How Bad Were the Good Old Days?

HOW BAD WERE THE GOOD OLD DAYS? F. HOWELL WRIGHT* More than 50 years ago, in September 1929, as a callow youdi I entered medical school at The Johns Hopkins Hospital in east Baltimore. Having spent childhood in the Bronx, high school in a middle-class Westchester suburb, and college in a small Philadelphia Quaker institution , I was thrust unprepared into the heady ferment of scientific medicine on the march, with litde appreciation of die achievements of die giants among whom I studied, nor anticipation ofthe major changes in medicine which would be wrought during my professional Ufetime. Let me first set the scene and then facilitate comparisons between dien and now widi a few discriminating figures. The Johns Hopkins Hospital and Medical School was conceded by its inhabitants to be die best in die world at diat time. Others in die medical profession grudgingly admitted that it was at least one of the best. The laity outside of Baltimore did not even know diat there was an undergraduate portion of the university which produced something odier than doctors. BuUt amid the slums of east Baltimore, the hospital dominated an unusual neighborhood. Its streets were lined with storefronts and neat lower-middle-class three-story brick houses widi carefully polished white marble steps, all of which had been buUt in die same pattern. Behind these buildings were alleys occupied by die underprivileged blacks in run-down shanties and houses. Even from die hospital windows one could see the occupants trudging dirough the mud and snow ofwinter to outhouses in die back. The whites of die area were heavily invested in running boardinghouses for the medical students and lived in peaceful harmony with die menial blacks. Crime was at a low ebb and seldom crossed racial Unes. Nurses, doctors, and hospital employees wandered die neighborhood widiout fear and were perhaps even regarded with reverence by the local population which depended on them for HveUhood and medical care. SmaU restaurants in the area served excellent seafood and alcohoUc potions which were for- *Professor emeritus, Department of Pediatrics, University of Chicago.© 1983 by The University of Chicago. AU rights reserved. 0031-5982/83/2603-0351$01.00 Perspectives inBiology andMedicine, 26, 3 · Spring 1983 | 459 bidden by federal law but tolerated and sampled by the local cops. The Ufe-style of that era has been well captured by Augusta Tucker in her book Mus Susie Shgk's. Pedagogic methods in the medical school were advanced for die times. In contrast to the European mediods still much in vogue in other American schools, emphasis was placed on doing radier than on formal lectures , textbook assignments, and quizzes. As a matter of fact, we received no grades and were left to our own study devices until the end of die school year when a series of comprehensive examinations determined our advance into die clinical years. Here, too, the organization was quite modern. Students were recognized as part of the clinical team, working intimately in small groups widi residents and instructors in the care of patients. Throughout all 4 years there was considerable opportunity for électives and for participation in research projects. Several of the original faculty which established die medical school at the turn of the century were still in evidence. Although Osier had gone, many of his disciples remained. Halsted's legacy of modern surgical techniques and instrumentation was Ukewise being carried on by his trainees. Popsy Welch was teaching medical history and glorying in his newly built library. Kelly was still calUng his gynecologic team to prayers at die beginning of his operations. The active bulk of the senior faculty was composed of men trained in die old empirical mediods yet excited about the prospect of converting medicine into a scientific discipline. Characteristic was the professor of obstetrics who, before an operation or a deUvery, would carefully read and follow die scrub-up instructions posted at his own behest—and dien reach up to dry his hands on a paper towel before putting on his sterile gloves. While the life of the medical student was relatively freewheeling, that ofthe house officer was nodiing short ofmedical monastacism. The food was good and die quarters...