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P&S Journal

P&S Journal: Fall 1997, Vol.17, No.3

Two Letters with Historical Perspectives

Dear Editor,
I am interested in learning more about the origin of the Saturday morning course in neurology once given by the P&S faculty. In my student days, the course was given by Dr. Carmine T. Vicale. I would like to learn more about the antecedents of the course and would very much appreciate hearing from P&S alumni about their personal recollections of the Saturday morning neurology course.

Donald H. Harter'57
Howard Hughes Medical Institute
Chevy Chase, Md.


Dear Editor,
I recently attended the 40th reunion dinner of my P&S class. I was struck by the impact that the Bard Professor of Medicine, Robert F. Loeb, had on our class. The written comments made before the reunion and the individual after-dinner remarks made by my classmates were replete with Loeb quotations, anecdotes, and encounters.

I believe that it would be important to preserve these Loeb experiences in a written collection. Possibly, the Alumni Association could oversee a project of this nature and bring it to fruition. As time passes, it will be more difficult to preserve Robert Loeb's legacy. In the absence of a written record, more and more reliance will have to be put in an ofttimes distorted oral tradition. The time to do a project of this sort now appears at hand.

Donald H. Harter'57
Howard Hughes Medical Institute
Chevy Chase, Md.


Editor's Note: The alumni office accepts Dr. Harter's challenge and will collect anecdotes any reader wishes to contribute. Send them to:

Alumni Relations
College of Physicians and Surgeons
630 W. 168th St. BB 2-250
New York, NY 10032
Phone: (212) 305-3498
Fax: (212) 305-8293


Bard Hall Players
Dear Editor,
Apropos of Eph Engleman'37's recalling Bard Hall players of yesteryear [Spring 1997], when his senior class spoofed the faculty in a show in the basement of Bard Hall (confirmed by his classmate, Mike Gompertz).

Two years later, our senior class wrote and produced a show called "The Horse and Boogie Doctor." One of its feature players was a burlesque stripper we hired for the occasion. Her entire role was to run, scantily clad, onto the makeshift stage, stop midway, face the audience of classmates and faculty members, and, looking at Dr. Walter Palmer, professor of medicine, say, "Hello, Walter." Then, turning to Allen Whipple, professor of surgery, she said, "Hello Whip." She followed these greetings with a grind and a bump and ran off the stage.
Backstage, we said, "Oh, oh, there goes 50 bucks" (her fee). Then the room exploded! Afterwards we learned that, as only students had been performers, everyone wondered which student she was.

William G. Cahan'39
Memorial Sloan-Kettering Cancer Center
New York


Faculty Remembered: Philip Smith
Dr. Philip Smith Dear Editor,
I enjoyed reading the article by Nicholas P. Christy'51 on Dr. Philip Smith [Winter 1997]. I was in the class of 1940.

As I try to remember Dr. Smith now, over 60 years later, I recall his pointing out the distinctive features of the tissue we were studying, and my being fascinated by it.

It was a positive feeling, and I was happy to get a picture of him, in his laboratory, for my picture book. Here is the picture [above]. I don't know who took it, but it looked like it was taken by a professional, or at least by a talented amateur.

Dr. Horatio Williams Also, I'm enclosing a picture of Dr. Horatio Williams [right], looking every bit the splendid scholar he was.

Warren F Gorman'40
Scottsdale, Ariz.


Editor's Note:
Nick Christy's profile of Dr. Smith included a photo taken from a P&S yearbook (1947), with the note that editors were unable to find any other image of Dr. Smith, who spent 26 years at Columbia.

Readers: As this issue entered its final stages, the U.S. Supreme Court issued a ruling that upheld the right of states to ban physician-assisted suicide. The ruling, described as tentative rather than definitive, likely will keep the debate on assisted suicide alive. If you have thoughts on this issue to share in P&S Journal, please send comments to:
P&S Journal Editor
630 W. 168th St., New York, NY 10032 (mail)
(212) 928-5799 (fax)



Dear Editor,
I enjoyed reading the reminiscences of former teacher Dr. Nick Christy about Dr. Philip Smith. Although he had left by the time our class entered in 1957, we used the histology text that Dr. Smith edited and heard references to "Whispering Smith," a nickname not mentioned in the article. The name stuck in my memory (not surprising for a future "Physician at the Movies") and I was glad to learn about the man behind the name. Given that Dr. Smith was a tall westerner who spoke "in a whisper," the nickname probably came from the 1948 western starring Alan Ladd as a soft-spoken special agent who investigated train robberies and appeared on the scene silently and unexpectedly. Unlike Dr. Smith, Ladd relied on elevator shoes and special camera angles to look tall. Please ask Dr. Christy for a confirmation and any embellishment.

Peter E. Dans'61
Cockeysville, Md.


Dr. Christy responds:
In our time, 1947, and apparently for many years before that, medical students' nickname for Dr. Smith was not "Whispering Smith" (a neat internal rhyme, I admit), but "Whispering Phil." The writer of Dr. Smith's biography, probably out of a sense of decorum (perhaps cowardice?), omitted the sobriquet as inappropriate to Dr. Smith's dignity as a man and his distinction as a scientist. That omission may well have been a mistake. Dr. Dans' guess as to the origin of the nickname is shrewd and imaginative but I doubt that it is correct. Philip Smith was universally known as "Whispering Phil" long before 1948. But I cannot say how long before. (P.S. Unlike Alan Ladd, Philip Smith needed no elevator shoes; he stood over six feet tall.)


A Physician's Self-Image

Public opinion of the physician has been much discussed. Paul Starr's excellent book, "The Social Transformation of American Medicine," has reviewed the changes in the public image from the witch doctor to the modern professor. He also documents the opinions of various cultures from Soviets' low esteem to the German high regard.

This article discusses not the public opinion but self-esteem of the physicians as influenced by "managed care." Thomas Kuhn in his book, "The Structure of Scientific Revolution," has used the term paradigm to express the shifts in the underlying assumptions of the major scientific revolutions. I would like to use this concept to express the coming shift in the self-image of physicians as "managed care" takes over the practice of medicine.

I can use my experience in medical school at the College of Physicians and Surgeons and residency at Bellevue Hospital in the 1940s. Caught up in the aura of teachers such as Robert Loeb, Dana Atchley, Allen O. Whipple, and Dickinson Richards, we thought of ourselves as scientist-humanists, a privileged group with internal standards of ethics. This era may have been the high point in the public image and the self-image because of the advances made during World War II, including antibiotics. Medical practice was using more science and the laity was left behind in understanding the science. Both of these aspects improved the self-esteem of physicians.

I wonder if the present practitioners are starting to think of themselves as the "technical component of the health care system" with the ethics driven by the entire system. An instance of the latter would be the recent news of physicians seeking patents on medical advances. Is this a result of self-image on behavior? As a contrast to this behavior, I remember a fellow student at P&S pointing out with awe a medical resident who "hadn't left the hospital in six weeks."

We are all aware of the causes of the change to "managed care": the phenomenal advances of science leading to greatly increased costs; the aging of the population; the growth of health insurance leading to increased demands, etc. Dr. Loeb predicted in 1959 (as quoted in A. McGehee Harvey's book, "Science at the Bedside") one of the consequences of "managed care" "is the use of full-time faculty in clinical care to increase income...the insidious trends now gaining momentum can only lead to a deterioration of the priceless standards which have been established." In "managed care" the physician is encouraged to think of himself as working for the general good rather than the individual patient.

All these changes seem inevitable. We probably don't yet know what the consequences are of the changes in the self-image of physicians. Medical schools and physician philosophers will be pondering. Historians of medicine will probably view this time as a major change in paradigm. The historian, Oswei Temkin, wrote in 1977, "...medicine has become so powerful a factor in human life with its choice of good and bad, that the conscious quest for its meaning forces itself upon us. In saying that we cannot yet see the future meaning of medicine, I merely claim for our time what was true at all times. The historian can try to perceive unity within the conflicting aims and possibilities of the past. Yet for a living generation, meaning has to be imparted."

In my opinion, we cannot make a moral judgment between the old and the new paradigms. But we should try to find a way of retaining some of the old self-image.

Sherwood Vine'45
Trenton, N.J.


Send Letters to:

Editor, P&S Journal
College of Physicians and Surgeons
630 W. 168th St.
New York, NY 10032


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