by Lewis Thomas
The NYU College of Medicine was located in a series of battered, late-nineteenth-century buildings along First Avenue just north of Twenty-sixth Street, across from Bellevue Hospital. Its reputation was based in part on great Bellevue, whose wards were the sole source of clinical teaching material for NYU. It was also known to be a school largely and traditionally populated by students from New York City itself, many of them from relatively poor families, mostly Jewish, some first-generation Italians, a few Irish Catholics, a very few blacks—a different student body from those at Columbia and Cornell. The school had turned out in the past some spectacularly famous people—James Shannon, Jonas Salk, Albert Sabin, Joseph Goldberger—but its solidest reputation was for its production each year of intelligent, soundly trained, above all Bellevue-trained, physicians who formed the backbone of medical practice in New York City and its immediate environs.
I knew some of the faculty personally, and more of them by reputation. This accounted for the alacrity of my response to MacLeod’s call and my eagerness to accept the job before it was even offered. Homer Smith in physiology, Severo Ochoa in biochemistry, Bernard Davis in pharmacology, Donal Sheehan in anatomy, MacLeod in microbiology. I knew of no medical school in the country with a basic science faculty to match the roster at NYU. In the clinical departments they had William Tillett in medicine, John Mulholland in surgery, Samuel Wortis in psychiatry and neurology, William Studdiford in obstetrics, Marion Sulzberger in dermatology, and Emmett Holt in pediatrics. Currier McEwen, a rheumatic disease specialist, was the dean. It was a small medical school, living in extremely cramped quarters, dependent on an underfinanced and overburdened Bellevue for its clinical teaching, drawing students only from its local community, and backed by a huge parent university known to be in chronic financial difficulties. And, at the same time, it seemed to me the best faculty and the most interesting and exciting medical school in the country. A new building was being constructed for laboratories and teaching areas across the street, just north of Bellevue, and there were plans for a new University Hospital.
A few weeks later I went to New York to be interviewed by the search committee, which consisted of most of the department chairmen from the NYU medical school. There was a conversation of a couple of hours. I was asked what I would do with the Department of Pathology if I were selected to head it. I knew the department was very small, having been depleted by recent retirements and resignations, and I replied that I would try to build it up, if I could, with research people skilled in experimental pathology (which included immunology, by my lights), and I would hope that the department’s teaching would include a fair amount of exposure of medical students to the major areas of ignorance in medicine. I said I thought the pathology department, poised as it was midway between the basic sciences and the clinical disciplines, was in a good position to pay special attention to ignorance along with its other more obvious responsibilities.
Several weeks later, in the spring, I was told by Currier McEwen that the pathology chairmanship was mine if I wanted it, and my wife and I settled down to make plans for moving to New York that summer. Up to then I had not discussed the budget with any of the NYU people. It was limited, I knew, and would need a substantial supplementation from NIH grant sources if the kind of expansion I had in mind was to be possible. My own salary, I learned in sorrow, would be somewhat less than I was getting at Minnesota, and we knew that living expenses in New York were going to be considerably higher. Still, the opportunity seemed even more fascinating than when I’d first learned of it, and we began exploring possibilities for housing in New York.
Our next-door neighbors in Minnesota, the Nafes, had moved to New York a few months earlier. John Nafe, professor of geophysics, had taken a position at Columbia and was working at the Lamont Observatory, fifteen miles north of the city on the west bank of the Hudson River. We got in touch with Sally Nafe, and she began house hunting. Just north of Lamont, built into a cleft in the Palisades, is the village of Sneden’s Landing, an antique Dutch settlement made up of around thirty-five houses, built more or less at random on either side of a winding road leading from the 9W highway down to the river’s edge. One of these, an old but recently remodeled Dutch farmhouse, was coming up for rent shortly, and Mrs. Nafe found out about it. Sneden’s Landing had been resettled long since by a mix of artists, writers, theater people, and a few scientists, and we were extremely lucky to find a vacant house; lots of people from the city wanted to live there, and Beryl and I made up our minds on the instant of hearing about it long-distance. We packed up the house while I finished the experiments still in progress in the laboratory, and moved in the summer of 1954.
Sneden’s was wonderful, nothing less. The elementary school was a short walk up the hill and across the highway. Alongside the school was the general store and the Palisades village library, to which generations of good readers had contributed good books for all ages. Our daughters, now aged thirteen, ten, and six, enrolled with enthusiasm and started school in September. The school activities were the center of interest for the village, and most of the teachers were local residents. Everyone went to the baseball games between Palisades and the other elementary schools in Rockland County. Our oldest daughter, Abigail, developed into a fair pitcher, a regular member of the team. I remember one game held on a Wednesday afternoon when the Palisades team was losing badly because of the county regulation that religious study was an option for all classes on Wednesday afternoons, and the team had been depleted of its best players. Toward the end of the game, losing gamely but embarrassingly, the team suddenly shouted in elation, “Here come the Catholics,” and so they did, running across the field flushed with virtue from their catechisms and ready to take on the world, which they then did, winning the game handsomely. Ever since, “Here come the Catholics” has remained alive in our family’s language, used whenever we felt ourselves disadvantaged but with hope just ahead—an unexpected check in the mail, for instance, was greeted with “Here come the Catholics.”
The only thing wrong with Sneden’s was the distance between the upper Palisades on the Hudson and East Thirtieth Street on the East River. There was no easy way. For a few weeks I indulged in the fantasy of becoming a regular, methodical commuter: Beryl would drive me to the railroad station in Tappan a few miles away, I would board the 7-something train, with briefcase and newspapers, ride the long slow trip to Weehawken, take the ferry across the Hudson, then a bus across Thirty-fourth Street and to the laboratory, late all the time. I gave it up and took to the car, south to the George Washington Bridge and down through Manhattan, an hour or more each day. Finally I joined a car pool and spent the next four years averaging four hours a day in gossip, which I calculated came to two solid months of the year sitting in an automobile.
The first responsibility of a new department chairman is recruiting, which usually involves the much more difficult (sometimes impossible) job of getting rid of people already on the scene. The latter was not a problem: the Department of Pathology at NYU had already become very small due to attrition during the preceding few years, and the people who had stayed were, perhaps by a process of natural selection, among the best in the business: John Hall, a master of surgical pathology; Marvin Kuschner (now the dean at SUNY–Stony Brook); and Robert McCluskey (now chief of pathology at the Massachusetts General Hospital). These men, together with a very small group of junior associates, were the core of the department. A year later, Sigmund Wilens, who had left NYU because of illness a while back, returned to take on the directorship of the pathology service in Bellevue.
The department’s quarters in the new Medical Science Building at Thirtieth Street and First Avenue were adequate in square footage but designed as though exclusively for the use of people looking down microscopes at slides. All of the rooms were narrow cubicles, with two benches for microscopes and a sink. The laboratory equipment on hand for the department’s research consisted, by actual inventory, of one water b
ath, one incubator, several dozen copper racks for test tubes, and two venerable centrifuges. Luckily, the walls were easy to knock out, since the wiring and pipes ran through the ceilings, and the benches were movable, so that within a few months we had some wide laboratories that could be used for more general research purposes.
I had expected recruitment to be very difficult. Pathology was at that time not a particularly promising discipline for basic researchers, even those engaged in experimental pathology with animal models, and the limited space available, the relatively low salaries paid by NYU, and the difficulties involved in family living in New York City or its suburbs all made it seem hard to attract the people we needed.
I had not counted on the same magnetic force that had brought me to NYU by a single telephone call. MacLeod, Smith, Ochoa, A. M. Pappenheimer, Davis, and the rest were attraction enough, and I began to get letters from some of the very people I had hoped to induce to come, asking me what I was up to and what the place was like. The first to come was Chandler Stetson, who had worked with me as a postdoctoral fellow at Hopkins, had gone on to the Rockefeller, and then into the army to do research on streptococci in the rheumatic fever laboratories at Fort Warren, Wyoming. I asked Stetson on the phone if he’d like to consider coming, and his answer was that he’d be there in a month.
Next I received a long-distance call from Leo Szilard, the nuclear physicist, from his laboratory at the University of Chicago. He had heard that I was planning a new kind of pathology department, he said, and I should get hold of Howard Green, who was doing interesting immunological work with chick embryos at the Walter Reed Hospital in Washington. I called Green, and he agreed to come sight unseen.
Later in the year I went to an immunology conference in Paris and met Baruj Benacerraf, a young immunologist working at the Broussais Hospital. Benacerraf had been raised in Paris, but had come to New York during the war, gone to college at Columbia, to the Medical College of Virginia for his M.D., to Kabat’s laboratory at Columbia for postdoctoral work in immunology, and then back to Paris. We had a long lunch together, and by the time coffee arrived he had agreed to join the department as assistant professor, at a salary of $5,000 per year.
These people became attractions for others, and within the next two years we had assembled a remarkably bright group of young investigators, most of them working on immunologic aspects of human disease mechanisms. At the same time, visiting investigators on sabbatical leave began coming to the department to work: Philip Gell from the University of Birmingham, Guy Voisin from Paris, Jaroslav Sterzl from Prague, Jacobus Potter from Edinburgh, and Peter Miescher from Basel. Miescher, a specialist in experimental hematology and immunology, came back for several visits and finally decided to stay on at NYU in a permanent position (he went back to Switzerland in 1966 to head up the hematology clinic at Geneva).
It was an exciting period for pathology, a field with a long history of meticulous study of morbid anatomy, preoccupied for many years with detailed analysis of the morphologic changes which characterized disease. At just about the time when we were organizing the new department at NYU, it was being recognized that the mechanisms of disease not only were the proper responsibility of academic pathology departments but were now becoming approachable by scientific experimentation; this was particularly evident in what had previously been the quite separate discipline of immunology. The presence of a concentrated population of young investigators in this field in a single department soon became of interest to the NYU medical students, and we began receiving a steady flow of students in our laboratories, working after hours, weekends, and through vacation time as voluntary assistants. This was probably the most important change of all for the department. Nothing so stimulates research as the presence of students, and the NYU students were the most interesting and most insatiably curious any of us had seen. One result was the production of a new generation of NYU graduates committed to research in immunology, many of whom achieved outstanding careers later on: Emil Gottschlich, who later devised vaccines against meningococci and gonococci at Rockefeller University; Gregory Siskind (now a professor of medicine at Cornell); Frederick Becker (now director of cancer research at the M.D. Anderson Center in Houston); Ronald Herberman (a research chief at NIH); and a long string of others first did research as medical students in the Department of Pathology.
The laboratories in the Department of Pathology were soon filled to overflowing; they were small rooms to begin with and outfitted for less than half the people who finally signed on, but it is my impression that the work went better for the crowding. No investigator of whatever seniority had more than a single room, about 400 square feet, at his or her disposal. There were occasional agonized complaints: people kept bumping into each other; there were traffic jams at the instruments, especially the pieces of high-cost, shared equipment; visitors had no place to sit down; and the offices, including mine, were alcoves measuring 6 by 4 feet, but the research kept coming. Everyone took part in the teaching, lecturing in the morning to the entire second-year class or walking from bench to bench in the teaching laboratories through the afternoon, but there were enough faculty people on hand so that the teaching responsibilities were not burdensome for anyone. The teaching laboratories and the autopsy rooms in the ancient Bellevue Hospital morgue were the two centers of teaching activity, always filled with students.
At first, the interns and residents who came to the department for postdoctoral training were young men, and a few women, who were headed for careers as hospital pathologists. These professionals were in short supply, and a community hospital pathologist (who usually had the added responsibility of running all the diagnostic laboratories) was assured of a useful career at a salary near the top of all medical specialties. Later, a couple of years after the department had been reorganized, we began receiving applications from candidates who planned to stay in academic medicine and wanted training as professional pathologists and at the same time as researchers. Still later, an even larger number of people came after finishing internships and residencies elsewhere in medicine, in order to learn immunologic research.
At the outset, there were some complaints about us within the national community of professional hospital pathologists, and a few hostile articles and editorials in the pathology journal. It was felt by some that we were skewing or trying to skew classic pathology away from its traditional objectives, training young people to do research instead of practicing pathology, downgrading the field in general. My response to these criticisms was that the problem of human disease mechanisms had been on the agenda of pathology since the time of Virchow in the nineteenth century, and we were not departing, as claimed, from that tradition. It was true, however, that we were not attempting to produce new generations of hospital pathologists; we would not have been very good at this if we’d wanted to, nor would more than a few of our students, and there were plenty of other medical schools training such people.
In the end, nevertheless, the record of experimental pathology as a source of teachers and investigators in universities was an encouraging one. In the eight years I spent in the immunology laboratories at Minnesota and NYU, ten of the younger people who passed through in the course of their training went on later to become the chairmen of departments at major universities, including Harvard, Yale, Florida, Texas, Mississippi, Minnesota, Northwestern, and New York University.
A year before the end of my term in pathology, the NYU medical school received a major grant of $750,000 from the Commonwealth Fund, with instructions to use the money in whatever way seemed best for the future of the school. The preliminary discussions with the foundation, and within the faculty, had concerned the possibility of installing some new educational programs for paramedical personnel—physiotherapists, occupational therapists, medical social workers, and other professionals who work in close collaboration with physicians. We did a lot of arguing, and a rump session of the chairmen, led by Colin MacLeod, beg
an meeting to discuss alternatives. We emerged several months later with a different plan, for which I had the job of drafting the initial proposal, a new program to be called the Honors Program, under which all of the new money would be set aside for the single purpose of providing new opportunities for selected medical students to undertake fundamental research while still in their student years, with fellowship support, ample time off from the regular curriculum, and the requirement of a formal, full-scale thesis before graduation “with honors.” The Honors Program won the day, after much debate, and was initiated with its base of operation and offices in the Department of Pathology. It was the first program of its kind that I am aware of, and later received support from NIH as the precursor of similar programs set up at other universities, culminating in the combined M.D.-Ph.D. training programs now under way in about twenty medical schools. Looking back, I think this was the most interesting experiment of all the ones I had a hand in during my time at NYU.
12
NYU BELLEVUE MEDICINE
In 1958, after four years as chairman of the pathology department, I was shifted into a different chair and a different world. Dr. William S. Tillett, who had been the chairman of medicine and director of the NYU medical division in Bellevue, retired that year at age sixty-five, and a faculty search committee was appointed to find a successor. I was not made a committee member, which puzzled me some, because the research linkages and interdependence between the departments of medicine and pathology had always been close, both by tradition and by the deep interest of both groups in human disease mechanisms. I thought my department ought to have representation in the decision, and I was about to approach the committee to protest the matter when the committee approached me instead and asked if I would like to take the job.