Weill Cornell Medicine : A History of Cornell's Medical School [1 ed.] 9781501703676, 9781501702136

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Copyright © 2016. Cornell University Press. All rights reserved. Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Copyright © 2016. Cornell University Press. All rights reserved.

Weill Cornell Medicine

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Copyright © 2016. Cornell University Press. All rights reserved. Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Weill Cornell Medicine A History of Cornell’s Medical School ANTONIO M. GOTTO JR., MD, AND JENNIFER MOON

Copyright © 2016. Cornell University Press. All rights reserved.

Foreword by Laurie H. Glimcher, MD

Cornell University Press 

ITHACA AND LONDON

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Copyright © 2016 by Cornell University All rights reserved. Except for brief quotations in a review, this book, or parts thereof, must not be reproduced in any form without permission in writing from the publisher. For information, address Cornell University Press, Sage House, 512 East State Street, Ithaca, New York 14850. First published 2016 by Cornell University Press

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Printed in the United States of America Library of Congress Cataloging-in-Publication Data Names: Gotto, Antonio M. Jr., author. | Moon, Jennifer E., author. Title:  Weill Cornell medicine : a history of Cornell’s medical school / Antonio   M. Gotto Jr. and Jennifer Moon ; foreword by Laurie H. Glimcher, MD. Description: Ithaca ; London : Cornell University Press, 2016. | ©2016 |   Includes bibliographical references and index. Identifiers: LCCN 2015037884 | ISBN 9781501702136 (cloth : alk. paper) Subjects: LCSH: Cornell University.  Joan and Sanford I. Weill Medical   College—History. | Medical colleges—New  York (State)—History. Classification: LCC R747.W45 G68 2016 | DDC 610.71/1747—dc23 LC record available at http://lccn.loc.gov/2015037884 Cornell University Press strives to use environmentally responsible suppliers and materials to the fullest extent possible in the publishing of its books. Such materials include vegetable-based, low-VOC inks and acid-free papers that are recycled, totally chlorine-free, or partly composed of nonwood fibers. For further information, visit our website at www.cornellpress.cornell.edu. Cloth printing  

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Cover photograph: Weill Cornell Medicine, York Avenue buildings. Photograph by Giovanni Savino.

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

To the students, alumni, faculty, staff, and board of

Copyright © 2016. Cornell University Press. All rights reserved.

Weill Cornell Medicine

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

From the river the medical center rises in a single mass, its base on the highway along the shore, its subordinate units grouped around the white slab of a central tower, topped by the pointed arches which are the identifying features of its design. Within are a hospital, a medical college, a nursing school, a psychiatric clinic, a lying-in hospital, a hospital for special surgery. Nearby on the adjacent avenues are resident buildings, other specialized hospitals, a university. This is not so much an institution as a community.

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Eric Larrabee, The Benevolent and Necessary Institution

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Contents

Foreword by Laurie H. Glimcher, MD  ix Preface xix Acknowledgments xxi List of Abbreviations  xxiii  1 Origins 1  2 Clinical Innovation and a Historic Partnership 29  3 A Move to Manhattan’s Upper East Side 48  4 The Medical School in Wartime 79  5 Postwar Boom 101  6 The Expansive 1960s 121

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 7 A Decade of Malaise 139  8 Discord and Disrepair 167  9 Renaming and Rebirth 194 10 Forging Ahead in the Twenty-First Century 213 Notes 239 Bibliography 271 Index 277

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Copyright © 2016. Cornell University Press. All rights reserved. Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Copyright © 2016. Cornell University Press. All rights reserved.

Foreword

In 1898, when Cornell University established its College of Medicine in New York City, both the education and the practice of medicine were not long removed from the primitive Civil War era, when for every three soldiers killed in battle, five more died of disease. Boston dentist William Morton had demonstrated general anesthesia fifty-two years previously in a historic operation in the Ether Dome at Massachusetts General Hospital, but it was still not universally used. The Pasteur Institute had been established only eleven years earlier as a first attempt to link basic chemical and biological research to practical applications. The Quaker surgeon Joseph Lister, whose 1867 invention of antisepsis came too late to save many of those Civil War casualties, was still trying to get his ideas accepted (the famed surgeon Lawson Tait, one of Lister’s enemies, had in 1898 still not even accepted the germ theory of disease).1 That year, William McKinley was president of the United States (he had only three more years to live); the modern City of New York had just been created by annexation of land from the surrounding counties; the United States had just declared war on Spain (the Spanish-American War would end before the year did); the legendary Wild West sharpshooter Annie Oakley had just written a letter to President McKinley “offering the government the services of a company of 50 lady sharpshooters” (probably the earliest political move toward women’s rights for combat service in the United States military); and Robert Allison of Port Carbon, Pennsylvania, became the first person to buy an American-built automobile (he had seen it advertised not on radio or television, of course—the first commercial radio station wasn’t created until 1920, and Philo Farnsworth wouldn’t invent television until 1927—but in Scientific American). The year 1898 also saw the Bayer Company begin to market heroin— first synthesized from morphine in 1874—as a nonaddictive painkiller. The history of Cornell University Medical College—now Weill Cornell Medicine—is essentially the history of modern medicine. To call either of their

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Copyright © 2016. Cornell University Press. All rights reserved.

Foreword

beginnings humble is like saying that a miser is not much given to overspending. As recounted in chapter 1, Cornell University Medical College began with just eight faculty, including William Polk, its first dean. Four of them, including Polk, had actually seceded from New York University earlier that year. Temporary housing for the medical college was provided by the Loomis Laboratory on East Twenty-Sixth Street and nearby rented buildings on the grounds of Bellevue Hospital. While a new building was in the process of construction, all classes took place in just four rooms. At the turn of the century, medicine itself was similarly restricted, though for reasons other than the lack of proper facilities. Only 5 percent of American physicians in 1900 were women (and that was still the case in 1949). Many Americans still believed the theories of male physicians like Harvard’s Edward H. Clarke, who wrote in 1873 that women seeking advanced education would develop “monstrous brains and puny bodies, abnormally active cerebration, and abnormally weak digestion; flowing thought and constipated bowels; lofty aspirations and neuralgic sensations.” From the first, Cornell University Medical College (CUMC) admitted women to the study of medicine; not many other medical schools did, except of course the women-only ones. The first class was 278 students, 26 of whom were female. A  year later, the Woman’s Medical College of the New York Infirmary for Women and Children, founded by Elizabeth Blackwell, the first woman to receive a medical degree in the United States, merged with CUMC, adding almost seventy women to the student body. The first graduating class had twelve women out of sixty-seven degree recipients. One wonders what Dr. Blackwell would make of the fact that, out of a typical Weill Cornell Medicine graduating class of around one hundred today, roughly half are women. She would probably be more surprised to learn that the medical college now has a branch in an Arab country, Qatar, which graduates over forty additional MDs each year, and that roughly half of them are women. Women didn’t join the CUMC faculty until 1914, and the first female dean was appointed only in 2012, 114 years after William Polk. Whether for men or women, medical education in the early days of CUMC was, like in the rest of the country, just starting to become scientifically based and rigorous. Only a few years previously, William Stewart Halsted had established the first formal surgical residency training program in the United States, and, amazingly, the legendary physician William Osler was just then introducing the radical idea of having third- and fourth-year medical students work with patients on the wards. Previously, believe it or not, they had not been required to leave the lecture hall for bedside clinical training. And in 1898 a college degree was not required for admission to any medical school in the United States (CUMC was to adopt such a requirement very early, in 1908). x

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Foreword

As a new institution, CUMC was not wedded to the often hidebound conventions of the previous century, and from the first it embraced the latest advances in medical education. In 1910, professional educator Abraham Flexner issued his report on the state of the 155 medical schools in the United States and Canada. That report set the standard for medical education for the next one hundred years. He praised the new Cornell University Medical College but noted that neither it nor Columbia University School of Medicine as yet had an affiliated teaching hospital. (Interestingly, they now have the same one: both are affiliated with NewYork–Presbyterian Hospital, which has branches next to both schools, and which is generally considered the best teaching hospital in New York and one of the best in the world.) Affiliation with New York Hospital provided the third element of CUMC’s three-pronged mission: education, research, and clinical care—a mission unchanged today. Chapter 2 of this book tells the fascinating story of the birth of this historic partnership, which dates to 1913 and has done so much to elevate both the hospital and the medical college. Later chapters trace the development of the relationship, which, as is the case with all medical schools, had its rocky periods. Happily, today the partnership between Weill Cornell Medicine and NewYork–Presbyterian Hospital is a strong one, with excellent trust and cooperation on both sides. It enables the whole of the medical center to put the patient at the center of everything that is done here. By the time the medical college and the hospital had completed their new medical center campus on the Upper East Side in 1932 (where it remains today), medicine had become a science-based discipline, and many of the academic departments we still associate with a modern medical center had been created. It was a time of extraordinary change in the way physicians were able to treat patients. Consider infectious disease, the leading cause of death for much of human history. Although traces of tetracycline have been found in human skeletal remains from ancient Nubia (Sudan) dating back seventeen hundred years, indicating the presence of this antibiotic in the diet, it was not until Paul Ehrlich’s discovery of the anti-syphilis drug salvarsan in 1909 and, especially, the development of the sulfa drugs in the 1930s and Alexander Fleming’s discovery of penicillin in 1928 (though it was not isolated and tested until the 1940s) that the era of antibiotics began to revolutionize public health. One has only to read Hemingway’s “The Snows of Kilimanjaro,” written in 1936, to be brought back to an era when the scratch of a thorn could lead to a fatal infection, and often did. Combined with vaccination, the use of antibiotics had enabled medicine to increase the average life expectancy in the United States from less than fifty years in 1900 to just over sixty in 1940—the greatest increase in any forty-year period in recorded history. And the universal use of anesthetics plus improved surgical training had eliminated much of the terror of the knife, allowing previously deadly operations such as caesarian xi

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Foreword

section and open-heart surgery to be used routinely. Thanks to such developments, during World War II, literally millions of soldiers and civilians who would have died in any previous war were saved. Chapter 4 tells the fascinating story of the Cornell University Medical College during those war years. But with these advances came an increased understanding of how much remained to be done. In the postwar period, recounted in chapter 5, as applications to medical school exploded and the involvement of the federal government in all aspects of life, including medical research, expanded greatly owing to Cold War pressures, attention began to turn to some of the remaining huge unmet medical needs, such as treatments for cancer and heart disease. The era of cancer chemotherapy began in the 1940s with the first use of nitrogen mustards and folic acid antagonist drugs, but these were like dropping a nuclear weapon on a tumor, and the collateral damage to the patient was enormous. It was clear that both basic and applied biomedical research were required to uncover the molecular causes of these diseases and find new approaches to their treatment. Cornell University Medical College was at the forefront of this new emphasis, as illustrated by the award, in 1955, to Vincent du Vigneaud, chair of the Department of Biochemistry, of the Nobel Prize in Chemistry for his discovery of oxytocin, a hormone that plays key roles before and after childbirth, and the award, in 1950, of the Albert Lasker Award for Clinical Medical Research to George Papanicolaou of the Department of Anatomy for the development of the Pap smear test for cervical cancer. With this growth in research activities came the establishment of a formal graduate program, which started with an enrollment of twenty-one students in 1953 and had more than doubled by the end of the decade. Expansion of all three facets of CUMC’s mission accelerated in the 1960s, as events such as the passage of Medicare in 1965 drove a parallel expansion in the health system. Chapter 6 provides a look at the effects of these forces on the medical college. Not all were salutary. Growth, it seems, can become an end in itself, and when it does, it can dominate all other considerations. At the end of the 1950s, Cornell was able to accommodate the entire student body, including married students, in modern rooms or apartments for the first time. However, although CUMC and New York Hospital would expend $34 million in the first half of the 1960s to construct new buildings or renovate existing ones, there would still remain a seemingly insatiable need for more laboratories, more classrooms, and more patient exam rooms. The medical college consequently embarked on a building boom that would eventually strain its resources. The budget was growing at a rate of approximately $1 million per year (or nearly $8  million in 2014 dollars) at the beginning of the 1960s, largely due to the increase in federal funding for research. Although that doesn’t sound like much, it marked the beginning of what would become a seemingly insatiable appetite for research dollars. And concomitantly, the xii

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Copyright © 2016. Cornell University Press. All rights reserved.

Foreword

cost of medical education was rising rapidly, soon to outstrip the ability of many middle-class families to pay for it. With the 1970s came a severe economic downturn, President Nixon’s announcement of the “war on cancer,” and the continuation of the ruinous conflict in Vietnam. Health care costs began their forty-year spiral out of control. As doctors became increasingly under the thumbs of insurance companies and government agencies, the doctor-patient relationship seemed to become more that of business-customer. And for the first time in over twenty years, federal funding for medical research failed to keep pace with rising costs. Economic constraints began to take their toll on CUMC as well. Student and faculty quality began to decline. Construction basically came to a halt. The medical college budget began to show a yearly deficit of more than a million dollars; the hospital had one five times as large. The situation eventually became so dire that, as chapter  7 harrowingly reveals, in 1979 both a total rebuilding of the medical school in another location and CUMC’s complete dissolution were seriously discussed. Eventually neither was actually proposed, but in order to make ends meet the School of Nursing was closed, and the basic science faculty was reduced by 8 percent. Still, not all was bleak. In 1972, CUMC and Rockefeller University launched a joint MD-PhD program, which was eventually expanded to include Memorial Sloan Kettering Cancer Center as well in 1992. Graduating students in the program receive an MD degree from CUMC and a PhD from Cornell’s Graduate School of Medical Sciences, Rockefeller University, or the Gerstner Sloan Kettering Graduate School. The Tri-Institutional MD-PhD Program, as it is now known, remains the jewel in the crown of Weill Cornell’s educational mission. Unfortunately the 1980s, whose story is told in chapter 8, were not much better. The arrival of managed care, which actually did little to control rising health care costs, hit teaching hospitals like a bomb. All across the United States, the educational and research activities at medical schools, which had previously been subsidized by the clinical income of teaching hospitals and their academic faculty, began to decline. Enormous pressure was put on the research faculty to obtain additional funding (with its attendant overhead payments), usually from the federal government. Of course, institutions whose faculty quality had slipped had more trouble competing for such funds. In 1983, just as things were looking dire, CUMC received a gift of $50 million from the philanthropist Ruth Uris—at that time, one of the largest single donations ever to an academic institution. It provided financial stability and foreshadowed an increasing dependence by CUMC and other academic medical centers on private donations as a major source of income. By the early 1990s, clinical revenues provided half of Cornell University Medical Center’s income, leaving it vulnerable to the ongoing financial squeeze xiii

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Foreword

of managed care (chapter  9). Labs were outdated, space was scarce, and research programs needed revamping—all of which required money that the school simply didn’t have. Part of its response was to make significant cuts in a number of areas, but no institution has ever managed to cut its way to excellence, and quality, especially research quality, suffered. Fortunately, thanks to private philanthropy by donors such as Maurice R. “Hank” Greenberg, both the hospital and the medical college were able to embark on modest building programs, and the financial health of the hospital began to improve. But ultimately, something drastic appeared to be needed. CUMC and New York Hospital had some discussions about possibly merging with North Shore Hospital, as well as more casual discussions about CUMC merging with Mount Sinai School of Medicine or New York University. Most serious were talks concerning a four-way merger between CUMC, Columbia, New York Hospital, and Presbyterian Hospital, a scenario that had actually first been broached in 1917. Although those talks broke down in 1995, the two hospitals did merge a year later, creating NewYork–Presbyterian Hospital and inaugurating a wave of hospital mergers around the country, few of which proved to be nearly as successful. So by the second half of the ’90s, CUMC was still on very shaky financial ground. All that was to change, though, when Antonio Gotto Jr. was chosen as dean in 1996. He immediately began to build a relationship with one of the overseers of the medical college, financial titan and self-made billionaire Sanford “Sandy” Weill. The outcome of that relationship was the historic meeting with Sandy and his wife, Joan, in March 1997 at which Dean Gotto and Cornell University president Hunter Rawlings III proposed renaming Cornell University Medical College after the Weills in return for a gift that would be one of the twenty largest philanthropic gifts in the history of American education. Astonishingly, the Weills agreed to the proposal the next day. As a result, in 1998, Cornell University Medical College officially became the Joan and Sanford I. Weill Medical College and Graduate School of Medical Sciences of Cornell University, a mouthful that usually, and mercifully, was shortened to Weill Cornell Medical College—now simply Weill Cornell Medicine. Weill Cornell’s association with Sandy and Joan Weill would eventually result in the Weills contributing more than $600 million to the school over the next sixteen years, at the time an unprecedented history of generosity of one family for one institution. It also inaugurated an era of large philanthropic gifts and medical school renaming that continues across the country to this day. But perhaps most significantly, it led to a much deeper involvement by Sandy Weill with the medical college, whose board he chaired. His personal philanthropy set the pace for an unprecedented era of philanthropy to follow, including gifts from Hank Greenberg, the Starr Foundation, the Feil family, Robert and Renée Belfer, Sandy and Ed Meyer, the Qatar Foundation, Helen xiv

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

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Foreword

and Bob Appel, Caryl and Israel Englander, Gale and Ira Drukier, and Ronald Perelman. Many of these gifts, along with many more, were personally solicited by Sandy. So effective was Sandy in this role that, after I  succeeded Dr. Gotto as dean in 2012, I remarked at an event honoring Sandy that, just as it was once said of Thomas Alva Edison that he would have been a great man even if he had never invented anything, Sandy would have deserved to have Cornell’s medical college named after him even if he had never given it a dime of his own money. The medical college that I agreed to lead in 2012 is now, as detailed in the book’s final chapter, in sound financial shape; has excellent relations with its affiliated hospital and its leader, Dr.  Steven Corwin; possesses outstanding faculty and students; has just opened (and already nearly filled) a new 480,000-square-foot, state-of-the-art research building named after the Belfer family that nearly doubles the research space on campus; and has seen the tenth graduating class of its affiliated medical school in Qatar, an endeavor that is transforming medical research and education throughout the Middle East. In every respect it is healthier and more influential than perhaps it has ever been. Yet many challenges remain. In the past ten years federal funding for biomedical research has declined by more than 20 percent in inflation-adjusted dollars, leaving all academic medical centers more dependent than ever on private philanthropy, which is itself subject to the vagaries of the economy. Health care demand is still rising—though the Affordable Care Act has, at least temporarily, slowed the cost growth considerably—and the rapidly aging population is about to usher in a flood of age-related illnesses that we are unprepared to meet. Obesity and diabetes are becoming a national epidemic, and we lack treatments for Alzheimer’s disease, stroke, and many other killers. The country faces a physician shortage that will soon reach alarming proportions, especially in some subspecialties like primary care and geriatrics, yet medical schools are unable to expand because the government has not increased the allotment of residency slots. Never before have physicians been saddled with so much paperwork and pressure to bring in revenues, reducing the time they have to do what brought them into medicine in the first place: take care of the sick. Weill Cornell Medicine may be in good condition, but it is hard to avoid the feeling that the general health of the country and the health of the institution of medicine are not what they should be. Nonetheless, I  believe the future can be incredibly bright. In 1998, the same year that Cornell University Medical College was renamed and celebrated its one hundredth anniversary, the breast cancer drug Herceptin was the first therapeutic antibody targeted to a specific (HER2) cancer-related molecular marker to receive FDA approval. Three years later, the FDA approved the drug Gleevec, the first small-molecule cancer drug targeted at a specific molecular xv

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

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Foreword

driver of a specific cancer. Two years after that, in 2003, the complete DNA sequence of the human genome was announced. The era of “personalized medicine” had begun. (I prefer the term “precision medicine,” for reasons I will illustrate.) It took more than thirteen years and cost more than $3 billion to sequence the human genome. Today, less than thirteen years later, it costs under $1,000 and takes a day to sequence an individual human genome. Our ability to produce sequence information from any person’s DNA has outstripped our ability to make full use of it, but even now the consequences are breathtaking. Imagine someone with a potentially fatal, inoperable lung tumor in 1950. That person’s only hope would have been one of the cytotoxic chemotherapy drugs, a one-size-fits-all approach to many different tumors that often came as close to killing the patient with side effects as it did to killing the tumor cells. Now imagine that same patient today. The genome of the lung tumor can be sequenced for less than the cost of a chest X-ray. Really? With luck, that sequence will show that the tumor’s survival depends on a particular protein that is not so important for the patient’s normal cells—a protein for which a specific drug already exists. The patient can be treated with a drug that is precisely tailored for the subset of lung cancer that he or she happens to have. Because of its precision, that drug will be more effective at killing the tumor, with fewer side effects for the patient, than any other treatment. This is the world of medicine we are entering into. In addition, after decades of failure, we have finally begun to harness a person’s own immune system to kill cancer cells and other invaders. We have started to find ways to use genes and stem cells as drugs. We are on the cusp of being able to grow new tissues and organs to replace diseased and damaged ones. And we may actually be able to fix genetic defects that cause horrible inherited diseases soon after birth. To capitalize on these breakthroughs—and to find equivalent miracles for Alzheimer’s disease, stroke, osteoporosis, and other unmet medical needs—will require a new breed of physician, one trained to understand science and think scientifically as never before. It will also require new types of interdisciplinary research, plus researchers who are attuned to translating basic discoveries into clinical applications, and who can work hand in hand with clinicians. It will require doctors and scientists who can learn from patients as well as help them, who can recognize that the flow of medical science is not just from bench to bedside but also from bedside back to the laboratory. It will require financial and intellectual resources on a scale never seen before, but the payoff will be nothing less than a longer, healthier life for all people. And it will happen at academic medical centers, where education, research, and clinical care work not just side by side, but hand in hand.

xvi

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Foreword

Weill Cornell Medicine is a place where the medicine of tomorrow is happening today. As we plan for the future, it is well to remember the lessons of the past. You will find them here, in this wonderful book.

Copyright © 2016. Cornell University Press. All rights reserved.

Laurie H. Glimcher, MD Stephen and Suzanne Weiss Dean, Weill Cornell Medical College Provost for Medical Affairs, Cornell University

xvii

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Copyright © 2016. Cornell University Press. All rights reserved. Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

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Preface

Weill Cornell Medicine is a story of continuity and transformation. Initially founded as Cornell University Medical College in 1898, Cornell’s medical school was renamed as Weill Cornell Medical College a century later and rebranded as Weill Cornell Medicine in 2015. Throughout its changes and colorful history, the institution has remained a leader in education, patient care, and research. This book is the first devoted to the history of Weill Cornell Medicine. Just after Dr. Antonio Gotto completed a fifteen-year stint as dean of Weill Cornell, we embarked on this project, which focuses on the medical school’s deans and the issues they faced as administrative leaders. This perspective emphasizes people, buildings, and the organization of the medical school as a whole. It takes a broad view of key events, unusual episodes, and controversies in Weill Cornell’s history, stretching from its origins in the late nineteenth century and concluding with the end of Gotto’s tenure in 2011. Our narrative situates the history of Weill Cornell in the context of nationwide trends in medical education and health care, as well as the challenges posed by war, economic instability, and pervasive social change. The shifts that have taken place in the teaching and practice of medicine since 1898 have been dramatic. Medical schools like Cornell’s have grown from small-scale institutions requiring little more than a high school diploma for admission into highly competitive, multibillion-dollar enterprises heavily supported by federal government funding and private philanthropy. The amount of medical information available at the beginning of the twenty-first century—from sophisticated imaging technologies, genomics, and vast patient databases—was unimaginable to bedside physicians practicing a hundred years earlier. As writers of contemporary history, we found that this expansion in the world of medicine was reflected in the proliferation of archival material at our

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Preface

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medical center, particularly starting in the 1960s. Our goal was to capture the highly publicized stories, crucial developments, and physical landscape that distinguish Weill Cornell from other medical schools and give it its unique flavor. There are many topics that deserve further exploration, such as the history of individual departments or the evolution of scientific knowledge on campus, that were simply beyond the scope of this volume. This is not an official institutional history. Throughout the narrative, we have tried to be objective and balanced in synthesizing information from multiple sources and presenting our own interpretation of events. Neither is this a history of New York Hospital (now remade as NewYork–Presbyterian). The fates of Weill Cornell and its adjoining hospital are closely intertwined, and we have included details that are important in understanding the relationship between the two. However, we have not attempted to construct an independent chronology of the hospital, its leaders, and their administrative concerns. Our principal sources for this book were archival material from the Medical Center Archives of NewYork–Presbyterian / Weill Cornell, especially papers from the Dean’s Office and annual reports submitted by deans of the medical college to the presidents of Cornell University. These records provided rich detail on institutional finances, personnel, affiliations, and educational, clinical, and research programs over time. Newspaper accounts in the New York Times proved especially helpful in identifying major milestones and engaging stories. Kenneth Ludmerer’s authoritative texts on medical education in the United States, Learning to Heal and Time to Heal, provided the framework for us to contextualize academic developments at the medical school. As Weill Cornell moves into the twenty-first century, we are optimistic about its future. Over the course of its history, it has dedicated itself to improving human health by training doctors, investigating the underlying causes of disease, and providing the best care possible to patients in New York and around the world. It has weathered difficult times and rebuilt itself anew. We are eager to see what the coming years may bring.

xx

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Acknowledgments

We would like to thank all our current and past colleagues at Weill Cornell Medicine, Cornell University, and NewYork–Presbyterian, without whose dedication and commitment there would be no history of the medical college. We greatly appreciate the assistance of Elizabeth Shepard and Lisa Mix, who helped us navigate the historical documents and photographs at the Medical Center Archives of NewYork–Presbyterian / Weill Cornell. Special thanks to J. Robert Buchanan, Robert Michels, Laurie Glimcher, Rees Pritchett, David Hajjar, and Larry Schafer for sharing their insights and stories with us. For their contributions to this book, we are deeply grateful to Frank H. T. Rhodes, Louis F. “Fritz” Reuter IV, Kathleen Burke, Peter Hirtle, John Rodgers, Kara Greenblatt, Marko Kokic, Yvonne Singleton, Steve Cohen, James Kahn, William Cunningham, Gloria Kao, Tammy Ziccardi, Tina Georgeou, and Janet Miller. We are also indebted to our editor Peter Potter for his support of this project and insightful suggestions. Many thanks to Ange Romeo-Hall, Mahinder Kingra, Jonathan Hall, Glenn Novak, Dina Dineva, and everyone at Cornell University Press for making this book a reality. AMG wishes to thank Anita Gotto for her support and encouragement. JM is thankful for having known Jo Beecham, for Eloise Harper Moon, and most of all, for Heather Seltzer.

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Copyright © 2016. Cornell University Press. All rights reserved. Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Abbreviations

CUMC

Cornell University Medical College

MCA

Medical Center Archives of NewYork–Presbyterian / Weill Cornell

NYT

New York Times

OTS

Office of the Secretary, Weill Cornell Medical College

WCGSMS Weill Cornell Graduate School of Medical Sciences Weill Cornell Medical College

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WCMC

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

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Weill Cornell Medicine

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Copyright © 2016. Cornell University Press. All rights reserved. Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

1 Origins Ever since the University opened, its sanguine friends have dreamt of a medical department.

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Jacob Gould Schurman, Annual Report of the President for the Year 1897–99

Although more than two hundred miles away from Cornell University’s campus in Ithaca, New York City was the most logical place to establish a medical school. Within a few years of Cornell’s founding in 1865, the university had started offering a four-year course in natural history leading to a bachelor of science degree. The program was considered good preparation for students contemplating a career in medicine, and a two-year version with classes in anatomy, physiology, histology, and chemistry was launched in 1878.1 Both courses of study were directed by Burt Wilder, MD, a professor of comparative anatomy and natural history, a former surgeon in the army, and a man of eccentric interests that included “brains, cats and war on athletic sports.”2 Although the programs were highly respected, there were no large hospitals near Ithaca that were suitable for training medical students. In order to gain sufficient experience with patients, Cornell undergraduates interested in medicine typically left after two years of study to finish their training at urban medical schools.3 It took several false starts before the right opportunity to create a medical school for Cornell presented itself—and when it finally did, it generated quite a bit of controversy. A group of independent physicians first tried to establish a medical school in New York between 1881 and 1885 but were unable to obtain sufficient funding to do so.4 In 1885, Charles Adams became Cornell’s second president and attempted to expand the university in Ithaca by creating a medical school, as well as a law school and a veterinary school. These efforts were frustrated when he failed to gain the support of Cornell’s board of trustees for such venturesome projects. 5 Adams was also involved in extensive discussions in 1891–92 about a proposed merger between Cornell and Bellevue Hospital Medical College, a proprietary school in New York City.6 These negotiations fell through because Cornell and its trustees were

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

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CHAPTER 1

averse to forming connections with the proprietary, or for-profit, medical schools of the time. Medical education was undergoing a period of intense change at the end of the twentieth century. By 1876, there were seventy-six medical schools in the United States, and new ones were opening at a fast rate. Many of these were proprietary schools owned by professors, with lower entrance requirements than those required for high school. Very few were connected to a university or to a teaching hospital. Instruction consisted primarily of students listening to lectures that provided a very superficial knowledge of medicine, and anatomy was the only scientific subject taught in detail. After students completed two four-month terms, medical degrees were awarded regardless of academic performance. Beginning in the 1870s, leading medical schools at Harvard, the University of Michigan, and the University of Pennsylvania began introducing educational reforms that marked a dramatic departure from the experience offered by the proprietary schools; the Johns Hopkins School of Medicine joined this vanguard after it opened in 1893. The length of medical school increased to three years, and eventually four. New subjects were introduced, and entrance requirements were raised. In addition to anatomy, students received instruction in physiology, physiological chemistry, pathology, pharmacology, and bacteriology. There was a shift in pedagogy; instead of being limited to passively listening to lectures and observing clinical demonstrations in amphitheaters, students became active participants in their own education. The introduction of laboratory work and clinical clerkships allowed students to learn by doing, rather than merely by watching. Students became increasingly engaged in the care of patients, and clinical teaching expanded beyond the traditional courses in medicine, surgery, and obstetrics to include gynecology, pediatrics, dermatology, genito-urinary diseases, laryngology, ophthalmology, otology, psychiatry, and hygiene.7 In the words of Jacob Gould Schurman, Cornell’s third president, “the University shrank from even a nominal connection with proprietary institutions whose ultimate object was economic and financial, not scientific and educational,” since “such unions offered no prospect for the advancement of medical education.”8 If Cornell decided to associate itself with a medical school, that institution would need to be committed to educational innovation. And in 1898, a proposal to create a new medical school that would maintain both high academic standards and financial stability presented itself. It was backed by the munificence of Colonel Oliver H. Payne and inspired by the close friendships he had formed with one of his classmates at Yale, Dr. Lewis Stimson, and with one of his physicians, Dr. Alfred L. Loomis. Payne gave Stimson, Loomis, and an entire medical school faculty the means to escape from a university administration that had suddenly turned 2

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Origins

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Cornell University Medical College’s Founders Oliver Hazard Payne was born to a wealthy Ohio family on July 21, 1839. He attended Yale as a member of the class of 1863 but left at the outbreak of the Civil War to join the Union army. While a solider, he received a gunshot wound to the thigh, which became a source of chronic pain and fueled a lifelong interest in health. After his discharge, Payne went into business and became a close associate of John D. Rockefeller and, later on, a treasurer and director of Standard Oil. He also had substantial investments in the American Tobacco Company and in coal, iron, steel, and paper. A bachelor, Payne moved in 1884 to New York City, where he spent a lot of time with Lewis Stimson.9 According to Stimson’s cousin Lewis Conner, Payne was a “modest, reticent, and rather lonely man.”10 Lewis Atterbury Stimson was born on August 24, 1844, in Paterson, New Jersey, and at the age of fifteen entered Yale, where he struck up a lifelong friendship with his crew teammate Oliver Payne. During the Civil War, he served as a general’s aide in the Union army. In 1866, he married Candace Wheeler, but her health soon began to deteriorate. Stimson abandoned a career in finance, began to study medicine in Europe, and ended up graduating from Bellevue Hospital Medical College in New York. Just two months after his wife died in 1876, he performed one of the first surgeries in the United States using antiseptic methods, a public demonstration of a leg amputation.11 According to historian George Adams Boyd, Stimson “look[ed] upon the world with the penetrating appraisal of a man sure of his integrity and who will tolerate no nonsense, hypocrisy or sham.”12 His cousin Lewis Conner wrote: “His somewhat reserved manner and cold exterior hid a generous and kindly disposition, which showed itself particularly in his relations with his subordinates.”13 Alfred L. Loomis is considered a founder of Cornell University Medical College because of his relationships with Payne and Stimson, although he died three years before the school’s establishment. An expert on physical diagnosis and tuberculosis, Loomis was associated with Bellevue Hospital and University Medical College, among other medical institutions in New York. Stimson, a close friend and colleague, introduced Loomis to Payne. After Loomis treated him for a pulmonary disorder in 1872, a grateful Colonel Payne donated $100,000 to build the Loomis Laboratory for medical research in 1886. Located across the street from Bellevue Hospital Medical College, the five-story Loomis Laboratory was used by physicians and students from Bellevue and University Medical College. After Loomis’s death in January 1895, his son Henry was appointed one of the first professors at Cornell’s medical school.14

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CHAPTER 1

oppressive. In the late nineteenth century, Stimson, Loomis, and colleagues including Dr.  William Polk were running the University Medical College. Organized in 1841, it was technically the medical department of New York University (NYU), although the professors who governed the school also owned it and were financially responsible for it. Their compensation was limited to any student tuition fees left over after operating expenses had been paid. Degrees were conferred by NYU, but otherwise the University Medical College was an independent institution. In 1883, the eight governing professors at the time purchased buildings for the school and formed a corporation called the Medical College Laboratory. In 1892, Colonel Payne made a $150,000 donation to help his friends pay off the mortgages on the buildings, which were then held in the name of the Medical College Laboratory. In 1897, the governing faculty of the University Medical College began negotiations to become a full-fledged branch of NYU. They hoped that this arrangement would lead to greater administrative and financial stability. The two other major medical schools in New York in the 1890s had recently made similar overtures to become university-based institutions. The College of Physicians and Surgeons joined with Columbia University in 1891, and Bellevue Hospital Medical College would go on to assimilate with NYU in 1898. According to an 1897 article in the Medical Record, the reasons for these mergers were primarily financial. As private institutions, the medical schools were unable to secure endowments or construct the facilities required to train modern-day physicians: they “had gone for years putting the moneys obtained from students that remained after paying current expenses into the pockets of their respective ‘sevens’ [faculty members]” and were now faced with “the alternative of closing their doors or of attaching themselves to some endowed institution.”15 In the case of University Medical College, however, the merger did not go as planned. Its medical faculty had made only an oral agreement with the chancellor of NYU, Henry MacCracken, regarding the governance of their medical school. They believed that they would share equally with the university in administrative decisions and faculty appointments. They also understood that in return for surrendering to NYU the property owned by the Medical College Laboratory, faculty members would receive fixed salaries paid by the university. This property included the Loomis Laboratory, built by Colonel Payne in honor of his physician, and its $250,000 endowment. After becoming incorporated as part of NYU, the professors were unpleasantly surprised to discover that control of the University Medical College was now entirely out of their hands. A stipulation that faculty salaries would not be fixed, but instead based on what each professor would have earned in private practice, especially rankled. A story in the New York Evening Post suggests that contemporary observers considered the university’s actions a form of

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Origins

trickery: “It became manifest that it was the purpose of the university council to violate the agreement upon which they had got possession of the property of the medical laboratory, and to drive the old faculty out, leaving the university the possessors of property acquired under false pretences, and without the burden of consulting or advising any gentleman to whose generosity they were indebted for the property.”16 In November 1897, some of the members of the council then responsible for governing the University Medical College, which included Colonel Payne, resigned. The disgruntled faculty members, believing that they had been deceived by MacCracken, proceeded to sue NYU for the restoration of property. The faculty members of the University Medical College then attempted to forge connections with Yale, Dartmouth, Princeton, and Cornell. On February  22, 1898, Payne and Stimson met with Cornell president Jacob Schurman to offer a proposal to form a new medical school. Most of the faculty of the University Medical College would move to Cornell, bringing with them the Loomis Laboratory and its endowment. Payne offered to finance the construction of a building worth at least $100,000 and would provide a guarantee that the financial costs of a new medical college would not be the responsibility of Cornell University for a period of five years. In addition, it was likely that many students from University Medical College would follow their professors and move to Cornell.17 Payne’s offer was well timed. There was a pressing need for well-trained doctors and adequate patient care facilities in New York City at the turn of the twentieth century, as the city was undergoing a period of rapid industrialization that severely impacted public health. Newly arrived immigrants frequently lived in teeming tenement houses, which lacked proper ventilation, plumbing, and sewage disposal. Air shafts were often used as garbage dumps, so windows looking onto them tended to be kept closed. For many residents, their small apartments doubled as workplaces and were used for activities such as sewing, cigar making, and necktie making. In 1890, there were thirty-seven thousand tenement buildings in New York City, housing more than 1.2 million people. Overcrowding was severe, with up to 522 people per acre, compared to 83.5 people in Chicago and 118 in Philadelphia.18 In 1890, the journalist Jacob Riis published his seminal work, How the Other Half Lives, about the deplorable conditions in New York City slums. Through vivid photographs and text, he exposed the life of the immigrant poor to a shocked public. For example, in one chapter he describes high mortality rates in “the Bend,” the “foul core of New York’s slums” located downtown: Here, in this tenement, No.  59½, next to Bandits’ Roost, fourteen persons died that year, and eleven of them were children; in No. 61 eleven, and eight

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CHAPTER 1

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of them not yet five years old.  .  .  . Well do I  recollect the visit of a health inspector to one of these tenements on a July day when the thermometer outside was climbing high in the nineties; but inside, in that awful room, with half a dozen persons washing, cooking, and sorting rags, lay the dying baby alongside the stove, where the doctor’s thermometer ran up to 115°!19

Not surprisingly, these kinds of cramped, unsanitary living conditions fueled the spread of infectious disease. The infectious diseases that caused the most deaths in New York in 1889 included scarlet fever, diphtheria, whooping cough, measles, “cholera infantum” (an often fatal form of gastroenteritis occurring in children), and tuberculosis. Overcrowded and underfinanced hospitals also contributed to the spread of infection. It was not unheard of to have two patients sharing one hospital bed, and antiseptic techniques were not yet in widespread use.20 In 1891, Lewis Stimson painted a dismal picture of the conditions inside the House of Relief, a small emergency care facility run by the New York Hospital. He described patients lying on every available space, including a table and the floor: “There they lie in the hot and fetid air, the conscious, the unconscious, the delirious, the sick, the injured, the drunken; and in the midst of them the work of the place goes on, the giving of ether, the dressing of wounds, the administration of the last rites to the dying, and when the door is opened to admit or transfer a patient, a curious crowd blocks the sidewalk and peers downward to catch a glimpse of what is going on within.”21 Under such conditions, the prospect of a new, fully financed medical school to help raise public health standards must have seemed very appealing. On March 1, 1898, Schurman responded to Payne’s proposal with a set of stipulations. The new medical school would need to have an endowment and could not be supported solely by student fees. Administratively, it would be under the control of Cornell and treated the same as other college departments. As was the case in Ithaca, the medical school had to be coeducational, and students with New York State Scholarships would not have to pay tuition. Finally, the first year or two of coursework would be offered in Ithaca as well as in New York City, although clinical training would necessarily be conducted in New York, because of the proximity of large teaching hospitals. A mere four days later, most of the University Medical College faculty, including Lewis Stimson and William Polk, formally resigned from New York University and announced their intention to form a medical school under the auspices of Cornell University. Henry MacCracken of NYU wrote two letters to President Schurman attempting to stop the faculty secession, to no avail. Schurman responded cordially to MacCracken, noting that “as to the hope expressed in your personal letter that Cornell University is not negotiating with the professors of a sister university, while I have no information to give on this particular 6

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Origins

subject, I may, however, say that it is the general practice of Cornell University to recruit its staff from the faculties of sister universities.”22 In a last-ditch attempt to assert control over its medical faculty, the secretary of New York University sent a pointed letter to every single one of its professors. The letter confirmed each faculty member’s appointment, with some caveats: “This appointment is under the condition that the Professor accept the statutes and rules of the University regarding the Medical College, and further that he strive to secure from the trustees of the Loomis Laboratory such agreement . . . as has been requested from them by the University.”23 It was much too little, and definitely too late. On April 14, 1898, the Cornell University Medical College (CUMC) was officially established by the Cornell Board of Trustees. The New York Times immediately reported the news and indicated that the new medical school had been made possible by an endowment of nearly $500,000, rumored to have been funded by Colonel Oliver Payne.24 The former faculty members of the University Medical College, along with four from the Bellevue Hospital Medical College, brought 215 of their students with them to Cornell. 25 On April 16, the New York Evening Post presented a detailed sequence of the events that had led to “a result so deplorable for the New York University—so fortunate, on the other hand, for Cornell University.”26 Later that fall, a more accurate account of the magnitude of Payne’s gift—over $1.6 million, or approximately $44 million in today’s dollars—was reported.27 Much of this was intended to construct a new building to house the medical school and for equipment. Payne agreed to supplement this initial gift with yearly contributions of $140,000 (nearly $4 million, after adjusting for inflation) to offset the school’s operating expenses.28 According to Schurman, Payne explained the motivations behind his philanthropy: “We all want to do some good in the world, and I should like to do something by improving the education of that profession which cares for the lives of men, heals their wounds, and alleviates their sufferings.”29 The Cornell trustees proceeded to appoint William M. Polk as the medical school’s first dean, as well as professor of gynecology and obstetrics. Seven other professors were appointed as founding faculty members: Lewis Stimson as professor of surgery; Henry P. Loomis as professor of materia medica, therapeutics, and clinical medicine; Austin Flint in physiology; W. Gilman Thompson as professor of medicine; Rudolph A. Witthaus in chemistry, physics, and toxicology; J. Clifton Edgar in obstetrics and clinical midwifery; and George Woolsey as professor of anatomy and clinical surgery. The following year James Ewing was appointed professor of pathology, and a few years later Graham Lusk became chair of physiology.30 Of these original professors, Polk, Stimson, Thompson, and Witthaus had been part of the group of faculty members that had seceded from New York University. 7

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CHAPTER 1

The members of the Medical College Laboratory eventually won their case against NYU, in April 1904, and the Loomis Laboratory was restored to its former owners.31 The deed to the property was subsequently transferred to Cornell University, and the Loomis Laboratory became a department of the medical college.32 Writing as dean of the medical school in 1928, Walter Niles praised these early professors for “possess[ing] courage to a rare degree in separating from the group with whom they had been long associated and assuming the burden and responsibility of organizing a new institution.”33 After CUMC moved to its current location on the Upper East Side in 1932, it was discovered that Cornell was obligated to continue to use the name “the Loomis Laboratory” in order to access the funds associated with that property. Since the original purpose of the Loomis Laboratory was to promote research in chemistry, biology, and pathology, it was decided that an area occupied by the department of pathology and by animal laboratories would be designated the Loomis Laboratory, and income from the Loomis Laboratory Fund was used as part of the budget for the pathology department.34 Cornell’s First Dean

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The first dean of Cornell University Medical College, William Mecklenburg Polk, was born in Ashwood, Tennessee, in 1844. His father was the Reverend Leonidas Polk, a Confederate general in the Civil War and an Episcopalian bishop who earned the nickname “the fighting bishop.” William Polk was also

Figure 1.1 William Polk, MD. (Photo by Harris & Sawyer; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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Origins

a nephew of President James K. Polk. His early education was in Marion, Alabama, and at St. James’s College in Maryland. He attended the Military Institute in Virginia, which was supervised by Thomas Jackson (later to become famous as General “Stonewall” Jackson). At the age of seventeen, he joined the Confederate army and saw active service during the four years of the Civil War, eventually being promoted to the rank of captain in the Army of the Tennessee. Following the war, he began to study medicine at Tulane and in 1866 married Ida Ashe Lyon. The couple moved to New York in 1868, and Polk obtained his medical degree from Columbia’s College of Physicians and Surgeons the following year. While an intern at Bellevue Hospital, he met Dr. Alfred Loomis and was gradually promoted to professor of materia medica, therapeutics, and clinical medicine at Bellevue. In 1879 he moved to the University Medical College to become the chair of obstetrics and diseases of women. During the last decade of the nineteenth century, he focused his career on the field of surgical gynecology and was appointed chair of gynecology and obstetrics at Cornell, in addition to his position as dean. He held various leadership positions, including president of the American Gynaecological Society and the New York Obstetrical Society, and vice president of the New York Academy of Medicine. William and Ida Polk had two sons, Frank Lyon Polk, a lawyer and publicist, and John Metcalfe Polk, a doctor who died at the age of twenty-nine.35 Ida Polk passed away in November 1912, and two years later William remarried, to Maria Dehon.36 Various quotes from Polk’s contemporaries indicate that he possessed a strong and urbane personality. Emily Dunning Barringer, a member of the medical school’s first entering class, wrote: “He was a dignified southern gentleman. . . . Magnificently groomed, meticulous as to every last detail of his appearance, he was an imposing figure when he arrived in his carriage behind a spanking team with coachman and footman to attend him. Nor was the impression false. He was every inch a man and a great dean from any point of view, who set ideals and standards that have brought renown to the institution.”37 Lewis Conner, who initially joined Cornell’s faculty as an instructor in medicine in 1898, gave the following description three decades later: “Dr. Polk had all the courtesy and charm of manner that characterized the gentlemen of the Old South, but behind his handsome presence and his gracious manner he possessed a vigorous personality and an executive forcefulness which watched over every detail of the School’s administration and was the mainspring of its every activity.”38 Reports from contemporaries and historians suggest that Polk may have been what we now term a micromanager. According to his assistant Jessie Andresen, Polk was not much involved in student matters, which were handled by the secretary of the faculty, Dr. Jeremiah Ferguson: “That was one of the 9

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CHAPTER 1

weaknesses of [Polk’s] administration. The students never knew the Dean. In their minds everything bettering the condition of the student was due to the Secretary, all disagreeable rulings due to the Dean, with the consequence that he was feared and hated (because an unknown quantity), never honored and loved as he should have been.”39 Cornell historian Morris Bishop wrote that he “ruled the college with gentle fury, inquiring into the least details of its management, shouting and pounding about expenses like any worried paterfamilias.”40 Bishop also recounts an anecdote in which Polk surgically removed a patient’s kidney, only to discover, when the patient soon died, that he had been born with just one kidney. New York Hospital historian Eric Larrabee describes Polk as “a volatile combination of courtly manner and forceful command . . . he both animated the entire organization and supervised its every activity down to the last detail.”41 In contrast, another observer of the New York medical world praised Polk’s ability to delegate: “[He] threw himself into the labor of putting the school on a sure and stable foundation, and found able and capable associates to carry out his plans, the resulting department being now recognized as one of the leading institutions of its kind in the country.”42 Frederick Gudernatsch, a German scientist who taught anatomy, histology, physiology, and endocrinology at Cornell from 1907 to 1920, provides a lively account of Polk in his 1958 memoir, “Out of the Early Cornell Years.”43 With his colorful style of writing, he captures Polk’s personal manner strikingly: “Dr. William G. Polk was ‘The Dean.’ No other designation could have been more precise and appropriate: Dean Polk, a man of stature and lofty manner, a cavalier par excellence, an aristocrat of Southern Stock, a bit blustering at times, and gruff, while kindly always (inside his shell), a man admired and beloved by all, extremely fair with everybody; to me especially friendly, genuinely so, though trying not to make it obvious; thus seemingly distant on occasions.”44 According to Gudernatsch, the department of pathology “served much more than the Dean’s Office as the meeting place for almost everybody on the teaching faculty,” since its head, James Ewing, was easily accessible at practically all hours; the implication is that Dr. Polk was not.45 After Gudernatsch became Ewing’s assistant, his first encounter with Polk was to take a message from him on the telephone. Polk spoke to him in an increasingly stern manner, repeatedly asking, “Do you know who I am?” Although Gudernatsch answered in the affirmative, Polk, as he recounted, felt the need to bellow: “Thundering, really thundering, and it seemed to me as if I heard some pounding on a table: ‘i am the dean of the college!’ ”46 After recovering from this episode, Gudernatsch found Polk “a bit facetious at times, even sarcastic, mostly in a very friendly tone.”47 Under Polk’s leadership, CUMC’s organizational structure was established on exactly the same footing as other colleges of Cornell University, as requested by President Schurman. Many of the responsibilities originally assigned to the 10

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Origins

dean remain the same to this day. Then as now, the dean was charged with administrative responsibility over the medical college, its personnel, teaching and research programs, and expenditures. Appointed by the Cornell Board of Trustees on the nomination of the university president, he or she reports to the president and is answerable to the board. The dean is also the executive officer of the faculty and the representative of the president of the university. Other administrative bodies were also set in place. The faculty of medicine was charged with the educational administration of the school, including all matters relating to teaching and educational policy, such as admissions, student promotion and graduation, and curriculum changes. Monthly faculty meetings were presided over by the president of the university, or in his absence by the dean. Faculty and instructor appointments were made by the Cornell Board of Trustees upon nomination of the president, or in practice by nomination of the dean after consultation with individual faculty members. The trustees also created the Cornell University Medical College Council, which consisted of the dean and two members of the medical college faculty, three trustees who resided in New York, and the president of the university as chairman. All business affecting the medical college was handled by this governing body, which then submitted recommendations to the Cornell Board of Trustees for action. Initially, the council was scheduled to meet once a month, on the day following the monthly meeting of the faculty.48 It was in charge of college property, authorized all expenditures, prepared the annual budget, and established student fees, but was not otherwise concerned with educational matters. All actions involving the disbursement of funds required ratification by the board of trustees.49

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Early Days and Early Students

On September 11, 1898, the New York Herald devoted a full front page to the announcement of Cornell’s new medical college and Colonel Payne’s generosity. The article was exuberant, proclaiming that “the most comprehensive medical college in the world . . . means that New York will surpass the great cities of Europe.” A  new building on First Avenue between Twenty-Seventh and Twenty-Eighth Streets, directly across from Bellevue Hospital, was to be designed by the firm McKim, Mead & White and constructed for a total of $800,000, including land. According to one of the architects, the medical college would be “an imposing building . . . designed in a severe style of Renaissance architecture.”50 Inside, the building was to contain a large theater for clinical demonstrations, the “largest and most elaborately equipped dispensary in the city,” dissecting rooms, lecture rooms, and laboratories. In just a few months, the medical college had already appointed twenty-six faculty members and twenty-one instructors.51 11

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The formal opening of Cornell University Medical College occurred on October 4, 1898, at a ceremony attended by about four hundred people in a lecture room of the Bellevue Hospital Medical College. President Schurman, Dean Polk, General Alfred C. Barnes of the Cornell Board of Trustees, and eleven CUMC faculty members were seated on a platform in places of honor. 52 In his address, Schurman described the opening of the medical school as a miraculous event akin to the birth of Minerva, the goddess of wisdom who leapt fully formed from the brain of Jove. He had high expectations because of the quality of the faculty—“a body of picked men, a corps of physicians and surgeons whose practice puts them in the van of their profession, and whose gifts as teachers, already exhibited in other schools, have won for them the united admiration of rival bodies of students.”53 He described Cornell University, which was particularly strong in the natural sciences, as an ideal base from which to establish a medical school: “Is not [Cornell’s] spirit and aim wonderfully congenial with the spirit and aim of your profession? What is needed for the training of physicians and scientists today? I answer, first, science; secondly, science; thirdly, science.”54 Dean Polk also spoke and was especially exhilarated by the prospect of a college building dedicated to medical education and patient care: “We engage to build for you as fair, as firm, as grand a spire as ever reared its head toward heaven.”55 Temporary housing for CUMC was provided by the Loomis Laboratory on East Twenty-Sixth Street and nearby rented buildings on the grounds of Belle­ vue Hospital. Since many faculty members held hospital appointments at ­B ellevue, they were able to make these facilities available for clinical teaching. While the new building was in the process of construction, all classes took place in four rooms, including a lecture hall, two recitation rooms, and a dissecting room. During this period, there were, not unexpectedly, frequent logistical difficulties, such as two classes being scheduled to meet in the same classroom at the same time.56 CUMC’s permanent home on First Avenue officially opened on December 29, 1900. The ceremony was marked by speeches from New York governor Theodore Roosevelt, Jacob Schurman, Columbia University president Seth Low, and Lewis Stimson representing the medical school faculty. Cornell historian Morris Bishop offers a concise description of the building: “The exterior was Renaissance, of brick and stone; the interior contained an ample dispensary and everything that physicians and architects could devise in the way of theatres, laboratories, dissecting rooms, and accommodations for such novelties as Roentgen rays. This structure, of unexampled magnificence for its purpose, was for many years Cornell’s very particular pride.”57 According to Cornell historian Waterman Thomas Hewitt, the two main entrances opened onto vestibules. One led to the main hall of the college, which contained offices for the dean, secretary, and clerk, a student reading room, and meeting rooms 12

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for the faculty and Medical College Council. The other vestibule led to the dispensary waiting room, which was surrounded by the pharmacy and the departments of surgery and medicine. In between the two entrances were a large amphitheater and the children’s department. The second through fourth floors housed the departments of genito-urinary diseases, neurology, dermatology, otology, ophthalmology, laryngology, and obstetrics/gynecology, as well as teaching facilities, including laboratories, recitation and exam rooms, and libraries. The fifth floor, which was reserved for human anatomy courses, “can be cooled by the refrigerating plant in such a manner as to permit the pursuit of practical anatomy with as much comfort in summer as in winter.” Lockers for three hundred students were also housed on the fifth floor. A half-story at the very top of the building contained the department of photography, the animal house, and “a room for the preparation of bones.”58 Unfortunately, no trace of the facility remains, as it was destroyed in 1968. 59 A total of 278 students, including 26 women, registered for the academic year beginning in 1898. At the time, Cornell was one of only a few medical schools in the United States, including the University of Michigan and Johns Hopkins, that admitted both women and men. In 1892, seventeen women’s medical colleges were also in existence, but the majority of these were forced to close within a decade owing to financial difficulties.60 The number of female students at Cornell received a significant boost when the Woman’s Medical

Figure 1.2  The first building of Cornell University Medical College was located at 477 First Avenue between Twenty-Seventh and Twenty-Eighth Streets. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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CHAPTER 1

College of the New York Infirmary for Women and Children, which was founded by Elizabeth Blackwell, the first woman to receive a medical degree in the United States, merged with CUMC in 1899. This decision was made after the building housing the Woman’s Medical College was destroyed by fire, and Blackwell and its board of trustees chose to focus on developing the New York Infirmary instead. Three classes of the Woman’s Medical College, which consisted of about seventy students, entered Cornell.61 Among CUMC’s first graduating class of sixty-seven students were twelve women, including Ida Scudder, who later founded a hospital and nursing and medical schools in India.62 Although women were welcome at Cornell, they were not treated exactly the same as the men. Female students were required to take their first two years of medical school in Ithaca, where they were housed in Sage College, a women’s dormitory. Male students were able to choose between pursuing their first two years of study either in Ithaca or in New York City.63 Regina Morantz-Sanchez, a scholar of women’s history, argues that “women physicians in New York understood from the start that Cornell’s commitment to their education was equivocal.”64 She cites as evidence the fact that Cornell did not appoint any women to its faculty until 1914, and she refers to letters from Dean Polk indicating that women students were required to spend two years in Ithaca in order to reduce their numbers in New York City. In a 1931 speech to entering students, Lewis Conner confirmed that the Ithaca policy was in fact designed to prevent male students from “turn[ing] aside from a co-educational school” such as Cornell and instead selecting “one where their associates would be only those of their own sex.” He continued: “It would be pleasant to point to this admission to the School of women in those early days when almost no schools accepted women as only another sign of the progressive and broadminded policies upon which the Cornell School was founded; but the truth is, I regret to say, that the School accepted woman students because it was compelled to and not at all from conviction and from foresight as to what would later become an almost universal policy.”65 It was not until 1920, the same year that American women won the right to vote, that female medical students were allowed to complete their first two years of medical school in New York City instead of Ithaca. Female graduates from medical school were also limited in their options. Since only a few women’s hospitals accepted female doctors for internships, women were not typically allowed to compete in the exams for internships at general hospitals. However, Emily Dunning Barringer, who received her medical degree from CUMC in 1901, succeeded in obtaining permission to join the “hospital quiz” at Cornell, which prepared students for the competitive internship exams. She received the second-highest grade on the exam for Gouverneur Hospital in New York. Although the hospital initially denied her application, she reapplied the following year and, with much public support 14

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behind her, was accepted by Gouverneur Hospital as the first woman admitted to a surgical residency program in the United States.66 She went on to become the first female ambulance surgeon, and her autobiography was made into a 1952 film called The Girl in White. Another trailblazing student was Roscoe Conkling Giles, a graduate of Cornell University, who matriculated in 1911 as the only African American student in the medical school. Although he was repeatedly asked to leave and received death threats, he persevered and in 1915 became the school’s first African American graduating physician. In 1985, a scholarship fund in Giles’s name was established at the medical school.67 Initially, the faculty had little involvement in the health or living conditions of students. Fifty years after his graduation, Robert L. Hutton, a member of the class of 1905, wrote a letter that provides one colorful perspective on student life: “Living and eating quarters were anywhere we could find, cheaper rent being a desirable point—a favorite location for many was the Students’ Club at the YMCA . . . its chief drawback being a gross lack of cleanliness and regularly occurring attacks of bed bugs, seriously curtailing sleep  .  .  . it is impossible to feel that the inadequate nourishment and unfavorable living conditions of some of the students were not in considerable part responsible for the fact that soon after graduation four of our class died of tuberculosis.”68 It was not until 1916 that Cornell became one of the first medical schools to provide health care for its students, a development that Dean Polk pushed for. Until then, students were admitted without any evaluation of their health and on several occasions had to abandon their studies after serious diseases were detected. Under Polk’s leadership, the dispensary began taking on the responsibility of monitoring student health throughout medical school, and students were regularly vaccinated against smallpox and typhoid fever.69

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Innovations in Medical Education

In a speech given at the opening of Cornell’s medical school in 1898, Lewis Stimson aptly captured the prevailing state of medical education earlier in the decade: The student sat for 6 or 7 hours daily during a term of 4 or 5 months and listened to descriptions and expositions, most of which he could find more systematically set forth in his textbooks. . . . The second year was a close textual repetition of the first, and so also was the third year for those whose means and ambition led them to take that unrequired year. Work in the dissecting room was obligatory, but the obligation practically ended with the payment of the fee, and the individual learned or failed to learn in accordance with the strength or weakness of his desire. Laboratory work was limited to a little chemistry and a few demonstrations in the use of the microscope. The much 15

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vaunted clinical lecture was the merest suggestion of what it should have been, for the students came to it in a body and their verification of statements and personal introduction to the symptoms of disease were limited to what could be seen from a distance. Of the training of hand, eye, and ear there was none, and of actual experience of contact with disease there was little more than the opportunities occasionally furnished by the student or his friends.70

According to Kenneth Ludmerer, a historian of medical education following the Civil War, Cornell was the prototype of the newly established institution that rejected such outmoded teaching methods and wholeheartedly subscribed to the latest advances in medical education. With an excellent faculty, a generous benefactor to provide financial backing, and a commitment to the new pedagogical techniques that emphasized learning by doing, “immediately, Cornell joined Johns Hopkins, Harvard, Columbia, Pennsylvania, Western Reserve, and Michigan in the forefront of the country’s medical schools.”71 In an address given to the entering class of 1931, longtime professor Lewis Conner similarly saw the establishment of CUMC as a significant event in the history of medical education: “It had behind it the vigor and spirit and ideals of youth, which had cast off the hampering cloak of old traditions. It was dissatisfied with medical education as it existed in New York and demanded something better.”72 Dean Polk introduced several innovations to the medical curriculum, which he described in an address at the opening of the medical school. These included a “broad basis of laboratory instruction, text-book drilling, with clinical demonstration superimposed, and presented to such small subdivisions of the class as to insure the direct impress of the teacher upon each student.” There was also a notable increase in bedside teaching, since “it is evident that patients are a necessity” in medical education.73 Thus, Cornell students learned medicine primarily in laboratories, dissecting rooms, recitations, and daily bedside teaching, rather than by attending didactic lectures. Class sizes were also limited so that each student would receive quality instruction. The pathology course, for example, which was modeled on courses taught at other university-based medical schools, consisted of eighty-four hours of laboratory work and sixty-four hours of recitation.74 Waterman Thomas Hewitt, a historian of Cornell, praised the introduction of textbook study and small group recitations: “The principle observed in the training of soldiers is quite apt in the making of doctors of medicine,” since “squad drill is the proper foundation of both systems.”75 Entrance requirements for medical school at the beginning of the twentieth century were dramatically different from what they are now. During the first years of the century, Johns Hopkins and Harvard became the first two medical schools to require a college degree for admission, while Western Reserve was 16

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the only other institution that had college coursework as a prerequisite. In 1900, only about 15–20  percent of schools required a high school diploma, and most accepted a high school equivalency certificate or administered an easy qualifying examination. A year after CUMC’s founding, the Cornell faculty had discussed requiring a college degree for admission but felt that such standards would be too high and that the school would not even be able to attract twelve to fifteen students per class. As a compromise, it required applicants to have a high school diploma, plus they had to complete a high school course in physics and inorganic chemistry. Nevertheless, admission to Cornell remained comparatively difficult; and once admitted, students were weeded out during their first year for failing to meet academic standards. Between 1900 and 1907, from 27  percent to 42  percent of each first-year class was dropped.76 In 1908, Cornell decided to raise its standards for admissions and join Johns Hopkins and Harvard in requiring an undergraduate degree or equivalent education and training. However, the school did allow Cornell undergraduates, as well as students from other approved colleges, to substitute their senior year with the first year of medical school. In addition, after 1909, all applicants needed to have completed the equivalent of a year of college-level physics and inorganic chemistry. These changes were underwritten by Colonel Payne, who guaranteed to support the school no matter how small its enrollment. The faculty voted unanimously in favor of the new policy on November 15, 1907, at a faculty meeting of “portentous stillness” and “seriousness.”77 At first, the number of entering students dropped dramatically, from seventy in 1907 to merely three in 1908. Total medical school enrollment declined steadily, from 320 in 1907–8 to a low of 118 in 1911–12, then gradually started to recover.78 The option—or for women, the requirement—to study medicine in Ithaca was seen as a potential benefit of receiving a Cornell education. The two programs were seen as exactly comparable to each other: “a student can find at Ithaca the same course in the first and second year of study he meets with in New York city. . . . Cornell students, therefore, have the same opportunity to pursue medicine at Ithaca that is afforded students of universities wholly situated in cities.”79 Individuals interested in studying medicine were encouraged to take their first three years of undergraduate coursework at Cornell University in Ithaca because a “liberal education in the arts and sciences is of great advantage to prospective students of medicine.”80 The senior undergraduate year could then be combined with the first year of medical school in Ithaca, and the second year of medical school could be taken either in Ithaca or New York. Beginning in 1903, medical instruction at Ithaca was held in Stimson Hall, which was constructed in honor of Lewis Stimson.81 For all students, the third and fourth years in New York incorporated clinical teaching in hospital wards, clinics, and dispensaries, which provided free 17

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care for the poor. Clinical teaching was conducted by faculty at various sites, depending on where they had appointments, but the majority took place at Bellevue Hospital. Small groups of third-year students, for example, would accompany professors of clinical medicine on rounds through the hospital wards. There they would have the chance to observe examples of common diseases, personally examine patients, and follow their daily progress. Weekly medical clinics were held in the amphitheater of Bellevue, where students would read written histories of cases they had previously studied while on the wards, demonstrate on patients, and answer questions posed to them. Rare or complicated cases would also be presented at the clinic. At the college dispensary, which saw about five hundred patients a day, they would receive instruction in general medical diagnosis and examine patients with a variety of conditions. A fifth year consisted of the “hospital quiz” to prepare students for hospital internship exams, plus practical training in the dispensary and labs. Charges for each of the five years, including tuition and laboratory fees, ranged from $180 to $200 (about $5,000 in today’s dollars) in the first years of the

Figure 1.3 William Polk (standing third from left) teaching a surgical class at the Bellevue Hospital amphitheater. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

18

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twentieth century. Students were additionally required to pay an annual $10 deposit in case of laboratory breakages and a $25 graduation fee.82 From the start, Cornell shared with other New York medical schools access to Bellevue Hospital, a public hospital that received approximately twenty-four thousand patients per year. In How the Other Half Lives, Jacob Riis refers to Bellevue, describing its “alcoholic cells” as a “way-station” for the poor, who traveled between “the penitentiary, the workhouse, the almshouse” and the asylum.83 In this kind of bustling environment, students initially observed cases until 1906, when Dean Polk arranged for students to work on the wards. In a letter to Dr. John W. Brannan, president of the Bellevue Board of Trustees, he requested that fourth-year students be admitted as workers in the wards, included a draft of rules for student assistants, and listed several advantages to his proposal, chief among them freeing up time for overworked house staff.84 Clinical clerkships in medicine, surgery, neurology, and urology at Bellevue commenced in 1911.85 Over the next five years, the organization of Bellevue evolved into four divisions to accommodate the different schools that used its beds for clinical teaching. The Second (Cornell) Division was reserved for Cornell students, and there were divisions for NYU and Columbia, as well as a fourth, or open division. Visiting staff from Cornell were responsible for ninety medical beds, ninety surgical beds, thirty-two gynecology beds, twenty-two for genitourinary diseases, and, for half the year, fifty-four obstetrical beds. It also shared equal privileges with the other three divisions to special services, which gave students access to cases of tuberculosis, alcoholic and psychopathic diseases, and children’s surgery.86 The directors of Cornell’s medical, surgical, and urological services were responsible to the trustees of both Bellevue Hospital and Cornell University. Staff members, who were chosen and paid for by Cornell, cared for patients, taught students, and conducted clinical research in the wards and general clinics.87 In addition, Cornell became affiliated in 1912 with the Russell Sage Institute of Pathology, which was located in Bellevue Hospital and afforded Cornell staff the opportunity to engage in laboratory investigations, particularly in the area of human metabolism. These arrangements at Bellevue were approved by the Bellevue Board of Trustees in January 1916 and were observed as a gentleman’s agreement, without any binding contract, until at least 1934. That year, Cornell’s dean, Dr. Canby Robinson, looked into the matter and expressed interest in reaffirming the affiliation along its original lines.88 A letter to Dean Polk from Walter Niles, then an assistant professor of clinical medicine at Cornell, provides information on the nature of clinical teaching at the time: “Each student makes many blood pressure observations. The mechanism of the heart beat, the use of the polygraph and interpretation of electro-cardiograph records, together with many examples of all forms of 19

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arrhythmia, are thoroughly considered. Vasomotor phenomena in disease and the influence of various circulatory stimulants are repeatedly observed; also shock and the vasomotor expressions of it; also the circulatory phenomena associated with increased intracranial pressure and the detailed study of many cerebrospinal fluids. Functional physiology of the kidney is especially considered, including various tests for its sufficiency.”89 Incidentally, Niles, who was to succeed Polk as dean, wrote a second letter to Polk on the same day, regarding his position on the faculty. This letter indicates that Polk had made efforts to secure a hospital appointment for him. While grateful, Niles also requested that he might be relieved of some of his hospital duties, so that he would have time to conduct research on circulation, through the Russell Sage Institute. Following graduation from medical school, young (male) physicians had a choice of four major New York hospitals in which to complete their internships: New York Hospital, Roosevelt, St. Luke’s, and Presbyterian. There were a total of only thirty-two openings per year, so competition was fierce and became even fiercer in 1912, when Presbyterian internships were limited to graduates of Columbia University College of Physicians and Surgeons and the total number of open slots was cut to twenty-four. Entrance examinations took place over three days at the Academy of Medicine and were administered by a hospital joint examination board. The first day consisted of six one-hour written tests and a five-minute oral exam. In 1913, about 140 people completed the first day of exams. Only 48 were asked to stay for the second day, which consisted of practical tests in surgery, pathology, and medicine conducted in groups at New York Hospital, Roosevelt, and St.  Luke’s. On the third day, the young doctors who had been chosen were announced at the Academy of Medicine, in the company of family and friends. After succeeding in being awarded a hospital position, interns could expect only room, board, uniforms, and laundry, with no salary, and they were not allowed to be married. However, a good internship was seen as a precursor to a successful career, particularly if the intern managed to secure a permanent position on the hospital staff. The most highly regarded physicians at the time could expect to be driven around town by a coachman in a horse-drawn carriage or, later, in a limousine, to have a brownstone office, and to dress in a tailcoat and striped trousers.90 Still, archival records indicate that faculty salaries varied widely at Cornell. In 1915–16, W. Gilman Thompson, professor of medicine and head of the department, made $4,000 ($92,000 in 2014 dollars), substantially more than Lewis Conner, professor of clinical medicine, who made do with a salary of $300 ($7,000 in today’s dollars). Walter Niles was paid $600 for teaching the hospital quiz and $600 for his work on the wards (for a total of $28,000, after adjusting for inflation).91 Department heads were also asked to evaluate their faculty members on “your estimate of efficiency.” In the department of 20

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Origins

medicine, W. Gilman Thompson noted in 1913–14 that Walter Niles was “one of the very best teachers in the school—a growing man,” while Lewis Conner was “excellent.” Early versions of the evaluation forms included department heads on the list of faculty, which produced a few witty comments. In physiology, Graham Lusk rated his own efficiency as “problematical,” while in experimental therapeutics, Silas Beebe filled in, “I have none,” then offered as an addendum, “It must be obvious that I cannot give an estimate of my own efficiency. The success of the department must be my answer to that question.”92 Affiliation with New York Hospital

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In 1910, the Carnegie Foundation published Abraham Flexner’s highly influential report, Medical Education in the United States and Canada. A professional educator, Flexner visited and evaluated each of the 155 medical schools then extant in the United States and Canada. In his report, he described Johns Hopkins as an exemplar of modern medical education: the ideal medical school, he observed, needed to be part of a university and connected to a teaching hospital, have stringent admissions requirements, maintain a significant endowment and ample laboratory resources, employ full-time faculty members, and be firmly committed to the conduct of medical research. Flexner also harshly criticized proprietary schools as profit-driven enterprises producing poorly trained physicians. His report had a huge impact on public opinion and led directly to the demise of proprietary schools, many of which were forced to close following its publication. In general, the report helped raise the quality of medical education in North America through its insistence on greater standardization and professionalism in medical schools.93 While Flexner saw Johns Hopkins as a model of excellence, he was favorably impressed by Cornell after a visit conducted in February 1910, just twelve years after the school’s founding: The school laboratories in New York are, in general, of modern equipment and organization, anatomy and chemistry being, however, less elaborately developed than physiology and pathology. . . . Otherwise the laboratories are in charge of full-time teachers, properly assisted, devoting themselves unreservedly to teaching and research. Despite geographical separation from the university at Ithaca, the department is animated to university ideals: in part, this is ascribable to actual intercourse, in part, to the selection of teachers devoted to science, whom the university has so generously supported that they have reproduced the university spirit.94

In his view, both Cornell and Columbia were already respectable institutions committed to research, and their primary shortcomings were the lack of affiliated teaching hospitals: “Their laboratories produce a high-grade student, to 21

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whom the university is bound to furnish a clinical opportunity of the same quality. . . . An effective affiliation, or endowment to support a teaching hospital and a scientific medical faculty, is therefore their immediate need and desert.”95 The need for a dedicated clinical facility to train Cornell students was recognized early on. Negotiations with the New York Hospital, then located on Fifth Avenue between Fifteenth and Sixteenth Streets, began in 1902 but did not reach fruition until a decade later. The second-oldest hospital in the United States, the New York Hospital had been granted a royal charter by King George III in 1771. As Lewis Conner expressed it, “the history of the New York Hospital is the history of New York City”: “In every war from that of the Revolution on; in time of pestilence from cholera and yellow fever; in epidemics of small-pox, typhoid, influenza, and poliomyelitis; in time of riot and of great fires the Hospital has played its great and humane part in serving the city and in bringing aid and comfort to its citizens.”96 Lewis Stimson, a strong believer in the importance of clinical teaching, was key to the initial affiliation between Cornell and New York Hospital. In 1912 Stimson informally approached George F. Baker, a governor of the hospital, about the possibility of increasing lab facilities and clinical instruction on the wards for Cornell medical students. Baker later related to another hospital governor that these conversations had inspired him to make a donation to the hospital. His primary intent was to help the hospital by bringing the fruits of Cornell laboratory research to hospital patients, but he also wanted to please Stimson.97 Lewis Conner provides some additional insight: “Not only were the medical schools feeling the need for closer hospital connections, but the hospitals, or at least the more progressive and far-seeing ones, were coming to realize that their welfare and progress required the co-operation of a university medical school.”98 On October 10, 1912, a resolution formalized a gift of $250,000 (nearly $6 million in 2014 dollars) from Baker to the Society of New York Hospital. The following year, on November  12, 1913, Colonel Payne sent a letter to President Schurman indicating that he was permanently endowing the medical college with $4,350,000 (almost $104  million, adjusting for inflation) in bonds. The bonds, which were issued by the International Traction Company, Liggett & Myers Tobacco Company, Great Northern Paper Company, and P. Lorillard Tobacco Company, would produce an annual income of $201,250.99 In his will, Payne left an additional $500,000 for the maintenance and support of the medical school.100 The gifts from Baker and Payne led to a limited affiliation between Cornell and New York Hospital, which greatly improved the clinical teaching of Cornell students, who were subsequently able to spend much more time with individual patients. Under the terms of the agreement, the medical school could nominate half the attending physicians and surgeons 22

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and all the pathologists of the hospital, and it would have access to half of the hospital’s beds for the training of medical students.101

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Building a Culture of Research

In 1912, Cornell University Medical College began to offer graduate courses in medical sciences in cooperation with the Graduate School of Cornell University. Students were able to register in the medical college for graduate work in New York City that would lead, after a minimum of three years, to a PhD from the graduate school. Courses were initially offered in anatomy, physiology, physiological chemistry and chemical pathology, pathology, experimental therapeutics, and pharmacology.102 By the end of Polk’s tenure as dean, tuition had been set at $150 per year (about $3,600 in today’s dollars), with a matriculation fee of $5 and a graduation fee of $20. Interestingly, doctoral candidates were required to submit one hundred printed copies of their thesis to the university library when completed.103 In 1913, CUMC’s first professor of pathology, Dr. James Ewing, facilitated an agreement with the Memorial Hospital, formerly the Skin and Cancer Hospital. The previous year, he had begun to develop a relationship with the philanthropist and copper magnate Dr. James Douglas, whose daughter had recently died of cancer. Douglas became a supporter of the Memorial Hospital, contributing nearly $1 million and considerable supplies of radium to it in 1914. His support was contingent on two conditions—that the hospital focus exclusively on the treatment of cancer and that Ewing become its chief pathologist. As a result of the affiliation, the pathology laboratories of Cornell were shared with Memorial Hospital, and Ewing was subsequently appointed director of cancer research and president of Memorial’s medical board.104 Cornell’s early faculty consisted of some distinguished researchers. In addition to heading the Memorial Hospital for twenty-six years, James Ewing cofounded the organization that became the American Cancer Society, identified a type of bone tumor that still bears his name, and penned the standard textbook on cancer of his generation.105 The physiologist Graham Lusk, an expert on nutrition, joined Cornell in 1909 and had a calorimeter specially constructed for his metabolic research. After becoming the scientific director of the Russell Sage Institute of Pathology in 1913, he had the calorimeter transferred to Bellevue Hospital, where for the next two decades he conducted a series of studies on heat production in animals.106 Carl Wiggers, also a physiologist, was renowned for his research on blood pressure and the circulatory system. During his years at Cornell, from 1911 to 1918, he developed a mobile device to measure blood pressure, analyzed pressure levels in the heart and circulation, and studied cardiovascular problems in draftees and soldiers during World War I.107 One of Cornell’s most influential 23

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Figure 1.4 A respiration calorimeter, the first of its kind in any hospital, was used for conducting metabolism research and was housed in the Russell Sage Institute of Pathology in Bellevue Hospital until 1932. It is shown here at the New York Hospital–Cornell Medical Center in 1939. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

researchers in its history was George Papanicolaou, who joined the faculty in 1914. He conducted groundbreaking investigations in cancer leading to the development of the “Pap smear” for cervical cancer screening in the 1920s, although the significance of his findings would go unrecognized until decades later (see chapter 4). Despite the presence of such prominent scientists, it took some time to establish a research culture at Cornell. In a letter to Dean Polk, Eugene DuBois, then medical director of the Russell Sage Institute, describes the Cornell faculty as predominantly clinical, rather than research oriented: I feel that as a clinician I need much more instruction in the laboratory subjects than is at present attainable at Cornell. The students come to the hospital splendidly prepared in the laboratory courses. It is difficult to keep up with the average student who remembers a small proportion of what he has been taught and it is impossible to keep up with the really good student. . . . The ordinary post-graduate course would not fit us to teach Cornell students. Is it not possible for the college to give us courses in pathology, physiology, 24

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anatomy, pharmacology etc.? . . . If the courses were merely optional, I would let other matters interfere. It is for this reason that I should prefer to be forced to do the work.108

His comments point to the quality of Cornell’s scientific curriculum, as well as to DuBois’s desire to stay abreast of current knowledge. Today DuBois is considered one of CUMC’s pioneering researchers for his work on calorimetry and human metabolism. In his memoir, Frederick Gudernatsch also provides some insight on the scientific culture at the medical school. On a couple of occasions, he became locked in battle with Dean Polk on matters related to the purchase of laboratory equipment, since all expenditures of more than twenty-five dollars needed to be approved by the dean. He also describes Polk as initially skeptical of nonclinical research and of the work that he and his colleagues were doing: “ ‘The Dean’ himself was unfamiliar with the newer trends in biological research  .  .  . it was in such situations that he often became chagrined and made facetious remarks: ‘What are you going to do next? Serve us some oyster cocktail or clam stew? Do you really know what you are doing? Well, as long as you keep away from jelly-fish.’ ”109 Gradually, the dean grew to appreciate Gudernatsch’s work and sent him one-hundred-dollar checks on two occasions. Their last encounter took place in April 1917, just as the United States was preparing to enter World War I. During a faculty meeting, Polk uncharacteristically took a seat next to Gudernatsch, who still had many relatives living in Germany. Jacob Schurman proceeded to ask the faculty to sign a loyalty oath to send to President Woodrow Wilson, as other universities were doing at the time. The paper made its way around the room, with everyone signing. Soon, however, Polk “placed his right hand on my left, quite firmly, and said with a soft but clear voice: ‘Don’t you worry! Nobody holds you responsible.’ ” Gudernatsch intended to sign the paper when it reached him, since at that time he considered Germany to be the “enemy.” However, in an act of compassion, Polk instead “grabbed it rather quickly, put his signature on it, and passed it on.” Soon thereafter, Polk passed away. For Gudernatsch, it was “a great loss,” and he concludes his memoir with a tribute to Polk, whom he calls a “genuine friend of mine, so kind of heart.”110 Toward the War in Europe

Following the initial affiliation agreement between CUMC and New York Hospital in 1912, Cornell president Jacob Schurman began to develop plans for an ambitious merger between four separate institutions into one medical center: New York Hospital, Presbyterian Hospital, CUMC, and Columbia 25

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University College of Physicians and Surgeons. On January 27, 1917, Schurman wrote to the president of Columbia University, Nicholas M. Butler, to follow up on a recent conversation about the possibility of such a merger. Referring to the “new Medical University,” Schurman noted that they both supported the idea in theory, since it would make it “possible to render service more economically and efficiently” and “would also conduce to the improvement of medical education and the advancement of medical science in the City of New York.” Although “the obstacles in the way of even the loosest kind of combination would be great and perhaps insuperable,” they both felt that it was important to consider the possibility, given its potential advantages. Schurman then proceeded to lay out some preliminary thoughts. The proposed four-way affiliation could be set up similarly to the University of London, as a system of self-governing colleges and research institutes. The proposed Medical University would need to be incorporated as a separate, overarching institution, so that it could hold property and be independently endowed. Cornell’s and Columbia’s medical schools, New York Hospital, and Presbyterian Hospital would each remain independent corporations, fully responsible for and in control of their own property, endowments, faculty, and staff. Schurman speculated that Cornell’s main campus in Ithaca might want to concentrate on medical research, while leaving medical education to the schools in New York City. He concluded his letter with a handwritten postscript, which aptly captured the capitalist spirit of the times: “Yet, with all these limitations, the union ought not to be impossible in a country in which both government and business have accustomed us so thoroughly to the idea and practice of federation and consolidation.”111 Shortly thereafter, on February 20, 1917, a report was submitted to the New York Hospital board on the proposed four-way merger.112 Two months later the United States entered World War I, effectively ending the discussions. A total of fifty-one faculty and staff from CUMC volunteered for military service in Europe, and two professors died in battle. During the remaining year and a half of the war, CUMC initiated a number of military activities to support the war effort. Summer instruction for members of the senior class took place in 1917 so that students could graduate early in January of the following year.113 All 110 students who registered for classes for the 1917–18 academic year also enrolled in the Enlisted Medical Corps of the Army or the Naval Reserve Force Hospital Corps. CUMC allocated space for the War Department’s School for Military Roentgenology, which was directed by the Surgeon General’s Office. Over the course of a year, the school provided instruction to three hundred medical personnel, plus a number of technical students, on the use of X-ray equipment and the identification of foreign bodies and fractures. In response to a request from the Surgeon General’s Office, CUMC introduced a course on fractures and war surgery that was attended by 26

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Origins

ninety officers from the U.S. Army Medical Reserve Corps. A  reclamation class was also started, which aimed to help individuals who were unable to volunteer for military service for physical reasons “to develop by medical and physical examination and training a physique to enable the applicants to pass the requirements of the service.” Individuals who were rejected at recruiting stations were referred to the class, where they received a thorough medical exam and “physical training calculated to increase their weight and physical development.” Of three hundred men who registered for the course, about a third were subsequently accepted for enlistment.114 Base Hospital Number Nine was a military unit formed entirely of medical and nursing staff from New York Hospital, which included some CUMC faculty and graduates. After the unit was mobilized on July 21, 1917, officers and enlisted men assembled at Governor’s Island, while nurses and civilian employees went to Ellis Island. Personnel consisted of 28 officers, 54 nurses, 5 civilian secretaries, and 150 enlisted men. On August 7, the unit left for France aboard the Finland. A hospital was set up in Châteauroux, France, and began admitting patients on September 15. It cared for more than fifteen thousand soldiers of the American Expeditionary Forces through January  14, 1919, when the hospital was officially turned over to another base hospital and the unit was demobilized. Remarkably, only 154 patients admitted to the hospital died, including 21 who were dead upon arrival. During the war, the unit treated primarily battle wounds and infectious diseases. In the spring of 1918, it was designated as the orthopedic center for the American forces in France, although it continued functioning as a general hospital. In July 1918, the worldwide pandemic of influenza afflicted 60 percent of the unit’s members, although the course of the disease at the base hospital was initially mild, with no deaths occurring during that first outbreak. Later in the fall, a large number of severe cases of bronchial pneumonia occurring as a complication of the flu were admitted to the hospital, and at least twenty-eight people died. A total of 1,041 flu cases were seen by the time the unit was demobilized.115 Toward the end of the war, the Clinic for the Functional Re-education of Disabled Soldiers, Sailors, and Civilians opened in July 1918. The only clinic in New York City offering specialized treatment for disabled patients, it was affiliated with CUMC under the direction of W. Gilman Thompson, then emeritus professor of medicine, and was used to instruct students in new methods of medical science developed during the war.116 The end of World War I coincided with the deaths of three of the founding fathers of CUMC and marked a turning point for the medical college. Oliver Payne, William Polk, and Lewis Stimson all died in 1917 and 1918, leaving the school without its primary benefactor, inaugural dean, and founding professor. Colonel Payne died first, on June 27, 1917, at the age of seventy-eight. During 27

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CHAPTER 1

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his lifetime, he had given the medical college a total of $8 million, in addition to a $500,000 bequest included in his will (for a total of $158  million in inflation-adjusted dollars).117 Payne Whitney, Colonel Payne’s nephew through his sister, inherited much of his fortune and in later decades would himself become a key benefactor of CUMC and of New York Hospital. Lewis Stimson, who cared for Colonel Payne during the last year of his life, died on September 17, 1917, in Shinnecock Hills on Long Island while walking his dog, after a morning playing golf. He was seventy-three years old.118 William Polk died on June 23, 1918, in Atlantic City at the age of seventy-four. Ten years later, his son Frank presented a bronze plaque with “a remarkably striking portrait of Dean Polk” to the medical school.119 Until the end of 2014, it hung near the main entrance of the medical school across from a plaque honoring Dr. Stimson and close to one memorializing Alfred Loomis. Farther down the hall, a large wooden plaque commemorates the college’s establishment in 1898 and the generosity of Colonel Payne and his heir Payne Whitney. Cornell University Medical College owes its existence to these men and their colleagues.

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2 Clinical Innovation and a Historic Partnership I wish to emphasize again the great need of the Cornell University Medical College, its one great defect—a hospital of its own or one which it can control absolutely. Without it we cannot progress; without it we shall retrogress.

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Walter Niles, “Report of the Acting Dean of the Medical College,” 1918–19

The last year of World War I was “undoubtedly . . . the most trying in the history of the College,” according to acting dean Walter Niles. The combat overseas had taken its toll, with a third of the teaching staff away on military service and all the departments engaged in war-related activities. Student instruction was disrupted with the initiation of the Student Army Training Corps, a short-lived, nationwide program implemented by the War Department in 1918 to train students as soldiers. And in January 1918 the so-called Spanish flu pandemic struck New York. The outbreak was so severe “that every person with any medical training whatsoever [was] engaged in caring for the sick.” For more than a month, third- and fourth-year students were spending most of their time tending to patients in city hospitals, primarily Bellevue.1 It was not until the spring of 1921 that Niles was able to declare that “for the first time since 1915 the Faculty feels that the work of the College has been normal in its accomplishments both in teaching and investigation. It was very evident last year that neither students nor teachers had regained their poise.”2 By 1921, plans to join with New York Hospital in constructing a new medical center had also begun to take form. The aftermath of World War I brought wide changes to the practice of medicine. Considerable technological advances were made in wound management, reconstructive surgery, radiology, and internal medicine. Psychiatry, orthopedics, and plastic surgery emerged as new specialties, which reflected a larger shift

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CHAPTER 2

within the profession toward specialists and away from general practitioners. By 1923, twenty-three specialist fields were listed in the American Medical Association directory, although this trend was not welcomed by all.3 As Cornell’s head of surgery wrote in 1927, “Specialization, if carried farther, will completely dismember surgery and medicine, in fact, it has almost done so already.”4 Wartime medicine also produced doctors trained to be highly efficient and accustomed to the organization of military hospitals. As a result, record keeping improved, and physicians started relying increasingly on modern diagnostic tests and technologies. Doctors in large cities like New York made fewer house calls and instead began to see patients primarily in hospitals, either as inpatients or as outpatients at clinics or private offices. This shift toward hospital-based care occurred because hospitals were more likely to have X-ray machines, as well as fully equipped and staffed laboratories. Yet the same level of care was not available to all patients. The poor, who had previously been treated at dispensaries, started to receive free care from hospital outpatient clinics. Patients who could afford better care—like the wealthy elites portrayed in F. Scott Fitzgerald’s classic novel of the decade, The Great Gatsby—chose private specialists. The urban working and middle classes who made up “the mass of wage earners . . . fell into some kind of no-man’s land” and “virtually by default, made the most use of general practitioners,” according to health policy historian Rosemary Stevens.5 The creation of the Cornell Pay Clinic in 1921, a major development at the medical school, attempted to remedy this situation by offering specialized care to middle-class patients at a reasonable price. It also served as a temporary and partial substitute for the dedicated teaching hospital that Walter Niles longed for. Socially, the Roaring Twenties were a time of change and contradiction. Women experienced greater independence, as epitomized by the image of the “flapper,” while young people enjoyed the rise of mass culture and the dawn of the Jazz Age. At the same time, Prohibition attempted to regulate public morality and protect society from the evils of alcohol abuse, forcing liquor consumption to go underground. It was a time characterized by a growing conflict between the ideals of rural, small-town voters associated with Protestant churches and those of Americans living in urban centers, where women, immigrants, and African Americans were becoming increasingly integrated in mainstream society. At Cornell, one particularly timely research project became embroiled in the politics of Prohibition. Headed by anatomist Charles R. Stockard in collaboration with George Papanicolaou, the study was reported in extensive detail in the New York Times and other publications. In 1910 the two researchers had begun investigating whether chronically exposing male guinea pigs to alcohol would produce changes in their offspring. What they discovered was that guinea pigs that were heavily intoxicated for six days out of the week 30

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Clinical Innovation and a Historic Partnership

produced a second generation of weaker offspring, but the fourth generation of offspring was stronger and healthier than the average guinea pig. When the study was reported in 1922, during the first years of Prohibition, Stockard interpreted its results to indicate that alcohol could have a beneficial effect on the human race. Over the long run, it “weed[s] out the unfit” who become alcoholics and who tend “to kill themselves early and to have fewer offspring.” The New York Times article opens on a provocative note: “The guinea pig which attained the greatest age ever recorded for a guinea pig was drunk every day of its life except Sundays since it was one year old, according to official reports of the Cornell University Medical School, where large numbers of guinea pigs have been made drunk daily for twelve years.”6 Although the experiments were initiated before the start of Prohibition, Stockard felt that they showed there was nothing inherently injurious about alcohol—a view he reiterated in 1924, further dismaying temperance advocates. Walter Niles and the Dean’s Office

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Appointed acting dean in 1918 following William Polk’s death, Walter Niles officially became dean the following year at the age of forty-one and served in this capacity until 1928.

Figure 2.1 Walter Niles, MD. (Courtesy of Medical Center Archives of NewYork– Presbyterian / Weill Cornell.)

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Walter L. Niles Walter Lindsay Niles was born in 1878 in the small town of Lebanon, New York, roughly forty miles southeast of Syracuse. Descended from ancestors who had arrived from England in 1634 and from Scotland in 1645, he grew up in the part of Lebanon known as Niles Settlement, where many generations of his family had lived. In 1896, Niles won a scholarship that enabled him to enter Cornell University’s School of Civil Engineering. As an undergraduate, he was actively involved in student life. He rowed crew as a freshman and sang in the glee club. During his senior year, he became chair of a committee that published the illustrated volume Songs of Cornell, which included pieces such as “Cornell Chimes,” “The Girls of Ithaca,” and “Ye Gallant Sophomore.”7 When his father died in 1898, Niles decided to change his career path from engineering to medicine. He graduated from CUMC in 1902 and served as an intern for two years at Bellevue Hospital. While there, he met Dr. W. Gilman Thompson, then professor of medicine at CUMC, who persuaded him to stay in New York to practice medicine after his internship. Soon thereafter, Niles was appointed to the staff of Bellevue Hospital and began to conduct metabolic research at the Russell Sage Institute. He later became an attending physician at the New York Hospital and a consulting physician at Bellevue, as well as at the Memorial Hospital, the New York Infirmary for Women and Children, and the Southampton, Nassau, and Jamaica Hospitals. On May 20, 1908, Niles married Louise Vezin, with whom he had four children. At the start of World War I, Niles received a telegram from Dr. Theodore Janeway, a professor of medicine at Johns Hopkins, who had joined the U.S. Army Service Medical Corps as a major. Janeway offered him a similar commission, and although Niles was tempted to accept, he was convinced by others that he could best serve his country by continuing to teach medicine. In 1916, he was appointed professor of medicine at CUMC and served as its second dean from 1919 to 1928. Niles was highly involved with the New York Academy of Medicine following his election as a fellow in 1908, and he was also a member of the Association of American Physicians, the American Clinical and Climatological Association, and the Harvey Society. He had diverse clinical and research interests, publishing papers on topics ranging from duodenojejunostomy to atrial fibrillation to the bacteriology of sputum in non-tubercular respiratory tract infections.8 In 1941, he became acting dean for the second time after CUMC’s fourth dean, William Ladd, retired because of illness. Niles held this post briefly, until his own death on December 22, 1941, following a cerebral hemorrhage.9 32

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Clinical Innovation and a Historic Partnership

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Whereas Dean Polk made a forceful impression on people, Niles appears to have had a milder temperament. According to a memorial statement penned by a fellow member of the New York Academy of Medicine, “People liked him and he liked people. I heard one man give the following reason for his success in the practice of medicine, ‘People felt safe in his hands.’ ”10 Cornell historian Morris Bishop described him as “a most capable and popular administrator.”11 McKeen Cattell, who had worked in the Russell Sage Institute of Pathology and later became chair of pharmacology at CUMC, remembered Niles as committed primarily to his clinical duties: “We had a dean, Dr. Walter Niles, who let things alone, as far as I know, and who had a practice all the time he occupied the deanship.”12 Other sources indicate that Niles’s strength lay in education. An evaluation by the head of medicine indicates that he was considered one of the medical school’s best teachers prior to becoming dean.13 Connie Guion, who graduated first in her class in 1917 and spent most of her career at Cornell, described him as being one of her favorite professors in medical school. In her biography, she recalled in particular his enthusiasm for Sir William Osler’s classic volume, The Principles and Practice of Medicine: “ ‘Let Osler be

Figure 2.2 Alumna Connie Guion completed her residency at the Second (Cornell) Medical Division at Bellevue Hospital; she is shown here with a Bellevue motorized ambulance in 1918. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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CHAPTER 2

your Bible,’ Dr. Walter Niles told the students. ‘There is no textbook in existence that can compare with his. It will give you a peg on which to hang the physical examination and history of every patient. Moreover, it’s filled with philosophy and is excellent reading.’ ” Under Dr.  Niles’s strict supervision, Guion and her classmates went through Osler page by page, studying each disease in detail.14 In addition, Niles was not afraid to speak his mind. In 1927, he lectured at a meeting of a New York merchants association, arguing that many of the world’s problems could be linked to poor health: “It is possible that if the Kaiser had not been affected with a physical deformity [a withered arm] he would not have developed a defense reaction against an inferiority complex and the World War would not have occurred. It is possible that some of Mussolini’s belligerent moods may be traced to a poor digestion.”15 A letter written by Miss Jessie Andresen, who was formerly Dean Polk’s assistant, to her new boss Niles in July  1920 provides some insight into the day-to-day functioning of the Dean’s Office. Andresen, who served as an administrator beginning with the college’s founding in 1898 and continuing until her death in 1933, had strong views about what she saw as an arbitrary division between faculty and student affairs. Under Polk, the Dean’s Office had dealt primarily with matters concerning the faculty, while the Secretary’s Office had handled student issues. Part of the reason behind this split was a conflict between the two offices, which Andresen implies originated with the secretary Dr. Jeremiah Ferguson: “Arbitrary lines will bring the old ugly arbitrary spirit. The offices are now co-operating. We are working together and helping each other. If the attitude which inadvertently came out the other day ‘then you will have nothing to do with the students’ prevails, in other words, personal prejudice, the old method of keeping the doors closed between the offices will again go into effect, all my last year’s hard work of ‘helping each other’ will be lost, and we might as well close up shop.”16 Expressing a genuine interest in student welfare, she encouraged Niles to take a more active role in student concerns. For example, she suggested that after student registration and the official welcoming address, the dean hold an informal reception: “the student will be made to feel that he is welcomed by the Faculty, and that the Dean is not Jove sitting in judgment, but a human being glad to see them. I think this will have an excellent effect upon the Ithaca students, and will take from the feeling that they are unwelcome in New York.” Andresen also proposed that student health be handled by the Dean’s Office since the secretary, Dr. Ferguson, “was seldom in his office and it seems to me there should be some one with some experience in these matters to send the student, in case of emergency, to the proper person.” She cited several examples where students turned out to have much more serious health issues than initially recognized: “Last winter a case of chronic appendicitis was 34

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Clinical Innovation and a Historic Partnership

operated on because the request for rhubarb and soda for intestinal indigestion brought forth a suggestion that it might be well for the student to consult some one. A case of serious ‘eye trouble’ was found to be kidney trouble. ‘Indigestion’ was again found to be ulcers of the stomach.” Andresen made several additional suggestions, such as having the Dean’s Office supervise the dispensary staff and monitor student visitors. She also requested “as a matter of sentiment” the “privilege of keeping the Alumni records and making up the records for the Polk prizes” since “Dr. Polk turned that over to me.” In addition, Andresen prepared a list of administrative tasks that the Dean’s Office and Secretary’s Office had traditionally been responsible for. For the Dean’s Office, these included the dean’s correspondence, filing, faculty appointments and resignations, other faculty matters, work for committees, distribution of senior final exam grades and diplomas, and the budget. Andresen’s tone indicates that she had clear views about how the Dean’s Office should be run and that she saw Walter Niles as an approachable figure open to feedback. For example, she wrote: “Of course I  realize that I  don’t know what your plans for the future are, and I  suppose you are entitled to some expression of them, but I only want to make the foregoing suggestions. If they don’t seem wise or feasible, why you know best, but I think you realize all I want to do is to help the College. The personal equation does not count.” She concluded the letter with some spunk, “Please tell me to mind my business, if I have been officious.” Her letter offers a hint that, while Niles and other deans may have been the public face of the medical college, much of the daily work was conducted behind the scenes by dedicated and caring staff.

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The Cornell Pay Clinic

The establishment of the Cornell Pay Clinic, an innovative experiment designed to address the health care needs of the emerging middle class, helped extend the medical school’s reach clinically. Created by Lewis Conner, a cardiologist who later cofounded the American Heart Association, it charged moderate fees and offered comprehensive clinical services to middle-income patients who could not afford private physicians but were not entitled to free care.17 A New York Times article announced its opening on November  1, 1921, and noted that it was “the first of its kind to offer general medical service in this city.” The article continued: “The pay clinic will occupy three floors in the wing of the college building formerly occupied by the dispensary. It will be open every afternoon from 1:30 until 4 o’clock, except Sundays and holidays. To those who cannot afford absence from work in the afternoons, evening clinics will also be open on Tuesdays and Fridays until 7 o’clock. The clinics will be under the direction of the Cornell medical faculty, which includes some of the most distinguished physicians and surgeons in New York.”18 35

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The decision to open the clinic was motivated by the results of a survey conducted by the Public Health Committee of the New York Academy of Medicine on the dispensary situation in New York City. The survey recommended the establishment of a clinic targeted at middle-class patients, which would be governed by a medical college or a hospital and involved in the teaching of students. Walter Niles described the needs of this segment of the population in the New York Times:

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For some years there has been a growing recognition on the part of physicians, social workers, and others interested in public health that there is great need of some agency through which diagnosis and treatment by specialists can be brought within the economic means of persons of ordinary income. The great proportion of the city’s wage earners are self-supporting, but they do not have sufficient margin of income to pay the office fees of specialists. It is estimated that more than two million persons in Greater New York are faced with the alternative of accepting charity or going without the skilled medical attention which their condition may demand.19

Medical social workers determined eligibility for services based on income, family size, and cost of treatment. When it first opened, the clinic charged an admission fee of $1 per visit ($13.30 in inflation-adjusted dollars), plus supplementary fees for special tests or services. These extra fees were still very reasonable: prescriptions cost 25 cents (equivalent to about $3.30), lab tests cost from 50 cents to $5 (or about $6.50–$66.50), X-rays were $2.50–$12.50 (or about $33–$166), and gastrointestinal studies cost $25 (or about $330). 20 Admission fees were subsequently raised to $1.50 in June  1923 (or about $20).21 Still, average charges to the patient were about 40 percent of what general practitioners and 20 percent of what specialists in private practice charged. 22 The clinic received support from the Commonwealth Fund and the Rockefeller Foundation through the United Hospital Fund, which helped cover its operating costs. About six months after it opened, the clinic cost $16,500 per month to run (equivalent to about $234,000 in 2014 dollars), and its average monthly deficit of $3,500 (or $50,000) was steadily decreasing.23 The new clinic received a flood of media attention when it opened and was soon overwhelmed by visits. On its first day of operations, the clinic’s 76 physicians treated more than 250 patients and scheduled appointments for 750 more the following week.24 In order to maintain the quality of service, the clinic had to turn away a large number of patients. Still, 18,803 people were seen during the clinic’s first five months, and many returned for repeat visits, mostly for the treatment of chronic diseases. After four months of operation, the clinic had 110 physicians on staff and 78 nonmedical personnel, including administrators, nurses, a historian, pharmacists, technicians, orderlies, and cleaners. Some of the 36

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Clinical Innovation and a Historic Partnership

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clinic’s physicians held teaching posts at CUMC, and senior faculty from the medical school also visited the clinic for teaching purposes.25 Other facilities, including the Neurological Institute of New York, the Brooklyn Hospital Dispensary, a diagnostic clinic at Massachusetts General Hospital, and dispensaries in Chicago and Cleveland, were similarly geared toward middle-class patients, although they were not called pay clinics. What was unique about the Cornell model was that it offered both diagnosis and treatment, provided by a wide variety of specialists in a private office environment. This allowed for a personal relationship between doctor and patient—an amenity typically available only to the wealthy at that time. 26 Another innovation was that staff physicians were appointed by Cornell and paid a salary for their services. Physicians who worked at charity clinics were not usually remunerated for the care that they provided.27 In newspaper accounts, Niles assured the public that the pay clinic would cooperate, not compete, with New York medical societies and physicians in private practice. General practitioners were welcome to refer needy cases to the clinic for diagnosis or a single consultation, then a report would be provided to the referring doctor for subsequent treatment. Physicians were also welcome to accompany their patients to the clinic. 28 Despite these friendly overtures, the clinic soon attracted its share of controversy, for two reasons. First, doctors and medical societies objected to the clinic as a source of unfair competition for patients who they felt should be paying private physicians’ fees. On March  29, 1922, a joint meeting of six local and state medical societies decried the pay clinic. Sensational headlines drawn from the remarks of two speakers at the meeting proclaimed that the clinic was “socialistic” and “one of the greatest crimes ever committed.” Dr. Henry Berg objected to the clinic on the grounds that its low prices went against the principles of American capitalism: When Cornell gives a clinic for $1 the patient gives $1 because Cornell is behind it. And if for his dollar he receives the services of a young and inexperienced man the money is taken under false pretenses in the name of Cornell. The human being born under the American flag wants to pay for what he gets. If you pauperize the citizen of the United States you take away his self-respect. There never was a socialistic proposition that was not offered on the grounds of philanthropy or patriotism. There is no reason why this clinic should exist and there is every reason why it should not. Cornell’s pauperizing of the middle classes is one of the greatest crimes ever committed.

Dr. L. I. Harris’s dislike for the clinic was more straightforward and was reportedly cheered by many physicians in attendance: “It is not pauperizing the patient so much as pauperizing the doctor that we oppose. Those who advocate pay clinics would obligingly take from us the middle classes.”29 37

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CHAPTER 2

The second objection was that the clinic had violated medical ethics by advertising its services in newspapers when it opened.30 According to Dean Niles, the faculty had been embarrassed by the amount of publicity that had been generated with the opening of the clinic. The Cornell faculty responded to the criticism by speaking at medical societies in more detail about the clinic’s fee structure and policies, opening it up for visits by other physicians, and limiting additional announcement of its work to individual physicians and medical journals. Gradually, much of the animosity died down, although the clinic was still drawing fire from the County Medical Society in 1928 for offering treatment to patients of moderate means, instead of merely diagnostic services.31 Dean Niles wrote several articles about the Cornell Pay Clinic in its first few years of operation, which provides an indication of both the facility’s novelty and its importance to him and the medical college. In Modern Hospital, five months after the clinic’s opening, he proclaimed that “the aim of the college to improve the material available for the instruction of students has thus far been achieved.”32 He also gave two lectures to the American Clinical and Climatological Association, of which he was a member. The first was delivered just a few months after the clinic opened. At that point, he described it as “an experiment in medical sociology” that would address “a distinct and growing strain in the relations between the public and the medical profession”: “It is true that only the very rich and the very poor can command the best medical service today, thus leaving the great mass of industrious and ordinarily self-supporting wage-earners to accept incompetent service or charity, for which they have no relish, when serious or prolonged illness overtakes them.”33 He also connected the Cornell model to changes in the profession of medicine: “It is no longer possible for one man to be conversant with, and skilled in, all of the methods essential for a complete diagnosis in a considerable percentage of cases, particularly the chronic conditions, and to assure a high quality of service various specialists must be consulted and extensive laboratory investigations must be made.”34 In other words, the pay clinic model represented a new trend in the provision of comprehensive medical care to the average patient. The second lecture to the American Clinical and Climatological Association was delivered in 1925, after the clinic had been in service for three and a half years. By then, it averaged about twenty thousand patients who were seen for a total of 115,000 visits per year. The typical patient was “one of a family of two or three members with a combined income of about $2,400.00 per year”—nearly $33,000 in today’s dollars—an economic group that represented more than two-thirds of the families in New York City.35 Medically, the patients had conditions that were more complicated and obscure than average, and the majority required consultation with specialists and relatively costly diagnostic procedures. Thus, the “proper handling of the patients [is] considerably more 38

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Clinical Innovation and a Historic Partnership

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time consuming and therefore more expensive than [for] the average dispensary patient.”36 Still, the clinic was considered a resounding success and filled a major need for the city’s population. Starting in 1926, the clinic was directed by Walter Klotz, an assistant professor in public health.37 In 1929, Connie Guion, one of CUMC’s most illustrious alumna and one of the first women to be appointed a professor of clinical medicine in the United States, became chief of the general medical clinic at the Pay Clinic.38 In Guion’s first annual report on the clinic, submitted just one month into her new position, she wrote: “As I understand the work entrusted to me it is first, to render to the patients the best medical service known to present day medicine[,] second, to train the medical staff to render such service[,] third, to teach the students to render such service[,] fourth, to organize the department so that the work may be done with such efficiency that the cost of the service will fall within our budget.”39 After reviewing this report, clinic founder Lewis Conner wrote to Walter Klotz: “Dr. Guion has entered into her new work with an enthusiasm and an energy that are quite beyond praise and I feel sure that the beneficial results of her activities are already apparent and will become more so as time goes on.”40 In addition to offering affordable, high-quality patient care, a primary goal of the clinic was to improve the teaching of medical students. A. Parks McCombs, a member of the class of 1929 and a nephew of Guion, described what it was like working at the Cornell Pay Clinic: The clinic was located in a big room, which was curtained off into cubicles where we interviewed and examined our patients. The set-up left something to be desired, as often a doctor with a stentorian voice asked questions several booths away and we would find our patients answering them! On the other hand, the morale of the staff was excellent, and all of us had a great loyalty to the clinic. . . . Each new patient was allotted an hour, and revisits were allotted 15 minutes, and we each followed our patients for as many revisits as they made. In addition, each of us practicing physicians was assigned one or two students for tutorial-type instruction. There were always senior doctors who were available to discuss problems with the students or the staff.41

The clinic provided a rich source of clinical material for student learning, although it appears that some faculty members felt that greater educational use could be made of it. Russel H. Patterson, the head of surgery, wrote in 1929: “We want to call attention again to the faculty of Cornell that the clinic is not being utilized as much as it should be for teaching purposes. Most of the doctors of the clinic work there for what they can learn, and if this be so why could not the students learn even more? How does one handle a patient in his private office.—This phase of a doctor’s education is neglected in our medical schools and in our hospital internship, but can be learned in Cornell Pay Clinic.”42 39

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The Cornell Pay Clinic operated for an additional three years under Klotz’s and Guion’s leadership, before closing on August  15, 1932, when CUMC moved to new facilities. After the conclusion of the ten-year experiment in medical care, the clinic had a small deficit of $2,000 (or $35,000, after adjusting for inflation), which was easily offset by $20,000 in funds that had been set aside for conducting research and meeting any potential debts. The plan was to continue to provide medical service to individuals of moderate means through the outpatient department of the New York Hospital at its new medical center.43 Klotz continued as director of the outpatient department until his death in 1941, and Guion remained chief until her retirement in 1953.

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Toward a New Medical Center

During the 1920s, Cornell’s medical school settled into the business of educating doctors. Entering classes were capped at sixty students, with approximately one-third commencing their studies in Ithaca and two-thirds in New York.44 Niles worked to bridge the physical distance separating the two campuses by encouraging reciprocal visits by faculty and administrators to learn about each other’s interests and concerns. The medical college’s first Alumni Day was held on May 16, 1921, and welcomed returning graduates with clinical demonstrations and a variety of social events.45 By then, most of the founding faculty had retired, and new department heads, including Lewis Conner in medicine, Charles L. Gibson in surgery, George Gray Ward in obstetrics and gynecology, Oscar M. Schloss in pediatrics, and George H. Kirby in psychiatry, had been appointed in their stead.46 Many of these physicians were considered leading authorities in their fields, which helped buttress Cornell’s reputation. Improvements were made to the curriculum and student life. After several years of studying the curriculum, the Committee on Educational Policy recommended a substantial reduction in the total number of hours required for structured study, more free time in the afternoons for students to work independently, and more in-depth focus and improved coordination between subjects. According to Niles, “while it is probable that under the new schedule students will learn fewer facts it is hoped that it will permit better individual development and that they will acquire more knowledge.”47 A  unit of the Reserve Officers’ Training Corps was organized during the 1921–22 academic year, and twenty-four students enrolled. The YMCA, in association with New York University and Cornell, opened a cafeteria and a club room for medical students. Efforts were made to increase faculty and student interaction, through social activities, club meetings, and an advisory system. The faculty additionally adopted a plan to conduct annual medical exams and provide better health care for students when they became sick. Cornell also arranged 40

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Clinical Innovation and a Historic Partnership

an affiliation with the John E. Berwind Maternity Clinic, which provided obstetrical care in patients’ homes. Under the terms of the affiliation, Cornell directed the clinic and appointed its staff, and students worked and resided at the facility for two-week periods.48 While these developments positively impacted student life and learning, student housing remained a problem, since “it is now almost impossible to find hygienic surroundings within a reasonable distance from the College at a price which can be met by the students,” a complaint that would doubtless still ring true to many university administrators today.49 Niles viewed the need for a student dormitory the second most pressing problem faced by the medical college, after the need for a close affiliation with a large hospital. The idea of merging Cornell’s and Columbia’s medical schools, New York Hospital, and Presbyterian Hospital into one medical center was not pursued after World War I. However, CUMC continued to explore other options for creating a medical center throughout the 1920s. A  primary motivation was practical: the college had simply outgrown its building on First Avenue. A comment in 1930 by Walter Klotz, director of the Cornell Pay Clinic, hints at the need for better facilities: “Considering present physical conditions, the terrific noise of traffic on First Avenue and 27th Street, the glaring sun, during the hot summer months, especially in the Department of Medicine, on the 27th Street side, together with working conditions in the crowded cubicles, the quality of the medical work being done in our Clinic is worthy of commendation.”50 Another comment by the head of otology similarly indicates a need for updated equipment, in addition to providing a glimpse into medical treatments of the time: “In regard to equipment I would advocate a little better arrangement for treatments. We have a receptacle of wood hollowed out to receive a few bottles of medicine such as Mandl’s, silver, alcohol and cocaine. It is the same type of receptacle I used in the Eye & Ear Infirmary 30 years ago and no doubt the idea was borrowed from that institution. Of course it is not up to date nor what would be expected in a clinic like Cornell. The patients expectorate into a tin pail into which are also thrown cotton waste and wooden tongue depressors.”51 In addition, a new medical center, established in collaboration with a hospital affiliate, was needed in order for CUMC to strengthen its clinical teaching program, as Abraham Flexner had indicated in his 1910 report. According to an early proposal from Cornell to the New York Hospital, an affiliation was essential in order for Cornell “to train practitioners of medicine, and to engage in and prepare men for research into the nature, treatment and prevention of disease,” which requires “abundant clinical material and the hearty co-operation of the hospital.” For its part, New York Hospital would benefit because it was “dependent upon the medical colleges for its professional staff and demands men of exceptional training.” A combined institution would “attract men of the highest talent” “from an unlimited field.” Although 41

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academic medical centers now play a well-recognized, multifaceted role in the United States, at the time the affiliation was being contemplated, such was not yet the case. As noted in the proposal to the New York Hospital, “The prevailing practice of operating hospitals and medical schools as independent and distinct or loosely affiliated organizations has hampered the progress of both, and it is the full realization of this fact which has initiated the movement in this country toward a more intimate and complete union of these organizations. This is not a novel experiment for close affiliation of medical schools and hospitals has been in practice in foreign countries for many years past.”52 Cornell’s goal at the time was to create a medical institution of the future, which would be devoted to advancing the field of medicine through the care of the sick, education of physicians, facilitation of research, and prevention of disease. In 1920, a committee of the New York Hospital Board of Governors, led by board president Edward Sheldon and vice president Payne Whitney, began to develop plans for a new medical center. Payne Whitney was the nephew of CUMC founder Oliver Payne and through his influence had joined the board of the New York Hospital in 1912. The committee was asked to consider how the hospital could develop its educational capacity and what an affiliation with a medical school or university might look like. It focused on an Upper East Side location, although another site that had been considered by Cornell was in the west Bronx near the Harlem River and 175th Street, since “prices for property on Manhattan Island are prohibitive, or at least so much higher than in other districts.”53 At nearly the same time, Presbyterian Hospital and Columbia University initiated plans to create a medical center on the Upper West Side at Broadway and 168th Street. In April 1920, Edward Sheldon and Payne Whitney met confidentially with the philanthropist Edward Harkness, who had donated land and money for the Columbia-Presbyterian Medical Center, which opened in 1928, to inquire about that project and possible sources of funding for their own medical center. It appears that Harkness pointed them in the direction of Abraham Flexner, who at that time headed the General Education Board of the Rockefeller Foundation.54 In April 1921, the New York Hospital committee submitted a memorandum to the Cornell Committee on Educational Policy about the possibility of establishing a joint medical center. That document was the product of more than a year of discussion, and at that point it was determined that the Cornell Board of Trustees should appoint its own committee to help move the negotiations forward. During the rest of 1921 and on into the beginning of the next year, the Cornell Board of Trustees committee, Dean Niles, and Cornell University president Livingston Farrand all weighed in on various points made in the affiliation agreement proposed by New York Hospital. 42

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Clinical Innovation and a Historic Partnership

Several major concerns emerged. First, would the affiliation be permanent, or would it terminate after a period of time? Second, New York Hospital wanted the joint administrative board that would oversee both institutions to have a majority of members from the hospital; quite naturally, Cornell pushed for equal representation. Third, who would own the title to the land underlying the buildings of the two institutions? This question in particular was never fully resolved and would return to generate considerable controversy and distress seventy years later. Collectively, the correspondence related to the proposed affiliation agreement reflects concerns on both sides that the prestige and reputation of each institution be properly recognized. For example, in discussing the order of the names for the joint institution, Niles wrote: “In New York City the long and distinguished career of the New York Hospital is universally known and appreciated and its name carries great prestige and distinction. Its fame is nevertheless of necessity chiefly local. On the other hand, Cornell University, in common with other great universities, is known educationally not only throughout the length and breadth of this country but in most other countries as well.” Similarly, the Cornell trustees committee objected to a line included in the hospital proposal that read, “The University lacks adequate endowment for the conduct of its Medical College in the most efficient manner.” Instead, it requested that the sentence be replaced to read: “The University desires such association for the purpose of broadening the scope of its Medical College and increasing its usefulness.”55 Such technicalities were amicably resolved through successful revisions of the proposed agreement. Before plans for the New York Hospital–Cornell Medical Center were even formalized, Payne Whitney proceeded to secretly purchase $2,750,000 (or about $39 million nowadays) worth of property along the East River between Sixty-Eighth and Seventieth Streets as a possible site. By 1924, New York Hospital board president Edward Sheldon had met with representatives from the Rockefeller Institute for Medical Research, which was located adjacent to the East River property, and with the Boston architectural firm Coolidge, ­Shepley, Bulfinch and Abbott, which would end up designing the New York Hospital–Cornell Medical Center complex. Tragically, Payne Whitney died of a heart attack on May 25, 1927, while playing tennis on Long Island, but he left a considerable bequest to both New York Hospital and CUMC that would make his dream of a new East River medical center a reality. The provisions in his will included $12.4  million for the hospital (about $170 million in inflation-adjusted dollars), $2.8 million for the medical college (or $38 million), and $6.2 million (or $85 million) to create a neurological or psychiatric clinic, which was later established as the Payne Whitney Psychiatric Clinic.56 During his lifetime and through his estate, his total contribution to New York Hospital amounted to $44  million, or almost $600  million in 43

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today’s dollars.57 At a meeting of the governors of New York Hospital on June 7, 1927, Edward Sheldon memorialized Payne Whitney: “It is known to but few with what discerning judgment, with what fertility of suggestion and with what patient attention he applied himself to the many problems involved—administrative, scientific, and educational.  .  .  . Notable success seems now beginning to crown all his efforts, but by a sorrowful fate he cannot enjoy the happy realization to which he had so fondly looked forward.”58 As a direct result of Payne Whitney’s generosity, an agreement for CUMC and New York Hospital to jointly establish a medical center was signed a week later—only three weeks after Whitney’s death—on June  14, 1927. E. Hugh Luckey, who later became dean of the medical college and director of the medical center, believed that Whitney might have been contemplating not just an affiliation of the hospital and medical school, but possibly even a merger.59 The final version of the affiliation agreement specified that New York Hospital would purchase the land and construct a new general hospital that would include space for clinical care, student education, and medical research. Cornell University would maintain the facilities for the medical college: “On the completion of the new building or buildings . . . the Hospital shall grant to the University every facility for the teaching of students and physicians and the prosecution of research. . . . The University shall supply or obtain from other sources the funds needed for its equitable proportion of the cost, maintenance and conduct of the premises and facilities required for Medical College purposes.”60 No mention was made of which institution would hold the title to the land and buildings, and no period of time that the affiliation would be in effect was specified. One of the major motivations for the hospital was “the importance of rendering a larger, better and more important service to the sick of the community and to medical education and to medical science through a more intimate and organic association with the Medical College.” For its part, Cornell “wishes to associate itself organically with the Hospital thus reconstructed for the express purpose of developing the Medical School on advanced and steadily advancing university lines.” Jointly, the two institutions would be in a stronger position to improve the clinical training of medical students and to advance research by offering “opportunities which will attract to their staff and faculty the ablest teachers, investigators and physicians that are anywhere procurable.”61 Although “the Hospital and University shall each continue its independent corporate existence and control,” the affiliation specified that the educational, clinical, and research programs, as well as faculty and staff, would be fully integrated between the hospital and medical school.62 The New York Hospital–Cornell Medical College Association was formed. According to the affiliation agreement, the association would be governed by a Joint Administrative Board, which would include three New York Hospital 44

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governors, three Cornell University trustees, and a seventh member-at-large. The first members from the hospital included Edward Sheldon, hospital board president and financier; a banker and racehorse owner named William Woodward; and Frank Polk, a lawyer and son of former Cornell dean William Polk. Cornell University president Livingston Farrand, banker J. Du Pratt White, and Dean Niles were Cornell’s representatives. The financier J. Pierpont Morgan Jr. rounded out the seven-member board, although he did not attend any of the board’s early meetings.63 The responsibilities of the board included overseeing the association as a whole and formulating its general policies, planning the construction of new buildings, supervising medical education, negotiating with hospitals wishing to affiliate, and regulating and apportioning expenses. In addition, the board would approve all nominations for appointment to the hospital staff and medical school faculty. These nominations would be made jointly by the president of the hospital and the president of Cornell University. The Joint Administrative Board would also appoint a director, to be jointly nominated by the university and hospital presidents, who would administer the educational, clinical, and research activities of the new center. The director would serve as the executive officer of the joint board and also as the executive officer of the medical faculty and “[absorb], in his own person or in the person of other officers, the duties now attached to the Dean.”64 His responsibilities included fostering a positive working environment in the hospital, managing the educational and scientific budget of the medical school, and coordinating hospital and medical school activities “so as to avoid friction and to promote harmonious and effective co-operation in teaching, research and the care of patients.”65 His salary would be split between the medical college and hospital. The leadership of the hospital would remain in the hands of its highest-ranking medical and executive officers. Dr. G. Canby Robinson was appointed the first director of the New York Hospital–Cornell Medical College Association in 1927, with responsibility for developing and executing the plans for the medical center. Recruited from Vanderbilt Medical School, he was “an outsider . . . bound by none of the loyalties so likely to be disastrous in an amalgamation.”66 However, he was a strong personality, as the Joint Administrative Board would soon discover. Although Cornell and New York Hospital were to be equal partners in the joint venture, it appears that the hospital may have played a larger role at the beginning. Edward Sheldon, Payne Whitney, and the hospital board of governors were responsible for initiating early planning discussions and taking the first steps to acquire funding and land for the new complex, years before a formal agreement was made. Sheldon consulted with Abraham Flexner over a period of several years, and it appears that he was influenced by him to involve Homer Swift of the Rockefeller Institute Hospital in the planning for the medical center. Flexner’s brother Simon was a director of the Rockefeller Institute, 45

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and Swift may have been the initial candidate for the position of director of the medical center. In February  1928, Abraham Flexner wrote Sheldon a letter about the need to plan for future expansion, and in the opinion of New York Hospital historian Eric Larrabee, “decision-making was increasingly in the hands of men whose sole corporate connection was with The New York Hospital and not with Cornell, and they were indeed making decisions in which Cornell might have wished to participate.” As further evidence of this, Larrabee describes how the New York Hospital Board of Governors independently acquired a city block to accommodate additional buildings and grounds for the medical complex, at a cost of almost $3 million.67 Public announcement of the new medical center was made on October 30, 1927, as reported in the New York Times a day later. According to the article, the combined resources of the New York Hospital–Cornell Medical College Association totaled $60,650,000, or about $830  million in today’s dollars. Construction of the new buildings was expected to start in July 1928 and be completed two years later at an estimated cost of $11 million, with an additional $4  million going toward the purchase of the land (for a total cost of $210  million, after adjusting for inflation). At that time, the “present and promised endowment” of Cornell Medical College was $9.8 million, while the New York Hospital had an endowment of $15 million, plus assets of $5.7 million in other hospital buildings and equipment. In order to create the center, additional funds of $10  million for New York Hospital and $5  million for Cornell Medical College were required to supplement both institutions’ endowments. In the article, Sheldon is quoted describing a major organizational and educational change for the new medical center—a shift to a full-time system for clinical faculty: “Among the most important features of the new enterprise is that embodying the distinctive element of having the heads of the major clinical departments of the Medical College and Hospital free from the burdens of practice outside of the institution. There will thus be in the combined institution a group of men giving their entire time to the care of patients, to the teaching of students and to medical research without other remuneration than their salaries.” When asked about the relationship between the planned medical center and the neighboring Rockefeller University, Dean Niles gave a tepid response: “There is no connection between them but, of course, it may be expected that they will exchange courtesies which are often exchanged by such institutions.”68 His reply, the last sentence in a long article, gave no hint of the strong ties that the New York Hospital–Cornell Medical Center would forge with its medical and scientific neighbors in the future. Niles’s enthusiasm for the venture shone through in other venues. At the end of the 1927–28 academic year, he reported to Cornell University president Livingston Farrand that “events of the greatest significance have taken place 46

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which will inaugurate a new era in the history of the College.” After briefly summarizing the plans to create a joint medical center anchored by CUMC and New York Hospital, Niles described his successor, G. Canby Robinson, as a person “with rare experience in medical education as well as building construction, which with admirable judgment and a prepossessing personality guarantee successful and vigorous administration.” Niles clearly saw the joining of the medical school with a hospital affiliate as a transformative event: “Thus, after ten years of uncertainty, the future of the College is now assured.” Niles concluded his final annual report to Farrand gracefully: “I  desire to express my deep appreciation of the constant support and cooperation which has been accorded to me by every member of the Faculty; and particularly do I appreciate the confidence and stimulating association of the President without which the accomplishment of our plans for the College would have been impossible.”69

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3 A Move to Manhattan’s Upper East Side At the center of medicine is the sick human being, the sole reason for its existence. The center of the building contains the hospital, with the two departments of medicine and surgery, which rise toward heaven like a prayer for healing. . . . The specialist clinics branch out as separate wings.

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Henry E. Sigerist, American Medicine, 1934

One of the most pivotal periods in the history of Cornell University Medical College is also one of the most conflicted. Between 1928 and 1934, the medical college joined with New York Hospital to construct a new medical center on the Upper East Side at the site of its present location, making possible a greater integration of clinical, research, and teaching activities than ever before. Yet the individual primarily responsible for transforming Payne Whitney’s dream of a medical center along the East River into a reality, G. Canby Robinson, was for decades the only dean who did not have an official portrait hanging in the medical college. Just two years after the new complex opened on September  1, 1932, Robinson retired as dean of the medical school and director of the New York Hospital–Cornell Medical College Association. Although this decision was not technically forced upon him, it is clear his options were severely limited. This episode proved deeply painful to Robinson, and it stands in sharp contrast to the general atmosphere of enthusiasm, optimism, and progress that was ushered in with the opening of the medical center. Canby Robinson’s career coincided with major developments within ­academic medicine.1 Robinson’s experience as an undergraduate and medi­ cal  student at Johns Hopkins, termed “the country’s first modern medical school” by historian Kenneth Ludmerer, was a huge influence throughout his  career, and indirectly it shaped Cornell as well. 3 Robinson was taught

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A Move to Manhattan’s Upper East Side

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G. Canby Robinson Born in Baltimore on November 4, 1878, to Quaker parents, George Canby Robinson was educated in Quaker schools and attended Johns Hopkins University both as an undergraduate and as a medical student. As a senior medical student, Robinson hoped to pursue a hospital internship at Johns Hopkins Hospital but ranked in the middle of his class, just one place shy of qualifying for his desired position. After graduating in 1903, he traveled to New York to take a two-day competitive exam for internships at the New York Hospital and St. Luke’s Hospital. Although he was offered an internship on the private patient service at New York Hospital, he declined it and instead taught anatomy for half a year in the Ithaca division of CUMC. He ended up at the Pennsylvania Hospital, first as an assistant pathologist and then as a resident physician. In 1910 he was appointed senior resident physician at the new Hospital of the Rockefeller Institute in New York, an organization that, along with the Rockefeller Institute for Medical Research, was unique at the time for being dedicated to the study of medical science. While there, Robinson investigated the heart and circulation, conducting experiments using the recently introduced electrocardiograph machine. Robinson married in December 1912, and in September of the following year he left for St. Louis, just a couple of weeks after the birth of his first child, to become associate professor of medicine at the Washington University School of Medicine. After being castigated in Abraham Flexner’s report, Washington University had begun to reorganize itself along the Johns Hopkins model. Robinson contributed to this effort in various capacities, while rising to acting dean in 1917–18 and dean in 1919–20. In 1920 he became dean of Vanderbilt University’s medical school, although he did not reside in Nashville until 1924. Vanderbilt Medical School had recently received a large endowment from the General Education Board—a philanthropy created by John D. Rockefeller for which Flexner then served as secretary—so that it could raise the standards of medical education in the South. Robinson was given the responsibility of completely reorganizing the medical school faculty and constructing new buildings. A minor dispute ensued when Robinson, who had been chosen for the job by Flexner, submitted his reorganization plan simultaneously to the General Education Board and to the chancellor of Vanderbilt University, James H. Kirkland, instead of first having it approved by Kirkland. His plan, which involved relocating the medical school’s facilities across town to the main Vanderbilt campus, was implemented, and the Vanderbilt Medical School and Hospital opened in September 1925 to great success.2 49

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Figure 3.1  G. Canby Robinson, MD, ca. 1925. (Courtesy of Eskind Biomedical Library Special Collections Photographic Archive at Vanderbilt University Medical Center.)

by the “Big Four” founding professors of Johns Hopkins, including the internist Sir William Osler, who created the first residency program for training physicians and whose humanistic values inspired Robinson’s later book, The Patient as a Person. When he came to Cornell, Robinson brought with him the hospital residency system, an additional Johns Hopkins innovation known as the full-time faculty system, and numerous colleagues who had also been trained at his alma mater. Although it took some struggle before the changes he introduced took hold, they were timely. With the publication of Abraham Flexner’s 1910 report on American medical schools, Johns Hopkins had become the standard by which all others were judged. Robinson came to New York Hospital–Cornell with considerable experience in building and reorganizing medical schools. Just one month after overseeing the opening of Vanderbilt’s new medical school, he met with Walter Niles, then dean of CUMC, at a meeting of the Association of American Medical Colleges. Niles described plans to construct a medical center for Cornell and the New York Hospital and asked whether Robinson might be interested in directing the project. Although Robinson replied that he “had no intention of leaving my baby on the doorstep,” a year later he agreed to visit New York

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A Move to Manhattan’s Upper East Side

and meet with New York Hospital president Edward Sheldon, Cornell University president Livingston Farrand, and hospital vice president and philanthropist Payne Whitney. At that meeting, the New York party revealed that land had already been purchased for the new medical center and asked Robinson to build and staff it. After weeks of agonizing indecision, Robinson “came to feel that not to accept the New York position would show lack of courage—choosing the pleasant and personally comfortable way instead of going on to a difficult battle in the arena of New York.”4 Like many before and after him, he agreed to tackle the challenge of living and working in New York, with the caveat that he would assume partial job responsibilities on July  1, 1927, and remain at Vanderbilt University for an additional year. In September  1928, Robinson assumed his full-time duties in New York, taking over the office of dean of CUMC from his longtime friend Walter Niles and becoming the first director of the New York Hospital–Cornell Medical College Association.5 The first years of Robinson’s administration were smooth ones. In his first annual report to the president of Cornell University, he noted, “Dr. Niles has been very helpful in initiating me into the office which he has filled with such splendid judgment, wisdom and fine spirit.” Robinson reported that 1928–29 was a relatively quiet year, with “no radical changes” and “a sense of general satisfaction” among the department heads. That year total enrollment included 257 students, including 37 women. Out of an entering class of 60 students, 37 began their first two years of study in New York City, while 23 did so at the Ithaca campus. Robinson had only words of praise for his new colleagues—“a finely coordinated group of earnest teachers and workers” who impressed him with their “fine spirit” and their “remarkable cordiality and cooperation.” Graciously, he credited Dr. Niles for “this favorable state of affairs” and for guiding the medical school through “difficult years of uncertainty and of restricted financial support.”6 In the following year’s report, Robinson related that he had been learning more about teaching and research at CUMC by meeting with nearly every single person involved in these activities. He found this in-depth investigation to be “a very stimulating experience” and the work being done “highly commendable.” He described “a general feeling among the members of the faculty that the quality of the student body is becoming consistently better” and noted a dramatic increase in the number of applicants, from about four hundred in the previous year to a total of seven hundred. In addition, he expressed optimism that the faculty would be able to be reorganized and integrated into the planned medical center with “a minimum degree of friction and without any disturbance of morale.”7 Immediately after taking up his duties as dean and director, Robinson began to work closely with the architectural firm Coolidge, Shepley, Bulfinch

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CHAPTER 3

and Abbott, which was responsible for designing the buildings for the new medical center. The same company had collaborated with Robinson on the construction of the Vanderbilt medical center, and this positive experience was a significant factor in his decision to take on the New York project.8 The contractor for the complex was Marc Eidlitz & Son, also the builder of the recently constructed Columbia-Presbyterian Medical Center on the Upper West Side of Manhattan. Architectural studies for the New York Hospital–Cornell buildings had been initiated in 1924, with final plans approved by the Joint Administrative Board in April 1928. During this interval, more land was acquired, and more facilities were incorporated into the plans. For example, depleted finances led the Lying-In Hospital and the Manhattan Maternity and Dispensary to approach New York Hospital with requests for a merger. It was agreed that these institutions would become, respectively, the medical center’s department of obstetrics and gynecology (Women’s Clinic) and the department of pediatrics (Children’s Clinic), although affiliation agreements were not officially signed until 1928 and 1929, respectively.9 Major donations were received in support of the Women’s Clinic, including $6 million from the General Education Board, $2 million each from J. Pierpont Morgan Jr. and the Laura Spelman Rockefeller Foundation, and $1  million each from George F. Baker Sr. and Jr.10 During the planning process, Robinson was primarily concerned with the size, location, and orientation of the individual facilities that would constitute the medical center. Academic departments and clinical, research, and educational facilities needed to be self-contained yet at the same time able to invite collaboration across the hospital and medical school. They needed to have enough space for just the right number of students and patients, be proportionate to each other, and placed advantageously in relation to the plant as a whole. The external appearance was given second priority: “only rightness of plan and orientation of parts were studied.” Years of planning resulted in “a mass, the proportions of which could be but slightly altered without causing the plan to suffer.”11 Given these strict requirements, it is somewhat remarkable that the architect was able to develop an elegant design for the exterior, which incorporated long, pointed arches inspired by the Palace of the Popes at Avignon. The site of the medical center was formerly occupied by the Central Brewing Company and several row houses, which were razed in 1929.12 Flora Jo Bergstrom, the librarian of the Cornell School of Nursing from 1932 to 1949, grew up in the neighborhood and remembers: “There was a brewery on the site . . . [and] a row of brownstones on 69th Street. The Lenox Hill Neighborhood House [now on Seventieth Street near First Avenue] occupied one of them. A  trolley car clamored up First Avenue, which was then cobbled, but York Avenue, then known as Avenue A, was paved from 64th Street to 92nd Street. At night we children had the whole length of it for roller-skating.”13 52

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A formal groundbreaking ceremony was held on June 17, 1929, and attended by hospital and medical college leadership, as well as by John Hay Whitney, the son of Payne Whitney.14 Just a few months later, in October, the stock market crashed, ushering in the Great Depression. The hospital suffered severe financial damage. In order to pay for the new buildings, it had to liquidate assets at a loss of $15 million, or $209 million after adjusting for inflation. Combined with the reduced ability of patients to pay for medical services, there was “a general feeling of insecurity which prevailed everywhere during the early days of the depression.”15 As of January  1, 1930, the New York Hospital had $46.2  million in available funds, while CUMC had $18.2 million ($659 million and $259 million in 2014 dollars, respectively).16 Estimates for the total cost of the New York Hospital–Cornell Medical College Association plant, including land, buildings, and equipment, was $30 million (or $428 million in 2014), according to Robinson’s autobiography, titled Adventures in Medical Education. Even though this estimate was made prior to the start of the Depression, the project was, remarkably, completed within budget.17 Still, the medical center’s financial difficulties worsened as time went on. About three hundred beds and equipment purchases for several floors of the hospital were cut, and department budget restrictions were imposed. Extensive documents were developed to estimate construction and maintenance costs, which varied from time to time. For example, one document indicates that based on an annual budget of $3  million and assuming that the hospital would contain 656 beds, each bed could be maintained at a cost of $12.92 per day. Another indicates that a total of 993 beds were planned for the hospital and that the estimated annual cost of hospital maintenance was $1.5 million. Yet another showed that the estimated cost of constructing the New York Hospital, about $22  million, would be approximately twice as much as the cost of building the Presbyterian Hospital on the Upper West Side, which had come in at $11.7  million (or $167  million in today’s dollars). According to this report, the New York Hospital would cost more because it would house CUMC’s teaching and research facilities, whereas Columbia’s equivalent facilities were maintained separately from the Presbyterian Hospital. In addition, the power plant would improve on Presbyterian’s, which contained “no facilities for the generation of electricity” and has “proved inadequate to such an extent that it is about to be abandoned,” just a few years after its construction.18 A document dated November  1, 1929, described in detail the methods used to estimate construction and maintenance costs. Of note, it suggested that patient fees be determined based on the operating costs of the hospital, so that a sufficient income could be maintained. The authors of the report commented that the question of appropriate patient fees required careful consideration: “The provision of medical services of high order within the means of 53

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Figure 3.2 Cornerstone-laying ceremony, June  12, 1930, for the New York Hospital–Cornell Medical Center. (Photo by Irving Underhill; courtesy of Medical Center Archives of NewYork– Presbyterian / Weill Cornell.)

persons of moderate financial standing is undoubtedly the outstanding economic and social problem today before the medical profession and the hospitals in their relations to the public.” According to the conclusion of this report, a total of $84.6 million in capital funds, or $1.2 billion in today’s dollars, was needed to meet the costs of land, construction, maintenance, and teaching and research support. This estimate did not include the funds that would be needed for future projects, including a pension plan, education and housing for nurses, fellowships and scholarships, and residential and recreational facilities.19 The cornerstone for the medical center was laid on June  12,  1930. In a volume celebrating the fiftieth anniversary of the student-run Cornell Daily Sun that year, Robinson wrote in enthusiastic terms of the affiliation between CUMC and the New York Hospital, which “should result in the creation of one of the most powerful agencies for promoting the well-being of mankind in the world”: “The time is therefore ripe for a complete and perpetual partnership in an undertaking which has for its purposes the care of sick and injured persons, the training of physicians, the cultivation of intellectual progress in medicine, the fostering of scientific and spiritual ideals in medicine, and the acquisition and dissemination of new medical knowledge. Each institution has come to realize that alone it can achieve these purposes only in part, while in 54

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combination an unusually favorable opportunity for the development of these lofty purposes of medicine would be established.”20 Robinson’s idealism was not just confined to the expansive possibilities presented by the affiliation and the construction of a new medical center in New York. Much of his writing and correspondence in general convey a deep-seated belief in the power of medicine, not just to heal bodies but also to inspire in the physician a near spiritual love of mankind and of service to humanity.

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Bringing Johns Hopkins to Cornell

Construction of a medical center was a major area of responsibility for Robinson; another was the reorganization of faculty and staff. Before he began to develop plans for New York Hospital–Cornell, Robinson ordered a series of studies examining teaching and administration at other institutions. Dr. Paul Reznikoff, a 1920 CUMC graduate who later directed the teaching of clinical clerks and administered the medical outpatient department and the adult hematology clinic and laboratory in the new medical center, was selected to conduct one such study in Europe in 1929–30. His memory of the experience, recounted in 1982, indicates that Robinson maintained friendly and personable relations with members of his staff: “When I told Dr. Robinson that I was planning to marry and neither wanted to leave my wife for that length of time nor could afford to take her to Europe with me, Dr. Robinson found a way to supplement my funds by means of a new research grant he had received. . . . Dr. Robinson was insistent that I go to Europe and that I take my wife with me. For one thing, he said, I would be of no use to the school and hospital for six months after I  married; for another, he would not trust me in Europe alone.”21 While abroad, Reznikoff sent monthly reports back to New York, but in retrospect he remembered the political atmosphere of pre–World War II Europe more vividly than the medical observations he made at the time. After the completion of these studies, Robinson forged together several plans for the New York Hospital–Cornell Medical Center. One dealt with the organization of the New York Hospital–Cornell Medical College Association. In order to facilitate interactions between the director and the Joint Administrative Board, the plan called for the formation of five groups that would advise the Joint Administrative Board in their respective capacities and be responsible for the various operations of the medical school and hospital. The Executive Faculty Council would bear responsibility for educational, teaching, and research issues related to the medical college. The Cornell Medical College Council, which had been in existence since the founding of the medical school in 1898, would continue to handle financial matters pertaining to Cornell University and would facilitate interactions between Cornell’s trustees and the joint board. The executive staff would be responsible for the clinical activities of the 55

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CHAPTER 3

hospital, while the hospital administrative staff would maintain control of the hospital’s administrative and financial organization. Finally, the Faculty of Nursing Education would advise the joint board on matters related to the education of nurses. The director would be a member of all five groups. Other members of the groups included Cornell’s president, department chairs, hospital chiefs, administrators, trustees, and elected or appointed individuals.22 The proposed relationship between the hospital and the medical college allowed each institution to maintain a certain degree of autonomy within a jointly run medical center. Each institution was to have administrative control over its own departments and divisions and their operations. However, the five major clinical departments of medicine, surgery, pediatrics, obstetrics/gynecology, and psychiatry in the medical school would be linked administratively with their corresponding hospital divisions, and department chairs would also serve as hospital chiefs. Pathology and radiology, though not considered major clinical departments, were organized in the same way. The specialties of dermatology, neurology, otolaryngology (recently combined from otology, laryngology, and rhinology), ophthalmology, orthopedics, and urology were considered subdepartments of medicine and surgery. Financial responsibility for the departments of medicine, surgery, and pediatrics were to be shared equally by the hospital and the medical school, while obstetrics/gynecology and psychiatry would be supported by specific endowments made to the New York Hospital. Medicine, surgery, and pediatrics were to be jointly supported because full-time staff members from these college departments would be responsible for much of the clinical care and administration of the hospital. In addition, research coming out of these departments would be jointly credited to the hospital and medical college or to the New York Hospital–Cornell Medical College Association. The basic science departments of anatomy, bacteriology and immunology, physiology, biochemistry, and pharmacology would be run and paid for by the medical college, as would the department of public health. Costs for the library, the department of illustration, and animal care were to be shared. 23 For the clinical faculty and hospital staff, Robinson implemented a new full-time system that had originated at Johns Hopkins under the leadership of Dr.  William H. Welch, one of its founders. He also imposed a mandatory retirement age of sixty-five for the professional staff. Both measures resulted in a loss of status for many Cornell faculty members who did not meet the criteria. Under the full-time system, which went into effect in the fall of 1932 with the opening of the medical center, faculty members were expected to devote themselves to their university and hospital responsibilities, for which they received a salary. While they could continue to see a limited number of private patients, any fees obtained would become part of the department’s funds. These funds could then be used to cover faculty travel expenses for meetings 56

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A Move to Manhattan’s Upper East Side

and exchange programs, as well as books and equipment for the department. The full-time professors would form the core of the hospital staff, which was to be supplemented by a large pool of physicians and surgeons in private practice who were to have part-time teaching and clinical responsibilities at the medical center. 24 This part-time group consisted primarily of members of the former CUMC faculty and the former staffs of the New York and Lying-In Hospitals. In addition, the staff of the New York Nursery and Child’s Hospital, where most of the training in pediatrics for medical students had previously been conducted, joined the department of pediatrics in 1934. 25 The first four professors appointed to the reorganized faculty were department chairs: Eugene DuBois in medicine, Oscar Schloss in pediatrics, Charles Stockard in anatomy, and Stanley Benedict in biochemistry, all of whom had previously served as Cornell faculty and were under the mandatory retirement age. These professors formed a curriculum committee to study the newly revised curricula of Harvard, Johns Hopkins, the University of Chicago, and Yale, and they conducted site visits at each institution. Their recommendations were incorporated into a revised curriculum at Cornell. Major changes included an expansion in clinical teaching made possible by the new hospital, division of the second through fourth academic years into quarter terms with rotating instruction conducted in smaller groups, and an increase in the time allotted for electives. In addition, an option to study during the summer term was introduced for students prior to the fourth year. 26 In 1932, William Ladd was appointed associate dean of the medical college and helped Robinson further reorganize the educational and student programs. The group of four newly appointed department heads evolved into the Executive Faculty Council, which was responsible for advising the Joint Administrative Board on educational policies, appointments, and other teaching and research issues. As other department heads were appointed, they were added to this council, which also consisted of Robinson as director, Ladd as associate dean, and the president of the university as presiding officer. By 1931, thirteen professors, many of whom had been trained at Johns Hopkins, had been appointed department heads. Although the full-time system is now widely accepted within academic medicine, at the time it was an innovation that proved to be a major source of tension between Robinson and some of the part-time faculty. According to Morris Bishop’s history of Cornell University, “in his role as new broom, [Robinson] wished to sweep out the accumulated traditions and practices of the college.” With the new policies, he “dismissed some of the oldest and most honored members of the faculty,” and not surprisingly, “much resentment was aroused.”27 Alumnus Norman Plummer ’26, who ran the infectious disease pavilion and pulmonary clinic when the medical center opened, provides a firsthand perspective on the situation: “Canby Robinson was an apostle of the full-time

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.

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CHAPTER 3

system at a time when that system had a lot more enemies than it has today, and he did not do much to ease the friction that imposition of this new system produced. People called the New York Hospital the new Baltimore club, referring primarily to Robinson [and other physicians who] had been imbued with the full-time system at Johns Hopkins. Unfortunately, some very good part-time surgeons, obstetricians, and gynecologists were led to feel that there was no place for them.”28 Another alumnus around at the time, Harry H. Gordon ’29, agrees that “the Hopkins people who had come here were intent on establishing a system that was essentially alien to New York institutional mores.”29 If there were members of the old medical college faculty and hospital staff who felt that their New York home was being remade along unwelcome, Johns Hopkins lines, they were surely dismayed upon hearing of another of Robinson’s innovations. When the medical center opened, a new system of residents was to be introduced from Johns Hopkins. Residents would live at the hospital while receiving clinical training, and staff quarters were incorporated into the building plans. Initially, the residency system posed some organizational difficulties for the hospital chiefs of service, and when it went into effect, Robinson was forced to deal with some disgruntled faculty members, particularly in the department of surgery. George J. Heuer, who was appointed head of surgery, is credited with setting up the first surgical residency program in New York City. Trained at Johns Hopkins under the pioneering surgeon William S. Halsted, he came to the New York Hospital–Cornell Medical Center from Cincinnati General Hospital. Heuer’s surgical skills were so highly regarded that when Halsted developed gallbladder disease, he requested that Heuer be brought from Cincinnati to operate on him. Under the system that he implemented at Cornell, a surgeon in training would complete a five- or six-year residency program, instead of the customary two-year internship. The program was structured as a pyramid, with surgeons rising from interns to residents and competing to gain the position of chief resident.30 Prior to Heuer’s arrival, a statement was sent to the members of the surgical staff of the New York Hospital, so that they would know what to expect. It describes a major shift in focus—from senior staff performing a large number of operations themselves to adopting a “spirit of generosity toward and interest in the training of graduate students” in surgery. The new system would involve “a large number of young surgeons living in the hospital for periods extending in some cases to six years.” The priority would be to give them as much surgical experience as possible, with the attending surgeons serving as advisers and assistants. An attending surgeon would perform only enough surgeries “to keep his ‘hand in’ ” or if there was a clinical case of particular interest, but “the privilege of operative work shall not be taken advantage of to the extent of injuring the service of the Resident Staff.” The tone of the letter 58

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A Move to Manhattan’s Upper East Side

indicates an awareness that this apparent inversion of the surgical hierarchy might cause trouble: “There is nothing unjust in this plan to the senior members of the staff” since “there is probably no satisfaction in medicine equal to that of producing a well-trained young surgeon.”31 The residency system, designed to turn out the most clinically skilled surgeons and physicians possible, is now common practice. However, at the time it was introduced in New York, it must have seemed like an affront to some of the senior staff, as Robinson was soon to discover. In developing plans for the medical center, Robinson ran into obstacles on other fronts. One concerned the creation of a university-based school of nursing, which was delayed ten years owing to the effects of the Depression. The New York Hospital Training School for Nurses had existed since 1877, and a committee was formed to investigate how best to establish a nursing program at the medical center that would lead to a bachelor’s degree to be granted by Cornell University. To maintain high educational standards, the committee recommended that students complete two years of college classes before being admitted to the nursing school. The plan called for an endowment of $2 million so that enrolled nursing students would not need to work at the hospital to help offset the school’s operating costs. Although the Joint Administrative Board approved the plan, funds for the endowment could not be secured. Nevertheless, an advanced nursing program based on the original plan was set up, and facilities and living quarters for the nursing school were included in the medical center. The advanced program operated for two years, but in 1934 financial pressures led to changes, including an easing of admissions requirements from two years of college coursework to a high school diploma. Still, Bessie A. R. Parker, who joined the medical center in September 1932 after ten years at the Methodist Hospital in Brooklyn, was “immediately struck by [Cornell’s] more advanced educational program,” which reflected a trend “to train nurses who not only could make patients comfortable but had an understanding of preventive medicine and community health.”32 The establishment of the Cornell University–New York Hospital School of Nursing had to wait until 1942. Robinson was also unable to create a department of social service staffed by professional social workers. A  lifelong proponent of the importance of social and emotional factors in physical health, he hoped that such a department would not only benefit patients but also provide another perspective in the education of medical students. However, he discovered that social work at the hospital had for many years been an entirely female-directed enterprise. Thus, his attempts to professionalize the field within the hospital were frustrated by “a group of fine, outstanding women who had rendered splendid service over the years” and who were not at all interested in cooperating with him. Not one afraid to assert himself, clearly Robinson felt that this was a battle he could not win.33 59

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Move to York Avenue

Between 1930 and 1932, as Robinson occupied himself with the impending move, much of the work at Cornell University Medical College carried on as normal at its First Avenue location. Annual reports submitted by the various departments provide an indication of the breadth and variety of research, clinical, and teaching activities at the medical school. For example, the department of anatomy reported in 1930 that Dr.  George Papanicolaou, who had recently shown that uterine cancer could be diagnosed using a vaginal smear, had also completed “his very comprehensive study on oestrus and ovulation in the human female.” At the Second (Cornell) Division of the Bellevue Hospital, studies on calorimetry and metabolism continued at the Russell Sage Institute of Pathology. Clinical care on the Bellevue wards was very busy, although Eugene DuBois, director of the Second Division, chose a perhaps unconventional means of describing the level of activity: “Our small division with three wards has averaged about as many autopsies as the whole Columbia Medical Center. The activity of our service is evidenced by the fact that we have almost as many deaths as the huge group of hospitals on 168th Street.” George B. McAuliffe, chair of otology, described a spirit of altruism among the members of his staff, some of whom worked with little to no remuneration and “without the stimulus which would ordinarily come from monetary reward.”34 In the realm of education, instruction in psychiatry was given to second-year students for the first time in 1930, and a total of seventy-four students were receiving training in military science as part of the Reserve Officers’ Training Corps. Making a complaint still familiar to subsequent educators, the chair of surgery noted: “There is a certain difficulty in teaching the fourth year clerkships in the latter part of the course as some of the students get indifferent and lazy. Most of them have obtained hospital positions and in some cases they are disinclined to do any more work than they have to and are apt to be most irregular and unpunctual in their attendance.” Another faculty member opined: “I find that no matter how intelligent the student body, its interest is kept up by concrete illustration or pictures more than by any particular effort on the part of the lecturer.”35 Charlton Wallace, head of orthopedic surgery, wrote: “It is my opinion that the student body as a whole has very much more class to it than it did several years ago. We are thankful for this.”36 In his annual report to the president of Cornell University, Robinson wrote in 1931 that the effects of the Depression were making it difficult for many students to meet tuition payments and that student scholarships had largely been discontinued because of a lack of funds. He expressed interest in finding more ways to increase financial aid, both for medical students and those pursuing graduate studies in the biomedical sciences. In 1932, just prior to the move to new quarters, Robinson noted matter-of-factly that the “academic year that has now been completed marks the close of a chapter in the history of the medical college.” The 60

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various department heads expressed anticipation and eagerness, while also commenting on the amount of work involved in reorganizing departments.37 Robinson and the faculty remained enmeshed in the details of the new medical complex up until it opened. A letter from Don S. Brown, the vice president and general manager of Westinghouse X-Ray Company, on April  14, 1932, indicates that Dr.  John R. Carty, an associate professor of radiology, had visited the Westinghouse factory the previous day to make a final inspection and review of a condenser-type X-ray generator, called the Dynex, that was to be installed in the medical center. Presumably because of the Depression, “Dr.  Carty impressed upon me the fact that appropriations had been materially reduced and that it would be necessary for us to make a very close price on the apparatus, if it were to be considered at all.” It appears that Carty and Brown were able to strike a deal, and it was agreed that the Dynex would be delivered and installed for a price of $5,000 ($87,000 in 2014 dollars).38 After many arduous years of careful planning, the medical center officially opened on September 1, 1932. R. Gordon Douglas, then an assistant professor of obstetrics and gynecology and the father of CUMC’s chair of medicine in the 1980s, recalled: “Those of us who were here at that time were privileged to

Figure 3.3  View of the New York Hospital–Cornell Medical Center, with medical school buildings along York Avenue in the foreground, 1930s. (Photo by Edward Beckwith; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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view, from various vantage points, an eclipse of the sun during an hectic afternoon preceding the official opening. . . . In the light of accomplishments since that time I always remember that eclipse as a good omen for our center.”39 On a different occasion, he offered a subtle point of clarification: “The term ‘medical center’ had been appropriated several years earlier by Columbia-Presbyterian. As a result, it was some time before the term ‘medical center’ was used to refer to New York Hospital–Cornell, out of fear that donations might wind up at Columbia.”40 Dr.  J. Lawrence Pool, an intern who was present at the official opening, remembers the hours waiting for the first patient to be admitted to the hospital:

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On opening day, in white starched-collared intern’s vest and white pants and jacket, I stood at a window of ward G-3—crowded with fellow interns and white coated attendings—overlooking the front door of the hospital. Wherever we looked we saw other windows crammed with white-coated figures—a host of doctors with their backs to a host of neat, empty beds, waiting. . . . An hour passed. No customers. Would this great new hospital remain forever empty? Did its massive walls scare people away? Was the whole thing a flop?41

Eventually, however, a cab arrived with an “obviously sick woman” who was lifted out of it. She appeared on Pool’s ward and was assigned to him and his superior. As it turned out, the hospital’s first patient had terminal heart failure, with an enlarged spleen and liver. Lab work and X-rays were ordered, but sadly, she soon passed away. During its first year of operations, the hospital would go on to admit 2,106 surgical patients. Of these, 1,663 patients received a total of 1,765 operations, half of which were for appendicitis, hernia, gallstone disease, rectal disorders, and goiter.42 Classes began a few weeks later, on September 26. William H. Eberle, a member of the class of 1934, remembers being overwhelmed by the beauty, size, and modernity of the new college facilities. More important, though, “No longer did we have to eat at the local soup kitchen—imagine, a cafeteria right in the school for the students!”43 Not all the students welcomed the move, however, finding the smaller clinical facilities at Bellevue warmer and more intimate. The new building proved an aesthetic success. Head architect Henry Shepley was awarded the Architectural League of New York’s gold medal in 1933 for “the orderly arrangement of the many and varied parts of an unusually complex problem, and the excellence of the plan and originality of the design.” Robinson himself was very pleased with what he considered to be “one of the finest buildings in the City of New York, where the foremost American architects have vied with another in designing the world’s greatest collection of monumental buildings.”44 Eric Larrabee, historian of the New York Hospital, describes only one minor “aesthetic mishap” related to the complex. The 62

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Figure 3.4 Dissecting classroom with skeletons and cadavers. (Photo by Edward Beckwith; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

original design, which had been drawn up prior to the rise of National Socialism in Germany, incorporated swastikas as decorations on a powerhouse chimney. When a hurricane damaged the chimney in 1938, more than a hundred donors contributed a total of a thousand dollars to remove what had by then become a hateful symbol.45 Dr. Walter F. Riker Jr., a 1943 alumnus who spent his entire fifty-threeyear career at the medical center, described his first encounter with the complex: “In 1934, while driving into Manhattan with my father, he suddenly detoured from his usual midtown route, saying, “I want to show you a beautiful new hospital that is associated with Cornell. This is where you ought to think about going to medical school.” As we approached, I was struck by the sight of the spectacular gleaming white buildings rising skyward. The magnificence of its neo-gothic architecture not only enhanced its beauty but endowed it with a façade that made the overall structure unique. One would hardly think it a hospital but more suggestive of a cathedral.”46 In contrast, the first time that Abraham Flexner saw the building, he reportedly had a more mundane concern—how its many large windows would be kept clean.47 Regardless of initial reactions, the hospital complex consisted in 1932 of a central, twenty-seven-story tower with four pavilions at its corners and two wings facing the East River. The tower originally contained a 459-bed general hospital on its first nine floors, two operating rooms, private patient rooms, and living and recreational areas for the house staff. The recreational facilities, 63

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CHAPTER 3

located on the top floors, included squash and tennis courts, an exercise room, and space to play ping pong and billiards. Hospital administration and separate wards for men and women were located in the two pavilions at the front of the hospital near Sixty-Eighth Street, while outpatients and specialized therapy were housed in the two rear pavilions near Seventieth Street. The Women’s Clinic and Children’s Clinic wings overlooked the East River, and the Payne Whitney Psychiatric Clinic occupied the current site of the Greenberg Pavilion along the East River. The main hospital entrance was located on Sixty-Eighth Street, and the medical college buildings were situated along York Avenue. The current occupants of the medical college buildings may wonder why they are so rarely afforded glimpses of the East River despite their close proximity to it. This was intentional on the part of the designers, who wished to reserve the peaceful river views for hospital patients. The college buildings contained four wings to house the departments of anatomy, bacteriology and immunology, physiology, and biochemistry and pharmacology. Pathology laboratories, the library, and administrative offices were located along a central corridor connecting the four wings. The Dean’s Office was located immediately to the left of the main college entrance, in a room labeled C-105.48 Originally, the medical center incorporated a feature not commonly seen at the time, that of planned open space, which included a front lawn for the hospital, a sunken garden, and courtyards containing grass and trees between the medical college buildings. New buildings have gradually encroached on these open areas since 1932. The medical center also contained other facilities that would now seem anachronistic, such as three steam engines to generate electricity and a central cooling system that carried brine through a series of pipes. In addition, there was a silver-plating shop to repair the silver-plated flatware that private hospital patients were given with their meals.49 Both patients and staff were housed in somewhat luxurious accommodations. The Payne Whitney Psychiatric Clinic, built as a self-contained building connected to New York Hospital only by tunnels, represented the antithesis of the public image of a mental health facility. Although it contained hydrotherapy tubs to calm patients, steel-framed windows that opened less than five inches to prevent suicide attempts, and soundproof ceilings, it also evoked a comforting atmosphere designed to appeal to upper-class patients. Its lobby resembled that of a fancy hotel, with a marble floor, elegant furniture and drapes, ornate fireplace, and a portrait of its namesake on the wall. As a recent New York Times article put it, “by the mid-1930s, Payne Whitney was the place for New Yorkers to repair their psyches, to dry out, to regain sanity.”50 Benjamin Spock, who was an assistant resident in psychiatry in September 1932, also greatly enjoyed the surroundings. In an interview conducted in 1982, he recalled: “My office in Payne Whitney Clinic, with handsome 64

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A Move to Manhattan’s Upper East Side

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furniture, carpeting, and a view of the river, made me feel dignified for the first time in my life. . . . The monthly salary of $50 [$870 in 2014 dollars], my first professional earnings, made me feel guilty. How could I  suddenly be worth all that?”51 The nurses’ residence was similarly pleasant and tastefully decorated. Two members of the nursing staff, Mary E. Klein and Margery T. Overholser, remembered the nursing student lounge as one of the most beautiful rooms in the medical center, containing “warmly colored” floor tiles, a “huge hand-loomed rug,” comfortable sofas and chairs, and even a grand piano. The staff took meals within the nurses’ residence, and, remarkably, “the food was superb.”52 The nursing school also had its own library, a novelty for the time. Investigators conducting basic research likewise remembered beautiful laboratories that afforded much more space than they were previously used to. In fact, for some, the facilities were almost too large, with colleagues much more spread out than before. However, according to Irvine H. Page, an alumnus of both Cornell University and CUMC who became a renowned expert on hypertension, basic science at the medical school was lagging at the time. Based on his experience working in a lab at the neighboring Rockefeller Institute Hospital, he wrote in 1982 that “the blunt truth is that my colleagues at Rockefeller did not consider the Cornell faculty to be among the elite of science, a few

Figure 3.5  Nurses and a gentleman caller in the student lounge of the Nurses’ Residence, 1937. (Photo by Paul Parker; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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Figure 3.6 Student nurse demonstrating how to take blood pressure at the nursing school. (Photo by Paul Parker; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

exceptions to the contrary . . . the clinical departments at Cornell did not seem much interested in research.”53 Still, his colleagues could not help but be slightly envious of “the enormous material advance represented by these marvelous new facilities next door.”54

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Growing Pains

The pleasure that some felt with their new surroundings may have been tempered by the changes in organization brought about with the implementation of the full-time faculty and residency systems. Within the department of surgery, vocal dissatisfaction emerged after only a few months. On December 2, 1932, eleven part-time members of the surgical staff who had previously held appointments at the New York Hospital sent a letter to the hospital board of governors protesting the new surgical residency system. In it, they stated that in the past three months, they had collectively been allowed to perform only two operations on ward patients, and these cases had been personally referred. In their view, their years of training were “not being used to advantage in the training of younger men.”55 A meeting with the protesting group was held later in the month, and according to a memo from Robinson, “It seems clear that as 66

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A Move to Manhattan’s Upper East Side

a group the men have not grasped the significance of the Full Time Plan and the Resident System as a university educational effort, are not aware of its implications, and are not in sympathy with it.” Residents claimed that they “had tried to interest the Group in their problems but had failed to get co-operation from them.” To remedy the situation, the medical center administration decided to give preference for performing surgeries to the part-time staff “of greatest experience and teaching ability” who also subscribed to the new system of organization.56 Canby Robinson additionally drafted a statement decrying the behavior of the part-time surgical staff, particularly its decision to appeal directly to the hospital board instead of first taking up its concerns with George Heuer, the head of surgery. In it, he takes a stern tone:

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There have been numerous occurrences which indicate that at least some members of the group are not in sympathy with the organization which Dr. Heuer has attempted laboriously, carefully, and thoughtfully to build up in the best interests of the Hospital and the Medical College. This belief is based upon a number of episodes which have served not only to create a hostile spirit among some of the members of the Department of Surgery, but have also been detrimental to the best interests of the Hospital and Medical College. . . . They should also be informed that their continuation as individuals in the Department of Surgery is contingent upon their whole-hearted support of a plan which Dr. Heuer may make for each one of them individually.57

Robinson never distributed this statement publicly, since he was informed that Edward Sheldon, the president of the New York Hospital Board of Governors, believed that the protesting surgeons were within their rights to appeal directly to the board. The matter did not end there. In June 1933, Robinson wrote to the Joint Administrative Board that he hoped that the problems within the department of surgery would “gradually disappear,” although they did not seriously impede the training of residents. He also conveyed his faith in the benefits of the full-time system: “It is clear that it is through this plan that the New York Hospital should assume a place of national leadership in the development of medicine as well as in the care of patients. It should stand as an example of the manifold benefits a great hospital can contribute to humanity, not only to the patients within its own walls, but also to countless numbers who are sure to benefit from the new facts and improved methods and from the well-trained medical graduates that go to the world at large.”58 Grievances were still being aired at the end of 1933, although they appeared to wane thereafter. In response to a letter from the part-time group, George Heuer called a meeting in November during which he reiterated that the policy of the surgical department was to educate young men in surgery. It was brought 67

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to his attention, however, that the surgical experience of the part-time staff varied greatly. There were senior surgeons who were highly skilled, an intermediate group, plus “a third group of younger men whose training and experience is frankly inadequate and who need further surgical education and experience in the same sense as does a Resident staff.” To address this concern, it was decided that this younger group of part-time staff would receive additional surgical training similar to that of the residents, while the “intermediate and senior groups will act as teachers and advisers with the understanding that they may operate upon cases in conformity with the policy which obtains in the department of surgery as a whole.”59 Reflecting fifty years later on their experience as members of the original resident staff, six surgeons who trained under Heuer recalled that the new system sparked “considerable enmity on the part of a number of the attendings from the old New York Hospital.”60 Although feelings were sometimes hurt, the “great strength of the system was that it was virtually impossible to get through it and not be a good surgeon.”61 Despite this improvement in surgical training, it appears that “the feeling was there all the time that somehow the new men had moved in and replaced the old regime.”62 Not only was there a change to the old way of doing things, which not surprisingly ruffled some feathers, but the distinction between part-time staff and full-time faculty also proved troublesome. As the members of Heuer’s original resident staff described the situation, the full-time faculty helped with the care of patients, but since they didn’t “generate the admissions that practicing physicians do, [a] feeling develops on the part of those who are in private practice that they are supporting the hospital while the full-time people ride on their coattails.” In addition, the full-time faculty tended to be younger, were better surgeons, and took their time on procedures. The part-time surgeons, who were generally older, valued speed since they had been trained when anesthesia and blood transfusions were in their infancy.63 The surgeons interviewed in 1982 also remembered being paid $25 a month as residents ($434 in 2014 dollars), half from the medical school and half from the hospital. Some felt that this meager income was made up for by access to superior medical equipment, such as a centrifuge on every floor, reported to cost $100 each: “We used to have little simple cheap centrifuges in Cincinnati, but here we had these monsters with a little laboratory on each ward. It was the sort of medical elegance that we weren’t used to. It was a highly endowed operation, and we felt that we were living very well.”64 Still, the conditions were very different from what they are today: “We didn’t feel abused, although by today’s standards we would have had every right to consider ourselves abused. First of all, any married man was very likely to be turned down for a residency. . . . Second, it wasn’t unusual to spend six months

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A Move to Manhattan’s Upper East Side

in the hospital without going out during the day,” since living quarters were incorporated in the facility.65 While the dissatisfaction within the department of surgery was especially intense, other departments gradually adjusted to their new quarters and organizational changes. In a report to the Joint Administrative Board in June 1933, Robinson wrote that the reorganization of the basic science departments had occurred smoothly. The library had been well arranged, and more attention to student health was being paid than ever before. Within the department of anatomy, the chair reported that the new classrooms had “proven to be very comfortable for the students and very well adapted for teaching,” although the staff was initially “a little disturbed after the move and in the effort to fit into the new quarters.” The consolidation of clinical facilities and laboratories in one complex made it “possible to conduct all the theoretical as well as practical teaching in obstetrics and gynecology” within the new Women’s Clinic building. Several department heads noted that the move made it more difficult to balance administrative, teaching, and research responsibilities, a common complaint even in less tumultuous years. Still, “Progress in the right direction was made throughout the year.” A new outpatient service, incorporating the departments of medicine and surgery and the former Cornell Pay Clinic, had posed some problems, however. It had originally been set up as a central diagnostic clinic that would serve all patients, except for obstetric, psychiatric, and pediatric cases. A patient would initially be seen at the outpatient department, then sent for additional diagnostic tests and treatment at medical or surgical clinics organized by specialty or on the hospital wards. This system of organization lasted for only six months before being discontinued, primarily because of a lack of coordination and agreement between the departments of medicine and surgery. These departments then became independent, but continued to be affiliated with various outpatient clinics.66 The absorption of the Cornell Pay Clinic into the medical center resulted in more spacious facilities to treat patients of limited means, who tended to be less well-off than those previously seen downtown. However, the former staff of the Pay Clinic, most of whom were granted part-time appointments, were no longer paid directly for their time spent seeing patients and were required to supervise interns as well as students.67 By 1934 most of the clinical teaching of medical students was conducted at the New York Hospital. The Second Medical Division of Bellevue, previously Cornell’s primary clinical venue, was then used only for a small group of third-year clinical clerks and for special electives. For the first time that year, one third-year student also completed a clinical clerkship in medicine at another institution, Columbia’s College of Physicians and Surgeons. This was viewed as a very positive experience by the head of medicine, Eugene DuBois, who wrote encouragingly about exploring future student exchanges with other

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medical schools.68 In 1982, Constance Friess, a 1932 graduate of CUMC who began her internship at the new medical center, describes key changes in the practice of medicine: We did all urine and blood counts for our patients, and took all the bloods. We made formal rounds every morning at 10 o’clock with our attendings. . . . We had less time off than the house staff has today, but did far fewer procedures. Of course, we saw different diseases. We saw a great deal of rheumatic fever and rheumatic heart disease. . . . We saw a lot of pneumonia of various kinds, as well as syphilis and tuberculosis. We had some cancer, though nowhere near the percentage we have today, and, of course, we had non-rheumatic cardiovascular disease, though, again, in nowhere near the percentage seen today. . . . Another difference with current practice is that we used to be very concerned about getting autopsies on our patients. If a patient died, we took it personally, and the attending and the entire house staff who had any contact with the patient would be at the autopsy from beginning to end.69

In general, the modern facilities of the new complex represented the cutting edge of medicine and made it possible for both Cornell University Medical College and New York Hospital to develop and grow, as academic medicine continued to evolve over the twentieth century.

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Robinson’s Departure

The financial effects of the Depression placed increasing pressure on the medical center during its inaugural years. Despite the initial $15 million loss sustained by the hospital when the stock market crashed, it was able to remain financially solvent because Payne Whitney had set up a $17.5  million trust (worth $320 million in 2014 dollars) with Edward Sheldon, president of the hospital board, as executor. According to New York Hospital historian Eric Larrabee, this relative security allowed Sheldon to take a morally superior position in relation to Cornell. In a letter to Cornell University president Livingston Farrand on March 30, 1933, for example, Sheldon politely requested $15,360.14 owed to the hospital ($281,000 in 2014), before mentioning a list of expenses for which Cornell was not responsible. According to Larrabee, “Sheldon does not say in so many words that he thinks the Hospital had been cheated [in the agreement of how expenses were to be shared with the Medical College], but the implication is there.”70 As the financial situation worsened, so did Canby Robinson’s position. In February 1934, Edward Sheldon, with whom Robinson had shared a certain rapport, passed away at the age of seventy-five. He was succeeded by Wilson M. Powell, previously the attorney for New York Hospital, whose management style, according to Robinson, involved taking matters into his own 70

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hands.71 Powell made major changes in the hospital’s business administration and conferred directly with department heads without consulting him. In Robinson’s opinion, these actions served to undermine his authority amid an atmosphere of anxiety caused by pervasive salary and departmental budget cuts. For example, the hospital decided in 1934 that it would be unable to pay for its half of the costs of supporting the departments of medicine, surgery, and pediatrics. A  decrease in hospital funding meant that either these three departments would suffer disproportionately, or all of the college’s departmental budgets would need to be cut. Although Robinson was able to obtain a $100,000 grant from the Rockefeller Foundation (worth $1.8 million in 2014 dollars) to temporarily alleviate the situation, the morale of faculty and staff suffered. That year Oscar Schloss resigned as chair of pediatrics “in a state bordering on confusion, and uncertainty and dissatisfaction became rather wide-spread throughout the staff of both the Hospital and College,” according to Robinson.72 In his 1957 autobiography, Robinson glosses over the circumstances leading to his retirement, just two years after the medical center began operations. He wrote that the executive faculty “began to create a situation in which my position as director soon became untenable,” while Wilson Powell “seemed to concur in the position taken by these members of the faculty.” Cornell’s Farrand “was sympathetic and friendly to me throughout this difficult time” but also “sympathetic to those who opposed me and did not take a strong position in the controversy, partly because of his desire not to disturb the relations of the medical college and hospital.”73 Powell and Farrand then proceeded to make arrangements for Robinson to retire on October 1, 1934. It was agreed that he would receive an extra year’s salary of $25,000 plus an additional $4,500 (or a total of $524,000 in inflation-adjusted dollars), then $5,000 (or $89,000) per year for the rest of his life. At his death, his widow would receive $2,500 a year as long as she lived. The payments were to be split evenly between the hospital and medical college.74 In 1935, William Ladd, who had been associate dean since 1931, was appointed professor of medicine and dean of the medical college, but the position of director of the New York Hospital–Cornell Medical College Association was not filled for thirteen years. While the lack of an overarching director may have weakened the relationship between the hospital and medical school, Murray Sargent was appointed the executive director of the hospital and went on to direct its administration ably until 1947.75 Looking back at his time at Cornell twenty years later, Robinson was magnanimous in not blaming anyone or trying to justify his own course of action. It seems, however, that an earlier draft of his autobiography was substantially more bitter and that Dr.  Stanhope Baynes-Jones, then president of the Joint Administrative Board, persuaded him to revise it.76 In the published version, 71

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Robinson presented the root of the problem as being the way that his position as director of the New York Hospital–Cornell Medical College Association had been originally defined. To his eyes, the problem was one of administration, not personality. He felt that under the strain of the Depression, his situation deteriorated because leadership of the association was not centralized. Although the director was responsible for the educational activities and administration of the medical college, he had no influence on the administration or financial operations of the hospital. The Joint Administrative Board was responsible for both the hospital and the medical college, but the director was not a voting member of the board and only acted as its secretary. Based on his past experience developing medical centers, none of the members of the Joint Administrative Board “was in a position to give the sort of leadership to this complex and comprehensive project” that had been available at other places he had worked, including Johns Hopkins, the Rockefeller Institute, Washington University, and Vanderbilt.77 Thus, Robinson lacked any real authority to make decisions regarding the hospital, even though he was responsible for developing the medical center as a whole. Then, according to Robinson, this lack of centralization took a downward turn when Wilson Powell became president of the hospital’s board and, without fully understanding the financial problems of the medical center, tried to solve them without consulting him. Their relationship soon became strained, with disastrous results: “Lack of harmony at the top of the organization gave an opportunity to the members of the faculty, who were especially disturbed and resentful, to bring forward relatively small but emotionally exaggerated disagreements.”78 New York Hospital historian Eric Larrabee argues that Robinson was in a hopeless situation, due to basic incompatibilities in the cultures of the hospital and the medical school: Had Canby Robinson been an angel of the Lord endowed with total wisdom (which he no more was than any of us) he would not have been able to close or even bridge the gap which divided his constituency. The vacuum of leadership at the level of the Joint Administrative Board was matched in its potentiality for trouble by a schism between college academics and hospital practitioners which their unwonted cohabitation had revealed. . . . Two groups of dedicated people were for the first time being compelled to share common quarters and to profess unanimity on a common goal to which neither in reality subscribed.79

For example, alumnus and faculty member Dr. Paul Reznikoff wrote in 1982 that “some of the staff from the old New York Hospital tended to scoff” at research since “there hadn’t been a great deal of research in the old hospital.” In contrast, Cornell had conducted important investigative studies at the Russell Sage Institute of Pathology, particularly in metabolism. Furthermore, Reznikoff 72

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continued, “I’m sure the Depression contributed greatly to Dr. Robinson’s problems. I  don’t know that anybody would have done well in his job with the Depression and the loss of endowment.”80 These issues, combined with the introduction of the full-time faculty and residency systems from Johns Hopkins, must have fueled widespread animosity toward Robinson’s leadership. Prior to his retirement, Robinson submitted one last annual report to the president of Cornell University. In his second paragraph, he mentioned the death of Miss Jessie Andresen, secretary of administration. An employee of the medical college since its inception, she had served as secretary to Deans Polk and Niles. Under Robinson, she had assumed other responsibilities, including charge of the Alumni Association. Robinson wrote respectfully that she “was beloved by all the graduates from those of the first class, as well as by the faculty and teaching staff.” Robinson also stated that the United States Army was discontinuing its Reserve Officers’ Training Corps program in medical schools. His report is much the same as previous ones in content and tone, if marginally less enthusiastic, and makes no mention of his impending departure or any administrative conflicts of the past year.81 Robinson’s retirement was not an easy transition for him. He had expended much energy and effort in directing the development of the medical center, only to be summarily rejected by his new creation. In retrospect, the retirement “created serious personal problems” and was “the most disturbing adventure I have had.” In his autobiography, he describes feeling disillusioned after seeing his high hopes for the medical center dashed by the behavior of some of the faculty: “Under the strain of disappointment and dispute, some of the more aggressive leaders of the faculty became particularly concerned with the attainment of selfish objectives and seemed to disregard the good of the medical school as a whole. Their state of mind and feelings were, I thought, unfavorable for the creation of an environment in which medical students should develop, and I regretted leaving when signs of a demoralized spirit were apparent.”82 In an attempt to resolve this situation, he sent a letter to each member of the executive faculty describing what he felt to be the responsibility of a medical school and its faculty toward its students. The tone of the letter is balanced and its message idealistic. His views reflect many years of experience in medical school administration and have more to do with medical education in general, although he does refer specifically to the environment at Cornell. He wrote that the responsibility of the faculty toward medical students goes beyond the impartment of medical knowledge and technical training. Medical education should also include the cultivation of industry and thoroughness, and it should instill a habit of lifelong learning. These sentiments are in keeping with the goals and objectives of many contemporary medical school curricula. Robinson goes further in his letter, arguing that the ideals of the medical college “must extend to the 73

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molding of character as well as the development of mind” and that students should be encouraged by example to act with sincerity, courage, independence, and goodwill toward their colleagues. He believed that Cornell and New York Hospital had the potential to produce a new type of young doctor who was unique not only for meeting high academic standards and receiving excellent clinical training, but also for displaying “leadership in right behavior, in sincerity, in civic righteousness, and in the sort of high-mindedness so much needed in the profession of medicine.” Robinson urged faculty members to cultivate the highest level of thought and action within themselves because he “felt that so far there is something lacking in the spirit of the student body which the faculty should earnestly endeavor to supply.”83 Considering the difficult situation surrounding his retirement, this last official action was itself quite high-minded and rose above the interpersonal disputes that fueled Robinson’s departure from New York Hospital–Cornell. Theodore Oppel, who was chief resident in medicine from 1934 to 1935, wrote that Robinson was “one of the best teachers I have had the pleasure of seeing in action.” In 1982, he described the opening lecture for Robinson’s course on physical diagnosis: “He would have one of the students come to the front of the class to examine a loaf of bread. The student would first feel and touch the bread, then percuss it, then listen with a stethoscope. Somehow Robinson would have managed to insert a watch in the middle of the loaf; listening through the stethoscope, the student could not have been more amazed.” Oppel opined, “It has always disturbed me that there is no portrait of Dr. Robinson on the premises,” as there were for other deans.84 In his autobiography, Robinson described a two-week stay as a patient in the New York Hospital during February  1956. Twenty-two years after his departure from Cornell, he was gratified to learn that “many of my cherished hopes had become realities and to see the recent developments that have gone beyond my early dreams.”85 In particular, he found that the medical center he had planned and brought to fruition had become the anchor of a multi-institutional medical complex. The neighboring Rockefeller Institute for Medical Research was in the process of constructing new buildings, while other adjacent institutions were collaborating with New York Hospital–Cornell Medical Center: the Memorial Hospital in cancer care, the cancer-focused Sloan-Kettering Institute as part of the recently formed Cornell University Graduate School of Medical Sciences, and the new Hospital for Special Surgery in orthopedic surgery. During his stay, Robinson met with medical center director Joseph Hinsey, who reported that although New York Hospital had continued to struggle financially over the years, the situation was much improved. The hospital had been able to obtain sizable grants to support scientific research, which had previously been limited only to the medical college. Robinson was impressed 74

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to hear that one of the medical center’s researchers, Vincent du Vigneaud, professor of biochemistry, had recently been awarded the Nobel Prize in Chemistry. He was also pleased to hear about the greater integration of disciplines in patient care and medical education, including greater attention paid to the role of emotional and social factors in health and disease. Psychiatry and public health were being coordinated with other fields, and the work of medical social workers was being incorporated as well. The chapter on New York Hospital–Cornell Medical College in Robinson’s autobiography ends on a happy note, not only because he received excellent surgical care. In addition, he “left the hospital with the feeling that, after all, a solid foundation had been laid” by him. Since he had outlived most of his former antagonists, no one was left to contradict this opinion, and he had a very enjoyable visit, which “removed all the hurt I felt at the time of my retirement years ago.”86 Although the description of his 1956 visit is one of his last published accounts pertaining to New York Hospital–Cornell, Robinson maintained correspondence with various members of the medical center leadership until his death. Letters between him and hospital and medical school administrators commenced shortly after his retirement. In August  1935, following the death of Wilson Powell, he wrote to Barklie Henry, the succeeding president of the New York Hospital Board of Governors. He noted that “the Hospital is constantly close to my thoughts and emotions” and that he retired “without any feeling of personal resentment or bitterness.” Still, it is “beyond the realm of possibility that I should ever again be connected with either institution.” He felt strongly that the New York Hospital–Cornell Medical College Association had departed from the ideals that had initially inspired it. Although he expressed a disinclination to overanalyze the past, Robinson believed that two factors had led to this unfortunate situation. First, Edward Sheldon, president of the hospital board during his tenure, had failed “to acquaint the Board of Governors with the full meaning of the Association of the Hospital and the Medical College, [and] the intended part the Joint Administrative Board should take.” Second, the financial effects of the Depression had left the Hospital with “a plant whose operation was too costly for its resources,” which had produced “a spirit of antagonism” between it and the medical school. What bothered Robinson most about this state of affairs was the “disregard of the spiritual values which had been so strong a part of the original conception.” Yet he still saw great potential in the medical center, particularly if it allied itself with the Rockefeller Institute, “to form the greatest center for the betterment of human health in the world today.” He proposed to appeal to the family of Payne Whitney for financial assistance so that this founding benefactor’s vision could be fully realized. Robinson enclosed a copy of a letter he planned to send to John Hay “Jock” Whitney, the son of Payne Whitney, which contained many of the same sentiments as the letter to Barklie Henry. 75

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It appears that Barklie Henry did not make any objection to Robinson sending the letter, although no record of a response from John Hay Whitney, who was U.S. ambassador to the United Kingdom and publisher of the New York Herald Tribune, remains.87 Over the next couple of decades, Robinson exchanged letters with Murray Sargent, administrator-in-chief of the New York Hospital until 1947; Stanhope Bayne-Jones, president of the Joint Administrative Board from 1947 to 1953; and Joseph Hinsey, director of the New York Hospital–Cornell Medical Center from 1953 to 1966. The tone of these letters to and from Robinson are cordial and respectful, and they indicate that individual administrators continued to share information with Robinson regarding the medical center and to occasionally ask for advice. In 1937, for example, Sargent showed Robinson a plan for improving the financial situation of New York Hospital, which involved reducing the hospital’s financial support of the medical center’s clinical departments. Robinson wrote back with a thoughtful and well-reasoned response, advising him that the hospital should not simply withdraw funds as a lump sum, but that it should study the various items in the departmental budgets and determine how much it was willing and able to pay accordingly.88 A few years later, Sargent made a more mundane inquiry, asking “what was the original thought for the use of the equipment in the Apparatus Shop located in the College,” to which Robinson confessed that “perhaps my memory is somewhat hazy on details.”89 In 1947, Robinson replied to a request from Stanhope Bayne-Jones, newly appointed president of the Joint Administrative Board, expressing a willingness to go over the history of the early days of the association and to describe the various problems encountered. Insightfully, he added: “Most of the persons that were involved in the problems of those days are no longer with us, but I expect some of the problems have outlived those that helped to create them.”90 In September of that year, Robinson, despite having developed severe sciatica, met with Bayne-Jones. Their encounter proved very helpful to Bayne-Jones, who thanked him, writing, “I  am impressed by the wisdom shown in the original planning. In trying to go forward I shall be helped by thinking over all you told me in our talk about the beginnings of this place.”91 Thus, this body of correspondence indicates that Robinson was still considered a valuable resource by the hospital and medical center administration. Robinson and Joseph Hinsey, who served as both dean of the medical college and director of the medical center, enjoyed a particularly warm correspondence. During Hinsey’s tenure as director, Robinson was engaged in writing his autobiography, and the two exchanged frequent letters about the book. Hinsey helped refresh Robinson’s memory by providing information about his time as director, read drafts, asked the China Medical Board of New York to review a chapter on Robinson’s work, and even helped him secure a 76

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publisher for the book by obtaining the support of the Commonwealth Fund. When Robinson was hospitalized after suffering a heart attack in August 1960, his wife, Marian, wrote to Hinsey: “You have been such a good and true friend to Canby and I thank you more than I can say it.”92 G. Canby Robinson passed away on August 31, 1960, in Greenport, Long Island, at the age of eighty-one. He was survived by his wife; a son, Otis; a daughter, Margaret; and six grandchildren.93 Laurence G. Payson, secretary and treasurer of the hospital board of governors, sent a note of condolence to Marian Robinson, stating that Dr. Robinson would be missed by many “who realize the contributions he made to medical science and to this Medical Center.”94 Mrs. Robinson’s reply was one of heartfelt appreciation:

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During the 47 years of our wonderful life together, the New York Hospital episode was the one great tragedy of Canby’s career. He came to New York so happy and hopeful that he could fulfill in that wonderful building his highest aspirations. When the collapse came, it was terrible to see his suffering. As you know he took it without bitterness, but the wound was deep. In 1956 when he returned to the hospital for his operation, the kindness and care he received and the visits and talks he had with his friends, helped to dispel any feeling of embarrassment and hesitation he had had in turning to you and went far to heal the wound. Now your expression of appreciation of the part he took in the creation of this great institution; your assurance that he is not forgotten, means more to me than I can possibly express.95

Mrs. Robinson received a pension from the medical center until her death in the beginning of 1965. After receiving a letter from Margaret Robinson Angell informing him of her mother’s passing, Joseph Hinsey wrote back, letting her know that he had been friends with her father since 1924, when Robinson had been one of his teachers at Washington University School of Medicine. He commented that he kept Robinson’s autobiography close to hand and referred to it frequently. He wrote that the medical center remained deeply indebted to her father for his service and requested a photograph of him.96 The last chapter of Robinson’s autobiography, Adventures in Medical Education, summarizes major changes in the field of academic medicine during the first half of the twentieth century. Based on decades of experience, Robinson formulated clear ideas about the goals and aims of medical education in the future as well. The book concludes with a deeply idealistic vision of medical education as the union of three fundamental human urges: The wonders of the human body should be contemplated with a sense of thankfulness, faith, and worship, which is an expression of the love of God. Love of man is surely the basic source of inspiration and stimulus that underlies interest in medicine and propels its progress. Love of truth is the 77

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CHAPTER 3 foundation of science and scientific progress as well as the keystone of human relations on which medicine is built. Medical education should cultivate the love of God, the love of man, and the love of truth because these form the foundation on which medicine should be firmly based in order that it may attain its highest place for the service of man.97

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Although no official portrait of Canby Robinson adorns the walls of the medical center he helped build and staff, one can only hope that echoes of his influence continue to inspire the medical students of today.

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4 The Medical School in Wartime People’s social ideas are changing fast. Revolution is the order of the day. The spectre of chaos threatens us all. At times the only salvation seems to be a dictatorship.

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William S. Ladd, “Address of Welcome, Cornell University Medical College,” 1933

Dr. William Ladd’s tenure as dean coincided with a period of intense societal change triggered by the Depression and a widespread loss of economic security among the American public. Reverberations were felt at Cornell, as questions regarding the evolving relationship between medicine and society became increasingly pressing. By the 1930s, the practice of medicine had improved to such a degree that the average life expectancy in the United States had increased by more than ten years since 1900, and infant mortality rates had declined dramatically. The leading causes of death had shifted from infectious diseases like pneumonia and tuberculosis to chronic conditions, particularly heart disease. With improved health care came rising costs, as could be expected: “Amputation of a toe in the modern operating room, with surgeons, anesthetists, laboratory workers, X-ray technicians, and a host of other personnel naturally cost more than the same procedure done by a general practitioner on the patient’s kitchen table.”1 By 1935, the nation was spending approximately 4 percent of its gross national product on health care—a far cry from its present level, but still significantly higher than at the turn of the century. In keeping with these rising costs, the profession of medicine had become increasingly prestigious, and the average take-home pay for a physician was about four times the national average. For most Americans, the increase in health care expenses was financially burdensome. And during the hard years of the Depression, the situation was exacerbated, with many families simply unable to pay for medical services.2

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Increasingly, public discussion turned to the problem of access to health care. The forerunner of the Blue Cross and Blue Shield private health insurance plans first appeared in 1929 at Baylor Hospital in Dallas and provided prepaid hospital care. Some politicians also began advocating for federal- and state-sponsored health insurance plans, and other insurance models, such as third-party reimbursement, were also proposed. These debates on health care were part of a larger push for social reform, exemplified in the 1930s by President Franklin D. Roosevelt’s New Deal, which introduced government-sponsored unemployment insurance, public relief programs, and Social Security. However, most physicians did not support increased government involvement in the provision of health care, which they saw as interfering with the doctor-patient relationship, and preferred a private medical marketplace. Health insurance was omitted from the New Deal, largely because of vocal opposition from the American Medical Association, although the group’s position softened in the mid-1930s, when it began to entertain the possibility of voluntary, but not compulsory, health insurance.3 Leaders from Cornell University and New York Hospital proclaimed their own views on these issues. University president Livingston Farrand urged graduating physicians to involve themselves in social problems, noting that “the medical profession is apt to close its eyes to the wider social and civil obligations that necessarily rest on the shoulders of each member of the profession.”4 In his 1933 opening address to students, Associate Dean William Ladd referred to the debates surrounding health insurance:

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The cry on the one hand is, “What can we do about this great cost of medical care?”, and on the other, “How can a doctor make a living?” The patient wishes the services of the doctor whom he chooses at less cost, and he wants personal service. The doctor is afraid that the state or social groups will rob him of the independence he believes he enjoys—the right to see what patients he chooses and the chance to make a comfortable income—which, he believes, will disappear if he is controlled by the state or other social groups.5

Ladd acknowledged the complexity of these problems, which had confronted European nations for years. In his view, existing “schemes of state medicine, health insurance, or group practice” had not provided an adequate solution, which could be found only through calm, reasoned discussion: “Now there should be criticism and debate, but there is no place for hostile vituperation.” He exhorted students “to make yourselves intelligently aware of what is going on about you” and to “be citizens as well as physicians,” instead of following the doctor’s tendency to become “an extreme individualist and non-cooperator.”6 At the medical school’s commencement exercises in 1937, Livingston Farrand offered a stronger perspective: “Of course we want as little State medicine as possible. The need for socialization of medicine, however, is obvious. 80

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The Medical School in Wartime

If the men and women in the medical profession shirk their responsibilities to the community, then we will be confronted with the dangerous situation where politicians, rather than the medical profession, will guide the community health programs ahead of us.”7 However, the issue of health insurance was not destined to be resolved at that time, or for many decades later. In 1941, Murray Sargent, administrator-in-chief of the New York Hospital, wrote that “the number and variety of the plans for health insurance . . . indicate that a certain confusion still exists” regarding the best way to ensure that all citizens had adequate access to health care.8 The Medical Center Matures

Ladd, who became dean of the medical college in 1935, helped restore calm and stability to the medical school despite the challenges of his time. As Cornell historian Morris Bishop wrote, “Under him the college flourished.”9

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William S. Ladd William Sargent Ladd was born on August 16, 1887, in Portland, Oregon. He graduated from Amherst College in 1910 and received his MD in 1915 from Columbia University College of Physicians and Surgeons. In 1913 he married Mary Richardson Babbott, with whom he had four children. Ladd interned at the Peter Bent Brigham Hospital in Boston, followed by positions at Columbia and Presbyterian Hospital, the Medical Corps of the Army during World War I, and Johns Hopkins. His primary area of research was human metabolism, and he conducted investigations with the calorimeter at Bellevue Hospital and studied diabetic acidosis, pernicious anemia, and hospital food. In 1931 Ladd became an assistant attending physician at Bellevue and New York Hospital, joined Cornell’s department of medicine, and was appointed associate dean because of his interest in medical students.10 As associate dean, he was responsible for interacting with students and directing the student health service. In 1934, Canby Robinson wrote: “In both these fields his work has been excellent.”11 An explorer and mountain climber, Ladd was president of the American Alpine Club from 1929 to 1932 and an honorary member of the French Alpine Club of Paris. He participated in two of the first expeditions to attempt the summit of 15,325-foot Mount Fairweather, located at the border of Alaska and British Columbia. The first attempt was made in 1926, but the party was forced to turn back after reaching 9,000 feet. On the second attempt in 1931, two members of the

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Figure 4.1 William Ladd, MD. (Courtesy of Medical Center Archives of NewYork– Presbyterian / Weill Cornell.)

expedition reached the top after Ladd and a companion descended in order to conserve supplies.12 Ladd’s reverence for this part of the world shines through in a passage he wrote in 1929: “Lovers of the sport of mountaineering will find no more glorious setting than the Alaskan Coast Range. Here are not merely climbs, up and down from a valley base; for those who seek these great summits will live and have their being upon the heights. From camps perched on high glaciers they will see the sun set in the placid Pacific, and will thrill with John Muir to the ‘strange unearthly splendor’ of the dawn on the peaks of the Fairweather Mountains.” Ladd’s poetic description currently serves as the introduction to the National Park Service’s informational leaflet on summit attempts in Glacier Bay National Park in Southeast Alaska.13 In addition to serving as dean of CUMC, Ladd was a member of the board of managers of Memorial Hospital and played a prominent role in the hospital’s relocation from the Upper West Side to a site adjacent to the medical center, a process that began in 1936. He also served as a trustee of the New York Academy of Medicine, Amherst College, and the American University of Beirut. After retiring in 1942, he passed away on September 17, 1949, of a heart attack.

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With the move to new facilities, CUMC became a truly modern institution with a dedicated teaching hospital and fully equipped laboratories for biomedical research. It had a clear mission, which Ladd aptly summarized in his last year as dean:

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Taking the medical school as a whole there is first the teaching to be considered and then the research. Considering the clinical departments particularly, of first importance is the care of the sick, secondly the teaching and research. We must not forget, however, that in the long run all of the teaching and investigative work of the school is directed toward the improvement of the healing art. To teach the art of healing and to restore the sick human being to as near a state of good health and able citizenship as possible is our basic reason for existence.14

Seventy-five years later, his patient-centered formulation still rings true at Cornell’s medical school. Modern medicine brought various changes to the medical college, including a sizable bureaucracy to support its growth. No longer was the administration of the medical school informal and centralized in the hands of one individual. Whereas Dean Polk had been responsible for authorizing all expenses greater than twenty-five dollars, the dean of the 1930s could no longer supervise every aspect of a school’s affairs in such detail. As at other institutions, the dean’s own research or clinical work generally became secondary to his administrative responsibilities, including fund-raising and faculty recruitment.15 And increasingly, administrative tasks began to fall on department heads, much to the dismay of Eugene DuBois, CUMC’s chair of medicine and a researcher in the field of calorimetry: “Unless measures are taken to counteract this tendency, the full-time professor who has made his name as a clinician-teacher and investigator will become nothing more than an executive, a sort of hospital superintendent, living on his past reputation. This is far from the idea of a chief who can act as the leader of a highly trained group of younger men.”16 Relations between CUMC and New York Hospital grew stronger as the medical center settled into its Upper East Side location. By 1936, Dr. Henricus J. Stander, president of the hospital’s medical board, was able to report that the affiliation “has become a much closer one during the past few years.”17 Murray Sargent, in the newly created role of hospital administrator-in-chief, wrote that “1936 saw the start of the fifth year since the opening of the New York Hospital with its affiliated institutions in its present site. Considering the complexities of the problems presented by the various units that formed parts of a complicated whole, it is gratifying that so much progress has been made in the direction of harmonizing and unifying methods both in administrative and professional policies. This is to be accounted for by growing sympathy for and 83

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understanding of the points of view of others associated in the enterprise.”18 Still, a major problem that Canby Robinson had faced—the financial effects of the Depression—continued to be felt by Ladd. The medical center struggled to reduce its operating costs during the 1930s, although it was still undergoing a period of growth and expansion. The number of patients admitted to the hospital and treated at the outpatient department increased steadily each year. Floors in the new buildings that had not been fully used because of lack of finances were gradually opened for clinical services. The hospital’s deficit in 1936 was less than half of the deficit incurred in 1935. And although the Depression continued throughout the decade, the hospital’s endowment and capital increased, as Henry G. Barbey, president of the hospital’s board of governors, reported: “The improvement in economic conditions has been reflected in higher market values and returns on securities owned by the Society [of the New York Hospital] and in gradual improvement in the real estate which constitutes an important part of the Society’s holdings.”19 By 1936, various clinical departments were already talking about the need to plan for expansion.20 Things were not quite so rosy at the medical college. In his annual report to Cornell University president Edmund Ezra Day, who assumed office in 1937, Dean Ladd expressed concern that although the college’s department heads were well qualified, not every department had “a second in command qualified for professorial duties.” Faculty members of lower academic rank were insufficiently paid and in short supply, and there was a pressing need for support staff, including laboratory helpers, animal caretakers, and technicians. He wrote that an increase in endowment was essential in order to build up the faculty and staff of the medical school and to adequately support its educational, research, and clinical missions. Ladd indicated that the medical college was “running under a considerable deficit which can not be removed without seriously impairing the efficiency of our teaching unless more endowment is obtained.”21 Efforts to secure additional funds were initiated in 1938, when New York Hospital and CUMC announced a joint campaign for a $17 million endowment (or $287 million after adjusting for inflation). Of that amount, $8 million would be allotted to the hospital, and $9 million would go to the medical school. The campaign was led by the hospital’s board of governors under its president, Henry Barbey, who also served as chair of the medical center’s Joint Administrative Board. In association with the campaign, the hospital published an ambitiously titled volume, So Near the Gods. According to this publication, the hospital’s annual deficit had been significantly reduced in recent years but still amounted to $1 million (or $169 million in 2014 dollars), primarily due to “the free and partly free care of patients.” Income from the hospital’s share of the

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endowment would help cover this deficit and would be used to add beds in the department of medicine, develop surgical specialties, open unused floors of the hospital, endow the hospital’s nursing school, and support twenty-four fellowships. For its part, the medical school had reportedly cut its expenditures during the Depression, but its research programs were in jeopardy since Cornell University had stopped being able to support them. Thus, “A careful analysis shows that in order reasonably to maintain the college in the first group of institutions for teaching medicine it will be necessary to secure an additional endowment” through the campaign.22 However, Barbey died a few months after the campaign was launched, and with the subsequent outbreak of war in Europe, fund-raising efforts became secondary to war preparations. Medical education and student issues were priorities to Ladd throughout his years at Cornell. As associate dean responsible for student affairs, he wrote in 1934: “I have been accessible at all times to students for consultation on all sorts of affairs. From the number of visits paid by students, I believe there is no doubt but that this custom should be continued.”23 And as an educator, he took a holistic view toward learning and medicine. In his welcoming address to the entering class of 1933, he encouraged students to focus on becoming good doctors or laboratory workers, not on grades. Of paramount importance was keeping their patients’ humanity always in mind: “Too often the tendency is to carry over your attitude toward the inanimate material with which you have been working, and regard the case as merely a thing. It may be a very interesting case, but the case is also a man or woman, even as you are.”24 Ladd also encouraged his listeners to “become philosophers, detached, and yet intimate with man’s problems,” to always retain their sense of humor, and to truly experience and enjoy life: “If you are imbued with the determination to be a doctor, to help people gain health and live again, in the fullness with which it is possible to live, you cannot help but be inspired by your work. Life itself is the greatest adventure.”25 Archival records from 1934, including a report that Ladd submitted to Canby Robinson immediately prior to becoming dean, provide some insight into student affairs at the time. The entering class of 1933 contained forty-nine men and six women; the number of women admitted to the medical college had declined over the previous decade and a half. Students were taught by ninety-three full-time professors, instructors, and assistants, including eleven women and eighty-two men. The clinical departments of medicine, surgery, and pediatrics were both the largest and had the greatest gender disparity. Of fifty-one individuals who worked full-time in these departments, only two professors of medicine and one surgeon were women. Biochemistry, which contained three female and two male faculty members, was the sole department in which women outnumbered men.26 In his report, Ladd also wrote that students

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were not especially inclined to begin their coursework at Cornell’s Ithaca campus, and this division of the medical college subsequently closed in 1938, having enrolled a total of 1,515 students.27 He described several recent faculty-student social events, a need for increased funding for the student health service, and, in particular, widespread student and alumni interest in constructing a combined dormitory and recreation center. He envisioned a building containing living quarters of varying sizes, which could accommodate single students as well as approximately fourteen married students, including two or three with families. Recreational facilities would ideally consist of six squash courts, two bowling alleys, and a gymnasium with mats, a punching bag, two rowing machines, horizontal bars, and a pommel horse. In his opinion, a swimming pool was “too expensive and not particularly hygienic,” although quiet rooms for socializing, reading, or playing chess, checkers, or cards were highly desirable.28 The clinical teaching of medical students improved with the move to new facilities, which combined various forms of patient care, clinical research laboratories, and hospital equipment under one roof. During clinical clerkships in medicine and surgery, students saw patients at New York Hospital, its dispensary, and its outpatient clinic. Most of the patients at the hospital were referred by physicians practicing in the city and suburbs, while all full-time faculty members worked in the dispensary providing free medical treatment to impoverished individuals. The outpatient department was staffed by part-time faculty who devoted considerable time to treating patients, despite receiving no payment for their services. Students provided assistance by taking histories, conducting physical exams, and performing lab work under supervision. They also observed surgical operations being performed, studied the pathological material removed, and participated in the dressing of wounds. According to Eugene DuBois, chair of medicine, the clinical teaching program was “extremely satisfactory,” and “the patients like the clinical clerks and look upon them as friends, doctors and personal advisors.” Yet at the same time, he wished for a greater focus on research among the faculty: “Unless the spirit of scholarship and research pervades the institution it will degenerate into a factory for the routine and unintelligent treatment of disease.” In his opinion, full-time faculty members, who received only modest salaries, were “paid largely by their opportunities for research,” which had the potential to establish their reputations and advance their careers.29 Other developments in student life included a yearbook, called the Samaritan, which first appeared in 1937 and was dedicated to Lewis Conner, a favorite professor and role model. It contained photographs and essays related to the history of the medical college and its associated institutions, including the Memorial Hospital, Bellevue Hospital, and the John E. Berwind Free Maternity Clinic in Harlem.30 And in 1938, the New York Times reported on a teaching

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Figure 4.2  Pharmacist making drugs, 1946. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

innovation at CUMC. Gigantic models of eardrums, more than fifty times the size of human ones, had been constructed in the department of otolaryngology. According to assistant professor Gervais W. McAuliffe, “We wanted something that could be moved from lecture hall to different seminars. We decided to construct a long, oblong box, 6.5 feet high, 5 feet long and 2 feet 4 inches deep and mount it on rollers. . . . By utilizing heavy galvanized sheet iron in reproducing the component parts of the device we were able to create the illusion of looking through an otoscope into the exterior auditory canal at the drumhead.”31 A total of eighteen electrically illuminated models of the middle ear were created for teaching purposes. In his last annual report to Cornell’s president in 1941, Ladd discussed concerns surrounding the school’s admissions policies and curriculum. At the time, CUMC was one of only twelve medical schools in the United States and Canada that required a bachelor’s degree as a prerequisite for admission. In Ladd’s words, “There is no evidence that on this account these schools turn out better physicians than the other schools.” An additional consideration was that “young men must spend so many years to become well trained physicians that they can only enter practice at too late an age.” According to Ladd, the teaching

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staff felt that some individuals with two or three years of college coursework that included both science and the humanities could become “the doctor of our ideals,” whether or not they possessed a bachelor’s degree. He also raised questions regarding CUMC’s curriculum, which included more required hours and didactic teaching than any other medical school in North America. Student learning was focused on “feats of memory rather than upon comprehension and understanding,” resulting in “a tendency to confusion.”32 As it turned out, the entry of the United States into World War II would soon precipitate dramatic changes in medical education and address these concerns directly. In other areas, the medical center continued to grow. A private patients’ consultation service was developed at the hospital in 1936 to care for patients who came to the dispensary for free treatment but were found to have incomes above the threshold level.33 Also that year, the medical college opened the Kips Bay–Yorkville Health and Teaching Center on Sixty-Ninth Street in cooperation with the New York City Department of Health. One of five similar facilities located throughout the city, the center was intended to improve medical education and research in public health, train technical personnel for the Department of Health, and provide medical treatment for two hundred thousand neighborhood residents. The land for the building was purchased with support from the Rockefeller Foundation and the Milbank Memorial Fund, and the property was then donated to the city. Funds from the Public Works Administration were used to finance half the cost of the building, and its cornerstone was laid on May 10, 1937. The new Health and Teaching Center subsequently housed the medical school’s department of public health and preventive medicine, as well as infant, tuberculosis, syphilis, and dental clinics. Clinical services at the center were expanded in 1947 to include cancer prevention and detection, and in 1968 the title to the facility was transferred to CUMC. The Kips Bay center continued to house public health and other departments until 2009, when it was demolished to make way for the Belfer Research Building.34 Additional developments in the clinical arena included reorganization of the department of psychiatry so that its services were better integrated with those of other departments, instead of being treated as a completely separate form of care.35 Beginning in 1937, psychiatric patients were seen as inpatients and outpatients both at the Payne Whitney Psychiatric Clinic and at the main general hospital. When patients were treated at the New York Hospital for primarily physical conditions, psychiatric consultants acted as advisers, with resident staff in the general hospital carrying out “the less complicated forms of psychotherapy” under the guidance of a psychiatrist. Patients with predominantly psychiatric conditions were treated at Payne Whitney, with “somatic study and treatment” carried out by psychiatrists in consultation with hospital internists and surgeons.36 And in 1938, the first blood bank in New York and the second in the United States was established for blood transfusions.37 Seven months after it 88

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opened, it was described as “operating satisfactorily and profitably,” having received 711 donations and performed many more transfusions.38 The medical center also acquired a new neighbor when groundbreaking for the twelve-story Memorial Hospital commenced on June  8, 1937, on York Avenue.39 The $4  million cancer hospital (or $66  million in 2014 dollars), which replaced an older facility at Central Park West and 106th Street, was built on land donated by John D. Rockefeller Jr. and constructed with a $3 million grant from the General Education Board of the Rockefeller Foundation. Dr.  James Ewing, director of Memorial Hospital, president of its medical board, and a professor of oncology at CUMC, was the keynote speaker at its cornerstone ceremony on May  20, 1938. His words indicate that the New York Hospital–Cornell Medical Center was rapidly establishing itself as a hub for medical care and research in the city: “To the public, rich and poor, patient or philanthropist, this conspicuous building, added to an already great medical center (the Cornell University Medical College), should offer renewed encouragement to approach the cancer problem with greater alertness, wider knowledge and finer discrimination, for by fighting cancer with such weapons we may eventually reach substantial control of this group of diseases.”40 The new Memorial Hospital opened in 1939, strengthening an affiliation with the medical college that had been in place since 1914.

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World War II

As Cornell University president Edmund Day proclaimed, the university under wartime conditions was both “an arsenal and a citadel”: “As an instrument for the prosecution of the nation’s war effort, it uses its resources of manpower, equipment, and leadership to help insure victory. At the same time it stands firmly as a living embodiment of the purposes for which this war is being waged—a citadel where freedom of thought and expression, devotion to the cause of truth, preparation for the arts of peace, and provision of equal opportunities for men and women, regardless of race, creed, or class, are permanent guiding principles.”41 CUMC began stocking its arsenal well in advance of the United States’ entry into World War II, when it began offering a four-year elective course in military science and tactics in 1937. An officer of the Army Medical Corps provided instruction on topics including projectiles and war wounds, mass hygiene, and the administration and technical organization of hospitals. Participants, who were not required to wear uniforms, attended a six-week military training camp in Carlisle, Pennsylvania, and were paid by the government during their last two years of study. Upon graduating, students received commissions in the Medical Officers’ Reserve Corps.42 Seven members of the class of 1941 were commissioned as first lieutenants under this program, and about half of the student body was enrolled the following year.43 89

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Figure 4.3  Students in the Medical Officers’ Reserve Corps program on an overnight hike at Carlisle Barracks, Pennsylvania, 1940: left to right, Arthur Philson, Willet Whitmore, William Eastman, and Daniel Lester, members of the class of 1942. (Photo by Daniel Lester and Lawrence Lee Jr.; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

In June 1940, Great Britain reached out to the U.S. medical community for blood for emergency transfusions to treat soldiers injured in battle. In response, physicians in New York organized the Blood Plasma for Great Britain Project, commonly known as Blood for Britain. Researchers had recently discovered how to isolate and store blood plasma, and even though techniques were still in an experimental stage, a group of hospitals opened a service for obtaining blood donations and preparing plasma for England later that summer. Volunteers soon flooded collection centers at New York Hospital and other sites throughout the city, and during the five months that the program was in operation, civilians made about 14,500 blood donations that were then shipped overseas.44 As the war raged in Europe, Dean Ladd reported to Cornell president Edmund Day in 1941 that the medical college and the hospital were “doing their part in the setting up of the proper organizations to take care of civilians and the military should we be called upon to do so.”45 The United States was indeed plunged into war with the Japanese attack on Pearl Harbor on December  7, 1941, but Ladd was not destined to oversee the medical college during wartime. Earlier that year he suffered a heart attack and took a leave of absence from his position as dean, although he began practicing medicine again after just a few months of recovery and was appointed chair of clinical medicine. Walter Niles 90

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Joseph C. Hinsey Born in Ottumwa, Iowa, in 1901, Joseph Clarence Hinsey received his undergraduate degree in 1922 and a master’s degree in biology in 1923, both from Northwestern University. Although he initially had plans for a career in medicine, a teacher at Northwestern persuaded him to pursue graduate studies in biology instead, and in 1927 Hinsey was awarded a PhD in neuroanatomy from Washington University in St. Louis. He served in a variety of academic and administrative posts at Washington University, Northwestern, and Stanford University, before becoming professor and chair of physiology at CUMC in 1936. Three years later, he moved from physiology to become the chair of the department of anatomy, a position he held until 1953. Hinsey served as dean at CUMC from 1942 to 1953 and remains the only individual to occupy that post with a PhD instead of an MD degree. He then became director of the New York Hospital–Cornell Medical Center until June 30, 1966. Upon his retirement, a professorship of anatomy was created in his honor. Hinsey was also active outside New York Hospital–Cornell. In 1952 he was appointed to President Truman’s Commission on the Health Needs of the Nation, charged with identifying the country’s short- and long-term health requirements and recommending appropriate courses of action. He maintained a high level of involvement in the activities of the Association of American Medical Colleges (AAMC), which was founded in 1876 to improve medical education among its members. He served as its president during the 1949–50 year and in 1953 published an edited compilation of papers that had recently appeared in the AAMC’s Journal of Medical Education, titled Medical Education Today: Its Aims, Problems and Trends. In 1958 he received the first annual Abraham Flexner Award for Distinguished Service to Medical Education, the AAMC’s most prestigious honor. A successful fund-raiser, he was a founding member of the National Fund for Medical Education, which was established by business and industrial leaders. From 1956 to 1971, he served as chair of the China Medical Board, a nonprofit organization that supports medical education and research in China. He passed away on March 25, 1981, in Scarsdale, New York. He and his wife, Sarah, whom he married in 1926, had two children and lived for a period of time in a two-room suite on the twentieth floor of the medical center.46

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was asked to serve as acting dean starting October  1, 1941, but he died two months later. Joseph Hinsey was then appointed acting dean at the beginning of 1942 and became dean on July 1, 1942, when Ladd officially retired. As Cornell historian Morris Bishop put it, “the Medical College had heavy war burdens,” but Hinsey “bore them valiantly on his broad shoulders.”47 Following the attack on Pearl Harbor, the medical center was promptly mobilized to be prepared in the event of an enemy attack on New York. According to Murray Sargent, “plans for the calling out of several emergency units to the scene of a local disaster were perfected. Facilities for taking care of an unusual number of casualties were arranged for. Methods were devised for protection of patients from flying glass and for the movement of patients to protected locations in the buildings in the event of bombing attacks. Plans for a blackout were formulated.”48 Specifically, New York Hospital–Cornell made preparations to accommodate up to one thousand casualties within twenty-four hours and twice as many under catastrophic conditions. It organized an emergency squad consisting of six fully equipped teams, but its first major rescue mission was not related to any military hostilities. On February 9, 1942, the squad was called into action when the USS Lafayette, a former French ocean liner then being converted to a troopship, caught fire while docked in New York Harbor. One person died in the accident, and nearly three hundred were injured. War-related efforts in medical education also intensified immediately. Interns and residents began to receive specialized training in traumatic surgery, wound care, and wartime diseases. CUMC’s department of public health and preventive medicine organized a course on tropical medicine and parasitology for medical officers, in response to a request from the navy. The chair of the department, Dr. Wilson G. Smillie, was appointed by the surgeon general as a special consultant on the control of acute respiratory diseases in army camps, on call for duty at all times. Dr. Thomas P. Magill, an assistant professor in bacteriology and immunology, was appointed as a consultant to the secretary of war on epidemic diseases.49 The war created a pressing need for newly trained physicians, both at home and abroad. In order to produce more doctors for military service and at the request of the Association of American Medical Colleges, CUMC increased its class size by 6 percent and, beginning on July 8, 1942, shifted to an accelerated year-round program so that students would graduate in three as opposed to four years. At the same time, the army established the Army Specialized Training Program to produce a corps of junior officers and soldiers trained in medicine, dentistry, and veterinary medicine, and the navy created the V-12 Navy College Training Program to increase the number of commissioned officers in the navy and marine corps. These programs required

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students to be in uniform and to receive weekly military instruction, and in return the students were provided wages, lodging, food, textbooks, and instruments. The army and navy allowed CUMC and other medical schools to select students for admission, and CUMC, in 1942, dropped its requirement that entering students have a college degree. This prerequisite was not reinstated until 1950. Once admitted, students were inducted for active service as trainees in medical school and became either privates in the army or apprentice seamen in the navy. Following graduation, the new doctors were placed on inactive duty for a year to complete civilian internships, then received commissions as officers in the reserve corps of the army or navy, and were assigned to active duty. 50 Despite these changes, Hinsey reported in 1943 that “our educational program and our administration has not been disturbed to any great extent.” Still, he was “much concerned that in the future we may not be able to select our students.”51 The army and navy programs also raised doubts regarding the quality of entering and graduating students. During medical school and the one-year postgraduate internship, for example, individuals received a total of only twenty-seven hours of advanced training in surgery—a far cry from the eighty-hour workweeks that surgical residents are now limited to. The acceleration of the curriculum also created considerable disruption for the faculty and administration, which were forced to process a large volume of admissions applications and assume added teaching responsibilities. This increase in workload occurred without any increase in compensation and was borne by a significantly reduced staff, since nearly 30 percent of its members were away fulfilling military obligations. The first class taught under the accelerated program graduated on March 29, 1943, and consisted of four women and sixty-nine men with reserve commissions in the armed forces. They voted to cancel their commencement ceremony, since their internships were scheduled to start two days later. 52 By January 1944, the vast majority of students were in military service, including 202 army and 89 navy trainees out of a total student body of 317. Only fifteen women and eleven men were enrolled as civilians. 53 According to Mary Ann Payne, a member of the class of 1945, “My most vivid memories . . . are the marching of the students up and down the avenue. They did not conform well to the discipline of the Army—and they never got the marching right.”54 One notable participant in the navy program was David Rogers, who graduated in 1948, was appointed chief of infectious diseases at CUMC in 1955, and became the youngest chair of a department of medicine in the United States when he was recruited to the Vanderbilt School of Medicine at the age of thirty-three. A national authority on AIDS policy, Rogers returned to Cornell in 1986, after having served for fourteen years as the first president of the

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Robert Wood Johnson Foundation, the nation’s largest philanthropy focused exclusively on health. 55 The army and navy programs were not hugely popular among medical school administrators. Shortly after the war, a committee of the Association of American Medical Colleges conducted a survey of sixty-eight deans, which reported that “immaturity of the students and physicians produced by wartime acceleration was a universal complaint.” Most of the deans opposed the armed forces participating in the selection of candidates for the study of medicine, and practically all who replied felt that medical students should be deferred from military service. Many disliked the army and navy programs because they threatened the autonomy of medical schools and subsidized all of the students’ expenses and equipment, thus setting up unrealistic expectations for their future careers.56 In a handwritten note on his survey form, Dean Hinsey commented: “Preference [is] given the Navy program in that the student was afforded a longer period of training, the curriculum was better organized, and more adequate credentials were provided upon which to evaluate the students’ qualifications for medicine.”57 Despite the tumult of the war and its impact on medical education nationwide, many aspects of CUMC’s curriculum remained unchanged. In 1944, Hinsey wrote that the facilities at the medical center and at affiliated institutions “seem fairly adequate for undergraduate instruction.” CUMC retained control of the Second Division of the Bellevue Hospital for clinical teaching and research, as it had for the past several decades. Students also continued to visit affiliated hospitals throughout the city for specialized clinical experiences: Memorial Hospital for cancer, Manhattan State Hospital on Ward’s Island for psychiatric diseases, St. Luke’s Hospital for surgery, Willard Parker Hospital for infectious diseases, Lincoln Hospital for medicine, and the New York Eye and Ear Infirmary for ophthalmology. Still, George Heuer, head of the department of surgery, hoped to increase affiliations with additional hospitals in order to improve the training of surgical residents in specialties such as orthopedics, ophthalmology, and otolaryngology. 58 A large number of Cornell’s alumni, faculty, and staff served in the military during the war. The first alumni casualty was Lieutenant Jacques Conrad Saphier of the U.S. Marine Corps, a member of the class of 1940 who had received the John Metcalf Polk Prize for placing at the top of his class scholastically. He was killed on August 21, 1942, in the battle of Guadalcanal.59 In October 1943, Dr. Marion C. Loizeaux, a member of the class of 1931, became the first female physician to hold a commission in the Army Medical Corps in the European Theater of War, as reported in the New York Times. She was made a captain and assigned to duty as a special consultant to the Women’s Army Corps, after serving as an emergency surgical assistant in England. She

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had originally left for Britain in June 1941 as part of a volunteer contingent of twelve women doctors to treat air raid casualties.60 CUMC and New York Hospital also created their own army unit, the Ninth General Hospital, which served as a military hospital in the South Pacific from 1943 until the end of the war. Initially formed as Base Hospital Number Nine by New York Hospital staff during World War I, it was reorganized in 1940 at the request of Secretary of War Henry Lewis Stimson, the son of CUMC’s founding professor and surgeon Lewis Stimson, who had contacted George Heuer, chair of surgery. The unit was one of thirty-two similar general hospitals set up under the War Department’s Protective Mobilization Plan. Just one day after it was announced, the number of doctors who had volunteered for service was already three times more than the number of available commissions. Dr. William Dewitt Andrus, assistant professor of surgery at CUMC, was chief of the surgical service, and Dr. Bruce Webster, assistant professor of medicine, was chief of the medical service. The unit consisted of 55 physicians and 150 nurses, enough to staff a one-thousand-bed military hospital. Of these, 47 physicians were members of the medical college faculty, and many of the nurses were from New York Hospital. After the unit was called to active duty on July 15, 1942, female members, including nurses, physical therapists, dietitians, and Red Cross workers, were sent to Fort Devens, Massachusetts. Male personnel, mostly physicians and administrators, went to Fort Banks and Fort Andrews in Massachusetts, where they trained new recruits as hospital orderlies, nurses’ aides, and technicians. A year later, the two groups were reunited in Boston, traveled by train to California, and then boarded an army transport ship bound for Brisbane, Australia. After arriving at the end of the summer, they found that orders had changed in the interim. Over five hundred male doctors, officers, and administrators then departed for Goodenough Island off the coast of New Guinea on October  18, 1943, while nurses and female personnel remained in Brisbane with the Forty-Second General Hospital, a similar unit formed by the University of Maryland. The Ninth General Hospital was the first to be stationed in a combat zone in the South Pacific. At Goodenough, its personnel were largely responsible for constructing hospital wards in a clearing in the middle of the jungle, pumping in fresh water from a dam more than a mile away, and establishing telephone communication with the outside world. Within six weeks of the unit’s arrival, the hospital began admitting its first patients, but it was struck by an outbreak of typhus, which killed eight members of the unit, and by a monsoon. The unit was moved to Biak, another island northwest of New Guinea, in August  1944 and constructed another hospital, where it treated about twenty-three thousand patients by July 1945.

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Figure 4.4 Dr. Frank Constantine, a captain in the Surgical Service of the Ninth General Hospital, at Goodenough Island off New Guinea, 1943–44. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

Figure 4.5 Admitting buildings of the Ninth General Hospital on Biak Island, 1944–45. (Photo by U.S. Army Signal Corps; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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Figure 4.6  Nurses’ living quarters in the Ninth General Hospital on Biak Island, 1944–45. (Photo by U.S. Army Signal Corps; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

Then it was transferred to Luzon in the Philippines, where it arrived on August 14, 1945, the same day as the Japanese surrender. The Ninth General Hospital was soon officially disbanded and later received the Meritorious Service Unit Plaque in recognition of its efforts during the war.61 Back in New York, faculty conducted war-related research on topics including nerve regeneration, the chemical structure of penicillin, the rate of burn healing, the prevention and treatment of shock, lack of oxygen in aviation, and the dangers of prolonged bed rest.62 One especially colorful research project was initiated at CUMC during World War II. Hugh DeHaven had attended one year of the Ithaca medical school program in 1914–15 before becoming a pilot in World War I. He survived a plane crash in 1917, and in 1936 began researching cases of individuals who had survived falls from great heights after landing on different types of surfaces. Cornell historian Morris Bishop reports that DeHaven also “tested a new sponge rubber by dropping fresh eggs on it from the eleventh floor of the 97

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Figure 4.7  George Papanicolaou, MD, with colleagues Charlotte Street and John Seybolt. (Photo by Michael Hollander; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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George Papanicolaou The roots of Dr. George Papanicolaou’s pioneering work in cancer detection began shortly after he joined CUMC’s department of anatomy in 1914, although his studies only began to gain scientific recognition during World War II. His early work with Charles Stockard on alcohol in guinea pigs (see chapter 2) led to additional studies on the animals’ sex cycle, using cytological examinations of vaginal smears. This work resulted in Papanicolaou’s first journal article, “Sex Determination and Sex Control in Guinea Pigs,” published in Science in 1915. It was followed by cytological studies of human vaginal smears obtained from his wife, Mary, and patients from the Cornell Pay Clinic and the Woman’s Hospital of the City of New York. Papanicolaou determined that abnormal cancer cells could be readily observed under the microscope and produced an early report of his ability to detect cervical cancer cells in 1928. The paper went largely unnoticed, and he discontinued his cancer work for the next ten years to focus on hormonal problems related to menopause and infertility. It

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was not until 1939 that Papanicolaou began to pursue his cancer research full-time, after being encouraged to do so by Joseph Hinsey, newly appointed chair of anatomy. In 1941 Hinsey helped him obtain an initial grant of $1,800 from the Commonwealth Fund, a foundation that proceeded to support Papanicolaou’s work over the next eleven years, for a total of $124,000.63 Shortly after the 1943 publication of Papanicolaou’s monograph “Diagnosis of Uterine Cancer by the Vaginal Smear,” coauthored with Herbert F. Traut from obstetrics and gynecology, Hinsey reported: “This technique promises to be of great value in the recognition of this disease early in its course and in the subsequent reduction of mortality in women who suffer with this condition.”64 With Hinsey’s support, Papanicolaou began training pathologists and cytologists in his Pap smear techniques in the mid-1940s. He received the Albert Lasker Clinical Medical Research Award in 1950 in recognition of his work enabling the early diagnosis of cancer; arguably, he should have received a Nobel Prize. Before the development of the Pap test, cervical cancer was the leading cause of cancer death for women, killing about twenty thousand women annually in the United States. That number has now fallen to four thousand. After forty-seven years at Cornell, Papanicolaou moved to Miami in 1961 and died the following year of a heart attack. In 1978, an oriental plane tree from the Greek island of Kos was dedicated to his memory and planted in a courtyard at CUMC. The tree had grown from a seedling obtained from the tree under which the Greek physician Hippocrates was said to have received patients in the fifth century BC. 65

Medical Center. The eggs bounced, unbroken, thirty-five feet in air. He tried to catch them on the bounce, and usually met with disaster.”66 DeHaven first published his findings in the journal War Medicine in 1942 and, based on his analysis of seven cases of human free fall, reported that the body can tolerate a force of two hundred times the force of gravity for brief periods.67 That same year, he initiated the Crash Injury Research Project at CUMC. As part of this program, he developed and operated a high-speed sled on the roof of CUMC to study deceleration effects on human subjects, which generated data for both military and civilian design engineers of aircraft and automobiles.68 His research evolved into a university-wide program in automotive safety, which reported in 1956 that seat belts were the best way to reduce injuries from car accidents.69 99

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A major development at the medical center during World War II was the establishment of the Cornell University–New York Hospital School of Nursing on July  1, 1942. Plans to merge the New York Hospital School of Nursing with Cornell University had been initiated in 1932, but adequate funds could not be obtained until a decade later. The new nursing school required applicants to have completed two years of college, and its graduates received a bachelor of science in nursing from Cornell and a diploma of nursing from New York Hospital after conclusion of a three-year training program.70 Bessie A. R. Parker, director of the School of Nursing, wrote enthusiastically about the arrangement: “it is not at all a breaking of old ties but rather a cementing of the old with the new. It is a cooperative venture which preserves all the fine traditions of The New York Hospital School of Nursing and combines with them the opportunities opened to us through the medium of a great University.” When the new school opened, a large proportion of the nursing staff had left to join the Ninth General Hospital and other divisions of the Army and Navy Nurse Services. To address the staffing shortage, the school reached out to inactive graduates to return to full- or part-time service at the medical center and offered special classes to train volunteers as nurses’ aides.71 In October  1943, a class of twenty-three graduates received bachelor of science in nursing degrees from Cornell University for the first time.72 Following the Allied victory in the war, the medical college slowly readjusted to peacetime conditions, although the influence of the military could still be felt on campus. In the summer of 1945, Hinsey wrote: “The element of fatigue on the part of staff and students has become much more apparent. The standard of our work is below that which is desirable.”73 A year later, however, he was able to report that most of the staff was back to work as normal. The army and navy training programs concluded in 1945–46, and all enlisted students were returned to civilian status.74 The accelerated curriculum was also terminated after four years in operation. Although Hinsey acknowledged some educational deficiencies with the accelerated program, he felt that “our students whom we have graduated have not been poorly trained. They have gone through the full curriculum and should be able to supplement any inadequacies by obtaining sufficient hospital training of a high order when they return from military service.”75 The Reserve Officers’ Training Corps (ROTC) unit at CUMC was reactivated in the fall of 1946 and operated until June 30, 1953, when it was discontinued as the oldest medical ROTC program in New York State. In addition, an experimental program in Medical Education for National Defense, designed to introduce elements of military medicine and civil defense into the curriculum, was instituted at Cornell and four other schools following the war.76 A sense of normalcy was gradually restored in the educational arena, although the threat of ongoing military conflict continued to be felt at Cornell— and throughout the nation—well into the next decade. 100

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5 Postwar Boom If this country is to prevail over its enemies it will not do so by numbers but by the superior quality of its educational programs and by its superiority in the field of research and other forms of intellectual productivity.

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Joseph Hinsey, Annual Report to Cornell University President, 1950–51

The cessation of military hostilities led to an economic boom and renewed prosperity throughout the country, much welcomed after the harsh years of the Depression and war. Postwar economic growth fueled an exponential increase in federal funding for research at medical schools nationwide, enabling them to develop extensive research programs and become highly regarded arms of larger “research universities.”1 Starting in 1937 with the establishment of the National Cancer Institute, the federal government had begun awarding research grants to scientists and funding fellowships for young medical researchers. In 1944, the Public Health Services Act was passed, which two years later allowed the original cancer grants program to be expanded to include the entire National Institutes of Heath (NIH). Subsequently, the total NIH budget grew from $8 million in 1947 to more than $1 billion in 1966. By 1952, the federal government had become the largest sponsor of medical research, providing $73 million annually for studies conducted in government laboratories and in nonprofit and higher education institutions. By comparison, private industry spent $60  million annually on medical research, and $40 million came from other sources.2 Cornell’s research program experienced a corresponding expansion. In 1939, total funds for research amounted to about $170,000. This number rose to $560,000 in 1946, doubled to $1,153,000 in 1950, and reached nearly $2.4 million in 1955, with approximately 40 percent coming from government sources, primarily the U.S. Public Health Service. After adjusting for inflation, this trajectory marked a dramatic 7.3-fold increase in research funding between 1939

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CHAPTER 5

and 1955. The influx of funds, which continued through the 1960s, allowed Cornell to build its research infrastructure, recruit new investigators, and direct additional resources toward finding better treatments for disease. Initially, Dean Joseph Hinsey took a pragmatic view of these changes: “In accepting government funds, we have been aware at all times that we must keep our operation so organized that we can withstand the possibility of having these funds withdrawn suddenly.”3 Inflation and operating expenses also increased dramatically during the early postwar era. Total expenditures doubled from $1.5 million to more than $3  million between the 1944 and 1951 fiscal years.4 Yet the medical school managed to keep its yearly deficit under control, in part by increasing tuition and beginning to charge a small application fee. By 1953, the medical college had succeeded in eliminating its annual deficit, which had reached more than $100,000 in 1947 (or about $900,000 in 2014 dollars).5 Still, finances continued to prove challenging, especially to the New York Hospital, which sustained large yearly losses that threatened the medical school. As Hinsey wrote in 1950, “Unless new income can be brought into this operation, I can see no escape from curtailment of our present program,” a situation he hoped to avoid by adding to CUMC’s endowment.6 Tuition fees only partially covered the costs of educating medical students, and Hinsey noted in 1948 that “it has been extremely difficult to raise funds for the support of our basic educational program. While the public has been educated to giving to special fields of research, i.e., cancer, poliomyelitis, cardiovascular disease, etc., they have not been given an appreciation that the medical colleges of this country must be adequately supported if work in these special fields is to be done properly.”7 In an attempt to remedy the situation, he helped found the National Fund for Medical Education and successfully supported Senate legislation designed to increase federal aid for medical education.8 As Cornell’s medical school regained its footing during the postwar boom years, anxieties regarding the spread of communism and the advent of the Cold War became widespread nationally. The political climate at Ithaca grew very highly charged, with allegations of communist sympathies leveled at several faculty members; but Cornell’s medical school was largely spared from Senator Joseph McCarthy’s witch hunt.9 According to historian Kenneth Ludmerer, “scarcely any evidence of the inquisition can be found in medical school records, perhaps because of the absence of political radicalism on medical campuses and the public’s satisfaction with what medical research was contributing to the common good.”10 The U.S. military intervention in Korea from 1950 to 1953 did not affect medical teaching and research to the same degree as World War II, although it did foster debate regarding the role of academic medicine in national defense strategies. 102

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A committee of the National Security Resources Board, an agency formed in 1947 to prepare the United States for industrial and economic mobilization in times of war, pushed for greater involvement by medical schools in the Korean War. As in World War II, it called for an acceleration of the curriculum and a nationwide increase in enrollment, in order to produce more doctors. Hinsey disagreed with this strategy because he felt that it lowered the quality of graduates, exhausted teaching staff, and interfered with research. Despite concerns regarding the quality of students admitted during World War II, however, an internal study suggested that mean grade-point averages may have actually increased during the war. It showed that the entering class of 1938 clocked in at 2.76 out of 4, compared to 2.87 in 1946 and 2.99 in 1948.11 Still, many at Cornell were relieved when the school was not compelled to adjust its educational program during the Korean War and when enrolled students and essential staff members were deferred from military service. To assist in military preparedness efforts, the medical school did introduce to its curriculum topics relating to atomic, bacteriological, and chemical warfare.12 As the 1950s progressed, the nation began demanding a larger supply of doctors to meet its health care needs, which prompted the creation of federal and state government programs designed to increase the number of students in medical school. After their experience with the army and navy training programs in World War II, the American Medical Association and many medical school leaders opposed these forms of government aid because they feared it would threaten their autonomy.13 Dr.  E. Hugh Luckey, CUMC’s dean from 1954 to 1957, asserted that CUMC would continue to limit its class size, arguing simply that “Cornell cannot and should not compete in quantity with the large state universities in this country; we can compete favorably in quality.”14 The 1950s also saw a pronounced increase in specialization within the profession of medicine. Fields of knowledge proliferated as biomedical research advanced, and specialists earned increasingly higher incomes compared to general practitioners. In 1940, 78 percent of all physicians had been generalists, but this proportion fell to 67 percent in 1949 and to just 38 percent in 1961.15 At Cornell, Luckey resisted the pressure to orient students toward general practice. In his view, “no penalty should be imposed on the student who ultimately chooses private practice or restricted fields, a career in research and teaching, or a position in medical administration.”16 Financial concerns played a role in the shift toward specialization. In 1955, Dean Luckey reported to the president of Cornell University that it was becoming increasingly difficult for middle-class families to meet the costs of medical school. That year student tuition was increased to $1,000 per year, or $8,900 after adjusting for inflation. Scholarship funds were limited, although more than 30 percent of students were able to receive some form of financial assistance from Cornell or other sources.17 In addition, the period of time between 103

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entering medical school and starting the practice of medicine had lengthened substantially by mid-century, which further contributed to the financial burden of medical graduates. The one-year rotating internship after medical school had been gradually replaced with a three- or four-year residency to pursue a specialty, and in some cases was followed by postdoctoral training in a subspecialty, such as cardiology or rheumatology. Doctors who had been deferred from the draft during the Korean War were also required to perform an obligatory two years of military medical service. Still, despite the cost and extensive period of training, increasing numbers of applicants flocked to Cornell.

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Cornell’s Students

Admissions practices at CUMC saw substantial changes and attracted their share of controversy in the postwar years. During the early 1920s, approximately 150 students had applied to CUMC annually. After the army and navy programs were implemented, there was a steady and gradual increase to 1,200–1,300 applicants during the war. This number dropped to 900 in 1945. In 1946, a revised version of the Medical College Admission Test (MCAT), which had initially been developed in 1928, was introduced. That year a total of 810 applicants to CUMC took the MCAT, scoring an average of 554 in General Ability and 543 in Pre-medical Science Achievement.18 With possible scores ranging from 200 to 800 for each section of the test, Cornell’s applicants were safely above the national mean, which was set at 500.19 The introduction of the Servicemen’s Readjustment Act, or GI Bill, which provided financial assistance to returning veterans to attend universities, triggered a flood of applicants at CUMC. A peak of 3,222 applicants occurred in 1949, when about half of the 240-member student body was enrolled as part of the GI Bill. By 1951, the number of applicants had dropped to 1,843.20 To deal with this deluge of paperwork, the admissions committee added new questions designed to elicit more information about student goals, achievements, and community service. In addition, it paid greater attention to “the care, neatness and judgment shown by the applicant in filling out the answers to questions.”21 The following year, a national system for making residency appointments by matching graduating students with hospitals based on preferences was introduced. According to Hinsey, the results “were very well received by our students,” with 86 percent assigned to their first-choice hospitals and all the rest obtaining positions at their second, third, or fourth choices. 22 With thousands of qualified students competing for about eighty slots in each entering class, competition was fierce. Charges of racism and anti-Semitism in medical school admissions began to emerge in New York and attracted considerable public attention. In 1946, five institutions—Cornell, Columbia, New 104

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Postwar Boom

York University, Long Island College of Medicine, and the New York Homeopathic Medical College—were accused of policies discriminating against Jewish, African American, and Italian students. In response, the City Council set up a committee to investigate complaints, and it found these allegations to be warranted.23 A letter from 1940 written by Dean William Ladd was reported in the New York Times as evidence that Cornell had a quota system in place. In it, Ladd replied to a rejected applicant, saying, “We limit the number of Jews admitted to each class to roughly the proportion of Jews in the population in this State.” However, in testimony to the City Council, he later stated that no official quota policy existed.24 The controversy around admission to New York medical schools persisted for several years. In 1953 the New York Times reported that the American Jewish Congress had conducted a three-year study showing that nine New York State medical schools, including CUMC, discriminated against Jewish applicants. 25 Five months later, the American Jewish Congress dropped anti­ bias charges against one of the medical schools named in its report, the Upstate College of Medicine at Syracuse, and it appears that the matter was not pursued further with any of the others.26 As the issue died down, Cornell remained the most selective medical school in the country in the mid-1950s, with fifteen to eighteen times the number of applicants to enrolled students, according to data from the Association of American Medical Colleges.27 Once admitted to CUMC, students often had trouble finding a place to live. The need for a student residence was, in Hinsey’s words, “one of our great problems.”28 Joseph Artusio, a member of the class of 1943 who later served as chair of anesthesiology, commuted to school on the subway and frequently walked across town with Hinsey. According to his recollection, “It was [Hinsey’s] great desire that we have dormitories for our students, rather than have to live in brownstones or commute.”29 During the war, male students had been housed on the sixth to tenth floors of the powerhouse of New York Hospital. Dr. Connie Guion, who became one of the first female professors of clinical medicine in the United States in 1946, arranged for female students to live in the East End Hotel for Women, a women’s residence located at Seventy-Eighth Street and the East River.30 After the war, a total of 180 male students were placed in temporary dormitories, which consisted of three former navy barracks on the corner of York Avenue and Sixty-Ninth Street that had been provided through the Federal Public Housing Authority, while 16 female students resided in a nurses’ annex.31 As head of the alumni association, Dr. Guion made an impassioned appeal at an alumni banquet in 1947 for funds for student housing, describing the temporary facilities as depressing buildings that might deter prospective students.32 Later that year, plans to raise funds for a new student residence commenced but had to be suspended when it was decided to combine the medical school’s and Cornell University’s development efforts. 105

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Figure 5.1  Students singing and playing the piano in the Olin Hall lounge. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

Cornell University then proceeded to launch the Greater Cornell Fund campaign, with a target of $12.5 million, including a goal of $2.5 million for the medical school. At its conclusion, CUMC ended up receiving just $130,000.33 The Olin Foundation came to the rescue on January  9, 1952, when it announced that it would provide $2,549,000, or $23 million after adjusting for inflation, to construct a twelve-story student residence on the corner of Sixty-Ninth Street and York Avenue. This was the third-largest gift in the medical school’s history at the time, coming after a $4,134,000 endowment received from Colonel Payne in 1913 and a $2,559,000 donation by the General Education Board in 1927. The Olin Foundation had been set up in 1940 by Franklin W. Olin, an 1866 alumnus of Cornell and a chemical manufacturer. The formal announcement of the Olin gift was made at a convocation attended by John M. Olin and Spencer T. Olin, the founder’s sons and both Cornell alumni. Also in attendance were Charles Horn and James Wynn, the respective president and vice president of the Olin Foundation; Cornell University president Deane Malott; Cornell trustee chairman Neal Dow Becker; and Dean Hinsey. At the time, the site of the new building, though owned by the university, was occupied by a garage building leased by truck rental operators. Demolition of the garage started on June 1, 1952, and groundbreaking ceremonies were held on March  4, 1953. On that occasion, James Wynn of the 106

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Olin Foundation dug into the ground with a silver spade that had previously been used for the medical center’s initial groundbreaking in 1929. Olin Hall, which ended up being ten stories high, was connected to the medical school through a tunnel beneath York Avenue. It was formally dedicated on November  15, 1954, when the Olin Foundation’s president, Charles Horn, handed over the key to the building to Hinsey.34 By 1956, Olin Hall had become “a milieu for spiritual and social cohesion in our students.”35

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Experiments in Education

During the postwar era, extensive experiments in medical education were taking place nationwide. Individual institutions struggled to craft unique solutions to concerns that had confronted medical educators throughout the century: achieving a better integration of basic science and clinical components of the curriculum, actively engaging students in the learning process, defining a core body of knowledge while medical practice was becoming increasingly specialized, and considering patients in a family or community context. The concept of interdisciplinarity gained currency, as did the view that human health was affected by many psychosocial and economic factors, in addition to purely medical ones. Some schools, like Johns Hopkins, Northwestern, Vanderbilt, and Boston University, started programs that incorporated undergraduate premedical study and shortened the time to an MD degree. Stanford added an extra year to its medical program, while Western Reserve University School of Medicine introduced a novel interdisciplinary approach focused around organ systems rather than departments.36 An important educational initiative started in 1952 was a program for comprehensive care and teaching, which was launched at CUMC, the University of Colorado School of Medicine, Temple University School of Medicine, and the University of North Carolina School of Medicine, with support from the Commonwealth Fund. The CUMC program, which was implemented largely through the efforts of Dr. David Barr, chair of medicine, and directed by Dr. George Reader, was one of the earliest and most influential in the country. In connection with the outpatient department, it focused on how best to provide clinically integrated, cost-effective continuity of care to individuals and families in a community context over a period of several months. Fourth-year medical students worked as family doctors in teams consisting of a doctor, social worker, and nurse, and they were specially trained to view the patient’s problems as a whole. Dean Hinsey predicted that the comprehensive care program, which “emphasized the importance of the total individual and recognized the significance of the psychological, environmental and social factors in health and disease,” would become one of the most important educational developments to 107

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Figure 5.2  Students receiving laboratory instruction, 1950. (Photo by Mclean Dameron; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

occur at the medical school in the 1950s and 1960s.37 As dean, Hugh Luckey was also a supporter of this holistic view of medicine: “A doctor cannot look at ‘parts’ of patients; he must get the whole picture—learn to understand the sick person and how to deal with him in his over-all environment.”38 Luckey was also a proponent of other interdisciplinary approaches that considered the social aspects of illness, including psychosomatic medical programs, since “it must be recognized that the great majority of human diseases cannot now be explained satisfactorily through information that meets the strict requirements of natural and physical science.”39 Dr. Peter Rogatz, who served as chief resident during the first year of the comprehensive care program, recalls: “Students were assigned to follow patients for several months, from initial registration as outpatients to the time of discharge, including, when appropriate, transfer from outpatient to home care. Nursing and social work activities were integrated with medical care. . . . Many Cornell students gained valuable insights into the lives and care of their patients and families, as did I.”40 Between 1952 and 1957, sociologists from Columbia University collaborated with CUMC faculty to study how student behavior and experiences were affected through their participation in the program. They reported that the program was widely considered a success, helped students develop self-confidence in dealing with patients and solving clinical 108

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problems, and raised important questions regarding the optimal organization of medical services both inside and outside a hospital. Although a major point of pride for Cornell, the comprehensive care program was discontinued in 1969 when the curriculum changed and the fourth year became entirely elective.41 Other radical pedagogical techniques were under consideration at Cornell during the 1950s, including elimination of the departmental system of teaching and allowing students to choose most of their courses. Although Dean Luckey was firmly convinced that academic departments should not be entirely eliminated, multidisciplinary labs were designed to enable simultaneous studies in several of the basic sciences. With “project” teaching—a precursor to contemporary “problem-based learning”—individual students or small groups were assigned a topic for study and experimentation, then asked to report on their results to the entire class: “This technique re-emphasizes student ‘participation’ in the educational process, extends laboratory experience, and affords a perspective in the scientific methods which should serve them well in any of the various careers in medicine.”42 Preclinical and clinical teaching were also better integrated. When students learned about the anatomy of the knee and the physiology of joint fluid, for example, they were simultaneously acquainted with diseases of the knee, fracture treatment, knee surgery, and degenerative conditions. Another innovative learning experience involved assigning first-year students, within a week of the start of classes, to families with new babies, and asking the students to serve as family medical advisers throughout the entirety of medical school.43 Collectively, these kinds of experiments at Cornell and other medical schools around the country helped inject some much-needed creative energy into the field of medical education. Yet by the mid-1960s, it appeared that the field of medical education had not changed substantially, with both students and educators bemoaning that too much emphasis was still being placed on lectures and memorization, rather than on intellectual stimulation and growth.44 From Hinsey to Luckey

Major developments outside the educational realm included the establishment in 1947 of the Institute of Child Development, an interdisciplinary center incorporating pediatrics, psychiatry, and public health that focused on the physical and emotional growth of infants and children.45 A  long-anticipated event was the medical school’s fiftieth anniversary, which was officially celebrated on March 11, 1948, with a day of clinics, demonstrations, and a luncheon. Dr. Lewis Conner, who had been a member of the original faculty in 1898, and his wife were featured as guests of honor. Attendees at the gala included three members of the medical school’s inaugural class, and the graduating students of 1948 published a special commemorative edition of the 109

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yearbook.46 Another milestone was the creation of the Vincent Astor Diagnostic Clinic in 1950, the first nonprofit diagnostic clinic in New York City for private ambulatory patients of all income levels. What made the clinic different from others was that it accepted all patients who could pay its fee, not just those below a certain income level. A donation by the businessman and philanthropist Captain Vincent Astor, a member of the hospital board since 1930, enabled the reconstruction of the two hospital wings in which the clinic was housed. Governed and staffed by New York Hospital, it saw approximately one thousand patients and arranged for diagnostic services for more than twenty-two thousand private patients of hospital staff members in its first year of operations.47 After shepherding CUMC through eleven taxing years as dean, Hinsey was ready to move on to even greater challenges.

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Accounts of Joseph Hinsey According to New York Hospital historian Eric Larrabee, Joseph Hinsey was “a man of ebullient spirits,” who transformed the medical center as its director by devoting himself “to the principle that the interest of the Hospital and the interest of the Medical College were the same.”48 At his retirement as director in 1966, he was described in the New York Times as “a plain, hearty man (6 feet 1 and 220 pounds) with a formidable jaw and a comfortable paunch.” He referred to his former students, who nicknamed him “Spike,” as “my boys, and I know every last mother’s son of them.”49 John Deitrick, dean of the medical college at the time, concurred: “Dr. Hinsey knew so many of our graduates that [an alumni] Directory was almost superfluous for him.”50 Dr. Walter Riker Jr., a 1943 graduate who spent his entire career at CUMC, remembers Hinsey as “Mr. Everything”—“a giant in Cornell University Medical College history” who was “renowned for his thunderous voice, which would rattle the walls of our lecture room.” After Riker’s first year of medical school, with his father unemployed and the nation sunk in the Depression, he recalls receiving a fortuitous phone call from Hinsey that “vibrated my ear drums.” Hinsey proceeded to invite him to work with him over the summer on studies of the hypothalamus. Although “blasted all summer long with questions on neuroanatomy and neurophysiology,” Riker survived the experience intact and continued working with Hinsey during his sophomore year. Despite the “backbreaking and mind-stressing task”

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to which Riker was assigned, he and Hinsey became friends, and later, colleagues. As a faculty member, Riker frequently dropped in on Hinsey in his office, and after Hinsey’s retirement, the two corresponded regularly. In Riker’s opinion, Hinsey found nothing more important than the teaching of others. Writing with heartfelt emotion in 1998, Riker pledged, “I shall never forget him so long as my memory remains.”51 J. Robert Buchanan, a 1954 graduate who went on to become the medical school’s eighth dean, calls Hinsey “a remarkable man.” Although he did not know him while a student, he remembers Hinsey coming to see him after he became dean in 1969, to offer his congratulations and a piece of advice: “He handed me a little pad of paper. He said, ‘Put this in your top drawer, because the first time somebody comes in and says to you, “If you don’t do this, I’m going to resign,” you hand them that pad, and give them a pen, and ask him to write his resignation right then and there.’ He was dead serious. Fortunately that never happened to me, but it told me a lot about that guy. He would put his action where his mouth was.”52 It is unknown how many times Hinsey was forced to follow his own advice during his time as dean and director.

Ever since the retirement of Canby Robinson as dean in 1934, the administration of the hospital and medical school had not been connected, and no director of the New York Hospital–Cornell Medical College Association had been appointed. In 1947, in order to strengthen this relationship, it was decided that the leadership structure of the medical center would be consolidated in one individual, who would be appointed jointly by the two institutions to serve as director of the medical center and president of the Joint Administrative Board. The original affiliation agreement was amended to reflect this change in administration. The first director after Robinson was Dr.  Stanhope Bayne-Jones, who had previously been dean of the Yale Medical School and a professor of bacteriology. When he retired in 1953, the affiliation agreement was again amended, and the official name of the joint institutions became the New York Hospital–Cornell Medical Center, which included the Cornell University–New York Hospital School of Nursing. This amended agreement redefined the position of director, who became the administrative officer for the entire medical center, with full financial and budgetary responsibility. 53 In 1953, Hinsey was appointed the director of the newly reconstituted New York Hospital–Cornell Medical Center and retired from his positions as dean and chair of anatomy at CUMC. In his last annual report to Cornell’s 111

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president, Hinsey wrote, “It is with great reluctance that I relinquish both of these appointments which have meant so much to me. However, my new position will be concerned with our great Center, an enterprise in which Cornell University and the New York Hospital have a joint interest. I look forward to working in cooperation with the staffs of both institutions in forwarding our progress.”54 Hinsey’s efforts to coordinate the policies of the hospital, medical college, and nursing school were soon met with appreciation by his colleagues and continued until his retirement in 1966. In 1955, Hamilton Hadley, president of the Society of the New York Hospital, wrote that Hinsey’s leadership “has been most effective, both from the point of view of the University and of the Society.”55 The following year, Hadley reported that a group of Hinsey’s friends had given the medical center a portrait of him to honor “his exceptionally able leadership” and “in recognition of our liking for him.”56 And in 1960, Dr.  Henry Pratt, director of the New York Hospital, paid special tribute to Hinsey in his annual report “for his fair-mindedness and rare good judgment which have done so much in the past few years to cement firmly the various elements of the Center, which in turn has prepared the climate for a joint fund raising effort, for his firm leadership, for his vast knowledge of all the factors which must be coordinated and guided in a great medical center, for his wisdom and for his unfailing willingness to give advice when it is sought.”57 During Joseph Hinsey’s transition from dean of CUMC to director of the medical center, Dayton Edwards, PhD, served as acting dean for a year. On July 1, 1954, at the age of thirty-four, Dr. E. Hugh Luckey was promoted from an associate professor of medicine to become one of the youngest medical school deans in the country.

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E. Hugh Luckey Born in 1920 in Jackson, Tennessee, Egbert Hugh Luckey was “a very agreeable southerner,” according to J. Robert Buchanan, CUMC’s eighth dean.58 After graduating from Union University in Jackson, Luckey attended medical school at Vanderbilt, at which time he met and fell in love with both his future wife and his future employer. According to a profile that appeared in Newsweek shortly after his appointment as dean, Luckey “came north to visit a pretty home-state girl attending high school in Bronxville, N.Y.,” and at the same time, paid a visit to the New York Hospital–Cornell Medical Center: “ ‘This,’ he murmured, ‘is for me.’ ” He married Betty Ann Black in 1942, and after receiving his medical degree in 1944 became an intern

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and resident at the New York Hospital. Subsequently, he and his wife had four children, including twin boys born prematurely at New York Hospital. Luckey served in the U.S. Army Air Forces from 1946 to 1948, then became a Niles Fellow in medicine at CUMC, conducting research on abnormal blood proteins. He joined the faculty and served as director of the Cornell Medical Division of Bellevue Hospital from 1949 to 1954. In 1950 he introduced a special course in internal medicine for visiting faculty from Latin America. An expert on heart disease, particularly congestive heart failure, he also directed CUMC’s cardiovascular teaching program. Luckey became dean at the start of the 1954–55 academic year and held the position for three years. Strikingly, Newsweek reported that “the new dean has no hobbies, aside from his family and his home at Tuckahoe, N.Y. In his spare time, he proposes to continue his cardiovascular research.”59 Luckey then served as chair of medicine at CUMC and physician-in-chief of New York Hospital for nine years. In a 1964 address to incoming medical students, he offered a brief description of his home life: “I have the apparently annoying habit of greeting my teenage boys each evening with the query: ‘What have you done today to justify your oxygen?’ Recently I discovered that this is now known, rather irreverently I think, as ‘Dad’s oxygen pitch.’ ”60 From 1966 to 1977, Luckey was president of the New York Hospital–Cornell Medical Center, vice president for medical affairs at Cornell University, and vice president of the Society of New York Hospital. In those posts, he led many initiatives, including a campaign to acquire air rights over the FDR East River Drive, creation of the Medical Center Archives, and establishment of a research program at the Federal University of Bahia in Brazil. 61 After retiring in 1977, he continued to see patients and engage in medical consulting. He died from lung cancer on August 6, 1989. 62

Accounts by contemporaries indicate that Luckey was a charismatic and very energetic individual who was especially drawn to the practice of medicine. Dr. Robert Michels, a psychiatrist and the twelfth dean of CUMC, remembers him as “a man of immense charm, and a brilliant medical leader.”63 R. A. Rees Pritchett, a 1948 alumnus whose entire seventy-year career centered on New York Hospital–Cornell, saw him as embodying the ideal of the “consummate physician”: “he could go to the bedside, take a history from the patient, examine the patient, and come up with what he felt was the proper diagnosis.”64 And 113

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Figure 5.3 Cornell’s deans from 1942 to 1976, photographed in 1976. Left to right: John Deitrick, J. Robert Buchanan, Joseph Hinsey, and E. Hugh Luckey. (Photo by Allen Green; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

J. Robert Buchanan, who served as dean while Luckey was president of the medical center, described him as having “a remarkable intellect” and being “a very dynamic man and a visionary. He was never at rest.”65

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Cold War Conspiracies

Although he was dean for only three years, Luckey’s time was marked by Cold War tensions and the threat of nuclear war. A  speech to incoming students given by R. Gordon Douglas, chair of obstetrics and gynecology, aptly captures the political atmosphere of 1954: “Today we are living in a world with ever-darkening clouds of a war that could be so devastating as to surpass our imagination. History of past and present making clearly indicates the absurdity and futility of war as a means of establishing permanent international peace.” He urged students “to serve as ambassadors of peace and do your part in creating better international relations.” Present and future generations of doctors needed to think on a much more global scale than ever before: “Destruction of physical facilities during the second World War and political meddling with freedom, have interfered with medical progress in many 114

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Postwar Boom

countries and imposed on us the responsibility for leadership. Complete fulfillment of this obligation will take all of the intelligence and all of the energy you possess.”66 Most likely, Douglas did not know exactly how close to home these Cold War tensions extended. It was not until 1977 that CUMC’s involvement in a top-secret medical research project was uncovered. At that time, it was revealed that following the Korean War, the Central Intelligence Agency had begun conducting a $25  million mind-control program at eighty-five universities, medical research institutions, and government hospitals in the United States and Canada, including CUMC. The project had various code names, including MK-ULTRA, Bluebird, Artichoke, and Often-Chickwit, and was initiated after the government received erroneous reports that the Russians and Chinese had developed brainwashing and mind-control techniques. The CIA sought to develop its own techniques to program operatives and enemy agents, but ultimately had little success using drugs or hypnosis. Funds for the experiments were funneled through military contracts and three private medical research foundations, including the CUMC-based Society for the Investigation of Human Ecology, the Geschikter Foundation for Medical Research in Washington, D.C., and the Josiah Macy Jr. Foundation. Many universities and investigators involved with this research were unaware that their work was actually being sponsored by the CIA.67 CUMC’s involvement with the mind-control program began when CIA director Allen W. Dulles approached his close friend, Harold Wolff, a professor of medicine at CUMC and a prominent neurologist and psychiatrist renowned for his research on headaches. Dulles asked him to prepare a report on brainwashing based on examinations of victims subjected to Soviet and Chinese methods. Wolff and Lawrence E. Hinkle Jr., who specialized in the influence of the physical and social environment on health and behavior, founded the Society for the Investigation of Human Ecology at CUMC in 1953 to fund the project. The Society was housed in the student residence Olin Hall, and secret documents were kept in a safe in a locked room. Only one individual at the society had the keys and combinations needed to access this information. Communication between Wolff and the CIA was made using unlisted phones and cover mailboxes. Despite this mandated level of secrecy, results of the brainwashing study were published in the peer-reviewed journal AMA Archives of Neurology and Psychiatry in 1956, presented as testimony before a United States Senate committee, and published in the Congressional Record.68 Another research project that ran until 1958 investigated why people defect or become traitors, how potential defectors might be identified, and how individuals might be encouraged to defect. This work involved studying the psychological characteristics of Chinese nationals and of refugees who had participated in the Hungarian Revolution of 1956. Throughout this time, 115

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Figure 5.4  Harold Wolff, MD, left, lecturing at grand rounds. (Courtesy of Medical Center Archives of NewYork– Presbyterian / Weill Cornell.)

Wolff also continued long-standing research involving patients with impaired functioning due to illness or brain damage. In 1956, the CIA assigned Colonel James L. Monroe, a brainwashing expert from the air force, to be the society’s executive director and treasurer, in order to support other mind-control research. Hinkle and twelve other CUMC personnel then bowed out of the project, but because of his friendship with Dulles, Wolff stayed on until his death in 1962. Newspaper accounts indicate that the society began to fund research at other institutions on the effects of isolation and sensory deprivation, tranquilizers, LSD, and alcohol, using psychiatric patients and staff as subjects. The society was disbanded in 1965, when many of its principals became part of another CIA-backed organization that operated in Washington until the mid-1970s. The nationwide mind-control program officially ceased operations in 1973. When the program was made public in 1977, Hinkle stated that Cornell University president Deane Malott and some of Cornell’s trustees had been aware of the relationship with the CIA at the time. Luckey was reportedly informed about 116

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the CIA connection a few months after becoming dean, and he and Hinkle both asserted that Wolff’s research had been a continuation of his past work and would have gone on even without CIA funding. A CIA document dated March 8, 1956, was produced and indicated that CUMC had been accommodating: “The medical school has been cooperative in arranging for us to use space, even at the expense of displacing others who have a great need for this space, because it is the desire of the administration to cooperate with the company [the CIA] in working on problems of importance to them.”69 Hinkle maintained that “absolutely no human experimentation was done on a project at New York Hospital or Cornell Medical Center and none was done by anybody connected with Cornell.” He additionally stated that “we didn’t have any intention of [the society] being used to support [the research of] other people,” although it is believed that the organization was indeed used in that way after he left it.70

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An Expanding Medical Center

In the twenty-five years following the opening of the New York Hospital–Cornell Medical Center in 1932, the dollars spent on research increased 3,000 percent, largely due to a steady stream of funds from the federal government.71 Although Luckey complained that research grant applications and reports “[exhaust] a great deal of the energy of investigators which could be spent with more profit in other activities,” he also noted that research activity at Cornell in the mid-twentieth century touched practically all areas of medical interest.72 After treating heart-attack patients with a clot-dissolving anticoagulant drug at military hospitals during the war, Irving Wright continued his studies at Cornell and in 1960 received the Lasker Award for Clinical Medical Research for this work.73 In 1955, Vincent du Vigneaud, chair of biochemistry, won the Nobel Prize in chemistry for his discovery of oxytocin, a hormone that plays key roles before and after childbirth. In an earlier breakthrough, he had isolated synthetic G-penicillin, and the following year he synthesized the hormone vasopressin, which helps regulate blood pressure and water balance in the body. Clinical studies at the medical school ranged from the psychiatric aspects of habitual abortion to a study of social psychiatry in the Kips Bay–Yorkville neighborhood adjoining the medical center.74 Farther away, the Navajo-Cornell Field Health Project, headed by infectious disease investigator Dr.  Walsh McDermott, initially focused on tuberculosis in Arizona. Cosponsored by CUMC, the Division of Indian Health of the U.S. Public Health Service, and the Navajo Tribal Council, it ran from 1955 to 1962 and expanded to address poor health conditions across the reservation.75 Archival records reflect the spread of information resources at CUMC. One of the earliest references to computers appears in 1952, when the medical school installed an IBM payroll system. The technology proved unsatisfactory 117

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and was soon replaced with a National Cash Register No.  3100 machine, which “has exceeded our expectations” and could be operated with the “utmost ease and accuracy.”76 Two years earlier, the library reported that despite rising costs, “there is no slackening of publication. New titles are added every day and it is hard to know where to draw the line on the growing series of annual reviews, year-books, recent advances, progress in many fields, to say nothing of transactions, proceedings, symposia and conferences.”77 Not surprisingly, keeping track of all the information generated by post–World War II research efforts presented some organizational difficulties. The federal government’s mounting investment in research also bolstered Cornell’s training of graduate students in the biomedical sciences. Following the war, medical research had become increasingly focused on the subcellular level, with the discovery of the structure of DNA and the development of powerful new tools capable of visualizing atoms and molecules. According to medical historian Kenneth Ludmerer, “Biochemistry turned from nutrition and intermediate metabolism to enzyme systems and biochemical and molecular genetics. Physiology moved from mammalian organ function to fundamental cellular processes like nerve conduction and membrane permeability. Bacteriology evolved into microbiology, the study of all microbial organisms.”78 This shift in focus from human patients to proteins and genes, combined with an infusion of federal funds, fueled dramatic growth in the basic sciences. Graduate programs around the country, including at Cornell, expanded and became dominated by faculty with PhDs instead of MDs. On June  20, 1950, an agreement between Cornell University, New York Hospital, Memorial Hospital, and the Sloan Kettering Institute for Cancer Research was signed to establish the teaching program of the Sloan Kettering Institute as a division of CUMC. Under the agreement, Sloan Kettering would use its staff and facilities to train graduate students in the physical and biological sciences, particularly in the field of cancer. Starting in 1912, students had been able to pursue graduate study in the biomedical sciences at CUMC, with degrees granted by Cornell’s graduate school in Ithaca, and the new Sloan Kettering division was intended to be an extension of this program.79 Then, on January  26, 1952, the Cornell Board of Trustees approved the creation of a separate Graduate School of Medical Sciences based in New York City, to be jointly run with the Sloan Kettering Institute. The dean of CUMC was appointed associate dean of the new Graduate School of Medical Sciences, reporting to the dean of the graduate school in Ithaca. It was not until 1969 that the graduate school in New York City would have a dean of its own, with the appointment of Thomas Meikle Jr., who at the time also served as associate dean of CUMC and would later become its dean in the 1980s.80 Instruction was provided at Cornell in anatomy, microbiology and immunology, biochemistry, pathology, pharmacology, physiology and biophysics, and public health 118

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and preventive medicine. The Sloan Kettering Institute offered advanced training in the fields of biochemistry, biology and growth, biophysics, pathology, and preventive medicine. Initially, the new graduate school was quite small, with twenty-one students enrolled in 1953–54, including four who received PhD degrees and one who was awarded a master’s of science.81 A decade later, total enrollment reached forty-seven students.82 David P. Hajjar, dean of the Graduate School of Medical Sciences from 1997 to 2012, provides one interpretation for this and subsequent growth: “It expanded, not because the medical school or Sloan Kettering were putting in huge resources, but because the college was hiring more and more research people. Research investigators wanted graduate students to assist in their work.”83 Another crucial addition to the medical center was the Hospital for Special Surgery, an orthopedic hospital formerly known as the New York Society for the Relief of the Ruptured and Crippled. Negotiations with the New York Hospital–Cornell Medical Center had initially begun in 1948, when the society began planning a move from its historic location on 321 East Forty-Second Street as the first orthopedic hospital in the United States. In an affiliation agreement signed in March 1949, New York Hospital agreed to give land on the East River between Seventieth and Seventy-First Streets to the Hospital for Special Surgery, which then began raising money to construct a 170-bed facility for orthopedics and arthritis. On November 1, 1951, a revised affiliation agreement was signed, and the Hospital for Special Surgery agreed to staff five orthopedic outpatient clinics and establish a twelve-bed inpatient orthopedic service at New York Hospital, as well as hold weekly orthopedic lectures for third-year medical students. Surgical and pediatric residents at New York Hospital also began rotating at the Hospital for Special Surgery. The cornerstone for the Hospital for Special Surgery was laid on May 17, 1954, and the new $6 million hospital opened in May 1955. John F. Kennedy, a sufferer of chronic back pain, was one of its first patients and was treated with a spinal fusion in October of that year. Unfortunately, he developed a wound infection, and the plate from the surgery had to be removed four months later.84 Later in 1956, Dean Luckey was able to report to Cornell University president Deane Malott that “the Medical College, though relatively young, has shown phenomenal growth in recent years. It finds itself the educational and intellectual core of an array of institutions and health facilities which together constitute one of the largest groups of contiguous private medical institutions in the world.” Referring to the New York Hospital, Memorial Hospital, Sloan Kettering Institute, and the Hospital for Special Surgery, he reported that CUMC and its affiliated institutions collectively expended over $32  million annually ($280 million in today’s dollars after adjusting for inflation). About half that amount was spent on clinical services, with a quarter going to research and a quarter toward teaching. Although CUMC’s budget represented less 119

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than one-sixth of the total, the medical school was “the only common band extending throughout these institutions,” and it exerted “much influence in the manner in which the remaining sums are spent.”85 By the end of Luckey’s tenure as dean, the medical center’s financial outlook was quite positive. CUMC was contributing 35  percent of New York Hospital’s budget for research and education, while the hospital was paying for half of the pathology department’s expenses. According to Luckey, “these changes remove important sources of irritation [between institutions] with only a modest increase in the total Medical College financial contribution in the Center.”86 In 1956–57, the medical school reported a modest budget surplus, with a total income of approximately $5.4 million and total expenditures of $5.3 million. In addition, donations had increased CUMC’s endowment by almost 35 percent, and New York Hospital’s deficit had shrunk to less than $40,000. Thus, the medical college was in an “unusually favorable position” to accomplish some of the objectives that had been delayed for years because of inadequate funds. These included implementing a formal long-range planning process, reorganizing the Dean’s Office administration, expanding public relations and fund-raising functions, and, most important, recruiting and retaining a distinguished, creative, and productive faculty and staff. As Luckey noted, “without these people, the most thoughtful plans, the most spacious and well-equipped plant, and unlimited financial resources will not allow us to reach our goals.” In his opinion, the key to attracting the best individuals was an environment of “free spirit in thought, speech, and action.”87 In his final annual report to Cornell president Deane Malott, he announced his successor as dean, Dr. John Deitrick, writing, “My three years as Dean have been happy, challenging, and, I believe, productive ones.”88 Most observers would wholeheartedly agree.

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6 The Expansive 1960s Ivory Towers are said to have little contact with the outside world, but . . . students and faculty have far ranging interests outside the walls of the Center.

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John Deitrick, “Dean’s Report 1968–69”

Cornell’s students and physicians had traditionally developed their clinical skills and provided medical care at New York Hospital and other facilities in the city, seeing a wide variety of patients at all socioeconomic levels. These activities placed them squarely in the community, not isolated from society and its concerns. With the passage of Medicare and Medicaid in 1965, health care underwent a major transformation, bringing new populations of poor and elderly patients to hospitals and clinics nationwide. Medical schools and teaching hospitals became even more involved in addressing the health care needs of their surrounding communities, while continuing to provide specialized treatment for more complex cases from farther afield. These shifts overlapped with the social activism of the 1960s. Many medical students at Cornell and around the country became passionately engaged in outreach efforts to underserved patients and began asserting their right to define their own education, particularly on topics of contemporary social relevance. Dr. John English Deitrick served as Cornell’s seventh dean from 1957 to 1969, during a time of intense social change that coincided with a period of pronounced growth at the medical college. While the 1950s had been characterized by a nationwide boom in biomedical research, the expansion of the 1960s was extended to the clinical and social arenas, and at Cornell was also reflected in the construction of several new facilities. Clinically, alterations in the provision of health care had been evolving for quite some time. At New York Hospital and other university hospitals around the country, the number of private or semiprivate patients, who were admitted and treated by personal physicians on the faculty for a fee, had been on the rise since 1950. During this same period, the number of patients admitted to hospital wards was decreasing. These individuals, who tended to lack health insurance and to be of more limited means, were assigned to staff physicians and residents for treatment and were drawn into the teaching and research activities of the hospital.1

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John E. Deitrick John English Deitrick was born in Watsontown, Pennsylvania, and attended Princeton, where he was a member of Phi Beta Kappa and Sigma Xi. After graduating in 1929, he entered medical school at Johns Hopkins, where he met the woman to whom he would be married for more than fifty years, Dorothy Geib. In 1934, he became a resident in medicine at the New York Hospital–Cornell Medical Center. In 1936, he joined CUMC’s faculty as a cardiologist and began supervising third-year clerkships in medicine. Deitrick did not serve in World War II because of a history of pleurisy; after the war he became the director of Cornell’s Medical Division at Bellevue Hospital and developed a training course for doctors who had been in military service. Deitrick set up labs and a library at Bellevue, and he conducted studies of the circulation, examining cardiac output and venous pressure. From 1948 to 1952, Deitrick took a new post directing a comprehensive survey of medical education for the Association of American Medical Colleges (AAMC) and the American Medical Association. One of its key findings was that staff and personnel were the major expenses facing medical schools.2 Deitrick then moved to Philadelphia to become the Magee Professor of Medicine at Jefferson Medical College. He was also a consultant to the U.S. Naval Hospital and a board member of the Magee Memorial Hospital. One of his interns at Jefferson was Thomas Meikle, who later became dean of CUMC. Deitrick returned to New York to become dean of CUMC in 1957, serving in that capacity until 1969. J. Robert Buchanan, CUMC’s subsequent dean, remembers him as “a very straight arrow”: “He prided himself on being a very tough‑minded, very sharp clinician, and could be quite angular at times and a little unbending. There wasn’t a lot of room for compromise with John, but I admired him greatly. He worked hard, he stood only for the best in quality, and he did not tolerate sloppiness on anybody’s part.”3 Deitrick served as president of the AAMC in 1963–64 and was elected to the board of the Prudential Insurance Company in 1966. After retiring as dean, he served as president of the New York Academy of Medicine in 1970, and in 1982 he received the Maurice R. Greenberg Distinguished Service Award from the New York Hospital–Cornell Medical Center, its highest honor. During his career, he was active in academic organizations including the National Board of Medical Examiners, the American Medical Association, the

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American Cancer Society, the W. K. Kellogg Foundation, and various medical groups in Pennsylvania and New York. On September 29, 2000, he passed away at the age of ninety-five, and was survived by three children, including two graduates of CUMC.4

Faced with postwar inflation and rising health care costs, hospitals began focusing on private patient admissions in order to increase revenue. A small number of very wealthy private patients actually took up residence at New York Hospital–Cornell, staying for years and making use of amenities like a dry cleaning outlet, barber shop, and beauty salon housed inside.5 Although such behavior was far from the norm, concerns were raised that the shift toward private patients would have a negative effect on teaching and research. Adequate medical instruction requires large numbers of patients with ordinary illnesses, while research focuses on patients with very serious conditions. At New York Hospital, the number of ward patients fell to less than half of all admissions for the first time in 1957–58, limiting student exposure to both common and severe manifestations of disease.6 Deitrick described the resulting split among Cornell’s faculty: “We are now working in a house divided . . . we have two faculty groups—those who serve on a voluntary basis and whose major efforts are in private patient care, and those on full-time or part-time salaries, carrying on all their work in the Center and primarily responsible for the teaching, research and administrative activities of the Center. The two groups have different goals and different means of earning their livelihood.”7 Approximately 110 faculty members received paychecks from the medical center, while about 1,000 physicians in the unsalaried voluntary group generated most of its clinical revenue.8 Deitrick’s inclination was to do away with the category of private patients. He envisioned a system in which all fees obtained by patients would support the clinical faculty as a whole, and all patients, whether admitted by private physicians or to the wards, would participate in teaching and research efforts. CUMC moved closer to this scenario in the mid-1960s with the introduction of federal legislation designed to improve access to medical services. In April 1964, President Lyndon B. Johnson charged the Commission on Heart Disease, Cancer, and Stroke, chaired by cardiac surgeon Michael DeBakey, “to reduce the incidence of these diseases through new knowledge and more complete utilization of the medical knowledge that we already have.”9 The commission recommended the establishment of regional centers for clinical care and research, as well as the creation of specialized research institutes 123

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within existing institutions. A  year later, the passage of the Social Security Amendments of 1965 led to the creation of the Medicare and Medicaid programs, which provided federal health insurance to individuals age sixty-five or older and to low-income patients and families, respectively. And in 1966, the Comprehensive Health Planning Act was designed to encourage states and local agencies to develop plans to improve and coordinate health services on a regional level. These new, centralized approaches to health care raised widespread questions about the organization of the nation’s health care services and the role and function of physicians and scientists within society. From Cornell’s perspective, the impact of these laws on the nation’s health care system amounted to a “social-medical revolution.”10 The movement to provide insurance for the elderly had begun in the 1950s, with the recognition that individuals over sixty-five years were twice as likely to have chronic health conditions and tended to be hospitalized for twice as long as younger patients. As the cost of medical care skyrocketed, it became increasingly clear that some form of financial assistance was necessary. An early effort to address this problem was the Kerr-Mills Act of 1960, which provided federal grants to states to support medical care for poor, elderly individuals. The Social Security Amendments of 1965 expanded this initial program, which had met with limited success. Under Medicare, elderly individuals received mandatory health insurance financed through the Social Security system and were offered additional voluntary insurance subsidized by the federal government. Medicaid provided the states with matching federal grants to support health benefits for indigent individuals, and states could develop their programs as they saw fit. The creation of Medicare and Medicaid led to a sharp increase in the use of health care services by the poor, and it changed the relationship between the federal government and health care providers. Most hospitals, including New York Hospital, nominated the Blue Cross Association to act as a “fiscal intermediary” with the government and to administer its Medicare claims and payments.11 Immediately after this health care legislation was enacted, Dean Deitrick noted “a growing demand for more medical service.”12 According to an article that appeared in the CUMC alumni magazine, Medicare and Medicaid were “welcomed by and were indeed inspired by the university medical centers.” Still, they presented medical centers with “some of the greatest challenges of their history,” including considerable pressure from local communities to assume responsibility for them.13 As president of the New York Hospital–Cornell Medical Center, Hugh Luckey expressed concern about the new legislation. If academic medical centers were to assume direct and primary responsibility for the care of large numbers of patients in the manner of a community hospital, their function as institutions of higher learning—to train the next generation of physicians and to advance biomedical science and clinical care—could be 124

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seriously impaired. He and Deitrick shared the view that the community would best be served with New York Hospital–Cornell continuing to function according to its historic mission, maintaining a balance between patient care, teaching, and research. As it turned out, the creation of Medicare and Medicaid did not radically detract from the primary function of the university teaching hospital, although it did erode the distinction between voluntary, or private nonprofit, hospitals and charity hospitals. The provision of federal health insurance to elderly and low-income individuals meant that physicians could begin to expect some sort of reimbursement when caring for these patients, instead of treating them as charity cases. According to medical historian Kenneth Ludmerer, Medicare “proved a bonanza to doctors and hospitals because of its liberal payment schedule and willingness to reimburse hospitals for capital expenses.”14 The increase in clinical revenues at medical centers around the country mirrored the explosive growth in federal research funding of the previous decade. In order to respond to these health care changes, the Cornell Medical Group was established on July 1, 1967. Under the terms of this new organization, patients receiving Medicare or Medicaid benefits were accorded the status of semiprivate patients. They were treated by teams of physicians, and their access to facilities and medical care was comparable to that of private patients who paid out of pocket or with private health insurance. Full-time faculty members, who tended not to maintain extensive private practices, began receiving a base salary from Cornell, plus part of their income from patient fees to the group. Private patients of part-time or voluntary faculty members were incorporated more into student teaching at the medical center. When the program was launched, it was anticipated that the distinction between the full-time and part-time faculty would grow smaller, lending greater cohesion to its members. Although the system worked well, the Cornell Medical Group was formally dissolved in December 1971 since it had been structured in such a way that the group and Cornell were required to make unnecessary, duplicate tax and insurance payments. A new Faculty Practice Plan was then developed under similar principles, with full-time clinical faculty receiving a fixed salary plus incentives based on the income generated from their practices. Most payments for patient care began to be handled by a central billing office rather than by individual physicians.15 These changes in the provision of medical care had important ramifications for the teaching of Cornell’s medical students. In the late 1950s, as the number of ward patients at New York Hospital decreased, the Cornell Division at Bellevue Hospital became increasingly important to CUMC’s teaching program. With its large caseload, the 2,670-bed municipal hospital afforded rich opportunities for faculty research and the education of medical students. However, the city did not have sufficient resources to maintain Bellevue’s 125

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upkeep. In 1957, the directors of Bellevue’s eight medical and surgical divisions, affiliated with Cornell, Columbia, and New York University, issued a statement demanding that the city tear down and rebuild the hospital. They claimed that the city had shamefully neglected Bellevue and had failed to provide adequate support for its facilities and personnel.16 By the mid-1960s, the situation had grown dire. New York City had neither directed additional resources toward Bellevue nor rebuilt it, and patients who had Medicare, Medicaid, or other forms of insurance were choosing hospitals with better facilities and staff for their medical care. The patient caseload dropped significantly at Bellevue, and its value as a teaching site for CUMC was subsequently diminished.17 The New York State Hospital Commission asked Cornell and Columbia to leave the hospital because there was an insufficient volume of patients, and in 1966 Cornell announced that its long-standing affiliation with Bellevue would be terminated. Students who had been receiving instruction at Bellevue would henceforth be trained at New York Hospital, the Hospital for Special Surgery, or the Memorial Sloan Kettering Cancer Center, which had been formed in a 1960 merger of the Memorial Hospital and the Sloan Kettering Institute for Cancer Research.18 New York University became Bellevue’s sole academic affiliate in 1968. Although CUMC did not leave Bellevue of its own accord, Dean Deitrick dealt with a tremendous backlash from alumni, who thought that the public hospital had been abandoned. For several years after the affiliation was terminated, alumni would approach him to ask “why weren’t we still there doing some good for

Figure 6.1  Students from the class of 1968 in a dental course. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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the city of New York.”19 CUMC soon formed new affiliations with the Winifred Masterson Burke Rehabilitation Hospital and the Manhattan Eye, Ear, and Throat Hospital in 1968. The following year, CUMC also became affiliated with the 310-bed North Shore Hospital on suburban Long Island. All three sites offered medical students a kind of teaching experience different from that formerly provided by the publicly funded Bellevue Hospital. 20

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Students and the Counterculture

The socially and sexually permissive atmosphere of the 1960s, which included increased concern for the needs of the disadvantaged, did not leave Cornell’s medical students untouched. In 1968, Dean Deitrick reported to Cornell’s president: “The students entering medical school in the last two years reflect some of the unrest and discontent with the ‘establishment’ that have been manifested on university campuses. They desire early contact with patients and with community health activities and are impatient with the requirements that they become adequately acquainted with the basic sciences before being allowed to participate in the study and care of patients. They have invited individuals to speak to them whom some of the faculty consider quite radical.”21 Still, compared to the protests going on at university campuses around the country, student unrest at Cornell’s medical school was quite tame. As Kenneth Ludmerer noted, “Medical students identified with the medical profession, unlike many university-based radicals, who openly disavowed the establishment. Student activists at medical schools wanted to change medical schools, not do away with them.”22 Student interest fueled discussions with the administration and the faculty about the medical center increasing its community involvement and its care of lower-income patients. In general, the faculty was open to the idea of establishing clinics in underprivileged neighborhoods but was not interested in directly operating a community hospital on behalf of the city. In Deitrick’s view, the administrative challenges associated with the second proposition would detract from the medical center’s mission of providing “both the best of specialized health care and the best of general care not only to local community residents but also nationally and internationally.”23 By the end of the decade, students were playing a more active role in their education than had previous generations. They organized a series of lectures on sexual behavior and a weekly research seminar to encourage brainstorming. An elective first-year course initially taught by fourth-year students on practical applications of pathophysiology subsequently evolved into a Saturday morning seminar taught by faculty for all students. Other new programs targeted disadvantaged communities and populations. Under the auspices of the department of public health, students began studying infant mortality in the 127

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CHAPTER 6

Bedford-Stuyvesant neighborhood in Brooklyn, while others traveled to St. Elizabeth Parish on the island of Jamaica to learn about health care delivery in a rural area. CUMC also launched a summer research program designed to encourage minority students to apply for medical school, after a faculty committee recommended that CUMC establish a goal that at least 10 percent of its student body be composed of members of underrepresented minority groups. During the 1970s, this program became the centerpiece of a major effort to increase minority student enrollment at CUMC (see chapter 7). 24 Research activities at the medical center reflected the social changes and interests of the times. Two years before the appearance of the oral contraceptive pill in 1960, six professors of gynecology, including R. Gordon Douglas, CUMC’s chair of obstetrics and gynecology, signed a letter protesting a ban on the prescription of birth control measures in municipal hospitals. 25 In a study of LSD published in 1967, Dr. Donald Louria, associate professor of medicine at CUMC and head of the infectious disease laboratory at Bellevue, reported that the number of patients admitted at Bellevue because of chronic LSD use had dropped by 50 percent in the past six months. He found similar trends at other cities and believed that no more than 1 percent of college students were using LSD, a figure much lower than reported in the media. He maintained that under medical supervision, LSD could be helpful in fighting alcoholism, homosexuality, and frigidity. 26 Other research projects investigated the impact of social class on health. One study of 1,660 residents living in the nearby Yorkville neighborhood of Manhattan reported a link between lower socioeconomic status and mental illness.27 The New York Hospital–Cornell Welfare Project examined the utilization of medical services by welfare patients living in the area. It found that adults on welfare who visited New York Hospital tended to be sicker than those who were more well off, while their children were relatively healthy, used fewer services, and presented greater opportunities for preventive care than their parents. 28 As president of the medical center, Hugh Luckey took a progressive stance toward the changes of the 1960s and believed that medical education would benefit from the introduction of a more socially minded perspective. In 1967, he stated: “The increased involvement of university medical centers in extramural community health services is certain to re-orient the clinical experience of undergraduate medical students. The study of systems of health care and research in patient care may finally gain academic respectability.”29 A Building Frenzy

At the end of the 1950s, Cornell was able to accommodate the entire student body, including married students, in modern rooms or apartments for the first 128

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time.30 Plans were in place to increase research space at a cost of $3 million, with half funded by the U.S. Public Health Service, and to acquire almost an entire city block for future expansion projects.31 Still, there was not enough space. A  mere twenty-five years after its opening, the medical center was cramped and outmoded: “The roomy, well-equipped research laboratories of 1932 are now crowded, awkward, and in many instances, poorly equipped to accommodate the staff and equipment resulting from the last twenty-five years of progress in research.”32 In 1962, Dean Deitrick wrote: “We are trying to run a nine million dollar institution, affiliated with a group of powerful and independent institutions, in space originally designed for a two to three million dollar operation.”33 During the 1960s and 1970s, Deitrick and J. Robert Buchanan, CUMC’s next dean, were asked by Cornell University “to snoop around and buy what real estate we could between 62nd and 72nd, York Avenue to 1st Avenue. We had to relocate families and all that kind of stuff to get those things opened up.”34 And although CUMC and New York Hospital would expend $34 million in the first half of the 1960s to construct new buildings or renovate existing ones, the need would remain for more laboratories, more classrooms, and more patient exam rooms. 35 The limiting factors, of course, were available real estate and money. The first new building to emerge during Deitrick’s tenure as dean was the Samuel J. Wood Library and Research Building. Deitrick became heavily involved in planning for a new library, after learning that the circulation of the old one had doubled between 1952 and 1958, to reach fifty thousand visits and thirteen thousand borrowers per year. He surveyed various medical school libraries and opted to place CUMC’s new facility opposite the auditorium: “I  said one place is where we stored our information, the next is where we dished it out.”36 In 1959, CUMC announced that it had received $1.6 million from the Samuel J. and Evelyn L. Wood Foundation and $1.3 million from the U.S. Public Health Service to construct a seven-story building to house a library and additional research space.37 The neighboring Memorial Sloan Kettering Cancer Center agreed to contribute at least 25 percent of the library’s operating costs.38 The Samuel J. Wood Library and Research Building was constructed at a cost of $4 million, or $31 million in inflation-adjusted dollars, and named in memory of a real estate agent and president of the Wood School of Business Efficiency in New York. Dedicated on October 17, 1962, it increased the educational and research facilities of the medical center by 25 percent. The Wood Library, which incorporated the collection of the New York Hospital School of Nursing, was open to CUMC faculty and students, as well as to staff of neighboring institutions. In 1982, Deitrick reminisced: “I still get a lot of pleasure out of walking down the street at night and looking right at the windows of the library on York Avenue, which I think is quite impressive.”39 At the same 129

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CHAPTER 6

time that the Wood Library was being developed, the Medical Library Center of New York was established to store books from the various medical colleges and health research institutions in the city. Cornell, New York University, Columbia, the Rockefeller Institute, Memorial Sloan Kettering, the Public Health Service of New York City, and the New York Academy of Medicine raised a total of $2 million for the depository. Located nearly adjacent to the Academy of Medicine, it delivered books daily, within twenty-four hours, to libraries within fifty miles of New York City.40 Another new facility, the Theodora Griffis Faculty Club, opened in 1963 and was named in honor of a woman who had been a patient at Memorial Sloan Kettering and died of leukemia at the age of thirty-nine. She was the only daughter of Stanton Griffis, a 1910 graduate of Cornell University who had been the editor-in-chief of the Cornell Daily Sun during his college years and had introduced articles from the Associated Press into the newspaper. A former owner of the bookstore Brentano’s, Stanton Griffis was reportedly disappointed when the Wood donation came in because he had planned to create a Griffis Library at the medical school. Instead, he provided $500,000 for a new faculty club and dining room because, in his words, “In the entire neighborhood of the Center and the Rockefeller Institute, there was no good restaurant. It was a shame.”41 A member of the Joint Administrative Board of the medical center and a Cornell trustee since 1930, Griffis had a large apartment in Sutton Place that was the source of many of the furnishings and decorations for the new faculty club. Mahogany Chippendale furniture, art from the French painter Maurice Utrillo and the Swedish etcher Anders Zorn, and Chinese porcelain were transferred from his duplex to the Griffis Faculty Club, which also boasted a specially ordered, very large white rug. When it opened, the Griffis Faculty Club was located in a one-story building, with a lounge and a smaller, informal gathering area on the main floor. The basement contained a large dining room for students, faculty, and staff, plus five smaller rooms for private parties. The dedication of the Dr.  Connie M. Guion Building on May  8, 1963, marked the first time that a hospital building in the United States was named for a living female physician. An expansion of New York Hospital’s outpatient department, the $5 million, four-story building housed ninety specialty clinics. When it opened, Dr. Guion, a member of the class of 1917 and then an emeritus clinical professor of medicine, was still putting in twelve-hour days at the age of eighty. While teaching medical students, she also saw approximately ten private patients each day.42 In 1968 the medical college’s educational and research facilities received a significant boost with the construction of the ten-story William Hale Harkness Building. Fund-raising for the building began earlier in the decade with the Fund for Medical Progress, a $54.7  million campaign for the medical

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center run jointly by CUMC and New York Hospital. The Fund for Medical Progress was announced on December  7, 1961, at a dinner commemorating both the 190th anniversary of New York Hospital and the 50th anniversary of the affiliation between the two institutions. A video message from President John F. Kennedy was played at the dinner: “I spoke about a year ago of what we could all do for our country. I can think of no more important work, or satisfying work, than the work in which you are engaged tonight—supporting this great institution, making it able to meet the great challenges that are coming.”43 John Hay Whitney, who was vice president of the New York Hospital Board of Governors as well as editor-in-chief and publisher of the New York Herald Tribune, served as general chairman of the fund. He and his sister Joan Whitney Payson, the cofounder and owner of the New York Mets baseball team, each contributed $5 million the week after the campaign’s launch. The Vincent Astor Foundation, the Samuel J. and Evelyn L. Wood Foundation, the Booth-Ferris Foundation, Stanton Griffis and the Griffis Foundation, and the U.S. Public Health Service also made donations that December, bringing the campaign to an early total of $22 million. Of the original $54.7 million goal, two-thirds was intended to support clinical, educational, and research programs, while the remainder was allocated for new buildings, renovations, and expansions.44 The medical college’s target was $16  million, of which a large portion would go toward the construction of the Harkness Building, initially estimated to cost $9  million.45 Later, the total campaign goal was increased to $60  million, or $440 million in 2014 dollars, to account for revised estimates for the Harkness Building. In May 1966, the Fund for Medical Progress succeeded in reaching its target, having raised a total of $26 million for the medical college.46 With funds in hand, construction of the Harkness Building began in October 1966. Its namesake, William Hale Harkness, was an attorney and Standard Oil heir who had died in 1954. His widow, the dance patron Rebekah Harkness, was briefly married in the early 1960s to Dr. Benjamin Kean, head of the tropical disease unit at CUMC and later the physician of the exiled shah of Iran. Rebekah Harkness gave $2  million to name the Harkness Building in honor of her late husband, and two of her children by a previous marriage each gave $250,000. Plans for the new structure included more than two hundred laboratories and two lectures halls, each to be equipped with closed-circuit televisions connected to operating and treatment rooms, as well as stethoscopes and consoles that would allow students to listen simultaneously to a patient’s heartbeat.47 Dean Deitrick ran into a few difficulties related to the construction of the Harkness Building. Government officials had initially made a verbal agreement to provide matching funds amounting to almost a quarter of a million

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dollars to support the building, but this offer was later rescinded. Deitrick needed these funds to go ahead with the project and was “just about ready to quit,” but the contractors advised him to wait until the builders’ bids came in. The bids were indeed much lower than expected, with the builders struggling to make ends meet in a tough economy, and the medical college was just barely able to cover the building costs. Deitrick also confronted the question of whether to use recirculated or fresh air for the air conditioning system. Although the cost of using fresh air was approximately $100,000 more than recirculated air, he decided to go with that option because laboratories were just beginning to use radioactive materials and there were concerns regarding a possible accident. Some fifteen years later, Deitrick remembered these small decisions as being very important “but very bothersome to the dean, trying to make the budget meet and [choosing] when he should spend a couple hundred thousand dollars.”48 Another impediment concerned the construction of a nearby parking lot. Cornell had purchased thirteen tenement buildings in 1964 as part of a project to develop an entire square block for additional research and clinical facilities. These buildings were to be demolished to make way for a parking lot. However, many of the tenants, some of whom had lived in their apartments for more than thirty years, were understandably dismayed by this prospect. In May  1966, a group of 180 residents signed a statement requesting that the university’s plans to evict them be denied by the city. Although their efforts proved unsuccessful, the experience affected future expansion projects and made the medical center very hesitant about encroaching on surrounding communities.49 New clinical programs to take up residence in the rapidly expanding New York Hospital–Cornell Medical Center included the Stroke and Critical Care Research Center, which was established in 1958 as the first federally funded center in this area of study. 50 The first kidney transplant program in the New York tristate area was founded in 1962, in collaboration with nephrologists at what is now known as the Rogosin Institute. The following year, the program performed the first kidney transplant from a living family member in the New York metropolitan area and in 1965 the first transplant in the area from a deceased donor. 51 And in 1969, the Cornell Program in Social Psychiatry opened the first suicide prevention clinic of its kind in the city, specifically created for patients who had already made an attempt on their lives. For reasons that were unknown, the Yorkville–Kips Bay neighborhood of the medical center had suicide rates that were 2.6 times higher than in the rest of the city. In a shift in mental health treatment that was characteristic of the 1960s, the clinic’s patients received antidepressants and weekly psychotherapy on an outpatient basis, instead of being hospitalized in psychiatric facilities. 52 132

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In addition to expanding geographically, CUMC experienced substantial growth in its human and financial resources during this time. One administrative report captured the rapid increase in the number of the medical college’s employees, which had risen from 400 in 1951 to 993 in 1963. 53 By 1960, the total faculty numbered more than 1,100, including one-third who were based at the Hospital for Special Surgery or Memorial Sloan Kettering. Although these affiliated institutions provided invaluable expertise in the fields of orthopedic surgery and cancer, Deitrick reported that the dispersion of the faculty “makes it difficult to develop an esprit de corps.”54 Over the course of his tenure as dean, the number of faculty increased by 43 percent, which significantly improved the ratio of faculty to students, if not the sense of community among the professoriate.55 Interestingly, a department chair at CUMC could expect to earn an average salary of $30,800 in 1967 (or nearly $220,000 in 2014 dollars), a jump up from $21,500 in 1956 (or $118,000 in 2014 dollars). 56 By way of comparison, the median household income in the United States in 1967 amounted to $7,200 (just over $51,000 in 2014 dollars).57

Figure 6.2 Switchboard operators at the New York Hospital–Cornell Medical Center, 1965. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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CUMC hired its first full-time public relations and development officers during 1964–65, and two years later established a Basic Science Faculty Council and a Clinical Science Faculty Council, which included members of the Hospital for Special Surgery and Memorial Sloan Kettering, in order to involve more faculty members in policy and decision making. 58 A General Committee to represent the faculty of the graduate school in New York City followed soon thereafter.59 Research expenditures increased from $1.2 million to $5.8 million between 1951 and 1963, with the proportion of funds received from the government rising from 39 percent to 77 percent.60 In inflation-adjusted dollars, this investment in research translates into a fourfold increase (from $11  million to $45 million). CUMC’s budget was growing at a rate of approximately $1 million per year (or nearly $8  million in 2014 dollars) at the beginning of the 1960s, largely due to this upswing in federal funding for research.61 However, like most medical schools during this period, CUMC was “almost overwhelmed” by research funds that were restricted for specific purposes or for the teaching of certain diseases, while it lacked general funds to be used at its discretion.62 It was not until 1966 that the federal government began awarding grants to CUMC in direct support of medical education; prior to that, it would provide only matching funds for the construction of educational facilities.63 To deal with CUMC’s rapidly expanding administration and bureaucracy, Dean Deitrick appointed J. Robert Buchanan as associate dean in 1964. In this position, Dr. Buchanan began to act as Deitrick’s direct assistant, helping with various administrative tasks, including the mail, research grants, supervision of the animal care committee, coordination with the Cornell Division at Belle­ vue Hospital, and development of a biomathematics facility.64 In Deitrick’s estimation, Buchanan was “a very effective administrator,” a comment that presaged his subsequent appointment as Cornell’s next dean.65 The Educational Realm

Cornell University celebrated its centennial in March 1965 with a weeklong program, “The Universities and the Arts,” held in New York City in conjunction with Lincoln Center. A  committee headed by Walsh McDermott, chair of the department of public health, organized a half-day program at the medical college, designed to provide a behind-the-scenes look at its basic science and clinical activities in the context of interesting patient cases. Board members of Cornell, New York Hospital, and all other affiliated hospitals and institutions were invited to CUMC for lunch, the scientific program, and cocktails at the new Griffis Faculty Club. According to Deitrick, the program was “excellent,” but sadly, “attendance was rather disappointing.”66 The day’s festivities concluded with a centennial concert performed by the New York Philharmonic Orchestra.67 134

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Medical education at CUMC continued to evolve under Deitrick’s leadership, with television successfully incorporated in the teaching of the departments of pharmacology and anatomy.68 Increased philanthropic and government support led to greater numbers of students participating in summer research projects, while the curriculum underwent a series of modifications. During the late 1950s, more time for electives and independent research was introduced into the first two years of study. Less emphasis was placed on numerical grades and more on evaluations of student accomplishments in and outside of classes.69 A new curriculum for third- and fourth-year students went into effect in 1967, with the third year devoted to a core body of knowledge and the fourth almost entirely to electives.70 A similar conversion of most of the fourth year to electives occurred in many medical schools during the 1960s, since the number of medical specialties had proliferated to such an extent that it was impossible to devote sufficient required lectures or clerkship rotations to each of them.71 In 1965, the Liaison Committee of the American Medical Association and the Association of American Medical Colleges surveyed CUMC as part of its medical school reaccreditation process. Although the report was complimentary overall, major criticisms included concerns regarding a lack of communication between the administration and younger faculty members, the relatively small size of the student body, and the need for additional space. In addition, the committee felt that the medical school could be obtaining more income from its full-time clinicians and that the educational resources of Memorial Sloan Kettering were being underutilized.72 Over the next few years, the medical college addressed many of these issues. For example, in 1967 CUMC agreed to increase its class size from eighty-four to eighty-nine students, a move that it had previously resisted. The situation changed when CUMC received its first federal grant of $68,400 in direct support of educational activities.73 Federal legislation had begun offering financial incentives to medical schools to increase enrollment after the publication of the so-called Bane Report of 1959, which projected a nationwide shortage of approximately forty thousand physicians by 1975. Cornell held out until the government began offering grants for each extra student enrolled, which unlike earlier payments could be directed toward educational operating expenses and did not need to be used toward the construction of educational facilities.74 In 1982, Deitrick reminisced facetiously: “There was also an increase in the number of women admitted, which of course I opposed, having a sister, a wife, and a daughter all doctors—that used to amuse girl students in class.”75 In actuality, Deitrick did resist the pressure to admit more New York State residents, since he wanted to maintain Cornell’s reputation as a medical school with national interests. The rising cost of medical school proved more difficult to remedy. In 1964, Cornell’s annual tuition of $1,800 (or $14,000 in 2014 dollars) was the thirdhighest among private medical schools, after Harvard and the University of 135

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Rochester. By 1967, thirteen schools were charging $1,800 or more, while faculty and staff salaries and operational costs continued to increase. In order to meet tuition expenses, students were increasingly holding part-time jobs as X-ray technicians, orderlies, laboratory technicians, and nurses. Deitrick bemoaned this trend, which he did not consider to be in the students’ educational interests. In his view, raising tuition to increase income and offset operating expenses was counterproductive, although a common strategy among medical schools. Tuition increases inevitably resulted in an increase in student scholarships, since institutions continued to compete in attracting the best students, so no money was actually saved. Ideally, he hoped that philanthropic donations to support medical education could decrease—or perhaps even entirely eliminate—tuition charges.76

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Cornell’s Partners

Relations between CUMC and New York Hospital were generally favorable during the 1960s. While the two institutions collaborated successfully on the Fund for Medical Progress, certain difficulties, some trivial and others not so trivial, did present themselves. As Deitrick put it, “A  lot of things weren’t spelled out. For instance, I was always told that the hospital owned my office and could kick me out as the dean anytime, and I guess that’s right. [But who] was responsible for cleaning the halls and washing the windows—and what part of the building, where are the dividing lines?” Still, relations “weren’t bad” overall because the hospital was receiving a lot of money for research, and Deitrick and Joseph Hinsey, director of the medical center from 1953 to 1966, worked very well together. Hinsey’s role put him in a tricky situation, however, since he was theoretically superior to the medical school dean and the hospital director, although those two individuals actually controlled the finances.77 A major point of contention was the relationship between CUMC, New York Hospital, and the Hospital for Special Surgery. According to the affiliation agreement signed in 1951, the Hospital for Special Surgery was the orthopedic surgery service of New York Hospital and did not have any official connection to CUMC. However, it wanted its faculty to obtain academic titles at Cornell, while still retaining its autonomy as an independent institution.78 In 1960, the Hospital for Special Surgery and New York Hospital publicly threatened to dissolve their affiliation agreement with each other, but eventually ended up signing a revised document that involved CUMC. Under this new arrangement, the two hospitals agreed to exchange residents and fellows, while orthopedic physicians and surgeons at the Hospital for Special Surgery would be able to hold faculty appointments and CUMC and hospital appointments at New York Hospital.79 136

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The Expansive 1960s

Another hospital affiliate that posed administrative challenges to Cornell was the Westchester Division of New York Hospital, a psychiatric facility located in White Plains, New York. When it was proposed that the Westchester Division be incorporated into the growing medical center, Deitrick expressed concerns that the governance of CUMC’s affiliate relationships was already sufficiently complicated. CUMC was then involved with five different boards of trustees in addition to the New York City Department of Hospitals and had more than twelve hundred total faculty responsible for twenty-four hundred hospital beds. No mechanism was in place to coordinate between the different boards, except through the Joint Administrative Board of CUMC and New York Hospital, and Deitrick hoped that Cornell University’s own board and leadership would play a more active role in managing these various affiliations. Despite these administrative complexities, CUMC agreed to assume responsibility for the academic titles of all the professional staff and the supervision of the teaching and research of the Westchester Division.80 On July 1, 1965, the Westchester Division was formally incorporated into the joint affiliation agreement between Cornell University and the New York Hospital. The expanded affiliation resulted in the medical center gaining 350 additional psychiatric beds, greater training and research potential, and broader opportunities for student instruction in psychiatry.81 Ties between CUMC and its parent university in Ithaca were strengthened under Deitrick, who enjoyed a good relationship with Cornell’s president, Deane Malott. Upon first becoming dean, Deitrick planned to invite Malott to New York City but was advised by the deans of other medical schools not to do it: “You don’t want the president sticking his nose in all your personal affairs down there. You’ve got to be the top dog with the faculty.” Undeterred, Deitrick ignored their advice, which he recounted to Malott a few years later. When Malott asked if he, Malott, had ever interfered in the medical school’s affairs, Deitrick retorted: “I make out the agenda, I wouldn’t put anything on the agenda I  wouldn’t want you to stick your nose in.” Still, Deitrick found Malott to be of great help when problems with New York Hospital or the Hospital for Special Surgery emerged, while Malott reportedly appreciated his visits to Manhattan: “He had fun with the executive faculty, he said he enjoyed it, it was more fun with a smaller group, he had more fun here than he had up in Ithaca.” In general, the medical school operated semiautonomously from Cornell University and was responsible for raising its own money. In Deitrick’s words, “It was excellent to be independent down here as a dean.”82 Deitrick did attempt to bring the administration and faculty of Cornell University and its medical school a bit closer by arranging visits between the two campuses. For the first time, the executive faculty of the medical college met on two occasions in Ithaca, while the administrative board of the Cornell Council traveled to New York City and was treated to demonstrations and 137

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presentations of the work going on at the medical school.83 The Cornell Board of Trustees also began meeting in New York once a year, and Deitrick was elected by the medical school faculty to serve as its trustee representative from 1962 to 1969. Toward the end of his tenure as dean, he proposed that the relationship between CUMC and the Ithaca campus could be strengthened if the university began to play “a greater role in helping to develop the health and hospital services in Ithaca and in the surrounding community.”84 However, it was not until 1993 that CUMC developed an affiliation with the Cayuga Medical Center in Ithaca, which serves the Finger Lakes region in upstate New York. According to J. Robert Buchanan, Dean Deitrick resigned “very precipitously.” At a monthly meeting of the executive faculty, he suddenly made an announcement that he would be retiring at the end of the academic year, without giving Cornell University president Dale Corson advance warning. To Buchanan, who would go on to become acting dean in his stead, “that was like a bomb.”85 In Deitrick’s final, brief report to Cornell’s president on the state of the medical college during the 1968–69 academic year, he concluded by mentioning several attached reports submitted by individual administrative departments, as well as “a few figures on the salaries of deans in the U.S. Medical Colleges which may be of value in considering the compensation of a new dean.”86

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7 A Decade of Malaise You are joining the medical profession at a time when the traditional esteem in which the physician is held is at a low ebb.

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J. Robert Buchanan, Opening Day Address, September 8, 1972

The term “malaise” is frequently used to describe the 1970s, a decade generally remembered for its economic and political woes. After years of optimism and invigorating postwar growth, the United States was plunged into a deep recession in 1973, beset with skyrocketing inflation and high rates of unemployment. As the nation’s involvement in the Vietnam War dragged on, discontent grew. Widespread distrust of the government and other institutions was exacerbated by the Watergate scandal and the resignation of President Richard Nixon. By the end of the decade, the situation had grown so serious that President Jimmy Carter proclaimed that the country was suffering a collective crisis of confidence. Medical schools, hospitals, and the health care system were not immune to the nation’s malaise. Faith in the medical establishment was shaken as health care costs escalated rapidly and the public became increasingly aware of factors such as lifestyle and the environment that affected health and were contributing to a rise in chronic conditions like cancer and heart disease. After the passage of Medicare and Medicaid, dedicated revenues from the government poured into medical centers, fueling enormous growth in the clinical arena but shifting focus away from teaching and research missions. Medical historian Kenneth Ludmerer argued: “as medical schools lost touch with their intellectual roots in the university, they also lost touch with their moral roots as a public trust.”1 Academic medicine and health care in the 1970s were increasingly identified with big business, raising concerns about whether doctors were always acting compassionately and in their patients’ best interests. As Dean J. Robert Buchanan wrote in 1971, the year of New York Hospital’s bicentennial: “Society has become increasingly aware that there exists an intolerable maldistribution of the health care advances which the past several decades of biomedical research have brought forth. There is also a widespread contemporary belief that the increasing scientific orientation of medical education of the past

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fifty years has had a dehumanizing effect on physicians to the extent, it is alleged, that they provide a depersonalized type of care.”2 Questions raised in the 1960s regarding the responsibilities of the academic medical center to the community and the need for medical schools to train more physicians continued to be debated in the 1970s. The academic medical center was also subjected to new pressures to reduce basic science research in favor of problems with direct clinical applications, to assume greater leadership in complex global health issues, and to increase the enrollment of minority students.3 University medical schools like CUMC confronted “an extremely trying future” and were forced to tread a fine line between charting a socially responsive course and maintaining a commitment to academic scholarship, especially given a decrease in federal funding for medical education and frustration by student activists at the slow pace of change.4 As the 1970s progressed, doubts began to accumulate about the effectiveness of the medical system as a whole. By the end of the decade, the situation had turned dire, particularly at Cornell. Serious reservations regarding the quality of its students and faculty had emerged, relations with New York Hospital had taken a precipitous turn for the worse, and financial problems appeared insurmountable. In 1978, Theodore Cooper, CUMC’s dean during the last few years of the decade, confided to Cornell University president Frank H. T. Rhodes: “It is time to abandon the well meaning but unrealistic rhetoric about eminence and greatness. . . . While I sincerely hope that we can contain the erosion of quality and retain a competitive position, at least in recruiting students, I must tell you that I doubt that it can be done.”5 The situation at Cornell was at the bleakest point in its history.

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Deans in the 1970s

J. Robert Buchanan stepped into the increasingly demanding role of dean in 1969. A  graduate of CUMC who had completed his residency at New York Hospital, he joined Cornell’s faculty in 1961 as an instructor in medicine. He soon became assistant director of the Comprehensive Care and Teaching Program and associate director of the Welfare Medical Care Project, while helping Hugh Luckey, then chair of medicine, with administrative responsibilities. When Luckey expressed interest in positioning Buchanan as a future dean of the medical school, Buchanan remembers being skeptical and thinking, “Now that has an ice cube’s chance in hell.”6 In 1964, however, he was appointed associate dean for administration by John Deitrick and, to his surprise, was asked to serve as acting dean following Deitrick’s retirement on June 30, 1969. When officially invited to become Cornell’s eighth dean, Buchanan accepted “with huge trepidation,” in large part because, being only forty-one, he had been a student of most of the senior faculty. The announcement of his appointment, while he was still 140

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J. Robert Buchanan Born in 1928 in Newark, New Jersey, J. Robert Buchanan attended Amherst College as an undergraduate, where he became intrigued by genetic research with fruit flies. Intellectual interest drew him to the study of medicine, and he received his medical degree from CUMC in 1954. He then completed a residency in medicine and a research fellowship in endocrinology at New York Hospital in 1958. From 1958 to 1960 he served in the U.S. Army Medical Corps as a captain and chief of medicine of the 121st Evacuation Hospital in Korea, as well as chief of outpatient services at Patterson Army Hospital in Fort Monmouth, New Jersey. While in Korea, he had an epiphany that changed the course of his career. Suddenly appreciating how emotionally rewarding the practice of medicine could be, he decided that instead of treating “one patient at a time,” he would move toward a role in academic medicine that might, in time, allow him to reach out into parts of the world that desperately needed help. Buchanan joined the faculty of CUMC in 1961 and married Dr. Susan T. Carver, then an instructor in medicine at CUMC like her husband. During the 1970s, Carver would go on to become a clinical associate professor in medicine at CUMC and associate director of professional services at New York Hospital. Buchanan also rose quickly through the ranks and in 1969 was elevated to the post of dean. In 1976, Buchanan was recruited to Chicago as the president of the Michael Reese Medical Center and associate dean of the University of Chicago Pritzker School of Medicine. There he was cast in the role of a corporate executive responsible for hospital operations, in contrast to his experience at CUMC, which involved little direct clinical involvement. In 1982 he was asked to become general director of the Massachusetts General Hospital and professor of medicine at Harvard Medical School, an offer that rendered him “the most surprised human being in the world.” That post allowed him to combine his administrative and academic experience as dean at CUMC with his executive role at Michael Reese. Buchanan was able to achieve the goal he had originally formulated in Korea of becoming involved in global health efforts. He served on the China Medical Board, which supports medical schools in China and Southeast Asia, for thirty years, and he has been a founding trustee of the Aga Khan University in Pakistan for more than three decades. He also helped to develop Boston Medflight, a nonprofit 141

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critical care transport service in New England, was elected to the Institute of Medicine in 1984, and served on the boards of state hospital associations, the Bank of New England, Charles River Labs, WorldCare, American Medical International, and L-Stat Corporation.7

an associate professor of medicine, was made on October  18, 1969. He was promoted to full professor in 1971. As deans during the 1970s, Buchanan and his successor Theodore Cooper dealt with administrative challenges of a kind unknown to their predecessors, in addition to a daunting social and financial milieu. While earlier leaders had been able to wield more direct control over a much smaller organization, Buchanan’s staff initially consisted of five associate deans, a fiscal officer, business officer, public information officer, the librarian, and the director of animal laboratory medicine.8 The deans of the 1970s and beyond found that “their responsibilities were progressively broadened, but their authority and their own ability to influence the course of events were not expanded concomitantly and, in fact, were often challenged.”9 While financially responsible for the school and heavily engaged with fund-raising, often at the expense of personal academic or clinical interests, they had reduced power over the overall budget. Increasingly, individual faculty members managed the money from their own research grants and contracts, while the dean’s discretionary funds were limited. In one study published in 1978, faculty members rated department heads as having a greater influence on policy-level decisions in education, research, and patient care than did deans. In addition, individual faculty members were perceived as having a greater impact on research policy than did medical school deans.10 According to Kenneth Ludmerer, “Many deans continued to be effective, but their success resulted mainly from persuasion, force of personality, and consensus-building rather than direct decision-making power.”11 Buchanan’s personal style and administrative skills made him well suited to the job. After a site visit in 1972, a committee of the accrediting body for medical schools noted in its report that the faculty had “a consistently high regard for the Dean in his managerial capacity and sensitivity” and that “access to the dean was possible at any time.”12 Robert Michels, who was recruited as chair of psychiatry by Buchanan, remembers him as “a charismatic, powerful figure,” as well as a “nice man and very devoted to Cornell.”13 According to Dr. Antonio Gotto, who met him on a recruiting visit, Buchanan was “very cordial,” “very well respected,” as well as “very young.”

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In retrospect, Buchanan felt that being dean was a “huge learning experience” that he enjoyed, especially since he relished working on tough problems. His status as a younger administrator, rather than someone focused entirely on education or research, may have helped him when dealing with students and the social issues of the time. Although he continued his clinical teaching by going on grand rounds, he soon realized that maintaining his endocrinology practice while dean was not sustainable. After Thomas Meikle, a former classmate at CUMC, was appointed dean of the Cornell Graduate School of Medical Sciences in 1969, Buchanan tapped him to become an associate dean of the medical school as well. With disarming modesty, Buchanan explained this choice in an interview conducted in 2013: “I recognized my academic, particularly research, credentials were not what I  thought they should be for Cornell. Tom’s were strong, so I felt he should come in and manage a good piece of that portfolio.”14 Buchanan’s role as dean involved extensive involvement with affiliated and neighboring institutions. In addition to participating in various meetings of the New York Hospital and the New York Hospital–Cornell Medical Center, Buchanan became a member of the boards of Memorial Sloan Kettering, Burke Rehabilitation Hospital, and the Medical Library Center of New York, and he was the main point of contact with the North Shore University Hospital on Long Island, the Northern Westchester Hospital, and the Phelps Memorial Hospital in Westchester. The York Avenue Institutions close to the medical center had formed a coordinating committee, of which he was a member, and he participated in the Association of American Medical Colleges Council of Deans and Executive Council. As president of the Associated Medical Schools of New York and New Jersey from 1972 to 1976, he also spent considerable time educating state bureaucrats and legislators about the importance of supporting medical education.15

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Student Unrest

Buchanan became dean at a time when student activism in the United States had reached a peak. During his first year, student volatility was high: “We had Kent State on our hands. We had the advent of the pill, and all the changes in living arrangements that brought about. We had protests about everything under the sun because it was just the spirit of the day. Frankly, I  think our population was very depressed by the Vietnam War.”16 By the end of the 1960s, opposition to U.S. involvement in the Vietnam War was widespread. At Cornell, students established a Moratorium Committee as part of a larger movement, the Moratorium to End the War in Vietnam, a massive demonstration and teach-in that occurred on October  15, 1969, at numerous national and international locations. Cornell students on the Moratorium Committee successfully requested that classes that day be devoted to a discussion of issues

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related to the war—not with the “intention of committing Cornell, its faculty, or its students to a position on the war, but rather, of committing us all to an open forum,” as indicated in an open letter to the faculty. While the committee acknowledged that “a medical school should of course, concern itself primarily with those issues relating to health,” it felt that the question of U.S. involvement in Vietnam “has become so crucial that we must, as American citizens, give it special consideration.”17 The October demonstration was followed by a Moratorium march on Washington, D.C., on November 15, 1969, which was attended by more than half a million people. After the shootings of student protesters and passersby at Kent State University on May 4, 1970, following President Richard Nixon’s announcement of the Cambodian Incursion, the executive faculty agreed to close classes for one day at the strong urging of students, particularly those in their first and second years.18 Buchanan remembers one particularly distraught student bursting into his office and demanding that classes be canceled. He gave her some sage advice—“it’s when things like this happen, that doctors ought to be prepared to do the most”—before kindly asking her to leave. Overall, Buchanan felt that “the students didn’t cause any trouble in New York, but everybody was edgy, and it was not a tranquil time for the country.”19 In addition to the Vietnam War, students expressed frustration with the medical college on a range of topics, including its responsibilities toward the socially disadvantaged, the environment, the traditional teaching and research activities of its faculty, and community health. In response to the rise in student activism, CUMC established a Medical Student Executive Council, students were appointed to most of the standing committees of the faculty including the Committee on Admissions, and a medical student representative was added to the Cornell Board of Trustees in 1970–71. In its first year, the Medical Student Executive Council organized a school-wide picnic and rugby match at the Westchester Division of the New York Hospital and began helping to establish student financial aid guidelines. A onetime elective, Aspects of Community Medicine, was offered at student request, with participants conducting fieldwork on topics such as abortion, health-related grassroots organizations and movements, and psychiatric services for the indigent. According to Buchanan, this program “defused a potentially troublesome generation/communication gap that was developing between the younger students and the Medical Center.”20 In addition, the first-year curriculum was altered to include a greater emphasis on social issues in medicine and a new grading system of “Pass, Fail, Pass with honors.”21 Students also posed problems of a different sort. CUMC introduced a Code of Professional Conduct for students in 1974, with infractions dealt with by a hearing board. The first two students accused of misconduct brought lawyers, including in one case a prominent civil rights attorney, to represent them at 144

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their hearings.22 Two other students were caught cheating soon after the code was implemented, leading Buchanan to comment: “I  personally believe that there has been no major change in the basic honesty of our general student body. However, I  believe that the competition to gain entrance to medical school has spawned a new morality which, unfortunately, sometimes lingers on after admission to medical school has been accomplished.”23

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A Changing Student Body

In the years following World War II, schools including Cornell were increasingly under pressure to produce more physicians to meet the country’s health care needs. Patients started to use health care services in greater numbers and with more regularity, leading to predictions of a nationwide shortage in doctors. The demand intensified during the 1970s following the introduction of Medicare and Medicaid. Primary care physicians and generalists, rather than specialists, were especially needed to treat the recently expanded outpatient population now covered by insurance. The government began to offer various financial incentives for medical schools to increase enrollment and decrease the amount of time required for students to earn a degree; these subsidies became increasingly difficult to resist as the United States entered a recession in 1973. Following the Comprehensive Health Manpower Training Act of 1971, which provided federal funding to increase enrollment, CUMC increased its class size by 10 students to a total of 101, which still kept it among the smaller medical schools. CUMC did not elect to shorten its curriculum, but in 1972 it dropped the requirement that students possess an undergraduate degree for admission and began accepting some with three years of college study. Especially talented students were also given the option of enrolling in a fourth-year clinical elective in a medical specialty, which could reduce the period of residency training by one year. Thus, it was possible to cut two years between the time of entering college and becoming board-certified in a medical specialty. 24 The following year, CUMC also reestablished a program with Cornell University that allowed undergraduate seniors to double-register as first-year medical students. And despite a growing trend among medical schools to reduce the amount of time and money spent on teaching the basic sciences, CUMC remained committed to providing a scientifically based medical education. The Cornell Board of Trustees had voted to increase tuition at the medical school by $300 a year in 1970; however, Buchanan and Thomas Meikle, dean of the Graduate School of Medical Sciences, agreed to waive tuition in the graduate school a couple of years later in order to ensure that a sufficient number of students would enter the basic sciences as future researchers and teachers.25 145

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The basic science program was further strengthened with the creation of a joint MD-PhD program involving CUMC and Rockefeller University. Alexander G. Bearn, a renowned geneticist who had recently left Rockefeller to become chair of medicine at CUMC, first conceived of the idea. After extensive negotiations between Bearn, Dean Buchanan, and Rockefeller’s president Frederick Seitz, the program was launched in the summer of 1972. 26 Its first class of five students was chosen from about seventy applicants. Participants spent their first two years following the basic science curriculum at CUMC, with a special focus on atherosclerosis, and working in the labs at Rockefeller during the summer. The next three years were spent at Rockefeller pursuing a research topic and completing a thesis. The sixth year consisted of the third-year medical curriculum at CUMC, including clinical clerkships. At graduation, students received an MD from CUMC and a PhD from Rockefeller. The program proved very successful, and a total of 157 students, including 27 women, applied for admission in its third year of operation.27 Buchanan considered the new MD-PhD program to be one of the highlights of his time as dean, although he regretted not being able to create a joint department of microbiology between CUMC and Rockefeller. Although he was eager to see that project succeed, the faculty at both institutions ultimately proved more successful in their resistance.28 Nevertheless, the relationship with Rockefeller and Memorial Sloan Kettering progressed along a “Three Corners” concept. According to Antonio Gotto, who visited CUMC in 1970, Bearn was very interested in building up the quality of research in the department of medicine and played an active role in fostering relations among the three neighboring institutions. In 1978 the Cornell Graduate School of Medical Sciences, the Sloan Kettering Institute, and Rockefeller started the first Tri-Institutional collaboration, a postdoctoral training program in endocrinology.29 Admissions at CUMC underwent a major transformation with the development of a robust affirmative action program in the 1970s. Between the medical school’s founding in 1898 to the early 1970s, only about eight African Americans and four black Africans had graduated as medical doctors.30 To increase minority enrollment, CUMC launched a summer research program for undergraduate students in 1969. Walter Riker Jr., chair of pharmacology, helped implement the program, which included career counseling and was initially supported by the Josiah Macy Jr. Foundation. Hampton University, a historically black university, sent the first batch of ten summer students to Cornell. An African American associate dean of minority affairs, Dr. James Curtis, who was also a psychiatrist, was recruited to help with admitting, supervising, and supporting underrepresented minority students.31 After its first year, the summer program was expanded to include African American and Puerto Rican undergraduates from around the country, although the majority ended up coming from New York State. Participants 146

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Figure 7.1  Students in the class of 1967 were overwhelmingly white and male. (Photo by Sol Greenberg; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

spent the summer at CUMC working on research projects in the laboratory of a faculty sponsor, visiting neighborhood health centers that served a high minority population, attending lectures and seminars on health issues in minority and disadvantaged populations, and participating in workshops on the medical school application process. Minority students already enrolled at CUMC worked as assistants, served as role models, and provided counseling and support. Dr. Carol Storey-Johnson, a member of CUMC’s class of 1977 and senior associate dean for education at the medical college for thirteen years, attended the program in 1972 before her senior year at Yale. In her experience, it “served as both an enrichment program and as a socializing and networking opportunity—to meet people who were at your same level, because there were not a lot.”32 Between 1969 and 1982, a total of 278 undergraduates completed the summer program, and more than 90 percent were accepted to U.S. medical schools. Approximately one-fifth chose to enroll at Cornell. 33 The Travelers Summer Research Fellowship Program, as it is now known, is still ongoing and is open to all premedical students with a demonstrated interest in aiding medically underserved communities, although most are members of underrepresented minority groups. According to James Curtis, who served as associate dean of minority affairs until 1981, college students who had participated in the summer program prior to joining Cornell were better adjusted emotionally and socially, so their 147

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academic work was improved. His role as associate dean entailed running the summer program, serving as a role model, recruiting medical students, and coordinating scholarships, loans, and academic and counseling services. He oversaw a substantial increase in minority applicants and matriculants to Cornell during the 1970s, combined with a high retention rate. In 1969, Cornell had 25 minority applicants, and out of its entering class of 91 students, 10 were African American and 2 were Puerto Rican. In 1977, the number of minority applicants had increased to 552, of whom 30 were accepted and 15 enrolled. The average science Medical College Admissions Test (MCAT) scores of accepted minority students at CUMC increased during this period from 500 to 601; these scores were consistently higher than the national average for minority students, although lower than for nonminority students.34 Throughout the decade, Cornell succeeded in enrolling minority students as at least 13  percent of its classes each year. 35 In contrast, the New York Times reported in 1977 that despite seven years of efforts aimed at increasing minority enrollment, New York City medical schools had fallen even further behind the national average, with CUMC as the only exception. In 1969, 4.3 percent of students entering medical schools in the city had been minorities, compared to 4.8  percent nationally. In 1977, the gap had widened to 6.9 percent in the city compared to 8.9 percent nationally. In Curtis’s opinion, the problem was that many medical schools had admitted African Americans

Figure 7.2  Students in the class of 1975 show a more diverse makeup. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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A Decade of Malaise

“almost indiscriminately,” with the result that many were unable to succeed academically.36 He felt that it was critical that admissions standards for minority and nonminority students remain the same. Cornell saw very few academic dropouts among minority students, although about one in ten were required to repeat a year of study. 37 Between 1969 and 1982, a total of 163 minority students entered Cornell, and their retention rate was 92  percent, compared to 98  percent for nonminority students.38 In general, Cornell’s affirmative action program enjoyed a high level of support from faculty and students across races, although occasionally problems did emerge. Because of academic difficulties, five second-year minority students were warned that their records might undergo special review at the end of the 1974–75 academic year. Of the fifty-four minority students then enrolled, forty-eight protested and threatened to take group action against the medical college. A series of meetings with administration, faculty, and minority students was held. According to Buchanan, “the minority group students felt that many faculty members are insensitive to them and to their problems and that when minority group students are in academic difficulty it is more the fault of the faculty than of the students. They feel unwanted, discriminated against and subject to unfair evaluation practices.” As a result, first- and second-year examinations began to be administered and graded anonymously. Subsequently, some nonminority students began to feel that minority students were having an “undue influence on student evaluation.”39 Still, despite such challenges, when the Association of American Medical Colleges established a Task Force on Minority Students in 1978, it outlined a model of an effective medical school program for minority students drawing heavily on Cornell’s experience.40 Working in collaboration with James Curtis, African American medical and nursing students set up a community outreach program at nearby Julia Richman High School in 1971. As preparation for screening African American students for sickle cell anemia, they initiated an intensive two-week educational program, tried to develop a cadre of fifty student leaders to act as liaisons with the medical center, returned to the high school several times a week to talk to students individually and to answer questions, and arranged to publicize the program on two local television stations. Despite high rates of absenteeism and lack of interest among the high school students, the medical and nursing students managed to screen most of the African Americans at the school for sickle cell anemia and provided those affected with genetic counseling. Related community outreach projects run by Cornell at the high school included a methadone clinic capable of treating fifty drug addicts at a time, as well as backup facilities designed to prevent students from dropping out of school for medical reasons.41

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Female Alumnae Reminisce

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From “Reflections: 100 Years of Women, Cornell University Medical College,” edited by Priscilla McAuliffe, MD ’99, and Heather Lipkind, MD ’99

Hilda Crosby Standish, MD ’28—“We numbered 67, of whom 11 were women. This ratio was true in the other classes during my four years. . . . And let me say, that never throughout my student years at Cornell, or later, during intern or residency appointments, did I experience any treatment different from that of the men. We were all doctors.” Eleanor Scott Goldbloom Basset, MD ’35—“As a Cornell medical student, class of 1935, there was nothing in the curriculum addressing the health concerns of women. Ob/gyn courses were about the physiological facts only—namely the hormonal changes resulting in menstruation, a discussion of dysmenorrhea. . . . Nothing about whether and when to do tubal ligation for sterilization, and nothing about the subject of contraception, other than the ‘rhythm’ method.” Anne C. Carter, MD ’44—“In those days as a woman it was difficult getting an interview for medical school as they were not interested in admitting women because they did not believe we would complete our medical education. . . . At Cornell, there were members of the faculty who did not support the women. Dr. Connie Guion was our role model and champion of women in medicine.” Artemis G. Pazianos, MD ’55—“Much to my dismay, on the first day of medical school, one of the men in my class approached me and said, ‘Do you realize because you are here a man is not!’ I replied, ‘Do you realize because you are here a woman is not.’ That was the end of that conversation! . . . My professor of anatomy was Dr. Charles Morrill and he absolutely refused to allow a woman and man to work together. In fact, the four women in the class were segregated and placed in a remote corner of the anatomy room. We were clearly in the minority! Dr. Morrill chose to pick on the women in the class every Saturday morning when we sat shaking in our shoes, waiting to be bombarded by all of his questions.” Michelle P. Warren, MD ’68—“I was one of six women in the class and we were well-treated overall. . . . I do remember being very dismayed that no ladies rooms were built into the new science building and I had to go to another floor and borrow a key to the secretaries’ private bathroom. Another irritating experience was the lack of scrub clothes, particularly in small sizes.” Drucy Borowitz, MD ’79—“Thirty percent of my class was female, an astounding amount in the history of CUMC. . . . I don’t remember any instances when I felt left out of the ‘medical student 150

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club’ because I was a woman. . . . These women [professors] encouraged us, but I don’t recall a strong presence or sense of support. It was almost as if I needed models of women who were physicians, rather than physicians who were women.”

Although women were not as aggressively recruited as minority students, their numbers also increased during the 1970s. While Cornell was able to boast that its 1898 inaugural class contained twenty-six women, the average number of women in each entering class between 1950 and 1970 had dropped to merely five, with a range of three to eight.42 In 1960, only 3 percent of Cornell’s applicants were female, although this figure rose to 10 percent in 1970 and 22 percent in 1973. Data from the 1971 entering class indicate that there were fifteen female enrollees, and that year a female member of the faculty was appointed to the admissions committee for the first time.43 By 1977, 27  percent of the student body was female.44 This dramatic increase was paralleled in U.S. medical schools at large, with the enrollment of women increasing by almost 250 percent between 1968 and 1979, so that women made up 24 percent of U.S. medical students at the end of the 1970s.45 Two key factors contributed to the upsurge in the number of women choosing to enter the medical profession. Congress passed Title IX of the Education Amendments of 1972, which prohibited discrimination on the basis of sex in institutions of higher education receiving federal funds. And the women’s rights movement mounted a sustained critique of the medical establishment, which it saw as a male-dominated profession insensitive to the needs and experiences of women. Through outlets including the classic text Our Bodies, Ourselves, published by the Boston Women’s Health Book Collective, the women’s health movement encouraged women to participate in their own health care and contributed to the rising numbers of women choosing to become doctors. From Faculty Anxiety to Air Rights

As student affairs were undergoing significant upheavals at Cornell, the faculty experienced a corresponding degree of anxiety. Student hostility toward traditional medical scholarship and a marked increase in student involvement in the college’s governance transformed the educational climate. At the same time, there was a rapid escalation in the cost of living and a “general deterioration in the urban condition,” with high rates of crime and widespread social disorder in New York City during the 1970s. In addition, the government was pushing for more service-oriented research and clinical programs, while withholding funding for the hard sciences.46 151

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In order to widen faculty involvement in the medical school’s policies and its response to contemporary problems, Buchanan appointed an ad hoc committee, which recommended in 1972 that previous governing bodies, the Basic Science Faculty Council and the Clinical Science Faculty Council, be abolished. In July 1972, the Executive Faculty Council, a managerial body made up of department chairs, and the General Faculty Council, a policy-making group of elected members, were created in their stead. Both councils also contained two nonvoting student members elected by the Medical Student Executive Council. One of the main features of the new governance structure was the creation of six-year departmental reviews, which included the performance of each department chair, beginning in 1973–74.47 Although intended to engage faculty members in determining their department’s future, the review process needed refinement after the first round of reviews had been conducted and probably contributed to the anxiety it hoped to alleviate. As Buchanan noted, “it is an unduly slow moving process which inevitably leads to ‘leaks’ in confidentiality, creates polarity in the faculty and causes the individual being reviewed to feel an unwarranted degree of insecurity.”48 Notable research at the time included the Human Sexuality Program at the Payne Whitney Clinic, founded by Dr. Helen Singer-Kaplan in 1970 as the first of its kind at a U.S. medical school. Believing that sexual difficulties could derive from underlying emotional problems, Singer-Kaplan ran an outpatient clinic for the evaluation and treatment of psychosexual disorders, developed a body of clinical training materials for physicians and mental health professionals, and supervised all education and training programs in human sexuality for Cornell’s medical students and psychiatric residents.49 One of her disciples was Dr.  Ruth Westheimer, the sex therapist popularly known as Dr.  Ruth, who studied with her and later became an adjunct associate professor at Cornell for five years. A  major research breakthrough in a related field was the development of the first reliable home pregnancy test by reproductive endocrinologist Brij Saxena; in 1979, royalties from the test exceeded $150,000.50 Other developments included the establishment of a Perinatology Center in 1975 for the care of high-risk mothers and newborns. And on December  10, 1976, New York’s first burn center opened at New York Hospital–Cornell Medical Center. Dr. G. Tom Shires, an expert in burn treatment, head of surgery, and future dean of CUMC, played a pivotal role in its creation. The burn center addressed a major need, since burn patients had previously been flown as far afield as Texas for treatment. In 1978, it opened New York City’s first skin bank, which greatly facilitated the treatment of patients who had been badly burned.51 New multidisciplinary centers were also established in cardiovascular disease, rehabilitation medicine, and kidney disease, with the dual goal of offering high-quality care and attracting financial support from the government and private donors. While Dean Buchanan viewed such centers favorably, he saw the 152

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A Decade of Malaise

trend toward tertiary care—involving highly specialized treatment and complicated procedures, often over an extended period of time—as potentially problematic when trying to teach students the fundamentals of clinical medicine.52 In comparison with the preceding decade, the 1970s were relatively quiet in terms of new construction and renovation projects. An increased demand for housing on the Upper East Side led Cornell to focus its expansion efforts on residences for students, faculty, and staff, while a massive campaign to obtain the air rights over the East River Drive adjoining the medical center was geared toward future growth possibilities. The only new building of the decade was the Jacob S. Lasdon House, a fifteen-story residential building located across the street from the medical center. Construction started on January  1973, after the building’s namesake left $2  million to Cornell, and the New York State Dormitory Authority helped finance the remaining $8.7  million of its cost.53 Lasdon House opened in September 1974 with three hundred housing units, which were made available to all Cornell medical, graduate, and nursing students, and it proved to be a very popular residence. Cornell additionally acquired two five-story walk-up apartment buildings adjacent to the medical center.54 A bookstore opened in November 1974 under Cornell management, but after it promptly ran a $45,000 deficit, its management was shifted to the retail bookseller Barnes & Noble.55 In an interview conducted in 2013, Buchanan remembered feeling that he, New York Hospital director David Thompson, and New York Hospital–Cornell Medical Center president Hugh Luckey formed a “smoothly operating” “triumvirate” that successfully coordinated joint efforts at the hospital and medical college and “managed never to have such serious disagreements as to threaten to disrupt things.” In addition to operating the medical center according to a detailed joint budget that they discussed annually, Buchanan, Thompson, and Luckey initiated two major real estate projects among the York Avenue Institutions, which included New York Hospital–Cornell, Memorial Sloan Kettering, the Hospital for Special Surgery, Rockefeller University, and the Manhattan Eye, Ear and Throat Hospital.56 The first project was the acquisition of Sutton Terrace, a nearby 435-unit luxury apartment building, by the six institutions. CUMC used its share of the apartments to provide housing for 133 staff members.57 A much bigger endeavor was a campaign to acquire air rights over the Franklin D. Roosevelt East River Drive, a highway running along the eastern edge of Manhattan. The main buildings of the Hospital for Special Surgery, the New York Hospital–Cornell Medical Center, and Rockefeller University were all situated within an eight-block stretch between York Avenue and the East River Drive. Memorial Sloan Kettering was primarily located on a block to the west of York Avenue, while the Manhattan Eye, Ear and Throat Hospital was about ten blocks away on the Upper East Side. Led by Luckey, who 153

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CHAPTER 7

chaired the Coordinating Committee of the York Avenue Institutions, the group began trying around 1969 to obtain the air rights over the FDR East River Drive, which would allow them to expand their existing properties by building on platforms extending over the highway. Several other options had been considered before settling on this particular strategy. Previous efforts to expand into the residential areas surrounding the medical center had angered longtime tenants and led to intense political conflicts in the 1960s. With a nationwide housing shortage currently under way, this option seemed best avoided.58 The medical center had also engaged in preliminary discussions with the city about building on Roosevelt Island, located in the East River, but these did not prove fruitful.59 In addition, New York Hospital had considered moving to suburban properties in Westchester County it already owned or rebuilding on its existing site, but both of those options would have substantially derailed existing operations.60 Specific projects included in the $300–$400 million East River Air Rights Proposal shifted over time, but included at various points an X-shaped, forty-story building for New York Hospital to be shared with the Manhattan Eye, Ear and Throat Hospital; a ten-story building to house New York Hospital–Cornell Medical Center’s departments of psychiatry and rehabilitation medicine; an underground parking garage for six hundred cars; a research and education center for Rockefeller University; and animal care facilities, a library, a computer center, an auditorium, and a conference center to be shared by Rockefeller University and the New York Hospital–Cornell Medical Center. Despite the constantly shifting plans, what was clear was that New York Hospital desperately needed additional space; and with Luckey driving the campaign, the specifics of who would build what where would gradually fall into place after the air rights had been obtained. The U.S. Public Health Service had recently specified that teaching hospitals should have at least sixteen hundred square feet per bed, and New York Hospital fell short of that requirement, with approximately one thousand square feet per bed. It was envisioned that a new high-story hospital tower would be designed with modern principles of patient care in mind, with no differentiation between the care and services offered to private and nonprivate patients. The existing New York Hospital buildings would be converted to examining rooms and doctors’ offices for ambulatory care. Funding for the various projects would be obtained from private and government sources, with construction to be completed within a decade.61 Consultants were hired to manage the complicated proposal, which required interaction with the Army Corps of Engineers and the U.S. Coast Guard, and a public relations strategist was enlisted to help manage the political process. The medical center made a concerted effort to gain the support of elected officials and other constituencies and to involve the community in the entire process. In 1971 Luckey pledged that the East River plan would not 154

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A Decade of Malaise

result in the eviction or relocation of any residents living in the area, even though it was estimated that the New York Hospital–Cornell Medical Center would require one thousand new apartments for staff over the next fifteen years. Although some local politicians and residents resisted it, the plan had the support of New York governor Nelson Rockefeller and Mayor John Lindsay, and the state legislature passed a bill allowing New York City to sell the air rights over the highway to the owners of the abutting properties. It was then left to the City Planning Commission and the Board of Estimate to negotiate a price. The New York Hospital, the Hospital for Special Surgery, and Rockefeller University, as the institutions with property actually adjoining the FDR East River Drive, were the three entities that ended up consummating the deal. Luckey proposed that the air rights be transferred to them in exchange for one dollar, which he considered a fair sum because, he said, speaking on behalf of New York Hospital, “we don’t think [the city agencies] can ignore 170 years of service to the community.”62 On April 2, 1973, the New York City Board of Estimate approved the plan on a vote of eighteen to four, despite opposition from the borough president of Manhattan, who feared that area residents would be displaced by medical center employees, and the borough president of the Bronx. In return for the air rights over the FDR Drive from Sixty-Third to Seventy-First Street, the three institutions agreed to improve the pedestrian waterfront area along that stretch of the river. These upgrades included enhancements to existing pedestrian bridges crossing the highway and the construction of new ones, as well as a publicly accessible, raised and landscaped walkway along the FDR Drive. Once obtained, the air rights were not used by any of the three institutions until the 1980s, when enough money to finance expansion projects had accumulated. Money was short throughout the 1970s, although CUMC was managing to make ends meet at the beginning of the decade. The accrediting body for medical schools reported in 1972: “Funds [at CUMC] are not abundant, and are less available than in earlier years, but they are adequate and the picture is better than in many other medical schools.”63 Starting in 1975, however, the medical school began dipping into its capital reserves to cover annual deficits of about a million dollars.64 In addition, the New York Hospital was losing more than $5 million a year, largely because of shorter patient stays and reimbursement problems. Since the hospital contributed more than $4 million a year to the medical college budget, its financial problems were particularly worrisome to Cornell.65 During the 1975–76 year, the total budget for the medical center was $174.3 million. Joint expenses amounted to $26.4 million, while the hospital budget dwarfed that of the medical school, with $127.3 million compared to $20.6  million.66 By that time, Dean Buchanan noticed “a growing migration” of New York Hospital leadership away from a commitment to the medical center, leading to increased strain between the two institutions. Luckey’s 155

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influence as president of the center was greatly reduced, while the hospital’s director and CUMC’s dean were functioning as “essentially independent executives of parallel operations.”67 A joint fund-raising campaign for the medical center, called the Third Century Program, was announced on May 20, 1976. It was cochaired by Cornell University president Dale Corson and two members of the New York Hospital Board of Governors, Eleanor T. Elliott and Arthur R. Taylor. Luckey, who retired from the medical center in 1977, agreed to remain involved in fund-raising for the campaign for at least three additional years. The $270 million campaign was organized into two phases. Phase One was expected to be completed by 1981 and had a target of $126.5 million for faculty and student support, clinical programs, and new facilities, including a blood bank, labs, and a radiation treatment center. The $140 million targeted in Phase Two was expected to go toward projects making use of the East River air rights, such as an auditorium, a science and library facility, and hospital pavilions. By the end of the 1970s, the campaign had raised approximately $63 million.68 The hospital and medical school were having increasing difficulty coordinating fund-raising efforts at that point. In June 20, 1978, correspondence between CUMC’s dean and Cornell University’s president indicate that the medical school was not being consulted regarding mail solicitations being sent out by the medical center’s development office. It was unclear how the money raised would be allocated between the medical college and New York Hospital, and the dean feared that “that we cannot now, or in the future, expect to realize any significant income or gifts from the Third Century Program as it is now constituted.”69

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A Period of “Unusual Stress”

In 1976, Dean Buchanan left CUMC for Chicago, penning in his annual report: “You can be certain that I stand ready to serve Cornell in the future in any way I can. My affection for this College and its parent University is profound and enduring.”70 Following Buchanan’s resignation, Thomas Meikle was appointed acting dean, a position he held from December  1, 1976, to June 30, 1977. That year marked a period of “unusual stress” at Cornell that did not dissipate with the appointment of the next dean, Theodore Cooper. As Meikle noted, the quality of the medical school’s educational and research programs had begun to decline as patient care gained in priority, relations with New York Hospital were increasingly troubled, and the financial situation was worsening—all at a time when Cornell lacked a clear leader: “These problems have aggravated deteriorating relationships among students, the faculty and the administration and have produced disastrously low morale.”71 With Buchanan’s departure, the medical school entered a troubled phase that 156

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had been building for the past several years. Many medical schools around the country experienced a similar malaise, although the situation at each institution was shaped by specific, unique factors. While Cornell was widely considered one of the country’s most competitive private medical schools, questions had begun to emerge regarding the quality of its teaching program. The grade-point averages and MCAT scores of incoming students had remained roughly the same, with the performance of minority students increasing, but student scores on the Part 1 Examination of the National Board of Medical Examiners, the precursor to today’s United States Medical Licensing Examination, deteriorated sharply between 1975 and 1977 in all subjects except pathology. More students were failing courses and withdrawing for academic reasons, and the research papers submitted for an annual student contest were of such poor quality that the top three prizes were not awarded in 1977. In addition, the number of Cornell students selected for medical residencies at New York Hospital dropped from fifteen in 1972 to seven in 1977. According to Meikle, graduating students were perceived as less prepared than in years past and in comparison to their peers. A  cluster of variables, including a general decline in the quality of faculty teaching, poor student-faculty relationships, an inadequate student advisory system, and a stagnant curriculum unrevised for almost a decade, likely contributed to this situation. At the same time, faculty research funding, which was increasingly seen as a primary indicator of an institution’s reputation and standing, started to drop. Between 1975 and 1977, the rate of funding for faculty research grant applications decreased from 53 percent to 42 percent. From 1966 to 1977, total research support had increased by 120 percent, but by only 28 percent when calculated in constant dollars. When considering other related factors, the quality of Cornell’s research enterprise appeared merely “middle-of-the-road” to Meikle.72 Still, in 1976–77, the medical school received the largest single grant in its history to date, an $8.6 million, five-year award from the National Institutes of Health to support the Clinical Research Center of New York Hospital. And according to a 1977 survey of medical school faculty, Cornell ranked ninth in terms of the perceived quality of its faculty, following Harvard, Johns Hopkins, Stanford, the University of California at San Francisco, Yale, Columbia, Duke, and Michigan.73 An additional strain was posed by Cornell’s relationship with New York Hospital, which was becoming increasingly tense by 1976. The hospital and medical school disagreed on the process of selecting and appointing new chairs for recently vacated clinical departments, while attempts to rewrite and clarify the joint affiliation agreement between the two institutions proved unsuccessful. Hugh Luckey announced that he would be retiring as president of the medical center on October 1, 1977, and the position was never again filled, which further contributed to a deterioration in joint planning and decision-making efforts. One of the first things to suffer was the medical center’s physical plant. 157

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Poor coordination between staffs and a lack of general maintenance had resulted in dangerous problems with the mechanical, heating, ventilation, and electrical systems. It was also discovered that Cornell did not have adequate emergency evacuation plans in place and that biohazards, toxic and explosive chemicals, and radioactive materials were not being properly managed, stored, and disposed. The cost of upkeep for the center’s aging facilities had contributed to operating deficits for two years, necessitating the withdrawal of funds from CUMC’s endowment. At the end of the 1977 fiscal year, the endowment had decreased by 35 percent from 1972 to a total of $11 million. Budget cuts were being implemented to address the college’s precarious financial situation.74 Dr.  Theodore Cooper inherited a formidable array of problems when he became dean in July 1977. Administratively, he also became Cornell University’s first provost for medical affairs, a position newly created by the board of trustees as a counterpart to Cornell’s provost in Ithaca. According to Robert Michels, who would become dean in the 1990s, Cooper was “an outsider who came in, which had not happened before very much.” Although “a sharp‑thinking, clear, goal‑oriented person,” he was, in Michels’s opinion, “frustrated and disappointed by the limitations of power he found in this complex organization.”75 Similarly, Antonio Gotto believed that Cooper, whom he knew well from his time at the National Heart and Lung Institute, felt caught between two forces, the hospital and the university, without having much real authority as dean. When Gotto visited Cornell on a recruitment visit in 1980, he remembers thinking that Cooper seemed very disillusioned by his job at that point.

Figure 7.3  Theodore Cooper, MD, PhD. (Courtesy of the National Library of Medicine.)

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Theodore Cooper Born on December 28, 1928, in Trenton, New Jersey, Theodore Cooper received his undergraduate degree from Georgetown University in 1949 and his medical degree and PhD in physiology from St. Louis University. After training as a cardiovascular surgeon, he conducted research at the National Institutes of Health on heart transplants, artificial hearts, and heart attacks. He briefly served as chair of pharmacology at the University of New Mexico School of Medicine before joining the National Heart Institute to work in research administration, where he introduced new funding mechanisms such as the Specialized Centers of Research, designed to translate basic science research to clinical care. Cooper served as director of the newly renamed National Heart and Lung Institute from 1968 to 1974 and helped establish the National Sickle Cell Disease Program and the National High Blood Pressure Education Program, the first educational program at the NIH to involve collaborations with industry and academia. He recruited more than two hundred national and state agencies and twenty-one hundred local agencies, plus volunteer groups, to educate the public on the importance of screening and treating hypertension. In 1972 he received the Albert Lasker Public Service Award in recognition of his efforts, which helped reduce the number of deaths from stroke, heart disease, and kidney disease nationwide. From 1974 to 1977 during the Nixon and Ford administrations, Cooper rose from deputy assistant to assistant secretary for health, working to shape federal policy on heart disease and nutrition. For three years, from 1977 to 1980, he was CUMC’s ninth dean and Cornell University’s provost for medical affairs. Cooper was elected president of the Society for Experimental Biology and Medicine in 1980, and on October 1, 1980, he left CUMC to become executive vice president of the pharmaceutical company Upjohn. He later became the company’s chairman and chief executive officer in 1987. In addition, Cooper was a board member of the Metropolitan Life Insurance Company, the Kellogg Company, Borden Inc., the Harris Trust and Savings Bank, and the Bronson Healthcare Group. He died on April 22, 1993, at the age of sixty-four from complications from multiple myeloma. He was survived by his wife, Vivian, and four children.76

Relations with New York Hospital began to fray significantly during Cooper’s time at Cornell. After extensive negotiations, a revised joint affiliation 159

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agreement was finally signed during his first year as dean, even though it “contradicts much of the sentiment of the original agreement” and “reflects a separatist philosophy.”77 The following year, Cooper felt that his status as dean had “considerably eroded” to the point where “I find it difficult to sustain a position of equal footing with the Director of The New York Hospital.”78 He attempted to improve the situation by setting up meetings with Cornell University president Frank H. T. Rhodes, hospital president Stanley Osborne, and hospital director David Thompson, who was also a 1946 graduate of CUMC. With Rhodes acting as facilitator, the group discussed how to jointly coordinate a variety of issues, including recruitment efforts for new clinical chiefs and department chairs, faculty tenure decisions, space needs and new renovation and building projects, the Third Century fund-raising program, and issues of hospital management.79 Although such efforts helped identify specific areas of concern, the growing rift between CUMC and New York Hospital reflected fundamental differences in outlook. In 1979 Cooper sent Frank H. T. Rhodes a document outlining major problems between CUMC and New York Hospital. From his perspective, New York Hospital’s priorities were geared toward “service-oriented, income-producing activities,” while Cornell’s were focused on education and research. This basic difference led to disagreements on what constituted the most desirable types of faculty member, hospital affiliation, and patient services. The two institutions were unable to develop compatible goals and objectives, had failed to compromise on fund-raising, and were not coordinating on joint budgeting and planning activities. In addition, Cooper felt that certain charges paid by CUMC to the hospital needed to be more equitable, and he pointed to a lack of trust and poor communication between the medical school and hospital leadership. He outlined five possible solutions, ranging from a total rebuilding of the medical school in another location at an estimated cost of $40 million, to CUMC’s complete dissolution and possible purchase by New York Hospital. In order for CUMC to continue at its current site and enter a period of renewal, he proposed that New York Hospital provide bridge financing to the medical college.80 Given the existing relationship between the institutions and the challenging financial environment, that course of action was unlikely to be taken. On June 5, 1979, New York Hospital decided to maintain a policy of separate management and “historic independence.” In principle, the institutions agreed to coordinate planning for the medical center whenever their interests overlapped, but as conflicts and disagreements continued to intensify, jointly undertaken efforts faded into the background.81 One example relating to real estate, seen from Cornell’s perspective, illustrates how easily lack of communication could perpetuate discord. In November 1978, the Cornell Board of Trustees put a group of buildings up for sale because of severe financial problems affecting the university, and the medical school in particular. The property, which included eight residential buildings 160

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and a loft building located on a square block bounded by First Avenue and York Avenue and Sixty-Eighth and Sixty-Ninth Streets, had been acquired in the 1950s and 1960s as possible sites for future expansion projects. Cornell planned to help any tenants who would end up losing their apartments find comparable housing.82 The nine buildings were advertised to brokers, along with an additional group of four buildings designated “Parcel C” that were not technically for sale but could be made available if a developer wished to use them as a relocation space for tenants of rent-controlled apartments. New York Hospital approached CUMC about the possibility of purchasing these four other buildings, but it was decided that the medical school would wait to see what bids came in for the nine main buildings first. A  real estate developer made the final offer to purchase all thirteen buildings for $3.185  million in cash, and the Cornell Board of Trustees approved the sale in January  1979. Before the closing, which was scheduled for July 31, the developer began trying to sell off some of the buildings. A representative from New York Hospital then approached the developer to purchase the four buildings from Parcel C, a deal was worked out, and approval from the Hospital Board of Governors was granted by the end of June. Dean Meikle happened to hear about the arrangement and was quite taken aback that New York Hospital had acquired the buildings without mentioning it to Cornell, even before they had technically been sold.83 New York City property records indicate that the deed for the four buildings was transferred from Cornell University to the Society of New York Hospital on August 8, 1979, and the buildings have been used since that time to house hospital staff.84 A few of the other buildings originally sold to the developer are still standing, while others were soon transferred to another developer, who opened the Kingsley, a 210-unit condominium, at a $20 million profit.85 Besides selling off real estate holdings, CUMC was forced to take additional measures in an attempt to balance its budget. In 1977, it suffered a $2 million deficit.86 The following summer, a hiring freeze was implemented, and cutbacks in expenses included, ironically, elimination of the financial planning office. Still, a withdrawal of $8.1 million in capital funds was necessary that year to cover operations and crucial improvements to the physical plant.87 A new affiliation with the Burke Rehabilitation Center in White Plains proved financially beneficial, with the Burke Relief Foundation providing $1.25  million to help pay off the debt on the medical college’s S building, now known as the Hamad bin Khalifa Biomedical Research Building, and additional money to fund two professorships.88 In 1978–79, austerity measures continued, with a reduction in the number of junior faculty and an 8 percent cut in basic science faculty.89 May 1979 saw the closing of the Cornell University–New York Hospital School of Nursing. The New York Times reported that the decision to close the school was based on a 1970 university planning review, which concluded that there were enough undergraduate nursing programs in the state and that 161

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Cornell should instead open a graduate-level nursing program in Ithaca. In a telephone conversation in 2015, Cornell University president Frank H. T. Rhodes recalled that the school had been evaluated by a distinguished committee consisting of representatives from the fields of nursing and public health, including Carolyne K. Davis, then dean of the University of Michigan School of Nursing. The committee made a unanimous recommendation to phase out the Cornell–New York Hospital program.90 A draft of a Cornell press release indicates that financial pressures were also a major contributing factor in the decision to close the school.91 At commencement that year, the last graduating class of 104 nurses presented President Rhodes with a T-shirt that read, “From distinction to extinction.”92 For Veronica Lyons Roehner, an associate dean at the nursing school, its closing was “a disappointment very nearly crushing,” and another nursing program was never subsequently established in Ithaca.93 In 1979, Cooper proclaimed grimly: “The future of the Medical College hangs in precarious balance: with luck and a venturesome attitude—restoration; with the present financial status—mediocrity, if even that. I  wish it could be otherwise.”94 Cooper estimated that in order to rebuild CUMC, $75.6  million was needed. He proposed that a board of overseers be created to provide management, governance, and fund-raising support. In his plan, the dean and the board would commit to raising an average of $7.5  million annually over the next ten years. A  development committee of the board would monitor fund-raising, a finance

Figure 7.4  Students from the Cornell University–New York Hospital School of Nursing, class of 1971. (Courtesy of Medical Center Archives of NewYork– Presbyterian / Weill Cornell.)

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committee would help plan and allocate resources, and an education and research committee would oversee the quality of the medical school’s academic programs. Eventually, representatives from all affiliated institutions would be included on CUMC’s board.95 Cooper left Cornell before a board of overseers was created in 1980. And in 1979, his penultimate year at the medical college, he became embroiled in a media controversy involving academic partnerships with industry. Under his leadership, CUMC participated in a continuing medical education program for physicians called “The Consequences of Stress: The Medical and Social Implications of Prescribing Tranquilizers.” The program was financed by Roche Laboratories, the makers of the tranquilizer Valium, at a time when the drug’s potential for abuse was becoming increasingly recognized. Promotional materials for the course were prepared by a third-party educational company, printed on Cornell stationery with Cooper’s signature, placed inside a red folder bearing a Cornell seal, and mailed to more than 100,000 physicians. Since the program was technically educational rather than promotional in nature, labeling information on the drug’s uses, risks, and dosages was not included. In a taped interview included as part of the course, Cooper mentioned Valium seven times, without referring to other similar drugs. He also participated in a televised symposium that was broadcast to twenty-six cities, including Houston, where Antonio Gotto happened to be in charge of the local educational event. The entire program cost Roche $6 million. Vocal critics included Dr.  Sidney Wolfe, who cofounded the Health Research Group with political activist Ralph Nader. The advertising investigator for the U.S. Food and Drug Administration (FDA) believed that Cornell had received contributions from Roche in exchange for participating in the program and was looking into revising the FDA’s federal labeling requirements. A syndicated newspaper columnist also published three articles criticizing Cornell for promoting Valium. Cooper publicly denied that the medical school had received any money, saying: “If I wanted to sell Valium, I’m perfectly free to do it, that is not illegal. . . . But believe me if I’m going to do that, I’ll take money for it, but it is not being promoted.”96 He did admit that he probably should not have mentioned Valium so many times by name in his recorded interview and explained that Cornell had agreed to participate in the program in order to increase the school’s visibility.97 The Cornell Daily Sun, an undergraduate newspaper, was Cooper’s harshest critic. One editorial called CUMC “a pawn in promoting what many doctors have called the most abused drug in the country.” It further speculated on the true reasons behind CUMC’s involvement in the project: “Cooper and the medical college have the responsibility not to prostitute the University this way. The medical college may be having financial difficulties, but that doesn’t permit Cornell to become a Bruce Jenner promoting Wheaties or a Karl Malden 163

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espousing the joys of American Express—especially when the product is as dangerous as Valium.”98 After Cooper announced that he was leaving Cornell to join the pharmaceutical company Upjohn, another editorial acknowledged that “his quiet and efficient manner . . . pulled the college through some extraordinarily hard times.” Still, it referred to the Valium controversy and sent Cooper off on a particularly acerbic note: “For some reason we suspect Cooper today is a happier man. No more fundraisers, no more cares about academic purity, no more big city noise, no more New York hustle, no more budget sessions with trustees. Now he works for the manufacturers of Kaopectate. So it goes.”99

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The Shah’s Visit

Cooper weathered yet another media storm in 1979, when the deposed Shah Mohammad Reza Pahlavi of Iran was treated at the New York Hospital–Cornell Medical Center. The shah had initially visited the hospital in 1949, and two years later a team flew to Tehran to perform a complicated appendectomy on him at President Harry Truman’s request. They also examined a possible tumor, but no cancer was discovered at that time. In 1974, the shah was diagnosed with Waldenström’s macroglobulinemia, a type of lymphoma, and was treated by two French doctors who traveled to Tehran to supervise his care. His condition was kept secret, and even his twin sister did not learn of his condition until years later. In 1979, the Ayatollah Ruhollah Khomeini mounted a revolution, and the shah was forced to flee the country. He traveled to Egypt, Morocco, and the Bahamas, where he was diagnosed with a new form of cancer called Richter’s syndrome. He eventually arrived in Mexico, jaundiced and ill, and was mistakenly diagnosed with malaria by local doctors. Dr. Benjamin Kean, then an emeritus professor of medicine at Cornell and a specialist in tropical medicine, flew to Mexico to examine him and realized that he was seriously unwell. An aide subsequently revealed to Kean that the shah had been fighting cancer for some time. On October 22, 1979, the shah was admitted to the United States on humanitarian grounds and was flown to New York covertly on a chartered plane. His close friends Henry Kissinger and Nelson Rockefeller helped him gain entry to the country, as well as facilitated his travel to other countries during his period of exile.100 Upon arriving at New York Hospital, the shah was admitted under the code name of David D. Newsom, who was then undersecretary of state for political affairs. His gallbladder and several gallstones were removed, and it was discovered that he had advanced cancer involving the lymph nodes. His physicians recommended that he stay in the hospital for about six weeks for further treatment, including removal of an additional gallstone that had escaped notice, and remain in New York for an extended period of time for intensive chemotherapy. The shah began secretly receiving radiation therapy at Memorial Sloan Kettering 164

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A Decade of Malaise

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Cancer Center and on ten occasions in the middle of the night was wheeled through a tunnel connecting that facility with the New York Hospital. The shah observed his sixtieth birthday on October 26 in a room costing $300 a day, located on the seventeenth floor of the Baker Pavilion. Newspapers reported that he was being treated at New York Hospital, and protests of up to seven hundred people began to form outside, demanding that he be returned to Iran to be tried for crimes allegedly committed during his reign. Stringent security measures were instituted at the medical center, and personal guards and plainclothes New York City police officers bearing automatic weapons protected him at all times. On one occasion, a plane towed a banner reading “Long Live the Shah” up and down the East River. On another, a man waving a long sword entered the medical school library and threatened to kill several employees unless the shah was turned over to the Ayatollah Khomeini. Fortunately, the man was immediately arrested, and no one was injured. However, on November 4, a group of Iranian revolutionary guards angered by U.S. support of the shah took control of the U.S. embassy in Tehran and began holding American diplomats and citizens hostage. In hopes of defusing the Iranian hostage crisis, the shah expressed a willingness to leave the United States after his medical treatment had been completed.

Figure 7.5  Protest against the shah of Iran, October 1979, outside the medical center. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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After a six-week stay at the New York Hospital, the shah flew on an air force jet to Lackland Air Force Base near San Antonio, Texas, for a period of recuperation. He left the hospital at 4 a.m. on December 3 in a van adorned with psychedelic decorations and accompanied by a motorcade of FBI agents bearing shotguns. Soon thereafter, he traveled to Panama because he did not feel completely welcome in the United States. Dr. Benjamin Kean knew that the shah needed a splenectomy and asked three American surgeons to perform the operation before the fourth, Michael DeBakey, finally accepted. Dr. DeBakey, primarily a cardiovascular surgeon who worked closely with Antonio Gotto in Houston, traveled to Panama with Kean, where they were turned away by security guards. DeBakey offered to withdraw from the situation, but he ended up removing the shah’s spleen, which had grown to ten times its normal size, in Egypt on March 28, 1980. He headed a medical team that included Hibbard Williams, chair of internal medicine at Cornell; one of the shah’s French physicians; and three Egyptian doctors. During the surgery, which DeBakey had anticipated would be “kind of ticklish technically,” it was found that the shah’s cancer had spread to his spleen and liver.101 He died on July 27, 1980, of complications from cancer. Subsequently, Eamon Brennan resigned as vice president for public affairs of the New York Hospital–Cornell Medical Center because he believed that the public should have been more fully informed about the shah’s medical situation, which would have justified his admission to the United States. He also felt that the hospital should have conducted regular briefings with the U.S. State Department on the shah’s health.102 After his three tumultuous years in New York, Cooper transitioned from academia to industry. In his last annual report to the president of Cornell University, he referred to some promising recent developments. Although a deficit of $2.8 million had been anticipated for the 1980 fiscal year, proactive budget measures had produced a surplus of $71,000. Federal funding for research had increased by $2.7 million, and other improvements in grant applications suggested that the faculty were again engaging in high-quality research. The percentage of female professors at the medical school exceeded the national average, although the number of faculty members from groups historically underrepresented in medicine trailed slightly behind the average. However, in attempting to focus on the upside, Cooper inadvertently drew attention to just how bad things had become: “I am aware that there have been perceptions of deficiencies or worse. We should put that anxiety behind and look at the positive side of things. After all, we have no labor relations problems; no sex discrimination or harassment complaints; only a couple of human rights complaints, which have been dismissed at the initial level; and . . . it has not been necessary for the University to ‘bail out’ the Medical College.”103 On that note, one turbulent decade ended, and another began.

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8 Discord and Disrepair Ultimately, the medical school is like the child of fighting, divorced parents, each of whom is bigger and more powerful than the medical school itself, and each of whom doesn’t want to get stuck with paying the bills that they feel the other should rightly pay. When resources are tight, that leads to problems.

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Robert Michels, interview, September 11, 2013

Public views toward the country’s increasingly costly health care system shifted from vague distrust in the 1970s to overt backlash in the 1980s. The enactment of Medicare and Medicaid in 1965 had greatly expanded access to health care, generating unexpected new sources of revenue for academic medical centers. Medicare was particularly liberal in reimbursing hospitals for their care of elderly individuals and for capital costs, and the clinical practices of academic faculty thrived. By 1980, the number of hospital admissions had increased by about 50  percent, and clinical revenues had surpassed federal research funding as the major source of income at many medical schools. Then the situation changed. The federal government and private insurers began setting limits on the amount of money they were willing to pay for medical care. Under legislation enacted in 1983, hospitals began receiving a set fee for Medicare patients based on their diagnoses, regardless of how much it actually cost to treat them. This measure forced nonprofit hospitals to maximize efficiency, lower the costs of care, and increase patient volume in order to maintain financial equilibrium. In addition, under the old system, hospitals generally received Medicare reimbursements as an annual lump sum, based on their total expenses over the course of the year. Many were not accustomed to tracking exactly how much was spent on categories such as direct patient care, staffing, supplies, daily operations, administration, and medical education. When the new “prospective payment” system went into effect, some hospitals, including New York Hospital, simply did not know how much it cost to perform specific

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CHAPTER 8

services and procedures. To ensure that expenses and reimbursements would align, they were forced to develop rigorous financial and accounting structures within a short period of time.1 Another challenging development was the rise of managed care. Under this system, third-party payers, such as employer-sponsored health insurance plans, demanded lower prices for medical services from health care providers, and they attempted to reduce medical costs by limiting the number of hospitalizations and the use of specialists by member patients. Health maintenance organizations (HMOs) were the most popular and most stringent form of managed care, in comparison to more flexible preferred provider organizations (PPOs) and fee-for-service plans. Managed care dealt a harsh blow to teaching hospitals, where medical services were generally 30 percent higher than at community hospitals. This disparity was due to costs associated with educating medical students and residents, conducting biomedical and clinical research, offering charity care, and treating the sickest patients in the area. Managed care organizations became less willing to cover extended stays and higher costs at expensive teaching hospitals, which were hard pressed to compete with community hospitals and their lower prices. The educational and research activities at university medical schools, which had previously been subsidized by the clinical income of teaching hospitals and their academic faculty, sometimes suffered as a result. Around the country, academic medical centers adopted a variety of strategies to boost revenue and protect themselves financially. Beginning in the 1980s and continuing through the 1990s, they worked on expanding their patient bases, launched new entrepreneurial activities and alliances with the health care industries, and forged relationships with other institutions through mergers, acquisitions, and affiliations.2 These trends in the world of health care threatened New York Hospital, CUMC, and, by extension, Cornell University. The hospital and medical school were financially intertwined, while any serious difficulties on the part of CUMC would impinge on the well-being of its parent university. As the New York Hospital–Cornell Medical Center struggled to weather the challenges of changing reimbursement patterns and managed care throughout the 1980s, relations between the hospital and medical school continued to deteriorate. Although both institutions were involved in patient care, medical education, and research, they had different priorities and goals. CUMC’s primary focus was academic, whereas the hospital’s was directed externally, toward attracting patients. Perhaps it was only to be expected that tensions between the two would proliferate as financial pressures mounted and CUMC attempted to rebuild itself after the stresses of the 1970s. On top of this, beginning in 1984 the hospital would face a string of highly publicized patient deaths.

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Dr. Thomas H. Meikle Jr., CUMC’s tenth dean, faced a number of clearly defined challenges. In addition to the increasingly troubled relationship with New York Hospital, questions regarding the quality of the medical school’s research and teaching programs persisted into the 1980s. Cornell lagged behind other New York medical schools, including Columbia, the Albert Einstein College of Medicine, and New York University, in terms of the amount of research funding its faculty received from the federal government. Nationally, its ranking had fallen to twenty-sixth out of sixty-eight research-oriented medical schools when considering the overall success of its grant applications to the National Institutes of Health. Student performance on medical licensing tests offered by the National Board of Medical Examiners continued to decline, while the student health, housing, grading, and insurance systems were proving inadequate and disorganized.3

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Thomas H. Meikle Jr. Born in Troy, Pennsylvania, a small town near the border with New York, Thomas H. Meikle Jr. graduated from Cornell University in 1951 and from CUMC three years later. He received a Markle Scholarship in Academic Medicine, which provided support to young investigators, and worked as a scientist for the Health Research Council of the City of New York. In 1961, he joined CUMC as an instructor in anatomy, rising to associate professor in anatomy and of neuroanatomy in psychiatry within five years. In 1970 he became a member of the executive faculty and associate dean under J. Robert Buchanan, was acting dean from 1976 to 1977, and in 1978 was appointed deputy dean to Theodore Cooper. A basic science researcher, Meikle focused his studies during the 1960s and 1970s on visual discrimination and processing in cats. In 1979, he left CUMC to join the Josiah Macy Jr. Foundation, an institution dedicated to improving medical education, as vice president and program officer. A year later, Meikle returned to CUMC when he was appointed dean and professor of anatomy on September 1, 1980. Contemporaries remember him as a very approachable and engaged dean. Robert Michels, CUMC’s dean during the early 1990s, described him as “devoted to medical student teaching.”4 According to David Hajjar, who first joined CUMC as a postdoctoral fellow in 1977, deans started to mingle more with faculty and students starting with Meikle. Instead of “an esoteric guy hidden behind the curtain,” the deans of the 1980s and 1990s enjoyed interacting with the medical school community and

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Figure 8.1  Thomas Meikle Jr., MD. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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became “more a dean of the people.” In his opinion, Meikle “really did more for that period of time than a lot of his predecessors.”5 After seven years working to revitalize CUMC, Meikle returned to the Macy Foundation in 1987, serving as its president until 1996. He passed away from cancer on July 20, 1997, at the age of sixty-eight. He was survived by his wife, Dr. Jacqueline Winterkorn, a longtime professor of ophthalmology at CUMC and a 1983 alumna, and their two daughters. He also had two children from a previous marriage. 6

Financially, the medical college succeeded in turning estimated annual deficits of $2 million to $3 million between 1979 and 1981 into modest surpluses of $100,000. Although fiscal affairs were “in better order than at any time during the past 8–10 years,” this degree of stability was obtained only by cutting funding to academic departments and continuing to defer maintenance of the school’s aging facilities, which were badly in need of renovation.7 Any further reductions in department funding were impossible without interfering with daily operations and seriously impairing morale. Increasing tuition was not a sustainable option, since Cornell already had among the highest fees in the Ivy League, and the median debt among graduates at private medical schools was 170

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Discord and Disrepair

soaring from about $20,000 to nearly $60,000 over the course of the 1980s.8 At the same time, the medical center faced escalating operating costs, inflation, and challenges obtaining payments from third-party insurers.9 According to David Thompson, director of the New York Hospital, the “only viable solution [was] a crash campaign to raise funds.”10 As closely intertwined as they were, the hospital and the medical school would not be able to maintain their individual reputations if the financial stability of the other were threatened. Various possibilities to strengthen CUMC and chart its future course were considered at the beginning of the decade. One strategy that was implemented and remains in existence was the establishment of a CUMC Board of Overseers in 1980. Its official role was to oversee policy making for the medical college, which had previously been the province of the Cornell University Board of Trustees. Initially, though, the trustees did not delegate any specific authority to the board of overseers, which prevented it from becoming an effective instrument of governance. Unofficially, CUMC’s board, by enlisting its own cohort of prominent New Yorkers, was intended to serve as a counterweight to the socially prestigious and powerful New York Hospital Board of Governors.11 It also provided a useful forum for discussing the medical school’s problems, which helped contribute to a renewed positive outlook for the future. Members were appointed from Cornell’s trustees and the general public, and the inaugural twenty-member board contained Dean Meikle, Cornell University president Frank H. T. Rhodes, and Jansen Noyes Jr., the chairman of Cornell’s trustees, as ex officio members. Stephen H. Weiss, an investment banker and 1957 graduate of Cornell University, served for two years as the overseers’ first chairman, insisting throughout that the “status quo is unacceptable.”12 Philanthropists Laurance Rockefeller and Brooke Astor also counted among the board’s inaugural members.13 In May 1985, after functioning for five years without any real authority, the CUMC Board of Overseers was granted specific governance responsibilities. The Cornell trustees empowered the overseers to approve budgets and institutional affiliations and to oversee plans for academic programs, facilities, and financial affairs, subject to ratification by the trustees. To satisfy the New York State Board of Regents, the trustees retained ultimate legal responsibility for both the university and the medical school, and they could amend or revoke the actions of the overseers if necessary. Final decisions regarding faculty tenure, student degrees, and finances lay with the trustees, but the strengthening of the board of overseers enabled the medical school to tap into the expertise of business and philanthropic leaders in New York City and beyond.14 Five overseer committees were initially set up—a steering committee and committees for budget and finance, academic affairs, membership and nominating, and development. After a few years, this number was reduced to three when the budget and finance committee was merged with the steering committee, and the academic affairs committee was eliminated.15 171

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Another option for reconstituting the medical school was to integrate CUMC and New York Hospital under a single management and a newly empowered joint board that would have greater authority for governance, particularly regarding the allocation of resources. That strategy soon proved untenable, since members of the New York Hospital Board of Governors adamantly opposed reorganization of the medical center.16 Nevertheless, CUMC proposed a memorandum of understanding in 1983 that would have pooled some of the assets of the two institutions, strengthened the joint board, and appointed an executive with responsibility for unified management. A counterproposal by the New York Hospital was presented in January 1984, which “rejected the concept of an integrated medical center with unified governance and management and instead supported a modest reorganization to improve coordination and cooperation.”17 Although Meikle and Cornell leadership were disappointed by this response, they continued discussions. In September of that year, a committee of CUMC overseers and New York Hospital governors successfully developed a memorandum of understanding, which would have created a new board for the medical center and appointed an executive to coordinate it. However, the proposal was not subsequently added to the agenda of the joint board or any other boards or committees, and no major organizational changes for the medical center were implemented.18 Although repairing relations with New York Hospital was Meikle’s top priority upon becoming dean, the two institutions often pursued divergent goals without opening lines of communication. For example, the hospital’s management unilaterally decided to terminate its existing program of ambulatory care, which included outpatient services and emergency department visits not requiring admission, and transfer the responsibility of caring for this largely indigent patient population to the medical college’s full-time faculty. This move effectively forced the medical college to absorb the financial losses associated with outpatient care that had previously been borne by the hospital. Meikle believed that the hospital’s actions may have been motivated by its desire to obtain state approval for a new building dedicated to ambulatory care, which would enable it to attract a more affluent set of patients. The hospital indeed began construction in 1981 of the nine-story C. V. Starr Pavilion for Ambulatory Care, Diagnosis and Treatment. Located over East Seventieth Street between York Avenue and the East River Drive, it was funded by an initial grant of $120 million from the Starr Foundation and a bond sale by the New York State Dormitory Authority.19 New York Hospital and CUMC also disagreed on a variety of administrative matters. By 1980, for example, the Rogosin Kidney Center and the Cardiovascular/Hypertension Center had both developed apart from the administrative structure of the department of medicine and basically functioned as independent entities. Directors of the centers addressed issues of 172

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space, funding, and personnel themselves, often without consulting the chair of medicine, and their faculty enjoyed higher compensation than other units. In trying to recruit a new chair for the department of medicine, CUMC discovered that candidates were unwilling to consider the position until these centers were brought under administrative control. The medical college recommended incorporating the centers within the department of medicine and establishing a new policy that would place future centers squarely within the administration of academic departments. In contrast, the hospital felt that the existing organization of the centers was satisfactory and recommended involving department chairs more fully in decision making, an approach that had not proved successful in the past.20 These kinds of nuanced differences in perspective were never resolved systematically, and as a result interfered with issues that affected the medical center as a whole, such as faculty recruitment and long-term planning. In addition to consolidating the administration of the hospital and medical school, another option that was being considered by Dean Meikle and Cornell president Rhodes was a possible merger of the medical schools of Cornell and Columbia to form a new institution that would be quasi-independent of both universities. This scenario could potentially resolve the threat that CUMC’s financial difficulties posed to Cornell University, and it was envisioned that the combined institution “could realistically become the premier academic medical school in the United States.” According to preliminary plans, the Columbia University College of Physicians and Surgeons would be responsible for teaching and research in the basic sciences, one of its areas of strength. Cornell’s basic science faculty would be relocated to a new building to be constructed within Columbia’s medical school complex in upper Manhattan, while clinical courses would be taught at both New York Hospital and at Columbia’s affiliate, Presbyterian Hospital. A potential name under consideration was the College of Physicians and Surgeons of Columbia and Cornell Universities. The deans of both medical schools recommended a merger in the summer of 1982, but the presidents of the two universities were unable to decide on a mutually acceptable mode of governance for the new institution. Concerns were also raised regarding the merger of endowments and the payment of faculty salaries. Although Cornell and Columbia faculty members who were aware of the proposal were in favor of it, merger discussions were terminated in the winter of 1983.21 An additional strategy for fortifying the New York Hospital–Cornell Medical Center was the initiation of a two-year, long-term planning project. Headed by hospital director David Thompson starting in September 1980, the project was supported by a $500,000 grant from the Andrew W. Mellon Foundation, and a new associate dean for long-range planning was recruited to help implement the process at Cornell. Meikle was highly enthusiastic about the 173

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CHAPTER 8

initiative, which had been one of his major objectives upon becoming dean: “When we react to immediate problems without a long-range plan, we increase the chance for error and faulty decisions.”22 A steering committee of department chairs was given the responsibility of eliciting individual plans for each academic department, in addition to more general institutional plans. An external advisory group of administrators and educators was also tasked with preparing its own plans plus critiques of the Cornell plans. 23 To achieve these goals, the steering committee launched seven task forces, involving a total of 125 faculty members, to assess the medical center’s affiliations, clinical services, education, fiscal situation, manpower, mission and goals, and research. Two retreats were held for department chairs, and consultants were hired to perform studies.24 During the 1982–83 academic year, various components of the long-range plan were presented to the joint board of the medical center. Its major findings were posed as a choice between two alternatives: either $450 million could be infused into the medical center over the next ten years to enable it to achieve a goal of eminence, or $70 million could be allocated to different programs and building projects during the next five to eight years to allow it to retain its current competitive status. 25 The medical center’s Third Century Campaign, announced in 1976, was concluded on June  30, 1981, after raising a modest $92  million, just over one-third of its original target. 26 A  year later, New York Hospital–Cornell announced an ambitious $300 million campaign that, if successful, would set it well on its way to reaching its long-term goal of eminence. For the first time, the medical center enlisted professional fund-raisers, and the joint development office for the medical center was expanded to include a staff of twenty-six. Cochaired by New York Hospital governor Eleanor Elliot and Jansen Noyes Jr., chairman of the Cornell Board of Trustees, the campaign was implemented in two stages, with the first phase targeting $125  million. Of that amount, $23 million was reserved for the medical center’s endowment, $42 million for improving its facilities, and $10  million toward recruiting and supporting junior faculty. A large proportion of the funds allocated for CUMC would be used to rebuild its basic science departments. 27 Gifts began to pour in. John Hay “Jock” Whitney, the son of Payne Whitney, whose generosity had made possible the construction of the medical center in 1932, left $15 million to New York Hospital–Cornell in his will. During his lifetime, he had contributed an additional $6 million, while his sister Joan Whitney Payson gave $8.3 million to the medical center.28 The first overseer chair, Stephen Weiss, and his wife, Suzanne, gave $1.5 million to endow the deanship of the medical school, and Meikle assumed the title of Stephen and Suzanne Weiss Dean. In December 1982, the annual fund-raising event “Cabaret” was held for the first time, with proceeds split between CUMC and New York Hospital. Cochaired that year by overseer Brooke Astor and banker 174

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Walter Wriston, the gala was underwritten by an anonymous donor for $150,000. It featured performances by singer and actress Kitty Carlisle Hart, the Cornell Medical College Chorus clad in operating room greens and joined by Brooke Astor, the Cornell University Glee Club, tap dancer Charles “Honi” Coles and the Copasetics, and a trampoline act and jugglers from the Big Apple Circus. A “longtime observer of the social scene” described the “star-studded” event as “the real cream—what the Met used to be when it was ‘it.’ ”29 With thirteen hundred guests in attendance, the first Cabaret raised more than $1 million, and the annual gala remains one of the most popular and successful for the medical center and its supporters. In 1983, CUMC received an anonymous $50 million gift, one of the largest single donations to an educational institution at the time. It was expected to generate a minimum of $3  million annually in income, and approximately $1  million for the next several years was reserved for revising the medical school curriculum, recruiting junior scientists, and funding student scholarships. The anonymous gift, which was later revealed to come from the philanthropist Ruth Uris, also assisted in the recruitment of senior scientists in areas needing development, such as genetics, and it supported a series of annual conferences on health policy. It proved enormously helpful in relieving many of the financial problems that had begun to plague CUMC in the 1970s. According to Meikle, it was “the single most significant event” for the medical college since the opening of the New York Hospital–Cornell Medical Center in 1932, and it “allows us to leap five years forward in our 10-year timetable of maintaining our position as a leading medical institution.”30 Another important source of philanthropy was the DeWitt Wallace Fund in the New York Community Trust, which was set up in 1984 by the founders of Reader’s Digest to support psychiatric research and training. The psychiatrist Robert Michels, who became CUMC’s dean in the early 1990s, was instrumental in developing this relationship. Over two decades, the Wallace Fund provided more than $40  million in contributions to the medical center’s psychiatry department, culminating with an additional grant of nearly $70 million in 2007.31 Backed by such generosity, the first $125  million phase of the campaign was completed in 1984, some eighteen months ahead of schedule. The second phase, which aimed to raise $175 million over four years, began in July 1984. Fund-raising focused on $30 million to construct a research building for Cornell, to be located in a courtyard along York Avenue between Sixty-Eighth and Sixty-Ninth Streets, in between the medical school’s D and E buildings. However, in the process of planning for the facility, Cornell made a startling discovery: “A  title search to verify University ownership of the south courtyard astonishingly disclosed that title is held by the New York Hospital to all land and buildings occupied by the Medical College between 68th and 70th Streets, east of York Avenue, despite documented payments by Cornell 175

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CHAPTER 8

for all property it occupies. Although Cornell possesses 99 year leases to the Harkness, Wood and Griffis Faculty Club buildings, the University lacks any documented property rights to the original Medical College buildings.” Immediately, the CUMC Board of Overseers directed that no further commitments to construct the research building be made “until the New York Hospital agrees to grant the University satisfactory property rights to the proposed new research building and to negotiate an acceptable agreement regarding the University’s rights to the other property traditionally occupied by the Medical College.”32 Cornell was forced to delay accepting a $7.5 million gift from William S. and Mildred Lasdon for the proposed building, but after a year, the donation was publicly announced in April 1985. William Lasdon, a former overseer and vice chairman of the Warner-Lambert Company who had passed away the previous December, was the brother of the namesake of the Jacob S. Lasdon House, the student residence constructed in 1974. Although no resolution to the underlying issue of property rights had yet been reached, the medical school resumed planning for a William and Mildred Lasdon Biomedical Research Center, to consist of a new ten-story building plus expansion of two existing buildings.33 In 1984, it signed a ninety-nine-year lease with New York Hospital for the land in the courtyard, with the stipulation that it could still pursue its claim against the hospital. 34 The problem of who owned the rights to the land and original buildings occupied by the medical school would go on to fuel a bitter dispute between Cornell and the New York Hospital later in the decade and on into the 1990s. J. Robert Buchanan, CUMC’s dean from 1969 to 1976, recalls that Meikle asked him for advice about the situation, which he was unable to provide: “I said, ‘Tom, I don’t know that I can give you any help, because I never had any disagreement with them.’ ”35 Despite worsening tensions between the leadership and boards of the two institutions, there was little option but to move on as normal with daily operations at the medical center. Joint fund-raising efforts continued, and the second phase of the $300 million campaign for the medical center was successfully completed at the end of 1987. Funds were used as planned to build up the endowment, renovate and construct new research and patient care facilities, and support various programs.36 Rebuilding the Medical School

One of Meikle’s major goals upon becoming dean was to expand relationships with Rockefeller University and Memorial Sloan Kettering Cancer Center, in order to amplify Cornell’s research and teaching efforts in the basic sciences. Initially, he met with some resistance from the heads of Rockefeller and Memorial, who felt that the “continuing weakness of Cornell’s science programs” 176

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was not their responsibility and “indicated they were unable to offer assistance through jointly developing programs.”37 Still, Meikle persisted and succeeded in building mutually beneficial relationships among the three neighboring institutions. Under Meikle’s leadership, the joint MD-PhD program between CUMC and Rockefeller, initiated in 1972, began admitting more students. In 1981, the faculty at the Sloan Kettering Institute, the research arm of Memorial Sloan Kettering, agreed to offer a parallel MD-PhD program of its own with CUMC. Two years later, Cornell set up its own independent MD-PhD program that integrated CUMC’s medical curriculum with the research training of the Cornell Graduate School of Medical Sciences. In 1987, the Cornell Graduate School, which had originally been set up in 1952 as a joint program run in collaboration with the Sloan Kettering Institute, was reorganized, and the graduate faculty from both institutions were unified. The restructuring allowed the graduate school to offer students expanded choices in coursework and laboratory research experiences while enrolling in one of seven interdepartmental doctorate programs, including biochemistry and structural biology; cell biology and genetics; immunology; molecular biology; neurobiology and behavior; pharmacology; and physiology, biophysics, and systems biology. At the same time, Cornell’s independent MD-PhD program was merged with the joint MD-PhD program run with the Sloan Kettering Institute. A year later, reviewers of grant applications at the National Institutes of Health recommended that Cornell’s two parallel MD-PhD programs with Rockefeller and Sloan Kettering be combined, and in 1989 the Andrew W. Mellon Foundation provided funding to support graduate students in a consolidated Tri-Institutional program. By 1991, students were able to apply for admission to a fully merged program, and a letter of agreement to establish a Tri-Institutional MD-PhD program was signed by Cornell, Rockefeller, and Sloan Kettering in September of that year. As a result of this agreement, graduating students in the program were able to receive an MD degree from CUMC and a PhD from Cornell’s Graduate School of Medical Sciences, Rockefeller University, or the Sloan Kettering Graduate School. In 1992, the Tri-Institutional program brought together a total of 396 research faculty from more than two hundred laboratories and enrolled seventy-four students, with plans to admit fifteen new students per year. 38 The situation for medical students at CUMC was mixed during the 1980s. Faculty members complained about the absenteeism, poor laboratory preparation, and “general lack of seriousness” of the entering class of 1981, which they felt was the poorest academically in recent years.39 Still, Cornell maintained a high reputation. In 1982, Meikle could boast that Cornell was second only to Harvard in the number of medical school deans it had produced in the past thirty years.40 Accepted students flocked to Cornell, even as tuition for the 1983–84 academic year reached $12,650, one of the highest among peer private 177

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CHAPTER 8

medical schools. Only four institutions had higher percentages of students who chose to enroll after being offered admission: Harvard, the University of California at San Francisco, Johns Hopkins, and Stanford.41 Another plus for Cornell was its high level of minority student enrollment, which was often well above the levels of other medical schools in New York State and around the country.42 To address the issue of students’ lackluster performance on medical licensing tests, the faculty initiated a three-year comprehensive review of the curriculum, the first in twelve years, beginning in January 1982. A proposal for a new curriculum was approved in September  1984 and implemented the following year. The curriculum’s principal objectives were to foster more independent study and research, better integrate preclinical and clinical instruction, and incorporate more diverse clinical settings in the fourth year. A variety of courses were introduced, including a journal club in the first year; ethics, pathophysiology, and an introduction to clinical medicine in the second year; and new clerkships in the third and fourth years.43 In one of the first programs of its kind nationally, students between their first and second years were able to participate in a six-week summer program in gerontology. Working with social service agencies, students visited elderly individuals in their homes and assisted with a variety of tasks, including helping with health insurance paperwork, paying bills, running errands, and arranging for medical and dental visits. Coordinated by the department of public health, the program afforded students the opportunity to form relationships with older people outside of a purely medical context.44 Despite a successful affirmative action program for students, minority faculty members at Cornell remained scarce. During the 1984–85 academic year, there were only seven African American and one Hispanic faculty members. Greater progress was made in terms of gender, with women constituting 37 percent of the student body and 24 percent of the faculty, including 15 percent of full professors, 29 percent of associate professors, and 26 percent of assistant professors. Still, inequities persisted, and women earned 88 percent of what men did in the basic sciences and 82 percent in clinical departments.45 In 1980, Dr. Maria New, a pediatric endocrinologist who had been a professor at CUMC since 1971, became the first woman to chair an academic department at the medical school and the first woman appointed head of a pediatrics department in New York. Two years later, she identified a genetic mutation linked to nonclassical congenital adrenal hyperplasia, a condition characterized by excess production of androgen in females and at the time believed to be the most common genetic disorder yet discovered.46 To support the growing number of female faculty and students, an Office of Women in Medicine was founded in 1980 by Dr. Lila A. Wallis, a pioneering women’s health advocate and then clinical associate professor of medicine at Cornell. The previous year, Wallis had created a teaching associates 178

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program that trained non-MD graduate students to become patient substitutes and advisers to medical students, who then learned how to perform pelvic and breast exams painlessly and with sensitivity. The role of the Office of Women in Medicine was to focus attention on the needs of women, provide data about women in the medical center, serve as a liaison between the administration and various women’s groups, and cosponsor conferences and meetings.47 Throughout the 1980s, faculty at Cornell made valuable contributions to clinical care and research, although their ability to attract federal research funding did not see dramatic improvements. In 1981, the country’s first Institute of Chronobiology was established at New York Hospital–Cornell’s Westchester division to provide diagnosis and treatment for sleep-wake disorders and to conduct research in chronobiology, or the study of internal biological clocks. One study that was reported in the New York Times and financed by the National Aeronautics and Space Administration simulated jet lag and was intended to reduce its effects on commercial pilots. Study participants volunteered to live in windowless, “time-isolation” apartments without televisions, radios, or telephones for two fifteen-day periods. Technicians delivering meals interacted with the volunteers, who were monitored for variables such as body temperature and brain sleep activity and asked to perform tests of mental function and manual dexterity. Halfway through the experiment, the schedules of participants were suddenly altered by six hours, as if they had flown to Europe, and researchers determined that it took several days for the body’s circadian rhythms to adjust. Initially, organizers had difficulty recruiting college-educated male participants between the ages of thirty-five and sixty, who represented the main demographic for commercial pilots, until they found that the isolation of the study was highly conducive to the work habits of people employed as freelance writers.48 In 1982, CUMC alumnus and professor of medicine Dr. Jean William Pape, along with other health professionals in Haiti, founded the Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO) in Port-au-Prince to investigate the disease later known as AIDS. Pape and colleagues were the first to document cases of AIDS in Haiti, and the GHESKIO program would go on to become the largest provider of HIV/AIDS and tuberculosis services in the Caribbean and a major center for epidemiologic and clinical research in a resource-poor setting.49 In the United States, New York Hospital–Cornell Medical Center was certified as an AIDS care center in 1988 by the State Health Department, and a decade later it was treating about one thousand patients with HIV/AIDS. In 1997, the medical center participated in one of the first collaborations of its kind when it opened the Chelsea Center for Special Studies at the AIDS social service agency Gay Men’s Health Crisis. The new center offered medical treatment as well as financial and legal help, counseling, and support groups for an additional one thousand patients.50 179

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Other notable milestones included the opening of the Center for Male Reproductive Medicine and Microsurgery, founded in 1982 by Dr.  Marc Goldstein as the first university center in the United States devoted to treatment of and research on male infertility. In 1983, the medical center was the first in the New York metropolitan area to acquire a magnetic resonance imaging (MRI) machine. While hospitals in Ohio and California also had MRIs, the machines had not yet been granted final approval by the U.S. Food and Drug Administration, so New York Hospital–Cornell planned to temporarily offer their use to patients free of charge. At a cost of $1.5 million, the MRI was described as looking “like a giant washing machine.”51 In addition, the Center for Reproductive Medicine and Infertility was established in 1988 with Dr.  Zev Rosenwaks as its director. In 1992, it reported the first successful pregnancy after embryo biopsy, in which embryos developed through in vitro fertilization are screened for genetic disorders before being transferred to the uterus, and three years later it started the first egg donation program in the United States. Prior to Rosenwaks’s arrival, thirteen babies had been born through in vitro fertilization at Cornell; under his leadership, that number surpassed twenty thousand in 2014.52

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Patient Deaths at New York Hospital

During the mid-1980s, the medical center was rocked by a series of highly publicized patient deaths at New York Hospital that thrust it into the limelight. The first involved Libby Zion, an eighteen-year-old college student who arrived at the emergency room on March 4, 1984, with an earache and a fever of 103.5 degrees. She was admitted to the hospital at 1 a.m. by Dr. Maurice Leonard and examined by Dr.  Gregg Stone, both second-year residents. Dr.  Luise Weinstein, a first-year intern who was caring for more than forty other patients that night, arrived and consulted with Dr. Stone. Both had been on duty for about seventeen hours. They ordered tests to try to determine the cause of Zion’s illness, before Dr. Stone left to go to sleep. For the next several hours, nurses warned that the patient’s condition was worsening and that she was thrashing around in bed, although no physicians saw her during this time. By telephone, Dr. Weinstein ordered that Zion be given the pain reliever and sedative Demerol and that she be physically restrained, since she was pulling out her intravenous tubes. Zion had previously advised that she was taking the antidepressant Nardil. Although Dr. Weinstein had looked up the medication in a reference book, she did not note that the combination of Demerol and Nardil could raise serotonin levels in the blood to a dangerously high, and potentially fatal, degree. Zion’s temperature was taken at 6:40 a.m. and found to be nearly 108 degrees. She then suffered a cardiac arrest and was pronounced dead at 7:30 a.m.53 180

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Libby’s father, Sidney Zion, a lawyer and former reporter for the New York Times and the New York Post, filed a civil suit in 1985. In it, he charged New York Hospital, Dr. Leonard, Dr. Stone, Dr. Weinstein, and Dr. Raymond Sherman, the Zions’ family doctor who had advised that Libby be taken to the hospital, with negligence. In January 1987, a Manhattan grand jury issued a report determining that “woefully” inadequate care and a series of mistakes made by unsupervised interns and residents had resulted in Libby Zion’s death. The report stated that diagnostic tests should have been performed upon admission and the patient should have been sent to an intensive care unit instead of a patient room. In addition, she received a lethal combination of drugs after being prescribed Demerol, and a doctor’s written order should have been provided before using physical restraints. Furthermore, the report called on the New York State Department of Health to issue regulations for greater supervision of interns and residents, who typically provided much of the care at teaching hospitals. According to the Manhattan district attorney Robert Morgenthau, the grand jury felt there was insufficient evidence to base an indictment on criminal charges. The New York Hospital was fined $13,000 by the State Health Department, although two days later it disputed the allegations of inadequate care, claiming that it was uncertain whether any particular course of treatment could have averted Zion’s eventual death. The hospital additionally suggested that an autopsy had identified traces of cocaine that could have been the cause of cardiac arrest, although the autopsy report itself was inconclusive regarding the presence of cocaine. In March 1987, New York Hospital reversed its position and admitted that it had failed to provide adequate care. It agreed to penalties that were imposed for the first time on a major medical center, including a requirement to submit monthly reports to state health authorities on the quality of medical care and an explanation of all patient deaths occurring within twenty-four hours of admission. The hospital also agreed to conduct a complete review of the credentials of its entire medical staff, including interns and residents. The state health commissioner, Dr. David Axelrod, subsequently formed a committee to evaluate the training and supervisions of doctors, which was headed by Dr.  Bertrand Bell, a professor of medicine at the Albert Einstein College of Medicine. On July 1, 1989, new regulations from the Bell Commission went into effect in New York State and limited the amount of time that interns and residents could work. Having previously tackled thirty-six-hour shifts and one-hundred-hour weeks on a routine basis, they were now limited to twenty-four-hour shifts and eighty-hour workweeks, with at least eight free hours between shifts and one full day off each week. Emergency room doctors were permitted to work only twelve hours at a time, and the state agreed to pay the cost of hiring more workers to make up for the shorter shifts. Libby 181

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Zion’s father Sidney was quoted as saying, “At least Libby didn’t die in vain. I  don’t sleep any better, but at least something was done.”54 In 2003, the Accreditation Council for Graduate Medical Education adopted similar regulations for all medical training institutions nationwide with the goal of ensuring that residents were adequately rested, supervised, and capable of providing suitable care. Although some medical educators doubted that the new regulations would have a positive effect on resident training, medical historian Kenneth Ludmerer interpreted them as reflecting a shift in attitudes toward health care: “In an age of consumerism, the public demanded more evidence that the house officers caring for them were rested and supervised—even if that mean tilting the delicate balance in graduate education away from the educational needs of learners and towards the needs of patients who did not wish doctors to learn at their expense.”55 The issue of sleep deprivation and resident work hours continues to be hotly debated in the medical community. 56 In November 1994, more than ten years after Libby Zion’s death, the case of Zion v. New York Hospital went to trial. Her alleged cocaine use figured prominently in the proceedings, which were broadcast on Court TV. After three months of testimony, the jury found that Zion was partly at fault because she had not told her doctors about using cocaine and other prescription drugs. Blame was split evenly between her and the hospital doctors. Three of Zion’s four physicians were found to have contributed to her death by prescribing the wrong medication and were required to pay a total of $375,000 to her family for their pain and suffering. Despite Sidney Zion’s efforts, the jury did not impose a heavy fine on the hospital. Although New York Hospital was found negligent for having left Dr. Luise Weinstein, the physician primarily responsible for Libby Zion’s care, alone with forty patients on that fateful night, the situation was not determined to have contributed to the patient’s death. Additionally, the jury did not find the hospital negligent in its supervision of interns and residents. According to an analysis by physician and medical historian Barron Lerner, the case underscored the fact that “the care of all patients, including Libby Zion, is based on percentages and hunches, backed up, when possible, by the medical literature.” The system at teaching hospitals routinely functioned, he argues, with overworked residents making their best guess, given limited information. Yet the trial failed to pose what he saw as the central question—at what point should Zion’s physicians have intervened more aggressively in her care?57 Incidentally, after completing her residency in 1986, Dr.  Weinstein joined New York Hospital–Cornell as a faculty member and has subsequently received numerous teaching awards for her contributions to student and resident education. Dr. Gregg Stone, the resident who examined Zion after admission, became an interventional cardiologist and renowned clinical investigator, especially in the area of clinical trials. 182

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The second patient death to draw media attention occurred shortly after the grand jury issued its report criticizing the care Libby Zion had received at New York Hospital. It was made even more sensational since the patient in question was pop artist Andy Warhol. In 1973, he had been treated for kidney stones at New York Hospital, and a gallstone was also identified by his private doctor at that time. Extremely fearful of hospitals, Warhol put off surgery until there was no other option but to remove his gallbladder. After the routine procedure, he appeared to be making a good recovery, but he died the next day, on February  22, 1987. New York Hospital reported that although his postoperative condition was stable, he died in his sleep after suddenly suffering a cardiac arrhythmia. On March 4, the hospital announced that it would no longer be employing the private nurse it had assigned to care for Warhol, although it did not specify why; it later asserted that the private nurse should have notified the nurse on staff as soon as she noticed that Warhol’s condition appeared to be worsening.58 After conducting an investigation into whether Warhol’s death could have been prevented, the New York State Department of Health charged that he had been given inadequate care. It faulted his personal doctor, the hospital’s medical and nursing staffs, and the private nurse for failing to conduct the proper tests prior to surgery, administering a drug that might have caused an allergic reaction, allowing him to become over-hydrated, and repeatedly failing to note his chart accurately. The hospital responded with a thirty-five-page statement rebutting almost all the charges, except those related to the private nurse, and stating that it had provided “thorough and appropriate care.” The Manhattan district attorney’s office also conducted an investigation, but no criminal charges were brought against the hospital. A doctor who participated in writing the Health Department report soon stated that it had been too strongly worded and should have only suggested the possibility that Warhol might have become over-hydrated. Still, Warhol’s estate conducted a private investigation and in December 1987 sued New York Hospital for malpractice and wrongful death, claiming that Warhol had “drowned” after being intravenously over-hydrated. The case went to court four years later, with the hospital asserting that Warhol had died of a heart condition, not excess administration of fluids. The suit was settled with New York Hospital agreeing to pay a substantial but undisclosed sum to Warhol’s estate, without admitting any liability in the case. In 1987, it must have felt that bad things came in threes at New York Hospital. On June 5, 1987, a twenty-two-minute power failure led to the death of a critically ill premature infant on a respirator. During routine maintenance, electricity was supposed to be supplied by four emergency generators, but they suddenly failed, despite having just been tested, and blacked out one-fifth of the medical center. In addition to the neonatal intensive care unit, where the 183

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infant died, five other intensive care units were plunged into darkness. A total of thirty-one patients were on respirators and were immediately placed on manual breathing units, with doctors and nurses pumping bellows by hand. The forty-day-old baby who died had been born after only twenty-five weeks and weighed one pound, nine ounces; no other patients were adversely affected. City Council president Andrew J. Stein called for the dismissal of David Thompson, director of the New York Hospital, “for failing to correct systematic deficiencies, which have plagued this hospital for some time.”59 Thompson had been planning to retire and left later that fall, after leading the hospital for twenty years.60 According to David Skinner, who became New York Hospital’s president and chief executive officer after Thompson, “the cumulative effect of the 1987 criticism has been devastating.” Dr. O. Wayne Isom, chief of cardiothoracic surgery, noted that he had to spend a third of the time typically allotted to each patient providing reassurance that “everything is going to be O.K. here.” New York Hospital saw a marked drop in its percentage of occupied beds, which decreased from 89.2  percent in 1985 to 83.9  percent in 1987. One news article reported that some patients and families had started writing down the names of the residents and nurses treating them, in case of potential mishap.61 Even while covering the three deaths and their extended aftermath, newspaper accounts generally chose to refer to New York Hospital as one of the oldest and most prestigious teaching hospitals in the country. In large part, the anxieties generated by these unfortunate incidents reflected a rising concern about how to determine and monitor the overall quality of care offered at any medical institution, rather than an indictment of the practices of one hospital in particular. As Dean Meikle stated at the time, “We are held to a higher level of care than the average hospital because we teach and provide a model for others.”62 The deaths that occurred at New York Hospital, particularly that of Libby Zion, ultimately provided an opportunity for making systematic improvements in medical training and hospital oversight. They also illustrate one of the paradoxes of modern medicine, as described by David Thompson at his retirement: “When I was an intern, you held the hand of a dying patient. Now, bulbs go off and people rush in to save the patient, so if they die, something must have gone wrong.”63 A Turn for the Worse

In July 1987, in the midst of the hospital’s turmoil, Meikle announced his resignation as dean. The board of overseers subsequently approved the appointment of Dr. G. Tom Shires, effective October 26, 1987, for a five-year term. 184

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G. Thomas Shires Born in Waco, Texas, on November 22, 1925, George Thomas Shires grew up in Dallas, earned an undergraduate degree from the University of Texas, and received his medical degree from the University of Texas Southwestern in 1948. He completed a residency at Parkland Memorial Hospital in Dallas, where he continued to practice after joining the faculty of UT Southwestern in 1957. Shires was then appointed chair of surgery at the age of thirty-five. During the late 1950s and 1960s, he conducted research on the cellular physiology of shock and demonstrated that trauma and surgical patients need to be given intravenous electrolyte solutions. On November 22, 1963, he successfully performed emergency surgery on Texas governor John Connally, who had been shot and seriously wounded while riding in the car in which President John F. Kennedy was assassinated. Shires issued a statement saying, “Medically, it was apparent the president was not alive when he was brought in. I am absolutely sure he never knew what hit him.”64 He also operated to no avail on Kennedy’s alleged assassin Lee Harvey Oswald two days later, after he was shot by nightclub owner Jack Ruby while being led to jail. For the 1974–75 academic year, Shires served as chair of surgery at the University of Washington School of Medicine, then moved to New York to join New York Hospital–Cornell as its head of surgery. He helped establish New York’s first burn center and was also a personal surgeon to many of the medical center’s board members. He also played key roles in organizing New York City’s system of emergency medical services and in launching the state’s first helicopter ambulance service. In 1985, the president of the American College of Surgeons analyzed 460 surgeons in the United States and found Shires to be the top academic surgeon in the country. Shires served as dean of CUMC and provost for medical affairs at Cornell University from 1987 to 1991. After resigning in January 1991, he became head of surgery at the medical school of Texas Tech University in Lubbock until 1995. On October 18, 2007, he passed away at the age of eighty-one from gastrointestinal cancer in Henderson, Nevada. At the time, he was director of the Trauma Institute of the University of Nevada School of Medicine. He and his wife of fifty-eight years, Robbie Jo, had one son and two daughters. During his career, Shires served as the chair of four university surgery departments and held leadership positions in various professional organizations, including the International Surgical Society, the American Board of Surgery, the American College of Surgeons, and

185

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Figure 8.2 G. Tom Shires, MD. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

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the American Surgical Association. He trained more than two hundred surgeons and maintained contact with them through an alumni group called Chirurgio, after the Latin word for “surgeon.”65

Whereas contemporary deans tended to focus on fund-raising and administration at the expense of their own clinical or research interests, Shires negotiated a unique agreement with his search committee that also allowed him to continue as chair of surgery. To help him balance his multiple responsibilities, he agreed to appoint two vice chairs for the department of surgery and an academic dean to assist in the daily management of the medical college.66 Still, he was perceived as “impatient with administrative organizational bureaucracies” and occupied at least half his time with running the surgery department and performing procedures.67 While he was considered “a very nice man,” some people found him to be “remote” and less focused than Meikle had been on developing relationships with neighboring institutions.68 Texas-born O. Wayne Isom, who had been recruited to Cornell by Shires, provided one colorful perspective: “Shires, in his quiet way, is so persuasive. He can sell you a dead horse and, when you come back to complain, sell you a saddle for it.”69 Shires became dean the same year that Dr. David Skinner became president and chief executive of the New York Hospital. To respond to nationwide shifts in health care reimbursement practices, Maurice R. “Hank” Greenberg, chief 186

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Discord and Disrepair

executive of the insurance company American International Group, had taken over as chairman of the hospital’s board of governors and began engineering a change in senior leadership, starting with Dr. Skinner. In addition to dealing with the fallout from the recent series of patient deaths, both Shires and Skinner were soon embroiled in the land dispute that had been precipitated by the discovery that New York Hospital legally held the title to all the property underlying the medical center. Disagreement focused on the site of the medical school’s Lasdon research building, which had been under construction for several years. CUMC wanted ownership of the Lasdon site in order to secure a loan for its new building and protect its investment. And although New York Hospital legally owned the land, its own plans to construct a new building— using the air rights over the FDR East River Drive that had been obtained in the 1970s—were complicated by Cornell’s claims. On a basic level, the land dispute between Cornell and New York Hospital was simply about money. No matter who owned the medical center’s land and original buildings, it was highly unlikely that Cornell would be evicted from the premises, particularly when its faculty members were in many cases the same people who staffed the hospital and admitted patients. What was at stake were Cornell’s past and future investments in the medical center. With hospital resources squeezed by changing reimbursement strategies and managed care, Cornell needed to ensure that it would retain a role in clinical decision making and that its academic and research programs would be able to thrive. The legal intricacies of the land dispute also complicated future possibilities for growth and expansion, not just for the medical school but for the hospital as well. Despite continuing strife regarding the building’s legal status, the groundbreaking ceremony for the William and Mildred Lasdon Biomedical Research Center took place on January  21, 1987, and the 140,000-square-foot center opened in 1989. Constructed at a cost of about $50 million, it housed the C. V. Starr Biomedical Information Center, which contained the existing Samuel J. Wood Library plus new computer and information resources facilities, on the basement and first floors. Upper floors housed labs in pharmacology and physiology, as well as faculty members from the departments of medicine, obstetrics/gynecology, and pediatrics. Renovations were also made to labs and offices in the existing D and E buildings adjacent to the new structure.70 According to former dean of research David Hajjar, the expansion in research space “gave us an opportunity to really blossom scientifically here.”71 While the new building helped brighten Cornell’s future, relations between the hospital and the medical school took a drastic turn for the worse. Differences in institutional priorities that had been popping up for quite some time were exacerbated by the financial difficulties posed by the evolving health care landscape and by a contentious personal relationship between Shires and Skinner. As Meikle put it, “There is a long history of recurring minor discord. What I hear 187

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now is that it has become much more bold and much more personal, and it has an effect on the operations of the institution.”72 When Skinner became president, New York Hospital was losing about $1 million a week, and it suffered a $57 million loss in 1988 and a $30 million loss in 1989.73 About $45  million passed between the two institutions each year, which meant that financial hardship for one adversely affected the other. Yet Cornell and New York Hospital had not successfully worked out a way to coordinate the administration and long-term planning of the medical center as a whole. Despite the considerable amount of money that flowed between the two, it was not until 1989 that a joint accounting project to develop clear financial policies, procedures, and records for these transactions was initiated.74 With strong support and regular involvement from his board, Skinner was able to reduce New York Hospital’s deficit to $8 million in 1990 by cutting costs and streamlining operations.75 Not surprisingly, not every measure was greeted with unanimous approval, but Skinner and the hospital board tried to manage a difficult process with as much openness and inclusiveness as possible. For example, hospital board chair Maurice Greenberg personally hosted three weekend retreats at his country home near Danbury, Connecticut, “during which all aspects of the challenges in play at that time were openly presented, argued, and discussed.” Included at these gatherings were many members of Cornell’s board and senior leadership.76 Still, numerous educational and research expenses associated with the medical school’s academic activities had been buried in the hospital budget and supported by its clinical income for many years. As insurance reimbursement strategies changed, the hospital was less eager to supplement the medical school’s resources, which generated tension. At a December 1988 meeting of the board of overseers, for example, Skinner reported that if New York Hospital’s budget targets were not met, it would have no choice but to cut clinical programs, which would necessarily affect the academic programs of the medical college. In response to questions, Skinner stated that any cuts proposed by the hospital would be shared with the affected department chairs and with Dean Shires, who could choose to share the information with the overseers. However, the implication was that such decisions would ultimately be made by the hospital.77 According to Robert Michels, who became dean after Shires, Skinner was also trying to expand the hospital’s affiliations throughout the New York region in order to funnel more patients to the medical center to replace those being lost because of changing reimbursement patterns. What Cornell sought in its affiliations was the potential for high-quality academic activities, including clinical teaching and research, and it wanted to build its reputation as an Ivy League medical school. The two institutions had conflicting goals and divergent criteria for what constituted the most desirable affiliation, and they lacked an effective mechanism for resolving such issues.78 188

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An intense rivalry between Shires and Skinner only contributed to the problem. Both were prominent academic surgeons, and it was widely believed that professional rivalry fueled their growing animosity toward each other. Initially, Shires had advocated for Skinner’s appointment as president of the hospital, and Skinner was on the search committee that recommended Shires’s appointment as dean. However, their relationship began to deteriorate after Shires was allowed to remain chair of surgery while also serving as dean, despite Skinner’s objections. Some clinical departments, including surgery, then began to fall behind their financial targets, as fewer patients were admitted and fewer procedures were performed than originally planned. Although Shires proceeded to recruit additional surgeons to increase admissions, he and the surgery department felt attacked and singled out for criticism by Skinner. As the situation worsened, the Cornell Board of Trustees requested a report of hospital management, which was prepared by Earl M. Collier Jr., a Washington lawyer specializing in health care issues. His review was highly critical of Skinner, whom he cited as responsible for ongoing financial problems, poor morale, failure to develop a long-term plan, and antagonism toward department chairs and Shires in particular. In his view, “Many chairmen saw Dr. Skinner’s attacks as petty, provoked perhaps by his envy of Dr. Shires’s greater eminence as an academic surgeon.” This interpretation, which was clearly biased toward Cornell’s interests at the time, was conveyed in the New York Times. While Shires was portrayed as “easy to work with,” Skinner was described as having a “reputation for being somewhat arrogant and autocratic.”79 Three years later, the New York Times presented Skinner, a preeminent esophageal surgeon in his own right, in a much more favorable light, praising him for his business acumen in restoring New York Hospital to financial health.80 While dealing with a very challenging shift in the health care environment, Skinner also succeeded in building a strong consensus within the hospital. Although Cornell and New York Hospital tried to work toward an amicable resolution of the real estate issue, time was running out. When it was first discovered in 1984 that the hospital owned the land underlying the medical center, CUMC had signed a ninety-nine-year lease with New York Hospital for the site of the Lasdon Biomedical Research Center in order to proceed with construction of the facility. The lease specifically reserved the right for Cornell University to pursue a property claim against the hospital in the future. In 1990, Cornell finally received a letter that had been written by one of the hospital’s attorneys back in July  1984, after the lease had been signed. It was felt that the letter, which took a firm position against the university’s claim, could be interpreted as triggering a six-year statute of limitations that would expire on July 10, 1990. Hospital and medical school leadership began meeting weekly in April to try to resolve the situation. On the one hand, New York Hospital maintained that it legally owned the land, and it was eager to move forward with a new $1 billion 189

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expansion project using the air rights over the FDR East River Drive. On the other, Cornell argued that since it had made an initial $5 million investment in 1927 to establish the medical center and had subsequently poured substantial funds into the facilities, it had an ownership interest in the land. The CUMC Board of Overseers proposed that New York Hospital grant Cornell a lease for a term of 999 years, but the hospital would not agree to this length of time. On July 3, 1990, the land dispute came to a head at a special meeting of the CUMC Board of Overseers. After discussion, it was felt that the matter was unlikely to be resolved before the statute of limitations expired in a week. Suing the hospital was perceived as a way to protect Cornell’s interests while buying time for further negotiations, even though this course of action could be expected to generate a great deal of negative publicity and further antagonize the hospital. Nevertheless, the board decided unanimously to serve a summons on New York Hospital if no agreement was reached by July 10, and it planned to enlist a public relations firm to deal with the potential fallout. At the same time, the overseers emphasized the “desirability of maintaining and strengthening the relationship of the University with the Hospital.”81 Cornell proceeded to sue New York Hospital, which it argued had “improperly blocked” a plan to build the $50 million Lasdon Biomedical Research Center. It requested that the court affirm its rights to the property or order the hospital to pay $500 million to cover the cost of Cornell’s investment in the center. Without protection from the courts, it claimed, financial problems resulting from “poor management” at the hospital could jeopardize the medical college’s future. The news was reported in the New York Times in December of that year. In the article, Cornell University president Frank Rhodes explained that the case had been filed “to clarify our property rights.” Maurice Greenberg, chairman of the hospital’s board of governors, was also quoted: “I don’t understand why they have embarked on this crusade. The hospital has ownership rights to the land; it has been clear all these years, and we are not going to waver.”82 According to interviews later conducted with faculty members, the climate became very hostile at the medical center, with people threatening to lock the doors connecting the hospital and medical school. Although the dispute occurred primarily at the board level, its effects were experienced on a day-to-day basis by doctors and administrators, many of whom felt torn between the two institutions.83 In January 1991, Dean Shires resigned and returned to his home state as head of surgery at Texas Tech University’s medical school. In the New York Times, he stated that his resignation was unrelated to Cornell’s lawsuit: “The issue between the two boards is real estate, and the dispute long preceded my appointment.” When asked, he did not comment on the rivalry between him and New York Hospital president David Skinner, except to say, “We are heads of two different institutions and we meet every day. The issue of real estate is external to both of us and that was not a problem.”84 190

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Shires’s successor as dean, Dr. Robert Michels, then chair of psychiatry at CUMC, was announced on April  17, 1991. At the same time, Cornell and New York Hospital declared that they had reached an agreement “in principle” to settle the land dispute. In addition to hurting morale, the institutions realized, the lawsuit was paralyzing fund-raising efforts and delaying construction projects.

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Robert Michels Born in Chicago in 1936, Robert Michels received his undergraduate degree from the University of Chicago in 1953 and his medical degree from Northwestern University Medical School in 1958. He trained in psychiatry and psychoanalysis at Columbia University and the New York State Psychiatric Institute, before becoming the Barklie McKee Henry Professor and chair of the department of psychiatry at CUMC in 1974. In an edited collection of the work of thirty leading psychoanalysts, Michels is described as “a major influence on a generation of young analysts who have benefited from his unique combination of dedication to psychoanalysis, devotion to psychiatry, and an amazing critical capacity to enlighten our areas of fuzzy thinking, complacency, and philosophical and ethical sloppiness.”85 According to David Hellerstein, a resident in psychiatry during the early 1980s, Michels’s style of teaching was akin to “psychic boot camp”: “The educational method consisted of inducing psychological crisis as a means of remaking us. . . . Michels was notorious for stopping residents a few sentences into a case presentation and tearing them to shreds, for standing up in grand rounds every week and upstaging the speaker by asking three (always three) devastating questions. We mocked Michels in our annual Christmas show, yet mimicked his psychiatric style as we strode the shadowy hallways in our long white coats.”86 Michels served as the Stephen and Suzanne Weiss Dean of CUMC and provost for medical affairs of Cornell University from 1991 to 1996. Despite a hectic schedule of meetings, he always reserved a couple of hours a day to see patients. In describing the changing role of the dean, he noted that as New York Hospital “has become bigger and bigger, and more and more important, the dean’s purview has become more and more the basic sciences, medical education, medical research, but not clinical care.”87 In 1996, Michels became the Walsh McDermott University Professor of Medicine and a University Professor of Psychiatry at CUMC.

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Figure 8.3  Left to right: Dean Robert Michels, New York Hospital Board of Governors chairman Maurice Greenberg, New York Hospital president David Skinner, and CUMC Board of Overseers vice chairman Arthur Mahon, 1992. (Photo by Brad Hess; courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

During his career, Michels has been president of the American Board of Psychiatry and Neurology, the American College of Psychiatrists, and the American Association of Chairmen of Departments of Psychiatry. He is also a longtime training and supervising analyst at the Columbia University Center for Psychoanalytic Training and Research. Starting in 1970, he has been a fellow at the Hastings Center, a bioethics research institute, and sits on its board of directors. His wife, Verena Sterba Michels, is a psychiatric social worker, and she and Dr. Michels have two children. 88 Their daughter, Dr. Katherine Michels, graduated from CUMC in 1991, receiving her degree from her father, and was later an assistant professor in psychiatry at CUMC.

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A final settlement was drawn up and approved by CUMC’s overseers on September 15, 1992. According to the terms of the agreement, each institution would retain the title to the buildings it currently owned. New York Hospital would keep its title to the land underlying the medical center, and Cornell accepted a 225-year, automatically renewing lease for the land beneath its buildings at a cost of $1 per year. The lease and the joint agreement between the two institutions, which had initially established the medical center back in 1927, could be terminated only by the joint action of both parties. In addition, New York Hospital agreed to sell the property on the southwest corner of Seventieth Street and York Avenue to Cornell for $10  million.89 A  gift from the Atlantic Philanthropies, established by Cornell University alumnus Charles Feeney, enabled CUMC to purchase the plot and two aging buildings on it, which were subsequently demolished. A formal ceremony, complete with Tiffany pens and photographs, marked the signing of the land settlement agreement by Stephen Weiss, CUMC overseer and chair of the Cornell trustees; Maurice Greenberg, chair of New York Hospital’s board; and Cornell University president Frank Rhodes.90 Both the hospital and the medical school were pleased with its terms and looked forward to a more harmonious working relationship, although the legal fees associated with the conflict were substantial.91 With Michels’s appointment as dean, it was hoped that interactions between the medical school and hospital would continue to improve and usher in a new era of reconciliation and growth. When asked about his relationship with David Skinner, Michels told the New York Times: “We’re good friends; there won’t be any problem.”92 At that point, Michels had worked with Skinner as the chair of the psychiatry department for several years. In a recent interview, Michels noted that although relations between the two institutions did become stronger, structural tensions related to their different missions and priorities were never fully resolved under his and Skinner’s leadership. According to Michels, their personal relationship remained intact, but “I  got along better with Dr. Skinner before I was dean.”93

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9 Renaming and Rebirth They said, “100,” and I said, “How many zeroes?”

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Sanford Weill, quoted in the New York Times, 1998

A hundred years after its founding, Cornell University Medical College was reborn as the Weill Cornell Medical College. An extraordinarily generous donation of $100 million from Sanford Weill, chair of the board of overseers, and his wife, Joan, led to the renaming of the medical school in 1998 and the completion of its first strategic plan. The gift could not have come at a better time. By the early 1990s, clinical revenues provided half of Cornell’s income, leaving it vulnerable to the ongoing financial squeeze of managed care.1 Labs were outdated, space was scarce, and research programs needed revamping. Like other medical schools and hospitals, Cornell considered a variety of ways to meet its financial challenges. Part of its response was to become “leaner, more efficient, more agile, and more cost-effective in the practice of medicine,” in the words of medical historian Kenneth Ludmerer, by implementing a long-range planning process.2 A growing trend of mergers, acquisitions, and affiliations among health care institutions represented another option, one that was pursued by New York Hospital. Finally, philanthropy became increasingly important to Cornell as it tried to build up its academic programs and faculty. Between 1990 and 2000, fund-raising at the medical college increased more than threefold to $93  million annually.3 Donations like the Weills’ enabled the medical school to reach beyond the status quo and work toward actively shaping its own future. The road to the Weill gift and a renamed medical school began in the early 1990s, when CUMC integrated its strategic planning and fund-raising efforts for the first time. In the fall of 1990, Cornell University launched a $1.25 billion, five-year Campaign for Cornell.4 Three years later, on September  22, 1993, the New York Hospital–Cornell Medical Center commenced a $600 million campaign called New Horizons for Medicine, which included a goal of $200 million for CUMC that was also part of the larger Campaign for Cornell. New Horizons for Medicine was cochaired by CUMC overseer Sanford

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Weill and New York Hospital governor Frank Bennack Jr. For the first few years of the campaign, the development office, which jointly supported CUMC and New York Hospital, concentrated its efforts on fund-raising for a new hospital building.5 It had already raised $220  million by the end of 1993, which was also the first year of the decade that the medical school did not run a deficit.6 At the same time as the campaign launch, a strategic plan for the medical college was being developed. Headed by overseer Harvey Sampson, the strategic planning committee appointed three subcommittees of faculty and administrators in the fall of 1993 to define long-term goals. In their estimation, Cornell’s strengths lay in training medical specialists, its PhD and MD-PhD programs, and its commitment to student diversity. In order for the medical school to “regain, and even surpass, its former eminence within a decade,” the committee recommended modernizing its curriculum to include interdisciplinary teaching, small-group learning as opposed to lectures, and earlier exposure to patients.7 To address current trends in the practice of medicine, it suggested that clinical and educational programs in public health, preventive medicine, and primary care be strengthened. The committee also noted that Cornell’s weakness lay in research. Although Cornell was ranked ninth by U.S. News and World Report in its listing of top medical schools, it was only thirty-first in the total amount of research funding received from the National Institutes of Health.8 Partly this was due to the small size of its basic research program, since CUMC ranked well above the national average when considering its research grants per faculty member. In order for Cornell to grow scientifically, the committee recommended focusing on three major areas: structural biology, which analyzes the structure of large biological molecules; the growing field of human genetics and gene therapy; and neuroscience.9 The resulting Strategic Plan for Research, which was approved in 1996, became the fund-raising template for the medical college’s component of the New Horizons for Medicine campaign. It allowed development officers to approach donors with a clearer sense of purpose and offer them the possibility of directing gifts to specific areas of interest. A  new mission statement also helped communicate Cornell’s long-term aspirations. Tying together the disparate activities of the medical and graduate schools, it stated that the two would strive “to provide the finest education possible for medical students and students pursuing advanced degrees in the biomedical sciences, to conduct research at the cutting edge of knowledge, to improve the health care of the nation and the world both now and for future generations, and to provide the highest quality of clinical care for the communities they serve.”10 Fund-raising for the New Horizons campaign initially focused on the CUMC Board of Overseers and the Medical Center Advisory Board, which consisted of fifty-seven individuals, the majority of whom were not members 195

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CHAPTER 9

of either the medical college or the hospital boards.11 Other donors were cultivated among physicians and their patients, and a variety of events were held to attract new supporters to the medical college, such as the Women’s Health Symposium, which featured noted feminist writer Gloria Steinem as a speaker in 1994.12 One of the medical center’s more colorful donors was the hotelier Leona Helmsley, who was a longtime patient of alumnus Dr. Rees Pritchett, a voluntary faculty member starting in 1953 who joined the full-time faculty in 1992. In Pritchett’s words, “Leona was very hard to get along with. She fired me many times over the twenty years I  took care of her, but she remained my friend.” When she was on trial for tax evasion in the early 1990s, Pritchett and Ellie Skinner, the wife of New York Hospital president David Skinner, frequently attended court. On one occasion, Helmsley had a fainting spell, beckoned to Dr.  Pritchett while leaving the courthouse, and was brought to the hospital coronary care unit. Although it turned out that she had not suffered a heart attack, reporters flocked to the medical center to speak to Pritchett. She later surrendered at the federal prison in Lexington, Kentucky, on April  16, 1992, for income tax fraud, accompanied by her niece, Dr. Pritchett, and her bodyguard Edward Brady, all of whom had flown from New York with her on her private jet. According to Pritchett, “there wasn’t a dry eye except for Leona’s.”13 She ended up serving eighteen months of a four-year sentence. Although Helmsley’s nickname was the “Queen of Mean,” she and her husband, Harry, were very generous supporters of medical research and health care. During their lifetimes, they donated more than $71  million to the New York Hospital–Cornell Medical Center, including $33 million to construct the hospital’s Helmsley Medical Tower, which contains ambulatory care services and guest accommodations for patients and visitors.14 Dr. Pritchett treated many other high-profile patients during his seven decades as a medical student, resident, and faculty member at New York Hospital–Cornell. In 1995, for example, he noted that the philanthropist and socialite Brooke Astor was having memory loss and was later asked to testify in the trial of her son, Anthony Marshall, who was found guilty of stealing millions from his mother after she developed Alzheimer’s disease.15 Some of the funds for the New Horizons for Medicine campaign were directed toward a major revision of the medical school curriculum, an effort that Robert Michels considered a highlight of his time as dean. At the time, medical education was experiencing a widening disjunction between biomedical research, which had become increasingly focused on the molecular underpinnings of disease, and clinical teaching and care, which considers physical signs and symptoms, organ systems, drug treatments, and surgery. The gap between the topics studied by physician-scientists and those that students needed to master in order to practice medicine was more pronounced than ever 196

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before. Medical schools began experimenting with different teaching methods, including problem-based learning and computer instruction, in an attempt to bridge this divide and promote independent study. They also explored the question of whether caring, compassion, and communication skills could be taught to students in order to make them better doctors.16 According to Michels, Cornell’s curriculum wasn’t “a maximally joyous experience” for students during the early 1990s and did not motivate them to learn about new developments in medicine on their own. He and Dr. Daniel Alonso, senior associate dean for academic affairs, visited other medical schools, including Harvard Medical School and McMaster University in Ontario, to learn about their curricular experiments. Cornell then introduced a hybrid, reformed curriculum in 1996, which incorporated multiple teaching formats to address different learning styles. The new curriculum included traditional lectures and clerkships, as well as interactive small-group sessions, journal clubs, and problem-based learning. A student-centered teaching method designed to promote critical thinking and peer collaboration, problem-based learning began with a clinical case and required small groups of students to generate hypotheses, make connections to their basic science coursework, and find additional information through independent research. After its introduction, students tended to find their learning experiences more enjoyable and engaging. The faculty also generally appreciated the curricular changes, and over time, those who were strongly invested in teaching medical students were identified and further integrated into the educational program.17 The Joan and Sanford I. Weill Education Center, established by the Weills with one of their first gifts to the medical school, opened in 1996 to coincide with the introduction of the new curriculum. With an auditorium, common area, and small-group teaching labs containing 116 computers, the twentythousand-square-foot facility was designed to bring medical education into the digital age. Extensive planning went into deciding how to integrate computers, then a novel technology with unknown potential, into classroom instruction. In a newspaper article, Daniel Alonso spoke about the importance of computers in independent study: “In medicine, there is so much new discovery all the time, students can’t possibly learn every single thing they need to know. They are going to learn their entire life, and you might as well show them how to do it from the beginning.” Computers were also incorporated in problem-based learning, as well as in gross anatomy courses. As students dissected cadavers, medical images such as anatomical photographs, X-rays, and CT scans were projected on screens to supplement the learning process.18 The entering class of 1996, which inaugurated the new curriculum, happened to be the largest in Cornell’s history. With a total of 112 students, it was also the first class in which women outnumbered men (60 women and 52 men), and it had the highest number of minority students at 26.19 As reported by the 197

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New York Times, the large class size occurred by accident rather than by design. That year, Cornell sent acceptance letters to 249 applicants, as it usually did. Instead of the typical 101–104 students deciding to matriculate, however, 119 agreed to enroll. “Like an airline trying to lure bargain-conscious passengers off an overbooked flight,” Cornell offered to waive the first year of tuition, then worth $24,000, for the first fifteen students who agreed to defer enrollment for a year. Although only a few students accepted the offer, the medical school managed to accommodate the unexpected increase in numbers.20

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Growth and Change in the Health Care Landscape

Like Cornell, New York Hospital was slowly moving toward improved financial health in the 1990s. By 1991, its president, David Skinner, had succeeded in transforming a loss of $1 million per week into a $2 million annual surplus. Faced with declining reimbursements from Medicare and Medicaid, along with constraints imposed by health maintenance organizations, the hospital pursued several long-term strategies aimed at increasing patients. One was to ensure that the hospital provided the highest standard of care, especially considering the previous decade’s storm of negative publicity. For example, after the fallout from the Libby Zion and Andy Warhol cases, mortality rates for Medicare patients at New York Hospital were reported as being among the lowest in the nation. The hospital also initiated a major modernization project to renovate and enlarge its decades-old facilities. At an estimated cost of $990 million, the project had been delayed for years because of a lack of sufficient funds. Although it was anticipated that the New Horizons for Medicine campaign would help finance a sizable portion of that amount, New York Hospital was willing to go deeply into debt in order to offer its patients the most cutting-edge services and amenities. 21 The focus of the modernization project was a new hospital building to be constructed over the FDR East River Drive, making use of the air rights that had been acquired in 1974. Since that time, the Rockefeller University had completed two buildings over the FDR Drive—the Scholars Residence in 1989 and the Rockefeller Research Building in 1993—and the Hospital for Special Surgery expanded over the highway in 1995. Planning for New York Hospital’s facility began after the C. V. Starr Foundation donated $25 million to the project in November 1990, a few years before the air rights were set to expire if they remained unused by 1993. Created by Cornelius Van der Starr, the founder of the insurance company American International Group (AIG), the Starr Foundation was chaired by Maurice Greenberg, AIG’s chief executive and a member of New York Hospital’s board since 1979. 22 Additional funding included $143 million from the medical center’s New Horizons for Medicine 198

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campaign and a $590 million loan from the Federal Housing Authority, then the largest in its sixty-year history. 23 The construction project, headed by New York Hospital vice president Louis F. “Fritz” Reuter IV, was one of the biggest in the city at the time and was expected to provide over eleven hundred jobs. 24 The groundbreaking ceremony for the twelve-story hospital, named the Maurice R. and Corinne P. Greenberg Pavilion, took place on May 10, 1993. Building over the FDR Drive was logistically complicated and required the approval of forty-four federal, state, and local agencies, including the U.S. Coast Guard and the Department of Transportation. The application for a certificate of need, which is required to build medical facilities in New York, was contained in multiple binders that collectively stretched thirty-three feet long. The actual construction process began in March 1994 when a two-level steel and concrete platform was set in place over the highway and along the East River between Sixty-Eighth and Seventieth Streets. Thirteen custom-built steel trusses, each of which would weigh nine hundred tons, were created by an ironworks in Toronto and transported across Lake Ontario, through the Erie Canal, and down the Hudson River to Piscataway, New Jersey, for assembly. They were then floated across New York Harbor and up the East River to a site adjacent the medical center. A crane situated on a barge lifted the trusses over the FDR Drive, which was specially closed from midnight to 5:00 a.m., and put them in position, but only when weather conditions were “perfect, with no wind, no waves in the river, and appropriate tidal conditions.”25 The process took two months and cost $40 million, but saved the project time and money overall. After the platform was erected, construction of the building proceeded on top of it. The platform’s upper level afforded emergency access to the hospital for ambulances, while its lower level contained parking and an additional entrance for passenger vehicles. 26 Various rumors about the construction project circulated at the medical center. Large drills were required to secure the platform over the freeway, and according to one tale, these machines were oil drilling rigs brought from the North Sea to bore into the solid granite bed of the East River. A patient who observed the work taking place reportedly called New York Hospital president David Skinner to tell him that he would be disappointed if he was hoping to hit oil under the river. According to another story, the mammoth crane that lifted the nine-hundred-ton trusses over the FDR Drive had been part of the Glomar Explorer, a deep-sea drilling platform built by Howard Hughes to help the Central Intelligence Agency retrieve a vanished Russian submarine with nuclear missiles still on board. 27 A group of endangered peregrine falcons that were often seen near the top of the New York Hospital tower provided an additional source of humor. Dr. Skinner liked to joke that representatives from the Environmental Protection Agency 199

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Figure 9.1 Construction of the Greenberg Pavilion, 1995. (Courtesy of Medical Center Archives of NewYork–Presbyterian / Weill Cornell.)

had warned him that construction could not proceed if the falcons built a nest on the tower and their habitat was disturbed. To prevent the falcons from nesting in the first place, Skinner reportedly instructed the work crew to shake the building each day and scare them from the area. In reality, the U.S. Department of the Interior, which includes the Division of Parks and Wildlife, brought forth a concern about the falcons, and New York Hospital agreed to monitor and note any adverse changes to their habitat during construction. In general, the project had no impact on the falcons, who continued to nest and produce hatchlings throughout. In an interesting reversal, the construction and hospital engineering workers ended up being the ones in need of protection. On at least three separate occasions during the spring hatching season, falcons attacked workers, in one instance so seriously as to require stitches. Following the conclusion of the project, the population of falcons nesting on the hospital tower has expanded greatly, thanks to conservation and protection efforts led by Cornell University ornithologists.28 To make room for the new hospital, the original Payne Whitney Psychiatric Clinic was demolished starting in the summer of 1994. Later that fall, the 200

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New York Times Magazine commemorated the facility in an article, which described it as a “monumental touchstone in Manhattan’s psyche, a center of stability in a stressed-out city.” Since its opening in 1932, it had served celebrities including poet Robert Lowell, artist Mary McCarthy, writer Jean Stafford, and actress Marilyn Monroe, who according to legend “stripped herself naked, screaming, in a Payne Whitney seclusion room.”29 In response to the article, Joyce V. Holly described the elegance of the facility during her time as head nurse in the 1950s: “If I could spare time on my day off, I might accompany patients to social activities. In this way, I managed to run up rather large shopping bills for the special clothes I needed to attend Broadway plays, cocktail parties, dinners, country weekends. Under no circumstances was there to be any indication that I was a nurse, with a patient. . . . Breakfasts were made to order; dinner tables sparkled with crystal; the silver was sterling and the napkins damask. Famous baritones sang arias in the shower, dancers practiced in the halls and actors rehearsed their lines in front of unbreakable mirrors.”30 Although no longer housed in a separate facility, the medical center’s psychiatric services were renamed the Payne Whitney Clinic and included both inpatient and outpatient care. Construction of the hospital’s new Greenberg Pavilion was completed a few months ahead of schedule at a cost of just under $900  million, about 10  percent below budget. It was dedicated on April  8, 1997, and opened to patients a month later. The 850,000-square-foot building extended over the FDR Drive and contained approximately eight hundred inpatient beds, as well as operating rooms, an emergency room, intensive care units, labor and delivery suites, a neonatal unit, and a burn unit. As part of the hospital’s modernization project, older structures that had formerly contained these units were renovated, and most outpatient programs and other facilities were transferred into them. The medical center’s central plant, infrastructure, and utilities were also upgraded.31 In addition to improving and adding to its space at the medical center, New York Hospital dealt with a challenging health care environment by forming a network of health care providers to help extend its reach geographically. The New York Hospital Care Network, as it was originally known, linked together affiliated hospitals, clinics, and nursing homes throughout the New York metropolitan area. Characterized in the New York Times as “essentially a friendly takeover of smaller institutions” requiring almost no exchange of money, the network represented a new health care model in an era of managed care. Hospital president David Skinner, who was described as a “hard-nosed, up-todate, computer-literate executive,” explained the rationale behind its formation: “We realized that health care delivery had to change from the very decentralized, Mom-and-Pop approach to streamlined systems that use modern technology and link together the various systems from primary care, community 201

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hospitals, to tertiary and emergency care to nursing homes into a seamless web.”32 Six months after it was formed in 1993, the network, which consisted of fifteen institutions with forty-one hundred beds, was capable of serving a population of nearly a million people. The New York Hospital network also generated more opportunities for the clinical teaching of Cornell’s medical students. A  number of hospitals in Brooklyn and Queens, including the New York Community Hospital, Methodist Hospital of Brooklyn, Wyckoff Heights Medical Center, Brooklyn Hospital Center, and Booth Memorial Hospital in Queens, all joined the network and became affiliated with Cornell. These institutions provided additional sites in the outer boroughs for clinical clerkships and electives and helped compensate for the loss of a twenty-seven-year affiliation with the North Shore University Hospital in Long Island, which had become the second-most important teaching site for Cornell’s medical students after New York Hospital. An affiliation with the Cayuga Medical Center at Ithaca was also forged and exposed students to the practice of medicine in a small-town environment.33 When CUMC’s new curriculum was introduced in the fall of 1996, a total of fifty-five physicians from affiliated institutions participated in a first-year course called Medicine, Patients and Society and taught students one-on-one in their offices for half a day each week. The following year, the program was expanded to include second-year students, and an additional fifty to sixty affiliated physicians were recruited to participate.34 Mergers of hospitals or medical schools represented an alternative strategy to the formation of networks. In addition to increasing patient volume, they enabled institutions to streamline operations and reduce costs by consolidating academic, clinical, and administrative departments and services. Mergers were also gaining traction in the world of business, which supplied medical schools and hospitals with many of their board members. Two of Harvard Medical School’s teaching hospitals, Massachusetts General Hospital and Brigham and Women’s Hospital, led the trend when they formed Partners HealthCare in 1994. In New York, various configurations for potential mergers were considered between North Shore Hospital, St. Luke’s–Roosevelt Hospital, New York University, Mount Sinai School of Medicine and Hospital, Beth Israel Medical Center, and Long Island Jewish Medical Center, but none came to fruition during the decade.35 There were fleeting talks about Cornell and New York Hospital merging with North Shore Hospital, as well as casual discussions about Cornell merging with Mount Sinai School of Medicine or New York University. Also briefly considered were mergers of the cancer research activities of the Sloan Kettering Institute with Cornell’s basic science departments, and of New York Hospital with Memorial Sloan Kettering Cancer Center.36 Discussions of a merger between CUMC and the Columbia University College of Physicians and Surgeons, a proposal that had also been contemplated in 202

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1982, were developed the furthest. Starting in January 1995, Cornell’s dean, Robert Michels, and Columbia’s dean, Herbert Pardes, had a series of meetings about the possibility. The primary motivation for Cornell was a desire to expand its basic science program, while Columbia sought a link with a more financially stable institution than its teaching affiliate, Presbyterian Hospital.37 According to Michels, a few problems immediately arose. If the two medical schools merged, would it be part of Columbia University in New York City or of Cornell University in Ithaca? Neither university wanted to relinquish its medical school to the other and weaken its economic clout within New York. And although the quality of the medical students at both institutions was felt to be comparable, there was some reluctance among Columbia’s faculty about joining with Cornell’s. Columbia was stronger in the basic sciences, enjoyed high levels of funding from the National Institutes of Health, and “in some areas felt that it was academically superior to Cornell faculty.” In addition, Columbia’s graduate programs in biomedical science were split between its medical center in Washington Heights and its main campus in Morningside Heights, while Cornell’s were integrally related to neighboring Memorial Sloan Kettering and Rockefeller University. Merging those programs would be logistically complicated. Still, consultants were hired and asked to perform economic analyses of various arrangements, including a four-way merger between Cornell, Columbia, New York Hospital, and Presbyterian Hospital, a scenario that had previously been envisioned by Cornell University president Jacob Schurman in 1917. In retrospect, Michels felt that a combined institution involving Cornell and Columbia “would certainly have been one of the leading medical schools in the country, if not the leading one.”38 However, the key areas of dispute were not resolved, and negotiations fell apart in September 1995.39 The following year, on July 24, 1996, plans to merge New York Hospital and Presbyterian Hospital were announced. Like New York Hospital, Presbyterian had been operating with a substantial deficit in the late 1980s, and it had recently succeeded in generating a surplus by cutting costs and expanding its patient base, despite being located in a low-income neighborhood in Washington Heights. Both hospitals hoped to further reduce operating expenses by combining administrative and financial offices. Negotiations between New York Hospital president David Skinner and Presbyterian Hospital president William Speck had begun in January 1995. Presbyterian Hospital also initiated merger discussions around that time with New York University’s Tisch Hospital. New York Hospital’s board was initially skeptical about the proposed merger with Presbyterian, since it was still trying to fund the construction of the Greenberg Pavilion, and Presbyterian’s finances remained shaky. By the following year, the financial outlook of Presbyterian had improved, and negotiations were reopened on April 22, 1996, at a dinner meeting between Skinner and Speck. Within two months, the boards of both hospitals had 203

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agreed on a full-asset merger, the first between two academic teaching hospitals. According to William Speck, president of Presbyterian, “As they say, you always come back to your first love. It took us a lot of dates with others and lots of talking with multiple parties to realize that we belonged together.”40 Largely in response to the pending merger of their teaching hospitals, Cornell and Columbia established an alliance called Columbia-Cornell Care in 1996. Its main goal, short of an outright merger of medical schools, was to combine the clinical faculties and affiliated doctors of both institutions in a single nonprofit organization, in order to streamline costs and obtain better managed-care contracts jointly. Each institution would operate independently, although functions such as marketing and computer technology would be coordinated between medical schools.41 Extensive plans were drawn up, but Columbia-Cornell Care was quietly disbanded by the end of the decade. There was thought to be insufficient shared risk among the participating physicians in the organization, which would have left Columbia and Cornell open to accusations of anticompetitive behavior. A more long-standing venture still in existence was the Cornell Physician Organization, formed in 1996 as a reorganization of its Faculty Practice Plan. Since the late 1960s, the Faculty Practice Plan had managed the patient care activities of Cornell’s full-time clinical faculty, primarily by billing for services. The income generated by faculty members’ clinical practices provided financial support to the medical school and also went toward faculty compensation.42 As Cornell and other medical schools became increasingly dependent on clinical revenues, the threat of managed care loomed large. At the beginning of 1995, for example, it was estimated that CUMC stood to lose $15 million, or 10.5  percent of its annual clinical receipts, by 2000 as a result of insurance restrictions imposed by HMOs.43 To protect this important source of income, medical schools began trying to increase efficiency by forming organizations, such as the Cornell Physician Organization, that were coordinated across departments and able to negotiate effectively with HMOs and other third-party payers.44 Conceptualized and developed by Dr. E. Darracott Vaughan Jr., then associate dean for clinical affairs and chair of urology, the Physician Organization began taking a more active role in consolidating the business operations of Cornell’s clinical practices. Members included all faculty physicians employed by Cornell, voluntary faculty members working primarily in private practice, and licensed health care professionals working for the medical college, such as nurse practitioners and physician’s assistants. As part of CUMC, it was run as a multi-specialty group practice under the leadership of clinical department chairs, directors of major clinical centers, the dean, Cornell overseers and trustees, and representatives of the soon-to-be merged NewYork–Presbyterian Hospital. It took on additional functions besides billing patients and negotiating 204

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managed care contracts, such as creating budgets, developing initiatives to improve the quality of care, marketing, helping integrate information technology systems across departments, and recruiting physicians.45 After it was established, the Physician Organization quickly became an important clinical and financial force at the medical center and a major interface between Cornell University, the medical school, and the hospital. In Dean Michels’s opinion, “Until 1996, there were two institutions involved, the New York Hospital and Cornell University Medical College. There are now three. The Physician Organization is in some ways separate and very big.”46 While its physician members also had faculty appointments at CUMC and admitting privileges at the hospital, the Physician Organization served as the representative body for the clinical activities of the medical school. These activities became part of a much larger enterprise when the New York Hospital and the Presbyterian Hospital officially merged on December 31, 1997. David Skinner, New York Hospital’s former president and CEO, became vice chairman and chief executive of the new entity. One key detail had yet to be ironed out, however. Just a month before the merger, no name or marketing materials for the new hospital had been decided upon. Initially, the combined institution was referred to as “The New York and Presbyterian Hospital.” After extensive board discussions and marketing polls, a second choice, “New York–Presbyterian, the University Hospital of Columbia and Cornell,” was introduced to the public in the spring of 1999. Clinicians and senior administrators from the former New York Hospital remained dissatisfied with that option, which seemed to reduce “New York” to an adjective. A third variation, “NewYork–Presbyterian,” with no space between “New” and “York,” finally met with approval. The NewYork–Presbyterian merger created one of the largest health care institutions in the country and the largest medical center in New York City. With 2,170 beds and 12,400 employees, it was poised to control an estimated 16 percent of Manhattan’s hospital patient market and to draw in $1.5 billion in revenue in 1998.47 In addition, the merger led to a sizable expansion of the NewYork–Presbyterian Healthcare System, a reincarnation of the former New York Hospital Care Network of regional health care providers. By 2000, it contained 31 acute-care hospitals, 19 long-term care facilities, 11 home health agencies, 4 specialty institutes, and 103 satellite clinics and ambulatory care sites. Each institution in the network was affiliated with either Cornell’s or Columbia’s medical school, and many provided sites for medical student teaching.48 Initially, it took some time to coordinate NewYork–Presbyterian’s operations and administration, including financial and information systems, across campuses. The merger technically involved three completely independent corporate bodies—the NewYork–Presbyterian board, Cornell, and Columbia—with the 205

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hospital serving as the entity primarily responsible for balancing the relationships between institutions. At first, NewYork–Presbyterian hoped that the academic departments and clinical faculties of Cornell and Columbia would merge as well, but the medical schools balked at this proposal. Similarly, Cornell and Columbia strongly objected to Skinner’s idea of forming a hospital-controlled organization of doctors from their faculties. Both issues became significant points of contention, but in many ways, Cornell and Columbia ended up largely unaffected by the merger. The medical school deans continued to approve faculty appointments only at their own institutions, although a few individuals received appointments at both campuses. Collaborations between the medical schools have increased, but except for a handful of programs that have chosen to merge some of their activities, the academic departments, clinical services, and research activities of each have remained largely autonomous. Exceptions include rehabilitation medicine, which shares one department chair across Cornell and Columbia campuses, a combined center for pediatric cardiology, and jointly sponsored residency programs in otolaryngology and emergency medicine. The decision to allow physicians at Cornell and Columbia to maintain independent clinical practices was an important factor in the success of NewYork–Presbyterian’s merger. As David Hajjar, then dean of the Cornell Graduate School of Medical Sciences, put it, “The hospital merger worked because they decided to have two separate entities. In terms of clinical services, we continued to function independently. Our doctors are our doctors. They get a Cornell paycheck, and they work on our campus. The same up at Columbia. In the end, the merger became primarily focused on naming and branding opportunities and improved operational savings.”49 Still, the name proved to be a sticking point. More than fifteen years after the merger, NewYork– Presbyterian and its two main campuses at Cornell and Columbia were still often referred to incorrectly in the media. Asking an ambulance or a taxi to go to “NewYork–Presbyterian” without specifying which location would be likely to provoke some confusion. A New Name for the Centennial

In the midst of the preparations for the NewYork–Presbyterian merger, Robert Michels completed his term as dean in the spring of 1996. Dr. Carl Nathan, a professor of medicine and of microbiology, served as acting dean for the remainder of the year. That September, the appointment of Dr.  Antonio M. Gotto Jr. as the medical school’s thirteenth dean was announced in the New York Times, which described him as “a heart specialist who was an author of a best-selling cookbook”—a reference to The Living Heart Diet, one of a series of books for lay readers written in collaboration with cardiovascular surgeon Michael DeBakey.50 206

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Antonio M. Gotto Jr. Born on October 10, 1935, in Nashville, Tennessee, Antonio M. Gotto Jr. graduated from Vanderbilt University in 1957 with a degree in chemistry and minors in English and math. In 1959, he married his high school sweetheart, Anita Safford, whom he had met at the age of fifteen while on a bus to summer camp. A Rhodes Scholar, he earned a DPhil in biochemistry from Oxford in 1961, after working in a lab under the supervision of the biochemist Sir Hans Kornberg and with Nobel laureate Sir Hans Krebs as a mentor. Gotto then received his MD from Vanderbilt University in 1965. He completed residency training in medicine at the Massachusetts General Hospital and became head of the Molecular Disease Branch at the National Heart and Lung Institute, where he worked with Donald Fredrickson and Robert Levy in the field of cholesterol and lipid metabolism. Gotto joined the Baylor College of Medicine in Houston as a professor of medicine and biochemistry in 1971 and was appointed chair of medicine in 1976. He also served as chair for atherosclerosis and lipoprotein research and scientific director of the Michael E. DeBakey Heart Center at Baylor and the Methodist Hospital, and he ran a specialized center of research for atherosclerosis. He was a close colleague and friend of famed heart surgeon DeBakey and worked closely with Ted Bowen, president of the Methodist Hospital. An expert in preventive cardiology, Gotto was president of the American Heart Association in 1983. He also conducted basic science investigations in the field of atherosclerosis and was president of the International Atherosclerosis Society from 1985 to 1997. His laboratory was the first to synthesize an apolipoprotein, a key component of lipoproteins, and also determined the cDNA and amino acid sequence of apolipoprotein B-100, one of the largest proteins to be sequenced at the time and a major factor in the development of atherosclerosis.51 In addition, Gotto played a leading role in several landmark clinical trials. He was a principal investigator in the Lipid Research Clinics Coronary Primary Prevention Trial, the first large study to show that lowering levels of LDL-cholesterol can reduce the risk of heart disease.52 He also chaired the Air Force / Texas Coronary Atherosclerosis Prevention Study, the first to demonstrate that individuals with average levels of LDL-cholesterol can benefit from cholesterol-lowering statin drugs.53 In 1991 he was elected a member of the Institute of Medicine, and in 2001 he became a fellow in the American Academy of Arts and Sciences. While dean at CUMC, he assumed leadership positions with several organizations, including the 207

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Council of Deans of the Association of American Medical Colleges, the Association of Academic Health Centers, and the Associated Medical Schools of New York. Tributes from senior administrators, published in a special issue of the medical school’s alumni magazine at the end of his fifteen-year tenure, captured key elements of Gotto’s personality and leadership style. Gotto is described as “a man of great integrity, passion, and grace. He also has natural kindness and humility, attributes that cannot be taught.”54 Both “affable and self-effacing,” he “naturally induces people to want to help him and to do the right thing for him. He invites loyalty and excellence by being an unassuming gentleman and exemplifying high standards.”55 Gotto was also not one to micromanage. One department chair wrote: “He guides, mentors, and remediates by nudging, not browbeating. He frees his faculty to blossom and meet their potential.”56 Another described him as having “a remarkable knack for pushing things forward, even though people don’t always realize they are being (gently) pushed.”57 He and his wife Anita have three daughters, Dr. Jennifer Roberts, Gillian Gotto, and Teresa Teague.

Gotto had also published The Chez Eddy Living Heart Cookbook, which included recipes from a heart-healthy restaurant he had established at the Methodist Hospital in Houston in 1981. Three previous attempts to woo Gotto to Cornell from Texas—as a professor of cardiology in 1970 and as chair of medicine in 1980 and 1988—had proven unsuccessful. By the fourth try, however, his three daughters had grown up, and Gotto felt ready to move to New York and take on the challenge of becoming Cornell’s dean. Another factor that drew him to New York was Cornell University president Hunter Rawlings, who had previously tried to recruit him to the University of Iowa while he was serving as president there in the early 1990s. Under Dean Gotto’s leadership, major differences with NewYork–Presbyterian Hospital were ironed out. After the retirement of David Skinner in 1999, Herbert Pardes moved from his position as dean of Columbia University College of Physicians and Surgeons to president and chief executive of NewYork–Presbyterian Hospital. Gotto and Pardes had a long-standing professional relationship, demonstrated a clear desire to work together as a team, and inspired the boards of the medical school and hospital to follow their lead.58 In many ways, Gotto was able to change the tone of the interactions between Cornell and NewYork–Presbyterian simply by refusing to engage on the petty issues that had previously fueled so much rancor. For example, at one point there was a dispute about whether the 208

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medical school’s or the hospital’s cleaning service was responsible for a particular hallway. The matter was debated at the highest administrative levels, but since no one could reach an agreement, the hallway went uncleaned. Gotto chose to bypass these details of daily operations and instead focused on the key issues. The timing of his strategy was particularly apt, since NewYork–Presbyterian was increasingly preoccupied with managing its recent merger. Meetings of the joint board of the medical center, which had typically served as a forum for airing these kinds of minor grievances, stopped being scheduled. Gotto used the opportunity to build a consensus within Weill Cornell, promote cooperation with the hospital, and for the first time assert the medical college’s own strategic priorities independent of NewYork–Presbyterian.59 Gotto also built strong relationships with the growing network of institutions affiliated with Cornell and NewYork–Presbyterian. The year after he arrived in New York, he visited nearly all the affiliates that were involved in medical student teaching, appointed a dean at each, and established a Council of Affiliated Deans to meet quarterly and discuss academic relationships.60 By the end of 1999, a total of sixteen institutions had academic affiliations with the medical school and were part of the NewYork–Presbyterian Healthcare System. Cornell especially benefited from the partnership that Gotto forged, soon after arriving in New York, with Sanford “Sandy” Weill. A self-made billionaire, Weill built two financial empires—the firm known as Shearson Loeb Rhodes in 1981, then the country’s second-largest firm in the securities industry, and Citigroup, formed in a 1998 merger that made it the largest financial services company in the world. Weill served as Citigroup’s chief executive officer until 2003 and retired as chairman in 2006. He has also maintained a high level of involvement with Cornell over several decades. He served on the Cornell University Board of Trustees from 1989 to 1997 and subsequently became an emeritus member. In addition, he has been an active participant of the medical school’s board of overseers starting in 1982 and served as its chair from 1995 to 2014. Gotto and Weill first met on February 19, 1997, at a breakfast at the Regency Hotel. To set Weill at his ease and challenge his preconceptions of cardiologists, Gotto ordered eggs Benedict. He also made a good impression when the next person waiting to meet Weill for a business meeting at the Regency happened to be one of Gotto’s patients, flown in from the West Coast. With their relationship off to a promising start, they proceeded to have a series of meetings over the next year. On one particular occasion, Weill was able to simplify negotiations with NewYork–Presbyterian Hospital effortlessly. As CUMC was planning to occupy space in the Whitney Pavilion owned by the hospital, a problem had arisen. The hospital was prepared to offer a short-term lease with a high rent, while the medical college wanted a long-term lease at a much lower rent. After more than a year of discussion, David Skinner, president and chief executive of 209

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NewYork–Presbyterian, felt that the matter needed to be decided by the hospital and medical school boards, since the difference between their positions was too great. Skinner and Gotto each appointed two members to negotiate on behalf of their institutions. Weill was one of the medical school’s representatives and discussed the matter with Gotto. Initially, he thought that the gulf between what the two institutions wanted was quite wide, but he nonetheless assured Gotto with confidence that the meeting would be very short. Sure enough, he called Gotto to tell him he had gotten him his deal after just a few minutes of conversation. The mysterious nature of how business was done in New York City made a considerable impression on Gotto at the time. Another meeting on March 2, 1998, proved to be especially momentous. On that day, Gotto and Cornell University president Hunter Rawlings sat down with Sanford Weill and his wife Joan at Citigroup headquarters. Not unusually, Gotto’s prior meeting ran late, and he and Rawlings were apprehensive, as Weill was known for arriving ahead of appointed times for meetings. Their objective, according to Rawlings, was simply not to get thrown out of the office. When the meeting started, Rawlings and Gotto proposed renaming the medical school in honor of the Weills, who were flabbergasted at the possibility. When Mr. Weill said he was waiting for the other shoe to drop, they replied that they had determined that an appropriate gift would be $100 million. Although he had been expecting a solicitation of a different order of magnitude, Weill promised to think about it. That night, according to Joan, “We made the chicken, and then we just sat there and stared at each other. We were very overcome that we were in a position to do it. It just floored us.”61 The following morning, Mr. Weill called Gotto and agreed to the proposal. He also added that he and his wife wanted Gotto to commit to being dean for an extended period of time and that they wanted to be active participants in the life of the medical college. On April 14, 1998, Cornell University Medical College kicked off a yearlong celebration of its centennial anniversary. Anthony Fauci, a 1966 graduate and director of the National Institute of Allergy and Infectious Diseases, gave the keynote address, titled “Return of a Native Son,” in which he proclaimed: “I carry around a bit of Cornell with me at all times, whether I am conducting a bench experiment, designing and executing a clinical trial, taking personal care of a very sick patient, looking something up in the library, or even testifying before Congress. It is all anchored here at Cornell. . . . And take it from a native son who went away—it stays with you forever.”62 Attendees at the festivities received red centennial umbrellas as souvenirs. In May, the medical school held a Centennial Science Symposium, with faculty members presenting scientific highlights from the medical school’s first hundred years, as well as a Centennial Community Block Party, which offered free medical services such as vision testing.63

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Figure 9.2 Sanford Weill and Antonio Gotto at the medical school’s centennial celebration, April 14, 1998. (Courtesy of Weill Cornell Medical College.)

At a press conference held on April 30, 1998, Rawlings and Gotto made one of the biggest announcements in the medical school’s history: it was acquiring a new name and would henceforth be known as the Joan and Sanford I. Weill Medical College and Graduate School of Medical Sciences of Cornell University. Gotto pronounced the occasion “the second most defining moment in the illustrious history of our Medical College,” after the school was founded one hundred years ago.64 With his wife Joan at his side, Sanford Weill spoke about their philanthropy: “I have been a New Yorker all my life. We like to do things that will improve the quality of life in New York City.”65 At the time, their gift of $100 million was among the twenty largest to an American university and the single largest ever received by Cornell. Some alumni were opposed to the name change. At reunion activities in October 1998, a few individuals challenged Gotto during a luncheon questionand-answer session, practically accusing him of selling the medical school to the highest bidder. According to Dr. Rees Pritchett, who was the class representative for the graduates of 1948 celebrating their fiftieth reunion, many alumni were “furious,” adamantly declaring that they had graduated from Cornell University Medical College, not Weill Cornell Medical College.66

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Still, the Weills’ donation was a huge boon to the medical college. Fund-raising for the New Horizons for Medicine campaign had grown sluggish after a few years, and the medical school had raised only about $65 million of its $200 million goal by 1997.67 At one point, Gotto spoke with the campaign chair, Hamish Maxwell, who told him that board members were unwilling to give any money because they believed that Cornell’s and Columbia’s medical schools were on the verge of merging. With the Weill gift, Weill Cornell Medical College was finally able to complete the New Horizons campaign in 1999, after raising a total of $211 million. Funds went toward renovating laboratory space in the Whitney Pavilion that the hospital had vacated after moving into the Greenberg Pavilion, in addition to the new curriculum and the Weill Education Center. A  total of twenty-eight basic science faculty members were recruited, bolstering the medical school’s research programs and its ability to attract funding from the National Institutes of Health. In addition, nearly three hundred housing units were acquired, including an apartment building in a new residential community on Roosevelt Island, and a new biomedical imaging research facility was planned. The conclusion of the New Horizons for Medicine campaign gave Weill Cornell a fresh start for the new millennium. Writing at the time of the medical school’s centennial in 1998, microbiologist and longtime faculty member Dr.  Carl Nathan clearly summarized the situation: “The last decade of CUMC’s first century constitutes an astonishing demonstration that a large academic institution can indeed bootstrap in a big way in a short time, once people decide to work together. . . . Not only did the medical school stay afloat while crossing a stormy sea of hospital realignments, but the magnificent gift from Joan and Sandy Weill quelled waves of fear of its imminent engulfment. Never has the medical college been more soundly positioned to improve human health.”68

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10 Forging Ahead in the Twenty-First Century as members of our community, your lives enriched us. through your selfless actions on sept. 11, 2001, you inspired us. in your memory, we renew our commitment to the care of our patients, our city, our nation.

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Inscription on “Inspired to Care” memorial

On September 11, 2001, news of the attacks on the World Trade Center hit the Upper East Side within minutes. Emergency room staff at NewYork–Presbyterian / Weill Cornell waited anxiously for a flood of injured patients, but tragically, few arrived. Two members of the medical center’s emergency medical services, Keith Fairben and Mario Santoro, were first responders and lost their lives trying to save others at the Twin Towers. Two firefighters and former paramedics at the hospital, Kevin Priefer and James Pappageorge, also perished in the disaster. A year later, a monument in their honor, designed by the artist Ed Schlossberg and titled “Inspired to Care,” was placed on the ambulance ramp to the emergency department, overlooking the East River. A video recognizing the collective efforts of the medical center’s staff was distributed to all employees as part of the first-anniversary commemoration.1

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Figure 10.1 On October 1, 2001, His Highness Sheikh Hamad bin Khalifa Al Thani, emir of the state of Qatar, made a visit to the medical center to express his personal condolences to the people of New York following the events of September 11. He announced a $1 million gift to benefit the burn center, which treated patients who had been severely burned in the World Trade Center disaster. Shown with the emir are, from left, Sanford Weill, Dean Antonio Gotto, and Cornell University president Hunter Rawlings. (Courtesy of NewYork–Presbyterian.)

As New York gradually started to recover from the tragedy, the theme of resilience began to take hold. The city had suffered the largest terrorist attack on U.S. soil in history, yet it was rebuilding physically and psychologically. And while Weill Cornell was renewing its commitment to caring for patients throughout the city, it was also looking well beyond those borders. The first years of the new millennium were characterized by an entirely new level of global engagement at the medical school, with the launch of a branch campus in the Middle East, a transnational affiliation with a hospital in Houston, and a proliferation of educational and research exchange programs around the world. These initiatives reflected the belief that medicine and education could help bridge the divides that separate different cultures. As Dean Gotto explained in a New York Times article announcing the medical school’s plans to open a campus in Qatar, “I am convinced that medicine and health are global problems, and we in the United States have an obligation to work with the rest of the world.”2 Weill Cornell’s increased involvement in global health also reflected a larger trend throughout the country, including at Cornell University, 214

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which was attempting to become “the land grant university to the world.”3 As globalization was producing an increasingly interconnected world, a number of universities in the United States began setting up international branch campuses and experimenting with foreign partnerships of various kinds. Weill Cornell’s academic ventures in the national and international arenas were possible because the medical school had finally attained a sound financial footing, after decades of turmoil and insecurity. Strong leadership and a clear vision for the future inspired a dramatic increase in philanthropy, which fueled vigorous growth in the school’s clinical, research, and educational programs in New York and enabled it to expand its mission even further to encompass global health. With a plan to remake itself into one of the nation’s leading researchoriented medical schools, Weill Cornell was eager to explore new models of what an academic medical center could look like in the new millennium. One of its boldest undertakings was the creation of the Weill Cornell Medical College in Qatar (WCMC-Q), which was founded as a partnership between Cornell University and the Qatar Foundation.4 An emirate in the Arabian Gulf, Qatar was aspiring to become a regional and international leader in the political, economic, and cultural arenas. As part of a comprehensive plan of self-transformation, it began aggressively developing its educational system and health care infrastructure as long-term investments designed to outlast its rich, but finite, energy resources.5 Cornell’s interest in establishing Qatar’s first medical school and its first coeducational institution of higher learning was piqued by two New York congresswomen. In March  1999, Carolyn Maloney and Sue Kelly from the U.S. House of Representatives observed Qatar’s first municipal elections, in which women were allowed to participate as both candidates and voters. They helped connect Cornell with the Qatar Foundation for Education, Science and Community Development, an independent nonprofit set up in 1995 by the emir, Sheikh Hamad bin Khalifa Al Thani. The Virginia Commonwealth University in Qatar School of the Arts had recently become the first international branch campus to take up residence in Education City, a twenty-five-hundred-acre campus located in the capital city of Doha, and the Qatar Foundation offered Cornell the opportunity to join the educational experiment as well. Cornell and its medical school were intrigued. Both recognized that the potential impact on Qatar and the region—by training physicians with roots in the Middle East, raising standards of health care, and stimulating scientific research—was enormous. Discussions began in January 2000 when Dean Gotto visited Doha with Daniel Alonso, senior associate dean for academic affairs, and Maria New, chair of pediatrics. Six months later, Gotto and Sheikha Moza Bint Nasser Al-Missned, wife of the emir and chairperson of the Qatar Foundation, signed an initial memorandum of understanding. After additional negotiations and extensive input from James Mingle and James Kahn in the office of university 215

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counsel, Cornell signed a formal agreement with the Qatar Foundation on January 25, 2001, to establish a branch of the Weill Cornell Medical College in Doha. The Qatar Foundation agreed to invest $750  million over eleven years to develop the school, in addition to paying a management fee and making a donation to Weill Cornell. In a New York Times article, Cornell University president Hunter Rawlings noted that members of the university community, particularly some Jewish trustees and alumni, had been initially concerned about conditions in Qatar related to human rights, the treatment of women, and the country’s political stability. Dean Gotto described additional doubts that were raised: “It’s far away. It could be dangerous. They have very different customs. You might dilute your resources, and distract your management. You may not be able to recruit faculty or find students. Some of your alumni and friends may not understand it.” However, Rawlings related that “as [people at Cornell] learned more about Qatar and its ambitions, they were willing to proceed.” He confirmed that the medical college would have a nondiscrimination policy similar to that of Weill Cornell in New York and would accept Jews, including Israelis, as students and faculty members. As Sanford Weill emphasized in the article, “I don’t think Arab-Jewish relations are the issue at all. This is about health care, medical education and medical research. We’re not in the political business, we’re in the science business, the education business.”6 Plans were developed to transplant Weill Cornell’s administrative and educational methods to Qatar, while making specific adaptations for the local context. It was agreed that WCMC-Q’s faculty and academic programs would ultimately be governed by Cornell’s president and boards, while the Qatar Foundation would provide the facilities and fund the operating costs for the new college. Dr. Daniel Alonso was appointed the first dean of WCMC-Q, reporting directly to Dean Gotto in New York. Originally from Argentina, Alonso had spent his entire career at Weill Cornell. His motivations for moving halfway across the world were straightforward: “How often does a medical educator get to build a medical school from scratch, even designing the building? I have been teaching, conducting research and working as a dean for a long, long time. My entire professional life has been a preparation for this challenge.”7 Academically, WCMC-Q designed a two-year premedical program for high school graduates leading into a four-year medical program. The premedical curriculum mirrored Cornell University’s, while the Weill Cornell campuses in New York City and Qatar shared the same medical curriculum, in addition to identical assessment methods and graduation requirements. To prepare Qatari high school graduates for the rigors of premedical and medical study, WCMC subsequently created a yearlong foundation program, which included training in the English language, study skills, and introductory math

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and science. Premedical faculty members in Qatar were appointed by Cornell University, while the medical faculty held appointments by Weill Cornell in New York. Construction of a new building for WCMC-Q commenced in April 2002. That fall, the first twenty-seven premedical students, including eighteen women, started classes. Fourteen were Qatari nationals, while others hailed from Bosnia, Canada, India, Iran, Jordan, Lebanon, Nigeria, Syria, and the United States. Official inaugural ceremonies for the medical school were held in October 2002. A year later, a delegation of more than sixty Weill Cornell overseers, Cornell trustees, administrators, and alumni traveled to Doha to celebrate the opening of WCMC-Q’s permanent home, a 375,000-square-foot facility designed by the Japanese architect Irato Isozaki. The first class of sixteen medical students entered in the fall of 2004, chosen from seventy-two applicants, including twenty-three who had completed the premedical program.8 Medical students began receiving clinical instruction at the Hamad Medical Corporation, the state health care provider and the medical school’s affiliated hospital system, where a large number of physicians were appointed members of WCMC-Q clinical faculty. Students also gained hands-on experience at community-based outpatient clinics and, starting later in the decade, at Aspetar, a sports medicine and orthopedic hospital. In 2008, the Qatar Foundation began construction on the Sidra Medical and Research Center, a specialty hospital and research facility focused primarily on women and children’s health, with advice from Weill Cornell and NewYork–Presbyterian. Its goal was to create an American-style academic medical center in Doha, to be anchored by WCMC-Q as its university affiliate. Initially, cultural differences posed a few unique challenges. To compensate for the absence of a tradition of body donation in the Middle East, Weill Cornell began shipping cadavers from New York to Qatar for gross anatomy courses, instead of using simulations. Owing to prevailing gender norms, female students were often hesitant about speaking up or challenging men in public settings. Another difficulty was finding enough female patients willing to have male students perform pelvic exams as part of their training. To deal with these kinds of gender-related issues, the medical school instituted cultural sensitivity sessions for faculty, and for the most part Weill Cornell’s experience with coeducational instruction in an Islamic context went smoothly. The first commencement of fifteen graduates took place on May 8, 2008, with Cornell University president David Skorton as the principal speaker. The occasion marked the first time that a medical degree from a U.S. university was awarded overseas. Sheikha Moza attended the ceremony and was presented with a physician’s white coat and a framed proclamation recognizing her contributions to education.9

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By that time, the New York Times was able to report that Doha’s Education City “has fast become the elite of Qatari education, a sort of local Ivy League.” The campus already boasted satellites of five American universities and would go on to incorporate three additional branches of institutions from the United States, the UK, and France. According to the newspaper’s analysis, the results of Qatar’s educational experiment were likely to have a liberalizing effect on the country: “Education City graduates will be a broadly educated elite, who have had extended contact with American professors and American ways of thinking, and, in some cases, spent time at their school’s home campus back in the United States. Although it is still small and new, it could be a seedbed of change, with a profound impact on Qatar’s future and its relations with the United States—and perhaps, some Qatari parents worry, on their traditional way of life.”10 Student outcomes from WCMC-Q’s early graduating classes indicated that the college was meeting one of its main educational goals—to train physicians in Qatar to the same standards as their New York counterparts. Students’ average scores and pass rates on the United States Medical Licensing Examination Steps 1 and 2 were the same as the U.S. average, while the number of WCMC-Q’s graduates who matched to residency programs in the United States was steadily increasing. In 2009, WCMC-Q was ready to move on to the next stage of its development. The Qatar Foundation signed an agreement for Cornell to assemble a self-sustaining biomedical research program at WCMC-Q, which it agreed to fund at a cost of $179 million over five years. Research would focus on non-communicable diseases and genetic disorders that are especially prevalent in Qatar, and faculty and personnel were recruited to staff brand-new laboratories. Four New York–based scientists were enlisted to help jump start the program by mentoring and collaborating with junior faculty in Doha.11 In one of the school’s early achievements, researchers sequenced the genome of the date palm, a staple food in the Middle East, and began investigating potential agricultural implications of their findings.12 By the end of 2011, Weill Cornell in Qatar had laid a solid foundation for becoming the hub of an academic medical center modeled along U.S. lines. It was training high-quality physicians, its faculty was helping to improve the health of the local population, and its researchers were beginning to investigate topics of particular relevance to the region. Cornell’s positive experience in Qatar illustrated that medical education could be successfully transferred from one culture to another and that close academic collaborations could survive a distance of nearly seven thousand miles. As Gotto remarked in an interview conducted on the eve of his retirement as dean, “I think that if anything can create better relationships among different cultures and different parts of the world, it’s medicine.”13

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Additional Forays in Global Medicine

Although the creation of a new medical school in Qatar was one of Weill Cornell’s most visible and dramatic forays in the world of global medicine, numerous other projects blossomed at the beginning of the new millennium.14 One not quite so far away involved the Methodist Hospital (subsequently renamed the Houston Methodist Hospital), a private, nonprofit 935-bed hospital located in the Texas Medical Center. Like the medical school’s branch campus in Doha, the partnership that NewYork–Presbyterian / Weill Cornell formed with Methodist was the first of its kind. In April 2004, the Baylor College of Medicine ended its forty-year affiliation with Methodist.15 This move destabilized Methodist, which had no independent research infrastructure or system for training hospital residents on its own. With no academic affiliate, Methodist stood to lose many of its staff members to Baylor and Baylor’s new teaching hospital, St. Luke’s Episcopal Health System. As a former chair of medicine at Baylor and chief of internal medicine at Methodist, Gotto had long-standing relationships with Methodist’s leadership, including its chief executive officer Ron Girotto and board chairman John Bookout, and had previously introduced individuals at Methodist and Weill Cornell to each other. According to an article jointly coauthored by many of these administrators, these “personal connections facilitated informal discussions,” which “led rapidly to formal negotiations about a substantive academic affiliation” between Methodist, Weill Cornell, and NewYork–Presbyterian.16 Mutual trust and respect were key to these conversations, which were bolstered by the strong bonds that continued to develop among the institutions’ administrative heads, Gotto and Girotto, and their board chairmen, Sanford Weill and Bookout. In addition, the idea of forging an affiliation between the two medical centers seemed feasible to both parties, even though they were separated by sixteen hundred miles, since they shared a common mission, were not competing for the same patient population, and could collaborate productively on research. The possibility of crafting a new transcontinental model for academic health centers was also attractive and evoked “a spirit of adventure” among the involved parties.17 After just two months of discussion, the boards of Methodist, Weill Cornell, and NewYork–Presbyterian lent their support to the proposal, and a formal affiliation agreement was signed on June  24. Weill Cornell became Methodist’s primary academic affiliate and its only affiliation in New York, while Methodist became Weill Cornell’s primary affiliate in Texas. It was agreed that members of Methodist’s medical staff would be eligible to apply for faculty appointments at Weill Cornell, and Methodist department chairs would acquire primary academic appointments in New York. The institutions

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also planned to collaborate on medical student and resident education, research training and projects, and clinical quality improvement. Weill Cornell would assist Methodist in creating its own research support infrastructure, while NewYork–Presbyterian would help it develop residency programs. In addition, medical students from New York would have the option of taking clinical electives in Houston. Methodist and Weill Cornell soon began collaborating on clinical research activities, including symposia, pilot grants, and a faculty training program. Regular visits between New York and Houston commenced in the fall of 2004, and Dr. H. Dirk Sostman, an executive vice dean at Weill Cornell, moved to Houston to further facilitate academic collaborations as executive vice president of the Methodist Hospital system. After just one year of affiliation, more than one hundred Methodist staff had received or applied for faculty appointments at Weill Cornell. Residents were training at Methodist again, and plans to build a new research institute were developing. Six collaborative research projects had been selected for funding, and a system for conducting clinical trials jointly between Houston and New York was on the horizon.18 Within five years, more than three hundred Methodist physicians and scientists had received Weill Cornell appointments, and Methodist was sponsoring twenty residency programs with more than 150 residents. A new building for the Methodist Hospital Research Institute had been completed and formed a base for research and clinical trials at Methodist. Affiliated with Weill Cornell, the research institute also housed a cutting-edge facility for surgical training and simulation, where medical students and physicians were able to learn techniques ranging from robotics to endoscopy to minimally invasive cardiac surgery.19 Although the loss of an academic affiliate located just a few blocks away was initially a major blow to Methodist, the partnership it formed with NewYork–Presbyterian / Weill Cornell helped it to remake itself as part of the first transnational academic medical center in the United States. The affiliation between Weill Cornell and Methodist enabled both institutions to offer their trainees and faculty educational and research experiences in parts of the country they might not otherwise have access to. Weill Cornell’s numerous global health initiatives accomplished a similar function for its students, clinicians, and investigators. In 2000, Dean Gotto demonstrated his commitment to international educational exchange by setting up an Office of Global Health Education. Throughout the following decade, at least one-third of fourth-year medical students took clinical or research electives abroad, while a sizable number participated in international projects during the summer after their first year of medical school. They traveled to a variety of countries where Weill Cornell maintained formal exchange programs, including Argentina, Australia, Austria, Brazil, Denmark, Germany, Haiti, India, Peru, Tanzania, and the UK. 220

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Students also initiated significant global health projects of their own. In 2007, a group involved with the Weill Cornell chapter of Universities Allied for Essential Medicines helped place the cholesterol-lowering drug simvastatin on the World Health Organization’s list of essential medicines. Intended to help developing nations gain access to high-priority drugs inexpensively, the list made it possible for the United Nations and philanthropic foundations to donate large quantities of a generic version of the drug to countries in need.20 Student interest also fueled the development of a global health curriculum, which was launched as an elective in the fall of 2009 for individuals interested in working with resource-poor communities in the United States and abroad. Supported by faculty with global health interests, the curriculum consisted of three elective courses, two applied experiences, and a monthly global health grand rounds. In its pilot year, thirty students registered for the weekly first-year course, An Introduction to Global Health. 21 At the start of the twenty-first century, Weill Cornell significantly increased its involvement in Tanzania, a country in sub-Saharan Africa with one of the lowest ratios of physicians to patients in the world. Plans to build a medical school in the western Tanzanian region of Mwanza had been brewing for a number of years, and Father Peter Le Jacq, a Weill Cornell alumnus, asked his alma mater to provide assistance. The board of overseers, including former Iranian ambassador Hushang Ansary and Sanford Weill in particular, indicated their strong support of the project. After the Bugando University College of Health Sciences (BUCHS) opened in 2003, Weill Cornell, the Tanzanian government, and the Touch Foundation, founded to help fund Father Le Jacq’s work in Tanzania, began collaborating to further the school’s development. Sanford Weill, Dean Gotto, and a delegation of Weill Cornell faculty traveled to Mwanza to assess possibilities for an exchange program, and Weill Cornell signed an affiliation with BUCHS and its neighboring hospital, the Bugando Medical Centre, in 2006. 22 The following year, the banking and financial services corporation Citigroup made a $5 million gift in honor of Sanford Weill, its former chief executive, to help support the new medical school, which was renamed the Weill Bugando University College of Health Sciences. With support from foundations and donors, Weill Cornell began sending residents, postdoctoral fellows, and faculty to Tanzania to teach on the hospital wards and conduct tutorials. Students also traveled to Mwanza to work with local faculty and students, where they gained a very different perspective on the practice of medicine. One Weill Cornell faculty member moved to Mwanza to facilitate the exchange program, and Tanzanian faculty, residents, and students began visiting New York for periods of training. Weill Bugando’s first graduating classes of new physicians numbered about one hundred. Weill Cornell’s long-standing program in Haiti drew some scrutiny with the publication of a New York Times special report in 1999. The GHESKIO 221

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organization, which had been founded by alumnus and faculty member Dr. Jean Pape in 1981, provided “some of the best AIDS treatment available in a country devastated by the epidemic.” Yet “that is a lower standard of care than patients receive routinely at American institutions,” the article continued. Although GHESKIO provided free condoms, screening, and treatment for HIV, venereal disease, and tuberculosis, it did not offer Haitian patients costly antiretroviral drugs that effectively suppress the AIDS virus. The article additionally questioned the ethics of a research study at the clinic that examined sex partners, only one of whom was infected with HIV. In an attempt to develop a vaccine, researchers studied the blood of both partners, “particularly the uninfected ones who continue to be exposed to the virus through unprotected sex.” Although the article highlighted the “moral ambiguities of AIDS research in indigent countries,” it also concluded with a quote from Dr. Pape, a native of Haiti: “You have to take into account people who mean well for their country and not impose on them things that you feel are good for Western ideas.”23 A decade later, GHESKIO played a pivotal role supporting international emergency relief efforts in the wake of the 2010 earthquake that devastated Haiti’s capital city of Port-au-Prince. Within days of the disaster, refugees began camping on the field next to the clinic, and GHESKIO quickly set up a “tent city” to house, feed, and provide free health care services to more than seven thousand individuals left homeless. In a dispatch to the New England Journal of Medicine published a month after the earthquake, Dr. Pape and the codirectors of Weill Cornell’s Center for Global Health, who were working from Haiti and New York, described their attempts to provide medication to the thousands of GHESKIO’s patients who customarily received treatment for AIDS and tuberculosis: “We try to contact patients by cell phone, but most patients do not have electricity to charge their batteries. One of our doctors went on a popular radio station to announce that GHESKIO is open and also provided the names of hospitals in the countryside that can provide drugs. About 65% of our patients are coming to the clinic, although public transportation is very limited. Another 15% receive their medications at four designated delivery sites. Approximately 20% of patients are unaccounted for.”24 Later in 2010, a cholera epidemic erupted in Haiti and spread through contaminated drinking water. In response, GHESKIO implemented large-scale vaccination, treatment, and clean water programs. That year, the organization received the Gates Award for Global Health, and Dr. Pape was honored with the Clinton Global Citizen Award, in recognition of his and GHESKIO’s efforts to treat and research HIV/AIDS and for their work in the aftermath of the earthquake. 25 With the aid of corporate donations, GHESKIO began to construct new facilities to replace three hospitals that had been destroyed, including a tuberculosis clinic and a family nutrition center for maternal and 222

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child health. It also offered programs in vocational training and microcredit to help four thousand of its tent city residents find jobs, return to their communities, and rebuild their homes.26

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Advancing the Clinical Mission

Back at home in New York, Weill Cornell was engaged in a concerted effort to transform itself from a relatively small medical school with a strong clinical reputation into a competitive, research-oriented player in the world of academic medicine. On September 8, 1999, with its first strategic plan and its accompanying New Horizons for Medicine campaign barely completed, Dean Gotto and Sanford Weill, at a breakfast meeting at the Regency Hotel, began laying the groundwork for their next major undertaking. A month later, they met again at the same venue to ask overseer Kevin Brine to chair a new capital campaign. Fund-raising was becoming increasingly important to the medical school, which needed new faculty and more space to develop its capacity in biomedical research, historically its main area of weakness. Although clinical revenues were robust, they were not sufficient to fuel the extensive growth that Weill and Gotto envisioned. Any surplus needed to be reinvested in the medical school’s Physician Organization, while raising tuition fees or borrowing large sums of money were not viable options. A philanthropic campaign was key to achieving Weill Cornell’s goals. The medical school’s leadership decided that the first step was to focus on strengthening its clinical practices even more and improving the care that it could offer patients. This strategy required “a huge investment in the most expensive city in the country in the richest congressional district in the country.”27 It was anticipated that a successful campaign would put Weill Cornell in a solid position to tackle a subsequent phase of growth in the research arena. The medical school proceeded to solicit proposals to create or expand more than 150 clinical programs. Sixty programs were then asked to submit detailed business plans, and thirty-seven programs were chosen as target areas for the campaign. Blueprints were drawn up for a new building to serve as Weill Cornell’s first facility dedicated to ambulatory care, and the medical school prepared to recruit sixty-four faculty members. 28 “Advancing the Clinical Mission,” a strategic plan and $750 million campaign, was launched at a press conference held on January 8, 2002. The timing of the announcement was intended to foster optimism in New York City following the economic upheaval engendered by the events of September 11 and the collapse of the Enron Corporation a month later. A $100 million gift from Joan and Sanford Weill and a $50 million donation from Maurice and Corinne Greenberg and the Starr Foundation kicked off the campaign that day. Shortly after the press conference, which was attended by Mayor Michael Bloomberg, 223

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Joan Weill joked with Gotto, saying, “You don’t have to be nice to me anymore; we have no more to give.” However, on that rare occasion, she proved to be wrong, as the Weills would go on to give an astounding total of $600 million to Weill Cornell and Cornell University by the end of 2014. To support the Advancing the Clinical Mission campaign, the Dean’s Council and the Lewis Atterbury Stimson Society were formed in 2002. Members of the Dean’s Council helped promote the campaign and had opportunities to interact with Weill Cornell faculty and leadership, both informally and through a series of educational events. The Stimson Society, named after one of the medical school’s founding professors, honored individuals who included a commitment of at least $10,000 to Weill Cornell in their financial and estate plans. After a year, total membership numbered 212. 29 The Weill Cornell Board of Overseers, inspired by the Weills’ generosity, played a substantial role in the campaign, contributing about 60 percent of the total goal. Two $50 million challenge matches, which allowed donors to be recognized for their own gifts plus an equivalent amount in matching funds, helped motivate new and longtime supporters and provided important financial boosts. Development officers were hired specifically to support the medical school’s campaign, although fund-raising efforts were typically coordinated jointly between Weill Cornell and NewYork–Presbyterian.

Anecdotes on Sandy Weill

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Excerpted remarks by Dr. Antonio Gotto Jr. at a tribute dinner to Sanford I. Weill, January 30, 2015

My wife, Anita, and I could have searched the world over and not found a better pair of partners than Joan and Sandy Weill. Whether it was kidnapping an overseer on their boat until he pledged a large gift or relaxing in a hot tub, snake dancing in Tanzania to belly dancing in Turkey, our experiences were in good humor, good taste, and good for Weill Cornell Medical College. For Sandy’s seventieth birthday, the college wanted to give him a surprise party. It is very hard to surprise Sandy about anything—and everyone who knows him also knows that he is very inquisitive. So I asked Joan how we could manage to lure him to a party without him becoming suspicious. She said, “I can tell you exactly how to do it— tell him Sheika Moza will be there. He’ll go anywhere, any time to meet Sheika Moza.” So we followed her advice, and it worked. After almost fifty trips to Qatar—mostly on Sandy’s plane at his expense—I got a call one day from Sandy with a request: “I am not

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going to take my plane to Doha this time. Can you come with me and teach me how to fly commercial?” This request was legitimate. First, he packed his favorite corkscrew in his briefcase, and we had to go through security three times before it was discovered and confiscated. About halfway through the return flight, I had the feeling I was being observed. Sandy had not worked out the technology to lower the partition between our compartments, and he was standing on tiptoes peeping over the top. He said, “I just wanted to see what you were doing.” Another thing I introduced to Sandy was Amarone wine. Sandy is a lover of fine wines, and he liked Amarone so much we went to some wineries near Verona. I purchased one case—and when Anita got the bill, she canceled my American Express card. Sandy bought over a hundred—so many that there was an acute shortage of Amarone in Italy. One brief story about Sandy and his doctors: Sandy was entering the hospital for a procedure and met with his surgeon. Sandy said to him, “I want you to know that you are not in my will, and it will be much better for you and the College if I leave in an upright position.” Fortunately for all of us, he left the hospital and remains in an upright position. Sandy, you have been indispensable, priceless, and a lot of fun. One final anecdote: When I took Sandy to Houston Methodist Hospital to announce our affiliation, we entered the lobby of the hospital. Sandy looked around and said, “This looks more like a Four Seasons Hotel than a hospital.” The first statue we saw was of Michael DeBakey, the famed heart surgeon. The next was a tall statue of Jesus, laying his hand on a woman who was kneeling. As we rode past on the escalator, Sandy said, “Tony, who is that guy?” To which I responded: “He was a great Jewish healer.”

Dean Gotto’s ability to form personally meaningful relationships with donors figured prominently in the campaign’s ultimate success. In many cases, he and his wife, Anita, became close friends with supporters of the medical school. One year during Weill Cornell’s reunion weekend, the Gottos and another couple decided to venture into Times Square to see how much it had changed in recent decades. They found a pinball parlor and spent a couple of hours playing pinball and enjoying each other’s company. A few months later, Gotto needed to cement a pledge that the other couple was considering as support for the medical college. Although large gifts are typically solicited in person, Gotto called the prospective donor while sitting on an airplane tarmac in Los Angeles and, because of the friendship that had already been forged, was able to obtain a commitment for 225

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$6  million.30 As Larry Schafer, vice provost for external affairs and longtime head of development, put it, “He approaches donors as valued friends—and when gifts come in, he is as happy for the donor as he is for Weill Cornell, because he knows that a special bond has been created.”31 Advancing the Clinical Mission, one of the largest fund-raising campaigns undertaken by a medical school at the time, was completed in 2006, a year ahead of schedule. It provided funding to support clinical programs, including cardiac services, the brain, aging, children’s health, and women’s health, and to recruit ten clinical department chairs and additional faculty. It also raised $18  million in student scholarships, which helped keep the average debt of graduating medical students lower than the national average. The centerpiece of the campaign was the Weill Greenberg Center, a thirteen-story, 330,000square-foot building focused on ambulatory patient care. In a lengthy process, Weill Cornell applied for and was granted a variance by New York City to construct a larger building than would typically have been allowed. When it opened on January 26, 2007, the Weill Greenberg Center, named in honor of Joan and Sanford Weill and Maurice and Corinne Greenberg, housed, in warm and spacious surroundings, many of the clinical programs that had been created or expanded as part of Advancing the Clinical Mission. The Margaret and Ian Smith Clinical Skills Center, which contained specialized technology for teaching medical students with actors trained to portray patients and with simulations, was also incorporated into the building, as was the educational Myra Mahon Patient Resource Center.32 Designed by the architectural firms Polshek Partnership and Ballinger, the Weill Greenberg Center was laid out and decorated with the patient experience in mind. The new building contained modern furniture, soothing colors and finishes, and contemporary art intended to promote a healing, spa-like environment. It also had larger exam and waiting rooms, with reception and checkout areas placed to be more patient friendly. The facility received several design awards, including Modern Healthcare’s Design Award of Excellence in 2008 and the National Design Award of Merit from the Society of American Registered Architects in 2010.33 A patient-centered focus was also evident in other areas of the medical center’s clinical operations. In preparation for the opening of the Weill Greenberg Center, the Physician Organization launched the Weill Cornell: We Care initiative, which began making a variety of improvements to the outpatient experience. These upgrades included a comprehensive physician directory, patient-friendly billing statements, improved signage, and a specialized telephone system to make it easier to schedule appointments.34 And in 2005, a New York Times article described the hospital’s recently opened Jay Monahan Center for Gastrointestinal Health, located across from the Weill Greenberg Center and named in honor of television anchor Katie Couric’s late husband, 226

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Figure 10.2  Students train with a simulated patient in the Margaret and Ian Smith Clinical Skills Center, which is directed by Dr. Yoon Kang. (Photo by Roger Tully; courtesy of Weill Cornell Medical College.)

who passed away in 1998 from colon cancer: “Nearly every aspect of the center seems to have been considered from a patient’s viewpoint, with the aim of blunting the tension-inducing cues of a typical doctor’s office.” As the facility’s architect Robin Guenther explained, patient-centered care made good business sense: “While [patients are] not necessarily qualified to make judgments about the relative excellence of medical treatment, they make a lot of judgments based on their experience when they walk through the front door.”35 Empathy and Education

Since World War II, medical schools around the country had introduced elements of the behavioral sciences, humanities, and bioethics into the curriculum, with the goal of training students to be more empathetic and to view the patient as a whole person.36 At the start of the twenty-first century, medical educators were increasingly aware of the need to prepare students for the challenges of practicing medicine in the new millennium. Doctors were relying more and more on technology rather than physical exams, they were working 227

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longer hours and seeing more patients, and they were becoming burned out and overwhelmed with insurance paperwork. To combat the resulting trend toward emotional fatigue, Weill Cornell introduced several initiatives designed to cultivate empathy and humanistic values in medical students, including the Humanities and Medicine program in 1999. Performers from across the humanities were invited to campus, so that students could experience medicine within a broader context and explore creative interests. The first presentation in the series was a performance of the one-act play Wit, which centers on an English professor dying of ovarian cancer. According to the actress Kathleen Chalfant, who played the main character, “We were all very nervous doing it for a roomful of doctors and medical students. But we got laughs we don’t ordinarily get. We got medical student laughs—they laughed at things that medical students would find funny that other people don’t. There was a huge guffaw at the beginning of the grand rounds scene.”37 Other events included informal talks with the writer Susan Sontag on illness and cancer and with the novelist William Styron on depression.38 The Humanities and Medicine program also began a collaboration with the Frick Collection, an arts museum located near the medical center. Titled “The Art of Observation,” the class was designed to improve students’ observational skills through the study of paintings.39 It was modeled after a class that was initiated at Yale after its creator became disturbed by the perfunctory treatment her friend had received by a resident prior to surgery. Designed as an antidote to contemporary medicine, where speed, efficiency, and technology often take precedence, the program asked students to notice and interpret visual cues in the human face and body by examining paintings. In one exercise, they analyzed two juxtaposed portraits by the sixteenth-century artist Hans Holbein—one of the Catholic martyr Sir Thomas More and the other of his Anglican nemesis Lord Thomas Cromwell—without being informed of their historical context. Students focused on the physical qualities of the figures, describing why More appeared sympathetic in comparison to Cromwell, who appeared scheming. According to Amy Herman, the Frick director of education and a creator of the program, the class was having its desired effect: “Already I’ve had students tell me that when they walk into a hospital room they don’t go right for the chart.”40 Medicine, Patients and Society, a three-part course attended by students during their first three years of study, provided additional opportunities to introduce a humanistic perspective into the curriculum and foster habits of empathy. On one occasion, first-year students were treated to a staged reading of Philoctetes, a play written by Sophocles in the fifth century BC. Its main character served as an example of the difficult patient who fears abandonment while suffering from chronic disease. The classicist Bryan Doerries, who directed the reading, explained the play’s contemporary relevance to medical 228

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Forging Ahead in the Twenty-First Century

students: “We have created a subclass of patients like Philoctetes with modern medicine. They are abandoned on their islands to live long, but have we risen to the challenge of taking emotional care of them?”41 A different teaching approach was taken with second-year students in the course, who visited drug treatment centers to talk to residents. Many, like Jonathan Austrian, emerged with their views on addiction completely changed: “I volunteered in the ER, and I saw drunks who came in who were unmanageable and unruly, out of control. My initial instinct was that this is their own fault and people like this create long lines and prevent other patients from receiving care. But after hearing the stories, I  am much more empathetic because I understand how fragile these people are, even those in recovery. One false step, one taste of crack, they could be thrust back into the depths of hell. This was a powerful lesson.”42 Finally, a clerkship was introduced in the third year of Medicine, Patients and Society to encourage students to be more self-reflective and compassionate, particularly when interacting with patients near the end of life. Activities included speaking to patients with cancer about their pain management, observing how patients and their families and friends responded to illness and dying, and visiting a hospice. The Music and Medicine Initiative, founded in 2009, attempted to bridge the gap between medicine and the performing arts. Spearheaded by two faculty members in the department of psychiatry, Dr. David Shapiro and the concert pianist Dr. Richard Kogan, the ongoing program gave students the opportunity to pursue their passion for music and medicine simultaneously. Student musicians performed at Carnegie Hall during Weill Cornell’s commencement exercises and at benefit concerts for the medical center, while faculty at the Juilliard School served as coaches and mentors to medical students. Weill Cornell also unveiled its own version of the Hippocratic Oath, traditionally administered as a rite of passage for new doctors as they graduate from medical school. Through 2004, the medical school had been using a modernized version of the original Greek text, which requires physicians to swear to uphold specific ethical standards. For several years prior to that, Dean Gotto had noticed students chuckling as he read the oath while rehearsing for commencement ceremonies. Intrigued by their laughter, he asked the chief of the division of medical ethics, Dr. Joseph Fins, to form a committee to examine and revise the oath. His goal was to adapt the Hippocratic Oath to make it “relevant, meaningful, and inspirational, while reaffirming our bond with the noble traditions of our profession.”43 Although most revisions of the oath have been undertaken by individuals or professional societies, a twenty-member committee consisting of faculty and students from the medical school’s New York and Qatar campuses took up the challenge. In order to remain respectful of differences in faith and belief, the committee chose to replace phrases with a religious connotation, such as “I  swear,” with more 229

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secular terminology, such as “I vow.” It also stressed the personal commitment of the speaker to maintaining the values and traditions of the practice of medicine. Weill Cornell’s version of the Hippocratic Oath debuted at commencement ceremonies held on June  1, 2005. After it was administered to the graduating physicians, Dean Gotto invited other doctors who were present to stand and recommit themselves to the oath’s principles by raising their right hands and reciting the newly revised lines.

The Hippocratic Oath at Weill Cornell

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A modified version of the Hippocratic Oath was used at Weill Cornell through 2004: A.  I do solemnly swear, to that which I hold most sacred: (1) That I will be loyal to the Profession of Medicine and just and generous to its members; (2) That I will instruct those who follow me in both the science and the art; (3) That I will withdraw in favor of others when they are more expert; (4) That I will lead my life and practice my art in uprightness and honor; (5) That into whatsoever house I shall enter, it shall be for the good of the sick to the utmost of my power, holding myself far aloof from wrong, from corrupting, from the tempting of others to vice; (6) That I will exercise my art solely for the highest interests of my patients; (7) That whatsoever I shall see or hear of the lives of my patients which is not fitting to be spoken, I will keep inviolably sacred; B. If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all people for all time to come; If I transgress it and swear falsely, may the opposite of all this be my lot. Starting in 2005, Weill Cornell began administering a newly revised version: A.  I do solemnly vow, to that which I value and hold most dear:   (1) That I will honor the Profession of Medicine, be just and generous to its members, and help sustain them in their service to humanity;

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  (2) That just as I have learned from those who preceded me, so will I instruct those who follow me in the science and the art of medicine;   (3) That I will recognize the limits of my knowledge and pursue lifelong learning to better care for the sick and to prevent illness;   (4) That I will seek the counsel of others when they are more expert so as to fulfill my obligation to those who are entrusted to my care;   (5) That I will not withdraw from my patients in their time of need;   (6) That I will lead my life and practice my art with integrity and honor, using my power wisely;   (7) That whatsoever I shall see or hear of the lives of my patients that is not fitting to be spoken, I will keep in confidence;   (8) That into whatever house I shall enter, it shall be for the good of the sick;   (9) That I will maintain this sacred trust, holding myself far aloof from wrong, from corrupting, from the tempting of others to vice; (10) That above all else I will serve the highest interests of my patients through the practice of my science and my art; (11) That I will be an advocate for patients in need and strive for justice in the care of the sick. B. I now turn to my calling, promising to preserve its finest traditions, with the reward of a long experience in the joy of healing. C. I make this vow freely and upon my honor.

Discoveries That Make a Difference

The completion of the Advancing the Clinical Mission campaign paved the way for the medical school’s next phase of development: expansion of its biomedical research capacity. Movement in this direction had been progressing steadily since 1997, when Gotto appointed David Hajjar, PhD, the dean of the Weill Cornell Graduate School of Medical Sciences, five months after his own appointment as dean of the medical school. The two worked well together, and Hajjar gradually took on key responsibilities in the administration of the medical college, particularly in the area of research. Hajjar also began his term as the graduate school’s dean by initiating a strategic planning process, with input from a committee of faculty and students from both the medical and graduate schools. The graduate school’s resulting strategic plan, which was approved by 231

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CHAPTER 10

the board of overseers in 1998, included funding to increase enrollment by two students per year for the next ten years, raise student stipends, and support student travel to conferences and special courses.44 These measures enabled Weill Cornell’s graduate school to better compete with other New York institutions in the recruitment of students and research faculty. They also strengthened the graduate school’s standing among its neighboring Tri-Institutional partners, Rockefeller University and the Sloan Kettering Institute.45 Since the early 1990s, the three institutions had been collectively offering a combined MD-PhD degree and had started Gateways to the Laboratory, one of the first summer programs in the country designed to encourage undergraduate students from underrepresented minorities to pursue MD-PhD careers. Under the leadership of Dr. Olaf Andersen, the Tri-Institutional MD-PhD Program grew in size and by 2007 was ranked among the top in the country by the National Institutes of Health. The links between the Tri-Institutional partners grew even closer in the twenty-first century. In 2000, an $80 million gift from an anonymous donor, which was later revealed to be the Atlantic Philanthropies, funded a new Tri-Institutional Research Program. The Atlantic Philanthropies had been created by Charles Feeney, a Cornell alumnus from the class of 1956 and cofounder of the Duty Free Shopping Group, and was headed by president and chief executive Harvey Dale, a 1958 graduate of Cornell. One of the primary motivations in establishing the Tri-Institutional Research Program was to strengthen collaborations between Weill Cornell and Cornell colleges on the Ithaca campus. Along with Memorial Sloan Kettering Cancer Center and Rockefeller University, Weill Cornell and Cornell University developed a comprehensive plan designed to accelerate the pace of biomedical research. The institutions agreed to pool research resources and technologies, jointly recruit Tri-Institutional faculty, and develop interdisciplinary educational and research programs. Two doctoral programs were established as part of the initiative. The Tri-Institutional PhD Program in Chemical Biology was launched in 2001 with Weill Cornell, Memorial Sloan Kettering, and Rockefeller to train scientists in an emerging field of research. And in 2003 the Tri-Institutional PhD Program in Computational Biology and Medicine was formed with Weill Cornell, Cornell University, and Memorial Sloan Kettering to advance the study of biological problems using computational approaches. Weill Cornell also deepened its investigations in the controversial but promising field of stem cell research. In 2004—at a time when scientists faced severe restrictions on stem cell research—the Ansary Stem Cell Institute was created with a $15 million grant from Shahla and Hushang Ansary. A prominent Houston philanthropist, Hushang Ansary was then serving as vice chairman of the Weill Cornell Board of Overseers. The institute’s investigations, directed by Dr. Shahin Rafii, were soon complemented by collaborative studies 232

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taking place at Weill Cornell, Memorial Sloan Kettering, and Rockefeller as part of the Tri-Institutional Stem Cell Initiative. This new program was formed in 2005 with a $50 million gift from the Starr Foundation, and together with the Ansary Stem Cell Institute it focused on identifying ways to harness the power of stem cells and regenerate human tissues lost to illness or injury.46 As joint research programs among the neighboring York Avenue institutions thrived, Weill Cornell leadership moved to strengthen its own independent capacity for biomedical research. Planning for its third strategic plan and major capital campaign commenced in the spring of 2004 with the formation of five work groups, focused on research, clinical care, education, the graduate school, and support services and campus life. The work groups reported to a steering committee that was chaired by David Hajjar and included Sanford Weill, Dean Gotto, overseers, faculty, and senior administrators from Weill Cornell and Cornell University. In total, more than seventy-five individuals were involved in a comprehensive evaluation of Weill Cornell and its mission. Together, they developed a master plan for the medical school for the next ten to twenty years, geared primarily toward growth in the realm of translational research, which aims to bring laboratory discoveries to the patient’s bedside as quickly as possible.47 The Discoveries That Make a Difference campaign, which aimed to raise $1.3 billion in private philanthropy, was launched in October 2006 at a joint press conference held with Cornell University. Keynote speakers included New York City mayor Michael Bloomberg, Sanford Weill, Cornell Board of Trustees chair Peter Meinig, Cornell University president David Skorton, Weill Cornell campaign chair Robert Appel, and Dean Gotto. A  New York City firefighter spoke about how research conducted at Weill Cornell and Cornell University had benefited him as a patient. The medical school’s leadership announced that the bulk of the funds raised in the campaign would go toward the construction of a $650 million research facility, which would double Weill Cornell’s existing research space, and the recruitment of approximately thirty scientific investigators to fill it. Faculty in new translational research centers would work toward developing novel treatments in the areas of cancer, cardiovascular disease, diabetes and metabolic disease, neurodegenerative diseases, global health and infectious diseases, molecular therapeutics, children’s health, and stem cell and reproductive medicine. The campaign would also provide support for medical and graduate education, patient care, and intercampus research collaborations with Cornell faculty in Ithaca.48 At a subsequent press conference on June  13, 2007, Weill Cornell announced that it had already received a total of $400  million toward the campaign. The majority of that amount came from Joan and Sanford Weill, who had pledged $250 million, believed to be the single largest gift to a medical school at the time. Sanford Weill explained his passion for supporting 233

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CHAPTER 10

medical research by speaking about his mother Etta, who had died of Alzheimer’s disease: “I felt close again to my mother after she died because being a victim of this disease she didn’t know me for the last 10 or 12 years of her life. She didn’t say a word for the last 10 or 12 years of her life.” He further elaborated on the forces motivating his family’s generosity: “My wife taught me that shrouds don’t have pockets.”49 Additional support for the campaign was provided by Maurice Greenberg and his wife Corinne, who contributed $25 million, and by the Starr Foundation, a philanthropic organization headed by Greenberg that also donated $25  million. The remaining $100  million was received as an anonymous gift from longtime supporters of the medical school. Four years later, these donors were revealed to be Robert and Renée Belfer, members of a prominent family in the oil and gas industry. At a formal ceremony held on November  9, 2011, the medical school dedicated its future research facility as the Belfer Research Building.50 During the first fifteen months of the Discoveries campaign, a total of $700  million was raised. Donations slowed considerably during the financial crisis of 2007–8, which plunged many countries into a recession. Cornell University’s endowment shrank by a third, and it began running a deficit. During the height of the crisis, Joan and Sanford Weill agreed to accelerate the payment of their recent $250  million pledge and make a $170  million cash payment immediately, instead of at their deaths, as originally planned. Cornell University president David Skorton had approached Sanford Weill earlier with the request, so the medical school could proceed with its plans for the Belfer Research Building. Although Weill had lost a significant amount of money during the crisis, he felt that “we can all do more and doing something in a time like this is much more important.” The funds he and his wife provided were used to establish the Weill Challenge, which matched every $1.50 given toward the research building with $1 from the Weill gift. Donors would then have access to naming opportunities in the Belfer building at a significant discount, and it was projected that the challenge would raise $200 million in new donations. Dean Gotto spoke for the medical school when he remarked at the time, “We are proud of the Weill name. Their philanthropy has totally changed this medical college.”51 A ceremony celebrating the start of the construction of the eighteen-story, 480,000-square-foot Belfer Research Building took place on May  26, 2010. By that point, the Discoveries campaign had raised a total of $1 billion, including ninety-three gifts of $1 million or more; it would go on to reach its target in January 2013. In planning for the building, the issue of air rights came up. Weill Cornell and NewYork–Presbyterian shared the air rights on the east side of York Avenue between Sixty-Ninth and Seventieth Streets and would have been permitted to transfer them to the west side of the avenue, at the site of the new building. At first, the hospital agreed to move the air rights, but then negotiations fell through. The city then granted Weill Cornell an exception to 234

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its zoning laws and allowed it to construct a building that was twice as high as what would typically have been permitted. Expectations for the new building, which was designed by Polshek Partnership (now Ennead) Architects and intended to encourage interdisciplinary collaboration through the use of open floor plans, were high. Many of Weill Cornell’s existing labs, though renovated, dated from the medical center’s opening in 1932. The Belfer Research Building would provide the opportunity for the medical school to recruit dozens of leading scientists and house them in creative configurations with access to the newest, cutting-edge technologies. In an innovative arrangement, Hunter College, the largest college in the City University of New York system, agreed to purchase the fourth floor of the Belfer Research Building in order to foster cross-institutional research projects. 52 As Dean Gotto predicted, “This building will be an enormous boon to our research scientists, who are pursuing translational research across the spectrum of medicine. It will make us highly competitive in terms of available workspace for scientists.”53 When the Belfer Research Building opened at the beginning of 2014, it was not just another structure added to the approximately forty-seven thousand other buildings spread throughout Manhattan. It was also a visible symbol of Weill Cornell’s commitment to research and to finding new ways to improve human health.

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Moving into a New Era

After fifteen years with Gotto as dean, Weill Cornell was well positioned on a trajectory of growth at the end of 2011. Its budget had increased from less than $500 million in 2000 to nearly $1.2 billion. Revenues from its faculty’s clinical practices and total research support had both more than doubled over the same period.54 The medical school had constructed one new building funded through philanthropy and was nearing completion on a second. It was bringing top physicians and scientists to Weill Cornell, offering innovative educational experiences to its students, and reaching out to parts of the world as far afield as Qatar, Houston, and Tanzania. These achievements stemmed from a clear vision of where the medical school wanted to go and what it needed to do to get there. Three strategic plans stretching from 1993 to 2011 and beyond provided a road map for Weill Cornell’s deans and leadership, as well as a means of clearly articulating its needs to donors. As the medical school gained greater financial stability and a renewed sense of purpose, its relationship to NewYork–Presbyterian also began to change. As Larry Schafer, Weill Cornell’s head of development, pointed out, “Now we are not the same size as the hospital, but we stand our ground as an equal partner with it. We have a very clear sense of what our mission is and when that intersects with the hospital and when it doesn’t. We have tremendous self-confidence, 235

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Figure 10.3  View of Weill Cornell Medical College along York Avenue, 2014. (Photo by Studio Brooke; courtesy of Weill Cornell Medical College.)

which we didn’t use to have. We were always the weaker link.”55 During this same period, NewYork–Presbyterian was also redefining itself and taking advantage of new opportunities. As other hospitals throughout the city closed because of financial pressures, NewYork–Presbyterian, which was consistently ranked as one of the best hospitals in the country, had the fourth-highest total patient revenues in the United States in 2011 at its Weill Cornell campus alone.56 Financial security at the medical center combined with harmonious relations between the heads of the medical school and the hospital and allowed both parties to put past conflicts behind them. Several major tasks lay in store for Weill Cornell’s next dean, as the medical school prepared for a transition of leadership. Foremost among them was the fulfillment of the promise embodied by the Belfer Research Building. Second was a comprehensive evaluation and revision of the medical school curriculum, a process that had been initiated in 2010. And third was an intensification of existing efforts to increase faculty diversity, which Gotto had helped stimulate with the creation of a dedicated office in 2009.57 The Office of Faculty Diversity, initially headed by Drs. Debra Leonard, Carla Boutin-Foster, and 236

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Rache Simmons, built on long-standing programs designed to enhance student diversity and was focused on creating a supportive environment for faculty members from diverse backgrounds to succeed as academic leaders. 58 Gotto’s successor, Dr.  Laurie H. Glimcher, was announced in September 2011. A renowned immunologist from Harvard Medical School, she joined Weill Cornell on January  1, 2012, as its first female dean. Gotto became cochair of the board of overseers and a vice president of Cornell University for a three-year term, as well as dean emeritus of the medical school and provost for medical affairs emeritus at Cornell. In an interview published in the alumni magazine Weill Cornell Medicine on the eve of his retirement as dean, Gotto was asked about the legacy he hoped to leave behind. His response was deeply personal, yet it also aptly captured the institution’s goals and mission as it prepared to continue on in the twenty-first century: “It’s hard to do this without seeming immodest. I would like to think that I have helped make Weill Cornell a gentler, more collaborative place, but also one that was transformed in its academic endeavors. . . . I hope that this is a place where students will want to come, where doctors will want to practice and do research, and where patients will want to be treated.”59

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Notes

Foreword 1. I thank Dr. Gregory Petsko for his thoughtful contributions to this foreword.

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1. Origins 1. Cornell University, “Sixth Annual Report of President Schurman, 1897–98,” in Annual Report of President, for the Year 1897–1899 (Ithaca, NY: Cornell University Press, 1899), 46, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=prrp005. 2. “Wilder of Cornell,” Daily Argus News (Crawfordsville, IN), March 9, 1895, 3. 3. Marion Hunt, “The Brightest Hope: A Centennial History of CUMC,” manuscript, February 1998, MCA, 2. 4. Morris Bishop, A History of Cornell (Ithaca, NY: Cornell University Press, 1962), 242. 5. Ibid., 260–62. 6. Ibid., 318. 7. Kenneth M. Ludmerer, Learning to Heal: The Development of American Medical Education (New York: Basic Books, 1985), 3–101. 8. Cornell University, “Sixth Annual Report,” 46. 9. Hunt, “Brightest Hope,” 161. 10. Lewis Conner, “An Historical Sketch of the Cornell University Medical College,” 1931, Cornell University Medical College Opening Day Addresses, MCA, 12. 11. Eric Larrabee, The Benevolent and Necessary Institution: The New York Hospital, 1771–1971 (Garden City, NY: Doubleday & Co., 1971), 277–88; Finding Aid to the Lewis Atterbury Stimson, MD (1844–1917) Papers, MCA, http://weill.cornell.edu/archives/pdf/per sonal_aids/LStimson.pdf. 12. George Adams Boyd, Lewis Atterbury Stimson, M.D. (A Paper for the Stoics Club of Summit, N.J., Season of 1946), December 1945, 40, box 3, folder 36, Carl A. Berntsen (1919– 97) Papers, MCA. 13. Conner, “Historical Sketch,” 7. 14. Paul Kligfield, “Order from Chaos: The Origins of CUMC, 1895–98,” manuscript draft, received June 7, 1999, MCA, 4; Hunt, “Brightest Hope,” 15–16. 15. George F. Shrady, ed., “A Sign of the Times,” Medical Record: A Weekly Journal of Medicine and Surgery (April 17, 1897): 558.

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NOTES TO PAGES 5–11 16. “Dissension in Its Council,” extract from the New York Evening Post, April 16, 1898, 4, miscellaneous records, folder Loomis Lab, 1898–33, MCA. 17. Kligfield, “Order from Chaos,” 7–10. 18. Madeline Crisci, Public Health in New York City in the Late Nineteenth Century (Bethesda, MD: National Library of Medicine, History of Medicine Division, 1990), 3–5. 19. Jacob Riis, How the Other Half Lives (1890; New York: Bartleby.com, 2000), chap. 6, paras. 6, 15, http://www.bartleby.com/208/. 20. Crisci, Public Health, 5–7. 21. Quoted in Carl Berntsen Jr., “A History of Medical Care in NYC: The Principal Founders of CUMC,” manuscript, MCA. 22. Quoted in Kligfield, “Order from Chaos,” 10. 23. “Dissension in Its Council,” 8. 24. “Cornell Medical College: Fund to Establish It Said to Have Been Given by Col. O. H. Payne,” NYT, April 16, 1898, 7. 25. Bishop, History of Cornell, 317–21. 26. “Dissension in Its Council,” 1. 27. “Cornell’s Medical Schools: Its Establishment Here Made Possible by a New Yorker’s Gift of Over $1,600,000,” NYT, September 11, 1898, 8. 28. Ludmerer, Learning to Heal, 148. 29. J. G. Schurman and W. M. Polk, Cornell University: Addresses at the Opening of the Medical College, 1898, MCA, 4. 30. G. Canby Robinson, Adventures in Medical Education: A  Personal Narrative of the Great Advance of American Medicine (Cambridge, MA: Harvard University Press, 1957), 193. 31. Bishop, History of Cornell, 317–21. 32. Memorandum, in re: Loomis Laboratory, April 13, 1904, miscellaneous records, folder Loomis Lab, 1898–33, MCA. 33. 1927–28 Annual Report from Dean to Cornell University President, box  1, folder 2, Dean’s Office Niles, 1903–34, MCA. 34. Chas. D. Bostwick to Livingston Farrand, letter, November 7, 1933, and extract from the minutes of the meeting of the Executive Faculty held November 15, 1933, miscellaneous rec­ ords, folder Loomis Lab, 1898–33, MCA. 35. James J. Walsh, “William Mecklenburg Polk,” in History of Medicine in New York: Three Centuries of Medical Progress (New York: National American Society Inc., 1919), 5:398–402; “Dr. Wm. M. Polk’s Funeral,” NYT, June 27, 1918, 11. 36. “Dr. Wm. M. Polk, 69, Weds Miss Dehon, 56,” NYT, May 13, 1914, 11. 37. Emily Dunning Barringer, Bowery to Bellevue (New York: W. W. Norton, 1950), 64. 38. Conner, “Historical Sketch,” 7. 39. Jessie Andresen to Walter Niles, letter, July  12, 1920, box  2, folder 19, Dean’s Office Niles, 1903–34, MCA. 40. Bishop, History of Cornell, 386. 41. Larrabee, Benevolent and Necessary Institution, 293. 42. Walsh, “William Mecklenburg Polk,” 401. 43. Finding Aid to the Frederick Gudernatsch (1881–1962) Papers, MCA, http://weill.cornell. edu/archives/pdf/personal_aids/gudernatschweb.pdf. 44. Frederick Gudernatsch, “Out of the Early Cornell Years: Reminiscences (Fall 1958),” MCA, 1. 45. Ibid., 2. 46. Ibid., 8. 47. Ibid., 9. 48. Schurman and Polk, Cornell University: Addresses, 7–8. 49. To the Board of Governors of the New York Hospital, undated proposal, box 2, folder 6, Dean’s Office Niles, 1903–34, MCA; Finding Aid to the Dean’s Office Niles, 1903–34, MCA.

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Notes to Pages 11–19 50. “Finest Medical College in the Country Will Be in New York,” New York Herald, September 11, 1898, 1. 51. “Cornell’s Medical Schools: Its Establishment Here Made Possible by a New Yorker’s Gift of Over $1,600,000,” 8. 52. “Cornell Medical College: Formal Opening Exercises Are Held in the Lecture Room,” NYT, October 5, 1898, 12. 53. Schurman and Polk, Cornell University: Addresses, 4. 54. Ibid., 10. 55. Ibid., 22. 56. Hunt, “Brightest Hope,” 39–40. 57. Bishop, History of Cornell, 320. 58. Waterman Thomas Hewitt, Cornell University: A History (New York: University Publishing Society, 1905), 2:282, https://archive.org/details/cornelluniversit02heweuoft. 59. Charles P. Bolton to Carl Berntsen, letter, October 4, 1993, box 1, folder 10, Carl A. Berntsen Papers, MCA. 60. Ludmerer, Learning to Heal, 60. 61. Regina Markell Morantz-Sanchez, Sympathy and Science: Women Physicians in American Medicine (New York: Oxford University Press, 1985), 246. 62. “A Brief History of Cornell Time,” Cornell Medicine 3, no.1 (Fall 1998): 29. 63. Cornell University Medical College in New York City, Announcement 1904–05, 24, http://archive.org/details/cornell1905corn; “Cornell University Medical College,” MCA, http://www.med.cornell.edu/archives/history/medical_college.html. 64. Morantz-Sanchez, Sympathy and Science, 246. 65. Conner, “Historical Sketch,” 8–9. 66. Barringer, Bowery to Bellevue, 68–90. 67. “Alpha Phi Alpha Fraternity: A  Centennial Celebration,” Cornell University Library, http://rmc.library.cornell.edu/alpha/earlyalpha/earlyalpha_3.html. 68. Quoted in Hunt, “Brightest Hope,” 36. 69. “Brief History of Cornell Time,” 30; Hunt, “Brightest Hope,” 93–94. 70. Conner, “Historical Sketch,” 7–8. 71. Ludmerer, Learning to Heal, 81–82. 72. Conner, “Historical Sketch,” 5. 73. Schurman and Polk, Cornell University: Addresses, 20. 74. Ludmerer, Learning to Heal, 295 n34. 75. Hewitt, Cornell University, 277–78. 76. Ludmerer, Learning to Heal, 113–15, 199; Bishop, History of Cornell, 385–89. 77. Conner, “Historical Sketch,” 10. 78. Bishop, History of Cornell, 385. 79. Hewitt, Cornell University, 287. 80. Cornell University Medical College, Announcement 1904–05, 24. 81. Bishop, History of Cornell, 388. 82. Cornell University Medical College, Announcement 1904–05, 34–41, 53–57. 83. Riis, How the Other Half Lives, chap. 33, paras. 12–13. 84. William M. Polk to John W. Brannan, letter, May 21, 1906, miscellaneous records, folder CUMC Affiliations with Various Hospitals, MCA. 85. “Cornell University Medical College,” MCA. 86. Cornell University Medical College in New York City, Announcement 1911–12, 21–22, http://archive.org/details/cornell1912corn. 87. Cornell University Medical College Council, Special Meeting, January 13, 1916, memorandum, miscellaneous records, folder Bellevue-CUMC Affiliation 1906–34, MCA. 88. G. Canby Robinson to John A. Hartwell, letter, January 25, 1934, miscellaneous rec­ords, folder Bellevue-CUMC Affiliation 1906–34, MCA; “Cornell University Medical College,” MCA.

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NOTES TO PAGES 20 –28 89. Walter Niles to William Polk, letters, December 4, 1914, box 2, folder 10, Dean’s Office Niles, 1903–34, MCA. 90. Larrabee, Benevolent and Necessary Institution, 297–300. 91. Salaries of the staff, memo, box 2, folder 17, Dean’s Office Niles, 1903–34, MCA. 92. Staff evaluations by department, box 2, folder 20, Dean’s Office Niles, 1903–34, MCA. 93. Ludmerer, Learning to Heal, 166–90. 94. Abraham Flexner, Medical Education in the United States and Canada (New York: Carnegie Foundation for the Advancement of Teaching, 1910), 269. 95. Ibid., 278. 96. Conner, “Historical Sketch,” 14. 97. Berntsen, “History of Medical Care.” 98. Conner, “Historical Sketch,” 13. 99. Colonel Oliver Payne to Jacob Schurman, letter, November 12, 1913, box 2, folder 16, Dean’s Office Niles, 1903–34, MCA. 100. Memorandum, September 15, 1917, box 2, folder 16, Dean’s Office Niles, 1903–34, MCA. 101. “NewYork–Presbyterian Hospital / Weill Cornell Medical Center 75th Anniversary,” MCA, http://weill.cornell.edu/archives/75years/site/index.html. 102. Cornell University Medical Bulletin: Announcement of the Medical College, New York and Ithaca, 1912–1913, vol. 2, no. 1 (New York: Cornell University, 1912), 82–88, http://archive. org/details/cornell1913corn. 103. Cornell University Medical Bulletin: Announcement of the Medical College New York and Ithaca, 1918, vol. 8, no. 1 (New York City: Cornell University, 1918), 84–91, http://archive. org/details/cornell1918corn. 104. “$1,000,000 Pledged to Cancer Hospital,” NYT, May  2, 1914; Hunt, “Brightest Hope,” 68. 105. Andrew Huvos, “James Ewing: Cancer Man,” Annals of Diagnostic Pathology 2, no. 2 (April 1998): 146–48. 106. Finding Aid to the Graham Lusk, PhD (1866–1932) Papers, MCA, http://weill.cornell. edu/archives/pdf/personal_aids/lusk.pdf. 107. Eugene M. Landis, Carl John Wiggers, 1883–1963 (Washington, DC: National Academy of Sciences, 1976), http://www.nasonline.org/publications/biographical-memoirs/memoirpdfs/wiggers-carl.pdf. 108. Eugene DuBois to William Polk, letter, November  29, 1914, box  2, folder 10, Dean’s Office Niles, 1903–34, MCA. 109. Gudernatsch, “Out of the Early Cornell Years,” 31–32. 110. Ibid., 56–57. 111.  Jacob Schurman to Nicholas M. Butler, letter, January 27, 1917, box 2, folder 8, Dean’s Office Niles, 1903–34, MCA. 112. “NewYork–Presbyterian Hospital / Weill Cornell Medical Center 75th Anniversary.” 113. “Cornell to Hasten Medical Training,” NYT, April 19, 1917, 11. 114. Cornell University Medical Bulletin: Announcement of the Medical College, New York and Ithaca, 1918, 20–21. 115. Raymond Shiland Brown, Base Hospital No. 9 A.E.F.: A History of the Work of the New York Hospital Unit during Two Years of Active Service (New York: New York Hospital, 1920), 16–33, 73–74, 149–50. 116. “Open Clinic for Men Disabled in War,” NYT, July 16, 1918, 9. 117.  Hunt, “Brightest Hope,” 73. 118. Larrabee, Benevolent and Necessary Institution, 309. 119. 1927–28 Annual Report from Dean to Cornell University President, box  1, folder 2, Dean’s Office Niles, 1903–34, MCA.

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Notes to Pages 29–36

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2. Clinical Innovation and a Historic Partnership 1. Cornell University, “Report of the Acting Dean of the Medical College,” in Official Publications of Cornell University, vol. 10, 1918–1919 (Ithaca, NY: Cornell University Press, 1919), app. 5, xxi, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=opcu004. 2. Cornell University, “Report of the Dean of the Medical College,” in Official Publications of Cornell University, vol. 12, 1920–1921 (Ithaca, NY: Cornell University Press, 1921), app. 5, xvi, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=opcu005. 3. Rosemary Stevens, American Medicine and the Public Interest: A History of Specialization (Berkeley: University of California Press, 1998), 132–48; Ira Rutkow, Seeking the Cure: A History of Medicine in America (New York: Scribner, 2010), 170–72. 4. Annual Reports for the Departments of Cornell Clinic 1926/1927, box 1, folder 1, Dean’s Office Niles, 1903–34, MCA. 5. Stevens, American Medicine, 134; William Rothstein, American Medical Schools and the Practice of Medicine: A History (New York: Oxford University Press, 1987), 119–39. 6. “Guinea Pigs on ‘Wet’ Side: Scientists, after Long Experiments, Report against Harmful Effects of Alcohol,” NYT, April 9, 1922, 90. 7. Hollis Dann, Songs of Cornell (Ithaca, NY: B. F. Lent, 1900). 8. Eugene H. Pool, Walter L. Niles, and Kirby A. Martin, “Duodenal Stasis: Duodenojejunostomy,” Annals of Surgery 98, no. 4 (1933): 587–618; Walter L. Niles and Carl J. Wiggers, “The Details of the Photographically Recorded Venous Pulse in Auricular Fibrillation,” Journal of Experimental Medicine 25, no. 1 (January 1, 1917): 1–19; Thomas Wood Hasting and Walter L. Niles, “The Bacteriology of Sputum in Common Non-tuberculosis Infections of the Upper and Lower Respiratory Tracts, with Special Reference to Lobar and Broncho-pneumonia,” Journal of Experimental Medicine 13, no. 6 (June 1, 1911): 638–51. 9. Malcolm Goodrich, “Walter Lindsay Niles, 1878–1942: An Appreciation,” Bulletin of the New York Academy of Medicine 18, no. 4 (April 1942): 289–92; “Dr. Walter Niles, Medical Educator,” New York Times, December 23, 1941, 21. 10. Malcolm Goodrich, “Walter Lindsay Niles, 1878–1942: An Appreciation,” Bulletin of the New York Academy of Medicine 18, no. 4 (April 1942): 292. 11. Morris Bishop, A History of Cornell (Ithaca, NY: Cornell University Press, 1962), 388. 12. “Greatly Expanded Quarters for the Basic Sciences; at Rockefeller Institute, a Certain Envy,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 42. 13. Staff evaluations by department, box 2, folder 20, Dean’s Office Niles, 1903–34, MCA. 14. Nardi Reeder Campion and Rosamond Wilfley Stanton, Look to This Day! The Lively Education of a Great Woman Doctor: Connie Guion, M.D. (Boston: Little, Brown  & Co., 1965), 254. 15. “Many World Woes Laid to Ill Health,” NYT, February 25, 1927, 20. 16. Jessie Andresen to Walter Niles, letter, July  12, 1920, box  2, folder 19, Dean’s Office Niles, 1903–34, MCA. 17. Jeffrey Fisher, “Lewis A. Conner: Cornell’s Osler,” Circulation 102 (2000): 1062–67. 18. “Offer Best Doctors at a Dollar a Call,” NYT, October 24, 1921, 17. 19. Ibid. 20. Walter L. Niles, “The First Five Months of the Cornell Clinic,” Modern Hospital 18, no. 6 (June 1922): 561. 21. Cornell University, “Report of the Dean of the Medical College,” in Official Publications of Cornell University, vol. 14, 1922–1923 (Ithaca, NY: Cornell University Press, 1923), app., xix, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=opcu007. 22. Bishop, History of Cornell, 513. 23. “Cornell Pay Clinic Has 22,828 Cases,” NYT, June 6, 1922, 15. 24. “Dollar Clinic Opens with 1,000 Patients,” NYT, November 2, 1921, 10.

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NOTES TO PAGES 37– 43 25. Niles, “First Five Months of the Cornell Clinic,” 560–61. 26. “A  Model Pay Clinic,” NYT, October  25, 1921, 13; Rothstein, American Medical Schools, 131. 27. “Cornell Pay Clinic Has 22,828 Cases,” 15. 28. “Dollar Clinic Opens with 1,000 Patients,” 10. 29. “Cornell Pay Clinic Scored by Doctors,” NYT, May 30, 1922, 17. 30. Walter Niles, “Three Years’ Experience in the Operation of a Pay Clinic,” Transactions of the American Clinical and Climatological Association 41 (1925): 6669. 31. “Criticizes Clinic as Doctors’ Rival,” NYT, June 12, 1928, 30. 32. Niles, “First Five Months of the Cornell Clinic,” 561. 33. Walter L. Niles, “Pay Clinics,” Transactions of the American Clinical and Climatological Association 38 (1922): 275. 34. Ibid., 276. 35. Niles, “Three Years’ Experience in the Operation of a Pay Clinic,” 66. 36. Ibid., 66–67. 37. Cornell University, Office of the Dean of the University Faculty, “Walter Carl Klotz” (Ithaca, NY: Cornell University, 1941), http://hdl.handle.net/1813/18283. 38. Finding Aid to the Connie Guion, MD (1882–1971) Papers, MCA, http://weill.cornell. edu/archives/pdf/personal_aids/cguion.pdf. 39. Annual Reports for the Departments of Cornell Clinic, 1928–29, box 1, folder 2, Dean’s Office Niles, 1903–34, MCA. 40. Lewis Conner to Walter Klotz, letter, November 23, 1929, box 1, folder 2, Dean’s Office Niles, 1903–34, MCA. 41. “In Medicine, a Chief Distinguished in Research Moves Uptown from Bellevue,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 21–22. 42. Annual Reports for the Departments of Cornell Clinic, 1926/1927. 43. Annual Report for the Cornell Clinic, 1931–32, box  2, folder 2, Dean’s Office Niles, 1903–34, MCA. 44. Bishop, History of Cornell, 512. 45. Cornell University, “Report of the Dean of the Medical College,” 1920–1921, app. 5, xviii–xix. 46. G. Canby Robinson, Adventures in Medical Education: A Personal Narrative of the Great Advance of American Medicine (Cambridge, MA: Harvard University Press, 1957), 196. 47. Cornell University, “Report of the Dean of the Medical College,” 1922–1923, app. 5, xviii. 48. Cornell University, “Report of the Dean of the Medical College,” in Official Publications of Cornell University, vol.  13, 1921–1922 (Ithaca, NY:  Cornell University Press,  1922), app. 5, xix–xxiv, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=opcu006. 49. Cornell University, “Report of the Dean of the Medical College,” 1920–1921, app. 5, xx. 50. Annual Reports of the Departments of 1929–30, box  1, folder 3, Dean’s Office Niles, 1903–34, MCA. 51. Annual Reports for the Departments of Cornell Clinic, 1926/1927. 52. To the Board of Governors of the New York Hospital, undated proposal, 1–2, 15, box 2, folder 6, Dean’s Office Niles, 1903–34, MCA. 53. Ibid., 4, 25. 54. Eric Larrabee, The Benevolent and Necessary Institution: The New York Hospital, 1771–1971 (Garden City, NY: Doubleday & Co., 1971), 312–13. 55. Agreement with NYH—Proposal of Association, Reports of Committees Re: Agreement, Abstract + Printer’s Copy, 1920–1927, box 2, folder 6, Dean’s Office Niles, 1903–34, MCA. 56. “NewYork–Presbyterian Hospital / Weill Cornell Medical Center 75th Anniversary,” MCA, http://weill.cornell.edu/archives/75years/site/index.html; Larrabee, Benevolent and Necessary Institution, 312–13.

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Notes to Pages 44–53 57. Hugh Luckey, “The Bicentennial of the New York Hospital (1771–1971),” JAMA 216, no. 7 (1971): 1184. 58. “$60,650,000 Centre Formed by Cornell and N.Y. Hospital,” NYT, October 31, 1927, 3. 59. Luckey, “Bicentennial of the New York Hospital,” 1184. 60. Agreement: The Society of the New York Hospital and Cornell University, June 14, 1927, 4, box 2, folder 6, Dean’s Office Niles, 1903–34, MCA. 61. Ibid., 2–3. 62. Ibid., 5. 63. Robinson, Adventures in Medical Education, 200–201. 64. Agreement: The Society of the New York Hospital and Cornell University, 7. 65. Ibid., 8. 66. Bishop, History of Cornell, 515. 67. Larrabee, Benevolent and Necessary Institution, 313–16. 68. “$60,650,000 Centre Formed by Cornell and N.Y. Hospital,” 1, 3. 69. 1927–28 Annual Report from Dean to Cornell University President, box  1, folder 2, Dean’s Office Niles, 1903–34, MCA.

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3. A Move to Manhattan’s Upper East Side 1. “Inventory of the Robinson, G. Canby (1878–1960), Collection Number 687,” Annette & Irwin Eskind Biomedical Library of Vanderbilt Medical Center, http://www.mc.vanderbilt. edu/diglib/sc_diglib/archColl/687.html; G. Canby Robinson, Adventures in Medical Education: A Personal Narrative of the Great Advance of American Medicine (Cambridge, MA: Harvard University Press, 1957). 2. Inventory of the Robinson, G. Canby (1878–1960), Collection Number 687,” Annette & Irwin Eskind Biomedical Library of Vanderbilt Medical Center, http://www.mc.vanderbilt. edu/diglib/sc_diglib/archColl/687.html; G. Canby Robinson, Adventures in Medical Education: A Personal Narrative of the Great Advance of American Medicine (Cambridge, MA: Harvard University Press, 1957); Robert D. Collins, Ernest William Goodpasture: Scientist, Scholar, Gentleman (Franklin, TN: Hillsboro Press, 2002), 129–35. 3. Kenneth M. Ludmerer, Learning to Heal: The Development of American Medical Education (New York: Basic Books, 1985), 58. 4. Robinson, Adventures in Medical Education, 186. 5. Ibid., 189–228. 6. Canby Robinson to the President of the University, letter, July 19, 1929, box 1, folder 2, Dean’s Office Niles, 1903–34, MCA. 7. Canby Robinson to the President of the University, letter, June 10, 1930, box 1, folder 3, Dean’s Office Niles, 1903–34, MCA. 8. Robinson, Adventures in Medical Education, 187. 9. “NewYork–Presbyterian Hospital / Weill Cornell Medical Center 75th Anniversary,” MCA, http://weill.cornell.edu/archives/75years/site/index.html. 10. Morris Bishop, A History of Cornell (Ithaca, NY: Cornell University Press, 1962), 514. 11. Robinson, Adventures in Medical Education, 205. 12. “NewYork–Presbyterian Hospital / Weill Cornell Medical Center 75th Anniversary.” 13. “In Nursing, 200 Caps and a Thrust toward University Affiliation,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 53. 14. “NewYork–Presbyterian Hospital / Weill Cornell Medical Center 75th Anniversary.” 15. Robinson, Adventures in Medical Education, 220. 16. “Funds on Hand January 1st, 1930,” box 2, folder 15, Dean’s Office Niles, 1903–34, MCA. 17. Robinson, Adventures in Medical Education, 203.

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NOTES TO PAGES 53– 63 18. Undated reports, box 2, folder 15, Dean’s Office Niles, 1903–34, MCA. 19. “An Estimate of the Financial Resources Needed by the New York Hospital–Cornell Medical College Association,” November 1, 1929, box 2, folder 15, Dean’s Office Niles, 1903–34, MCA. 20. G. Canby Robinson, “Making a Name in Medicine,” in A Half-Century at Cornell, 1880–1930: A Retrospect, Sponsored by the Cornell Daily Sun to Commemorate the Fiftieth Anniversary of Its Founding (Ithaca, NY: Cayuga Press, 1930), 47–48, 74–75. 21. “In Medicine, a Chief Distinguished in Research Moves Uptown from Bellevue,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 17. 22. “Plan for the Organization of the New York Hospital–Cornell Medical College Association,” undated, box 2, folder 15, Dean’s Office Niles, 1903–34, MCA. 23. “NewYork–Presbyterian Hospital / Weill Cornell Medical Center 75th Anniversary”; Robinson, Adventures in Medical Education, 220; “An Estimate of the Financial Resources Needed by the New York Hospital–Cornell Medical College Association.” 24. “The Hospital and Educational Policies of the New York Hospital–Cornell Medical College Association,” undated, box 2, folder 15, Dean’s Office Niles, 1903–34, MCA. 25. “NewYork–Presbyterian Hospital / Weill Cornell Medical Center 75th Anniversary.” 26. Annual Reports to Cornell University President from Director/Dean Canby Robinson, 1931–34, box 2, folders 2 and 4, Dean’s Office Niles, 1903–34, MCA. 27. Bishop, History of Cornell, 516–17. 28. “In Medicine, a Chief Distinguished in Research Moves Uptown from Bellevue,” 20. 29. Harry H. Gordon, “Despite Problems, a Strong Initial Impetus for Pediatrics,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 36. 30. “The First Surgical Residency Program in New York City,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 27. 31. “A Statement Regarding the Proposed Organization of the Surgical Service in the New York Hospital,” box 2, folder 15, Dean’s Office Niles, 1903–34, MCA. 32. Robinson, Adventures in Medical Education, 50. 33. Ibid., 189–228. 34. Annual reports of the departments submitted to Canby Robinson, 1928–30, box 1, folders 2–3, Dean’s Office Niles, 1903–34, MCA. 35. Annual reports of the departments submitted to Canby Robinson, 1928–30. 36. Annual reports of the departments submitted to Canby Robinson, 1930–31, box 2, folder 1, Dean’s Office Niles, 1903–34, MCA. 37. Annual report to Cornell University President from Director/Dean Canby Robinson, 1930–32, box 2, folders 1 and 2, Dean’s Office Niles, 1903–34, MCA. 38. Don S. Brown to Canby Robinson, letter, April 14, 1932, box 2, folder 12, Dean’s Office Niles, 1903–34, MCA. 39. R. Gordon Douglas, MD, “Reflections on Why We Are Here,” September 1954, Address to Students at Opening Exercises, MCA. 40. “At the Lying-In, an English Doorman, Superb Facilities, and a Controversial Chairman,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 38. 41. “In Medicine, a Chief Distinguished in Research Moves Uptown from Bellevue,” 24. 42. Annual report of the department of surgery submitted to Canby Robinson, 1932–33, box 2, folder 3, Dean’s Office Niles, 1903–34, MCA. 43. “Among CUMC’s Students, Awe Mixed with Disapproval,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 47. 44. Robinson, Adventures in Medical Education, 206. 45. Eric Larrabee, The Benevolent and Necessary Institution: The New York Hospital, 1771–1971 (Garden City, NY: Doubleday & Co., 1971), 318. 46. Walter Riker Jr., “Postscript: Wally Remembers,” Cornell Medicine 3, no. 1 (Fall 1998): 54. 47. “Greatly Expanded Quarters for the Basic Sciences; at Rockefeller Institute, a Certain Envy,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 44.

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Notes to Pages 64–74 48. “NewYork–Presbyterian Hospital / Weill Cornell Medical Center 75th Anniversary”; “The New York Hospital and Cornell University Medical College,” blueprint booklet from Coolidge, Shepley, Bulfinch and Abbott, September 15, 1932, MCA. 49. Alan Van Poznak, “The Last Smile of Skyscraper Romanticism,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 14–16. 50. David Hellerstein, “Letting Go of Payne Whitney,” New York Times Magazine, November 6, 1994, 50. 51. “At Payne Whitney Clinic, a Commitment to Intensive Individual Therapy,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 41. 52. “In Nursing, 200 Caps and a Thrust toward University Affiliation,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 53. 53. “Greatly Expanded Quarters for the Basic Sciences; at Rockefeller Institute, a Certain Envy,” 44. 54. Ibid., 45. 55. Letter to Board of Governors of the New York Hospital, December 2, 1932, box 2, folder 21, Dean’s Office Niles, 1903–34, MCA. 56. Memorandum, December 20, 1932, box 2, folder 21, Dean’s Office Niles, 1903–34, MCA. 57. Canby Robinson to Committee, memorandum, January  16, 1933, box  2, folder 21, Dean’s Office Niles, 1903–34, MCA. 58. Annual report to Joint Administrative Board from Director/Dean Canby Robinson, 1932–33, box 2, folder 5, Dean’s Office Niles, 1903–34, MCA. 59. Memorandum, November 23, 1933, box 2, folder 21, Dean’s Office Niles, 1903–34, MCA. 60. “First Surgical Residency Program in New York City,” 26. 61. Ibid., 27. 62. Ibid., 28. 63. Ibid., 29. 64. Ibid., 31. 65. Ibid., 32. 66. Annual reports of the departments submitted to Canby Robinson, 1932–33, box 2, folder 3, Dean’s Office Niles, 1903–34, MCA. 67. “In Medicine, a Chief Distinguished in Research Moves Uptown from Bellevue,” 22. 68. Annual reports of the departments submitted to Canby Robinson, 1933–34, box 2, folder 4, Dean’s Office Niles, 1903–34, MCA. 69. “In Medicine, a Chief Distinguished in Research Moves Uptown from Bellevue,” 23. 70. Larrabee, Benevolent and Necessary Institution, 320. 71. Robinson, Adventures in Medical Education, 189–228. 72. G. Canby Robinson to Barklie Henry, letter, August 1935, miscellaneous records, folder Robinson, G. Canby, 1934–65, MCA. 73. Robinson, Adventures in Medical Education, 222. 74. Excerpt from Minutes of Meeting of Board of Governors of Society of the New York Hospital, November  7, 1934, 133, miscellaneous records, folder Robinson, G. Canby, 1934–65, MCA. 75. Bishop, History of Cornell, 518. 76. Larrabee, Benevolent and Necessary Institution, 319. 77. Robinson, Adventures in Medical Education, 201. 78. Ibid., 225. 79. Larrabee, Benevolent and Necessary Institution, 321. 80. “In Medicine, a Chief Distinguished in Research Moves Uptown from Bellevue,” 19. 81. Annual report to Cornell University President from Director/Dean Canby Robinson, 1933–34, box 2, folder 4, Dean’s Office Niles, 1903–34, MCA. 82. Robinson, Adventures in Medical Education, 222, 225. 83. Ibid., 223.

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NOTES TO PAGES 74 – 82 84. “In Medicine, a Chief Distinguished in Research Moves Uptown from Bellevue,” 21. 85. Robinson, Adventures in Medical Education, 226. 86. Ibid., 228. 87. G. Canby Robinson to Barklie Henry, letter, August  1935, and G. Canby Robinson to John Hay Whitney, letter, August  21, 1935, miscellaneous records, folder Robinson, G. Canby, 1934–65, MCA. 88. G. Canby Robinson to Murray Sargent, letter, January 22, 1937, miscellaneous records, folder Robinson, G. Canby, 1934–65, MCA. 89. Murray Sargent to G. Canby Robinson, letter, June 25, 1940, and G. Canby Robinson to Murray Sargent, letter, June  26, 1940, miscellaneous records, folder Robinson, G. Canby, 1934–65, MCA. 90. G. Canby Robinson to Stanhope Bayne-Jones, letter, June 26, 1947, miscellaneous rec­ ords, folder Robinson, G. Canby, 1934–65, MCA. 91. Stanhope Bayne-Jones to G. Canby Robinson, letter, September 3, 1947, miscellaneous records, folder Robinson, G. Canby, 1934–65, MCA. 92. Marian B. Robinson to Joseph Hinsey, letter, August  29, 1960, miscellaneous records, folder Robinson, G. Canby, 1934–65, MCA. 93. “Canby Robinson, Educator, Dead,” NYT, September 1, 1960, 27. 94. Laurence G. Payson to Marian B. Robinson, letter, September 1, 1960, miscellaneous rec­ ords, folder Robinson, G. Canby, 1934–65, MCA. 95. Marian B. Robinson to Laurence G. Payson, letter, September 5, 1960, miscellaneous rec­ ords, folder Robinson, G. Canby, 1934–65, MCA. 96. Joseph Hinsey to Margaret Robinson Angell, letter, February  12, 1965, miscellaneous records, folder Robinson, G. Canby, 1934–65, MCA. 97. Robinson, Adventures in Medical Education, 320–21.

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4. The Medical School in Wartime 1. Rosemary Stevens, American Medicine and the Public Interest: A History of Specialization (Berkeley: University of California Press, 1998), 180. 2. Ira Rutkow, Seeking the Cure: A History of Medicine in America (New York: Scribner, 2010), 188–92. 3. Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 266–79, 295. 4. “Farrand Presides at Medical Class,” NYT, June 7, 1935, 14. 5. William S. Ladd, “Address of Welcome Cornell University Medical College,” 1933, 8, Cornell University Medical College Opening Day Addresses, MCA. 6. Ladd, “Address of Welcome,” 8–9. 7. “Farrand and Rice Warn New Doctors,” NYT, June 17, 1937, 17. 8. Society of the New York Hospital, “Report of the Administrator-in-Chief,” in 169th Annual Report, for the Year 1940 (New York: Society of the New York Hospital, 1941), 31, http://archive.org/details/annualrep42newy. 9. Morris Bishop, A History of Cornell (Ithaca, NY: Cornell University Press, 1962), 518. 10. Cornell University, Office of the Dean of the University Faculty, “William Sargent Ladd,” (Ithaca, NY: Cornell University, 1949), http://hdl.handle.net/1813/18535; “Dr.  W. S. Ladd Dies; Ex-aide at Cornell,” New York Times, September 18, 1949, 92. 11. Annual Report to Cornell University President from Director/Dean Canby Robinson, 1933–34, box 2, folder 4, Dean’s Office Niles, 1903–34, MCA. 12. Chris Jones, Climbing in North America (Berkeley: University of California Press, 1976), 152. 13. National Park Service, “Glacier Bay Mountaineering History,” http://www.nps.gov/glba/ planyourvisit/upload/Mountaineering-History-of-Glacier-Bay.pdf.

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Notes to Pages 83–88 14. Cornell University, “Report of the Dean of the Medical College,” in Annual Report of President, for the Year 1939–1944 (Ithaca, NY: Cornell University Press, 1944), 1940–41, app. 5, xxiv, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=prrp006. 15. Kenneth M. Ludmerer, Learning to Heal: The Development of American Medical Education (New York: Basic Books, 1985), 256–60. 16. A. McGehee Harvey, Science at the Bedside: Clinical Research in American Medicine, 1905–1945 (Baltimore: Johns Hopkins University Press, 1981), 244. 17. Society of the New York Hospital, “Report of the President of the Medical Board,” in 165th Annual Report, for the Year 1936 (New York: Society of the New York Hospital, 1937), 30, http://archive.org/details/annualrep42newy. 18. Society of the New York Hospital, “Report of the Administrator-in-Chief,” in 165th Annual Report, for the Year 1936 (New York: Society of the New York Hospital, 1937), 20, http://archive.org/details/annualrep42newy. 19. Society of the New York Hospital, “Annual Report of the Society of the New York Hospital for the Year 1936,” in 165th Annual Report, for the Year 1936 (New York: Society of the New York Hospital, 1937), 9, http://archive.org/details/annualrep42newy. 20. Society of the New York Hospital, “Report of the President of the Medical Board,” in 165th Annual Report, for the Year 1936, 21–31. 21. Cornell University, “Report of the Dean of the Medical College,” in Annual Report of President, for the Year 1939–1944 (Ithaca, NY: Cornell University Press, 1944), 1939–40, app. 5, xxiv, xxxi, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=prrp006. 22. “Hospital-School Seeks $17,000,000,” NYT, March  31, 1938, 25; Society of the New York Hospital, So Near the Gods (New York: Society of the New York Hospital, 1938). 23. Report of Associate Dean William Ladd, 1933–34, box 2, folder 4, Dean’s Office Niles, 1903–34, MCA. 24. Ladd, “Address of Welcome,” 6. 25. Ibid., 11. 26. G. Canby Robinson to Alice B. Carman, letter, June 19, 1934, box 2, folder 4, Dean’s Office Niles, 1903–34, MCA. 27. Bishop, History of Cornell, 518. 28. Report of Associate Dean William Ladd, 1933–34. 29. Report of the Medical Department of New York Hospital, February 6, 1934, and New York Hospital, Out-Patient Department Report for year, January  1 to December  31, 1933, box  2, folder 5, Dean’s Office Niles, 1903–34, MCA; Annual report of the department of surgery submitted to Canby Robinson, 1932–33, box  2, folder 3, Dean’s Office Niles, 1903–34, MCA. 30. “A Brief History of Cornell Time,” Cornell Medicine 3, no. 1 (Fall 1998): 32. 31. “Gigantic ‘Eardrum’ Devised for Study,” NYT, June 12, 1938, 49. 32. Cornell University, “Report of the Dean of the Medical College,” in Annual Report of President, for the Year 1939–1944, 1940–41, app. 5, xxix. 33. Society of the New York Hospital, “Report of the President of the Medical Board,” in 165th Annual Report, for the Year 1936, 21. 34. “New Health Unit to Rise in 69th St.,” NYT, August 28, 1936, 19; “History of the Kips Bay Building on East 69th Street,” WCMC Department of Public Health, http://weill.cornell. edu/publichealth/about_us/kips_bay.html; “Grant to Medical School,” NYT, May 15, 1941, 25; Bishop, History of Cornell, 578. 35. Society of the New York Hospital, “Annual Report of the Governors of the Society of the New York Hospital for the Year 1938,” in 167th Annual Report, for the Year 1938 (New York: Society of the New York Hospital, 1939), 21, http://archive.org/details/annualrep42newy. 36. Society of the New York Hospital, “Report of the President of the Medical Board,” in 170th Annual Report, for the Year 1941 (New York: Society of the New York Hospital, 1942), 35, http://archive.org/details/annualrep42newy.

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NOTES TO PAGES 88–94 37. “NewYork–Presbyterian Hospital / Weill Cornell Medical Center 75th Anniversary,” MCA, http://weill.cornell.edu/archives/75years/site/index.html. 38. Society of the New York Hospital, “Report of the President of the Medical Board,” in 168th Annual Report, for the Year 1939 (New York: Society of the New York Hospital, 1940), 42, http://archive.org/details/annualrep42newy. 39. “Memorial Hospital Starts Building,” NYT, June 9, 1937, 30. 40. “Cornerstone Laid at Cancer Center,” NYT, May 21, 1938, 17. 41. Edmund Day, “Cornell and World War II,” 1942, Cornell University Medical College Opening Day Addresses, MCA. 42. Cornell University, Announcement of the Medical College for 1937–38, 85, http://archive. org/details/cornell1942unse. 43. Cornell University, “Report of the Dean of the Medical College,” 1940–41, app. 5, xxvi. 44. Society of the New York Hospital, “Report of the President of the Medical Board,” in 169th Annual Report, for the Year 1940 (New York: Society of the New York Hospital, 1941), 40, http://archive.org/details/annualrep42newy; Rutkow, Seeking the Cure, 209–13. 45. Cornell University, “Report of the Dean of the Medical College,” 1940–41, app. 5, xxvii. 46. Finding Aid to Joseph C. Hinsey Collection, 1966–1981, Bernard Becker Medical Library Archives, Washington University School of Medicine in St.  Louis, http://beckerarchives.wustl. edu/index.php?p=collections/findingaid&id=8655; Dorothy J. Gaiter, “Joseph Hinsey, Noted Teacher of Physicians,” New York Times, March 26, 1981, D23. 47. Bishop, History of Cornell, 547. 48. Society of the New York Hospital, “Report of the Administrator-in-Chief,” in 170th Annual Report, for the Year 1941 (New York: Society of the New York Hospital, 1942), 24, http://archive.org/details/annualrep42newy. 49. Calvin S. White, “The Medical College Goes to War,” Cornell Alumni News 44, no. 24 (April 2, 1942): 313–14. 50. Cornell University, “Report of the Dean of the Medical College,” in Annual Report of President, for the Year 1939–1944 (Ithaca, NY: Cornell University Press, 1944), 1941–42, app. 5, xxxv–xxxvii, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=prrp006; “Medicine and the War,” Journal of the American Medical Association 122, no.  2 (May  8, 1943): 120–23; Society of the New York Hospital, “Report of the President of the Medical Board,” in 170th Annual Report, for the Year 1941 (New York: Society of the New York Hospital, 1942), 27, http://archive.org/details/annualrep42newy. 51. Cornell University, “Report of the Dean of the Medical College,” in Annual Report of President, for the Year 1939–1944 (Ithaca, NY: Cornell University Press, 1944), 1942–43, app. 10, lv, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=prrp006. 52. Bishop, History of Cornell, 547–49; Marion Hunt, “The Brightest Hope: A Centennial History of CUMC,” manuscript, February 1998, MCA, 145–46; Cornell University, “Report of the Dean of the Medical College,” 1942–43, app. 10, xliii, lv. 53. Cornell University, “Report of the Dean of the Medical College,” in Annual Report of President, for the Year 1939–44 (Ithaca, NY: Cornell University Press, 1944), 1943–44, app. 10, xlvi, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=prrp006. 54. “Centennial Reflections,” Cornell Medicine 3, no. 1 (Fall 1998): 40. 55. Finding Aid to the David Rogers, MD (1926–94) Papers, MCA, http://www.med.cornell. edu/archives/pdf/personal_aids/drogers.pdf. 56. George Packer Berry, Dayton J. Edwards, and Stockton Kimball, “Report of the Committee on the Training and Supply of Doctors in the Event of Another War,” Journal of the Association of American Medical Colleges 22, no. 2 (March 1947): 67. 57. Joseph Hinsey’s handwritten responses to AAMC survey on medical education in wartime, miscellaneous records, folder Wartime Medical Education, 1946–47, MCA. 58. Joseph C. Hinsey to the Committee on Affiliations of the Joint Board, letter, June  23, 1944, miscellaneous records, folder Affiliations 1944–64, MCA.

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Notes to Pages 94–101 59. “Necrology, ’36 AB, ’40 MD—Lieutenant Jacques Conrad Saphier,” Cornell Alumni News 45, no. 5 (October 22, 1942): 66; Hunt, “Brightest Hope,” 147. 60. “Holds Honor in European Theatre of War,” NYT, October 7, 1943, 20; “Concerning the Alumni, ’31 MD,” Cornell Alumni News 45, no. 28 (May 13, 1943): 374. 61. “War Hospital Unit 9 Reorganizing in City,” NYT, June 13, 1940, 18; White, “Medical College Goes to War,” 313–14; Rachel Moskowitz, “67 Years Ago This Month . . . ,” A View from the 25th Floor, MCA, http://weill.cornell.edu/archives/blog/2011/01, January 26, 2011; Finding Aid to the Records of Ninth General Hospital, New York Hospital, MCA, http:// weill.cornell.edu/archives/pdf/institutional. . ./NinthGeneralHospital.pdf. 62. Hunt, “Brightest Hope,” 148; White, “Medical College Goes to War,” 313–14. 63. Roy Swan to Robert Buchanan, letter, September  18, 1968, Dean’s Office Buchanan/ Cooper/Meikle, folder Papanicolaou, George, Correspondence 1957–73, MCA; Finding Aid to the Joseph Hinsey, PhD (1901–1981), Papers, MCA, http://weill.cornell.edu/archives/pdf/ personal_aids/Hinsey.pdf; Elizabeth Shepherd, “George Papanicolaou: Development of the Pap Smear,” A View from the 25th Floor, MCA, http://weill.cornell.edu/archives/blog/ 2011/06, June 29, 2011. 64. Cornell University, “Report of the Dean of the Medical College,” 1942–43, app. 10, xlvi. 65. “Discoverer of Pap Test Is Honored,” New York Times, May 20, 1978, 23. 66. Bishop, History of Cornell, 548–49. 67. Hugh DeHaven, “Mechanical Analysis of Survival in Falls from Heights of Fifty to One Hundred and Fifty Feet,” Injury Prevention 6 (2000): 62–28. 68. Finding Aid to the Hugh DeHaven, PhD (1895–1980), Papers, MCA, http://www.med. cornell.edu/archives/pdf/personal_aids/DeHaven.pdf. 69. Damon Stetson, “Car Crash Expert Lauds Seat Belts,” NYT, August 30, 1956, 27. 70. Cornell University, “Report of the Dean of the Medical College,” 1941–42, app. 5, xxviii. 71. Society of the New York Hospital, “Report of the Director of the School of Nursing and Director of the Nursing Service,” in 171st Annual Report, for the Year 1942 (New York: Society of the New York Hospital, 1943), 54, http://archive.org/details/annualrep42newy. 72. Society of the New York Hospital, “Report of the President of the Medical Board,” in 172nd Annual Report, for the Year 1943 (New York: Society of the New York Hospital, 1944), 22, https://archive.org/details/annualrep47newy. 73. Cornell University, “Report of the Dean of the Medical College,” in Annual Report of President, for the Year 1939–1944 (Ithaca, NY: Cornell University Press, 1944), 1944–45, app. 10, 59, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=prrp006. 74. Cornell University, “Report of the Dean of the Medical College,” in Annual Report of President, for the Year 1945–1949 (Ithaca, NY: Cornell University Press, 1949), 1945–46, app. 10, 68–70, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=prrp007. 75. Cornell University, “Report of the Dean of the Medical College,” 1945–46, app. 10, 81. 76. Cornell University, “Report of the Dean of the Medical College,” in Annual Report of President, for the Year 1945–1949 (Ithaca, NY: Cornell University Press, 1949), 1946–47, app. 10, 81, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=prrp007; Annual report to Cornell University President from Dean Joseph Hinsey, 1952–53, 14, box H5, folder Deans—Past / Deans Report 48–50, 50–55, MCA.

5. Postwar Boom 1. Kenneth M. Ludmerer, Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care (New York: Oxford University Press, 1999), 139–45. 2. “A  Short History of the National Institutes of Health,” Office of NIH History, http:// history.nih.gov/exhibits/history; William Rothstein, American Medical Schools and the Practice of Medicine: A History (New York: Oxford University Press, 1987), 237.

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NOTES TO PAGES 102–106 3. Annual report to Cornell University President from Dean Joseph Hinsey, 1950–51, 84A–86, box H5, folder Deans—Past / Deans Report 48–50, 50–55, MCA; Annual report to Cornell University President from Dean E. Hugh Luckey, 1954–55, 7, box H5, folder Deans—Past / Deans Report 48–50, 50–55, MCA. 4. Annual report to Cornell University President from Dean Joseph Hinsey, 1949–50, 59, box H5, folder Deans—Past / Deans Report 48–50, 50–55, MCA; Annual report to Cornell University President from Dean Joseph Hinsey, 1952–53, 8, box H5, folder Deans—Past / Deans Report 48–50, 50–55, MCA. 5. Cornell University, “Report of the Dean of the Medical College,” in Annual Report of President, for the Year 1945–1949 (Ithaca, NY: Cornell University Press, 1949), 1946–47, app. 10, 97, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=prrp007. 6. Annual report to Cornell University President from Dean Joseph Hinsey, 1949–50, 67–68. 7. Cornell University, “Report of the Dean of the Medical College,” in Annual Report of President, for the Year 1945–49 (Ithaca, NY: Cornell University Press, 1949), 1947–48, app. 10, 110, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=prrp007. 8. Annual report to Cornell University President from Dean Joseph Hinsey, 1949–50, 63. 9. Glenn C. Altschuler and Isaac Kramnick, Cornell: A History, 1940–2015 (Ithaca, NY: Cornell University Press, 2014), 74–99. 10. Ludmerer, Time to Heal, 143. 11. Cornell University, “Report of the Dean of the Medical College,” 1947–48, app. 10, 85. 12. Annual report to Cornell University President from Dean Joseph Hinsey, 1950–51, 91, 96. 13. Rothstein, American Medical Schools, 282–83. 14. Annual report to Cornell University President from Dean E. Hugh Luckey, 1956–57, 13, box H4, folder Deans—Past / Deans Report 55–60, MCA. 15. Ludmerer, Time to Heal, 180–82; Rothstein, American Medical Schools, 200. 16. E. Hugh Luckey, “Role of Undergraduate Medical Education in Preparation for Graduate Education,” Journal of the American Medical Association 153, no. 17 (April 27, 1957): 1586. 17. Annual report to Cornell University President from Dean E. Hugh Luckey, 1954–55, 5. 18. Cornell University, “Report of the Dean of the Medical College,” 1947–48, app. 10, 85. 19. William C. McGaghie, “Assessing Readiness for Medical Education: Evolution of the Medical College Admission Test,” Journal of the American Medical Association 288, no. 9 (September 4, 2002): 1085–90. 20. Annual report to Cornell University President from Dean Joseph Hinsey, 1950–51, 4–5. 21. Annual report to Cornell University President from Dean Joseph Hinsey, 1948–49, 5, box H5, folder Deans—Past / Deans Report 48–50, 50–55, MCA. 22. Annual report to Cornell University President from Dean Joseph Hinsey, 1951–52, 32–33, box H5, folder Deans—Past / Deans Report 48–50, 50–55, MCA. 23. “New York: Higher Education,” NYT, December 29, 1946, 68. 24. “Race Bias Charged at Cornell School,” NYT, October 23, 1946, 24. 25. “Medical Schools in State Accused,” NYT, June 22, 1953, 24. 26. “Jewish Unit Drops School Bias Charge,” NYT, November 7, 1953, 19. 27. Annual report to Cornell University President from Dean E. Hugh Luckey, 1956–57, 1. 28. Cornell University, “Report of the Dean of the Medical College,” 1947–48, app. 10, 112. 29. “Centennial Reflections,” Cornell Medicine 3, no. 1 (Fall 1998): 40. 30. Cornell University, “Report of the Dean of the Medical College,” in Annual Report of President, for the Year 1939–1944 (Ithaca, NY: Cornell University Press, 1944), 1944–45, app. 10, 78, http://ebooks.library.cornell.edu/cgi/t/text/text-idx?c=cuda;idno=prrp006. 31. “$2,549,000 Gift Aids Cornell Medical,” NYT, January 10, 1952, 31. 32. Marion Hunt, “The Brightest Hope: A Centennial History of CUMC,” manuscript, February 1998, MCA, 161–62. 33. Cornell University, “Report of the Dean of the Medical College,” 1947–48, app. 10, 111–12; Morris Bishop, A History of Cornell (Ithaca, NY: Cornell University Press, 1962), 577.

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Notes to Pages 107–113 34. “$2,549,000 Gift Aids Cornell Medical,” NYT, January 10, 1952, 31; Hunt, “Brightest Hope,” 162–63. 35. Annual report to Cornell University President from Dean E. Hugh Luckey, 1955–56, 5, box H4, folder Deans—Past / Deans Report 55–60, MCA. 36. Ludmerer, Time to Heal, 196–204. 37. Annual report to Cornell University President from Dean Joseph Hinsey, 1951–52, 10, 43. 38. “The Young Dean,” Newsweek, July 26, 1954, 49. 39. Luckey, “Role of Undergraduate Medical Education,” 1587. 40. Peter Rogatz, “Cornell Pioneered Comprehensive Care Curriculum in Medical Education,” American Medical News, February 14, 2005, http://www.amednews.com/2005/02/14/ edrb0214.htm. 41. Theodore M. Brown, “George Canby Robinson and ‘The Patient as a Person,’ ” in Greater Than the Parts: Holism in Biomedicine, 1920–1950, eds. Christopher Lawrence and George Viesz (New York: Oxford University Press, 1998), 152–53; George G. Reader and Mary E. W. Goss, eds. Comprehensive Medical Care and Teaching: A  Report on The New York Hospital–Cornell Medical Center Program (Ithaca, NY: Cornell University Press, 1967). 42. Annual report to Cornell University President from Dean E. Hugh Luckey, 1956–57, 4. 43. R. Gordon Douglas, “Reflections on Why We Are Here,” 1954, 6, Cornell University Medical College Opening Day Addresses, MCA. 44. Ludmerer, Time to Heal, 203–4. 45. Cornell University, “Report of the Dean of the Medical College,” 1946–47, app. 10, 98. 46. Hunt, “Brightest Hope,” 160–61. 47. “New York Hospital Opens Astor Clinic,” Rhinebeck Gazette, January 5, 1950, 1; Annual report to Cornell University President from Dean Joseph Hinsey, 1950–51, 19–20. 48. Eric Larrabee, The Benevolent and Necessary Institution: The New York Hospital, 1771–1971 (Garden City, NY: Doubleday & Co., 1971), 326. 49. McCandlish Phillips, “Medical Director Needled Fondly,” New York Times, January 22, 1966, 31; Marion Hunt, “The Brightest Hope: A Centennial History of CUMC,” manuscript, February 1998, MCA, 131. 50. Annual report to Cornell University President from Dean John E. Deitrick, 1965–66, 13, box H4, folder Deans—Past / Deans Report 61–66, MCA. 51. Walter Riker Jr., “Postscript: Wally Remembers,” Cornell Medicine 3, no. 1 (Fall 1998): 55–56. 52. J. Robert Buchanan, interview by Jennifer Moon, November 20, 2013. 53. G. Canby Robinson, Adventures in Medical Education: A  Personal Narrative of the Great Advance of American Medicine (Cambridge, MA: Harvard University Press, 1957), 226. 54. Annual report to Cornell University President from Dean Joseph Hinsey, 1952–53, 18. 55. Society of the New York Hospital, “Report of the President,” in Annual Report for the Year 1955 (New York: Society of the New York Hospital, 1956), 21, http://archive.org/details/ annualrep59newy. 56. Society of the New York Hospital, “Report of the President,” in Annual Report for the Year 1956 (New York: Society of the New York Hospital, 1957), 20, http://archive.org/details/ annualrep59newy. 57. Society of the New York Hospital, “Report of the Director,” in Annual Report for the Year 1959 (New York: Society of the New York Hospital, 1960), 50, http://archive.org/details/ annualrep59newy. 58. Buchanan interview. 59. “The Young Dean,” Newsweek, July 26, 1954, 48–49. 60. E. Hugh Luckey, “Remarks at Opening Exercise,” 1964, 8, Cornell University Medical College Opening Day Addresses, MCA. 61. Adele A. Lerner to Carl A. Berntsen, letter, March 19, 1980, box 1, folder 10, Carl A. Berntsen Collection, MCA; Steve Balt, “Centennial Science Symposium,” Cornell Medicine (Fall 1998): 69.

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NOTES TO PAGES 113–121 62. Joan Cook, “E. H. Luckey, 69, Hospital Chief,” New York Times, August 9, 1989, B7. 63. Robert Michels, interview by Jennifer Moon, November 20, 2013. 64. R. A. Rees Pritchett, interview by Jennifer Moon, February 23, 2012. 65. Buchanan interview. 66. Douglas, “Reflections on Why We Are Here,” 4–5. 67. “Private Institutions Used in C.I.A. Effort to Control Behavior,” NYT, August 2, 1977, 16; Jo Thomas, “Extent of University Work for C.I.A. Is Hard to Pin Down,” NYT, October 9, 1977, 78; Mark A. Levenson, “New Papers Detail Cornell-CIA Link,” Cornell Daily Sun, October 12, 1977, 1, 3, 8; Drafts of press releases, August 2, 1977, and October 5, 1977, box 1, folder 9, Dean’s Office (Buchanan/Cooper/Meikle), 1969–87, MCA. 68. Lawrence E. Hinkle Jr. and Harold G. Wolff, “Communist Interrogation and Indoctrination of ‘Enemies of the States’; Analysis of Methods Used by the Communist State Police (a Special Report),” AMA Archives of Neurology and Psychiatry 76, no. 2 (August 1956): 115–74. 69. Barbara Burke, “Medical Professor: CU Knew of CIA Link,” Ithaca Journal, October 12, 1977, 1, 3. 70. “Private Institutions Used in C.I.A. Effort to Control Behavior,” 16. 71. Annual report to Cornell University President from Dean E. Hugh Luckey, 1956–57, 6. 72. Annual report to Cornell University President from Dean E. Hugh Luckey, 1954–55, 7. 73. Richard L. Mueller, “Irving S. Wright—Innovator in Cardiovascular Medicine,” Clinical Cardiology 18 (1995): 181–83. 74. Annual report to Cornell University President from Dean E. Hugh Luckey, 1954–55, 6. 75. Elizabeth Shepherd, “The Navajo Cornell Field Health Project,” A View from the 25th Floor, MCA, http://weill.cornell.edu/archives/blog/2011/06, June 29, 2011. 76. Annual report to Cornell University President from Dean Joseph Hinsey, 1952–53, 8. 77. Annual report to Cornell University President from Dean Joseph Hinsey, 1950–51, 16. 78. Ludmerer, Time to Heal, 149. 79. Annual report to Cornell University President from Dean Joseph Hinsey, 1949–50, 74. 80. “WCMC and WCGSMS Orientation Manual” (booklet for Board of Overseers, OTS, June  2012), 3, 26; Annual report to Cornell University President from Dean Joseph Hinsey, 1951–52, 44. 81. Cornell University, Graduate School of Medical Sciences Announcement for 1954–55 Sessions (Ithaca, NY: Cornell University, 1954), 23–24, https://archive.org/details/cornell universit1954corn. 82. Cornell University Medical College, Graduate School of Medical Sciences, 1962–1963 and 1963–1964 (New York: Cornell University, 1964), 28–30, https://archive.org/details/cornell universit1962corn_0. 83. David P. Hajjar, interview by Jennifer Moon, September 13, 2013. 84. Annual report to Cornell University President from Dean Joseph Hinsey, 1950–51, 98–99; David B. Levine, “The Hospital for Special Surgery Affiliates with Cornell University Medical College and New York Hospital, 1951; Philip D. Wilson Retires as Surgeon-in-Chief, 1955,” HSS Journal 5, no. 2 (September 2009): 83–91. 85. Annual report to Cornell University President from Dean E. Hugh Luckey, 1955–56, 1; Annual report to Cornell University President from Dean E. Hugh Luckey, 1954–55, 8. 86. Annual report to Cornell University President from Dean E. Hugh Luckey, 1955–56, 11. 87. Annual report to Cornell University President from Dean E. Hugh Luckey, 1956–57, 12–15. 88. Ibid., 16.

6. The Expansive 1960s 1. William Rothstein, American Medical Schools and the Practice of Medicine: A History (New York: Oxford University Press, 1987), 270–81.

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Notes to Pages 122–128 2. John E. Deitrick and Robert C. Berson, Medical Schools in the United States at Mid-Century (New York: McGraw-Hill, 1953). 3. J. Robert Buchanan, interview by Jennifer Moon, November 20, 2013. 4. “Sarah Deitrick, Physician, Dead,” New York Times, September 29, 1963, 86; “Medical College Dean Appointed by Cornell,” New York Times, April 14, 1957, 19; “Board Names Medical Dean,” Cornell Daily Sun 73, no. 122, April 15, 1957; “Cornell Medical Dean Joins Insurer’s Board,” New York Times, April 6, 1966, 63; “Paid Notice: Deaths, Deitrick, John E., Sr., M.D.,” New York Times, October 1, 2000; “John English Deitrick ’29,” Princeton Alumni Weekly, November 8, 2000, https://paw.princeton.edu/memorials/37/88/index.xml. 5. Buchanan interview. 6. Annual report to Cornell University President from Dean John E. Deitrick, 1957–58, box H4, folder Deans—Past / Deans Report 55–60, MCA. 7. Annual report to Cornell University President from Dean John E. Deitrick, 1964–65, 10–11, box H4, folder Deans—Past / Deans Report 61–66, MCA. 8. Report of the Survey of Cornell University Medical College by the Liaison Committee on Medical Education, June 12–15, 1972, box 1, folder 4, Liaison Committee on Medical Education (Accreditation), 1972, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969–87, MCA. 9. “A  National Program to Conquer Health Disease, Cancer, and Stroke,” Journal of the American Heart Association 192, no. 4 (1965): 299. 10. “Planning for the Third Century,” Cornell University Medical College Alumni Quarterly (Summer 1967): 3. 11. Rosemary Stevens, American Medicine and the Public Interest: A History of Specialization (Berkeley: University of California Press, 1998), 432–43; Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 363–78. 12. Annual report to Cornell University President from Dean John E. Deitrick, 1964–65, 1. 13. “Planning for the Third Century,” 3. 14. Kenneth M. Ludmerer, Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care (New York: Oxford University Press, 1999), 223. 15. The New York Hospital–Cornell Medical Center, Cornell University Medical College– Faculty Practice Plan, January 20, 1978, box 6, folder 1 CU/CUMC relationship/operations review 1977–79, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969–87, MCA; Report of the Survey of Cornell University Medical College by the Liaison Committee on Medical Education, June 12–15, 1972. 16. “Doctors Demand Bellevue Razing,” NYT, May 4, 1957, 23. 17. Annual report to Cornell University President from Dean John E. Deitrick, 1965–66, 3, box H4, folder Deans—Past / Deans Report 61–66, MCA. 18. “Planning for the Third Century,” 2–3. 19. Interview with John Deitrick by Ralph Engle, November  18, 1982, transcript, 6, Oral History Transcripts A–G, folder 1, MCA. 20. “North Shore Hospital Affiliates with Cornell’s Medical College,” NYT, October  7, 1969, 36. 21. Annual report to Cornell University President from Dean John E. Deitrick, 1967–68, 5, box H4, folder Deans—Past / Deans Report 67–69, MCA. 22. Ludmerer, Time to Heal, 24. 23. Annual report to Cornell University President from Dean John E. Deitrick, 1967–68, 6. 24. Annual report to Cornell University President from Dean John E. Deitrick, 1963–64, box H4, folder Deans—Past / Deans Report 61–66, MCA; Annual report to Cornell University President from Dean John E. Deitrick, 1968–69, 6–8, box H4, folder Deans—Past / Deans Report 67–69, MCA; Thomas Meikle to Senator Martin Connor, letter, May 14, 1982, box 1, folder 2, Affirmative Action, Democratic Task Force of 1982, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969–87, MCA. 25. “Doctors Hit Ban on Birth Control,” NYT, August 31, 1958, 56.

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NOTES TO PAGES 128 –133 26. “Use of LSD Drops, Expert Reports: Dr. Louria Says Dangers Are Being Understood,” NYT, January 25, 1967, 46. 27. “Poverty Linked to Mental Ills,” NYT, February 21, 1959, 24. 28. Charles H. Goodrich, Margaret Olendzki, and George G. Reader, “The New York Hospital—Cornell Medical Center: A Progress Report on an Experiment in Welfare Medical Care,” American Journal of Public Health 55 (1965): 88–93. 29. “Planning for the Third Century,” 4. 30. Annual report to Cornell University President from Dean John E. Deitrick, 1959–60, box H4, folder Deans—Past / Deans Report 55–60, MCA. 31. Annual report to Cornell University President from Dean John E. Deitrick, 1957–58, 1. 32. Annual report to Cornell University President from Dean E. Hugh Luckey, 1956–57, 6, box H4, folder Deans—Past / Deans Report 55–60, MCA. 33. Annual report to Cornell University President from Dean John E. Deitrick, 1961–62, 12, box H4, folder Deans—Past / Deans Report 61–66, MCA. 34. Buchanan interview. 35. Annual report to Cornell University President from Dean John E. Deitrick, 1964–65, 1. 36. John Deitrick, interview by Ralph Engle, November 18, 1982, 2. 37. “2 Gifts Will Help Cornell Build Library at New York Hospital,” NYT, June 28, 1959, 54; “$4,000,000 Medical Library Dedicated at Cornell Center,” NYT, October 18, 1962, 18. 38. Annual report to Cornell University President from Dean John E. Deitrick, 1961–62, 6. 39. John Deitrick, interview by Ralph Engle, November 18, 1982, 3. 40. Ibid., 3–4; Erich Meyerhoff, “Death in the Family: The Medical Library Center of New York, 1960–2003,” Journal of the Medical Library Association 92, no. 1 (January 2004): 4. 41. “The Theodora Griffis Faculty Club,” Cornell University Medical College Alumni Bulletin (Spring 1962): 14; John Deitrick, interview by Ralph Engle, October 19, 1982, transcript, 14, Oral History Transcripts A–G, folder 1, MCA. 42. “Hospital Dedicated to Woman Doctor at Cornell Center,” NYT, May 9, 1963, 39. 43. “54 Million Goal Set by Hospital,” NYT, December 8, 1961, 33. 44. “Whitney and Sister Give Hospital 10 Million,” NYT, December 17, 1961, 68. 45. Annual report to Cornell University President from Dean John E. Deitrick, 1963–64, 2–3. 46. Society of the New York Hospital, “Report of the President,” in Annual Report for 1964 (New York: Society of the New York Hospital, 1965), 6, https://archive.org/details/annual reportsoci1963newy; Annual report to Cornell University President from Dean John E. Deitrick, 1965–66, 1. 47. “Cornell Medical Center Begins a New Clinical Research Building,” NYT, November 20, 1966, 123. 48. John Deitrick, interview by Ralph Engle, November 18, 1982, 5. 49. “180 Tenants Fight Plans of Cornell,” NYT, May 22, 1966, 66. 50. “NewYork–Presbyterian Hospital / Weill Cornell Medical Center 75th Anniversary,” MCA, http://weill.cornell.edu/archives/75years/site/index.html. 51. “50 Years of Transplant Excellence,” Weill Cornell Transplant Program, Department of Surgery, http://cornellsurgery.org/transplant/50years.html. 52. “Clinic Here Tries to Avert Suicides,” NYT, February 9, 1969, 96; Starr, Social Transformation, 365. 53. Comparison of Expenditures for Research and Total Number of Employees 1951–63, box 1, folder Clinical Research Center Grants, 1964, 1966, Dean’s Office Deitrick, 1936–73, MCA. 54. Annual report to Cornell University President from Dean John E. Deitrick, 1959–60, 6. 55. “Paid Notice: Deaths Deitrick, John E., Sr., M.D.,” NYT, October 1, 2000. 56. Annual report to Cornell University President from Dean John E. Deitrick, 1965–66, 7. 57. “Household Income in 1967 and Selected Social and Economic Characteristics of Households,” Current Population Reports, ser. P-60, no. 62 (July 15, 1969), http://www2.census. gov/prod2/popscan/p60–062.pdf.

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58. Annual report to Cornell University President from Dean John E. Deitrick, 1964–65, 9–10; Annual report to Cornell University President from Dean John E. Deitrick, 1966–67, 5–6, box H4, folder Deans—Past / Deans Report 61–66, MCA. 59. Annual report to Cornell University President from Dean John E. Deitrick, 1967–68, 2. 60. Comparison of Expenditures for Research and Total Number of Employees 1951–63. 61. Annual report to Cornell University President from Dean John E. Deitrick, 1964–65, 3. 62. Annual report to Cornell University President from Dean John E. Deitrick, 1959–60, 7. 63. Annual report to Cornell University President from Dean John E. Deitrick, 1965–66, 2. 64. Annual report to Cornell University President from Dean John E. Deitrick, 1964–65, 9. 65. Annual report to Cornell University President from Dean John E. Deitrick, 1966–67, 9. 66. Annual report to Cornell University President from Dean John E. Deitrick, 1964–65, 8. 67. Walsh McDermott to John Deitrick, letter, January 11, 1956, and Cornell Week at Lincoln Center, memorandum, box 1, folder Cornell University Centennial Celebration Correspondence, reports, programs: 1965, Dean’s Office Deitrick, 1936–73, MCA. 68. Annual report to Cornell University President from Dean John E. Deitrick, 1963–64, 4. 69. Annual report to Cornell University President from Dean John E. Deitrick, 1958–59, 5, box H4, folder Deans—Past / Deans Report 55–60, MCA. 70. Annual report to Cornell University President from Dean John E. Deitrick, 1966–67, 6. 71. Rothstein, American Medical Schools, 310–12. 72. Annual report to Cornell University President from Dean John E. Deitrick, 1964–65, 8–9. 73. Annual report to Cornell University President from Dean John E. Deitrick, 1965–66, 2. 74. Ludmerer, Time to Heal, 209–15. 75. John Deitrick, interview by Ralph Engle, November 18, 1982, 1. 76. Annual report to Cornell University President from Dean John E. Deitrick, 1957–58, 7; Tuition, July  13, 1967, box  1, folder Tuition Paper re: 7/13/67, Dean’s Office Deitrick, 1936–73, MCA. 77. Interview with John Deitrick by Ralph Engle, October 19, 1982, 18–19. 78. Annual report to Cornell University President from Dean John E. Deitrick, 1958–59, 6–7. 79. “2 Hospitals End a Policy Dispute,” NYT, July 9, 1960, 21. 80. Annual report to Cornell University President from Dean John E. Deitrick, 1963–64, 1–2. 81. Annual report to Cornell University President from Dean John E. Deitrick, 1964–65, 3. 82. Interview with John Deitrick by Ralph Engle, October 19, 1982, 16–17. 83. Annual report to Cornell University President from Dean John E. Deitrick, 1959–60, 2. 84. Annual report to Cornell University President from Dean John E. Deitrick, 1966–67, 14. 85. J. Robert Buchanan, interview by Jennifer Moon, November 20, 2013. 86. Annual report to Cornell University President from Dean John E. Deitrick, 1968–69, 8.

7. A Decade of Malaise 1. Kenneth Ludmerer, Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care (Oxford: Oxford University Press, 1999), 337. 2. Annual report to Cornell University President from Dean J. Robert Buchanan, 1970–71, 1, box H4, folder Deans—Past / Deans Report 69–73, MCA. 3. Report of the Survey of Cornell University Medical College by the Liaison Committee on Medical Education, June 12–15, 1972, box 1, folder 4, Liaison Committee on Medical Education (Accreditation), 1972, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969–87, MCA. 4. Robert J. Glaser, “The Medical Deanship: Its Half-Life and Hard Times,” Journal of Medical Education 44 (December 1969): 1116. 5. Theodore Cooper to Frank H. T. Rhodes, letter, November  17, 1978, box  9, folder 1, Rhodes, Frank H. T., correspondence to/from 1977–79, Dean, Office of CUMC (Buchanan/ Cooper/Meikle), 1969–87, MCA.

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NOTES TO PAGES 140 –147 6. J. Robert Buchanan, interview by Jennifer Moon, November 20, 2013. 7. “Cornell Medical College Names Graduate as Dean,” New York Times, October  19, 1969, 77; “Buchanan, J. Robert, MD,” Museum at Mass General, http://www2.massgeneral. org/history/catalogueDetails.asp?catalogueNo=182; “Susan T. Carver Will Be the Bride of J. R. Buchanan,” New York Times, August 12, 1962, 78; “Susan Carver, John Buchanan Are Wed Here,” New York Times, October 28, 1962, 92. 8. Report of the Survey of Cornell University Medical College by the Liaison Committee on Medical Education. 9. Glaser, “Medical Deanship,” 1120. 10. Marvin R. Weisbord, Paul R. Lawrence, and Martin P. Charns, “Three Dilemmas of Academic Medical Centers,” Journal of Applied Behavioral Science 14, no. 3 (1978): 284–304. 11. Ludmerer, Time to Heal, 330. 12. Report of the Survey of Cornell University Medical College by the Liaison Committee on Medical Education, 6. 13. Robert Michels, interview by Jennifer Moon, November 20, 2013. 14. Buchanan interview. 15. Annual report to Cornell University President from Dean J. Robert Buchanan, 1974–75, 25, box H4, folder Deans—Past / Deans Report 74–75, MCA. 16. Buchanan interview. 17. CUNYH Moratorium Committee to Members of the Faculty, Cornell University Medical College, letter, October 18, 1969, box 1, folder Moratorium Committee 1969, Dean’s Office Deitrick, 1936–73, MCA. 18. Annual report to Cornell University President from Dean J. Robert Buchanan, 1969–70, 2, box H4, folder Deans—Past / Deans Report 69–73, MCA. 19. Buchanan interview. 20. Annual report to Cornell University President from Dean J. Robert Buchanan, 1970–71, 15. 21. Annual report to Cornell University President from Dean J. Robert Buchanan, 1969–70, 3. 22. Annual report to Cornell University President from Dean J. Robert Buchanan, 1974–75, 13. 23. Annual report to Cornell University President from Dean J. Robert Buchanan, 1975–76, 4, box Dl6, folder Deans / Deans Report 75–80, MCA. 24. Annual report to Cornell University President from Dean J. Robert Buchanan, 1971–72, 4–5, box H4, folder Deans—Past / Deans Report 69–73, MCA. 25. “Cornell Tuition and Fees to Increase $275 a Year,” NYT, January 25, 1970, 70; Annual report to Cornell University President from Dean J. Robert Buchanan, 1972–73, 9, box H4, folder Deans—Past / Deans Report 69–73, MCA. 26. Buchanan interview. 27. The Rockefeller-Cornell MD-PhD Program in the Biomedical Sciences, 1973, and Thomas Meikle Jr. to Roland Schneckloth, letter, June 27, 1974, box 8, folder 5, RU-CUMC MD-PhD program, 1969–76, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969–87, MCA. 28. “The Academic Medical Center, Fifty Years Later,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 7–8. 29. “WCMC and WCGSMS Orientation Manual” (booklet for Board of Overseers, OTS, June 2012), 3, 26; Annual report to Cornell University President from Dean Theodore Cooper, 1978–79, 4, box Dl6, folder Deans / Deans Report 75–80, MCA. 30. James L. Curtis, Affirmative Action in Medicine: Improving Health Care for Everyone (Ann Arbor: University of Michigan Press, 2003), 35. 31. Thomas Meikle to Senator Martin Connor, letter, May 14, 1982, box 1, folder 2, Affirmative Action, Democratic Task Force of 1982, Dean, Office of CUMC (Buchanan/Cooper/ Meikle), 1969–87, MCA. 32. “Well Traveled,” Weill Cornell Medicine (Fall 2013): 36.

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Notes to Pages 147–154 33. Thomas Meikle to Senator Martin Connor, letter, May 14, 1982, box 1, folder 2, Affirmative Action, Democratic Task Force of 1982, Dean, Office of CUMC (Buchanan/Cooper/ Meikle), 1969–87, MCA. 34. Curtis, Affirmative Action, 35–57; Annual report to Cornell University President from Dean J. Robert Buchanan, 1969–70, 1–3. 35. Annual report to Cornell University President from Acting Dean Thomas Meikle Jr., 1976–77, 8, box Dl6, folder Deans / Deans Report 75–80, MCA. 36. Charlayne Hunter-Gault, “New York Medical Schools Lag in Attracting Minority Students,” NYT, April 28, 1977, 1, A25. 37. Curtis, Affirmative Action, 42. 38. Thomas Meikle to Senator Martin Connor, letter, May 14, 1982. 39. Annual report to Cornell University President from Dean J. Robert Buchanan, 1974–75, 13. 40. Thomas Meikle to Senator Martin Connor, letter, May 14, 1982. 41. Report of the Survey of Cornell University Medical College by the Liaison Committee on Medical Education; Nancy Hicks, “Sickle Cell Tests Begun in High School by a Group of Black Medical Students,” NYT, January 19, 1972, 18. 42. Thomas Meikle to J. Robert Buchanan, Admissions Report, 1972–73, June  15, 1973, box  1, folder 1, Admissions, Committee on Admissions Report 1972–73, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969–87, MCA. 43. Annual report to Cornell University President from Dean J. Robert Buchanan, 1970–71, 8. 44. Annual report to Cornell University President from Acting Dean Thomas Meikle Jr., 1976–77, 9. 45. Thomas H. Meikle Jr., “Selecting Students for Medical School in the United States,” Danish Medical Bulletin 27, suppl. no. 1 (May 1980): 21–28. 46. Annual report to Cornell University President from Dean J. Robert Buchanan, 1970–71, 20–21. 47. Report of the Survey of Cornell University Medical College by the Liaison Committee on Medical Education, June  12–15, 1972; Annual report to Cornell University President from Dean J. Robert Buchanan, 1974–75. 48. Annual report to Cornell University President from Dean J. Robert Buchanan, 1975–76, 2. 49. Wolfgang Saxon, “Dr. Helen Kaplan, 66, Dies; Pioneer in Sex Therapy Field,” NYT, August 19, 1995, 46. 50. Annual report to Cornell University President from Dean Theodore Cooper, 1979–80, 5, box Dl6, folder Deans / Deans Report 75–80, MCA. 51. “A Brief History of Cornell Time,” Cornell Medicine 3, no. 1 (Fall 1998): 36; Lawrence K. Altman, “A Burn Center Is Opening in New York City—It’s a First,” NYT, December 9, 1976, 49; Ronald Sullivan, “Burn Center Sets Up First Skin Bank in New York,” NYT, April 2, 1978, 50. 52. Annual report to Cornell University President from Dean J. Robert Buchanan, 1974–75, 19–21. 53. Annual report to Cornell University President from Dean J. Robert Buchanan, 1971–72, 9–10. 54. Annual report to Cornell University President from Dean J. Robert Buchanan, 1969–70, 8. 55. Annual report to Cornell University President from Dean J. Robert Buchanan, 1974–75, 17–18. 56. Buchanan interview. 57. Annual report to Cornell University President from Dean J. Robert Buchanan, 1969–70, 7–8. 58. David K. Shipler, “Medical Complex Aims to Build over Drive,” NYT, February 17, 1971, 1, 43. 59. Buchanan interview.

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NOTES TO PAGES 154 –160 60. John Sibley, “Medical Complex Details Expansion,” NYT, May 24, 1972, 1, 59. 61. Buchanan interview; Annual report to Cornell University President from Dean J. Robert Buchanan, 1970–71, 30–31; David K. Shipler, “Hospital Pledges Not to Evict or Relocate East Side Tenants,” NYT, March  30, 1971, 69; Sibley, “Medical Complex Details Expansion,” 1, 59; Max H. Seigel, “Medical Centers over Drive Voted,” NYT, April 3, 1973, 89; Report of the Survey of Cornell University Medical College by the Liaison Committee on Medical Education, June  12–15, 1972; Shipler, “Medical Complex Aims to Build over Drive,” 1, 43; Annual report to Cornell University President from Dean J. Robert Buchanan, 1972–73, 11–12; “East Siders Gain Demand for 2d Air-Rights Hearing,” NYT, March 23, 1973, 41. 62. Sibley, “Medical Complex Details Expansion,” 59. 63. Report of the Survey of Cornell University Medical College by the Liaison Committee on Medical Education, June 12–15, 1972, 13. 64. Annual report to Cornell University President from Acting Dean Thomas Meikle Jr., 1976–77, 17–18. 65. Annual report to Cornell University President from Dean J. Robert Buchanan, 1972–73, 5. 66. 1975–76 Budget, box 1, folder 3, Budget 1976, Dean, Office of CUMC (Buchanan/Cooper/ Meikle), 1969–87, MCA. 67. Annual report to Cornell University President from Dean J. Robert Buchanan, 1975–76, 11. 68. Morris Kaplan, “New York Hospital Starts a $260 Million Fund Drive,” NYT, May 21, 1976, 44; Society of the New York Hospital, “Report on the Progress of the Third Century Program,” in 1976 Annual Report (New York: Society of the New York Hospital, 1977), 26, https://archive.org/details/annualreportsoci1976newy; Society of the New York Hospital, “Report on the Progress of the Third Century Program,” in 1977 Annual Report (New York: Society of the New York Hospital, 1978), 33, https://archive.org/details/annualreportsoci1976 newy; Society of the New York Hospital, “Report of the Chairman of the Development Committee,” in 1979 Annual Report (New York: Society of the New York Hospital, 1980), 24, https:// archive.org/details/annualreportsoci1976newy. 69. Theodore Cooper to Frank H. T. Rhodes, letter, June 20, 1978, box 9, folder 1 Rhodes, Frank H. T., correspondence to/from 1977–79, Dean, Office of CUMC (Buchanan/Cooper/ Meikle), 1969–87, MCA. 70. Annual report to Cornell University President from Dean J. Robert Buchanan, 1975– 76, 16. 71. Annual report to Cornell University President from Acting Dean Thomas Meikle Jr., 1976–77, 1. 72. Ibid., 10. 73. Jonathan R. Cole and James A. Lipton, “The Reputations of American Medical Schools,” Social Forces 55, no. 3 (March 1977): 641–61. 74. Annual report to Cornell University President from Acting Dean Thomas Meikle Jr., 1976–77. 75. Michels interview. 76. “1968–1974 Theodore Cooper, M.D., Ph.D.,” National Heart, Lung, and Blood Institute, http://www.nhlbi.nih.gov/about /directorscorner/previousdirectors/cooper/theodorecooper.html; Edward D. Frohlich, L. Gabriel Navar, and Richard N. Ré, “Theodore Cooper Memorial Lectureship,” Hypertension 25 (1995): 154; “Albert Lasker Public Service Award, Award Description, Theodore Cooper,” Lasker Foundation, http://www.laskerfoundation. org/awards/1978_p_description.htm; “Upjohn Company Chairman and CEO Theodore Cooper Dies,” Upjohn press release, Kalamazoo, MI, April 22, 1993. 77. Annual report to Cornell University President from Dean Theodore Cooper, 1977–78, 3–4, box Dl6, folder Deans / Deans Report 75–80, MCA. 78. Annual report to Cornell University President from Dean Theodore Cooper, 1978–79, 2.

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Notes to Pages 160–166 79. Frank H. T. Rhodes to Theodore Cooper, letter, March 6, 1979, box 9, folder 1, Rhodes, Frank H. T., correspondence to/from 1977–79, Dean, Office of CUMC (Buchanan/Cooper/ Meikle), 1969–87, MCA. 80. Theodore Cooper to Frank H. T. Rhodes, letter, April 11, 1979, box 9, folder 1, Rhodes, Frank H. T., correspondence to/from 1977–79, Dean, Office of CUMC (Buchanan/Cooper/ Meikle), 1969–87, MCA. 81. Theodore Cooper to Frank H. T. Rhodes, letter, October  15, 1979, box  9, folder 1, Rhodes, Frank H. T., correspondence to/from 1977–79, Dean, Office of CUMC (Buchanan/ Cooper/Meikle), 1969–87, MCA. 82. Draft #1 First Avenue Property Announcement, November 6, 1978, box 8, folder 4, Real Estate, CUMC 1968–83, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969–87, MCA. 83. Christopher N. Carson to William G. Herbster, letter, August 9, 1979, box 8, folder 4, Real Estate, CUMC 1968–83, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969–87, MCA. 84. Automated City Register Information System, http://a836-acris.nyc.gov/CP. 85. Bobby Minter, “The Erector Set,” Manhattan, inc. (May 1985): 31. 86. Draft #1 First Avenue Property Announcement, November 6, 1978. 87. Theodore Cooper to Frank H. T. Rhodes, letter, June 30, 1978, box 9, folder 1, Rhodes, Frank H. T., correspondence to/from 1977–79, Dean, Office of CUMC (Buchanan/Cooper/ Meikle), 1969–87, MCA. 88. Annual report to Cornell University President from Dean Theodore Cooper, 1977–78, 4. 89. Annual report to Cornell University President from Dean Theodore Cooper, 1978–79, 1–2. 90. Frank H. T. Rhodes, telephone conversation with Jennifer Moon, February 11, 2015. 91. Draft #1 First Avenue Property Announcement, November 6, 1978. 92. Judith Cummings, “Last Class Leaves Cornell Nursing School: Sorrow for Its Passing,” NYT, May 24, 1979, B8. 93. “In Nursing, 200 Caps and a Thrust toward University Affiliation,” Cornell University Medical College Alumni Quarterly 45, nos. 3–4 (1982): 51. 94. Annual report to Cornell University President from Dean Theodore Cooper, 1978–79, 6. 95. Theodore Cooper to Frank H. T. Rhodes, letter, October 15, 1979. 96. Gordon Silverstein, “Med School Accused of Promoting Valium,” Cornell Daily Sun, February 20, 1979, 8. 97. Jack Anderson, “ ‘Vested Interest’ Law Evaded,” Toledo Blade, January  10, 1979, 17; UPI, “Stress Course Is Under Stress,” Hour, January 13, 1979, 16; Gordon Silverstein, “Cooper Televised Live in National Stress Show,” Cornell Daily Sun, March 30, 1979, 1, 10. 98. “Mother’s Little Helper,” Cornell Daily Sun, February 22, 1979, 4. 99. “Off to Kalamazoo,” Cornell Daily Sun, October 2, 1980, 4. 100. Rose McDermott, “The Decisions about Admitting the Shah,” in Risk-Taking in International Politics (Ann Arbor: University of Michigan Press, 2001), 77–105. 101.  Lawrence K. Altman, “DeBakey to Remove the Shah’s Spleen,” NYT, March 13, 1980, A17. 102. Lee A. Daniels, “Protesters Shout ‘Death to Shah’ outside Hospital,” NYT, October 25, 1979, 22; Lee A. Daniels, “Shah Needs to Stay in U.S. Up to a Year, Doctor Says,” NYT, October  27, 1979, 22; George Goodman Jr., “200 Foes in the Street and a Fan in the Sky Mark Shah’s Presence,” NYT, October 28, 1979, 47; Lawrence K. Altman, “Shah’s New York Doctors Said to Be Giving Iran Data on His Illness,” NYT, November 2, 1979, A25; Ronald Sullivan, “Sadat Offers Shah a Refuge in Egypt,” NYT, November 10, 1979, 8; “Policemen Help Guard the Shah at Hospital,” NYT, November 20, 1979, A14; Ronald Sullivan, “Security Mix-Up Delays Shah’s Motorcade to La Guardia,” NYT, December 3, 1979, 12; Youssef M. Ibrahim, “Surgery to Remove Shah’s Spleen Is Called Successful,” NYT, March 30, 1980, 12; Lawrence K. Altman, “The Shah’s Health: A  Political Gamble,” NYT, May  17, 1981,  SM12. 103. Annual report to Cornell University President from Dean Theodore Cooper, 1979–80, 9.

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8. Discord and Disrepair 1. Louis F. “Fritz” Reuter IV, e-mail message to Jennifer Moon, March 11, 2015. 2. Kenneth Ludmerer, Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care (Oxford: Oxford University Press, 1999), 221–28, 327–36, 349–57. 3. Annual report to Cornell University President from Dean Thomas Meikle, 1980–81, box l6, folder 37, Annual Report of the Dean, 1980–85, Gotto Dean’s Office, MCA. 4. Robert Michels, interview by Jennifer Moon, November 20, 2013. 5. David P. Hajjar, interview by Jennifer Moon, September 13, 2013. 6. “Thomas H. Meikle Jr., 68, a Cornell Dean,” New York Times, July 21, 1997, B9. 7. Annual report to Cornell University President from Dean Thomas Meikle, 1980–81, 11; Annual report to Cornell University President from Dean Thomas Meikle, 1981–82, box l6, folder 37, Annual Report of the Dean, 1980–85, Gotto Dean’s Office, MCA. 8. Ludmerer, Time to Heal, 297. 9. A Program for the New York Hospital–Cornell Medical Center, November  23, 1981, box 6, folder 5, Development (Fundraising), 1981, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969–87, MCA. 10. David Thompson to Robert Hatfield, letter, March 24, 1981, box 7, folder 9, Planning, Long-Range, Advisory Group, NYH-CMC 1980–81, Dean, Office of CUMC (Buchanan/ Cooper/Meikle), 1969–87, MCA. 11. Larry Schafer, interview by Jennifer Moon, July 1, 2014. 12. Annual report to Cornell University President from Dean Thomas Meikle, 1981–82, 4. 13. “WCMC and WCGSMS Orientation Manual” (booklet for Board of Overseers, OTS, June 2012), 140; Annual report to Cornell University President from Dean Thomas Meikle, 1983–84, box l6, folder 37, Annual Report of the Dean, 1980–85, Gotto Dean’s Office, MCA; Cornell University Medical College, Announcements 1981–82, 67–68, https://archive. org/details/cornelluniversit1981corn. 14. Annual report to Cornell University President from Dean Thomas Meikle, 1984–85, box l6, folder 37, Annual Report of the Dean, 1980–85, Gotto Dean’s Office, MCA. 15. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1988,” January 6, 1989, OTS. 16. Annual report to Cornell University President from Dean Thomas Meikle, 1981–82. 17. Annual report to Cornell University President from Dean Thomas Meikle, 1983–84, 2. 18. Annual report to Cornell University President from Dean Thomas Meikle, 1984–85. 19. Annual report to Cornell University President from Dean Thomas Meikle, 1981–82; Samuel Weiss, “Hospital Wing to Use 70th Street Air Rights,” NYT, October 4, 1981, R14. 20. Categorical Clinical Centers, memorandum, December 2, 1980, box 1, folder 12, Clinical Centers, Categorical 1973–80, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969– 87, MCA. 21. Annual report to Cornell University President from Dean Thomas Meikle, 1982–83, box l6, folder 37, Annual Report of the Dean, 1980–85, Gotto Dean’s Office, MCA; John A. Kastor, Mergers of Teaching Hospitals in Boston, New York, and Northern California (Ann Arbor: University of Michigan Press, 2001), 148. 22. Dan Weil, “Med School Picks Meikle to Be Dean,” Cornell Daily Sun, September  3, 1980, 1, 8. 23. Annual report to Cornell University President from Dean Thomas Meikle, 1980–81. 24. David Thompson to John E. Sawyer, letter, September 29, 1981, box 7, folder 9, Planning, Long-Range, Advisory Group, NYH-CMC 1980–81, Dean, Office of CUMC (Buchanan/ Cooper/Meikle), 1969–87, MCA. 25. Annual report to Cornell University President from Dean Thomas Meikle, 1982–83.

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Notes to Pages 174–179 26. Annual report to Cornell University President from Dean Thomas Meikle, 1980–81. 27. Annual report to Cornell University President from Dean Thomas Meikle, 1981–82; Form letter from James H. Evans, September 17, 1982, box 6, folder 5, Development (Fundraising), 1981, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969–87, MCA. 28. Kathleen Teltsch, “Medical Center Gets $15 Million Whitney Gift,” NYT, October 24, 1982, 40. 29. Anne-Maria Schiro, “The ‘Real Cream’ Comes to Hospital Gala,” NYT, December 15, 1982, C20. 30. Kathleen Teltsch, “Cornell Medical Unit Given $50 Million; Donor Anonymous,” NYT, December 9, 1983, A1; “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1987,” December 28, 1987, OTS. 31. “The New York Community Trust’s DeWitt Wallace Fund Gives Nearly $70 Million to Advance Psychiatry at NewYork–Presbyterian / Weill Cornell,” NewYork–Presbyterian, March 23, 2007, http://nyp.org/news/hospital/wallace-psych.html. 32. Annual report to Cornell University President from Dean Thomas Meikle, 1983–84, 5. 33. Joseph Berger, “New York Hospital Planning Research Center,” NYT, April 14, 1985, 46. 34. “Proceedings of the Board of Overseers, Meeting held July 3, 1990,” Cornell University Board of Overseers, Agenda, Meeting of October 3, 1990, box 3, Board of Overseers, WCMC, Agendas 1987–90, MCA. 35. J. Robert Buchanan, interview by Jennifer Moon, November 20, 2013. 36. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1987.” 37. Annual report to Cornell University President from Dean Thomas Meikle, 1981–82, 2. 38. Annual report to Cornell University President from Dean Thomas Meikle, 1980–81; “WCMC and WCGSMS Orientation Manual,” 26–27; “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1992,” December 31, 1992, OTS. 39. Annual report to Cornell University President from Dean Thomas Meikle, 1981–82, 8. 40. Thomas Meikle to Senator Martin Connor, letter, May 14, 1982, box 1, folder 2, Affirmative Action, Democratic Task Force of 1982, Dean, Office of CUMC (Buchanan/Cooper/ Meikle), 1969–87, MCA. 41. Annual report to Cornell University President from Dean Thomas Meikle, 1983–84; Annual report to Cornell University President from Dean Thomas Meikle, 1984–85. 42. Ronald Sullivan, “Medical Schools Show Big Drop in Minorities,” NYT, March  1, 1982, B1. 43. Annual report to Cornell University President from Dean Thomas Meikle, 1984–85; Annual report to Cornell University President from Dean Thomas Meikle, 1982–83. 44. Glenn Collins, “Medical Students Learn to Understand the Aging,” NYT, July  15, 1984, 50. 45. Annual report to Cornell University President from Dean Thomas Meikle, 1984–85. 46. “Dr.  Maria I. New: First Woman in New York and Seventh in U.S. to Head Medical School Pediatrics Department,” press release, August 29, 1980, box 6, folder 7, Development, Pediatric (Fundraising), 1980, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969–87, MCA; Jane E. Brody, “Change Linked to the Most Common Genetic Disorder Is Identified,” NYT, August 11, 1985, 33. 47. Ann Peterson to Thomas Meikle Jr., letter, September 17, 1980; James Curtis to Thomas Meikle, letter, September 23, 1980; David B. Hayter to Lila Wallis, letter, December 5, 1980; Lila Wallis to Thomas Meikle, letter, December 10, 1980, all in box 10, folder 7, Women in Medicine, Office of, 1978–83, Dean, Office of CUMC (Buchanan/Cooper/Meikle), 1969– 87, MCA. 48. Ann Silverman, “Volunteers Used to Explore Jet Lag,” NYT, June 30, 1985, WC13.

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NOTES TO PAGES 179 –186 49. Jean W. Pape, Bernard Liautaud, Franck Thomas, Jean-Robert Malthurin, Marie-Myrtha A. St. Amand, Madeleine Boncy, et al., “Characteristics of the Acquired Immunodeficiency Syndrome (AIDS) in Haiti,” New England Journal of Medicine 309 (1983): 945–50. 50. Lynda Richardson, “Hospital Opens Clinic at AIDS Agency in Chelsea,” NYT, December 15, 1997, B6. 51. Dena Kleiman, “New York Hospital Unveils Advanced Diagnostic Tool,” NYT, August 2, 1983, A1. 52. “A Brief History of Cornell Time,” Cornell Medicine 3, no. 1 (Fall 1998): 37–38; Trip Gabriel, “Eggs and Egos: Cornell Staff Clashed over Issue of Safety,” NYT, January  7, 1996, 19. 53. David Margolick, “New York Hospital and 4 Doctors Are Sued in Death of Patient, 18,” NYT, August 27, 1985, B18; Ronald Sullivan, “Grand Jury Assails Hospital in ’84 Death of 18-Year-Old,” NYT, January 13, 1987, B3; Deirdre Carmody, “New York Hospital Disputes Allegations on Patient’s Death,” NYT, January 15, 1987, B3; Ronald Sullivan, “Hospital Admits Fault in Patient’s Death,” NYT, March 24, 1987, B3; Jan Hoffman, “Jurors Find Shared Blame in ’84 Death,” NYT, February 7, 1995, B1. 54. Suzanne Daley, “Hospital Interns’ Long Hours to Be Reduced in New York,” NYT, June 10, 1988, A1. 55. Ludmerer, Time to Heal, 321. 56. Nachiket Patel, “Learning Lessons: The Libby Zion Case Revisited,” Journal of the American College of Cardiology 64, no. 25 (December 30, 2014): 2802–3. 57. Barron H. Lerner, “ ‘You Murdered My Daughter’: Libby Zion and the Reform of Medical Education,” in When Illness Goes Public: Celebrity Patients and How We Look at Medicine (Baltimore: Johns Hopkins University Press, 2006), 216. 58. James Barron, “Nurse on Duty When Warhol Died Is Barred from Hospital,” NYT, March 5, 1987, B2; M. A. Farber, “Agency Isn’t Sure about Possible Link between Treatment and Death,” NYT, April 11, 1987, 1; M. A. Farber, “Hospital Rebuts State’s Charges in Warhol Case,” NYT, April 16, 1987, A1; Kirk Johnson, “No Criminal Charges Brought by Inquiry on Death of Warhol,” NYT, August 1, 1987, 1; Associated Press, “Estate of Warhol Sues Hospital and Doctors,” NYT, December 11, 1987, B2; Steven Lee Myers, “Treatment of Warhol Is Defended,” NYT, December  6, 1991, B2; “Warhol Heirs Settle Suit with Hospital,” NYT, December 23, 1991, B3. 59. Ronald Sullivan, “Power Fails at New York Hospital and Infant on a Respirator Dies,” NYT, June 6, 1987, 1; David E. Pitt, “Hospital Is Puzzled by Power Failure,” NYT, June 7, 1987, 36. 60. Sandra Opdycke, No One Was Turned Away: The Role of Public Hospitals in New York City since 1900 (New York: Oxford University Press, 1999), 172. 61. M. A. Farber and Lawrence K. Altman, “A Great Hospital in Crisis,” NYT, January 24, 1988, SM18. 62. Ronald Sullivan, “Despite Scrutiny, State Backs Care in New York Hospitals,” NYT, May 3, 1987, 54. 63. Farber and Altman, “Great Hospital in Crisis,” SM21. 64. William Dicke, “G. Tom Shires, 81, Trauma Expert, Dies,” New York Times, October 22, 2007, A19. 65. Dennis Hevesi, “New Dean at Divided Medical Center,” New York Times, April  19, 1991, B2; Steve Balt, “Centennial Science Symposium,” Cornell Medicine (Fall 1998): 66; Ivan Oransky, “G Tom Shires,” Lancet 371 (January 19, 2008): 200. 66. Cornell University Board of Overseers, Agenda, Meeting of January  20, 1988, box  3, Board of Overseers, WCMC, Agendas 1987–90, MCA. 67. Michels interview. 68. Hajjar interview.

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Notes to Pages 186–194 69. Farber and Altman, “Great Hospital in Crisis,” SM57. 70. Cornell University Board of Overseers, Agenda, Meeting of January  21, 1987, box  3, Board of Overseers, WCMC, Agendas 1987–90, MCA; “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1987”; “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1988.” 71. Hajjar interview. 72. Josh Barbanel, “Medical Center Hyphen Becomes a Vs.” NYT, December 16, 1990, 42. 73. Tina Kelley, “Dr. David B. Skinner, 67; Oversaw a Hospital Merger,” NYT, January 26, 2003, L22; “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1989,” January 3, 1990, OTS. 74. Cornell University Board of Overseers, Agenda, Meeting of October  11, 1989, box  3, Board of Overseers, WCMC, Agendas 1987–90, MCA. 75. Barbanel, “Medical Center Hyphen Becomes a Vs.,” 42. 76. Louis F. “Fritz” Reuter IV, e-mail message to Jennifer Moon, March 11, 2015. 77. “Proceedings of the Board of Overseers, Meeting held December 12, 1988,” box 3, Board of Overseers, WCMC, Agendas 1987–90, MCA. 78. Michels interview. 79. Barbanel, “Medical Center Hyphen Becomes a Vs.,” 42. 80. Tom Redburn, “Rebounding from Crises, New York Hospital Changes Its Ways,” NYT, November 10, 1993, B1, B12. 81. “Proceedings of the Board of Overseers, Meeting held July 3, 1990,” Cornell University Board of Overseers, Agenda, Meeting of October 3, 1990, box 3, Board of Overseers, WCMC, Agendas 1987–90, MCA. 82. Barbanel, “Medical Center Hyphen Becomes a Vs.,” 42. 83. Kastor, Mergers of Teaching Hospitals, 149. 84. Lawrence K. Altman, “Medical Dean at Cornell Quits to Take Texas Job,” NYT, January 26, 1991, 29. 85. “Robert Michels, M.D.,” Contemporary Psychoanalysis in America: Leading Analysts Present Their Work, ed. Arnold M. Cooper (Washington, DC: American Psychiatric Publishing, 2006), 402. 86. David Hellerstein, “Letting Go of Payne Whitney,” New York Times Magazine, November 6, 1994, 51. 87. Michels interview. 88. Hevesi, “New Dean,” B2; Michels interview. 89. “Summary of Agreement between Cornell University and the Society of the New York Hospital Relating to the New York Hospital–Cornell Medical Center,” Cornell University Board of Overseers, Agenda, Meeting of September 15, 1992, tab C, box 4, Board of Overseers, WCMC, Agendas 1991–92, MCA. 90. Schafer interview. 91. Kastor, Mergers of Teaching Hospitals, 149. 92. Hevesi, “New Dean,” B2. 93. Michels interview.

9. Renaming and Rebirth 1. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1992,” December 31, 1992, OTS. 2. Kenneth Ludmerer, Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care (Oxford: Oxford University Press, 1999), 391.

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NOTES TO PAGES 194 –199 3. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1990,” January 8, 1991, OTS; “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 2000,” January 17, 2001, OTS. 4. Cornell University Board of Overseers, Agenda, Meeting of October  3, 1990, box  3, Board of Overseers, WCMC, Agendas 1987–90, MCA. 5. Larry Schafer, interview by Jennifer Moon, July 1, 2014. 6. The New York Hospital–Cornell Medical Center 1993 Annual Report, Progress through People, box X1–07.00, folder Academic Affairs—Michels’ Files / Dean’s Letter 92–94, Michels Dean’s Office, MCA; “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1993,” July 12, 1994, OTS. 7. CUMC and Graduate School of Medical Sciences Preparing for the 21st Century, memorandum, January 27, 1995, 7, box 35, folder Dean’s letters [94–95], Michels Dean’s Office, MCA. 8. Karen W. Arenson, “$100  Million Donation Set for Cornell Medical School,” NYT, May 1, 1998, B3. 9. Dean’s Letter from Robert Michels, November 17, 1994, and February 23, 1995, box 35, folder Dean’s letters [94–95], Michels Dean’s Office, MCA. 10. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1996,” January 22, 1997, OTS, 2. 11. “A  Strategy for the Cornell University Medical College Campaign New Horizons for Medicine,” Cornell University Board of Overseers, Agenda, Meeting of January  15, 1992, box 4, Board of Overseers, WCMC, Agendas 1991–92, MCA. 12. The New York Hospital–Cornell Medical Center 1994 Annual Report, The Hands to Care, box X1–07.00, folder Academic Affairs—Michels’ Files / Dean’s Letter 92–94, Michels Dean’s Office, MCA. 13. R. A. Rees Pritchett, interview by Jennifer Moon, February 23, 2012. 14. “Helmsley Surrenders at Prison,” NYT, April 16, 1992, B3; “Leona Helmsley, ‘Queen’ of Hotel Chain, Dies at 87,” NYT, August 21, 2007, B5; Mark Hemingway, “Who Left the Dogs Out?” Philanthropy, Summer 2009, http://www.philanthropyroundtable.org/topic/donor_intent/ who_left_the_dogs_out. 15. John Eligon, “Astor’s Doctor Tells of Years of Decline,” NYT, June 24, 2009, A20. 16. Ludmerer, Time to Heal, 288–95, 303–7. 17. Robert Michels, interview by Jennifer Moon, September 11, 2013. 18. Joyce Cohen, “For Cornell Medical, a Macro School in Micro Space,” NYT, December 15, 1996, R5. 19. “Outline of Annual Report . . . for Calendar Year 1996,” 2. 20. James Barron, “At Cornell Medical, Stay Away a Year and Get One Free,” NYT, August 13, 1996, A1. 21. Tom Redburn, “Rebounding from Crises, New York Hospital Changes Its Ways,” NYT, November  10, 1993, B1, B12; Louis F. “Fritz” Reuter IV, e-mail message to Jennifer Moon, March 11, 2015. 22. Kathleen Teltsch, “New York Hospital Receives $25  Million Gift,” NYT, November  25, 1990, 44. 23. The New York Hospital–Cornell Medical Center, 1994 Annual Report. 24. The New York Hospital–Cornell Medical Center, 1993 Annual Report. 25. John A. Kastor, Mergers of Teaching Hospitals in Boston, New York, and Northern California (Ann Arbor: University of Michigan Press, 2001), 163; Trip Gabriel, “Erector Set, Big-Time: Drama on F.D.R. Drive,” NYT, March 7, 1994, B3. 26. Kastor, Mergers of Teaching Hospitals, 163–64; Teltsch, “New York Hospital Receives $25 Million Gift,” 44; New York Hospital–Cornell Medical Center 1993 Annual Report. 27. Louis F. “Fritz” Reuter IV, e-mail message to Jennifer Moon, March 11, 2015.

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Notes to Pages 200–208 28. Louis F. “Fritz” Reuter IV, e-mail message to Jennifer Moon, March 13, 2015. 29. David Hellerstein, “Letting Go of Payne Whitney,” NYT Magazine, November 6, 1994, 50. 30. Joyce V. Holly, “Letting Go of Payne Whitney,” NYT, December 4, 1994, SM20. 31. The New York Hospital–Cornell Medical Center, 1993 Annual Report. 32. Redburn, “Rebounding from Crises,” B1, B12. 33. “WCMC and WCGSMS Orientation Manual” (booklet for Board of Overseers, OTS, June 2012), 17; Weill Cornell Medical College Catalog 2009–2010, 13–16; “Outline of Annual Report . . . for Calendar Year 1996.” 34. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1997,” OTS. 35. Elisabeth Rosenthal, “Leading Academic Hospital, Squeaking By, Seeks Merger,” NYT, July 8, 1995, 1; Barbara Benson, “Seven Little Indians,” Crain’s New York Business, June 3–9, 1996, 1, 40; Kastor, Mergers of Teaching Hospitals, 119–68; Elisabeth Rosenthal, “2 More Hospitals Decide to Merge in New York City,” NYT, July 25, 1996, A1. 36. Michels interview. 37. Benson, “Seven Little Indians,” 1, 40. 38. Michels interview. 39. Kastor, Mergers of Teaching Hospitals, 147–57. 40. Rosenthal, “2 More Hospitals Decide to Merge,” A1. 41. “Outline of Annual Report . . . for Calendar Year 1996,” 14–15. 42. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1987,” December 28, 1987, OTS. 43. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1994,” January 18, 1995, OTS. 44. Ludmerer, Time to Heal, 363. 45. “WCMC and WCGSMS Orientation Manual,” 63–67 and app. A. 46. Michels interview. 47. Rosenthal, “Leading Academic Hospital, Squeaking By, Seeks Merger,” 1; Somini Sengupta, “2 Hospitals Announce Completion of Merger,” NYT, January 12, 1998, B3; Kastor, Mergers of Teaching Hospitals, 119–258. 48. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1999,” January 18, 2000, OTS. 49. David P. Hajjar, interview by Jennifer Moon, September 13, 2013. 50. William H. Honan, “Heart Specialist Named to Head Medical School,” NYT, September 26, 1996, B7. 51. Gerald F. Sigler, Anne K. Soutar, Louis C. Smith, Antonio M. Gotto Jr., and James T. Sparrow, “The Solid Phase Synthesis of a Protein Activator for Lecithin-Cholesterol Acyltransferase Corresponding to Human Plasma apoC-I,” Proceedings of the National Academy of Sciences 73, no.  5 (1976): 1422–26; San-Hwan Chen, Chao-Yuh Yang, Pei-Feng Chen, Debra Setzer, Masako Tanimura, Wen-Hsiang Li, Antonio M. Gotto Jr., and Lawrence Chan, “The Complete cDNA and Amino Acid Sequence of Human Apolipoprotein B-100,” Journal of Biological Chemistry 261, no. 28 (1986): 12918–21. 52. “The Lipid Research Clinics Coronary Primary Prevention Trial Results; Part 2, The Relationship of Reduction in Incidence of Coronary Heart Disease to Cholesterol Lowering,” Journal of the American Medical Association 251, no. 3 (1984): 365–74. 53. John R. Downs, Michael Clearfield, Stephen Weis, Edwin Whitney, Deborah R. Shapiro, Polly A. Beere, Alexandra Langendorfer, Evan A. Stein, William Kruyer, and Antonio M. Gotto Jr., “Primary Prevention of Acute Coronary Events with Lovastatin in Men and Women with Average Cholesterol Levels: Results of AFCAPS/TexCAPS, Air Force/Texas Coronary Atherosclerosis Prevention Study,” Journal of the American Medical Association 279, no. 20 (1998): 1615–22. 54. Beth Saulnier, “Passing the Torch,” Weill Cornell Medicine (Special Issue 2011): 25.

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NOTES TO PAGES 208 –219 55. Ibid., 26, 29. 56. Ibid., 25. 57. Ibid., 24. 58. Hajjar interview. 59. Schafer interview. 60. “Outline of Annual Report . . . for Calendar Year 1997.” 61. Arenson, “$100 Million Donation.” 62. Anthony Fauci, “Return of a Native Son,” Cornell Medicine 3, no. 1 (Fall 1998): 27. 63. “A  Happy 100th Birthday for the Medical College,” Cornell Medicine 3, no.  1 (Fall 1998): 12–19. 64. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1998,” OTS, 20. 65. Arenson, “$100 Million Donation.” 66. Pritchett interview. 67. “Outline of Annual Report . . . for Calendar Year 1997.” 68. “Centennial Reflections,” Cornell Medicine 3, no. 1 (Fall 1998): 53.

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10. Forging Ahead in the Twenty-First Century 1. “In Remembrance: September 11, 2001,” WCMC, http://weill.cornell.edu/news/news/2002/ 09/in-remembrance-september-11–2001.html. 2. Karen Arenson, “Cornell Will Open a Medical School in the Persian Gulf,” NYT, April 9, 2001, A1. 3. Glenn C. Altschuler and Isaac Kramnick, Cornell: A History, 1940–2015 (Ithaca, NY: Cornell University Press, 2014), 449–78. 4. David P. Hajjar and Antonio M. Gotto, “Launching of an American Medical College in the Middle East: Educational Challenges in a Multicultural Environment,” International Journal of Higher Education 2, no. 2 (2013): 67–75. 5. Mehran Kamrava, Qatar: Small State, Big Politics (Ithaca, NY: Cornell University Press, 2013). 6. Arenson, “Cornell Will Open a Medical School.” 7. Chris Hedges, “Carrying a Bit of Cornell, and Argentina, to Qatar,” NYT, April 17, 2001, B2. 8. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 2002,” OTS; “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 2003,” OTS; “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 2004,” OTS. 9. “Annual Report of the Chairman of the Board of Overseers of WCMC and WCGSMS to the Board of Trustees for Calendar Year 2008,” OTS. 10. Tamar Lewin, “In Oil-Rich Mideast, Shades of the Ivy League,” NYT, February  11, 2008, A1, A12. 11. “Annual Report of the Chairman of the Board of Overseers of WCMC and WCGSMS to the Board of Trustees for Calendar Year 2009,” OTS. 12. “Qatar to Be a Leader in Date Palm Research,” WCMC, press release, October 21, 2012 http://weill.cornell.edu/news/pr/2012/10/qatar-to-be-a-leader-in-date-palm-research.html. 13. Beth Saulnier, “Passing the Torch,” Weill Cornell Medicine (Special Issue 2011): 27. 14. “Global Health,” WCMC, http://weill.cornell.edu/globalhealth/. 15. Mimi Swartz, “Till Death Do Us Part,” Texas Monthly, March 2005, http://www.texas monthly.com/story/till-death-do-us-part. 16. H. Dirk Sostman, Laura L. Forese, Marc L. Boom, Lynn Schroth, Arthur A. Klein, Alvin I. Mushlin, John E. Hagale, Herbert Pardes, Ronald G. Girotto, and Antonio M. Gotto Jr.,

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Notes to Pages 219–229 “Building a Transcontinental Affiliation: A New Model for Academic Health Centers,” Academic Medicine 80, no. 11 (November 2005): 1046. 17. Ibid., 1047. 18. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 2005,” OTS. 19. “Annual Report . . . for Calendar Year 2009.” 20. “Weill Cornell Medical College Students Help Change Global Health Policy,” WCMC, press release, May  21, 2007, http://weill.cornell.edu/news/pr/2007/05/weill-cornell-medicalcollege-students-help-change-global-health-policy.html. 21. “Annual Report . . . for Calendar Year 2009.” 22. “Outline of Annual Report . . . for Calendar Year 2004.” 23. Nina Bernstein, “For Subjects in Haiti, Free AIDS Care Has a Price,” NYT, June 6, 1999, 1, 10. 24. Jean William Pape, Warren D. Johnson, and Daniel W. Fitzgerald, “The Earthquake in Haiti—Dispatch from Port-au-Prince,” New England Journal of Medicine 362 (February 18, 2010): 575–77. 25. “Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 2010,” OTS. 26. “Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 2011,” OTS. 27. Larry Schafer, interview by Jennifer Moon, July 1, 2014. 28. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 2001,” January 16, 2002, OTS. 29. “Outline of Annual Report . . . for Calendar Year 2002.” 30. Schafer interview. 31. Saulnier, “Passing the Torch,” 25. 32. “Weill Cornell Ushers in New Era for Patients, Opening and Naming the Weill Greenberg Center, an Innovative Ambulatory Care and Medical Education Building,” WCMC, press release, January 26, 2007, http://weill.cornell.edu/news/pr/2007/01/weill-cornell-ushers-in-newera-for-patients-opening-and-naming-the-weill-greenberg-center-an-innova.html. 33. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 2006,” OTS. 34. “Outline of Annual Report . . . for Calendar Year 2003.” 35. Teri Rogers, “Square Feet: Blueprints; It’s a Waiting Room That Keeps Patients Busy,” NYT, November 20, 2005, B22. 36. Kenneth Ludmerer, Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care (Oxford: Oxford University Press, 1999), 304–5. 37. “Medical Matinee,” NYT, January 22, 1999, B2. 38. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1999,” OTS. 39. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 2000,” January 17, 2001, OTS. 40. Leslie Berger, “Observing Art, Med Students Learn Art of Observation,” NYT, January 2, 2001, F5. 41. Abigail Zuger, “The Difficult Patient, a Problem Old as History (or Older),” NYT, March 6, 2007, F5. 42. Linda Villarosa, “Recovering Addicts Help Educate Future Doctors,” NYT, December 24, 2002, F6. 43. “Dean Gotto Unveils Revised Hippocratic Oath for New Generation of Weill Cornell Graduates,” WCMC, http://weill.cornell.edu/news/news/2005/06/dean-gotto-unveils-revised-hippo cratic-oath-for-new-generation-of-weill-cornell-graduates.html.

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NOTES TO PAGES 232–237

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44. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 1998,” OTS. 45. David P. Hajjar, interview by Jennifer Moon, September 13, 2013. 46. “Outline of Annual Report . . . for Calendar Year 2000”; “WCMC and WCGSMS Orientation Manual” (booklet for Board of Overseers, OTS, June  2012), 31–32, 52–58; “Weill Cornell Launches New Stem Cell Center with $15 Million Grant,” NewYork–Presbyterian, http://www.nyp.org/news/hospital/201.html. 47. “Outline of Annual Report . . . for Calendar Year 2004.” 48. “Outline of Annual Report . . . for Calendar Year 2006.” 49. Anthony Ramirez, “Cornell Medical School to Get $400 Million for Research Centers,” NYT, June 13, 2007, B1. 50. “Outline of Annual Report of the Chairman of the Board of Overseers to the Board of Trustees for Calendar Year 2007,” OTS; “New Medical Research Building Named at Dedication Ceremony,” WCMC, http://weill.cornell.edu/news/news/2011/11/new-medical-researchbuilding-named-at-dedication-ceremony. 51. A. G. Sulzberger, “Weill Gives Cornell $170  Million, Well Ahead of Schedule,” NYT, April  7, 2009, A22; “Joan and Sanford I. Weill Agree to Boost Capital Campaign at Weill Cornell Medical College with $170 Million Cash Payment of Pledge,” WCMC, press release, April 7, 2009, http://weill.cornell.edu/news/pr/2009/04/joan-and-sanford-i-weill-agree-to-boostcapital-campaign-at-weill-cornell-medical-college-with-170-m.html. 52. “Hunter College and Weill Cornell Medical College Join Forces to Advance Bench-toBedside Medical Discoveries,” WCMC, press release, October 24, 2013, http://weill.cornell. edu/news/pr/2013/10/hunter-college-and-weill-cornell-medical-college-join-forces-toadvance-bench-to-bedside-medical-dis.html. 53. “Weill Cornell Medical College Breaks Ground for New Medical Research Building in NYC,” WCMC, press release, May 26, 2010, http://weill.cornell.edu/news/pr/2010/05/weill-cornel l-medical-college-breaks-ground-for-new-medical-research-building-in-nyc.html. 54. “Outline of Annual Report . . . for Calendar Year 2000”; “Annual Report . . . for Calendar Year 2011.” 55. Schafer interview. 56. Jaimie Oh, “100 Top Grossing Hospital in America,” Becker’s Hospital Review, August 29, 2011, http://www.beckershospitalreview.com/lists/100-top-grossing-hospitals-in-america.html. 57. “Annual Report . . . for Calendar Year 2010.” 58. “Weill Cornell Medical College Creates Office of Faculty Diversity,” WCMC, press release, September 15, 2009, http://weill.cornell.edu/news/pr/2009/09/weill-cornell-medical-college-createsoffice-of-faculty-diversity.html. 59. Saulnier, “Passing the Torch,” 29.

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Bibliography

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The principal primary sources are fully documented in the chapter notes. They are drawn from the following: • Documents and records from the Medical Center Archives of NewYork–Presbyterian / Weill Cornell (MCA) • Annual reports from Cornell University Medical College deans to Cornell University presidents, 1898–1980 • Annual reports from the Medical College Board of Overseers to the Cornell University Board of Trustees, 1987–2012 • Cornell University Medical College Announcements • Annual reports of the Society of New York Hospital • WCMC and WCGSMS Orientation Manual, 2012 • New York Times (NYT) • Cornell Daily Sun, Cornell Alumni News, and Cornell University Medical College Alumni Quarterly (later Cornell Medicine and Weill Cornell Medicine) • Interviews with Rees Pritchett, J. Robert Buchanan, Robert Michels, David Hajjar, and Larry Schafer • Weill Cornell Medical College and NewYork–Presbyterian websites • Miscellaneous newspapers, magazines, press releases, and websites Additional primary and secondary sources follow.

Primary Sources Barringer, Emily Dunning. Bowery to Bellevue. New York: W. W. Norton, 1950. Berry, George Packer, Dayton J. Edwards, and Stockton Kimball. “Report of the Committee on the Training and Supply of Doctors in the Event of Another War.” Journal of the Association of American Medical Colleges 22, no. 2 (March 1947): 65–76. Brown, Raymond Shiland. Base Hospital No. 9 A.E.F.: A History of the Work of the New York Hospital Unit during Two Years of Active Service. New York: New York Hospital, 1920.

Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

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BIBLIOGRAPHY Chen, San-Hwan, Chao-Yuh Yang, Pei-Feng Chen, Debra Setzer, Masako Tanimura, Wen Hsiang Li, Antonio M. Gotto Jr., and Lawrence Chan. “The Complete cDNA and Amino Acid Sequence of Human Apolipoprotein B-100.” Journal of Biological Chemistry 261, no. 28 (1986): 12918–21. Cole, Jonathan R., and James A. Lipton. “The Reputations of American Medical Schools.” Social Forces 55, no. 3 (March 1977): 641–61. Dann, Hollis. Songs of Cornell. Ithaca, NY: B. F. Lent, 1900. Deitrick, John E., and Robert C. Berson. Medical Schools in the United States at Mid-century. New York: McGraw-Hill, 1953. Downs, John R., Michael Clearfield, Stephen Weis, Edwin Whitney, Deborah R. Sha­ piro, Polly A. Beere, Alexandra Langendorfer, Evan A. Stein, William Kruyer, and Antonio M. Gotto Jr. “Primary Prevention of Acute Coronary Events with Lovastatin in Men and Women with Average Cholesterol Levels: Results of AFCAPS/TexCAPS; Air Force / Texas Coronary Atherosclerosis Prevention Study.” Journal of the American Medical Association 279, no. 20 (1998): 1615–22. Flexner, Abraham. Medical Education in the United States and Canada Bulletin Number Four (the Flexner Report). New York: Carnegie Foundation for the Advancement of Teaching, 1910. Glaser, Robert J. “The Medical Deanship: Its Half-Life and Hard Times.” Journal of Medical Education 44 (December 1969): 1115–26. Goodrich, Charles H., Margaret Olendzki, and George G. Reader. “The New York Hospital– Cornell Medical Center: A  Progress Report on an Experiment in Welfare Medical Care.” American Journal of Public Health 55 (1965): 88–93. Goodrich, Malcolm. “Walter Lindsay Niles, 1878–1942: An Appreciation.” Bulletin of the New York Academy of Medicine 18, no. 4 (April 1942): 292. Gudernatsch, Frederick. “Out of the Early Cornell Years: Reminiscences (Fall 1958).” MCA. Hasting, Thomas Wood, and Walter L. Niles. “The Bacteriology of Sputum in Common Non-tuberculosis Infections of the Upper and Lower Respiratory Tracts, with Special Reference to Lobar and Broncho-pneumonia.” Journal of Experimental Medicine 13, no. 6 (June 1, 1911): 638–51. Hewitt, Waterman Thomas. Cornell University: A History. Vol. 2. New York: University Publishing Society, 1905. Hinkle, Lawrence E., Jr., and Harold G. Wolff. “Communist Interrogation and Indoctrination of ‘Enemies of the States’: Analysis of Methods Used by the Communist State Police (a Special Report).” AMA Archives of Neurology and Psychiatry 76, no.  2 (August 1956): 115–74. “The Lipid Research Clinics Coronary Primary Prevention Trial Results. Part 2, The Relationship of Reduction in Incidence of Coronary Heart Disease to Cholesterol Lowering.” Journal of the American Medical Association 251, no. 3 (1984): 365–74. Luckey, E. Hugh. “The Bicentennial of the New York Hospital (1771–1971).” Journal of the American Medical Association 216 (1971): 1183–84. ——. “Role of Undergraduate Medical Education in Preparation for Graduate Education.” Journal of the American Medical Association 153, no.  17 (April  27, 1957): 1585–87. “Medicine and the War.” Journal of the American Medical Association 122, no. 2 (May 8, 1943): 120–23.

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Bibliography Meikle, Thomas H., Jr. “Selecting Students for Medical School in the United States.” Danish Medical Bulletin 27, suppl. no. 1 (May 1980): 21–28. “A National Program to Conquer Health Disease, Cancer, and Stroke.” Journal of the American Heart Association 192, no. 4 (1965): 299–301. Niles, Walter L. “The First Five Months of the Cornell Clinic.” Modern Hospital 18, no. 6 (June 1922): 560–62. ——. “Pay Clinics.” Transactions of the American Clinical and Climatological Association 38 (1922): 275–84. ——. “Three Years’ Experience in the Operation of a Pay Clinic.” Transactions of the American Clinical and Climatological Association 41 (1925): 65–72. Niles, Walter L., and Carl J. Wiggers. “The Details of the Photographically Recorded Venous Pulse in Auricular Fibrillation.” Journal of Experimental Medicine 25, no. 1 (January 1, 1917): 1–19. Pape, Jean William, Warren D. Johnson, and Daniel W. Fitzgerald. “The Earthquake in Haiti—Dispatch from Port-au-Prince.” New England Journal of Medicine 362 (February 18, 2010): 575–77. Pape, Jean W., Bernard Liautaud, Franck Thomas, Jean-Robert Malthurin, MarieMyrtha A. St. Amand, Madeleine Boncy, et al. “Characteristics of the Acquired Immunodeficiency Syndrome (AIDS) in Haiti.” New England Journal of Medicine 309 (1983): 945–50. Pool, Eugene H., Walter L. Niles, and Kirby A. Martin. “Duodenal Stasis: Duodenojejunostomy.” Annals of Surgery 98, no. 4 (1933): 587–618. Reader, George G., and Mary E. W. Goss, eds. Comprehensive Medical Care and Teaching: A Report on the New York Hospital–Cornell Medical Center Program. Ithaca, NY: Cornell University Press, 1967. Riis, Jacob. How the Other Half Lives. 1890; New York: Bartleby.com, 2000. Robinson, G. Canby. Adventures in Medical Education: A  Personal Narrative of the Great Advance of American Medicine. Cambridge, MA: Harvard University Press, 1957. Sigler, Gerald F., Anne K. Soutar, Louis C. Smith, Antonio M. Gotto Jr., and James T. Sparrow. “The Solid Phase Synthesis of a Protein Activator for Lecithin-Cholesterol Acyltransferase Corresponding to Human Plasma apoC-I.” Proceedings of the National Academy of Sciences 73, no. 5 (1976): 1422–26. A Sign of the Times, Medical Record: A Weekly Journal of Medicine and Surgery. Edited by George F. Shrady. New York: April 17, 1897. Sostman, H. Dirk, Laura L. Forese, Marc L. Boom, Lynn Schroth, Arthur A. Klein, Alvin I. Mushlin, John E. Hagale, Herbert Pardes, Ronald G. Girotto, and Antonio M. Gotto Jr. “Building a Transcontinental Affiliation: A New Model for Academic Health Centers.” Academic Medicine 80, no. 11 (November 2005): 1046–53. Walsh, James J. History of Medicine in New York: Three Centuries of Medical Progress. Vol. 5. New York: National American Society, 1919. Weisbord, Marvin R., Paul R. Lawrence, and Martin P. Charns. “Three Dilemmas of Academic Medical Centers.” Journal of Applied Behavioral Science 14, no. 3 (1978): 284–304. White, Augusta Francelia Payne. The Paynes of Hamilton: A Genealogical and Biographical Record. New York: Tobias A. Wright, 1912.

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BIBLIOGRAPHY

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Secondary Sources Altschuler, Glenn C., and Isaac Kramnick. Cornell: A History, 1940–2015. Ithaca, NY: Cornell University Press, 2014. Bishop, Morris. A History of Cornell. Ithaca, NY: Cornell University Press, 1962. Brown, Theodore M. “George Canby Robinson and ‘The Patient as a Person.’ ” In Greater Than the Parts: Holism in Biomedicine, 1920–1950, edited by Christopher Lawrence and George Viesz, 135–60. New York: Oxford University Press, 1998. Campion, Nardi Reeder, and Rosamond Wilfley Stanton. Look to This Day! The Lively Education of a Great Woman Doctor: Connie Guion, M.D. Boston: Little, Brown & Co., 1965. Collins, Robert D. Ernest William Goodpasture: Scientist, Scholar, Gentleman. Pp. 129– 35. Franklin, TN: Hillsboro Press, 2002. Crisci, Madeline. Public Health in New York City in the Late Nineteenth Century. Bethesda, MD: National Library of Medicine, History of Medicine Division, 1990. Curtis, James L. Affirmative Action in Medicine: Improving Health Care for Everyone. Ann Arbor: University of Michigan Press, 2003. Fisher, Jeffrey. “Lewis A. Conner: Cornell’s Osler.” Circulation 102 (2000): 1062–67. Frohlich, Edward D., L. Gabriel Navar, and Richard N. Ré. “Theodore Cooper Memorial Lectureship.” Hypertension 25 (1995): 154. Hajjar, David P., and Antonio M. Gotto Jr. “Launching of an American Medical College in the Middle East: Educational Challenges in a Multicultural Environment.” International Journal of Higher Education 2, no. 2 (2013): 67–75. Harvey, A. McGehee. Science at the Bedside: Clinical Research in American Medicine, 1905–1945. Baltimore: Johns Hopkins University Press, 1981. Huvos, Andrew. “James Ewing: Cancer Man.” Annals of Diagnostic Pathology 2, no. 2 (April 1998): 146–48. Jones, Chris. Climbing in North America. Berkeley: University of California Press, 1976. Kamrava, Mehran. Qatar: Small State, Big Politics. Ithaca, NY: Cornell University Press, 2013. Kastor, John A. Mergers of Teaching Hospitals in Boston, New York, and Northern California. Ann Arbor: University of Michigan Press, 2001. Larrabee, Eric. The Benevolent and Necessary Institution: The New York Hospital, 1771–1971. Garden City, NY: Doubleday & Co., 1971. Lerner, Barron H. “ ‘You Murdered My Daughter’: Libby Zion and the Reform of Medical Education.” In When Illness Goes Public: Celebrity Patients and How We Look at Medicine, 201–21. Baltimore: Johns Hopkins University Press, 2006. Levine, David B. “The Hospital for Special Surgery Affiliates with Cornell University Medical College and New York Hospital, 1951; Philip D. Wilson Retires as Surgeonin-Chief, 1955.” HSS Journal 5, no. 2 (September 2009): 83–91. Ludmerer, Kenneth M. Learning to Heal: The Development of American Medical Education. New York: Basic Books, 1985. ——. Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. Oxford: Oxford University Press, 1999. McDermott, Rose. “The Decisions about Admitting the Shah.” In Risk-Taking in International Politics: Prospect Theory in American Foreign Policy, 77–106. Ann Arbor: University of Michigan Press, 2001.

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McGaghie, William C. “Assessing Readiness for Medical Education: Evolution of the Medical College Admission Test.” Journal of the American Medical Association 288, no. 9 (September 4, 2002): 1085–90. Meyerhoff, Erich. “Death in the Family: The Medical Library Center of New York, 1960–2003.” Journal of the Medical Library Association 92, no. 1 (January 2004): 4. Morantz-Sanchez, Regina Markell. Sympathy and Science: Women Physicians in American Medicine. New York: Oxford University Press, 1985. Mueller, Richard L. “Irving S. Wright—Innovator in Cardiovascular Medicine.” Clinical Cardiology 18 (1995): 181–83. Opdycke, Sandra. No One Was Turned Away: The Role of Public Hospitals in New York City since 1900. New York: Oxford University Press, 1999. Oransky, Ivan. “G Tom Shires.” Lancet 371 (January 19, 2008): 200. Patel, Nachiket. “Learning Lessons: The Libby Zion Case Revisited.” Journal of the American College of Cardiology 64, no. 25 (December 30, 2014): 2802–3. “Robert Michels, M.D.” In Contemporary Psychoanalysis in America: Leading Analysts Present Their Work, edited by Arnold M. Cooper, 401–2. Washington, DC: American Psychiatric Publishing, 2006. Rothstein, William. American Medical Schools and the Practice of Medicine: A History. New York: Oxford University Press, 1987. Rutkow, Ira. Seeking the Cure: A  History of Medicine in America. New York: Scribner, 2010. Starr, Paul. The Social Transformation of American Medicine. New York: Basic Books, 1982. Stevens, Rosemary. American Medicine and the Public Interest: A History of Specialization. Berkeley: University of California Press, 1998. Walsh, James J. “William Mecklenburg Polk.” In History of Medicine in New York: Three Centuries of Medical Progress, 5:398–402. New York: National American Society, 1919.

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Index

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Page numbers followed by letter f refer to figures. Adams, Charles, 1 admission policies: in 1900s, 16 – 17; in 1940s, 87 – 88, 103; in 1950s, 104 – 5; in 1970s, 146; college degree requirement, x, 16, 17, 87 – 88, 93, 145 Advancing the Clinical Mission campaign, 223 – 26 affirmative action, 146, 149, 178 African Americans: discrimination in medical school admissions, 104 – 5; efforts to increase enrollment of, 128, 140, 146 – 49; enrollment in CUMC, 15, 146, 148, 148f; faculty members, 178 Albert Einstein College of Medicine, 169, 181 Al-Missned, Moza Bint Nasser, 215, 217, 224 Alonso, Daniel, 197, 215, 216 Al Thani, Hamad bin Khalifa, 161, 214f, 215 Alumni Day, 40 American Cancer Society, 23, 123 American Heart Association, 35 American Medical Association, 30, 80, 103, 122, 135 Andersen, Olaf, 232 Andresen, Jessie, 9, 34 – 35, 73 Andrus, William Dewitt, 95 anesthesia, development of, ix, xi Angell, Margaret Robinson, 77 Ansary, Hushang, 221, 232 Ansary Stem Cell Institute, 232 – 33 antibiotics, development of, xi antisepsis, introduction of, ix, 3 Appel, Helen, xiv – xv Appel, Robert, xiv – xv, 233

Army Specialized Training Program, 29, 92, 94 Association of American Medical Colleges (AAMC), 91, 122, 135, 149 Astor, Brooke, 171, 174, 175, 196 Astor, Vincent, 110 Astor Foundation, 131 Atlantic Philanthropies, 193, 232 Austrian, Jonathan, 229 awards, xii, 75, 91, 99, 117, 122, 222 Axelrod, David, 181 Baker, George F., 22, 52 Bane Report of 1959, 135 Barbey, Henry G., 84 – 85 Barnes, Alfred C., 12 Barr, David, 107 Barringer, Emily Dunning, 9, 14 – 15 Base Hospital Number Nine, 27, 95 Basset, Eleanor Scott Goldbloom, 150 Baylor College of Medicine, 207, 219 Bayne-Jones, Stanhope, 71, 76, 111 Bearn, Alexander G., 146 Becker, Neal Dow, 106 Beebe, Silas, 21 Belfer, Robert and Renée, xiv, xv, 234 Belfer Research Building, 88, 234 – 35, 236 Bell, Bertrand, 181 Bellevue Hospital, 12, 62; calorimeter at, 23, 24f; clinical teaching at, 18, 18f, 19; motorized ambulance of, 33f; Second (Cornell) Division of, 19, 60, 69, 94, 122, 125 – 26 Bellevue Hospital Medical College, 1, 3, 4, 7, 9

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INDEX Benedict, Stanley, 57 Bennack, Frank, Jr., 195 Berg, Henry, 37 Bergstrom, Flora Jo, 52 Berwind Maternity Clinic, 41 biochemistry department, 85 biomedical research, 118, 121; vs. clinical care, in medical education, 196 – 97; expansion in 1990s–2000s, 223, 231 – 33 Bishop, Morris, 10, 12, 33, 57, 81, 92, 97 Blackwell, Elizabeth, x, 14 blood bank, 88 – 89 Bloomberg, Michael, 223, 233 Blue Cross Association, 80, 124 Bookout, John, 219 Booth-Ferris Foundation, 131 Borowitz, Drucy, 150 Boston University, 107 Boutin-Foster, Carla, 236 Bowen, Ted, 207 Boyd, George Adams, 3 Brannan, John W., 19 Brennan, Eamon, 166 Brine, Kevin, 223 Brown, Don S., 61 Buchanan, J. Robert, 114f, 141 – 42; as associate dean, 134, 140; as dean, 114, 140; and Deitrick, 122, 129, 138; and faculty, 152; and graduate program, 146; on Hinsey, 111; and Luckey, 112, 140, 153; on malaise of 1970s, 139 – 40; and Meikle, 169, 176; on multidisciplinary centers, 152 – 53; on relations with medical center, 155; resignation of, 156; and student affairs, 143, 144, 145, 149 buildings/facilities: construction in 1940s, 88; construction in 1960s, xii, 128 – 32; construction in 1970s, 153 – 55; construction in 1980s, 170, 172, 175 – 76, 187, 189 – 93; construction in 1990s, 198 – 201, 200f; construction in 2000s, 226, 233 – 35; in early days of CUMC, x, 12; federal funding for, 129, 134, 135; on First Avenue, 11, 12 – 13, 13f, 41, 60; on Upper East Side, 48, 51 – 52, 61 – 66, 61f, 236f Burke Rehabilitation Hospital, 127, 161 burn center, 152, 185, 201 calorimetry, 23, 24f, 60 cancer research, xv – xvi, 23 – 24, 98 – 99 Cardiovascular/Hypertension Center, 172 – 73 Carter, Anne C., 150 Carter, Jimmy, 139 Carty, John R., 61

Carver, Susan T., 141 Cattell, McKeen, 33 Cayuga Medical Center, 138, 202 Central Intelligence Agency, 115 – 16 Chelsea Center for Special Studies, 179 Child Development Institute, 109 Children’s Clinic, 64 China Medical Board, 76, 91, 141 Chronobiology Institute, 179 Clarke, Edward H., x class size, 92, 103, 135, 145, 197 – 98 clinical teaching: in 1900s, 17 – 20, 18f; in 1930s, 57, 69, 86; in 1940s, 94; in 1960s, 132; in 2000s, 226, 227f; importance of, 21 – 22; in late 19th century, 2; New York Hospital network and, 202, 205 Cold War, 102, 114 – 17 Collier, Earl M., Jr., 189 Columbia-Presbyterian Medical Center, 42, 52, 62 Columbia University College of Physicians and Surgeons, xi, 4, 20; and Bellevue Hospital, 19; clinical clerkships at, 69; and Cornell, 202 – 3, 204, 206, 212; Flexner report on, 21; proposed merger with, 26, 41, 173, 202 – 3; research funding for, 169 Commonwealth Fund, 36, 107 community involvement: in 1950s, 107; in 1960s, 127 – 28, 132; in 1970s, 140, 144, 149; in 1990s, 210 comprehensive care program, 107 – 9, 140 Comprehensive Health Manpower Training Act of 1971, 145 Comprehensive Health Planning Act of 1966, 124 computers, 117 – 18, 197 Connally, John, 185 Conner, Lewis, 3, 9, 14, 16, 20, 21, 22, 35, 39, 40, 86, 109 Constantine, Frank, 96f Cooper, Theodore, 140, 142, 156, 158 – 60, 158f, 162 – 64, 166, 169 Cornell Board of Trustees: and CUMC Board of Overseers, 171; and faculty nominations, 11; meetings in New York, 138; students appointed to, 144 Cornell Daily Sun, 54, 130, 163 Cornell Graduate School of Medical Sciences, 74, 118 – 19, 143, 145, 146, 206 Cornell Medical Group, 125 Cornell Pay Clinic, 30, 35 – 40, 69 Cornell Physician Organization, 204 – 5, 223, 226 Cornell Program in Social Psychiatry, 132

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Index

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Cornell University: centennial of, 134; pre-med program at, 1 Cornell University Medical College (CUMC): centennial anniversary of, 210; early days of, x, xi, 12 – 15; establishment of, ix, xix, 7, 16; expansion in 1960s, xii, 128 – 32; fiftieth anniversary of, 109; Flexner report on, 21 – 22; formal opening of, 12, 15; founders of, 2 – 7, 27 – 28; Ithaca campus of, 14, 17, 86; malaise of 1970s, xiii, 139 – 40, 156 – 66, 169; mission of, xi, 83; renaming of, xiv, xix, 194, 211 Corson, Dale, 138, 156 Corwin, Steven, xv cost of health care, rise in, xiii, xv, 79, 80, 124, 139, 167 cost of medical education, xiii; in 1900s, 18 – 19, 23; in 1950s, 102, 103; in 1960s, 135 – 36; in 1970s, 145; in 1980s, 170 – 71, 177 Couric, Katie, 226 CUMC Board of Overseers, 171, 190, 194 – 95 curriculum: concerns in 1940s, 88; humanistic values in 21st century, 227 – 29; innovations in early 20th century, 16, 17 – 18, 18f, 40; during Korean War, 103; modernization in 1990s, 195, 196 – 97, 202; revision in 1930s, 57; revision in 1950s, 135; revision in 1980s, 178; revision in 2010, 236; stagnation in 1970s, 157; student activism of 1960s–70s and, 127 – 28, 144; during World War II, 92, 93, 94, 100 Curtis, James, 146, 147 – 49 Dale, Harvey, 232 Davis, Carolyne K., 162 Day, Edmund Ezra, 84, 89, 90 dean(s): in 1920s, 31 – 35; in 1930s, 71, 81 – 83; in 1940s, 92; in 1950s–60s, 112 – 14, 114f, 120, 121; in 1970s, 114f, 140 – 43, 156, 158; in 1980s, 169, 184 – 86; in 1990s, 191, 206; first, x, 7, 8 – 11; first female, x, 237; responsibilities of, 11, 83, 142. See also individual deans DeBakey, Michael, 123, 166, 206, 207, 225 DeHaven, Hugh, 97 – 99 Deitrick, John E., 114f, 122 – 23; and Buchanan, 122, 140; construction projects under, 129, 131 – 32; as dean, 120, 121, 123, 124, 126, 127; on Hinsey, 110; on hospital affiliations, 136, 137; rapid expansion and, 133, 134; relationship with Ithaca campus under, 137 – 38; retirement of, 138; on tuition costs, 136

dental course, 126f Discoveries That Make a Difference, 233 – 34 DNA research, xvi, 118 Douglas, James, 23 Douglas, R. Gordon, 61, 114 – 15, 128 Drukier, Gale and Ira, xv DuBois, Eugene, 24 – 25, 57, 60, 69, 83, 86 Dulles, Allen W., 115 Eastman, William, 90f East River Drive air rights, 153 – 55, 187, 198 – 99 Eberle, William H., 62 Edgar, J. Clifton, 7 Edwards, Dayton, 112 Ehrlich, Paul, xi electives, 135, 145, 221 Elliott, Eleanor T., 156, 174 empathy, fostering habits of, 227 – 29 Englander, Caryl and Israel, xv Ewing, James, 7, 10, 23, 89 Executive Faculty Council, 57, 71, 73, 137, 152 facilities. See buildings faculty, CUMC: in 1930s, 85; in 1950s, 120; in 1960s, 123, 125, 133; in 1970s, 151 – 52, 157, 161; appointments of, 11, 206; diversity of, 178, 236 – 37; first, 7, 11, 12, 23 – 24; full-time system for, 50, 56 – 58, 66 – 69, 73; mandatory age of retirement for, 56, 57; part-time, 57, 86; recruitment in 1990s, 212; review process for, 152; Robinson on, 73, 74; salaries in 1900s, 20; salaries in 1960s, 133, 136; women on, x, 14, 39, 85, 166 faculty club, 130, 134 faculty councils, 57, 134; reorganization in 1970s, 152; students appointed to, 144 Faculty Practice Plan, 204 Fairben, Keith, 213 Farrand, Livingston, 42, 45, 46, 47, 51, 70, 71, 80 – 81 Fauci, Anthony, 210 federal funding: for facility construction, 129, 134, 135; for medical education, 102, 103, 135; for research, xii, xv, 101, 115 – 16, 117, 134, 157, 166, 169, 179 Feeney, Charles, 193, 232 Feil family, xiv Ferguson, Jeremiah, 9, 34 financial affairs: in 1920s–30s, 53, 70 – 71, 84 – 85; in 1940s–50s, 102, 119 – 20; in 1960s, 134; in 1970s, xiii, 155, 158,

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INDEX

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financial affairs (cont.) 160 – 61, 162; in 1980s, xiii, 166, 170 – 71, 173; in 1990s, xiii – xiv; in 2000s, 215, 234, 235 financial aid, 60, 103, 136 Fins, Joseph, 229 Fleming, Alexander, xi Flexner, Abraham, xi, 21 – 22, 41, 42, 45, 46, 50, 63 Flexner, Simon, 45 Flexner Award, 91 Flint, Austin, 7 Fredrickson, Donald, 207 Friess, Constance, 70 full-time faculty system, 50, 56 – 58; dissatisfaction with, 66 – 69, 73 Fund for Medical Progress, 130 – 31, 136 fund-raising: in 1930s, 84 – 85; in 1940s–50s, 105 – 6; in 1960s, 130 – 31, 136; in 1970s, 156, 160, 174; in 1980s, 174 – 76; in 1990s, 194 – 95, 210 – 12; in 2000s, 223 – 26, 233 – 34; annual gala, 174 – 75; deans and, 83, 142, 162 – 63, 209 – 10 General Education Board, 42, 49, 52, 106 GI Bill, 104 Gibson, Charles I., 40 Giles, Roscoe Conkling, 15 Girotto, Ron, 219 Glimcher, Laurie H., 237 global engagement, 140, 141, 214 – 18, 220 – 23 Goldstein, Marc, 180 Gordon, Harry H., 58 Gotto, Anita, 207, 224, 225 Gotto, Antonio M., Jr., 207 – 8; construction projects under, 233 – 35; as dean, xix, 206 – 7; and DeBakey, 166, 206, 207; and faculty diversity, 236; fund-raising by, xiv, 209 – 10, 223, 225 – 26, 233, 234; and global engagement, 214, 214f, 215, 216, 218, 220; and Hajjar, 231; and Hippocratic Oath, 229, 230; and Methodist Hospital affiliation, 219, 225; perceptions of colleagues, 142, 146, 158; and renaming of CUMC, xiv, 210, 211; retirement of, 237; and strategic planning, 233; and Valium controversy, 163; and Weill, 209 – 10, 211f, 223, 224 – 25 graduate programs, CUMC: in 1950s, 118 – 19; in 1970s, xiii, 145 – 46; in 1980s, 177; biomedical training in, 118; establishment of, xii, 23, 74; Tri-Institutional MD-PhD program, xiii, 146, 177, 232. See also Cornell Graduate School Great Depression, 53, 59, 60, 70, 72, 73, 75, 79, 84 – 85, 110

Greater Cornell Fund campaign, 105 – 6 Greenberg, Corinne, 223, 234 Greenberg, Maurice R. “Hank,” xiv, 186 – 87, 188, 190, 192f, 193, 198, 223, 234 Greenberg Distinguished Service Award, 122 Greenberg Pavilion, 199 – 201, 200f Griffis, Stanton, 130, 131 Griffis Faculty Club, 130, 134 Gudernatsch, Frederick, 10, 25 Guenther, Robin, 227 Guion, Connie, 33 – 34, 33f, 39, 40, 105, 130 Guion Building, 130 Hadley, Hamilton, 112 Haiti, HIV/AIDS program in, 179, 221 – 23 Hajjar, David P., 119, 169, 187, 206, 231, 233 Halsted, William Stewart, x, 58 Hamad bin Khalifa Biomedical Research Building, 161 Hampton University, 146 Harkness, Edward, 42 Harkness, Rebekah, 131 Harkness, William Hale, 131 Harkness Building, 130 – 32 Harris, L. I., 37 Harvard Medical School, 2, 16, 17, 177, 178, 197 health care: increased government involvement in, 80 – 81; Medicare/Medicaid and changes in, xii, 121, 124, 139, 145, 198; rising costs of, xiii, xv, 79, 80, 124, 139, 167; for students, 15, 34, 40, 86. See also medicine health insurance: debates surrounding, 80 – 81; managed care, xiii – xiv, 168; private, origins of, 80 health maintenance organizations (HMOs), 168 Health Research Group, 163 Hellerstein, David, 191 Helmsley, Leona, 196 Henry, Barklie, 75 – 76 Heuer, George J., 58, 67 – 68, 94, 95 Hewitt, Waterman Thomas, 12, 16 Hinkle, Lawrence E., Jr., 115, 117 Hinsey, Joseph, 91, 110 – 11, 114f; on comprehensive care program, 107; as dean, 92, 93, 94, 100, 103, 106; on government funding, 102; as medical center director, 74, 76 – 77, 110, 111 – 12, 136; and Papanicolaou, 99; on student affairs, 104, 105, 107 Hippocratic Oath, 229 – 31 HIV/AIDS research and treatment, 179, 221 – 23

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Index Holly, Joyce V., 201 Horn, Charles, 106, 107 hospital affiliation(s): in 1900s, 19; in 1940s, 94; in 1960s, 125 – 27, 136 – 37; in 1970s, 143; in 1990s, 138, 202; in 2000s, 219 – 20; and faculty dispersion, 133; need for, xi, 29, 30, 41 – 42. See also specific hospitals hospital-based care, shift toward, 30 Hospital for Special Surgery, 74, 119, 133, 134, 136, 153, 155, 198 housing, student/faculty: in 1920s, 41; in 1950s, 106 – 7, 106f; in 1970s, 153; in 1990s, 212; appeal for, in 1940s, 105 Houston Methodist Hospital, 219 – 20, 225 Hughes, Howard, 199 human genome sequencing, xvi Humanities and Medicine program, 227 – 29 Human Sexuality Program, 152 Hunter College, 235 Hutton, Robert L., 15

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infectious diseases, xi, 6 influenza pandemic of 1918, 27, 29 information technology, 117 – 18, 197 insurance. See health insurance interdisciplinarity, 107 – 9, 152 – 53 internship(s): in early 20th century, 20; vs. residency program, 58; supervision requirements, 181 internship exams, 14, 18, 20 Isom, O. Wayne, 184, 186 Ithaca campus, 14, 17, 86 Jackson, Thomas “Stonewall,” 9 Janeway, Theodore, 32 Johns Hopkins School of Medicine, 2; admissions policies at, 16, 17, 178; Flexner report on, 21; in postwar era, 107; Robinson’s leadership and impact on CUMC, 48 – 50, 56, 57, 58; women at, 13 Johnson, Lyndon B., 123 Kahn, James, 215 Kean, Benjamin, 131, 164, 166 Kelly, Sue, 215 Kennedy, John F., 119, 185 Kent State University shootings, 143, 144 Kerr-Mills Act of 1960, 124 Khomeini, Ayatollah Ruhollah, 164 kidney transplant program, 132 Kips Bay – Yorkville Health and Teaching Center, 88, 117 Kirby, George H., 40 Kissinger, Henry, 164

Klein, Mary E., 65 Klotz, Walter, 39, 40, 41 Kogan, Richard, 229 Korean War, 102 – 3 laboratories/laboratory instruction, 2, 16, 65, 108f, 235 Ladd, William, 81 – 82, 82f; on admissions policies, 87 – 88, 105; as dean, 71, 81 – 86; on health insurance debates, 80; retirement of, 32, 90, 92; on student affairs, 85 – 86; during World War II, 90 Larrabee, Eric, 10, 46, 62, 70, 72, 110 Lasdon, Jacob S., 153 Lasdon, Mildred, 176 Lasdon, William S., 176 Lasdon Biomedical Research Center, 176, 187, 189 – 93 Lasdon House, 153, 176 Lasker Award for Clinical Medical Research, xii, 99, 117 Laura Spelman Rockefeller Foundation, 52 Le Jacq, Peter, 221 Leonard, Debra, 236 Leonard, Maurice, 180, 181 Lerner, Barron, 182 Lester, Daniel, 90f Levy, Robert, 207 libraries, 64, 65, 118, 129 – 30, 187 Lincoln Hospital, 94 Lindsay, John, 155 Lister, Joseph, ix Loizeaux, Marion C., 94 Loomis, Alfred L., 2, 3, 4, 9, 28 Loomis, Henry P., 3, 7 Loomis Laboratory, x, 3, 4, 5, 8, 12 Louria, Donald, 128 Low, Seth, 12 Luckey, E. Hugh, 112 – 13, 114f; and Buchanan, 112, 140, 153; on class size, 103; on comprehensive care, 108, 109; as dean, 112 – 14, 119 – 20; and East River plan, 153 – 55; as medical center president, 124, 128, 153, 155 – 56, 157; on research grant applications, 117; on Whitney, 44 Ludmerer, Kenneth, xx, 16, 102, 118, 125, 127, 139, 142, 182, 194 Lusk, Graham, 7, 21, 23 Lying-In Hospital, 52 MacCracken, Henry, 4, 5, 6 Magill, Thomas P., 92 magnetic resonance imaging (MRI), 180 Mahon, Arthur, 192f

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INDEX Mahon Patient Resource Center, 226 Maloney, Carolyn, 215 Malott, Deane, 106, 119, 120, 137 managed care: financial impact on hospitals/ medical schools, xiii – xiv, 168, 194; and provider networks, 201 – 2, 204 Manhattan Eye, Ear, and Throat Hospital, 127, 153, 154 Manhattan Maternity and Dispensary, 52 Manhattan State Hospital, 94 Maxwell, Hamish, 212 McAuliffe, George B., 60 McAuliffe, Gervais W., 87 McCombs, A. Parks, 39 McDermott, Walsh, 117, 134 McKinley, William, ix McMaster University, 197 medical center(s): community responsibilities of, 140; Medicare/Medicaid and challenges for, 124 – 25; use of term, 62. See also New York Hospital – Cornell Medical Center Medical College Admission Test (MCAT), 104, 148 medical education: biomedical research vs. clinical care in, 196 – 97; dehumanizing effect on physicians, 139 – 40; federal aid for, 102, 103, 135; Flexner report on, xi, 21 – 22; Korean War and changes in, 103; Ladd on, 85; postwar experiments in, 107 – 9; Robinson on, 73 – 74, 77 – 78; scientifically based, in 1970s, 145 – 46; socially minded, in 1960s, 127 – 28; at turn of 20th century, x, 2, 15 – 16; World War II and changes in, 88, 92 – 94, 100. See also curriculum medical licensing tests, student performance on: decline in 1970s–80s, 157, 169, 178; at Qatar branch, 218 Medical Officers’ Reserve Corps, 89, 90f Medical Student Executive Council, 144, 152 Medicare/Medicaid: impact on health system, xii, 121, 124, 139, 145, 198; impact on medical schools, 167 – 68 medicine: advances in 1930s–1950s, xi – xii, 70, 79; advances in early 21st century, xix; as big business, 139; Cornell model of, 37, 38; expansion in 1960s, 121; in late 19th-early 20th century, ix – x; World War I and changes in, 29 – 30 Meikle, Thomas, Jr., 122, 169 – 70, 170f; as CUMC dean, 156, 161, 169 – 77, 184; as graduate school dean, 118, 143, 145; resignation of, 184; on Shires-Skinner relationship, 187 – 88 Meinig, Peter, 233

Mellon Foundation, 173, 177 Memorial Hospital, 23, 74, 89, 94, 126 Memorial Sloan Kettering Cancer Center, 126, 129, 133, 134, 135, 153; and biomedical research, 232; and CUMC, 176 – 77, 202, 203; Iranian shah at, 164 – 65 mergers, in 1990s, 202 – 4 metabolism, research on, 19, 23, 24f, 60, 72 Methodist Hospital, Houston, 219 – 20, 225 Meyer, Sandy and Ed, xiv Michels, Robert, 191 – 92, 192f; on Cornell Physician Organization, 205; as dean, 191, 193, 196, 197, 203, 206; on financial challenges, 167; and fund-raising, 175; on previous deans, 113, 142, 158, 169; and Skinner, 188, 193 Milbank Memorial Fund, 88 military science, courses in, 60, 89, 100 mind control research, 115 Mingle, James, 215 minority students, at CUMC, 15, 178; in class of 1975, 148f; in class of 1996, 197; efforts to increase enrollment, in 1960s–70s, 128, 140, 146 – 49. See also African Americans Monahan, Jay, 226 Monahan Center for Gastrointestinal Health, 226 – 27 Monroe, James L., 116 Morantz-Sanchez, Regina, 14 Morgan, J. Pierpont, Jr., 45, 52 Morgenthau, Robert, 181 Morrill, Charles, 150 Morton, William, ix Mount Sinai School of Medicine, 202 multidisciplinary centers, in 1970s, 152 – 53 Nader, Ralph, 163 Nathan, Carl, 212 National Cancer Institute, 101 National Fund for Medical Education, 91, 102 National Institutes of Health (NIH), 101, 157, 177, 195, 203, 212 Navajo-Cornell Field Health Project, 117 Navy College Training Program, 92, 94 networks of health care providers, 201 – 2, 204 – 5 New, Maria, 178, 215 New Deal, 80 New Horizons for Medicine, 194 – 95, 212, 223 New York Academy of Medicine, 9, 20, 32, 33, 82, 122, 130 New York City: choice as CUMC’s location, 1; at turn of 20th century, 5 – 6 New York Eye and Ear Infirmary, 94

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Index New York Hospital: affiliation with Cornell, xi, xx, 22 – 23, 29, 41 – 47, 131; bicentennial of, 139; clinical clerkships at, 86, 157; dispensary at, 86, 87f, 88; and East River air rights campaign, 153, 155; financial pressures on, 102, 155, 188; improved financial health in 1990s, 198; merger with Presbyterian Hospital, 203 – 6; modernization project of 1990s, 198 – 201; network of, 201 – 2, 205; outpatient department at, 40, 130; patient deaths in 1980s, 180 – 84, 198; patient exodus in 1950s, 123, 125; property rights dispute in 1980s, 175 – 76, 187 – 93; proposed four-way merger and, 25, 26, 41; relations in 1930s, 83; relations in 1960s, 136; relations in 1970s, 156, 157 – 61; relations in 1980s, 168, 171 – 73, 175 – 76, 187 – 93; and research, 72, 74 – 75; under Skinner’s leadership, 184, 186, 188, 198, 201 – 2; Westchester Division of, 137, 144, 179 New York Hospital Board of Governors, 42, 171, 172, 187 New York Hospital – Cornell Medical Center: administrative structure of, 55 – 56, 71 – 72; aging facilities of, in 1970s, 157 – 58; challenges in 1980s, 172 – 73; construction of Upper East Side facilities, 48, 51 – 52, 53, 54f, 55, 61 – 66, 61f; Cornell Physician Organization and, 205; dissecting room at, 63f; East River Drive air rights campaign and, 153 – 54; establishment of, 43 – 47; financial pressures on, 70 – 71, 155, 171; first patient at, 62; growth in 1940s, 88 – 89; growth in 1950s, 117 – 20; growth in 1960s, 132, 137; Iranian shah as patient at, 164 – 66; Johns Hopkins’ influence on, 57 – 58; long-term planning project for, in 1980s, 173 – 74; under Luckey’s leadership, 124, 128, 153, 155 – 56, 157; malaise of 1970s and, 156, 157 – 61; Medicare/managed care and challenges for, 124 – 25, 167 – 68; outpatient service at, 69, 86, 172; proposed reorganization in 1980s, 172; Robinson as patient at, 74 – 75; surgical department at, 58 – 59, 62, 66 – 69; switchboard operators at, 133f; during World War II, 92 New York Hospital – Cornell Medical College Association, 44 – 45; first director of, 48, 51, 71 New York Infirmary for Women and Children, x, 13 – 14 NewYork – Presbyterian Hospital, xi, xiv, 205 – 6, 208 – 9, 235 – 36

New York University: and Bellevue Hospital, 19, 126; faculty seceding from, x, 4 – 7; proposed merger with, 202; research funding for, 169 Niles, Walter, 21, 31f, 32; as acting dean, 90 – 92; on clinical teaching, 19 – 20; as dean, 31 – 35, 40; on founding faculty, 8; on hospital affiliation, 29, 30; and medical center, 45, 46 – 47; on pay clinic, 36, 37, 38; and Robinson, 50, 51; and student affairs, 40, 41 Ninth General Hospital, 95 – 97, 96f, 97f, 100 Nixon, Richard, xiii, 139, 144 Nobel Prize, xii, 75, 99, 117 North Shore Hospital, 127, 202 Northwestern University, 107 Noyes, Jansen, Jr., 171, 174 nursing school: class of 1971, 162f; closing of, xiii, 161 – 62; Cornell – New York Hospital merger and, 100; delay in opening of, 59; demonstrations at, 66f; library collection of, 129; student residence at, 65, 65f Office of Women in Medicine, 178 – 79 Olin, Franklin W., 106 Olin, John M., 106 Olin, Spencer T., 106 Olin Foundation, 106 – 7 Olin Hall, 106 – 7, 106f, 115 Oppel, Theodore, 74 Osborne, Stanley, 160 Osler, Sir William, x, 33 – 34, 50 Oswald, Lee Harvey, 185 otolaryngology department, 86 – 87 outpatient services: in 1960s, 130; in 2000s, 226; medical center and, 69, 86 Overholser, Margery T., 65 oxytocin, discovery of, xii, 117 Page, Irvine H., 65 Pahlavi, Shah Mohammad Reza, 164 – 66 Papanicolaou, George, xii, 24, 30, 60, 98 – 99, 98f Pape, Jean William, 179, 222 Pappageorge, James, 213 Pap smear test, xii, 24, 99 Pardes, Herbert, 203, 208 Parker, Bessie A. R., 59, 100 Patterson, Russel H., 39 pay clinic model, 37, 38 Payne, Mary Ann, 93 Payne, Oliver H., 3, 27; and origins of CUMC, 2, 4 – 7; philanthropy of, 17, 22, 28, 106

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Copyright © 2016. Cornell University Press. All rights reserved.

INDEX Payne Whitney Psychiatric Clinic, 43, 64, 88, 152, 200 – 201 Payson, Joan Whitney, 131, 174 Payson, Laurence G., 77 Pazianos, Artemis G., 150 Perelman, Ronald, xv Perinatology Center, 152 personalized medicine, xvi philanthropy: in 1910s, 22, 23, 28; in 1920s, 42, 43 – 44, 52, 70; in 1930s, 71; in 1940s, 88; in 1950s, 106 – 7, 120; in 1960s, 129 – 31; in 1980s, xiii, 172, 173, 174 – 75; in 1990s, xiv – xv, 193, 194, 196, 197, 198 – 99, 211 – 12; in 2000s, 215, 216, 221, 223 – 24, 232, 233 – 34; increased dependence on, xiii, xv; and origins of CUMC, 4, 7, 17 Philson, Arthur, 90f physicians: female, in early 20th century, x, 14 – 15; shortages of, xv, 135, 145; status in early 20th century, 20; take-home pay in 1930s, 79 Plummer, Norman, 57 – 58 Polk, Frank, 28, 45 Polk, William, 8 – 9, 8f, 27, 28; assistant to, 34 – 35; and clinical teaching, 18f, 19; as dean of CUMC, x, 7, 8 – 11, 12, 14, 15, 16, 83; at New York University, 4, 6; Niles compared to, 33; on nonclinical research, 25 Pool, J. Lawrence, 62 Powell, Wilson M., 70 – 71, 72, 75 Pratt, Henry, 112 precision medicine, xvi preferred provider organizations (PPOs), 168 Presbyterian Hospital: cost of building, 53 – 54; merger proposals, 25, 26, 41, 173, 203; merger with New York Hospital, 203 – 6 Priefer, Kevin, 213 Pritchett, R. A. Rees, 113, 196, 211 proprietary schools, 1 – 2, 21 psychiatry: instruction in, 60, 75, 137, 191; reorganization of department of, 88 Puerto Rican students, 146, 148 Qatar, CUMC branch at, x, xv, 214, 215 – 18 Qatar Foundation, xiv, 215 – 16, 218 Rafii, Shahin, 232 Rawlings, Hunter, III, xiv, 208, 210, 214f, 216 Reader, George, 107 research: in 1910s, 23 – 25; in 1920s, 30 – 31; in 1930s, 60, 65 – 66, 85, 86; in 1940s, 97 – 99; in 1950s, 115 – 18, 121; in 1960s, 128, 134; in 1970s, 140; in 1980s, 178 – 80; in 2000s, 232 – 33, 235; federal funding for, xii, xv,

101, 115 – 16, 117, 134, 157, 166, 169, 179; and graduate program, 118, 119; New York Hospital and, 72, 74 – 75; at Qatar branch, 218 Reserve Officers’ Training Corps (ROTC), 40, 60, 73, 100 residency training program: demands of, 68 – 69; first, x; at Houston Methodist Hospital, 220; under Robinson, 50, 58 – 59, 66 – 69, 73; after World War II, 104 Reuter, Louis F. “Fritz,” IV, 199 Reznikoff, Paul, 55, 72 Rhodes, Frank H. T., 140, 160, 162, 171, 173, 190, 193 Riis, Jacob, 5, 19 Riker, Walter F., Jr., 63, 110 – 11, 146 Robinson, G. Canby, 47, 49, 50f; autobiography of, 71 – 75, 76, 77; correspondence of, 75 – 76; as dean, 19, 48 – 58, 60, 61; on financial aid, 60; financial pressures and, 70 – 71, 72, 73; and full-time faculty system, 56 – 58, 66 – 69, 73; and Hinsey, 76 – 77; and Ladd, 81; and medical center, 45, 51 – 52, 54 – 55, 57 – 59, 67, 69, 75; on medical education, 73 – 74, 77 – 78; as patient at New York Hospital, 74 – 75; and residency system, 50, 58 – 59, 66 – 67, 73; retirement of, 71 – 74, 75; as teacher, 74 Robinson, Marian, 77 Roche Laboratories, 163 Rockefeller, John D., 3 Rockefeller, John D., Jr., 89 Rockefeller, Laurance, 171 Rockefeller, Nelson, 155, 164 Rockefeller Foundation, 36, 42, 71, 88, 89 Rockefeller Institute for Medical Research, 74, 75 Rockefeller Institute Hospital, 45, 65 Rockefeller University, 177 – 78, 203; and East River Drive air rights campaign, 153, 155; and joint MD-PhD program, xiii, 146, 177, 232; and medical center, 46 Roehner, Veronica Lyons, 162 Rogatz, Peter, 108 Rogers, David, 93 – 94 Rogosin Institute, 132, 172 – 73 Roosevelt, Franklin D., 80 Roosevelt, Theodore, 12 Rosenwaks, Zev, 180 Sage College, 14 Sage Institute of Pathology, 19, 20, 23, 24, 60, 72 Samaritan (yearbook), 86

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Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

Copyright © 2016. Cornell University Press. All rights reserved.

Index Sampson, Harvey, 195 Santoro, Mario, 213 Saphier, Jacques Conrad, 94 Sargent, Murray, 71, 76, 81, 83, 92 Saxena, Brij, 152 Schafer, Larry, 226, 235 – 36 Schloss, Oscar M., 40, 57, 71 Schlossberg, Ed, 213 School of Nursing. See nursing school Schurman, Jacob Gould, 1, 2, 5, 6, 7, 10, 12, 25 – 26, 203 Scudder, Ida, 14 Seitz, Frederick, 146 September 11 terrorist attacks, 213 – 14 Seybolt, John, 98f Shapiro, David, 229 Sheldon, Edward, 42, 44, 45, 46, 51, 67, 70, 75 Shepley, Henry, 62 Sherman, Raymond, 181 Shires, G. Thomas, 152, 184 – 90, 186f Sigerist, Henry E., 48 Simmons, Rache, 237 Singer-Kaplan, Helen, 152 Skinner, David, 184, 186, 187 – 89, 192f, 193, 198, 199, 201 – 2, 203, 205, 206, 208, 209 – 10 Skinner, Ellie, 196 Skorton, David, 217, 234 Sloan Kettering Institute, 74, 126; and graduate program, xiii, 118 – 19, 146, 177, 232; proposed merger with, 202 Smillie, Wilson G., 92 Smith Clinical Skills Center, 226, 227f social work, 59, 75 Society for the Investigation of Human Ecology, 115 – 16 Sostman, H. Dirk, 220 specialization: in 1960s, 135; in 1970s, 145; pay clinic model and, 38; after World War I, 29 – 30, 103 Speck, William, 203, 204 Spock, Benjamin, 64 – 65 Stander, Henricus J., 83 Standish, Hilda Crosby, 150 Stanford University, 107, 178 Starr, Cornelius Van der, 198 Starr Biomedical Information Center, 187 Starr Foundation, xiv, 172, 198, 223, 234 Starr Pavilion, 172 Stein, Andrew J., 184 Steinem, Gloria, 196 stem cell research, 232 – 33 Stevens, Rosemary, 30

Stimson, Henry Lewis, 95 Stimson, Lewis, 2, 3, 4, 5, 6, 7, 12, 15, 17, 22, 27, 28, 95 Stimson Hall, 17 Stimson Society, 224 St. Luke’s Hospital, 94 Stockard, Charles R., 30, 31, 57, 98 Stone, Gregg, 180, 181, 182 Storey-Johnson, Carol, 147 strategic plans, 195, 223, 233, 235 Street, Charlotte, 98f Stroke and Critical Care Research Center, 132 student affairs: in 1900s, 13 – 15; in 1920s, 40 – 41; in 1930s, 60, 85 – 86; in 1940s, 103; in 1950s, 103 – 7; in 1960s, 127 – 28, 135 – 36; in 1970s, 143 – 51; in 1980s, 177 suicide prevention clinic, 132 summer research programs, 146 – 48, 232 summer term, introduction of, 57 Swift, Homer, 45, 46 Tait, Lawson, ix Tanzania, Weill Cornell’s engagement in, 221 Taylor, Arthur R., 156 Third Century Campaign, 156, 160, 174 Thompson, David, 20, 153, 160, 171, 184 Tisch Hospital, 203 Title IX, 151 translational research, 235 Traut, Herbert F., 99 Tri-Institutional MD-PhD program, xiii, 146, 177, 232 Tri-Institutional Research Program, 232 – 33 Truman, Harry, 164 tuition. See cost of medical education United Hospital Fund, 36 University Medical College, 3, 4 – 7, 9 University of Michigan, 2, 13 University of Pennsylvania, 2 Uris, Ruth, xiii, 175 U.S. Public Health Service, 129, 131, 154 USS Lafayette, 92 Valium controversy, 163 – 64 Vanderbilt School of Medicine, 50, 51, 52, 93, 107 Vaughan, E. Darracott, Jr., 204 Vietnam War, 139, 143 – 44 Vigneaud, Vincent du, xii, 75, 117 Wallace, Charlton, 60 Wallace, DeWitt, 175 Wallis, Lila A., 178

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Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.

INDEX Wilder, Burt, 1 Willard Parker Hospital, 94 Williams, Hibbard, 166 Winterkorn, Jacqueline, 170 Witthaus, Rudolph A., 7 Wolfe, Sidney, 163 Wolff, Harold, 115, 116, 116f Woman’s Medical College, x, 13 – 14 women: faculty at CUMC, x, 14, 39, 85, 166, 178 – 79; in graduate program, 146; in leadership positions, x, 237; medical school enrollment in 1970s, 151; physicians, in early 20th century, x, 14 – 15; at Qatar branch, 217; in Roaring Twenties, 30; students at CUMC, x, 13 – 14, 51, 85, 105, 135, 150 – 51, 197, 217; during World War II, 94 – 95 Women’s Clinic, 52, 64, 69 Wood Foundation, 129, 131 Wood Library, 129, 187 Woodward, William, 45 Woolsey, George, 7 World War I, 25, 26 – 27, 29, 32, 95; changes in medicine following, 29 – 30 World War II, xii, 89 – 100; and changes in medical education, 88, 92 – 94, 100 Wright, Irving, 117 Wriston, Walter, 175 Wynn, James, 106 yearbook, 86 Zion, Libby, 180 – 82, 184, 198

Copyright © 2016. Cornell University Press. All rights reserved.

Ward, George Gray, 40 Warhol, Andy, 183, 198 Warren, Michelle P., 150 Webster, Bruce, 95 Weill, Joan, xiv, 197, 210, 211, 224 Weill, Sanford “Sandy”: fund-raising by, xiv – xv, 194 – 95, 233; and global engagement, 214f, 216, 221; and Gotto, 209 – 10, 211f, 223, 224 – 25; philanthropy of, xiv, 194, 211 – 12, 223 – 24, 233 – 34; and strategic planning, 233 Weill Cornell Medical College/Weill Cornell Medicine: current state of, xv; global engagement of, 214 – 18, 220 – 23; renaming of CUMC as, xiv, xix, 194, 211 Weill Education Center, 197, 212 Weill Greenberg Center, 226 Weinstein, Luise, 180, 181, 182 Weiss, Stephen H., 171, 174, 193 Weiss, Suzanne, 174 Welch, William H., 56 Welfare Medical Care Project, 128, 140 Westchester Division of New York Hospital, 137, 144, 179 Western Reserve University School of Medicine, 107 Westheimer, Ruth, 152 White, J. Du Pratt, 45 Whitmore, Willet, 90f Whitney, John Hay “Jock,” 53, 75, 76, 131, 174 Whitney, Payne, 28, 42, 43 – 44, 51, 70, 75 Wiggers, Carl, 23

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Gotto, Antonio M., and Jennifer Moon. Weill Cornell Medicine : A History of Cornell's Medical School, Cornell University Press, 2016.