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1985-10-24 Interview with John Sprague, October 24, 1985 1985OH233 UKMC 08 00:43:24 UKMC001 University of Kentucky Medical Center Oral History Project Louie B. Nunn Center for Oral History, University of Kentucky Libraries Sprague, John, 1911- -- Interviews University of Kentucky. Medical Center -- History Fayette County Medical Society (Ky.) Medical education John Sprague; interviewee Richard C. Smoot; interviewer 1985OH233_UKMC08_Sprague 1:|11(13)|20(5)|27(9)|39(8)|53(2)|62(12)|69(5)|81(3)|89(13)|104(10)|117(9)|131(12)|143(7)|151(5)|157(14)|186(2)|212(6)|222(3)|245(8)|263(6)|286(3)|301(3)|322(2)|333(10)|341(13)|352(5)|361(3)|373(1)|379(7)|392(13)|406(8)|419(8)|430(2)|440(9)|452(6)|468(4)|481(6)|489(1)|504(11)|510(11)|521(7)|546(2)|566(8) audiotrans UKMCoh interview SMOOT: Dr. Sprague, I think the last time when we were talking we had touched upon the development of the philosophy of the Medical Center at the University of Kentucky. I wonder if you could tell me a little bit more about that philosophy that they had developed and how well it worked, how it was reflected in the curriculum, in the architectural design of the Medical Center, other aspects of the Medical Center? SPRAGUE: Well, it was very interesting to me, in that uh, in the year when the search committee which had been appointed to investigate the best way to begin a medical school, Medical Center, I happened to be president of the Fayette County Medical Society that year and so I was- -enabled, or I had the good fortune to sit in on the search committee interviews and it was a-- it was really fascinating, these were luncheon meetings. Uh, we'd have something to eat and then the person who was uh, "it" for the day would get up and present his philosophy, his ideas of what somebody coming as dean of the first medical school, uh, coming as the person to convert a cornfield -- which is what it was then -- into a Medical Center similar to that which you see today, well, what he should have and what he should be thinking about. Fascinating. And there were several people who represented the fall- out from the group of people who had been interviewed, um, perhaps by a visit or perhaps by telephone. Um, there were about four and it was fascinating to hear the different approaches to their ideas of what they would like to do if the terrible responsibility of creating a Medical Center and creating just from nothing a philosophy of what they felt, not only a curriculum should entail, but what kind of doctors they would like to have the center produce. Needless to say, Dr. [William] Willard was the winner and um, when Dr. Willard came here from Syracuse, New York, uh, he had with him a cadre of five people, four besides himself. I think we've been over this a little bit. SMOOT: Yes. SPRAGUE: Um, and these-- these people with him spent days and literally nights, uh, going over their ideas, batting their ideas back and forth-- SMOOT: Um-hm. SPRAGUE: --mutually criticizing each other's concepts. These uh, meetings were held in an old brick farmhouse which was uh, on Rose Street adjacent to what now I believe is the Agricultural Engineering building. Uh, this building also was the site of operations of the architects. There was a group of architects who were particularly skilled and who specialized in the design of Medical Centers, uh, from Chicago. Was their name Ellerbe? It may have been. SMOOT: I think so, yes. SPRAGUE: Uh, in conjunction with a local firm of architects. SMOOT: Um-hm. SPRAGUE: And as a result of their being in the same building there was a very great and very frequent consultations up and down the stairs. SMOOT: Hmm. SPRAGUE: Well, what do you think about this little point and uh, how could we best solve this problem? Um, Dr. [Richardson] Noback, of the cadre, was the person who perhaps was most expert in architectural design. Dr. Willard, of course, was the expert in philosophy. In uh-- in trying to arrive at a concept of how perfectly ideals could be meshed with practicality and oh this was-- this was a tough task. The practicality involved of course, first of all finances, because although Governor [A. B.] Chandler had uh, promised that there would be a medical school and although the legislature was committed to its creation and support, uh still you can't have everything and this was realized. Dr. Howard Bost, the medical economist, was uh, just a fantastic member of the cadre in the way he -- more I guess than any other one person -- uh, realized and-- and furthered the--the um-- the-- [Pause in recording.] SPRAGUE: The development of the concept of practicality and idealism. SMOOT: Hmm. SPRAGUE: A large part of the concept of the school as it was developed was emphasis on research and in the early days, it was an insistence of Dr. Willard that the faculty be on a strictly salary basis-- SMOOT: Um-hm. SPRAGUE: --and that uh, there be no extra emolument as a result of the treatment of patients. This uh, of course has been-- over the years has been one of the great difficulties in-- in keeping the Medical Center in step with modern times and in uh, permitting the attainment of the-- the-- the luring, you might say, to the Medical Center faculty-- SMOOT: Um-hm. SPRAGUE: --of clinicians of the stature that the original concept demanded. SMOOT: And yet that original concept attracted an outstanding group of people didn't it? SPRAGUE: It did, because of the challenge , uh, which was so ably described by Dr. Willard. He was an enthusiast of the first water. He uh, was a salesman to a degree you wouldn't believe. SMOOT: (laughs) How-- how do you think this philosophy has been maintained or has it been maintained in the Medical Center -- the ideals of the originators, the original group, the social consciousness that they hoped to instill in physicians going out into the world -- has that been maintained? SPRAGUE: I believe it's been maintained um, as much as similar ideals are being maintained elsewhere in medical schools over the country, which is not to say it's maintained to the point of desirability. SMOOT: Yes. That was seemingly -- uh, and correct me if I'm wrong -- that was one of the major selling points, I guess, of the new University of Kentucky Medical Center. It was different, innovative, in the fact that there was such an emphasis on social concerns and it gave a new twist to things uh, in medical education, generally speaking. Most Medical Centers, at least it has been my impression from what I have read and learned and talked about, did not give that kind of emphasis to social concerns among their developing physicians. Now some adopted those things later. Is that correct? SPRAGUE: I think generally speaking that's correct. I don't think you can generalize this over the country. I think there are other schools that uh, that were similarly concerned. SMOOT: Um-hm. SPRAGUE: I believe uh, one aspect of medical teaching which I have greatly deplored and regretted uh, observing over the years is the uh-- the increasing uh, depersonalization of the attitude of the faculty and therefore as a result of their teaching and example of the medical students. The tendency not to present the facts of the case being presented on grand rounds for-- for instance and then saying, uh, "Okay, we'll step out in the hall and discuss this." There's a tendency these days, not sufficiently to consider the patients' feelings, but to go with the discussion right in the patients' presence. I mean this is-- this is just one example. SMOOT: Um-hm. SPRAGUE: (clears throat) One of the parts of medical teaching which I have been particularly interested in along those lines and which I have, in my small contact with senior medical students who have chosen to elect a period of training in the student health service has been the importance of the patient as an individual, as a human being, with feelings which, although they may be totally masked by a rough and uncultured exterior appearance, may be just as present and just as acute and just as easily wounded as those of the medical student himself and uh, I've tried to instill, along with these humanitarian aspects of doctor-patient contacts, the pragmatic matter which seems to shock most medical students--(laughs)--the pragmatic matter that patients who are treated with compassion and with empathy perceive this and they love the physician who expresses this to them. They tend to love the physician to the standpoint that uh, they will say, "Well, somebody else may be better, but he's the doctor I want to go to." SMOOT: Um-hm. SPRAGUE: And this of course, uh, in addition to furthering the higher ideals, puts dollars in the pocket-- SMOOT: Yes (laughs). SPRAGUE: --of the physician who recognizes and practices these concepts. SMOOT: Hmm. You mentioned that you were president of the Fayette County Medical Society when support was forthcoming from that society for the development of the Medical Center. Is that correct? SPRAGUE: Correct. SMOOT: Was there opposition to the development of the Medical Center here, within the Fayette County Medical Society? SPRAGUE: Yes, I-- I think we've-- SMOOT: Touched on that. SPRAGE: --discussed this before, yes. SMOOT: Yes. SPRAGUE: Um, there was uh, the same degree of-- of doubt as to the wisdom of such a development-- SMOOT: Um-hm. SPRAGUE: --uh, as there was in the profession at large in-- and of course the-- the medical society uh, constituted the profession-- SMOOT: Um-hm. SPRAGUE: -- practicing profession, they-- there were-- there were very little-- very few people practicing in Lexington who were not members of the society. SMOOT: Um-hm, but there-- really did not entail any serious, uh, threat to the development of the Medical Center from this opposition? SPRAGUE: No. SMOOT: Okay. SPRAGUE: Oh, once Governor Happy decided it (laughs), there was no further doubt as to whether it would be done. SMOOT: I'm not sure if we-- if I asked you about the um, Kentucky Medical Association -- the state association -- uh, opposition or support coming from that particular group in the years leading up to the development of the Medical Center. SPRAGUE: I believe that the Jefferson County Medical Society, uh, the Louisville contingent, um, expressed some doubts and someum-- some disapproval on the same bases as the people in Fayette County did. Namely that uh, they said we have a good medical school here, why dilute or deplete the state's resources by having another medical school? SMOOT: Um-hm. Had you seen the Anderson-Manlove report from the-- the Anderson-Manlove report from the gentleman from the AMA [American Medical Association] that came down, uh, to study the situation in medicine-- medical practice in Kentucky? Uh, it had been presented to the Kentucky Medical Association. Had you been aware of that report? SPRAGUE: This was back about 1950, roughly? SMOOT: Roughly, I think a little bit later than that, it-- before '55. SPRAGUE: Yes. SMOOT: You had seen that report? SPRAGUE: Yes. SMOOT: (coughs) I had heard that that report had been--covered up is not a good word -- it had been suppressed somewhat by the state association because it was actually favorable to the development of a Medical Center at the University of Kentucky. Had you heard something to that effect? SPRAGUE: No, I'm not aware of that. SMOOT: Okay. So as far as your own knowledge is concerned on this particular subject, the report was open and everybody really was pretty much aware of what was going on and what the opinion of the AMA was, at least in this report, towards the development of the Medical Center. SPRAGUE: That's correct. SMOOT: Okay. Let me spring from the state association, I think that probably covered that sufficiently, and ask you about, um, federal and state government programs to assist the Medical Center at the University of Kentucky. What can you tell me about state programs, uh? SPRAGUE: My memory of these subjects is very, very sketchy. SMOOT: Um-hm. SPRAGUE: In fact, (laughs) I'm afraid I can't be helpful to you with specifics at all. SMOOT: All right. That would include Federal programs as well, something we can move from then. Um, how about medical politics? Going back to something similar to the KMA [Kentucky Medical Association] and we-- lobbying efforts, did you ever participate in any of the lobbying efforts for the Medical Center, uh, in Frankfort? Did you ever have to-- SPRAGUE: No. SMOOT: --never called upon to (laughs) do that? SPRAGUE: No, this was very adequately handled by the cadre. SMOOT: Okay. Who was the chief uh, spokesman in Frankfort for the Medical Center? SPRAGUE: Dr. Willard and Dr. Bost. SMOOT: Um-hm. Apparently did a-- in your opinion, a very sufficient job there. SPRAGUE: Fantastic. SMOOT: (laughs) What is your opinion of the efforts -- and it wasn't just in Kentucky, it was all over the United States -- but the efforts have been made for many years to bring low cost medical care to the mass public and-- through such things-- Medicare, Medicaid, um, you see HMO's [Health Maintenance Organizations] coming out and all these types of things, indigent care, concerns. You think that the Medical Center has attempted to bring low cost medical care to the public in Kentucky, uh, that they have tried to fulfill a mission of--of taking care of indigents, so forth? SPRAGUE: Yes indeed. Uh, this has been a--an inseparable part of the mission of the Medical Center, to bring medical care to those who need it. SMOOT: Um-hm. SPRAGUE: Uh, in Eastern Kentucky. SMOOT: In particular Eastern Kentucky. SPRAGUE: In particular, because uh, Western Kentucky has sort of been in the bailiwick of the Louisville school. SMOOT: Um-hm. SPRAGUE: Of course, Western Kentucky too, I mean, it's uh-- I don't mean to imply that uh, primary medical care is denied people who seek it from any part of the state. SMOOT: Um-hm. You think that the job done by then, by the Medical Center here has been sufficient in taking care of that aspect of--of, uh, medical concern, taking care of people in--uh, that would be classified as indigents and so forth. SPRAGUE: If I were to say sufficient that would imply that uh, there is adequate medical care throughout Kentucky-- SMOOT: Yes. SPRAGUE: --which certainly there is not. SMOOT: How might we have adequate medical care throughout Kentucky? SPRAGUE: This is a question simply asked and answered with difficulty. I think, uh, medical care is continuously being improved in part by the development of more and more widely separated facilities such as small hospitals, small medical clinics which are being staffed by better and better trained personnel, by improved means of transportation which is a part of the improved road system, um, the development of helicopter availability in case of need. I think perhaps one of the very most important aspects of the improvement of medical care is the improved education, the greater awareness of the people who live up the hollow that they don't just have to suffer through an illness, they can and should get advice, help, treatment. SMOOT: Hmm. That brings to mind the question I-I may have already asked also, but I'm not quite sure. One of the arguments that was used uh, by the Medical Center--the University of Kentucky Medical Center -- in its developmental stages, was that we needed more physicians from Kentucky for Kentucky. University of Louisville would argue that, I think they did argue in several forms that they were fulfilling that need as best as could be done. They received lots of applicants from Kentucky, but most of them were simply not qualified. They did not have the educational background to enter medical school. Uh, do you think that that situation has-- has changed, that there are now a larger number of Kentucky students that could enter law or -- law -- enter medical school? Uh, has the educational system then, essentially, in Kentucky improved to a sufficient degree to produce more doctors? SPRAGUE: That's an easy answer -- yes. It has improved, uh, of course education can never be sufficient. It never can be so good that more education available to more people wouldn't produce a better outcome, but the record of medical schools -- not only nationwide, but here in Kentucky -- as regards qualified applicants shows that-- that premedical education whether here in the state or elsewhere that it might be available to Kentucky residents if they choose to go elsewhere, um, is vastly improved over what it was. SMOOT: Um-hm. And what accounts for this improvement? Just more money, uh, better people, more education across the board? SPRAGUE: I think that -- more education across the board. SMOOT: What do you think has been the impact of the University of Kentucky Medical Center on the University community over the past twenty-five years or so? SPRAGUE: I think it's been for the good. I think any center of education, of course there are counter arguments to this thesis, but I think any center of education can be said to provide a richer and more productive learning environment than the one room school house -- just to make a ridiculous comparison. I think the propinquity of the main university campus and the Medical Center campus is a good one. Maybe I shouldn't even imply that these are two separate campuses, but I think the availability of the disciplines of each instructional group to each other is all for the good. I think there's hardly anyone around today who would disagree with that. SMOOT: What about the impact on Lexington and Fayette County? SPRAGUE: Well, the commercial impact is undoubted. Education is the biggest going concern of-- of the local community and this can be translated very directly into economics and numbers of dollars spent in Fayette County in Lexington. The impact is great. SMOOT: And positive. SPRAGUE: You don't have to talk to the people down at Civic Center about the flow of dollars engendered by [Bruce] Springsteen concerts (Smoot laughs) and such. This is a small part of it. SMOOT: Well, the impact on the state of Kentucky? SPRAGUE: Great, in a similar fashion. Many, many people, many students come to Kentucky from other states, in part because they're attracted by the educational, the scholastic programs that are available here. SMOOT: Um-hm. SPRAGUE: In part because they know people who have been to Kentucky and who speak highly of it, in part because they like this part of the country, they like the people that live here. SMOOT: So you would say that the impact has gone well beyond the borders of Kentucky. SPRAGUE: Indeed. SMOOT: How would you say the University of Kentucky Medical Center ranks with other Medical Centers nationally? Arbitrary question, I know, but-- SPRAGUE: This-- a meaningful answer to that question really requires more specific information than I have. I really don't know what to say about that. There are a few schools in the country which undoubtedly rate ahead of the University of Kentucky. Again, I-- I don't know the exact ranking of-- on-- according to one or the other criteria. SMOOT: Um-hm. SPRAGUE: Harvard, Johns Hopkins, Northwestern -- these schools -- uh, Duke and others that I haven't mentioned and uh, comprising a long list perhaps are ones that perhaps a person living in Hawaii or Alaska or someplace uh, far away would think of before they'd think of Kentucky unless there was some specific, uh, program offered at Kentucky in which they were particularly interested. That's the best I can do for that answer. SMOOT: How would you assess the general attitude of your colleagues towards the University of Kentucky Medical Center or rather the physician's thought of the Medic-Medical Center here? SPRAGUE: I believe they feel in general, as do I, that this is a good school, that with certain exceptions, uh -- some of which would apply to any medical school -- the students receive teaching of a nature and of a quality uh, which with proper interaction between the curriculum and the student himself can be expected to produce a good physician. SMOOT: Hmm. You've been involved with the community -- Lexington- Fayette County community -- for a long time as well as the University community which u--- like to ask you what other activities you've had within the community. We know you've been president of the Fayette County Medical Society; you've worked very closely with the health services at the University. Uh, what other community activities have you participated in? Civic boards, organizations, fund drives, any other leadership activities which you might wish to identify. SPRAGUE: Oh, I've been on the board of the YMCA, I've been associated with the United Fund drives. Um. (laughs) SMOOT: Do you have any personal anecdotes, aside from the one--- the very good ones you've already told me, uh, about the Medical Center or about personnel at the Medical Center that you would like to relate? SPRAGUE: Shut it off. [Pause in recording.] SPRAGUE: In the course of talking about the external portions of creating the medical school and its interactions with Frankfort, I haven't uh, mentioned one of the original cadre from Syracuse, Dr. Robert Straus, who has been, since its inception, has been chairman of the department of behavioral sciences and who has been, from the very beginning up to the present time, has been closely associated with the development of curriculum-- SMOOT: Um-hm. SPRAGUE: --and also with the increasingly difficult task as the years go by and as more and more applicants come to the Medical Center, to the Medical School, of deciding who will be the best bet-- SMOOT: Um-hm. SPRAGUE: --for producing a good physician, a physician of the nature and of the qualities that the basic, uh, philosophy of the Medical School envisions and is striving toward. Dr. Straus in his efforts along these lines, I believe has been at least as effective and as valuable to the Medical Center as any other one person. The reason I haven't mentioned him before simply is because uh, he hasn't seemed to come into the flow of-- of questioning that we've been going through. SMOOT: That can be rectified easily enough. (laughs) He brought some special, I suppose you would call them some special talents and some special background to a medical school didn't he? Uh, trained as a sociologist, going into medical sociology, um, had worked at Yale, then went to Syracuse, then comes to Kentucky. SPRAGUE: Right. SMOOT: Um, would you say his influence on Dr. Willard was great? Uh, would you say that perhaps it was the other way around? Uh, how would you assess the relationship between the two-- the two gentlemen? SPRAGUE: This is difficult, but the just the thought that-- that flashes in my mind is that it was about two parts from Dr. Willard to Dr. Straus and about one part from Dr. Straus to Dr. Willard. (Smoot laughs) That's-- if I thought about it a little more I might-- I might come up with a different ratio, but that just flashes. Two of Dr. Straus's particular interests over the years have been communication skills, not only as regards verbalization, but as regards, uh, total contact between not necessarily the student or later the physician and the patient, but also between one person and another in the human environment. Another uh, field of his very particular interest and concern which he has written several well received and well recognized, and authoritative books is alcoholism. He uh, perhaps uh, has been one of the first few people in this country in the medical literature who has recognized and emphasized the fact that alcoholism is a disease and it's not something which can be done away with or cured by a slap on the wrist or even by incarceration for a period of months or years. [Pause in recording.] SMOOT: Discussing Dr. Straus and his uh, expertise in the field of alcoholism and uh, goes on into drug abuse too, I think. SPRAGE: Oh yes. Well, not to distinguish between alcohol and drugs. SMOOT: Exactly. SPRAGUE: Alcohol is a drug and this is a point that-- SMOOT: Alcohol is a drug, of course. SPRAGUE: --he has made clear in his writings and teachings. SMOOT: Um-hm. SPRAGUE: Really, they should not be separated in the public consideration. SMOOT: Um-hm. Less so now I think than earlier. Um, I think that there was-- at one time there was uh, a feeling among many people that it--they were separate, for one reason or another, uh, perhaps it was because alcohol use uh, was sanctioned by law--there were laws which permitted its use, and a lot of the drug abuse was perceived as an illegal and in most cases is still an illegal, uh, activity. SPRAGUE: True. SMOOT: But that does not change the-- the nature of the substance, does it? SPRAGUE: No, nor its effects. SMOOT: Are there any other individuals you would like to discuss? Of course we've touched on Dr. Straus, we've-- Howard Bost, uh, Alan Ross, Richardson Noback. I'm leaving out a huge number of individuals of importance, uh-- and of course we've talked about Dr. Willard. SPRAGUE: No. SMOOT: Could you compare Dr. Willard with Dr. [Peter] Bosomworth? SPRAGUE: No, I don't choose to. SMOOT: Hmm. Different sorts of administrations. Are there any other subjects you would like to discuss or that you think we should touch on that I have failed to discuss with you? SPRAGUE: I think you've brought out more facts than I knew were in my memory. I don't think there are any more. SMOOT: Well, if you do think of some more I hope you'll let me know. SPRAGUE: Right. SMOOT: I certainly-- SPRAGUE: Thank you very much. SMOOT: Well, thank you so much, Dr. Sprague. I've enjoyed it and I've learned a great deal from you. [End of interview.] During Dr. Sprague’s (Director of University of Kentucky Student Health Services 1957) second interview, he details the founding cadre assembled by Dr. Willard to head the Medical Center. He also considers the problems they faced and the reasoning and identity of the opponents of the Medical Center. In addition, Sprague compares different educational institutions, both medical and premedical, and the impact of the Medical Center on the community and on health care in Kentucky. insert here