Chapter 21: Sons of Aesculapius

Slightly south of Elmwood Avenue the first unit of the Medical Center was erected, a plain red brick structure of two stories which stood for four decades. Called a research laboratory, it was intended for eventual use as quarters for animals required in research programs. A copper plaque in a new animal house explains the many purposes the original building, served.

The Embryo of the School of Medicine and Dentistry
Research Laboratory - Library - Administration Offices
Testing Laboratory - School of Technologists - Incinerator
Animal House -Antivivisection Target - Metabolism Emporium
1922-1965

To the inscription, "temporary" might accurately have been added for many items. As an animal house the structure resembled Noah's Ark, for at one time or another it sheltered alligators and bears, calves and cats, chickens and chipmunks, dogs--above all, dogs--ferrets and frogs, geese and goats, guinea pigs, lizards and mice, monkeys, owls and pigeons, pigs, rabbits and rats, sheep and skunks, snakes and sparrows, squirrels and starlings, turtles and woodchucks, a horse and a donkey, a seal, and even a kangaroo--all essential in the unrelenting search for cures of human aches and ailments.

Not inappropriately, on Thanksgiving Day of 1922 that part of the Medical School staff already domiciled in Rochester occupied quarters in the Research Laboratory, and the next month the dogs for Whipple's investigations on anemia arrived from California. Each senior professor had a room or rooms for his laboratory, technicians, graduate students, along with storage space. Dogs had their special section on the ground floor, and space was given over to a small library. Biochemistry seminars, attended by School members, chemistry teachers at the College, and interested Rochester doctors, were also conducted in these cramped quarters.

The staff worked away in the Research Laboratory, bringing lunch from home and brewing tea or coffee on a hot plate; warmth was furnished by an apparatus that later did duty as an incinerator. In the spring of 1923 a frame lunch room--known as "The Greasy Spoon"--was improvised in which secretaries, laboratory technicians, and artisans constructing the medical complex might obtain a noonday meal. "A good many of us used to eat there regularly," a youthful fellow in biochemistry remembered, "despite the very obvious dirt and the greasiness and unpalatableness of the food."

It was in the Research Laboratory that the steadily growing Advisory Board, Whipple and Faxon especially, mapped out construction designs, consulted with architects and draughtsmen, and rigorously tested building materials and equipment, even such commonplace items as water closets--a day-long undertaking. For every dollar spent, the planners were intent on getting a dollar and a quarter's worth of results! Estimates place the costs of building the complex at only about half the expenditures for comparable construction elsewhere at the time, and, exactly as Whipple wanted, outlays were covered by the income from the funds that had been donated, without invading the principal at all. 1

Four structures had to be planned: the central building for the School and the Strong and Municipal hospitals, a heating plant, a residential hall for nurses, and living facilities for about sixty-five internes and residents. It was decided that this last unit should occupy a section facing Elmwood Avenue, while the main complex would front on a new thoroughfare, eventually called Crittenden Boulevard, and the nurses home would be laid out to the south of this roadway. The heating plant, which would supply the needs of the Medical Center and of a contemplated Men's College on Oak Hill, would be strategically located directly north of Elmwood Avenue.

Senior professors, professional consultants, architects--and George Eastman--combined forces in arriving at basic decisions on construction. Gordon and Kaelber of Rochester were retained as architects, with McKim, Mead, and White of New York City in a consulting capacity. The central structure, it was agreed, would be of six stories, built of brick, and with courtyards and wings arranged so as to ensure an abundance of light and fresh air. To meet future requirements, the general plan envisaged relatively inexpensive expansion.

Backed by some U. of R. trustees, the consulting architects urged that the exterior should be stylistically attractive, but Whipple and Eastman advocated the veriest minimum of costly decoration. During the debate that ensued, animated at times, President Rhees chose to stand above the battle, to hold the balances steady between the rival conceptions. Recalling the friction with McKim, Mead, and White over the design of the music center, Eastman bluntly declared that unless they abandoned "the classic and produce exactly what they are told--an outstanding example of simplicity and economy, I would cut them out of the job." An anecdote with a folklorish tinge recounts how Eastman took architect Edwin S. Gordon on a drive past a Kodak factory and said, "That's what I want. No fancy stuff." It may be, of course, that he felt that the music center had been too expensively ornamented or perhaps he thought that beauty of architecture would be more fitting for college halls contemplated on Oak Hill.

The Eastman-Whipple trinitarian doctrine of utility, efficiency, and economy won through, both outside and within the medical institution. On the exterior, a solitary modest concession to aesthetic adornment was permitted; the entrance to the Strong Memorial Hospital was a dignified, classical portico, composed of four Doric columns and surmounted by commemorative tablets over the architrave. Many an observer, early and late, lampooned the rest of the huge complex as a tasteless example of "early penitentiary" architecture.

Inside the building, concrete, being cheap, was employed wherever possible. "Brains rather than bricks" had priority in decisions on furnishings and equipment, Faxon explained; it was infinitely preferable, he reasoned, to have brilliant investigators "working with ample facilities...in simple surroundings than to provide luxurious quarters for less competent men hampered by insufficient budgets."

The main structure contained four principal axes, about one hundred feet apart, two running north and south, two east and west. Where the axes crossed; elevators were installed--but not enough of them. Everywhere corridors were of uniform breadth and ceilings of the same height. Facilities for the preparation and consumption of food were so designed that workers in the building, professional or other, and hospital patients could be served with maximum efficiency. As requested by Eastman, to whom the term "ward" suggested a barracks, hospital sections were known as "divisions," though not all staff members became accustomed to that designation. Not many rooms for private patients were initially provided, but the number was subsequently enlarged.

Teaching departments of the School and related hospital areas were laid out in close proximity, and generous space was allocated to clinical and research laboratories and to classrooms for around 300 students. Chiefs of departments were given wide latitude in determining how space assigned them should be used and equipped for teaching and investigation. A museum of pathology, whose displays would serve all teaching departments, and a crematory were included. Floors were naked concrete, except in the hospitals where linoleum was laid on, pipes in laboratories were left exposed, and only a minimum of paint was applied to walls and ceilings; certain professors brightened their quarters with rugs and window draperies. Planners regretted later on that a full-sized, finished basement had not been provided. It is noteworthy that new medical centers in other communities paid the Rochester complex the most sincere expression of flattery--imitation.

Here, as at the music center, Eastman carefully followed planning and construction, proffering practical suggestions drawn from his lengthy experience in factory management. For example, he saw to it that corners in stairways were painted white to discourage visitors from throwing litter in them. Luckily, Spartan principles were not invoked in designing the handsome reception room of the Strong Memorial Hospital. Fine wood paneling, paintings on the walls, comfortable settees and chairs, and a fireplace bespoke welcome and cheerfulness as in a high-class club. The grounds of the property were planted with grass, trees, shrubbery, and near buildings climbing ivy, which modestly tempered the austere mountain of red brick and windows. Healthy nursery trees on the tract were preserved for transplantation to other University acreages. 2

II

Construction proceeded more rapidly than had been calculated, thanks to excellent coordination between planners, contractors, and workmen. Instead of an overall contract, separate agreements were negotiated for bricklaying, plumbing, electric wiring, and so on, in the belief that construction would thus be accelerated. As was the U. of R. custom, Rochester firms were preferred in granting contracts; in fact, the only big jobs awarded to bidders from outside were for reinforced concrete skeletons, and even then it was prescribed that Rochester workmen should be employed and at wage rates for comparable jobs in the city. Labor troubles were insignificant; a minor dispute involving union painters was smoothed out in a couple hours.

"Snow-belt" weather conditions interfered somewhat with construction and heavy rains deposited pools of water--dubbed Lakes Whipple, Rhees, and the like--which had to be drained off. At times, mud bogged down workhorses for hours. The presence of quicksand in the soil necessitated deep concrete piles for foundations--at heavy, unexpected, and unwelcome expense; tents shielded building materials and equipment from the elements. Flocks of pheasants returned periodically to see how the work was progressing.

In April of 1923, excavation for the central structure started and followed for the other units on an orderly schedule. Without serious delays, bricks, structural steel, lumber, and other materials, and laboratory equipment of the most up-to-date and most durable quality flowed to the site. So that work would not be seriously interrupted during the winter of 1923-24, canvas tarpaulins were stretched between floors of the central building and heat was furnished by "salamanders," burning soft coal. Smoke filled the rooms and, with sulfur fumes and other gases, caused workmen to cough and sneeze--but construction went on.

Crittenden Boulevard was laid out and surfaced, and a subway beneath connected the Strong Hospital and nurses' home; presently, trolley cars were lurching and lumbering along. Not far from the Barge Canal, at the southern extremity of the U. of R. property, a small sewage disposal plant was built. On the eve of a great fund-raising campaign to finance a men's college on Oak Hill, November, 1924, the heating plant went into operation, Rhees applying a torch to the fuel in a firebox beneath a boiler. The joyful company that had assembled applauded lustily as spirals of smoke issued from the tall chimneys. Tunnels conveyed warmth to the several parts of the medical complex.

Workers in biochemistry had the distinction of being the first to take up quarters in the main building, moving in in January, 1925. Artisans had not quite finished installing laboratory equipment and connecting up electricity, water, air, gas, and steam lines, so that researches were carried on only with difficulty. At the initial biochemistry seminar, January 22, 1925, Whipple and many of the staff attended, Rhees uttered a few dedicatory sentences, and cider replaced the customary tea. Investigators who worked at night faced real hazards, for unfinished stairs of steel frames and treads lacked illumination. "One had to feel one's way carefully down these treacherous stairs in pitch darkness," an ambitious technician remembered "having escaped from the dangers within one had to contend with more dangers without in the shape of mud and puddles..." 3

III

Even before all the senior professors had been selected, steps were taken to accumulate a medical library, with emphasis on long runs of scientific journals required for research and on standard medical works of reference. Under the general supervision of University Librarian Donald B. Gilchrist, James F. Ballard of the Boston Medical Library was engaged in 1920 as consultant and purchasing agent; reputedly he was the canniest buyer of medical literature in the whole United States. After preparing a model list of publications essential for original research, Ballard set about acquiring as many as possible and he was astonishingly successful, obtaining roughly three out of four of the titles he deemed important. He returned from purchasing missions in Europe with rich burdens, thanks to the economic malaise following the First World War and to the high purchasing power of dollars in relation to gyrating currencies abroad.

The Rochester Academy of Medicine and the Reynolds Library in the city turned over sets of scholarly journals and other medical works, some volumes were transferred from the U. of R. college collections, and medical libraries in other cities generously presented duplicates to the School. Rochester alumni and other friends of medical learning, notably Edward W. Mulligan, Edward G. Miner, and George W. Goler, donated books or funds to buy books, supplementing the acquisitions from other sources.

Collections were stored first on the Prince Street Campus, then moved to the Research Laboratory, and in 1925 installed in the main building of the Medical Center. The Library of Congress cataloguing system was adopted and a special librarian was appointed (1923). Although an early idea of a common library for the College for Men and the Medical School was given up, the holdings of the School were listed in the College library catalogue. It was decided to locate the School library at the heart of the principal building on its first floor, easy of access, which rendered unnecessary large book collections in the several teaching departments. Stacks could accommodate 100,000 volumes and capacity could be doubled inexpensively whenever required; fifteen cubicles (or stalls) for readers were provided in the stacks. Sixty persons could study in the reading room, where cases around the walls held current medical journals and important books of reference.

When the first students arrived in 1925, library resources exceeded 19,000 volumes, already one of the largest collections in the United States, and with no "dead wood;" by 1928 holdings had passed the 29,000 mark, two-thirds of them sets of periodicals, and more than beginnings had been made in acquiring a working collection of books on medical history, many of them exceedingly rare titles. At that point current issues of 421 scholarly journals were being received, 133 of them in the German language alone. All the library resources were open to medical practitioners in the Rochester area. Due primarily to Goler, an instructive array of obsolete medical and surgical instruments was assembled. In 1926 a library for hospital patients was started, and it was manned by volunteers exclusively until 1933 when a paid librarian was appointed. 4

IV

With befitting ceremonial the cornerstone of the School was laid by Rhees on June 14, 1924, in the presence of a large assembly. At the time only the ground floor of the central structure had been finished, and it was announced that in due course "a more complete and satisfying inspection" would be arranged. In his address the President stressed that both. Physicians and dentists would be trained and identical standards of admission would apply to candidates for both professions; the education of dentists in their second two-year period would be carried on at the Dental Dispensary. Only the School staff--full-time scientists--and selected practitioners in Rochester would be permitted to care for patients in the hospital, it was explained, but any Rochester physician could refer ailing persons for diagnosis and treatment.

The principal speech of the occasion was delivered by Lt. Colonel Edward B. Vedder, U. of R. 1898, a physician attached to the Chemical Warfare Service of the United States. He remarked approvingly upon the accent on investigation and experimentation that would prevail in the School, praised the appointment of research-oriented professors, and rejoiced over the large endowment which would support investigations. The colleges of the U. of R., Vedder supposed, would prepare students for entrance upon medical training. At the close of the exercises, Rhees, wielding a trowel stamped "1923" and assisted by workmen, set the cornerstone in place. 5

"Firsts" then followed in rapid succession. In September of 1925 the School welcomed the original contingent of medical and nursing students. The Strong Memorial Hospital and the Municipal Hospital received their first patients in January 4 and July 30, respectively, 1926. No pageantry marked the opening of the hospitals; at the Strong, Faxon simply unlocked the front doors, observing, "Never again as long as this building stands will these doors be locked." On the first day a solitary patient, one Harry (or Henry) T. Commons, ventured inside, complaining of a stomach ailment; the entire medical corps and some fifty nurses were on hand to relieve his discomfort, but he lost courage and refused to be treated. Next day, however, he returned and was admitted. (He died in the Hospital in 1966.)

Ten days later the first baby was delivered--Robert Beavers, grandson of the hospital's chief pharmacist. On January 20, 1926, Whipple performed the first autopsy, and on February 15 the first sick person received treatment at the outpatient or dispensary clinic; in October the first ambulance was donated to the Strong Hospital.

In completed form, School and hospitals covered an acre and a half, floor areas and roof equalled ten acres, and corridors if laid end to end would extend for one and a half miles; the vast pile contained over 2,100 windows and about 1,200 doors. As of 1939, the Strong Memorial Hospital contained 272 beds and thirty-six bassinets; beds for private patients numbered only forty with seventy-two semi-private accommodations. Additionally, the Municipal Hospital had 321 beds and thirty-six bassinets. For medical and nursing services and allied matters, the two hospitals operated as a single unit. 6

Mindful of the role which Abraham Flexner played in bringing the institution into being, Eastman sent him aerial photographs of the structures, describing them as "the most visible and latest signs" of the "trouble" the medical statesman had started in Rochester. Appreciative of the pictures, Flexner rejoined that he had "less and less remorse for the trouble in which he involved" Eastman, the University, and the Flower City. 7

V

Formal ceremonies dedicating the Medical Center were held on Monday and Tuesday, October 25 and 26, 1926, just after the return of George Eastman from a big game safari in Africa. The city newspapers teemed with articles by University leaders on the institution and its exciting potentialities. Rhees, for example, lucidly surveyed the thrilling evolution of the whole enterprise, which Whipple supplemented by peering into the crystal ball of the future. From the pen of Faxon came a piece on the role of hospitals, Goler discoursed on "Research, the Key to New Cures," while Burkhardt set forth his ideas on the schooling of dentists.

Among the distinguished medical figures who converged upon Rochester were Abraham Flexner, the venerable William H. Welch, and delegates from seventy medical and dental organizations and hospitals. At Monday morning's exercises in the Eastman Theatre, John C. Merriam, president of the Carnegie Institution in Washington, gave the main address on "Medicine and the Evolution of Society," and the honorary degree of doctor of science was conferred upon Professor Friedrich von Muller of Munich, author of a famous work on clinical diagnosis and widely regarded as the foremost teacher of medicine in Germany, and upon Andrew Balfour (in absentia), director of the London School of Hygiene and Tropical Medicine. Musical selections by the Eastman Orchestra enlivened the proceedings.

At the School itself, scientific medical conferences and technical clinics proceeded during both days; von Muller gave an address on "The General Pathology of Joint Diseases" and conducted a medical clinic, while Harvey Cushing, of the Harvard medical faculty, a teacher of Morton, presided over a demonstration in surgery. On Monday afternoon in the reception room at Strong Hospital, President Rhees spoke moving words of tribute to the Strong family for its benevolence, then handed a symbolic key for the front door to Mrs. Gertrude Strong Achilles who passed it along to Director Faxon. The company moved across to the nurses' residence for a reception. 8

VI

The U. of R. initiated medical training at a point in history when drastic changes and readjustments, induced by scientific and humanitarian forces, were coming over the education of physicians and the practice of medicine. In some respects the Rochester institution blazed new trails that were followed by other strong schools.

Significant trends included the use of many tests and of x-rays in medical care, novelties with regard to laboratories and their equipment, experimentation in teaching techniques, and the growing conviction that adequate medical care should be available at all economic levels of society. Investigations to discover--and then apply--improved ways to prevent or cure illness were being cultivated to an unparalleled extent. And a proliferation of specialties attended the explosion of medical knowledge; more and more, advances in medical science came from hospital medicine. With the passing of the decades, it became increasingly evident that no one physician could possibly know about more than a small part of the many sicknesses that could afflict the human organism. Inescapably, the prestige of the general practitioner--the historic "family doctor"--suffered a decline and that trend kept gathering momentum; the obverse of the coin was the constantly rising status of the medical specialist.

During lengthy discussions the School Advisory Board deliberated on the best ways to prepare students for the practice of medicine throughout their professional careers. As finally formulated, though not immediately published, the first two years of work would concentrate on preclinical subjects, leaving clinical instruction to the final two years. Accordingly, anatomy, biochemistry, physiology, pathology, bacteriology, and the practical applications of each subject occupied the time of first and second year students with medicine, surgery, obstetrics, and pediatrics were reserved for the last half. Much of the fourth year would be spent in the out-patient clinic where the experience would resemble the work of a full-fledged practitioner. Once the degree of doctor of medicine had been obtained, the embryonic physician would serve an internship on the staff of a hospital and then at last would be ready to engage in the care of patients on his own responsibility.9

The Rochester faculty encouraged abler students to interrupt their medical studies for a year and devote themselves to scientific research--a practice that Whipple and Corner had promoted before coming to Rochester. This so-called drop-out-a-year program grew into an important tradition at the U. of R., and many of those who participated chose to pursue academic careers instead of the practice of medicine; lesser research projects by students were likewise fostered. "I don't remember whether everyone was exposed to research during his early medical school days but I was," one of the men in an early class recalled. "During my freshman year my roommate and I did some hormonal research...in anatomy. Later we collaborated on a second research project in Vital Economics (nutrition). Both were subsequently published. It seems that everyone was given an opportunity to engage in original research...."

Repeatedly, the Advisory Board debated at length on how many students should be admitted annually. It was uniformly agreed that the number should be relatively small, so that intimacy between teacher and taught could be established and maintained. Quality not quantity served as the ruling principle. Eventually, class size was fixed at a maximum of seventy-five, fifty in medicine and twenty-five in dentistry. Applicants were required to have had three years at least of undergraduate training, which must include three years study of chemistry, one each of biology, physics, and English; and they had to possess a reading knowledge of German or French with Latin desirable.

From the very beginning, applicants, moreover, were carefully screened by an admissions committee, normally comprising the Dean and three colleagues, who more or less applied the criteria for Rhodes scholarships: intellect, character, physical vigor, leadership promise--in short "the best man for the world's fight." Not men only, though, for admission was open without regard to sex or creed, color or race.

"Scholastic ability is essential to carry the tough medical training program," Whipple wrote, "but the character and personality of the student were thought to be equally important. Health and determination are also important." {Beginning in 1927, candidates for admission had to pass a physical examination satisfactorily.) "In my opinion," the Dean continued, "the aptitude tests tell less than the academic record plus the evaluation of the student coming from senior science college teachers. Personal interviews also are important--single, but not group interviews--to gain some knowledge of the initial contact personality. 'Would this person appeal to a sick patient and gain his confidence?' "

Throughout his long tenure, the Dean shared continuously in the chore of interviewing. Corner looked over one student "in a very informal, pleasant manner" while dissecting a calf's liver in his laboratory. "He was very gracious and kind to a rather frightened novice." Applicants from a distance might be interviewed near their home by a medical person in the vicinity chosen by the School.

From more than sixty who sought entrance in the first class in medicine, twenty-two were actually selected and commenced work on September 21, 1925. They were drawn from eleven colleges in the United States and one in Canada, and one man had received pre-medical schooling in Sweden, two of the students were women, and seven came from Rochester. Nobody had applied for a dental education.10

VII

"The atmosphere of the School, in general," an early student has testified, "was friendly and helpful--like that in a small intimate neighborhood in a small town." Every effort was expended to advance each man through medical school to his degree. The few who were dropped suffered attrition for personal reasons usually -- at least it seemed so. Consequently, the spirit of aggressive competition--'dog eat dog'--was lacking." Students soon discovered that methods of instruction varied considerably from department to department due to the pedagogical philosophy of the individual teacher or to the nature of his subject. Perhaps Professor McCann hit off the general approach of his colleagues as well as of himself when he wrote that teachers "must be alert to see each tiny spark of interest or curiosity [in a student] and fan it into flame."

As a rule, however, lectures were rarely presented, attendance upon them was optional, and long examinations were rarities; instruction was given for the most part to small groups in laboratories or alongside an autopsy table. For the clinical subjects, daily "rounds," or examinations of patients followed by informal discussion of cases, and weekly clinics were the main techniques of teaching.

Students frequently complained that professors expected too much work, and some students whose health cracked were obliged to withdraw from the School; the Advisory Board reported that tuberculosis and nephritis were the most serious causes of breakdown. Periodically, that body thoroughly discussed students whose academic performance was judged below acceptability and dropped the poorest of them. Certain professors recommended similar medicine for students who entered into matrimony; but no immediate action was taken.

On June 17, 1929, the U. of R. conferred its first M.D. degrees--seventeen men and one woman, Edith E. Emerson, who had received a Rochester bachelor's honor four years earlier. Precisely at this point, it may be mentioned, the first woman, Margaret Bondfield, was appointed to a British cabinet post--feminism was on the march. 11

Several significant organizations, meanwhile, had emerged inside the School. There was the U. of R. Medical Society, for instance, started in December of 1925, to consider clinical problems or hear preliminary reports on current research projects. It was standard custom to have a demonstration or a lecture by a professional guest at each session of the Society.

Professor Corner organized a "Book and History Club"--subsequently called the Medical History Club--which first convened on January 24, 1927. At meetings papers were read on a wide variety of medical themes, such as "Early Experimentation in the Biological Sciences" by Adolph, "The Cholera Epidemic in Rochester" by Goler, "Medicine in the Poetry of Geoffrey Chaucer" by Corner, or the health record of Jean Paul Marat, a prominent personality in the great French Revolution, by Bayne-Jones. Two highly respected European historians of medicine, Charles Singer of London and Arturo Castiglioni of Padua, Italy, also spoke to the Club. Now and then, rare and seminal medical books and antique instruments were displayed at meetings.

In May, 1929, a chapter of the non-secret national honor society of medical students, Alpha Omega Alpha, was installed at the School. Translated from the Greek, the motto of the fraternity read: "To be worthy to serve the suffering." High scholarship, personal integrity, and potential leadership were the tests for election to the society. Meetings consisted of discussions of scientific articles and clinical cases; by 1962 Alpha Omega Alpha had over 300 members on its rolls.

VIII

It would be erroneous to assume that medical education at Rochester was all work and no play. Tennis courts were laid out and handball courts were improvised in vacant rooms of the principal building; recreational facilities were also available in the nearby Genesee Valley Park or on the Genesee River. Softball games were played between the several classes of students and between students, internes, and teachers, with faculty families sometimes observing. When the buildings of the Men's College on Oak Hill were nearing completion, medical students made use of the gymnasium and the student union, and were eligible to occupy rooms in a dormitory.

On the social side, medical classes occasionally arranged parties and once a year the whole student body had a grand ball; a few men organized these affairs and pocketed any surplus revenues. Now and then, Rochester families entertained students at dinner. "Best of all," one of them has written, "was a free meal at someone's home where the price of sitting next to the marriageable daughter was not too high to pay."

Since dormitories were not provided (except, of course, the staff house for interns and residents), students from out of the city in the early years, had to find rooms in private homes. Until 1930, tuition charges were fixed at $300, and then raised to $400; equipment cost $30, and each student had to have a microscope of his own. 12

IX

The General Education Board in giving its large grant to the U. of R. assumed that graduate training in the sciences generally would be made available. Accordingly, as early as 1923 advanced students started work for a Ph.D. in biochemistry. President Rhees insisted that quality, not mere numbers, should be the goal in graduate instruction, and he very much wished to get away from the time-honored ritual of accumulating credits for a degree--"the adding machine regime," he tagged it. On Commencement Day, 1925, Warren M. Sperry received the first earned Ph.D. ever awarded by the U. of R. for his work in biochemistry; thereafter, he carried out important investigations on cholesterol metabolism, metabolism in relation to mental disease, and neuro-chemistry, and rose to the position of chief of psychiatric research and biochemistry in the New York Psychiatric Institute and Columbia University. Two more Ph.D.'s in biochemistry were awarded in 1927, one of them to Vincent du Vigneaud, who subsequently distinguished himself in teaching and research, winning many scientific honors and a Nobel Prize in chemistry (1955).13

So quickly did the U. of R. become known internationally as a center of fertile research that it attracted advanced medical students from overseas, who engaged in investigations that often resulted in cooperative publications. Foreign professors, too, made pilgrimages to Rochester to see what was being undertaken and how; one of them, exclaimed sardonically that the professors were all boys working in a barn!

It may be recalled that the full title of the Rochester institution was the School of Medicine and Dentistry, for it was originally intended that professional training would be furnished to dentists along with doctors, and that creative research in the care of teeth would be cultivated. Standards of dental education would be improved by fixing entrance requirements at the same high level as for medical candidates and setting the course of study at four years. For the first two years dental students would be taught basic preclinical subjects in classes with aspirants to degrees in medicine; in the third and fourth years candidates in dentistry would obtain clinical experience and practical instruction at the Rochester Dental Dispensary with a view to becoming dental diagnosticians of a high order. Initially, the director of the Dispensary, Harvey J. Burkhardt, approved the program enthusiastically, and publicly declared that in alliance with the Medical School "the best dental school in the world" could be created in Rochester. But subsequently, fearful lest the Dispensary be submerged, he turned unsympathetic and personality cleavages rendered impossible the cooperative policies Eastman had so strongly desired.

Beyond that, the U. of R. program for dentistry was distinctly avant garde and would require training nearly twice as long as in established and respected dental schools. For five years in a row, very few young people applied for admission, and even they could not satisfy the entrance requirements; the plans for a dental school failed of consummation.

Instead, a novel venture in dental education was devised and launched in 1930. Well-equipped holders of professional dental degrees would be offered fellowships, which would enable them to equip themselves to be investigators and teach dentistry. Dean Whipple, the prime architect of this program, reasoned correctly that dental research, then in its infancy in the United States, would yield a handsome harvest. At the School, research men would work under the guidance of the chief of one or another medical department, and both masters and Ph.D. degrees might be earned. Disappointed though George Eastman was that the original scheme for a dental school could not be carried out, he acquiesced in the radical policy change.

For an experimental period the Rockefeller Foundation subsidized the dental fellowships. The pioneer fellow, Basil G. Bibby, originated in faraway New Zealand, and earned a Ph.D. (1935) in bacteriology; later on he became dean of the Tufts Medical School and in 1947 he returned to Rochester as director of the Eastman Dental Dispensary. Bibby was only one of the distinguished dentists who received advanced graduate training at the School, published scientific papers, and went on to fill important teaching, research, and administrative posts in American dental schools. 14

XI

At the time of the founding of the U. of R. Medical Center, schools of nursing attached to an institution of higher learning were still in an experimental stage. True enough, in 1909 the University of Minnesota established a nursing school as an integral unit of its educational complex, but there were few immediate imitators. A nurse might conceive of herself as a potential replica of Florence Nightingale, but a classic definition described the nurse as "a critically unstable combination of nature and science, put together with adhesive tape, safety pins, and starch."

The ideal at Rochester was to raise nursing to the status of an academic profession. What was referred to as the School of Nursing was considered part of the hospital and as such, was under the jurisdiction of Director Faxon. It was taught by a superior corps of teachers directed by Helen Wood, Superintendent of Nurses, to whom reference has previously been made. Her top assistant, Leone N. Ivers, directed nurse's training in general, while Grace Reid, a Columbia University graduate, supervised instruction, and Esther Henckell Ratcliffe, U. of R. 1919, taught nursing arts and practice; standards of instruction paralleled normal college levels. To cooperate in resolving administrative problems, an Advisory Committee of five Rochester ladies was instituted in 1927 and carried on until 1945, when it was replaced by a Special Committee for the School of Nursing.

It was prescribed that applicants for nursing education must be graduates of a four-year high school, in the age range of eighteen to thirty-five, in good health, and unmarried. Two categories of training were recognized: first, the diploma program, which required twenty-eight months of schooling, the first four of which would be of a probationary character to determine a candidate's fitness for nursing; if satisfactory, the student would be decked out with a nurse's cap and would enter upon two years of class work in nursing techniques and of hospital duty. Almost all the registrants in the earliest phase of the School were enrolled in the diploma program. For the preliminary term expenses might run as high as fifty dollars, but thereafter training and maintenance were gratis, by way of compensation for service in the hospital. The second classification of nurses comprised young women who combined three years of college study with two summers and two calendar years of professional education, receiving a bachelor's degree at the end; this educational experience was designed to prepare recipients to become teachers or administrative officers in nursing schools.

Nursing instruction began at the U. of R. on September 28, 1925, with sixteen diploma candidates (nine from the Rochester area) in attendance, the following February nine more entered the second section of the class. When instruction started, living quarters for nurses were far from ready. Wet paint in student rooms, no dining room, no sidewalks, and the front door awaited installation, so that students who returned after the ten p.m. closing hour had to clamber up the fire escape. When completed, the residence hall contained a spacious living room, reception rooms, an administrative office and library, classrooms (though some teaching and laboratory instruction was given at the Medical School), a sun porch and garden, as well as individual sleeping quarters.

If rules and discipline were less strict than nurses of an older generation had known, they were rigorous by present standards. Students had to be in their rooms by ten in the evening, with lights out half an hour later; one "late" pass a week was permitted. Smoking was absolutely forbidden. Students wore austere gray uniforms, skirts nine inches from the floor, black cotton stockings, and black oxfords.

From the beginning, instruction was carried on in small groups, and a splendid esprit de corps was quickly fashioned. Until the hospital was opened to patients, students practiced the nursing arts on each other or on a famous dummy, "Mary Chase." In June of 1928, a class of twenty completed the diploma course, though Iola Aab Peth, who had finished training a few months before, is regarded as the first alumna in the nursing program. Joint graduation exercises with nurses from other Rochester hospitals were held in the grim Convention Hall of the city, the Municipal Park Band furnishing what was euphemistically called music. Three years later, Marion McManus Spencer, 1930, received the first bachelor's degree in nursing at the regular U. of R. Commencement.

At that point Miss Wood left for the Massachusetts General Hospital and Claire Dennison came from that institution to direct the nursing department. Under the splendid leadership of Miss Wood, so Faxon wrote, the School of Nursing had been placed on firm foundations and excellent student standards had been established. On recommendation of the Nursing Alumnae Association, founded in 1928, the University trustees recognized the signal contributions of the first director by naming the nurses' home Helen Wood Hall. 15

XII

Even before the Medical Center had taken shape, the School authorities had to contend with anti-vivisectionist zealots who demanded that animals should not be used in the search for new methods to advance the healing of sick humans. Letters to the Rochester press denounced cruel treatment of animals, and animal research was the subject of discussion and impassioned debate at city forums.

Whipple, who in California had been involved in similar controversies, denied cruelty, though acknowledging that animals sometimes suffered pain and discomfort in spite of anaesthetics, narcotics, and humane care. Many dogs, it was pointed out, were obtained from the municipal pound, where they were scheduled for destruction since nobody claimed them; other dogs were specifically bred for laboratory studies. Skeptics were invited to visit the School animal house, which compared not unfavorably with facilities for patients in the hospitals. Quarters were clean, proper ventilation held odors to a minimum, and runways enabled animals to get out of doors when the weather was clement. Later the American Association for Accreditation of Laboratory Animal Care periodically inspected and approved the house for research animals.

Yet in one form or another the controversy over research animals kept cropping up. It was repeatedly asserted that animals stolen from their owners--"petnapping" was the word for it--were mishandled and sold to the Medical Center, and anti-research forces tried recurrently to secure the enactment of laws to prohibit or gravely restrict the use of animals in medical research. The official stand of the University, voiced by President Rhees, insisted on "the necessity of continuing the use of animals for experimental purposes, as we assume that medical science must progress and gain new knowledge of diseases.... To promote legislation to cripple or obstruct this type of research would be nothing less than disaster." U. of R. scientists busied themselves in acquainting lawmakers and the media of mass communication with the rationale of animal experimentation and with the care with which animals were looked after. 16

Finances represented another standing and worrisome problem, due largely to the costs of operating the Strong Hospital, which was seldom filled to more than half of its capacity, while operating expenses were almost as high as if practically all the beds were occupied; and the cost of nursing personnel significantly exceeded calculations. No ready answer was forthcoming on how to increase the number of patients without antagonizing Rochester physicians and hospitals. Efforts were made to secure funds to cover the deficits from Rochester industrial concerns and from the General Education Board, which actually donated (1928) $350,000, strictly speaking to cover building and equipment costs. Deficits in current operation continued to mount, however, and to absorb income from endowment which the authorities would have much preferred to expend on School undertakings. 17

On another plane, the senior clinical professors and some of their junior associates chafed under the unwritten rule that they should confine themselves solely to teaching and research; they wished, that is to say, to enlarge their personal incomes by fees that would accrue from the care of private patients. As Rhees interpreted the terms of the gifts to the School by the General Education Board and by George Eastman, the full time principle, while not explicitly spelled out, was morally obligatory. Yet the Rockefeller Board let it be known that it never interfered with policies of the institutions that it assisted and that the U. of R. should determine the issue as seemed prudent and right; and Eastman adopted a similar position.

Abraham Flexner, who regarded the full time idea as a sovereign remedy for the shortcomings of American medical education, pleaded earnestly for the preservation of the principle. It was a fair assumption, too, that many practicing Rochester physicians would resent serious competition by University professors.

Be that as it may, the clinical chiefs unanimously proposed that fees should be paid for professional services rendered in the Strong Hospital up to an amount equal to their University salaries. The Advisory Board thoroughly discussed the recommendation and concluded that the University had not rigidly enforced the full time plan, and that in fact it was impracticable to try to do so. Reluctantly, the U. of R. policymakers yielded, "in order to obtain and retain men essential to the conduct of a medical school of the highest order," Rhees stated, and on the understanding that private practice would not prevent the discharge of obligations as teachers and investigators. Ten per cent of the fees would pass to the hospital for the use of its facilities, and bills for services would be sent on the physician's own stationery, not on University paper. The revised pattern went into full operation in February, 1931. For Flexner the new course meant inescapable retrogression which would reduce Rochester to a second grade school, but experience proved that his fears that "distracting outside work" would check the forward progress of medical science at the U. of R. were groundless. 18

Not long after the School began sending forth M.D.'s, it became customary on Commencement Day, as graduates prepared to receive their diplomas, for the Dean to recite the historic Oath of Hippocrates:

I swear by Apollo the Physician, and Aesculapius, and Health and Hygeia, and all the gods and goddesses, that according to my ability and judgment I will keep this oath and stipulation: I will follow that system of regimen which, according to my ability and judgment I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. Into whatever house I enter I will go into it for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption. Whatever, in connection with my professional practice or not in connection with it, I see or hear in the lives of men which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this oath unviolated, may it be granted me to enjoy life and the practice of the art, respected by all men in all times; but should I trespass and violate this oath, may the reverse be my lot.

Fledgling physicians solemnly acquiesced in this pledge of faith, as their successors would do for long generations to come.

Footnotes to Chapter 21

Whipple, Planning and Construction..., pp. 20-23. Whipple, op. cit., 274. Advisory Board Minutes, I, June 2, 1923. Robert G. Sinclair, "Reminiscences," Rhees Library Archives. Anon., "Medical College Developments," RAR, I (1922-23) no. 2, 27. Anon., "The First Decade," Ibid., XIV (1936), no. 3, 61-63.
Whipple, op. cit., 272, 274-275, 282. Whipple, Planning and Construction..., pp. 8-17. Corner, Whipple, pp. 146-147. Advisory Board Minutes, I, Sept. 21, 1922. Rush Rhees to Edwin S. Gordon, Nov. 16, 1921. Rhees Papers. Rhees to Alexander Lothian, Oct. 14, Nov. 22, 1922. Ibid. Rhees to Helen S. Carter, April 28, 1925. Ibid. McKim, Mead, and White to Rhees, June 14, 1922. Ibid. George Eastman to Rhees, July 7, 11, 1923. Ibid. Eastman to McKim, Mead, and White, July 18, 1923. Ibid. Brighton-Pittsford Post, Feb. 25, 1965. Advisory Board Minutes, II, Nov. 27, Dec. 4, 1925. Nathaniel W. Faxon, "Administrative and Building Plans of the New Medical College and Hospital," RAR, II (1923-1924), no. 2, 27-31. Faxon, "Rochester's New Medical Group," The Modern Hospital, XXIX (1927), no. 5, 1-9. R D&C, Sept. 3, 1925. The Medical School Archives has (1968) a historic film, running for forty minutes, showing the construction of the medical complex and members of the original faculty.
Whipple, Planning and Construction..., pp. 23-28. Whipple, op. cit., 275-278. Corner, Whipple, pp. 148-149. George H. Whipple to Rush Rhees, July 17, 1922. Rhees Papers. Rhees to G. F. McNaughton, Nov. 22, 1924. Ibid. Rochester Herald, Nov. 11, 1924. R T-U, Dec. 11, 1925. Sinclair, op. cit. Lawrence A. Kohn, "Memories of Strong, 4 Decades Back," R D&C, Oct. 2, 1965.
Donald B. Gilchrist, "A Modern Medical School Library," The Journal of the American Medical Association, LXXXII (1924), 1287-1290. Gilchrist, "The Library of the School of Medicine and Dentistry of the U. of R.," Methods and Problems of Medical Education (New York, The Rockefeller Foundation, 1928), Tenth Series. A series of articles prepared by senior professors for the Rockefeller Foundation. (Hereafter referred to as Methods and Problems...) Gilchrist, "An Adventure in Libraries,'' RAR, I (1923), no. 3, 53-54. Rush Rhees to James F. Ballard and vice versa, a voluminous correspondence, July 7--December 31, 1920, November 22, 1922. Rhees Papers. Rhees to Charles A. Dewey, 1861, and vice versa, May 19--November 8, 1920. Ibid. George W. Corner to Rhees, November 3, 1926, May 7, 1927. Ibid. Whipple, op. cit., 279. Corner, Whipple, 152. Florence Bradstreet Cooksley, 1923, A History of Medicine in the State of New York and the County of Monroe (n.p., 1937), pp. 50-54. See, also, Alice Creighton, "Creatures So Very Diminutive," URLB, XXIII (1967-1968), no. 2, 25-33.
Anon., "Laying the Cornerstone of the School of Medicine and Dentistry, June 14, 1924" (a pamphlet). Rochester Herald, June 15, 1924. Anon., "Cornerstone Laid for New Medical College," RAR, II (1924), no. 5, 101.
R T-U, January 5, 1926. Rochester Herald, February 16, 1926. R D&C, July 31, 1926. Anon., ''Strong Memorial Hospital Now in Operation," RAR, IV (1926), no. 3, 78.
George Eastman to Abraham Flexner, October 14, 1925 (copy). Rhees Papers. Flexner to Eastman, October 20, 1925 (copy). Ibid.
R D&C, Nov. 24 (including gravure pictures of the medical institution and its senior personalities), Nov. 25, 26, 27, 1926. Advisory Board Minutes, II, March 26, June 27, 1926. John C. Merriam, "Medicine and the Evolution of Society," Science, LXIV (1926), 603-609. Rush Rhees to Mrs. George R. Carter, Oct. 28, 1926. Rhees Papers. Anon., "School of Medicine is Officially Opened," RAR, V (1926), no. 1, 3-4. John F. Fulton, Harvey Cushing (Springfield, Illinois, 1946) p. 541. Dorothy O. Widner, 1922, "Notes on the Early Days of the U. R. Medical Center"--full of interesting--and some very amusing--incidents. Rhees Library Archives.
Methods and Problems... For a Rochester-flavored disquisition on the changing temper in medical education and care, see, Alan Valentine, Trial Balance (New York, 1956), pp. 153-159.
Advisory Board Minutes, I, December 15, 1922. Abraham J. Tatelbaum to A. J. May, February 13, 1967. Whipple, op. cit., 279-280. Corner, Whipple, p. 153. R T-U, Sept. 17, 1925.
Advisory Board Minutes, III, Sept. 29, 1927, March 30, May 17, 1928. R D&C, June 15, 17, 1929.
Abraham J. Tatelbaum to A. J. May, Feb. 13, 1967. Rhees Library Archives. Rudolph Angell, 1933, to A. J. May, Jan. 9, 1967. Ibid.
Warren M. Sperry, 1925, "Reminiscences about Rochester" (Oct. 15, 1965) in Estelle E. Hawley, " Background Data of the Vital Economics Department." Rhees Library Archives.
Rochester Herald, June 22, 1920. Corner, Whipple, pp.132-134, 223-225. Whipple, Planning and Construction..., pp. 14-15, 75-77. Whipple, op. cit., 275-276. William J. Gies to Rush Rhees, November 8, 1926. Rhees Papers. On the legal annulment of the contract of October 19, 1920, between the University and the Dispensary, see, Nixon, Hargrave, Middleton and Devans to the Eastman Dental Dispensary and the U. of R., January 17, 1947 (copy). Rhees Library Archives.
Grace Reid, "Fifty Years of Change," Rhees Library Archives. Reid, "A History of the U. of R. Nursing School" (about 1965) Ibid. The School of Nursing Bulletin, I (1925). [College] Faculty Minutes, IX, March 5, 1925. Executive Committee Minutes, IX, Jan. 27, 1927. Helen Wood to A. J. May, Jan. 18, 1967. Rhees Library Archives. Iola Aab Peth, "Personal Recollections, Ibid. Ruby Rogers Hendryx, 1955, "Notes on the History of Nursing Education at the U. of R., 1 924-1965 " Ibid. Nathaniel W. Faxon to Rush Rhees. May 14, 1931. Rhees Papers.
Rochester Herald, March 1, 22, 1925. R T-U, March 4, 1925. Slater, Rhees, p. 217. David R. Branch, "New Threat to Medical Research...'', RAR, XXIX (1967), no. 2, 15 ff.
Executive Committee Minutes, June 14, 1927. Raymond N. Ball to Rush Rhees, May 2, 1927. Rhees Papers. George H. Whipple to Abraham Flexner, Dec. 7, 1928. Ibid.
Advisory Board Minutes, I, March 20-21, 1924, III, May 26, 1930. Rush Rhees to William S. McCann, May 8, 1925. Rhees Papers. Rhees to George H. Whipple, February 21, 1931. Ibid. Trevor Arnett to Rhees, February 6, 1929, January 20, 1931. Ibid. Rhees to Arnett, December 8, 1930, February 24, 1931. Ibid. Abraham Flexner to Whipple, March 13, 1930. Ibid. Flexner to Rhees, January 2, June 6, 1931. Ibid. Rhees to Flexner, February 24, 1931. Ibid. Corner, Whipple, pp. 228-231. Credit for proposing the "full time" principle belongs to a Chicago anatomist, Lewellys Barker. Fulton, op. cit., p. 379, n. 16.