WEBVTT 00:00:00.000 --> 00:00:04.060 [National Library of Medicine HF1092 - This transfer made: 08/02/2004 - Length: 00:54:40] 00:00:13.910 --> 00:00:18.640 [A National Medical Audiovisual Center Production] 00:00:18.640 --> 00:00:23.850 [In cooperation with Alpha Omega Alpha National Honor Medical Society] 00:00:23.850 --> 00:00:28.310 [Leaders in American Medicine] 00:00:28.310 --> 00:00:38.490 [L. T. Coggeshall, M.D. Frederick H. Rawson Professorship of Medicine University of Chicago February 15, 1975] 00:00:38.490 --> 00:00:47.290 [Interviewed by: John Z. Bowers, M.D. President, Alpha Omega Alpha National Honor Medical Society] 00:00:47.290 --> 00:00:56.290 Bowers: The biographical memoir which you are about to see is part of a program 'Leaders of American Medicine.' 00:00:56.290 --> 00:01:08.970 The program is sponsored by Alpha Omega Alpha, the National Honor Medical Society, the National Library of Medicine, and the National Medical Audiovisual Center. 00:01:08.970 --> 00:01:16.330 It was inspired by Professor David Segal and his wife, Professor Beatrice Segal. 00:01:16.330 --> 00:01:22.860 And they subsequently made a generous benefaction to continue the program. 00:01:22.860 --> 00:01:39.960 The leader of American medicine who is the subject of our interview today is Lowell T. Coggeshall, Frederick H. Wasson Distinguished Professor at the University of Chicago. 00:01:39.960 --> 00:01:53.990 Dr. Coggeshall is the only man in the history of that institution, save the president, to simultaneously hold the title professor, vice president, and trustee of the University of Chicago. 00:01:53.990 --> 00:01:56.290 Coggeshall: Good Morning, John, pleasure to be here. 00:01:56.290 --> 00:02:03.250 Bowers: Talking about the National Library of Medicine, I think you were sort of a founding father of that institution within its present form. 00:02:03.250 --> 00:02:10.590 Coggeshall: In a way I was. It was during the period when I was a special assistant to Secretary Folsom, HEW. 00:02:10.590 --> 00:02:22.670 Some of the friends of American medicine were concerned about the Surgeon General's Library, probably the best collection of medical periodicals in the world, [texts], etc. 00:02:22.670 --> 00:02:29.490 We were faced with the dilemma of seeing them destroyed because there was neither adequate housing or budget. 00:02:29.490 --> 00:02:43.940 So the late Alan Gregg, myself, went to the Senate before the late President Kennedy and induced him to have this activity, the library, changed to the HEW. 00:02:43.940 --> 00:02:49.820 The main reason being that there would be insured adequate support. 00:02:49.820 --> 00:02:58.740 And after we had obtained the late Senator Kennedy's support we went to Senator Lister Hill, who's been so important in American medicine 00:02:58.740 --> 00:03:03.840 and indeed one of the founders, and the National Library of Medicine was established in that year. 00:03:03.840 --> 00:03:14.870 And I had the pleasure of transferring the official title to the first director of the National Library, Dr. Rogers, Mr. Rogers. 00:03:14.870 --> 00:03:21.720 And I'm gratified here today to see this satellite so active and engaged in such important activies. 00:03:21.720 --> 00:03:29.600 Bowers: Well my first recollection of you goes back long before you pioneered the National Library of Medicine. 00:03:29.600 --> 00:03:38.580 I think it was either 1939 or 1940, that a classmate of mine at medical school who was interning in Detroit, 00:03:38.580 --> 00:03:50.890 drove out to Ann Arbor to attend grand rounds. And a man came in, of all things, to talk to them about malaria in the midst of a howling blizzard in Ann Arbor. 00:03:50.890 --> 00:04:01.640 And the man was Lowell Coggeshall and he opened by saying, "I guess you fellows wonder what I'm doing coming out to Ann Arbor to talk to you about malaria," and I think you were the malariologist in those days. 00:04:01.640 --> 00:04:12.550 Coggeshall: I remember that incident very well and and you indicate malaria at that time, even the entire study of tropical diseases had dropped to a very low ebb. 00:04:12.550 --> 00:04:28.360 And there were a few of us interested in malaria, which was my primary interest. And incidentally this gives me an opportunity to say that I came into medicine largely through the study of malaria. 00:04:28.360 --> 00:04:39.110 Malaria had been so important in my life, that I sort of hated to see it go, [ ] my medical education and furnished me one of the most exciting careers in medicine. 00:04:39.110 --> 00:04:48.410 But I started out with the Rockefeller Foundation after graduating at Indiana University with a degree in medical zoology. 00:04:48.410 --> 00:05:00.890 And from then on I obtained my medical degree at Indiana and was associated first in malaria research in South Carolina and in Georgia. 00:05:00.890 --> 00:05:05.200 Here [ ] in Georgia where malaria was very rife at that time. 00:05:05.200 --> 00:05:12.600 The director of the research project, who was Dr. Samuel Taylor Darling, came out of the Panama Canal Zone where he was chief pathologist, 00:05:12.600 --> 00:05:20.600 one of the most inspirational and least published man in medicine I've ever met. 00:05:20.600 --> 00:05:30.420 And it was largely through his influence that I obtained my medical degree and continued from then on to pursue a career of research 00:05:30.420 --> 00:05:34.640 and teaching which I did until the outbreak of World War II. 00:05:34.640 --> 00:05:44.430 And it was during this interlude when I was at the Rockefeller Institute as a member of the Rockefeller Foundation, studying malaria, immunology, and chemotherapy, 00:05:44.430 --> 00:05:51.470 that I was invited to the university and I went out in this howling blizzard and the only thing I knew to talk about then was malaria. 00:05:51.470 --> 00:06:00.760 I was gratified, though, that they seemed to appreciate the topic even though the setting seemed a little out of line. 00:06:00.760 --> 00:06:06.600 Bowers: When I studied about malaria in medical school, of course, it was rampant in many parts of the world in those days 00:06:06.600 --> 00:06:15.750 although I think that through the work of the international sanitary division, I think it was called, of the Rockefeller Foundation. 00:06:15.750 --> 00:06:17.950 Coggeshall: International Health Division and International Health Board. 00:06:17.950 --> 00:06:20.620 Bowers: They were working on malaria and on hookworm. 00:06:20.620 --> 00:06:21.780 Coggeshall: And on hookworm. 00:06:21.780 --> 00:06:23.580 Bowers: And cleaned it up. 00:06:23.580 --> 00:06:32.160 And in those days we were taught that there were no immunological mechanisms associated with malaria. 00:06:32.160 --> 00:06:38.910 My comment, my question then is, what did you find out about the immunology of malaria and how'd you do it? 00:06:38.910 --> 00:06:50.770 Coggeshall: If I might step back just a step or two, John. After I completed my medical education, I was about to start an internship, at the United Fruit Company hospital in Honduras, 00:06:50.770 --> 00:06:55.970 which [burned] down approximately two days before I was supposed to start. 00:06:55.970 --> 00:07:06.180 So I returned to the Rockefeller Foundation offices and talked to Dr. F. F. Russell, who was very important in American public health, told him I needed an internship 00:07:06.180 --> 00:07:12.470 and he introduced me then to Dr. Franklin McLean who said he had an internship in Chicago. 00:07:12.470 --> 00:07:27.850 And so by that coincidence I went to the University of Chicago and was thrown in with Dr., I say thrown in, was invited by Dr. O. H. Robertson who was studying lobar pneumonia, 00:07:27.850 --> 00:07:39.270 long before the antibiotics and sulfonamides. And through the laborious studies and through his great leadership, an anti-pneumococcic serum was developed. 00:07:39.270 --> 00:07:48.680 Terribly expensive, terribly difficult to administer but it saved lives of a disease that claimed about half its victims at that time. 00:07:48.680 --> 00:08:00.940 But about the time it was ready to be produced on a large scale, not just on an experimental scale, sulfonamides came on the market and this program was literally shot out of the saddle. 00:08:00.940 --> 00:08:13.440 Now this is the introduction to the story because I was intending to return to tropical diseases and I was enthralled by the experiences of the man I had met in Georgia here 00:08:13.440 --> 00:08:20.680 who had done so much to eradicate malaria and hookworm throughout the world, or at least taught the health people how to do it, 00:08:20.680 --> 00:08:32.280 that I went back to the Rockefeller Institute with this intention of working for the Rockefeller Foundation, going to some parts of the world, and like many of your preconceived plans 00:08:32.280 --> 00:08:40.260 I was assigned to a laboratory there and told that was the only immunology and trying to develop a vaccine for malaria and so forth, 00:08:40.260 --> 00:08:55.550 so without any subject knowledge of malaria other than what I'd obtained in the field, I started the program literally almost identical along the lines of Dr. Robertson had used on lobar pneumonia. 00:08:55.550 --> 00:09:06.420 And now to your question, up to that time there had never been anyone who could develop who had been able to develop any demonstration or protective antibodies that 00:09:06.420 --> 00:09:18.080 protect the [action] of a malaria serum or glutination reaction and we were successful in demonstrating all of this largely because of two malaria parasites, 00:09:18.080 --> 00:09:34.210 one that came from India [in ] and another in Canaries, so I was very proud of that contribution which did not turn out to be of any practical importance as far as control of malariology but it was vary gratifying. 00:09:34.210 --> 00:09:47.160 Bowers: My recollection of Dr. Robertson, who was certainly a very famous man, was that he worked in the laboratories of Peyton Rous at the Rockefeller Institute during World War I. 00:09:47.160 --> 00:09:54.760 And through using Ringer-Locke's solution he did the first successful trans storage of blood 00:09:54.760 --> 00:09:55.830 Coggeshall: Storage of blood 00:09:55.830 --> 00:09:59.810 Bowers: took it to the western front and gave it on the battle lines in Belgium. 00:09:59.810 --> 00:10:00.870 Coggeshall: That's correct. 00:10:00.870 --> 00:10:10.740 Bowers: Then he went to PUMC and then the Pekingese alumni were congregating at the University of Chicago under Franklin McLean's recruitment. 00:10:10.740 --> 00:10:13.340 But then you were with Peyton Rous, I think, weren't you 00:10:13.340 --> 00:10:24.430 Coggeshall: At the Rockefeller Institute he was a member, of course, of the Rockefeller Institute staff and I was in the same building but a member of the Rockefeller Foundation and we were working primarily there were three groups, 00:10:24.430 --> 00:10:45.080 Dr. Mike Connor attempting to develop a serum and a vaccine against yellow fever, which he did, and Frank Horsfall and Dr. Tommy Francis, both the late Dr. Horsfall and Francis working on influenza and I was responsible for the malaria program, 00:10:45.080 --> 00:10:55.020 so that my connection to, my relationship with Dr. Rous you might say was a junior colleague, who was very very helpful to me. 00:10:55.020 --> 00:10:57.970 And that's [something] I shall never forget. 00:10:57.970 --> 00:11:06.180 My first paper I published was on preferential breeding habits of the anopheles mosquito which, as you know, carries malaria. 00:11:06.180 --> 00:11:24.060 When I went to the Rockefeller Institute and published my, submitted my first paper to the Journal of Experimental Medicine, this Dr. Rous whom I consider one of the greatest medical editors in this country, that this country ever had, 00:11:24.060 --> 00:11:30.980 I was doing a study on the immunology of malaria and one of the problems that I had tackled was what was the effect on the spleen. 00:11:30.980 --> 00:11:37.670 And I could show that by removing the spleen the animals would invariably die of this experimental malaria, 00:11:37.670 --> 00:11:47.510 so it was sort of a trick to get the spleen out and I exteriorized it and put a cup over it and measured its volume and it would go up and down with malaria, and 00:11:47.510 --> 00:12:00.950 so in my paper I said I had very carefully dissected out the spleen, and I shall never forget Dr. Rous said, "Do you mean to imply that usually you're very sloppy about this," and then I said I dissected the spleen. 00:12:00.950 --> 00:12:02.850 Bowers: Never give a paper to the editor of a journal. 00:12:02.850 --> 00:12:04.600 Coggeshall: That's right. 00:12:04.600 --> 00:12:09.260 Bowers: Well, you, did you go off to Ceylon and India to get the parasites that you worked on or 00:12:09.260 --> 00:12:18.890 Coggeshall: No, that's, I think a very interesting story. Malaria, as I say, I'm very grateful to that disease because it did so much for me, 00:12:18.890 --> 00:12:34.690 speaking facetiously, but at the outbreak of World War II as we've indicated earlier, as we've said earlier, we had practically no one in this country interested in the tropical diseases and malaria in particular. 00:12:34.690 --> 00:12:49.720 When the Germans and the Japs got busy in their activities, all quinine and atabrine, a synthetic drug against malaria, was cut off from this country and there were not enough supplies to carry us but for a few weeks. 00:12:49.720 --> 00:13:05.770 So it became very evident that a new drug to handle malaria, either control it or cure it, would be essential because by that time the war was being focused in the South Pacific. 00:13:05.770 --> 00:13:19.200 So not having an adequate experimental animal, we began to search for parasites and unfortunately we couldn't find any, but Professor Brumpt at the Pasteur Institute in Paris found one in chickens, 00:13:19.200 --> 00:13:32.910 plasmodium gallinaceum in Ceylon, and this was ideal because it was easily kept, it would invariably kill the baby chicks, which made an ideal experimental animal for the testing of drugs. 00:13:32.910 --> 00:13:37.860 Unfortunately the Bureau of Animal Industry wouldn't let us bring it into this country. 00:13:37.860 --> 00:13:51.370 And I practically was invited to leave the Rockefeller Foundation laboratories at the institute because I was so persistent in my request to get it, promising everything in the world to quarantine it. 00:13:51.370 --> 00:14:03.340 And I was denied this. And I understand why because of its tremendous economic importance so when I'd drive [ ] to my home in Westchester county I'd pass the Bronz Zoo 00:14:03.340 --> 00:14:14.860 and it occurred to me those there have a lot of animals that came from Southeast Asia and I asked the curator of birds if he would let me bleed a few and he said, "Yes, if you let us hold the animals," 00:14:14.860 --> 00:14:24.490 so the long story is that out of one of these animals that had [been] this parasite or first cousin to it at the Bronz Zoo literally there for years 00:14:24.490 --> 00:14:30.050 and it became the parasite on which all the [anti] malaria research was conducted during World War II 00:14:30.050 --> 00:14:41.530 which, as you know, eventually culminated in the discovery for the first time of cheap new drugs that would for the first time sterilize a patient on the infection, 00:14:41.530 --> 00:14:44.530 which atabrine or quinine would not do previously. 00:14:44.530 --> 00:14:46.160 Bowers: What did they name it, plasmodium coggeshall? 00:14:46.160 --> 00:15:00.750 Coggeshall: No. Well, I was the discoverer so it was called plasmodium lophurae because it was obtained from the fireback pheasant of Borneo, which was known as gallinaceum lophurae lophurae. 00:15:00.750 --> 00:15:04.700 So it's still, I think it's still being used experimentally. 00:15:04.700 --> 00:15:19.290 Bowers: Well then your work in malaria came to the attention of the armed forces and off you went to another heroic phase in your career and a particularly fascinating one. 00:15:19.290 --> 00:15:27.360 Coggeshall: Well it was to me and I was fortunate to be in World War II doing the things that I'd been, doing the thing I had been trained to do. 00:15:27.360 --> 00:15:44.310 At the middle of '41 I think it was July President Roosevelt and Prime Minister Churchill met in the South Atlantic and set up a secret air route from Miami, Florida through to China 00:15:44.310 --> 00:15:58.720 and the principal function of this air route was to carry vital supplies such as could be carried by air at that time which were not very heavy, of course - bomb sights, tracer bullets, important documents, and personnel. 00:15:58.720 --> 00:16:08.510 And so since we had no air force at that time and neither the army nor navy were capable of flying over the oceans, Pan American was given a contract 00:16:08.510 --> 00:16:19.540 and they quickly, this organization, threw together a force of about 5,000 young men and they scattered these men through [built] airports right through the heart of Africa, 00:16:19.540 --> 00:16:26.790 through the Middle East, and over the hump and into the Philippines in the Far East. 00:16:26.790 --> 00:16:32.900 This was before of course before the Jap attack on Pearl Harbor. 00:16:32.900 --> 00:16:46.230 Unfortunately, there was not sufficient importance given to the control of disease along this route and within a year, less than a year, matter of fact, 00:16:46.230 --> 00:16:52.980 they went over at the beginning of malaria season and about five months later almost fifty percent of those boys had malaria. 00:16:52.980 --> 00:17:06.660 Not only the boys but the leaders were housed over there, so Mr. Juan Trippe, who was president of Pan Am, called me at Ann Arbor where I'd gone from the Rockefeller Institute to head up the Department of Tropical Diseases, 00:17:06.660 --> 00:17:16.830 called and said "We have a serious problem with Pan American Airways and of importance to our national interest and would you come to New York?" 00:17:16.830 --> 00:17:28.970 And I got on a plane that night, went to New York. The first thing I knew I was headed across Africa, across South America into Africa. 00:17:28.970 --> 00:17:37.830 And what I found was that these young pilots that were in charge of the transport unit and all the backup forces were all sick with malaria. 00:17:37.830 --> 00:17:49.540 So, because of the urgency of the situation, and so many of them sick with malaria, I got practically anything I needed to control the disease - something my predecessor didn't have. 00:17:49.540 --> 00:17:56.840 Because he was told "Well go ahead and do all the sanitation you can but don't get in our way because we're about ready to fight a war." 00:17:56.840 --> 00:18:10.070 This is an oversimplification, but when I went since most of them were ill, I was - netting was flown from Paris to us, Paris green from the states and so forth. 00:18:10.070 --> 00:18:21.080 And we set up a very rigid control program where the troops are, where they built the airports, and where the personnel, this is all civilian, were housed, 00:18:21.080 --> 00:18:36.650 so that we were able to lick malaria to a standstill fortunately because we could get adequate anti-malarial control implements and measures and of course we didn't have to control large areas, 00:18:36.650 --> 00:18:49.370 we merely controlled [the] three miles. This was one of the great satisfactions of my medical life which I felt that I made a contribution and if I may be immodest, 00:18:49.370 --> 00:18:56.230 Lord Moran who went with Churchill, [where when] you probably knew him, I'm sure you did, 00:18:56.230 --> 00:19:04.910 said that the opening of, the maintenance of an open air route through middle Africa when the Germans were going rampant in North Africa 00:19:04.910 --> 00:19:12.010 was one of things that made this successful and the [ ] of the Germans in World War II. 00:19:12.010 --> 00:19:25.470 Bowers: Lord Moran, I had dinner with him, Cogg, in London where we - I had the honor, I should say, of sitting beside him at a dinner at the Royal College of Physicians in London in 1971. 00:19:25.470 --> 00:19:32.750 He was quite old then. And he talked and I was asking him of course about his days with Churchill. 00:19:32.750 --> 00:19:37.450 And also about the period when he was president of the Royal College of Physicians. 00:19:37.450 --> 00:19:47.480 And after dinner one of my friends talked to me and said, "Say, John, did you enjoy Corkscrew Charlie?" And I said, "Is that what you call Lord Moran?" 00:19:47.480 --> 00:19:57.160 He said, "That's what everybody calls him." I said, "Why?" He said, "Well, you know, when he was president of the Royal College of Physicians," he used the word, 00:19:57.160 --> 00:20:03.490 "he conned us into joining the national health service." Into accepting it I should say, and joining it. 00:20:03.490 --> 00:20:12.780 "for which we've never forgiven him and we thought that he was devious so henceforth he's been referred to as Corkscrew Charlie." 00:20:12.780 --> 00:20:22.780 Well you didn't have DDT to spread around Africa which would have been the first thing today, and of course you would have defoliated Africa perhaps. 00:20:22.780 --> 00:20:24.560 How did you do it? 00:20:24.560 --> 00:20:35.770 Coggeshall: We had, primarily it was done by insisting that every member of the personnel responsible for flying the planes from 00:20:35.770 --> 00:20:43.510 I'd say Miami across the hump had to be in bed before darkness when the malaria mosquitoes, you know, bit. 00:20:43.510 --> 00:20:51.910 There were bed nets over each bed and around each camp there was a drainage program that eliminated all the breeding sites, 00:20:51.910 --> 00:21:07.130 so it was really the very strict and meticulous carrying out of known anti-malaria measures - because, as you say, we had none of the modern methods or materials to whip malaria 00:21:07.130 --> 00:21:15.080 and I think that it demonstrates that even today malaria is one of the most serious problems throughout the world in many areas 00:21:15.080 --> 00:21:23.010 but it's largely an economic problem rather than a health problem because it can be done if you have the money. 00:21:23.010 --> 00:21:32.220 We had control, of course, limited to very small areas which made it - it wasn't too easy but in comparison to eliminating malaria in Africa it was pretty simple. 00:21:32.220 --> 00:21:34.110 Bowers: You had no chemo prophylactics. 00:21:34.110 --> 00:21:44.460 Coggeshall: No chemo - we didn't use any. Matter of fact, I didn't believe in it and I wouldn't allow it to be used because in the first place if you use [then] chemotherapy agents, atabrine, and quinine - 00:21:44.460 --> 00:21:53.690 all you did is subdue the infection and let it smolder, you see, and you never knew when you were coming down, so I wouldn't take any of it myself, 00:21:53.690 --> 00:22:01.620 preparing to treat the disease, if it occurred, rigorously rather than to sort of subdue it, partially. 00:22:01.620 --> 00:22:16.500 Bowers: I understand that malaria still is the number one scourge of the world, the most prevalent, disastrous communicable disease and it still infects large areas 00:22:16.500 --> 00:22:26.000 although in some countries such as India, where two thirds of the population had the disease, it has been suppressed. 00:22:26.000 --> 00:22:34.020 Coggeshall: I think that's true. And I think probably as unfortunately even with the World Health Organization the statistics on that are not readily available 00:22:34.020 --> 00:22:47.000 but it primarily affects those areas where the population is the densest, where there are so many people, and the tools are there to whip it and I was glad to be a part of it. 00:22:47.000 --> 00:22:49.370 Still I have a great interest in the disease. 00:22:49.370 --> 00:22:57.130 Bowers: You sort of came to a - you didn't sort of - you came to a highly significant crossroads in your career then. 00:22:57.130 --> 00:23:06.880 Coggeshall: I did. I [ ] my career as I said was starting out with the Rockefeller Foundation in the south here and field malaria 00:23:06.880 --> 00:23:14.720 and then back to the University of Chicago where I took my internship and worked on pneumonia with Dr. Robertson 00:23:14.720 --> 00:23:24.110 and then to the Rockefeller Institute where the fundamental studies on the immunology of malaria carried up to World War II. 00:23:24.110 --> 00:23:34.340 And I was at the - shortly before the onset I went to Africa and carried out this public health and administrative program 00:23:34.340 --> 00:23:42.240 and I was given a lot of administrative responsibility, incidentally, other than that applied to medicine. 00:23:42.240 --> 00:23:49.070 When the Air Force was established our first contract was dissolved so I went into the U.S.Navy 00:23:49.070 --> 00:23:59.790 and from then on my career was largely confined to medical education and government service in an advisory capacity 00:23:59.790 --> 00:24:09.810 and development of facilities for medical research and teaching so my career was research and then administration. 00:24:09.810 --> 00:24:16.480 And pretty widely dispersed, I'm afraid too widely dispersed to be effective. 00:24:16.480 --> 00:24:30.040 Bowers: We're going to explore that. But you did come to a crossroads. You had done - you had demonstrated administrative managerial skill when you put that program together to control malaria. 00:24:30.040 --> 00:24:38.040 And this drew you to the attention of universities looking for administrators. 00:24:38.040 --> 00:24:49.580 I heard a rumor in Boston awhile ago that you had been awfully close to going there but somehow you ended up at Michigan instead [ ] straightened out. 00:24:49.580 --> 00:25:05.510 Coggeshall: Just [was it] after World War II, I've forgotten what year it was, at this time. No, it was just before when I was still at the Rockefeller Institute. 00:25:05.510 --> 00:25:20.610 I had been told that I would be offered the post of the professor Theobald Smith Professorship of Comparative Pathology and Tropical Diseases in one of the best departments in the United States, 00:25:20.610 --> 00:25:26.550 one of the best financed and certainly one of the outstanding if not the outstanding medical university in this country. 00:25:26.550 --> 00:25:40.370 And I was looking forward to being tapped on the shoulder, so to speak, but the wheels of the gods move slowly and so forth and I knew I didn't want to stay at the program at the Rockefeller Institute 00:25:40.370 --> 00:25:57.010 because I wanted to be more actively engaged in teaching. So the late Dr. Francis had offered me the post heading up the section on tropical diseases at the New School of Public Health and I delayed answering for some time 00:25:57.010 --> 00:26:01.920 until he called me one day and said,"Are you coming or are you not?" 00:26:01.920 --> 00:26:05.720 And I'd told him previously about this potential offer at Harvard 00:26:05.720 --> 00:26:18.710 which I would have loved to have accepted but I waited until Friday night and I called Dr. - I sent him a wire - I said I will be coming to Michigan. 00:26:18.710 --> 00:26:26.590 The next morning I got a telephone call from President James Conant, said I have the honor to announce that you've been appointed the - 00:26:26.590 --> 00:26:34.430 obviously I had accepted this other post and - but I'm not sure it wasn't good for Harvard that I went to Michigan. 00:26:34.430 --> 00:26:47.580 Bowers: But in your early period in academic medicine you completed your house officership at the University of Chicago clinics 00:26:47.580 --> 00:26:52.690 and then you stayed on as secretary to the department of medicine 00:26:52.690 --> 00:26:59.810 and you rose to an assistant professorship, then you left the midway, then the midway wanted you back. 00:26:59.810 --> 00:27:15.410 Coggeshall: After the experience in Africa I accepted a commission in the Navy and headed up, for the Surgeon General, a research unit and a care unit for marines and sailors coming out of the South Pacific. 00:27:15.410 --> 00:27:26.880 We had a five thousand bed facility out there, most of the patients were ambulatory because, as you know, malaria patients are only incapacitated for short periods. And I ran that program. 00:27:26.880 --> 00:27:35.040 I was responsible for its direction I should say with a very able staff of young doctors from Harvard, Michigan, Chicago 00:27:35.040 --> 00:27:43.090 and we were given some citations for outstanding work in connection with curbing the problem. 00:27:43.090 --> 00:27:52.770 At that time there was a good deal of speculation that filariasis in particular - we were going to sterilize a lot of our troops and ruin the lives of many of the boys 00:27:52.770 --> 00:28:05.750 and this died down so that neither problem became as important as they thought it might be and indeed there was no spread of these infections to the people back in the states, here. 00:28:05.750 --> 00:28:13.980 And I was returning to Michigan when I was intercepted on my way and offered the post of Chairman of the Department of Medicine, 00:28:13.980 --> 00:28:17.930 Professor and Chairman Department of Medicine in Chicago and I'd always loved this institution [ ] 00:28:17.930 --> 00:28:30.130 and I think this is interesting, historically interesting at least, that President Harper, who started this great institution, it is truly a great one, one of the great ones of the world or the country, 00:28:30.130 --> 00:28:38.000 had from the beginning insisted that there be a - what he called an academic medical school on the campus, 00:28:38.000 --> 00:28:45.590 as you know that very good medical school, Rush, was in the Presbyterian Hospital on the other side of town. 00:28:45.590 --> 00:28:57.870 So his theory was that there should be a medical school whose professors spent their entire time in teaching and the care of patients and doing research 00:28:57.870 --> 00:29:06.670 and they should be on a par academically with their colleagues in astronomy and physics and English and you name it. 00:29:06.670 --> 00:29:27.990 So he had drawn up a design for a new medical school and later years when - what became - resources available which he did not have at the beginning. He had bled John D. Rockefeller almost annually from - 00:29:27.990 --> 00:29:31.360 and his tactic was to get a certain sum to build a new department or building and then spend twice as much 00:29:31.360 --> 00:29:37.930 and ask Mr. Rockefeller to pick up the check which he did and he didn't quite have the courage to start a medical school so - 00:29:37.930 --> 00:29:49.770 this school started in 1928. [Though] first admitting patients in 1927 and admitting students and patients. 00:29:49.770 --> 00:29:54.650 And it had three unique characteristics, which I thought was extremely important. 00:29:54.650 --> 00:30:00.960 I think it is important today. I wouldn't advise, wouldn't recommend that this be the common pattern for a medical school. 00:30:00.960 --> 00:30:12.410 He first insisted, as I say, that all the professional staff be on a full-time basis so that they are not distracted from the routine of practicing medicine. 00:30:12.410 --> 00:30:20.010 Second that the clinical sciences and the non-clinical biological sciences be united in a single group 00:30:20.010 --> 00:30:31.470 so that it was possible for the student to get his PhD in biochemistry and surgery both at the same time. 00:30:31.470 --> 00:30:43.370 There was no conflict or abrasiveness that I've seen in some areas. At the outset it was proposed that there be sufficient funds to subsidize all the patients - 00:30:43.370 --> 00:30:50.890 and you'd select patients exclusively on the basis of their interest as teaching material and so forth, but 00:30:50.890 --> 00:31:02.740 the Great Depression of 1929 and so forth stopped that and since that time paying patients are utilized for teaching medicine 00:31:02.740 --> 00:31:08.630 and I think the [of course] many of the other institutions - Hopkins, Columbia - had fulltime men for some time, 00:31:08.630 --> 00:31:17.240 but this was the first and only institution where the entire staff is full-time. 00:31:17.240 --> 00:31:20.630 Bowers: You had no practitioners who came in periodically to do some teaching? 00:31:20.630 --> 00:31:28.380 Coggeshall: Well, yes, we had occasional ones, but they did not see the patients, they were largely conducting clinics and so forth, which - 00:31:28.380 --> 00:31:34.090 it presented some problems but I think the strengths of the program overcome this weakness. 00:31:34.090 --> 00:31:44.100 So I went, as you ask, I went there and headed up the department of medicine but since I'd been out of clinical medicine for so many years 00:31:44.100 --> 00:31:51.210 and my interest while in clinical medicine was largely in the field of infectious diseases, 00:31:51.210 --> 00:32:03.680 I thought that too much time had passed and the medical progress during World War II had been so phenomenal that it just took more energy and time than I had to go back and catch up. 00:32:03.680 --> 00:32:16.970 So when the late - when the then president of the University, Robert Maynard Hutchins, offered me the deanship of this biological division, of which a medical school is an integral part, I became a dean. 00:32:16.970 --> 00:32:25.880 And I served as a dean of that division for fourteen years and then was during this period that I changed my - 00:32:25.880 --> 00:32:37.400 I tried to do research but unfortunately - my malaria - I was working on [lympho chorio] meningitis and still had some malaria 00:32:37.400 --> 00:32:49.450 and my [animals] seemed to die whether I had a meeting or not. They were not very respectful of my time, so it just didn't work 00:32:49.450 --> 00:32:59.830 and I was - the last twenty-five, thirty years of my life was entirely academic - medical education, government service. 00:32:59.830 --> 00:33:06.590 Bowers: Well - to meant to go back to - we're not going back - President Robert M. Hutchins had 00:33:06.590 --> 00:33:17.980 and continues to have a high reputation as an innovator - what we would say today, a mover and a shaker in education. 00:33:17.980 --> 00:33:22.630 Did he make similar efforts in regard to medical education or was this more in other areas of the University? 00:33:22.630 --> 00:33:33.100 Coggeshall: It was in the other areas of the university. The pattern had been laid out and Bob Hutchins was a great innovator, as you say, in other disciplines. 00:33:33.100 --> 00:33:44.310 But he could live with the scientists and so forth but he did not enter actively in that field. He did some very interesting - 00:33:44.310 --> 00:33:52.680 institutes and very interesting developments in education at a lower level and college - in other words he developed colleges much on the English system 00:33:52.680 --> 00:34:04.330 in which the students got some rather advanced material at a very early age but he was not an important factor in the medical school. 00:34:04.330 --> 00:34:10.390 Bowers: Do you think he might have found it a little tougher to shape the medical school than he did some other [ ] in the University? 00:34:10.390 --> 00:34:12.360 Coggeshall: I think it might have been, yes. 00:34:12.360 --> 00:34:25.410 Bowers: But in general I think medical school faculties have a reputation, at least today, during your era, of being the most innovative and those that are most willing to - 00:34:25.410 --> 00:34:39.280 I wouldn't say tinker with a curriculum but - to try to make major changes. And you observed some of these during your period at Chicago, such as integration, electives and so forth. 00:34:39.280 --> 00:34:56.230 You were barely on the scene at Chicago, began to make trips to Washington, because in November 1947 when I went to work at the Division of Biology and Medicine at the Atomic Energy commission, 00:34:56.230 --> 00:35:07.300 you were one of the first people whom I met and I continue to cherish and enjoy that friendship that we established then. But you were in and out of Washington quite a bit. 00:35:07.300 --> 00:35:23.780 Coggeshall: Yes, after the war because of the importance of tropical diseases and a rather broad interest and activity in several fields relating to medicine and the care of troops 00:35:23.780 --> 00:35:41.880 and how to handle the sick veteran and so forth, I was a frequent visitor to Washington largely in two areas. First as a National Research Council was attempting to consolidate some of the gains it made in medicine during World War II, 00:35:41.880 --> 00:35:49.700 but more specificially I was for a few years chairman of Committee on Medical Sciences for the Department of Defense, 00:35:49.700 --> 00:36:04.010 which required a group of civilians to oversee the research aspirations and programs of everything medical in the three armed services - the army, navy, and air force. 00:36:04.010 --> 00:36:17.810 We, with the late Francis Blake and several others traveled to every medical institution in the armed service. So I kept interested in that program for two or three years 00:36:17.810 --> 00:36:29.460 and I think this ultimately led to my interest in medical education and the internships and the residencies for the men who were in the armed services 00:36:29.460 --> 00:36:46.500 or going back to try to recapture some of their earlier experience, led to my trips to Washington on a permanent basis when I was assistant secretary, or rather special advisor to Secretary of HEW. 00:36:46.500 --> 00:36:58.730 Bowers: When I came out to Chicago and first visited you in your office when we were establishing a program to build the Argonne Cancer Research hospital which, incidentally, 00:36:58.730 --> 00:37:08.830 I learned recently is now the Franklin McLean hospital but that was - when I got out there you were in the midst of a very major building program. 00:37:08.830 --> 00:37:23.690 Coggeshall: Yes, what had happened there, briefly, was that at Chicago - there - really, was the headquarters of a basic program of fission and atomic energy and some great scientists had been assembled there from the - 00:37:23.690 --> 00:37:43.830 not only physicists but all the related disciplines - and so in order to capitalize on this talent and make available to science the potential benefits of atomic energy we were 00:37:43.830 --> 00:37:55.070 selected to have, as you know, being part of the Atomic Energy Commission, one of the first hospitals - this was the atomic energy hospital and devoted almost exclusively 00:37:55.070 --> 00:38:07.370 to the study of radioactive materials and its effects on the normal and on the human body and it's a great institution and it's made many, many contributions. 00:38:07.370 --> 00:38:18.430 Like you, I recall with affection, our early contacts to - that particular activity. 00:38:18.430 --> 00:38:29.800 Bowers: Will you expand - I remember that in some departments you were coming to the end, as it were, of the first era of the faculty of medicine of the University of Chicago 00:38:29.800 --> 00:38:42.870 and on some of your trips to the East you were recruiting, you were bringing in new talent and of course on other trips East you were recruiting funds. 00:38:42.870 --> 00:38:50.150 And you did that very successfully in Chicago, Washington, New York and I don't know whether you went to California but you were everywhere else. 00:38:50.150 --> 00:39:08.560 Coggeshall: Yes, we were rather successful in collecting funds for the development of this school which, incidentally, had utilized the University hospital on the campus exclusively, almost exclusively, for its teaching purposes. 00:39:08.560 --> 00:39:14.130 And I think between surgery and medicine when I first went there there was less than one hundred and forty beds. 00:39:14.130 --> 00:39:34.670 So we embarked on a major expansion program and money was more readily available because public, government, and private interests had been shown quite effectively the beneficial effects of medical research during World War II, 00:39:34.670 --> 00:39:50.860 when all these marvelous developments of new measures to improve health plus sophisticated instrumentation and so it was, I wouldn't say easy, but it was much easier than it is today, 00:39:50.860 --> 00:40:05.230 we created several new buildings that was essential - had several new buildings erected at the University, I think the total expenditures was something in the neighborhood of thirty million dollars during my tenure. 00:40:05.230 --> 00:40:16.010 It's still going on. But I was particularly proud of the fact that, although the University was - had a reputation - had considerable restricted endowments 00:40:16.010 --> 00:40:29.790 and indeed I think when I went there the restricted endowment for the biological sciences, which include the medical school, was twenty-five million, when I left it was fifty-six 00:40:29.790 --> 00:40:38.310 so I think we were able to not only expand but to store up some more resources and during this period also there was, as you say, the initial group, 00:40:38.310 --> 00:40:49.010 many of whom came from Peking Union Medical College all about the same time, they retired almost at the same time. 00:40:49.010 --> 00:41:00.490 There was this problem of difficult recruiting when so many medical schools were being created and expanding. It was a very active and interesting and demanding program. 00:41:00.490 --> 00:41:21.080 Bowers: I know that one of the qualities that you have which so many of us admire and benefit from is the capacity for warmth and also the quality that you have for people willing to tell you exactly what their problems are. 00:41:21.080 --> 00:41:33.550 I've commented on this to several people and one of them who worked with you on malaria at the Rockefeller Institute said, "Yes," he said, "I remember that Cogg's door was closed a lot." 00:41:33.550 --> 00:41:43.060 Because people from all over the institute would come to you with their troubles. I said, "Did he get much research done?" 00:41:43.060 --> 00:41:50.050 He said, "Oh, sure, he got a lot of research done," but he said, "He was the chief counselor and confidant of people," 00:41:50.050 --> 00:42:03.180 and I think you, in recruitment, found this quality to be beneficial and many other of us have enjoyed it. But then your interests at Chicago were flourishing. 00:42:03.180 --> 00:42:19.470 You were more and more in the public eye and you were more and more in the vortex of activities in Washington. On my way to Peru in 1956 I tried to contact you 00:42:19.470 --> 00:42:32.250 and I discovered that you were in Washington in the office of the Secretary of Health, Education. and Welfare. What were you doing there? 00:42:32.250 --> 00:42:45.300 Coggeshall: Well, when the Department of HEW was established, I think it was in '54 or '55, I don't want to be too dogmatic about that date because I'm uncertain. 00:42:45.300 --> 00:42:54.410 President Eisenhower named to his cabinet Oveta Culp Hobby, who was the first secretary, I believe. She was the first prominent one. 00:42:54.410 --> 00:43:10.490 And then, of course, one of the principal activities of the HEW Department was in the medical arena and she asked Dr. Chester Keefer of Boston to accept the post of special advisor to the secretary. 00:43:10.490 --> 00:43:22.670 And he wanted to help and indeed did help, but he was unwilling and unable to give more than an occasional two or three days a week. 00:43:22.670 --> 00:43:32.240 When she resigned Marion Folsom, who was on the board and treasurer of Eastman Kodak and the father, the principal architect of the social security system, 00:43:32.240 --> 00:43:44.770 asked if I would assume the responsibility.This was at a time when I personally had problems that occupied a [good deal] part of my time. I had a major program at the University, 00:43:44.770 --> 00:43:54.720 I was president of the American Cancer Society and trustee of the Rockefeller Foundation - I hope I don't sound immodest - but I was very busy and I was unwilling to accept this 00:43:54.720 --> 00:44:05.780 even though I would have liked to have done it. But largely through the suggestions of the chairman of the board of the University of Chicago, Glen Lloyd, 00:44:05.780 --> 00:44:15.920 and president Kimpton at that time I was more or less invited to accept the position. So I went there and accepted on a full-time basis 00:44:15.920 --> 00:44:25.180 with the exception that I went back to Chicago each weekend and had my appointments on Saturday afternoon and all day Sunday. 00:44:25.180 --> 00:44:35.770 And it was a very enjoyable experience because I felt I was a part of a new era in government-university relationships. 00:44:35.770 --> 00:44:46.180 I'm not sure that's all been good, but it was essential and I would say the principal architects on the government side were non-partisan 00:44:46.180 --> 00:44:58.120 but Senator Lister Hill, from Alabama, and Representative John Fogarty were very active and interested in promoting authorizations for research funds 00:44:58.120 --> 00:45:06.210 to help the medical schools out. And at that time many of the medical schools were in a real quandary whether they should accept government money or not. 00:45:06.210 --> 00:45:17.430 I think, to me, it was a good philosophical question but I'm sure that many of the institutions that we have today that are very strong would have gone down the drain without them. 00:45:17.430 --> 00:45:28.280 So it was interesting to talk with the members of Congress about the programs and where the strengths and where the difficulties were and keep them under control. 00:45:28.280 --> 00:45:45.440 And I enjoyed that experience very very much and I think this activity was possibly most important bringing my name out a little more widely 00:45:45.440 --> 00:45:50.510 because the government has its public relations activities. They don't skimp them too much. 00:45:50.510 --> 00:46:00.340 Bowers: When you went to Washington my recollection is that the controversy over whether or not federal funds should be used 00:46:00.340 --> 00:46:11.930 to subsidize the construction of medical research facilities was red hot. There were organizations within medicine who opposed it. 00:46:11.930 --> 00:46:26.820 And medical school people in general needed it and wanted it. And you were the key man, I think, in establishing the legislation which made the first government investments in facilities possible. 00:46:26.820 --> 00:46:43.260 Coggeshall: I think that's true. There is a background to it with a lot of spade work being done previously. I might just encapsulate - the story really started out 00:46:43.260 --> 00:46:49.800 in nineteen forty-nine or fifty-one when the late Senator Taft was very much interested in medical problems 00:46:49.800 --> 00:47:05.100 and the supply of doctors to make them more readily available to the people of our country. Introduced a bill that called for support of medical research and medical teaching. 00:47:05.100 --> 00:47:21.680 And one of the inducements to increase the class, the size of graduating classes of M.D.s was to provide a bonus of five hundred dollars per student. 00:47:21.680 --> 00:47:29.830 At that time our - good - mutual friend Dr. George Berry, one of the great leaders in American medicine, particularly medical education, 00:47:29.830 --> 00:47:37.530 thought that this might result in the deterioration of the quality of, particularly schools that were struggling and didn't have strong faculties. 00:47:37.530 --> 00:47:53.900 So this was dropped. So then the program was renewed four or five - [ ] along until I went to Washington and at that time there was money available for certain research, 00:47:53.900 --> 00:48:01.590 primarily categorical. [ ] all right for heart, cancer, and indeed the institutes were created at that time. 00:48:01.590 --> 00:48:11.220 But there was still an element of distrust of the government supporting anything that can be related to medical education. 00:48:11.220 --> 00:48:22.920 I recall, for example, that there were research institutes they would delete - the Senate and the House - would delete support for the libraries, 00:48:22.920 --> 00:48:37.750 which is interesting in view of this today, because libraries were considered by some in Congress to be educational and they felt, 00:48:37.750 --> 00:48:38.370 believed, that the government should not be identified with education. The federal government should not be identified with education. 00:48:38.370 --> 00:48:51.530 But it was so obvious that the programs that were essential to carry on the vast amount of basic research that was engendered in World War II, that it just had to go on. 00:48:51.530 --> 00:49:03.600 And so the research program was subsidized. I'm sorry to say I think it became too much a way of life and many, some individuals went into medical research 00:49:03.600 --> 00:49:17.380 because they thought this was a new way to succeed. I think today we have plateaued in that area. Meaning that the problems are not just increasing each and every year, 00:49:17.380 --> 00:49:29.330 but I think it is getting to the point that we should support, genuinely support, the real, the good investigators but not make it a - to excess. 00:49:29.330 --> 00:49:34.200 So this is a long answer to your question but this was a very interesting period in my life. 00:49:34.200 --> 00:49:46.530 Bowers: Well I think we should spend our final few minutes talking about one of your most important contributions - there were several important ones we talked about today. 00:49:46.530 --> 00:49:57.810 That is in medical education. You were president of the Association of American Medical Colleges and chairman of the editorial board of Journal of Medical Education 00:49:57.810 --> 00:50:05.940 and the author of the Coggeshall Report, which I think is in its sixth printing. 00:50:05.940 --> 00:50:07.220 Coggeshall: Sixth printing, yes. 00:50:07.220 --> 00:50:08.260 Bowers: Did you -? 00:50:08.260 --> 00:50:11.070 Coggeshall: I just got a letter the other day. 00:50:11.070 --> 00:50:14.880 Bowers: About the Coggeshall Report? 00:50:14.880 --> 00:50:25.460 Coggeshall: After the enormous expansion of activities in medical education and research, it seemed that medical education was going in several different directions, 00:50:25.460 --> 00:50:39.150 there was no cohesive opinion about how it should materialize and so Lloyd [Darley] who was then the, president, the executive director of the Association of American Medical Colleges, 00:50:39.150 --> 00:50:45.960 asked me if I would assume responsibility of trying to assemble a knowledge of where we stood today and where we should go. 00:50:45.960 --> 00:51:00.450 So out of this committee that I had the honor to chair, there came a report - progress of education, progress of medicine through education, 00:51:00.450 --> 00:51:14.950 that I thought would be another report that would probably collect dust on the shelf. Apparently it was issued at the right time and instead of being in the archives, 00:51:14.950 --> 00:51:28.550 I understand it's sold literally a hundred thousand copies have been made and it restructured the, it suggested the restructuring of the Association of American Medical Colleges 00:51:28.550 --> 00:51:45.340 and diverting it from sort of an exclusive group of deans who were concerned, inwardly concerned with problems, to having the deans take a more directive role in working with the university as a whole, 00:51:45.340 --> 00:51:55.080 looking outward to the community, and reorganizing itself so that it could get an input from other professional and learned societies. 00:51:55.080 --> 00:52:02.700 And I think it's been a good thing by and large, although any report is not worth the paper it's written on unless somebody takes it and improves it, 00:52:02.700 --> 00:52:15.430 but it has attracted a good deal of attention and I really am proud of it today, although I thought it would just be like many others I've written - should have been filed in the archives. 00:52:15.430 --> 00:52:31.620 Bowers: Well, I suppose we certainly are going through a lot of wrenching changes in medical education today. A number of new medical schools, existing schools expanding. 00:52:31.620 --> 00:52:42.480 People - so many feel a loss of emphasis in the basic sciences. So would you tell us finally how it looks to you today. 00:52:42.480 --> 00:52:53.060 Coggeshall: Yes, I don't think there is any doubt that we must maintain our interest in the basic sciences and in the fundamentals. 00:52:53.060 --> 00:53:07.700 There's no routinization of medical education that will tell us how good or bad we are. To me, I think the important thing, we've got to stick to a very solid core of, program of medical education 00:53:07.700 --> 00:53:18.060 and expand where you will if you must but don't sacrifice quality. I know in 1837 I think it was Graves said the curriculum was too large to be absorbed 00:53:18.060 --> 00:53:30.880 and [ ] and Osler said that you can't possibly teach the students what they had to teach, what was available to be taught at that time is a mere fraction today, 00:53:30.880 --> 00:53:44.210 so I would say that I think unfortunately we may expand a little too far in creating medical schools that there should be a good sound basic reason. 00:53:44.210 --> 00:53:57.860 I don't see that the influx of new programs to create the general practitioner is going to change that ratio very much. I'm somewhat disturbed to see the constant intrusion of external influence 00:53:57.860 --> 00:54:10.830 on government and other activities in the medical arena. I'm sure, John, that you and I thought we had tough jobs when we were deans, but it was child's play compared to the responsibilities they have today, 00:54:10.830 --> 00:54:18.900 but I know that the deans are doing an excellent job and our country is going to continue to lead and have medical leadership. 00:54:18.900 --> 00:54:25.220 [L. T. Coggeshall, M.D. Frederick H. Rawson Professorship of Medicine University of Medicine University of Chicago February 15, 1975] 00:54:25.220 --> 00:54:30.400 [Leaders in American Medicine] 00:54:30.400 --> 00:54:39.360 [National Medical Audiovisual Center - U.S. Department of Health, Education, and Welfare - Public Health Service - National Institutes of Health - National Library of Medicine]