RICHARD ROSS 13 April 2000

Transcription

1 RICHARD ROSS 13 April 2000 Mame Warren, interviewer Warren: I am Mame Warren. I'm in Baltimore, Maryland, with Dr. Richard Ross, and today is the thirteenth of April, the year Let's start at the beginning. What brought you to Johns Hopkins in the first place? Ross: I graduated from Harvard Medical School in July, or June, 1947, and in those days there was no such thing as a matching plan for internships, so along in the year, I began thinking about where I would go as an intern. I had a teacher, an attending physician at the Massachusetts General Hospital, who had been a Hopkins graduate, and he and I talked a good deal about Hopkins. I then was offered a job at the Massachusetts General, and Miles Baker, who was a Hopkins person I got to know, said, "Why don't you go down to Hopkins for one year just to see how they do things elsewhere." So I applied and I was accepted, and I declined the MGHjob, but postponed it a year. The plan was to come here for a year and then go back to Boston, spend the rest of my life there. But I came here for one year and I stayed for fifty-five. So that's how I came to Baltimore. Warren: What made you stay? Ross: What made me stay? Well, the spirit of this place, the relative smallness in those days, the intimate contact between junior and senior people, the ability of Hopkins to give great responsibility to very young people, and the camaraderie of the house staff and taking care of very sick people coming out of East Baltimore. And I loved it. I think everybody has periods in their 1

2 life in which they are really truly happy and truly identify with the situation they're in, and for me those first few years on the Hopkins house staff were special. Very good people, kind people, people who entertained the house staff, not often, but I mean occasionally invite them over at dinner at home and so forth. It was all a very small, intimate, warm family kind of place from the junior intern coming from Boston right up to Mac Harvey, who was the chairman of medicine. It was Mac Harvey's first year as chairman of medicine, so I think that was a very special thing, to come in at the beginning of a new chief and be one of his boys throughout all those fifty years. Warren: Tell me what you mean by that. Tell me about Mac Harvey. Ross: Well, he was a very quiet, shy person, but very, very smart, tremendous ability to solve problems, tremendous ability to apply information to a problem. A very loyal friend, a man who never broke a promise as far as I know. Ifhe told you that there will be a job waiting for you, there would be a job waiting for you. Example. After I'd been here two years, I went in the Army to do my payback time for medical school. I was out in Japan, and I didn't know-it was in the Korean War time and I had no idea when I'd get back, if ever, and I got a letter from Mac saying, "I identify with you, because I was in New Guinea a few years ago in World War II, and I know you're wondering what's going on, but I can tell you that whenever you get released from the Army, there will be a job waiting for you." And I came back in August of two years later, August of '51, and went right back to work. He was a remarkable, remarkable leader. A lot of people passed through these halls who have gone on to be very successful elsewhere and attribute a lot to Mac Harvey. There was a big symposium in his honor last June, which I had a big hand in organizing. It was about a year after his death. All the people that he had trained came back and spoke about what Mac had meant to 2

3 them. That's all filed down in the archives if you should want to look at it. Warren: What kinds of things emerged from that? Ross: Well, many of the things I've mentioned, namely his ability to give you responsibility. Many people spoke of his initial instructions, which were, "Just remember, you're the patient's doctor and not the visiting man or the attending man. We're sort of throwing you into the deep water and having you swim." Also his ability to solve problems, as mentioned. His ability to apply the research to the clinical problems. And his warmth and loyalty and faithfulness to his promises. Warren: I understand that when you came as an intern, you were in the Osler Service. Ross: Yes. Warren: What was the Osler Service and why is it distinguished that way? Ross: Well, back in those days, probably up until mid '50s, there were two medical services here. There was the Osler Medical Service and the Marburg Service. First let's talk about the Marburg Service. It was small, it was located in the Marburg Building, which was then the "private pavilion," where people who had private doctors were taken care of It was a very fancy place. The Osler Service was the big teaching service which took care of all the patients that would come into the accident room and come in from all around. It was not all black. About half the patients were black people and half were white people. But the criterion for admission was being sick, having a problem. The Marburg Service, there were sick people with problems, but they had :financial resources. The sort of prime service, from the point of view of someone interested in academic medicine, was the Osler Service. The service if you were interested in going into practice in Baltimore or elsewhere, you went into the Marburg Service. So the Osler Service was the one 3

4 that was most selective from the poiht of view of which medical students were selected. Warren: You made a mention of the fact that Mac Harvey had been away in New Guinea. Ross: Yes. Warren: That's something that I haven't had anybody talk about yet. I know that there was a big contingent of people who left. I know all that was over with by the time you got here, but do you know anything about that unit? Ross: I do know a fair amount about it from many, many people that were in it. Mac was one, and the late Dr. R. Carmichael Tilghman wrote the history of the 155th [sic]. I think that was the number. I'm not sure. Don't write that down. But it was the Hopkins army hospital unit, which first went to Sydney and was based in Sydney at the Royal Prince Albert Hospital, and there's still a walk outside the Royal Prince Albert called the Johns Hopkins Parade in honor of the Hopkins hospital that was there. Then they moved up into New Guinea and eventually the Philippines, and then the unit was split, and some of them went to India. Tilghman is the person that I have heard most about. Warren: He's somebody I wanted to interview, but it was too late. Ross: Yes. Well, I wrote an obituary of Mike Tilghman, which you might find interesting. It's a bit of the flavor of the man and the place. So the people that were there were-well, we've mentioned two, Tilghman and Harvey. Bill Gross, a surgeon, who is now in Roland Park Place, was with them George Finney was the chief of surgery. Ridgeway Trimble, Benjamin Baker, many, many more that I can't remember. But it really was a big part of Hopkins that went away for the war. Warren: I've only talked to people who were in their first or second year in medical school and 4

5 it didn't impact them to have all those people gone, but I can imagine that it would have made a big difference in this place. Ross: Well, the place was big enough to handle it, probably. Everything was sort of on a wartime footing and working on half staff and so forth. Warren: Who else? You've certainly given me a really good impression of Mac Harvey. Were there any other people who really made a difference in your training? Ross: Well, one of the most admirable people around here is Ben Baker, Dr. Benjamin Baker, and he goes back to the-well, he's now ninety-nine, I think, practically. Warren: I think so too. Ross: And there's a video interview that McKusick did with Ben Baker not too long ago that you might like to see. It's really pretty good. Steven Acoff and McKusick went out and talked to Ben, took an oral history of him. There's an oral history of Mac Harvey, too. Ben Baker, then there was a wonderful internist named Warde Allan, who's long dead. Elliot Newman was a member of the full-time faculty when I was an intern, and I worked with him in cardiology, and sort of got started in cardiology with him. Warren: So what made Hopkins' training Hopkins' training? How would you define it? Ross: It was a total corrunitment to medicine. In those days, house staff were on twenty-four hours a day every day. You never had an official time off. The only time you could go out-well, to go to the movie, you'd go to the State movie up here, where they would page you. They had a little board up by the screen that would say "Dr. Ross," and then you'd go back and take the phone call. But to go out on a date or go out to see somebody out in residential Baltimore, all you could do would be to sign out to your co-worker. There would be two interns on the floor and 5

6 you'd just say, "George, can you cover me for a couple of hours?" And if he could, fine. The total commitment to the care of patients and the great reverence for research and for new information. The most wonderful thing that could happen would be to make a discovery, to see something new and put it together and contribute to knowledge. Warren: Tell me an example of that. Tell me things you saw happen along those lines. Ross: Well, in those days, lumbar pneumonoccal pneumonia was a big disease every winter, and there was a pneumonia study carried on here for many years, in which one year pneumonia would be treated one way, another year it would be treated another way. Penicillin was just coming along then, and so how and when to give penicillin was still uncertain. This sort of thing was worked out at the house staff level, an organized, systematic control of treatment so that when everything was done, you knew something. If you just do hit-or-miss treatment, do what it feels like today, when the year's over, you're not going to know any more than you did when the year began. But if you decide that this year we're going to try giving penicillin three doses for three days in three separate doses, and compare that to multiple doses over a week, and so forth and so on, that kind of thing. The pneumonia study was an example of that. Then just case reports. Victor McKusick and I saw a patient with a strange disease and began looking up other patients and other patients and other patients, and put together a paper which-my first experience of writing a paper with Victor, which was wonderful, tremendously energetic, smart guy, prolific writer, and that was an eye-opening experience. He would certainly go down as one of the Hopkins greats. That's about all I can think of right now. Warren: A while ago you made a reference to the accident room. Tell me about the accident 6

7 room. Ross: Well, I mean, that's now called the emergency department. In those days it was the place where people walked in off the streets when they'd been shot or when they were sick, where the ambulances brought people, and it was the portal of entry to the institution. Warren: And did everyone have to spend time there? Ross: Yes. The Osler intern, I think, spent two months there, and that was a fabulous experience. Warren: Tell me about it. Ross: Well, you'd just see four or five patients, you'd maybe see fifty patients over a twentyfour-hour period, but you'd see four or five really unusual serious problems that required your attention to unravel them and to bring about treatment. You didn't give much treatment in the accident room. The decision down there was, does this patient need to be in the hospital, and is he or she going to benefit by hospitaliz.ation. But those patients would then come in the hospital, and the intern from the accident room could follow them around and see how they turned out. As I say, the house staff was one very small, close-knit family, and although you might have admitted a patient in the accident room to one of your buddies on the ward, you wouldn't lose track of that patient. Warren: I would think that that would bea part of medicine that would have changed radically in the time you've been here. Ross: It has. I think that now the emergency department is staffed by people in the Department of Emergency Medicine, so it's not part of medicine anymore. Patients are admitted to the medical service where the Osler people take care of them, but the accident room itself, the emergency department, is staffed by people who are in the Department of Emergency Medicine. 7

8 And I think disease has changed a lot. You don't see these acutely ill patients. And some of the diseases are just essentially gone. I mean, you used to see people with typhoid fever in the summer come up from the Eastern Shore of Maryland or southern Maryland. Typhoid, a currentday intern wouldn't know what you were talking about. Amebiasis, another disease. Tuberculosis was very common. Infectious diseases were big because it was very early in the antibiotic era, and penicillin came out during the war, in '42 to '47. So it was not even a decade old when I was an intern, and it was in very short supply. I can remember seeing the first patient treated with-patient who had bacterial endocarditis treated with penicillin at the Brigham Hospital in Boston when I was a medical student. So that's how early in the antibiotic era we're talking. Warren: You've seen a lot of changes through your time. Ross: I have. Right. Warren: I suppose any doctor can say that, but this has been a particularly exciting time. Let's move along in your career, because as we both know, you spent a lot of time in a very important job. Ross: As the dean. Warren: Yes. Ross: As the dean. Well, let's just say a little bit about cardiology first. Warren: Shall we not skip over cardiology? [Laughter] Ross: I did that for fifteen years or more, ran the division for fifteen years. But how did I get into cardiology? When I was on the house staff, I became interested in reading the electrocardiograms and got pretty good at that. Then I went away to Boston for a year to study cardiac physiology and wrote some papers on that. So then I came back and sort of got into adult cardiology, like 8

9 that. Then this, of course, was the great era of the Blalock-Taussig operation in congenital heart disease, so all kinds of congenital heart disease. Dr. Taussig had lots of patients who had been seen first as children, but then became adults and had to be admitted to the medical service. There was a very rigid rule that no patient over fourteen could be admitted to pediatrics, and no patient under fourteen could be admitted to medicine. This was a very rigid rule, and some people chafed at this rule, namely Dr. Taussig, who had a lot of patients that she'd followed for years. So Mac Harvey said, working out a compromise to this problem, said, "Okay, Dick Ross will be the person that you work with on all these adult patients. They will be admitted to this service, and you'll see them as a consultant, but you and he will work very closely together." So this put me in a wonderful, close relationship with Helen Taussig. Warren: Oh, my goodness. Ross: For a number of years before she died. I saw all the adult congenital heart disease. I ran the cardiac catheterization laboratory. We introduced cineangiography, X-ray motion pictures of the heart to this institution. Did the first cinecoronary arteriograms. Those fifteen years were probably, next to the house staff years, were the happiest of my life, had wonderful associates. Mike Criley, "Bud" [Gottlieb] Friesinger, O'Neal Humphries. There's Helen, me and Helen. But these guys, Criley, Humphries, and Friesinger, were my colleagues in those days and have become and have remained my very best friends in medicine. Warren: Tell me their names again. Ross: Mike Criley. Joe Michael Criley. J. O'Neal Humphries. And Gottlieb C., known as "Bud," Friesinger. And those were wonderful years. Lots of things happened and we had this new method 9

10 and just applied it to a constant stream of people with different kinds of heart disease. Wrote lots of papers and presented all over the world. It was wonderful fun. Warren: Tell me more about Helen Taussig as a human being. What was she like? Ross: She was a very driven person. She was very ambitious, hard-working. The patient was everything. She had no sense of time when she was dealing with a patient. She'd just stick with it until it was done. She had a great knowledge of congenital heart disease and trained a lot of people around the world. She was a great internationalist, great social activist. Warren: I wonder what it must have been like to be one of those blue babies. Ross: Oh, sure. Oh, sure. I mean, most of the ones I saw had been-well, that's not true. There were sort of two populations. There were those who had been operated on as infants and had grown up, and then developed other complications. Warren: I guess that's my question. After the operation did they continue to have issues? Ross: They did, and some of them developed new things because the operation doesn't restore the circulation to normal; it creates another abnormality to counteract the one they're born with, essentially. So there are problems related to that operation which was one of the things I studied and wrote a paper with Helen about, the development of pulmonary hypertension, high blood pressure in the vessels in the lung, as a consequence of the Blalock-Taussig operation. But I started to say there were those who were fixed in childhood and developed complications. But then in those days, in the '40s and '50s and '60s, there were still a lot of patients who hadn't been operated on as children, that had been sort of borderline sick and had gotten into adult life without having any correction. So you had sort of a different set of problems in those adult congenitals. 10

11 Nowadays it's a very different situation because most congenital heart disease is picked up in infancy and is fixed, really fixed, with the availability of the open-heart surgery and the pump oxygenator. Instead of just creating a shunt, they can actually close defects, open the heart and close defects. So congenial heart disease is like a lot of the other diseases of that era, is very, very small now. So that was fifteen years. I did that from '60 to '75. That was a period of time in which cardiology was exploding. I was president of the American Heart Association for one of those years, and very active in the national scene. Then along came the opportunity to be the dean or to do a lot of other things, most of which required leaving Baltimore and leaving Hopkins, and I didn't want to do that, so I decided I'd accept the offer to be the dean. Warren: What exactly does that mean? Ross: [Laughter] Well, it was different then than it is now. It's better now because [Ed] Miller has control of both the hospital and the medical school. In my day, there were some pretty difficult times in dealing with the hospital, and Bob Heyssel would say there were pretty difficult times dealing with the medical school. But the medical school had the doctors, had the practice, and the biggest thing that happened during my-two big things that changed during my tenure as dean. One, the clinical practice exploded. We began to make money from seeing patients, and that provided a source of revenue to support the academic enterprise which had not been there before. As things became more expensive, as endowment was relatively small compared to the total need, 11

12 it was good to have another source ofrevenue. So the practice grew from, oh, $10 or $12 million a year to, I think, almost $300 million. That was one thing, growth of the clinical practice. And the other thing, which is probably even more important, is that we really put emphasis on redeveloping the research endeavor, which it sort of languished a bit during my predecessor's time. There was the Dave Rogers era, in which it was the '60s and riots and commitment to social activism and black students and the neighborhood, and so forth and so on, and then he left and Russ Morgan became the dean for a very brief time, just to restore fiscal ability. During that period, the research activity had maybe not been as strong as it should have been, so he made a conscious effort to increase the Hopkins presence on the research field and the research scene. For example, I think Hopkins was number twenty-seven or something like that-elaine Freeman could give you these numbers-in the NIH [National Institutes of Health] list of how much money you get from the NIH, and by the time I was through, we were number one. So we really went after it. And the way you do that is recruit people who are very good and make it easy for them to work by building buildings and making it a research-friendly climate. Warren: Tell me what you mean by research-friendly. Ross: Well, rewarding research accomplishment and the dean knows who you are and knows what you're doing, is interested in your projects. I always used to take sort of selfish interest. People would come in to talk to me about anything, I'd say, "Tell me what you're doing over there in the lab. What's the most important thing on your plate today?" And we'd talk about that and then we'd talk about money or space or whatever else. [Laughter] So I love talking about the science. Warren: And what kinds of things were they talking about? 12

13 Ross: Oh, it depends on what they were doing. Some of it I couldn't understand, but I liked to create the impression that I was really interested in laboratory work, of course. And I got to know people like Dan Nathans very well and Dan Lane in biochemistry. I recruited Tom Pollard. That was one of my great recruits, I think. He was a young man up at Harvard and never had any idea of moving, but we worked on him and brought him down here. He had a rough beginning, because we didn't really have any space for him, but we tore down the old Women's Fund Memorial Building right on that comer and built this building. Warren: The Preclinical Teaching Building? Ross: The Preclinical Building. Warren: What was Tom Pollard working on? Ross: Tom Pollard worked on the contractile proteins in the cell, what makes heart muscle contract or skeletal muscle. And we had a very interesting guy named Alan Walker, who was an anthropologist, I guess, who taught gross anatomy. He was interested in skulls and bones and so forth. I thought that was sort of a unique thing to get somebody like that in to teach gross anatomy. I actually gave the lectures on gross anatomy of the heart for a few years. Then the schedule got so I couldn't do that. Warren: Take me through a day with the dean. What exactly does the dean do all day? Ross: I'm afraid mostly what he does is sit in his office and meet people, one after another, all whom are coming with a problem, usually a request for something, or he goes over to the hospital and sits in endless meetings, discussing things like common problems of the hospital, the medical school. The hospital can't function without the doctors. Doctors are all medical school faculty. The hospital would like to see the emphasis placed on the clinical activities, the production of 13

14 more and more revenue. The medical school wants to see emphasis placed on teaching, research, that kind of thing. So these lead to conflicts. And then money. Money is always a discussion. A lot of the medical school offices and activities are carried on in the hospital, and so the medical school is the hospital's tenant, and the medical school pays rent to the hospital for all the space it uses. Then the hospital pays the medical school for part of the salary of the chief who runs the Department of Surgery, the Department of Medicine, and so forth. So there's this money flowing in both directions. Nowadays, you see, that's not such a big problem because Miller sits over both sides of it. But in my day, it was always a problem to make sure that that was arranged in an equitable manner. So that's what the dean does. Warren: [unclear]? Ross: Right. Well, unfortunately, in this university that's not a terribly important part of the dean's life because the other things are so important. I used to go to meetings out there every Monday morning regularly. Warren: At Homewood? Ross: At Homewood, in the president's office. But I just had more than I could handle over here. I did anything that Steve Muller asked me to do, but, you see, in those days the medical school was bigger than all the rest of the university put together. It was over fifty percent of the total budget, people, everything. In a way, I think Homewood resents it very much because of the fact that the medical school is so well known. You go anywhere in the world and ask, "What do you know about Johns Hopkins?" they're going to say, "Medicine." I think that's getting better, though. I think Bill Brody's done a great job of making the rest of the university stronger, and 14

15 that imbalance isn't quite so great. That's what you're looking at, I guess. Is that a fair assessment, do you think? Warren: I'm trying to look at the place as a whole and understand those interrelationships. I need to tum the tape over. Ross: Sure. [Begin Tape 1, Side 2] Warren: There are all kinds of other interrelationships going on down here. How do all those component parts interact? Ross: Well, School of Public Health is a great source of strength. I had very good relationships with D.A. Henderson, who was the dean then. We had a number of joint ventures together. Teaching, for example. Leon Gordis taught epidemiology to the medical students, although he was basically a School of Public Health person, ran an excellent course for the medical students. Henry Wagner, in nuclear medicine, was sort of a joint appointment. My relationships with the School of Public Health were far greater than they were with the School of Nursing because there really wasn't-the School of Nursing hadn't really been reborn in those days. I didn't really have much to do with the School of Nursing. Warren: So as it was being formulated in its present incarnation, you weren't really involved? Ross: Not too much, no. Not too much. Warren: Something else that I presume must have been an issue in your time is the issue of expanding diversity. Ross: Yes, absolutely. Well, I don't claim that I did anything about it, but when I became dean, there were maybe ten or twelve women in each class, and when I finished, it was fifty percent or 15

16 very close to. Now, that was a trend throughout the country, but I certainly didn't resist it. It was inevitable. I remember when I first became dean and the numbers were only ten or twelve or something like that, I was in Boston giving a talk to the Hopkins alumni in Boston, and Mary Ellen Avery, who was a graduate and former faculty here and was then the chief of pediatrics in Boston Children's, I had been talking about the story of Mary Elizabeth Garrett and the women and how the medical school got started by the women, and she said, "Dick Ross, don't tell that story anymore. Tell us what you've done for women lately." So that sort of brought me up short. [Laughter] And we didn't do anything specific, but certainly we watched women enrollment rise from ten percent to fifty percent during those fifteen years. Warren: How could that change happen if nothing was done? Ross: Well, maybe we did do some things, but, number one, more young women wanted to go into medicine. More of the women who wanted to go into medicine got first-class science education, so they were eligible, and there wasn't any active recruitment effort for women. It was just that there were more better women available and they were picked on the basis of their availability and the other factors and their suitability for medicine, and they just gradually rose. I don't think we ever had any active recruiting program. Warren: How about racial diversity? Ross: Yes. Well, that's a terrible problem. I don't know exactly what the situation is now, so you'll have to get that from someone else. But in my day, just prior to me, in the Dave Rogers era, there was a very activist program to bring in black students, and, of course, the inevitable happened, we got a lot of students who couldn't make the grade. So there had to be support 16

17 groups set up to give them help, and it was not altogether happy. So the number went up, but the dropouts also increased. That's the way I remember it. Then during my era, with Levi Watkins and a few other people helping, we struck a medium in which what we went for was the qualified minority student, and I think the attrition rate essentially is the same as it is for everybody. We don't have as many, but they're able to do the work and stay the course. And that's, I think, what we should strive for. Now, of course, the diversity is very complex. The white male is the minority the last time I looked. Half are women and I forget what it is, but a huge number are Asian, are of Asian background, and they actually-i think the African-Americans are small, far smaller than the Asians. Asians are the predominant ethnic group. But you should talk to the people in the admissions office about that. Talk to Jim Weiss Hopkins. Warren: That's certainly true at Homewood. Ross: Asian? Warren: Yes. Ross: Yes. Warren: Not only in person, but I can see it in photographs. Another thing I can see in photographs is the explosion of buildings here. How involved were you? Ross: Well, I was very involved in that. I thought that was terribly important. We built this building here [1830 Monument] and the building on the comer, the basic science [unclear] up there that was an old-it was called the Hunterian Building. And we tore that down. So the Preclinical Teaching and the Hunterian. And then the building that I call the Rutland Avenue research building, is called the Ross Building, was built to provide-see, that's part of the 17

18 research-friendly climate that I told you about. You have to be able to allow good people to expand, and you can only do that if you have space. If you get to the point where a very good person who really has a wonderful future in science says, "Look. I've got to have another laboratory and so forth and so on, a few more people to take advantage of all the new ideas I have," and you can't do that, you can't give him that, then he goes somewhere else. The better he is, or she is, the more offers they're going to have. And if you can't supply the needs, the research-friendly environment, you're going to lose them. So that's what happens. That building I thought was going to be the last building we were going to build for research because of the NlH climate at the time we built that, that was NlH budget was essentially flat, wasn't growing, and they were thinking of removing the ability to charge essentially the mortgage payments on the building through to the grants through indirect cost. And if that happened, that building couldn't have been built because what's happened, you borrow $100 million and you build the building. Then the debt service on the $100 million, that's for paying the principal and the interest, you can put that into so-called indirect costs, which go along with the grants. In other words, a man gets a grant for one hundred thousand dollars when there are indirect costs that go with that of maybe sixty percent, or sixty thousand dollars. And into that sixty thousand dollars goes such things as heat, light, security, things that support the research effort, the library, but also the debt service on new buildings. At the time I was in my last few years in the dean's office, there was very good evidence that they were going to try to make it impossible to put that debt service into indirect costs, and that would have just killed our building program. So I thought that building was the last one that we were going to be able to charge indirect cost and there won't ever be another, but that turned 18

19 out to be not true. Warren: How did that get solved? Ross: Yes. Well, prosperity. Prosperity and the Congress loves the NIH and they keep pumping money in. And the NIH sees the same thing I've just been telling you: good people need space, and so expansion is inevitable. Warren: You may call that building the Rutland Avenue building, but no one else does.? Ross: Nobody else does. [Laughter] Warren: What's it like to have a building named for you? Ross: Well, I was very surprised, very startled. I had no idea it was going to happen. Goodness, I couldn't say no. I'm very proud to be a part of this place. Warren: It's a stellar building. Ross: Yes. Warren: I took a walking tour one day around all these buildings and I was flabbergasted at how many labs there are here. Ross: Yes. Well, they can tell you that in the dean's office. Warren: Well, I wonder what's going on in all these labs. Ross: The new Bunting-Blaustein Building over behind the Cancer Center and the new cancer center, just huge expansion. During my era, we built, as I mentioned, this one and the Hunterian and the Rutland building. Then we also built a building out at the City Hospital campus, the Bayview campus, the Asthma and Allergy Center. The Outpatient Center was built during that fifteen-year period, and the building next to it, where radiology and EMT are, was built. So a lot of building. 19

20 Warren: [unclear]? Ross: Yes, I guess that was finished about that time. I'm not sure. It was there, certainly, through most of my time. And the Meyer Building was built during that time, too. The Meyer Building, the Women's Clinic was tom down, the Meyer Building was built. Warren: Oh, is that where the Women's Clinic was? Ross: Right. It was right next to the pathology building. Warren: They come and go and I look at aerial photographs and try to understand. I figure when it comes time to write captions, I'll sit down with Louise Cavagnaro. Ross: Right. She can help you. Right. Warren: Tell me about the Nobel Prize. Ross: Well, that was very exciting. I was over in Washington at a meeting and got the telephone call from Claudia Ewell, who was my-that's somebody who will give you a long-time perspective. She came to work at eighteen years old, so worked for Phil Bard in the dean's office and stayed around in and out, and worked for me for fifteen years. Claudia called me and told me that this had happened, and I came right back from Washington and we organized a big celebration that afternoon in Turner Auditorium. Warren: Tell me what happened. Ross: Demonstration? Oh, I had looked up some of the information about Ham Smith. He'd been a medical student here, and I had looked up his admissions folder and what various people who had interviewed him had said about him, none of which was very complimentary, about his future and so forth and so on. I read that and got some laughs. Then I called upon Dan to describe what they'd done, and Ham to describe what they'd done. It was just a joyous family festival. Then 20

21 they invited me to go to Stockholm with them, which I was very honored to be invited. I think it was sort ofrecognition of the fact that I had been supportive of basic science and was interested in what they'd been doing. You know that whole discovery, I was reading in The Wall Street Journal this morning about the University of Rochester suing Pifzer and S about the patent on so-called inhibitors and all the money that they're going to make if they win their suit. I thought that Ham Smith discovered the restriction enzymes. Without restriction enzymes, the whole biomedical biotech industry would be nowhere. That has made it possible to manipulate DNA. If this place had had a patent on restriction enzymes, we wouldn't have to worry about a penny, ever. But in those days people didn't do that. Dan Nathans wouldn't have thought of patenting anything or forming a company. Nowadays people are doing that all over the place. Warren: What do you think about that? Ross: Well, I guess it's inevitable in this time of commercialism and prosperity, but I think there have been some very-there's some aspects of it I find very difficult to accept as a necessary part of academic enterprise. Warren: Seems like a real shift. Ross: Yes, yes. Warren: Another huge event was the centennial. Ross: Yes. Well, that was a big event, that's for sure. Mac Harvey wrote all these books. He was chairman of the Centennial Committee. It put a focus on Hopkins. Unfortunately, the sort of final celebration was supposed to be the big national event occurred the same day as the Chinese came into Tienanmen Square, and we were sort of knocked off the front page of all the newspapers 21

22 everywhere. [Laughter] The way it happened. It was a good thing. I'm not a big person for celebrations and festivals, I guess, but it was okay. Warren: I didn't realize that. Ross: Didn't realize what? Warren: That it happened the same day as Tienanmen Square. Ross: Yes. Right. Warren: I like to ask about the people behind the scenes, the people who often get overlooked. I'm sure there must be hundreds of volunteers who keep this place going. Ross: Yes. I think in any subunit you have to really go down to that level to look and see the people that keep things going. Cardiology, which I knew well, there were a couple of--two or three women that had been there for forever, who ran the heart station, a woman by the name of Ruth Murphy, now dead, absolutely dedicated to Johns Hopkins and to running the best heart station that she could, recruited people, trained them in how to handle patients. Warren: What was her position? Ross: She was chief technician in the heart station. That means electrocardiographic laboratory. There were nurses, head nurses, nurse anesthetists. A woman by the name of Olive Berger, who was Dr. Blalock's nurse anesthetist. Let's see. People behind the scenes. I don't know them too well anymore. I'm afraid I've risen to the point where I didn't know the workers. Warren: I'm not so much asking about specific people as much as the idea. Ross: Well, I think one of the things about Hopkins is it has this sort of ambiance, ethos, whatever you want to talk about it, whatever you want to call it, that commands loyalty and sort 22

23 ofreverence for people, and you don't just see it in the faculty, you see it everywhere. The old days, there used to be a lot of people who lived in the neighborhood and would work here as porters or doormen, whatnot, who would love to tell you the history about the old days, Dr. [William] Osler, Dr. [William] Halsted, Dr. [William] Welch. Well, I think in any successful organization there has to be a fair amount ofloyalty to the institution, not just to running it. It's not just a job, and I think that working at the Hopkins medical institutions has never just been a job to most people, and that's what makes it successful. Warren: It certainly feels that way. It feels like there's a lot of pride about being here. Ross: That's true. Yes, pride. Warren: Did you have any connections with APL? Ross: That happened during my time. When I was in cardiology, Dick Johns got us involved with the APL [Applied Physics Laboratory], and they participated in the development of what we called the myocardial infarction research unit. I got to know some of those guys there. But I think that's really blossomed through biomedical engineering during Dick Johns' tenure as chief of biomedical engineering. I can't claim any credit. I certainly supported it and condoned it. Yes, it's a great resource. It took a lot of doing on Dick Johns' part to get doctors and engineers talking to each other, because they don't-it takes some doing to straighten it out. Warren: They don't naturally speak the same language. Ross: Yes. [Laughter] Warren: So what haven't we talked about that we ought to? Ross: Well, I think that still the great strength of Johns Hopkins is its combination of excellent clinical care for patients and superb research, both in the clinical departments and at the basic 23

24 science level. We may not realize how important some of the research is until another decade's gone by. That's one of the problems with evaluating an institution. But a tremendous amount is going on. We still get excellent students and they become excellent house officers and excellent junior faculty. I used to always like to say that I thought there was an unbroken chain from the very beginning: Osler, Halsted, Welch, Kelly. They picked their successors, and then they picked their successors, and they picked their successors. So all the way down we're seeing people that had the same heritage of excellence-the phrase Tommy Turner likes to use-that the original people had. Take Department of Medicine. Mac Harvey was picked by [Warfield] Longcope and E. K. Marshall, and Longcope was picked by Osler. Tilghman, in writing his thing, said something to the effect that he provided a link with the first people. He had known Dr. Welch, and then I knew Tilghman, so through Tilghman, who lived to be ninety-five years old, I'm linked to Welch. Have you talked to Elaine Freeman at all? Warren: Oh yes. Ross: How about Nancy McCall? Warren: Oh yes, we're in daily contact. Ross: Nancy has a lot of information. Warren: I've spent many hours at the Chesney Archives. Ross: Good. Warren: This has been a wonderful interview. Ross: Thank you. 24

25 Warren: [unclear]. Ross: We've probably forgotten a lot of things, but you can call me up and we can fill them in. Warren: Thank you for that also. [End of interview] 25