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1985-10-29 Interview with Edmund D. Pellegrino, October 29, 1985 UKMC001:1985OH235 UKMC 010 01:58:29 University of Kentucky Medical Center Oral History Project Louie B. Nunn Center for Oral History, University of Kentucky Libraries University of Kentucky. College of Medicine -- History University of Kentucky. Medical Center -- History Hospital buildings -- Design and construction University of Kentucky -- Presidents Pellegrino, Edmund D., 1920- -- Interviews Community Health Services -- Kentucky Medicine -- Study and teaching (Continuing education) -- Social aspects Social medicine Rural health -- Kentucky Medical Care, Cost of Kentucky. General Assembly Chandler, Happy, 1898-1991 Kentucky. Governor (1959-1963 : Combs) Kentucky. Governor (1967-1971 : Nunn) Dickey, Frank Graves Oswald, John W. (John Wieland), 1917-1995 Willard, William R., 1908- Kentucky -- Politics and government Edmund D. Pellegrino; interviewee Richard C. Smoot; interviewer 1985OH235_UKMC10_Pellegrino 1:|12(10)|24(5)|35(9)|47(4)|60(9)|73(3)|85(3)|97(4)|111(14)|128(13)|142(11)|154(9)|166(13)|186(7)|202(10)|217(12)|234(5)|260(2)|279(2)|293(13)|310(1)|324(15)|344(6)|361(5)|388(5)|400(9)|416(1)|452(4)|462(11)|489(5)|501(3)|515(3)|546(4)|578(8)|597(15)|616(2)|637(4)|670(4)|703(10)|723(12)|738(11)|755(2)|769(7)|793(3)|813(11)|832(2)|845(6)|860(9)|873(9)|894(13)|910(8)|922(1)|939(10)|966(10)|990(8)|1004(2)|1014(11)|1025(1)|1039(2)|1056(2)|1083(3)|1102(8)|1114(8)|1135(6)|1163(5)|1176(13)|1188(9)|1199(5)|1213(6)|1224(7)|1234(14)|1251(6)|1272(3)|1284(8)|1299(1)|1322(9)|1338(9)|1360(8)|1371(9)|1383(12)|1421(3)|1445(10)|1478(6)|1494(6)|1518(3)|1533(5)|1544(3)|1567(5)|1580(13)|1604(2)|1624(1)|1641(3)|1672(11)|1691(10)|1706(8)|1721(4)|1736(6)|1768(7)|1782(1)|1791(9)|1829(5)|1844(7)|1875(10)|1892(7)|1908(8)|1926(12)|1956(2)|1969(10)|1979(11)|1988(5)|2000(2)|2033(5)|2059(10)|2073(5)|2085(9)|2101(8)|2112(5)|2146(8) audiotrans UKMCoh interview SMOOT: Dr. Pellegrino, to begin would you give me a brief autobiographical sketch of yourself, say leading up to your, uh, college days. Uh, tell me a little bit about your family background, uh, the community in which you were raised and so forth. PELLEGRINO: Well, I'm, uh, was born in New Jersey, but spent all of my early years in Brooklyn. I am, um, the son of, uh, two parents born in this country, but of Italian extraction, grandparents came to this country about a hundred years ago--little over a hundred years ago. Uh, I'm the first member of my family to have graduated high school, college, medical school or anything else. Uh, I have three brothers all of them are professionals. My father was a very hard working, very intelligent man, uh, who had only a sixth grade education and very poor, but, uh, instilled in us of course the work ethic very, very strongly and the education ethic and, uh, so I feel I owe him and my mother a tremendous amount for getting us on the right pathway. I went to, uh, public high sch-, public grammar school and then to a Jesuit high school, uh, which, if you know anything about Jesuit education in those days a very rigorous, very difficult, but demanding kind of education for which I am eternally grateful and an education in the classics, so that I come at things still very much as a classicist does--Latin and Greek and foreign languages and mathematics. So I then went to a Catholic college--Saint John's University--where I majored in chemistry and philosophy and, uh, graduated summa cum laude from that school. Then went to New York University's Medical School and, uh, from there developed my interest in an academic career in medicine. Now, that flowed also out of my strong training in chemistry and I really, right from the beginning, wanted to be an academician, uh, but also to do clinical medicine. So I finished my training in medical school. I of course served in the Air Force. I was chief of the, uh, medical service at the Air Force Regional Hospital in Montgomery, Alabama, had my first taste of the South there--the deep South--uh, and also there, became, uh, aware of something that I think was very important in my Kentucky experience--uh, of rural medicine and the needs and requirements of people in rural areas, which was certainly something new for a boy from Brooklyn. Uh, enjoyed my experiences in the Air Force since I did medicine all the time in a very good quality institution. When I returned, I completed my residencies at Bellevue Hospital and at the Goldwater Memorial Hospital at Columbia University, New York University, and then I started a research fellowship in kidney physiology and kidney diseases. Uh, in the midst of that, suddenly without warning I developed tuberculosis. Uh, I'd been working very hard, I was exposed to tuberculosis very heavily in my clinical work and so I spent three years, uh, hospitalized curing that. It was in the middle of that, uh, experience--or toward the end of it--that, uh, as I beginning to look to get back to a job, uh, that my friends at New York University who happily thought highly of my qualifications and so on, suggested me as the director of the medical service in a new, rural community hospital and so my interest in rural medicine, which had developed in Alabama, uh, became suddenly something confronting me very directly and so I went out to this experimental community hospital in New Jersey as the first chairman of the Department of Medicine at the age of thirty-two, uh, and, as is characteristic of me, I was not qualified for the job, but I, every job I've taken I've been unqualified for--(Smoot laughs)--and it's never worried me and that goes back to my high school, having a liberal education. Uh, you know, if you have it properly you can tackle any problem-- have confidence in--so I went out there and had I think extraordinary productive experience. Within a year I became the director of the hospital as well as the chief of the medical service and we developed, without going into detail, what I think it's fair to say was the outstanding community rural hospital in the United States and really in the world, which had its aim, its--and this is in, significant for Kentucky that's why I'm giving you a little detail--which had as its aim the, uh, provision of high quality, university type medical care for a rural community. So as a consequence of that, we really had an experiment in community medicine that combined teaching, which was my love and therefore wasn't inconsistent with my going there, and so I was teaching medical students from five medical schools that came out there. I established my laboratory and got back to my laboratory research. I directed the hospital and I directed the medical service, uh, and just had a wonderful time, but was also introduced to community medicine. Well, that becomes important because my entry into, uh, Kentucky was a little bit different from the others. Here I was out in a community hospital and, uh, how the devil did Bill Willard get wind of me? Well, it was through the Commonwealth Fund, which, uh, had funded our hospital as an interesting and unusual program--experimental program--much has been written about that hospital. Uh, and at time, after I'd been there seven years and pretty much gotten things organized, done a lot of interesting experimental things in health care delivery as well as in teaching and so on, uh, Lester Evans who was in the Commonwealth Fund, uh, was talking to Bill Willard and said, "Well, you ought to go out and see this guy, uh, Pellegrino, out there in New Jersey," and Bill had not heard I think of, uh, me obviously before, came out to visit with me and shared his vision of Kentucky and, uh, it was something that I think would not have appealed to most standard academic types. Uh, even though I was out there I was still a very heavily academically oriented physician because I was teaching at Bellevue Hospital once a week, going in the seventy miles to New York and spending the whole day teaching, in the laboratory and so on and, uh, keeping my contacts in the academic world. Uh, so Bill shared his vision. He was very impressed what we were doing and what attracted me to Kentucky was, uh, a second experience, at a very young age, to start with a clean canvas. I had done that at Hunterdon--it was my show. I mean the Department of Medicine was, uh, and I had sketched in my own idea and here was a second opportunity and Bill was the kind of man I felt would give me the opportunity to express myself. I'm a very strongly opinionated person. I know what I want to do, you know. Generally what I say to you is, get out of the way. If you want me to do it, tell me what you want done, get out of the way, I'll get it done and Bill was the kind of man I could with, not that he didn't have input obviously, but he knew enough to, when you have a strong person that's good, which was true of the other chairmen, that he would give them their head. So I took the job then with him because we shared a vision and we shared an ideal. Uh, I'd gone to Hunterdon because of the ideal, quite frankly -- the idea of starting this new hospital and so on. Here's a new medical school. So I arrived there shortly after, Howard Bost was there fir-, with, and Bob Straus and Dick Noback and, uh, then I joined them. Uh, Bill had brought his group from Syracuse and I guess I was the first outsider really to that group and, uh, well, I won't go into the details of what I did there, but in any case that's leading up to my going to Kentucky and Lester Evans always likes to say, uh, and I've said this a number of times and some people would find it offensive, but I don't, uh, only Bill Willard would have appointed Ed Pellegrino to the chairmanship of the Department of Medicine--(Smoot laughs)--because at that time it was a very aberrant thing. You see, I had stepped out of the mainstream when I had the tuberculosis and had lost, my colleagues were going ahead and I was three years behind. So I was running from behind and I was running from behind, uh, in a rural institution. I wasn't in the mainstream of New York City, but nonetheless, Bill saw the possibilities and, uh, there we were. I'll stop at this point. SMOOT: Let me share this vision with you of Kentucky. PELLEGRINO: Um-hm. SMOOT: It must have been a, not only a vision of opportunity for a younger man, uh, and in your particular instance a second opportunity for some expansion, some, uh, possibilities that you may not have had otherwise. Uh, what, what was his selling point? How did he present the situation in Kentucky to you that was so convincing? PELLEGRINO: Well, what was convincing to me was first, here was a medical school that was to have an interest in its community and having had that rural community experience and having developed a community hospital, uh, that was very congenial to me. Second point was that I, being a teacher also, the opportunity to develop my own service and develop certain ideas about patient care. Now, Bill mentioned those in a general way, but they were congruent with my own ideas generally, but I also had the detailed way of how you do it. So, how you can improve clinical teaching as a clinical teacher and the care of patients and my philosophy, which is that the best academic clinical teaching occurs in the circumstance in which the best patient care occurs. So I put the emphasis on the patient care first and the teaching second rather than the teaching first and the patient care second, likewise in research and that was something that Bill shared. The third one was the, uh, opportunity to try to integrate the basic and the clinical sciences. Since I had been trained in the basic sciences as well as the clinical sciences and really had been doing renal physiology and chemistry, uh, to me it was natural to put my clinical skills and my scientific knowledge together and to do that for students to help them to see that the basic sciences and the clinical sciences were mutually reinforcing. Uh, the idea of an involvement in continuing medical education, which is something that I had very intensively done in Hunterdon, I established a very, very significant teaching program for the general practitioners. I love to teach practicing doctors, uh, and Bill's interest and the Kentucky interest in that, uh, I think the excitement of a new school within a university setting--very important to me--this wasn't an isolated school it was in a setting of the University of Kentucky and, uh, then the people I met when I went there, including such people as the presidents of the University of Kentucky. At that time they took an interest in this and then I was attracted, quite frankly, uh, to the Kentucky ambiance, uh, to the warmth of the, I'm not being romantic, but the reception and, you know, for a New Yorker having lived a little bit in the South, but I was still leery about how people would accept me. Uh, I didn't find any problem and said, well, I guess that if they're going to give me half a break that's all I need, I can prove myself. So all of those things seemingly came together, uh, and I think the last one I was ready. I had gotten on top of the Hunterdon job and when I get on top of something, uh, that's the time to give it up because I don't like to just sit around and grow tomatoes. I want to look for some new trees to cut. So here's an opportunity for new trees. SMOOT: What were your impressions of the, the leadership? Of course you've already indicated somewhat-- PELLEGRINO: --yes-- SMOOT: --could you give me a little bit more detail on your own impressions of people like, of course Dr. Willard, uh, Bob Straus, Howard Bost, these people that you were coming into see and, uh-- PELLEGRINO: Well, I, as I say, I was impressed with all of them. Uh, we had congruent ideas and again, I was a peculiar, uh, I hope in the best sense of the word, academician because I had broad interests. SMOOT: Um-hm. PELLEGRINO: So when I saw someone like Howard Bost who had come with an economics background and, uh, political science, that seemed to me to be consistent with the ways in which new schools ought to go. Uh, Bob Straus in medical sociology, we worked very closely together and I, some of the things I, all of the things I had done in Hunterdon, you see, were preparation for this, so they just fitted in beautifully. Um, Alan Ross in statistics, uh, and Dick Noback who was a clinician and we shared many, many ideas together on how to teach so, so, uh, I found myself easily moving into that group and, uh, as a matter of fact, in some ways being a person who could put into practice much of what they were talking about and shared their theoretical notions, but also as chairman of the Department of Medicine I think it's fair to say--not because I occupied the role, but wherever it--that's the department that sets the intellectual tone of the university medical school, no question about it and so, since I found my own notions so consistent with theirs I found when I here, we're going to have a good marriage. I'm going to have support of these people in what I want to do. Now, if I had thought they were thinking of something else I wouldn't have taken the job. So here was a group of people I felt I could work with and that turned out certainly to be true. SMOOT: Did you find any unexpected difficulties when you arrived in Kentucky, uh? PELLEGRINO: Honestly, no. Now, you've got to put that in context that what some people might call difficulties, I might see as a challenge, but I mean that sincerely. No, we were, my family immediately took to the place. No problem there. My wife got to love it and, uh, she went with a little trepidation, she, although she had lived in Savannah, Georgia in the earlier part of her life she also had spent her older years in New York City and, you know, Kentucky, where is that--(Smoot laughs)--kind of thing. She loved it. So our family living was just, from our point of view, quite ideal. We loved Lexington. Uh, no, I really would say that, uh, there were no unexpected difficulties. Remember, I had started from scratch before. I went to Hunterdon before there was a hospital; likewise I went to Kentucky before there were any buildings, just tobacco fields, cornfield. Uh, so I, I knew what to expect for they had all of those little vexing problems-- sometimes big problems-- SMOOT: -um-hm-- PELLEGRINO: --but those are not unexpected. So I'd sort of been through the fire but once before on a smaller football field and now on a bigger field it was the same thing, but size was a little bigger. SMOOT: Um-hm. PELLEGRINO: So I didn't find any, at least anticipate any difficulties that were not there. SMOOT: What about the, uh, political situation? Had you been, uh, made aware of what had gone before-- PELLEGRINO: --oh, yes-- SMOOT: --in Kentucky with-- PELLEGRINO: --yes, yes, yes, I was fully aware of that. Uh, one of the challenges I had, and the other clinicians had, was of course to, uh, make contacts with and develop a relationship with the practicing medical community. SMOOT: Hmm. PELLEGRINO: That happened, at least in my case, I think very easily without any problem and so there was a certain amount of wariness, as you'd expect, a certain amount of, uh, resistance to some of the ideas that Bill was putting forward, but again, uh, the political situation for me didn't pose a problem. We had politics in New Jersey too, and I was always amused when they told me, you know, here in Kentucky our politics are really, really, you know, you never have seen anything like that and I'd always say, and you ain't seen nothing like New Jersey either, fellows--(both laugh)--let me tell you, that's pretty rough stuff. So, you know, it was nothing new. SMOOT: Hmm. What was your impression of the, the philosophy of the, um, leadership, Dr. Willard and his, and his administration, in, I, well, should back up and say the application of that philosophy? Did you find that the philosophy that had been, uh, expressed to you--this vision-- as you were going along was being applied in, uh, in such a way-- PELLEGRINO: --well-- SMOOT: --that it'd be effective? PELLEGRINO: --I think you have to understand something about my answer to that. While I came only a year or two after the, you know, the so-called founding group, I was quickly an important part of that group and therefore I became quickly identified and much of what happened, I mean, I was there before the thing started to operate, uh, pretty soon I was pursuing my own ideas and, uh, my own philosophy, which is not incongruent with theirs, don't misunderstand me, but in other words, I was closely identified with that same broad gazed approach. I think there were other chairmen who were not that closely identified. SMOOT: Um-hm. PELLEGRINO: So in many ways, for example, Bill Willard, uh, pretty much, uh, depended on me for the recruitment of the other clinical chiefs and so on. I'd wander the country on that kind of business. So I was soon, very soon doing the selling, so therefore, it would be hard for me to say that I found any problem with the basic philosophy. I think that the, if there, there's one conceptual problem that I think I felt and others might have and this is no criticism of anybody, uh, but since I had come from the strong scientific and clinical background, uh, at times I thought those who were pushing the social sciences and so on were maybe a little less understanding of the fact that in modern medicine you have to have a good scientific base as well. I always held for both being developed simultaneously and with strength, but sometimes I saw the people who were, you know, pushing this dir-, on the other hand, the basic scientists sometimes are pushing against the sociological view, so to speak. My whole life motif, uh, is the balance between these two, which is of course what I did when I went to start my own center at Stony Brook. SMOOT: Hmm. PELLEGRINO: Which is a much bigger operation at the time and a more complex one, that might be, but, uh, so that's the only thing I would say. The other point was that I observed the unreadiness sometimes of the practicing community to understand what Bill was driving at, uh, because it was foreign to their own education, but for me that was not a personal problem. It was something, again, that they had to deal with and work with and my way of dealing with it, of course I had a great advantage in that being a clinician, being respected as a clinician, I could say, okay fellows, I've got all the plastic cards and don't give me that stuff. Let's talk, let's look at what you're saying, let's look at it objectively. Uh, that's a little bit of a New York approach, if you will, but I'm saying put your money where your mouth is. He's saying that this is not consistent with the clinical medicine. I'd say, well, you saw me operate as a clinician; you got a problem with that? Oh, no, no, no, no. Well, okay, it's possible to do both. So I tried to do it that way, in a more positive way, rather than, than picturesquely making it aggressive. It's not that way obviously, but, uh, what I was saying fundamentally was the two don't need to separated--can be put together. Now, other chairmen didn't necessarily agree. I hope, if you'll talk to others you'll find different approaches--surgery particularly. (laughs) SMOOT: As you would in most things, I imagine. PELLEGRINO: Yes, although I highly respected the chairman of surgery, but we were, as I told Bill when he brought him on, I said, Bill, I think this man is going to do a very good job. He and I are going to be very good opponents and I think that's good for the school to have some creative tension SMOOT: Hmm. Hmm. Who did you recruit directly? PELLEGRINO: Well, I'll have to go down the list, but I, Bill involved me in going around and visiting the chairman of surgery, the chairman of obstetrics, the, uh--pediatrics had been already lined up pretty much because that was Bill's own field-- SMOOT: --um-hm-- PELLEGRINO: -- um, neurology, uh, uh, anesthesia came in later, but it came in more through surgery than, but the, the big ones I was involved in the crucial surgical, uh, and then the basic sciences as well--pharmacology and so on. Uh, Bob Straus and I worked very closely together on these kinds of things. In some ways, Bob was kind of, unofficially, dean for basic science and I was unofficially on the clinical side, but I never wanted such a title and, uh, wanted to be what I was chairman of medicine, which is the most important, single influential position. I repeat that again in medical school. SMOOT: Hmm. PELLEGRINO: So I think you, that's a crucial situation and, uh, I enjoyed doing that without portfolio of any, you know, specific Bill had occasionally talked about, as he did, reorganizing and I think they always dissuaded him from that. SMOOT: Did you participate at all with the development of the physical plant? PELLEGRINO: Yes, yes. SMOOT: I have talked with some who have indicated that there was more involved than just, of course the money aspect, and naturally you have to have-- PELLEGRINO: --yes-- SMOOT: --the capital, but also, uh, this physical plant was intended to reflect the philosophy-- PELLEGRINO: --that's correct, that is correct-- SMOOT: --of the original team. PELLEGRINO: That is correct. SMOOT: Could you tell me a little bit about? PELLEGRINO: Yes, I can tell you very, very clearly. Uh, if you take a look at the way thing's structured, it's different now, so, but the idea was to, let's take the clinical departments--they either have clinical department and basic science department on the same floor, the ones that were more closely associated with it, so that my Department of Medicine was opposite the Department of Biochemistry which was a natural, given my interest in the kinds of people I was recruiting to do basic work and so we had a close relationship with chemistry and physiology. Not that we ignored the others, but those were the ones that, and that's, so on one side your, your clinical department articulated with the basic science physically. That's very important that you see them every day. I would see the Chairman of Biochemistry every day. We'd talk in the hall, we'd meet each other. On the other side, we went around the corner and we had contact with the outpatient department. So that from my office I could go to basic science, I could go and see my patients. The next step connected physically was the hospital and then was the long-term care or progressive care unit. That became a number of other things later, but on one floor, all of the multitudinous activity, in which I and my faculty were involved were close at hand and we had the physical articulation of people that would express in a concrete way the intellectual and conceptual articulations we were hoping to get. I did this on a much grander scale later in Stony Book, also. That building was designed that way. SMOOT: Hmm. PELLEGRINO: But that's not different from what I had in Hunterdon. They have the same situation. Now, I'm not responsible, I don't mean to take credit for, uh, the design of the Kentucky hospital, not at all, but that was the idea behind it and I had, I participated in that planning. SMOOT: Um-hm. PELLEGRINO: I think the man who has the, should get the greatest credit for that is Dick Noback and, uh, Dick, uh, was well advanced in those plans when I came. I think I added to it and helped and so on, but, uh, so did Bill and others, but Dick Noback I think did the most--the talent. SMOOT: Um-hm. Was it the best possible reflection of the philosophy that you? PELLEGRINO: In my view, yes, yes. SMOOT: Um-hm. PELLEGRINO: Within a single building. SMOOT: Um-hm. PELLEGRINO: That you could bring about. SMOOT: How else could you, or what else could you, identify as reflecting the philosophy of the-- PELLEGRINO: --you mean in the physical plant-- SMOOT: --physical plant, yes-- PELLEGRINO: Well, other aspects of it, for example, uh, the idea that all patients should be treated equally--something very important to me. SMOOT: Um-hm. PELLEGRINO: Still very important, that paying and non-paying patients could be handled in the same settings, uh, so that for example, the outpatient department, in which I had a great interest, so did Dick Noback, uh, was by appointment only, there were no long rows of benches such as I was familiar with at Bellevue Hospital. So you could be a poor mountaineer or you could be a horse farm owner and we'd see you in the same setting and the physical plant was so designed that you would have privacy, in any case, and I would see you in that office, by appointment and you'd never know that the person that preceded you or that you followed was a poor man who wasn't paying anything. I come from the days of equality and equity in access to health care. I don't belong to the Adam Smith generation or to the Reagan, uh, view of health care. I think it's too vital a thing to be left to the market. SMOOT: Um-hm. PELLEGRINO: So that was very much, uh, an attraction to me, and it was expressed in the building. And we didn't have a private service. As an example, uh, shortly after we opened Governor Chandler was a patient of mine. All right he was on the, he had a private room--fair enough-- SMOOT: --um-hm-- PELLEGRINO: --but he was out walking the wards and well, you know Happy, he would be happy anyway talking to those people--(both laugh)--but I had every, virtually every governor who was alive at the time as a patient at one time or another and I saw them in that outpatient department. SMOOT: Hmm. Since you brought up Governor Chandler, did you have a chance to talk with him, uh, during the stages when you were-- PELLEGRINO: The recruitment phase? No. SMOOT: Yeah. Okay. PELLEGRINO: No, no, my meeting with Governor Chandler was humorous. As a Kentuckian you'll, you'll get a kick out of this. You'll think less of me of course, but--(Smoot laughs)--I, he, it was when he was a patient and, uh, I was in his room and we were chatting and in walked this short, beefy, little guy with a red face and, uh, Chandler said to me, "Well, you know the baron, don't you" and I said, "No, I'm sorry, I don't know who the baron," and he said, "What!" like this, as Happy Chandler liked to do--(Smoot laughs)--"You don't know the baron, coach of our basketball team." He said, "What kind of a doctor are you?" I said, "Well, I think I'm a pretty good one. I told you what was wrong with you, didn't I?" He says, "Yeah, you're damn good," but, he says, "You don't know the baron Rupp?" and I said, "No, I don't." (both laugh) That was my first meeting, uh, but no, I had not met him, but I must say, uh, uh, but, I tell you a little, funny story about Happy Chandler, this has got no place I guess in our history (??) but, uh, he was sent in by his doctor with a peculiar pain and so on and happily for me, since it was rather left in the open I was able to make the diagnosis quickly and I said, uh, "Well, Governor, I think you've got a kidney stone and I think it's the likelihood, you know, I can't be exactly sure, but I think you've going to pass it within the next couple of hours, so we're not going to have to do anything else and I'm going to give you this big bottle of, with cheesecloth over it and want you to urinate in it, when that stone comes through." He said, "How will I know?" I said, "Governor, you will know." (both laugh) So he said, "Okay." I went back to my office. You see, we had that closeness of the office, so about two hours later, almost on the dot, I get this call from the nurse, come over, the governor wants to see you. I said, "Oh, my god, what happened?" I went over there and the governor's in the hallway saying, "Where's my doctor? That's the best damn doctor I ever saw in my life. (Smoot laughs) He said it would be gone in two hours and there it is--hurt like hell--but there it is." He showed me that stone and going all over the ward showing his stone to everybody. (both laugh) Oh, gosh, so anyway that was the contact with, with him and I saw him of course quite a few times after that. SMOOT: Hmm. PELLEGRINO: Always enjoyed being with him. SMOOT: Did you have to work very much with, the, with the funding aspect of the Medical Center? PELLEGRINO: No, I didn't work directly. I think Howard Bost and, uh, Bill Willard did most of that. SMOOT: Um-hm. PELLEGRINO: What I had to do in that I think was rather incidental in preparing, uh, information, materials, so on, arguments some time. SMOOT: Um-hm. PELLEGRINO: By arguments I mean justifications for the things we were doing. SMOOT: Um-hm. PELLEGRINO: But, uh, I didn't have to deal with that. They went through the university -- Frank Peterson and he was at the time and Frank Dickey and so on. SMOOT: Um-hm. What about outside funding? PELLEGRINO: Well, yes, a lot to do with that of course for my own department. SMOOT: Um-hm. PELLEGRINO: You see, each of us had the responsibility of raising research funds, so I had to do that. SMOOT: Um-hm. Uh, any contact with the Kentucky Medical Foundation? PELLEGRINO: Some contacts, yes, through the people who were, uh, you know, prominent in it. SMOOT: Um-hm. PELLEGRINO: Uh, more on a personal basis and, uh, again whenever they wanted me to assist in something, uh, I was reasonably good at public speaking, so if they wanted, uh, a show put on or something I would do it for them. SMOOT: Um-hm. Did you find that a worthwhile, uh, organization, uh, helpful? Uh, I think there's mixed opinions on-- PELLEGRINO: --yes, it-- SMOOT: --how helpful-- PELLEGRINO: --I realize that. Well, looked at it from my point of view, uh, I found it in general helpful and, uh, because remember I came in as a stranger to Kentucky and here were people who were, had some pretty solid roots in the community and, uh, they were very helpful to me in making certain kinds of contacts, uh, and so I didn't, I think maybe if I were the dean I might have had a different relationship to them or something else, but-- SMOOT: -- um-hm-- PELLEGRINO: -- uh, the other thing I think is I had an advantage over all of those other people who came in earlier, uh, because I was a clinician, you see. SMOOT: Um-hm. PELLEGRINO: In talking with docs and there were a lot of them on the KMF. Uh, I spoke the language and while Bill Willard was an MD, he was not involved in clinical medicine and doctors are funny creatures. If you lose your plastic card, no matter what your degree is, they don't really regard you as one of them, but I was one of them. So, and I was, I did something I think was smart that I learned in New Jersey. The minute I hit the ground I started getting involved in continuing medical education and I also the minute I hit the ground I went out to Eastern Kentucky and started doing cardiac clinics. So I'd go out there and spend two days and the docs would bring in the tough cases and I'd see twenty or thirty patients a day, tell them what I thought- -do a consultation free of charge. So I got to know those people and I got to know, and that got back to the KMF ----------?? So that it, it, for me they were a facilitating organization. I realize they had some of their own ideas and that, but, uh, they didn't impinge on what I was doing. SMOOT: Um-hm. PELLEGRINO: That doesn't mean there weren't problems, but I didn't feel them in what I was doing. SMOOT: Um-hm. What specifically were you doing in continuing education and in Eastern Kentucky aside from the one clinic that you didn't charge for? PELLEGRINO: Well, I used to do those clinics about every, uh, month or two -- SMOOT: --um-hm-- PELLEGRINO: --Kentucky Heart Association. Secondly, since we didn't have a school hospital, uh, I would go to the hospitals and teach in their own hospitals from their own cases. So I'd go out to McDowell and I'd go out to wherever they'd invite me, uh, and gradually I began, began inviting in the Lexington hospitals. SMOOT: Um-hm. PELLEGRINO: You don't push, you just wait, do a good job and, uh, you know they come to you. So that's the way I, I have a tendency to function. I participated any time they invited me to Kentucky State Medical Society or in a county society. I'd give talks there. I became he-, quickly involved in one of the clubs, one of the doctors' clubs, they were nice enough to elect me and, uh, so I began to participate there and I'd give papers and so on, on my work. Uh, uh, I established myself fairly early at the VA going out and doing consultations when it was out in the old spot. SMOOT: Um-hm. PELLEGRINO: Uh, went out to the Public Health Service Hospital. Um, travelled all over the darn state. Whenever anybody wanted a program I'd go and do it. SMOOT: Did you find yourself going more towards Eastern Kentucky rather than Western Kentucky or? PELLEGRINO: Yes, although we, we lapped over into Western Kentucky too, but pretty much that was the territory of Louisville. SMOOT: Um-hm. PELLEGRINO: But, uh, no, I've been out to Hopkinsville and I've been out to Paducah. I've been out to, uh, Owensboro. SMOOT: Um-hm. PELLEGRINO: Uh, I can remember distinctly visits there and teaching visits. SMOOT: Um-hm. PELLEGRINO: Little hospitals. SMOOT: Hmm. PELLEGRINO: Big hospitals, Saint Anthony's in Louisville, Norton Infirmary, spoke there, University of Louisville. Um, I was all over that state. SMOOT: Did you find the situation in Eastern Kentucky, uh the, in the least, uh, good condition? It was, it was a poor, much poorer area generally speaking, uh, socially and well as economically. Uh, did you see these problems often and-- PELLEGRINO: Oh, yes, of course, of course. You can't go out there and not be impressed with the-- SMOOT: --um-hm-- PELLEGRINO: --uh, economic and socio-cultural-- SMOOT: --um-hm-- PELLEGRINO: --issues and problems-- SMOOT: --um-hm-- PELLEGRINO: --which I found interesting for my own education. SMOOT: Um-hm. PELLEGRINO: Very important in my teaching and in my evaluation of patients who came from there, because after all that was a different culture and I actually learned about that culture-- SMOOT: --um-hm-- PELLEGRINO: --and how they responded to illness and disease and so on and that was very, very important to me and, uh, then also of course was. I found an important reason for again being in Kentucky and kind of how do we get things out there. SMOOT: Um-hm. PELLEGRINO: To those people. And, uh, one venture I was involved, in which, uh, was very specific in getting out there was establishment of a hospital in Morehead, Saint Claire's, which in its beginnings, I don't know about now, was patterned after Hunterdon, so I had a very important role in helping that board of trustees and staff and everybody else build a Hunterdon in Kentucky. SMOOT: Hmm. PELLEGRINO: Hunterdon was the place I was at in New Jersey. SMOOT: Oh yes. Um, how do you think the Medical Center administration worked with the university administration--Dr. Dickey to begin with? PELLEGRINO: Well, again I observed that only pretty much at a distance. SMOOT: Hmm. PELLEGRINO: Um, part of my, uh, approach to things is stay out of the political if I can. I'm not going to get involved in it by virtue of my position later as the president of the university and the vice- president and the chancellor and so on, but as chairman, uh, I stayed out of that. I presume, I saw some of the signs of what is pretty classical and not anything new, uh, in every place I've been--certain amount of stress between the university administration and the medical center. That's not new. Uh, there was some issues that you as a humanist would recognize. Uh, for example, to hire the chairman of surgery and to hire me, to hire Bill Willard, uh, they had to raise the salary of the president and the governor. Uh, it was, at the time I came to Kentucky there was a twelve thousand dollar limit on the university salaries. Well, I wasn't about to go to Kentucky for twelve thousand dollars. (Smoot laughs) I couldn't. Uh, I wasn't making a heck of a lot more, but I couldn't go for that. So, uh, that had to be changed. That created animosity in the university. SMOOT: Um-hm. PELLEGRINO: Secondly, as you know, the Medical Center salaries are very much higher than those in university. That creates stress. Third, university people, many of them, look down on medical people as being you know, sort of rude and untutored, uneducated technicians. Well, I could match my classical education against anybody in university, so I wasn't taking any backseat on that--(Smoot laughs)--but that created some stresses. On the other hand, not from me personally, I ended up being chairman of the university senate, which was quite unusual for a medical person, that subsequently had happened, but that was a, that was quite a thing for them to do, you know. Here was this doc and you make him chairman of the UK senate. You know, some of those old birds had been there a long time, everyone had thought, but it went very smoothly and as a matter of fact, uh, that was one of the positions I really enjoyed and I think one of my contributions to Kentucky was to build those bridges between the university and the Medical Center, on an intellectual basis and on an administrative basis--much more important to do it on the basis of intellectual interest. [Pause in recording.] PELLEGRINO: In fact, I would credit the, uh, that experience as chairman of university senate and, uh, the way at least, uh, Jack Oswald got me involved in general university affairs-- SMOOT: --um-hm-- PELLEGRINO: --as, uh, basically the preparation for my own becoming a university president later on. SMOOT: Um-hm. Who were the, uh, people that you found most helpful on the other side of campus, uh, arts and sciences and other departments on campus-- PELLEGRINO: --yeah-- SMOOT: -- with the Medical Center? PELLEGRINO: Well, I think the, I always found Frank Dickey a good guy to work with, uh, very sensible, moderating influence on, on those tensions. SMOOT: Um-hm. PELLEGRINO: Least so far as I could see. Um, when Jack Oswald came of course it was a very close relationship with Jack. Uh, he was my patient--(laughs)--uh, but not because of that. I mean we respected each other and went from, and we had somewhat the same kind of go-go personality. Let's get it done, you know. No long chit-chat--this we're going to do, what's the next step, tomorrow we'll do it, let's go. Uh, I think that, I didn't find, I just felt, that they may have seen it differently, but I felt, uh, that everybody I ever approached was helpful in anything that I wanted to get done-- SMOOT: --um-hm-- PELLEGRINO: --on that campus. I don't think that's romantic glow. Uh, one of the more prickly individuals for some people in the Medical Center was Morris Scherago for example, but I always got along well with Morris. We worked together on a number of things and he tried to, I tried to cement the relationship between microbiology and his department-- SMOOT: --um-hm-- PELLEGRINO: --and that was a stressful thing probably ----------(??). Uh, chairman of chemistry and I got along very well. Um, the, uh, I had interest in the humanities and so Carl Cone and people of that kind were people that, and I think that's why they elected me chairman of the senate-- SMOOT: --hmm-- PELLEGRINO: --because they felt I could see some, you know, some things that they were interested in. You may or may not be aware that they also wanted me to become president of UK, so, when, uh, before Jack Oswald came, but I couldn't leave because I'd just taken the job at Stony Brook, to undertake a new center. If it had come before that I certainly would have taken it. I felt very close to Kentucky. Uh, so I, I didn't see any obstructions, what I saw were the tensions that we-- SMOOT: --hmm-- PELLEGRINO: --talked about. Salary, sort of anti-doctor feeling, but I've felt that everywhere, uh, and I'm not paranoid, it's just, it's there because the doctors have deserved a fair amount of it. Let's be frank about that. Uh, the law school, Paul Overest was, uh, a staunch ally. Uh, the, uh, let's see, the things we wanted to do that I was interested in were cooperative arrangements, so that I would bring over people from various departments in university, uh, to the medical school on my rounds for example, anthropology, religion, philosophy or whatever it happened to be it's, I, I never found them to be, uh, not cooperative or obstructive. Not in my view anyway. They, as I say, they may have seen me differently, but I didn't see them as enemies. SMOOT: Well, undoubtedly your, your background, your classical background was, was-- PELLEGRINO: --I think it was very influential-- SMOOT: --helpful? PELLEGRINO: Yes, and the fact that I read very, very extensively and, um, I'll never forget, oh, yes, I'll tell you a little story about, a little story that I think illustrates, Thompson, Thompson was the head of the library, you don't remember him, but, well he was sort of a, I guess, uh, punctilious a bit kind of chap and one day he called me on the phone and he said, uh, "See here" to start with, and he said, uh, "What do you mean being a member of the Medieval Academy of America?" I said, "Well, is it a crime?" He said, "No, but beside me you're the only person on this campus that's a member of the Medieval Academy of America." I said, "Yes." He said, "What, what business you got in that." (Smoot laughs) And I said, "Well, I just happen to be interested in the Middle Ages" and so on. (both laugh) Well, he was so astounded, he wa-, he was not being insulted, but he didn't, he wasn't, shall I say he didn't have a touch of diplomacy, but, uh, when we got to talking about it he was rather pleased that there was another member and that was over in the medical school. So, uh, after that he sent me a couple of books to review in Latin and so on and so, uh, but I think that helped a lot because I could talk philosophy and I could talk some of these things and, uh, I think I had a sincere and honest respect for the humanities. I was more attuned to that than to the social sciences. I, I mean of the things I, I respect social sciences, but for me the humanities are the true intellectual heart of the university. I used say all the time and that would get them--the heart of the university is in the College of Arts and Sciences, not over in the medical school--got to remember that. And I would--(both laugh)-- and I wasn't saying that to win votes. I believe it. And you know, Carl Cone would respond to that and talk and I didn't do that to get their votes. I would say, but I really believed it, I still believe it and I still say it. SMOOT: Hmm. PELLEGRINO: Now, I'm a professor of philosophy as well as medicine, I got to say it. (both laugh) SMOOT: You talked about Jack Oswald briefly. PELLEGRINO: Yes. SMOOT: Did that relationship begin, uh, very early, uh? PELLEGRINO: Yes, yes, because Jack was very interested in medicine. He had come from California. He had come from the University of California at San Francisco, which was then beginning to reach, move to what it is now one of the top five medical schools in the country, in the world. And, uh, Jack had had a fair amount of troubles with the medical people, but also a lot of understanding. In other words, he was much more knowledgeable than Frank was about that because Frank had no previous experience. SMOOT: Um-hm. PELLEGRINO: Uh, but, uh, so when, when Jack came over he immediately came over to the medical school and met all of us and, uh, I think we struck it off very quickly because, you know, around the table, we went around talking about it and I, and I guess he spotted me as someone who had something of his style, which I know created trouble later, I'm fully aware of that. But nonetheless, uh, I guess he said, here's a guy after my own heart this guy goes after things and he doesn't take a lot of time talking about it. So, uh, then he became a patient and I got to know him personally--he and Rose both were patients and, uh, I got to admire them as people and to like them and then Jack would turn to me very often for advice and so that--having to do with medicine obviously and then when I became chairman of the senate having to do with the whole university. Uh, so we, we struck it off very, very quickly and, uh, I always liked Jack. I think he was good for Kentucky. I think Jack lacked diplomacy and tact and you know Kentucky better than I do, but I think I know a little bit about it and while I tell you about my aggressiveness that I never made that obvious. I was always very gentle in my approach. Uh, I think Jack sometimes was a little too brash and he rubbed people the wrong way for that reason. He's got a, he had a heart of gold. He really meant well and he wanted to do the right thing, but having decided something was right he would pursue it--(laughs)--and sometimes not realize that you gotta by take things by indirection rather than by the frontal attack on the castle. SMOOT: Damn the torpedoes, huh? PELLEGRINO: Yeah, yeah, and while we were alike in one sense, we were not alike in that and sometimes I would feel like that when he would say something. You know, standing in line and say something critical about somebody three feet down the line, dear god. (both laugh) But an honest man and, uh, I think that at least the time I was there, Jack did really pull Kentucky up into a higher level of, uh, academic prominence around the country. Some would deny that I'm sure, but that's my estimate-- SMOOT: --hmm-- PELLEGRINO: --of what Jack did. I think off the, well, I can't be off the record so I'd better not say anything. Uh, Jack, I think, did a good job. SMOOT: Um-hm. PELLEGRINO: This was not going to be a negative about Frank. I think Frank was a good man, too. I, I like both of them. SMOOT: They had very different styles though, didn't they not? PELLEGRINO: Very different styles, yes. And of course Frank's predecessor also was a different man, I knew him a little bit. Oh, I was very fond of Frank and got to work with him later in his other capacities and, uh, respected him, but they're two different kinds of people. SMOOT: Hmm. PELLEGRINO: Uh, Jack, I think, is what they needed at that time and I wish they had continued the thrust of what Jack was trying to do with, uh, somewhat, uh, different tactics than Jack might have used. SMOOT: Um-hm. PELLEGRINO: And that's why I, I would have been, uh, you know, very interested to, to try to, uh, do that job. SMOOT: Um-hm. I understand that on one level at least, uh, Dr. Oswald's style interfered somewhat with the style that the Medical Center had employed to further their interest for. PELLEGRINO: Oh, yes, yes, well, yeah, the tensions between Jack and, and Bill Willard, I think, are, will be, people will tell you about that. SMOOT: Um-hm. PELLEGRINO: And, uh, there, I think it was a, very sharp difference of personalities. SMOOT: Um-hm. PELLEGRINO: The chemistry just was a, not the right chemistry, uh, and it's not a criticism of either of them because of what I've said already, it's obvious to you I admire both men-- SMOOT: --yes-- PELLEGRINO: --very much and feel I owe a great deal to them. So I couldn't say who was right or wrong, you know, but I think the chemistry was just not right, uh, and I think that, uh, stresses then, with the chemistry not being right, then you have the inbuilt stresses, uh, of a Medical Center and I think maybe a few words about that are important because I went on then to do a similar job to Bill's and then I did it there and, uh, I did it at Yale and, uh, I did it at Tennessee as chancellor. Uh, it's a more complex job to run a medical center than to run a university. Having had both jobs I can tell you that with confidence. SMOOT: Um-hm. PELLEGRINO: Uh, and a university president vis-a-vis his medical center has a limited number of choices because it's so complex and there's so many things riding in it and a lot of dollars in it as you know and today even more so and the medical staff is a feisty bunch and, uh, they also can be damned annoying with their, uh, Jehovah complexes and so they're always a challenge and I think he has a couple of choices. A, he can ignore it and hope it'll go away, which it won't. Some presidents do that. B, he can appoint someone like Bill Willard, whoever, in whom he has confidence and say, now, look Bill, I want you to run that damn thing. I want you to keep me posted on what's going on. I don't want to be caught off base, but you're my buffer. I'm not going to waste a lot of time with those people. I'll make decis-, I mean that's a strong president's approach to it or you can have a strong and foolish president who's going to try to get on top of the medical center and get his finger in the works. It, he will get ground up, no question about it. So it won't go away and he can't get on top of it, so the best thing to do is have a person with the understanding that if it doesn't work he's, you're going to get rid of him, but not try to do it yourself. Now, I don't know anything about, and that is very honest, uh, about how Jack and Bill got into whatever their difficulties were because it was after I left. See, I left in '66. It's my feeling that if I were Bill Willard's physician I would have said to him, as a friend and physician, it's time for you to move out of this job. You have created this Center, you have created something extraordinary that I think will go down in the history of medical education as one of the two or three experiments--for that period of time--uh, that pointed the way, as I'm sure Hunterdon will go down, and now you ought to be looking for new fields to conquer. Now, that's a Pellegrino interpretation. That's my personality, which is come, do your job, cut the trees, get it set and then don't tarry. You loose up, you use up your chips and, uh, everyone doesn't agree with that. But I think Bill got a little tired and, uh, it was a tremendous job getting that off the ground and here was a feisty, energetic president Jack Oswald, uh, with a different kind of man running the Medical Center who didn't respond like that. That was not Bill's way. He would have considered that the wrong way to go. Let me stop and think about it. SMOOT: Hmm. PELLEGRINO: But I guess Jack and I have the philosophy, there's no straight-line relationship between the time it takes to make a decision and the quality of the decision. There's no relationship. Well, Bill would not. Bill would like to, and really he, I worked well with him, we didn't have a problem because I knew that was his way and I said, okay, I'd already made the decision or would, by the time we got to it I was already down the line and we were doing it, uh, but he knew that and I wasn't fooling Bill. I mean he was a smart man, so I think they ran a foul on the chemistry issue and I think on the issue that Bill was getting a bit tired and I think Bill should have picked up a new challenge because he had a lot of, a lot left in him. But he'd worked that horse as far as I think that horse was going to take the wagon-- SMOOT: --um-hm-- PELLEGRINO: --at that point. SMOOT: Hmm. Tell me a little bit about, uh, the development of the curriculum in the College of Medicine. Um, obviously you had to work intimately with that and-- PELLEGRINO: --yes-- SMOOT: --how did you balance that curriculum-- PELLEGRINO: --well, I think-- SMOOT: --looking for the types of things the philosophy was looking for? PELLEGRINO: I think the, the, uh, basic science curriculum pretty much Bob Straus-- SMOOT: --um-hm-- PELLEGRINO: --pulled together and the clinical curriculum I had a major role-- SMOOT: --um-hm-- PELLEGRINO: --and without going into the details of that curriculum, uh- -oh my, this dropped off--I don't know how much detail you want on the curriculum, but I think what we tried to do in the clinical curriculum was, as I said. A, put the emphasis on patient care, so we started with the interesting approach of developing first a patient care committee, which I chaired. It was also, Richard in a great, big book, um, and how are we going to take care of patients in this hospital? SMOOT: Um-hm. PELLEGRINO: Then how, oh, and that meant how are we going to treat them in some humane way, how are we going to make available to them not just the technical care, but the, uh, other things that went it--the social welfare, the proper nursing-- SMOOT: --um-hm-- PELLEGRINO: --the sociological perspectives, the anthropological perspectives and so on. Then how in that context do we teach, how do we work the medical student into it and the house staff into it and there were tremendous details. I'm just giving you a broad outline. Uh, how do we pick up from where the basic scientists have left off and tie the basic science and the clinical together? How do we correlate these? So we started to teach clinical medicine in the first year and I had that responsibility--the correlation of clinics. I was chairman of that, uh, thing-- bringing together the anatomy, the physiology, the chemistry--working with those departments so that we would present a case in the first year and then talk about the clinical and the biochemicals, so that when they were doing the--let's say the anatomy of the lung--uh, we would present a patient with emphysema and I would make a brief thing about what emphysema was, even though in their first year, then Dr. Knisely, the chairman of anatomy, was a superb teacher, would talk about the lung and the alveolar scepter and so on, all the details, how they're broken down. Uh, then the, Dr. Carlsen, the chairman of physiology--also superb person--uh, who worked very well together, you see, the clinicians and the basic sciences--would talk about the, the way oxygen was transported and carbon dioxide across the alveoli membrane, so on. So we had these correlation things through, uh, I think it's a tribute to Bill Willard, excluding myself, that he chose superbly when he chose his chairman, with maybe one, two exceptions. I'm not going to tell you who those two are, but I think the rest of the people I consider to be, were first class and Bill had the capacity to sense that and choose those people. That was his greatest strength. SMOOT: Hmm. PELLEGRINO: And he was willing to take a chance on people. We were all untested. SMOOT: Hmm. PELLEGRINO: You know, in the full fire. SMOOT: Yes. PELLEGRINO: We had, uh, we had promise, all of us, but none of us was a distinguished world famous person, but we came to be later, of course, but, uh, in all seriousness--(Smoot laughs)--Bill, Bill, and having done that job myself I think that's the most crucial job of the founder. Certainly he has to have the ideas and articulate them, but he's got to pick the people. SMOOT: Hmm. Well, yeah, I don't, I don't suppose that the resources were there to pull in these world class sorts of ---------(??). PELLEGRINO: Yeah, and maybe it's a good thing they weren't because the world class guys would've quickly settled down to, you know, continuing to be world class and it wouldn't have been around Kentucky. SMOOT: Um-hm. PELLEGRINO: It only took us a couple of years to get into that class and then we started to be away from Kentucky. I mean that's you know, it, it, invited to do this and invited to do that and so on. SMOOT: Um-hm. PELLEGRINO: But I think what he had were, you get your fighter on the way up. SMOOT: Um-hm. PELLEGRINO: We were hungry fighters, in the sense that we hadn't made our, our mark yet, so we were in there pitching all the time. SMOOT: What were your impressions of the first class? PELLEGRINO: Well, that's very interesting because I, I'll tell you another anecdote to illustrate my impressions. Uh, you'll, you'll put the story into perspective since I've lived in Kentucky and told you how much I like it that it was not a negative story at all, but in my first teaching session with Kentucky students--sessions--I'd come from New York University. Now, at New York University you teach aggressively, you know, and the student really pushes against the wall. That's delightful. But you've got to know what you're talking about because they'll really and the teacher comes back rather aggressively, uh, well, I started to teach that way and, you know, bing, bing, bing, getting them involved with you and I noticed that, you know, they were sort of sitting back and then I noticed some real hostility so I called one of the fellows in, who is now a quite famous medical academician, very fine man, I said, "Bill, tell me something, you guys aren't responding. I'm not the best teacher in the world, but I'm not the worst either and besides there's no fun in this business, uh, have you guys sitting there like a bunch of guans (??). What's going on here?" (Smoot laughs) So he said, "Well, you really want to know?" I said, "Yeah, I really want to know." He said, "Well, we've been talking about you." I said, "Oh, good, what have you been saying?" And then he told me, very interesting. He said, well, these are his words, he said, "You assault us intellectually." He said, "You're teaching a way we just don't, not familiar with. Uh, our teachers tell us what we're supposed to know and we give it back. You're forever challenging us. You're forever saying that we, you think we're as smart as you are and we don't think that. We can't compete with you." I said, "Bill, I, not only do I think you're smarter, as smart, I think probably the, most of you are smarter than I am, uh, and just because I'm a professor doesn't mean a damn thing. I mean, I want you to learn and not because I said it." He said, "Well, we're just not used to that and we feel you're really assaulting us." I said, "You're really saying that I'm impolite too, huh?" He said, "Well, yes." I said, "Okay, and I appreciate that." And I changed my technique, but, what am I saying in that with reference to your question was that I had to learn that I was in a different culture. Now, being a teacher I will change and fit that culture to the best of my ability to, couldn't do it completely, but at least I stopped that. So let me say, my impression of the first class was that the individuals there were as good as any I had taught anywhere, that the class, however, was bimodal in distribution, that while I had the very good ones here, I had more of ones at the other end who were--this was in the early years-- SMOOT: --yes-- PELLEGRINO: --would not be up, let us say, to New York University, not because the people in New York are smarter, but you had a cultural lag here. I mean, you had, this was 1959, '61, you had students who had had a very inadequate early education. That had nothing to do with intelligence. Uh, I think that's wiped out now, but that was the situation there, uh, but I liked the students and, uh, after I got over and I learned what I was doing wrong. Uh, I think, however, they never really did take, uh, to my brand of teaching as well as they did to the more directive. I mean I'm directive as hell, but it's by indirection. In other words, I'll bring you along and next thing you know you've admitted to something you never thought you'd admit to, uh, but I think they'd rather have the, you know, lecture and the other thing is, I couldn't do what I did, I couldn't make references to literature, to history, to classics, I couldn't mention that at all. Uh, so I couldn't teach that way and it was kind of an inhibition to, to my style, uh, but again, no major problem. My task was to learn how to do it and then I did something; however, when I got them as residents, I would in morning rounds, say look, you know, you just mentioned, we talked about the justice of this particular case, anybody here read book one of Republic? Joe, you read book one of The Republic. Tell us what it says about justice three days from now. So I'd give them little assignments like that. Uh, years later I got a wonderful letter, several students saying they were, wanted me to know that, uh, they were appreciative of my clinical teaching, but they also appreciated the liberal education, that they were now reading this or that or the other thing. Uh, now, I'm not, please, I mean, I'm not trying to say that here I went in and I was bringing, uh, culture to Kentucky, that's ridiculous, but what I'm saying is that I think they just hadn't had that contact. They were just as susceptible, but you had to sort of be more direct about saying why don't you read that. SMOOT: Um-hm. PELLEGRINO: Now, I know the New Yorkers, they would have phonied me, some of them, but you see, playing by that game I would have had them exposed in two minutes. You don't really know who Thrasymachus was, you're just using the word. That would go in New York, couldn't do it in Kentucky. Well, any case, I think that, that, uh, the student body was not terribly different in terms of the good students were as good as any anywhere I taught. I taught at Yale, I taught at, you know, Columbia, uh, but down at the other end they weren't quite as good. SMOOT: Um-hm. How did you find the students responding to this, uh, idea of incorporating the social sciences-- PELLEGRINO: --yeah-- SMOOT: --into the program? PELLEGRINO: They were negative about it. SMOOT: Why? PELLEGRINO: Uh, because they didn't see it--remember now, we're talking about 1961--but it was a brand new idea, it was the only medical school that had a full-time department of behavioral sciences and Bob Straus was truly a pioneer. Uh, Western Reserve had had some of this, but not as a separate department. So here was a mandatory course, uh, in the soci-, in sociology in the first year. That isn't what they thought they came to medical school for number one. I mean anatomy they could understand, sociology--what are you talking about? The second point was some of the faculty members were negative about it. In fact, I would say a good half of the faculty was negative about it. Uh, they didn't all share my enthusiasm for teaching with the sociologists. Third, uh, Bob made some mistakes, which he realized and he's learned since. Clearly a long time ago he learned. He tried to lecture sociology to medical students. You cannot lecture them on philosophy, history, sociology or anything else. You've got to teach them with a case. Well, if you do that you can teach them almost anything. So Bob learned that soon, or very quickly. We, I taught in his course with him in the first year, so we'd have a nice relationship to show them-- clinician and sociologist could be looking at two different perspectives of a very important situation and the sociologist had something to contribute that the clinician didn't have, uh, and in the coord-, uh, coordination clinics we did that. We'd bring the sociologist in as well as the physiologist or biochemist, um, but I think that that was a tough row to hoe and they, it used to pain me, but they referred to Bob's course as hearts and flowers and, uh, but medical students are cruel that way, uh, but Bob straightened that out and I think he's done a yeoman job, but to answer your question, everyone didn't accept it with the same degree of alacrity. SMOOT: Um-hm. PELLEGRINO: And that's true of all of the other innovations that we did--were not always accepted. I suppose surgery was the greatest opponent to all of this, but Bob ran some resistance from psychiatry where he shouldn't have had it, um, less so from, let's say, anatomy where you might have expected it, but again the character of that chairman was different from, he was an extraordinary kind of anatomist and physiologist. Loren Carlsen was an extraordinary man as well. SMOOT: Um-hm. PELLEGRINO: But, you know, it wasn't, wasn't accepted like that and the students did resist. My son, a grad-, is a graduate of UK's Medical School and, uh, he graduated maybe ten years ago, I guess, and he said some of that was still there at the time. SMOOT: Hmm. Well, even so, if, if, uh, there's going to be opposition to a certain course, that, that, that's not really so striking. PELLEGRINO: No, of course not, course not. SMOOT: What about the influence, was there a noticeable influence-- PELLEGRINO: --yes-- SMOOT: --of this class? PELLEGRINO: Yes, I think very definitely so, there's a noticeable influence that the students, certain number of the students, sensitivities were raised to the sociological and the anthropological issues and the psychological issues, and they were able to appreciate those issues. They were able to discuss them more freely. SMOOT: Um-hm. PELLEGRINO: When people wrote back to us about the evaluation of all our students, when they were on the house staff, they would comment on their better awareness of these issues. So there was an impact, there was an impact, not on everyone, but as you point out, I don't care what it is you introduce, I mean obviously everybody didn't love my course in internal medicine either and yet that's central to medi-, to, to medicine, uh, so I don't think that's extraordinary, but there was an undeniable impact on the students at Kentucky which gave them a different flavor when they were outside. We also had a strong emphasis on family medicine, community medicine. I mean that's another one of the real innovations, remember, I just touched that in passing, but community medicine, I had a real hand in bringing in the chairman of that department. That's where you could have had a lot of friction between the internal medicine and community medicine, but there was none because Kurt Deuschle and I were people who worked well together and we complimented each other and our departments complimented each other and we were, incidentally, also on the same floor. That's very important. SMOOT: Hmm. How do you think the, of course you've indicated already that when you were getting reports back, uh, from the Kentucky graduates-- PELLEGRINO: --right-- SMOOT: ----------(??) core that they were, uh, being noted as having a greater social consciousness. Uh, how were they stacking up with the other doctors generally? PELLEGRINO: Well, well, well. They stacked up well clinically-- SMOOT: --um-hm-- PELLEGRINO: --and, uh, we gave them a good clinical training. They weren't always as up to date on the basic science, not, not that we didn't have, that we had core basic sciences, but we didn't have the absolutely outstanding investigators you might have at Harvard or Yale and so on, but we had very good ones and, uh, I think the general impression was that we turned out a good clinical doctor and, uh, who had in addition this capacity in the behavioral and social sciences- -awareness of that, sensitivity to patient care, uh, comprehensive medicine and community medicine and we built a reputation on that. On the other hand, again, uh, people in that first class went on to other places and did just as well as anybody else. Um, I use my son again as an example because his experiences are interesting to me. He came later on in the course of things. Um, he went to Yale for his house staff training, graduated from Kentucky and that was a big jump--I think maybe one of the first to do that and, uh, not because I was there, he did it on his own, and he said he didn't feel in any way unprepared. Uh, as a matter of fact, he was voted the best house officer and I always like to tell Kentucky they can be proud of that they prepared him. So there is, it's up there, you know, his name and Kentucky next to it, best house officer. So I, I think, uh, the Kentucky product, if you want to look at it that way, became quite well respected. At the present moment, Kentucky is in decline on the national scene and that's another story. SMOOT: Well, can we get into that story a little bit? Uh, could you tell me a little bit. PELLEGRINO: There's not much I can say about it except the general impression because when I go back, you know, it's always a very pleasant visit. I get no chance to really see why. Uh, it's just that the general, general status of the school has dropped somewhat. SMOOT: Do you think you could identify some of the reasons that may exist-- PELLEGRINO: --I really-- SMOOT: --as one of the-- PELLEGRINO: --no, I, I think, it would-- SMOOT: --it's way too speculative-- PELLEGRINO: --I, it would be too speculative in my view, because I really don't, I mean, I've been back there, um, and I can't detect those things in a, you know, on a quick visit that, it's just that people come to me and say, you know, what's happened at Kentucky? And I say, well, I don't know what's happened at Kentucky. SMOOT: Hmm. PELLEGRINO: Do you get that impression? I mean, I don't know who or. SMOOT: I've had, I've had that impression from people that I've talked with. PELLEGRINO: Yeah. But that too, going back to what you said earlier about social sciences, may not be, uh, so surprising. There's a natural history to new institutions. SMOOT: Um-hm. PELLEGRINO: Having started one, two, three, four of them now--I've been involved in starting them--there is a natural history. You go through the phase of the enthusiasm of that first blush and again, this is not meant to be self-serving, when you're starting out you attract an unusual kind of person. They come, they make their success, they move on and it's like an air, a jet plane, you know, when you, when you, let those flaps up it does this before it gets its full power again and I think that may be part of the syndrome--a sort of natural thing. SMOOT: Um-hm. PELLEGRINO: Uh, and it catches up and goes on again, so I-- SMOOT: --I sh-- PELLEGRINO: --that's about all I can offer. SMOOT: Hmm. I should probably add that, uh, I think that the, the efforts are really being made, uh, to change that situation. PELLEGRINO: Yeah. SMOOT: It's very clear that all efforts are being made. PELLEGRINO: Oh, that's good. So it's, it's recognized locally as a, as a fact then? In other words, I'm not making an unfair statement? SMOOT: Of course it's, different opinions have-- PELLEGRINO: --yeah, okay-- SMOOT: --been expressed to me on that, but generally speaking I would, I would say at this point, uh, that is a general opinion and now efforts apparently are being made to rectify that situation. PELLEGRINO: Good, good. Well, that's good, that's good. SMOOT: W-, time will tell whether. PELLEGRINO: Because I'm, I really, um, as I say, I'm very fond of Kentucky and I want to see it come back. SMOOT: Hmm. How were the relationships with the University of Louisville? PELLEGRINO: Oh. Well, again, those were at levels that I didn't get very much involved in. Uh, relationships at my level were dang good and cooperative-- SMOOT: --um-hm-- PELLEGRINO: --a certain amount of envy on their part. We had a new institution, they felt that the money we were getting should have gone to them or could have gone to them. SMOOT: Um-hm. PELLEGRINO: Understandable, uh, but the chairman of medicine, Beverly Towery and I were, worked well together. I made rounds in his place, he made rounds in my place. Um, we sort of divided the world, like South America between the Portuguese and the Spanish. I don't know whether I was Portuguese or Spanish, but I was on the east side--I guess it was Portuguese, felt like the papal bull. (Smoot laughs) Uh, we didn't really have any friction along the line. There was always the friction between the Jeff-, Jefferson County and Fayette County, Louisville, Lexington, but that's older than the medical school. It's upstart, you know, uh, but, uh, well, like I knew the deans up there as well. I lectured up there, gave away lecture and that kind of business. Uh, I didn't detect any real friction. They were competing for money, so at the top level with the legislature I'm sure there was some. SMOOT: Um-hm. PELLEGRINO: But we didn't feel it. SMOOT: So professionally there were, there were no difficulties really? PELLEGRINO: I didn't detect any, no. SMOOT: Um-hm. PELLEGRINO: No. SMOOT: What about the development? Well, perhaps we should stop for a moment. [Pause in recording.] PELLEGRINO: Well, we can do it very, very briefly. It's only that, um, to finance a clinical faculty you have to have, uh, some way of supplementing what the university can pay because those salaries are so much higher than university salaries. SMOOT: Um-hm. PELLEGRINO: And secondly, one of the embarrassing things about, uh, running a university hospital is that it makes income and what do you do with that income and how do you divide it and that's a source of continuing friction of every medical school. Well, Howard Bost and Bill Willard firmly believed, and I believed too because I had come from Hunterdon where I worked on that system, in a full, full-time plan, namely that we would have a salary and that we would do our clinical care and so on and the money would come in and not come to us directly, but go into a fund from which our salaries might be paid to supplement and, so the university didn't have to spend that much and then if there were in excess to use it for the purposes of the school. SMOOT: Um-hm. PELLEGRINO: I believe that's the way it should be done. Uh, that was a continual source of friction. Largely the surgical specialties who have a greater earning capacity than the non-surgical specialties, periodically we would have a eruption and revolution and poor Bill Willard had to deal with that. They wanted to go to a situation in which they could make more money and go off the salary plan, uh, and, uh, really have the limits taken off and more money go to their departments, so they could move ahead and, uh, Bill was opposed to that, so was Howard Bost and so was I and, uh, many a tough session we would have and it would come down to a vote of one or two, with just that margin to retain that plan. Um, I guess I was the strongest defender of that plan beca-, within the faculty because I really believed in it very, very much. SMOOT: Um-hm. PELLEGRINO: And I think one of the forces for deterioration is when you go the other way. It did change fairly rapidly after I left. SMOOT: You and Dr. Willard and, and the rest of the people that had come in with him, the original team, uh, had recruited these individuals. Was it just so difficult to find people of like mind in the profession because you, you've indicated more than once that there was always kind of a close, uh, um, difference of opinion, uh--the traditionalist sort of, uh, philosophy versus the more innovative, socially conscious-- PELLEGRINO: --that's right-- SMOOT: --philosophy that you and others were trying to, uh-- PELLEGRINO: --right-- SMOOT: --employ. PELLEGRINO: Yeah, I think it, the answer to your question, it, it, was very difficult to find people who shared that and I had that same experience when I went to Stony Brook to start my own. SMOOT: Hmm. PELLEGRINO: And if I've failed--and we all fail at some parts of what we do--it was that I wasn't always able to get people who were really able to, who believed it, were able to carry it out. The second thing is that--and I'm not imputing dishonesty to anybody--but in the eagerness to get a job in a new medical school many people would deceive themselves to believing that they understood what Bill or Howard Bost was talking about and would say, oh, yes, and then when they would come they would unpack the baggage from their previous institution and be selling the old wares in a new bazaar and, uh, that I think was damaging, deleterious, divisive. So, it is hard and I would not single out individuals, but I would say there were five departmental chairmen who really never bought the basic concepts. SMOOT: Hmm. What were the most innovative departments, aside from medicine, uh, the ones where the-- PELLEGRINO: --yes-- SMOOT: --people were really reflecting this philosophy? PELLEGRINO: Yeah, okay. I would say, in the basic sciences, anatomy-- SMOOT: --um-hm-- PELLEGRINO: --physiology-- SMOOT: --um-hm-- PELLEGRINO: --uh, biochemistry. Um, in the clinical departments--you said the most, I have to leave out some--community medicine and medicine and pediatrics. SMOOT: Um-hm. What about the other colleges? Was the College of Dentistry? Uh. PELLEGRINO: Yeah, well, I haven't commented on those, I've limited myself to the medical school. SMOOT: All right. PELLEGRINO: Of course I was very active with the other schools too. SMOOT: May we branch out? PELLEGRINO: Of course, if you wish. Uh, well, I think the College of Dentistry was, as a total, more innovative within its own genre, uh, in some ways than the medical school. The University of Kentucky Dental School was really a shining light in the time it was started and the dentists--I want to say this in a way which, not be, uh, condescending- -were rather more intellectually impoverished and, uh, therefore more easily lighted up by, I mean as a general, the whole profession, they, let's put it, maybe a better way to paint it, what, they weren't so pretentious or self-satisfied and complacent as the physicians and, uh, so Kentucky was really, that dental school was really the innovative dental school of its time and Al Morris, the dean, was able, because it was a smaller football field, to recruit more people of like mind. Bill had a harder job because medicine is so much bigger and the disciplines are so desperate that in dentistry there is a greater cohesion. So I think, you know, if we're talking about the Medical Center there's no question that the dental school was a very innovative school. SMOOT: Um-hm. PELLEGRINO: Was able to do many things, so that it became a leader. It too has faded badly. SMOOT: Um-hm. PELLEGRINO: Uh, the School of Nursing, I was very close to the School of Nursing and very interested in the things they were trying to do. Let's put it this way, that their articulation of ideas was also in advance of its time and they were leaders, but they were not able to implement to the degree that dentistry was or medicine. Uh, I don't know how much of this is going to be attributed to, is this, am I going to be quoted? SMOOT: You could be quoted, yes. PELLEGRINO: Well, then I reserve further, I'll take the Fifth Amendment. SMOOT: Very well. PELLEGRINO: Stated it as charitably as I could. SMOOT: All right. PELLEGRINO: I don't want to reflect on any person. SMOOT: All right. PELLEGRINO: Or persons. SMOOT: What about the other colleges, uh? PELLEGRINO: Well, you, those were the, pharmacy was not part of the Medical Center at that time. SMOOT: Okay. PELLEGRINO: Uh, the hospital was I think under very good directorship with Dick Wittrup, I think was a very capable administrator. Bill had a very good team around him. SMOOT: Um-hm. What do you think has been the impact of the medical school, Medical Center, generally on the standard of medical care in Kentucky? At least in the time that you were there? PELLEGRINO: (laughs) Yeah. SMOOT: I can't ask you to evaluate it now, really. PELLEGRINO: No. Well, that's very hard to answer because while the school was developing, medicine was changing. SMOOT: Yes. PELLEGRINO: New knowledge was coming in and as historian you know how difficult it is to avoid the, the error of interpreting within today's frame what happened in those days. My guess would be that it wouldn't be condescending to what was there before nor inappropriate to say that the development of a new medical school in any state would upgrade in general the distribution of good quality care because, uh, you're training more people, more younger people--were retaining some of them in Kentucky. They were going out to areas that others weren't going out to. There was continuing medical education. There was a relationship with the general practitioners, things which hadn't existed before, and if we have any faith in education, it seems to me that it's fair to expect that those resources would have an impact on the quality and level of care, but it's not exclusive because at that time I'd say medicine itself was changing. SMOOT: Um-hm. PELLEGRINO: I think the major contribution of the school to the people of Kentucky, to the state of Kentucky--looked at now--not to the academic world, but to the people of Kentucky was A, a supply of physicians-- SMOOT: --um-hm-- PELLEGRINO: --which was increased, B, an interest in the community, which Louisville didn't have, the statewide community, so that we had influence out there. You know, maybe measurable in only small terms, but nonetheless an influence out there. Three, uh, a prominence to the Center that brought physicians in. It certainly was a great benefit to Lexington, which had always been a center, as you know, of referral, good doctors, but it enhanced that significantly. An-, when we came in, for example the open heart program, uh, I was very close to Dick Fletcher, who was a very fine person whom I have the highest respect for and regard as a friend, but Dick's program in open heart surgery at Saint Joseph's couldn't possibly have the resources we would have. Dick, being the kind of honest man he was, closed out his program and we got Frank Spencer, who is today one of the world's leading cardiovascular surgeons with Kentucky. Great credit must be given to the chairman of surgery, by the way, for his capacity to attract very, very good people and while you will hear that he was a disruptive element at times, uh, I think on balance his contribution to Kentucky was very great, even though he was very much opposed to most of what I was trying to do in patient care or what Bill was trying to do and I say that with great respect. We differed, he was an opponent, but I think he was, did tremendously for the department of surgery and for Kentucky. SMOOT: Hmm. PELLEGRINO: We did it in two different kinds of ways. SMOOT: Put the question-- PELLEGRINO: --yeah-- SMOOT: --that, uh, it was a movement really that started around 1950, I suppose, was it not, that medical centers were being developed around the country, you saw for example Texas, the University of Texas had developed a-- PELLEGRINO: --yes-- SMOOT: --a major medical center-- PELLEGRINO: Yeah, John Truslow. SMOOT: Um, how did Kentucky's Medical Center fit into this national scene? PELLEGRINO: Yeah, well, I think it fit into that movement very well. The, the medical center idea, uh, is of course older than the fifties. It, it really started in New York with the Columbia Presbyterian and the New York, uh, Cornell Medical Center. SMOOT: Um-hm. PELLEGRINO: Uh, the multi-unit, uh, medical school, hospital complexes. SMOOT: Um-hm. PELLEGRINO: Then, that was postwar, post World War II. After, excuse me that was pre World War II. Forgive me, that was in the thirties, uh, but then after World War II, uh, tremendous stimulus for growth in medical schools and so on, the medical center idea began to develop, but it's fair to say that until the University of Florida, University of Kentucky, University of North Carolina--and notice in what part of the country these are located--uh, the medical center idea that we were working with at Kentucky and North Carolina and Florida was not an actuality. Now, you take Columbia Presbyterian and New York Cornell, uh, you didn't have the notion of multiple schools. Medicine dominated everything. SMOOT: Um-hm. PELLEGRINO: And it really, uh, so if you look at the history of medical education, I think those schools I've mentioned to you--uh, and later Hershey, um, and in a kind of megalithic way Stony Brook and so on, places like that--but the early days, sixties, Kentucky was out there really with the two or three front runners, if not the front runner and the notion of a unified, multi-unit, multi-school center that would try to coordinate the activities of the different professions-- coordinate them in some way although, well be it that was always difficult to do and reality was always a long way from the aspiration, the aspiration was that the hospital as really part of the center at Cornell and Presbyterian they dominate. They're very powerful, uh, and the hospital is part of the center and part of the university and the medical center is part of the university. Those are concepts, which were just coming into the fore at that time. So I would think, if I were writing the history of medical education, I would point to that decade of the sixties as the time when the medical center really came to fruition the concept of the medical center and in that movement Kentucky would have a very prominent role. SMOOT: Hmm. PELLEGRINO: And that was a real contribution, although today we're leaning away from that idea now. SMOOT: Exactly what I was going ask. Um, I've seen manuscripts pointing to the fact that this is not an idea that should be continued. This is something that-- PELLEGRINO: --right-- SMOOT: --we, we over spent, we over built, et cetera. Your impression seems to be a little bit different, at least. PELLEGRINO: --it is, indeed different-- SMOOT: --it's modified-- PELLEGRINO: --yes, it is different and not because I'm an ossified oldster. I think that the coordination of all of those functions is something which has to be done and I think we're, the thing that's dividing us and pushing it away from it right now are the economic factors. SMOOT: Um-hm. PELLEGRINO: I'm hoping sanity will return to the country. Uh, as you've gathered I'm not necessarily a Republican--(Smoot laughs)--uh, nor am I a Kennedy Democrat. I'm an Independent, but I feel strongly that health care and equity of access and availability and quality. Uh, the Johnson era, talk even if, if Johnson wasn't himself the most admirable person, nonetheless he said some very great things about the kind of society I think we ought to be. I think we will come back to it and then the medical centers will again have a role of community responsibility. I think what happened was too much was unloaded on them. SMOOT: Um-hm. PELLEGRINO: They led people to believe they could do everything. People turned to them to do everything. SMOOT: Um-hm. PELLEGRINO: And we had a failure of expectation and then a loss of nerve and I think that now everybody is worried about economics and they're not thinking clearly, but I believe the idea is valid and I believe it will come back and I've already written about what direction I think it ought to be. I won't vex you with it here, but, uh, I think we're going to have a new pattern emerging. SMOOT: When you said too much was unloaded, are you looking specifically at, uh indigents, uh? PELLEGRINO: No. SMOOT: Is this the problem that's? PELLEGRINO: No, I think the care of the indigents was more a matter of the state picking up its responsibility to pay for those indigents. That's where the difficulty was. SMOOT: Um-hm. PELLEGRINO: Uh, everybody tried to unload the indigent on somebody else. The corporations don't want it, the federal government doesn't want it, the states don't want it and so now we have thirty-five million uncovered people in the country and another thirty-five million inadequately covered. Uh, no, I was thin-, what I was meant by that was that the medical center was seen as the answer and sometimes unfortunately by the heads of those centers and by some of my colleagues who ran those centers as the answer to the delivery of health care. SMOOT: Um-hm. PELLEGRINO: Uh, have you read the Sick Citadel, by Sheps? I don't know how much reading you want to do. It's right over here. They're at North Carolina. I wrote a review of the book because I don't agree with his thesis, but, uh, they take the view that, you might want to make a note of that, that's the really sort of a recent history and I'd like to give you my review too-- (laughs)--so you can see the opposing view. [Crashing sound] Oops. (Smoot laughs) But, um, I think the val- , idea is still valid. I think it's going to have to be redone with a different relationship of the hospital and so on, but, uh, and I have a blueprint. There's nothing that I, you know, would wish to say, uh, unless it's something that you think is pertinent and interesting and I don't know what, you know, what your general theme is. Uh, as far as I'm concerned, you've covered most of what I consider to be important about the Kentucky experience. SMOOT: Um-hm. PELLEGRINO: Um, I've been, trying to think, how, uh, well, I don't want to comment about Kentucky now, I don't know enough about it. SMOOT: Um-hm. PELLEGRINO: Uh, I just think it was a very bright and exciting period in American medicine and in Kentucky and, uh, it's not because I was young then because I'm, I think there are other bright experiences I've had. I feel very fortunate myself-- SMOOT: --um-hm-- PELLEGRINO: --in having been able to start so many things from scratch, um, so that it's not a question of my flagging or energy. As you can see, I've got my blueprint for the next medical center, where does it go, but, uh, that was a, a very high point in the history of the country too. There's a kind of, well, we had confidence in the future and we had confidence that we could provide a good life for everybody in some way, obviously not giving people things they don't deserve and all that kind of nonsense, but, uh, we had a feeling that through health, through medicine, through education we could better our nation. SMOOT: A reflection of the can-do society. PELLEGRINO: Yeah, yes, and, uh, but so far as medical education goes, I think, um, I've pretty much told you what I think is pertinent without going into-- SMOOT: --um-hm-- PELLEGRINO: --evaluation of individuals, which of course is the interesting part, but I'm not about to go into that. SMOOT: One other question I might ask then, you have been on both sides, you've been involved with the development and administration of medical centers-- PELLEGRINO: --um-hm-- SMOOT: --you have been involved as the president of a university-- PELLEGRINO: --yes-- SMOOT: --what would you say are the major things that I should look for, uh, from those perspectives, in the relationships between-- PELLEGRINO: --yeah-- SMOOT: --those two areas? PELLEGRINO: (laughs) I'm an expert at that. (both laugh) Well, let me tell you this, before I say it, let me give you again just a little bit of predju-, so you can evaluate what I say. SMOOT: Um-hm. PELLEGRINO: When I was running a medical center, I fought like crazy with the president. Now, again that's a matter of personal style, but I had to get Stony Brook off the ground and I pretty much said to the president of Stony Brook, who's also a very forceful and a very capable man, look John you take care of that side of the street, I'll take care of this side of the street. His view was, you're part of the university, therefore keep me posted. I said, I'll keep you posted, but I'm running this show. So that's the first tension, who's running the operation and as I said to you earlier, the president may take, having occupied both sides of the streets, may take any one of those several alternatives I outlined. Uh, the president of Stony Brook at first tried to be on top of it and, uh, I don't think he succeed because I just wasn't going to make him succeed. I couldn't function that way. I knew what had to be done and I had a lot of track record and, uh, so I think the first thing you look for then is, if I were interviewing them, I'd say, uh, to the president, how did you see the medical center in relationship to the university and then I would ask the vice-president, how did you see the medical center in relationship to the university? Leave out the personalities at the beginning and then, what problems did you see in your vision and the way in which it actually turned out? Uh, I think you'll find stress in almost every circumstance because as I say, these medical centers really, uh, throw the university out of orbit. They're such dense, heavily whirling masses. And they pull it out and it's a challenge to any president. The only president I worked with who knew what it was about and understood it very well was Kingman Brewster at Yale. He was the most intelligent of them all about how to handle it and, uh, I'm sure he had his problems too, but, uh, Brewster had a philosophy about Yale and its administration that couldn't work at a state university. Uh, first of all, Yale is a relatively small institution and second, uh, he ran the show. He didn't have to worry about a legislature and he could ignore the practicing community if he wanted to and if he and the dean and the dean was his appointment got together things would go. He had his problems with the hospital which was a separate entity, but I think he was the most knowledgeable president I've ever met on those issues, he knew how to handle it, but I think back to your question, it's fundamentally how do they see those pieces. Some people say they should never be married. I feel firmly the medical center should be part of the university, absolutely, and that given all the tensions it's to the advantage of both the university and the medical center to be living together. Now, obviously speaking from my point of view, I like a certain creative tension and if it's too peaceful I think that's the cemetery and, uh--(both laugh)--that's what happens, so, okay, that's what I would say from that point of view. I think, uh, I would ask those questions. The, the things to look for are how did they see it? What were their visions? What problems did they see and then what did they think were the causes of the problems and you'll slowly come down to persons. SMOOT: Always in the final analysis. PELLEGRINO: Styles and chemistries, yeah. SMOOT: Hmm. PELLEGRINO: Yeah. Now, uh, now, with the president of Stony Brook, we are friends today and we respect each other, uh, but it was not a peaceful existence. SMOOT: Hmm. Are there any other subjects you would like to touch upon about? PELLEGRINO: No, I, I don't really want, unless there's something you want to know about. I, I mean I can expatiate forever, but I'm not going to use you that way. (both laugh) SMOOT: Well, could you bring me up to date? We, we've touched upon your, your subsequent career after leaving Kentucky. PELLEGRINO: Yes. SMOOT: Just for the record-- PELLEGRINO: --yeah-- SMOOT: --that I'm making here--that we are making here--uh, from Kentucky you went to, uh-- PELLEGRINO: --From Kentucky I went to Stony Brook-- SMOOT: --Stony Brook-- PELLEGRINO: --yes, that's right. SMOOT: Okay and then after Stony Book-- PELLEGRINO: --yeah, Stony, Stony Brook, I stayed for seven years. SMOOT: Um-hm. PELLEGRINO: And established a six-school health sciences center from scratch. SMOOT: Um-hm. PELLEGRINO: The biggest one ever put together anywhere, uh, at a time when the state of New York was riding high and with great aspirations and so on and there I certainly used many of my experiences at Kentucky and at Hunterdon on an even bigger football field. Okay. Then after that I got involved as a consultant with the University of Tennessee system and they were thinking at that time of building two or three, under the pressure of the legislature and the Commission on Higher Education, separate medical schools and I was a consultant who came in among others and I said, "No, don't do that." My advice would be to establish a statewide system with satellites, but under one unifying influence and that's your center at Memphis which has a lot of resources and is a very good center and, uh, set up clinical campuses, but don't set up ---------?? schools and use one basic science campus and so on. Well, they bought that notion and I got involved with Tennessee because then they said, and they called my bluff. They said, okay, we've, we're going to follow your plan and we want you to come and do it. Well, I had been at Stony Brook seven years. I had got them off the ground, got the buildings, got all the money committed, two hundred and fifty million dollars worth, we had started, all the schools were accredited. There was still work to be done, but keeping with my own philosophy, you go and you do it and so on. I figured in another couple of years probably I could do some more, but here was Tennessee and they were saying come and do it and, uh, I said, "Yeah, okay, I'll come and do it." So I went to Memphis and got that organized pretty fast. I, while I was at Memphis I got an offer from Yale to put together for them a medical center and they had not had a functioning medical center idea to become president of that medical center. I couldn't turn that down; I went to Yale, did that and from there I went to Catholic University as president, uh, and, uh, without talking about my accomplishments did some things for them and then saw the one side of the thing that I didn't like, which was I was going to have to raise a hundred million dollars. Well, my sights are high, I mean they might, they don't, they didn't think that, but I thought we needed a first rate Catholic University, truly first rate, we don't have one in this country, academically, intellectually those are my goal, I mean, I, that's what I would like to achieve is that, that kind of excellence and, uh, said, well, you've got to have a hundred million minimum, maybe two hundred million and then we can break into the first rank and have something that's comparable to Yale and Harvard and so on--not because they're Yale and Harvard--but let's face it, what they've got is intellectual excellence and, uh, I don't know what your religion is, but the Catholic tradition in education is a very rich one, but we're not using it and we've got something to contribute. SMOOT: Um-hm. PELLEGRINO: And remain Catholic as well. Uh, okay. So that, I started, I talked about the intellectual ministry which scared the life out of a lot of people and, uh, which meant you tangle with any idea. Homosexuals want to, well, take them on, the, abortion, birth control, we've got to, you don't have to run away from error deal with it. Well, anyway, so I, but I didn't want to raise two million dollars--(laughs)- -because at that, already at that time, now, it was '62, and, uh, I had kept up my scholarship, I was still writing, I was still teaching, I'd written a couple of books and so on and I looked at my own life and I said, no, I want to spend the rest of my time on scholarship--teaching. I've been an activist all my life and, uh, I've done three hundred and fifty articles that way, let me see if I can do something of quality now. So Georgetown offered me a university professorship. I have a chair and then unfortunately, uh, the president at one point they had a crisis here in the institute said, "Well, would you help me out? Would you go over and straighten that place out?" I said, "Oh, my god, yes, of course. I'm here to serve Georgetown. I will do it." So that's how I'm here. Uh, I enjoy what I'm doing of course, but my ideal would be to be just left alone to do my research and my teaching, which I love-- SMOOT: --um-hm-- PELLEGRINO: --and my writing-- SMOOT: This is why, I suppose I've, one of the reasons I wanted you to, to make this listing for me while on the record is that we could talk all day long and-- PELLEGRINO: --yeah, I understand-- SMOOT: --there's so many things you could teach me and I---- PELLEGRINO: No, no, nothing I can teach you. SMOOT: --but, uh, as a matter of efficiency, I suppose we should. PELLEGRINO: And you've got to save tape. (both laugh) SMOOT: Let me thank you on behalf of the Medical Center of the university-- PELLEGRINO: --oh, well, listen-- SMOOT: --and, and personally as well. PELLEGRINO: --well, thank you. And let me just say that I, as far as I'm concerned the years at Kentucky were delightful, productive and I am really, really proud to have been part of it. SMOOT: Thank you. [End of interview.] Dr. Edmund D. Pellegrino (Chairman of the Department of Medicine 1959-1966). This interview focuses heavily on the creation of the Medical School and the Medical Center at the University of Kentucky. Dr. Pellegrino discusses his views on practicing medicine in rural areas, his impressions on the early staff of the Medical School and Medical Center, the view of Kentucky’s politicians toward the University of Kentucky’s decision to start a Medical School and Center, his experiences practicing medicine in rural Kentucky and the future of the medical profession. insert here