There were only about
six of us, and I found that to be very sad, [when] that happened. After the first
year, I ended up being on the dean's list most of the time. I still did not really
have a top record, but I was probably in the upper quarter of the class at Yale by
the end. I only went three years to undergraduate because the war [World War
II] came along. I had already, at that point, declared as a pre-med; in fact,
sometime in my third year, I had already been accepted to medical school. So
the military, at that time, was thinking this was going to be a fifteen-year war.
They were recruiting just as voraciously as they could all the pre-meds,
particularly those who had been accepted to medical school. I got in the Navy
V-12 program, [which] paid my third year at Yale and, of course, some of my time
in medical school. It was the first time I had ever had any spare money--and I
spent it. Yale was a very enlightening experience for me, although I felt, as I
say, "in over my head" at least for the first year. But this was the first time I had
an opportunity to look at issues in any depth. By issues, I am talking about
everything from religion to government to social policy. I was raised in a
fundamentalist home. My father taught Sunday school classes up until he was
eighty-eight years old or something like that, and we went to the prayer meeting
on Wednesday nights and Sunday evening sessions as well as the regular noon
ones. There was never any question, and there was not any other way of
thinking about morality or ethics. That is one of the things I prize most about
Yale, as a matter of fact, still, that there are no doctrines that people have to
believe. There is free discussion of everything.

P: What kind of courses did you take at Yale?

T: I took a lot of science and math. I had three years of college calculus. Then, I
was very fortunate in biology and in my advisor. My advisor, the faculty advisor,
was a man named Evelyn Hutchinson. You may have never heard that name,
but Hutchinson-and I did not know it at that time-was really one of the eminent
figures in American biology. He was an Englishman, and he would come over to









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Yale, I do not know how long, before I knew him. I will give you some of the
things that he worked on: protective coloration and mimicry in insects, for
example. That was all his original work, and there were many other things like
that.

P: That explains, to some degree, your later interests, in medicine.

T: Oh yes. Sure, and the other people who I had in the biological sciences were all
quite good, too.

P: Did you take any English courses or history courses?

T: Yes, you had to. At Yale, still, you have to take things out of your own major so
you, "get a broad liberal education"--just exactly the opposite to what the
University of Florida is now promulgating, and which I think is a disaster. I had
one or two history courses. I continued in French, which I had started in high
school. I had at least two English courses. This was the first time I had really
experienced analysis of what Shakespeare, or whoever, was getting at in some
of his writings, and I found that immensely enjoyable.

P: Where did you live while you were at Yale, after the first year?
T: At Yale, all of the undergraduates live at what are called residential colleges. I lived in
Saybrook College, which was one of twelve residential colleges. I brought up the idea
of residential colleges here, incidentally, to one of the presidents (who shall remain
unnamed, unless you ask me), and he said, such things are not practical. But the
residential college was basically a mechanism by which a relatively small group, about
300 or 400 kids, could live together for their entire college career after the first year and
have their own intramural things, their own activities-that is where I learned to drink
beer-their own little parties and so on. I think it was remarkable, and a senior faculty
person who was well-regarded lived as the master of the college, with his family.
Actually, the master of ours was a fellow named Dunlop Smith, and one of his sons
became a classmate of mine at Harvard Medical School. So I am a great fan of that style
of university housing and living.

P: Were you classmates with any important people?

T: A lot of them, but I am not sure I know all of them. That was essentially the only thing
that I regretted about college. See, living off-campus for the first year and then having
only two years of college, the second of which was semi-military and then going to
medical school. Incidentally, Yale counted my first year of medical school as my fourth
year in college, so I did get a full degree, but still it was a limited experience. So, I did
not know but twenty or so of my classmates real well. I knew many others and yes, they
went off to be various figures in the government, authors, chemists, and some, but I
cannot call them by name which ones did and did not.









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P: I think Gerald Ford [38th president of the United States, 1974-1977] was at the law
school then.

T: Well, he was a little later.

P: When you look back at Yale, how do you access the influence that has had on your career
and your life?

T: Well, I think as far as my life. It really changed it completely. As I told you, I had
never had the opportunity to be trained to think about knowledge, a block of knowledge,
and thinking about issues. So, that was one of the special qualities. Plus, it cemented
my relationship with my cousin, Myres McDougal. He continued after this time, until
he died, coming down often to Mississippi, and that meant that he would often stop by
and see me in Durham, where I was a resident and research fellow at the medical school.
He once told me that the research that I was doing was assault and battery, and I would
have to clean it up. And it was It is true that we did not get informed consent from
research patients. This was in the early days of cardiac catheterization. I was not doing
diagnostic study by catheterization. I was doing catheterization of the liver. My mentor,
with whom I did my research fellowship at Duke, and I worked out a lot of the methods
for measuring pressures and blood flows in the liver. We gave minimal explanations tot
he subjects, most of them were people with minimal disease.

P: Let me go on to Harvard. Why did you pick Harvard Medical School?

T: You want one answer? It was the best in the country. Still is.

P: And you were allowed to take your choice--the Navy...?

T: I had been accepted to Harvard Med before I got in the V-12 program.

P: Oh, I see--before the Navy...

T: I must say that medical school admissions were somewhat different than the admissions
process nowadays. I sent in my application, was invited to come up, was interviewed by
one person who was Worth Hale, who worked as the Associate Dean, but actually did
most of the administrate work of the Dean.

T: It was the best medical school in the country. This goes back to another thing. You
asked me once before about what stimulated me to go on to Yale. We used to have huge
family reunions down in Mississippi. I am talking about all of the nine siblings coming
to the old Smith home and all of their children and some grandchildren. I happened to
be the youngest grandchild in that whole group. They would all sit around and have a
big feast, but then they would yak about what their kids were doing. All of them were









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trying to say that their kids were the greatest in the world and that they had done this and
that, and many of them had done quite notable things. But, Myres was the one, when he
was there, that everybody sort of [knew] was great; he was at Yale, he was on the faculty
there, he was the top of these high-achieving people who thought their family tree was
the greatest in northeast Mississippi, which I think was snobbery. At any rate, there was
no question that, too, was a force that made me want to go on. When I was at college, I
worked the whole time I was there. Yale strictly limited how many hours a student
could work, but I had an absolutely fabulous job. I worked in the medical historical
library there, and Harvey Cushing had just given his major collection of books to Yale
about a year before. John Fulton was sort of the overall director of the library, although
he was not a librarian. He was a neurophysiologist. Anyway, Cushing had given these
magnificent books, and part of my job was to put the frontispiece in these books. Here I
was, looking at original prints of Leonardo da Vinci, his anatomical drawings, all of these
great works. It is one of the best medical history libraries in the world, really, and I was
really enamored with that job. I worked for two years there and had a great time.
Anyway, I had recognized that Cushing was a Harvard professor, one of the real leaders.
So, I went up there [to Harvard Medical School] and was interviewed, as I stated earlier
by only one person, the associate dean, Worth Hale. The dean at Harvard then was an
internist who specialized, to a degree, in pulmonary problems. He was a full-time
faculty person, but the dean was not thought of as a full-time job. He was a faculty
person primarily, and Worth Hale then did all the actual deaning. If truth be known, his
major secretary did a heck of a lot of it, too. I guess I applied to Yale Medical School
and maybe one other and shortly got a letter back from Harvard that I was admitted.
That settled that, and I went on up to Harvard.

P: So, that was 1943?

T: No. I started Yale in 1941 because I graduated high school in 1940. Then, I took that
extra year, so I went to Yale in the fall of 1941. The war broke out in December of that
year. I remember very well listening to the news of Pearl Harbor and all that kind of
thing. We went winter and summer at college, to push us through quickly and I guess I
did go up, probably, in 1943.

P: When you started medical school, did you have a specialty in mind at that time?

T: Oh no. I think, by and large, Harvard did not encourage people to "specialize" in
medical school. That is a relatively new event; by that, I mean in the last twenty or
twenty-five years. I think it is a terrible thing but at any rate, no, I did not have any idea.
I did not have any idea of whether I would be a practicing physician, a medical educator,
or what. I was just going to get a good medical education.

P: Why did you decide on medicine over science?

T: That was a hard thing. It was actually medicine versus mathematics or science. I told









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you that I took three years of college calculus, but I recognized that I really was not a
person who could do high-level theoretical mathematics without really digging into it. It
did not interest me as much as did the science stuff, which I experienced at Yale because
I also had excellent chemistry and biology professors. As far as science versus
medicine, I think that this was, to a considerable degree, because my parents felt that it
would give me a more secure career. They did not know anything about academic
medicine. It was not that. But, they were not sure how folks made a living. The
Depression was very much a part of their lives, forever.

P: Describe a typical day in medical school, particularly your first year.

T: Medical school days were intense but really stimulating because we had world- class
professors. They were so good in teaching anatomy and physiology and all these basic
science things that they made it fun. We had lectures roughly half the day, maybe more,
concentrated lectures. Then we had laboratory for the remainder of the time to make up
a full eight-hour day. We always had intense write-ups of our laboratory procedures
and, of course, studying for the next day. So, it was intense. There is no question about
that.

P: Was there a great emphasis on memorization?

T: No, not nearly as much as I subsequently found at other places. Certain things, in a
sense, one has to memorize: the name of a bone or a joint or an artery or something like
that. But, Harvard was already getting away, to a degree, from that absolute
memorization kind of thing, not completely [because] there were many hours of that.
They did try to throw in some general clinical correlations-this artery originates here and
goes to such and such organ-and [that] is important in certain circumstances. We did
not know any medicine, but they tried to make it relevant. As I said, they were all
excellent people in their own right and had done superb research. We were very, very
lucky. There was not any of this business about junior instructors; we had full
professors giving us lectures in medical school.

P: When did you start your practical experience?

T: We started that in our third year, just like is common now. There was a little touch of
medicine, if you want to put it that way, or practical stuff, in the first year, only in the
fact that they had, I guess, every two Saturdays-or maybe it was every Saturday, I do not
remember-sessions in which a really eminent, usually older, professor would come in
and talk with us about some clinical development. These were always, again, just
superb people. One of them was the first guy, Reginald Fitz, to describe appendicitis,
for example. But we did not really have any hands-on stuff, in the first two years.


P: How did you eventually decide on your specialty, cardiology?









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T: That came much later during my residency. It was not in medical school at all, or even
internship.

P: What faculty members, in specific, had the greatest influence on you in medical school?

T: Again, that is an extremely hard thing to answer because so many of them did. The
things that influenced me most in medical school were, I guess, first, my classmates, and
then second, the faculty, [and] thirdly-I almost hate to put it this way, but it is
true-patients. The reason patients in medical school were a lesser influence was that
students do not have any opportunity to form long relationships. In the first two years of
basic science in medical school, the pathology professor was a man who had been the
first one to describe a number of the Rickettsial diseases; those are the ones that ticks
carry. He would talk with us about this. The pharmacologist was a man named Otto
Krier who, again, had done some of the original work on what is called the heart-lung
preparation. That is a dog preparation in which the heart and lungs are isolated, and you
can then modify both the pressure against which the heart is pumping and the filling
pressure of the heart and get a lot of the fundamental physiology out of it. The chair of
physiology was also a very, very important figure. I cannot think of any professor who
did not have some effect. The man who taught me physical diagnosis was a man named
Chapman, who never did do very much in the Harvard scene. Harvard is a funny place
in a lot of ways. It had a number of folks attached in sort of peripheral ways and paid
full-time, but they were never on tenure tracks. Unfortunately, some people think they
can mimic that, but they have a hard time because these were people who would have had
professorial rank at many a medical school but had wanted to stay in Boston in lesser
roles. Anyway, this man was not a terribly good physical diagnostician, I knew later,
but he was very enthusiastic and a very good teacher. He took us out to chronic
hospitals where people had been for years with chronic illnesses and showed us many
abnormal physical findings. Probably, if I had to pick one, I would say it was an
internist named Bill Castle. The name may not mean anything to you, but Bill Castle,
although he did not receive the Nobel Prize which he should have -was the person who
recognized liver as the treatment for pernicious anemia. In turn this led to vitamin B-12,
a cure of a really bad disease. Dr Minot, his senior mentor, and Dr. Murphy won the
Nobel for this. People do not realize how bad pernicious anemia was. It could make
people demented and have severe neurological disease, in addition to the anemia. Bill
Castle, a very eminent professor taught some in the second-year physical diagnosis, but I
happened to have him in medicine the third year. He was an incredible force as a
professor. There was one surgeon who stood out, although I had no major interest in
surgery, That was Robert Gross, at the children's hospital, who was the first individual in
the world to operate successfully for congenital heart disease. Robert Gross also
lectured to us some, but I had the opportunity of watching him operate. At that time,
they had the operating theaters where you could look down from the balcony. You
would never guess what I saw him do. Now remember, this is the most eminent cardiac
surgeon in the country and, perhaps, in the world. He was doing a hernia repair. Can
you imagine one of our prima donna heart surgeons doing a hernia repair [nowadays]?









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Anyway, it was the cleanest field you have ever seen. He was going lickety-split, but
you could see every fascial plane, every muscle, everything, just as clearly outlined as
you could imagine it to be.

P: It was so easy for him.

T: Oh yes. But, he had been trained so well as a general surgeon before he became a
cardiac surgeon, and he did not feel he had to stick his nose up. Now, he could look
prima donna in a different way. He wore a little carnation, and his hair was always
slicked back. But as far as the nitty-gritty, he was not a prima donna at all. Another
one I have to mention, Fuller Albright, again a name you probably never heard. Fuller
Albright was the father of endocrinology in this country, and many of his ideas still
influence it. I did an elective with him at Massachusetts General in my senior year.
Fuller Albright had developed Parkinsons', and I mean bad Parkinsons', with a
propulsive gait. You know, you walk along, and you have to keep going faster and
faster and faster. He had a severe tremor, and none of the medications that were used for
Parkinsons now were available. Nothing. Zero. So, he had this and, of course, he
would also have a little problem speaking. On these electives, he had medical students
do some of the physical exam for him, the abdominal exam and heart and all, which he
really could not do anymore. He had learned to adjust to the Parkinsons' so that when
he would make hospital rounds, which he did regularly-he did not depend on what
somebody else told him, he did it himself-the group was never with him. They were
either catching up with him or slowing down for him. So, it was sort of funny to see him
going by, but here was this man with intense physical disability who kept right on going.
Our class dedicated a yearbook to him and asked him something about what he thought
about Parkinsons', and his answer was, "I never had time to think about it; I have been
busy with my work." And that was true. That was the way he lived his life. He was
the first one to describe Turner's Syndrome, which has been subsequently determined to
be women who are missing an X chromosome. They are XO. They do not have a Y
either. In fact, this was before-almost twenty years before but not quite-human
chromosome count was correctly identified. He had suggested that maybe this could be
a defect in the chromosome. He did a lot on calcium metabolism, the original work on
osteoporosis, osteomalacia, and rickets. He studied a whole variety of sexual
abnormalities, the hermaphrodites. People talk about science being difficult now. They
are so crazy. Science is easy now. When they say it is so hard, they say, well, you have
to devote your full-time energy to it, to do anything, to compete. To identify the various
estrogens and androgens, the male hormones, he had to collect three- and four-day urine
samples, get all the extraneous junk out of this, then isolate the thing he was interested in,
and then do a chemical reaction, to identify this hormone. Think of all the work
involved in that. Now, of course, he had absolutely dedicated technicians but,
nonetheless, he was the one who was doing it. Now, they have a radioimmunoassay
they can order a kit from a dozen companies, put it together, do the appropriate counts
and there is your answer. Now, which is easier? At the same time, Fuller Albright was
the first man to really show that estrogen, for example, is beneficial in post-menopausal









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osteoporosis, [in] keeping bones from breaking and hurting. So, he followed those
women who he was treating for years and saw them regularly himself.

P: You finished medical school in four years?

T: Yes. The first part [included] going in the summer, too.

P: Then you became an intern at Harvard. Talk a little bit about that experience.

T: I am going to add something else in about medical school. I told you that, for the first
time in my life, I had some money when I got into the Navy V-12 program, and I spent it
and had a lot of fun. Medical school was a ball. I really enjoyed it. I hear people
talking about how tough medical school is. We worked hard, but it was great. But, the
V-12 program ended when the war abruptly ended in 1945. They immediately got rid of
the V-12 program. I had to stay in the reserve, but we did not receive any money. So
there, I was back in the same boat I had been in before. So, the medical school was good
to me and gave me another scholarship for, I think, my tuition.

P: Is this the American College of Physicians scholarship?

T: No, that is later, a research fellowship. The medical school gave me a scholarship to pay
my tuition each of my last two years, but I do not think they paid anything else. So, I
had to get a job. I got a job that was highly meaningful, in many ways, at the Boston
Psychopathic Hospital. Psychopathic Hospital is right there in the whole group of
Harvard Hospitals. Peter Bent Brigham, the Childrens Hospital, the Boston Lying In, and
then the Boston Psychopathic was down the next street. So, it was about two and a half
or three blocks from the rest of the medical school. I earned board, room, and laundry
working there for my last two years of medical school. My job was as a night attendant,
from eleven to one-thirty. I had a lot of interest in neuroscience, including psychiatry.
At that time, the boards in neurology and psychiatry were together. I enjoyed my
experience at the Boston Psychopathic immensely. There were three of us over there at
that time, two other classmates and I. I will give you some idea of what they were doing
at that time at the Boston Psychopathic. They were calling in chronic, catatonic, mute
schizophrenics from the outlying state psychiatric institutions, the chronic institutions,
and doing prefrontal lobotomies. One of our jobs, then, as night attendants, was to give
these people medication, tiny doses of penicillin, at midnight, which we did. I then got
to follow what happened to them for a period of time. The other thing that was going
on--are you familiar with the term general paresis? General paresis is tertiary syphilis of
the brain, which causes dementia as well as psychosis and a lot of other things. This was
being treated with fever therapy, and there were two forms of fever therapy. One of
them was to give people malaria and then see what effect this had. The idea was very
straightforward and good, [since] the treponema that causes syphilis could not survive at
high temperatures. There are a lot of organisms that cannot, and that is probably what a
good fever does in general, help get rid of some of [them]. So, they treated some of the









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patients with malaria for periods of time, and they were also putting them in hot boxes.
These were boxes in which they would stay for-I forget precisely-two or three hours at a
time, and body temperatures were kept up to about 105 degrees Fahrenheit, which is
pretty high for this period of time. They were also giving them arsenicals and, maybe,
bismuth, which were the first drugs. The arsenical was the early magic bullet, as far as
treatment of syphilis and later I saw penicillin cure tertiary syphillis. Anyway, there was
a lot of high-level research going on at the Boston Psychopathic Hospital at that time.
There still is, but it is now called the Massachusetts Mental Health Institute because
Boston Psychopathic Hospital does not sound nice. It is not a good name.

P: What was your view of prefrontal lobotomies at that time?

T: It was absolutely incredible to see somebody who had not spoken for ten years, have this
procedure done and, within two to three to four weeks, be talking and counting and doing
things. So, there was absolutely no question in my mind that, in select people, it was
incredibly effective. I can tell you specific patients who I still remember. One of them
was an elderly woman with severe obsessive-compulsive psychosis so that she was
always carrying around a roll of tissue paper and was obsessed with defecation. Her
whole life was gone because of this obsession that was driving this woman. That is all
she talked about. That is all she did. Again, within two or three weeks after her
surgery, this woman was living a pretty normal life. So, you could not help but be
impressed positively.
P: Wasn't it sometimes used incorrectly on people who were retarded?

T: Yes, it was but not at the Psychopathic Hospital. Just like patients with mental
retardation now are given intensive tranquilizers and for a time have been treated with
lithium to control them, that is bad. They were also still using a lot of electric shock
therapy and insulin shock therapy for people with manic-depressive disease. There was
one ward where they used-well, it was not really the ward, [but] it was connected onto
it-insulin shock therapy, and they brought 15 or 20 people in, three or four times a week,
and give them enough insulin to lower their blood sugars down to about ten to twenty
milligrams per deciliter, which puts them in a coma. They are kept that way for several
minutes, maybe an hour. I do not remember the detail. Again, in people with severe
manic depressive disease, both electric shock and insulin shock was beneficial.

P: This is before they had any of the current drugs? So they had no other options?

T: Oh yes. We had true locked wards there. I worked, primarily, on the male locked ward.
In Boston, everybody who committed a murder or anything with any hint of possibility
[of mental problems] was sent to this ward. All of these [radical treatments] were good,
were beneficial to some patients. Now, they all obviously had potential side effects and
sometimes bad side effects, so I am not saying that they are things that have much place
now, although electric shock has had some bit of a comeback. Even prefrontal
lobotomy, I hear, is occasionally being used. Anyway, the fact that surgical things [like]









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severe shocks, both metabolically and electrically, can have beneficial effects led me to
believe that most of the major psychotic illnesses were due to some organic brain thing.
Freud was [wrong], I was beginning to think. I still think that, and I think everybody
does now. Most of these schizophrenia and manic depressive diseases are due to some
problem [in the brain].

P: Usually [because of] a chemical imbalance?

T: It is hard to know. All of this has not been worked out, although the genetics of some of
it is getting worked out now, whether it is a chemical imbalance or whether it is actually
a distortion of the connections between neurons. But I became convinced that it was, to
a considerable degree, organic, and that influenced my thinking about it a great deal. At
the same time, I might add, they did have an active psychoanalytical group there, and I
had some contact with them. I began to have questions about them, let us say, but I still
accept it, and I still think that Freudian perceptions, as far as personality development and
all, are, in many ways, correct. Back to the locked wards, when you have seen a person
in a perfectly bare wall room, like this, nothing in it, tear that wall to pieces with bare
hands, you know what mania is. It was something to see, very impressive, the power
that is, in some way, released in these severely manic individuals. I am going to tell you
why I did not become a psychiatrist because you keep asking me about why I became a
cardiologist. One time, a young psychiatry intern over there had one of these patients, a
severely manic guy, come in. There were six so-called padded cells, bare walls, in the
back end. There are none now. Anyway, this patient's name was Prettyman, or
something like that, and he was about 250 pounds and had been a professional wrestler.
This intern said, well, we will just take him down to hydrotherapy, which was soothing
waters running over the patients who sat in the tub. He got this guy and led him off
down to the basement where this was, and he got the guy in the tub but made the mistake
of bending over, and the guy put him in a hammer lock. He looked liked he was going
to kill him. The people down there were screaming and hollering and carrying on.
Now, I was not there, but I had first-hand information of what went on. They were trying
to grab this guy's arm and pull it loose. The harder they pulled, the harder he locked it.
They thought he was going to choke him, and the attendants were getting on him. They
did not have anything easily available to stop him, but there was an old
attendant-probably in his fifties-who had worked in mental institutions for most of his
life. He was not actually a superintendent, but we called him that. He just happened to
come by and noticed what was happening, and he walked over, clapped the patient on the
back, held up his other hand, and said, the winner! And [the wrestler] turned him loose.
So, you see, I learned something from that about what people who are "unskilled" can do.
It is a lesson you can tell. I have not told this story more than half a dozen times, but it
was remarkable insight that this guy had.

P: And he could do that because he had experience with these people, and the intern did not.

T: Well, he had real knowledge and insight, where the intern had read the book. I learned









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an awful lot about psychiatric disorders in living there for two years. The nurses sort of
thought of us as colleagues and friends, which was nice. The doctors, the psychiatrists,
thought of us as junior doctors. The patients were a little confused but, by and large,
thought of us as friends. So, we got insights from three different groups of people about
what was going on there. It was great, but I decided I did not want to be a psychiatrist
because in general, with one or two exceptions, the quality of the medical personnel was
not up to what I was seeing in the other medical subspecialties, although [the doctors at
the mental hospital] were reputed to be, and were, tops in the country.

P: What was it like when you started your first rotation as an intern?

T: It was great. I interned at the Boston City Hospital, which had two Harvard services
then. The Boston City was a huge hospital [with] 3,000 beds at that time. Harvard,
Tufts, and BU [Boston University] all had medical services there and surgical services
and so on. It was one of the prestigious training hospitals. The Mass General, the
Boston City, and the Peter Bent Brigham were the three prestigious places to do house
staff training. They were quite different hospitals, though. Mass General had a large
private service as well as the public service, and the Brigham, again, was mixed, private
and public. Boston City was all public, so you saw a different group of patients.

P: Did you choose?

T: Yes.

P: Why did you prefer [Boston City]?

T: Well, I had done third and, maybe, fourth year medicine there, and I liked it. I had
listed the Mass General, too, and I am not sure which I had listed first and which I had
listed second. But I was very glad to get the Boston City because I had worked there as
a student, and I knew what it was like. My first rotation was what was called night call,
then. That was because, in contrast to interns who came from other schools, I had some
familiarity with the place. That meant that I cared for all the patients on the second
medical service and admitted all the patients who were admitted to the medical service
from eleven at night until, I guess it was, seven in the morning.

P: So, most of these would be emergency types?

T: The ones who came in were, and they were really emergencies. They were not people
coming in with a headache and feeling bad. These were people with myocardial
infractions and who were diabetic or in diabetic acidosis or [had] severe pneumonia and
shock. So, they were sick, sick patients, and there was nobody else there but me, as an
intern.


P: You had no resident supervisor?









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T: There was a resident, but he was not in the hospital and, in general, was not called. That
was considered not the thing to do.

P: But you could if you really needed to?

T: Well, I could, but I do not remember that I ever did. I may have, once or twice, but I do
not think so. So, these were sick, sick, sick people who were coming in, plus you were
looking after everybody else who was on these wards. The two Harvard services were
very proud, and they never closed a ward. That may not mean much to you, so I will
explain. Some of the services, if they filled all their beds, closed the ward, but we did
not. We would line beds up in the hallway, in addition to our ordinary ward beds. We
never closed our wards, neither of the two Harvard services, and we often would have six
or eight beds lined up in the hallway of our wards.

P: That is quite a bit of pressure for an intern, was it not?

T: Yes, it sure was, and you had to write these all up, and be ready to turn them over the
next morning to the regular intern and residents who would come in. So, it was
pressure, but it was very stimulating. I do not recall any of us, any of my fellow interns,
complaining about the amount of work to be done or anything like that. We made
regular teaching rounds, either five or six days a week from, roughly, ten to twelve-thirty
or so with senior professors, like Bill Castle, [whom] I mentioned and Max Finland who
was, one of the top five infectious disease people from the country.

P: Would you say that is really where you learned medicine?

T: Sure. I feel that medicine has to have its foundation of basic science, of physiology and
so on. I had a good background. All of our graduates there had a good background in
these things, and we had good introductions to medicine. As far as the practicality, sure,
that is how I learned medicine, but it was not starting out cold. It was building on a
sound foundation which I think, again, is critical.

P: But there were things that you had never encountered before?

T: There were things I had never encountered before but, you see, my view of medicine is
that it is a problem-solving exercise, not a memorization thing. That is one of the
disagreements I had with some of my faculty friends here, because medicine is a
problem-solving thing. In other words, you get the clues, you put them together, and
you reach a conclusion. So, it does not really matter whether you had seen something
before. What mattered was whether you could recognize what the clues were and how
they would lead to something that you may have heard of but never seen. This is
boasting a little bit. I feel I can go to the bedside anywhere in the world and look after
people.









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P: Let me shift you off medicine for a minute because in 1948, you met and married your
wife. Tell me how that came about and where you met her.

T: I had taken an elective in neurology at the Boston City when I was a fourth-year medical
student, with a man named Derek Denny-Brown. Dr. Denny-Brown was British
trained-I think he came originally from New Zealand-and was, again, probably the top
neurologists in the country at that time, maybe in the world. He did all sorts of amazing
things. Audrey was his executive secretary when I took my elective with him. Now, he
was always a very polite man, but he was also a very demanding man. He could stand
over someone and turn red and, boy, they would start trembling because they knew he
was not happy about something. Anyway, she was his secretary, and she said that I
came to the door and rather insolently asked for some of Dr. Denny-Brown's reprints. I
do not remember the insolent part, but I do remember asking for the reprints from her and
was rather struck by her beauty. We never dated or anything at that point, and we barely
spoke during the rest of that rotation in neurology. She then went down to the
Massachusetts General and took a research job, because she had worked in the Mass
General before in research, and she decided that she preferred that to being a secretary.
She went down to the Mass General and was doing some very fundamental things, in
fact, is listed as a co-author in the Journal of Clinical Investigation, which is most
prestigious. She was putting tubes down people's intestines with condoms tied around
them to make balloons and then measuring pressure and pressure waves in the intestines.
Now they have highfaluting transducers to do all that. Anyway, she shifted down there,
and I was on some rotation there at the Mass General, and a party came up at the med
school, sort of impromptu. I did not have anybody to take that night, and we were going
through the dining room for lunch when some of the other guys and I saw Audrey. I
said, well, I will just get a date from that young woman over there, and they bet I could
not. So, I went over and asked her to go to a party that same night and got a date.
Then, one thing led to another, and we got married. I had a pretty intense relationship
before that with another young woman and that had broken up and was the reason I was
alone and free. Audrey went back and got her master's in anthropology here, after our
youngest son had completed high school. We have just come back from this trip to the
Four Corners and saw almost every ruin out there. She had already seen a number of
them. She added on a few, and I saw some of them I had never seen. It has been great.

P: Let me go back to 1948.

T: After that night [rotation], I did all the rest of the things that go in an internship, mostly
ward work, some outpatient clinic. The patients were, basically, all indigent. City
Hospital was an absolutely remarkable place. I spent a month on the communicable
disease ward. Such things rarely exist. I saw diphtheria over there, which we never see
anymore. So the medical experiences were superb, the work was demanding-and I think
this is important when people are talking about medical training, and they bitch and moan
and what have you-[the interns] had to do such things as lab work. I often checked









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twenty urine sediments with a microscope every morning to see whether there were
sulfurcrystals in it. We did not have all these fancy antibiotics. Sulfonamides were still
the major thing that was being used. We had little dabs of penicillin but not much.
Sulfurcrystals showed that your levels were getting high enough that they were going to
block the kidneys if you were not careful. We could not just send a sample to the lab
and get back, within a few hours, a blood level of the suflouamide, so you looked in the
urine for crystals. We picked up the actual tubes that we used to draw blood cultures, to
draw prothrombintimes. We had to make a tour every morning, [and send] somebody
from the ward to go to four or five different things down in the basement, six and a half
floors down, to pick up stuff that we were going to need to use. I am not saying that I
think interns ought to do all those things, but I do not think it hurts. Furthermore, we did
all of our blood counts, hemoglobins, white blood counts, differential blood counts.
Smears; if we had not smeared, for TB and ordinary pneumococcal disease, any kind of
fluid we had-spinal fluid, sputum-we were in bad, bad trouble when we were presenting
this case the next day. We were all proud. We wanted to do it right. So, I learned to
do all of those kinds of things. It was second nature to do it. That is why I was able to
do it when I went to Africa. Think how many years later. It was from 1948 to 1974.
In the meantime, I had all this other fancy lab stuff, but I could still do these things.

P: Why did you pick Duke [for your residency]?

T: Well, I really did not want to leave Boston, to be honest with you. But, at that time, the
house staff programs were strikingly pyramidal. In other words, there were a certain
number of interns, and then there were fewer junior assistant residents, and there were
even fewer senior assistant residents, and then there was a top resident. I wanted to stay
at the Boston City, but I was not in that next level. Bill Castle called Eugene Stead, who
was the chair of medicine at Duke and said, this is an excellent man, and I would like for
you to give him ajob. And he did, as simple as that. Then, I did send in an official
[residency application] to Duke but no place else. I knew of Duke, and I knew of Stead.
I had actually heard him speak as a guest speaker up there at Harvard. I knew that he
had been chief resident and, then, a fellow at the Peter Bent Brigham and was considered
one of the sharpest up-and-coming people in American medicine, which he was. Eugene
Stead turned out more department chairs to the departments of medicine and untold
numbers of division chiefs than anybody in the country for about twenty-five years.

P: How different was your experience at Duke-I am talking about the medical school
facilities-from Harvard?

T: The facilities at Duke were basically the same as they were at the Mass General or the
Peter Bent Brigham or the Beth Israel. There was not any particular difference there.
There was a lot of difference between the Boston City Hospital because we often had to
wait a couple of days to get a chest X-ray on the patient at the City, and I told you about
the business of having to collect our own specimen bottles. But the facilities at Duke
and the other major Harvard hospitals were about the same. The set-up was quite









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different because Duke had, and still has, a major private service which they call the
Private Diagnostic Clinic, PDC, as well as the indigent wards. In fact, I am not sure how
many indigent wards they have right at the moment, in their big new hospital.

P: You were there four years?

T: I took my junior residency there, my senior residency there, and then two years of
research fellowship, two years in the Navy, and came back as, sort of, a combination
third-year research fellow and instructor.

P: Talk about your first two years of residency. What did you do, primarily?

T: Okay. We worked on the ward and in the clinic. Gene Stead was another
extraordinarily demanding person. Medical residents were required to sleep in the
hospital five nights a week. That is unheard of now, but we did it. Gene Stead rounded
on the ward regularly himself and saw patients with the students and the house staff
Again, the number of chairs of medicine who make any meaningful ward rounds, in this
country, you can count on the fingers, probably on one hand. He believed that if he was
going to teach medicine, or his faculty was going to teach medicine to people, they had to
be involved in taking care of people. I think that is a tremendous commitment and a
very important one which has gone by the boards.

P: Part of that is due to all the extraordinary federal regulations and all the administrative
work that is required?

T: No, it is because nowadays, many of them are not good clinicians. They feel insecure at
the bedside. It is as simple as that. So, they do not go to the bedside. They may have
conferences where somebody presents a patient, usually with all of the answers already
known and all of the tests, and they have discussed it as if it were a topic you could read
in a book. Stead did not do that, and he demanded that all of his senior faculty make
rounds. Like Jack Myres, with whom I went to Pittsburgh, who was considered the best
bedside clinician in the country by most people. I am not talking about just by Duke
people but by most people. I copied a few things from him, but I left behind some. He
was fierce on his students and house staff. I mean, I have heard him tell students, you do
not really belong in medicine if that is the way you are going to do things. And at the
bedside, I mean with everybody around him, including the patient. That is pretty harsh.
So, I never did do that, although I did question them at the bedside a lot because I made
rounds. Ninety percent of my teaching was at the bedside. It was not often some
conference room. So, Stead demanded that. We had Sunday school at Duke. Sunday
school was a session, roughly, from eight to nine-thirty every Sunday morning with a
presentation by a member of the house staff, and everybody was there, not the faculty but
Stead and all the residents and interns. He had morning report every morning--he did
it. You had basically two minutes to summarize each admission that you had from the
previous day, and he would ask very penetrating questions and come up with some very









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good insights. He was also very attuned to the role of the psyche in illness and response
to illness and made all of his chief residents-there was only one per year-have
psychoanalysis for a year, sometimes two years. It was given by a man named Bingham
Dai. So, the house staff joked that all these guys were being "Dai-alized". He also had
all of the house staff take psychometric tests. Lou Cohen, who was the first chair of
clinical psychology at UF, was at Duke at that time. Stead had all the house staff go
through, and we did Rorschak tests and thematic apperception tests and all that kind of
stuff. He convinced the chair of surgery and one or two of the others to get their house
staff to have them also so he could do some comparative studies. Stead was very
involved in the personal life of patients, and that meant taking a detailed social history.
The social history now; you pick up a lot of charts that say, "has one drink a day, used to
smoke, and so on." That is ridiculous. That is not social history. Those two things
belong in the review of systems. No, the social history is who the parents were, what
they did, and what was their background. Also, is the patient married, working, etc.
Again, the house staff there was superb, just like the students. I have always said that
my classmates at Harvard were the single most productive, impressive group of people
with whom I was ever associated with. The Duke house staff rated pretty close up to
them, too.

P: You did two years of residency, and then you did two years as a research fellow? What
did you do during those two years?

T: Stead did not believe in clinical fellowships, which is what a lot of folks take now, in
cardiology [or] in pulmonary. He thought that you should learn enough in your medical
residency to be able to educate yourself about whatever clinical subspecialty you ended
up going into. Basically then, a fellowship should be a research experience in his view.
I more or less agree with that, although I see the need for some types of clinical
fellowships now. Stead is an amazing man. He was the one, incidentally, who started
the physician's assistants program. He was very interested in circulation. This was
early on when cardiac cathederization was going on. He had parsed out, so to speak, the
circulation. The guy who was my mentor, Jack Myers, was given the liver circulation.
Father Walter Cargill studied the kidney circulation. John Hickam, who became the
chair of medicine at Indiana, was the pulmonary blood flow guy. Peritz Scheinberg,
who became the chair of neurology down at the University of Miami was the cerebral
blood flow guy. So, Stead was going to have people put together all the portions of the
circulation. I was doing liver blood flow studies with Jack Myers. Jack had already
done the fundamentals of what was the normal blood flow of the liver and what was the
blood flow to the liver in heart failure. So, we started testing the effect of various agents
on the liver circulation and then introduced the technique of wedged pressure in the liver
as an index of portal pressure. Now, that does not mean anything to you, so I will give
you a brief explanation. The liver is the only major organ that has a dual afferent
circulation. Blood is going in from an artery as well as from the portal vein, about
two-thirds of it is from the portal vein. The portal vein is the vein that has collected
blood leaving the spleen and much of the intestine. Since the liver has many functions,









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not the least of which is to metabolize some of these things that are picked up in blood
from the intestine, it makes sense for the portal vein to evolve. But, if the liver becomes
scarred with cirrhosis from alcohol or from hepatitis, pressure builds up in the portal
vein. These folks develop varices in their esophagus, which are very much like varicose
veins. They rupture, and folks bleed to death. So it was important to have a method to
estimate the portal pressure without having to make an incision and put a needle in it. A
researcher at Harvard named Lou Dexter had introduced what is called the wedge
pressure in the pulmonary circulation as an index of the pressure in the pulmonary veins,
and it worked out very well. Lou Dexter was one of my instructors, incidentally, at
Harvard. Jack thought about this business of doing the wedge pressures in the liver-this
was across the capillary circulation-[to] see if we could get an index of the portal venous
pressure. It turned out to be just great. It was the first demonstration of a relatively
non-invasive method of measuring portal venous pressure.

P: Let me ask you a question that may seem a little strange. Listening to this explanation, it
reminds me of the extraordinary machine the human body is, that it works so efficiently
so much of the time. How did it get to that point? Did it evolve? Do you see
something like the portal vein evolving over the years?

T: It was not created, if that is what you are getting at. Sure, it evolved, and it took millions
of years, from the time these single-celled organisms developed on up through the whole
scheme of evolution. It is a remarkable system. It is, indeed.

P: Is it still evolving?

T: Sure.

P: So, part of the difficulty is trying to understand that.

T: I do not know whether it is a difficulty or not. Why do you want to understand it? I
know why most people would want to understand it, so they could manipulate it. That is
probably the worst thing that can be done, because we have not done very well in
manipulating things, in my views.

P: What would you [do]? You would just make sure they work like they are supposed to
work?

T: This probably would not have come out if you had not asked that particular question. I
gave a talk to medical students, a small group of them. They had set up some elective
evening discussion group where people could talk about a whole variety of things, and
they asked me to talk. This was at least twenty-five years ago. I said that humans are in
a delicate predicament, and I drew a little diagram on the blackboard. There was a time
when people like Lucy [the fossil of a primitive human species aiin\l 1hlpii/th/ ille found
in Ethiopia in the 1970s and estimated as being 3.2 million years old] were beginning to









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come along and evolve, where certain traits of aggression in fighting the saber-toothed
tiger were probably very beneficial in the evolution and, indeed, in the survival of
mankind, but many of these traits are now counterproductive and destructive. Then,
there is a race in time as to whether this one, the aggression one, is going to be overtaken
by one which has to do with cooperation, making the world better for everybody rather
than just a small fraction of us. I still believe that very, very, strongly. Incidentally, E.
B. Wilson, the Harvard biologist who has written extensively on a lot of issues, has
suggested that there is indeed a genetic basis for cooperation and empathy and all of
those kinds of things. Altruism.

P: Whereas, we know there is a genetic base for this aggression.

T: Well, probably. People debate that, too.

P: There has been quite a bit of writing on that.

T: Oh sure. So yes, I believe we are still evolving, but physical evolution is such a
long-term process, there is real question in my mind as to whether we can do it that way,
whether there is enough time.

P: Do we see increase in height and weight and size? Is that a product of society, or is that
a product of evolution? Is it better medical care or better nutrition or more physical
training?

T: None of that has anything to do with my view of genetics. For example, I remember
very clearly [that] in my high school, I had two or three close friends who were definitely
shorter than anybody else in the class. I went to their homes, spent the nights with them
out in the boondocks, twelve miles from my metropolis at McMinnville. Their doors
were low, just like the doors you would go through in the ruins of the Anasazi people,
because all of the family members were short. Well, they are not any more. When you
go back and see their kids, well, they are not as tall as I am, but they are 5'8", 5'9", 5'10".
That is all nutrition. My sister had rheumatic fever when she was eleven or twelve
years old and we were living out in east Tennessee, there in the mountains. Rheumatic
fever was rampant in this country. Twelve percent of the children in England died of
rheumatic fever in 1920. Penicillin, to prevent it by curing the streptococcus sore throat,
did not come into being in any meaningful sense until the early 1950s. The incidence of
rheumatic fever was already dropping all over the industrialized world, including the
United States, and it had to do with better social conditions. That is what has been the
primary reason for the gain in life expectancy in the United States. It had not been all of
our fancy medicines or heart surgery. It has to do with standards of living.

P: When you are making a diagnosis, obviously you look at the genetic circumstances.


T: Right.









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P: But, you look equally as strong at the social environment?

T: Absolutely, yes. I have written several chapters, as you may have noticed, on the
genetics of heart disease.

P: Let me go to your 1952 experience. You left Duke, and you went into the Navy, to the
medical hospital in Charleston.

T: And then to the Minecraft Base. I was only at the hospital for four or five months.

P: What did you do while in the Navy?

T: When I was in the hospital, I ran their GI [gastrointestinal] ward. I guess that was
because I had done stuff with the liver blood flow, but it was also because I had more
training than anybody in internal medicine there, including the chief of medicine.

P: Did you choose to go into the Navy, or was this [the result of] the Korean War?

T: I had to stay in the Navy Reserves because I had gotten that V-12 training, so I was
called up. Maybe the Korean War had already ended. I know that I was deferred from
being called up in the Korean War because Jack Myers and I were doing studies on liver
blood flow using a variety of blood substitutes, and the military was highly interested in
these. Dextran, a polymer of dextrose, you may or may not have heard of, is a fluid
that is given as a blood substitute under acute emergencies. There were a couple of
others that we were studying as far as their effects. So, I guess they said, well, keep on
doing the research for a year, and then go into the Navy. But no, I did not have any
choice.

P: Do you look at that experience as wasted time?

T: I do not think anything I have done was useless, as far as time being wasted. I learned
some things about it, and I had some views about the Navy, which I still have.

P: At the end of your Navy experience, then you went back for your third research year at
Duke.

T: Yes, I continued my liver studies when I went back to Duke.

P: Then, in 1955, you went to the University of Pittsburgh, and this was because Jack Myers
was going, and you had trained with him?

T: Yes. He went as the first full-time chair of the Department of Medicine.









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P: So, you are still not yet into cardiology?

T: That is hard to say. Jack, as I have already mentioned, was a superb physical
diagnostician and, obviously, that included a lot about the heart. Although I was doing
liver blood flow studies, we also had to do diagnostic cardiac catheterizations,
interestingly at that time mostly on children with congenital cardiac defects or adults with
rheumatic heart disease because they were the only ones for whom anything could be
done surgically. Coronary artery surgery was in the future. So, I had done diagnostic
cardiac catheterizations at Duke, and I knew how to do cardiac Cathederization. I did
not just flip the catheter down to the liver, although I got to where I could do it with only
thirty seconds fluoroscopy time, which is pretty fast, from here down to there. So yes, I
then went to Pittsburgh.

P: At this point, you are an instructor in medicine, is that correct?

T: Correct, but I was on a tenured faculty line.

P: At this point, did you ever think about private practice?

T: One thinks about it off and on, for I knew that incomes were vastly different. Gene
Stead at Duke, as the department chair, made $25,000 a year and housing. He did get
housing, but that was not much money.

P: What would he have made in private practice? Three or four times that?

T: Easily, $100,000 or $200,000. Ed Orgain was the cardiologist at Duke, in the PDC. He
did not do any of the research kind of stuff that I was talking about. I am sure he
made...I do not know, but all of the PDC people lived well in the best part of Durham.

P: What job did you have while you were at Pittsburgh?
T: I did everything. In essence, I was Jack's right-hand man, although I do not know that
he ever called me that. He depended on me more than anybody, as far as getting things
done or talking with him. Now, he was not a person who asked for advice very often.
If he did ask anyone, it was more likely to be me. There were four or five of us who
went there at about the same time. The University of Pittsburgh is one of the oldest
medical schools in the country. A lot of people do not know that. It had always had a
faculty which consisted of practicing physicians in the city of Pittsburgh. Most of them
were born in Allegheny County, had gone to public school or parochial school there, had
gone to the University of Pittsburgh to undergraduate, and then to the University of
Pittsburgh to medical school and had taken a rotating internship in one of the various
Pittsburgh hospitals. Some of them specialized elsewhere, but most of them stayed
around Pittsburgh. It was really a highly inbred private practice oriented school. Jack
and the people there immediately clashed, and I mean clashed big-time. I told you how
he had spoken to medical students. He was almost the same in talking to all the people









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in the community. I had a number of friends out in the community and got along with
most of them. But, it was very hard to change a whole system of a medical school. As
far as what I specifically did, I set up the cardiac catheterization laboratory in the hospital
there, the first one they had at Presbyterian Hospital, which was the teaching hospital at
the University of Pittsburgh. I set it up so we would interpret the electrocardiograms,
organized rector cardiograms, which are spatial electrocardiograms. I taught the
physical diagnosis course. I went up to the VA Hospital and made rounds on the
cardiology ward once a week. It was a busy time. Then, I rounded on the ward a
certain number of months a year. I am talking about the general medical ward. I do not
remember how many months, probably six or something like that. And I set up my
research.

P: Did you enjoy your experience at Pittsburgh?


T: Yes, I enjoyed it a great deal as a matter of fact, although as you might imagine from all
these things, I was really pushed. But, [those] of us who went there with the feeling that
we could change things, get things done, we did not envision the degree of difficulty in it.
Of the original ones who went up with Jack, only one stayed long-term. I do not know
whether I was the first one to leave, but there were two or three others who did about the
same time or shortly thereafter, in part because he was difficult to work with and in part
because of the community relations. But yes, I enjoyed it. I did some research there
that had a great influence on the remainder of my career, in two ways. One of them
[was] we continued to do some liver blood flow studies, and I demonstrated that the
block in the liver could be at two different places in the liver-I am talking
microscopically now-depending on the disease. There is a heritable disease, called
Wilson's Disease, in which copper is deposited in the brain and in the liver, and they get
severe cirrhosis and portal hypertension, but it is not reflected in our wedge pressure.
You had to diagnose it by sticking the spleen, which I did a lot, and measuring the
pressure there. I found out it was high in the spleen but low in the liver, whereas in the
ordinary alcoholic cirrhosis or post-hepatitis cirrhosis, the wedge pressure and the portal
pressure are the same, or within two or three millimeters of mercury the same. So, I
demonstrated that, which I think is a pretty significant thing, although I bet you 90
percent of the gastroenterologists in Gainesville are not even aware of it, including the
ones at the medical school. The other thing that we did, I am very proud of in a sense.
Wally Jensen, the hematologist who came up from Duke with us, presented a patient at
Medical Grand Rounds with sickle cell disease. Now, I might add that Grand Rounds
[has] also changed for the worse in medical education, for a long time. At Grand
Rounds when I was a medical student and when I was at Duke and when we were at
Pittsburgh, a patient was presented and the particular ramifications of that patient's
presentation and disease were discussed by a discussant. There were two of these
presented within an hour. Now, somebody gets up and drones something in half an
hour, or sometimes a full hour, that I can read out of a book in five minutes, or they do a
topic discussion, not one directly focusing on how this individual patient presents and









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through whom you can elucidate some of the fundamental mechanisms. Anyway, Wally
presented a patient with sickle cell anemia and was presenting the typical view that these
sickle cells, which look like sickles, get wedged in the capillaries and block blood flow,
so they have their painful crises and they get small infarcts which kill the tissue and
muscles, and damage the kidney. He based this, of course, on work that, again, Dr.
Castle at Harvard with a Chinese researcher, S. S. Chen had done in test tubes on
sickling. They demonstrated, that in low oxygen tension and low pH, sickle cells form
and do all this business of clogging up the capillaries and also are more fragile because
the ends of these little old sickles break off easily. That is what causes the anemia in
people with sickle cell disease. I talked to Wally after his conference and said, that
sounds all well and good, but does it happen in the body? A simple little question, you
know. I said, I think we can test that hypothesis, [and] I will tell you what: if you will
count the sickle cells and so on, I will collect for you blood samples from the vein of the
kidney, of the liver, the jugular, of the heart, and so on. Now, the reason for that is,
kidney blood flow is very rapid, and it is not a metabolic organ, so the oxygen difference
between an artery and a vein in a kidney is very small. The liver is significantly higher,
two or three times as high. In the coronary sinus, the vessel from the heart itself, almost
all the oxygen is taken out. Then, in the jugular, it is more like the liver. So I said, we
can line up the oxygen content in all these things and count the sickle cells and see about
this correlation in the body. I thought that was a pretty neat idea. So, we did it, and two
or three things turned out. One of them, and the most important one probably, is that the
number of sickle cells did not vary very much in any of the veins despite a difference in
oxygen saturation. Now, there were two reasons for this. I interpreted this as meaning
that when people are severely anemic, their cardiac output increases a great deal. So if a
sickler has six grams of hemoglobin, normal being fifteen, they whip up their circulation,
so the blood is going around a lot faster. That means, that the oxygen differences
between these organs are not nearly as much as they are in normal people, because it is
flowing so rapidly. The second thing is that sickling is a phenomenon that takes time to
develop the red blood cell. The aggregation of the hemoglobin molecules in the cell is
starting, but they have not actually sickled so we can count them because they get back to
the lung quickly and oxygenated again. So, we had two reasons why there were not
nearly as many sickles scattered along. The other thing that we learned was that not
only are these people anemic, but their arterial oxygen saturation is abnormal. Your
oxygen saturation in your arterial blood is about 98 percent. The lowest limits of normal
are about 96. But, in the sicklers, some of them were down in the upper 70s. I had
been happy, in a sense, at the University of Pittsburgh. I thought we were making
progress. I had gotten teaching awards. The research was doing well. But, the
animosities in the community were difficult. When I was invited to at least look at
[University of Florida], it seemed to me that it would be a lot easier to start a new
medical school than it would be to renovate an old one. That was the major reason, but I
think, like many decisions that are made at all levels, that there were also other personal
things. My guess is that a number of people move for personal reasons, but they rarely
tell anybody about them when they are being interviewed. But, my wife's mother had
leukemia, had it for three, four, or five years. I was very fond of her. My wife went









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from Pittsburgh, then up to Boston, to be with her for three, four, or five months-I do not
remember exactly-before she died. That was a pretty difficult time so that, again, made
me really get to thinking about other things than the difficulties at the medical school. I
do not think it was as important as the other reasons but I do not think, there is any doubt
that it did influence my decision to leave.

P: When you came to Florida in 1958, the hospital was just being built at that time?

T: It was almost opening. I came because Sam Martin [Samuel Martin, UF, JHMHC,
professor and head of medicine, 1956-1969], the first chair of the Department of
Medicine, invited me to come. I had known Sam at Duke. He was another one
of Gene Stead's fair-haired men. So, I knew Sam, and I knew his wife, Ruth.
Ruth was an anesthesiologist but has been retired for some years. Anyway, I
knew Sam. I did not know George Harrell [George Harrell, UF, JHMHC, dean of
the College of Medicine, 1954-1965], the dean at that time [1954-1965], but I
came down and was highly impressed by George Harrell and the various other
faculty people whom I met over the two days. I do not even remember whether I
came back for another visit or, essentially, made my decision after that.

P: What was the faculty like in 1958?

T: Tremendous. It was the best faculty that has ever been here, despite what
some may say.

P: These were all brand new people?

T: Oh yes. I met most of them when I was interviewed but then, later, the ones I
did not [know], I came to know--all of the basic science chairs. Tom Maren
[Thomas H. Maren, UF, department of pharmacology and therapeutics,
1955-1999]-who, of course, is getting a lot of press because of his glaucoma
medication-was tremendously dedicated to teaching and had these great ideas.
Jim Wilson [James G. Wilson], was the chair of anatomy at that time, and he was
one of the leading teratologists in the country. Teratology is the study of the
production congenital malformations with various drugs or other chemicals.
Arthur Otis [Arthur B. Otis, UF, professor of physiology, 1956-1986], who still
lives here in Gainesville, was the chair of physiology. Edwards was the chief of
pathology [Joshua Leroy Edwards, UF, professor of pathology, 1955-1967]. So,
they really had a bang-up group of people. The major one with whom I had
dealings [was] Frank Putnam in biochemistry. Frank came close to winning the
Nobel Prize for his work on the immunoglobulins, the things that protect us from
infections. I worked with him some, and one of my first Fellows got his Ph. D. in
biochemistry while doing his research with me. That was Hiram Kitchen, who
became dean of the veterinary school at the University of Tennessee. George
Harrell had an incredible knack in identifying people, both faculty and medical









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students, and he did it, basically, by himself. It is true that after he had two or
three or four of them aboard, they all did meet the people, like they all met me
and, I am sure, made certain suggestions or recommendations. But, it basically
boiled down to George. He was a very creative man. People do not realize
that. Then, in the clinical areas, we did not have many people. There was Sam
[as] chair of medicine. The psychiatrist Peter Regan [Peter F. Regan, professor
of psychiatry, 1958-1965], I believe was here, shortly after I came if not by the
time I came. Orthopedics was not a separate department at that time. It was a
part of the surgery like it was in most places. Neurology was not a separate
department. It was a part of the department of medicine like, again, it was in
many places.

P: Who was chair of surgery?

T: Ed Woodward [Edward R. Woodward, UF, professor of surgery, 1957-1985] was
the chair of surgery. Ed, of course, came with the credentials of having trained
with a good friend and patient of mine, Lester Dragstedt, the man who introduced
vagotomy for the treatment of peptic ulcer disease. I knew him very well.

P: Talk about the facilities.

T: The central building was all here. The pharmacy wing down to the west side of
the building was there. None of that stuff to the east side, which is the new
hospital and, now, the Brain Institute, were there. There was the central
building, a beautiful building, the prettiest building that has ever been there.
George had the idea of continuing the same style throughout and if you look
down there now, there are at least six different architectural [styles], and it is
hideous. Anyway, the central facility was there, and the facilities, as far as
teaching, were unparalleled in the country because of George Harrell. He had
three or four concepts that were critical to the medical students. One of them
[was], they had to have a good library. So, he had circulated people all over the
United States, as far as I know, maybe Europe, and had gotten libraries to give
him their second or third copies so that you will find journals like the New
England Journal of Medicine back to volume one down there. Then, he believed
that the medical students should be treated like junior doctors. So, they had
their little cubicle offices the first two years where they could put their books and
sit down to study or read [with] access to the library and to the labs upstairs.
Their third and fourth year, they had cubicles in the connecting hallway between
the medical school and the hospital. Who do you think is there now, and has
been for some years? The vice president.

P: How many students were in the first class?

T: George believed that the medical student class should be limited to sixty-four.









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In the first class, there were forty. I think, thirty-six graduated, or something like
that. We have a number of good examples of them around. Mark Barrow who
[was] a member of the first class, was a Fellow of mine in cardiology later on.
So, that was one of the ideas George had for teaching, but the other one was
that there were these fairly large laboratory rooms that could be partitioned into
four. So, four into sixty-four, you can see how many students he envisioned
having there. There were going to be sixteen students in each of these areas,
and they can do their demonstrations and their little lab experiments. Again, that
is a superb idea. You are not going to be working with mob scenes. The
facilities, then, for teaching were excellent. Now, the hospital was still being
finished when I came here, September 1, 1958. The hospital opened on
October 20, if I remember correctly and I am pretty sure I do. There was only
one ward on the hospital that was open that day. So, we had the adult patients,
the pediatric patients, the surgical patients, everybody on that one ward, because
October 20 had been advertised, and they wanted to make sure that it went off.
And it did. So, all kinds of patients were mixed in there.

P: When it opened, was this a primary care facility or a referral hospital?

T: It was always a referral hospital, but it depends on what you mean by a primary
care facility. By a referral hospital, every patient had to be referred by a
practicing physician and patients, in general, were to go back to them, but [with]
some of them who had particular problems, the referring physician liked to have
joint follow-up. I had some of my original patients, who I followed for over thirty
or thirty-five years, in the outpatient clinic.

P: This was envisioned as the referral hospital for the state of Florida?

T: Certainly for north Florida, and George probably preached it for the total state,
but remember [that] the University of Miami had pulled a political maneuver and
got the first medical school in the state. There were two people, in my view, who
were responsible for having the medical school here, and there was one person
who was responsible for implementing it. The implementor was George Harrell,
who I have just mentioned. The two people who were responsible for having it
here were J. Hillis Miller [UF, president, 1947-1954] and old Bill Shands [William
Shands, Florida State Senator from Gainesville]. Miller, I never knew because
he died before I came here, but I knew his wife extremely well; in fact, I drove all
over the state with her to Heart Association meetings and so on. Nell Miller was
just a jewel of a person; in any way you can think about it, she was. She,
incidentally, participated in decision-making, not so anybody knew it but just in
talking with her husband, because she was a very bright and perceptive woman.
Miller had come from New York state and recognized that the state of Florida
was going to grow and that for any major university, there should be a medical
school. He thought-correctly, I believe-that medical schools should be









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associated with universities. Cornell Medical School, for example, is in New
York City, and the University is in Ithaca. There are other examples of that,
although that is a fairly glaring one. Miller also recognized the strength and
personality of Bill Shands, and so they started working together to get a bill
passed to start a medical school in the state of Florida. At that time, the Pork
Chop gang was still controlling things. Shands, whom I knew very well,
incidentally, got the legislature to pass the bill so that the first medical school to
produce medical students would get a capitation grant of so much per student
from the state. So the University of Miami converted some old hotels and this
and that into their basic science departments, and they had the county hospital
down there already, so they graduated the first medical students and, I think, still
get the capitation grant from the state of Florida. You have to give them credit
for that.

P: When all of this was set up, was there always a private component to the
patients, like you had at Duke, or were your salaries paid by the state and
supplemented by private patients?

T: It has worked the same way all along, as far as I know. As far as the clinic
operation at that time, there was no physical separation of private and public
patients. I never did separate mine and none of the other clinics did then. I
saw indigent patients and private patients at the same physical site. Now, there
are some of them that are separated now. To what degree I cannot tell you,
because things have been changing fairly rapidly in the last few years. As far as
compensation, I cannot tell you exactly what has gone on in the last four or five
years but, in general, there was a state stipend and there were monies that came
from the "academic enrichment fund." I put quotes around it, although it is a real
entity.

P: Where did the money for the academic enrichment fund come from?

T: That came from patient income, but it did not come directly. The patient that I
saw would not necessarily be paying me. It was a lump sum that went to the
department, but there were several cuts in it. The dean got a cut. Basically, it
came to the department chair, who allocated it to the faculty people.

P: Based on what criteria?

T: Lord only knows. I made a suggestion about that, some years later, that did not
fly. After a few years, it became rapidly evident that there were certain
departments and certain divisions that would generate a heck of a lot more
money than others would. Thoracic surgery probably brings in more money
than anything else, although there are some other surgery divisions that do pretty
well. Invasive cardiology does a heck of a lot of money, too. Cardiology brings









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in more money, probably, than all the rest of the departments of medicine,
certainly a lot. I do not know the precise percentage. My concern was fairly
straightforward. I felt that when people became involved primarily in a
money-making operation that their research and teaching might suffer. I still feel
that way. So, I suggested that there be what amounts, in a sense, to an inverse
income tax. In other words, a department that brings in, just for round figures
we will say $1,000,000, gets to keep 10 percent-now, these are not the figures I
used-and the department that brings in $250,000 gets to keep 80 percent, so we
would level out these things. I also felt that not only was that beneficial as far as
motivating faculty-not the way it is being used now to motivate faculty; i.e. money
as motivation but a better way to motivate-but I also recognized and stated that
departments that control the largest amounts of money are likely to have the
biggest role in decision-making, which I thought was the wrong way to make
academic decisions.

P: Even though your department would have had more clout.

T: At least within the Department of Medicine, my division would have. That is not
the way decisions should be made in an academic institution. It is the way they
are being made now at the University of Florida in toro, as far as I can tell.

P: What percentage of your salary would be state money, and what percent would
be from academic enrichment fund?

T: It varied a great deal, and I cannot tell you honestly. I was trying to remember
what I was paid when I came here because I thought you might ask that.

P: Yes, and the reason I ask is [that in] the first year, there could not have been
much money from the clinical fund because you had just opened up.

T: I think I was paid something like $14,000 a year. I can tell you that nobody joins
the faculty down there now for anything like that.

P: What would be a basic salary for people who start today?

T: I honestly do not know. It has really changed. It has changed in several ways.

P: But it is still much less than in private practice?

T: I am not sure in certain divisions, about that. The discrepancy is not nearly as
great. The other way in which it has changed is that they are now hiring a
number of people, who are not on tenure lines, just to see patients. As I told
you, Harvard, to a degree, has had that system for a long time, but what works at
Harvard but the pool they can call on is not the same as what works at the









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University of Florida.

P: Well, it is a different environment.

T: And they do not recognize that, apparently. The other thing that has happened,
since we are talking about things that are going on, is this business of talking
about increasing, over the next few years, the enrollment of the medical school, I
think, to 180 students or something like that. It was in the paper. I cannot think
of anything worse.

P: Was it difficult for you coming to Gainesville, having been in Pittsburgh and
having been in Boston?

T: Not really. Of course, I was born in the South. Audrey was not. She was born
in Canada, in Manitoba, but she was educated, primarily, in New England. That
is where we met and were married. We did notice, let us say, the limited
perspective of some people around.

P: You came as an assistant professor of medicine?

T: That is correct.

P: Who was chair of cardiology, or who was head of the division of cardiology?

T: I was.

P: So you were a professor of medicine, but now you were working in your
specialty?

T: Yes.

P: So, you were not doing what you had done previously? You were doing
cardiology?

T: Well, no. See, I have always done general internal medicine as well as
cardiology.

P: Is that not unusual?

T: It is now. It was not then.

P: But today most people would not do that?

T: There is a division of general internal medicine in the department of medicine









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now. George Caranasos [UF, professor of medicine, 1965-present] was the
chief of it. That is a big thing nowadays, that we need to turn out more
generalists. I have been a generalist all of my life. I have always felt
comfortable in treating people with a number of diseases, not just in cardiology.

P: About the medical school: what set-up did you use? Did you use the same
set-up that Harvard had?

T: In what way?

P: In that the first two years are basic science.

T: Oh yes. That was what, essentially, every medical school in the country was
doing at that time. Now, there were some differences. George, again, had
some really good ideas. He believed that there should be a lot of
interdisciplinary teaching. That is a glib term, a buzzword, but that meant that I
taught some with the physiology people and knew all of them. In the clinics,
when the students were beginning to see patients, he would have it so that
consultants from different specialists would see them. Now, that did not go over.
It did not last very long but, in a way, it was a good idea. But, I can tell you
when you had, say, a neurosurgeon seeing a patient who had a general
non-neurological disease, they did not take to it very well.
P: I understand that George Harrell wanted his physicians to be generalists first and
then specialists and that he used a term; he liked to refer to them as humanists.

T: I do not recall George ever saying humanists, as a matter of fact.

P: But, the concept of being generalists first.

T: That was true of everybody in medicine then, and that is how I came along.
That is how most of the Harvard instructors were. It is true that many of them
then became very eminent subspecialists of one sort or another, but we were all
taught that you could not be a good cardiologist without being a good generalist
first. Unfortunately, that is no longer true.

P: Where did you get your nurses? Was the nursing school started then?

T: Yes, and the nursing school was an important portion of this. Dorothy Smith
was the dean of the nursing school, and I had a lot of contact with her, too,
because she was an innovative person. She believed that nurses should be
collaborators and not handmaids for doctors and she believed that nurses should
have better basic training, so she hired the people in the nursing school who
were not nurses. Did you ever hear of a guy named Sid Jourard [Sidney M.
Jourard, professor of psychology, 1958-1964]? His appointment was in the









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College of Nursing. He was a psychologist, and quite a good one. She had a
statistician and other kinds of people like that. She was going to educate
nurses. They were not all going to be graduate school types, but they were
going to have a good academic kind of background. As I said, I did lectures for
her. Incidentally, at that time, people who gave lectures in other departments
did not expect a stipend from them, which I understand they do now.

P: Where did [the medical school] get cadavers?

T: I do not know who did that. George Harrell had arranged all of that, and I think
he went through the state board. There is a fairly straightforward mechanism for
that. It is not a major problem.

P: When you [taught] medical students, did you ever [require] an ethics course?

T: Medical ethics, now called more generally bioethics, was not, again, the thing
that it is now. There have been a lot of things that have caused the incredible
proliferation in bioethics. Some people who are, perhaps, a little snide have said
that this was because philosophers could not find jobs otherwise. There is
probably some truth in that. Anyway, there was not a full course in bioethics.
However, George had set up in the curriculum so that students had-I do not
remember whether it was once a week or, again, every two weeks-a conference
with a couple of faculty people who would present some topic which would now
be covered under medical ethics. There is now, of course, and has been for a
number of years a course in bioethics. Although I like the people who have
been in bioethics, I have never participated in that course because I have some
disagreements about how bioethics should be taught and, actually, what
constitutes bioethics. I am sure you are aware that the things that are talked
about most in bioethics now have to do with things like death with dignity, with
patient's rights, [and] stopping methods of continuing life, i.e. life support. Those
are important, the prerogatives of the patient in making decisions, patient
autonomy rather than paternalism, but I do not think those are the most important
things in bioethics, so that is part of the reason I have never participated.
Furthermore, I do not think those can be taught in lectures. Those should be
taught at the bedside, just like the diagnosis and the treatment and all that I was
talking about, and I tried to incorporate those issues when I was seeing patients
at the bedside.

P: What is your view on euthanasia?

T: I believe that is a right of the individual to decide, so I believe in euthanasia.


P: Your view of Dr. Jack Kevorkian?









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T: Well, I do not know all of the details about Jack Kevorkian. I think in the long
haul, he has done a good service to the people in this country by making it a
focal issue that will make people think about it. Now, when you are talking about
euthanasia, I know quite a number of doctors who have assisted the death of
their patients.

P: There is an active process, or you can not treat the illness, right?

T: That is Mickey Mouse talk. That is wordiness. When a doctor gives a patient
enough morphine or whatever, pills, that they know is a lethal amount and the
patient uses them, that is active, but it is considered passive because he did not
do anything like Kevorkian does. If you wanted to pick out one group of people
in the United States who have been most likely to get assisted in dying, who
would you guess it would be?

P: I would not have any idea.

T: Doctors, and I could name some right around here.

P: But, in many cases, it is the decision not to treat the illness, as it were? I am not
talking about unplugging. I am just saying that we are not going to use any
extreme measures to keep this person alive.
T: No. That gets, then, to a definition of extreme. To most people, extreme means
putting on a ventilator, giving them artificial feeding and so on. Now, I had a
very, very intelligent, disabled patient with severe rheumatoid arthritis, almost
lifelong, who was up in his seventies, still bright. He had been an editor for
some of the major, major magazines in the United States. He got pneumonia,
which is treatable, but we had an agreement not to give him an antibiotic.

P: That was his choice?

T: Yes.

P: Other than that sort of choice and the knowledge, informed consent as they call,
what else do you see as basic rights that the patients have?

T: I am writing a paper on medical ethics right now, for Winston Nagen in the [UF]
law school. Lord knows when, and I almost say if, but it is supposed to be
published by the University of North Carolina Press. I had never written
anything like that, although I have written things sort of related. I start out [with
the premise] that ethics and the prescription of ethics is the development of
methods and tenets by which people can live together productively and happily
and that these basic rights are those that my cousin Myres McDougal and his
collaborator, Harold Lazwell, introduced thirty or forty years ago. They are









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rights, among other things, to well-being (which includes health care) to
education, to power, access to jobs, to respect, as a fundamental one, to two or
three others that are, basically, extensions or collaborative parts of this. Now, I
think that all people, not all patients, but all people have rights to well-being [and]
that means access to pure water, to clean air, to health care...

P: Free health care?

T: We will talk about that. That is a separate issue. The first one is to get to the
business of what everybody has a right to: to all of the things that make life
bearable and full. Everything. I believe that very strongly. Now, when it
comes to health care precisely, of course, I recognize [that] rheumatic fever was
not cured by penicillin; it was cured by a better quality or life. Malaria used to be
common in the state of Florida. It was not insecticides, chloroquine or any of the
anti-malarial drugs that got rid of it; it was screens that got rid of malaria here.
Hookworm ravaged the southeast during the Depression. It was not the the
anti-worm medicines that took care of it; it was wearing shoes. So, I believe all
of those things are related to health care and that everybody has a right to all of
these fundamental human rights. Now, in the United States, there are currently
something like forty million people who do not have health insurance or any other
necessary means of health care. The administrative cost under managed care
are somewhere between 25 and 30 percent. The administrative cost for
Medicare is about 3 percent. This difference is made up in innumerable forms
by which health providers; including doctors, have to fill our trying to squeeze the
most they can out of insurance and/or the government. Other people who are
paid to check on them to see that they do not get too much. So I believe in a
single-payer health care system that the federal government runs, just like every
other industrialized country in the world has.

P: So, in effect, national health insurance.

T: I did not say insurance. I am leery of insurance because the insurance
companies are the biggest dealers in managed care now and are ripping off
people and not providing universal care, because of who they try to get rid of.
People who are sick. They want a body of people who are healthy and paying
premiums, so they can pay their executives $4,000,000 and $5,000,000 a year.

P: I want to go back to a couple other things in the beginning of the medical school.
Were there any women or minorities in either of the faculty or the medical
school?

T: There were no minority members of the faculty, originally. The closest to it
was-oh, we used to call him Deaner in the department of pathology. He
assisted, in the anatomy gross dissection laboratory and was very, very good at









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that. [He] was liked immensely by the students and contributed, but he was never
on the professional faculty. I think, maybe, a few years before he retired, he
was given some kind of title. No, there were no minority faculty. There were
three or four women in the first class; in other words, roughly 10 percent. I think
it was three or four. I do not believe there were any minority students in the first
class. There were a few who came along pretty soon after, usually one or two
per class. I remember very vividly what I was told by one of the very first ones.
He was a little guy. He said that he could walk down the hall in the hospital, in
the medical school, when an exam was coming or something or they had gotten
their grades, and one of the black custodial people would come up and say, "you
didn't let us down, did you?" Think of the burden that has on a person. The
[number of] women gradually went up. Incidentally, there were no women, zero,
in my class at Harvard Medical School. I did win a bet, though, ten bucks, that I
made in my first year with one of my classmates, that there would be women
admitted before we graduated. I just sneaked by: there were some there the
last year we were.

P: Obviously, this [was] not a priority at this time for either the faculty or the medical
school.

T: Back in the beginning?

P: Yes.
T: I do not think so. George was in favor of minorities and women, but there were
several other factors operating then. Women were not advised to apply to
medical school, then.

P: Plus, if African Americans were admitted, it could hurt the funding for the medical
school. There were a lot of political issues.

T: There were political issues here, but I am talking now more nationally than just
here. There probably were political issues here but, even more, there were not.
There were very few black people who were advised to go to medical school. I
might add, that is one of the things that I am [commenting on] in this article I am
writing on medical ethics. The hospital changed, in some ways, less than the
medical school changed. The hospital, obviously, from a start of one ward in
1958 that took all kinds of patients-surgical, pediatric, and so on for a short
period of time-developed into a full-fledged institution with a number of very
effective medical, surgical, and specialty wards. It also had many, many
changes as far as technology, which was true of medicine throughout the
country. As an example, open-heart surgery started here in 1959, but the
advances on up through, as far as the procedures, developed a great deal. So,
by 1974, we were doing coronary artery bypass surgery which had not, of
course, even been on the playing field when the hospital opened. Similar things









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could be said about all of the medical subspecialties. I might add that, as far as
I was concerned, the staff of the hospital-I am talking about at all levels: nursing,
physicians, and so on-did not change markedly and certainly did not get better.
That may sound like a peculiar thing to say, but Bill Wheat [Myron W. Wheat,
professor of surgery and director of professional services of Shands, 1959-1968]
was the first chief of cardiac and thoracic surgery and he was an incredibly good
surgeon, the best with whom I have ever worked, personally. Josh Yourkavitz
was the chief of plastic surgery; again, an absolutely superb individual. There
were a number of excellent people on the medical staff. I do not believe that the
productivity of the medical staff changed over time. One striking thing which
was not good, in my view, was that the, in a sense, esprit between the staff-I am
talking now about everybody from custodial workers to very skilled
nurses-declined over that period of time. As the institution got larger, people did
not work as hard in making sure that everybody was part of the team.

P: Why is that?

T: I mentioned the fact that the place got bigger, but I think the other reason is the
one that is true, as far as I am concerned, in all institutions. That is that it takes
leadership from the top to make things work. Secretaries behave like their
bosses behave, and workers behave like their crew chiefs. I do not think people
put as much energy into that as George Harrell had.

P: This is going past 1974, but what impact did things like the CAT scan and some
of these new technologies have on diagnosis?

T: There is no question that the MRIs and the CAT scans greatly improved imaging
over anything that we had with X-ray. You would also include nuclear scans and
ultra sound when you talk about these because these are very important. So
yes, they helped a great deal in diagnosis. Interestingly, we are also dependent
on the computer because all these scans had to be computerized before they
came out in any readable form. So there were a number of technologies which
were converging, as far as imaging, and all that was good, except for three
things. Medicine was good except for the overuse of them. Secondly, the
incredible expense that they introduced into the system. The third thing that was
bad about them was not technology's fault: that people at all levels from medical
students on up to senior staff began to depend so much on them that they never
honed their clinical skills. This, then, just led to a spiraling cycle of more and
more use of them. I have often regretted that at a time when it was possible to,
in many senses, prove whether you were right or wrong on one of your physical
diagnoses it has not been used it in that way. We should have been able to turn
out the best physical diagnosticians the world has ever seen. In actual fact, it
has turned out just the opposite, because they do not do that, and I want to put
that into contrast. Many of the early fathers of physical diagnosis-I am talking









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about 200 or 300 years ago-were so concerned about whether they were right or
wrong, in hearing a murmur or interpreting the size of an organ, that they would
actually pay the families to allow them to do autopsies to determine. Here, we
have a way of proving, before death, whether we were right or wrong and if
physicians would put down what they believe before they get the test and then
check back, it would be a tremendous boon.

P: So, they just let the machine do the diagnosis.

T: Sure, and they would list about ten different alternatives and if the ninth on the
list turned out to be right, say, oh yes.

P: Let me mention another thing that you brought up. Doctors do not do as many
autopsies anymore. Is that because of cost? Or because the machines have
already demonstrated what is wrong?

T: No. They have had numerous studies of this in the literature in the last four or
five years, and they do not do them because it takes time. You have to have a
rapport with the family to get permission. When I was an intern at Boston City, I
would sometimes take the subway at two in the morning to go out to see the
family whom I already knew and ask them about an autopsy. We strove for as
close to 100 percent as we could get, and it was usually over 90 percent autopsy
rate. The current rate is probably about 20 or 25 percent. All the studies that
have been done in recent years demonstrate that there are still some unknowns
that were not recognized. So, as you can see, I believe that autopsies are
greatly productive and needed.

P: Talk a little bit about the specific technological changes in cardiology.

T: I have already mentioned two or three. One of them has to do with the
Catheterization techniques that are utilized. These are much, much better than
they were then. The coronary arteriography did not exist when Shands opened,
and did not for some years after that. Coronary arteriography was obviously
critical if one was going to plan to operate on the coronary arteries. That,
actually, has probably changed cardiology more than any one thing, the
development of coronary artery surgery. The reason it has is, that at a time
when rheumatic heart disease has greatly declined in adults, coronary artery
disease is still [commonplace]. So this has been a tremendous thing. But,
echocardiography has come along, which is tremendous, too, another [test with
which] you can prove whether your diagnosis is correct on a valvular defect, if
you make the effort to make a diagnosis before you get it. Some people just get
it for a murmur and see what happens. The entire field of electrophysiology is
coming along. Do not get me wrong: I did not say electrocardiography because,
that dates back to Einhoven, roughly 100 years ago. I am talking about where a









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catheter is put within the chamber of the heart and the electrical impulses are
recorded. That is what it is called electrophysiological studies. With that, then,
electro physiological therapy, because they sometimes zap, one way or another,
some of the conducting system and change a rhythm, or the propensity to a
rhythm, in the heart. So, in almost every way, there have been major changes.
The other major thing in cardiology, as far as development, are the coronary care
units, which did not exist and were not planned in the original Shands. There is
no question that intensive care for a person with acute heart attack has made a
difference.

P: Over a period of time, there have been a lot of studies about the causes of
coronary artery disease and from time to time, these solutions or causes have
changed. At one point, it was high cholesterol, then bad cholesterol and good
cholesterol. What is the status today?

T: I think there has always been recognition that it is a multi-factorial process; in
other words, there are many potential causes. To lessen the importance of the
cholesterol and other lipids, I think, is a big mistake. The most flaming example
of coronary artery disease is the homozygous-in other words, inherited from both
parents-form of familial hypercholesterolemia. People who are homozygous for
that disease have cholesterols at birth and shortly thereafter at 800 or 1000
milligrams per deciliter and almost invariably have died before the ages of fifteen.
So, there is no question that extreme levels of cholesterol are bad. I might add
that this one genetic disease led to the family of drugs that is most commonly
recommended for the treatment of elevated cholesterol, and that is the staten
group of drugs, lovostaten and a variety of other drugs like that. The reason it
was so important is that in that disease that I have just mentioned, the Nobel
Prize winners Goldstein and Brown of the University of Texas, Southwestern,
demonstrated that it was due to a defect in uptake of cholesterol by receptors.
When that mechanism was faulty, the cells continued to make huge amounts of
cholesterol, particularly in the liver, because a chemical that has to do with the
formation of cholesterol, HMG co-A reductase, was not blocked. They then
developed drugs that would block it and the formation of cholesterol. Anyway,
cholesterol is still very important. When you say the good cholesterol, what you
are really saying is that is a transporter of high-density lipoprotein (HDL), of
cholesterol out of the body. People who have a low level of HDL also have an
increased incidence of coronary artery disease. So, there are many things
about lipids. I do not think there is any major controversy about that.
Everybody believes that, basically, one should lower total fat intake. Now, there
is talk about how much of it: saturated, not much of it; if it is unsaturated, that is
important, too. The highly saturated ones tend to make your cholesterol go up
more. Now, there is talk about fish oils, which have omega-4 lipids in them. I
think that is on less firm ground, although some very distinguished people believe
heavily in it. So, lipids are still important. What has come out, though, in the









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last few years has been this debate about other chemical substances, like
homocystine. It is true that, epidemiologically, there is a link to atherosclerosis
in people who have higher levels of homocystine. Incidentally, that was known
at least thirty years ago, but it has only been in the last few years that a handful
of folks have picked up on it and gotten on their PR machines, which happens in
medicine just like it does on Wall Street and everywhere else. The other thing
besides other chemical substances has been the further definition of something
well-known, that is that diabetes makes people much more prone to coronary
artery disease, some through lipid effects, some by still not-well-understood
effects, [and] that hypertension [and] smoking does. So all of those risk factors
have been worked out through a variety of studies over forty years.

P: How important was the Framingham heart study?

T: The Framingham study was the one that, in a sense, laid the basis for all of this.
The Framingham study is based in a suburb of Boston, Framingham, which is
right near Wellesley, where Harvard medical students love to go because it is
only about nine or ten miles directly up the road. The Framingham study is a
prospective study that is seeing what happens to people relative to their level of
cholesterol, or smoking hypertension, diabetes, etc. The other one along that
line was one by Ansel Keys in Minnesota, who did what is called the Seven
Countries Study. That was the comparison of coronary disease in seven
countries-Japan, the United States, and a variety of European countries-and
again demonstrated the difference with cholesterol and smoking and all those
kinds of things. It was a terribly important study.

P: Explain the importance of beta blockers and other new medication to prevent
heart attacks.

T: The beta blocker family of drugs basically block a part, or the receptors for a part,
of the sympathetic nervous system--the autonomic nervous system. Everybody
knows about epinephrine speeding up the heart and making it pound and work
harder. Well, some of that epinephrine response is blunted, not by a direct
chemical thing but by an effect on where the epinephrine works on the cell.
Basically, then, the beta blockers slow the heart rate a good deal, and decrease
the workload on the heart. They probably have a direct effect on arrhythmias,
premature beats and other worse things. So, they are blocking a part of the
stress if you want to put it that way, on the heart.

P: So, these kinds of things, even taking aspirin, reduce the rate of heart disease?

T: It is not clear that the beta blockers in any way reduce the incidence of heart
disease, except when they are used in the treatment of hypertension. That was
how they were originally primarily utilized, and they are effective in hypertension.









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So, only indirectly do the beta blockers probably influence the incidence of heart
disease. They are influencing the manifestations of it. Aspirin is a completely
different thing. Some people around here would shoot me for saying this, [but] I
am not as great a believer in aspirin. There have been a number of studies that
have been touted, and the majority of them probably do indicate that a small
dose, and I am talking about a very small dose of aspirin, a day may prevent the
development of heart attacks. That is through their blocking [of] a clotting
mechanism, not through the lipids or anything else. Aspirin are routinely
recommended. I would not argue with that because the dosage given is so
small that it essentially does not create any side effects.

P: Is there too much medication now?

T: Oh yes, no question about that, and too much medication which is too potent.
This is particularly true in elderly folks. Also, sadly, there is often no one overall
doctor who knows all the medicines that a patient is taking. So, the cardiologist
is giving them this, the urologist is giving them that, the gynecologist is giving
them that. Many of these drugs do interact.

P: Why is that the case? Why would not, in an acute illness, one medical
practitioner take over the responsibility for the overall care?

T: Well, you can be cynical about that, as many people are about American
medicine now, and say it is because subspecialization pays more than being a
generalist, and that, by and large, is true. Subspecialists control the high-tech
procedures. We have already mentioned cardiologists and their catheterizations
and echocardiograms, but the GI people were also starting to do various
endoscopies from the top down and from the bottom up and a lot of money is
involved in [those] procedures. So, I think that clearly was a part of it. But,
there was a tendency, in general, to get away from family physicians. Some
people believe that is changing some, but it is not clear that is changing entirely
in a good way now because "generalists" are now being used as gatekeepers by
the HMOs. So, there are so many things that have changed in medicine.

P: What about the changes in multiple bypass and microsurgery and laser surgery?
How have they changed?

T: The bypass surgery still has a very definite place in the treatment of coronary
artery disease. What has changed, though, has been balloon angioplasty, which
was introduced twenty years ago. There are a number of areas that are narrow
in the coronary arteries that can be opened up by a balloon angioplasty and
stents without having a big twelve-inch scar from an incision on the front of your
chest and, obviously, with pretty remarkable results. Unfortunately, following
bypass surgery, about eight or ten years down the road, depending on what









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people do in the interim, the arteries are often blocked again or new ones are
blocked. They block even earlier after an angioplasty. Lasers have always
been a bit difficult. One of the people here was one of the first folks to start
working with lasers in the coronary arteries. He is now at Michigan State as the
chief of cardiology. They have never really quite established themselves, in part
because it is difficult to direct and to limit the effect of the laser. They still have
some potential. I, of course, believe that the best thing is prevention. That is
the reason that I feel very strongly that we have fallen far behind in that, in many
ways. There has been in the last few years, an epidemic of obesity in this
country, and often in children. There is no question that [this] promotes
coronary disease and atherosclerosis in general. How much do the current
college football and professional football players weigh? 300 pounds?

P: Probably 275, average.

T: Well, it depends on the position you play. If you average in the light, fast,
defensive backs, that might be true. If you look at the line, it will be closer to 300
and over. These are people [of whom] it is true [that] some of them are big, 6'6",
6'7", but there are some of them who are 6'1" and 6'2" weighing that. This,
then, is setting a goal for all those aspiring young athletes. Boy, we have to be
big. I think images contribute, just like in Forbes or Newsweek; you see a
picture of a man. What is considered a sign of success? Well, his cheeks are
nice and big and round, and his face is square. They do not show his pot, but I
know it is there.

P: What about the use of these supplements like creatine? Do you worry about
that?

T: Yes, I do, because there have been very few good studies of them to
demonstrate what they may or may not do.

P: What is the ultimate future for genetic engineering?

T: I would answer that by saying that the future in all biological sciences-I am
talking about zoology and entomology and everything else, as well as
medicine-is heavily dependent on molecular biology. Molecular biology is what
we are talking about when we are talking about genetics nowadays. It is also
dependent on another thing, and this may be more difficult. That is, it is
depending on a synthesis of all the material in an ecological sense, or in the
whole sense of a society and the body. Those people are not recognized as
much now. The Harvard biologist E. O. Wilson is a good person to read
regarding that because he has outlined the real battles that went on for a time in
major departments in major universities, between the molecular biology people
and the classical biologists, many of whom were ecologists. Now, in most









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departments of zoology, you will see one or two real ecologists, and all the top
places are trying to load up with molecular biologists because it is true that is
where a lot of the very exciting stuff is going on now. But, the ultimate synthesis
has to be [addressed] too. So, as far as genetic engineering, I think that
depends a little bit on how one defines it. Genetic engineering has gone on as
long as civilization, in that people have picked animals and plants because they
grew faster, produced more, or were bigger. That was genetic engineering. It
was not the stuff of replacing a gene. I am very, very excited about what is
going on in molecular genetics, but I am also very concerned about it. Let us
talk about the human genome first, before we get into manipulating it. What the
insurance companies do is, as far as health insurance? They try to pick out the
healthiest people and avoid those who might be impaired in some way. So, try
to get somebody say a kid who has developed diabetes at twelve--which is the
most common age, for juvenile diabetics--medical insurance. They cannot get it,
or the premium is [costly]. That has been true of many diseases [like] epilepsy.
Now, let us say that you find a gene in this individual which makes him
susceptible to or at an increased risk to developing carcinoma of the breast or
carcinoma of the colon. What is the insurance company going to say? To heck
with you, boy or girl or what about discrimination in employment? That is the
real problem about knowing the genome constitution. Now, I believe in our
continuing on in completing the Human Genome Project, which is going to be
another two or three years, probably. But, I am very, very concerned about how
it is applied. That is the important thing. It is just incredible, the number of
things that have been learned about human genes. The gene for muscular
dystrophy, for example, is known now. It has been known for almost ten years
now, before the Human Genome Project got under way, but using the techniques
that they are using. So, they have identified this gene on the female part of the
sex chromosome, a great, big long gene which is, therefore, subject to multiple
mutations in it. This explains some of the variations in the disease that we did
not know the causes of years ago. But we still do not have a way of curing it.

P: What about the ethics of gene replacement?

T: I think isolated gene replacement in some clearly defined disease is ethical. I
see no problem with that, but I do not see it, in my lifetime. That is a different
thing. Sure, they have transgenic animals of one sort or another, but it is a lot
easier to fool with them than it is with humans and, furthermore, their
reproductive cycle is a lot closer. Humans do not reproduce, by and large, until
they are almost fifteen, twenty years old, but mice do when they are a few
months. So, you can create things a lot faster if you are working with mice. So
yes, I think there is a place for it, but it has to be done very carefully. [With] Dolly,
the sheep that there was so much turmoil about in cloning, the technique that
was used was one which had been used in amphibians for twenty years, but it
had never worked, in mammals. I give the guy a lot of credit who did that over in









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England. See, they took, an adult cell nucleus and inserted it in an egg from
which the nucleus had been removed and then got this implanted and developed
in another sheep. Not very often, 1 in 200 or 300, if I remember, eggs that this
worked on, but it did work. It clearly worked. But, is this offspring, Dolly, then
going to age more rapidly? You have probably seen this in the newspaper.
The odds are pretty good that she will.

P: We do not know the long term results of this kind of engineering.

T: That is correct, and particularly in...I started to say, a more advanced organism
like a human, but no. I was thinking over the weekend about something else
that had to do with Darwin and survival of the fittest and what humans think about
this. It is clear that most people think that humans are at the apex of the
evolutionary tree and that, that includes increased survival as a species. [But]
how long has a tortoise been around? How long have a number of insects been
around and are still surviving? We do not come anywhere close in survival to
any number of species you can list. Well, are they the fittest? I thought of this
in particular because Audrey and I were out looking at a number of the Anasazi
Ruins in the southwest. Here were civilizations, and I use the word precisely,
civilizations, that are gone.

P: Let me shift gears a second and get back to your work as chief of cardiology.
Talk a little bit about your responsibilities and duties in the administrative area.
T: That is pretty much like any other department. Well, it was not a department. It
has always been a division in the [College] of Medicine. I was the director of two
NIH training grads, one for undergraduate, the so-called undergraduate
cardiovascular training grant. I was the director of a graduate training grant from
NIH. The first one, the undergraduate one, was for the teaching of medical
students, as the term denotes. The graduate one was for the training of
cardiology Fellows, with an emphasis on cardiology Fellows who would go into
research. So actually, I continued directing the graduate training grant until
1974 and then turned it over to the new chief of cardiology with a year or two to
go on it. That was one thing. Then, there was the usual supervision of the
clinical areas, like the consultations, the care of cardiac patients in the clinics and
in the hospital, teaching medical students at all levels about cardiology. I
preferred, at least at the clinical area, to do this in cardiology electives. We
always had more students applying than we could take because I only took, at
that time, two on a rotation, and the rotation was generally six or eight weeks. It
was not just a two-week kind of thing. I had to interact with the hospital
administration and the supervisors in the electrocardiogram laboratory and the
Catheterization laboratory. In fact, I designed the first cath lab here. I did the
same thing over at the VA Hospital when it opened. [I had to] recruit faculty.


P: Were you allowed to hire your own?









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T: Yes, by and large. It was contingent, of course, on the chair of the department
of medicine. It was a difficult slow deal because there were so many areas in
the department of medicine that were understaffed. You know, if you are going
to be part of a department, you have to try to believe [and] try to support all of the
activities in the department. That, unfortunately, is one of the things that
changed over the years. People became more interested in "me" than they did
in "it."

P: As chair, you still had to get into the game of fighting for funds and hiring and
space allocation.

T: In the beginning-and when I say in the beginning, I am talking about for eight or
ten years-that was not a huge problem because, as I think I mentioned earlier in
our discussion, most of us felt we were in this game together and, also, because
I had research [and] I had the training grants that I mentioned, so that there was
not as huge a battle as subsequently developed, even more so in the 1980s and
1990s. So, that was not a huge problem for the first ten years or so. It became
more of one as the place grew and as personnel changed. George Harrell, as I
mentioned to you, was superb in picking people but when he left, I was not
always convinced that the choices were as good. I am not talking just in the
department of medicine. I am talking about in a variety of departments. It is
surprising how a few people can have a major detrimental inflow.
P: How [did] you allocate your time between research, your administrative duties,
medical school teaching, and seeing patients?

T: There is no real way. Of course, there was the way that was always handed in
by the medical school to the university records and the state about time
percentages spent on this and that. I am not sure of the accuracy of that, let us
say. At any rate, I can put a couple of those easily. I was very fortunate.
Ninety-plus percent of all of my teaching, forever, was done at the bedside. So,
I combined patient care and teaching. I feel that is the way it should be done, in
the clinical arena. Now, in basic science, one has to have a certain number of
lectures and demonstrations, but [students] also should be doing more lab work
than they do. Now, they do not do any. Well, they do a little dissection in
anatomy, but they do not do any physiological studies or anything like I did and
like we did here in the earlier years at the medical school. So, teaching and
patient care were very closely coordinated. Indeed, in my cardiology clinic, most
of the new patients were first worked up by a student or an interne or somebody,
and then I saw the patient with them. Now, that does not mean I did not take an
hour or more on every new patient, even though they presented the patient to
me. If you are going to do this combined thing, it is very time-consuming. That
is one of my real areas of disagreement with the way the med school is doing
things now. There are not many people who round at the bedside, and there are









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not many who spend that much time with their patients, with the student.

P: Could you give me sort of a typical day? What time would you start, and how
would you go through your day?

T: In part, it depended on whether I was rounding on an inpatient service. If I was
rounding on an inpatient service which was, in the early days of the hospital,
usually about six months of the year--later, it got a little less, maybe four
months--I would get into the hospital, ordinarily, at eight, and I would have a
couple of hours to talk with anybody I needed to, with my lab technicians, with
students or house staff who wanted advice about what are they going to do next
year and so on. Then I started making ward rounds at ten. Those were,
theoretically, from ten to twelve but often, depending on the number of patients
who had been admitted and so on, I would make rounds from ten to one-thirty or
whatever. Some of the house staff thought that was too long but nonetheless,
most of them liked them and requested further rotations. So, that took half an
ordinary day. Then, in the afternoon, I would have outpatient clinic probably, at
that time, once a week. That would take all of the rest of the afternoon until,
probably, six o'clock. On the ones that I did not have afternoon clinic, I would try
to keep up with correspondence, try to do a little writing, try to correlate some of
the research, go to committee meetings. I was on an incredible number of
committees. I chaired and did most of the house staff recruiting in the
department of medicine for five years in the beginning. Then, I was on various
committees from the dean. I decided fairly early on that I would also have
contacts up on campus, although I did not get involved in as many campus
committees for the first five years as I subsequently did. So, there were all
those kinds of things.

P: Patient care committee, what was that about?

T: At the hospital? That was a committee which kept track of the various wards, as
far as nursing, staffing, complaints by personnel who worked on it, complaints by
patients, just looking at future needs and so on. It also considered issues
having to do with the acquiring of new technology.

P: What would you do if you got a patient complaint about malpractice?

T: Those ordinarily did not come to us. In the early days, there were very, very few
of those. I would not have known the whole hospital, so I better back off on that.
But, there were very few. The malpractice thing in the state of Florida began,
really, to pick up in the mid-1970s, and then it [became] one of the biggest in the
country, although it is now still a very tiny percentage of money involved in the
health care system.









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P: Is there an internal investigation?

T: Oh yes.

P: Who does that?

T: There is a hospital attorney and staff that looks into that In fact, any time
anyone knows of a potential for a malpractice suit, they are supposed to report it
to this office. They have some good people in it who deal with the investigations
and trials or hearings or whatever.

P: What happens if you were to find in-house culpability prior to a lawsuit? What
would happen?

T: Again, that would be reported to this committee.

P: What if they found a person, let us say, who was an alcoholic? What would
transpire at that point?

T: Well, you used an unfortunate example, but it is probably the most common one.
I know of at least one very able professor who, basically, was fired because of
an alcohol problem. I do not know, whether he ever was involved in any
malpractice related to the alcoholism, but it was known to be interfering with his
function and, basically, he was fired. This may have happened to others about
whom I have no knowledge, but I know him. He was a pretty senior one, I might
add.

P: That is difficult to do, though, is it not?

T: Not really, because alcohol, when you are at a bedside or in the operating room,
is pretty gross misconduct.

P: The medical practices committee, what was that about?

T: That was very similar.

P: The patient care committee was appointed by the dean and the medical practice
committee appointed by the chief of staff.

T: Yes. The chief of staff, then, [oversees] the hospital [committee], and the
[patient care committee in the medical school] was [under] the dean.

P: Do you feel like, in terms of your medical committees, that you made important
changes, or do you see that some of these committees wasted your time?









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T: For those first formative years, while we were still in our infancy-I would put that
for the first five or ten years-these committees were critical to setting up a lot of
things, and I believe they were valuable. Most of the people who served on
them with me were dedicated to the task, and I think that we made real
contributions and were a necessity. I think committees on which I have served
in the last ten years before I retired often were a waste of time.

P: I noticed that you were very active in both the American Heart Association and
the Florida Heart Association. What, specifically, did you contribute to those
organizations?

T: The Florida Heart Association, a fascinating organization, was really a very small
operation with one or two staff people and [a] budget of a few hundred thousand
a year. It grew just fabulously in the 1960s and 1970s. There was a very
dedicated group of volunteers: a fellow, Don Warren, an internist down in West
Palm Beach, a close friend of mine; Gib Hooten over in the Clearwater area. I
was president [of] the Florida Heart Association [in 1964-5], and I think Don was
the next year. At any rate, over the 1960s, we strengthened the organization,
grassroots-wise, all over the state, and hired a very competent staff. There had
been one guy who had been the executive director who, probably, embezzled
some money, but there had never been any legal actions or anything. But, we
got an excellent staff, and Florida Heart was budgeting $1,000,000 or $2,000,000
by the later 1960s.
P: Where did they get the funds?

T: Folks like you. Donations. The Heart Association has always depended
primarily on donations. The Palm Beach Heart Association also put on an affair
which, at one time, was the biggest single fund-raiser in the United States, Palm
Beach Heart Ball. And it may still be. So, I look back and [I] put a lot of time
and work into the Heart Association. We had programs on nurse education,
general education, supported research fellows and those kinds of things. I have
a lot of good feelings about my years with the Heart Association.

P: Was the main purpose of it to disseminate information?

T: No, it was two-fold. That was one reason for it, but the other was the support of
research, and including support of personnel is necessary.

P: Let me go back to your rounds, and what I would like to do is read you a
comment about your work by one of your early students:


He was the most outstanding teacher I have ever known.









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Some students did not like him because he pushed us

very hard intellectually. The bright students adored him

because he taught you what was called "bedside thinking."

He taught at the bedside. He was the consummate bedside

physician.



You won a lot of teaching awards so, obviously, the students liked that. When
you look back on that, what kind of satisfaction do you get from this kind of
response?

T: Clearly, not just the awards from the students but the personal ties that I had and
still have with a number of the former students have been incredibly meaningful.
I am not sure I can say any more meaningful than my relations with patients. I
had patients for whom I had cared for thirty years. As far as a personal kind of
feeling, those two things were the greatest, but I am also very proud of some of
my research and feel that, because I was always labeled the way that student
[described], a lot of people did not recognize what I did in research.

P: Let me ask you a question that is a little bit off the discussion. A colleague of
mine, a friend of mine, said that patients will sometimes tell their doctors things
that they would not tell anybody else. Why is that?

T: Well, in the first place, communications between doctors and patients are
confidential. Secondly, an awful lot of people do not have anybody to whom
they can tell their, let us say, innermost secrets. So, if it is a doctor with whom
they have had relationships for a significant period of time, they will talk to them.
Furthermore, a good doctor in the very beginning-I think I mentioned this about
my training at Duke with Gene Stead-will recognize that the psychosocial
aspects of a patient's problems are very important to the physical aspects of their
problems. All of those things come together, or did come together.
Unfortunately, now, they are being lost almost completely, by many physicians.

P: Can you give some either amusing stories [or] poignant stories about patients? I
am sure you must have a few of those tucked away.

T: I will tell you one that is neither funny or poignant but, again, demonstrates
bedside teaching. I was presented a patient at the bedside for whom I do not
remember the precise details except that this patient had been made to sign out









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of the hospital against medical advice. Now, he had said [that] he was going to
leave, and the resident said, well, you cannot leave without signing these papers.
This had happened sometime the day before, and we were discussing it at the
bedside. There were two patients in the room, and I went into a lot of the
rigamarole about the process of signing out against advice, that it really reflects a
problem with the doctor because somehow rapport has been destroyed or the
understanding of the patient's problems [that made him] want to leave were not
recognized and, furthermore, that it had no legal binding anyway. If you were
going to do this, what you had to do was have two other unrelated people in
there [to] witness your discussion about why you feel the patient should stay in
the hospital. [The patient] hears it, and [the witnesses] sign that he hears it. [The
patient] does not sign any document about leaving against your advice, but it is
all documented as to your reasons for feeling he should [stay]. So, you do not
make the patient sign out against [the doctor's] medical advice because it creates
such a barrier. Well, it happened-and I did not know this at the time-that the
patient in the next bed was an attorney, on another service, incidentally. He
called me over either that afternoon or the next day and said, you know, I
listened to all of that stuff, and you are absolutely right; it is too bad that most
doctors do not realize that is the way to handle it.

P: Was that hospital policy at the time to have him sign?

T: Oh yes, and it still is. It is at every hospital around in the country, but it is not
worth a hill of beans when it is done. So, that is one little story. One that I
found amusing-and you may not-occurred in the last few years at the VA
Hospital. There was this man, well up in his seventies [and] from a little-bitty
town up off the Suwannee River, and he basically lived in isolation, was nowhere
near relatives or anybody around. His major complaint was abdominal pain.
So, the student presented his case to me, at the bedside of course. The man
was, in a sense, smart, but he was not erudite, so I couldn't tell what I [needed to
know] about this abdominal pain from the student description. I always went
through critical aspects of the patient's history at the bedside. That is one of the
main reasons for doing it at the bedside. So, I started asking this old codger a
little bit about what he did, how he ran a few cattle and this and that and, then,
what was this pain like? He said, this pain just comes and leaves; big old waves
that are terrible. The "leave" part helped because it meant in a minute. He
said, I can be out there walking in the pasture or somewhere, and it will come on.
There is not anything I can do but lie down on my back and put my feet up on a
log. He said, sometimes when I get up, there is a big rush of this pain, and then
I just produce the most stuff you have ever seen. He said, it is just like chopping
a big fire hose with an axe and then seeing it let go. How dramatic a description
of symptom could you get? So, I just stood aside and let the student ponder it,
and it was great.









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P: What was the final diagnosis?

T: He had been having some bouts of diverticulitis and when he had a bad one,
then he would get this cramping pain and explosive diarrhea. But, it was a
marvelous example of what you can learn from people if you just talk with them a
little bit.

P: Let me go on to talk about your research. You have done a lot of different types
of papers. One on cirrhosis of the liver, one on sickle cell, [one on] pulmonary
hypertension in children. How did you get interested in all these different types
of diseases?

T: As I told you before, I was trained, I think, pretty thoroughly as a generalist. I
really enjoyed all aspects of medicine, not just cardiology. But, the work in the
liver and cirrhosis was what I mentioned to you before. I worked with Jack
Myers in measuring liver blood flow which, of course, is circulatory research,
studying the amount of blood going to the liver. We devised the method of
measuring the wedge pressure in the liver which was the first technic which
made it possible with a relatively non-invasive technique to measure the pressure
in the portal vein. That was, really, a major development and was highly quoted
in the literature for twenty years or more, because portal hypertension is a major
problem in cirrhosis of the liver. So measuring liver blood flow and pressure
dynamics was the first thing in which I had any formal research training. In a
sense developing and describing the method was a classical research. In
Wilson's Disease, a heritable disease of copper metabolism which produces
cirrhosis as well as neurological diseases, the microscopic site of obstruction
within the liver is different than it is in alcoholic cirrhosis. So, that is my liver
disease involvement, primarily circulation. Re-sickle cell, I think I mentioned to
you that there had been this guy, Wally Jenson, who presented a case in Grand
Rounds of sickling and emphasized in vitro studies and I said, we can study that
in vivo, and we did.

P: But, your work later on tends to get more toward things like systolic murmurs and
aortic bulb valve prosthesis and things like that?

T: No, not really. Those were clinical papers that took various clinical correlations.
This business of the valve, for example involved hemolysis (the descrustion of
red cells) which was very important because valve was being widely proposed by
its manufacturer and inventor, a surgeon named Art Buell, and it caused real
problems. Then, we did looked at some systolic murmurs. What is that, the
late systolic murmur? Well, there are two things about that. The late apical
systolic murmur was originally thought to be a functional murmur, that it did not
mean any disease at all. That paper was early in the history of recognition that
it, indeed, was caused by what is called a prolapse of the mitral valve. We









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actually wrote the first suggestion of its being a heritable disease and, secondly,
that it could be a site of a serious infection on the valve. That was in the early
history of the definition of a disease which is now recognized to be common.
Everybody talks about a prolapsing valve nowadays.

P: You also talked about replacing the mitral valve.

T: Sure, in some circumstances. Yes.

P: You did some work with coral snake venom. How did you get interested in that?

T: That was a great study, and more should be done. I was involved in that is,
because one of my Research Fellows was Howard Ramsey, who is just a great
guy [and] who set up the first cath lab, incidentally, at the North Florida Regional
Hospital. Howard had worked as a medical student with Joe Gennero, a
professor in anatomy who was interested in venoms. When he started to be a
Fellow in cardiology with me, we got the idea that we could do something that
had not been done, and that was to fractionate snake venoms-well, some
fractionation had been done but not much, particular with coral venom-using the
same techniques that I was using to study the deer sickle cells. It turned out to
be absolutely incredible. You have probably have been taught, by newspapers
and otherwise, that coral venom is primarily a neurotoxin; in other words, it
paralyzes you. We put dogs on a pump that would keep them breathing and
gave them certain amounts of coral venom, and they still died. So, it was not
just respiratory paralysis killing them. Then-and this is a fascinating thing,
evolutionary-we found that coral venom had about five active fractions that could
be separated by electrophoresis. Remember, in electrophoresis, a gel is made
out of agar, starch or other supporting medium and you put your samples in this
case venom along it and then put electric current across it. The protein will
migrate, and factions will migrate different distances, depending on the charge of
the amino acids. So, we separated coral venom into four or five fractions, and
one of these was an incredibly cardiotoxic thing. Cardiotoxic. I mean, bad in
tiny, tiny doses, so much so that I believe that it may be that one molecule of this
toxin on one cell is enough to do the dirty work. In animal preparations with an
isolated heart is a faction of verom venom produces an immediate increase in
contractility for about a minute and then the bottom falls out.

P: It just stops beating?

T: Yes. It is obviously doing something very, very critical in there. Nobody has
followed up on that fraction. Nobody. And it should be done.


P: What is your view of using animals in experiments?









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T: I have gotten very careful in supporting animal research, or human research as a
matter of fact. I believe that certain animal research is legitimate, that it should
be done, and I think there have been great strides in looking after animals since
the time I started doing it. I support it as long as the studies are justified,
scientifically, and the care of the animals is good, that it is all right. But the latter
has not always been true. That is why when I started working with the deer, I
really liked that better, because we were not doing anything to the deer except
bleeding them, and we usually did that without any problems with them. Still, it
was very important research.

P: How else could you get the research you did with the coral venom?

T: There is no other way. So, that is what I say, [that] I think it is justified. But
now, animals with which we worked were always adequately anesthetized,
adequately given pain medication and so on. I also worked with animals with
alcohol, as you may have known, later on. So, I think that animal research is not
completely verboten, but I think extreme care has to be taken.

P: What was this business with alcoholic mice?

T: That paper on alcoholic mice, with Carrie Randall, was the first work to show that
alcohol by mouth would create congenital malformations. Now, everybody
knows about the fetal alcohol syndrome, and it had been reported a handful of
times at that point. Some people had given alcohol [by] IV and produced
malformations, but nobody had done it by mouth, which is how alcohol is
ordinarily taken. I am very proud of that work. The reason it happened, or the
way it came about, was that Mark Barrow, another one of my Fellows, and I had
modified a technique of dissecting rat fetuses-their fetuses, basically, at the time
of birth, or twenty-one days-to examine the heart because I had been interested
in the question as to whether some congenital malformations were related to
anti-organ antibodies. In other words, something had caused the mother to
have antibodies against the heart and these, in turn, produced congenital
malformations of the heart when she became pregnant. It turned out it was not
that simple but anyway, you can produce all the congenital malformations you
want by anti-sera, that is, antibodies, against kidney or lung tissue, placenta, just
all over the place. As I said, we had developed a technique which was a
modification of one which Jim Wilson, the first chair of the department of anatomy
here, had for gross dissection of the fetus. But, we had added on the gross
dissection of the heart. Carrie Randall was here as a post-doctorate Fellow in
neuroscience, but was interested in teratology. She found out that I had done
work with teratology and dissecting fetuses, so she came to me and said, there is
all this work about alcohol and fetuses and so on; do you suppose we could do
something? So I said, well, I do not want to do something that just repeats what
somebody else has done, but I know a fellow here in the med school who has









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been able to get mice and rats to drink alcohol, by putting it in a chocolate drink
which has all the nutrients in it. This is Gerhard Freund [Gerhard Freund,
Assistant Professor of Medicine, 1963-1964; full professor through 1990s]. I
said, if we are going to do it, then we want to do it in a natural way. So, we did.
We gave mice alcohol at the seventh and eighth day of gestation and, lo and
behold, we could produce malformations all over the place--of the kidney, the
brain, the eyes, the skeleton, the heart--in various combinations.

P: How much of a translation is it from the incidence in mice to humans?

T: It is exact. Women who drink in the first trimester of pregnancy, particularly the
second and third months, but maybe even before that, have a huge incidence of
congenital malformations.

P: So, the smaller the fetus, the worse the damage?

T: No. The gestation period in a mouse is twenty-one days. Gestation in people
is 270 days. The vulnerable period in the mouse is the seventh and eighth day.
You can give a teratogen at that time, no time else, in the pregnancy, and they
will have malformations. In people, you have to spread it a little bit more to get
the requisite. But, there is no question, and it is widely recognized, that alcohol
is still one of the major causes of congenital malformations. The sad part of that
story, as far as the mice go, is that we had been going to set up some
psychometric tests on the mice, to attempt to determine how many of them might
have learning disorders or psychological disorders even though there were no
gross malformations like a hydronephrotic kidney or hydrocephalus or absent
eyes. There is a lot of question still remaining as to whether some of the
children with mental retardation have it because of alcoholism in their mother,
who do not have the full-blown fetal alcohol syndrome. We were getting set up
to do this, but the member of the psychology department-I with whom we
planned it--unfortunately, and that sort of fell by the wayside.

P: How did your research change over the years?

T: I can phrase it conceptually. The research on liver disease and the wedge
pressures was, basically, a description of how things are wrong in other words,
the physiological derangements that occur in a disease, as far as blood flow,
pressure, and so on. I have conceived, essentially, all of the other work as
being not about how, but why? In other words, why do people get congenital
malformations? Why do the sickle cells occur? What is the genetic
relationship? You, incidentally, may have skipped over, in a sense, one of the
most important things I ever did, which was at Pittsburgh, to recognize this
disease called hypotrophic cardiomyopathy. We called it familial muscular
subaortic stenosis. That disease was not recognized at that time and has turned









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out to be the most common cause of sudden death in young athletes. We put
together a two-generation, or maybe three-generation, pedigree on the family
that I studied up there and indicated the genetic link, that it was inherited as a
Mandelian dominant. I have been very interested in the disease ever since.

P: There have been a lot of public examples of that sort of thing.

T: Yes, there have. Again, it is a fascinating one because, probably the most
eminent academic cardiologist of the last fifty years in the United States, Eugene
Braunwald at the Peter Bent Brigham Hospital of Harvard, when he was at the
NIH earlier, stated that this is a disease that is either sporadic, occurring just
hit-or-miss, or genetic, and that there was completely different courses in the two.
Gene was completely wrong. He called it IHSS, idiopathic hypotrophic
subaortic stenosis, and that was [considered] gospel. But now, about seven or
eight years ago, at the same old Brigham, a couple of molecular biologists, man
and wife, the Seidmans, found the gene that causes it. Well, there are actually
two or three very closely related genes that cause it. They cause the variations
in the disease, and there are, probably, no sporadic cases.

P: You also did some work with idiopathic dilation of the pulmonary artery.

T: That was with Russ Green [James Russell Green, Jr., professor of medicine and
community health and family medicine, UF, 1959-1996].

P: What was your finding in that study?

T: Our finding, basically, was [that] idiopathic dilation of the pulmonary artery, which
has mostly been talked about in kids, was not an uncommon thing in adults and
that you could sometimes recognize it. Then, most of the time, it did not amount
to anything.

P: You have also been involved quite a bit with international medicine. For
example, you were a visiting professor of medicine in Nigeria, at the University of
Ife.

T: 1974 and 1975 was a transition time, basically. I had become a Distinguished
Service Professor of Medicine but no longer chief of cardiology, and I thought
and Audrey thought that it was high time that I had a sabbatical, and we-I am
sure I can say "we" on that-prefer[red] to do something that we could not do in
the United States. A lot of people take sabbaticals and, no offense meant, they
go to Italy or England or Paris, and they are basically doing the same kinds of
things that they have done [during] all the rest of their academic career. That is
being simplistic but, nonetheless, it is, to a degree, accurate. So, at first, I
thought of going to South America and spent some time, actually, looking for a









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position in one of the medical schools in South America. There were several
opportunities but, unfortunately, they did not carry any stipends, and I had still
had, at that point, two college-age sons, so I had to get more money than the
university was willing to put into a sabbatical. The South American medical
schools deal, primarily, with people who are in practice, so a lot of them spend
three-quarters or half of their time practicing medicine and get pinched from the
medical school. So, I really could not find any situation in South America that
seemed fitting and contacted Project Hope, which was then starting to close
down their ship-based program...

P: That was the Good Ship Hope?

T: Yes, and going to land-based programs. So, after I approached them, they
asked me if I wanted to go to Asmara, then in Ethiopia, now Eritrea. I said, sure,
that sounds fine. We worked feverishly-Audrey doing more work than I did
getting supplies ready because they were going to have a big contingent: nursing
school, pharmacy, the whole works. I did not quite understand all the
ramifications there. We read books on the White Nile and the culture of
northeast Africa but about ten days before we were to leave, the Eritrean
Liberation Force (ELF) killed a nurse and doctor and two or three other kinds of
people, and Dr. Walsh, who was the head of Project Hope said we could not go
there [but] what about going to Nigeria? So we said, fine. That is 4,000 miles
away, in a completely different culture with all that goes with that. So, we went
to Ife, Nigeria, for a year, and then I went back later for one summer.
P: What did you do, primarily, while you were there?

T: It will sound a little bit like the early days of Shands. I did everything. The dean
of medical school at the University Ife was a remarkable man, Dr. Grillo. He was
the first Sub-Saharan African to get a PhD from Cambridge, and he was a very
proud man. Yoruba people are proud in general, and he was typical Yoruba but
a very nice man. Our seven-year-old was walking there on the campus within a
few days after we arrived, and he stopped and picked him up and carried him
around to see horned bills, weaver bird nests and so on. Anyway, the thesis
there by Dr. Grillow had been that medical students should not be taught in an
ivory-tower hospital. He is absolutely right. So he was going to have them
taught in state hospitals and rural clinics. One of the state hospitals happened
to be on the edge of Ife [but] was in no shape to have medical students. They
had two or three hired expatriates, none of whom were very good in medicine,
working in the hospital. So, I considered my responsibility to get the medical
service in shape to see medical students. Now, the medical students were on
the British system, so their first three years are what we would call pre-med and
basic science stuff, but they were coming on the wards the year after I was there.
Basically, I was the consultant. [That is] what they called me there, meaning the
attending physician, the house staff, and the students on the medical service. I









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was everything on it, working up all the patients in the medical ward, writing all
the notes and all of the orders on them, everything. I did have, during the year,
six medical students come, by pairs, from the U. K. and take rotations with me,
which I thought was pretty interesting. So, in that sense, I had a little help.
Then, there was one Nigerian woman who worked with me for part of the year as
a resident but, basically, I did everything in the care of the patients.

P: What were the medical facilities like?

T: At the state hospital? Well, it was a typical tropical state hospital in a developing
country. The wards were built with a roof, a big overhang to help shield the sun
and the heat and, also, to open across for a little ventilation. Outside then,
under this overhang, was a concrete deck/patio thing. The nurses had a
habit-and they essentially ran the place anyway, at that time-of putting patients
with diarrheal diseases out on the porch-and there were a lot of them-because it
was just easier than to flush the stuff in the gutter. It was a long, big open ward.
At each end, there were separate smaller wards of about four beds each, but
the big part of it was an open ward of something like thirty or thirty-five beds.
The only X-rays we could get were bones and chest, and the chest was not very
good. We had minimal chemistries, almost none. We did have a little
laboratory where they could do blood counts for us, but they did not do accurate
sickle preps. I set up and taught them how to do those. Early on when I was
there, I had a man come in who I knew had terminal tuberculosis, just rampaging,
and I sent a sputum to the lab to be smeared for a diagnosis. I got back a
report, no tubercle bacilli, which I knew could not be correct. From then on, I did
all my smears myself. I went and did one on him, and he was loaded with
tubercle bacilli. They just were not trained to be able to do that, so I did all my
lab work, essentially, except for the blood counts, and looked after the patients.
It was a tremendous experience.

P: You have also visited] Sweden, West Germany, [and the] Soviet Union.

T: Those three visits were all as a part of the International Physicians for the
Prevention of Nuclear War and, again, remarkable visits, particularly the one to
Sweden.

P: What would be your comment on [Sweden's] medical system? Because it is
pretty much what we in this country would label socialized medicine.

T: It is about twice as good as ours.

P: Why is that?

T: Because everybody is covered. I will give you an example, and I doubt it has









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changed much. If a man is hospitalized with an acute myocardial infarction, he
stays in the hospital a certain period of time, not long, and then moves into a
convalescent unit there, in the hospital, where his wife and he are taught a
proper diet, [and] started on an exercise program [and] rehabilitation program.
All of this time, he continues to be paid [by] his job at the company, and his job is
held for him until he is ready to go back, and he is followed by the same
physicians all through this process. That does not happen here, I can tell you.
Another example. If a child is admitted with, say, a psychological problem-and
children do get major psychological problems-the whole family moves into the
unit, because they consider it a family problem [and] not just a child problem, and
they stay there as long as need be.

P: How are the doctors paid under that system?

T: They are paid salaries.

P: Does that destroy incentive?

T: It sure did not seem to [as] I saw it over there. I lived with one for the week or
ten days we were there, and met several others. They were hardworking folks.

P: One of the complaints of this system is that, if you go for free medical care, you
have a long wait or you have to put off surgery for two months because there is a
long waiting list. Is that true of these kinds of medical systems?
T: Well, that is the complaint about Canada, that people wait. I will give you some
examples about that. My wife has had a hip replacement. She had been
bothered by that hip for about seven or eight years. It had been bothering her a
good bit for the last several years, but she did not make up her mind to have it
done. Now, when she made up her mind, she got it done. But, what I am
telling you is, these folks who yack about [how] they cannot get things done have
often had things going on for a long time that they have put off for one reason or
another. I think that when something urgent comes up, like appendicitis,
gallstone colic and so on, the Canadians get it done just as quickly as we do in
the United States.

P: So you are talking about elective surgery where you have to wait?

T: Yes.

P: What is the long-term prognosis for the American system? What do you think
we will end up with, and what do you think is the best solution?

T: The second part of your question is easier than the first part. The ideal solution
would be a single-payer national health program which is designed utilizing the









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best parts of the Swedish system, the Canadian system, the Australian system,
the English system, and you can keep on naming. Then, we will be able to
provide medical care for everybody. As I told you in the beginning, I consider
that medical care is a basic human right.

P: Would the AMA support that?

T: Not currently, although it is interesting that more and more doctors are leaning in
this direction. Organized medicine has been willing to go so far as to say they
believe everybody has a right to access to medical care. That is the term they
use.

P: You might remember that the AMA fought bitterly against Medicare and
Medicaid.

T: Sure. I remember it very well.

P: And in the long term, that was of great benefit to physicians.

T: It depends on how you mean benefit. They sure made a pile of money. But it
also, probably, was one of the factors that led to this super-subspecialization.

P: What do we do about Medicare and Medicaid? How do you preserve that, or
save it?
T: That is like the argument about Social Security and any of these other things. I
have to watch my words. My wife sometimes says, it is not what you say; it is
the way you say it. I think it is a disgrace to this country, as wealthy as this
country is, that we squinch on health care, that we squinch on education, that we
squinch on infrastructure and all of these things. It is absolutely a disgrace.
Life expectancy [and] childhood infant mortality is better in sixteen countries than
it is in the United States. Something is wrong.

P: And that is mainly indigent care, right? The failure to take care of people who do
not have insurance?

T: That is, clearly, one part of it. It is not necessarily only that. It also has to do
with issues having to do with ethnic origin and beliefs. But, it is mostly the
indigent business, yes. Indigent patients are looked after in clinics where they
feel degraded.

P: Is there a benefit in doing what Shands is doing? They have taken over
Alachua, they have taken over Jacksonville, [and] they have rehab centers.
Does that make it more efficient? Are these like leverage buyouts where one
entity can run the system more efficiently? Is that one solution?









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T: I think you should know that one of the big ones like that-I think it was called
Allegheny Health System-has gone broke, in Pennsylvania, and there are a
handful of others that are related to med schools that, I understand, are teetering.
I do not happen to know the financial status of Shands Hospital. I doubt that it
is flourishing, and that is all I will say.

P: So, it is like Hospital Corporation of America. It is going to be difficult for anyone
of those entities to survive financially?

T: Hospital Corporation of America is a bit different.

P: Because it is private?

T: It is not only private, but it is for excess profit. They got caught with their hand in
the till in a variety of ways, some ways of which a variety of hospitals are using.
There are ways of, sort of, fleecing the system by the way one codes diagnoses,
and it is hard to know. But, what is known pretty clearly is about 25 percent of
the health care dollar now goes to administrative costs and profits. It may pull it
up even a little more, whereas Medicare has an overhead of about 3 percent.
There is not any other industrialized country that has it over 7 or 8 percent.

P: So, that is why, in essence, not-for-profit hospitals cannot break even?

T: That is part of the reason, but there are not many of those anymore. They,
essentially, are going by the boards. They have been bought out, those that
were in places where they might make it. Now, one out in some very rural area
in Montana or whatever was going to have a hard time making it anyway, for a
variety of reasons. The other thing that is happening in health care, that you
may or may not be aware of, is that medical insurance has become, well, several
things. One of them [is], it is often no longer linked with employment like it was
for a long time. Secondly, if it is linked with employment, it may not pay anything
for the family. There are also major deductibles and on and on. It has been,
pretty much, demonstrated by the people who are interested in this that the
amount of money that is spent on administrative costs and insurance kind of
gizmos would take care of all of these uncovered people whom we have in the
United States.

P: Well, you can see from a point of view of a patient [when] a patient looks at the
bill, and aspirin was $6 apiece and the room was $800 a day, and there were all
these other fees, nursing fees and surgical fees. They wonder, with those kinds
of prices-now, of course, that is just the bill they see-why the hospitals cannot
make it, and you say the issue is, to a large degree, administrative.









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T: Yes. The whole thing is a fiasco. There is a group called Physicians for a
National Health Program that has been working for ten or fifteen years, for just
what they say, a national health program. I think, in answer to the first part of
your question, that eventually, this is what will happen. But, I do not expect to
see it in my lifetime. And, my father lived to be almost twenty years older than I
am now, and my mother almost as old.

P: Let me get back to something else I failed to ask you about. What is the great
benefit of all of these international medical exchanges?

T: I can only speak to the ones in which I have been involved. The International
Physicians for the Prevention of Nuclear War won a Nobel Prize ten years ago
for their work in peace, their education of folks all over the world about the fact
that there are no winners in a nuclear war and that there are a tremendous
number of social costs. As far as the specific things, our trip to Uppsala,
Sweden, consisted of five of us from the United States and five from the then
Soviet Union living in the homes of five Swedish doctors, and we talked, I mean
ten or twelve hours a day, about problems and the exchange between these
groups. One of their physicians, incidentally, was a physician to Gorbachev, so
she had direct, sort of, contact. Another one was one of their leading cardiac
surgeons. So, these were folks who had some clout. They were tremendous
folks. I think for the first time, they recognized that the United States was not a
huge threat to them like they had been raised to believe, just like we had been
raised to believe they were, and that both sides were looking at each other as
devils but were really pretty good folks. So, I think it was a tremendous
exchange that we had. I have not told you much humor. The mayor of Uppsala
had a banquet for us the last night, I think, we were there. It was just for us, the
Americans, the Soviets, and the host families. It was not a big old banquet or
anything. What he told us was Hans Christian [Andersen]'s little story. I had
never read it, although I have read a lot of those stories. He said there was this
frog that fell into a glass of milk and was, really, just drowning, and the frog sank
a time or two and said, I am not going to do this; I am going to paddle. So, he
started paddling. He paddled, and he paddled, and he paddled, and he paddled.
Again, he thought, oh, it is nonsense, but I will keep paddling and paddling.
And guess what happened? He made butter and was able to climb out. So, we
called ourselves the International Frog Society.

P: Now, if we look at these cultural exchanges, do you feel like you got as much out
of, let us say, your work in Botswana and Uganda and Nigeria as you gave
them?

T: Probably I got more.


P: How so?









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T: It broadened my horizons. It was really exciting.

P: Is the best medical care in America the best medical care in the world?

T: I do not like to use those terms, like best, in this regard. The best medical care
in most of the industrialized countries is pretty comparable. There is not all that
amount of difference.

P: Americans do not understand that, do they?

T: That is just like best university and best this and that. It is how much PR they
are given.

P: I wanted to ask you [about] the Physicians for Social Responsibility.

T: It is the American affiliate of the International Physicians for the Prevention of
Nuclear War.

P: Can I ask you another question that is not related to medicine but to your basic
philosophy? What was your view of the war in Vietnam and conscientious
objectors? If you do not want to talk about that, that is fine.

T: I do not mind talking about it. Our oldest son was sentenced to four years in
prison because he, basically, was a conscientious objector, but we did not have
any formal church affiliation, and the court rule[d] that without such, you could not
be a conscientious objector, that you had to have a formal religious affiliation. In
the time that his case was being fought, up to the Supreme Court of the United
States, not of Florida, a similar case was adjudicated, and they ruled that you did
not have to have a formal church affiliation to be a conscientious objector but that
the ruling was not retroactive and that, therefore, it did not apply to our son and
they would not hear his case.

P: So, did he spend time in jail?

T: No. He went to Canada for four years and then returned when, I guess it was
President Ford, gave the amnesty.

P: As I recall, you supported him in that all the way and testified for him.

T: Oh absolutely. I have often felt that my sons and their social views, most of
which I think are very good, have paid the price for my beliefs.

P: How would you equate what Bill Clinton and Dan Quayle did under similar









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circumstances?

T: That is hard because I do not know the details of either case. I do know of some
of the things here in the city of Gainesville that bothered me considerably, and
that is that I knew children, young men, of some people who, one way or another,
got a medical release for minimal reasons even though these people were
publicly supporting the war.

P: It is different when it is your son going to fight.

T: Yes. Actually, my son had legitimate reasons that he could have had a medical
disability. He has about 20/400 eyesight and has allergies which can cause him
to get tremendous swelling of his throat, but he did not want to use those.

P: Were you personally opposed to the war in Vietnam?

T: Yes, absolutely.

P: Why?

T: Because it was a terrible mistake, as far as international political policy, just like
the Korean War was and, to a degree, one or both of them were inflamed and
produced by the United States.

P: You have also been involved in the ecological movement, in the environment, the
Sierra Club, the Audubon Society. I noticed that you wrote a letter to the
Gainesville Sun in opposition to the cement plant. What active role do you play
in these organizations?

T: Really not very much. I send them some money, and I occasionally write letters
to the editor or to my representatives or senators. But, I am not active in any
leadership role.

P: Discuss the relationship between the hospital and the medical school and the
university administration. How has that changed over the years?

T: I honestly do not know, and I am not sure many people know. I know that the
relationship between the medical school and the hospital changed fairly
dramatically, when the so-called Tubbs bill, named for a state legislator, I was
passed. That was the one that made Shands Hospital sort of a separate entity
so that they were no longer under all the rules of the state of Florida, so they
could pay nurses more than were paid at other state hospitals. That changed
things a lot because up until that time, the dean of the medical school and the
vice president for health affairs-the [job] that Challoner [David R. Challoner, vice









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president for health affairs, UF, 1982-1998] had that was over the dean of the vet
school, the medical school, the nursing, the health related professions, the dental
school and so on-had much more, let us say, leverage with the hospital than
they did after that act was passed. I sort of think it ended up being the wrong
act, then.

P: Why?

T: Because certain policies of the hospital have not necessarily been the best for
education in my view. But, I will also add something else here, which I do not
think we have touched on before. A lot of the costs of medical education in this
country are paid by sick people. Well, then Shands Hospital makes a lot of
money, some of which goes then to the running of the medical school, not much
[but] some. And, the academic enrichment fund, which you asked me about
before, pays a lot of the salaries of the medical school faculty, and that is derived
from patient care. I do not happen to believe that sick folks ought to be the ones
who are paying for medical education. I think that is an overall governmental
responsibility that should be paid by general taxes. I think it would solve some
problems if that were done.

P: Did you approve of the idea of a vice president for all of the medical facilities?

T: That existed, actually, when I came. A fellow named Russell Poor [Russell
Spurgeon Poor, provost, UF, J. Hillis Miller Health Center, 1952-1962] was the
provost. They called it provost then, rather than vice president. Yes, I think it
makes sense, but I think that it requires considerable care in the selection of
such an individual.

P: What is your view of John Lombardi [John V. Lombardi, UF, president,
1990-1999] and his relationship to the medical school and the hospital?

T: I know what the scuttlebutt is, and I do not know what the facts are. The
scuttlebutt is that he runs it, like he does everything else around the university.
Whether that is true or not, I do not know. I am not privy to that.

P: Should he be running it?

T: I do not think so. John's background is not in health care, and he does not
necessarily know as much about it as he should.

P: Since you have retired, do you still involve yourself in research? Are you at the
medical school at all? Do you do any consulting? What medical activities are
you involved in now?









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T: Very little. I go to Medical Grand Rounds, which is a weekly major rounds, when
I am in town, most of the time. I no longer have an office there, as of a year
ago. I go to occasional noon sessions that the students arrange, particularly
about things like PSR or international affairs. Unfortunately, there have not
been as many of those as there used to be. So, I do nothing else, medically.
Well, last year, I guess I gave one malpractice deposition. I have done very little
of that, incidentally. I know a number of doctors, including some here in
Gainesville, who make a considerable amount of money that way. I have done
less than ten in forty years. I just do not do them. Occasionally, when some
special kind of a problem comes up where I think somebody is being wronged or
whatever, I will [but I've done] almost none. At any rate, I have done that, and
that is it, practically. Well, I have given a couple of lectures in Ethiopia and
Zimbabwe, but not really medical practice.

P: When you look back on your medical career, for what would you most like to be
remembered?

T: I would like to be remembered for helping build a new medical school because
included in that are the relationships that I had with the students, with other
faculty people, and with my patients. I think that was the major legacy.

P: Is there anything else that you want to touch on and talk about that we have not
covered?

T: Yes. You have not asked me much about the university at large, and I had
contact with a number of people in the university. You asked, for example,
about President Lombardi a moment ago, but you have not said a word about
President Reitz [J. Wayne Reitz, UF, president, 1955-1967], President Criser
[Marshall M. Criser, UF, president, 1984-1989], [or] President Marston [Robert Q.
Marston, UF, president, 1974-1984]. I knew all of those people to varying
degrees and had some interesting contacts with them as well as some of the
other significant figures in Gainesville, regarding the university.

P: What would be your assessments of those presidents, then?

T: I think President Reitz was a tremendous president, not so much because he had
innovative ideas because I think I said before that President Miller was the one
who really had the ideas about developing the University of Florida, as far as I
was concerned. But, Wayne Reitz was a man of tremendous integrity and
compassion. I will tell you one event that occurred that, sort of, cemented for
me what I think of him as a person. Reitz was still the president in some of the
early days of the integration struggle. There was a fellow on the faculty of the
medical school named Marshall Jones [Marshall B. Jones, assistant professor of
psychiatry and psychology, College of Medicine, UF, 1962-1968]. I do not know









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whether you ever heard of Marshall or not. He actually was a statistician, I think
in the psychiatry department, but he was one of those who was participating in
demonstrations in Daytona Beach and Jacksonville about the problems of the
blacks and integration. This, then, led him to give a lot of speeches, to be sort of
a guru, if you want to call it that, for certain liberal students who were pushing the
same kind of agenda. Marshall was refused tenure by the University. Now, his
department had voted in favor of his getting tenure [and] the medical college had
voted for him, and President Reitz turned it down. I happened to be, at that
time, an elected faculty member to the medical school executive committee.
The executive committee otherwise consisted of all the department chairs. So,
this issue came up before the executive committee. Some of them were off a
little bit, but we all, as a committee, voted to have President Reitz or one of his
representatives come down and explain to us why he denied Marshall Jones
tenure. He sent down one of the vice presidents, a very good man, Fred Conner
[Frederick William Conner, vice president of academic affairs, UF, 1968-1972;
professor of English, UF, 1935-1972]. Fred outlined and read some of
Marshall's writings, one of which said he doubted that any major changes in
society could occur without revolution. Now, Marshall was very careful in
defining this revolution not as physical combat, injuries and so on. But
apparently, Reitz and/or other higher officials interpreted this as improper. That
was the basis. I was probably the most outspoken individual at that meeting
with Fred, as far as objecting to this and trying to point out the other stuff. It is
pretty clear that my stance on that was, let us say, known. The very next day, I
happened to be walking down the hall, between the med school and the hospital.
Lo and behold, guess who walks up behind me. It is Wayne Reitz. He puts
his arm around my shoulder and says, hi Jape, let us go have lunch. So, we sat
down, and we had lunch together. It was very pleasant, just like all of my
meetings were [with him]. He knew what I had done, but he was not holding any
kind of grudge.

P: But did he reinstate Marshall Jones?

T: He did not reinstate Marshall Jones, but Marshall then got an appointment at
Penn State, sued the University [of Florida], and won money.

P: I think Reitz also, in terms of the Johns Committee [the Florida Legislative
Investigation Committee functioning under the direction of Senator Charley E.
Johns, 1956-1965] with gays and "communists," was not very tolerant of that
behavior.

T: Anyway, that is in marked contrast to how I have seen certain other university
presidents behave.

P: Talk about Marston, who had a medical background, as president.









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T: Marston was an interesting guy. He was a Virginia gentleman. Marston had
been director of the NIH and had been dean of the medical school at the
University of Mississippi. I always felt that Marston was not particularly an idea
person and that he had basically gotten most of his jobs, high positions, by not
rocking the boat. I think that is exactly how his administration was carried out
here.

P: Although he was very effective in raising money.

T: Well, that is part of not rocking the boat, because the people who have the
money do not want the boat rocked.

P: What about O'Connell [Stephen C. O'Connell, UF president, 1967-1973]?

T: I knew him quite well, too. I was on two or three university committees while he
was president. I once flew up to Tallahassee with him on a small plane with four
or five people. Anyway, I did not think that O'Connell had the necessary
academic qualifications to be a university president, and I think that this lack also
tempered some of his actions in some ways. [Once] he had a number of black
students who occupied his office arrested and hauled downtown to jail. This
was the time when the black students were vigorously pressing to have a vice
president for minority affairs and various other things. I think that by that time, I
may have already been chair of a minority committee on the campus, although
that may have come later. I wrote O'Connell a long, two-page letter about this,
pointing out the differences and the students' backgrounds and his background
and how these things influenced both of those actions. It did not change
anything, but what I was really coming to was the fact that another very
prominent person in Gainesville did have an effect.

P: How do you feel about the basketball arena being named after O'Connell?

T: I think this business of hooking names onto stadiums, buildings, colleges, and so
on, on the basis of political and/or financial influence is demeaning to the
university.

P: What is your evaluation of Criser's presidency?

T: Criser was an interesting man who came in at a very tough time. I think he was
extremely well-meaning, that he had a broader background, although it was not
academic, than President O'Connell had, and that he was more receptive to
ideas. He had been on the Board of Regents, and he had been involved in
virtually every kind of civic and educational organization you can imagine in Palm
Beach County. I did not know him intimately, but I knew him reasonably well. I









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thought, under difficult circumstances, he did pretty much what he was asked to
do to help calm things down, which is what it really was.

P: John Lombardi?

T: I do not think one can find a unanimous view about President Lombardi in many
places. I believe that he came here and with[in] the first six to twelve months,
had probably the highest approval rating among the faculty of any president that
has been here. He was thought of as a person who really understood what the
university was about, could articulate it, could conceive of the changes, all for the
better. I suspect that the large majority of the faculty no longer feel any of those
things because he has not been an individual who would listen to advice from
any quarter. I think that the willingness to listen and to learn is very critical to
people in positions like the university presidency and that if you cannot do that,
then it makes it very difficult to do a good job.

P: You served, at one point, on the university committee on intercollegiate athletics.

T: Yes. That was at the end of Reitz's term and, I think, for another two or three
years.

P: Talk about the influence of athletics in the university community.

T: Well, I believe that university athletic programs are important to universities.
They help the esprit of the student body, many of the faculty, the alumni, and so
on. So, I believe in them. On the other hand, though, I think that some of the
extremely high-level, high-profile athletic programs in the country-and I would
certainly include the University of Florida as among those-have the potential for
doing some bad things, and they probably have done some bad things. I
consider all of this flap about the agent Black signing these football players, to be
hypocrisy of the greatest sort. This university certainly, now, is working on a
capitalistic system of money. It is very important that everybody should bring in
money and should make money. Now, you have these kids. That is what most
of these high-level athletes are, just kids, seventeen, eighteen, nineteen years
old, most of whom have come from impoverished backgrounds, not all but many,
and all of a sudden, you say, you cannot sign a contract with a man who may,
then, be your representative two years down the line. I think that is unfair, and it
is not serving the kids' best interests. The best interests that it is serving are
several. The city of Gainesville apparently makes millions and millions of dollars
every weekend there is a football game here. So the city of Gainesville really
wants to be sure there is a good football team here because folks, in mobs, do
not come to basketball games or soccer games or what have you. So, they
want a big winning one. The university sure in the heck makes money. The
university athletic association makes millions of dollars on it. Coach Spurrier









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[Steve O. Spurrier, UF Head Football Coach, 1990-present], who I think is
excellent and I really like the guy, is one of the highest paid coaches in the
United States. What is wrong, then, with these kids being paid a small salary in
addition to their scholarship and, then, signing with somebody who will work with
them two years down the line? It is not for the kids' benefit that all this stuff is
being done. It is for all these other folks who are making money off of it.

P: Have athletics exceeded their importance at the University?

T: I do not think so, in the overall, probably. As I said, I believe that this hypocrisy
is bad. On the other hand, I remember when the first black high school kids in
this area began playing. That was a long time ago, now, but in another way, it
was not so long ago. I think university athletics has helped in the integration
activities, just like they probably have at the professional level. There are still
problems there to be worked out. So no, I think with the business of the esprit
that I mentioned and the positive effect, to a degree, on race relations that
university athletics have been important and are good. Where you draw the line
is another issue. As you know, I went to an Ivy League school where there are,
basically, no athletic scholarships. All scholarships are need-based. I think the
athletic scholarships should be need-based, too, because I know a handful of
guys, not many but a handful, who are from pretty wealthy families who still got
football scholarships. But, I can tell you that I went to some games at Yale
within the last few years, and they were just as much [fun] as these. In fact,
some of them were more fun. Particularly, the halftime events were a lot more
fun than they have generally been here. I think that there is a happy medium
somewhere in athletics and whether we have gone a bit over, I do not know.
Maybe.

P: Okay. Is there anything else that you want to talk about?

T: No, I do not think so.

P: Well, I want to thank you very much for your time, and this concludes the
interview.




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