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Regional Oral History Office University of California 

The Bancroft Library Berkeley, California 



Frank Leven Albert Gerbode 

FRANK LEVEN ALBERT GERBODE: 
PIONEER CARDIOVASCULAR SURGEON 



With an Introduction by 
Norman E. Shumway, M.D. 



An Interview Conducted by 
Sally Smith Hughes 
1983-1984 



Copyright (c) 1985 by The Regents of the University of California 



All uses of this manuscript are covered by a. legal 
agreement between the University of California and 
Frank Leven Albert Gerbode dated November 8, 1983. The 
manuscript is thereby made available for research purposes , 
All literary rights in the manuscript, including the 
right to publish, are reserved to The Bancroft Library 
of the University of California at Berkeley. No part of 
the manuscript may be quoted for publication without the 
written permission of the Director of The Bancroft Library 
of the University of California at Berkeley. 

Requests for permission to quote for publication 
should be addressed to the Regional Oral History Office, 
486 Library, and should include identification of the 
specific passages to be quoted, anticipated use of the 
passages, and identification of the user. 

It is recommended that this oral history be cited 
as follows : 

Frank Leven Albert Gerbode, "Frank Leven Albert 
Gerbode: Pioneer Cardiovascular Surgeon," an oral 
history conducted 1983-1984 by Sally Smith Hughes, 
Regional Oral History Office, The Bancroft Library, 
University of California, Berkeley, 1985. 



Copy No . 




1 



FRANK LEVEN ALBERT GERBODE 
1907 - 1984 



Underwritten by the Gerbode children 
in memory of their father. 



TABLE OF CONTENTS Frank Gerbode 

INTRODUCTION by Norman E. Shumway, M.D. i 

INTERVIEW HISTORY ill 

I FAMILY BACKGROUND, EDUCATION AND EARLY CAREER 1 

Grandparents, Parents, Brother and Sisters 1 

Grammar and High School Education 4 

Undergraduate Education at Stanford 4 

The Decision to Go into Medicine 5 

Extracurricular Activities at Stanford 6 

Financing the Stanford Tuition 6 

The Major in Physiology 7 

The Decision to Become a Surgeon 9 

The Stanford Medical Curriculum in the 1930s 10 

Research in Medical School 11 

Emile Holman, Surgeon 12 

F.L. Reichert, Neurosurgeon 14 

Cardiovascular Surgery before World War I 15 

Marriage 16 

Internship at Highland Hospital, 1935-1936 18 

Assistant in Pathology at the University of Munich, 1936-1937 20 

Hans Borst 23 

Surgical Resident and Instructor in Surgery at Stanford, 1937-1942 27 

Early Cardiovascular Surgery 29 

Prewar Cardiovascular Research 31 

Premonitions of World War II 33 

II SURGEON, U.S. ARMY MEDICAL CORPS, 1942-1945 35 

Decision to Go to War 35 

Preparations in the U.S. 36 

Casablanca 38 

Andrew Peatroscka 40 

Palermo, Sicily 41 

Anzio 43 

Wound Treatment 45 

Salerno and Southern France 46 

The Story of Carpentras 47 

Field, Mobile and Base Hospitals 49 

The German Retreat to the Vosges Mountains 50 

Wartime Surgery 51 



Heidelberg 52 

Mutzig 53 

The Battle of the Bulge 54 

Wartime Surgery (Continued) 54 

The German Wounded 58 

Booby Traps and Mines 59 

Pushing Back the Germans 59 

Dachau 60 

Munich 61 

The German Surrender 62 

Return to the United States 64 

Dwight Barken 65 

Combat Medals 66 

Other Base Hospital Units 67 

The Commanding Officer 68 

Correspondence to and from Home 69 

III THE IMMEDIATE POSTWAR YEARS 70 

Research and Surgery 70 

Decision to Stay at Stanford 70 

Simulated Congenital Lesions and Extracorporeal Circulation 71 

Patient Referrals 72 

Early Vascular and Heart Surgery in the United States 74 

Robert Gross: Operations for Patent Ductus and Coarctation 75 

The Blalock Procedure 75 

Factors in the Advance of Thoracic Surgery 77 

Endotracheal Anesthesia 77 

The Engstrom Volume Respirator 78 

Advances Affecting Cardiovascular Surgery 80 

Cardiac Catheterization 80 

Rapid Xray Film Changers 83 

Blood Transfusion 85 

Penicillin 86 

Drugs Regulating Blood Coagulation 87 

Visiting Professor at St. Bartholomew's Hospital, London, 1949-1950 89 

Frank Rundle, George Ellis and Emmanuel Amoroso 89 

Dog Surgeon 91 

Honorary Perpetual Student 93 

American and British Postwar Surgery: A Comparison 94 

Cardiovascular Surgery 97 

Hypothermia 98 

Vascular Anastomoses to the Heart 99 



IV THE DEVELOPMENT OF CARDIOVASCULAR SURGERY 101 

The 1983 California State Bill on Animal Experimentation 101 

Oxygenators, Hypothermia and Open Heart Surgery 101 

John and Maly Gibbon: The First Heart-Lung Machine 102 

John Kirklin and the Gibbon Heart-Lung Machine 103 

The DeWall Bubble Oxygenator 103 

George Clowes and the Membrane Oxygenator 104 

The Bramson Membrane Oxygenator 104 

Hypothermia (Continued) 107 

Teamwork 109 

M.L. Bramson and the Membrane Oxygenator 110 

Industrial Development of the Membrane Oxygenator 111 

The Disk Oxygenator 113 

Pump Technicians 115 

The American Society for Artificial Organs 116 

Pumps 117 

Dennis Melrose's Heart-Lung Machine 118 

Patient Response 119 

Patient Selection 120 

Cardiologists 120 

Mitral Valvotomy 122 

The Crippled Children's Services 125 

Funding for Cardiovascular Research 127 

Mitral Stenosis: Operative Procedures 128 

Communication Among Surgeons 129 

Mitral Stenosis: Operative Procedures (Continued) 130 

Mitral Stenosis: Patient Selection 132 

Heart Valve Replacement 133 

The Korean War and Its Aftermath 138 

Service as a Brigadier General 138 

John Howard: Blood Replacement 141 

Frank Spencer: Early Repair of Blood Vessels in the Field 142 

Vascular Suture 142 

Vein Grafts 143 

Heart Transplantation 146 

The Problem of Rejection 146 

Norman Shumway 147 

Fallout from Surgical Advances 148 

Consultant Positions 149 

Oak Knoll Naval Hospital, Oakland 149 

Letterman General Hospital, San Francisco 149 

Positions in Washington, D.C. 150 



PRESBYTERIAN MEDICAL CENTER, THE HEART RESEARCH INSTITUTE, AND 

COMPUTERIZED PATIENT MONITORING 153 

The Stanford Medical School's Move to Palo Alto, 1959 153 

Debate Over the Move 153 

Decision to Stay in San Francisco 154 

Attempts to Retain a Connection with Stanford 155 

Staff Decisions about the Move 157 

The Institutes of Medical Sciences 159 

Foundation 160 

The NIH Program Project Grant 161 

The Heart Research Institute Fellowship Program in 

Cardiovascular Surgery 163 

Presbyterian Hospital 166 

The Presbyterian Church 167 

St. Joseph's Hospital 167 

The University of the Pacific 168 

The Bank of America 169 

Designing the New Presbyterian Hospital 169 

Computerized Patient Monitoring 171 

IBM 171 

Hewlett-Packard 174 

Research Programs at the Heart Research Institute 175 

Postoperative Problems after Open Heart Surgery 175 

The Bramson Membrane Oxygenator 176 

Heart-Lung Machines Elsewhere 176 

Platelets 177 

The Institutes of Medical Sciences (Continued) 178 

Administration 180 

Research 182 

Commercialization 182 

Administrative Policy 183 

The Peer Review System 184 

The Institutes of Medical Sciences (Continued) 186 

Teaching and Training Programs 186 

Reasons for Establishing a Medical Research Institution 188 

Ph.D.s and M.D.s 190 

Founding New Institutes 191 

Sharing Equipment and Facilities 192 

Accomplishments and Reputation 193 

The Decision to Do Heart Transplantations at Pacific Medical Center 194 

Ethical and Psychological Considerations in Medicine 196 

Computerized Patient Monitoring (Continued) 198 



VI MEDICAL /SURGICAL ACTIVITIES AND HONORS 201 

The Frank Gerbode Medical Research Foundation 201 

Professional Societies and Associations 202 

The American Association for Thoracic Surgery 202 

The Society of Thoracic Surgeons 203 

The American Surgical Association 203 

The Society of University Surgeons 204 

The Society of Clinical Surgery 205 

Presidency of the American Association for Thoracic Surgery 205 

The Bay Area Vascular Society * 206 

The International Surgical Society 207 

Surgery in Various Countries: Comparisons 212 

The Pan-Pacific Surgical Association 214 

The Society for Vascular Surgery 215 

The International Cardiovascular Society 215 

The American Heart Association 216 

The California Academy of Medicine 217 

Honors 218 
Master of Surgery (Honoris Causa) , the National University of 

Ireland, 1961 219 

M.D. (Honoris Causa), Uppsala University, 1965 219 
Honorary Fellow of the Royal College of Surgeons of England 

and Edinburgh, 1969 and 1975 220 

M.D. (Honoris Causa), University of Thessaloniki, 1964 220 

The Rene Leriche Prize, International Society of Surgery, 1973 221 

Alexis Carrel 221 
The British Order of St. John of Jersualem, 1956; Knight, 1978 222 

Service on Editorial Boards 224 

Affiliations with Medical Institutions in the Bay Area 227 

Children's Hospital, San Francisco 227 

Oak Knoll Naval Hospital, Oakland 227 

The University of California, San Francisco 228 

The California State Board of Health 236 

Visiting Professorships 236 

St. Bartholomew's Hospital, London, 1949 237 

The Royal North Shore Hospital, Melbourne, 1953 237 

The Prince Henry Hospital, Sydney, 1963 238 

St. Thomas' Hospital, London, 1958 240 

The Free University of Berlin, 1960 241 

The University of Heidelberg, 1964 242 

The Karolinska Hospital, Stockholm, 1964 243 

Duke University, Durham, North Carolina, 1973 245 

The University of Alberta at Edmonton, 1974 246 



VII COMMENTS ON MEDICAL /SURGICAL TOPICS 248 
More on Research in the Surgical Laboratory of the Old Stanford 

Medical School 248 

Experimentally- induced Cyanosis 249 

The Heart-Lung Machine 250 

Norman Shumway: Cold Arrest of the Heart and Heart Transplantation 251 

Dieners 254 

The Artificial Heart 255 

Targeted vs. Basic Research 257 

Legal and Ethical Aspects of Medicine 258 

The Legal Aspect 258 

The Ethical Aspect 259 

Malpractice Suits 260 

The Legal Aspect (Continued) 261 

Medical Ethics Committees 262 

Research Versus Patient Benefit 263 

The Doctor-Patient Relationship 265 

Patient Referral 265 

Medical Uncertainty 266 

New Diagnostic Techniques in Cardiology 266 

Teaching 268 

VIII PHILANTHROPY, FAMILY AND RECREATION 269 

The Wallace Alexander Gerbode Foundation 269 

Religion 280 

Martha Alexander Gerbode 281 

Family Life 288 

The Chit Chat Club 290 

The Home on Divisadero Street 294 

Children 297 

Wallace Alexander Gerbode 297 

Susan Gerbode 298 

Wallace Alexander Gerbode (Continued) 298 

Maryanna Gerbode Shaw 298 

Frank Albert Gerbode III 300 

The Adoption 302 

John Philip Gerbode 303 

Property on Kauai 304 

Hobbies 305 

Tennis 306 

Carpentry 306 

Photography 306 

Painting 307 

Sailing 308 

A Brush with McCarthyisra 310 



IX TRIPS 314 

Russia 314 

China 

Saudi Arabia 
Australia 335 

X FURTHER COMMENTS ON MEDICAL /SURGICAL TOPICS 338 

NIH Support of the Multidisciplinary Team in Cardiovascular 

Surgery 338 

The Artificial Heart Program 341 

Targeted Medical Research 342 

The Transventricular Mitral Valve Dilator 344 

The First Open Heart Surgery Team on the West Coast 345 

Endocardial Cushion Defects 348 

The Membrane Oxygenator 349 

Counseling Patients 
Aortocoronary Bypass Operations 

Keeping Patients Alive at Any Cost 353 

Heart Transplantation Programs 354 

Etiology 357 

Setting and Controlling Medical and Surgical Fees 358 

Artificial Heart Valves 

Extrapolation from Animal Research to Operations on Humans 365 

Consent Forms 
Correcting Septal Defects 
Early Open Heart Operations 

Postoperative Problems after Open Heart Surgery 
An Aortic Valve Prosthesis 
The Early Membrane Oxygenator 

The Bubble Oxygenator 375 

Early Extracorporeal Research 377 

XT PACIFIC MEDICAL CENTER AND ITS PREDECESSORS 

The Institutes of Medical Sciences and the Old Presbyterian Hospital 

The Institutes 

The Old Stanford Hospital and the Presbyterian Church ->87 

Proposal for a Medical School 390 

Free Hospital Beds 395 

Mergers with Other Hospitals 397 

The New Presbyterian Hospital 398 

The Heart Research Institute Fellowship Program 

Frank Rundle * 

John Callaghan 

Dennis Melrose 



Mark Bainbridge 

Gutmund Semb 

The Evarts Graham Fellowship 

AM 7 

Torkel Aberg 
The Accomplishments of the Medical Research Institute 



XII MISCELLANY 412 

Honors 412 
The Second Henry Ford International Symposium on Cardiac Surgery 412 

Shiley ' s Celebration of the 40th Anniversary of Cardiac Surgery 413 

The Michael E. DeBakey Award 414 

Communication Among Surgeons 415 

The Bohemian Club 416 

The Tuberculosis Hospital in San Luis Obispo 417 

Early Surgical Lists 420 

A Letter to John Kinmouth, January 1957 424 

A Letter from John Kinmouth, January 1959 425 

A Letter to John Kinmouth, April 1959 426 

A Case Report from Letterman General Hospital, February 1960 427 

A Letter to Viking BjiJrk, May 1960 428 

The Look Magazine Article, 1963 428 

A Letter from John Kinmouth, September 1960 431 

Fritz Linder and the University of Heidelberg 432 

A Contract to Retrain Female Physicians 433 
A Contract to Develop a Computer System to Identify Vacant 

Hospital Beds 434 

A Grant for a Training Program in Cardiovascular Surgery 434 
More on the Possibility of a Medical School at Presbyterian 

Medical Center 435 

Arthur Selzer, Ian Carr and Pediatric Cardiology 436 

A Letter to Hans Borst, September 1971 437 

Operating Room Donors at the New Presbyterian Hospital 438 

A Letter from Hans Borst, January, 1955 439 

Grants to Establish Cardiovascular Centers 439 

Heart Clinics in Alaska 440 

Surgical Films 444 

Malpractice 445 

The Salgo Case, 1957 446 

Consent Forms 451 

The Captain of the Ship Doctrine 452 

The University of California and the Salgo Case 454 

Expert Witnesses 454 

Pre- and Postoperative Consultations 456 

Malpractice Insurance in California 457 

The California Medical Association and Medical Liability 457 



XIII FURTHER COMMENTS ON EARLIER TOPICS 459 

Recent Problems at the Medical Research Institute 459 
Possible Affiliation of Pacific Medical Center and Children's 

Hospital 462 

Recent Problems (Continued) 463 

Heart Transplantation 468 

Family Background and Early Education 470 

Surgical and Medical Societies 477 
The American College of Surgeons and the American 

Surgical Society 477 
The International College of Surgeons and the International 

Society of Surgery 477 

The International Cardiovascular Society 481 

The Society of University Surgeons 483 

The Postwar Growth of Cardiovascular Surgery 484 

The Fellowship Program in Cardiovascular Surgery 484 

A Letter to Costas Tountas, 1974 486 

A Letter from Norman Shumway, December 1976 486 

TAPE GUIDE 488 

APPENDICES 490 

INDEX 533 



INTRODUCTION 



Frank Gerbode was a man of many parts. Fortunately, these transcripts 
reveal some of the facets that made Frank Gerbode a household name everywhere 
there is any surgery of the heart. In 1954 after years of careful research 
Dr. Gerbode performed the first successful open heart surgical procedure in 
the western United States. In 1958 an actual open heart surgical procedure 
was televised live from the old Stanford Hospital in San Francisco. An atrial 
septal defect was found to have anomalous pulmonary venous drainage so a 
more complicated surgical procedure was carried out than was originally planned. 
The patient made an uneventful recovery, and a wide public audience began to 
realize the potential of this new approach to previously hopeless cardiac 
diseases. Working first with the ingenious Dr. John Osborn, then with the 
dynamic Dennis Melrose of the United Kingdom, Dr. Gerbode developed a safe and 
reliable heart-lung machine to maintain the patient during open heart surgery. 
Dr. Gerbode was among the first to appreciate the importance of a versatile 
and loyal laboratory staff. Bing Moy and Don Toy were of outstanding help in 
the early days of the open heart, and they reflected Dr. Gerbode 's admiration 
and confidence. 

Dr. Frank Gerbode was a meticulous and outstanding cardiac surgeon. He 
was the first to suggest the median sternotomy for all kinds of cardiac surgery. 
Prior to his use of this approach, the bilateral tranverse sternotomy was 
universally utilized. The number of postoperative complications incidental to 
the bilateral thoracotomy was greatly reduced. Dr. Gerbode reported the first 
series of left ventricular-right atrial shunts and their successful closure. 
In the very important area of postoperative care for the open heart surgical 
patient, Frank Gerbode was at the vanguard of those who computerized the 
various physiological parameters so important in that crucial period of 
convalescence . 

Outside of the operating room, Frank Gerbode was a most generous individual. 
Colleagues from all over the world were welcome in his beautiful home, and he 
liked nothing better than to take them out in his sailboat for a day on 
San Francisco Bay. Having trained upwards of 200 cardiac surgeons worldwide, 
Dr. Gerbode never needed to find hotel accommodations wherever he travelled. 
He was the father figure for many younger cardiac surgeons and physicians. 

Frank Gerbode brought much worldwide attention to Stanford University. 
As it is said, however, a prophet is never without honor except in his own home 
town. With the retirement in 1955 of Emile Holman from the chair of surgery 
at Stanford, the obvious choice of Frank Gerbode to be the successor was not 
forthcoming. The Pacific Coast Surgical Association, for which Frank Gerbode 



ii 



had often been the host when that group would meet in Hawaii, likewise failed 
the opportunity to appreciate Dr. Gerbode by making him its president. Neither 
of these slights seemed ever to bother Frank Gerbode, but it is interesting 
to speculate what might have happened to clinical medicine at Stanford if 
Frank Gerbode had been chairman of the department of surgery when the medical 
school moved to Palo Alto. 

Staying in San Francisco and almost single-handedly building a new 
medical center to become known as the Presbyterian Hospital and the Pacific 
Medical Center, Frank Gerbode continued to perform and support significant 
research as well as developing in a private hospital environment a most 
respectable educational program. National and international honors compensated 
for the lack of local recognition and appreciation given to Frank Gerbode. 
He was an honorary member of the Royal College of Surgeons of England and 
Edinburgh. He was president of the American Association for Thoracic Surgery. 
In 1982 he was the first recipient of the Michael E. DeBakey Award for 
Excellence in Cardiac Surgery. 

All-in-all, Frank Gerbode was a man of tremendous quality. Everything 
he did had the touch of excellence about it. Like the late Henry Kaplan, the 
renowned radiotherapist and conqueror of Hodgkin's disease, Frank Gerbode 
would tolerate only the highest quality work. 

Frank Gerbode had his off days. As Somerset Maugham once said, "Only a 
mediocre man is always at his best." But on his best days, and Frank Gerbode 
was usually at his best, he had mighty few peers. As Frank would say, "Life 
goes on," so it is left for the rost of us to do our best and hope that its 
performance will come close to the standard that he established for us. 



Norman E. Shumway, M.D. 



29 April 1985 

Department of Cardiovascular Surgery 

Stanford University 

Palo Alto, California 



iii 



INTERVIEW HISTORY 



Frank Leven Albert Gerbode was interviewed by the Regional Oral History 
Office to document his professional career as a pioneer of cardiovascular 
surgery and to record other aspects of his many-sided life. Highlights of 
the medical and surgical portions of the interviews include his contributions 
and those of his surgical colleagues to the explosive growth of cardiovascular 
surgery after World War II, his development with M.L. Bramson of a membrane 
heart-lung machine, his formation and leadership of the first open heart 
surgery team on the West Coast, his collaboration with John J. Osborn in the 
organization of a computerized monitoring system for postoperative patient 
care, and his prominent role in the foundation of the Institutes of Medical 
Sciences (now the Medical Research Institute) at Pacific Medical Center, San 
Francisco. 

Although retired from surgery since 1980, Dr. Gerbode at the time of the 
interviews was anything but inactive. He was director of the Heart Research 
Institute, and a trustee on the board of directors of both MRI and the Pacific 
Medical Center. He was an active member of numerous surgical societies, and 
made frequent trips to attend meetings across the country and around the 
world. On these occasions he usually encountered some of the former fellows 
of the training program in cardiovascular surgery which he founded at the 
Heart Research Institute. Dr. Gerbode regarded the training of this outstanding 
group of surgeons as his greatest professional accomplishment. 

Dr. Gerbode 's international renown in cardiovascular surgery appears from 
his account in the interviews to have been due to a combination of factors. 
He returned from World War II with wide surgical and organizational experience. 
However, like many other American surgeons who had interrupted their careers 
to go to war, he found few opportunities to operate when he returned home. With 
time on his hands, he turned to the dog lab where he developed operative skills 
and procedures which were to serve him well when surgical cases subsequently 
were referred to him. The war and immediate postwar years produced the 
ingredients for the rapid growth of cardiovascular surgery: such things as 
antibiotics to control postoperative infection, better blood typing and handling 
methods , improved techniques for administering anesthesia with an open chest , 
efficient respirators, and the first primitive heart-lung machines. 

There was in addition a conceptual change. The prewar notion that the 
heart was surgically inviolate had been proven wrong by Dwight Harken and other 
pioneers of heart surgery. Dr. Gerbode, well trained in the practice of surgery 
and the protocol of the research laboratory, was in a fine position to take 
advantage of the opportunities in the promising new field of cardiovascular 
surgery. 



iv 



But circumstance and timing are not in themselves sufficient to explain 
Dr. Gerbode's professional achievements. First and foremost, he was a man of 
diverse abilities. In respect to surgery, he possessed the rigorous education, 
manual dexterity, and wide surgical experience required for the formation of 
an outstanding surgeon. In addition he had the ability to attract able people 
as his collaborators and assistants. His successes with the open heart surgery 
team, the surgical fellows training program, computerized patient monitoring, 
and the membrane heart-lung machine are testimony to this ability. He also 
had organizational and leadership skills and what he called a logistical sense 
which permitted him to keep his complex professional and personal affairs 
running smoothly and productively. Last but not least, he had vision, a 
willingness to risk the unknown and untried, and the personal warmth and social 
and financial connections to win support for his ventures. 

In addition to his professional concerns, Dr. Gerbode had many philan 
thropic, social, and artistic interests. He was a trustee of the Wallace A. 
Gerbode Foundation, a family philanthropy which he and his wife, Martha Alexander 
Gerbode, established in memory of their oldest son. After the death of Mrs. 
Gerbode in 1971, their daughter, Maryanna Gerbode Shaw, and son, Frank Albert 
Gerbode III, became board members. 

A genial and sociable man, devoted to family and friends, Dr. Gerbode was 
also active in the social and artistic life of San Francisco. In his free 
time, if that can be imagined, he enjoyed sailing on San Francisco Bay, skiing 
at Sugar Bowl, duck hunting in the Sacramento Valley, visiting his farm on the 
island of Kauai, and painting in oils and acrylics. 

Dr. Gerbode was a tall man, distinguished in appearance, with glasse, a 
full head of white hair, and a neat mustache. He was fond of clothes, particu 
larly ties, and was always impeccably dressed. One was struck by the directness 
of his manner and gaze, which were tempered by his sense of humor, ready 
chuckle, and infectious love of life. 

Dr. Gerbode died unexpectedly on December 6, 1984. A memorial service, 
attended by family, friends, and members of the medical and civic communities, 
was held at Grace Cathedral on December 14. A tape recording of the service led 
by Dr. Gerbode's friend, the Very Reverend C. Julian Bartlett, Dean Emeritus 
of Grace Cathedral, is on file in The Bancroft Library. 



The interviewer: Sally Smith Hughes is an interviewer on medical and 
scientific topics for the Regional Oral History Office. She has degrees in 
zoology and anatomy from the University of California and a Ph.D. in the 
history of medicine from the University of London. 



Circumstances of the interviews: The first twelve interviews were 
conducted between July 20, 1983 and October 23, 1983 in Dr. Gerbode's office 
in the Medical Research Institute at 2200 Webster Street, San Francisco. The 
office, replete with medical books and memorabilia, included a couch stacked 
with current journals and catalogs which he was in the process of reading. 
Over his desk hung a collage of family photographs and mementos, including 
several shots of his sailboat. 

A second set of ten interviews was conducted between April 12, 1984 and 
November 14, 1984 after Dr. Gerbode and the interviewer realized that several 
topics had inadvertently been omitted from the earlier sessions. Many of the 
topics were suggested by reading Dr. Gerbode's extensive correspondence which 
provides an insider's account of the growth of cardiovascular surgery on the 
West Coast.* 

The second series of interviews were conducted in the library of Dr. 
Gerbode's large, art-filled home on Divisadero Street in San Francisco. The 
sessions were preceded or followed by lunch and conversation in the dining 
room overlooking an old fashioned flower garden and San Francisco Bay. 

Editing: The transcribed interviews were edited with an eye to accuracy 
and clarity. In a very few instances material was rearranged for the sake of 
continuity; the change in such cases is noted at the bottom of the appropriate 
page. Repetitions understandably occurred because of the long period (almost 
one and a half years) during which the interviews were conducted. They were 
not eliminated unless they added no further information. Dr. Gerbode reviewed 
the edited text and made minor deletions, changes, and additions. His sudden 
death prevented his editing the final three interviews. 

Note on terminology: The name changes of several institutions with which 
Dr. Gerbode was associated may be confusing to the reader. Stanford Hospital 
in San Francisco became Presbyterian Hospital when Stanford University moved 
its medical school to Palo Alto in 1959. The new Presbyterian Hospital, whose 
operating and recovery rooms Dr. Gerbode helped to design, opened in April 
1973. In 1959, the Institutes of Medical Sciences (IMS) were organized by 
Dr. Gerbode and others to continue the medical research activities of Stanford 
Hospital. In 1982, the name of the IMS was changed to the Medical Research 
Institute. The organization consisting of the Presbyterian Hospital, the 
Medical Research Institute and several other buildings, and bordered by Clay, 
Sacramento, Buchanan, and Webster Streets, is now known as the Pacific 
Presbyterian Medical Center. 



Sally Hughes 
Interviewer-Editor 

6 April 1985 

Regional Oral History Office 

486 The Bancroft Library 

University of California at Berkeley 



*At the time of writing, the destination of Dr. Gerbode's correspondence was 
unsettled. 



I FAMILY BACKGROUND, EDUCATION AND EARLY CAREER 
[Interview 1: July 20, 1983 ]## 



Grandparents, Parents, Brother and Sisters 



Hughes: Dr. Gerbode, could you tell me a little about both sets of grand 
parents, what their names and professions were, and where they 
lived? 

Gerbode: I don't know too much about my grandparents, because they were in 
Europe, except for one, and they were quite old. I was the last 
of four children, so that by the time; I came along, they'd pretty 
much vanished from the scene. But in any event, the first Frank 
Gerbode came to California in 1850. He apparently came through the 
southern route, from New Orleans. He was Frank Albert Gerbode and 
the first one in California. He became a goldminer. What he was 
before he was a goldminer, I don't have any idea. He established 
a homestead in El Dorado County and started gold mining. When he 
was there, he hired some Chinese and French [workers] to help him 
with what was then a pocket mine. We still have the property. It's 
a hundred and sixty acres in El Dorado County. It hasn't been 
mined since he died many years ago. 

He brought over my father, Frank Albert Gerbode*, from Germany 
when my father was quite young, and became his foster father. In 
other words, he adopted him after he got him over here. My father's 



##This symbol indicates that a tape or a segment of a tape has 
begun or ended. For a guide to the tapes see page 505. 

*Frank Albert Gerbode II was the nephew of Frank Albert Gerbode I. 



Gerbode: mother was named Mary Lewis. She was an English woman from 

London. How they got together, I haven't any idea. But apparently 
they were married. 

Then on my mother's side, she [Anna Marie] came from the 
Rhineland, and her father was a Scotchman by the name of Leven. 
How her father got to the Rhineland from Scotland, I haven't any 
idea. 

My father came to Placerville and eventually started a 
construction business and built several small towns and mining 
towns in El Dorado County. He was a hard-working, honest man. He 
was a good deal older than I. My mother was forty-three when I 
was born.* My father was fifty-three, so there was a big gap of age 
between both of them and myself. 

Hughes: Were they married late? 

Gerbode: Yes. Then they had four children. They had a son named Albert, who 
was in a submarine in the First World War. He settled in Florida 
after the war, went into real estate and was quite successful. Then 
he was on his way to New York on a yacht with a friend of his. They 
had to stop for fuel, and in the skiff in which he was rowing, a big 
wave came, the fuel tank hit him in the head and knocked him out, 
and he was drowned. He had no children. 

Hughes: Was this right after World War I? 

Gerbode: Soon after the war. I had an older sister by the name of Louise, 
who was a beautiful girl. She died of acute glomerular nephritis 
a few days after she graduated from high school. That was a 
tremendous blow to my mother and father. 

I had another sister, Gertrude, who became a business woman 
and worked for Blake, Moffitt and Towne, a paper company, and 
became an expert in fine paper. She was quite an authority on where 
to get fine paper for special jobs. 

Hughes: Is she alive? 

Gerbode: No, she died of a coronary about ten years ago. So that's the 
family. 

Hughes: Let me ask you a question about the name Gerbode. You said that 

your real father was German, but what about your step grandfather? 

Gerbode: My step grandfather was from near Hanover. 



*February 3, 1907. 




Frank Gerbode, at three months and at school age 



Hughes: So Gerbode is 

Gerbode: Gerbode is an old Saxon name. It's a strange name. Once I found 
a Gerbode in the telephone directory when I was traveling around. 
I didn't look them up because I wasn't sure that I might want to 
get connected with them. You never know what you might run into. 
There are some big advantages in having a name that's rare. People 
know who you are. 

A friend of mine in Australia once was curious about the name. 
He's a voracious reader, and he found an old Belgian book. In it 
there is a Count Gerbod, and he thought this probably was an 
ancient ancestor. He apparently was a soldier-type who lived in the 
early fifteenth century. But whether that's true or not, I 
haven't taken the trouble to find out. But he thought this was a 
great discovery, that he'd found a Count Gerbod, who was apparently 
from an old Belgian family. It's possible, because it's not too far 
from Saxony. I suppose if I wanted to spend some money, I could 
trace it all back. 

Hughes: I'm interested in the fact that your father was adopted by your 
great uncle. Do you know any more about that? 

Gerbode: No, I don't know why. It was so long ago by the time that I got 

curious that none of us in the family really paid much attention to 
it. I guess when [my great uncle] brought him over here, he felt 
that he'd do better adopting him than just having him live here. 

Hughes : But it was more than a working arrangement . 

Gerbode: I think he was very fond of him, and I guess helped him get started 
in his business. There's the old miner's cabin there on the wall, 
[points to photographs] That's the original miner's cabin, which 
my father and I rebuilt when I was seventeen years old, using some 
of the original logs, but cutting other logs from the same property. 

Hughes: Was he successful as far as the gold mining was concerned? 

Gerbode: He apparently was fairly successful, but unfortunately, he was very 
generous, and no one came by his place, I guess, without leaving 
with something. He hired quite a few people to help him with that 
mine. He once also saved old man Studebaker's life. The original 
Studebaker lived up there at the same time. I guess they were out 
at a wild party some Saturday night. He pulled him out of a creek 
before he drowned. So the story goes, anyway. 



Hughes : 



Gerbode: 



Grammar School and High School Education 

Let's get a bit more detail about your childhood, 
where you went to grammar school? 



Do you remember 



Yes, I went to public grammar school in Sacramento. I went through 
half of high school there, too. My sister was living in San Francisco, 
and I decided I'd rather come to San Francisco to finish high school. 
So I came and stayed with my sister and her husband , and went to 
private school to finish high school. 



Hughes: Which school? 



Undergraduate Education at Stanford 



Gerbode: It was called Raymond School. It doesn't exist any more, but it 

was a school with very few students. I finished there, and then I 
took the college board examinations and applied to the University 
of California in a premedical course. I didn't like the University 
of California. I went for a summer session, and I found it highly 
competitive and too big for me. So I decided I didn't want to go 
there. 

This was in the summer, and it was too late to apply to 
Stanford then, so I went to the University of San Francisco. I stayed 
there until I could get into Stanford, which was a year or so later. 
Then I finished my premedical courses at Stanford and went into 
medical school there. 

Hughes: What about this decision to come to San Francisco? 

Gerbode: Maybe I had a feeling Sacramento was too small. That sort of sounds 
demeaning, but I wanted to see something on a broader basis. I'd 
been to San Francisco a few times, and I liked the atmosphere in 
the city very much. I had a good opportunity to stay with my sister, 
so that's what I did. 




Left: 

Frank with his first car (?) 



Be low : 

Frank, about seventeen, with 
his father, Frank Albert 
Gerbode, II, at the log 
cabin which they rebuilt one 
summer on family property 
near Placerville, California 






, * 









The Decision to Go into Medicine 



Hughes: What about your parents' attitude toward education? 

Gerbode: My father wanted me to be a businessman. I don't know why he 

thought I would have made a good businessman, but to satisfy him, 

I went to a business college for about six months and learned how 

to do bookkeeping and accounting and a few things like that. 

Hughes: That was in Sacramento? 

Gerbode: Sacramento. I got a good job for about six months with the Pacific 
Gas and Electric Company and showed him that I could do it. Then 
I went to him and said, "Now I showed you I could do it, but I don't 
want to do it." My mother wanted me to be an architect. 

Hughes: Why did she have that idea? 

Gerbode: I don't know. She thought I could draw, and she thought it was a 
very good profession. They both thought being a doctor would take 
too long, and maybe it was uncertain. It was a kind of a future 
that they hadn't been closely familiar with. 

Hughes: There was nobody in the family in the medical profession? 

Gerbode: No. 

Hughes: How did you get the idea to go into medicine? 

Gerbode: I suppose because in Sacramento I got to know a few doctors, and 
they all seemed to lead quite independent lives, which I liked. 
They didn't have bosses, and they weren't beholden to anybody. I 
think the independence appealed to me, as well as being able to 
do something for somebody else. So I think it was the independence 
and the desire to do something for somebody else that got me 
started on it. 

Hughes: Had you had any particular interest in the sciences? 

Gerbode: No, I hadn't. I took the usual courses in high school, but I can't 
say that I was very good at them, [although] I got fairly good 
grades. I think all the courses I took in high school, and later 
on in college, were to accomplish the aim of getting there. If they 
set a path for you in any career, and they say you have to go 
through these steps to get there, then you have to do it. So I did 
it. 



Extracurricular Activities at Stanford 

Hughes: What about extracurricular activities? 

Gerbode: I didn't do too much. When I was at Stanford, I really wanted to 
play tennis and do some other things like that, but I was too 
worried about not getting into medical school. So I really 
studied very hard. I got very good grades. 

I did run for men's council at Stanford, though, and was 
elected. Men's council is a student body group which governs a lot 
of activities and sets standards for students. I was pleased that 
they elected me. 

Hughes: Was that your first taste of politics? 

Gerbode: I think it probably was the first time I ever accepted an invitation 

to run for an office. Later on, in medical school, I was president 

of the student body. I can't say that I worked very hard to get 
the job, but they elected me anyway. 

Hughes: Does that imply that you were a well-known individual in medical 
school? 

Gerbode: I guess maybe nobody else wanted the job. I believe I was pretty 
well liked. 

Hughes: What year of medical school was this? 

Gerbode: Nineteen thirty-six. 

Hughes: So this was your last year at medical school. 

Gerbode: Yes. 

Hughes: Do you have to be a senior? 

Gerbode: They usually elect somebody in the senior class. 



Financing the Stanford Tuition 



Hughes: How did you finance the Stanford tuition? 

Gerbode: I worked in the summer. I accepted a certain amount of money from 
my parents. I won a scholarship when 1 was down there, too. 



Hughes: This is medical school or undergraduate? 

Gerbode: Undergraduate. I kept it for a year. It was a scholarship which 
paid my tuition. I also worked in the summers at various jobs. 
When I ran short of money, I would call my family for support, and 
he always helped, but I didn't really depend on him entirely. 
Although he would have helped me more than he did, I didn't want to 
do it that way necessarily. 

Hughes: Were they pleased that you were going to Stanford? 

Gerbode: Yes. I think it scared them half to death to think that I was 

going to try to become a doctor rather than a businessman, but they 
accepted it after a while. 



The Major in Physiology 



Hughes: I know you majored in physiology. Did you know immediately that 
that's what you were interested in? 

Gerbode: I think the reason I got involved in physiology was that I 

realized that this was a science very close to medicine. Also I 
had an opportunity to do research in the summer in the department 
of physiology, and I liked the idea that I could start doing 
research as an undergraduate. 

My brother probably is responsible in part for that, because 
he was also very interested in research and worked with Thomas 
Edison for quite a while on electrical devices. Even when he was 
in real estate, he worked some with Edison. Maybe my brother was 
a hero to me in a way, and maybe I thought, "If he can do it, 
maybe I should try to do it, too." 

Hughes: Did he have any special background? 

Gerbode: He was trained in electrical engineering, and he was on a submarine 
during the First World War as a trained electrical engineer. 
Submarines run on electricity, so they need people who can understand 
it. I guess maybe he inspired me in a way which he didn't know about. 
Then when I had the opportunity to do research at Stanford in the 
summer in the physiology department, I was rather intrigued with 
the possibility of making a discovery. It was a very good summer. 

Hughes: Can you tell me about your first research project? 



8 



Gerbode: The first research project was like Pavlov's experiment, and it 
was to teach cats to go a certain way through a maze. I had to 
construct a maze and train them in avoiding certain turns in 
this maze to get at the food. It was an experiment in conditioned 
reflexes. 

Hughes: Was this something that somebody in the department was interested 
in? 

Gerbode: Yes. 

Hughes: What was the standing of the department of physiology? 

Gerbode: The department of physiology was one of the good departments. It 
wasn't outstanding. Unfortunately, at the time they were changing 
the chairmanship, and the two men who were assistants to the chief 
were not sure about their future , and the chief was not very 
effective. But one of the young men who was second in command was 
the one who helped me do the research. 

Hughes: What was his name? 

Gerbode: Victor Hall. 

Hughes: Were you seeing this research as a tie-in with medicine? 

Gerbode: I was thinking it might help somewhere along the line. At the same 
time I took a minor in psychology. So it was part of the same 
concept of understanding things about the mind, I guess, that got 
me started. 

Hughes: Were you toying with the idea of specializing in psychiatry? 
Gerbode: No. At that time I thought maybe I might be a roentgenologist. 
Hughes: Why? 

Gerbode: Because I had met a couple of roentgenologists, and they seemed 
to be connected with all the various specialties and had to 
understand everything to understand the xrays properly. So I felt 
this was quite good. They also were quite independent as 
individuals, and this appealed to me as well. 

Hughes: What changed your mind? 

Gerbode: There were too many other fascinating things as time went on. 



The Decision to Become a Surgeon 



Hughes : 
Gerbode: 

Hughes: 
Gerbode: 



Hughes: 
Gerbode: 



Hughes: 



Gerbode: 



When did you decide that it was going to be surgery? 

I decided that after my sophomore year. I think I decided that 
I could do it, and if I could do it, then that's what I probably 
should do. 

Do it in what sense? 

Manually do it. And the other thing is, when I came up here to 
the campus.... You see, the second year [of medical school] was in 
San Francisco. It was in the old Cooper Medical School building, 
which was then the Stanford Medical School. I got interested in 
research as a student in the surgery department. That helped me, 
because then I could operate on animals and do certain experiments. 
The one who helped me with that was Professor [F.L.] Reichert. He 
got me interested in doing research. Dr. [Emile] Holman, who was 
the professor, was also very keen on doing animal research. He 
did a lot of experiments, and I started helping him as well. 

Was that unusual for a medical student to be engaged in research? 

No, not so unusual. There were always a few medical students who 
were doing some research. I would say that the vast majority did 
not do anything like that, but there were always two or three or 
four in every class who were interested. Later on when I was on 
the faculty and found a student who was interested in doing research, 
I was very anxious to help him, because I knew what pleasure he 
was going to get out of it . We had several students in the old 
lab whom I helped get started, who are now professors of surgery. 

One of them was a biomedical engineer. He had two degrees 
from Stanford, one in biology, and the other in engineering. He 
went to Cornell as an intern, and he soon was doing better research 
in the medical school than some of the senior departmental people, 
because he was trained properly, and he had the experience in the 
laboratory, so he knew what to do. 



Was the European model of medical research still in force? 
very early that Germany was held up as the prototype. 



I know 



The big thing in those days was Vienna, but Vienna was not so 

well known for research as they were for pathology. The people who 

went over to Germany in surgery, when they came back, were very 






10 



Gerbode: accepted. They were accepted because they presumably had had 
exposure which they couldn't get in this country. Vienna, and 
Scotland, too, had very good reputations for training young men. 

Hughes: You were already thinking of combining surgery with research? 

Gerbode: Yes. 

Hughes: In an academic setting? 

Gerbode: Yes. I never really stopped doing it, either. I started doing it 
as a student, and I did it when I was in training. As soon as I 
came back from the war, I started right back in the experimental 
laboratory. 



The Stanford Medical Curriculum in the 1930s 



Hughes : 
Gerbode: 



You were in medical school between 1932 and 1936. 
Depression. Did that influence you in any way? 



This was the 



Hughes : 
Gerbode: 
Hughes : 
Gerbode: 
Hughes : 
Gerbode; 



Nobody really had very much money in those days. I was able to 
have a little car. I had a little Ford. The medical school was 
clinically oriented. It was an Oslerian type of medical school, 
built on studying the patients and teaching from them, so we had 
lots of contact with patients, even as students. And lots of 
contact with the professors, too. 

The first year? 

In the sophomore year, not in the freshman year. 

The freshman year was at Stanford. 

Yes. 

In the basic sciences? 

That was anatomy and biochemistry and physiology. The old Stanford 
Medical School was built around sick people. The science and the 
practice was built on the [medical] problem. There were fewer 
lectures than in some schools, so it wasn't a didactic kind of 
school. A lot of people still think that that's a much better way 
to teach than with lectures. 



11 



Hughes: What subjects did you take in the second year? 

Gerbode: It was required that we took physical diagnosis, history taking 
and learning how to write orders, and pharmacology. I found 
pharmacology pretty hard. I don't know why. I got a B in it 
finally, but it didn't come easily for me for some reason. I 
think the professor scared me. 

Hughes: Do you think it was the chemistry? 
Gerbode: It may have been the chemistry. 

Hughes: Were you finding that your undergraduate education was holding you 
in good stead? 

Gerbode: I think it was all right. I managed to get good grades. I could 
understand what was going on all the time. 

Hughes: Was the medical school pulling from all over the country, or was it 
a local, California school? 

Gerbode: They brought students from all over the country, but most of them 
were Calif ornians. 

Hughes: What was its reputation? 

Gerbode: It was considered among the top medical schools in the country. 



Research in Medical School 



Hughes: Tell me a little about the research that you did in medical school. 

Gerbode: I got interested in some research, first of all, on a certain 

inflammatory disease of the intestine. Nobody could find out why 
it occurred in certain people, so we tried to simulate it in the 
experimental animal. Professor Reichert thought it was due to 
obstruction of the lymphatic system of the small intestine, so we 
had to try to design an experiment which would prove or disprove 
that. I'm not sure that we ever proved that it was caused by 
that, but we spent a lot of time on it. I wrote a couple of papers. 

Hughes: Was there anything else? 



12 



Gerbode: Later on I got interested in the heart and did some experiments 
to create certain congenital abnormalities in the experimental 
animals, so that we could study them, and the animal that had 
that disease. This was great fun, and I liked that very much. 

Hughes: Why the heart? 

Gerbode: 1 guess because some of us felt that this was going to be the next 
frontier in surgery. The other thing was, Dr. Holman was very 
interested in curculation and the heart. I helped him with a lot 
of cases connected with the major vessels. Also, he had done some 
experiments on the heart as a medical student at Hopkins, and I 
guess this interested me as well. I began to read about what 
the previous generation had done, and tried to understand what was 
happening in the circulation. Probably the fact that I had taken 
physiology for more than the average amount of time fitted in well 
with trying to understand the heart and circulation. 



Emile Holman, Surgeon 



Hughes: Holman [was your mentor]? 
If 

Gerbode: As soon as 1 decided 1 wanted to be a surgeon, then [Holman] was 
my boss. He had a very fine reputation in the country as an 
experimental surgeon, but also because he was the last resident 
trained under [William S.] Halsted, who was the father of American 
surgery. [Holman] also started the residency type of training at 
Stanford Medical School. 

Hughes: Do you remember when that was? 

Gerbode: I think he came out in the twenties from Hopkins and started the 
residency type of training, which then followed right straight 
through until he retired. 

Hughes: Was he American? 

Gerbode: Yes. He was the son of a minister. This also came out in many of 
the things he did, in his personality. 

Hughes: Can you expand a little on that? 



13 



Gerbode: He had strong feelings about right and wrong. He was of German 
ancestry, and this was also very apparent. So he combined some 
of the things he picked up from his father with his Germanic 
background; it brought out a very strong person. 

Hughes: I'm sure that influenced your relationship. 
Gerbode: I had to cope with it. 
Hughes: He was very much the boss. 

Gerbode: No question about it, he was the boss. And if you did something he 
didn't like, he told you right away. There was no question about 
that. 

Hughes: Was he a general surgeon? 

Gerbode: He started out being a general surgeon, but he really finished by 
being a general and a thoracic surgeon. He also made his 
reputation by being one of the early vascular surgeons, although 
he didn't do many of the new, innovative things as a vascular 
surgeon. He was mainly interested in arteriovenous fistulas, which 
are connections between the arteries and the veins. These 
connections produce certain physiological changes in the veins 
and in the circulation, which interested him a great deal. He spent 
most of his experimental life working on these particular 
abnormalities . 

Hughes: In animals? 

Gerbode: In animals and in humans, too. Some [arteriovenous fistulas] are 
congenital , and some are the result of stab wounds or gunshot 
wounds. So we always had a certain number of patients around with 
these abnormalities. For somebody interested in the circulation, 
this was very good. 

Hughes: And the fistulas could occur anywhere in the body? 

Gerbode: Usually they were between the major vessels, like the femoral 
vessels or iliac vessels or arm vessels. 

Hughes: That would mean operating right around the pericardium. 

Gerbode: Operating there, and also on the major vessels. 

Hughes: Which I believe was very unusual in the prewar days, was it not? 



14 



Gerbode: Yes, it was unusual. 

Hughes: My understanding, from the little reading I've done, is that the 
heart was considered until World War II to be surgically 
inviolate. 

Gerbode: Oh, yes. There were some German surgeons who said that any surgeon 
who ventured to operate upon the heart was virtually insane. 
[C.A. Theodor] Billroth was one. The first stab wound was repaired 
by [Ludwig] Rehn in 1896, I believe. 

Hughes: Were you actually participating in surgery on humans at this 
point? 

Gerbode: Not as a medical student. We were required, if we had a patient 
assigned to us on the wards, to follow the patient through the 
operating room, so I did help operate upon patients by being an 
assistant, such as holding a retractor. But most of [the surgical] 
work came during or after the war. 

Hughes: Would you consider yourself a protege of Holman? 
Gerbode: Yes. 

Hughes: Were there other people on the faculty with whom you had a special 
relationship? 



F.L. Reichert, Neurosurgeon 



Gerbode: Reichert, the professor of neurosurgery, influenced all of us a 

great deal. He was very interested in the residents, very interested 
in training, and very hard on us if we did things wrong. He 
watched our careers a great deal. Sometimes even more than Holman. 
He was more interested in seeing that the young men got on in 
their careers, and very interested in getting things published. He 
was always available for advice. 

He wanted me to be a neurosurgeon and almost killed me , I 
think, when I told him I didn't want to be a neurosurgeon. The 
reason I didn't want to be a neurosurgeon simply was because, for 
all the hard work they did on the nervous system, there were very 
few patients who got well. We worked terribly hard keeping them 
alive during my residency period. Long hours of operating upon 
them, and then you'd end up by having somebody that was paralyzed 
or a vegetable. 



15 



Hughes: Was it mainly the length of the operation? 

Gerbode: No. The brain is a very sensitive organ. If it gets a tumor, 
unless it's one of the rare benign tumors, you can keep people 
alive, but they are not very well when they're alive. 

Hughes: So it was the poor success rate that discouraged you. 

Gerbode: Yes. Actually, a great many young men were quite entranced with 
the idea, brain surgery being the big thing when I was a young 
surgeon. It was very exciting to be a brain surgeon, or to be 
training as a brain surgeon. I didn't like the poor yield. 

Hughes: And yet some people would have considered that you had jumped from 
the frying pan into the fire by turning to cardiac surgery. 

Gerbode: Yes, I think so, but on the other hand, I could see that [cardiac] 
conditions could be mechanically corrected, if you could just 
figure out how to do it, and you didn't end up by having somebody 
who was decerebrate or paralyzed. 

Hughes: Were you doing a fair amount of reading at this time, too? 
Gerbode: Yes. 

Hughes: Did the fact that you were doing so much practical work mean that 
there wasn't a lot of bookwork connected with your studies? 



Cardiovascular Surgery Before World War II 



Gerbode: The reading in cardiovascular surgery was very limited at that time, 
when I was in my early training years, because there wasn't very 
much going on. 

Hughes: What was there? 

Gerbode: In medical school there was very little. During the war, we got 

more of it. But before I went into the war, around that time, some 
of the first heart operations were beginning to be done. This was 
very exciting, to see that you could physiologically improve 
somebody with an operation on the heart, and you had a living person 
who then could walk and work and be effective again. 



16 



Hughes: A few people were trying I believe it was in the twenties to 

do mitral valve surgery. Then there was a great hiatus until the 
postwar years. 

Gerbode: Yes, that's right. I was very fortunate, because I was there at 
the right time. I guess that some of the first operations were 
done by people like Elliott Cutler at [the Peter Bent] Brigham 
Hospital. Then there was a fellow by the name of [Sir Henry Sessions] 
Scouttar, an Englishman, who did one of the first mitral valve 
operations. But a lot of people thought that both of them were a 
little bit off their rockers for trying it. 

Hughes: They both had trouble getting patients, did they not? 

Gerbode: Oh, they had terrible trouble. But we also had trouble here later 
on.* 

Hughes: Had Cutler and Holman had any contact? 

Gerbode: Yes, they were associated because Dr. Holman was at the Brigham 
for a little while. After his residency at Hopkins, he went to 
Brigham for a year or two. They got to know each other then. 
There was another fellow who was around at that time at Hopkins 
by the name of Mont Reid. He went to Cleveland and he was also 
interested in the circulation. Halsted was the one that started 
thinking about the circulation. He did simple things, like tying 
off an artery, but illustrated some very fundamental points about 
the circulation in so doing. 

Hughes: And that's probably what got Holman started. 
Gerbode: That's right. 

Hughes: Did you have any time for extracurricular activities during medical 
school? 



Marriage 

Gerbode: I was married in 1931. 

Hughes: So just before you started medical school? 



*The problem of the resistance of cardiologists to heart surgery is 
discussed in session 5, 8/16/83. 



17 



Gerbode: Yes, my last year at Stanford. 

Hughes: Was that a bit unusual in those days? 

Gerbode: A little. 

Hughes: How did you handle it financially? 

Gerbode: My wife, Martha Alexander Gerbode, had a little money, and between 
the two of us, we were able to make it go. She had quite a bit 
more money than I did. 

Hughes: So she didn't have to work. 
Gerbode: She didn't have to work. 
Hughes: Tell me how you met. 

Gerbode: We met in the experimental psychology class at Stanford. My 

parents had meanwhile moved to Piedmont across the bay and her 
parents were in Piedmont, too. So we started riding back and forth 
to Stanford together. 

Hughes: Does that mean you lived at home? 

Gerbode: No. I went home for weekends. That's how we got to know each 
other. 

Hughes: Why did your parents move to Piedmont? 

Gerbode: I can't remember why they did. But I guess it was because my sister 
was living in the Bay Area, and they wanted to live closer to her. 
It wasn't because of me, because I'd already wandered off into .this 
academic path. 

Hughes: Where did you live? 

Gerbode: We lived at Stanford together. First, we rented a little house. 
Then when I came up to medical school here, we lived in a nice 
little brown house on Broadway. We had our first child there, a son, 
Wallace Alexander. 

Hughes: What year was that? 

Gerbode: I think that was about 1933. He subsequently was killed at 
Stanford in an auto accident. 



18 



Hughes: How old was he? 
Gerbode: He was nineteen.* 



Internship at Highland Hospital, 1935-1936 



Hughes: Tell me about your internship at Highland Hospital in Oakland. 

Gerbode: By the time I finished medical school, I decided I wanted to try 
to be a surgeon. I felt that if I got into a regular surgical 
training program, then I wouldn't have an opportunity to deliver 
babies and do a lot of things in general medicine. So I decided 
a year of rotating internship would be good for me. 

Hughes: This was before you graduated, is that not true? 

Gerbode: Yes, you took your internship before they gave you the degree. 

Hughes: It was still four years? 

Gerbode: Still four years, and then another year before they gave you a 

degree. But anyway, the other reason was, my mother was very sick. 
She was in Piedmont, and she was bedridden. We had one son, so I 
wanted her to have the pleasure of seeing her grandson. My wife's 
mother was also not well. [We were] the only family they had 
really. So I felt it was better to be over there and let them see 
the grandson and see more of us, too. 

Hughes: Can you describe your internship? 

Gerbode: It was very hard work. I was sick twice during it, because I just 
got worn out. I got sore throats and all kinds of things. I 
really took it very seriously. 

Hughes: Were you getting paid anything in those days? 
Gerbode: Yes, fifty dollars a month. [laughter] 
Hughes: For twenty-four hour days. 



*Discussion of Gerbode family members and property on Hawaii was 
incorporated in later sections of the interview transcripts. 



Gerbode: 

Hughes : 
Gerbode: 

Hughes : 
Gerbode: 

Hughes : 
Gerbode: 

Hughes : 
Gerbode: 

Hughes : 
Gerbode : 



Gerbode: 



19 



I think the most I ever made as a resident was sixty dollars a 
month and room and board and laundry. Now they get paid over a 
thousand a month. 

You were living at the hospital? 

No. We found a little house in Piedmont, and rented it. Once in 
a while I had to stay the night, of course, when we had some 
special thing to do. 

Did Highland have any special reputation? 

It was a favorable place for a general rotating internship. It had 
a loose connection with Stanford. 

Stanford rather than UC? Do you know why that was? 

I guess because several of the people who became prominent in 
running the place were Stanford graduates. 



I was just too 



What about research? 

No, there was nothing at all. I had to drop that, 
busy taking care of sick people. 

Did you learn a lot from that experience? 

I took out a lot of tonsils. I delivered a lot of babies. I helped 
at a lot of gynecological operations and things like that, which I 
never really ran into afterwards, but I'm glad I did it. 

I was glad once, years later, when I was up at Lake Tahoe, and 
the clerk at the desk said, "There's a lady in labor in room X-Y-Z, 
and she found out that you are a doctor. Would you mind going to 
see her?" [laughs] So I went up to see her. She was certainly 
in labor, all right, but not too far along. I said, "Why did you 
come here when you're [about to] have a baby?" She said we just 
went to various resorts until we found there was a doctor registered. 

H 

Dr. Leo Eloesser was a good friend of mine. He was one of the 
famous professors [at Stanford San Francisco Hospital]. He had 
operated upon my mother, my father-in-law, and my mother-in-law. 
He had an extremely interesting life which has just been written 
up by Harry Schumacher. He liked me and was interested in me. Of 
course, I got to know him fairly well because of his having 



20 



Gerbode: operated upon the family so much. So I went to him and said, 

"I want to go into surgery eventually , but I want to go to Highland 
Hospital for my internship because I want that experience." 

He said, "Get out of that place as soon as you can." He 
didn't like the idea at all. 

Hughes: What was his reason? 

Gerbode: It wasn't a big teaching hospital like our county hospital 

[San Francisco General]. If I'd said I wanted to do the same here, 
it would have been all right , because he was the chief Stanford 
surgeon. People are that way. I wasn't surprised. 



Assistant in Pathology at the University of Munich, 1936-1937 



Gerbode: There are two reasons why I went to Germany. First of all, by that 
time I had decided I was going to try to be a surgeon, and I felt 
that pathology would be very important in the training of a 
surgeon. Now the belief is that physiology is a better preparation 
for surgery than pathology. 

There were two great German pathologist.s, world famous. One 
was [K.A. Ludwig] Aschoff and one was [Max] Borst. Aschoff was 
[head of the Institute of Pathological Anatomy] in Freiburg, and 
Borst was in Munich. So I did a little research on it, and I 
found out that Aschoff was a Nazi, or at least he was playing with 
the Nazi party, and Borst was not a Nazi. He didn't come out 
against [Nazism], but he wouldn't join anything connected with it. 
The Nazis didn't dare do anything to him, because he was too 
famous. As long as he didn't do anything overtly, they let him 
alone. Then I heard also that he was a very fine gentleman. So I 
wrote to him and asked him if he would take me on as a fellow for 
a year. 

Hughes: Was this the thing still, to go to Germany? 

Gerbode: No, not necessarily. Some went to Germany. Some went to other 
countries. 

Hughes: But it was usual for an American to go abroad? 

Gerbode: Not necessarily, no. 
[interruption] 



21 



Gerbode: Another man on the Stanford faculty, Alvin Cox, a pathologist, went 
with Aschoff the same year that I went to Borst. I found Borst 
to be an extremely nice gentleman, a real cavalier of the old 
school. We hit it off perfectly. 

The other reason I went was because I was curious to know 
what was happening in Central Europe at that time. The Nazis were 
getting terribly strong and talking a lot about things which I 
thought were very important to the world. So I decided if I went 
there, I could really look it over a bit without getting involved 
and at the same time get this training in pathology. 

Borst gave me the job, which meant I had a little lab. I went 
there every morning, went through the whole business of pathology 
every day, and went to the lectures. It was a very, very 
interesting time. Then my wife and I had to find a place to live, 
and we almost gave up in desperation. We were living in a tiny 
hotel in Munich. Finally somebody said, "We know a woman from 
Boston who's got a house just outside of Munich, and she rents it 
once in a while." So meanwhile I'd gotten myself a little Ford, and 
we went out and found this beautiful house outside of 
Munich in Geiselgasteig. That's where the movies are made now. 
They were beginning to make movies then, too. She said, "I'm 
terribly glad to see you, because I want to leave very shortly, and 
I'd much rather have somebody living in the house." She said, "You 
can have my servants, too." 

So we had this beautiful house with a driver and a cook and 
an upstairs maid on practically nothing. I was a young doctor, and 
she liked me. She was married to a wealthy banker from Boston, so 
the money didn't make any difference to her. So we moved in very 
promptly. We had one son at that time, the one that was killed 
later. The living part was wonderful. Johann, the man-servant, 
was terribly excited that I had a little Ford. He was a good driver, 
so he would drive my wife to do shopping once in a while. The 
lady had him fitted out with various uniforms for every occasion. 
So when he went into town, he had a driver's uniform. By the time 
you drove up in front of the house, he'd go around to the back of 
the house and open the door for you with a white coat on. 

Hughes: Wonderful! How is and was your German? 

Gerbode: I'd taken two years of German at Stanford. I could just barely get 
by, but the conversational German came to me fairly easily, because 
of the German I had at Stanford. I can still converse in German 
to a certain extent if it isn't too complicated. 

Hughes: And the lectures, of course, were in German. 



22 



Gerbode: The lectures were in German and I finally began to understand what 
they were talking about. 

Hughes: Was pathology in Germany a different beast than the pathology you 
had been exposed to at Stanford? 

Gerbode: Much more serious. Every person who dies in a hospital in Germany 
is autopsied and studied. It's a law, so it's a very important 
part of the whole structure of medicine. 

Hughes: How much pathology had you had? 

Gerbode: I'd had the regular courses in pathology in medical school, which 
was about a year. But in any event, at that time Nazism was just 
beginning to get pretty strong in Germany, and of course, Munich 
was where it all started. I began to notice driving into the 
institute in the morning that there were a lot of men out crawling 
through the mud and through barbed wire and marching. 

One time the whole southern German army went on maneuvers and 
came back and paraded through Munich. They'd obviously been put 
through the most severe training you could imagine. I didn't want 
to go to jail over there. I wanted to finish my year, so we were 
very careful not to break any laws. 

However, once we decided to go to Innsbruck, which is in Austria, 
and at that time the widow of the professor of surgery, Mrs. Ernest 
Ophuls, was over there, too. She was one of the great ladies of 
San Francisco. Even later in life she wore a dickie all the time. 
She looked us up as soon as I got there and was very friendly. She'd 
been going over every year to some place in Switzerland or Germany 
or Austria, and just happened to be nearby when we were there. So 
we went to Innsbruck together in my car. There was a rule that 
you couldn't take any German marks out of Germany. A lot of people 
were trying to smuggle them out in tires. We stopped at the border 
and were searched . I had about forty marks , which my wife had put 
somewhere on me as change, and without telling me. So there was a 
great deal of activity about that. 

Hughes: It all came out all right? 

Gerbode: Eventually. We had to appear before kind of a court in Munich a 
few days later. 

Hughes: You were allowed to go on? 



23 



Gerbode: Yes. We had to leave the money and to pay a fine, and then come 
back, and it was all right. But Mrs. Ophlils was so indignant with 
this guy later in Munich that he finally dropped all the charges 
against me. She was such an aristocratic woman, who spoke perfect 
German. She just alayed him verbally. 

Hughes: You were lucky. 

Gerbode: Oh, lucky, yes. But you know, they took her off and searched her 
completely. They made her take her clothes off, and they took my 
wife in a back room and did the same. 

Hughes: Why were they so concerned about the marks leaving Germany? 
Gerbode: They wanted to have everything regulated and under control. 

Hughes: What were your colleagues in the institute saying about the 
situation? 

Gerbode: Periodically they would say, "Don't you think that Germany is much 

better than the United States?" Little things like that. Or they'd 
ask me if I wanted to go to one of these indoctrinating lectures. 
I went to a couple of them where they were talking about racial 
background. This was when they were talking a lot about Lebensraum 
and about the people in East Prussia and Poland being of German 
extraction, and they really ought to be with the German government, 
and "We need that: land; they ought to be with us." There wasn't 
very much going on about the Jews that you could see on the surface, 
although there was an awful lot going on beneath the surface, I'm 
sure. 

Hughes: But you weren't really aware of that? 

Gerbode: Not in the beginning. But after I was there about six or seven 

months, I began to hear about Jewish people losing their property 
and jobs. 



Hans Borst 



Gerbode: Professor Borst had a son by the name of Hans. He was a charming 
young man. Then he was only about fourteen years old. [The senior 
Borst] began to worry that there was going to be a war. We began 
to discuss whether I would take Hans back with me to the United 
States. I said, "Sure, I'll take him." 



24 



Gerbode: This was his only son. He'd had a daughter who'd died of 

tuberculosis, and this was the child of a second marriage. He'd 
married a beautiful Hungarian woman who is still living in Munich, 
and they had this son Hans. Hans got all the beauty of his mother 
and all the savoir faire and intelligence of his father. But 
finally the professor decided that since he'd waited so long for a 
son, he just couldn't part with him. So we decided that we wouldn't 
take him to America. 

Anyway, the story of Hans goes on and on. It's still going on, 
incidentally. Whether you're interested in that now 

Hughes: Why don't you tell me. 

Gerbode: The war went on, and a couple of years later, Hans was old enough 
to be drafted into the army, so they put him in the paratroopers. 
He was such a strong fellow and a great skier, he went into a 
parachute outfit in Germany. They were fighting the English toward 
the end of the war, and his whole unit was captured. Then he was 
sent to an English prisoner of war camp, where he learned how to 
talk English perfectly. 

After the war was over, he decided that he wanted to become 
a doctor, so he went to the university, and then he decided that 
he'd like to come to this country to go to medical school. So I 
tried to get him into Stanford Medical School , but the dean 
wouldn't think of taking a foreigner into medical school. He was 
a very strange man in that respect, not very big minded about such 
matters. However, another friend of mine by the name of Harry 
Beecher, who was professor of anesthesiology at Harvard, and I got 
him into Harvard Medical School. So Hans then went through medical 
school at Harvard, and was married to a girl with some Jewish blood. 
He came out with me for an internship here , and I got him 
interested in pulmonary physiology. He did some work studying lungs 
and later went back to the public health department at Harvard 
and took a fellowship in physiology, continuing his work that he 
had started here. Then he got interested in running a heart-lung 
machine, because he was very good at physiology, so he started 
doing some work on extracorporeal circulation there. Finally he 
went back to Germany and got a job with a professor by the name of 
Rudolf Zenker, who was then professor of surgery at Munich. Later 
on, when heart surgery began to become a serious objective, [Zenker] 
put him on running the heart-lung machine. This continued for 
several years, until he was really kind of a super technician for 
the unit. The reason [Zenker] kept him there was because he was so 
good at it. But that wasn't the way to become a surgeon or a 
professor. 



25 



Gerbode: I went back to Munich several times after the war and kept in 

touch with Hans. I finally went to Zenker and said, "You can't 
do this to him. You've got to get somebody else to run that 
machine and put him in the regular training program in surgery, 
starting with general surgery and going through the whole business." 
So he did. He stayed on in the department there in Munich for 
quite a while and divorced his wife. I won't go into why. 
Subsequently he got married to a charming girl and had another 
daughter. He has a son by his first wife, who is a very fine 
student, very brilliant. He'll undoubtedly be a professor one day. 
When they started a whole new medical school in Hanover, [Hans] 
applied for the job and got it. So he's now the professor of 
surgery at Hanover and one of the strongest academic surgeons in 
Germany. Big, handsome, wonderful guy. Speaks perfect English. 
Very intelligent. Reads a lot. I see him almost every year. When 
he comes out here, he stays with me, and I see him at various 
meetings. 

So anyway, the year went by over there. I managed to stay out 
of trouble, and I think I learned quite a bit about pathology. My 
wife had a grand time. She loved shopping with the German hausfraus. 

Hughes: Were you being singled out as a foreigner? 

Gerbode: Yes. 

Hughes: You'd be particularly watched? 

Gerbode: Oh, yes. 

Hughes: What were they worried about? 

Gerbode: I guess they were afraid that we might take money out of the country 
or help people who were under surveillance. As an example, our 
cook's husband was a writer of some kind or other, and he was 
arrested because he wrote an article against the Nazis. He was 
put in a concentration camp. He stayed there for about six months, 
and they finally let him out if he agreed to write articles for 
the Nazis. They decided he might as well do that rather than die. 
So he came back to the house. He'd lost all his teeth. He looked 
like a walking cadaver. 

Hughes: So you were beginning to 

Gerbode: Get the picture. Then another family whom we met there, a Jewish 
family, an ophthalmologist, wanted to get out, too, because he 
could see that his job in the university was going to be terminated 
before long, and he might even be shipped off. So we helped them 
get out of the country, and I got him a job here at Stanford. 



26 



Hughes: How did you manage that without the German authorities knowing? 

Gerbode: I think at that time they were able to get out. If they didn't 

have a bad record, they let them emigrate. So that's what they did. 
She's an artist. She's still living. He died of cancer of the 
kidney after a while. I have at least twelve of her paintings at 
home. She still lives here. She married a publisher, Ed Grabhorn, 
in San Francisco. He subsequently died. She goes on painting. 

Hughes: What was his name? 
Gerbode: Sam Engel. 

Hughes: Was that the beginning of the persecution of the Jews, as far as 
you knew? 

Gerbode: No. When we were there, they began to take them out of positions of 
importance, demote them, or actually encourage some of them to 
leave the country. Those who were active, I guess, were simply 
locked up. You never knew about them. But I knew about the 
concentration camp outside of Munich. I knew it was there, because 
my cook's husband told me all about it. 

Hughes: Which camp? 
Gerbode: This was Dachau. 

I didn't write any papers when I was in Germany. I certainly 
learned that if a political group gets control of every part of 
the government, they can be pretty terrifying. 

Hughes: Were you specializing in any particular form of pathology? 

Gerbode: No, just general pathology. 

Hughes: What about Borst himself? What was his area of interest? 

Gerbode: Tumors. He wrote a very good book on tumors. 

Hughes: He was an MD? 

Gerbode: Yes. 

Hughes: Did he practice medicine? 



27 



Gerbode: 



Hughes : 
Gerbode; 



Hughes: 
Gerbode; 

Hughes : 
Gerbode: 



Only pathology. He was a full-time pathologist and a very famous 
person. Because of his work on tumors, he was an international 
scientist, you might say. Another part of the Borst story is that 
he had a little place in the mountains where he used to go on 
weekends. The head deiner in the institute would drive him up 
there. He invited me up a couple of times to this lovely little 
place in the mountains outside of Munich. After the war, his car 
broke down. He was standing on the highway while a man was fixing 
it, and an American truck came along and hit and killed him. 

Does that take care of the University of Munich? 

I think the other thing that I enjoyed very much there in Munich 
was the museums. Munich is an art center, always has been, for 
generations, I guess. Hitler, wanting to show people that he had 
an interest in art, built a whole new museum, with big pillars in 
front, advertising the fact that the Nazi party was for culture. 
It's still used as a museum now, but nobody knows that Hitler built 
it. I guess they all know, but they don't say anything about it. 



Was it very selective in the art that they exhibited? 

Yes. The Nazis threw out all the modern paintings, 
classical and propaganda paintings. 



They only kept 



Did Munich perk your interest in the arts, do you think? 

I think it probably did. I certainly paid more attention to it 
there than ever before. I also enjoyed a lot of the people, their 
lifestyle. They like skiing, they like music. The opera was a 
great feature there and still is. The opera house in Munich is 
one of the great opera houses in the world. It's the first one 
I'd ever seen where the stage could go up and down and turn. It 
was almost totally destroyed during the war. They rebuilt it and 
made it bigger, but exactly in the same form. It's really quite 
beautiful. 



Surgical Resident and Instructor in Surgery at Stanford, 1937-1942 

Gerbode: After I returned to California, Dr. Holman took me into the 

department of surgery as an assistant resident on the lowest level. 
So I started like anyone else, learning how to be a surgeon. 



Hughes: Did you ever have any thoughts of going anywhere else? 



28 



Gerbode: Yes, I thought about it, but not very long, because I like 

California so much. This problem has come up many times, about 
my leaving San Francisco and going elsewhere. I didn't want to 
go anywhere else. If anyone says, "You've had a very successful 
career," I say, "Yes, and I didn't even go to Harvard." [laughter] 

Hughes: We should talk about the fact that you are West Coast. My under 
standing is that most of the early work in cardiac surgery was 
pretty much East Coast oriented. 

Gerbode: The first things were all East Coast. There's no question about it. 
The first patent ductus and first coarctation were done by [Robert 
Edward] Gross in Boston. The first mitral valve operations were 
done by [Charles Philamore] Bailey in Philadelphia and [Dwight] 
Harken in Boston. I can assure you that we followed very quickly 
thereafter, as did others. 

Hughes: Is that just the fact that these were traditional medical centers, 
and the ones in the West were new? 

Gerbode: Yes, I think also the fact that they really had bigger and more 
elaborate departments. The East really held the leadership in 
medicine for quite a while. They're still great, of course, but 
there are other smaller places that have done exceedingly well, 
even though they aren't in the so-called mainstream of American 
medicine. 

Hughes: Was Stanford medicine always research oriented? 

Gerbode: No, it wasn't, [although] it had good research going. [There was] 
a big research building which is still up the street, called the 
Stern Laboratory. There were people on the faculty who were always 
busy with one kind or another of research, and some basic discoveries 
were made in the medical school. But overall, I think the emphasis 
was on good clinical medicine. 

So anyway, I came back as an assistant resident and had to 
learn how to be a surgeon. You learn by assisting, working up the 
cases. I went right back to the laboratory again, though. 

Hughes: Was this Holman's laboratory? 

Gerbode: This was mainly Reichert at that time. I watched what Holman was 
doing and sometimes would help, but it was Reichert mainly who was 
doing most of the laboratory work. 

Hughes: Holman was mainly a surgeon. 



29 



Early Cardiovascular Surgery 



Gerbode: Yes. Reichert was, too, but Holman was running the department. He 
had more administrative work to do. During those few years we 
began to do more major vessel cases. Then later on we began to do 
mitral cases and patent ductus and coarctations. These were some 
of the early operations. I was able to assist on them, and later 
on able to catch one every once in a while for myself. 

Hughes: You were allowed to do these big operations? 
Gerbode: Later on, after I was there for two or three years. 
Hughes: What was the success rate in those early days? 

Gerbode: I don't know that we ever lost a patent ductus. I think I only lost 
one coarctation out of a lot of them. The mortality rate for 
mitral operations was about 5 percent, something like that. But 
they weren't open; they were closed mitral operations. They were 
all done with instruments or an index finger in the heart. 

Hughes: The valvulotome? 

Gerbode : Yes . I devised an instrument for cracking the valve , too , which 
we used in many cases. You'd put it in through the apex of the 
heart, and then you'd feel it in the atrium and then get it in 
the valve and open it. That would split the valve so it could 
move again. 

Hughes: Does it have a name? 

Gerbode: They called it a mitral valve dilator. It's still sold, as a 
matter of fact. 

Hughes: Did you patent it? 

Gerbode: No. 

Hughes: The name of the game then was to operate as quickly as you could? 

Gerbode: No, the name of the game by then was to operate cautiously and 

selectively. For example, the first criteria we set up for mitral 
valve operations were that the patients shouldn't be over forty-five 
years of age, they shouldn't have this and shouldn't have that. 

Hughes: Was that social usefulness, or was that just chances of survival? 



30 



Gerbode: Chances of survival. We thought if they had atrial fibrillation, 
which is very common, that it was too dangerous. But later on we 
found that 90 percent of the patients we were operating upon had 
atrial fibrillation. It was just something that we had thought 
of as being the safest thing to do in the beginning. 

Hughes: You mean in the normal course of events they would incur 

fibrillation, not just when they were being operated upon. 

Gerbode: That's part of their disease. 

[interruption] 
Gerbode: It was picked up. 

Hughes: It was picked up? 

Gerbode: Yes, you could make the diagnosis easily. But they thought that 
maybe it was too dangerous to operate upon people who had it. 

Hughes: But you found that that wasn't the case. 
Gerbode: Later on. It wasn't the case at all. 

Hughes: It seems to me in any surgery there's always that very fine line 

of decision in regards to choosing patients that are seriously ill. 
How ill should they be for an [operation] that is still experimental? 

Gerbode: You proceed cautiously, and you keep operating upon something 

that's a little more difficult. Then if you begin to be successful 
in doing it, then that encourages you to take on more. In the end, 
you operate upon very sick people. 

Hughes: What was the rest of the medical profession saying about these 
operations? 

Gerbode: The cardiologists were very conservative about mitral surgery. 

Hughes: Was it Holman who was doing the heart surgery? 

Gerbode: Yes, Holman was. 

Hughes: Reichert didn't ? 

Gerbode: No, he didn't. 

Hughes: Can you describe how an operation for patent ductus was done? 



31 



Gerbode: [Now] it's done routinely by residents. A patent ductus is a 
connection between the pulmonary artery and the aorta. [The 
ductus arteriosus is] a tube which is present in the embryo, and 
that's the way the blood gets from the mother into the child. 
Within a few weeks after birth, the duct closes. If it doesn't 
close, then it produces a physiological change which is not very 
good for the patient and can produce heart failure. 

The operation consists of a left thoracotomy, exposing the 
connection which is right near the heart. Initially it was just 
tied with a couple of sutures. But later on there were perhaps 
5 percent recurrences when this was done, so then surgeons began 
to divide it, by first putting clamps on it, then cutting between 
them and sewing each end. 

Hughes: The actual suturing had to be very quick, didn't it? 

Gerbode: No. The ductus doesn't do much to the rest of the circulation when 
it's clamped off. 

Hughes: You weren't actually operating on the heart itself? 

Gerbode: Not in those days. It wasn't until 1953, more or less, that we 
started on the heart . 



Prewar Cardiovascular Research 



Hughes: Were you doing research during this time as an assistant resident? 
Gerbode: Yes, I always had a little something going. 
Hughes: What was going in 1937-38? 

Gerbode: I was trying various things on the heart, producing conditions in 
an experimental animal which were like those found in the human, 
and then measuring them and seeing what we could learn from them. 

Hughes: What types of things? 

Gerbode: Experimental hypertrophy of the heart, for example, making the 
heart muscle bigger [on] one side or the other. 

Hughes: I know there were some postwar papers about ligating one of the 
great vessels in puppies. 



32 



Gerbode: That was the kind of work. 
Hughes: Did that start before the war? 

Gerbode: No, this was after the war, when I came back. Then I wanted to 
produce a cyanotic animal, which had only been done once before 
successfully. So I finally was able to produce a small collection 
of blue animals, because we were interested in blue babies by that 
time. I finally published that work. It didn't seem terribly 
important, but it was important for me to be able to do it. But 
it's a funny thing that when the Swedes gave me an honorary degree* 
and I stood up and listened to the eulogy which described this 
honorary degree, they mentioned this work. They dug it out and 
said that's important. I didn't think it was so important. 

Hughes: Did other people think it was important at the time? 

Gerbode: I don't think so. 

Hughes: How did you produce cyanosis? 

Gerbode: I switched the inferior vena cava from the right side of the heart 
to the left side of the heart. 

Hughes: What happened between 1938 and 1942 when you went off .:o war? You 
were still an assistant resident for that whole period? 

Gerbode: I'd finished my residency, and I was already an instructor on the 
faculty. 

Hughes: That's right. In fact, according to your curriculum vitae, from 
1937 to 1938 you were an assistant resident in surgery as well as 
an assistant in surgical research. 

Gerbode: That's because I was always up there doing something in the 
laboratory. 

Hughes: Then from 1938 to 1939 you were an assistant resident in surgery, 
1939 to 1940 a resident in surgery. 

Gerbode: Yes, the chief resident. 

Hughes: Did that mean an increase in operating opportunities? 



*Dr. Gerbode received the M.D. degree, honoris causa, from the 
University of Uppsala in 1965. 



33 



Gerbode: Oh yes, because when you're a chief resident, you do all the 

operations on the clinic service, unless you think you shouldn't 
be doing it by yourself. Or the chief would help you do a 
difficult case. 

Hughes: But you were expected to be able to do all of the cases? 

Gerbode: Expected to do most of them. 

Hughes: What about these very innovative ones? 

Gerbode: If you were doing an innovative one, you'd usually have one of 
the professors scrub with you. 

Hughes: Were you considered a cardiac surgeon at this time or a general 
surgeon? 

Gerbode: General surgeon. At that time, there wasn't really a specialty of 
thoracic surgery. It wasn't until after the war that they began 
to recognize the subspecialties. 

Hughes: Because you and Holman were particularly interested in the heart, 
was Stanford developing a reputation for heart surgery? 

Gerbode: I think Holman really developed a reputation for being interested 
in circulation and great vessel, not heart. 



Premonitions of World War II 



Hughes: The next step is the war. 



Gerbode: 



Hughes : 



Gerbode: 



Having been in Germany before the war started, I could see that 
was coming. One taxi cab driver there said, "One day Austria will 
go. The next day we'll take Poland just like that." They'd 
figured it all out. Austria did fall while we were there, and 
Poland came not too long afterwards. 

But that was not the thinking in 1937 when you returned to this 
country, was it? 

People had their heads buried in the ground. When I told them what 
I'd seen them doing over there, they thought I was praising them. 
I said, "I'm not praising them. I'm merely telling you what I saw." 



34 



Gerbode: The same thing happened to Lindbergh, whom we met at a reception 
in Berlin. He'd seen the preparations for war. He came back and 
told people about it, and they accused him of praising the Germans. 

Hughes: That must have been frustrating for you, seeing the writing on 
the wall. 

Gerbode: After a while I just decided I wouldn't say anything about it. But 
[I] saw this army actually drill down to the bone, and saw their 
tanks, and how they were teaching all these youngsters to drive 
jeeps and cars and everything. You could see them in the fields 
learning how to go through mine fields and through barbed wire. 
They weren't doing that for football. 

Hughes: Did you also feel that the United States would have to become 
involved? 

Gerbode: Eventually, sure. 



35 



II SURGEON, U.S. ARMY MEDICAL CORPS, 1942-1945 
[Interview 2: August 1, 1983 ]## 



Decision to Go to War 

Gerbode: [Anyone] around the time of 1938 to '42, would wonder whether or 
not we were going to get into this war which Hitler had started. 
But having been there [Germany] for practically a year and having 
seen the preparations and having heard what the Nazi ideology was 
turning out, it was quite apparent [to me] that we would have to 
get into the war eventually, because there would be no stopping 
Hitlerism if he won the war in Europe. The next thing would be 
South America, and then Lord knows what else. 

So I decided pretty early that I would have to get into it. I 
suppose in my position I could have stayed home, stayed in the medical 
school and taught like some of the men did. It was necessary for 
some of them to stay home to keep the medical school going. Also 
having a rather large family, I could have used that as an excuse 
for staying home, too. But I wanted to be counted. My thoughts 
came to a head in New York when I heard a lecture by a very 
distinguished English surgeon by the name of Sir Gordon Gordon-Taylor. 
He was a very fine, beautiful gentleman. He came to New York and 
showed pictures of the bombing in London and the problems the English 
were having with fighting the Germans. His mission was, of course, 
to get Americans more interested in fighting Hitlerism. 

I also was very impressed with The Life of Harvey Gushing, 
which is a biography written by one of Harvey Gushing 's students, 
[John Fulton]. In it it was quite apparent that an affiliated 
team of doctors, in that instance from Harvard, was able to 
accomplish a good deal in a war effort. 



36 



Preparations in the U.S. 



Gerbode: At this time the Stanford medical faculty here was putting together 
two teams, one a navy team, the other army. This subsequently 
developed into a rather good-sized effort of Stanford physicians 
and surgeons. 

Hughes: Was that a spontaneous effort? 

Gerbode: Yes. I think they felt they wanted to get into the war and get 
in as a group. The army group was brought together by Stanford 
doctors mainly from the San Francisco General Hospital. I could 
have, I suppose, joined either of these two efforts, but I decided 
that, from what I had read, it seemed to me that a surgeon would 
have more to do in the army than in the navy, and I wanted to be 
busy and to participate. So I joined the Stanford army unit. 

Hughes: Were you thinking of yourself as a thoracic surgeon? 
Gerbode: I was trained as a general and thoracic surgeon at that time. 

Hughes: So you were thinking still in terms of general surgery in terms of 
the war? 

Gerbode: I was just thinking in terms of getting into the war and being a 
surgeon. So we went into the reserve and waited until we were 
called. The call came in early 1942. Something like forty-five 
doctors and fifty-two nurses had joined the reserve unit. They 
were all called together at one time. I was lucky, because I had 
finished my training and had enough experience so that I was given 
a major's commission, which was quite a good commission at that 
time. 

We were sent up to Ft. Lewis, Washington, where we went into 
basic training for about six weeks, had to do all the same things 
as the infantry. Several of the doctors who were not very 
physically fit had trouble coping with this training. I must say 
that I didn't do terribly well, but I didn't fall by the wayside 
anyway . 

Then we came down to Ft. Ord, near Monterey, and there we were 
supposed to get ready for some sort of an amphibious landing. They 
shipped out the complete equipment for an evacuation hospital. 
The equipment when we opened the boxes was World War I equipment. 
It was just terrible. I was given the job to sort this stuff out 
and package it so it could be landed somewhere and put together again 



37 



Gerbode: as a complete hospital. I was glad to do this, because otherwise 
there wasn't much else to do at Ft. Ord except hike and eat and 
complain about the army. [laughter] 

So I set up really what amounted to a construction unit, 
making boxes and things to put all this stuff together. I kept 
asking the commanding general down there for more and more material, 
and once he got so fed up with me that he said to the man on the 
phone, "God damn it, don't give him what he wants. Give him what he 
requires." [laughter] Well, I felt that I did require this stuff, 
and we got it finally. 

The unit was put together just before the Dieppe raid. I 
think that the idea was that we were going to go to England and 
then follow the Dieppe raid into Normandy if it was successful. But, 
as you may recall, the Dieppe raid failed. It was kind of a 
disaster. So instead of going there, we were sent to Virginia for 
further waiting to see what would happen next. Meanwhile all that 
equipment which we had put together had gone to England, which was 
lucky, because it wasn't any good anyway. 

Before that we had a very brief period in New Jersey where 
we were supposed to be staging for the leap to England, but when 
the Dieppe raid failed, we were moved down to Farmville, Virginia. 
There we put together another hospital, but this time with more 
modern equipment. We had the experience, so it was easier to do it 
the second time. 

Hughes: This was a complete hospital? 

Gerbode: A complete hospital, tents right down to the bedpans. Everything. 
It came in boxes, and then we had to sort it out and put it 
together. We would have an operating room set of boxes and an 
intensive care room set of boxes and so forth. Why the commanding 
officer put me in charge of this, I don't know, but later on I 
think he had a feeling that I had logistic ability. In any event, 
I didn't mind doing it. 

To do this, I found a couple of very fine noncommissioned 
officers to help. One was a fellow by the name of Carson, who was 
a very fine carpenter. The other was a fellow by the name of 
Querhammer, who was a farmboy from the Middle West. They turned out 
to be excellent workers and very enthusiastic about the project, and 
really, with guidance, put it together. So then we had another 
complete hospital. We stayed there until the army decided where 
we were going to go. 



38 



Casablanca 



Gerbode: As it turned out, some time later we were sent to Africa and landed 
in Casablanca. It was a gigantic convoy across the Atlantic, the 
second big convoy to go into Morocco. We landed in Casablanca 
a day before Christmas [1942]. You think of that part of Africa 
as being warm all the time, but in the winter it's very cold. Our 
equipment was scattered all up and down the coast . It took weeks 
to get it together again. We had no tents, for example, when we 
landed. We were put in a field next to an Arab cemetery. We 
borrowed some hay and a few tarpaulins from another army unit . They 
were given to us very reluctantly, but we improvised some sort of 
a tent to cover us during the night, and slept on hay until we 
could find some of our tents, which took a couple of weeks, really, 
to get organized. 

Hughes: There were a lot of other American units in the area? 

Gerbode: A little bit later on [General George] Patton arrived with his tank 
division, and they were billeted right across the road from us. 
Patton, of course, was a very amusing but very good general. I 
think he was a fine general in the field, a terrible general at 
headquarters. He issued an order, for example, when we were there, 
that the knit wool cap , which went under the helmet , should not be 
worn without the helmet. We were bombed nearby by some German 
planes a few nights before, so we were issued an order to dig slit 
trenches in case they came back again. One of our captains, who has 
since died, was shoveling out there with a knit wool cap on when 
Patton came by. He stopped his jeep and got out with these big 
revolvers on each side, stomped over and said to this fellow, "Stand 
up. Are you an officer or not an officer?" "Yes, Sir, I'm an 
officer." "What have you got on your head?" "I've got a wool cap." 
"Take that thing off, and in the future behave like an officer." He 
was so furious that he went through his own billet across the road 
and bawled everybody out everywhere he went. He bawled them out 
for hanging laundry outside their puptents and everything else. We 
were near him several times. 

In any event, we stayed in Casablanca for quite a while and 
took care of troops or injuries which were evacuated from Algeria 
and northern Africa. A lot of Germans had been wounded previously 
in the fighting in Russia, and they'd come in with old shrapnel 
wounds and old pieces of metal in their bodies, in addition to the 
new metal. A rather sorry lot of soldiers, I must say. 



39 



Gerbode: We set up a very good tent hospital and realized for the first 
time that you could do very good surgery in a tent hospital. 

Hughes: Had you worked with most of this team before? 

Gerbode: No, I hadn't. We were all from around here. There were several 
men from the University of California. But they were all highly 
trained. They were all residents and had good training in surgery. 
Carl Matthewson, who was the chief surgeon, was particularly good 
because he had had special training in the treating of fractures. 
Since so many of the injured had fractured bones, it was very 
useful to have him establish methods of treatment for the unit. 

Hughes: Were you doing vascular surgery? 

Gerbode: We did everything. Anything that was on the table, we did, including 
brain surgery. I did brain surgery and spinal cord surgery. But 
we weren't doing very much reconstructive vascular surgery at that 
time. That came later on in the war. In retrospect, of course, we 
were not very quick to realize that a lot of this could be done. 

Hughes: When you say that, are you thinking in terms of grafts? 

Gerdode: Grafts and repairing arteries, and using vein grafts to insert for 
deficits in an artery. 

Hughes: Not too much of that had been done anywhere . 

Gerbode: No, that's right. It was really developed at that time. But we 
were kind of silly not to think of it, you know. 

Hughes: Do you think the war gave an impetus to vascular surgery? 

Gerbode: Oh, yes. But actually, vascular surgery in the front areas really 
was developed in the Korean War. 

Hughes: That late? 

Gerbode: Quite a bit later. Some repair work was done in old injuries in 
base hospitals after they had been evacuated from the front. 



40 



Andrew Peatroscka 



Gerbode: Anyway, long before going to Africa, I had once been to Poland to 
a little village called Druskininka. My wife and I went there to 
visit a classmate of hers. That's a very interesting part of the 
world , because it had been overrun by Germans and Russians in 
several wars before, and there were a lot of old houses with bullet 
holes in them, and so forth. It was sort of a haven for Jewish 
people. This particular family we visited were not Jewish. They 
were Polish and had a violent history, as a matter of fact. The 
mother of the girl whom my wife had gone to school with had, we 
think, killed her first husband in a violent encounter. Grajina, 
the girl, had married a Polish army officer in the regular Polish 
army, who'd been in a saber duel and had the end of his nose sliced 
off. When they put it back on again, they put it on a little bit 
crooked, so the tip of his nose was turned about thirty degrees, 
[laughter] 

Anyway, it was a very interesting time going there. Andrew 
was a very handsome, intelligent young man, the brother of Grajina. 
He came in late one night, and we asked him where he'd been, and 
he said, "We just had a little pogrom." 

Now to come back to Casabla'nca: I'd operated upon a German and 
reconstructed his nerves and arteries, and I was rather curious to 
know how he was getting along. So I got permission to get a jeep 
and go to the prisoner-of-war camp near the hospital. I saw the 
patient, and his wounds had healed, and he was coming along pretty 
well. As I walked out of the prisoner-of-war camp, a Polish officer 
came up to me, and he said, "Are you going to Casablanca?" I 
said yes, and he said, "Could I get a ride with you?" I said, 
"Sure, get in." So he got in, a nice looking fellow, and I said, 
"Where are you from in Poland?" He said, "I'm from Druskininka." 
I said, "I know where Druskininka is. It's near Wilno." I said, 
"Did you ever know a Peatroscka family?" He said, "I'm a Peatroscka. 
My name is Andrew." Here was Andrew, the brother from Poland. I 
had met him casually outside of a prisoner-of-war camp in North 
Africa! 

Then subsequently I learned the story of what had happened to 
Andrew. He had joined the Allied forces in Europe and was chased 
out of Europe with the English and went to England. 
There, because of his language ability and intelligence, he was 
trained as a paratrooper, and also trained in observation and 
other things. So one night, when he was fully trained, he was put 
ashore from a submarine near Algeria. He was supposed to disappear 



41 



Gerbode: into the countryside and then through a network of intelligence 

people send messages back as to the number of planes going in and 
out of a certain airport and various items of that type, which he 
successfully did, and he was never captured by the Germans. 
Finally, when the Allies landed in North Africa, he said, "I was 
a member of the welcoming committee." His job when I met him in 
North Africa was to interrogate Polish prisoners who might defect 
when they got well and join the American forces. That was what 
he was doing actually at that prisoner-of-war camp. 

I've subsequently met Andrew several times. He'd gotten 
rather fat. He was trained as an engineer. The last I heard of him, 
he was in South America somewhere. The mother who was there at 
that time, lost her second husband. She came to the United States 
and married a Kellogg, the very rich man who owns much of the 
cereal business. She then moved to Minneapolis or St. Paul and 
lived in rather splendid circumstances there, but never would help 
her children. I think Grajina now is working in a restaurant in 
London. 



Palermo, Sicily 



Gerbode : 



Hughes: 
Gerbode: 



In any event, we stayed in Casablanca until the Germans were chased 
out of North Africa, which took about seven or eight months. 
Rather heavy fighting. Then we went to Bezerte, which is in the 
north, and staged in an olive grove, got all our stuff together, 
and then finally we were put on a boat in a convoy and went to 
Palermo, Sicily, the Germans having just been driven out of 
there. 

There was a bit of bombing after we got there, but not very 
much. Our billet as a hospital was in the University of Palermo 
Medical School building. The place where I slept was the professor 
of orthopedic surgery's office. That was quite luxurious compared 
to the other things we'd done. We took care of a lot of Italian 
wounded there and a lot of Italian prisoners of war, who defected 
by the hundreds. They were pretty tired of the war even then and 
were easy to capture. 

Were patients coming in in rushes? 

We had to chase the Germans off of Sicily, so there was a lot of 
fighting right up to the Straits of Messina. They were treated in 
a field hospital first and then sent to us. Sometimes they came 
to us straight from the front, but usually through a field hospital. 



42 



Hughes: Would a field hospital do any operating? 

Gerbode: Yes. They were doing life-saving procedures. If the patients 

weren't terribly bad off, they were shipped right back to us, and 
we would operate upon them and take care of them. There was a lot 
of illness. There were a lot of soldiers with hepatitis and 
gastroenteritis and infectious diseases of one kind or other. So 
we had a lot of sick soldiers. 

Hughes: Typhus was a problem during the war, wasn't it? 

Gerbode: A bit, yes. There were a certain number of cases of typhus. There 
were a certain number of cases of tetanus, particularly among the 
Germans, and some of the Italians, because they had not given all 
their soldiers tetanus antitoxin or tetanus injections. 

Hughes: Was that because they didn't have enough to go around? 

Gerbode: I don't think they had enough to go around, and they perhaps weren't 
so concerned about it. But there were a few cases. 

In any event, Patton was there, too. His billet was in 
Palermo. He had a castle there when he was sick a good deal of 
the time with a kind of bronchitis and other things, so he didn't 
really get up to the front at all. Our [medical] people would go 
see him and take care of him. But when it was quite apparent 
that the Germans were going to be driven out of Sicily, he put on 
his big helmet and got his guns and went up in his jeep, as soon as 
the photographers were there. He made a triumphant entry so that 
the news media would have pictures of it back home. I don't mean 
to say that we didn't admire him. I really think that Patton was 
one of our greatest generals. He was a terrible person when he 
was nonactive. 

Hughes: Was he bad-tempered? 

Gerbode: Well... What he did later on in Europe was very remarkable. If he 
had had his way and hadn't been stopped by some of the other 
generals, I think the final solution of the war would have been 
completely different. 

Hughes: What? 

Gerbode: He would have taken all of Czechoslovakia and Yugoslavia, I'm quite 
sure. But he was stopped several times. 



43 



Gerbode: Anyway, we stayed in Palermo for quite a while. We must have 

been there about five or six months. Then we had to somehow get 
a landing in Italy, so they landed us just south of Salerno. 
General Mark Clark was in charge of the operation there. They 
just barely made it, as a matter of fact. But they finally did 
get a foothold, and also at Anzio. At Anzio they were surrounded 
by the Germans and took an awful beating. 

Hughes: How were you getting news about all this? 



Anzio 



Gerbode: Through the wounded soldiers who came back. Anyway, we stayed in 
Palermo until it looked as though we were going to chase the 
Germans north. Then they brought us over just south of Anzio. Then 
we went into Anzio and relieved all the other hospitals, took all 
their wounded and let them go on up toward Rome. Anzio was an 
absolute stinkpot. There were so many thousands of soldiers in a 
very small area, that about every hundred feet was an old latrine. 
We had to sleep in a dugout below ground, which smelled terribly, 
because the latrine odors seeped through all the soil. It wasn't 
very pleasant. 

Hughes: When you were moving like this, were other Americans being 
relieved? 

Gerbode: Yes. 

Hughes: What was the rationale for that? 

Gerbode: There were different kinds of hospitals. There were field 

hospitals, which were smaller units. They were up closer to the 
front than we were usually. We were a big unit. We had a capacity 
of seven hundred and fifty beds if we used all of them. 

Hughes: So each time you made one of these moves, you were taking all the 
contents of your hospital along with you? 

Gerbode: Yes, everything. Which meant truckloads full of boxes and stuff. 
Hughes: How good was your equipment proving to be? 



44 



Gerbode: It was fine. The replacements were excellent. They finally sent 

us good generators so we could be self-sufficient with electricity, 
and the kitchen equipment got better all the time. 

Hughes: What about the medical equipment itself? 

Gerbode: The medical equipment was all right. We had to improvise our 

operating rooms, though. What we did was make floors, so we could 
put mobile floors in sections and put them on a truck. Then when 
we came to a new place, we could just lay down these floors and 
put a tent over the top of them. That gave us a pretty good 
operating room complex. 

Hughes: You could maintain the usual sterile conditions? 

Gerbode: Yes, it was surprising. We had the same rules in the operating 
room as we had at home. It was harder to maintain them, though, 
because you couldn't keep all the flies out, and there was a 
certain amount of dust around. But it's surprising how much you 
could do, if you observed certain strict rules about the operations 
itself. 

Hughes: Early in the war there were no antibiotics, were there? 

Gerbode: No, there weren't. We had sulfanilamide. Early in the war, it was 
thought that if you put sulfanilamide in the wounds, this would 
prevent infection. 

Hughes: You mean in powder form? 

Gerbode: In powder form. But actually that proved not to be very good. 

Hughes: It wasn't effective? 

Gerbode: It wasn't effective, and I think it actually in some cases retarded 
healing, too. 

Hughes: And that was only effective against certain bacteria anyway, 
wasn't it? 

Gerbode: That's right. It wasn't until later that we got penicillin. That 
changed things. 

Hughes: This was just a year or so before the war was over, wasn't it? 
Gerbode: Yes. 



45 



Hughes: That must have made a tremendous difference. 

Gerbode: It made a big difference, yes. 
## 



Wound Treatment 






Gerbode: A lot depended on how you treated the wounds. You see, all the 
wounds were left open, except the abdominal, chest and brain 
wounds. The rest of them, the flesh wounds, were all left wide 
open. The big thing was to let them granulate for a while, and 
then do secondary closure. That was something that really was 
developed on a big scale in that war. 

Hughes: That wasn't a prewar technique? 

Gerbode: Not so much. So when we did the original debridement of a wound, 
we tried to debride it in such a way that ten days later or two 
weeks later, it could be closed loosely. We'd try to think of 
which way we'd make the excision so it would be easy to close later. 

Hughes: This was so that the wound would drain? 

Gerbode: Yes. It would have to stay open until it was not grossly infected. 
Of course, it was still somewhat infected, but as soon as there was 
healthy granulation tissue, not very much in the way of secretions, 
then you could close it loosely. That saved a lot of time. There 
were a great many things about the war which we learned which were 
new. That was one of them, secondary wound closure. 

Hughes: Did you carry on that technique after the war? 

Gerbode: It was used later in the war and in accidental injuries. 

In any event, we stayed in Anzio, which was a smelly, rotten 
experience, and cleaned up the patients who were there, shipped 
them back to base hospitals or put them back into active duty. 
Meanwhile, they were pushing the Germans back toward Rome. You 
may remember Cassino, the big battle there where some of the 
Germans were in this monastary on top of a hill, and it was 
devilishly hard to get them off those buildings. They just were 
terribly resistant, and it was terribly hard to get at them. This 



46 



Gerbode: is where the Hawaiian-Japanese division did such a noble job. 

These were native Japanese-Hawaiian from Hawaii who had formed 
a unit. They were very brave and did a tremendous job at that 
point in the war. 

Finally the Germans were driven up north. They were pretty 
upset with the number of Italians who were defecting or giving up. 
They got pretty stern and strict with them. We don't know all the 
things they did to try to keep the Italians fighting, but they 
tried everything. They were finally driven back over the Brenner 
Pass into Austria. 



Salerno and Southern France 



Gerbode: We stayed there for quite a while, and then we went back to Salerno, 
which is where the original landings were. Here we took care of 
the troops while they were training for the landing in southern 
France. That was mainly station hospital kind of work, taking 
care of whatever injuries they had or other things. 

Hughes: You mean not combat. 

Gerbode: Not combat. They were staging for the landing in southern France. 
The other big units were staging in England, too, for the landing 
in Normandy at the same time. 

Finally, everybody was ready. The artillery was ready. The 
infantry was ready. So we all got in a gigantic convoy in Salerno 
and started going toward southern France. When we got to southern 
France, we didn't know how many Germans were still left, so they 
just blasted Saint -Tropez, that beautiful place. Every house that 
was in view that looked as though it might have a machine gun in 
it had a shell go through it. But we landed without much resistence. 
The Germans, meanwhile, had gotten pretty weak and had started 
evacuating up toward the north. 

Then after getting there, we set up a series of hospitals, and 
I was then appointed the job of selecting the place where the 
hospital should be and getting it started, again this darn logistic 
job. 

Hughes: [laughs] You had a reputation. 



47 



Gerbode: One of my problems in the army was to keep that logistic number 

off my records, because I felt that if I had a logistic number, I'd 
be taken out of the hospital and put back in headquarters somewhere 
in a planning unit. I didn't want to do that. So I got to know 
the chief sergeant in the office who controlled these numbers 
they were called MOS numbers and bribed him to keep that MOS 
number off my file. Which he did. [laughs] 

Then we started chasing the Germans up the Rhone Valley. 
We'd no sooner get a hospital set up than they'd say, "You've got 
to move it now. Tomorrow we move up another fifty miles or so." 
We set up three hospitals before we got to a little town called 
Carpentras. Now the story goes back to before the war again. 



The Story of Carpentras* 



Gerbode: My wife and I got to know Lily Pons and Andre Kostelanetz quite 

well. They came to the Hawaiian Islands and had part of a summer 
with us. Then periodically when they came to California, they 
would stay with us or we would see them. 

They had a friend by the name of Bill Schweitzer in Elizabeth, 
New Jersey, who is a short-wave expert and was president of a 
large paper company which made paper for Chesterfield cigarettes. 
The linen for their paper largely came from southern France. I 
didn't realize that linen was such an important part of making 
cigarette paper, but apparently it is. 

In any event, as things got closer to our being involved in 
the war, I would see Andre and Lily once in a while in New York, 
and also got to know Bill Schweitzer pretty well, and actually 
visited him in New Jersey. Then when we got into the war and I got 
a commission, it was apparent that I was going to be sent with our 
unit to the European theater one way or the other, and Bill 
Schweitzer also had joined the army. He once said to me in New York, 
"If you ever get to southern France, we haven't heard anything 
from our factory, which was taken over by the Germans, please 
look up our manager, we don't know what happened to him. His name 
is Mr. LaDerriere. Tell him that our family is fine and that you'd 
like to have him get in touch with us." 



*The section on Carpentras was moved from the interview on 10/23/83. 



48 



Gerbode: So the war went on, and we went through Africa and Sicily and Italy 
and finally landed in Saint-Tropez with an invading army and 
worked our way up through southern France through the Rhone Valley, 
making two or three stops, chasing the Germans up there, and finally 
landed in a small village. After setting up the hospital several 
times for a period of a few days or a week and then tearing it 
down and moving on, finally I picked a field near a village in 
southern France. After getting things organized and deciding where 
the tents would go up and so forth, I was sitting on my cot, I 
pulled out my wallet , and saw a note to look up somebody in 
Carpentras. So I asked somebody near me if he knew where Carpentras 
was, and he pointed to a village in full view a few miles away 
and said, "That's Carpentras right over there." 

So I got on my bicycle, which I had secretly stored with the 
surgical equipment , and went over to the village and asked somebody 
if they knew where Mr. LaDerriere lived, and he said, "Yes, that's 
his house over there." So I went over and range the doorbell and 
Mr. LaDerriere opened the door, very surprised to find somebody 
from America. Actually our hospital had liberated that town, in a 
sense. Non-fighting liberation, but we were the first American 
troops to stop near there and do anything about the little village. 
So he was overwhelmed with joy to find the Germans had been chased 
away and to find somebody who knew his boss. 

He had a rabbit which he cooked. We had some wine and talked 
a good deal. He spoke very good English. Then we ceremoniously 
took Hitler's picture off the wall and put up his father's picture, 
which he had secretly stored in the attic. A fine bearded Jewish 
gentleman. Big tears flowed during this emotional ceremony. 

I also took a trip later on over to the factory where they 
made paper. But the main thing was that he introduced me to the 
mayor and photographer of the town, both very good friends of his. 
We had a meal or two there as well. Actually, our unit didn't 
stay there longer than a week or two, because we were chasing the 
Germans pretty hard at that point, and finally ended up quite a 
bit further north. But anyway, we said fond farewells, and I said 
I'd be back one day to see him. 

So after the war I was teaching in London and had a vacation 
period and decided to visit some friends near Ez-Sur-Mer on the 
Mediterranean. My wife meanwhile had gone down there to stay with 
them. I had my oldest son with me in London, the one who was 
killed at Stanford. We decided to drive through southern France 
and go to Ez to meet my wife and daughter. We stopped in Carpentras 



49 



Gerbode: on the way down, having told them that I was going to be there on 
a certain day around late afternoon. Well, we got there and they 
laid on the most terrific banquet you've ever seen in your life. 
The mayor, the photographer, Mr. LaDerriere, and a couple of other 
friends of his took over a whole restaurant. We started eating 
about four o'clock in the afternoon and had about ten courses. 
Each one we thought was going to be the last, and it wasn't. With 
all kinds of wine and everything. We finally got out of there at 
nine o'clock. And I still had to drive all the way down to Ez. 
But anyway, it was a great occasion with speeches and all this sort 
of stuff. We set out for Ez about nine o'clock. About a mile out 
of town I stopped and Alec got rid of the entire dinner. Then he 
felt much better. 

We finally arrived at Ez about one o'clock in the morning, and 
my wife and the hostess were still waiting outside on the terrace 
for us to arrive. We had a little confusion in finding the place 
that delayed us about half an hour, but we got there safely. So 
that is the story of Carpentras. 

Hughes: How is your French? 

Gerbode: No good. 

Hughes: Was this going on in French? 

Gerbode: They were all talking in broken but understandable English. 

So we stayed in Carpentras for about two weeks and gradually 
went up north in several hops until we got to Epinal and set up a 
hospital in an old French barracks. 



Field, Mobile and Base Hospitals 



Hughes: When you were moving so often, what happened to soldiers that were 
wounded and needed care? 

Gerbode: We would take care of any freshly wounded patients, and then the 
ambulances would take them to an evacuation port where they were 
put on a ship and sent home, or sometimes flown home in ambulance 
planes to base hospitals in the United States or England. 

Hughes: But at some point it seems that you would be in transit when 
patients were needing care. 






50 



Gerbode: There were field hospitals right close up to the mobile [hospital]. 
Then as we penetrated further, the army set up our own general 
hospitals. We had a big general hospital in Italy and later a 
big general hospital they call them a base hospital in France 
as well. We would send [the wounded] back to these base hospitals 
where, if they were recoverable and could be put back into combat 
duty within a reasonable time, they stayed until they were ready 
to go back. 

Hughes: So there were about four different types of hospitals? 

Gerbode: We had special hospitals. We [also] had [special] groups. Actually, 
these were teams which went into field hospitals and operated as a 
team. We had a chest unit, for example, which some of my friends 
were associated with. We had neurological outfits. They would 
go into a place where there was heavy fighting and take care of 
these specialty cases. 

Hughes: How broad an area would a team like that cover? 

Gerbode: They would set up close to a combat area. They called them auxiliary 
teams. We had maybe three or four of them in North Africa and the 
same ones then went into southern France later. They were mainly 
operating teams, teams that were operating on special cases. They 
didn't take care of all these special cases, though, because some 
of them came to us anyway. 



The German Retreat to the Vosges Mountains 



Gerbode: Meanwhile the Normandy landing had taken place, and that really 
made the Germans think twice about what was going to happen, but 
they hadn't given up at all. We chased the Germans back, and they 
got to the Vosges Mountains, where they consolidated everything. 

On the way up to the Vosges Mountains, the Germans who'd been 
in the southern part, from Saint -Tropez up to the Vosges Mountains, 
had lost a lot of their equipment and trucks, and the whole roadside 
all the way up was littered with wagons and dead horses and wounded, 
and everything else, because actually they were just sitting ducks 
for the air force. All it had to do was go up and down and strafe 
them. Their casualty loss was terrific. They lost most of their 
equipment which they'd had down there, which wasn't very much, I 
guess. But they got enough of it together to set up a pretty strong 
line in the Vosges Mountains. 



51 



Gerbode: Then we were stuck there trying to get them out of these mountains 
for quite a while. We had very heavy casualties there. We were 
extremely active. But luckily, we had this old French barracks in 
Epinal set up as a hospital. When I went there to set this place 
up, the German operating list was still there in German script on 
a chalkboard. There was potato salad all over the place. 
Mattresses were bloody and dirty. I had them take everything out 
of the place, put it in the yard, pour gasoline on it, and burn it 
all up . Then we moved in our own equipment . 



Hughes: Did it make any difference in any way whether you were dealing 
with an American or a German wounded? 

Gerbode: No, we treated them all exactly the same. Actually, there were 

always other nationalities around who were watching out for their 
people. For example, there was always a Polish liaison officer 
who would watch out for Polish prisoners or wounded and try to see 
how they felt about the war and see whether or nor they were good 
enough to fight for the Americans when they got well. 

Oh, incidentally, at that time this Mr. Schweitzer whom I 
mentioned before had gotten into the army and was in charge of 
rehabilitating prisoners of war or moving them out to one place or 
another. He found out where I was, and he came to the hospital, 
and he didn't recognize me, I was so thin. [laughter] I didn't 
realize how thin I'd gotten. 



Wartime Surgery 



Hughes: What sort of hours were you working? 

Gerbode: Sometimes we'd work almost twenty-four hours, if it was very busy. 
Then we'd just flop down and get some rest and start over again. 
At other times, we wouldn't have anything to do for days and days. 

Hughes: Were you learning a lot? 

Gerbode: Harvey Gushing said, "War surgery either makes or breaks a 

surgeon." If he goes into the war not knowing much surgery and does 
a lot of war surgery, he compounds his mistakes and comes out really 
worse off. But if he's well-trained and applies his good training 
to war surgery, then he'll come out knowing more than he did when 
he went in. I think that's true. In our unit, which was mainly an 



52 



Gerbode: academic unit, we kept applying our training. I think it was 

quite apparent, and word would get back from base hospitals, that 
they liked the way we treated the wounds. They had to cope with 
fixing them up afterwards. 

Hughes: Were you having to operate much more quickly than you were used to 
at home? 

Gerbode: Oh, sometimes you'd stay there for twelve hours and do twelve, 

fourteen, fifteen, or twenty cases. It was a real assembly line. 

Hughes: I was wondering about blood substitutes. Wasn't that a problem 
earlier? 

Gerbode: Yes. Blood and plasma were sent to us overseas. We never really 
had quite enough of them. 

Hughes: How were they sent? 

Gerbode: They were sent over cold in airplanes from the United States, mainly. 
Sodium pentathol was a very useful drug. We'd have one man just 
fixing up syringes of sodium pentathol. That's all he did. 

Hughes: You could keep supplies like that? 

Gerbode: They kept us well supplied with things like that. 

Hughes: When you ran out of blood, then you were forced to use plasma? 

Gerbode: Then we used plasma or glucose. 



Heidelberg 



Gerbode: Finally they chased the Germans out of the Vosges. I was lucky to 
get out soon. I went right to Heidelberg, which is a place I had 
known before the war, and went to the university hospital. It 
was very interesting, because the Germans had left their wounded in 
the hospital. They were using paper casts for fractures. They had 
run out of plaster. You could see that their treatment was beginning 
to get pretty second or third rate at that point. The professor 
of surgery met Tie, a fellow by the name of Wolf, as I recall. 
He showed me around the hospital and introduced me to some of the 
other academic people there. I guess we had blown up the bridge 




Two sides of a postcard 
sent from Europe by 
Lt. Col. Frank Gerbode 
shortly before his return 
home. 




53 



Gerbode: across the river, so they'd run out of water, because the water 
came across on the bridge. That was a problem until the army 
built another bridge and brought the water back again. 

Hughes: When you went into a hospital like that, would you just literally 
take over? 

Gerbode: Oh, yes. 

Hughes: What would happen to people like Wolf? 

Gerbode: He stayed on. In fact, he even stayed on as professor after the 

war, until Fritz Linder went there to take his place. In fact he 
stayed on after that. They gave him a cancer institute to run. 

Hughes: But he wouldn't have been caring for patients once the Americans 
arrived? 

Gerbode: No. I think they let him take care of the Germans who were still 
there, but not the Americans. We moved in our whole unit there. 



Mutzig 



Gerbode: We moved out of that area and chased the Germans all the way up to 
the Rhine. I set up a beautiful little hospital in Mutzig which 
is in view of Strasbourg across the Rhine. I set it up in the 
middle of the night in a gigantic rainstorm. It was in an old 
French barracks. Our boys really did a tremendous job of converting 
it into a hospital. They worked just like demons. It became a 
beautiful little hospital in about forty-eight hours. 

We took care of the wounded there for about two weeks. This 
was over Christmas. We had a Christmas tree. The Germans were on 
the other side of the Rhine at that time, which was not too far 
away. Every once in a while, they'd come over and bomb some of the 
units nearby. They tried to knock out the water tower, for example, 
that we were using, but they missed it. 



54 



The Battle of the Bulge 



Gerbode: Then around New Year's Eve, the Battle of the Bulge started. We 

had to pack up and get out within twelve hours. They sent ambulances 
up. They took all the patients back to base hospitals or other 
hospitals. We packed everything up and rushed out of there on the 
way back to the other hospital in Epinal, which we had left 
previously. This was an evacuation of about a hundred miles. In 
the excitment our executive officer, who was a doctor, was in a 
jeep which was run over by a French tank. It was on the wrong side 
of the road. He was killed. 

Anyway, we went all the way back to our previous base and 
stayed there until the Battle of the Bulge stabilized. It was kind 
of a scary business for a little while. But we got out in time. 



Wartime Surgery (Continued)// # 
[Interview 3: August 8, 1983] 



Hughes: Dr. Gerbode, we talked some about the war, but perhaps you could 
tell me a little bit about how you were actually set up for 
surgical procedures. 

Gerbode: We first of all had to get a hospital put together in a number of 
hours to take care of the injured and wounded. So the idea was 
to set up the hospital in units. We first set up an intensive 
care unit, which is where the patients would be triaged. The word 
triage means to separate the patients into emergency cases and 
patients who can wait, those who were medical and those who were 
surgical. The triage team in the receiving tent did this work. 
The wounded and the sick would come in, and then they would be 
separated into these groups. 

The second thing we put up was the operating room. Then a 
fifty-bed ward. This would all go up within five or six hours. 
We had floors for the operating room and special tents. The 
packages of instruments and drugs were all ready to go as soon as 
we got the boxes unloaded from the trucks. 

The operating teams would then be ready to start operating. 
Usually it was a surgeon and an assistant surgeon, and sometimes 
a noncommissioned officer, a sergeant or somebody like that. 



55 



Hughes: Were those teams static? Did you work with the same group? 

Gerbode: Not always, but pretty much they worked together. I had the same 

assistant pretty much during most of the activity. The other thing 
was, to use the noncommissioned officers and sergeants. It was 
great to train some of these fellows to be assistants. After a 
while, they were so good, they were really better than some of the 
doctors, because they would do what you told them to do, and they 
would remember. Then they'd do it exactly the same the next time. 
There was never any argument about what they should do when they 
were assisting. Not that the doctors would argue, but still, it 
was great having a first-class assistant. I had two that were 
excellent. I think I mentioned their names before. One of them 
was Querhammer , who was a farmer from the Middle West. The other 
was Carson, who was a carpenter from Los Angeles. I've lost track 
of Querhammer, but Carson is a successful contractor now. I met 
him a couple of years ago. Very attractive, very intelligent guy. 

The patients would be brought into the operating room, the 
ones who needed operations, and we had one captain who was assigned 
to arranging all the anesthesia. He immediately would get busy 
getting the anesthetic things together. Sometimes he would be an 
anesthetist, and sometimes other doctors would act as anesthetists. 
Sometimes we'd use the nurses. Then we would operate, and then 
the patients would go back to a recovery room, which was another 
tent, where they would sometimes be evacuated in a day or two or 
three to another base hospital or might even stay there if we 
thought they would recover quickly. The patients would come in 
pretty muddy and pretty messed up, so it was a job getting them 
cleaned up so that they could be operated upon. But luckily, they 
were mostly in good health, so you were operating upon somebody who 
was young and healthy, and this helped a good deal, particularly 
when we had enough blood so we could replace their blood loss. 

We tried to send patients to tables where the surgeons had a 
little more expertise in one field rather than another, and this 
meant that those who had good orthopedic training would get most 
of the bone injuries, and those who had other training would get 
the other kind of [injuries]. My table, I guess, got pretty much 
anything that came along. We had lost our neurosurgeon somewhere 
along the line, so that we had to do the neurosurgery as well as 
the general and thoracic surgery. I had to do a fair number of 
brain cases and spinal cord injuries as well. 

Hughes: Had you done anything like that before? 



56 



Gerbode: 



Hughes : 
Gerbode: 

Hughes : 
Gerbode: 



Hughes : 

Gerbode: 

Hughes: 



I was trained in neurosurgery to a certain extent during my 
residency, so I knew the essential features of it. There were 
some pretty horrible injuries. For example, I had several 
patients who had had both their eyes shot through with frontal 
brain bullet wounds. Pretty much of a mess to see them. One 
would have to enucleate the remnants of the eyes and patch them 
up so they wouldn't get meningitis. It's a curious thing that one 
of these fellows had part of the frontal lobe shot away and one eye. 
I had gotten some preserved dura mater, which I used to cover over 
the defects on the brain so that the brain wouldn't become infected 
or exposed. 

A curious thing, many years later in the old Stanford Hospital, 
I was having rounds, and there was a fellow on the eye service, and 
somebody mentioned my name. He said, "Is that Dr. Gerbode who was 
in the war in France?" I said yes. He said, "You operated upon 
me and removed an eye in France during the war." He said, "I've 
never forgotten your name." He came in for some plastic surgery on 
his eye. 

That use of dura mater, was that something new? 

No, I guess it was generally used by some people. It was a piece 
of tissue that you could use to cover the brain. It was available 
because there were enough dead soldiers to give us the material. 

There's not a problem with rejection? 

No, it would be incorporated in the scar tissue. 

Anyway, sometimes we'd operate for long hours. We'd have to 
operate, obviously, until all the wounded were taken care of. If 
you got overly tired, you could rest for a couple of hours and 
then come back. Usually it was a matter of working maybe twelve- 
fourteen hours and then having a quick ward round on the patients 
upon whom you'd operated, although they were well taken care of by 
ward surgeons who were assigned more or less to postoperative 
care. Then you'd flop down in your bed and maybe try to get a 
shower and something to eat, and then go back on the line again. 

How many were you? 

I think we had forty-nine officers and fifty-two nurses. 

And all the officers had medical training? 



57 



Gerbode: No. They were about half medical and half surgical, and various 

levels of training. I was lucky, although I was young and not too 
far out of my surgical residency, I was given a major's commission. 
This was pretty good for a young guy going right into the war. 

Hughes: Why? 

Gerbode: Because I'd had very good training, and they recognized this. Then 
there was an opening in the unit, so I fitted the bill pretty 
well and got the commission. This of course was a great help, 
because being a senior officer gave me lots of opportunities which 
I wouldn't have had if I was a junior officer. 

Hughes: You haven't said anything about diagnostic tools. 

Gerbode: We had a mobile xray machine which we used. We had a whole team 

of roentgenologists who did nothing but take pictures and interpret 
them. They were pretty fast at it, so that if you had a compound 
wound with a fracture, they'd have a picture for you in fifteen 
minutes or so. Then you could use that to decide what to do about 
the patient. 

We were lucky in having surgeons who were very good at 
orthopedic surgery, particularly Dr. Matthewson, who was the chief 
surgeon. He had had good training in fractures and bone injuries, 
both in Europe and at San Francisco General Hospital, so he helped 
a lot to establish the kind of operations which would be best for 
these patients. 

There were quite a few joint injuries which required special 
care. We'd try to get them cleaned up and closed so that they 
wouldn't be infected. An infected joint is pretty difficult to 
cope with later. 

The operating activity would come in great bursts of furious 
work and then there would be periods when there wouldn't be anything 
to do for quite a while. This is bad in any army or navy unit, 
because then everybody starts looking around and finding things to 
complain about. Usually it's the army or the commanding officer, 
and anything bad, including the food. I tried to avoid these long 
discussions as much as possible, and maybe that's why the commanding 
officer gave me these special assignments, because he realized I 
didn't want to sit around and gripe very much. I would much rather 
be busy doing something than worrying about what was wrong with the 
army. 



58 



The German Wounded 



Gerbode: We had interesting cases , because as the war progressed, we of 

course had many German wounded and also some other ancillary wounded, 
some Poles and Hungarians and others , who had been brought into 
the German army. But they were mainly Germans, and the farther 
along we got in the war, they were younger soldiers they were just 
boys, really and older ones. The middle ones had either been 
shot up pretty badly or been captured or killed. 

Hughes: How young were the youngest? 

Gerbode: I guess they were fifteen, sixteen, and seventeen. Toward the end 
they were just kids. 

Hughes: And probably no time for much training. 

Gerbode: They weren't very well trained. The older ones were kind of 

tired of the war, and many of them had been wounded in previous 
battles. All the German soldiers in France had a peculiar smell 
about them. They didn't seem to have time to get fresh clothes or 
take baths, so they all smelled pretty badly. 

Hughes: Did they come in with diseases as well as injuries? 

Gerbode: They had some diseases. One thing that I think I mentioned before, 
they weren't very well protected against tetanus, so some of them 
got tetanus from their contaminated wounds. We had tetanus 
antitoxin; we could give it to them, but that doesn't cure people 
right away. They were not very well fed, because Germany was 
running out of food for them. They certainly ate a lot of potatoes 
and that sort of thing. 

Hughes: Because they weren't in as good health as the American boys, did 
you have more problems postoperatively? 

Gerbode: No, they were in good enough shape so they came through pretty well. 

Anyway, it was a very sad experience to have built this 
beautiful little hospital in Mutzig near Strasbourg on the Rhine. 
We could look out and see the Rhine from this old French barracks, 
and we knew the Germans were on the other side of it, until the 
Battle of the Bulge. It really was a very, very nice little 
hospital, and we were terribly busy there. I had it organized so 
that we were really almost like a regular hospital, because we had 
walls and water. 



59 



Booby Traps and Mines 



Hughes : 
Gerbode: 



Gerbode: Another thing that I found out, when we started exploring places 
to set up hospitals, you had to watch out for booby traps. Those 
clever Germans would put a little bomb on a toilet flushing chain, 
or they put something that would look like a little prize or a 
souvenir on a pedestal. If you picked it up, the thing would explode 
and blow your hand off. So we were very careful about any objects 
like that. 

Did you have a crew that went through when you first arrived? 

Yes. Then of course in some areas they had mined the roads and 
the areas around where they thought the [U.S.] army might go. 
So the army had a whole team of people that would go ahead and find 
out about mines and remove them. Some of the mine wounds were 
terrible. They had a cement mine which, when it exploded, would 
drive hunks of cement into the tissues. Of course that makes 
terribly infected wounds. We had a terrible time getting some of that 
[out]. 

Hughes: Was that the point? 

Gerbode: That was the point of it. It was cheap to make them out of cement 
rather than steel or nails or whatever. Then wien they exploded 
and drove these hunks of cement into the tissues, they all had to 
be gotten out, otherwise they were surely going to cause infection. 
When they went in through cloth, they carried bits of cloth with 
the pieces of cement. That all had to be removed. It was pretty 
messy. 



Pushing Back the Germans 



Gerbode: When they drove us all the way back to Epinal again from Mutzig, 

it was a very depressing turn of events, because we didn't realize 
the Germans were that strong. They had made this big effort to 
push us back. It was one gigantic, final effort. 

Hughes: This is 1944? 

Gerbode: Yes, 1944. So anyway, we went all the way back to Epinal. Then 

we waited there for a while until the Battle of the Bulge was over, 
until we started pushing the Germans back again. We had to go 
through the Hindenburg Line, so-called, and get through heavy 
fortifications. 



60 



Gerbode: We then had a series of moves up into eastern France and western 
Germany. We moved I guess three times into villages in various 
places, and finally ended up in Heidenheim, which is not too far 
north of Munich. A nice little village. I selected this place 
because it had a nice field. It turned out to be kind of muddy 
later on, but the engineers filled it in with rock and so forth, 
so it wasn't quite so bad. 

The Germans were really on the run at that point and going all 
the way back into the Austrian Alps and defecting quite frequently. 
We had a German colonel walk into the hospital one night and give 
himself up. I could talk a little German. So I talked to him and 
asked him why he was giving up. He said, "Well, we're going to 
lose the war." I said, "Why do you think [you're] going to lose 
the war?" He said, "Because of that two and a half ton truck of 
yours. It can always get there faster than we ever expect you to 
get to an intersection or a crossroad. You'd arrive with all your 
guns and equipment hours before we thought you could get there, 
because that transportation was so great." Those trucks were 
marvelous. They were fast and strong. 

Hughes: Were they developed during the war? 

Gerbode: Yes, they were a war product. After the war, we saw these trucks 
all over everywhere, because people wou.'.d pick them up right away 
and use them. Even down in the Hawaiian Islands , a lot of the 
plantation people bought them from the army surplus because they 
were so useful on the plantations. They are so strong and well 
made. 



Dachau 



Gerbode: When we got close to Munich, I really got more and more interested, 
because I'd been there for almost a year before the war. I knew 
Munich pretty well. When we got word that Dachau was going to fall, 
I got permission from the commanding officer to get a jeep, and Roy 
Cohn and I went right to Dachau. We got there the morning after 
we'd taken it. The moat around Dachau [contained] about a dozen 
German soldiers [who] had been killed and were lying in the water 
still. The people in Dachau were celebrating as best they could. 
They had some improvised flags they put up. The army brought them 
food. They were just scarecrows, just skin and bones. Whatever 
you read about Dachau is not exaggerated. The gas chamber room was 
filled with bodies, smoking and smoldering because they had run out 



61 



Gerbode: of oil to burn the bodies, so they just stacked them in this big 
room about seven or eight feet deep, one on top of the other, and 
smelling pretty awful. [The Germans had] taken their clothes off, 
and of course taken all the gold out of their teeth and any rings 
they'd had. Outside of the gas chamber was a big pile of bodies 
of men, women, and children, just skeletons really, piled up like 
cordwood. Then outside was a couple of open tank cars filled with 
bodies as well. Some of them died of starvation; some of them 
had been killed; and some had died of typhoid or typhus or various 
other things. If anyone disbelieves this happened, they shouldn't, 
because it was really true.* 

One thing I can say for the Germans is that they have documented 
this. If you go to Dachau now, you can see pictures of the whole 
thing, although some Germans just still don't want to believe it. 
But the Germans have made a big point of showing actual photographs 
of how they did everything, the places where [the Jews] had to sleep, 
and how they killed them and so forth. 

Hughes: Why did you want to go? Was it for a medical reason? 

Gerbode: No, I was just curious. I had known about Dachau; I just wanted 
to see it. 

Hughes: It was well known? 

Gerbode: Oh, yes. Remember I told you, when I'd been in Germany before, my 
cook's husband had been sent there. 



Munich 



Gerbode: In any event, Munich fell the same day [I went to Dachau]. So 

Dr. Cohn and I went right down to Munich. I found the little house 
we had rented in Geiselgasteig. It was in a forest, a beautiful 
location. There was an air-raid shelter dug in the front lawn. 
The house was locked; there was nobody there. I looked in the 
window, and there was a meal unfinished on the table. The people 
had left in a great hurry. 

Hughes: Where did people like that go? 



*Partly because of this experience, Dr. Gerbode contributed to the 
construction of the statue commemorating the holocaust, which stands 
near the Palace of the Legion of Honor in San Francisco. 



62 



Gerbode: They usually went further into the mountains, because the mountains 
were close by, and they had cabins up there where they could get 
away from the scene of activity. Then we went down to Munich 
itself. It was real devastation. The center of the town had been 
blasted to smithereens. I had a hard time finding my way around. 
The Frauenkirche was in the center of the city. I finally found 
it, because part of one tower was still standing. From there I could 
orient myself to the rest of it. They had already, after some of 
the bombing, built little stores out of plywood on the main streets, 
so they could do a bit of business with the remaining Germans 
before the Allies came. 

I knew the building where Hitler had had his headquarters on 
a great big square. This is where [Prime Minister Neville] 
Chamberlain had signed the appeasement pact. So I went right to 
the building. Since I was a lieutenant colonel at that point, the 
army sergeant that occupied the building let me go in. So I went 
right up to Hitler's office, and there was a sergeant from Texas 
with his feet on Hitler's desk and this great big room lined in 
pigskin. Our army had already stripped a lot of the pigskin 
leather off the walls for souvenirs. The army sergeant was there 
and really quite happy with himself, just sitting at Hitler's desk. 
He said, "Hi, Doc, you want a souvenir?" I said, "Sure." He said, 
"Well, the flag from the building is in Hitler's bathtub behind me 
in this room." So I went in there, and there was this big bathtub 
and the [flag] which they had taken off the building. He gave it 
to me, and I have it at home now. 

We drove around a little just to see the devastation, which 
was really awful. We'd really bombed the smithereens out of that 
town. 

Hughes: Were most of the inhabitants elsewhere? 



The German Surrender 



Gerbode: They were elsewhere. Hardly anybody was left. Once in a while an 
old person would be rummaging around in the debris. So then we 
went back to Heidenheim and waited. The Germans were really giving 
up here and there. As you went along the roads, you'd see a whole 
truckload of prisoners being brought back from somewhere. 



63 



Gerbode: Just before that the thing that was so obvious [was] that we 

had complete dominance of the air. Every night, and during the 

day, too, these huge flights of British and American bombers 

would go over to bomb various cities, just bombing them off the 

face of the earth. That was the only way you could get [the Germans] 

to give up, really: wreck the factories and the towns. They 

actually went after the center of the towns, too, because they 

had to get the people to realize that they were losing the war. 

En fact, one thing that happened several times on the way down 
through western Germany, the mayors would come out and surrender 
the village, and then as soon as our troops started going through, 
the windows would open on the second floor, and the SS would start 
shooting at the troops. They killed a lot of our soldiers this way. 
They were such rabid Nazis, they just couldn't believe that they 
were going to lose the war. So then our commanding general said, 
"Look, if this happens once more after the village has surrendered, 
we're going to back off and level the town. Nobody is going to 
survive." So the next time it happened, it was a town called 
Crailsheim. It was a modest sized town, maybe fifty thousand 
people. And sure enough, the SS was there with their machine guns. 
So then_ the general pulled everybody out , surrounded the town with 
tanks, called in the air force, and they absolutely leveled it. I 
don't think there was even a chicken alive. But that was the last 
time the Germans did that. That was the only way you could deal 
with it, you know. We went through Crailsheim right afterwards on 
our way down further south just smoking ruins. 

Hughes: Would you do anything about the German wounded? 

Gerbode: Oh, yes, we'd take care of them, just like the Americans. We took 
care of a lot of civilians that way. 

Hughes: What was their attitude? 

Gerbode: Well, at that point, they knew the game was up. They were sad, 

dejected, disillusioned people. This was even true of the soldiers, 
the old people they brought in, and the young people; they 
realized that it was hopeless. 

The other thing, of course, is the German air force was wiped 
out. We could never find Stucke bombers in airports. They used 
the Reich autobahns for their airstrips, and then they'd bring the 
planes into the forests where they had everything camouflaged. 

II 



64 



Return to the United States 



Gerbode: When the Germans finally gave up, I was lucky, because they had 
a system of points, and the people who had the most points were 
allowed to go home first. I had a wife and three children, and 1 
had been in from the very beginning. I had gone through all these 
five or six campaigns, so I had more points than most of the 
others, so I was among the very first to be permitted to go back. 

We were sent back to Paris and put up in the Galerie Lafayette, 
which was a big department store in the center of Paris. It's 
still there, rebuilt. The Americans had taken it over. They had 
showers, bunks two or three high, where we slept while waiting for 
evacuation. We were there for about a week. We were there actually 
on Bastille Day, which is always a big celebration. It was very, 
very emotional because this was the first Bastille Day after the 
Germans had been defeated. Some friends and I walked all the way 
up the Champs Elysee with the crowds of people celebrating the end 
of the war. 

I went back to the Hotel Crillon, which is on the corner of 
the Place de la Concorde where the family and I had gone a couple 
of times before the war. It was then an American officers' 
rehabilitation center or something like that. They had an orchestra 
so that the Americans could dance and play around with the French 
girls and the nurses. I went up to the desk and asked the steward 
if he knew that my family and I had been there before, and he said, 
"I'll look it up." He found our old bill. [laughs] 

Finally we were told that we were ready to leave to go home. 
I was with some of the University of California group, who had a 
base hospital. Brodie Stevens* was one of the men who was there at 
the same time waiting to be evacuated, along with some of the other 
University of California officers. So a whole bunch of us were 
cart ad out to an airstrip and put in a C-54, a four-engine motor 
plane, and started home. We all sat in metal bucket seats around 
the inside of the plane. We were given evacuation instructions in 
case we went down in the ocean. 

We were going from Paris to Newfoundland to make our landing, 
and about three-quarters of the way across, one of the engines in 
the plane went crazy, and we lost thousands of feet in a great hurry. 



*Brodie Stevens was a surgeon and member of the medical faculty of 
the University of California, San Francisco. 




Above: On a landing craft between Sicily and 
Italy, 1944. 

Right: Off to war, April 1942. In the garden at 
the Gerbode home on Divisadero Street. 








Frank and Martha Alexander Gerbode soon after his return from war, ca. 1945, 



65 



Gerbode: So we were all told to get ready to go in the drink. Brodie Stevens 
said, "Well, Frank, I guess this is it." Luckily, these kids who 
were driving the plane to us these youngsters looked like high 
school students managed to feather this crazy engine and got it 
under control so they could get it into Newfoundland. We were 
very happy to land safely. [laughs] That was really something, 
to think that we'd go down in the ocean after going through all this 
other business [during the war]. 

They put us on another plane in Newfoundland, and finally we 
got to New York, after a couple of transfers of airplanes. My 
wife met me there. She was waiting in the Gotham Hotel. We had 
been able to send messages saying that we were coming home. 

The thing that I remember so clearly on arriving in New York 
was to find business as usual, no sign of any suffering, and nobody 
really seemed to care very much about the war. It was very strange. 
And the same thing was true in San Francisco later. I could write 
another little chapter about the attitude of the people that didn't 
go away during the war. 

Hughes: Could you say something not a whole chapter about that? 

Gerbode: One of them that didn't go away said, "We're going to have refresher 
courses for you fellows [who have come back from the war] so you can 
remember how to take care of gall bladders and hernias and so forth, 
and get you back into shape." This was a terrible thing to say. 

Hughes: Yes, as though you'd been away on a vacation. 

Gerbode: We looked healthy, because we were all slimmed down and brown, so 
they thought we had been on a gigantic vacation. They were home 
taking care of everything and really suffering terribly. 



Dwight Harken 



Hughes: 



Gerbode : 



Dwight Harken crops up a lot in talks about the war. Since you both 
were more or less in the same field, I wondered if you had any 
contacts with him or knew about what he was doing? 

Dwight is a friend of mine. He was with a Harvard unit which 
stayed in England at a base hospital, so he got a lot of these 
patients who had been evacuated by hospitals like mine. There he 



66 



Gerbode: was one of the first to demonstrate that you could remove shell 
fragments from inside and around the heart without using 
extracorporeal circulation. He did, I think, several hundred 
patients this way with very, very good results, the first time that 
anyone had really tackled this kind of surgery with such success. 
It really made him quite famous. 

Hughes: Had you gone into the war with the feeling that the heart was 
surgically inviolate, so to speak? 

Gerbode: No, we had no feelings about it being inviolate. But actually, 

if a shell fragment was lodged near the heart and the soldier was 
doing well, well enough to be evacuated, we'd send him back with 
his shell fragment, take care of his external wounds, because most 
of the time a shell fragment in or around the heart was not life- 
threatening at that time. Later on a shell fragment would erode 
parts of the heart and patients would bleed, or they'd get infected, 
or they'd interfere with the function of the heart. This was also 
true of the boys coming back from Korea. They also had shell 
fragments in and around the heart which had to be removed when they 
came back. 

Hughes: But you didn't have to do that in World War II. 

Gerbode: We didn't have to do it at all. We did take out shell fragments in 
the chest and around the heart if they were causing trouble at the 
time. But Dwight really did a magnificent job in doing this 
electively in England. He'll be remembered forever because of the 
work he did. 

Hughes: Yes, I read that he removed one hundred and thirty-four missiles 
without one death. 



Combat Medals 



Hughes: You modestly neglected to talk about the combat medals. Could you 
tell me a little bit about how those are awarded? 

Gerbode: It's a curious system. Combat medals are awarded because you were 
in a given campaign. Our unit ended up with six combat medals. 

Hughes: Per person. 



67 



Gerbode: Yes, everyone got one. It's a little star on a bar. I don't 

think any of us were wounded, so none of us got a purple heart. 
But there were several medals for meritorious work that were given 
to members of our unit. I didn't get one. 

Hughes. But you got a unit citation. 

Gerbode: Yes. The whole unit was cited for having contributed such a lot of 
good work during the war. 

Hughes: When they say good work, they mean in the medical-surgical sense. 
Gerbode: Yes. 

Hughes: I know it's hard to be objective when you were part of it, but I've 
had the feeling this was an exceptional unit. 

Gerbode: It was. It was so good, because we had all been academically 

trained, we all had gone through residencies, we knew good medicine 
and good surgery, and we tried to apply it to work in the field, 
which is a very good way to do it. We were so good that they 
constantly tried to break us up, put us in other units. But most 
of us resisted any attempts to move us. If the question came up, 
we said, no, we'd rather stay with our own group. But there were 
two or three surgeons who left the group and went to other units. 



Other Base Hospital Units 



Hughes: I saw allusion to the Fifteenth Medical General Laboratory which in 
1943 was apparently moved into Italy. I don't know much more about 
it, but I thought maybe since you were there, it might have 
influenced what you were doing. 

Gerbode: There were several big base units that were moved into 
Hughes: This was in Naples. 

Gerbode: Yes, and also later on in Rome. For example, the Harvard General 
Hospital I think moved into Naples first and then Rome and stayed 
there during these final pre-evacuation treatments of patients. 
They did close a lot of the wounds secondarily that we had made 
originally in the evacuation hospital. 



68 



Hughes: So these were serving the same function as Harken's unit. 

Gerbode: Yes, except they were closer up to the front. In fact, [the 

Harvard unit] landed in Casablanca very shortly after we landed 
there. We were quite jealous of them, because they got a nice big 
school or two to set their hospital in, and they had a lot more 
amenities than we did out in the field in our tents, including 
having a better supply of liquor. [laughter] 

Hughes: That was very important. 

Gerbode: But their commanding officer was not very popular. He was an 

obstetrician. Most of the officers hated him. I won't mention 
his name. There were a couple of officers in that Harvard unit 
that were very outspoken, very much individuals, and they were 
constantly being punished by this commanding officer. I had some 
good friends in this unit. One was Tygve Gunderson. We rented a 
double bicycle and explored the countryside around Casablanca. 



The Commanding Officer 



Hughes: You didn't have a problem with your commanding officer? 

Gerbode: We had a regular army surgeon who was our commanding officer. He 
was not at all well liked by our people. I got along with him, 
because I didn't think there was any point in antagonizing him. 
Maybe that's why I got all these little extra assignments. It 
wasn't because I expected to be promoted or to get a medal for it. 
I just didn't want to be inactive. I wanted to do something 
constructive. 

He was an orthopedic surgeon and had been in World War I. He 
acted as though the war was just another experience like the 
previous one in a way. But he was very high in the hierarchy of 
the regular army and may have had some influence on where we were 
sent at various times. 

Hughes: Was he dictatorial? 

Gerbode: Well, he had some peculiarities. For example, he carried with 

him a McGuffy's Reader, sort of like a Bible. Do you know what a 
McGuffy's Reader is? 



69 



Hughes : 
Gerbode: 
Hughes: 
Gerbode: 



Hughes: 



Gerbode; 



It's a primer, isn't it? 

It's a children's primer. He carried this all during the war. 

What was that for? 

I don't know why he did it. Maybe he read it once in a while, 
[laughter] It was only when people started griping and complaining 
a lot that he'd get cranky and do things that they would dislike 
even more. To me that was kind of a waste of time, because if you 
weren't acting up, he would leave you alone. 



That's all I have to ask about the war. 
to say? 



Do you have anything more 



I don't really have anything much more to say about it. I said 
already that Harvey Gushing had long since said that war either 
makes or breaks a surgeon. From my own personal point of view, I 
guess what I got out of the war from a surgical point of view was 
confidence, because there wasn't anything, really, that phased me 
after doing all that work in the war. I guess that you get used to 
handling all kinds of situations. 



Correspondence To and From Home 



Gerbode: From the point of view of hearing from home, this was difficult, 
because we got very little mail. Once in a while, we'd get a 
batch of mail. I had a few people who wrote to me regularly. Mrs. 
Happy East Miller, a very lovely older woman of the Miller family 
in San Francisco, wrote to me regularly, and several other 
acquaintances. I guess they enjoyed writing to a soldier overseas. 
I would answer their letters, and they would go through all right. 

Hughes: I wonder if any of those letters have survived. 

Gerbode: I have some letters that I wrote at home. I haven't looked at them 
since I got back. 

Hughes: Don't let anything happen to them! 

Gerbode: I wrote a lot of letters, because it was a way to soak up time. 



70 



III THE IMMEDIATE POSTWAR YEARS 



Research and Surgery 



Decision to Stay at Stanford 



Hughes: Then you were back as an instructor in surgery at Stanford. Did 
you ever consider going anywhere else? 

Gerbode: I'd had offers to go several places very soon after I got back. 

The army asked me to stay. I had an offer to go to New York, and 
an offer to go to Washington, D.C., and a couple of tentative 
offers elsewhere. 

Hughes: Did those offers have anything to do with your wartime experiences? 

Gerbode: No, it was the fact that they could see I wanted to pursue an 

academic career. I'd written a few papers and gotten this was a 
few years after the war to be known a bit. But I turned them all 
down. I didn't want to leave San Francisco. No matter what the 
honor might be to go elsewhere, it didn't mean anything to me. 
Even Palo Alto later on. [laughs] 

Anyway, I came back from the war and, as I said, the boys 
who had not gone away said, "Now, we're going to set up some 
refresher courses for you." That was one thing, and another group 
said, "We really need you in the outpatient clinic to work with the 
students." This again was like a kick in the pants, you know. 
But I accepted some of these things, and I went to the outpatient 
clinic a little of the time, and finally got back on the team 
teaching in the hospital. But mainly I went right back to work in 
the laboratory, because if nobody was going to send me any patients 



71 



Gerbode: to operate upon and there wasn't much else to do, there was always 
a lot of work we could do in the laboratory. So that's when I 
started working with things which finally led to extracorporeal 
circulation. 

Hughes: Why? 

Gerbode: Vascular surgery was just beginning to be born, and I could see 
its future was going to be very exciting because if you could 
correct a congenital lesion, you usually had a pretty whole person. 
The choice then was either to do that or to do brain surgery or 
cancer surgery. Cancer surgery didn't make me very excited. It's 
a matter of cutting out a lot of tissue and then waiting to see 
whether a patient was going to get [the cancer] back again. One 
of the professors wanted me to be a neurosurgeon, and he tried 
everything possible short of killing me, which is really true, to 
get me to be a neurosurgeon. 

Hughes: This was [Reichert] during your surgical residency? 

Gerbode: Yes. It was really something to cope with him, because he was a 

very strong man. He had a very strong wife, who had decided, too, 
that this would be best for her husband, to have me be a neurosurgeon. 

Hughes: Of course it was a compliment. [laughs] 



Simulated Congenital Lesions and Extracorporeal Circulation 



Gerbode: I finally just said, "No, I don't want to do that at all." So then 
I started making simulated congenital lesions in animals and trying 
to reduplicate what sometimes happened congenitally and then 
experimenting finally with extracorporeal circulation. Some of 
the first things we did were really quite curious. For example, 
the first oxygenation we did was to put the venous blood in bags 
with oxygen and shake them. Then we'd get the blue blood to turn 
pink, and then we'd give that back to the animal. This was the 
first time we had tried to do anything to simulate an artificial 
lung. I did this with John Callaghan, now a professor in Edmonton, 
Canada. 

Hughes: This was right after the war? 
Gerbode: Late '40s and early '50s. 



72 



Hughes: What kind of success did you have with that? 

Gerbode: Pretty good. The trouble was, we didn't realize it at the time, 
but when you shake the blood this way, a lot of bubbles get in 
the blood. This happened later on when we got into using bubble 
oxygenators in extracorporeal circulation, and it's still a bit 
of a problem now. Microbubbles will occur, and they're not very 
well tolerated by the body. We [did] a lot of experimental work 
on that later on in our laboratory. 

We had a good diener in the laboratory, a fellow by the name 
of John Kratsch. He was very helpful and was there every day and 
very good at helping with animals. Later on another Jewish German 
emigre* was there by the name of Ludwig. He got to be very good, 
too, at helping with animals. 

The laboratory that I went back to in the old [Stanford] 
medical school was absolutely infested with cockroaches and lice. 
Periodically we'd try to get somebody to come in and blitz the 
place, but they were under the floors and in the drawers and 
everthing. During the war, nobody worked in the laboratory. It 
was an old building, and the bugs and beasts just took over. But 
we finally got it cleaned up reasonably well. When you'd bring 
the animals in, they were usually filled with ticks and lice. They 
would have to be cleaned up. 



Patient Referrals 



Hughes: How were you faring right after the war with patient referrals? 

Gerbode: Oh, few and far between. I had no place to see a patient. Although 
they were very happy [for me] to be an instructor and work in the 
outpatient clinic, nobody offered to give me a place where I could 
see an occasional patient. Frank Norris, who had not gone away to 
the war and who was a gynecologist here in town, was a friend of 
mine, and he said, "You can have a little space in my office on 
Van Ness Avenue." So that's where I went once or twice a week 
just to see if somebody would come. [laughter] The cases that 
were referred to me were breast tumors or once in a while a thyroid 
or a hernia or an appendix. But I'm very, very grateful to Frank 
Norris for giving me a place to hang my hat. 



73 



Gerbode: 



Hughes : 
Gerbode; 

Hughes: 
Gerbode: 



Hughes : 
Gerbode: 



Hughes: 

Gerbode; 
Hughes : 

Gerbode; 

Hughes : 
Gerbode; 



Eventually, as I worked my way into the faculty a little and 
became useful to them I thought I was useful to them in the 
beginning, but more useful to them they gave me a place in the 
old Stanford Hospital where I could see patients twice a week. 
But then the dean said, "I don't really want you to send any cards 
announcing that you have an office here." [laughs] He said, "You 
can see patients here, but don't send out any cards." 



He was a rather 



What did he think would happen to you? 

I didn't really want to find out why he said that, 
peculiar man anyway, so it didn't matter. 

How did that situation gradually change? 

Well, one thing that changed it was the fact that Dr. Holman found 
I was a good assistant, and he was the professor, so he had a 
pretty large private practice. So did Reichert, the neurosurgeon. 
They needed good help in the operating room, aside from the 
residents. So I would just scrub in and help them, and then finally 
once in a while, somebody would refer a case to me instead of to 
them, particularly if they went away. [laughs] 

Was that all right with them? 

They couldn't say much about it. If the boss goes away, whoever is 

left behind can do the work if he can get it. This is generally 

true in all medical schools. The second or third in command is 

always very happy to see the boss leave. 

This sort of thing, I would imagine, always happens to a younger man 
trying to break into a field, but 

It does. 

the fact that you had been away and they hadn't would aggravate 
that situation. 

Yes. The other thing is that there were quite a few people who 
hadn't gone away, you see, and they had most of the practice. 

Yes. 

Holman went away to the navy, and Reichert didn't. Holman served 
very well in the South Pacific and at Mare Island. But when he 
returned he was the professor, the chief, so he had no problem 
getting patients again. Reichert had stayed home, and I must say. 



74 



Gerbode: it was terribly hard on him. He was very conscientious about 
teaching and his responsibilities to the house staff. So he 
worked really hard, almost to the point of becoming a little bit 
psychotic sometimes, I thought, under the pressure. This carried 
over later on when Dr. Holman came back and took over. Then 
Reichert was not the big chief any more, and this was a little bit 
of a problem, too. 

Then when we began to do heart surgery, Dr. Holman liked to 
have me assist, because f was a pretty good assistant. I had 
already done most of the procedures in the dog lab, because I was 
constantly working over there with all my free time, doing 
experimental procedures on animals. Managing blood vessels and 
things around the heart was becoming quite familiar to me. So 
gradually I just got a few of these patients. 

Hughes: These were mainly congenital anomalies? 

Gerbode: These were congenital anomalies, but not open heart surgery. These 
were procedures like doing patent ductus and coarctation and the 
Blalock procedure, which came along a little later. 



Early Vascular and Heart Surgery in the United States//// 



Gerbode: [What] first pushed vascular surgery and then heart surgery forward 
in this country was the access that young university men had to 
the laboratory, and the fact that if they had made a name for 
themselves in the experimental laboratory and could present papers 
at meetings, this was very good for their record and promoted them 
in the faculty almost faster than anything. 

Hughes: Now, was this unusual? 

Gerbode: This was more or less American. 

Hughes: Not British. 

Gerbode: No. The British frowned on experimental surgery. 



75 



Robert Gross: Operations for Patent Ductus and Coarctation 



Gerbode: 



Hughes: 
Gerbode: 



Hughes: 
Gerbode: 

Hughes: 
Gerbode : 



Anyway, there were two men in our country who really pushed things 
forward, and they were both men who'd worked a lot in the laboratory. 
One was [Robert] Gross in Boston, who did the first patent ductus 
arteriosus. Dr. Holman had been offered a patient to operate 
upon a patent ductus before this by Bill Dock, who was then on the 
medical faculty, but [Holman] turned the patient down. He didn't 
want to do it for some reason. So then he lost a chance to become 
immortal. But Gross did one, and he ligated it successfully. There 
had been a couple of attempts before, and they had failed. But his 
patient survived, and he was working in a hospital where there 
were children with all kinds of defects, and so he had lots of 
material. He immediately did a whole batch of patients with patent 
ductus. 

He was from Boston? 

He was at Children's Hospital in Boston. He worked with Charlie 
Hufnagel in the laboratory. Between the two of them, they had made 
experimental coarctation and perfected an operation. About the 
same time that Clarence Crafoord in Stockholm had done a successful 
coarctation [October 19, 1944], they had done one in Boston [June 28, 
1945]. This also caused tremendous excitement. 



And then you did one noc long thereafter, 
it in 1951. 



You published a paper on 



Yes, I did some very early. I did the first patent ductus at 
St. Bartholomew's Hospital in London in 1949. 

Yes, I read that paper a young boy with a psychiatric problem. 

That was a coarctation. Christopher Frye. He became a doctor at 
St. Bartholomew's later, and I saw him in London when I was over 
there recently. 



The Blalock Procedure 



Gerbode: Anyway, Blalock had also been experimenting on animals to try to 
correct coarctation. He really didn't think he could cut out the 
coarctation and sew the ends together. 



76 



Hughes: Why? 

Gerbode: He said later, "The reason I didn't think of doing it that way 

was because I'd never seen a coarctation. I'd only seen pictures 
of them." 

What he did then was to turn down the left subclavian artery 
into the area beyond the coarctation to make kind of a bypass 
operation. He didn't realize it at the time, but this was an 
operation which later became the Blalock procedure for blue babies. 
That was a tremendous thing. It is said that Helen Taussig 
persuaded him [Blalock] to do this, because she had seen Gross 
produce an artificial ductus by sewing the subclavian artery into 
the pulmonary artery, and that produces the same physiology as a 
patent ductus. So she knew that blue babies who had tetralogy 
of Fallot, who had a patent ductus, did well. Then if the patent 
ductus closed, the children would die. She then rightfully said, 
if we can make a patent ductus, then we can keep some of these blue 
babies alive. She persuaded Blalock to try it. He had a very fine 
black man, Julian, working in the laboratory who helped him a great 
deal. He was terribly good with his hands. He and Al worked on 
this operation for blue babies. 

Hughes: You mean he would actually assist Blalock? 

Gerbode : Yes , and they worked together in the lab . Julian got so good at it , 
I think he was doing it very well himself. 

Hughes: Did you subsequently do some of those operations yourself? 

Gerbode: Oh, yes, I did maybe a hundred or so. When I went to England in 

'49, I did this operation and nobody else [there] was doing it very 
much. 

There were thousands of blue babies in this country and in 
Europe. This was the first operation that came along that could 
help them at all, so that everybody was trying to do these blue 
baby operations after they knew a little bit about the field. Dr. 
Holman's wife was named Dr. Ann Purdy, and she was a pediatric 
cardiologist. She had a bunch of these children on a string. She 
developed a tremendous practice and fed these patients to Dr. Holman, 
and I was helping Dr. Holman. As time went on, once in a while 
she'd slip me one, too. [laughs] If it went well, then that was 
fine. 

Hughes: The success rate in the beginning was not all that high, was it? 



77 



Gerbode: The mortality rate wasn't so very great, maybe 5 or 6 percent. 
Hughes: Most of these children were terribly sick, were they not? 

Gerbode: They were very blue. Well, most of them were not very well 

developed, because they hadn't been able to run or play very much. 
But they blossomed with this operation. 

Anyway, with [Clarence] Crafoord's operation for coarctation, 
Gross's operations for patent duct us and coarctation, and Blalock's 
developing the Blalock procedure, this caused a tremendous amount 
of excitment. Then everybody started trying to find other things 
to do. The ones who could were better off. These were usually 
ones who had worked a lot on experimental animals in the dog lab. 
This was generally true of the young academic surgeons. Now, the 
other thing that contributed to this a bit later was the fact that 
a lot of these young faculty members, like me, didn't have much to 
do when they came from the war. [laughter] So we were working in 
the lab anyway to keep busy. 

Hughes: So it was a blessing in disguise. 

Gerbode: They were the ones, then, who pushed the field forward. Harken 
was one. He very quickly started doing these mitral valve 
operations. He was accepted as a thoracic and heart surgeon 
because of his war record. 



Factors in the Advance of Thoracic Surgery 



Hughes: Would you say something now about some of the other things that 
were coming along that were essential to the advance of thoracic 
surgery? 



Endotracheal Anesthesia 



Gerbode: There was a great deal of activity in thoracic surgery. In fact, 
because of endotracheal anesthesia, surgeons were able to control 
an open chest operation much better than they could before [the 
war], when we didn't have very good anesthesia, didn't have 
anesthesiologists who could manage patients with an endotracheal 
tube. 



78 



Hughes: Was that a war development? 

Gerbode: The war pushed it forward a lot. When the young surgeons found 
they could do so many operations in the chest, there were papers 
at all the meetings, transthoracic this and transthoracic that. 
One of my friends, who was mainly a cancer breast surgeon in Boston 
said, "I've got to figure out how to do a transthoracic breast 
amputation." [laughter] "It would be worth a lot." 

Hughes: That's lovely. 

Gerbode: He's a wonderful guy. We had a lot of fun together in Africa. 

[interruption] 
Hughes: You were talking about anesthesia. 

Gerbode: Yes, the anesthesia improved enormously, and the anesthesiologists 
learned how to manage patients with an endotracheal tube. This 
was very important. They mainly did it with their hands at that 
time. They had bags which they would squeeze to bring about a 
respiratory movement. 

Hughes: Was the anesthesiologist a member of the surgical team on a par with 
everybody else? 

Gerbode: The anesthesiologists were not quite that far along. Wall, in 
1 49 and ' 50 , they began to become very important . 

Hughes: The British have a history of using different sorts of anesthetics 
than the Americans; at least that's the way it started out. 



The Engstrom Volume Respirator 



Gerbode: Yes, but I think the biggest advances in the open chest work came 
from the Swedes, because they are the ones who developed one of 
the first artificial respirators, the Engstrom respirator. That 
came out really because Engstrom was an engineer , and he had another 
fellow who was a physiology engineer who worked with him. These 
were patients who had very bad trauma to their lungs in automobile 
accidents, and there wasn't any way, really, to keep them 
going without some kind of artificial respiration. For a long time, 
they had to have a nurse stand there and use a bag to respire for 
the patient. Those who had polio and were paralyzed and couldn't 
breathe were put in the so-called iron lung. This is a machine where 



79 



Gerbode: the head stuck out of the end, and they had a rubber collar around 
the neck. The inside of it would expand or contract the chest by 
negative or positive pressure. We had one of these machines over 
here and used it for a while on polio patients, but that was a 
terrible way to do it. 

Anyway, the Engstrom respirator was a volume respirator. It 
would take over the patient's respiration for long periods, months. 
It was a big advance. 

I got to know the Swedes pretty well. I had been over there 
a few times. In '49 I went over there from England and saw this 
machine in operation. When I came back, I said we need to get an 
Engstrom unit, which seemed to me much better than having the 
anesthesiologist stand there squeezing the bag during the whole 
operation. The anesthesiologists said, "We can tell much better 
by the feel of the bag whether we're doing a good job or not." I 
said, "You may think that, but..." 

There was only one anesthesiologist who was willing to try 
one of these machines. I got my friend Viking Bjork to send me a 
second-hand one. I didn't, have enough money to buy a new one, but 
he gave me one which was about a year old and had it shipped over. 
I gave him what he thought was a fair price for it. Everybody in 
the place was scared to death of it. My associate, Dr. [John] 
Osborn, after we'd been experimenting with it for a while, wrote me 
a memorandum telling me he thought it was a dangerous machine that 
was killing patients, and we shouldn't ever use it. 

Hughes: Was it killing patients? 

Gerbode: No, it was saving patients. The chief of anesthesiology, [Philip] 
Bailey, wouldn't use it. One anesthesiologist by the name of 
[Ernest] Gianotti finally was willing to try it, and he began to 
use it very successfully. 

Later on they were still not convinced, so I brought over the 
engineer and professor of anesthesia from the Karolinska Institute 
in Stockholm. I got money enough to pay for them, to bring them 
over to keep them here for a couple of months to work in the 
intensive care unit, in postoperative care, and also in the 
operating room. They finally were able to demonstrate that the 
machine was a big advance. We were the first unit in the country 
to use the volume respirator clinically. 



80 



Gerbode: There was another group who came along very soon afterwards. That 
was [William Henry] Muller and Dammon, who was then in Virginia. 
They had been in California. They saw the light, too, and began 
to use [the Engstrom respirator] and wrote some papers on it. 

About this time I went to [the Peter Bent] Brigham Hospital, 
where Dwight Harken was then operating on quite a few mitral 
patients. They had a postoperative recovery room. I noticed 
that they were using pressure respirators, which were made by 
Bird, a California outfit. We used a lot of them, too. They're 
not bad, but they're not as good as the volume respirator. They 
were sort of a poor man's respirator. I said to Franny Moore, "I 
think that you ought to get interested in volume respirators." 
He said, "Write me a letter about it." So I wrote him a letter, and 
he wrote me back, "I've turned this over to my chief of anesthesiology , 
and I'll send you back a report later." So what he did, like a 
general, he said, "Now, you study this and tell me whether you 
think it's any good or not." After a couple of months, he sent me 
a letter and he said, "I've turned this over to Dr. So-and-so in 
anesthesia, and he has studied the matter and believes [volume 
respirators] are dangerous and shouldn't be used." But they all use 
them now. [laughter] 



Advances Affecting Cardiovascular Surgery//// 
[Interview 4: August 10, 1983] 

Cardiac Catheter izat ion 



Gerbode: One of the essential aspects of doing cardiac surgery is cardiac 
catheterization. As you know, one team got a Nobel Prize for 
developing cardiac catheterization.* Then young people were being 
trained in the technique. It was apparent that in order to carry 
cardiac surgery forward, you had to have a cardiac catheterization 
laboratory. 

It was my job to get this done at the old Stanford Medical 
School. It was very difficult, because we had to have a room with 
a certain amount of equipment, in addition to getting someone to do 



*Werner Forssmann, Dickinson Richards and Andre F. Courland received 
the Nobel Prize in medicine in 1956 for discoveries concerning heart 
catheterization and pathological changes in the circulatory system. 



81 



Gerbode: the work. It was very difficult to get this room [from] the 

administration. The people in control of the rooms were not quite 
sure whether this was going to be a big thing or not, and people 
like to hang on with great enthusiasm to their territorial 
acquisitions in any setup. So I finally got a storage room in the 
basement to start the lab. Then we bought some catheters and used 
them on experimental animals first of all. Then as time went on, 
we found Herbert Hultgren on the East Coast, who was trained in 
cardiac catheterization. He got a fellowship to come out and start 
the lab. 

Hughes: Excuse me for interrupting you, but with a technique so relatively 
new, how would Hultgren have received training? 

Gerbode: He trained with some people in the East who had one of the early 
catheterization laboratories. 

Hughes: Where was he? 

Gerbode: He was trained [at Thorndike Memorial Laboratory, Boston]. 

Hughes: So there were a few institutions that did cardiac catheterization. 

Gerbode: There were a few institutions that had already started, that's 
right. 

So [Hultgren] came out. I think it was the Giannini Foundation 
that paid his fellowship. But the amount they were willing to pay 
for a fellowship at that time was pretty small. However, he was 
willing to accept it as a starter. Then we had to get money for 
technicians as well , because somebody had to do the blood chemistries 
on the blood samples. We found money here and there to do that. 

Dr. [Arthur] Bloomfield, who was professor of medicine at 
that time, said, "Well, we shouldn't charge anybody for this test 
the first year, because it's an experimental procedure. We have 
to do it for nothing." Which shows you how tentative the faculty 
members can be with new things. They have to go ahead very 
cautiously. 

Hughes: Because it was experimental, in those days did you have to get 
any special patient consent? 

Gerbode: No. At that time we didn't have to go through the business of 

getting informed consent. However, we would tell patients anyway 
what the risks were. But the risks were practically nil anyway. 
The patients were very anxious to find a proper diagnosis. 



82 



Gerbode: The first operations we did were simpler ones, like patent ductus 
and coarctation, but later, as I've indicated previously, we got 
into operating on blue babies, too. We had a very nice doctor in 
physical therapy by the name of [Fred] Northway. He had virtually 
a whole floor in the medical school devoted to physical therapy, 
and I finally persuaded him to give up one room for a cath lab. We 
moved from the basement to this room. Again, it was pretty 
primitive stuff. We had to use a portable xray to watch where the 
catheter was going, and that wasn't very satisfactory. 

Hughes: Was this done under local anesthetic? 

Gerbode: Yes. It's very simple. 

Hughes: A child will lie still long enough for that? 

Gerbode: Yes, the children really are quite good about it. Later on we had 
to use a light general anesthesia for some of the cases, but not 
very often. 

Hughes: It's not terribly painful then? 

Gerbode: No, it isn't. As soon as we were able to operate upon these 

children, then we had a lot more patients offered for study. The 
administration finally began to realize that this was something 
important, [and] they'd better get on with it. Hultgren did a 
very good job of getting it started. 

Hughes: Could you explain exactly how catheterization helped diagnosis? 

Gerbode: The simplest explanation is that you put a long tube in an arm 

vein, thread it up into the heart, and then you take blood samples 
in the heart, and you measure pressures in the heart. You measure 
pressures because if there is a blockage in, say, the pulmonary 
artery, and you have the catheter in the right ventricle, the 
pressure is very high. You can sometimes get it through the valve 
into the pulmonary artery, and then you can see the difference 
between the two pressures. 

Hughes: The name Helen Taussig, of course, stands out in this area; how 
was she doing diagnosis before cath labs were established? 

Gerbode: Mainly on physical examination and xrays. 
Hughes: How did she do that? 



83 



Gerbode: Well, there was quite a bit of science and history connected with 
making a diagnosis without catheterization in congenital heart 
disease. You could tell by the contour of the heart and the 
physical findings, the sound of the heart. You could tell pretty 
well the general category of the type of congenital anomaly there 
was. Then they had a lot of hearts to examine postmortem, because 
a lot of these children were dying. So they were very careful to 
do postmortem examinations on them. They developed quite a science 
of correlating what they had seen preoperatively or before the 
child died with what they found in an autopsy. You can do a pretty 
good job of guessing what's wrong that way. 

But coming back to catheterization, the other thing the 
catheter would do, you could take a blood sample from the chambers 
of the heart, and if, for example, you found the oxygen saturation 
in the right atrium very high, as compared with a vein, then there 
is certainly mixing of arterial blood with it. This meant that 
there was a shunt somewhere, a hole between the two sides of the 
heart. If you found the step-up oxygen saturation to be in the 
right ventricle, and it wasn't so much on the right atrium, then 
that meant the shunt was between the two ventricles. There were also 
pressure differences, too, when there was a shunt from left to 
right in the ventricle. 

Hughes: [Werner Forssmann inserted a catheter into his own heart in 1929.] 
I was just wondering why it took so long for the technique to 
catch on. 

Gerbode: Because people shuddered at the thought of sticking something up the 
vein into the heart. It's like murdering your sister or something. 
It's the same idea as you can't touch the heart and operate upon it. 
You're doing something which everyone said would never be possible 
or should never be done. 

Hughes: So really, one reason that catheterization came into general 

practice after the war was because the heart was by then considered 
touchable. 



Rapid Xray Film Changers 



Gerbode: Yes. It was not inviolate any more, and they found out they could 
do it repeatedly and not harm anybody. So this made it very much 
more acceptable. Later on, of course, we began to inject dye into 



84 



Gerbode: the heart through the catheter and take pictures, but that's 
another story, because there weren't any rapid film changers 
available when we started, and we had to work on fixing one up 
ourselves. So we made the first rapid film changers in our own 
laboratories here. 

Hughes: This is for xrays? 
Gerbode: Yes. 

Hughes: Because then there's a later stage with radioisotopes, is there 
not? 

Gerbode: Yes. That's much later. But anyway, just to inject dye into the 
heart and follow it through with serial rapidly changing xrays 
could tell you where there was a hole or tell you where there 
[was] obstruction. 

Hughes: When did that technique come in? 

Gerbode: This is all about the same time. Luckily, there was a young fellow 
in the xray department who was a pretty good engineer, and we 
worked with him to develop the first film changers. I had to 
push the film through manually in the first ones. In fact, I've got 
some little white spots on my hand from having too much xray. 

Hughes: Overexposure. 

Gerbode: Yes, overexposure. But none of these turned to cancer. 

Hughes: When you're doing something like that, is the xray beam continuously 
on? 

Gerbode: It goes on and off, but it's pretty continuous, because it's so 
quick, you see. But we had aprons on to protect ourselves. 
Anyway, it wasn't until quite a bit later that the commercial film 
changer became available. 

Hughes: I saw a reference to thorotrast. 

Gerbode: Yes, thorotrast was the dye they were injecting. 

Hughes: That's a thorium compound, isn't it? 

Gerbode: Thorium. And it has iodine in it. I don't know the exact chemistry. 



85 



Hughes: I thought thorium was a no-no by then because of the danger of 
radiation damage and cancer. 

Gerbode: [It was later stopped because it was absorbed by the spleen and 
other organs and was thought to be carcinogenic.]* 

We used that catheterization unit for a number of years. They 
took the old machine down to [Palo Alto] when Stanford moved, which 
was just as good, because then we were able to get a more modern 
one here . As luck would have it , a very wealthy man came into the 
hospital with heart disease around that time, and he appreciated 
very much how well he'd been treated, not surgically, but medically. 
He said, "What do you need now that Stanford is moving to Palo Alto?" 
We said, "We need a modern angiocardiographic machine," which then 
cost about eighty thousand dollars, I believe. He said, "All 
right." So he gave us the newer model. We came out all right on 
that one. 

Hughes: [laughs] I bet the people at Stanford were hating themselves! 

Gerbode: Yes. But since then they've done very well. They have everything 
they need down there, so there's no worry about them. 



Blood Transfusion 



Hughes: What about techniques for rapid blood transfusion? 

Gerbode: There wasn't anything really special about rapid transfusion. 
The blood came in bags, and you'd just squeeze [blood] into a 
vein by squeezing the bag. Or you could put a blood pressure 
cuff on the bag and pump it up and squeeze it that way, which 
works very well. 

Hughes: These were techniques that you'd been using before the war as well? 

Gerbode: Yes. The blood bank here in San Francisco [Irwin Memorial Blood 
Bank] has always done a fantastic job. [San Francisco] was among 
the first to have a voluntary blood bank, because of the war in the 
South Pacific. 



*Dr. Gerbode added this comment later in the course of editing. 



86 



Hughes: Where did blood come from before the war? 

Gerbode: It came from the same place, but it was on a very small scale. 
I can remember when there was one man in town who was very good 
at giving a blood transfusion. He made a living on going around 
to hospitals giving transfusions, just because he could cut down 
a vein and get a needle in it. He became a specialist in just 
that. Now, of course, every intern, even medical students, can 
get into a vein and put blood in. 

Hughes: It would seem to me, though, that lack of blood would certainly 
hold back surgical procedures on a large scale. 

Gerbode: Oh, it did. 

Hughes: You need massive amounts, don't you? 

Gerbode: Yes. We found that out in Europe during the war, as they did in 
the South Pacific. On the East Coast the blood was taken and 
shipped off to Europe or Africa. On the West Coast it was taken 
and shipped to the South Pacific, either in the form of whole blood 
or in the form of plasma. 

Hughes: Were cross-matching techniques very sophisticated back then? 
Gerbode: Yes, they were good enough. 

Hughes: Do you want to say any more about penicillin? You mentioned it 
coming in about 1944? 



Penicillin 



Gerbode: It came in during the war in Europe. It was quickly distributed, and 
we set up a little special unit so we could have the penicillin 
ready to give. It was put in the charge of one of the captains in 
the medical department. 

Hughes: Was there plenty of it? 

Gerbode: There was enough. The curious thing is that we didn't get very many 
reactions from it. Since then, of course, it's been found that there 
are quite a few people who are sensitive to it. 

[interruption] 



87 



Hughes: 
Gerbode: 

Hughes: 
Gerbode: 
Hughes: 
Gerbode: 



Hughes : 
Gerbode: 

Hughes: 
Gerbode: 



Do you have any idea why there weren't many reactions during the 
war? 

No, I don't know why. I guess maybe it was not as pure as it is 
now. From some reason, it wasn't apparent that there were many 
people sensitive to it. 

Was the dosage well worked out? 

Yes, the dosage was pretty well standardized. 

When you returned to the states, was the supply still plentiful? 

No, it wasn't very plentiful when we came back. For civilian use 
it wasn't nearly as plentiful and generally used as it was during 
the war. But it was later, of course. There was a tremendous 
market, and all the companies started making it. That brought 
the price down and made it available very quickly. As soon as 
there is a big market for anything, situations improve. 

In those early postwar years, how were decisions made about which 
patients would receive penicillin? 

Virtually every wounded person has an infected or contaminated 
wound, so you give penicillin to protect [him] against massive 
infection. 

I was really meaning when you were back in the states and the supply 
wouldn't cover everybody. Then you had to make a decision. 



You didn't give people prophylactic penicillin, for example, 
give it to people who really had a serious infection. 



You'd 



Drugs Regulating Blood Coagulation 



Hughes: I see. Drugs to regulate blood coagulation. 

Gerbode: We were using massive quantities of blood in extracorporeal 

circulation. In fact, at one point, our unit here was using 10 percent 
of the total output of the Irwin Memorial Blood Bank. We were the 
biggest users of blood because of the heart-lung machine. We were 
the only ones [on the West Coast] doing open heart surgery then. 
So we were very important customers for them. I realized very soon 



88 



Gerbode: that we needed to know more about blood coagulation and the use 
of heparln and how to neutralize heparin. So we got a full-time 
blood person by the name of Herbert Perkins as a research worker 
in blood. 

Hughes: He was a hematologist? 

Gerbode: An M.D. hematologist. He stayed with us during the formative years 
and helped us a lot in working up techniques to neutralize heparin, 
which we gave during extracorporeal circulation to prevent the 
blood from coagulating, and developed methods of testing how much 
protamine to give to neutralize heparin. He began to be pretty 
well known, so he was offered a job [at] Washington University in 
St. Louis. In any event, either that situation or another one 
occurred. Let us say he went to St. Louis and got an academic 
post and stayed there for several years and found, like a lot of 
people, that St. Louis is not a very nice place to live. [laughs] 
The weather is terribly hot in the summer and terribly cold in the 
winter. So he soon realized he'd rather come back to the Bay Area. 
So he got a job with the blood bank as a research person, and he's 
still there now. He is the director of research at the Irwin 
Memorial Blood Bank. [He is] on full-time salary there and is 
well known throughout the world for his contributions in blood. 

The problems with blood and everything related to it are much 
more involved than they were in the beginning. [The problems were] 
with platelets and platelet transfusions and separating platelets 
and other cells from the blood, and then later giving red blood 
cells without plasma, and then giving plasma without red cells. 
These are all things that have developed with the use of blood. All 
the methods of keeping blood in good condition for longer periods 
of time have been worked out. 

Hughes: And it was the heart-lung machine that 
Gerbode: That was part of it, yes. 
Hughes: made this knowledge essential. 

Gerbode: Well, [Perkins] got started with extracorporeal circulation at our 
unit, and then all these other things have developed since then. 






89 



Visiting Professor at St. Bartholomew's Hospital, London, 
1949-1950 



Frank Rundle, George Ellis and Emmanuel Amoroso 



Gerbode: In 1949 I was offered a position as an associate [in surgery] at 

St. Bartholomew's Hospital. It was largely because of the experimental 
work I was doing in a field which was opening up. Some of the 
papers I'd written on experimental vascular and cardiac surgery 
were being published. I guess I had a mini reputation at that time. 
Frank Rundle was the associate director of the professorial unit 
at St. Bartholomew's. Actually, as time went on, I was offered 
the job, because he wanted to go back to Australia. 

Hughes: What was the unit? 

Gerbode: The professorial unit is the main teaching unit, although they 
[also] teach in other units there. 

Hughes: In surgery? 

Gerbode: Yes. But they had a professorial unit in medicine as well. Then 

the other London hospitals had similar ones, where they were teaching 
medical students. That unit is the one that makes up all the 
schedules for the medical students and arranges the lectures and 
does all the teaching and research functions. 

*# 

Gerbode: The ward services are run by consultants; they teach, too, but not 
as much as the professorial unit. 

I had an operative list that I was given almost daily. I 
operated very soon after I got there. I did the first patent 
ductus at St. Bartholomew's. I operated upon some blue children, 
too. This was before open heart surgery. They would just assign 
me some cases on the operative list every week. At that time the 
anesthesiologist became a very good friend of mine. His name was 
George Ellis, a very, very fine chief of anesthesiology, a bachelor 
and a very interesting man. He used kind of old fashioned medicines, 
but he was very good in managing an open chest, usually just by 
inflating a bag by hand.* 



*This sentence was transferred from the session recorded on 10/23/83. 



90 



Gerbode: Anyway, Frank Rundle was the assistant director of the unit. He 

was like an associate professor in a medical school. He had pretty 
well decided he was going to leave England and go back to 
Australia. They wanted to get some research going at that time. 
I think I mentioned this before, that I was able to get permission 
to operate on animals at the Royal Veterinary College in London 
through Professor [Emmanuel Ciprian] Amoroso,* who was professor 
of physiology. He was an extremely kind and intelligent man, almost 
blind from some sort of eye disorder. 

In England at that time, food was still rationed. Particularly 
meat and eggs were hard to find. "Amo" was also the chief physician 
for the London zoo, and every once in a while an animal would 
disappear somehow [laughter], and then I'd get a leg of something or 
other, which might have been a goat or pig. It would arrive at the 
house and keep us supplied with some meat. Also, I was doing 
vascular and cardiovascular and pulmonary research in the [Royal] 
Veterinary College which had an abundant supply of animals, dogs, 
sheep and goats. 

Hughes: Because of this connection with Amoroso. 

Gerbode: Because the Royal Veterinary College had to be supplied with 

animals, so we had plenty of animals to work on. I did a lot of 
research there. At the same time, there was a neurosurgical group 
doing a lot of research, too. Their animals were always sacrificed 
at the end of their experiments, so they quickly found it was very 
desirable to do their experiments on sheep or goats. So that way 
they had a good supply of meat, too. [laughter] The one who 
worked with me at the time was Jerry Taylor, who had been a fellow 
here with me in San Francisco. 

Incidentally, Rundle came over here and was the first fellow 
I had. He had been at the Mass [Massachusetts] General Hospital 
previously and found that he really had a hard time getting 
laboratory time, and he couldn't really get anything going. But 1 
gave him lots of opportunity in the lab here. It was then that I 
got to know him, and I think that's probably why I was invited to 
go over there the following year. He came, I guess, in 1947 or '48. 

Jerry Taylor came later. Jerry was just a young man in the 
department. He worked with me in the dog lab at the Royal 
Veterinary College. He got a young girl who was trying to be a vet 
to come help us as well, and he finally married her and had some 



*Professor Amoroso died 10/30/82 at the age of 81. 



91 



Gerbode: children by her. But I think they've subsequently been divorced. 
She was a great help to us, because she loved to go back on 
weekends and take care of the animals. She just thought that was 
a great thing to do, and she was very good at it. 



Dog Surgeon 



Hughes: All this was unusual for British surgery at this time? 

Gerbode: Oh, yes. I mentioned before that most of the British surgeons 

didn't believe in experimental surgery . They called the people 
like me "dog surgeons." Not all of them, but some did. 

Hughes: How did they expect surgeons to learn? 

Gerbode: They would just start doing things on human beings. Of course, 

they weren't doing very much. They were doing what you might call 
old-fashioned surgery, because they weren't doing vascular or 
cardiac surgery, and they were just beginning to do thoracic 
surgery. They were operating on lung tumors or bronchiectasis 
or tuberculosis; that was acceptable, and that was about it. There 
were a few people who recognized that to get on in a new field., you 
had to use experimental animals. Otherwise you'd be doing 
experiments on humans. 

Hughes: Is that what Rundle recognized? 

Gerbode: He recognized that I could do it. He saw in our old lab [at 

Stanford San Francisco] experiments that we were able to conduct, 
and Amoroso in London believed in it, too. That's why he was 
very anxious to help me. 

Hughes: It sounds as if you were very fortunate in having these two 

connections. You could have gotten over there and found you had 
no [opportunity for research] . 

Gerbode: It was. Well, I wouldn't have gone unless I had a pretty good 

prospect of being able to do something. The dean was a fellow by 
the name of Harris, and after I'd been there for a few months, he 
began to ask whether I would be interested in staying. He told me 
how lovely it was to have a house in the country, and so forth and 
so on. But. . . 

Hughes: It didn't work. [laughs] 



92 



Gerbode: No, I didn't want to do that. There were too many obstacles, and 
there were too many built-in restraints in London even in the 
medical schools and hospitals. You didn't have the freedom that 
you have in this country in getting on with what you wanted to do. 

Hughes: Are you thinking particularly of the hierarchy? 

Gerbode: Yes, and the concepts. The professor of surgery, Sir James 

Patterson-Ross, had a laboratory for experimental surgery built 
in the hospital, but it was built in a very strange way with 
cubicles and a lot of things which were not modern in concept. It 
was for that reason that I went over to the veterinary college, 
because there we had a big room with lots of space and people to 
take care of the animals. It was a different concept. 



Research on Vascular Anastomoses and Respiratory Problems 



Hughes: Did the type of experimentation you were doing stay pretty much 
the same? Were you still working on vascular anastomoses? 

Gerbode: Oh, yes, it was directly in front of doing open heart surgery. It 
was the leading edge of getting there, you might say. 

Hughes: And was that what you were consciously working toward? 

Gerbode: Yes. I didn't have an extracorporeal machine at that time. But 
the techniques we were using were the forerunners of what we were 
able to use later on when we did get an extracorporeal machine. 

Hughes: Would you explain what those techniques were? 

Gerbode: We were doing vascular anastomoses and experiments on the problems 
of respiration in thoracic surgery. 

Hughes: There were several papers on positive pulmonary pressure. Was that 
what you were thinking about? 

Gerbode: Yes, that's what we were thinking about, what was the best pressure 
to use and how to control respiration. There were some concepts 
based on experimental surgery which I felt at the time were probably 
wrong. So T/e devised some experiments to prove that they were 
probably wrong. It takes a while to do these things, you know. 



93 



Hughes: What were the wrong concepts? 

Gerbode: One of the concepts was why did the blood pressure go down when 
there was too much intrapulmonary alveolar pressure. The old 
concept was that the heart was squeezed by the lungs, and that's 
why the pressure went down. My feeling was that the pressure went 
down mainly because the alveolar circulation was interfered with 
by too much intrapulmonary pressure at the capillary level. 

Hughes: How do you get a feeling like that? Observation? 

Gerbode: No, it's just that you think about a concept, and you think about 

whether it's right or wrong. If you think it's not right, you have 
to prove that it isn't right. That's where experimental work comes 
in, you see. Or if you think something is right, and everybody else 
thinks it isn't right, then you have to show why it's right. 

Hughes: But the hard part is getting the idea to counter the existing idea. 

Gerbode: Well, I suppose that is hard, but you're not filled with some of 

these things every day. You think of one thing, and then you have 
to work on it for months to prove it so or dispose it so. That's 
what experimental surgery is about. 

Anyway, we had a wonderful year there in London. I made lots 
of friends and have kept up an association with England ever since 
in various ways. I had made some friends among the English surgeons 
during the war, mainly in Sicily. They were friends when I got to 
London, and we saw them and got interested in their careers, and 
this was very nice for us. 



Honorary Perpetual Student 



Gerbode: Later on, because of having been at St. Bartholomew's, they made me 
an honorary perpetual student, which is the only honorary degree 
they can give at St. Bartholomew's. I guess when I was made an 
honorary perpetual student, there had only been seventeen before, or 
maybe I was the seventeenth. They had a little ceremony and gave 
me three huge volumes of the history of St. Bartholomew's Hospital, 
which started in the fifteenth century. They said at the time, "We 
have to make you a perpetual student because it's going to take you 
that long to read these three books." So anyway, that meant that 
I could wear the honors tie of St. Bartholomew's. They have two 
different kinds of ties. They have one [for] a regular graduate. 



94 



Gerbode: Then they have an honors tie, too, which is slightly different, 

and it has a little bit of the colors of Cambridge University built 
into the little diagram because they were associated with 
Cambridge University for a long time. 

I'm going back in September [1983], because they're having a 
big banquet at St. Bartholomew's. There's a huge hall there, the 
Great Hall of St. Bartholomew's, with a high ceiling and pictures 
of all the old famous surgeons who have been there. They also 
have a list of people who have made contributions. Mrs. So-and-So 
gave fifty pence to a certain fund. These names are all written 
on the old wall there. And the pictures of the famous men, 
Percival Pott and many of the others who have been there. 

The hospital is in a section of London called Smithfield. 
Smithfield was Smoothfield at one time, and that's where the farmers 
brought in their produce to sell. It was a smooth field. That 
later became Smithfield, and that's where the name Smithfield ham 
came from. Across the square is the wholesale market for all the 
meat being distributed in London. It's a huge building, and the 
wholesalers go in there and look at the carcasses and pick out the 
ones they want to buy. 

Hughes: An historic area. 

Gerbode: The hospital was started by I think the monk's name was Ruher 

in the fifteenth century. It was set up as a small dispensary type 
of a hospital. They didn't have much else to do except lance boils 
and operate on a few things, take care of a few injuries. But it's 
a very famous hospital in England. As they say, you can always 
tell a Barts man, but you can't tell him very much. [laughter] 






American and British Postwar Surgery: A Comparison 



Hughes: Do you care to say anything more about the comparison between 
American and British surgery in the postwar years? 

Gerbode: There have always been excellent surgeons in England. I'd say that 
the general level of surgery in England was very high and probably 
across the board better than the surgery in this country across the 
board, because we permitted a great many practitioners who had 
not been trained in surgery, to do surgery. We still have, 
unfortunately, too many of those around, whereas in England major 



95 



Gerbode: surgery was done in big hospitals by men who were consultants after 
they had been trained for some years. Sometimes they weren't as 
modern as they might be, but they were good anyway. They followed 
concepts which were pretty well developed, and technically they did 
good work. They always had good assistants and good people to take 
care of the patients afterwards. 

The other thing about the British hospitals is that the nurses 
have a great deal to say about the patients. They take the patients 
very seriously, and if they find that a patient hasn't any place to 
go home, they'll keep the patient [at the hospital] until they feel 
it's nice to send the patient home. They don't allow the surgeons 
into the surgical wards until a certain time, ten o'clock or 
something like that, because they say, "This is our time to clean 
up the patients and get them set so that you can come around and 
have your ward rounds at ten o'clock." I was trained [in the U.S.] 
to arrive at the hospital at seven thirty or eight o'clock in the 
morning, and [in London] I'd get there every day, and I couldn't do 
anything. They would look at me as though I was a little bit 
nutty by getting there so early. 

Hughes: Did you find that in general British surgeons were open to new 
ideas? 

Gerbode: I think after the war they were a little more receptive to new 

ideas. As I say, British surgery had been good for a long time. It 
didn't set the standard for the training of surgeons as much as 
the Germans in the prewar period. The Germans really were the ones 
who set the standards for the training of surgeons and were the 
basis for what later developed as the surgical residency type of 
training in this country. That was brought over by [William Stewart] 
Halsted and some others from Germany. Halsted is credited with 
being the first to introduce the resident surgery training program, 
which is about five years of graduated responsibility. This is 
still called the Halsted method in this country. 

Hughes: Did the British have something similar? 

Gerbode: Not really. Not quite as formal as the Germans. But they kept 
their young men around in hospitals for a long time before they 
were made consultants. 



Hughes: They still do. 



96 



Oferbode: So they did have graduated responsibility in a way, but they 

didn't quite do it as methodically as the Germans. But then, of 
course there have been great [British] surgeons. [Joseph Jackson] 
Lister and his technique of preventing wound infection set the 
standard for the whole world, and there were other men who did 
remarkable things in surgery. 

Hughes: How do you explain the fact that in your field, in cardiovascular 
surgery, the British weren't even trying? 

Gerbode: No, they didn't get it started until [after] we had gotten started. 
As I mentioned before, one of the main reasons, I think, was that 
there were a lot of young well-trained [American] surgeons who went 
into the war from universities, from residencies and from minor 
academic positions. Then when they came back from the war, many 
of them wanted to get back into university life, but there wasn't 
really much to do. They weren't given clinical responsibility, 
so they went into the dog lab. So you had all these bright young 
lads working in the dog labs while they were waiting to have a 
chance at clinical surgery. They were teaching, and they also were 
pretty experienced in managing big-time surgery because of the war, 
and they had a lot of confidence. Furthermore, they could see what 
the future was because of some advances that I mentioned before, 
[which] sort of opened the door. Then once the door was opened, 
inside the room were hundreds of people who needed to have operations- 
children mainly at that time. 

Hughes: The British, however, would have had similar opportunities, except 
for the opportunity to do research. 

Gerbode: That's right. 

Hughes: Probably that was the key. 

Gerbode: That's right. They didn't have the laboratories to do the research. 
Furthermore, they didn't encourage people to do the research. They 
didn't give them an opportunity. Whereas in this country, luckily 
we had federal money given, pumped into the universities, to train 
young people. For example, almost from the very beginning, as soon 
as I began to write some papers [after World War II], I was given 
a training program by NIH, to train one or two cardiac surgeons 
who had already trained in general surgery. Uncle Sam paid for it. 

Hughes: And the [British] Medical Research Council, was that formed much 
later? 






97 



Gerbode: This was when it was starting. 

Hughes: But they weren't funding experimental surgery? 

Gerbode: Not very much it was very, very difficult. To do experimental 
surgery, you were supposed to have a veterinary license at that 
time. So they said if you are going to operate on animals, you're 
going to have to get a veterinary license. So I said, "Okay, I'll 
apply for one," and I got it the day I left, almost a year later, 
[laughter] 



Cardiovascular Surgery 






Hughes: Now that we've talked so long, maybe we've covered everything in 
this quote. You start the paper, which is called "Experimental 
Surgery of the Heart and Great Blood Vessels"* you're the first 
author; the second author is F.F. Rundle with the following 
paragraph: 

Substantial as are the recent advances in the therapy 
of the congenital defects, it is not too much to say that 
cardiovascular surgery is still in its infancy. Thus 
the chief scourge, coronary artery disease, is still 
beyond surgical grasp . So , too , are the chronic valvular 
defects. Yet we are conscious today that the field is 
developing rapidly. Further spectacular advances may 
well lie just ahead, for the surgeon has new and powerful 
weapons at hand, drugs to regulate the coagulability of 
the blood, penicillin, blood transfusions, controlled 
respiration during thoracotomy, and methods for vascular 
suture and hemostasis. 

I was wondering first of all what you were thinking about when you 
said cardiovascular surgery is still in its infancy. 

Gerbode: We didn't know exactly how to close a hole in the heart. It wasn't 
until later that the patient's own pericardium was used, or 
various cloth materials, the same as for vascular grafts. 

Hughes: Were there not people operating for holes in the heart before the 
war? 



Gerbode: No. 



*Stanford Medical Bulletin 6 : 247-256, 1948. 



98 



Hypothermia* 



Gerbode: Very soon after the war, hypothermia came into being, mainly [due 

to] the early work by [Wilfred G. ] Bigelow in Toronto and [C. Walton] 
Lillehei and [John F.] Lewis in Minnesota. [Lillehei and Lewis] 
were in Dr. [Owen H.] Wangensteen' s department there. They 
collectively found that they could reduce the body temperature of 
a patient and then quickly do an intracardiac operation. 

Hughes: How much time did they have? 

Gerbode: They had about fifteen or twenty minutes. That meant in those days 
that they could fix a hole in the right side of the heart, in the 
atrium, because it was accessible, and they could relieve pulmonary 
stenosis, which was an obstruction of the outflow trackof the right 
ventricle. 

This also led, under Lillehei 's direction, to the use of 
cross-circulation to do intracardiac surgery. He found out he 
needed more time, and so he operated on children with the mother 
being the donor. They'd hitch the mother to the child or the baby. 
The mother would supply the circulation while the baby was operated 
upon. This was quite complicated and led to a fair number of 
mishaps. But it did show that if you could use some kind of an 
extracorporeal arrangement , that you could open the heart and 
operate upon it.** 

## 

Gerbcde: Anyway, hypothermia came in, and then some people even tried to 
close holes in the ventricles with hypothermia. But that didn't 
work very well, because it takes a little longer, and it's more 
complicated than closing a hole on the atrial side. 

Hughes: It's more complicated anatomically, you mean? 

Gerbode: Yes. You have to do more sewing, and it's harder to do it. 

Hughes: This is going back to something you said just a minute ago, that 
the right atrium is more accessible. I don't understand that. 



*See the session recorded on 8/16/83, pp. 107-109, for further 
discussion of hypothermia. 

**A discussion of heart-lung machines was moved to the session 
recorded on 8/16/83. 



99 



Gerbode: It's on the right side of the heart, and either with a medial or a 
right thoracotomy, it's right there in front of you. You can 
cut into the atrium and sew on it and take pieces of it out without 
interfering with the circulation. The atrium will tolerate that. 

Hughes: But wasn't that a new concept in itself, that you could do these 
things without interfering with the circulation. 

Gerbode: Well, it wasn't a concept; it was a finding, really. 



Vascular Anastomoses to the Heart 



Hughes: Was that your finding when you were doing the work on vascular 
anastomoses? 

Gerbode: Yes, it was. When I was doing experimental surgery, I found that 
I could sew the atrium and do anastomoses to it. In fact, I wrote 
some papers on it. 

Hughes: Right after the war. 
Gerbode: Yes. 

Hughes: Now, was that a first? You were working with the superior vena cava, 
as I recall. 

Gerbode: Yes, that's right. It was among the first, but I'm sure other 

people were working, not exactly the same way that I was, but they 
were finding out they could cut into the heart and sew it up. 

Hughes: I read something that gave me the impression that keeping the heart 
in its natural position was very important. One of Elliott Cutler's 
problems apparently was that he was displacing the heart as he 
was operating, and it was only 

Gerbode: Yes, it was. You can't do that. 

Hughes: later that it was found that you really had to keep the heart 

Gerbode: You had to keep the heart if it was going to pump where it 
belongs. 

Hughes: The reason I bring this up now is that when you were doing these 
anastomoses, you really had to be very careful about how you were 
handling [the heart]. 



100 



Gerbode: 



You had to be very careful. You couldn't displace the heart very 
much, because then the patient the dog would go into shock. So 
you had to do these things with the heart in situ, in its customary 
place. 



Hughes: What's the mechanism there? 

Gerbode: It's a complicated mechanism. Part of it has to do with the nerve 
supply to the heart. But I think also it means that the valves get 
distorted when you move the heart, and they don't function as well. 



101 



IV THE DEVELOPMENT OF CARDIOVASCULAR SURGERY 
[Interview 5: August 16, 1983 ]//# 

The 1983 California State Bill on Animal Experimentation 

Gerbode: Even now there is a bill before our state legislature to limit the 
use of animals for experimental purposes. This is extremely 
foolish, and is mainly sponsored by southern Calif ornians, mostly 
in Hollywood. What they don't realize is that animals are 
sacrificed in pounds every year by the thousands. In San Francisco 
alone we kill five thousand dogs a year, stray dogs that have 
been cast out by people who don't want them. These animals could 
be used very beneficially for humanity for experimental projects 
of a wide variety. The animals do not suffer. They're all 
anesthetized or very carefully taken care of. This work is always 
supervised by special people who are watching constantly about 
whether or not bad treatment is given to the animals. High standards 
have to be maintained because we get government projects, and they 
maintain surveillance over the work. 



Oxygenators, Hypothermia and Open Heart Surgery* 

Gerbode: When we came back from the war, most of us, as I mentioned before, 
didn't have very much clinical work to do, so we were interested 
in working on what we thought was the frontier of medicine, and 
we turned to the laboratory. Just with regard to open heart surgery, 



*See the session recorded 4/23/84, pp. 349-352, for further 



discussion of these topics. 



102 



Gerbode: I performed over three hundred animal experiments before I did a 
human open heart operation. You must realize in those times we 
didn't even know what type of tube to pump blood through. In 
England they were still using rubber tubes, which is of course 
very bad. It wasn't until industry got into the picture, realizing 
that there was going to be a huge market in plastics, that they 
became competitive. They knew that there was going to be quite 
a bit of money in it, as there has been. 



John and Maly Gibbon: The First Heart -Lung Machine* 



Gerbode: The first heart-lung machine was developed by Dr. John Gibbon and his 
wife Maly. He started his work in Boston when he was a young staff 
person before the war. He had a young lady who had a pulmonary 
embolus, and he'd watched her die because there wasn't anything 
they could do to get that blood clot out of her lung. He said to 
himself, "If I only had a machine that would take over the pumping 
and oxygenating of the blood, then I could have taken that clot 
out of there." That's when he and his wife Maly [Mary Hopkinson] 
started working on a heart-lung machine. Jack has since died, but 
his wife now lives in the Boston area. They worked together in the 
laboratory for years. Subsequently, when he was made professor of 
surgery at Jefferson Medical School in Philadelphia, he continued 
his work there, and he was helped financially by the IBM Corporation. 

Jack was the first one to use extracorporeal circulation with 

a heart-lung machine in the successful closure of an atrial-septal 

defect. So not only did he have the first heart-lung machine, but 

he was the first one to use it successfully. 

Hughes: This was in the early '50s? 

Gerbode: Yes. Unfortunately, his machine was rather complicated, difficult 
to run. 



*This section incorporates material recorded on 8/10/83. 



103 



John Kirklin and the Gibbon Heart -Lung Machine 



Gerbode: It was a screen type of oxygenator and was only used extensively in 
one place in the country, and that was with Dr. [John W. ] Kirklin 
at the Mayo Clinic. He quickly used it, or a modification of it, 
on a large series of patients at the Mayo. Dr. Gibbon himself did 
the first successful patient with that machine, but he did not 
have the volume nor the organization to do lots of cases, which 
was true of Dr. Kirklin. 

Hughes: Was it deliberate that Kirklin was the only one that had access 
to the machine? 

Gerbode: The Mayo Clinic decided that it was very important to get into the 
field of open heart surgery. They have tremendous resources and a 
big organization, so they can go into anything that way with lots of 
people participating. Then the Mayo also is in the center of 
the United States and is a place where they collect all kinds of 
cases. They made it advantageous for the cardiac patients to go 
there. 

Hughes: Why did the Mayo decide that cardiovascular surgery was the thing? 

Gerbode: They always like to get into whatever is going to be important in 
medicine or surgery, and they are financiallly so well off that 
they can do it. They can get resources, spend money on equipment 
without delay or the problems that you might find at a university. 
So they got into the picture very quickly. 



The DeWall Bubble Oxygenator 



Gerbode: Working in Walt Lillehei's laboratory was a fellow by the name of 
[Richard A.] DeWall. DeWall used the principle of running oxygen 
through blood to oxygenate it. The oxygen would drive out the 
carbon dioxide, so he had blood that was fully saturated with oxygen 
without much C02- He made what is called the DeWall bubble 
oxygenator , which is the prototype for the most widely used type 
of oxygenator everywhere now. It's not the best, but it's practical 
and it's cheap and easy to run, and this has big advantages. For 
a short case it's adequate, but for a long case it isn't. 

Hughes: Why is that? 



104 



Gerbode: Exposing blood directly to oxygen and bubbling it through a device 
such as they use requires some method of getting the bubbles out, 
which they do with chemicals or collecting tubes. But they can't 
get them all out. There are still microbubbles in the blood, and 
the body doesn't like those. The body will tolerate a certain 
number of them for a while, but if the operation goes on for three 
or four hours, then so many of them accumulate that organs fail, 
and the brain is damaged, too. 

Hughes: So the membrane oxygenator would be used for lengthy operations? 

Gerbode: People realized that the bubble oxygenator was useful and practical 
up to a certain point, but the membrane oxygenator was a more 
ideal [device] , because there was not a direct interface between 
the oxygen and the blood. The oxygen had to diffuse through a 
membrane to get to the blood, and the CC>2 had to go out through 
that membrane, which is better. In other words, the blood wasn't 
exposed to air or the atmosphere. One of the first to work on this 
principle was George [H.A. ] Clowes, [Jr.]. 

[Interruption] 



George Clowes and the Membrane Oxygenator 



Gerbode: George Clowes developed a membrane type of oxygenator which was 
very complicated to run, but it actually demonstrated that one 
could use a device of this kind, simplified if possible, for open 
heart surgery, and that it would probably be better than the other 
types. 



The Bramson Membrane Oxygenator 



Gerbode: This led a lot of laboratories, including our own, to get started 
in developing a membrane oxygenator. I am rather sad to say that 
we have spent approximately twenty years on this project. We 
finally went through several versions, one of which I used in about 
two hundred fifty cases, which was a prototype for one which will 
hopefully be made commercially very soon by the Harvey Company. 






105 



Gerbode: The problem with all these devices is that things have to be 

simple to use and be economical. So it's been a problem to make 
it so simple that any profusionist could use it and then have it 
disposable and not have to be resterilized or cleaned, because 
that increases labor and raises the cost a good deal. 

There have been three or four membrane oxygenators developed 
since Clowes introduced it. They are sold commercially by a 
number of firms now. We think the one we've been working on is 
going to be better, but we'll have to wait and see whether it will 
be. The tests seem to indicate that it will be. It takes an 
awful lot of money to develop something like this. I can't tell 
you how much money we've spent on this one project, but it's probably 
a hundred and fifty or two hundred thousand dollars. The company 
that is working on it has already spent a half a million dollars 
to bring it up to commercial availability. 

Hughes: Was that a competitive matter? 

Gerbode: Oh, yes, it's competition against several others which are on the 
market already. People, logically, will pick the one which works 
the best and is cheapest. 

Hughes: What are the advantages of yours? 

Gerbode: One advantage is that it has a built-in heat exchanger, so you can 
cool and warm the blood easily, which means that- you can use 
hypothermia, reduced body temperature, quite simply with the 
device. Some of the other devices require another instrument to 
raise or lower the body temperature. The other things is that it 
is extremely atraumatic. Also it preserves the platelets better 
than some of the others, and platelets are very important in blood 
coagulation. 

Hughes: I assume it's a synthetic material from which it's made. 

Gerbode: It's mainly design, the internal method of oxygenating the blood. 
The blood goes through a very thin layer while it's exposed to 
the oxygen through a membrane. The way that turbulence is caused 
inside, in the machine, either damages the blood or doesn't. It 
either oxygenates it perfectly or it doesn't. And we've done so 
many experiments on how to run the blood through the machine to 
make it atraumatic and efficient that we think that maybe we're 
better than others in that respect. 

Hughes: Were you influenced at all in the theoretical stage by anatomy, 
by how nature does it? 



106 



Gerbode: Oh, yes! You see, this oxygenator is like the lung. It's like the 
blood going through capillaries in the lung. And there the red 
cells and white cells tumble around as they go through, and the 
blood is turbulent, so that all the cells will be exposed to 
oxygen. You do the same thing with the membrane oxygenator. 

Hughes: One of the real problems in the early days was hemolysis, was it 
not? 

Gerbode: Hemolysis is another one. Our oxygenator has a very low hemolysis 

rate. The bubble oxygenator has a very high incidence of hemolysis, 
and the longer you use it, the more hemolysis there is. These 
are some of the factors. 

It's also been shown that a membrane oxygenator is really 
well tested by using it on a baby, because the baby is a very 
fragile little human being, and if you use coarse equipment like a 
bubble oxygenator on a baby, unless you operate quickly, the baby 
will get sick or maybe die. But it's been shown by several centers 
in the world that you can put a baby on a membrane oxygenator much 
more safely to do various things. We're operating on small 
children and babies much more frequently than when we started. 

Hughes: Because you trust the machine? 

Gerbode: And because it's better to correct many of these things early in 
infancy, before secondary effects from the lesion they have begin 
to affect the anatomy of the child. 

Hughes: How early? 

Gerbode: Some open heart procedures are done in the first year, maybe six 
to twelve months. And there are other ones like a patent ductus 
or a Blalock procedure which can be done very soon after birth 
with a relatively low mortality rate. 

Hughes: Even with surgical expertise, that would have been impossible before 
you had an adequate heart-lung machine. 

Gerbode: Yes. But a lot of these things, like doing a ductus or Blalock 
procedure early, [are] possible because of better anesthesia, 
specialized anesthesia, and understanding the physiology of a 
big operation in a baby, what not to do. Fluid balance and such 
things as how much pressure you use in the anesthetic machine, and 
the delicacy of the administration of the anesthetic. Some 
anesthesiologists just don't like to touch babies, because they're 
too apprehensive. 



107 



Hughes: That, then, is not a standard part of a residency in anesthesia? 

Gerbode: Oh, I think most residents have at least to be there when babies 

are done, but I don't think a first-year or second-year resident in 
anesthesia would be given a baby to do until they were pretty 
sure he knew what he was about. 

Hughes: I hope not. You mentioned in the case of the early British machines 
that the rubber tubes were causing damage. 

Gerbode: Yes. It's even true now. Russia and China don't have a very good 
plastic industry. China has virtually none. So they take the 
tubes which they've used to conduct blood and clean them with 
brushes and chemicals in a special room. Then they're all hung up 
like spaghetti on the wall to dry out. Then they're sterilized. 
But you cannot really clean a tube perfectly that way. There are 
always tiny bits of foreign material still left in there, and the 
body senses that very quickly. So when you use equipment like 
that, there are fevers and sometimes infections. Where the tube 
is put into the vein, in an arm, it will thrombose quite easily or 
get infected. 

Hughes: So that's yet another advantage of your machine; the very fact that 
you're seeking to make it disposable isn't just a money matter, 
it's also a safety precaution. 

Gerbode: Well, you know, it is a money matter in the end, because you know 
the one who can produce the best disposable machine is the one 
that's going to be sold. 



Hypothermia (Continued) 



Hughes: You mentioned hypothermia and talked a little bit about it last 
time, but I'm curious about the fact that hypothermia and the 
heart-lung machine were really going in tandem, and yet it took a 
number of years, maybe ten years, before the two techniques were 
put together. Why was that? 

Gerbode: The main reason that hypothermia took hold in the beginning and 

was used by people like Henry Swan, John Lewis, and Walt Lillehei, 
among others, was that they didn't trust the heart-lung machine. 
Maybe this was justified, because the early heart-lung machines 
were traumatic and not terribly good. So they would choose 



108 



Gerbode: operations which they could do under reduced body temperature, 
which would last only, say, ten minutes. They did them quickly 
and got in and out in a hurry. When they tried to use hypothermia 
to close ventricular septal defects, it would take twenty minutes 
or thirty minutes, and then they got into bad trouble. 

Hughes: That would be impossible, wouldn't it? 

Gerbode: It's possible, but it's very, very risky. You never know for sure 
what will be found. The advantage of the heart-lung machine is 
that if you find something that you didn't quite expect, or if you 
find the repair is more difficult than a standard repair, there is 
time to make the adjustment. Although the longer you stay on the 
machine, the harder it is on the patient, you can keep a good machine 
going for four or five or six hours not a bubble oxygenator , but a 
membrane and still the patient won't be bothered too much by it. 

Hughes: Did you yourself ever use hypothermia? 

Gerbode: Yes, I've used hypothermia, but I avoided the broad use of it for 
open heart surgery, because I didn't want to waste time on it. I 
thought if I got started up that path, it would take me away from 
[developing] a heart-lung machine that worked. 

Hughes: So you were convinced from the start that the heart-lung machine 
was possible. 

Gerbode: Oh, yes, possible and the best. So instead of worrying about how 
much to use hypothermia, I spent all the time in the laboratory 
trying to develop a machine. We have used hypothermia with the 
heart-lung machine, and most people do, because it reduces the 
necessity for full take-over of the circulation. In other words, 
you can take over maybe half or two-thirds of the circulation and 
use modest hypothermia to protect the body for the reduced amount 
of circulation that is necessary [at lower body temperatures]. 

Hughes: Were you also involved in research to determine the proper level of 
hypothermia? 

Gerbode: Yes, we did quite a bit of that. We did a whole bunch of patients 
using hypothermia for brief operations, not requiring more than, 
say, ten or fifteen minutes. But I never liked it very much. It 
was too scary. So now, of course, hypothermia of the heart itself 
in other words, using the heart-lung machine and using cold plus 
chemicals to stop the heart during open heart surgery or valve 
replacement or valve repair is the standard procedure. Everybody 



109 



Gerbode: uses it now. They inject cold solutions into the coronaries 

through the root of the aorta to stop the heart, make it quiet, 
and then you have a bloodless field which isn't moving, so you can 
operate faster and it's better. 

Hughes: Is that the way you initially used hypothermia? 

Gerbode: No. We didn't use that until after it was introduced in Germany, 
mainly, and after a few other places in this country started 
using it. We were not very early in the development of hypothermia 
of the heart. 

Hughes: I've seen pictures of bathtubs in the operating theater. 

Gerbode: Yes. [laughter] That was total body hypothermia, mainly for 

children. Some people even now use total circulatory arrest for 
complicated repair of children's hearts. The Japanese and some 
surgeons in New Zealand have the child in a tub of ice-cold water 
and reduced the body temperature to twenty or twenty-one degrees, and 
then operated quickly, and then raised the body temperature again 
ofter the repair. 

Hughes: Is that [done with] children particularly because they can bounce 
back better? 

Gerbode: They bounce back. They can respond to this better than an adult 
can, and of course they're smaller, so you can [better] control 
the [temperature] of the mass of the child. 

Hughes: I understand that was quite a problem: the temperature would drop 
after you thought you had reached the proper level. 

Gerbode: Yes, it goes down even more, and it's slow to recover, too. We 
find, for example, when we use hypothermia with a heart-lung 
machine and we think that the body temperature is thirty-seven in 
the operating room, by the time the patient is in the recovery 
room, very often it's lower. So we always quickly start putting 
blankets on to keep the patient warm so that won't happen. 



Teamwork 



Hughes: Perhaps this is the time to talk about teamwork. I think it under 
lies a lot of your research, but in one paper you particularly 
stress the importance of teamwork in cardiovascular surgery. I was 
wondering if you could say a little more about this, because I think, 
again, this was a postwar realization, was it not? 



110 



Gerbode: Although the surgeon always gets credit or abuse for whatever 

happens during a heart operation, actually how well he does really 
depends on his team. The best results are found in places where 
there is good teamwork: good assistants, good nurses, excellent 
postoperative care, and the use of other ancillary personnel who 
understand the problem. 

One of the first things I found out when we were experimenting 
and trying to develop the whole field was that we were constantly 
trying to invent things, which was really a form of biomedical 
engineering electronic devices, gadgets of different kinds. We 
were constantly going off to instrument makers and other people 
trying to get them to understand what we wanted, and to get them 
to make it. Well, the work was frequently crude and, not being 
engineers, we really didn't do it very well. 



M.L. Bramson and the Membrane Oxygenator 



Gerbode: So one day I met a fellow by the name of M[ogens] L. Bramson, who 
was working at that time as a consultant with Mr. Ed Heller. Ed 
was terminating [his] work, because [he] felt that Mr. Bramson had 
done everything he could for them his research involved byproducts 
of wood. I met Mr. Bramson in Paris at a cocktail party, and I 
said, "What are you doing?" He said, "I'm an engineer, but I'm 
terminating with Mr. Heller." I said, "Would you be interested in 
biomedical engineering?" He said, "Of course I would. I'd be very 
interested." 

So I brought him into our unit and got him the first established 
investigator ship for a non-M.D. in the American Heart Association. 
Everybody said you can't have the American Heart Association paying 
for an established investigator unless he's an M.D. I said, "Why 
not?" They finally gave him an investigator ship. The money wasn't 
very great. We had to supplement it a good deal, but still the 
principle was there. Now, of course, everywhere in the world there 
are all sorts of engineers and people working with doctors. 

Hughes: This was now maybe early '50s, would you say? 

Gerbode: Yes, early "50s. We called him "Bram." That's his statue over 
there. Bram very quickly mastered all the mathematics and 
physiological principles of dealing with blood and circulation and, 
being a very brilliant man, he quickly saw the problems and began 





Above : 

On a visit of the Surgeon 
General to Presbyterian 
Medical Center's Cardiopulmonary 
Unit, 1966. Dr. John Osborn, 
far right; Dr. Frank Gerbode, 
third from right. 



Left: 

Mogens L. "Bram" Bramson, 
IMS engineer who designed the 
Bramson membrane oxygenator, 
and Dr. John Osborn, Director 
of the Presbyterian 
Cardiopulmonary Unit, test out 
the promising life-saving device. 



Ill 



Gerbode: to try to solve them. Well, making a membrane oxygenator in the 

early 1950s was not anything you did in a few months. We realized 
that it was going to take a long time, and we had [a backlog of] 
patients waiting for operation. So he and I and Dr. Osborn made 
another type of disk oxygenator as a temporary expedient, waiting 
for the years to roll by before the membrane would be ready. We 
used that disk oxygenator for maybe three hundred cases or more. 
It was very good, atraumatic, and we could control body temperature 
very well with it. 

In any event, Bram worked shoulder to shoulder with us all 
the way through. Finally, it got to the point of having our first 
prototype membrane oxygenator , which was used in prolonged 
profusions, mainly with the help of Dr. [Donald] Hill, who took 
over the project of applying it to traumatic lungs and viral 
pneumonia patients who were really in desperate shape because of 
their reduced pulmonary capacity. Bram participated in all the 
early experiments using that prototype membrane oxygenator. We 
found that we could keep a dog alive for days with it, which was 
something you couldn't do with a bubble oxygenator. And we finally 
applied it to human beings in a project sponsored by the National 
Institutes of Health. This was a cooperative project with a number 
of other centers in the world. It was a controlled experiment of 
alternating patients to see whether or not using a device like that 
in patients who were dying from severe pulmonary insufficiency 
would work. 

We found out [we could] 



Gerbode: ...quite safely keep a patient alive for days. The longest one was 
twenty-three days. We kept a patient on almost complete control 
of the lungs with a machine for twenty-three days. That's a record, 
I think, and it showed that a membrane oxygenator could be a very 
useful tool in various types of pulmonary insufficiency. 



Industrial Development of the Membrane Oxygenator* 



Gerbode: We finally got our membrane oxygenator up to the point where it had 
to be further developed by industry, because you can show the value 
of a certain concept or a certain group of instruments to do a 



*This section was moved from the session recorded on 9/27/83. 



112 



Gerbode: certain job biologically, but if you're going to apply that to 

thousands of people, then you have to get into a different category 
of investigation. So we turned over our patents to our membrane 
oxygenator to [the Harvey] Company. They meanwhile spent about a 
million dollars developing it to the point where it could be produced 
on a large scale for daily use and made safe. 

Hughes: Does that company have large research labs? 

Gerbode: Yes. 

Hughes: How do they handle the patient trial aspect of it? 

Gerbode: They farm it out. For example, this membrane oxygenator was tried 
in a university hospital with a certain number of patients, very 
carefully observed, very carefully documented, and proven to be 
quite effective. 

Hughes: The company made the choice? 

Gerbode: The company made the choice where to do it. They had to get somebody 
to agree to do it. They were required to obtain FDA* approval. 
Usually good places will try things out if they look safe. These 
new things are all presented to patients clearly, so nobody is 
victimized by any experiment. 

Hughes: And the company pays the hospital for doing the testing? 

Gerbode: Sometimes, or they give them all the equipment and everything to 
do it with. 

Hughes: Does the government regulate this in some way? 

Gerbode: Oh yes. You have to submit the protocols. You have to go through 
a certain testing protocol with animals first. That's evaluated by 
the FDA and by peer committees, and if that is satisfactory, then 
the patient testing is approved, and they will designate a certain 
number of patients to be done, and that certain observations have 
to be made on these patients. 

Hughes: A panel makes those decisions? 



*Federal Drug Administration 



113 



Gerbode: Yes. A peer group outlines what has to be done. So with our 

membrane oxygenator, we've gone through all this already, and now 

the company is just getting it down to the point where they can 

produce the device with virtually no possibility of any failure 
in any part of it. 

Hughes: Remarkable. To graduate from one stage to the next, i.e., from the 
animal experimentation to the human, is solely based on survival 
rate? 

Gerbode: No. It's a matter of making certain observations, and these 
observations are designated by a peer group of experts. For 
example, [if] you're using something in which blood is being used, 
you can't have a certain amount of hemolysis, you can't lose 
platelets, you can't lose red cells. A lot of criteria are set 
up. The FDA has done this, acting on advice from experts. 

Hughes: Yet when it comes to pure surgical procedures, without the use of 
artificial devices of any kind, there's no such regulation, is 
there? 

Gerbode: If you're using a new surgical procedure which has been more or 
less established, you have to go to the patient and say, this is 
still somewhat experimental. You require the patient to sign a 
document stating that he understands, because otherwise he might 
sue you. 

Hughes: But that's a different sort of regulation. 
Gerbode: Yes. 



The Disk Oxygenator 



Hughes: How did the disk oxygenator fit into the picture? 

Gerbode: The disk oxygenator was a temporary thing which we were using because 
we couldn't get the membrane oxygenator working properly. We finally 
did, but it was only a prototype. The one we are hoping to get on 
the market soon is an outgrowth of that prototype, but is a much 
better device and very easy to use, and it's disposable. 

Hughes: Do you remember the date when the disk oxygenator was first used? 

Gerbode: It was late '50s, early '60s. 

Hughes: Was that always just a one-model machine? 



114 



Gerbode: 



Hughes: 
Gerbode: 



Hughes: 
Gerbode: 
Hughes : 
Gerbode: 

Hughes : 
Gerbode: 



We had twelve of those devices, and they were rotated. They were 
taken over to Cutter Laboratories [in Berkeley] in Mr. Bramson's 
car and completely cleaned and sterilized and brought back ready to 
use. It was a terribly cumbersome, difficult process. But we 
found that unless we removed every tiny bit of blood or protein from 
the inside of that device, patients would get the same thing they 
get when you put blood through a rubber tube. They get fevers and 
various other things which are very disagreeable. 

Why did Cutter have the sterilizing set-up? 

We'd been working with Cutter for quite a while on devices of 
various kinds. In fact, we worked with them until they moved to 
Santa Ana a few years ago. We were always having some kind of a 
project. In fact, they worked with us in the later development of 
the now being finalized membrane oxygenator. They shared in our 
patents, too, because there was a lot of work in using membranes 
and how to put them together and how to test them, which Cutter 
helped us with. 

They had a whole research staff? 

They had a whole research room set aside for our work. 

Did they ever sell an oxygenator? 

No, they never got to the point of commercial development of the 
membrane oxygenator. They sold some of the disk oxygenators. 

When did the membrane oxygenator come in? 

I suppose we tried it on these prolonged pulmonary profusion patients 
about ten years ago. Cutter, of course, shared in some of our 
developments. When the whole project was taken over for commercial 
development by the Harvey Company, the Harvey Company paid Cutter 
a certain amount for their patents , so they could use them in the 
final development. 

This is very exciting work. To find that you could put a 
patient on this device for days meant that if you put them on for 
hours, that they'd be better off than they would have been if 
you'd had them on a bubble oxygenator or another kind of device. 
In fact that they would stay alive after a long time [on the 
membrane oxygenator] meant that they'd be not so sick for a shorter 
time [on it]. That's why people still want to have that device. 



115 



Hughes: 



Gerbode: 



Would you care to say something about the acceptance of these 
machines by your colleagues? 

The acceptance is a bit difficult until you can make it easy [to 
use], because the men who run the profusion devices, run the 
heart-lung machines, are usually technicians, and they don't really 
like anything that's very complicated. They like to have it easy 
to put together, easy to run, easy to get rid of. We've always 
been lucky here, because we've always had a physician supervising 
the work. Dr. John Osborn has followed all this work and has been 
responsible for many of the developments from the very beginning. 
So we were always ahead of the game by having an expert physiologist, 
you might say, standing side by side with the project that whole 
time. 



Pump Technicians 



Hughes: What about the training of the technicians? 

Gerbode: We were lucky in training our own. We got a technician from the 
East Coast who was very good with bubble oxygenators (which we 
finally had to say we were going to use as a temporary expedient, 
and we still use them). Angelo latridis is a very good profusionist. 
He trained at least, five technicians with us, who are equally good, 
and one who was especially good at doing research. See, we still 
do a lot of research on animals in various ways. We're constantly 
testing devices and doing things on animals to find out what's best. 

Hughes: Is there now a formal setup for training technicians? 

Gerbode: No. I don't know exactly where there is right now. I know that 
they've been wanting to have a formal training period. They have 
their own society, and they meet once or twice every year, and they 
have a publication. But I'm not sure what the requirements are 
for training. The ones we have are really good. Actually, Mr. 
latridis and Dr. Osborn very seldom had to be there early in the 
morning to get things going. [The other technicians] got it all 
going very well. Then Mr. latridis and Dr. Osborn came in and kept 
an eye on it, and were there if anything happened. 

Hughes : Do technicians have some engineering know-how? 

Gerbode: Oh, yes, they know how to run it very well, and if anything goes 
wrong, they know what to do. 



116 



Hughes: Do they also know the physiological aspects? 

Gerbode: Not too much, but they know when to take [blood] samples and how to 

run the tests during an operation. The interpretation is really 

done either by the anesthesiologist or the physician, if he's 
there, or the surgeon. 

Hughes: Could you say something more about the tests, how often they're 
done? 

Gerbode: They do oxygen saturations. They measure the temperature of the 

blood. They measure the CC>2 of the blood. Then as they're coming 
off profusion, they measure the blood coagulability and adjust the 
dosage of protamine to be sure the heparin in the blood is 
neutralized properly. 

Hughes: Is there now an established protocol for all of this? 

Gerbode: Yes. As I mentioned to you before, there were so many problems 

about blood and using machines that we got Dr. Herbert Perkins to 
work with us. He now is the chief research hematologist for the 
blood bank in San Francisco and has made a lot of contributions 
in blood banking. We published some good papers in the early days 
on various things about blood and profusion. Since then, of course, 
the literauure is full of all sorts of papers. 

Hughes: It's very interesting to an historian to follow something like this 
through, because with time, the normal development is for more and 
more formalization. Institutions grow up. You mentioned the 
technicians now have a society. Is there something similar for 
physicians? 

Gerbode: The hematologists have their own society. 
Hughes: But I mean even more subdivided than that. 



The American Society for Artificial Organs 



Gerbode: There is an artificial organ society, and they discuss heart-lung 

machines, artificial hearts, various devices to augment the circulation 
in shock and other situations. They meet a couple of times a year 
and have a publication, too. 

Hughes: That's for physicians? 



117 



Gerbode: Yes, physicians and profusionists. But it's really mainly run 

by physicians or research people. It's called the American Society 
for Artificial Organs. 

Hughes: You mentioned that some people preferred hypothermia and distrusted 
the heart-lung machine. I wonder if that interfered with grants 
in the beginning. Were people in NIH, for example, skeptical of 
the success of the heart-lung machine? 



Pumps 



Gerbode: No. Actually, I was on the surgical study section at the time when 
this all exploded, you might say. There were many applications 
for devices which when put together would become a heart-lung 
machine. In fact, one of the pumps they were using at that time 
was the so-called sigma motor pump. It was used by people in the 
field because it was the first pump available that would pump 
something through a tube. It was a pump which was used by the milk 
industries to move milk along in a tube from where they took it 
out of a cow to a tank where it was stored. 

On the surgical studies section where all these applications 

were coming through for research funding, they all [required] 

a sigma motor pump, and a lot of them were put together so they 

could get a sigma motor pump. I suggested one time during one of 

the meetings that we buy a whole bunch of them and give everybody 
a sigma motor pump so they wouldn't have to apply for it formally 
through a research protocol. [laughter] 

But then other pumps came in which were much better. There 
was another type of roller pump which is called a DeBakey pump. It 
was actually devised by some French people. Dr. DeBakey brought 
it over from Europe many years ago to push blood along in a tube 
for transfusions. Then they made larger and improved versions of it. 
Roller pumps just roll the blood through a tube. They've become 
less traumatic and much better as time has gone on. 

Hughes: What was happening in Europe in regard to the heart-lung machine? 



118 



Dennis Melrose's Heart -Lung Machine 



Gerbode: There wasn't really much on the continent. Dr. Melrose in London, 
who came to work with us, had a machine which he devised and 
actually produced commercially. In fact, I brought one over with 
him to try out in our laboratory. I tried it on some patients. We 
found it was too traumatic to use routinely. 

Hughes: That was the design? 

Gerbode: Yes. There was too much turbulence in it. It was like a washing 
machine. He introduced it into some centers in Europe, mainly 
Eastern Europe, and they used it there for a while, until better 
devices came along. I never really did any more than try it 
experimentally and in a few clinical cases, because our tests 
showed that it was producing a lot of hemolysis and was hard on red 
cells. It was too traumatic. 

Hughes: Was that holding back British open heart surgery? 

Gerbode: Not only that. As soon as the bubble oxygenator became available 

commercially, they started using it over there, and then their heart 
surgery program went ahead. 

Hughes: From what you're saying, it doesn't sound to me as though there was 

much resistance to the very idea of using extracorporeal circulation. 

Gerbode: There wasn't . You see, it's the fear of the unknown again. A 

lot of them went into hypothermia, using total body hypothermia to do 
quick cases, while they were becoming more confident in a machine 
of some kind. And as soon as a machine of some kind was available, 
they began to use it. 

Hughes: That's quite a step. 

Gerbode: Oh, yes, it was a big step. It's particularly a big step if nothing 
is known, and you have to make that step yourself, and that's where 
we were, you see. As I've said to you, we didn't even know what 
kind of tube to pump blood through. 

Hughes: I would think it would be absolutely as great a step as the idea 
that the heart is touchable. For the first time in history, we 
were allowing a mechanical device to take over this extremely vital 
function. 



119 



Gerbode: Yes, that's right. 

Hughes: So it's more than just a technical barrier. It's a whole conceptual 
barrier. 

Gerbode: It was. That's true of the pump aspect of it. The pump was 
relatively easy, but the pulmonary part of it, to get the gas 
exchange in the blood, was the more difficult part. That's why 
all these different types of oxygenators were developed, to find 
which was the most satisfactory. 



Patient Response 



Hughes: What about the patients' responses? 

Gerbode: The early patients frequently had fevers postoperatively, and some 
of them didn't wake up as quickly as we wanted them to. There were 
minor complications quite often in the early days. But we gradually 
sorted out the reasons for everything by constantly testing and 
watching. Every time, in the early days, you did-an open heart 
case, you kept track of everything, and if a little thing went wrong, 
you corrected it that day. Nothing was left over . Even if you had 
to go back at night and fix something. You did it that day. 

Hughes: So you mean you would not do another operation until 

Gerbode: Until that was corrected. 

Hughes: Was that common procedure everywhere, do you think? 

Gerbode: I think mostly it was pretty common. I don't think anyone would 
go on with a complication that was repeating itself, but I guess 
some people would. 

Hughes: I'm wondering about the degree of patients' [concern about] going 
onto a machine to sustain their life. 

Gerbode: You'd have to explain to the mothers or the fathers or the patient 

what it was all about. In a child with a hole in the heart that was 
making the child very sick and almost dying a number of times, you'd 
have to say, "Well, now, there's only one way that we can try to 
stop chis, and that is to try to close that hole. And in order to 
close the hole, you have to use a machine." Then you'd tell them 
what the machine was about, and you'd tell them what the risks were, 



120 



Gerbode: and what experience there had been. Then they'd almost invariably 
would say, "We'd much rather take a chance on doing it than to have 
the child die. 1 . 1 

Now, the early mortality rates were quite a bit higher than 
they are now. For most procedures they might [have been] 10 or 12 
or 15 percent on a sick child. Now they are 3 or 4 percent because 
of all the improvements, not only in the machinery, but in the 
management of the patients. On the other hand, those other patients 
would have died from natural causes. 



Patient Selection 



Hughes: Were you selecting very sick children in the early days? 

Gerbode: Actually, when we first started using open heart surgery with a 

machine, I didn't. I did just the opposite. I picked the ones I 
was quite sure I could fix quite quickly and safely. 

Hughes: So you had great confidence in the machine by then? 

Gerbode: Well, I had confidence, but I wanted to be sure the team and every 
body could manage their assigned duties, so I didn't get into 
something where I'd have to make a big decision anatomically or 
physiologically about a correction. So I picked holes and 
obstructions and things that I knew that I could usually repair in 
fifteen or twenty minutes, something like that, and where I knew 
what the anatomy was going to look like. This was a very good 
thing to do, because it gave cardiologists and others confidence in 
the machine. If I'd taken the very sick patients, I would have 
lost a lot of them, and they would have lost confidence in the 
whole venture. 



Cardiologists 



Gerbode: Cardiologists are just as afraid of their own reputation as they are 
of the patients' survival, and they don't like to get involved in 
something where the result isn't going to be good. 

Hughes: Did you have problems at any time with cardiologists? 



121 



Gerbode: Oh, you always have problems with cardiologists. [laughter] 

One of my best friends, who is a very, very famous cardiologist 
in New England he's one of the great cardiologists, a pioneer with 
a tremendous reputation said to me, "Frank, a cardiologist without 
a surgeon is a nothing." [laughs] And it's true, because 
cardiology as practiced today really got started because surgeons 
could repair these things in the heart. That brought out all the 
diagnostic techniques cardiac catheterization, angiocardiography, 
use of sound to diagnoses abnormalities in the heart. It all started 
because the surgeons could do something about it. Many cardiologists 
forget this. They get to the point where they think they can order 
an operation and even order the type of repair as they would order 
a meal in a restaurant. This is very irritating to surgeons. Some 
surgeons will take it because they don't want to offend the 
cardiologists. 

Hughes: Because of this resistance, did you have times have trouble getting 
patients? 

Gerbode: Right after the war, when we were doing closed mitral valvotomies 
that is, we were fracturing tight mitral valves there was a lot of 
resistance among the full-time faculty in the medical school. They 
wanted to treat the patients with digitalis and diuretics forever. 
Patients started coming in when they found out that one could correct 
mitral stenosis with a rather simple operation. If they ended up 
in the cardiology ward, they'd stay there for days and days while 
everybody scratched their heads and decided how many pills to give 
them and how sick they were. It was only very rarely that they would 
turn one of these patients over to the surgeon. So when I found that 
a referring physician wanted to have a patient come into the hospital, 
I'd get him to bring the patient in on the surgical ward [rather 
than on the medical ward]. And then I'd invite the cardiologist who 
was most surgically minded to see the patient and bypass all the rest 
of them. 

Hughes: How long did this go on? 

Gerbode: It went on for a couple of years. We obviously had to prove ourselves 
to them. But when they found that the mortality rate was very, very 
low and the results were good, they got more confidence in the 
procedure. They were always very quick to point out the complications. 
They were afraid of the unknown, afraid of their reputatiors. Fear 
has a lot to do with it.* 

Hughes: Was some of the resistance due to the knowledge of the really rather 
discouraging prewar record of operations for mitral stenosis? 



*These two sentences were moved from session 1, 7/20/83. 



122 



Mitral Valvotomy 



Gerbode: Yes. The ones that really put mitral valvotomy on the map were 
[Charles P.] Bailey in Philadelphia and Dwight Harken in Boston. 
At every surgical meeting they were there talking, and fighting, 
too, claiming priority, saying that we did more, we did it first, 
or something. But actually, they talked so much that people began 
to realize there was something to it. They did hundreds of patients 
in Boston and Philadelphia before very many patients were done in 
the West. We did early operations; as soon as mitral valvotomy 
became a feasible procedure, we did it. 

One of the first patients I did, right after the war, was a 
paratrooper who'd been in the army. He was an air force paratrooper, 
and he had a severe mitral stenosis, had gone through all the 
testing to get into the service. He went through the whole war, 
and then at the end of the war, he was in severe heart failure, 
with a calcified mitral valve. 

Hughes: They'd missed it all? Good heavens. The history of operations for 
mitral stenosis is interesting. There was a moratorium between 
Cutler's last operation, which was in 1928, and 1945 when Bailey 
did his first human operation. Actually, there were people in 
between who were doing operations. 

Gerbode: Yes. There was [Sir Henry S.] Souttar in England. 
Hughes: He, of course, was much earlier. 
Gerbode: Much earlier. He was the first, I think. 

Hughes: And then there was somebody by the name of [Horace] Smithy. He died 
very soon himself. 

Gerbode: I'm not quite sure about him. 

Hughes: And Murray 

Gerbode: Arthur Murray, yes. 

Hughes: who did some successful operations, I believe. 

Gerbode: Yes, he did. 

Hughes: But with a rather bizarre technique. 



123 



Gerbode: 

Hughes : 
Gerbode: 
Hughes : 
Gerbode: 
Hughes : 
Gerbode: 



Hughes : 



Gerbode: 



Hughes: 
Gerbode: 



He was looked upon as being kind of a wild man because he was doing 
this, too, you know. He has a son with the same name who's a 
surgeon. 

[laughs] Do you know any of these people? 

Oh, sure. 

I know you know Harken 

Oh, sure. I knew Elliott [Cutler] quite well. 

Is this the place to say a little bit about these men? 

Starting with Bailey, I'd say that he was so successful in 
Philadephia that it really went to his head. He proposed all kinds 
of operations which were very often radical. As we would say, he 
would try the operation on the human, then prove it on the animal, 
[laughter] He did an awful lot of straight operations on humans 
before it was established that the procedures were feasible, because 
there were a tremendous backlog of people with congenital and 
acquired heart disease that needed doing. So he had lots of 
material, and he ran kind of a factory there at Hahnemann Hospital 
in Philadelphia. 

In those days, the decision to operate was solely that of the 
surgeon? 

Yes, or he had very compatible cardiologists. In that particular- 
place, there wasn't really much wasted time on ward rounds and 
decision making. If it looked as though there was something that 
could be done, they'd just do it. 

Dwight Harken in Boston was quite a bit more careful. He used 
his cardiologists and the other people at Harvard in determining 
the feasibility of operations. But he did an awful lot of cases, 
too. There wasn't anybody really to stop it. It was like sinking 
a hole in the ground and getting a gusher. There was oil there and 
it was coming out like crazy, then you tried to capture as much of 
it as you could. 

In general, were they operating on very sick patients? 

The first ones we got were quite sick, too. There the problem was 
really one of not getting patients from the cardiologists unless 
they were pretty sick, class 3 and class 4 heart failure very often. 
So the mortality rate was high. 



124 



Hughes: When was that class system set up? 

Gerbode: New York Heart Association. 

Hughes: Do you remember when? 

Gerbode: No, I don't, but it was maybe twenty years ago. 

Hughes: Why New York? 

Gerbode: I don't know why. They just decided they ought to classify heart 
failure so people would know what they were talking about. 

Hughes: And that was immediately accepted? 
Gerbode: Yes, it's accepted pretty much everywhere. 

Hughes: Would there be a stigma against a surgeon who operated on a class 
1 or a class 2 when the procedure was still [experiental]? 

Gerbode: Not really. [Frederick] Glover, who was working with Bailey at that 
time, said, "I think we ought to operate on these people before they 
have very many symptons, so they won't get symptoms." [laughter] 
Of course, he knew if he was operating on them very early, he would 
practically never lose one. 

Hughes: There's always a tension there, I should think. If you are 

convinced that a procedure really is going to be very hedpful when 
it's in the early stages, I would think there would be the temptation 
to take less sick cases, knowing that your chances of success are 
greater and consequently the procedure is more likely to be accepted. 

Gerbode: I told you when we started open heart surgery and had a heart-lung 
machine, I picked the cases of very low risk. But when it came to 
things like mitral stenosis, you couldn't get the patients with 
very few symptoms, because the cardiologists wouldn't give them up. 
They'd only give the ones to you that were in constant heart failure 
regardless of how many pills they took. 

Hughes: Nowadays it's very ritualized, is it not? 
Gerbode: It is ritualized and standardized. 



Gerbode: We now have methods of visualizing the chambers of the heart, testing 
the lungs, and being able to determine very accurately how badly 
the lungs are affected by the heart and getting numbers to determine 



125 



Gerbode: how bad it is. It's pretty well standardized. There are differences, 
however. One big clinic in the Midwest I won't say which one 
for many years would not use cardiac catheterization or exotic 
testing for routine cases. They felt so confident of their ability 
to make a clinical diagnosis, they would take an xray, an EKG, and 
make a clinical diagnosis, and let the surgeon find out during the 
operation how bad things were. If you're good enough, you can do 
that , and it ' s a lot cheaper . 

In fact, my own feling is we do too many tests on these patients. 
Whenever a new test comes along, there's a tendency not to subtract 
another test for the new one, but to add it onto the list, which 
means that there ' s another five hundred dollars or whatever in 
expenses. So now a patient comes in, has a physical examination, 
a chest film, electrocardiogram, an echocardiogram, a cardiac 
catheterization, and pretty soon he'll have several other very 
expensive things done to him. Then they'll add it all up, and it'll 
come out exactly the same as their clinical diagnosis was in the 
beginning. But you have to keep all these people busy, you know. 

Hughes: Is there now a system derived from the granting organization itself 
that ensures that an institution follows these guidelines? 



The Crippled Children's Services 



Gerbode: No, not really. The only control [was] that the Crippled Children's 
Services in the late '40s and early '50s decided that it would set 
certain minimum requirements for heart surgery, and these requirements 
had to be met before it would approve payment for patients. We 
helped establish the first criteria. 

Hughes: Can you tell me what they were? 

Gerbode: You had to have a cardiac catheterization laboratory. You had to 

have done a certain number of cases with a very low mortality rate. 
You had to be able to do good angiocardiography, with good equipment, 
and you had to have a pediatric service which could take care of the 
ordinary illnesses associated with children. Initially you had to 
have the use of an experimental laboratory. This was very difficult 
for some people. For example, the ones in Oakland who wanted to do 
open heart surgery were held up for a while because they had no 
experimental laboratories over there. But the Gripped Children's 
Services realized that an institution to be very good would have to 



126 



Gerbode: be doing some experimental work, trying things on animals before 
they tried them on human beings, which is a very mature attitude. 
If some of those southern California congressmen [who oppose 
research with animals] knew more about what they're talking about, 
they'd believe this, too. 

Hughes: Who was responsible for this enlightened attitude in the Crippled 
Children's Services? 

Gerbode: I won't take credit for the whole thing, but I was pretty close to 

them. But they were wise enough, when you talked to them and showed 
them what it was all about, told them what you believed in. Then 
they could look around and see that nobody was trying anything in 
the laboratory experimentally, and nobody had very much experience 
yet. [Crippled Children's Services was] not going to approve them 
until they somehow got some experience and knew what they were doing. 

Hughes: What about money? 

Gerbode: I'll tell you about cardiac catheterization, which is another story. 
You see, the Crippled Children's Services had never really paid for 
heart operations; they were paying for children with cleft palates, 
harelip, various congenital malformations of the bones, like club 
feet and dislocated hips, spina bifida, and that sort of thing. 
But when heart surgery came along, they suddenly realized that if 
they were going to approve heart surgery on the state Crippled 
Children's Services, it was going to be a big change in the amount 
of money they were going to have to spend. So they looked at it very 
carefully. And then it became apparent that cardiac catheterization 
was going to be a very important part of a service to take care of 
children with congenital heart disease. They'd never paid for that 
either. So I took a trip over to their headquarters in Berkeley and 
sat down with [the director and assistant director] and told them 
that I thought that cardiac catheterization was going to be very 
necessary and that they were going to eventually have to pay for it, 
like they had to pay for an xray. 

So they sent their man over, and he came and looked at our 
unit. We had another meeting, and I took him out to lunch. Finally 
they sent me a letter saying that they'd pay two hundred and fifty 
dollars for a professional fee for cardiac catheterization. This 
was a fairly good amount of money, since we weren't getting anything 
for the procedure before. They also agreed that they would pay two 
hundred fifty dollars for an operation if it was necessary.* 



*These two sentences were moved from a similar discussion in session 
4, 8/10/83, the rest of which was eliminated. 



127 



Hughes: 
Gerbode: 

Hughes: 
Gerbode: 
Hughes: 
Gerbode: 



How was Crippled Children's Services raising this money? 
have been considerable. 



It must 



They got more of an allocation. The next year around, they just 
said we are going to have to take care of this many more children, 
and so they allocated more money. 

From the state? 

From the state, and some federal. 

Was that the major source of your income? 

Most children with congenital heart disease come from families with 
not very much income. The families who had enough income so that 
they wouldn't be eligible for Crippled Children's Services had 
enough money to pay for their [treatment] because it wasn't very 
expensive then. A lot of them had comprehensive insurance. The 
insurance companies found out that if they had a family policy, it 
had to cover the child, too. This was quite a discovery on their 
part. They began to pay the same fee as the Crippled Children's 
fee then. 



Funding for Cardiovascular Research 



Hughes: 



Gerbode: 



Hughes: 

Gerbode: 

Hughes: 



What about the research side of it? 
from? 



Where was that money coming 



All the research money came out of Heart Association grants, 
private contributions, or NIH. 

One of our first contributions was not from any of these; it 
was from the Life Insurance Medical Research Fund. [It] must still 
exist, although we've never applied for it since the early days, 
but once we got twelve thousand dollars from them. I remember our 
professor, Holman, couldn't believe that anyone would give us twelve 
thousand dollars to do research. 

How did that come about? 

He applied, and then that came right back, and he was bowled over. 

How did the life insurance people learn so quickly that this was a 
field that they should support? 



128 



Gerbode: They were smart. All their premiums were based on life expectancies 
and if we could prolong the life expectancy or prevent certain 
illnesses or get people out of the hospital quicker, that was money 
in their pockets. When penicillin was discovered, they made millions 
of dollars because people were being cured of pneumonia and various 
infections, and this wasn't in their actuarial calculations yet. It 
took a number of years for that to catch up. But meanwhile, they 
made plenty of money. 

Hughes: Were they foreseeing enough to realize that they should support 
this field before the demands on insurance policies came in? 

Gerbode: No, I don't think so. These things are always very sluggish and 
slow to develop. I don't think they had enough vision to look 
forward to that. 



Mitral Stenosis: Operative Procedures 



Hughes: Do you have the energy for a couple of more questions about mitral 
stenosis? 

Gerbode: Sure. 

Hughes: You stated in your paper published in 1951, and I'm quoting, "The 
operative treatment of mitral stenosis resulting from rheumatic 
fever has been one of the most challenging problems in cardiac 
surgery." Could you enlarge upon that? 

Gerbode: If a surgeon saw a patient with mitral stenosis, with pulmonary 

edema, a very reduced capacity to work or walk, and peripheral edema, 
and then he saw the patient die and he saw the lesions, saw the valve, 
and saw that it was tightly held together so the blood couldn't get 
through, he could realize that if he could open that valve, then 
the patient would be benefited enormously. So then various ways 
were tried to do this. Actually, Souttar tried by putting his 
fingers through the valve, and later on Harken and Bailey did the 
same. We developed an instrument to crack the valve by passing it 
through the apex of the ventricle, transventricular valvotomy we 
called it. 

Actually, to answer your question, if you see an autopsy of a 
congenital heart with a hole in it, the surgeon says, "How can I 
close that hole? What do I need to close that hole?" And that's 
where it all starts, you see. We actually made holes in the heart 



129 



Gerbode: in experimental animals, before we had a [heart-lung] machine, to 
study the physiology and to see what could be done. I tried to 
pass various kinds of experimental devices into the heart with the 
heart beating buttons and things like that to close those holes. 
But I never had very much hope that it would work. But we were 
stimulated by the fact that if we could figure out a way of doing 
[the operation] , that there were lots of people who needed to have 
it done. 



Communication Among Surgeons* 



Hughes: 
Gerbode: 

Hughes: 
Gerbode: 



Hughes : 
Gerbode: 



Hughes: 
Gerbode; 



Now, when you were working on these very innovative procedures, were 
you following the literature very closely? 



Oh, very closely, 
to every meeting. 



We were not only following the literature; we went 



Is that generally the way you kept up? 

I think there were a group of people in the country who were working 
hard in the laboratory and trying to get [cardiovascular surgery] 
put forward. They would appear at various meetings in the country, 
and sometimes abroad, two or three times a year. My travel budget 
for those years was very big, and I was away from home a lot, as 
were these others, too. 

Meetings occurred frequently enough to keep you abreast? 

There were at least two or three very important meetings a year. 
But then also, even in those days, we had a kind of a communication 
network, where you met people in the same position you were in and 
knew them by their first names and liked them, and they liked you, 
and so you'd call them up quite often and discuss things on the 
telephone. Or if they did something that was very important, they'd 
call you and tell you about it, knowing that you'd always give them 
credit if it was something original. 

So because of that system, people were very free? 

Not all of them, but most of them were. The good ones were. And it 
was important to always remember if you did something that was an 
idea that somebody else had had and gave to you, that you'd give them 
credit for it. That's still mostly true. 



*See the session recorded on 6/13/84, pp. 415-416, for further 
discussion of communication among surgeons. 



130 



Mitral Stenosis: Operative Procedures (Continued) 



Hughes: Could you talk a little bit more about the procedure itself? 

You mentioned transventricular valvotomy, but I believe you also 
used the finger fracture technique. 

Gerbode: Yes. We had little thimbles, for example. Some people found that 
if they put a thimble on their finger, that it would increase the 
diameter of the finger and make the fracture more complete. Also, , 
a thimble is hard, so you could fracture a valve and separate it 
better if you had something hard to do it with. I used thimbles 
and various other things. Some people actually put knives in and 
cut the valve, but this proved to be a very dangerous thing to do, 
because frequently they cut it in the wrong place and made the valve 
incompetent. That wasn't very good. 

Hughes: That was Cutler's problem, was it not? 

Gerbode: Yes, he thought you'd have to cut it. But actually, it was shown 

by Souttar (although they forgot about that) that you could fracture 
it. We spent a lot of time trying to open that valve at least two 
finger breadths in diameter. We wanted to get it open to the end 
of the commissures so the valve would be mobile, so it wouldn't get 
stuck together so easily. If the corners were out quite far enough, 
then it would open and shut more completely. If it was still tied 
in the corner, then it wouldn't open completely, and there was a 
chance that it would fuse again. 

The other big problem, of course, was how to cope with clots 
in the heart. There were various techniques devised to get rid of 
a clot that you found unexpectedly in part of the heart. There were 
methods of flushing the heart out, letting the blood gush out of 
the atrium to carry the clot with it. 

Hughes: Was this a result of the procedure? 

Gerbode: No. About half the patients with mitral stenosis sometime or 

other get clots in the heart, and these clots go to the brain and 
various parts of the body and are very bad. Sometimes you encountered 
so many clots in the heart that you couldn't really go ahead with 
the procedure of mitral valvotomy. On the other hand, if the clots 
were up in the auricular appendage, near where you had to work, you 
could flush the heart out, and the blood gushing out would sometimes 
carry the clot with it. 



131 



Hughes: It sounds like a rather gross thing, to just push your finger 

through the valve. But I gather that the split was rather clean, 
and that the valve leaflets, once split, would appose correctly? 

Gerbode: Oh, they would mostly appose correctly. You would very seldom 
produce insufficiency. The main problem is if the valve is so 
fibrotic that it doesn't move properly, so that it doesn't open. 
Even though you split it, it'll only open a little bit, because it's 
still too stiff. Also if it's too stiff, it makes it much more 
susceptible to fusion again. 

Hughes: Did you ever have to cut? 

x 

Gerbode: I cut a few, but I never liked to do it very much. I had all the 
knives to do it with, but I didn't use them very often, because it 
was always dangerous to put that knife in there. 

Hughes: I understand that antibiotics influence the very character of the 
valve, that before antibiotics came into use, calcification of the 
valve itself tended to be much more severe. 

Gerbode: I don't know that antibiotics were really responsible for that. 

I think antibiotics stopped the course of rheumatic heart disease. 

Hughes: Ah, so the problems didn't go on as long. 

Gerbode: They didn't go on as long, or never appeared. If you give antibiotics 
to a patient with a certain type of strep throat, then he won't get 
rheumatic fever. That's why the incidence is going down. 

Hughes: At some state you must have been dealing with patients that had had 
rheumatic fever before antibiotics came into use. 

Gerbode: We didn't have as many children with rheumatic heart disease as is 
found in many other countries. For example, the Eskimos have quite 
a bit of rheumatic heart disease in children. In certain other 
foreign countries, this is true, too. It's very difficult to take 
care of those patients, because they get a severe form of valvular 
disease. You can't use a palliative operation very much on them. 
You have to put a valve in some of them when they're a child, and 
we don't like to do that. If you put a valve in a child, you have 
to expect it to last a long, long time, and most valves probably 
won't last that long. Then, if it's a mechanical valve, one has to 
give cumadin or a cumadin-like drug to prevent clotting on the 
valve. With Eskimos and Indians and some other people, it's almost 
impossible for them to regulate the dosage very well. 



132 



Hughes: Why is that? 

Gerbode: They live in an igloo somewhere, and they can't get in and get a 

test done very often. Then they don't understand that you can take 
too much of the drug and make matters much worse. 

I remember one child living way up in northern Alaska in whom 
I had to put a valve. The child was brought down to Anchorage 
bleeding from every orifice and requiring massive blood replacement 
and everything else. The mother said, "The little girl was not doing 
very well, and I thought if I gave her more of the medicine, she'd do 
better." 



Mitral Stenosis: Patient Selection 



Hughes: One other statement from one of your papers, this one from California 
Medicine in 1951.* You say that the mortality rate for mitral 
surgery varied directly with the degree of morbidity of the patient. 

Gerbode: That's true. 

Hughes: That leads us into the question of patient selection, and I believe 
you established fairly early on the optimal age range from mitral 
operations. 

Gerbode: When we began talking about mitral stenosis, I think we said we 
didn't want to operate on anyone over forty-five, no one with a 
history of thromboembolism, and nobody in atrial fibrillation. 
These were the criteria. Well, as time went on, those were the 
patients we were operating on most of the time. Just the reverse. 

Hughes: Why? 

Gerbode: Because they were the sickest, and they needed an operation more 
than anybody [else]. Most of the patients ended up by being over 
thirty-five or forty, and most of them were in atrial fibrillation, 
and many of them had thromboembolism. We also were afraid of heart 
failure in the very beginning. But we very quickly realized that 
one of the main reasons for operating on the patients was heart 
failure. 

Hughes: Does that pretty well cover mitral stenosis? 



*F. Gerbode, "The Surgical Treatment of Acquired Heart Disease," 
California Medicine, 1951, 75:185-188. 



133 



Gerbode: Yes. 

Hughes: Were you doing a lot of cases of mitral stenosis? 

Gerbode: Yes, it was the most frequent operation. But even now there are 
a lot of operations for mitral and aortic valve disease that are 
being done in all the units in the country and in the world, 
because a lot of the patients in whom we had done the palliative 
operation of mitral valvotomy, are coming back now with more 
fibrosis or calcification, and they require an open heart operation 
and a valve. So there are a lot of repeat operations being done, 
and then, quite a few people are coming in who avoided operations 
all these many years because their doctors just didn't believe in 
having them operated upon. So they come in at sixty-five or seventy 
requiring a valve replacement. We do these cases without much worry 
any more, because we can manage most of them. 



Heart Valve Replacement* 



Gerbode: We very early realized in the '50s that we'd have to replace valves. 
So I had a fellow by the name of Franz Segger start working on 
making an artificial [aortic] valve. We had models made, and we 
finally made a valve out of plastic material, which looked and functioned 
like a human valve. But we didn't know how long it would last. 
However, I had several very sick patients who were dying from 
valvular disease, so I used it on several of these people. It 
functioned perfectly for about a year and a half or two years, and 
then it fell apart. You can do a certain amount of investigating 
in animals, but you really have to try it on a human eventually. 

Later on in the laboratory we made pig valves , and we sterilized 
the pig valves with formaldehyde, which we found was not the chemical 
to use. Later on it was shown that glutaraldehyde was the aldehyde 
of choice. This was developed by Alain Carpentier in Paris and a 
number of others. Glutaraldehyde is the kind of aldehyde they use 
to cure leather so it'll stay soft and pliable. This was adopted 
by certain people and proven to be quite good. Most of the pig 
valves, other animal valves and pericardial valves that are made now 
are sterilized and cured with glutaraldehyde, with various pH 
regulations and so forth. Virtually thousands of these have been 
put in patients. 



*This section was moved from the session recorded on 9/27/83. See 
the session recorded on 5/15/84, pp. 362-364, for further discussion 
of heart valves. 



134 



Gerbode: Mr. Bramson also worked on an artificial valve on his own. I didn't 
get him started on it; Jack Osborn got him started on it. It was 
not feasible, because the way he wanted to mount it in the aortic 
root was not biologically satisfactory. We never used it clinically. 

Hughes: It was not just a matter of fit? 

Gerbode: No, it was a matter of it not being designed so that it'd become 
part of the patient's tissues. 

We put in a certain number of these pig valves cured with 
peraldehyde really quite early in the business, long before 
glutaraldehyde came into being, and I could see that there might be 
a big advantage in using tissue valves. So I organized a world 
tissue valve conference, which we set up, with NIH's backing, at 
Silverado.* They brought surgeons from England, Norway, Australia, 
and New Zealand for a three-day conference on tissue valves. 

Hughes: When was this? 

Gerbode: I've forgotten. The '60s sometime. This was published by NIH. But 
the only thing that came out of it really was the fact that it looked 
as though glutaraldehyde-preserved tissue valves might be the best. 

Hughes: Was there a debate at that time about the virtues of the human donor 
valve as opposed to an artificial or even an animal valve? 

Gerbode: The whole discussion at this conference was [about] different kinds 
of tissue valves. People were making them out of pericardium and 
fascia lata. I did about twenty some-odd fascia lata valves, taking 
fascia lata off the side of the thigh and making a valve in the 
operating room. 

Hughes: What gives it structure? 

Gerbode: Fascia lata is very strong. It's a tendonous type of material. 

Hughes: Can you describe the valve? 

Gerbode: The valve looked like a human valve. We had a little cusp, and we 
sewed it together in the operating room and made it the same size 
as the patient's valve. 

Hughes: Was the main virtue of this technique that there was no problem with 
rejection? 



*The First International Workshop on Tissue Valves, Silverado, 
California, October 4 and 5, 1969. 



135 



Gerbode: We thought this would be the big thing. It was a strong material, 
and it came from the same person, so we thought it might be quite 
good. The early work on this was done by Marian lonescu. He is 
a very innovative surgeon in Leeds. He had put in quite a few of 
them there, and he claimed a very early success. Well, the ones 
that I put in, about twenty of them, I guess, all finally became 
calcified or fell apart after a year or so. So that didn't turn 
out to be so good. They had to be replaced with other valves, which 
fortunately were coming along at that time. 

Then ball valves were developed. The first one was developed 
by Dwight Harken in Boston. The Edwards Laboratories then worked 
on another type of ball valve with Albert Starr in Portland, and 
they produced a Starr-Edwards ball valve which was a silastic valve 
in a metal cage. This was the valve of choice for several years. 
Some people still use them. 

Hughes: Is that the one that makes a lot of noise? 

Gerbode: It clicks, all right. 

Hughes: Did you ever use that? 

Gerbode: Yes. We put in a lot of them. 

Hughes: What is the lifespan of those valves? 

Gerbode: Some have been in for a long time. I've got some in for fifteen 

years. The early silastic ball wore out or fragmented, and it would 
escape from the little cage and produce a very serious insufficiency, 
and then you'd have to find this ball valve in the system somewhere 
and remove it. Usually it was in the aorta. Later, better material 
was developed which lasted. 

Hughes: Are these all aortic valves that you're talking about? 

Gerbode: No, mitral valves, too. So anyway, we used that Starr valve, and 
they finally changed the type of material in the ball so it was 
harder and wouldn't wear out. At the same time, in Sacramento, 
another group produced another type of ball valve in a cage, the 
Smelloff-Cutter valve, and that probably in many respects is the best 
one. 

However, with all the mechanical valves, regardless of which 
one, the surgeon is obliged to use anticoagulant drugs, because the 
incidence of thrombi forming on these valves is pretty high 
without the use of cumadin. 



136 



Hughes: Why more so than with a human valve? 
Gerbode: Tissue valves are not so thrombogenic. 
Hughes: But why? 

Gerbode: I guess metal, struts and things like that, produce more turbulence, 
and that favors stagnation and thrombosis. I think there's a little 
bit of electricity involved, too. 

Hughes: Was there ever a problem with hemolysis with the artificial valve? 

Gerbode: Yes, there still is. An artificial valve which is not functioning 
properly or which is leaking will produce hemolysis. 

Hughes: Is the leakage usually between the artificial valve and the tissue? 

Gerbode: It can be there, or at the edge of the valve, where the ball or 
disk seats on the valve. If it's not fitting properly, there's 
turbulence over that area, which is very damaging to red cells. 

Hughes: So that's a problem with the manufacture of the valve. 

Gerbode: No, not necessarily. It's a problem of not fitting the valve 
properly. Sometimes it is the manufacturer, but rarely. 

Hughes: Does that mean, then, that the alignment of the valve in the orifice 
is extremely important? 

Gerbode: Yes. It has to be seated perfectly so it won't leak. All these 

valves now have a cloth cuff around them. The cloth is used so that 
the patient's tissues will grow into that cuff and hold it in there. 
Sometimes healing isn't very satisfactory, and that's why it leaks. 

Hughes: In the early days they didn't use cloth? 
Gerbode: They used cloth from the very beginning. 
Hughes: How long does it take for the invasion of the tissue? 

Gerbode: It starts right away. In a couple of months it's pretty solidly 
embedded. 

Hughes: Did you ever have a strong feeling of the artificial valve versus 
the tissue valve being superior? 



137 



Gerbode : 



Hughes : 
Gerbode: 



Hughes: 
Gerbode: 

Gerbode: 



Hughes : 
Gerbode: 

Hughes : 
Gerbode: 

Hughes : 
Gerbode: 



I always thought that tissue valves were going to be the best 
eventually, and that's why we made some out of the patient's 
tissue and studied some in the laboratory. Any mechanical device 
in the circulatory system has certain inherent disadvantages. 
True, there have been thousands of mechanical valves put in patients, 
and for the most part, about 75 percent of them have lasting virtue 
and a very low failure rate; about 75 percent of them survive more 
than five years with a low incidence of thrombotic complications. 
But there is always some instance of thrombotic complications, and 
they all have to take ant i coagulation drugs, cumadin. 

Forever? 

Forever. There are a certain number of incidences of bleeding from 
cumadin. In our own service here, I know of several disastrous 
hemorrhages from patients taking too much cumadin and not regulating 
it properly, and getting brain hemorrhage and other big hemorrhages. 
You have to be very careful. 

Tissue valves may have to be replaced in a few years? 

Well, the tissue valves are almost as good and [of] lasting quality 
as the artificial valves. 

H 

One basic reason is that the tissue is made inert by being cured 
by glutaraldehyde, so it's like a little piece of flexible leather, 
you might say. And this is true whether it's pericardium or any 
other tissue. 

Did you use donor valves to any extent? 

I only put a few fresh aortic valves in. The ones I put in actually 
have lasted very well. I have one in an Indian doctor, for example. 
It's [been] about fifteen years now; he's still doing well. 

Why did you put so few in? 

They're hard to get, and we didn't have a massive supply available, 
and we had a massive number of patients to be operated upon. 

Do you think that covers valve surgery? 

I haven't talked about all the various people who've worked on this 
problem. There's Carpentier in Paris at the Broussais Hospital who's 
made some very good contributions. And Marian lonescu in Leeds has 



138 



Gerbode: continued to make very valuable contributions. His present valve 

is made out of pericardium, which is cured again with glutaraldehyde. 
It's seemingly lasting better than some of the pig valves. 

Hughes: Why is a pig the animal of choice? 

Gerbode: [Its] valve is like a human valve. It's easy to get a pig's valve. 
A great many of them are coming from the Philippines now. 

Hughes: Why is that? 

Gerbode: Because they eat a lot of pork out there. 

Hughes: Does size have anything to do with it? 

Gerbode: Yes, they're sized. There's a pretty standard size for most adults. 
But then for children and some adults you have to have different 
sizes. 



The Korean War and Its Aftermath 



Hughes: Is it too big a question to get into the impact of the Korean War? 

Gerbode: I can probably cover that. The Korean War was a war which nobody 

liked very much. I guess you could philosophize about why we should 
have done anything about it. But having gotten into it, then we had 
a lot of troops over there who were getting sick and getting hurt. 
The surgeon general of the army wanted to be sure that the troops 
were getting modern medicine. So he asked people in some of the 
university centers if they would go over to have a tour of duty and 
inspect the hospitals and make any suggestions about improving the 
care of the soldiers. Franny Moore was one that was sent over from 
Harvard, John Howard from Philadelphia, and a number of others. I 
guess there were quite a few who were asked but didn't want to do 
it, didn't want to leave their civilian work. I was asked by the 
surgeon to do it , and I was very happy to do it . 



Service as a Brigadier General 



Gerbode: So I went over. I was assigned a colonel in the regular medical 

corps of the army to stay with me the whole time and get me through 
all the various paperwork that was necessary to move me around. I 



139 



Gerbode: was at that time a lieutenant colonel in the army reserve. But to 
move me around in Korea, 1 had to have a title a little bigger 
than that, so I could get priority on airplanes and helicopters. 
So the surgeon general said, "Don't tell anybody about your being a 
lieutenant colonel in the reserve; I'm going to make you a temporary 
brigadier general [laughter] so you can get around." So I was a 
brigadier general during the Korean War. 

Hughes: They withdrew that title after the war? 

Gerbode: Yes. There wasn't any necessity to keep it going. Actually, when 
I came back, I decided that if they thought enough of me to make 
me a general when they wanted me, that there wasn't much point in 
my retaining a lieutenant colonel's commission, because all I would 
do is make myself susceptible to being drafted. Then when I was, 
I'd be brought in as a lieutenant colonel, whereas if they really 
wanted me, and I had no title, they'd make me a general. I think my 
reasoning was valid. 

I went to Seoul first. The ritual was to visit all the 
hospitals and to have ward rounds and give a few lectures. I had a 
few subjects I talked about, resuscitation and shock and things 
that were common to the treatment of seriously wounded soldiers. I 
would give these lectures if they were necessary. But mainly I 
would go on ward rounds with the young surgeons who were doing most 
of the work they were mostly captains and see how they were 
handling the wounded, and make suggestions if I thought they were 
pertinent. I did this in virtually all the army hospitals, and 
some of the navy hospitals, in Korea. 

Hughes: Did you find that people were pretty much up to date? 

Gerbode: Yes, they were. Some curious things happened though. I ran into 
one station hospital where they had a young captain who had been 
trained in a certain hospital in the Philadelphia [area] where 
the professor had used fine wire in most operations. 

II 

Gerbode: Well, wire is fine in certain situations, but it's not very good in 
traumatic wounds, because eventually it has to be taken out. It's 
irritating. I tried in my ward rounds to try to dissuade him from 
using it. He really didn't think very much of my advice. I said, 
"When I go back to the base in Japan, what would you like to have 
me have them send you?" He said, "Just have them send me some more 
wire." [laughter] 



140 



Gerbode: It was interesting. It was during the wet weather, so most of the 
lectures and subjects were handled in tents, just like MASH. The 
only difference was that all the little things that MASH was involved 
with sex and everything if they went on, I didn't see them, and 
there weren't a lot of foolish commanding officers. All of them were 
sensible people. 

Mainly, I guess, what I did was make little suggestions about 
things. I wrote a big report at the end. But the thing that I 
really was very interested in was how they took care of the wounded 
up at the front. To do that, I had to go up in a helicopter. So 
they assigned a fellow by the name of Tex. (Anybody from Texas is 
called Tex.) He was the helicopter pilot, and he took me around 
to various front-line units, flying under the artillery barrage. 
You'd hear the gun go off on your right, and then the shell would 
go over and land on the enemy on the other side, and you kept 
thinking, "I hope they don't aim too low." [laughter] 

But anyway, they would go up there with these helicopters, and 
they strapped the wounded on the outside on little platforms, and 
then flew them back within an hour or so of being wounded. It was a 
very efficient way of doing it. 

Hughes: Was the helicopter used in World War II? 

Gerbode: No, they were started, but we didn't see many helicopters over there. 
But they used them a lot in Korea. It was a great way of getting 
around, when they wanted to move me from one place to another. It 
was just fifteen to twenty minutes in a helicopter, whereas it might 
have taken hours on a road. 

Hughes: A lot of lives were saved. 

Gerbode: A lot of lives were saved. [If it was] raining, they'd cover up 

[the wounded] with tarpaulins and put them on these platforms on the 
side of the helicopter and take them right out. While on the 
helicopter, they would receiving an intravenous of blood or saline, 
if necessary, while they were being flown back to the hospital. 

Hughes: Was the setup similar to World War II? 

GerboJe: Yes, but it was more like it was at the end of the war, because at 
the beginning of the war, it was a mess. At the end of the war, 
these forward hospitals really were pretty well standardized and 
were very efficient. They had good instruments, plasma, antibiotics, 
and blood. They knew what they were doing. 



141 



Gerbode: It's interesting, though, that in both wars it wasn't the regular 
army that was doing this. The regular army was in all the command 
positions. But the work was mostly being done by reserve officers. 
The regular army could never have done the job in World War II. 

When I came back from the Korean War, it was very hard to find 
a regular medical officer who'd been over there. They were all in 
base hospitals starting training programs in thoracic and cardio 
vascular and general surgery, and not over there in the front line. 
There wasn't much future in doing that. 

Hughes: Now, are you speaking just about medicine? 
Gerbode: Yes, I'm speaking about medicine and surgery. 

Hughes: After the Korean War, I know you wrote a number of papers on repair 
of war injuries to the major blood vessels. 



John Howard: Blood Replacement 



Gerbode: There were two fellows who really made a lot of contributions to the 
understanding of the wounded during the Korean War. One was John 
Howard. He was the one who made the observation that [when there 
was] a lot of bleeding, you had to give [the patient] more blood 
back than the blood that was lost. This was a very important observa 
tion, because it meant that blood replacement had to be much greater 
than you might expect. The physiology of why this was true was not 
understood. It probably still isn't fully understood. But the body 
usually needs more blood than it has lost. John Howard [made] a lot 
of physiological observations over there in the field which were very 
good. He's a very, very nice fellow, lives in Philadelphia. 

Hughes: How did he even come to that concept? 

Gerbode: He found out that by the time they replaced all the blood they 

thought the boy had lost, that he still had a low blood pressure, 
and there was also other evidence. 

Hughes: Ah, so they put a little more in. 

Gerbode: Well, basically that, but they had methods of studying blood volume, 
too, which refined the concept. But it was mainly that they found 
they had to give more blood. Later on they did blood volume 
observations, which made it more scientific. 



142 



Frank Spencer: Early Repair of Blood Vessels in the Field 



Gerbode: Frank Spencer was a very interesting, very nice young guy, whom I 

had met at the Oak Knoll Naval Hospital, when he went into the navy 
service. I was a consultant over there. Then we worked together 
on some patients at the naval hospital. He went over [to Korea] on 
his tour of duty and began to repair arteries in the field. He and 
a couple of other surgeons were very influential in changing the 
concept of early repair of major vessels in the field. That was 
a big advance, because even in World War II we didn't try to repair 
many arteries. We tied them off. Then there was a fixed rate for 
example, with a leg artery of amputation for gangrene, at certain 
levels. We did repair a few [vessels] in World War II in the field, 
but not very many. 



Vascular Suture 



Hughes: Was that just a conceptual barrier because weren't the techniques 
adequate? 

Gerbode: Oh, the techniques were there. Nobody I guess was smart enough to 
apply them. See, the technique of vascular suture was really 
started in Europe. [Just after the turn of the century] Alexis 
Carrel saw some of these things being done in the laboratory by the 
French, and he came to the Rockefeller Institute and began to use 
vascular suture in animals. He found that he could join arteries 
together, that they would stay together, and they wouldn't leak and 
would heal. So he used the technique to transplant organs. He 
transplanted a heart into the neck of a dog and anastomosed the 
vessels. The vessels stayed open, and the heart lived. A number 
of his experiments of this type were responsible for his getting the 
Nobel Prize. These are techniques which young residents do all the 
time now. 

Hughes: Yes, but there was a tremendous gap before 

Gerbode: Well, that is true. It takes almost twenty years, almost a whole 

generation, between the discovery of a method or a technique and its 
full application. 

Hughes: Do you think that's a matter of one generation dying off and a 
new one ? 



143 



Gerbode: No, it just takes that long for the idea to sink in. Now, the 

great people of this present generation are the ones who recognize 
those things which are all about us now and start doing them now 
rather than [waiting] for the next generation. 

Hughes: Was the main problem the fear that the sutures wouldn't hold? 
Gerbode: Yes, they didn't think they could do it technically. 

Hughes: You published a paper on coarctation with Geoffrey Bourne in 1951,* 
which meant you did the operation in 1951 or 1950, very soon after 
the first operations for coarctation had been done. Was that a 
fear of yours? I would think that suturing the aorta would be one 
of the most scary things to do. 

Gerbode: Yes. The difference between that operation and suturing an artery 
in a wound is that if you suture it in a wound, you'd feel that 
maybe the wound would get infected and then the arterial suture 
would break open. That was one of the scary things. But as it 
happened, there are methods of covering that arterial repair with 
a flap of tissue, and then also being sure that the tissue that you 
used was absolutely clean. Also, later we had antibiotics. We had 
penicillin. We could cover infections a lot better. Those were 
the main reasons. But I think just the fear of being [un]able to 
suture it together and the fear that it might break open or rupture 
was something you had to overcome. 

Hughes: Was that in the back of your mind when you first started? 

Gerbode: I don't know. When I was operating on children for congenital 
disease, I wasn't really thinking very much about war surgery. 



Vein Grafts 



Gerbode: Later on, toward the end of the Korean War and in Vietnam, I was 

still a consultant for the navy, so they had me over at the Oak Knoll 
Naval Hospital about once a week operating on arterial injuries. I 
was doing the leg repairs over there. I wrote a paper on it.** 



*"Surgical treatment of a case of coarctation of the aorta with 
unilateral hypertension, associated with ungovernable tempers," 
British Journal of Surgery, 1951, 38^3840386. 

**E.H. Dickson, T.E. Ashley and F. Gerbode, "The definitive treat 
ment of injuries to the major blood vessels incurred in the Korean 
War," Western Journal of Surgery, 1951, _5_2:625-634. 



144 



Hughes: I believe that was the one where the cases were mainly arteriovenous 
fistulas and aneurysms? 

Gerbode: Yes. I did some vein grafts on patients who'd had ligation of major 
vessels, and I put a vein in as a graft. 

Hughes: I noticed that in some cases you used a vein graft for the artery. 
Why would you use a vein? 

Gerbode: Because there wasn't an artery available to put in. 
Hughes: Oh, it's as simple as that! [laughs] 

Gerbode: And also the fact that a vein is usually available. For example, in 
all these coronary bypass operations now, where they jump over a 
diseased portion of an artery to the heart, they use a vein from 
the leg. 

Hughes: And these in most cases were autonomous grafts? 
Gerbode: Yes, they're from the same patient. 
Hughes: But you did use homografts as well? 

Gerbode: No. Well, later on, when I set up a graft bank at the Irwin Blood 

Bank, where we freeze-dried arterial grafts, I used some of those in 
patients instead of veins. 

Hughes: When was that? 

Gerbode: Fifties, after the war. But after a year or so, we saw that some 
of those grafts became calcified. 

Hughes: Both types now? 

Gerbode: No. Mainly the homografts. So we stopped using them. At that same 
time, we began to use cloth grafts, which were becoming very much 
available.* The first cloth grafts were made out of nylon at 
Columbia mainly by a fellow by the name of [Arthur B.] Vorhees, [Jr.]. 
They were made out of very thin nylon cloth. Later on even lady's 
nylon stockings were sewed together and used in fact, I made some 
myself and used them in humans. 

Hughes: Why did you choose nylon? 



*Part of the discussion of cloth grafts was moved from the interview 
session on 8/10/83. 



145 



Gerbode: Because it was thin and strong and easy to work with. But we found 
later on that nylon disappeared in the body. It was absorbed. 
After a year or two these grafts would get soft and become aneurisms 
or would get weak. So it was later that dacron was used. Dacron 
was found not to disappear this way. This again was based on 
experimental surgery. This was all found in animals. 

A lot of the best research on cloth grafts was done by Dr. 
[Michael E.] DeBakey. He quickly saw that he should get the cloth 
manufacturers interested in it, which he did. They produced some 
materials, first with rayon and nylon, and then later dacron. They 
found that rayon and nylon didn't last long enough; they got soft 
and broke. But dacron lasted indefinitely. So when these [dacron 
grafts] became available, we used those in clean wounds, and they 
still do, although at the present time, it's still a bit better 
statistically to use a vein for a graft in a leg than it is to use a 
cloth graft. 

Hughes: Does anybody know why? 

Gerbode: Because it's living tissue, the patient's own tissue. 

Hughes: Then why wouldn't that apply elsewhere? 

Gerbode: Well, that's where they're using them mostly, in the leg. We use 
them everywhere around the heart, in the heart. 

Hughes: And calcification isn't a problem? 
Gerbode: No, it isn't. 

Hughes: So the body obviously is, in a certain sense, recognizing that the 
homograft is foreign. 

Gerbode: Sure, it's a form of rejection. 

Hughes: Can you say something about the knowledge in those days of the 
mechanism of rejection? 

Gerbode: We really didn't know about the whole field of rejection until 
people were able to type blood and tissues. People could type 
tissues to find out whether they were more or less compatible or 
completely incompatible. This was necessary because of the early 



146 



Gerbode: techniques of using renal transplants. They found that if they could 
tissue type them, and found that they were compatible, that more 
grafts would take. 

Hughes: So it was renal transplants 

Gerbode: The renal transplant really was the one that put tissue typing on 
the map. 

Hughes: That was the '60s? . 
Gerbode: Yes. 

Hughes: So you didn't have any sophisticated system when you first started 
the vein grafts? 



Heart Transplantation* 



The Problem of Rejection 



Gerbode: No. Actually, we could talk about heart transplants in this regard, 

too. Dr. [Norman] Shumway and a team were doing cardiac transplantation 
in our old [dog] laboratory on Sacramento Street very early on, using 
hypothermia, just cooling the heart down and then transplanting 
it quickly. I kept watching these procedures, and I could see that 
technically it was feasible, all right, but I kept raising the 
question of rejection. I said, "There's not much point in doing all 
this if the body is going to discard the heart very quickly." 

Dr. Shumway believed that sooner or later they would find out 
a way of controlling rejection, which is more or less true right now, 
because they use the same techniques for blood and tissue typing, 
as is used for renal transplants.** That was closer to what they 
wanted. There was one very well known surgeon in the South who said, 



*See pp. 194-196, 354-355, and 468-469, 

for further discussion of heart transplantation. 

**Further discussion of Shumway 's work on heart transplantation occurs 
in the session recorded on 9/27/85, pp. 251-253. 



147 



Gerbode: "I don't think there's anything to this tissue typing. I think the 
main thing is just to put that heart in." Well, he put about twenty 
of them in, and they all died. But he's that kind of a fellow. 

Hughes: This isn't a Texan now? 
Gerbode: Well, I'm not saying. 

More recently drugs have been used to control rejection. We 
can talk about that later sometime perhaps, although that's not 
much I have anything to do with, because I never got into transplan 
tation. 

i 
Hughes: Why? 

Gerbode: I stopped operating a few years ago. We did a lot of experiments 
in cardiac transplantation in this lab in 1975-76-77. The animals 
would live for a certain length of time, but the hearts would be 
rejected. And there wasn't anything we knew about in an animal that 
could keep that [from happening]. So it was kind of a futile thing 
to me at the time. 

Hughes : Yet other people were using the technique on humans , is that not 
true? Christiaan Barnard? 

Gerbode: Yes, they were. Shumway was using it on humans then, too. But the 
success really got going when they began to use drugs to help 
prevent the rejection phenomenon and improved tissue typing. 

Hughes: So that's what held you back? 

Gerbode: Yes, I couldn't see any way of controlling [rejection]. 



Norman Shumway 



Hughes: Could you wind up by saying a little about your association with 
Shumway? 

Gerbode: Norm was trained in Minneapolis. He didn't have a full residency 
in surgery according to the regular method of training a surgeon. 
He was exposed to hypothermia as a technique for doing open heart 
surgery through the work of [John F. ] Lewis, who was then on the 
faculty at the University of Minnesota. Norm came out here looking 
for a place to work. Dr. [Victor] Richards was the acting chief of 



148 



Gerbode: surgery at that time, and he gave him the opportunity to work in our 
old dog lab, where I was working, too. Norm started doing cold 
arrest of the heart a technique of cooling the heart down, so it 
could be stopped and then operated upon and developed a technique 
for that which he used later for a long time on humans. The rest of 
us used it , too , to a certain extent . 

He also kept plugging away at transplanting dog hearts. Then 
he started a unit of cardiac surgery at Children's Hospital, which 
was really in competition with our unit here. But there wasn't any 
place for him to work other than over there. So he did a few cases 
over there. But they never really had a good team at Children's 
Hospital. It wasn't organized as a big team, and every operation 
was kind of a new experience. 



Fallout from Surgical Advances 



Gerbode: One of the most important points about Norm Shumway continuing his 
transplant work in the face of no real ability to cope with the 
rejection phenomenon is that when surgeons demonstrate they can do 
something, it stimulates a lot of activity around that particular 
procedure. Now, when it was demonstrated that we could repair the 
inside of the heart, or the heart itself, it stimulated a tremendous 
amount of work among the cardiologists. As I mentioned to you 
before, it made cardiology a different thing entirely. It taught 
the anesthesiologists a whole different way of dealing with anesthesia. 
It taught cardiac physiologists all the principles of dealing with 
seriously ill patients. It brought out all the developments in 
better resuscitative care of pulmonary insufficiency, and so forth. 

So the fact that the surgeon could demonstrate repeatedly that 
[transplantation] was technically feasible put the burden of 
experimentation and development on the others who could support 
this venture. In other words, if you could conquer the rejection 
phenomenon, it was apparent that you could transplant almost any 
organ except the brain and spinal cord. 

Hughes: And that was apparent early on, was it not? 

Gerbode: It was apparent as soon as surgeons demonstrated they could do it. 

Hughes: Carrel had shown that way back in the early years of the century. 



149 



Gerbode: [He] did. It took twenty years for them to catch up with what 
Carrel was saying. But the same thing is true about vascular 
suture and arterial repair. As soon as surgeons demonstrated that 
they could repair arteries and help patients with arteriosclerotic 
occlusive disease with grafting, then this brought out the production 
of vascular grafts made out of fabrics the biggest industry of this 
kind in the whole world. There isn't any country that can touch us 
in this industry of making grafts out of prosthetic material. 



Consultant Positions//^ 
[Interview 6: August 24, 1983] 



Oak Knoll Naval Hospital, Oakland 



Gerbode: After the war, both the army and the navy recruited some of the 
people who had been in the war to be consultants. The first 
government group to ask me to become a consultant was the United 
States [Oak Knoll] Naval Hospital in Oakland. I guess they invited 
me over because I'd already established myself to a certain extent 
in vascular work and was doing the beginnings of heart surgery. They 
had a fair number of patients there who were service people who had 
vascular and heart problems. I would go over once a week and 
lecture and occasionally would do an operation. In the beginning 
[I would] operate perhaps once a week on the same day as doing a 
lecture. I found this very rewarding. I liked going over there, 
because they were very fine people, and they approached everything 
very much on an academic level. The pay was very small, fifty 
dollars a day. 



Letterman General Hospital, San Francisco 



Gerbode: I felt I was continuing to do my duty toward the armed forces. 

Then a year later, I guess some of the army people realized that 
having been in the army for three and a half years, it was rather 
strange that I was being a consultant for the navy. So the army 
invited me to be a consultant at Letterman. This was very good, 
because I could easily get there, and the people who were in charge 



150 



Gerbode: were very compatible. I started operating at Letterman as well 

and, in the beginning, teaching them how to do major vascular work 
and some cardiac work. 

Hughes: Did you go on a regular basis? 

Gerbode: About once a week I'd go there for a half a day and would lecture 

or go to their conferences, and then operate when the occasion arose. 
Now, of course, they have a full training program in thoracic and 
cardiovascular surgery. I got there only as a consultant on call, 
not operating any more. All during this early period, some of the 
people from the army and the navy would come to our conferences here , 
which was then Stanford, as part of their educational program. 

Hughes: How did that arrangement arise? 

Gerbode: I arranged it. I just invited them to come, and they would come 
once a week, mainly to our catheterization conference, where we 
would discuss cases. This was also a very nice arrangement. I 
am still a consultant with the army, but I terminated my 
consultant's job with the navy, because it wasn't practical for me 
to go over there any more. 



Positions in Washington, D.C. 



Gerbode: I've held various consulting jobs, not only in the two hospitals, 
but in the central government in Washington as well. I was on the 
National Research Council for several years. I was on the Surgical 
Studies Section of NIH for a long time, and several other 
committees like that in Washington. So I have a long track record 
of round trips to Washington, paid for by the government. 

Hughes: Do you know why those appointments came about? 

Gerbode: I guess they thought I had a reputation for doing things fairly 

and squarely and making decent decisions. I enjoyed being on those 
committees, because I was always with friends. 

Hughes: Did it tend to be the leading people in the field? 

Gerbode: They were all academic people. They were professors of surgery or 
associate professors. 

[interruption] 



151 



Hughes: 



Gerbode: 



Hughes : 
Gerbode: 
Hughes : 

Gerbode: 



Hughes : 



I was wondering what the differences, if any, were between Letterman 
and the naval hospital? 

They were very much the same. In fact, for a long time there was 
a big discussion about whether they should build a new hospital in 
Oakland and a new hospital at Letterman. The programs were so 
similar that I was one who advocated building one armed services 
hospital instead of building two. My friend Frank Berry, who was 
then undersecretary of health in Washington, was also a 
strong advocate of building one hospital. But one cannot get these 
services together. The one place where they got them together was 
in Honolulu, where they built one hospital for the army and the 
navy and the marine corps. But it went down as a very strong, big 
pill, which nobody really liked to swallow. 

Too much territoriality. 
Yes. 

Was it unusual for military hospitals to have such an academic 
interest? 

It was unusual before the war, but after the war the veterans' 
hospitals and the [military] service hospitals realized they'd have 
to have training programs to train specialists in general surgery, 
general medicine, and all the other specialities. In order to do 
that, they had to have some sort of an academic program going, so 
they had to utilize the nearby medical schools. 

The veterans' hospitals reorganized their entire approach by 
putting the hospitals in charge of medical schools. The dean's 
committee of the medical school in that area really ran the 
professional aspects of the veterans' hospitals and improved the 
care of the veterans enormously as a consequence. This is still in 
existence. The professional part of the veterans' hospital here 
in San Francisco is really run by the dean of the University of 
California. He puts men over there as consultants, and usually 
they're academic people. He actually puts residents through there 
from his training program at the county hospital [San Francisco 
General] and at U.C. So it's been very good. 

After the war, you wrote a number of papers on vascular surgery 
[where] the injuries were the result of the war. Were those cases 
done at one of those hospitals? 



152 



Gerbode: Yes, I did quite a few, mainly at the naval hospital, because they 
had a whole batch of marines who were shipped in there who had been 
badly shot up in the Far East. So they invited me over to consult 
on them. I helped them reestablish circulation, mainly in legs 
and arms. Occasionally I would take a foreign body out of the chest 
somewhere. Frank Spencer was over there with me for a little while, 
before he went to the Far East. He's now professor of surgery at 
New York University. 

Hughes: You mean he was there on a permanent basis? 

Gerbode: No, he was there to do his military duty for two years. In any 
event, I guess the army thought I'd contributed something to 
developing their thoracic training program at Letterman. So a 
number of years later they gave me a very important civilian service 
award, which is a nice little medal. They had a ceremony when they 
gave it to me at Letterman, and they had the army band from 
Sacramento playing on the stage. At the same time that they gave 
me the award, they were giving the certificates of training to their 
residents. The band was playing merrily on, and when my turn came 
to get this award by the general, I thought the music sounded rather 
strange and semi-familiar. But if you've ever heard an army band, 
you sometimes have difficulty understanding what they're playing, 
[laughter] I finally realized they were playing "I Left My Heart 
in San Francisco." [laughter]* 



*A discussion of the peer review system was moved to the session 
recorded on 8/26/84. 



153 



V PRESBYTERIAN MEDICAL CENTER, THE HEART RESEARCH INSTITUTE, 
AND COMPUTERIZED PATIENT MONITORING 



The Stanford Medical School's Move to Palo Alto, 1959 



Debate Over the Move 



Hughes: Do you want to move on to the move to Stanford? 

Gerbode: Yes. As soon as I came up [to San Francisco] from Palo Alto and 
medical school, which was 1932, I began to feel that there were 
people around who wanted to move that school to Palo Alto. The 
faculty in San Francisco mainly wanted to rebuild the hospital and 
the medical school up here. They liked San Francisco. They had a 
very good teaching program at the county hospital, half of which they 
ran. They felt that it was better for a medical student to grow 
up in a relatively big city, and see all the various aspects of 
medicine than to be in a small town which is not representing a 
cross-section of what the world is about. 

However, as time went on, we had a president [of Stanford] by 
the name of Don Tressider, who was a member of a family that had 
been with Yosemite for a long time, and he was very interested in 
rebuilding the school in San Francisco. He was a very good friend 
of the dean, Yank [Loren R. ] Chandler. As long as Tressider was 
president of the university, the thought of rebuilding the school 
was predominant. But unfortunately he had a coronary and died on the 
East Coast. 

Then Wally Sterling was made president. Wally was very much 
influenced by some of the people in Palo Alto, particularly some 
of those who were connected with the Palo Alto Clinic. Although he 
is a very fine man, and I've liked him, and I think was a great 



154 



Gerbode: president of Stanford, I think he had very strange thoughts about 
doctors and medical schools. Some of it may have come from the 
fact that he came from a minister's family. But I think he really 
has never been exposed to what went into medical schools. However, 
as time went on, his thoughts predominated, and it was decided to 
move the school to Palo Alto. 

Hughes: What was he afraid of? 

Gerbode: He wanted to have everything on one campus, and there's certainly 
justification for it. 



Decision to Stay in San Francisco 



Gerbode: So at this time [1959] there were forces which tried very hard to 
get me to move to Palo Alto. Various committees approached me to 
ask if I would go down and be chairman of the department of surgery. 
Another committee asked me, if you don't want to be chairman, 
would you go down and be dean of the medical school? At the same 
time, the University of California, thinking that maybe the school 
was going to move, thought they could capture some of the faculty 
of the old Stanford school. So two committees came to see me and 
asked me if I would start a heart program at U.C. They had one 
going already, but they weren't particularly happy with it. 

Hughes: This was the late '50s? 

Gerbode: Yes, 1958 or '59. I realized that if I moved to Palo Alto, it would 
mean that I would go back to living in a very controlled environment, 
and so would my wife. She was at that time, in the '50s, getting to 
be known in San Francisco in various organizations and enjoying it, 
too. She liked working with things in the City. I'm quite sure that 
had I decided to go to Palo Alto, I would have had to go down there 
alone, [laughter] which I was not too keen to dc anyway. 

The other thing about moving to Palo Alto is that I really don't 
like the small-town concept of a university [community]. A university 
community [is] like a small town. Everybody knows what you're doing. 
When you buy a new car, it's a subject of general conversation. If 
your house is bigger than somebody else's, there is a great deal of 
discussion about that. If you give a party, everybody knows it. It's 
Main Street all over. I don't like that part of it. Now, some 
people can live in this environment and thoroughly enjoy it, but I 
couldn't. 



155 



Gerbode: The other reason I didn't want to go was that I felt that in 

building a new medical school at Stanford, there was going to be 
an awful lot of administrative planning, a lot of committee work. 
This would mean that if I had gone, I would be in committees all 
the time and not trying to develop heart surgery. I knew the history 
of other medical schools that had moved. It usually took one whole 
generation before all the problems were sorted out.* So I had to 
decide whether or not I wanted to become the professor or develop 
heart surgery. I decided that I wanted to stay in San Francisco, 
and my wife didn't want to go to Palo Alto. So that was the 
decision. 



Attempts to Retain a Connection With Stanford 



Gerbode: 



We tried desperately to get Stanford to keep a connection with us up 
here, retain an academic program as a post graduate medical school, 
or something. But Dr. Sterling wanted to cut it off completely. He 
wanted a complete amputation. 

I can remember the discussions with some of the board members 
of the university, notably Dave Packard, who was chairman of the 
board of trustees. He obviously was told, "Don't let those 
San Francisco people have anything, because we need all the patients. 
We need everything we can get down here to get this school going." 
This was a different point of view than what they were saying. They 
were saying that there were plenty of patients in the area around 
San Jose and Palo Alto, and they had big charts to show this. They 
also had charts showing the population growth, so they needn't 
have feared competition up here at all. However, at meetings, which 
were being held mainly at the Fireman's Fund Insurance Company, Dave 
Packard's theme song was to bury the old medical school. They even 
wanted to close the outpatient clinics, thinking that if we retained 
an outpatient clinic, that this would take patients away from Palo 
Alto. Obviously, most of the patients didn't come from Palo Alto. 
A great many lower income residents came from nearby. This was, 
again, a foolish position to take. They said [they were] going to 
lose money to keep those outpatient clinics going. This was then 
called San Francisco Stanford Hospital. So then I said to some of 
my colleagues, "Suppose we get a group of people together and say 
we will underwrite the expense of keeping the outpatient clinics 
going?" So we got forty doctors to each pledge a thousand dollars 
if necessary to keep the outpatient clinics open. With this threat, 



*The two foregoing sentences were added from the session recorded 
on 8/16/83. 



156 



Gerbode: Stanford couldn't very well close them. [laughs] So they kept 

them as they were, and nobody lost any money, and the clinics went 
on. But we had to play a strong game with them to get them to do 
this. 

However, regardless of what I did or anybody else did, they 
would not retain any academic connection with San Francisco. I made 
several trips down to talk to Wally Sterling about it. They were 
very much influenced by Russ Lee, who was then running the Palo 
Alto Clinic. He had the ear of the president and the people on the 
campus. They listened to him more than they listened to anybody 
else. Russ Lee's primary mission in life was to make the Palo Alto 
Clinic a bigger and better place on the peninsula. 

To show you how Russ Lee operated: [He], some of the faculty 
members from San Francisco and some of the ones who were going to 
be in Palo Alto were having dinner together. Russ Lee said to me, 
"Frank, I think the best thing to do when the medical school moves 
to Stanford is for the Palo Alto Clinic to take all the private 
patients, and we'll give you plenty of teaching material. We'll 
give you all the teaching material you want in exchange for running 
the private patients." Well... As if nobody could see through 
this suggestion. It was obvious that this was the way he was working 
and thinking. He was a very smart, clever man in this respect. 
Unfortunately, I think some of the people in Palo Alto listened to 
him rather seriously. 

In any event, since the decision was made to move, then we had 
to try to figure out what to do with what was left. The San Francisco 
Stanford Hospital was really in terrible shape. The old medical 
school was really in worse shape. 

Hughes: Excuse me, but the preclinical years had always been at Stanford? 

Gerbode: They had the first year and the first quarter of the second year 
at Stanford. So the rest, two and three-quarters years, were up 
here. 

Hughes: And that was all going to change. 

Gerbode: The whole thing went down there. Simple things like putting two 

automatic elevators in the old Stanford Hospital was a huge hurdle. 
But we finally got Stanford to underwrite these two automatic 
elevators. But things were financially in very bad shape. 

Hughes: They just weren't willing to pay for anything. 



157 



Gerbode: They weren't willing to do anything . 

Hughes: Were they just hoping that the place would fold up? 

Gerbode: Oh, yes. They wanted it to fold up. In fact, a lot of the doctors 
who had been sending patients into the old Stanford Hospital thought 
it was folded up. But anyway, the thing that really saved it was the 
fact that heart surgery was really kind of exploding, and we began to 
fill up the place with heart patients, because we were the only one 
on the West Coast doing open heart surgery. All the old channels 
opened up, and they sent all the patients to us. This wasn't 
only from the Bay Area, but also from Alaska and Oregon and Nevada. 

Hughes: The whole West. 

Gerbode: The whole West, really. Some of the patients even came from 

Los Angeles. Of course, this also made Stanford want us to move 

to Palo Alto even more. Anyway, the lady that runs the cashier's 

desk [at Presbyterian Hospital], who's still over there as a matter 

of fact, said, "Please, Dr. Gerbode, don't leave town." [laughter] 

The heart surgery and all the cardiology connected with it was 
really keeping the place alive. 



Staff Decisions about the Move 



Hughes: What about the staff, now? 

Gerbode: A handful of the senior, high-level faculty moved to Palo Alto. 

Hughes: They were attracted by good positions there? 

Gerbode: Good positions. Some of them were promoted. They were made 

professors or associate professors, and they automatically got 
tenure then, which appealed to them a good deal. 

Hughes: It would have been possible here, too. 

Gerbode: No, we had no way of giving them tenure up here. The bulk of the 

clinical faculty who was not full-time stayed here in San Francisco, 
because they had practices here and didn't want to move. Some of 
the full-time faculty decided to stay as well. 

Hughes: Who was there at that time in cardiovascular surgery? 



158 



Gerbode: Norm Shumway had moved out from Minneapolis. He came out really 
to try to get a job somewhere, and there wasn't anything open. 
So he started doing experiments in our old dog lab. 

Hughes: Right about this time. 

Gerbode: Nineteen fifty-five or '56, somewhere in there. 



Gerbode: I was at the same time developing heart-lung machines. So the 

old lab was pretty busy, busier than almost any other place in the 
old hospital. 

Hughes: Was there anybody else? 

Gerbode: Yes, there were some others who were trying to get into the heart 
picture at the time. Jack Connolly was doing some experiments 
and trying to get into the picture. 

Hughes: Did he succeed? 

Gerbode: He didn't really get fully into the heart surgery business. He 

moved down with the group to Palo Alto for a short while, and then 
became professor of surgery at U.C. Irvine. 

Hughes: Was there any feeling of betrayal when people left? 

Gerbode: No, there wasn't. We just felt that they should go where they 
wanted to go. 

Hughes: What about your frame of mind with the threat of the whole 
institution folding under you? 

Gerbode: I had my ego to cope with, because I had to make a decision of 
whether to be the professor and ride the tide or to fight a 
different kind of a battle up here and stay. It took me several 
months to really sort this out and decide to stay. But when I 
thought about my family and wife and the life in San Francisco, this 
made the decision quite a bit easier. 

Hughes: Did you ever have doubts about it? 
Gerbode : Once I made up my mind , that was it . 

Hughes: You didn't have any doubts about the institution itself being 
viable? 



159 



Gerbode: I had doubts, but I felt that, knowing the history of the place 
You see, it was the first medical school in the West, and it was 
the best hospital in the West for many, many years, even before 
Stanford took it over. It had a beautiful location in San Francisco. 
The property was ideal for a hospital and for a teaching hospital, 
because they were right next to the people on one side that could 
pay for services, and on the other side, the people who needed to 
have services and couldn't pay for them. [Elias Samuel] Cooper 
and [Levi Cooper] Lane, who started this whole thing, realized 
this. So they had both the outpatient services and the paying 
beds filled. An ideal situation. 

But in any event, I really believe that heart surgery saved 
the place. That plus the fact that we really kept telling people, 
"We aren't dead. The place is still open, and we're going to go 
somewhere. " 



The Institutes of Medical Sciences* 



Gerbode: Then the question came up, what to do about research? With Stanford 
pulling out and not being willing to sponsor anything in research 
or teaching, I decided that the hospital really couldn't have 
a very good research program at that time, because the departmental 
chiefs were not particularly interested in research, and everybody 
was thinking more than anything else about how to save the hospital, 
which was justified. 

So I decided that I'd get together with the people who were 
going to stay who were former full-time teachers in the medical 
school and put together some other kind of organization to keep the 
research going. At that time, we had about two hundred and fifty 
thousand dollars of grants with NIH and the Cancer Society and a 
couple of other small organizations, like the Heart Association. I 
asked them if we [started] another [research] organization in 
San Francisco, would they transfer the money to this organization. 
I also went to Stanford and asked, since the money wasn't going 
to go to Palo Alto, would they mind letting us move it into 
another organization. They all agreed. 



*See the sessions recorded on 5/15/84, pp. 380-387. 



160 



Foundation 



Gerbode: So then I had my cousin, Bud Chandler, put together a nonprofit 
research organization called the Institutes of Medical Sciences. 
Jack Osborn, Henry Newman, Arthur Selzer and Fred Merrill joined 
in this basic thinking with me and were the original founders. 
Mrs. Harley Stevens, an old friend, was also one of the original 
founders. 

Hughes: Was it your administrative abilities coming to the fore again? Why 
were you spearheading this? 

Gerbode: I don't know. I suppose I've always had a certain amount of 
momentum, and it was the momentum that made me do it again. 

Hughes: [laughs] That sounds like an understatement. 

Gerbode: I realized that I had to do something to form the basis for a 

research organization. I went back to the Rockefeller Institute 
in New York and sat down with the director and asked him how it all 
started back there. I said, "I'd like to see your bylaws and 
your original charter." He said, "It was very simple. We had very 
few rules and regulations, and we simply set up an organization 
where research people could work freely without being interfered 
with, and kept the environment simple, but good for them." This is 
what I more or less had in mind, that we would have a simple 
organization where there weren't many rules and where people who 
wanted to do research, could do research without interference. 
The organization was to be simply there to help them, not to 
regulate them. Perhaps the old Stanford expression "Die Luft der 
Freiheit weiht," the winds of freedom blow, was in the back of my 
mind to a certain extent. 

Anyway, we transferred the grants to this little organization. 
We had one lady running the administrative part. She did everything. 
She established the first payroll and the first everything that was 
necessary, in one little room. Now we have a huge administrative 
staff in this organization. Some people think it's too big. 

Hughes: Did people stay pretty much on the same salary when they moved from 
Stanford to the institutes? 

Gerbode: Yes, they did. 

Hughes: But there was no longer any academic connection? 



161 



Gerbode: No academic connection at all. Some people had academic appointments 
with the University of California, and some of them retained 
clinical appointments with Stanford. I was made a clincial 
professor at Stanford and a clinical professor at U.C. , which meant 
that I would teach part-time or be called upon to do teaching, 
research, or administration, when necessary. 

Hughes: I know that the clinical appointment at Stanford had been long 
standing, but do you remember when the appointment at U.C. occurred? 

Gerbode: When I decided not to move to Palo Alto at that time I was an 

associate professor the dean, who was Windsor Cutting, promoted me 
to clinical professor. This was about the same time that U.C. made 
me a clinical professor as well.* 

Hughes: Was there any particular tie-in with the move? 

Gerbode: I guess U.C. wanted me to be [part of the U.C. program]. I was 

not the only one who was brought into the U.C. program one way or 
the other. We had a pretty good thing going [cardiovascular 
surgery], better than theirs, and so they wanted to have us 
associated with them. 

.Since the heart surgery was going so well, and since the 
people in Washington were really quite sentimentally connected with 
some of the people who didn't want to go down there, they were 
anxious to help us. There were people in Washington who felt that 
it was a mistake to move the school back to Palo Alto , that it would 
have been better to leave it in San Francisco. They cited North 
western, New York University, Harvard and Hopkins as examples of 
medical schools which are great and which had stayed in the bigger 
city. So they were rather favorably inclined toward helping us one 
way or the other. We had such a vigorous program going in cardiac 
surgery. We were writing papers, too, and developing research to 
back up the programs. 



The NIH Program Project Grant 



Gerbode: So I applied to NIH for a huge grant, called a program project grant. 
The administrator in Washington of the Heart Research Institute 
of NIH came out, and we spent a couple of days talking about it. I 



*According to Dr. Gerbode 's curriculum vitae, he became clinical 
professor of surgery at UCSF in 1964. The appointment ended in 1976. 



162 



Gerbode: said, "How much do you think I should apply for?" He said, "You 

apply for whatever you think you need, and the peer committee will 
decide whether or not you get anything. 

So I applied for a million dollars a year for all sorts of 
things. 

Hughes: That was an enormous sum in those days, wasn't it? 

Gerbode: It was. The committee came out, and looked us over. We had a 

couple of meetings in Washington. Finally it was all done; they 
gave me something like four hundred and fifty thousand dollars a 
year for five years. After this other grants were given for 
another five years. 

Hughes: Were you satisfied with that? 

Gerbode: Oh, yes. It was that big grant which put together the heart unit 
here in San Francisco. 

Hughes: What were the stipulations? 

Gerbode: I had a separate training program, too, which [NIH] gave me, so I 
could train two fellows in cardiac surgery a year. That was paid 
for out of [an NIH training grant]. The money entitled me to buy 
equipment, to do research with equipment, to pay for dieners 
engaged in research and some salaries for research people not 
for me or for any of the professional people. 

Hughes: That was coming from the Institute? 

Gerbode: I never took a salary from anybody. I made enough money out of 

operating. In fact, over the years, I put more money back into the 
heart program than I ever took home. I made contributions to pay 
for personnel, equipment or travel whatever. 

Hughes: This was through the Gerbode Foundation? 



163 



The Heart Research Institute Fellowship Program in 
Cardiovascular Surgery* 



Gerbode: No, this was direct contribution from my practice. We had some 
money for training from Washington, and I got Mrs. Ed Heller of 
San Francisco to give me another training fellowship for about 
three years. So I began to bring fellows in to train in cardiac 
surgery. I needed them anyway, because we didn't have any 
residents. The residency program [had] moved to Palo Alto. We 
had a few interns, but that's all. 

Hughes: How did you select the fellows? 

Gerbode: A lot of people wanted to come and work with us, because there 
was a lot of heart surgery [and] research going on, and it was 
one of the most active places in the country, both in the laboratory 
and clinically. So I had applicants from a lot of places, and I 
decided that I would choose the best men every year regardless of 
where they came from. This was quite different from the attitude 
of many other places, which felt obliged to take only Americans 
in their training programs. But I felt that cardiac surgery was a 
world enterprise, and that all countries needed to do it, and they 
needed young men to push it forward. So I took people from any 
country. If the candidate was better than anybody else I had 
locally, I would take him. As a consequence, among the very first 
were the English. I eventually had twelve men from the U.K. whom 
I had trained. 

Hughes: Each of whom stayed for a year? 

Gerbode: One to two years, sometimes even three. I gave them a lot to do. 
They didn't really do all of heart surgery when they were in 
training, but they did parts of every operation. Whatever I felt 
they could safely do, I let them do. I thoroughly enjoyed this 
part of my career. I just loved working with these young men, 
because they were all bright and very able, and they had a place 
to go. That was one other stipulation I made, that I wouldn't 
take them unless their institution would take them back in the 
field [of cardiovascular surgery] . So that meant that a professor 
would send his brightest man over, or the man he was going to 
designate to carry on with the work when he came home. 



*Some of the fellows participating in the program are discussed 
on pp. 400-407. 



164 



Gerbode: Also, the American Association for Thoracic Surgery had an Evarts 
Graham Traveling Fellowship. They appointed [a fellow] every year. 
Once he was given the traveling fellowship, he could go anywhere 
he wanted. I was lucky to get four of these Evarts Graham fellows, 
and they were sponsored by their own universities or groups at 
home, so they really all had a good place to go back to. 

Hughes: I would think not only were you helping the individual, but you 

were certainly giving an impetus to cardiac surgery in each one of 
those institutions. 

Gerbode: Yes, it helped, because once these fellows came over here and had 
a year or two, when they went back, they had a story to tell, and 
people listened to them. So they had to give them equipment; they 
had to help them get started. It was great leverage. 

Hughes: Has [the Heart Research Institute fellows] program been discontinued? 

Gerbode: Yes, it has. It was discontinued I guess for two reasons. One is 
that I was no longer running the department and the others in the 
department were not as interested in teaching. But the other 
reason is that the government turned off the foreign fellows program. 
There was much pressure on Uncle Sam to keep the flood of immigrants 
in the professional sciences out of this country. Many of them came 
from underprivileged countries and then never went back. It takes 
an awful lot of money to turn out a doctor in a third-world country, 
and then having spent all this money on him and sent him over here 
for further training, to not have him ever come back is not very 
good. 

Hughes: I guess it would have been an abridgement of individual freedom to 
stipulate that in order to participate in the program here, the 
individual must return to his native country. 

Gerbode: I tried to always pick my fellows so that it would be a requirement 
that they would have to [return to their country] . I think all 
but two or three have gone back to their country to continue their 
work. There are two Indians who didn't go back. All the Germans 
went back; all the English went back except one.* 

In the end I had over eighty men go through the unit. They 
weren't all real fellows. Some of them were residents. I think 
there were eighty-eight fellows. Out of the eighty-eight I've kept 



*Some of the foregoing material was moved from the session recorded 
on 8/26/83. 



165 



Gerbode: track of them pretty well sixty-three currently now are either 

chiefs of service or associate chiefs of service or professors of 
surgery. There are only two or three that went into pure private 
practice. And they're scattered all over the world. 

Hughes: Did the fellows not only operate, but also do research as well? 

Gerbode: It wasn't a requirement that they do research, but everyone had a 
research program, either clinical or experimental. Most of them 
did experimental surgery. 

Hughes: I imagine that in most cases that was unusual in their countries 
of origin. 

Gerbode: Yes. Many of them had never done any experimental surgery at all. 
When they went back, they helped their institutions set up 
experimental laboratories, and that pushed their programs forward 
quite a good deal. 

The great thing about having these fellows all over the world 
is wherever I go now, there's somebody there who's been in the 
institute. It's like being a member of the family. For example, 
in India there are four outstanding heart surgeons who may meet 
you at the airport. There are four in Australia, all doing very 
well. Twelve in the U.K. I think three of them in Germany. Two 
of them in Norway. One in Sweden. He's going to be made professor 
of surgery in one of the biggest and oldest medical schools this 
year. Halsted, who was the so-called father of American surgery, 
the professor of surgery at Hopkins, was quoted to have said that 
if a professor or a chief trains six men in his lifetime, he will 
have accomplished what he should have. 

Hughes: Well, you did much more than that! 

Gerbode: Anyway, it was really great fun, and also my wife enjoyed having 
people from outside of the United States in my home. We'd have 
little after-dinner discussions once in a while at home. My daughter 
[Maryanna], who was a little girl then, used to like it because we 
always had donuts, and she loved to come down during the party 
and eat a donut. 

Hughes: In most cases, did they go home to find that their chiefs were 
receptive to the changes.... 

Gerbode: In most cases they were. But they found that it was very difficult 
to get things done in many places. 



166 



Hughes: I imagine equipment would be a great problem. 

Gerbode: Yes, and the politics really floored them in many cases. For 
example, one of my fellows from Denmark went back, and he was 
persumably to be given a job to get heart surgery going better 
than it was. But the politics were so terrible in the hospital, he 
just was very frustrated. In fact, I saw him last year, and he 
said although he's gotten it going, there's still jealousy and 
pulling and tugging. He said, "You taught me how to do the work, 
but you didn't tell me how to do the politics." [laughter] I said, 
"Well, that's something you just have to learn as you go along. 
All life is politics." All life is politics, and all life is 
compromise. 

It is true that the political aspects of anything like this 
are really horrendous at times. In fact, the politics here were 
very difficult. It was very difficult for the doctors to accept 
the fact that we wanted to build a research building. 

Hughes: You mean the doctors that were part of this complex? 

Gerbode: The doctors who didn't go to Palo Alto. They wanted a hospital, 
and they couldn't understand why we would spend a hundred and 
fifty thousand dollars to build a research building. I said, "You 
can't build a hospital for that amount of money. You don't even get 
started with a hundred and fifty or two hundred thousand dollars, 
liicle Sam is giving you the research building." 



Presbyterian Hospital 



Gerbode: It was hard for them to understand that. They felt that everybody 
should be doing one thing, getting a new hospital. Well, we 
needed to do that, too, and finally we did it. But that's another 
story, how we got it done. 

Hughes: Isn't this the time to talk about it? 



167 



The Presbyterian Church 



Gerbode: Yes, I think probably. [We] got a new board of trustees when 
Stanford finally decided to transfer the property to the 
Presbyterian Church. The presbytery of San Francisco said they'd 
be willing to take on the hospital. Traditionally in the 
Presbyterian Church they have good hospitals in a lot of parts of 
the country that are very successful. There's one in New York. 
They'd just finished another one in southern California at that 
time. It was very good for their church, I guess, to be associated 
with a good hospital. They changed the name from San Francisco 
Stanford Hospital to Presbyterian Hospital. 

Hughes: What does that mean, when the church takes over? 

Gerbode: Well, it didn't mean as much as people thought. They thought that 
the church then would pour money into making a new hospital. But 
the church poured very little money in. As somebody said, the 
Presbyterians are mainly Scotch. They're very good at collecting 
money, but not very good at giving it away. [laughter] There 
were various committees about the old hospital, about what we could 
do to rebuild it. They had several planning groups come in and do 
things. But it was obvious you needed to get another group of 
people with some money or influence to make the thing go. 



St. Joseph's Hospital 



Gerbode: So at that time, the nuns at St. Joseph's Hospital here in 

San Francisco said that they looked favorably upon joining with us. 
They had some money to put into the program. This was fine, in 
the beginning, but then as time went on, the trustees realized that 
they weren't going to put in very much. They wanted to dominate 
the board of trustees of the newly formed hospital group. All they 
really were basically interested in was to get this hospital into 
their domain. 

Hughes: Did they have access to a hospital? 

Gerbode: Yes, they had St. Joseph's Hospital, and they were members of a 
national group in the Catholic Church. It was apparent that the 
national group was not going to put up any money either. Although 
the local people thought they would, they didn't. 



168 



Hughes: Why were they interested in yet another hospital? 

Gerbode: Well, prestige, with a great history, you know. Their hospital, 
St. Joseph's, really existed because of one specialty, orthopedic 
surgery. That's all. The rest was really nothing. 

Hughes: What about the Presbyterians? Was it a similar motivation? 

Gerbode: We had the remnants of everything here, a little bit of everything 
was still hanging around, left over. So anyway, it was really a 
dilemma to know what to do. 



The University of the Pacific 



Gerbode: I was up at the Bohemian Grove that summer just at this critical 

time, and I ran into Bob Burns, who was president of the University 
of the Pacific. I sat down with him on a log, and I said, "Bob, 
I think with your university and a little luck and a little 
enterprise, we could start another medical school under the University 
of the Pacific. But you've got to get that hospital straightened 
out . It has promise if you want to do it . " 

He said, "I'll go talk to Fred Merrill right now." 

So we walked over and talked to Fred Merrill, who was then 
chairman of the board. Bob said, "I'll see if I can work something 
out." He really went to work on it. He really thought that we 
could put together a different kind of medical school under the 
University of the Pacific. 

With that, we decided that we would really have to get this 
hospital going. At that time, it was the last phases of the 
Hill-Burton money to build new hospitals.* So with Burns 's help 
and connections in Sacramento, we got approval for the Hill-Burton 
funds to build a new hospital. We had about a million dollars or so 
left to us by various people. Ed Westgate, who was on the board 
of trustees of the hospital, was a contractor and developer. He 
got together a bank consortium to lend the money for a new hospital. 



*The Hill-Burton Act of 1946 provided federal money to build 
hospitals across the United States, primarily in poor and rural 
areas, with stipulations on providing some free care to indigents. 
At least 9,200 hospitals, clinics and health centers were eventually 
built. 



169 



The Bank of America## 



Gerbode: The day before the meeting of the consortium was supposed to occur, 
Ed had a call from Rudy Petersen, the president of the Bank of 
America. The president of the Bank of America said, "Ed, don't 
meet the consortium. We'll take the whole thing." I've forgotten 
how much they loaned us, something like eighteen million dollars 
or so, a big sum of money. 

Hughes: Why do you suppose he made that decision? 

Gerbode: He knew that there was connected with the old hospital a tremendous 
number of people, old friends, old patients, faculty, new patients. 
He knew that if the Bank of America was advertised as being the 
backer of this enterprise, that they'd put their accounts in the 
Bank of America which is true, a lot of them did and that the 
hospital would put their accounts with the Bank of America. It was 
a good deal from their point of view, as it turned out, because now, 
even after all these years, we're right up to snuff on paying off 
our principal and interest, and we have money in the bank. So that 
was a wise decision. 



Designing the New Presbyterian Hospital* 



Gerbode: We got the hospital built. There were a lot of design characteristics 
of the hospital which were influenced by the fact that they thought 
that eventually it might have a bigger role than just a community 
hospital. So they allowed for space for seminars and small groups 
to meet. This has proven to be very, very beneficial for conferences 
and things like that. 

The only thing they didn't build into the hospital was a big 
conference hall. But they finally converted something which was 
originally designated for administration into a meeting [hall], so 
they have a conference center now. 

Hughes: Did you have a role in the design? 

Gerbode: Yes, I did. Luckily, I can read plans. At the same time as we 
were designing this hospital, they were designing Stanford 
Hospital in Palo Alto. We were supposed to make suggestions about 



*See the session recorded on 5/22/84, pp. 398-399, for further 
discussion on the new Presbyterian Hospital. 



170 



Gerbode: the Stanford Hospital down there. In fact, Vic Richards, who was 
then chief of surgery [at Presbyterian], was supposed to go down 
to Palo Alto to be the chief down there. He had said that he 
would move to Palo Alto, so he was in charge of the design 
characteristics of part of the new hospital in Palo Alto. But 
actually, what he would do is put the plans of the new hospital in 
Palo Alto up in the operation room [in San Francisco], and then he 
would [ask people to make suggestions]. Well, nobody around here 
was going to make any suggestions. So as a consequence of this 
approach, when the new hospital at Stanford was built, the 
department of surgery was very small, very inadequately represented. 
Whereas Henry Kaplan, who was on the committee for selection of the 
architect and also very aggressive in what he wanted , was there 
every day with his suggestions about the department of radiology. 
As a consequence, the department of radiology had an enormous 
complex and everything they wanted. 

Anyway, coming back to San Francisco, I had a lot of fun in 
the beginning when we built this research building [the Institutes 
of Medical Sciences] , a lot of fun designing the dog lab and other 
parts of it, too. I went through the business of getting plans 
from other laboratories which had been built in the country, 
particularly the one which Al Blalock had built at Johns Hopkins, 
and used some of their plans and some of the things that I'd wanted 
in the design of this research building. 

Coming back to the hospital, there were certain things which 
I considered to be important from the surgical point of view. I 
felt that the intensive care unit should be on the same floor as 
the operating room, because there are lots of times when a patient 
needs to go back to the operating room quickly. Also, after an 
operation, it's very bad for [patients] to be in an elevator, to 
have to go to another floor, because at that critical time, they 
need a lot of care quickly. It's better for them to get into the 
intensive care unit right away, so that the special nurses can 
take care of them and monitor them. So they put the intensive care 
unit on the same floor as the operating room. 



171 



Computerized Patient Monitoring* 



IBM 



Gerbode: The characteristics of how it was designed were influenced to a 

certain extent by the research we'd been doing with IBM Corporation. 
We began to use computers among the very first in the country. 
IBM wanted to get into the computer business, so [Thomas] Watson, 
[president of IBM], himself, came out with a small committee and 
met in the library here on this floor to discuss what might be done 
in monitoring with a computer. We began to show him some of the 
things we'd done. Jack Osborn had gotten together some very nice 
illustrations of what he had done with a computer which somebody 
had given us. 

Finally Mr. Watson turned to me and said, "Dr. Gerbode, you've 
got this wrong. We didn't come out here to have you sell us your 
program. We came out here to sell you our program." [laughter] 
I said, "That's fine. When do we go to work?" They agreed that 
they would put their main research emphasis in developing 
computerized monitoring in our hospital. 

Hughes: What was the date? 

Gerbode: This was '60 or '61. We signed a contract with IBM. They sent 
out a team of Ph.D.'s to work with us full-time. We set up a 
computer room on the top floor of this research building. At that 
time everything was on tape with big disks, so this huge computer 
machinery went in up there, at the expense of IBM, with their full- 
time people running it and connecting it with the old hospital 
intensive care unit. John Osborn worked out a program. On our 
big research grant, we were able to put two or three people into 
this computerized monitoring effort as full-time research people. 
So the joint committee worked out all the details of what was 
necessary. The computers got smaller and smaller. We finally got 
rid of those big machines. IBM worked with us for about ten years. 
They spent over a million dollars developing the programs which 
were largely directed by John Osborn. 

Hughes: Meanwhile computerized monitoring of patients was spreading to other 
centers? 



*See pp. 198-200 and 437-438, for further discussion of computerized 
monitoring. 



172 



Gerbode: Yes. We were writing papers and giving talks, and people were 

coming out to see what we were doing and carrying back what they 
thought they could do at home. After it was successful, another 
group came out from IBM to decide what they wanted to do next. 
They decided finally, after all this effort, that they didn't 
want to go into the front end , which is the sensing end , where you 
take the samples and get a result and then put that number for 
that sample into the machine. They didn't want to develop the 
front end, although they had helped us develop the front end 
initially. They said, "We have demonstrated how to use the computer. 
We'll let other people develop the front end, the sensing part of 
it." 

Hughes: Why did they make that decision? 

Gerbode: I don't know. I guess they just didn't want to do it. So that 

meant that other people wanted to have our concepts in a front end 
console, a thing that you could move up to the patient, take the 
samples, have a machine analyze them, put that information into 
the computer. So Dr. Osborn, who had been running this whole 
program full-time, decided that he would set up a little company on 
Van Ness Avenue and make front ends. Later he expanded this in 
South San Francisco, and finally, after it became successful, he 
sold it to Johnson and Johnson for about three million dollars. 
He got a million dollars for himself, or something like that. The 
institute didn't get anything back out of that whole effort, however. 

Hughes: What about equipment when the move was made? 

Gerbode: That's very interesting. Before the move was really seriously 
decided upon, our department of roentgenology wanted to get an 
angiography unit going. So they applied for one through the NIH, 
through the radiology section, and were turned down. I was on the 
surgical studies section at that time, so I said, "Why don't you 
reapply and put it through the surgical studies section?" They did, 
and I talked long and hard with the group in the studies section, 
and they finally approved building a cineangiography machine out 
here. 

Hughes: Now, was that still in the early stages? 

Gerbode: It was the first one out here in the West. It ran for a couple of 
years very successfully, and then they decided that they were going 
to move to Palo Alto and take the machine down there with them. So 
that meant they had to rip it out and reinstall it down in Palo Alto. 
But meanwhile, the state of the art had improved a good deal. So 
the next generation of machines came along, which were even better. 






I 



Cardiopulmonary Intensive Care Unit in the old hospital- 
the first computer monitering system. 




173 



Gerbode: At that time, a man by the name of [Newton] Bissinger was in the 
hospital and liked very much how he was treated for his heart 
attack. He asked, "How can I help you fellows?" They said, "Why 
don't you buy us a new angiography machine." So he did. So we 
got the latest model then, and they had taken the old model to 
Palo Alto. [laughter] (But a few years later they got the new 
model down there, too.) 

Hughes: What about other equipment? 

Gerbode: The other equipment was very expensive, and we constantly had to 
raise money to pay for our share of the development costs of all 
that equipment in the intensive care unit. 

Hughes: How'd you go about raising money? 

Gerbode: One big thing I did, I applied to the Bothin Fund here in 

San Francisco, which is run by the descendants of the Bothin 
family Princess Genie de San Faustino and now her son, Lymon 
Casey, run it for a large grant to support the development of 
the intensive care unit. They gave us a lot of money to help 
complete the program. 

Hughes: Do you think most of this was thanks to the growing reputation in 
cardiac surgery? 

Gerbode: Oh, yes. It was very exciting. The other thing was building a 
new hospital; we could design everything so they could put the 
monitoring equipment in properly. 

One thing I insisted on was not to have the electronics 
connected with monitoring or the display screens in view of the 
patients. They were in back of the patient. 

We designed it so that any repairs to the monitoring equipment 
would be done in a room behind tha room where the patient was. 
So there was a wall; in front of the wall were all the displays; 
in back of the wall was another room where the repair people could 
work on the equipment as it broke down, or replace it. 

Hughes: In general, had the instrument companies jumped 6n the bandwagon 
very quickly? 



174 



Hewlett-Packard 



Gerbode: Oh, yes, they did. At the beginning of all this, I went down to 
talk to Mr. [William] Hewlett and Mr. [David] Packard. I said, 
"Look, we're going to need a lot of this work done in monitoring 
patients, sensing devices and computers. Why don't you help us? 
Why don't you make this a joint effort?" They turned me down 
absolutely flatly. 

Hughes: Why? 

Gerbode: Because they were completely sold on Stanford's program, and they 

felt that if they helped us, it would be disloyal for the new venture 
in Palo Alto. So they put all their money into Palo Alto and didn't 
give us one nickel. Mr. Hewlett's father was professor of medicine 
up here in the old medical school. There was even a local society 
here called the Hewlett Society, which would meet once a month in 
various hospitals and have clincal sessions. But [Hewlett and 
Packard] were both absolutely tied into Palo Alto and Stanford and 
I suppose decided that it would seem disloyal to send any money up 
here. 

Actually, as time went on, they bought out a company I think 
it was called the Sanf ord Company which was engaged in the business 
of sensing devices. They bought them out, improved on them and 
then got into the business of the front end [sensing device] very 
seriously. As a matter of fact, now we're in the third generation 
of our sensing devices in the hospital, and it's mostly Hewlett- 
Packard stuff. 

Hughes: What did you do when they turned you down? 

Gerbode: IBM came in voluntarily Just at that time and said they would do 
it for us. But it took a lot of money to build that unit the way 
it is now. We had to scrounge. I gave a lot of money personally 
out of the practice to it and had people make contributions 
periodically. Mrs. Stevens gave the money for the coronary 
intensive care unit [in] the intensive care unit. She gave that in 
memory of her husband, who died of a coronary. Her sister, Mrs. 
Charles Kuhn, gave another room there for coronary patients, because 
her husband had died of a coronary. The Bothin Fund finally set 
up a clinical research area, which they paid for, adjacent to the 
intensive care unit, where research in the cardlorespiratory diseases 
could be carried on. It's still being used for that, although there 
are some clinical units in there now which are using some of the 
space formerly designed for pure research. We can be very grateful 
for the help that the Bothin Fund gave us. 



175 



Hughes : 



Research Programs at the Heart Research Institute 



How were you dividing up your research and your surgery? Did you 
have certain days when you were in the dog lab? 



Gerbode: In the beginning, I was in the dog lab most of the time. But then 

as we worked out the programs and got busier in the operating room, 
we shifted some programs to those related to the clinical work. 
In other words, we'd study patients. 



Postoperative Problems after Open Heart Surgery* 



Gerbode: One of the principal problems in those days was to find out why 

people were sick after open heart surgery. Some of them would be 
mentally confused for a while. Some of them would have fevers 
which were unexplained. So a lot of our research at that time was 
to find out why the patient didn't wake up as quickly as after a 
normal operation. It was something to do with the machines. So we 
had several big research programs going, both in the dog lab, 
which was then here in this new [medical research] building, and in 
the operating room. 

One of the first things we found with our own oxygenator, which 
Bram had designed, was that it had to be absolutely meticulously 
cleaned. Even the tiniest bit of old blood in there would cause a 
fever and make the patient sick afterwards. It wouldn't kill him, 
but it would make him sick and have a fever. So we finally realized 
we had to clean that machine with concentrated acid to get everything 
out of it. 

Hughes: Did that mean taking the machine completely apart? 

Gerbode: Completely apart, and it had to be taken over to Cutter Laboratories. 
We were constantly sending them over by car and bringing them back. 
We ended up by having twelve of them in rotation. It was expensive 
and cumbersome. We found out a lot of things about what happened 
to blood in machines, and wrote quite a few papers on it. 



*See the session recorded on 5/22/84, pp. 370-371. 



176 



The Bramson Membrane Oxygenator 



Gerbode: At the same time, we were working experimentally on the membrane 

oxygenator. We had a team specifically assigned to that, Bram and 
another engineer. Cutter Laboratories had a group on it, too. 
Then we began to use it for long-term profusions in the experimental 
laboratory. That's when Dr. [Donald] Hill came aboard and ran a 
series of dogs on the membrane to see how long you could keep an 
animal alive on it. We had others working in the lab, too, on 
various projects. Dr. David Hill did some very good work on 
membranes as did Dr. [John] Wright from Australia. This was going 
on while the program was developing clinically. I eventually used 
the membrane in over 300 operations. 

Hughes: Were people coming specifically to work on this particular project? 

Gerbode: No. We developed our own research team locally out of people who 
were with us. 



Heart -Lung Machines Elsewhere 



Hughes: Is it appropriate to talk about what else was going on in the 

country and in the world in regard to the heart-lung machine during 
this time? 

Gerbode: Yes. There were different kinds of heart-lung machines being developed 
in several places in the country. Several big corporations were 
manufacturing heart-lung machines commercially, based on the research 
done mainly in labs like ours or universities. The membrane 
oxygenator work was being carried on under [Willem] Kolff at the 
University of Utah and a couple of other places. As an outgrowth of 
that, there are several membranes on the market. Ours is still no<; 
on the market, but we hope to get it on the market soon.* 

Hughes: How far along were Gibbon and that group when you were working on 
the membrane? 

Gerbode: Gibbon never got into membrane oxygenators. In fact, he didn't do 
anything beyond developing a screen oxygenator. As people began to 
test what was happening to blood, they found that the screen 



*The commercial fate of Dr. Gerbode 's membrane oxygenator is discussed 
on pp. 349-352. 




A version of the Bramson 
membrane oxygenator: 
initially used at Pacific 
Medical Center for open 
heart surgery, later used 
for patients whose lungs 
have collaped from 
disease or injury. 




Left to right: 

J. Donald Hill, Frank Gerbode, 
John Osborn, Mogens "Bram" Bramso: 
with a version of the membrane 
lung machine. 



177 



Gerbode: oxygenator was not very good, was not very easy on blood, either. 
It was also very difficult to clean, for the same reason that I 
mentioned with our disk oxygenator. You had to clean it so 
meticulously that it was a big chore. In Gibbon's own unit, very 
soon after he had retired from the chairmanship of the department, 
chey switched to a bubble type of oxygenator, and the Mayo Clinic 
did the same. 

Hughes: Is one of the advantages of the membrane oxygenator that you're 
developing that the membrane is disposable? 



Platelets 



Gerbode: That's one thing. But the other is that it's less traumatic to 
blood. If you study platelets, for example we did some of the 
original work on platelets here you find that whatever machine you 
use, in the first few minutes of any perfusion, the platelet count 
goes way down. The platelets simply disappear from the blood. 

So we tried to find out what happened to the platelets. David 
Hill found out in our laboratory, that they went into the liver 
temporarily. They went into hiding, so to speak. Then slowly, after 
the perfusion was over, they'd come back into the circulation. With 
a bubble oxygenator, they'd come back much more slowly and not 
completely. With a membrane oxygenator, they'd come back slowly, 
but they came back almost completely and faster which meant that 
they weren't made as sick while they were hiding in the liver, or 
on their way to or from the liver. This was rather a basic discovery. 

Hughes: That meant no clotting then. 

Gerbode: Well, the fact that the platelets disappeared meant that the 

patients bled more postoperatively. We frequently had to give them 
platelet transfusions. 

Hughes: Were the platelet transfusions a direct outgrowth of the discovery 
that platelets were going into seclusion? 

Gerbode: No. We discovered that we had to <jive them platelet transfusions 
because the platelet counts were so low. We didn't know at that 
time where the platelets had gone or what had happened, but we knew 
that they weren't in the circulation. So we had to give them platelets 
to build up the quantity so that the blood would clot. The [Irwin 
Memorial] Blood Bank had to develop methods of getting platelets out 
of bank blood, so we could give platelet transfusions. They developed 
that quite successfully. 



178 



Hughes: That was developed here in this blood bank? 

Gerbode: It was developed in various laboratories throughout the world. 

Everybody at that point was having more or less the same experience. 

Hughes: Is it mainly the platelets that are disturbed? 

Gerbode: No, other things happen, too, to red cells. Some of the red cells 
hemolyze and other clotting factors are affected. 



The Institutes of Medical Sciences (Continued) 
[Interview 7: August 26, 1983 ]## 



Gerbode: We had something over two hundred thousand dollars of approved 

research grants for the people who were not going to move to Palo Alto. 
I asked the National Institutes of Health, the Cancer Society, and 
a few other grantors if they would be willing to transfer these funds 
from Stanford to the Institutes of Medical Sciences, and they all 
said they would. Stanford University, in addition, said they would 
not object to doing this. 

Most of these grants were for research in circulation and heart, 
but there were some smaller grants in eye research. In any event, 
we started out with an institute called the Heart Research Institute, 
which I directed with Jack Osborn. Then later on Dr. [Arthur] 
Jampolsky started an eye institute. Subsequently an institute of 
neurological sciences was started as well by Knox Finley. 

As time went on, other institutes developed. For example, some 
years later George Williams, who had been director of the laboratories 
at the NIH hospital in Bethesda, decided to retire and move to 
California. So he established, with some private funding an 
institute of aging and brought some people with him to set this up. 

Various other people have come into the research programs. 
The general feeling has been that we didn't want to have too many 
separate institutes, but we have ended up with seven. Probably one 
or two are small enough so that they shouldn't really be institutes. 
Dr. William Kuzell got a million dollars [from] a grateful patient 
to set up an arthritis institute, which is going very well. 

It was not difficult, really, to get the research started, 
although there has always been a problem with space. We had a 
beautiful animal laboratory set up in the new research building. 



179 



Gerbode: At times it has been difficult to find enough research to keep 
that animal laboratory funded properly, so they've had debates 
about whether it should be a core facility. But presently this 
has been worked out. For a long time we had a tremendous amount 
of work in the animal laboratory testing devices, such as heart- 
lung machines and membrane oxygenators, and so forth. 

Politically, there really weren't very many problems, except 
relative to space. This had to do with people wanting to have 
more laboratories and more office space for their research workers , 
and looking at others who perhaps weren't utilizing their space as 
well as the others thought they should be. But we established 
some committees to settle these matters, and finally formulae were 
worked out so that there was very little hard feeling about it. 

Gradually, from a single woman running the office and taking 
care of the bookkeeping, we have added more and more people until 
now we have a rather huge staff of administrative people. We worry 
about it being greater than it should be , but bureaucracy always 
grows. You can't stop it very easily. So now at this moment we 
have a lay president, an executive vice president, personnel managers, 
chief accountants, bookkeepers, and all sorts of other people 
keeping track of the approximately three million dollars of expendable 
funds every year. 

Hughes: Is there a medical president as well? 

Gerbode: No, there isn't. We have had medical presidents in the past. In 
fact, I was president for about three years. We had various other 
doctors who were president, but they resigned for better positions. 

One of the best ones we had was Dr. James Hundley, who came to 
us from Washington. We liked him very much and he was very 
effective. He got to be so good and well known that the American 
Heart Association offered him quite a bit more money than we could 
pay him and some other prerogatives, so he left and went to New York 
to run the American Heart Association. But within six months he 
was disillusioned not only about the job but also about how he had 
to live in New York, and a short time later resigned, moved back 
to California, where his daughter was living in Mar in County. A 
month or so later he was killed by a truck in a highway accident, 
which was very sad. We would have been very happy to take him back 
again, but unfortunately the accident prevented this. 



180 



Administration 



Gerbode: We've had a lot of debates and some infighting about how the 
institute, which is now the Medical Research Institute of San 
Francisco, should be administered. It's been my belief that we 
should have a research-oriented Ph.D. or M.D. who is knowledgeable 
about research funding and research. The rest of the administration 
can be run by people who know about bookkeeping and things like 
that. 

However, some of the people at MRI have been afraid of having 
a strong research man as head of MRI because they, I guess, believe 
that he might interfere with their work or make suggestions about 
some of the private funds which have come into some of the 
institutes. They were afraid to accept the premise that we should 
have a really high-caliber research person running it. So now we 
have a president* who is fund raising for the ballet association 
and other things in town and who is a social figure, but he doesn't 
know anything about research. He is acceptable to most people, but 
some people still feel, as I have all along, that we should have a 
thoroughbred research person in the job. 

Hughes: So the way it stands now, all research policy is established by the 
director of each institute? 

Gerbode: Yes. But then we have a board of trustees, and they establish 

broad policies. We have a science council which also participates 
a great deal in establishing policies relative to research, and 
various other committees which come into the picture relative to 
space and finance. 

Hughes: The board of trustees would not make decisions concerning scientific 
and medical matters? 

Gerbode: No, it wouldn't. 

[telephone interruption] 

Gerbode: The board establishes broad policies and also can form and terminate 
institutes. They've never terminated one yet, but they think 
about it once in a while when institutes run out of funding. They 
also have trouble deciding how to set up a new institute. It's 
easier for them to believe that money should be the determinant. 
I don't believe in this. I think it's a mistake to advertise that 



*The president of MRI, James Ludwig, resigned in March 1984. 



181 



Gerbode: we will establish an institute because a certain group has 

x numbers of dollars. I'd rather have them have fewer dollars 
but bigger ideas. 

Hughes: Aren't the strikes against you in a sense if the board is composed 
of people without predominantly scientific or medical interests? 

Gerbode: It is difficult because they don't really understand research. It's 
very hard to find lay people who really understand voluntary 
research efforts. This is generally true throughout the world 
except in some places where people have made fortunes out of their 
research and development. Then they understand the beginnings of 
an idea and how it develops into something worthwhile and profitable. 

We are one of the ten largest private research organizations 
in the country, and we are known. We belong to all the voluntary 
nonprofit research organizations in the country. So it is an 
effective and strong institution. It's the biggest [private research 
insitute] in San Francisco. There isn't anything else here that 
could match it except for the University of California. It has 
by far a much bigger budget with many more researchers than when 
the [Stanford] medical school was here. 

Hughes : What is the division of labor between the board of trustees and 
the science council? 

Gerbode: The science council is composed of scientists. Each institute can 
appoint two members of the science council. They discuss things 
like compensation and the value of the science. They determine who 
gets money which has been awarded on a broad basis to the institute 
as a whole. For example, NIH gives us a grant every year based on 
how much money we have raised ourselves. This amounts to anywhere 
from eighty to ovex a hundred thousand dollars a year. It's called 
a basic research support grant. The science council reviews 
applications from the scientists in MRI applying for money in this 
BRSG fund. Everybody accepts its decision pretty well. 

Hughes: NIH doesn't place any stipulations about how the money will be 
spent? 

Gerbode: No. The BRSG fund is to be used to stimulate new research, to 

encourage young people to get into research, to support research 
which is ongoing but is periodically short of funding in various 
categories. It's really quite a great thing to have this fund. 
It's certainly to the credit of NIH that they recognized the 
necessity for it. 



182 



Research 



Hughes: Is most of the research fairly directly connected with medical 
practice? 

Gerbode: Originally practically all the research was connected with medical 
problems we saw in patients. This was certainly true of the heart 
research program, because we had to develop heart-lung machines and 
learn how to take care of very seriously ill heart patients who 
had operations and who needed operations. We also had to perfect 
the instrumentation to manage them safely. But more recently we've 
had research efforts which are very basic, particularly in the field 
of immunology. We have a lot of immunology going now. One big 
group has come forward after about seven or eight years with a 
method of making interferon more inexpensively than anybody else. 
So they're about ready to burst out of our lab into a big 
production somewhere in Hayward and really begin to sell their 
product. 



Commercialization 



Hughes: Is there any problem with going commercial? 

Gerbode: No, there's no problem. Actually, the same thing was true of our 
developing a membrane oxygenator, which we spent so many years 
working on and finally have gotten it to the point where a commercial 
firm has taken it. They've spent about a million dollars developing 
it to the point where it can be sold. In the end, whenever it is 
sold, we will get royalties. The royalties don't go to persons; 
they go back into a heart research fund which will be used for 
other research. 

Hughes: Do individuals own the patent? 

Gerbode: With regard to our membrane oxygenator, individuals relinquished 

their patents, or sold their patents to the Harvey Company. We no 
longer hold any patents, but we have an agreement with the Harvey 
Company that when [the machines] go into production we will get a 
royalty. The same thing is true of the group who has developed the 
method of producing interferon. Assuming that they don't forget 
about their commitment , we should get a fair amount of money back 
into our research efforts. 



183 



Gerbode: 

Hughes : 

Gerbode: 
Hughes: 

Gerbode: 



We have some people who have gotten patents on various devices, and 
we have policies established for that. The policies usually either 
give all the royalty money to research programs or split it between 
MRI and the individual. 

So that would be a real incentive for an investigator to come 
here. 

Oh yes. 

I'm thinking of the problems that have arisen at U.C. in connection 
with recombinant DNA and the fact that the university holds the 
patents. 

Yes. Well, we let the individual hold patents mostly. We have an 
agreement with the individual, if he's developed the new idea or 
the instrument in MRI, that we will share in any rewards that come 
out of it. I must say, we haven't made much money from this so far. 
But a great deal of what you do in research is built on hope. 



Administrative Policy 



Gerbode: Another thing I should say about the total research effort is that 
we have brought people here to give them an opportunity to do 
research without interfering with them. We don't even tell them 
what to do. We'll help them do their research and answer questions 
and make constructive suggestions if they're requested. But we 
don't look down anybody's neck at all. We want to create an 
atmosphere, as I mentioned before, of freedom of thought and freedom 
of activity. 

This is quite different from the usual university research 
structure, where everything is under a departmental head, and 
depending upon what he likes or dislikes, the research can either 
go forward or stop. This has to do with space and a lot of other 
political factors in a university structure. We wanted to avoid all 
that. 

Hughes: So the director of an institute has a much looser hold on his 
membership than the head of an academic department? 

Gerbode: If you want to take me as an example of a director, I've brought 
people in who have independent thoughts about what they wanted to 
do in their research, and give them space, helped them a little bit 



184 



Gerbode: financially one way or the other with equipment or personnel, and 
let them go, let them run with it. The only thing we insist on 
is that they do it honestly and present their results in scientific 
journals. 

Hughes: So you do pay attention to publication? 

Gerbode: We encourage them to publish as much as possible, but these fellows 
usually realize that their survival depends on publication. So 
they usually crank out as much as they can. 



The Peer Review System 



Gerbode: Research is really governed by peer review committees in various 
ways. Every NIH grant is reviewed by a peer review group in 
Washington or wherever they want to have the meetings. They look 
it over very carefully, and [the applications] are all very 
competitive. If a peer review group in NIH gives a grant 
application a rating of two or two and a half or three, there is 
very little chance of it being funded. 

Hughes: What is the scale? 

Gerbode: One to five. Five, of course, is a complete reject. They don't 
even hardly look at it. The competition is between the ones and 
twos. Currently I think that practically anything that gets bigger 
than a two rating has very tough going. 

Hughes: Maybe this is the time to say a bit about what criteria are used 
for these peer review committees. 

Gerbode: A research grant is submitted to a particular section of NIH. That 
section has a study section committee which reviews all these 
applications. They look at each application [to determine] whether 
or not the prospect of accomplishing the goal set out by the research 
worker is reasonably possible or not, and also whether or not the 
type of research fits in to what we're trying to do generally in the 
country. In other words, we know right now that cancer and 
arteriosclerosis are the two big killers, so generally speaking 
something related even remotely to these would be looked upon more 
favorably than others. 



185 



Gerbode: However, there are a great many other projects that are valid and 
worthy. So they look at the people and the research environment. 
They look at the track record of those involved, the promise of 
the individuals, and the age of the individuals. They're more 
inclined to favor a grant to a younger person than to an older 
person. 

Hughes: Is the feeling there to give the younger person a chance? 

Gerbode: Part of it, because in the country as a whole* we want to get young 
people interested in research, so we favor giving them some money 
to get them started. Also, there is generally a feeling that after 
forty or forty-five, the prospect of any original research coming 
out of a worker is slimmer and slimmer as time goes on. Unfortunately 
for this generalization, not infrequently it doesn't apply at all. 
Some of the best projects come from older men. But in general, the 
committees favor younger people. 

Hughes: Does NIH give you criteria by which to judge the applications? 

Gerbode: No, they don't. The peer group establishes its own criteria. It 
evaluates the program suggested by the application and either 
accepts it with a priority or rejects it. 

Hughes: Is it pretty much on the scientific merits? 

Gerbode: It's not political. Although over the years, it was obvious to 
me that if one of the Ivy League medical schools applied for 
something, it was much more apt to get it than some little 
university in the Midwest. But time, I think, has changed that a 
bit. I think people began to realize that you could do good 
research in a lot of different places in the United States other 
than New England. Some of the very best things are not done in 
New England or the East Coast. 

Hughes: Do you think that the system works pretty well? 

Gerbode: I think the system is excellent. The American Heart Association has 
similar committees which examine these applications. In fact, the 
local heart association does, too. They have a research committee 
which looks at all the applications and votes on them. 



186 



The Institutes of Medical Sciences (Continued) 



Hughes: Back to the Institutes, if you don't mind. The subject of choosing 
investigators. The way I understood your explanation was that a 
man would come here with a specific project in mind. 

Gerbode: Yes. Very often they've already been working in a particular field 
on a particular problem and have already established a track record. 
For example, they may be studying the immunological aspects of 
cancer, and they would have some publications and worked in 
laboratories somewhere. For one reason or another, the person 
wants to leave that institution, either because he doesn't like 
the climate politically in the institution or the climate otherwise, 
or because his wife or husband wants to move to another part of the 
country. We have gotten people from the University of California 
locally because of departmental problems which they didn't like 
there. The same thing is true of the Veterans' Hospital. We've 
gotten some people from there as well because they'd rather work in 
a free-standing institution where politics is at a minimum and 
they can really do their thing without interference. 

If you pursue this policy, you're apt to get stronger people. 
This sometimes can cause difficulties, because when they come into 
our complex, they want to swing the bat and influence things a bit, 
too. Well, that's fine. I think that's being a good citizen. So 
I don't mind that, providing they'ro fair about it. 



Teaching and Training Programs 



Hughes: Since the institutes are not set up along strict academic lines, 
what do you do about such things as teaching and exchanging 
information among the institutes? 

Gerbode: Those are good questions. We've always had some kind of training 
going on. In fact, for a while we had a Ph.D. program with the 
University of the Pacific. In cardiovascular work we had a master's 
program with the University of the Pacific. Both of these have 
been dropped now because of no takers, mainly because doing graduate 
work in a university which is eighty miles away in Stockton is 
difficult. If the university were on this campus, we'd have more 
of these programs going. There is currently again talk of reviving 
the Ph.D. program in one or two of the disciplines. 



187 



Hughes: Would that mean taking on new staff? 

Gerbode: No, we'd use our own staff. Right now we're talking more about 

having postdoctoral fellowships, which is a form of teaching. We 
would take on people as fellows who have gotten their Ph.D.'s 
and want to get started in a good research program and get them 
going until they can stand on their own feet. We're going to do 
more of that in the future. 

We have also always had a summer student program. During one 
summer program Dr. Osborn and I had twelve students working here 
in cardiovascular surgery. It was like running a boy scout camp, 
[laughter] I must confess, it was just too much. 

Hughes: What level were these students? 

Gerbode: They were mostly university students, premed or in biological 

sciences or engineering. It is interesting to note that many of them 
have later gone to medical school and have done very well. 

More recently we've lowered the number of summer students to 
three or sometimes four. These are sponsored by the local Heart 
Association or by a local woman's group, ARCS, who sponsor summer 
students' stipends. I must say, they are very generous with their 
stipends, too. 

In the hospital we take a certain number of externs in various 
departments for part of a year, because most medical schools in 
the world now have some free time for the students to go away 
somewhere. The West has always looked good to people everywhere, 
so we always have a lot of people wanting to come to California. 
We can always take a certain number. Unfortunately, they can't 
do anything more than observe and take histories. They can't treat 
or write orders because of being foreign students. 

#1 

Hughes: What if they're American students? 

Gerbode: American students can do that, and we have externs who can write 
orders and help in the operating room. 

Hughes: What body would choose those students? 

Gerbode: Those students are chosen by the department of education of the 

hospital. They have a director; he or she runs all the interns and 
residents and would run the externs or fellows, too. 

Hughes: How closely are the institutes and the hospital affiliated? 



188 



Reasons for Establishing a Medical Research Institution 



Gerbode: Well, we should talk a little bit about why there is a research 
organization here at all, and then what is the relation of the 
research to the hospital. Being the person who founded all this, 
when Stanford left, my idea was that someday there might be 
another medical school here. And if you were seriously thinking 
about having another medical school, then one of the things you 
would have to have is a group of people interested in research. 
Since there were a number of people who wanted to do research and 
were not going to move to Palo Alto, I felt that they should be 
put together in some kind of an organization. I think I've mentioned 
this before to a certain extent. 

I also had a very strong feeling that any medical institution 
dealing with patients would be a better one if there was research 
going on at the same time. I think the best hospitals and clinics 
in the country are those which have good research programs. It not 
only improves the quality of medicine in the institution, but it 
brings people around who are interested in basic problems relative 
to health. When they're talking about it and giving seminars, it 
sharpens the ordinary clinician. 

This has been true here. I believe the fact that we have all 
these research people around, some of them working with doctors in 
the hospital, and others working on problems which the doctors can 
see, is very beneficial. The problem, of course, is that many of 
the clinical departments in the hospitals are run by the people 
who don't care or know much about research. They're good doctors, 
but they're not interested in discovery or scientific matters. 

Hughes: Does that make it difficult when an investigator is ready for 
patient trials? 

Gerbode: It's almost impossible, if a research worker wants to do a clinical 
program in research, to get it accomplished unless the departmental 
chief wants it. And then you get back to the same thing that 
happens in the universities. But so far we haven't really had 
much problem with that. The ones who don't do any research and who 
are in charge of departments at least don't try to stop research 
if it doesn't interfere with them too much and as long as they don't 
have to pay for anything. 

Hughes: But there's no system set up for any sort of automatic acceptance? 






189 



Gerbode: 



Hughes : 
Gerbode; 

Hughes : 
Gerbode: 



Hughes : 
Gerbode: 



Nothing's automatic. Currently we're trying to get hospital 
research increased, and we currently have a joint research committee 
of trustees and research people in the hospital and MRI. They 
meet quarterly. Currently the general policy decision is that all 
research for both should be administered through MRI. This is a 
bit difficult sometimes because people leave money to the hospital 
for research, and the hospital doesn't like to turn that money over 
to somebody else. They want to try to run it one way or the other. 
That's perfectly natural. 

I would think also that the hospital would resist having MRI 
have control over the decision. 



You see, the problem is that there aren't many people in the 
hospital who can make [scientific] decisions [about research], 
we [in MRI] have a big advantage there. 



So 



I would think that the same would apply to the board of trustees. 

It does apply to the board of trustees, absolutely. For example, 
one of the most important people on the board of trustees of the 
hospital once said at a board meeting, "I think all of the research 
we do should be directed toward improving patient care in the 
hospital or problems in our patients." In other words, you find 
out that a certain group of patients gets warts when they come to 
the hospital; therefore the research program should be designed to 
eliminate this strange phenomenon. [laughter] That's kind of an 
exaggeration. He's trying to liken the research in a hospital to 
that in IBM or Hewlett-Packard or some big corporation, or even the 
stock market. These big people engaged in the stock market all 
have research organizations. It's all designed to help them make a 
decision relative to investing their money, or somebody's money. 
But so much of research cannot be pointed to a specific problem of 
the day. 

I think that's very difficult for a layman to grasp. 

Even doctors have difficulty understanding it. I would say in 
general, however, that our research, as I mentioned earlier, was 
designed to try to overcome some of the difficulties in applying 
treatments which we were ready to apply but couldn't apply until 
we understood how to apply them better. This was certainly true 
of open heart surgery. That's why we spent so much money on 
developing techniques and instrumentation and studying the physiology 
of what happens when you use [heart-lung] machines. 



190 



Hughes: Would you say that your research today is still pretty much with 
the idea of future application? 

Gerbode: I think, generally speaking, our research is basically clinically 
oriented. Even the work in immunology and interferon is certainly 
intimately related to cancer and a number of other basic things 
we're working on so seriously. The people running the clinical 
programs in the hospital don't really do any basic research. I think 
the people in MRI are better informed on what the problems in 
basic research are and how to try to solve them. 

Hughes: I asked a question about communication and you mentioned the 

committee which brings together the hospital and MRI. Is there 
anything that does that for the institutes as a whole? 

Gerbode: We have weekly scientific conferences to which all the hospital and 
MRI people are invited. They are usually basic science lectures of 
one kind or another describing the work which an individual is 
engaged in, what he's accomplished and what he hopes to do. Some 
of them are quite lively, because a lot of good questions are asked. 

Hughes: They're well attended? 

Gerbode: No, the hospital people practically never come. The younger 

research people come, the ones whose careers really are based on 
what they might be able to do [in research]. Usually when we bring 
a new person in, one of the first things we do is give him a 
chance to give a talk or two to all the other research workers about 
what he wants to do "or what he can do. Those are pretty well 
attended because people are kind of curious to see what the new 
person looks like. 



Ph.D.s and M.D.s 



Hughes: What about the ratio of Ph.D.s to M.D.s in the institute? 

Gerbode: I'd say that 90 percent of the research is done by Ph.D.s or 

masters. Originally it was the other way around; it was mostly 
M.D.s. But M.D.s find they can make a lot more money and have an 
easier life in practice rather than trying to compete for funds to 
do research. Funding organizations don't pay research workers very 
much. 



191 



Hughes: That of course is feeding into some of the problems you see between 
the hospital and the institute. 

Gerbode: Oh yes. There's a constant deep feeling of the Ph.D.s that they 

are underpaid and they are the martyrs of the system, because they 
don't make nearly as much money, and they feel as though they're 
making all the big contributions toward the improvement of medicine. 
But I've told them whenever this comes up, "If you wanted to be a 
doctor, you should have gotten an M.D. degree." It's easier to get 
an M.D. degree frequently than it is to get a Ph.D. 

One fellow who worked with us had a Ph.D., and he kept saying 
this all the time. I said, "Go get an M.D. degree." So he did, 
and he continued doing research at the same time he was getting his 
M.D. degree. But I must say that his research suffered and was 
really questionable. But as a consequence of this change in 
direction, he is now a faculty member in a clinical department in 
New England. I presume he's still doing some research back there 
in the clinical department. At least he's making more money. 

Hughes: Going back to when the institutes were first being formed, what 
would you say then was the reason for adding a new institute? 
Was it a matter of money? 



Founding New Institutes 



Gerbode: Yes. It was a matter of money well, not so much money, but a 

group of people who could be funded. In other words, you had to be 
sure that a person to whom you gave a laboratory could run it 
financially. 

We didn't have any set figures, though. We simply looked at the 
group and if they had a pretty good track record and had the 
promise of going somewhere, we'd give them space and help them. 

Hughes: Was there any tie-in with current scientific and medical problems? 

Gerbode: In other words, have we decided that we should go into certain 
fields because we feel they're important? 

Hughes: Yes. 



192 



Gerbode: Yes, to a certain extent. When George Williams wanted to set up 
an institute of aging, we thought that was very good, because 
aging is something we're faced with everyday! In fact, Mrs. 
Florence Mahoney, who used to be on our board she's a wonderful 
and very effective woman in Washington felt so strongly about the 
aging question that she worked hard on certain senators and finally 
got them to approve an aging institute as one of the institutes in 
NIH. I notice that they've got very good appropriations now, and 
she's very proud of the fact that she did it. 

Our aging work has dropped of f a bit because of poor funding. 
Dr. Williams has shifted his interest into cancer research. 

Hughes: In connection with the aging problem? 
Gerbode: Well, not really. 



Sharing Equipment and Facilities 



Hughes: 
Gerbode: 



Hughes: 



Gerbode: 



You touched upon the question of equipment, 
ideal but not an actuality at the moment? 



Is shared equipment an 



As a general rule, every research worker Likes to have his own 
"microscope." He doesn't like to share it with anybody else. So 
mostly the institutes and the research workers have their own 
research instrumentation. However, when it gets to big things, 
no one institute can afford to buy them and maintain them, so we do 
share certain things. 

We have two things which currently are examples of this. We 
have a research lab which is called a core facility lab, which 
contains certain expensive equipment, such as spectrophotometers , 
that can be shared by a number of workers. We also have a machine 
shop which can make beautiful equipment out of metal, make almost 
any instrument. Anybody can go over there who can afford to pay 
for whatever they need, and can get it done. 

What about the use of the core facility lab? I would think that 
sometimes there would be tremendous competition between institutes. 

No, they get together and say, "Would you mind if I use it on 
Tuesday?" or something like that. 



Hughes: So it's an informal 



193 



Gerbode: Informal arrangement, sure. They are very fair about it. So 
there's never been much problem about that. 

Hughes: The dog lab is used by ? 

Gerbode: The dog lab is now used by a number of people, but not nearly as 

much as it was a few years ago. However, they do dog and cow work 
two or three times a week. The instruments and the respirators 
are shared. There's a basic charge for using the animal laboratory; 
for each experiment there is a basic charge. That goes into a fund 
in central administration which then pays for replacement of 
instruments and materials, drugs and things like that. 

Hughes: Why has use fallen off? 

Gerbode: I guess the main reason is that some of the people who were using 
it a lot are so busy in practice now that they don't use it as 
much because they're busy taking care of sick people. 

Hughes: Do you wish to say anything more about the institutes? 



Accomplishments and Reputation 



Gerbode: I think my premise that a hospital complex with a research institute 
would be a much better place to be working and a much better place 
for sick people has been accomplished. I think the fact that we 
have a very strong medical research institute here has increased 
the value and prestige of the [Pacific Medical Center] enormously 
and has increased the quality of care of patients a great deal. I 
think quite a few people envy us. 

Hughes: What would you say about the reputation of the institutes on a 
national scale? 

Gerbode: Their reputation is very good. NIH and their committees never 

hesitate to consider an application from MRI. It's considered on 
an equal basis with universities. 

Hughes: Has that always been the case? 

Gerbode: It was pretty much, because when we started we had reputations back 
there, and I was on several committees myself. 



194 



Hughes: That helped. Should we talk about the relationship of the institute 
with other research organizations? I'm thinking of Stanford and 
U.C. 

Gerbode: We've always had some joint programs, not great ones. For example, 
in the kidney transplant work, which has now reached a level which 
is among the best in the country, there are research programs 
which are shared by Stanford and ourselves. What will happen to 
those programs in the future I don't know, because Stanford now is 
going to have a kidney transplant unit of its own. 

Hughes: Will some of the people go down there? 

Gerbode: Well, they'll have their own sources of patients, because they have 
a lot of people with sick kidneys come in there. I think they'll 
get enough work to keep a kidney transplant team going. By the 
same token, we're probably going to do heart transplants here. 

Knowledge is generally shared in these ventures. People who 
are working in a field usually share their experiences pretty 
freely. 

Hughes: A particularly strong field, say the kidney transplant program, 

would that influence the research of another institute? I'm thinking, 
for example, of the tie-in with immunology. 

Gerbode: Oh, very much so. There's a lot of cross-fertilization. 



The Decision to do Heart Transplantations at Pacific Medical Center 



Hughes: What about the decision to have heart transplantation here? 

Gerbode: First of all, you have to have a team that feels as though it can 
do it. We have a very strong cardiovascular department here, with 
very good backup in postoperative care, and we have the kidney 
transplant program, which then brings in all the various aspects 
of controlling the rejection phenomenon. They're pretty knowledgeable 
about that now, too, so that's a help. And then the fact that organs 
are offered to the kidney program means that there are hearts 
available as well, as there are eyes. So we have a corneal 
transplant group here which has been in existence for many years. 
If you're taking organs for one purpose you can usually get the 
other organ as well, so these programs help each other. 



195 



Gerbode: I'm sure that part of the reason why Stanford is going into kidney 
transplants is because they already have all the other elements 
of what goes into transplantation. All they need is to have 
somebody to do the work. 

Hughes: Is the motivation for setting up one of these programs the idea 

that you're going to help patients with severe problems, or is it 
a money-maker? Or both? 

Gerbode: I think a great deal of it really is the objective of having a 
complete center. People want to be responsible for starting 
something and running it. It does have some financial aspects, of 
course, because people have to make a living. If they make a 
little extra money and it's doing what they want to do, then more 
power to them. The only feeling I have about that is that if a 
person does get into a field where the money comes in pretty 
liberally, I feel the person should put something back into the 
organization. 

Hughes: That doesn't usually happen, does it? 

Gerbode: No, unfortunately it doesn't happen. But I can say that, as far as 
I was concerned, over the years I've put as much back into HRI as I 
took home. Otherwise it wouldn't have gone. 

Hughes: You said earlier that one reason that you didn't become involved 
with heart transplantation was the problem of rejection. Do you 
really think that that has been handled? 

Gerbode: Oh, it's been handled pretty well now, because they have drugs that 
can control it. They have ways of studying the heart to see 
whether a rejection is imminent or not. Then they temporarily 
fire up the drugs. 

I think [transplantation] is accepted, and I think it's going 
to increase in numbers and quality. I think pancreas transplantation 
is going to be accepted very widely pretty soon, and liver transplanta 
tions more than they are now.* 

Hughes: Neither of those is done here? 
Gerbode: No. 



*There is further discussion of transplantation on pp. 468-469 
in the session recorded on 5/30/84. 



196 



Ethical and Psychological Considerations in Medicine 



Hughes: There are a lot of ethical problems connected with any form of 
transplantation. Have committees been set up to handle these 
questions? 

Gerbode: Oh yes. There are committees all over the place. There are 

committees in the United States Senate. There are committees in 
the Heart Association, committees in the medical societies, and . 
local hospital committees. We have a joint committee of MRI and 
the hospital which has to approve any research program that involves 
humans. It has to go through that committee on human experimentation. 
If we invent a device for the treatment of something which, let us 
say, requires a continuous intravenous drip to administer a drug, 
it has to go through this committee, and they have to consider 
whether it might be harmful. And all the people on whom this 
particular venture will be tried have to sign a paper saying they 
understand what's going on, that it is experimental, and relinquish 
any lawsuits or conditions about it. It doesn't really prevent 
a full lawsuit, but it makes people a little more aware of the fact 
that they're engaging in something which is a new venture. 

Hughes : Are the criteria used by this committee set up by the committee 
itself, or are they government criteria? 

Gerbode: Some of them [have been established at the national level]. For 
example, the question of when death occurs, what is death: that 
has been debated at all levels in the country. So finally criteria 
to establish death have been established. 

Hughes: Which is brain death. 

Gerbode: Yes. 

Hughes: How does that sit with you as a heart man? 

Gerbode: Oh, I think that's fine, because if a person's brain is dead and 

you're keeping the patient alive through machines at great expense 
and with no ultimate outcome, I think it's a waste of effort and 
money. If the family would be willing to donate the organs of that 
person, that's great. People are generally accepting brain death 
in the country and in the world [as a criterion of death] . 

If 

Hughes: In cases where the patient is literally dying, it makes "consent" 
rather questionable. The patient is hardly going to be looking at 
the situation from an objective standpoint. 



197 



Gerbode: Yes. Now we're getting into things which are not essentially 
related to research. 

Hughes: That's true. But they are things which must be dealt with. 

Gerbode: Yes. Usually we've dealt with those things by talking to the 

family, the husband or the wife. If you can't get through to the 
patient, spell out the facts to the husband, wife or family in 
some form, and record in the chart the fact that you have done all 
, this, so that it is well known that you have covered the risks 
and the essential aspects of what you intend to do. It isn't a 
complete protection against being sued, but it certainly helps a 
great deal. 

Hughes: What about the moment when you decide that research in the dog lab 
or wherever has progressed far enough and it is now time to do the 
procedure on a human? What goes into making that decision? 

Gerbode: If you've done it repeatedly in the lab, you know how to do it 

technically, and you've seen the result physiologically or otherwise, 
then it is time to apply it. You simply go to the patient and tell him 
that you've been working on this now for a year or so and have 
"done it repeatedly in animals, and this is the best treatment for 
you, or your son or daughter or husband or wife. Do you want us to 
try it or not? 

Hughes: You would make it clear that it's a new procedure? 

Gerbode: Oh yes, make it clear and write it all down in the che.rt , and the 
history. Sometimes people have gone to the point of having 
[patients] sign a document [which] reads something like, My doctor 
has told me all the risks connected with this venture and explained 
all the various possibilities, and I hereby give him consent to 
apply it. 

Hughes: Is that something that the individual physician would ^decide to do 
or not do? 

Gerbode: Yes, that's right. 

Hughes: Are most patients willing to go ahead with a new procedure? 

Gerbode: Yes, they are. If they're in a hospital with a good reputation 
and dealing with good people, they're willing. I never really 
had difficulty, even in the early days of open heart surgery, getting 
people to agree to have the operations. You'd present the 
statistics, the facts, the problems. On the one hand there's 
hope; on the other hand there isn't much hope. 



198 



Hughes: What about your frame of mind when you are trying a new procedure 
for the first time on a human? Do you think you're tenser? 

Gerbode: I think I've always been pretty aware of what the risks were and 
what the promise would be. For example, if you can close a hole 
in the heart successfully, and a given patient has done better 
with that hole closed, then you're really quite excited about it, 
because there are lots of holes around to be closed. 

Hughes: But when you're starting on the first closure, how do you feel? 

Gerbode: I think if you've tried it out on animals and thought it out 

carefully and you know what other people have tried it's like 
going through a forest , you can see the marks on the trees and the 
path, and you watch out for wild animals. [laughs] But you'll 
get through it all right. 

Hughes: So the psychological step is not that great from the dog lab to the 
human? 

Gerbode : It ' s much harder to get a survival in a dog than it is in a human 
for a given situation. 

Hughes: Why is that? 

Gerbode: A lot of reasons. One thing is, you have some ways of treating 
human beings which you don't have in animals. But also, many 
animals are not as resilient. 

Hughes: Is that just an inbred characteristic? 

Gerbode: I don't really know. But I think it's generally true. 



Computerized Patient Monitoring (Continued)//// 
[Interview 8: August 29, 1983] 



Hughes: We talked previously about computerized monitoring of patients, but 
I don't think we really brought out how innovative this whole 
procedure was. I'd like you to comment on that, and also say 
something about what impact the technique had on medicine. 



199 



Gerbode: When IBM came to us, they obviously felt that using a computer would 
be of benefit to the treatment of patients. We of course had felt 
this all along and had therefore started using a computer to monitor 
certain physiological events in the postoperative care of patients. 

The obvious things one would think about [monitoring] would 
be the blood pressure, the venous pressure, and the heart rate. But 
then there were so many metabolic things which were important in 
the treatment of a seriously ill patient, it was our decision to 
monitor some of these as well. So we developed methods of following 
the CC>2, the work of respiration, and a number of other very 
useful parameters, and put them into a program which would come out 
as a display on a screen for a nurse to watch. We could also have 
laboratory tests put into the computer so that [patients] could 
come back into the recovery room immediately, as soon as they were 
finished [with the operation]. The nurse then would not have to 
wait for a piece of paper to come from a lab or a telephone call; it 
would be there as soon as the test was completed. So we had 
terminals set up in the laboratories to put these bits of information 
into the patient's computerized record. Dr. John Osborn with the 
assistance of IBM's James Beaumont was in charge of this project. 

We ended up by being able to monitor on-line twelve very 
important parameters. This is very sophisticated medicine, because 
when a nurse or a doctor can look at twelve physiological effects 
in a seriously ill patient, he or she has a lot of very useful 
information. What actually happened after a while is that nurses 
got to be expert at interpreting these data and could make decisions 
themselves about giving blood or changing the respirator: increasing 
the amount of respiratory pressure, the volume of respiration, the 
amount of oxygen, a lot of things like this. 

I likened the use of a nurse in this capacity [to] flying an 
airplane with the use of instruments rather than with the seat of 
her pants. If you learn how to fly an airplane with instruments, 
you can fly it through hail and storms and everything, but if you 
are doing it with the seat of your pants, you sometimes get into 
terrible trouble. This obviously requires a certain amount of 
intelligence, and we were lucky to have nurses who were very 
intelligent. Furthermore, once they learned the method of following 
patients with the computer, they liked it very much. Some of them 
left the hospital for various reasons to go to other hospitals, but 
they always tried to get back again, because they felt more comfortable 
having precise information. 

Hughes: Did they have to go through a training program? 



200 



Gerbode: We had a training program set up for them. We had one girl in 
charge of training all of the new girls and checking them out. 
Kay Martz was her name. She now has left the unit and has gone to 
live with her husband in Modesto. But she has trained other people 
in the art of training nurses, so the system goes on. 

The concept of having this on-line observation of patients 
was quickly copied by other units. Actually Dr. Osborn later put 
together a little company so that he could make the front end, the 
sensing devices, so the signals could go into the computer. These 
devices now are being sold to various other hospitals throughout the 
world. The Johnson and Johnson Company bought the little company, 
and they now are in the process of making and selling them. 

[Computerized monitoring] is a very, very sensible way of 
following patients. When you get reliable information, you don't 
guess so much. 



201 



VI MEDICAL/SURGICAL ACTIVITIES AND HONORS 



The Frank Gerbode Medical Research Foundation 



Hughes: Now the Gerbode Medical Research Foundation. 

Gerbode: A few years ago several members of the board of [what was] then 
IMS [the Institutes of Medical Sciences] , which is now MRI [the 
Medical Research Institute], thought it would be a good idea to 
have an endowed chair in my name. So they decided to have a small 
fund raising activity to establish this chair. Actually, as time 
went on, it turned out to be more reasonable to have a foundation 
which would support research than to have a chair, although they 
could function similarly as far as using money is concerned. 

Anyway, this was set up as a nonprofit foundation. Funds were 
raised. I must say that they didn't pursue a very vigorous fund 
raising campaign, which was fine with me because it's kind of 
embarrassing to sit here and have people raising money for you in 
this way. Anyway, they did raise a certain amount of money, and 
this has been used to support new research, support young people 
getting started in research, and to pay for equipment and other 
expenses which were not foreseen in the beginning of any program. 
One is always short of money in research. 

Contributions come in slowly. The trustees decided that they 
would not use the capital but only the income from the fund. This, 
then, meant that there wasn't very much money to spend. But still, 
it's better in the long run to keep a capital fund going, I think, 
than it is to spend it all. [The foundation] continues, and I 
imagine it will continue in the future. 

Hughes: Can more than one individual be supported at a time? 



202 



Gerbode: What we do is support parts of programs; when somebody has a new 
idea and isn't funded for it, providing that what he requests 
doesn't cost too much money, we can help get him started or get 
him over a hurdle. 

Hughes: Is it unusual to have an endowed foundation connected with a 
private research foundation? 

Gerbode: The Smith-Kettlewell Institute of Visual Sciences has some monies 
which are used in a similar way, and they had several big grants 
given to then. They're a bit out of MRI, though. There are no other 
MRI endowed chairs or funds of this kind, except for the Smith- 
Kettlewell funds. 

Hughes: But other private research institutions do have endowed chairs? 

Gerbode: Yes, they do. Universities have them. I know there's one in honor 
of Vic Richards at Children's Hospital. I think that's mainly used 
to help research in that hospital. 

Hughes: The establishment of the foundation was an idea that developed from 
your colleagues? 

Gerbode: No, it really came from several of the institute directors. It wasn't 
from the doctors. Doctors really don't give very much money for other 
doctors. There's only one other group that's worse than that and 
those are the lawyers. Lawyers don't give any money to other lawyers. 



Professional Societies and Associations* 



Hughes: Now let's turn to your membership in professional associations, of 
which there certainly are many. What I did is to single out a 
few which seemed to me to be significant or in which you had held 
office. Certainly you're free to add more to the list. 



The American Association for Thoracic Surgery 



Hughes: Perhaps you'd like to start by talking about the American Association 
for Thoracic Surgery. You were vice president from 1971 to 1972 
and president from 1972 to '73. 



*For further discussion of professional societies, see the discussion 
recorded on 11/14/84, pp. 477-483. 



203 



Gerbode: The American Association for Thoracic Surgery is the largest and 
most prestigious thoracic and cardiovascular organization in this 
country. I felt very highly honored that they made me president. 
I had served on various committees along the way, the membership 
committees for one thing for several years. It has an annual 
meeting. That meeting is always attended by a vast number of 
thoracic surgeons in the country, most of whom are not members. 
There are many people who come from other countries to attend the 
meeting as well. For example, Europeans are always heavily 
represented at the meeting. It's a very friendly meeting to attend, 
too. The atmosphere is very good. The scientific papers I think 
are among the best in this particular category anywhere. 



The Society of Thoracic Surgeons 



Gerbode: There's another society called the Society of Thoracic Surgeons, 

which was started many years later because it was felt that younger 
thoracic surgeons needed to have their own organization, many of whom 
could not get into the American Association for Thoracic Surgery. 
It has very good meetings annually as well. Generally speaking, 
there are more younger people attending it. The attendance has 
always been excellent right from the very beginning. 

Hughes: The associations have membership by appointment, by election? 

Gerbode: Yes. Your name is usually submitted by two or three people who write 
letters of recommendation. Then you have to send in your curriculum 
vitae and list of publications. Then you go through a long process 
of being looked over by the membership committee. The society 
usually accepts the recommendation of the membership committee. 



The American Surgical Association 



Gerbode: The American Surgical Association is another very prestigious 

American [organization]. I was fortunate in being made a member of 
that quite a while ago, too. That probably is the most prestigious 
of all the surgical associations in this country. Most of the men 
in it have done quite a bit of teaching or research, have a lot of 
publications and are more or less in a leadership position, mostly 
in universities in the country, although not entirely. 



204 



Hughes: Is the American Association for Thoracic Surgery also inclined 
toward research people? 

Gerbode: It's inclined toward people who've done teaching and some research, 
although there are some people who are members who've done most of 
their work along the experimental line. But in general the member 
ship favors people who are in university settings. 



The Society of University Surgeons 



Gerbode: Another quite prestigious society is called the Society of University 
Surgeons. That was started just before or around the time of the 
war for young people who wanted to have university careers. The 
criteria for selection to membership really had to do with whether 
the young man was showing promise in research or publications and 
looked as though he was going to go on into an academic career of 
some kind. They made me a member when I was quite new in the 
academic field. I enjoyed those meetings a great deal. The 
presentations in that society are now so exotic that sometimes you 
can't even understand what they're talking about. [laughter] The 
young men are presenting the papers mostly, and they're in the 
forefront of some pretty sophisticated kinds of research and they 
like to talk about it, too. The meetings are very exciting from 
that point of view. Certainly I think the new things which come 
aboard in surgery are more apt to be seen at the meetings of the 
Society of University Surgeons. 

Hughes: You had mentioned earlier that attendance at meetings was one way 
that you kept abreast of new developments. 

Gerbode: Yes. Most of these societies require attendance. If you don't 

attend three meetings in a row without an adequate excuse, they may 
drop you, or at least you get a threatening letter. If I can't go 
to one of these meetings I write a letter telling them why I can't 
come. 

Hughes: Was any one of these associations that you've mentioned more 

important than the others as far as conveying new information is 
concerned? 

Gerbode: I think the two most important ones are certainly the American 
Association for Thoracic Surgery and the American Surgical. 



205 



The Society of Clinical Surgery 



Gerbode: The Society of Clinical Surgery was started by Harvey Gushing and 
some of the Mayo brothers many years ago. They had meetings twice 
a year. They'd go to the various clinics, have an operative 
clinic, a discussion of operations, and a clinical session where 
the best of what that particular university department or clinic 
was doing [was presented]. A small group of people [were members], 
ten or fifteen originally. Membership in that society has gone 
up to perhaps fifty or sixty. They have a meeting once a year now. 
The meeting is usually an operative session in the morning and then 
a sit-down discussion in the afternoon. 

Hughes: Do they deign to include West Coast institutions? 

Gerbode: Oh yes. I've been a member for many years and they have had 
meetings here and in Los Angeles. 

Hughes: In the early days it was pretty much an East Coast phenomenon, was 
it not? 

Gerbode: Oh yes. In the early days it was entirely East Coast, and mostly 
New England and Baltimore. But then by the time I came along my 
chief, Dr. Holman, was a member, and I guess maybe Dr. [Howard] 
Naffziger at the University of California was a member too. 



Presidency of the American Association for Thoracic Surgery 



Hughes: Is there anything significant to talk about in connection with your 
presidency of the American Association for Thoracic Surgery? 

Gerbode: I don't think so. If you're president, the big worry is that you 
have to give a very formal paper. That bothers people. As soon 
as they say you're going to be president, that means you have to 
start thinking about what you're going to say. [laughs] 

Hughes: Which is on a research topic? 

Gerbode: It can be anything you want. Luckily we were right in the midst of 
this computerized monitoring, [so] I then gave my paper on 
computerized monitoring for seriously ill patients, which was a 
very timely thing at that point . 



206 



Hughes : 
Gerbode: 



Hughes: 
Gerbode: 



Hughes : 
Gerbode: 

Hughes: 
Gerbode: 
Hughes : 

Gerbode : 



Hughes : 
Gerbode: 



Is Chat the main responsibility of the president? 

No. He presides at the council meetings and during the scientific 
sessions. He gives a reception, and he presides at the annual 
dinner, which is a big event. He has a chance to help make policy 
decisions through various committees. So it's a fairly important 
position. 

Policy in regard to the association itself? 

Yes, whether or not they're emphasizing a certain kind of work more 
than another. In this society there had been a tendency to shift 
everything into heart surgery, so lung surgery suffered as a 
consequence. So they tried to have a session on thoracic non-cardiac 
surgery as well. 

Is that mainly due to the fact that the cardiac people outnumber 
the lung people? 

Yes, and everybody is doing cardiac surgery, and they're all doing 
AC [aortocoronary] bypasses, and so they all want to talk about it. 

How old is this society? 
It was founded in [1917]. 

Before the days when a man was specializing in thoracic surgery, is 
that not true? 

Well, there were a few. Locally the ones who were founders were 
Dr. Leo Eloesser, Dr. Harold Brunn, who did one of the early lung 
resections in the United States, Evarts Graham, and John Alexander. 
These are all men who were pioneers in thoracic surgery. 



You said locally 

Locally it was Leo Eloesser and Brunn. 
founders in San Francisco. 



Those were two of the early 



The Bay Area Vascular Society 



Hughes: I was wondering about the Bay Area Vascular Society. 



207 



Gerbode: They made me an honorary member a few years ago, which is nice to 
receive. They meet about once a month, usually in a hospital 
setting, and talk about any new ideas they have or new contributions. 
It's a very pleasant organization to belong to. 



The International Surgical Society 



Gerbode: To me the most important society outside of the American ones which 
I belong to is the International Surgical Society, or Societe 
Internationale de Chirurgie. I spent many years in that society. 
I first heard about it through Evarts Graham, who was the president 
of it at one point. He was professor of surgery at Washington 
University, St. Louis. He found that this society, which was 
dominated entirely by Belgians, was so confusing and difficult to 
understand that it was very frustrating to him. For example, 
keeping records of payments of dues [and memberships was] done in 
a curious way, and he couldn't really ever get good figures for 
them. Even though it was an international society, they had absolutely 
no democracy in electing their presidents. The same family of 
people became president by their own decision. "Well, I guess I'll 
be president for another four years. Then I don't think I want to 
be president after that." There wasn't any nominating committee or 
anything like that. It was just sort of handed around. It was 
just terribly irritating, particularly to Americans. We don't 
like that kind of thing very much. 

[telephone interruption] 
Hughes: You were talking about the International Surgical Society. 

Gerbode: I was made president of the American chapter of the International 
Surgical Society and then got on the program committee of the 
International Society. So I went to Brussels twice a year to work 
on the program for the meeting which occurs every two years. I 
got to see the office and to know the people and began to work on 
the problem [of the society's organization]. 

The office [was] run by a woman who had been there, firmly 
established, for years. She really ran the whole thing in her own 
way. She kept track of who paid dues [by making] little dots in a 
book beside [members'] names. If they paid it would be a blue dot, 
and if they didn't pay it was a red dot, or something like that, 
which was a terribly curious way of doing it. The money I guess got 
deposited in a bank in Brussels. We never quite could see any 
balance sheet, although a Belgian accounting firm went over the books 



208 



Gerbode: and reported to us annually that things were all right. However, 
members in many countries never paid their dues, and they weren't 
thrown out. But the Americans paid their dues, and they had the 
biggest membership , and it looked to me as though the Americans 
were really holding the whole thing together in many respects. 
The Russians paid their dues regularly, though. 

Hughes: Was the membership worldwide? 

Gerbode: All over the world. Virtually, every country was represented and 
therefore it had a great inherent strength. I liked the idea. 
Through that society and going to the meetings, I got to know a 
great many people all over the world and made some very good friends. 
In any event, I finally got on the council of the society and then 
I began to work on how they elected the president, and finally put 
over the idea that the president should not always be a Belgian, 
should not always be more or less self-appointed, and above all not 
a member of the same family. 

Hughes: Wasn't this rather sticky? 

Gerbode: This was rather sticky. They didn't like me for suggesting this. 
But I had enough support from the Germans and some of the French 
and certainly the other Americans to change some of these things. 

Hughes: You had gone around before the confrontation? 

Gerbode: I'd talked to them at other meetings about it. Every year we'd 
have a meeting of the American chapter , and these things were 
discussed there, too. So finally we managed to get some good 
presidents elected outside of Belgium, and to take the secretaryship 
out of Brussels. The charter had said that the secretary's office 
should always be in Brussels. Well, finally after some deft 
manipulation I got the bylaws changed so that the secretary could 
be elsewhere. We finally prevailed upon a Swiss by the name of 
Martin Algower to be president. He volunteered to set up a modern 
office with computerized membership cards and all the rest of it 
and to have a private foundation he was connected with subsidize 
the society for three or four years to the tune of about seventy-five 
thousand dollars. Then with this, we were able to get the records 
out of Brussels, inadequate as they were, and modernize them and 
bring them up to date. 

Hughes: How had the society existed previously if much of the membership 
didn't pay its fees? 

Gerbode: It was mainly members in some countries who didn't pay. 



209 



Hughes: So there was money? 

Gerbode: Oh, there was an adequate amount of money, because as time went on 
the Americans had so many members appointed in this country, that 
that in itself amounted to quite a bit of money. So now the 
secretaryship is in Basel, Switzerland under the direction of 
Martin Algower. It's modernized and is very active and very good. 
What will happen in the long run I don't know, but at least it's 
on firm footing for the time being. 

Another thing which bothered some of us a great deal was the 
publication [of the papers from the meeting]. 

II 

Gerbode: [The papers] would come to you in a bound volume at great expense, 
and always so late that you more or less had forgotten about them. 
I finally got the [headquarters office] to tell me how much this 
was costing them; it amounted to about sixty thousand dollars. A 
good deal of the money that was being paid into the society went to 
subsidize this antediluvian type of publication. These things would 
arrive, you'd put them on the shelf and never read them, or they'd 
go to libraries, and nobody would ever read them in libraries either. 

We finally got the society to consider having a good journal. 
Various organizations were canvassed, and the suggestion was made 
to them, "Would you like to publish a journal that would be the 
official journal of the society?" The papers would be selected for 
this journal not only from the meeting but from other contributions 
throughout the year. Finally Springer Verlag, the German [publishing] 
company, said that they would be willing to do it if we would 
subsidize them for a number of years. We got enough money together 
to subsidize the publication for two or three years. Springer 
Verlag itself lost money, and is still I think losing money. But 
we finally have the World Journal of Surgery, and it is very good. 
Only the best papers from the meeting get into it. They have to 
go through an editorial committee so a lot of the bad papers never 
are published, which is good. Then they have developed a very good 
way of presenting symposia on important aspects of surgery, not 
related to that meeting. They have a very good editorial board 
from all over the world. It's turned out to be a very fine journal. 

Hughes: Is the criterion excellence or is there also an attempt to get a 
broad representation? 

Gerbode: We try to get everybody to participate in it, but they don't take 
papers unless they're high quality, even though they are from a 
country that doesn't publish very much. 



210 



Hughes: Why did the society grow up in Belgium? 

Gerbode: Belgium [is] a neutral country. The United Nations had a big office 
there, and the world trade organizations were all there, because 
it's supposed to be a neutral country and not politically very 
active. 

Hughes: So it didn't have anything to do with the quality of surgery? 

Gerbode: No. 

[telephone interruption] 

Hughes: Dr. Gerbode, I know you've always been interested in training young 
people, and I know for a time you had many foreign scholars at the 
institute. Did your membership in the International Surgical 
Society help you find likely candidates? 

Gerbode: A little bit perhaps, but I guess the likely candidates came out 

of the fact that we had a very active unit going here in San Francisco. 
It was well recognized throughout the world. The countries who 
didn't have any heart surgery going [wanted] to send their young 
men somewhere in the States to have them trained so they could help 
their programs locally. The other places in the country, the Mayo 
Clinic and some places in New York, were active in those early days 
in open heart surgery. The other advantage I had, I gue.3s, was the 
fact that I didn't have to have a big residency program going for 
Americans. That was because we didn't have an approved thoracic 
training program for Americans. 

Hughes: Was that because it was ? 

Gerbode: Because of the university not being here anymore. 

Hughes: And they didn't count the University of the Pacific? 

Gerbode: No. 

Hughes: It was too far. 

Gerbode: Yes. It wasn't important enough for them. So that was another 

reason why I've selected so many foreign people to train. But I 
also enjoyed training them very much, because they were the cream 
of the crop from all these countries. 

But coming back to the International Surgical Society, the 
other important thing we had to work on was the fact that the bureau 
in Brussels always decided themselves where the next meeting would 



211 



Gerbode: be and who the president was going to be. We felt this was not 
being very democratic and we had to change that as well. We did 
this through the council, which is a group of representatives from 
various countries. The council finally had courage enough to say 
no, we're not going to let you decide where the meeting is going to 
be. We're going to decide. This was a little traumatic for the 
bureau, but we finally put it through. The Belgians are very 
strange people in many ways. They're stubborn, difficult to deal 
with. I guess psychologically they've been affected by being 
conquered so many times by the Germans. 

At the meeting in Kyoto the bureau tried to push through its 
own president. I didn't think its selection was going to be very 
good at all. It had selected the person, I think, because it was 
going to get something back from the person it had nominated, in 
terms of membership, or paying off an old obligation in one way or 
another. I was president at the meeting in Kyoto. They nominated 
this fellow for presidency, and then I had a little group of 
people who were going to nominate some other people from the floor. 
I said, "The nominations are now open from the floor," which they 
had never heard of before. They just said, "We've decided the 
president will be so-and-so," and then everybody said yes. But I 
said, "We're going to vote on this." So there was another 
nomination from the floor. Then I said, "I think we ought to have 
s'ome discussion of these candidates," which had never been heard of 
before either. So various people got up and talked about the 
virtue of the two candidates, and so forth and so on. Finally the 
candidate whose name had been submitted from the floor won quite 
easily. [The candidate who didn't win] had to have a major 
operation on his aorta performed about three or four months after 
the meeting, and he died afterwards. So he wouldn't have been 
president anyway. It was too bad. He was a nice man, but not a 
very brilliant person. 

Hughes: Were you the first American president? 

Gerbode: No. 

Hughes: Is there any subdivision? Surgery is a big field. 

Gerbode: No. There has been a conflict, because so many of the bright young 
people went into cardiac surgery, and the programs are a lot more 
exciting in cardiac surgery than they are in let's say gastrointestinal 
or colon surgery. Hardly anything ever comes out that's very new 
[in these fields]. So the vascular people got kind of snooty about 
it. We used to have the meetings [of the International Cardiovascular 
Society and the International Surgical Society] at the same time or 



212 



Gerbode: sequentially. The vascular people, which is the International 
Cardiovascular Society, for which I was president of the North 
American chapter at one time, decided this year not to have the 
meeting with the International Society of Surgery, and so they're 
meeting on September 18, [1983], I think it is, in Rio de Janeiro. 
But I have a feeling they'll come back again to the sequential 
meeting with the International Surgical Society, because although 
they now have demonstrated that they can be their own people and 
all that, I think actually it's better to bring all the surgeons 
together. 

Now, two other societies meanwhile have asked to have joint 
meetings with the International Society. There's a gastrointestinal 
group and an endocrine group who are now going to meet with the 
International Society. Then there's another group mainly interested 
in education and research in centers in the world that's called the 
Federation Colleges. They always meet now with the International 
Surgical Society. That's a good idea, too, because they talk about 
training of surgeons and basic things like that. 

I look forward to this meeting in Hamburg. I think it's going 
to be a very good meeting. It's a good place to have an international 
meeting. They have good facilities, good hotels. 



Surgery in Various Countries: Comparisons 



Hughes: When you get into the higher echelons of surgery, is there much 
technical difference, from nation to nation? 

Gerbode: Yes, I think there is. Some of the countries in Eastern Europe are 
really quite poor in their technical ability, and that's mainly 
because their training methods are not very good and selection of 
the top people very often is done on a political basis rather than 
on skill. For example, in Yugoslavia there's one professor of 
surgery whose biggest contribution is his mouth. He's the most 
outspoken, loud-mouthed surgeon I know. He talks everybody down 
wherever he's been. But actually his presentations are terrible. 

I'd say the Germans are very skilled. Some of the French are 
very skilled. I don't know very much about many of the centers in 
France, but certainly the Parisian surgeons are very good. I think 
most of the English surgeons are quite good, especially those in 
medical schools. 



213 



Hughes : 
Gerbode: 

Hughes: 
Gerbode: 



Hughes : 
Gerbode: 



Hughes : 
Gerbode : 



When you say quite good, do you mean in a technical sense? 

Yes, they are able technically and they understand how to take care 
of a sick patient. 

Are most of these top people associated with a research institution 
as well? 

Research is not done on nearly as broad a basis in England and 
Ireland as it is in this country. The Germans are increasing their 
research capabilities a good deal by granting money from their 
federated treasury to medical schools and institutions. Also the 
Germans have recognized that the excellence that we have in America 
has really come from the great support of the National Institutes 
of Health and societies like the Heart Association and the Cancer 
Society. I think also the young people here in the United States 
who wanted to go on in academic careers found that if they published 
good things, their academic careers would be pushed forward. So 
they're all trying to make their way with contributions of that 
kind. 

British governmental policy has not been favorable to medical research? 

They don't have as much money in their allocations. They have 
barely enough money to keep their medical institutions going. They 
found that a national health service cost them a lot more money 
than they ever expected, and that it isn't very good. Actually, 
currently the fastest growing insurance in England is private 
medical insurance. People have found that by paying for it they 
get better care and they can select their own doctors. They would 
rather go to a smaller hospital with their own doctor than to go 
to a big teaching hospital and not know who is going to take care 
of them. The backlog in the big teaching hospitals is enormous. 
It's unfortunate, but that's the way it is. It just isn't working 
out. 

Is the United States really in the lead in most fields of surgery? 

Oh yes, I think so. Across the board, I think there's no question 
about it. There are places in the [world] where men and 
institutions have emerged in a very great way. For example, 
there are one or two very prominent surgeons in China who've done 
an enormous job in cancer of the esophagus. They've done very good 
work and they've published their work, and it's stood up very well 
as compared with other countries. For example, G.B. Ong, who is 
the professor of surgery in Hong Kong, has a remarkable record in 
major surgery. 



214 



Hughes: But these are individual exceptions. 
Gerbode: Yes. 

Hughes: Would you credit the leadership of the United States in surgery 
mainly to the tie-in with research? 

Gerbode: I think that's one [reason]. I think the rewards given to young 

people who have made contributions are so worthy that they try to 
do something unusual, they try to make a contribution. The other 
thing is, we have residency training programs in our country which 
are not generally accepted elsewhere. For example, in Germany a 
man stays in training for years and years and years , which is 
good for him in a way. He becomes very skillful. But there aren't 
many trained in the system this way. 

Hughes: So there's a sharp pyramid. 
Gerbode: Yes. 



The Pan-Pacific Surgical Association 



Hughes: Is there anything particular to say about the Pan-Pacific Surgical 
Association? 

Gerbode: The Pan- Pacific Surgical Association is a very good organization. 
I started going to their meetings because I was going to the 
[Hawaiian] Islands quite often anyway, and it was great fun to go 
down there to a meeting. When I went to the first meeting I was 
really quite surprised to find it was well attended by Japanese, 
Chinese, Australians, New Zealanders, and many from [other parts of] 
the United States. Even though they were not working in the Pacific, 
they liked the idea of going to the Hawaiian Islands for a meeting. 
[Some] of the presidents have come from the eastern part of the 
United States. That was done deliberately so that they would 
encourage memberships in the mainland. So there are a great many 
members all over the United States. 

Hughes: Is there a journal? 

Gerbode: They publish a journal although every paper is not published. 

The best papers are selected, [as in] some other organizations. 



215 



The Society for Vascular Surgery 



Hughes: We've mentioned the Society for Vascular Surgery. You were president 
of that as well. 

Gerbode: The Society for Vascular Surgery was started in this country when 
vascular surgery got to be a pretty recognized field. 

Hughes: After the war. 

Gerbode: After the war. I was very active and always went to the meetings 
and eventually they elected me president . 



The International Cardiovascular Society 



Gerbode: Harry Shumaker and I put together the International Cardiovascular, 
North American Chapter because some of the elder statesmen said, 
"You two fellows are busy in the field and know all the vascular 
surgeons. Why don't you put together the International Cardiovascular, 
North American Chapter?" So we just sat down and picked out the 
good people in the country and asked them if they would like to 
join. They all joined, so then they had a good chapter. 

Hughes: Is there any problem with having so many surgical societies? 

Gerbode: Oh, there is a problem. If I went to the meetings of every society 
I belong to, I'd be in meetings all the time. It's bad enough as 
it is going to maybe one out of three meetings. I haven't been to 
a meeting of some of the organizations for a long time. The 
Halsted Society, for example. Luckily, I 'm a senior citizen now, 
so that I'm forgiven if I don't show up at a meeting. 

Hughes: It must have been a problem when your career was so pressing, to 
find time for these meetings. 

Gerbode: I'll tell you, it was hard. First of all, I tried to be with my 

family some of the time. But this work in developing heart surgery 
was very demanding, and to have a training program going, a 
research program going, and try to devleop the field of cardiac 
surgery was very hard on family life. I think my wife was very 
brave to live through it. It was hard on her, I can tell you. I 
know quite a few families which really fell apart because the men 
had to work so hard. [One problem was] that you had to go back to 



216 



Gerbode: the hospital almost every night to check on the patients. Some men 
don't do it. But if you're conscientious you do. Or you're in 
touch on the telephone, which means that you're not sitting around 
enjoying life; you're sitting around waiting for the phone to ring. 

Hughes: And 1 imagine there was a certain tension involved when the 
procedures were all new. 

Gerbode: Yes. Also, relative to the societies, if you're in the leading 

edge of a new speciality, you're very anxious to make contributions 
before anybody else. So you're constantly trying to do something 
that will get on a program, and probably trying to do it before 
somebody else gets on the program. It's very competitive. It's 
good for the organization itself to be competitive this way. So 
you go to a lot of meetings and you try to present your material as 
often as you can. 

Hughes: We talked earlier about free interchange of information, and yet 
I would think that an individual would have certain reservations, 
particularly if he was working on something that wasn't quite 
ready for publication. Would you really be quite so free with 
information at that stage? 

Gerbode: I think you would certainly hide certain things that were really 

pretty fresh and new and not let them out of the bag too soon . But 
actually most people know what you're doing anyway. There's so 
much interchange, visiting around in laboratories and places, that 
the word gets around that you've got a new valve, a new way o:: 
doing something. 

Some men in the biological field have developed a reputation 
for stealing ideas. I know one very famous man at the University 
of California who liked to visit other laboratories all the time, 
but some of the men in these other universities would lock every 
thing up whenever he was going to come around, otherwise he'd take 
the idea home and work at it in his laboratory. 



The American Heart Association 



Hughes: You had quite a bit of money over the years coming from the American 
Heart Association, didn't you? 

Gerbode: I was president of the San Francisco Chapter of the American Heart 
Association. But the best thing I did with the Heart Association 
outside of spending their money wisely, I thought, was to get 



217 



Gerbode: Mr. Bramson on as an established investigator when he wasn't an 

M.D. As I mentioned before, he was the first pure engineer in the 
country to become an established investigator and he was paid 
a small stipend from the AHA. Now it's quite accepted, and there 
are Ph.D.s and others who are not M.D.s who are supported by the 
Heart Association, and their research is supported by the Heart 
Association. 

One of the biggest things I felt that we did in our unit was 
to bring people who were not doctors right to the bedside to help 
with clinical problems. [They were] engineers and Ph.D.s and 
physiologists. It's amazing, if you get a non-M.D. looking at a 
problem what you can learn and discover. Mr. Bramson didn't know 
anything about biology when I hired him to work with our research 
unit. He very quickly learned all the basics about blood and 
circulation. He did all the mathematics connected with it. He 
studied and learned about physiology and blood. He became a very 
successful biomedical engineer. 

Hughes: Probably this interdisciplinary approach to medical problems is 
one of the key features of modern medicine, wouldn't you say? 

Gerbode: Yes, and I'm very proud of our unit because we were among the 
very first to bring people who were not medical people to the 
bedside. 

Hughes: That whole episode with IBM and computer monitoring is another 
example. 

Gerbode: Absolutely. You see, IBM sent out three very top-grade Ph.D.s to 
work with us. They watched all the signals as they came into the 
computer, and pretty soon they could tell when things were not 
going well with a patient just by looking at the signals. 



The California Academy of Medicine 



Hughes: You were president of the California Academy of Medicine as well. 

Gerbode: The California Academy of Medicine is an old California institution. 
Originally it was the licensing organization for the State of 
California before we had a State Board of Medical Examiners or 
whatever they call it now. It's kind of a prestigious organization. 
They have a meeting about once a month [with] a big dinner and a 
guest speaker, somebody well known in the world. The Family Club 



218 



Gerbode: is where they previously had the cocktail party and dinner, and 
then they'd roll down the hill to the St. Francis Hotel, where 
they'd have the lecture. By that time everybody was so spiff icated 
that most of them wanted to go to sleep. Now they have the lecture 
first, and then the dinner. 

fi 

Gerbode: [The dress is] black tie. 

Hughes: Do they publish California Medicine? 

Gerbode: No. They don't publish anything. 

Hughes: So that particular association is more social than 

Gerbode: Yes. It's social, a little bit prestigious, and old and venerable. 

Hughes: There are other associations on this list. Do you want me to read 
them? 

Gerbode: Well, being a member of some of these societies gets to be like 
the domino principle. If you're made a member of one particular 
organization, then it's almost sure that you're going to be asked 
to be a member of another. And you never know how this happens. 



Honors* 



Gerbode: I think probably the most gratifying thing to me in looking back 
at my career is the fact that I got some honorary degrees. These 
are things that aren't gained by political access to universities. 
As a medical student I would have thought perhaps that getting an 
academic degree in another famous university was going to be beyond 
me. So when I started getting some honorary degrees I was 
enormously pleased. My wife was enormously pleased, too, because 
a wife really shares in these things, you know. For example, the 
eulogy [for] the degree from the National University of Ireland 
was read in Latin by [Eamon] De Valera himself. It was a very 
impressive event in my life. 

Hughes: Do you know in each case why you were awarded the degree? 



*See the session recorded on 6/13/84, 
discussion of honors. 



pp. 412-415, for further 



219 



Master of Surgery (Honoris Causa), The National University 
of Ireland, 1961 



Gerbode: I think the reason that I was awarded the degree in Ireland was the 
fact that I set up what you might call an international training 
center for cardiovascular surgery. In other words, I welcomed 
people from all over the world and whenever possible taught them 
something. I trained many people from other countries, in addition 
to doing pretty good research. 

Hughes: Had the Irish been particularly well represented? 

Gerbode: No, not very well represented. 

Hughes: Are these honorary degrees awarded by a committee? 



M.D. (Honoris Causa), Uppsala University, 1965 



Gerbode: Yes. 

I was really quite surprised at the honor from Uppsala 
University because that is probably one of the two or three most 
prestigious universities in [Europe] . When they read the reasons for 
giving me the degree, it was mainly about my experimental surgery 
on animals some years before. They dug this up and said [you were] 
among the first to do these things. 

Hughes: Are the Swedish research oriented? 

Gerbode: They are very research oriented, and they do good work. 

Hughes: That might be some of the reason. 

Gerbode: Yes, that's another reason. They do excellent work and they've 
made notable contributions, and still do, and in a country where 
medicine is probably more socialized than any other country outside 
of Russia. For example, a [Swedish] surgeon who does a case let's 
say on a Saudi Arabian prince can only collect five dollars for 
it. He's supposed to do it for nothing really. The man has to pay 
for his hospitalization, but [the surgeon] can't accept a fee. I 
imagine that some of these very wealthy people arrange somehow to 
compensate the surgeon. 



220 



Hughes: So the Swedish surgeon is on strict salary? 

Gerbode: Oh yes, and he's limited in the amount of money he can collect 

from private patients. Many of them leave the country if they have 
a chance to go somewhere else. The same as the English. 

Hughes: Within the country concerned, is the salary sufficient to be an 
incentive to enter that field? 

Gerbode: I guess it's comparative. None of the salaries anywhere in Sweden 
are high, so everybody is reasonably poor. If you're a professor 
you can have a small house, maybe even a tiny house at the beach 
somewhere. Private property still exists, so that's an advantage. 



Honorary Fellow of the Royal Colleges of Surgeons of England and 
Edinburgh, 1969 and 1975 



Gerbode: The Royal College of Surgeons in England made me a member. That's 
an honor, as did the Royal College of Surgeons in Edinburgh, that's 
an honor, too. But I think that's given mainly on the work you've 
been doing, the publications you made and the people you've trained 
and that sort of thing. I guess England and Scotland were happy 
to honor me because I'd trained about twelve surgeons in England and 
I'd been to many meetings and I have lots of friends. Certainly 
that helps in getting through a committee. You don't propose 
yourself. Having friends anywhere in the world I guess is a help. 



M.D. (Honoris Causa), University of Thessaloniki, 1964 



Hughes: What about the honorary M.D. from the University of Thessaloniki? 

Gerbode: That came largely because I had two or three very close friends 

high up in the university. I had helped to train a couple of Greek 
surgeons, [and] I'd been to Greece a number of times and given some 
lectures at the University of Thessaloniki. To get a degree there 
is a very ancient ritual , because you wear a long robe that looks 
like a monk's robe and has a picture of an angel on the side. The 
hat looks like a cardinal's hat. 



221 



Hughes: 
Gerbode: 



Hughes: 
Gerbode: 
Hughes: 
Gerbode: 



The Rene Leriche Prize, International Society of Surgery, 1973 

What about the Rene Leriche Prize? 

Every year the International Surgical Society makes an award to an 
individual who has made contributions in cardiac or vascular surgery. 
The selection is made by a committee. One year they gave it to 
me. 

On the basis of what aspect of your work? 

I think all the publications in cardiac and vascular surgery. 

Who was Rene Leriche? 

Rene Leriche was a famous French surgeon who did not grow up in 
Paris. This became a disadvantage for him later in life, because 
in order to become a professor or the head of a department in Paris 
you have to really grow up in the system in Paris. When some people 
wanted him to become chairman of the department in Paris, it was 
stopped, I think, on the basis that he came from Strasbourg or 
somewhere outside of Paris. But he wrote very good papers on 
vascular disease. 

There is one syndrome called the Leriche Syndrome, and that is 
thrombotic and arteriosclerotic occlusion of the abdominal aorta. 
[It] occurs mainly in middle aged people, middle aged men more than 
women, although women can get it. The basis is mainly arteriosclerosis 
of the abdominal aorta. The syndrome is associated with weakness, 
tiredness and coldness of the legs and reduced sexual capacity 
because the blood suppy to the genital organs is decreased as well 
as to the legs. So men cannot have a proper erection and can't 
sustain an erection. The nerves to the genital organs are affected, 
too, from ischemia. 

[interruption] 



Alexis Carrel 



Hughes: Talking about Leriche made me think of Alexis Carrel, who had done 
some very early vascular work in France and then later at the 
Rockefeller Institute. Was there any association between them? 



Gerbode: No. 



222 



Hughes: Was it just coincidence that those two pioneers were French? 

Gerbode: I think Alexis Carrel really didn't orginate the vascular surgery 

techniques that he applied at the Rockefeller Institute. I think he 
saw other French surgeons using them. But anyway, he transplanted 
organs and kept them alive with vascular suture. For example, he 
transplanted a heart into the neck of a dog and it stayed alive for 
a while. He demonstrated that you could sew arteries together and 
that they would heal. This work plus a number of other things such 
as tissue culture techniques is what gave him a Nobel Prize. 

Now, the curious thing is, you see, that this was in [1912]. 
It really took one whole generation for this concept to be applied 
on a broad basis. This is generally true that it takes twenty 
years for an idea to become widely accepted and adopted. It was 
certainly true of the heart-lung machine that Jack Gibbon started 
working on before the war in Boston. It took twenty years for that 
to get on the road. 

Hughes: Is it mainly changing people's points of view? 

Gerbode: I don't really know what the reason is. As somebody said, the 

future belongs to the people who see things around them that can be 
utilized right away. The thing is we don't really accept them or 
use them, but they're all around us. 



The British Order of St. John of Jerusalem, 1956; Knight, 1978 



Hughes : 



Gerbode: 



I'm looking at the honors again. 
Jerusalem. 



The British Order of St. John of 



This is the oldest order of chivalry in the British Empire and goes 
back to the Knights of Malta. The Knights of Malta were the ones 
who fought against the infidels in the Middle East. They were 
trying to get the Holy Grail out of the Middle East and they were 
also fighting against the Mohammedans. It was a big thing for a 
wealthy young man in England or Germany or France or Italy to become 
a knight and go and fight this war against the non-Christians. The 
Knights of Malta were from all these various countries. It was 
mainly a Catholic organization. Henry VIII stopped the Catholicism, 
including the English chapter of the Knights of Malta. There are 
Knights of Malta in France, Italy and Germany. Finally the British 
reestablished the Knights of Malta on a non-Catholic basis. It 



223 



Gerbode: was more or less put into the hands of the Church of England. So 
there is an association between the various countries that have 
the Knights of Malta, but it's a rather loose association. 

They decided some many years ago to have an American chapter. 
They had ones in Canada and Australia, too. They first make you a 
brother officer, which is the lowest in the echelon, and then 
finally you get elevated to something else, and then if you're a 
very, very good boy or good girl you become a knight. The women 
become dames. 

Hughes: Is it for any good work in any field of endeavor? 

Gerbode: I think in any field of endeavor, poetry, business, diplomacy, 

medicine, science. Anyway, I was made a brother officer in New York 

about ten years ago. You see the big [emblem] [referring to a 
photograph] on the sleeve? 

Hughes: Yes. That's impressive. 

Gerbode: Four years ago they made me a knight here. They sent out the 

head of the order from England to go through the formalities with 
the sword and the robes . In northern California I guess there are 
three or four other knights. 

They have an annual meeting in London which is quite an affair. 
You meet in the Old Priory Church and have a high Church of England 
ceremony. Then you have a typical English breakfast afterwards. 
Then you go to the Town Hall in London. There they discuss what 
the various chapters have done throughout the world. They maintain 
an ophthalmic hospital in Jerusalem, which is a very good one. 
Then they all go to St. Paul's Cathedral. You line up in the order 
of the degree of your appointment. The English and Scotch knights 
are in the front of the procession. The other knights are behind 
them, depending on the country they're from and whether they're 
knights of English descent or not. 

They have silver and gold robes, and the gold robes with the 
golden insignia mean that your family came from England or Scotland. 
The silver ones mean that your family did not come from England or 
Scotland. I could get in on the gold thing if I really wanted to, 
because I had an English grandmother, but I don't think it's worth 
going through the nonsense. 

At any rate, everybody lines up in St. Paul's Cathedral. The 
order runs the ambulance service in England. They're always out in 
mass quantities for parades and coronations, and they pick up all 



Gerbode : 



Hughes: 



224 



the fainting people on the street, and they maintain law and order. 
They train people in ambulance services and first aid. They do a 
really good job. Many members are present at this annual meeting 
in London. Then the most exciting thing is seeing all the little 
children who are junior members and who are taking first aid. They 
have uniforms, like Girl Scouts, and they're all in the back of 
the church, their eyes fairly popping out of their heads to see all 
these berobed gentlemen with all these insignia. They love it. 



And you do , too . 
dearest? 



[laughter] Which of these many honors do you hold 



Gerbode: I guess I like the English ones the best because I've spent so much 
time there and have so many friends there. 



Service on Editorial Boards//// 
[Interview 9: September 19, 1983] 



Hughes: Dr. Gerbode, you are on several editorial boards, and perhaps I 

should read them for the record. The Annals of Surgery, the Review 
of Surgery, the Annales de Surgerie Thoracique et Cardio-vasculaire , 
the Journal of Cardiovascular Surgery, and Surgery in Italy. Can 
you tell me how those appointments came about? 

Gerbode: I think the most important one on the list is the Annals of Surgery. 
I was appointed to the editorial board by John Gibbon, who was a 
friend of mine and also was the creator of the first heart-lung 
machine. Being on an editorial board means that you review and 
criticize manuscripts before they're published and vote in favor 
or not in favor of having them published. Sometimes they're 
reviewed and then sent back for revision. With regard to the Annals 
editorial board, I suppose on an average we reviewed about two or 
three manuscripts a week. Now the load is less because we have a 
larger board, and perhaps they're taking some pity on me and not 
sending me as many as they used to. But in any event, it's been 
very interesting, because you really have to know the field pretty 
well. Sometimes you have to look up the literature to confirm 
whether the new manuscript is really contributing anything [new]. 
Knowing the people in various academic centers is important, too, 
because if the author is a reliable person, it's very likely that 
what he's written is going to be reliable. 

We have an annual meeting of the Annals of Surgery during the 
meeting of the American Surgical Association. Usually a luncheon is 
put on by the publishers, which is Lippincott and Company, and it's 
very well attended, and a nice event. I've always brought up the 



225 



Gerbode: rather mean subject of Lippincott Company not making a contribution 
to the American Surgical Association for a fellowship or some sort 
of reward, because I know they make a fair amount of money from 
that journal, and none of the editors are paid anything, nor do 
they want to be paid. But some of the other organizations, like 
the American Association for Thoracic Surgery, publishes in the 
Journal of Thoracic and Cardiovascular Surgery, which is owned by 
another company. They give the AATS a fairly large contribution 
every year, sometimes as much as fifty thousand dollars. I know 
that Lippincott could easily match that if they wanted to, but thejr 
never have. I guess I shouldn't bring this up any more at meetings, 
because it makes me rather unpopular with the publishers. I 
don't think any of the editors want any money, but they would like 
to have some contribution to education or fellowships or something 
like that. 

Hughes: Do you remember when the Annals was founded? 

Gerbode: The Annals of Surgery has been founded for probably a hundred years. 

Hughes: Is an editor chosen on the basis of his prominence in the field? 

Gerbode: I think he's chosen because people know he is a conscientious 

person and is knowledgeable about surgery in general and about 
his own specialty. But he's also known for being punctual and 
doing a good job in various contexts. 

[interruption] 

Gerbode: Some of the other boards I've been on don't require very much work. 
Periodically a manuscript will come frora the chief editor for 
review. It's usually something which is slightly controversial, 
and then an editor, such as I've been, would be an arbiter between 
the various positions. It's been interesting to do these jobs, and 
it's nice to read material before it's in print, too. 

Hughes: Does the editor send you papers that are: roughly in your field? 

Gerbode: Sometimes, but when you're chosen to be one of these editors, 
you're supposed to be knowledgeable about the whole field of 
surgery, so the bulk of material is general surgery. Some specialty 
work comes through. 

Hughes: What is the exact procedure? 

Gerbode: Usually the paper is sent to two or three sub-editors, and each one 
reads the paper, makes comments, and advises the main editor whether 
or not he thinks it should be published, and gives it a rating from 



226 



Gerbode: one to five. Sometimes you can suggest that something be published 
immediately, because it's so good and so pertinent. So you can 
write a priority publishing note on a manuscript, which means they'll 
probably turn it out in the next issue. Sometimes manuscripts get 
bounced around between editors , because they want to review and 
revise them, and sometimes a sub-editor will say he can't really 
decide whether to have it published or not, and he'll leave it up 
to the main editor to decide. 

Hughes: How is consensus reached amongst the sub-editors? 

Gerbode: The main editor will look over the criticisms and remarks of the 
sub-editors, and make up his own mind. It's curious how close 
the agreements usually are. We get the comments back from 
everything we've reviewed, and it's very common to see that all 
the sub-editors will say the same thing about the paper. 

Hughes: Is there much difference in outlook amongst these various journals? 

Gerbode: I think there's prestige connected with publishing in some of these 
journals. Annals of Surgery has a lot of prestige, because it's 
been so good and [is] so old, being founded in 1885. So if somebody 
who has something they want to publish, and have it be presented 
to the general surgical public in a very flattering way, he would 
try to get it published in Annals . It's very easy to publish in 
some journals, and very hard to publish in others. 

Hughes: So Annals is 

Gerbode: It's one of the very best. The Journal of Surgery is very good, too. 
We have a new journal called the World Journal of Surgery, which 
some of us got started with the International Surgical Society.* 
That's turning out to be quite a good journal, too. 

Hughes: You're not connected with the editing of that particular journal? 
Gerbode: No, I'm not. 

Hughes: Is there a story behind the appointments to the other journals that 
I mentioned? 

Gerbode: I don't think so. Some of these appointments are made on a regionel 
basis. In other words, they try to have editors in various parts 
of the country. I guess I've been appointed in some instances 
because I live in San Francisco when they wanted to have a West 
Coast editor or a northern California editor. 



*See discussion on p. 209. 



227 



Affiliations with Medical Institutions in the Bay Area 



Hughes: Hospital affiliations. 

Gerbode: I've not tried to be on a lot of hospital staffs, because I never 
have liked operating in a number of different hospitals. I have 
really only operated in two private hospitals, Children's Hospital 
and the old Stanford Hospital, which is now Presbyterian. I have 
[also] operated quite a lot at the Oakland Naval Hospital and 
Letterman Army in San Francisco. 

Hughes: Why don't you like to operate in other hospitals? 

Gerbode: I don't like to operate on a patient and not be able to see the 
patient the same day or follow the patient closely. The big 
advantage in operating in the old Stanford Hospital was that I was 
there all day long, so if I operated upon somebody, I could go see 
them quickly and easily. If you have an office downtown and 
something happens with your patient in a hospital, then you have to 
get somebody else to look in quickly or hop in a car and try to 
get there yourself. I've never liked that very much. 

Hughes: So you'd really rather follow a patient through all the way in 
your own hospital? 



Children's Hospital, San Francisco 



Gerbode: Yes. I did some work at Children's Hospital, because they wanted 

to start a heart program. This was particularly true when Dr. Holman 
retired from the chair and wanted to get out of Stanford Hospital and 
do some closed heart surgery at Children's Hospital. I helped him 
get started by getting instruments for them and more or less 
telling them what was required to do the work. I did a few cases 
over there, too. But my main affiliation always has been with 
the old Stanford Hospital. 



Oak Knoll Naval Hospital, Oakland 



Gerbode: I operated at the Oak Knoll Naval Hospital, particularly during the 
Korean War. They had a lot of casualties coming back, particularly 
among the Marines, and I went over there at least once a week and 



228 



Gerbode: helped the chief surgeons operate on some of those patients. Some 
were vascular cases and some were chest cases. And I rather liked 
that , because I felt that I was needed and I could make a 
contribution. 

Hughes: Does the surgical staff in that case welcome you with open arms? 

Gerbode: Oh yes. They like to have a civilian consultant come in. I did 

the same thing later at Letterman Army Hospital. When they wanted 
to start a vascular and thoracic program, I was one of their 
consultants, and so I spent a lot of time with their chief surgeons, 
getting them started in these various procedures, helping them do 
them. The army appreciated this very much, and for that reason, 
and perhaps some other reasons, they gave me a Distinguished 
Civilian Service Award. They credited me with getting their 
thoracic surgery program started. The other person who helped a 
lot was Paul Samson from Oakland. The two of us really put together 
their thoracic and cardiovascular program. 



The University of California, San Francisco 



Hughes: 



Gerbode: 



Hughes: 
Gerbode : 



In 1965 you became an associate surgeon at UCSF. 
something about that appointment? 



Could you say 



When Stanford decided to move, which was 1959, we had a very 
vigorous open heart surgical team going, and were making pretty good 
contributions. There were several hospitals and groups in the 
Bay Area who thought maybe the old Stanford campus [in San Francisco] 
would be closed. So they offered me and my unit an opportunity to 
move. Several delegations from UC San Francisco came to see me 
about making me a professor there and giving me the opportunity to 
run their heart program. 

Did they not have much of a heart program at that stage? 

They had one, which I won't mention too much about that, but they 
were not particularly satisfied with it. I don't know whether they 
were justified in their position or not. But that was why they 
came to see me. 

I also had a delegation from Mt. Zion Hospital with the same 
idea in mind, and also from Children's Hospital. The Children's 
Hospital approach was rather funny, because before they asked me to 
become head of their open heart surgery program, the trustees had 



229 



Gerbode: decided that we would give our obstetrical service and pediatric 
service entirely to Children's Hospital, and they would send all 
their heart patients to us. This was a fair trade, because they 
didn't have any heart program that amounted to anything, although 
they tried later, rather unsuccessfully, to get one going. But a 
few days after the trustees had decided this, the chief of staff, 
whose name I won't mention, called on me at home, wanted to know 
if I would come and start a heart program at Children's Hospital, 
entirely ignoring the decision of the trustees. 

Hughes: That's interesting. 

Gerbode: Well, it is. It's kind of funny that they thought, well, it's 
nice for the trustees to make these decisions, but we don't 
necessarily have to follow their suggestions or decisions. 

Hughes: Did you look twice at any of these? 

Gerbode: No, I didn't. If I'd gone to UC, I would have gone into a hornet's 

nest. It's such a big campus, and there are so many forces that play 
up there, and I knew so many people personally, that I would have 
had a hard time cleaning house and getting anything set correctly, 
and I didn't want to do that. 

Hughes: Did the various contingents that came to you from UC imply that 
there was considerable division within that department? 

Gerbode: Yes. They weren't satisfied with the way it was going. I guess 
they wanted to have somebody come in who could make decisions and 
push it forward. I could have done it, but I would have made 
enemies, too. 

The same thing happened, of course, at Stanford. They sent 
several delegations to get me to move to Palo Alto, either to be 
professor of surgery in the department or a chief of cardiovascular 
surgery, or even to be a dean. 

Hughes: Do you care to say anything about some of the individuals in 

cardiovascular surgery at UC? I'm thinking of people like Paul 
Ebert and Benson Roe. 

Gerbode: Paul Ebert has been very recent. He caiie from New York just a 

matter of a few years ago and has done an excellent job. He's a 
very nice man, and I like him as a friend and as a surgeon. 



230 



Gerbode: I think Benson Roe was the chief of that department or division 
before [Ebert], but he was getting close to retirement age. I 
suppose that's why they wished to have a younger person come in. 

Hughes: Have you considered all along that that program was competitive 
with yours? 

Gerbode: It was terribly competitive when Stanford was up here, when we were 
getting started. Without bragging at all, we were quite a bit 
ahead of their department, because we didn't have departmental 
jealousies or other factors to interfere with us. We just had our 
own show and good people, and nobody was trying to interfere with 
our work. It makes a big difference. We had a good research 
program going as well, which was well funded, and this helped, too, 
to get our unit established sooner than theirs. 

Hughes: I'm hearing the theme throughout these interviews of how important 
it is to tie surgery in with research, and I was just wondering if 
there was an impact when the Institute of Medical Sciences was 
founded. 

Gerbode: I think when we got the Institute of Medical Sciences going, and a 
heart research institute within it, and it had very ample funding 
from NIH, this made a big difference, because we could then train 
people in various aspects of open heart surgery and postoperative 
care. We had money to develop machines and various paraphernalia 
that you need to invent or buy to make it go properly. UC didn't 
have that. 

Hughes: No, it didn't but when Julius Comroe came along and founded the 
Cardiovascular Research Institute, wasn't one of the motives for 
founding that institution to provide research that would be directly 
applied to heart problems? 

Gerbode: I don't know what the people had in mind when they brought Julius 
out to San Francisco. He wasn't particularly involved with 
cardiovascular surgery or surgery of congenital heart disease or 
even acquired heart disease. He mainly was interested in pulmonary 
physiology, and he was the leader in that field. Some of our 
people went over and took courses under him in pulmonary physiology. 
But Julius did not have the slightest notion of how to train a man 
in any residency sense. He was not interested in that kind of 
approach. 

Hughes: He had a more strict academic ? 



231 



Gerbode: He had a very strict basic research goal in mind, and he did it 
very well, and he had very good people working with him. 

Hughes: So as far as you know, that wasn't a jumping off place for 

Gerbode: I don't think it helped the heart program, as far as I can see. 

Indirectly I think some of the people who went over there and took 
courses under him helped us in our postoperative care, because they 
had some very good basic concepts, which Julius was teaching, that 
helped us understand pulmonary problems in. postoperative patients. 

Hughes: Did the department of surgery at UC have a strong research program? 

Gerbode: I don't know whether you could say it was very strong or not. They 
were doing research and had been for quite a while. But they 
weren't doing the kind of research that we were because they didn't 
have a big enough organization and funds to do it very effectively. 

Hughes: Do you think some of that could be attributed to the policy of the 
regents? 

Gerbode: No, I don't think so. These things go back to individuals and the 
chiefs of departments. The chiefs of the departments at that time 
were men who weren't very talented in doing research. I don't want 
to de-emphasize them or anything, but they were more or less 
clinically oriented. Some of the positions they took, for anyone 
wanting to push open heart surgery forward, [must] have been quite 
frustrating. 

Hughes: UC did not have a strong tradition of medical research, certainly 

in comparison to Stanford. I believe it was well after World War II 
that medical research was emphasized, and some of that was because 
people holding positions there were in private practice. They were 
taking care of patients; there wasn't a place in their lives for 
the research lab. Whereas Stanford, from what you've said, had 
always honored the research tradition. 

Gerbode: Dr. Holman, my chief, was very strongly oriented toward research, 
and he helped young people do work in the laboratory. He was not 
very good at raising money for them. He didn't seem to think that 
that was terribly essential. You can do a lot with a little bit 
of money, if you have a good laboratory. What he didn't do in fund 
raising for the lab, he did in actual work himself. Even in the 
last few years [of his life] he was doing some research in the 
animal laboratory. 



232 



Hughes: Have you recognized all along the importance of the fund raising 
aspect of research? 

Gerbode: You can't do anything in medicine without money. The way you 

get money is by publishing good papers and having good people work 
with you. I recognized this as being an essential aspect from the 
very beginning. Every fellow that came to me had a research 
problem, and they knew when they came here they were going to have 
to do research. I didn't tell them what kind of research they were 
supposed to do. I said, "You have three months to make up your mind 
what you want to do, but I want you to have a research program 
during your fellowship , and I want you to do something that you 
like to do." 

Hughes: You didn't try to be selective about what that research was? 

Gerbode: I had only to say that it would have to fit in with what the 

department was doing, but I didn't tell anybody they had to do one 
thing or another. Some of them did research on certain aspects of 
the use of heart-lung machines. Some people studied anatomical 
[problems]. I would say in general the animal laboratory was the 
basis for most of the research these young men did. 

Hughes: The umbrella was something to do with the cardiovascular system? 

Gerbode: The umbrella was the cardiovascular system or lungs. 

Hughes: Getting back to the appointment at UCSF, what did you actually do? 

Gerbode: That's a good question. Well, I didn't do very much. The only thing 
I really did up there was sit on a couple of committees which were 
involved with decision-making about involvement with the government 
in various programs. I was on a couple of committees which met 
periodically to thrash out whether to join these programs or not, 
and I must say, it was a lot of wasted time. I went there because 
I felt that the old Stanford people should be counted in the decision- 
making. But actually the decisions that were made were not very 
effective, and it didn't really matter in the end. 

Hughes: It seems unusual to have a person such as yourself, who must have 

been looked upon as a competitor, being included in policy decisions. 

Gerbode: Yes, I suppose some people didn't like that. But on the other hand, 
I think they recognized that I'm pretty fair-minded, and I suppose 
they would assume that if anybody from the outside were going to 
come in there and help them make a decision, that they ought to get 
somebody who wasn't too prejudiced. 



233 



Hughes: I imagine the fact that you had been such a successful money-raiser 
for your own institution also was impressive, was it not? 

Gerbode: I guess that counted to a certain extent, 
[interruption] 

Gerbode: I have one strong feeling about UC, which I've said to some regents 
and some of their higher staff for years. I've felt all along that 
UC is physically in the wrong part of town. The reason they're up 
there is because they got a little gift of land and the Hooper 
Laboratory, which are on the side of a hill, and they were so happy 
about getting it for nothing that they built everything else 
around it at great cost. It's terribly expensive to build on that 
ledge up there. Furthermore, I've said all along that it's the 
wrong place for sick people to have to go , because there's only one 
bus line. It's not in any stream of traffic anywhere. It's very 
difficult for people to get there, both staff and patients. I had 
several long talks with [John B. de C.M. ] Saunders, who was then 
chancellor, about this subject. In fact, he came and talked to me 
about it at one point. I said I thought they ought not to abandon 
that whole center up there, but de-emphasize it and build a whole 
new center [in] Japantown. It was relatively cheap, because it was 
low-cost housing. There is ready access from various directions, 
and good transportation facilities. 



Gerbode: [Saunders] felt that the students at UC were not getting as good 

bedside teaching as they should be getting. I don't know why he felt 
that. He actually thought of starting a whole new campus somewhere 
else, which I felt, too, would be a good long term move. There 
were many parts of the Parnassus site which could be used for other 
medical aspects. 

Hughes: He didn't have a location in mind? 

Gerbode: He thought this Japan Center idea was a good one. But of course the 
politics involved with anything like that are really terrific. 

Hughes: What would be the argument for staying at Parnassus? 

Gerbode: Because they'd already put millions into the place. It's just like 

pourirg good money after bad. The money comes from the state treasury 
so it's easier to get. If they had to survive on that edge up there 
on the basis of private support, they'd never make it. I think it's 
a very bad place geographically for a big medical center. They have 
to build vertically, and the parking's terrible. 



234 



Hughes: Did anybody listen to you? 

Gerbode: They listened to me, but then they didn't do anything about it. 

Hughes: Did you speak to the regents informally? You didn't actually appear 
before the board, did you? 

Gerbode: No, just informally. 
Hughes: You happened to know ? 

Gerbode: I knew one regent who was very important, and I talked to him quite 
a bit at some length about this. He used to show me the budgets of 
the UC Medical School and ask me to comment on the budget requests, 
which I thought was probably not very [proper] to do. But I didn't 
have much to suggest about their budgets. 

Hughes: Those seemed to be in line? 

Gerbode: They were all right. The hospital and the medical school should be 
down where people could get to it, as they have it in Houston. They 
decided in Houston, wisely, that they would put all their big 
institutions on a campus. So their hospitals are fairly close to 
each other, and the medical school is close to the hospitals. Every 
thing is flat so you can drive there easily and buses can get 
there easily. None of these things can happen up on Parnassus. 

Hughes: There has been a longstanding controversy about whether the campus 
should be at Berkeley. 

Gerbode: I know about that. 

Hughes: Did you ever have any input into that? 

Gerbode: Oh, I heard discussions about it. But the clinical men in 
San Francisco were too powerful to let that happen. 

Hughes: They didn't want to give up their practices? 

Gerbode: They just didn't want to move to Berkeley. They didn't want to be 
close to the campus and the campus activities. You see, as soon as 
you move over there, then you have the professors of anatomy and 
biochemistry and all the other basic sciences looking down your 
throat, and they didn't like that idea. They wanted to be 
independent of that. So what finally happened is that they moved 
the various basic science departments to San Francisco. They did 
just the reverse. 



235 



Hughes: 
Gerbode: 

Hughes: 
Gerbode: 



Hughes: 



Gerbode: 



Hughes: 
Gerbode: 



Hughes: 



Gerbode; 



Yes, and that caused a lot of trauma, too. 

And that caused a lot of trauma, too. But actually the clinical 
men who were very powerful at that time were the ones who really 
swayed that. 

The rationale was that they didn't want to be too close to the 
basic scientists? 

They didn't want to be under close scrutiny. That's why some of the 
people didn't move to Palo Alto, too, when Stanford moved. This 
proved to be true, because there are people that went to Stanford, 
who still are very unhappy about the whole move and what happened. 

Yet from a purely academic standpoint, I should think that a close 
association between basic research people and applied scientists, 
if you want to call them that, could be very fruitful. 

It's always held to be very advisable. At Columbia in New York they 
put the physiologists and the biochemists right across the aisle from 
the chiefs of departments, thinking there would be cross-fertilization 
and free communication. They wouldn't even open the door to go 
across from one side of the building to the other. 

Why are people like that? 

I don't know. I don't know even at Stanford now whether the 
clinical departments really spend much time with the physiologists 
or the biochemists. I think they have their own programs, which 



are quite separate from the clinical programs, 
fertilize each other hardly at all. 



I don't think they 



You mentioned when we were talking about the institute, that there 
was some problems of the same nature here, in that the hospital 
people are not very good about attending lectures and seminars given 
by the research people of the institute. So that seems to be a 
common characteristic. 

It's a common characteristic. See, the people who finally emerge 
as the leaders in medical departments frequently are not research 
minded. In places where there are research departments, their 
institutions and their departments have gained tremendous stature. 
I'll give you one example. Duke University, where the professor of 
surgery is David Sabiston, has always had a very fine research 
program, in which his fellows and residents participate and publish 
papers. It's an outstanding department, and he's a very good clinical 
surgeon as well, so he didn't sacrifice anything by spending a lot of 



236 



Gerbode: time [on research]. In fact, his clinical program benefited 

enormously because of the research. But on our campus, the men 
in charge of clinical programs are completely without any back 
ground in research. 

Hughes: Do you think that goes back to a fault in their medical education? 

Gerbode: Well, I suppose you have to have the research bug in your craw 

somewhere along the line, and those who have too much of a research 
bug in their craw, sometimes are not considered as good clinically. 
So the rare combination of somebody who can do the research and 
has the desire to do it, and at the same time is a good clinician 
[is] the best, I think. 



The California State Board of Health 



Hughes: Another topic is the California State Board of Health. 

Gerbode: I suppose I got that [appointment] because of the Crippled Children's 
Program. We were the first in northern California to be approved 
by the Crippled Children's Program to do heart surgery in children. 
I can't quite remember, but I think they gave me an appointment on 
the State Board of Health to cover that aspect of it. 

Hughes: Does that mean that you had to have some state affiliation in order 
to receive funds from Crippled Children's? 

Gerbode: No. I think [it was] because the state was paying for the work, and 
they had to approve my unit to do the work. 

Hughes: So that was just a paper appointment? 
Gerbode : Yes . 



Visiting Professorships 



Hughes: The rather large topic of your visiting professorships. 

Gerbode: I found that very interesting, and I could talk about each one 
individually if you like. 

Hughes: Why don't you do that. 



Gerbode: 



237 



St. Bartholomew's Hospital, London, 1949 



My first real [foreign] exposure after the war was 1949, when 1 
went to St. Bartholomew's Hospital. 



Hughes: We have talked about that one in an earlier interview. 



The Royal North Shore Hospital, Melbourne, 1953 



Gerbode: Some of the other visiting professorships were in Australia. 
Hughes: One was in 1953 at the Royal North Shore Hospital. 

Gerbode: Yes, that came about because of Frank Rundle, who was then chief 
of surgery there, and he had worked with me in our experimental 
laboratory. He wanted to get research going in Australia on a 
full-time basis in these various institutions, so he invited me to 
come down there as a visiting professor. I gave lectures in 
Melbourne and some other places, and even one TV appearance 
suggesting that they ought to have full-time [academic] people 
there. In most of the medical schools in Australia at that time, 
the clinical positions were [held by] practicing physicians [who 
were] not very keen on research, in fact not very keen on modern 
teaching methods. But this has been vastly improved since then. 

Hughes: Was that the influence of the British system? 

Gerbode: I think quite a bit. They were copying the British consultant 

methods. But in any event, I went to the North Shore Hospital and 
gave lectures and made suggestions about their research program, 
helped Frank Rundle get a full-time clinical research unit started. 
He got it funded locally himself. He got some young people going, 
and they are now professors and running that clinical research unit. 
I had to do a certain number of operations. That was before open 
heart surgery had gotten started, so I did some closed heart 
surgery. Some of the patients I operated upon still correspond with 
me. 

Hughes: Had Frank Rundle, because he had been in your lab, already introduced 
the techniques that you were using? 

Gerbode: He was not a cardiac surgeon. He was mainly an idea man who put 
together concepts, and he finally became dean of the new medical 
school and put together a whole new medical school in Sydney. He 



238 



Hughes: was not very well liked by people, because he was rather blunt. 
But he got the job done. He was mainly a thyroid surgeon. That 
was his best operation. 

Hughes: So you had a lot of work to do to introduce the new surgical 
techniques that you were then very much developing. 

Gerbode: There were a certain lumber of closed heart techniques which we 
had been doing in San Francisco. It was relatively easy to 
demonstrate those. The people that were assisting me were good 
surgeons and nice people. 

Hughes: And receptive? 

Gerbode: They were very receptive. The chairman of the board of trustees 

was very kind to me and introduced me to people and listened to me. 
I think I may have made a contribution there. 

Hughes: When you did something like this, was it a setback as far as your 
own research interests were concerned? 

Gerbode: No, [the research] would keep on going, because there were young 
people [in San Francisco] working on the program. I was not gone 
for very long. 

Hughes: You didn't stay a whole year? 

Gerbode: No. I stayed almost a year in London. But that was before I had 
a big research program going involving a lot of different things. 
I didn't get that started until eight or nine years later. 



The Prince Henry Hospital, Sydney, 1963 



Gerbode: I went back to Australia [in 1963 to the Prince Henry Hospital]. 
At that time we had started our open heart surgery program, so I 
was invited down really to help them in open heart surgery. I took 
my chief nurse with me, Marilyn Blake, who is still the chief heart 
surgery nurse in the hospital. I had trained her first in our 
experimental laboratory. She and Nancy Nagareda came when we did 
our first dog surgery many years ago. They're both still there in 
the operating room. They're great. When operating with those girls, 
I didn't even need to ask for an instrument. It was always in my 
hand. They could look over and know what I was going to do next. 



239 



Hughes : Did you take your family? 

Gerbode: I took my wife. They put us up at a very nice little cottage on 

the campus. The other interesting thing about it, they assigned a 
pastry cook to cook pastries and bread, so everyday these huge 
quantities of cookies and cakes and bread would arrive, none of 
which I eat very much. We were constantly giving all this stuff 
away to various people in the hospital. 

Hughes: The cook was assigned just to you? 

Gerbode: Yes. It actually was very interesting to be at the Prince Henry 
Hospital. At one point during that experience, they invited all 
the heart surgeons from New Zealand and Australia to come to the 
hospital for a session on the status of heart surgery. At one 
point I was doing a blue baby operation, tetralogy of Fallot, before 
all this illustrious group. After I'd finished the repair on this 
little girl, there was one last thing I had to do, and that was to 
tie off a previous Blalock at the left subclavian artery, an 
anastomosis which had been done previously at a blue baby operation. 
As I tied this artery, the tie cut it off completely from the aorta, 
which caused an enormous flooding of blood all over the place, at 
which point the very kindly and sympathetic surgeons walked out, 
thinking that this was the end. But I put my finger over this place 
where the artery had been torn loose, and asked the engineer who had 
invented the heart-lung machine we were using, a man by the name 
of [Vivian R. ] Ebsary, who had become a millionaire after the war 
through his engineering work, if he could reduce the body temperature 
in this little girl. He said, "Yes, I can do that." So I said, 
"All right, you lower the body temperature down to about twenty 
degrees, and then I'll see if I can repair this thing." So he did, 
and in about twenty minutes or so he had the body temperature down 
to twenty degrees. 

Hughes: Your finger was still over the hole? 
Gerbode: Still over the hole. 

We turned off the machine entirely, and then there was just a 
little dribble of blood coming out of the hole, because there 
wasn't any pressure in it, and I was able to see it and sew it. I 
got the other end and tied that. Then we warmed her up again and 
started the machine, and in another twenty minutes or a half hour, 
the temperature was normal, and everything was dry. So then all the 
visiting firemen came back into the operating room. They were rather 
amazed that we had gotten out of this terrible situation. 



240 



Gerbode: Anyway, that little girl became a very accomplished pianist. She 
knitted me a sweater sometime after the operation and sent it to 
me. I used to hear from her. I think she's probably married and 
has a dozen children at this point. She's a very sweet girl, with 
a lovely mother. 



St. Thomas' Hospital, London, 1958 



Hughes: Then you went back to London in 1958 to St. Thomas' [Hospital]. 

Gerbode: Yes. John Kinmouth, who was a professor of surgery there, asked me 
to be a visiting professor. So I went back, and I did a few simple 
operations there and helped them try to get their open heart program 
going. They were still in the laboratory working with the machines, 
not on humans. I helped them a little in getting their machinery 
together and getting organized. But they didn't have anybody who 
could really take it on. John Kinmouth thought that he might like 
to do it, but then he really didn't have the time, being chairman of 
the department, to really work at it very seriously. 

Hughes: You mean the whole field of open heart surgery? 

Gerbode: Yes. So he confined his activities to peripheral vascular surgery, 
and it wasn't until later that one of our trainees, Mark Bainbridge, 
was invited to go there. He then took hold of the program, and now 
has one of the finest open heart programs in all of England. Mark 
has trained people. He's done excellent research. He's very highly 
thought of by the profession at large. And I'm godfather to one of 
his sons. 

Hughes: What sort of heart-lung machine was being used in 1958? 

Gerbode: At that time they were using one which we had invented, the so-called 
Bramson disk oxygenator. But later on everybody pretty much 
switched to bubble oxygenators, because they were cheaper and 
easier to put together and run. 

Hughes: If I remember correctly, there was a chap at the Hammersmith Hospital, 
whose name I've forgotten, working on a heart-lung machine? 

Gerbode: Yes, Dennis Melrose. He invented a machine which was like a 

washing machine in a sense. It had big baffles which thrashed blood 
around, and it was rather traumatic to blood. 



241 



Hughes: Melrose's machine was not being used at the Hammersmith? 

Gerbode: No. He introduced it to the continent, and it was used in East 

Europe by some units for a while. But when the bubble oxygenators 
came into being, they quickly switched to those. 

Hughes: How did it come to be that St. Thomas' unit picked up on your 
machine rather than Melrose's? 

Gerbode: Because we'd already demonstrated that ours was better. 



The Free University of West Berlin, 1960 



Hughes: In 1960 you were guest professor at the Free Thiversity of West 
Berlin. 

Gerbode: Yes. Professor [Fritz] Linder was the chairman of the department. 
That was a very interesting experience. They took good care of me. 
They gave Mrs. Gerbode and me a nice apartment in town and 
transportation to get around. I took Miss Blake over with me 
again to help with the operations. We made a lot of suggestions 
about how to inprove their sterile techniques. 

Hughes: Were theirs not; very good? 

Gerbode: They were in an old hospital, and it was difficult in many ways. But 
I think they accepted some of the things we suggested. I operated 
quite a bit there. They gave me the worst possible cases to do. 

Hughes: Can you say something about the state of heart surgery in West 
Germany? 

Gerbode: They were just starting it. They had a fellow running the machine 
who, as soon as I saw him operating, I knew was not going to be 
any good at all. He was an American, who kind of grew up in that 
department in West Berlin. But he was a very opinionated person and 
not very smart. I very quickly told the professor that he shouldn't 
be in charge of that part of the work. He was really quite 
dangerous. So he was, I think, sent back to America. I don't know 
what happened to him, but I hope he didn't try to run a heart-lung 
machine when he came back. 



242 



Gerbode: I gave a number of lectures there in English. At that time most 

of the Germans were not very good at English. Now, of course, they 
all speak good English, because English is the second language in 
most European schools. So they had to translate some of my 
little talks. They had simultaneous translation. But it was a 
very interesting experience to be there and to go into East Berlin, 
as we did a few times, to the opera and concerts and to see how 
the Russians in the Unter den Linden, which is their famous 
street, had built up the front of the buildings to look very 
impressive. But if you took the road in back of the buildings, they 
were pretty cheesy looking. 



The University of Heidelberg, 1964 



Hughes: Then another trip to Germany in 1964, to the University of Heidelberg. 

Gerbode: Yes. Professor Linder went to Heidelberg. It was a big decision 

on his part. I perhaps helped him make that decision as to whether 
he should stay in West Berlin they were promising him a new 
hospital or whether he should go to Heidelberg. I think Mrs. 
Linder wanted to stay in West Berlin. She rather liked it. But the 
challenge of being in Heidelberg, which of course is a famous old 
university, was a greater one, I felt, and I urged him to take it. 
I think he went there believing he could change the concept of the 
German professor, in the sense that the German professor was the 
only one who really had private patients. He could allocate some 
patients to somebody else in the department. The old German professor 
didn't allow anybody to rise up and be great under him. I think 
when Fritz went there he wanted to change that, and I think he did 
succeed. He retired from that chair just recently. I think he 
succeeded in having his assistants in various departments become 
prominent on their own without too much governance. 

Hughes: What were his feelings about the importance of research? 

Gerbode: He thought research was very important. He started some research 

there and got some of his young people to do research, but never on 
a very vast scale. Most of the contributions from that department 
were clinical contributions. 

Hughes: Was that true of German surgery as a whole, that it was not closely 
allied with research? 



243 



Gerbode: It was a slow transition after the war, because the Germans really 
were the first country in Europe after the war to realize that 
research was terribly important. So they allocated a fair amount 
of money for research to various university centers, and helped 
young people get started. And this still is true. I think anyone 
who has a good research concept in Germany can get funded, and also 
contributions in research are rewarded in the academic ladder, which 
is very important. They're following the Americans in this respect, 
because, as we mentioned before, one of the big rewards for research 
is to promote the person academically, give him a better position in 
the structure. 



The Karolinska Hospital, Stockholm, 1964 



Hughes: In 1964, the same year, you were a lecturer and surgeon at the 
Karolinska Hospital in Stockholm. 

Gerbode: Yes. They asked me to go there to be surgeon in residence in 

the most famous cardiac hospital in Sweden. I went there at the 
request of Professor Crafoord, who was one of the pioneers in 
cardiac surgery. I think he brought me there because he wanted to 
get my ideas about the treatment of tetralogy of Fallot. So I did 
some cases for him there. 

H 

Gerbode: My good friend Viking Olov Bjork was the assistant and was more or 
less in line to succeed Clarence Crafoord. He had to go back to 
become professor at Uppsala University first, which he did very 
successfully, and he always did great research. He always is doing 
some research and publishing. 

Hughes: Crafoord, of course, had a long research tradition. 

Gerbode: He had a long research background. He was one of the first to start 
experiments with an artificial heart-lung machine. They made a 
disk oxygenator, one of the very first, experimentally, and used 
it clinically some years after everybody else had gotten into the 
field. Even in 1949, when I went over there, they had a disk 
oxygenator they were experimenting with in dogs. They showed it to 
me in their lab. There were several other groups in Europe at the 
same time who were doing research on disk oxygenators. But 
anyway, the group in Stockholm was very kind to me and very 
hospitable. I gave a few talks, they put me up in a very nice 
accommodation, and gave me a very nice stipend to be there. 



244 



Gerbode: Going back to the Free University of West Berlin, when I went over 
there, I took a first-class ticket for me and my wife. They said, 
"We'll pay your transportation." So I submitted my bills for 
transportation to the bourse at the university, who is the 
treasurer of the university, and after I had been there a while, 
she said she wanted to talk to me about my expenses. So I went 
over to her office. She said, "I don't understand; we invited a 
professor of pediatrics over from Los Angeles around the same time, 
and his travel expenses are quite a bit less than yours." I said, 
"How did he travel?" She said, "I guess he traveled economy." 
I said, "The thing you have to remember is that surgeons always 
travel first-class." [laughter] She was so amused at that, she 
said, "Oh, that's fine." 

Hughes: I'd like to hear a little bit about Crafoord as an individual. 

Gerbode: Clarence Crafoord did the first coarctation in Europe and one of 
the first in the world at the same time that Bob Gross did one in 
Boston. He did other operations in the cardiovascular field, too, 
not open heart operations originally, but he did patent ductus 
procedures very early on, and did some closed mitral operations, too. 
But he was considered one of the great European pioneers, a world 
pioneer in cardiac surgery. He attended all the big meetings, 
always had something constructive and useful to say. I think he 
would probably consider me a friend. 

Hughes: Did you ever operate with him? 

Gerbode: Yes, when I went there as visiting surgeon at the Karolinska. He 
either scrubbed with me or was there in the operating room when I 
was operating. 

Hughes: Do you have any comments to make on his surgical technique? 

Gerbode: He was very meticulous as a surgeon. Extremely careful about 
detail. He had an operating nurse who worked with him called 
Sister Lisbet that is Elizabeth and she actually is still there 
in some capacity working with Viking Bjork. She came here a number 
of years ago on a leave of absence and passed her nurses' examination 
in the States, so she could come back here sometime if she wanted 
to and practice nursing. But she has never come back. 

Hughes: What was Crafoord like as an individual? 

Gerbode: Well, typical Swedish personality. A little brusque and rather 
opinionated about some things. He was well liked by people. 



245 



Hughes: Did he allow the young people in his department to have room to 
move ahead ? 

Gerbode: He brought two great surgeons forward. One of them was Ake Senning, 
who went to Zurich as the professor of surgery and has done an 
outstanding job there. And the other one was Viking Bjork. There 
were other [members of his team] who got lesser jobs in Sweden. 
He was one who sponsored young people, no question about it. 

Hughes: He was responsible for putting cardiovascular surgery on the map 
in Sweden, was he not? 

Gerbode: Oh yes, he certainly was. 

Hughes: Was he a revered name all over Europe? 

Gerbode: Yes, and in the world. He was always invited to speak or comment 
wherever he went to medical meetings. He's still living. You 
don't need to put this down anywhere, but he called me long distance 
about eight months ago and wanted me to quickly send my curriculum 
vitae to him. I don't know why. He wanted it by return mail for 
some reason. He wanted to propose me for something, I guess, 
which didn't materialize. [laughter] 

Hughes: Another deanship! 

Gerbode: No, I think he wanted to suggest that I be made a member of some 

organization, but apparently it didn't go through, because I haven't 
heard anything from him since. 



Duke University, Durham, North Carolina, 1973 



Hughes: We skip nine years, and then in 1973 you were guest professor of 
surgery at Duke. Was there a reason for the long interval? 

Gerbode: I was busy keeping the unit going and training young people. They 
were building a new hospital [at PMC] during that time, too. There 
was a lot of work with the architects and planning that needed 
doing. We were working a lot on postoperative care and the 
monitoring of patients during that time, because we had the first 
real computerized monitoring unit in the world. It took a lot of 
work to get that mounted properly. Jack Osborn and IBM's Jim Beaumont 
were in charge of that and did a fantastically good job. We also 



246 



Gerbode: had another fellow by the name of Bob Eberhart , who was a Ph.D. 
who worked very hard in that field and helped our program a good 
deal. He is a biomedical engineer and is now a professor in 
Texas. 

Hughes: Was the computer program off the ground when you were at the 
Karolinska? 

Gerbode: No. 

Hughes: What was the reason for the invitation from Duke? 

Gerbode: I guess Dave Sabiston had always had people he thought of value 

come there, because he had a very fine training program, and I guess 
he liked to have his young men [talk to] people who had done something 
that he considered valuable in the country. So I spent a lot of 
time with his residents, just talking about philosophy of surgery 
and why things were done and who did them, and what was important. 
I don't think I operated when I was there. I think I just talked 
and collaborated on some of the operations they were doing. 



The University of Alberta at Edmonton, 1974 



Hughes: The University of Alberta at Edmonton. 

Gerbode: John Callaghan was one of the first fellows I had in training, 

before we really got our open heart surgery program going. We'd 
done a lot of experimental work together before we had heart- 
lung machines. We did some things which now sound rather childish, 
but we worked very hard in the laboratory and did some cases in the 
early '50s. 

Hughes: Which kind? 

Gerbode: Open heart cases. Which were not very successful, I might say. 

He went up to Edmonton, became chief of cardiac surgery, and finally 
developed a very fine program. He's now retired, too. Then in 
1974 I went to Edmonton as his visiting professor. I didn't 
operate. I just lectured and observed his cases and talked to the 
residents. It was a very nice experience. They have a very fine 
medical school there. 

Hughes: Are the Canadians more akin to the American system of training than 
to the British? 



247 



Gerbode: Oh yes, absolutely. 

Hughes: We talked about your contributions to these various institutions 
when you were a guest; do you think you came away with anything 
from these experiences? 

Gerbode: You always gain something in one of these assignments. Attitudes, 
objectives make an impression on you. I don't think I learned too 
much from them about the technical aspects. But I learned some 
things not to do. 

Hughes: From seeing it demonstrated? 

Gerbode: Yes. In some institutions. 

Hughes: Do you have anything more to say about your guest professorships? 

Gerbode: No, I think we've covered that subject pretty well. 



248 



VII COMMENTS ON MEDICAL /SURGICAL TOPICS 
[Interview 10: September 27, 1983 ]## 



More on Research in the Surgical Laboratory of the Old Stanford 
Medical School 



Gerbode: One of the great assets of the old Stanford Medical School on Clay 
and Webster Streets was the surgical lab, which had been developed 
by Dr. Holman and Dr. Reichert. We usually had fifteen or twenty 
animals for experimental surgery and research. I was granted 
the privilege of having a small room in the laboratory during my 
assistant residency, and later I spent virtually a whole year doing 
surgical research in the old laboratory. It was a dirty place, 
filled with cockroaches and ticks and whatnot. It was virtually 
impossible to eliminate this hoard of invaders because of the age 
of the building. They had gone under the rugs and in the walls 
and, although they had exterminators there on a regular basis, all 
they could do was keep down the population to a certain extent. 

However, the spirit in the laboratory was great, and a great 
many of my fellows, and of course Dr. Holman and Dr. Reichert, were 
constantly doing research on animals. We were never really 
bothered by the antivivisectionists, although a couple of times 
they tried to send spies up to see if they could find something to 
complain about. But they were spotted and ushered out of the 
place quite quickly. 

In any event, the first experimental work I did was with Dr. 
Reichert in studying a rare inflammatory disease of the bowel. This 
work was published sometime later. Dr. Reichert taught me the 
necessity for accuracy and the value of good observations. After 
the war, the first thing I did was try to find a little place in 
the lab to work. The little room which I had lined with plywood 



249 



Gerbode: was occupied by a dermatologist. I quickly escorted him out of 
the place, since he was not there legally, and I needed to have 
a place myself. Furthermore, he wasn't doing any research. 

So I set up shop again and started doing animal work, the 
other reason being that I had no patients. The clinical work had 
long since vanished with having been away for three and a half 
years. In fact, those of us who'd been away at war were invited 
to go to the outpatient clinic and help with the minor surgery and 
with the students. Eventually we were put on the consulting staff 
in the hospital, so that we could work with residents. But this 
took a while. 



Experimentally- induced Cyanosis 



Gerbode: Meanwhile I started doing experiments on the heart and made some 
dogs cyanotic, which was the second time this had been done 
historically, and published a few papers on this work. 

Hughes: How did you do that? 

Gerbode: We transferred the inferior vena cava from the right to the 'left 
side. It's kind of a tricky operation, and there weren't many 
survivors, but the few that did survive were very cyanotic and 
developed all the signs of chronic cyanosis. 

Hughes: You were interested in the cyanosis rather than the transplantation 
of the vessels? 



Gerbode: There were certain congenital anomalies which could be corrected if 
you could move the major vessels from one side of the heart to the 
other. This proved to be true later, when there were several 
operations to correct cyanosis in children which were based upon 
moving the major vessels from one side of the heart to the other. 
This little work which I did after the war was cited rather 
extensively by the Swedes when they gave me an honorary degree. I 
never thought they would dig that up as an important contribution. 



250 



The Heart-Lung Machine 



Gerbode: 



Hughes : 
Gerbode : 



Hughes: 
Gerbode: 



This work went on, and soon afterwards it became apparent that a 
heart-lung machine would be the thing we should work on, so that 
we began to assemble the gear necessary to do work with the use 
of a heart-lung machine. My good friend Jack Gibbon in Philadelphia, 
who is the father of the heart-lung machine, gave me our first pump, 
which he took off his shelf in his experimental laboratory. This 
was a roller pump. Later on, after developing a machine which 
worked experimentally, we used that pump on quite a few clinical 
cases. 

We had a visitor, a very important faculty member, chief of 
surgery, University of California, during this early stage. He 
was curious to see what we were doing about this machine. He shook 
his head rather dubiously about the whole effort. Subsequently 
another member of the University of California faculty came over 
and said that he didn't think that this was going to be nearly as 
good as using deep hypothermia, because of the fact that we used 
so much blood. Well, we have used a great deal of blood in this 
work, but not as much as we did originally, and blood is not the 
factor anyway. 



What was the problem with using so much blood? 

Filling the heart-lung machine with the blood to prime it, and 
replacing the blood lost during the operation and postoperatively. 
However, we were not deterred by this. At this time I got Mr. 
Bramson to come with us, because I felt that George Clowes 
[pronounced clues] had shown that a membrane oxygenator was a 
satisfactory type of oxygenator, and I wanted Mr. Bramson to work 
with us to develop [it]. 



Where was Clowes working? 

He was working at that time at Cleveland, 
sailor and a good friend of mine. 



Incidentally, he's a great 



In any event , Bram started to work with us to develop an 
oxygenator, and eventually, after a couple of years, he developed 
a disk type of oxygenator which I used in about three hundred cases. 
It proved to be difficult, however, for various reasons, and wasn't 
the ideal solution to the problem. 

Did I say something about this before? 



251 



Hughes: You did, but I have a question. You realized quite soon that the 

disk oxygenator was not the optimal machine, but I believe you said 
that until the membrane oxygenator was ready, that you were prepared 
to use 

Gerbode: We had to use something, because the patients were there and needing 
operations, so we had to use whatever we could get. 

Hughes: How many years did that go on, do you think? 
Gerbode: About three or four years, I guess. 



Norman Shumway: Cold Arrest of the Heart and Heart Transplantation 



Gerbode: At the same time we were working on the heart-lung machine, Norm 
Shumway came into the laboratory. He had been in Minneapolis and 
had moved to California, believing that he might find a place 
somewhere. Dr. Holman gave him a spot in the laboratory to work. 
He started doing animal experimentation, and worked mainly on two 
things, cold arrest of the heart for open heart surgery, which is a 
technique which was used extensively and then subsequently was 
used in combination with cold cardioplegia by injecting potassium 
solutions into the base of the aorta to stop the heart. Norm did 
not believe this was as good as it has turned out to be. He 
thought that he could do just as well with bathing the heart in ice 
slush. But most people now use ice slush and cold arrest of the 
heart by injecting cold solutions containing potassium into the base 
of the aorta and prof using the heart through the coronaries. 

The other thing that Norm started working on was cardiac 
transplantation. He had Richard Lower with him. Richard Lower now 
is a professor of surgery on the East Coast and a very good one. 

Hughes: Now, was heart transplantation in the wind by this time? 

Gerbode: No, I'm not aware of it being a big item in any of the other 
laboratories. 

Hughes: This is the early fifties? 

Gerbode: Late fifties. So watching Norm, I could see that it was technically 
feasible to transplant the dog's heart, but the survival rate was 
extremely low, because the heart was always rejected. So I told 



252 



Gerbode: Norm it was a great idea and a great thing to do, but I really 

thought that it wouldn't work until the rejection phenomenon was 
controlled one way or the other. This proved to be only partially 
true. It's been shown repeatedly by surgeons that if they demonstrate 
the feasibility technically of doing a procedure, then other people 
come in to show that they can back this up. For example, when 
Dr. Blalock did the first blue baby operation, he showed that you 
could operate on blue babies and make them better, and a whole host 
of cardiologists arose out of almost nowhere, and got interested 
in the diagnosis of cyanotic heart disease in children. It became 
a specialty overnight because of that. 

The same thing is true of Jack Gibbon. When he demonstrated 
the feasibility of using the heart-lung machine, there was a great 
flurry of activity everywhere to produce another type of heart-lung 
machine that was simpler than the one he had devised. 

Hughes: Isn't it true that there was quite a bit of transplantation going 
on before many inroads had been made in the understanding of 
rejection? 

Gerbode: Yes. The thing that they tried to do, and still do, is tissue 

typing. In other words, the closer you get to matching the patient's 
tissue, the better the result is. This has been proven particularly 
in kidney transplants. But this wasn't the final answer. 

Hughes: Was tissue typing well developed when transplantation first began? 

Gerbode: No, it wasn't, but as soon as kidney transplants became feasible, 
then tissue typing became another speciality which arose from 
nowhere, you might say. Men developed laboratories to study this 
and apply the techniques to human organ transplantation. 

Hughes: There was a drug related component, too. 

Gerbode: The drugs came later. Of course, a great deal of research was done 

to find drugs that would control the immune reaction. So now we have 
several drugs which are being used. No drug, however is without 
its bad effects. You can't even take an aspirin without losing 
something. However, the pluses are much greater than the minuses. 

I must say that I was rather pessimistic about the outlook for 
cardiac transplantation. But Norm was extremely persistent and 
worked terribly hard, and finally, as everyone knows, did some 
cardiac transplantations at Stanford after the medical school moved. 



253 



Gerbode: The interesting story about Christiaan Barnard, who did the first 
heart transplant, is that he was visiting Lower's clinic on the 
East Coast and saw Lower doing cardiac transplantation in animals. 
He had actually gone there to study kidney transplantation, but when 
he saw Lower do the cardiac transplant in the animal, he said, "I'm 
going to try that when I get home." So he went back to South Africa 
and practiced on a few dogs, all of which I think, did not survive, 
but he finally did a cardiac transplant, the first in the world, 
very successfully. But the only reason he did it was that he had 
watched Lower do it and used the technique which Lower and Shumway 
had developed. 

This was extremely embarrassing to the research effort in the 
United States, and very quickly after Barnard did that cardiac 
transplantation successfully, a great deal of money was poured into 
research in this country. 

Hughes: Was that one-upmanship? 

Gerbode: Yes. It's like Australia winning the America Cup [in sailing]. Now 
there's going to be feverish activity to develop a boat to bring it 
back again. [laughter] Millions more dollars will be spent doing 
it. 



Hughes: But Barnard had some contact with Stanford as well, didn't he? 

Gerbode: Well, he did later on, but the first exposure was with Lower. Norm 
had not done any clinical cases up till that point. As soon as 
Barnard did one in fact, he did another one shortly afterwards 
then there was such excitement in the world that it made it a lot 
easier for Shumway to try it on humans, which he then did. And he 
began to be more successful than anybody. 

Hughes: And Lower did the same? 

Gerbode: Lower has done the same. Now cardiac transplantation is done in 
many centers in the world. 

Hughes: Were they using any immunosuppressant drugs? 

Gerbode: Not in the very beginning. One of our most vocal and widely 

publicized surgeons in the South said to me once, "There's no use 
trying to type these hearts or anything like that. Just transplant 
the heart. That's the only thing to do." Well, all of his patients 
died, every single one. He's the same person who said, "You don't 
need to protect the heart. Just clamp the aorta and do the operation. 



254 



Gerbode: Let the heart quiet down. You've just got to be fast." But 

then later on he described what is called the "stone heart," [which] 
is simply a heart that's been made dead from ischemia, in other 
words, rigor mortis of the heart. But he didn't recognize it as 
such. 

Hughes: Sounds like an unusual technique. 

Gerbode: Well, he's got a tremendous ego and he thinks he can say and do 
anything. Actually his approach has been very successful with 
doctors and [patients] , because his clinic is flooded with patients 
all the time. 

Hughes: Because of the bravado? 

Gerbode: Yes. And he's a good surgeon. 

Hughes: But I should think the mortality rate would put people off. 

Gerbode: It's not bad. 

Hughes: Now. 

Gerbode: Now [that] he's adopted everybody else's technique. 



Dieners 



Gerbode: 



Hughes: 
Gerbode: 



There was a fellow by the name of John Kratch, a German, who ran 
that surgical laboratory [at the Institutes of Medical Sciences] 
for years and years. He was just an absolute slave to the people 
who were doing the research there. He could set up almost any 
experiment for you. Later on he trained another Jewish German 
refugee by the name of Ludwig, and Ludwig carried on when John got 
too old. Ludwig was equally good. Ludwig then trained Madelaine 
Petillo, who is a fantastic French girl, and Don Toy, who is 
Chinese. Those two carried the laboratory spirit on until the 
early '70s with our new lab. 

Is it just chance that all these people are foreign? 

It's hard to find people to do this kind of work. We have Americans 
now doing experimental surgery in all these labs. 



Hughes: 
Gerbode: 



Hughes : 



Gerbode: 



255 



But in most cases these people merely set up the operation, 
didn't actually participate, did they? 



They 



In some cases [in other laboratories] they would conduct the 
experiment after it had been established. We didn't do it that 
way. We did all of our own experiments, but they would set up the 
animal and get the equipment ready and prepare blood if it were 
necessary. 

When the diener did the experimental work, would that be noted in 
the paper? 

Sometimes, sometimes not. It just depends on the person. We always 
used summer students in the laboratory, and some of them have gone 
on to have quite distinguished careers. A professor of surgery at 
Davis was one of our summer students. Actually Lower was a summer 
student, too, way back. We had another summer student with a degree 
in biomedical engineering from Stanford; he went to medical school 
at Cornell, and by the time he got established there he could do 
better research than the members of the regular department , so the 
professor gave him a lab. 



The Artificial Heart* 



Hughes: Would you comment on the artificial heart? 

Gerbode: The National Institutes of Health decided that there was going to 
be a great need for the artificial heart in the future, so they 
funded [seven or eight] centers to develop the artificial heart, 
either a left heart or a whole heart. The biggest funding went to 
Kolff in Salt Lake. A lot of the money was given to him because 
he'd done such a good job with developing artificial kidneys. 

Don Hill, who was then one of my assistants, got one of the 
grants to develop a left heart bypass which was [a device] to take 
over the work of the left heart when it was failing. He worked in 
the lab here in San Francisco with a company called Thorotek, and 
got to the point where they were doing pretty well with experimental 
animals. Then Thorotek, being a private company in which Dr. Hill 



*See the session recorded on 4/23/84, pp. 341-342. 



256 



Gerbode: was a major investor, wanted to do more testing privately and to 
use our laboratories. Well, quite a few of us didn't think [it] 
was a proper use of the laboratory for a private company to come 
in and use the lab for their own economic benefit. So they 
finally set up their own shop in Berkeley, and they now have a 
rather big lab over there where they do testing of various devices. 
I believe they still have a government contract to work on the left 
heart bypass. 

Hughes: How would a left heart bypass be used? 

Gerbode: It has to have the same arrangement that the artificial heart has 
at the present time. It's a pump activated by air or fluid, which 
squeezes a small chamber containing blood, like a small heart. You 
squeeze it from the outside and make it pump that way, and that 
synchronized with the electrocardiogram. But then it requires a 
tube coming out of the chest, which is the problem with the total 
heart as well, as was demonstrated by the man in Salt Lake [Barney 
Clark who received an artificial heart in 1983] . So the left heart 
bypass is conceived mainly to take over a failing left ventricle 
as a temporary adjunct, until that left heart recovers. It hasn't 
been used clinically very much. There are a few places that have 
tried it. 



Hughes: It's used in conjunction with the human heart. 

Gerbode: Yes, it's attached to the heart, and functions like a left heart. 

Hughes: In developing these devices, there seem to be two schools of thought, 
one school being the anatomical school, where the aim is to make 
the mechanical device as close to nature as possible , and the other 
school, which tries to make an efficient device, regardless of 
whether it mimics nature or not. In developing these artificial 
hearts, which way has it gone? 

Gerbode: The artificial heart is a combination of artificial valves, which 
usually are mechanical valves, although some use pig valves. The 
rest of the device is pure mechanics and electricity. 

Hughes: So it looks nothing like the human heart. 

Gerbode: It is like the human heart in that it is designed to pump the same 
amount of blood as the human heart would. It has to, to be a 
replacement. 

Hughes: Does that mean that each artificial heart has to be tailor-made 
to the individual recipient? 



257 



Gerbode: No. We know pretty well the spectrum of volume which the heart 
needs to pump for an adult. If you put a heart in within that 
sort of volume load or output, it'll work all right. 

Hughes: What do you think are the chances of developing an artificial 
heart that really will sustain life for many years? 

Gerbode: I think it will eventually come, but the main problem is how to keep 
it running without having a tube come out the chest wall. Of course 
they're trying to use nuclear energy to do this, but the heat exchange 
involved with this is something that hasn't been solved yet. 



Targeted vs. Basic Research* 



Hughes: You mentioned that NIH made a decision at some point to fund the 
artificial heart. How does NIH decide that now is the time to 
support some new procedure? 

Gerbode: They bring up various questions like this periodically. They 

usually have a panel of experts come to Washington; they sit around 
and discuss it, and they say, what is the most important thing we 
should be spending our money on in the country? [NIH] usually 
listen to the panel. Some of the conclusions are presented -to 
Congress. One of the best ways to get a certain kind of research 
started is to have a congressman or a president get one of these 
diseases. In the Kennedy family there was a child born with a 
mental disease, so when Kennedy was president there was a great deal 
more money put into research in mental health. When Eisenhower got 
a stroke, the same thing happened. They had to study arteriosclerosis 
more, so money was put into arteriosclerosis. And this happened 
when Lyndon Johnson got a coronary. No objection to that. You have 
to have some reason for doing something. 

Hughes: Some people object, though, to this extremely targeted research, 
I think on the principle that sometimes a very goal oriented type 
of funding isn't very successful. 

Gerbode: I think both have to be done. I think targeted research is necessary. 
I think pure research, which doesn't have a target but is involved 
with basic problems of biology, will periodically produce perhaps even 



*See the session recorded on 4/23/84, pp. 342-344. 



258 



Gerbode: greater things. But it takes a long time for it to rise to the 
surface. You take the whole business of antibiotics. After 
[Sir Alexander] Fleming discovered penicillin, there was enormous 
targeted research in antibiotics. Now we have dozens of antibiotics, 
all targeted research, but mainly done by drug companies, because 
there's so much money involved. 

fl 

Gerbode: Some big company or individual will profit by the research 

eventually. Eventually the public has to profit. Nobody will 
profit unless some good is being done. If somebody knows how to 
dig a better hole to find oil, he should be compensated for it. 
There always is an argument going on in higher circles about so- 
called basic research versus targeted research, but I think there's 
a great place for both. 

Our research at the present time in my institute is mainly 
concerned with immunology. We're targeting on the rejection 
phenomenon and on how to juggle the body's physiological reactions 
so that we can control the rejection phenomenon better. 

Hughes: And you chose that to target because of its importance? 

Gerbode: I chose it because there is a great deal of interest in immunology 
so there's money available to do the research, and I think it's 
one of the big frontiers. We also have the laboratories and the 
people who can do it. 

Hughes: Good reasons. 

Gerbode: There's no use our spending our present major effort on developing 
the heart-lung machine. There are things which we can use the 
heart-lung machine for in research which will add to our knowledge 
about other things. This is being done in various places in the 
world. 



Legal and Ethical Aspects of Medicine* 



The Legal Aspect 



Gerbode: Right now this country is litigiously minded, because we've got 
so many hungry lawyers who get vast sums of money for winning a 
case, that you have to explain every serious operation to the 



259 



Gerbode: patient and tell [him] this might happen, that might happen, and 
document the explanation. For example, here in San Francisco 
recently one of the heart surgeons was sued for over a million 
dollars and lost the suit because he didn't tell the patient that 
there might be a certain complication. The complication occurred, 
and he was sued. You can't, obviously, tell [paitients] every 
possible complication; otherwise nobody would want to have an 
operation. But you have to more or less cover the major ones. 

The whole question of the medical-legal aspects of the practice 
of medicine is a mess at the present time. No good surgeon can 
practice without being sued. 

Hughes: How recent a phenomenon is this? 

Gerbode: It's been developing for twenty years. The main thing is that 

contingency fee which lawyers get. They'll say, "Sure, we'll sue for 
a million dollars, and my fee is 40 percent of whatever we get, 
and you have to pay the expenses of everything as we go along." 
One of our famous laywers here in San Francisco has his wall 
decorated with facsimile copies of the checks he's received. Instead 
of hanging up trophys shot in Africa or something, he has framed 
copies of checks. he's received for medical malpractice. 

Hughes: How has this all affected innovative surgery? 

Gerbode: It makes medicine much more expensive, because you have to do so 
many tests to be sure somebody won't sue you because you haven't 
done a test. You take more xrays; you do more laboratory 
investigations. You have to be extremely careful if you're doing 
an operation that you don't do something that is even the slightest 
bit out of common practice. It's all right if it works, but if it 
doesn't work you're in trouble. 



The Ethical Aspect 



Hughes : 



Gerbode: 



I'm interested in the development of the various ethical procedures 
that now limit medical practice in virtually all fields. I was 
wondering if you could remember when things began to tighten up. 
Was it right after the war? 



Yes, soon after the war, I think, 
development. 



There's been a crescendo 



260 



Hughes: Were the Nuremberg trials something that the medical profession 
really took note of and said, we've got to adopt some of these 
regulations into our own practice? 

Gerbode: Well, we had to be more careful. That certainly is true. 

Hughes: But at that point [1946] it was really up to the individual. The 
government hadn't stepped in. 

Gerbode: That's right. This was up to the individual and the courts. 

Hughes: Prior to that it had been very much up to the individual physician 
how much or how little he informed the patient, is that not true? 

Gerbode: Right. In many instances they didn't inform [patients] very much 
of anything, and in Europe they still don't. In England, for 
example, the contingency fee for lawyers is against the law, and 
it's against the law in Canada, too. Therefore malpractice 
insurance is very low. So [if] the patient needs to have a stomach 
operation, he believes the doctor is going to do a good job, because 
he's in a good hospital and he's got a good name, but the doctor 
doesn't tell him everything that might happen. 

Hughes: In the prewar days were patient consent forms required? 
Gerbode: Not generally. 

Hughes: The whole structure of peer review and the labyrinthian contortions 
that the government now requires a physician to go through is a 
relatively recent development, is it not the late '60s? 

Gerbode: It developed in the '50s, too. 

Hughes: Do you remember what the provocation was? 

Gerbode: I think the provocation came because the lawyers found they could 
influence the juries to make favorable verdicts, and they worked 
very hard on it because they were making so much money from it. 



Malpractice Suits* 



Hughes: Have you ever been involved in a malpractice suit? 



*See the session recorded on 7/17/84, pp. 445-455, for an extensive 
discussion of malpractice and related issues, including the 
celebrated Salgo case. 



261 



Gerbode: Oh sure. I've never lost one, but I've been sued three times. A 
lot of people sue thinking that maybe you'll get scared and not 
want publicity and try to settle, just to avoid the difficulty of 
going to court. But if people want to sue me, they're in for a 
tough battle. [laughter] Two [suits] were dropped. Actually, 
they were really just nonsense suits to try to get me to settle. 

One suit, the Salgo case, we lost in the first round, a suit 
in which my involvement was simply to write a request for a 
procedure to be done. I didn't do the procedure. But during the 
procedure a bad result came about. The doctrine of res ipse loquator 
applied. In other words, the fact speaks for itself" It was a 
very fundamental suit, and it's a famous case. It was printed word 
for word in the Journal of the American Medical Association. It 
involved a question of residency training and writing orders and 
having residents do things by order. The appellate court threw 
the case out. They said it was nonsense. 

Hughes: Was the suit against you? 

Gerbode: Against me and Stanford University, the xray department, and several 
of the men who were working as residents at the time. 

Hughes: Who supposedly had not carried out their 

f 

Gerbode: They tried to find that [the residents] had done the test 

erroneously, but they did not do the test erroneously. It's just 
that the patient was so badly off that he had a bad result. 



The Legal Aspect (Continued) 



Hughes: I don't think patients in general are well-served by having such a 
lopsided system that seems to be so heavily in favor of the legal 
people. 

Gerbode: It's really bad. It interferes with everything you do everyday. 
You have to be so careful that you probably sometimes don't 
deliver the first-class medicine the patient should have. 

Hughes: It's not just the medical profession that's affected either; look 
at the hassle that the drug industry has to go through and the 
consequent cost of their products. 



262 



Gerbode: The whole product business is in a state of chaos because the lawyers 
found they could make pots of money, too, by suing people making 
instruments and devices. 

Hughes: How can the pendulum be forced back? 

Gerbode: I think if they just struck out the contingency fee, that would stop 
90 percent of it. But you know the reason they can't do it? Because 
all the judges and people involved are lawyers, too. 



Medical Ethics Committees 



Hughes: A quick question about medical ethics. Did you ever have any role, 
either on a national level or in the hospital here , in defining 
bioethical procedures? 

Gerbode: No, I didn't. I wasn't even on the committees. 
Hughes: Was that just chance? 

Gerbodes I suppose so. Most of these things were determined on a national 

level, and then you'd more or less follow the established protocols 
in your local hospital. 

Hughes: What is the procedure at Presbyterian? 

Gerbode : We advocate informed consent . In other words , we advocate that the 
medical or surgical doctor should explain to the patient the nature 
of his illness and what kind of treatment is planned or rendered, 
with the possibilities of complications. 

Hughes: So you don't have to make a presentation to a committee when you're 
starting off on a new procedure? 

Gerbode: Yes, you do. We have a committee to whom you have to submit any 
new device or radical new procedure. It is called the committee 
on human experimentation [and is] composed of doctors, research 
people, and trustees. It shouldn't be called that because it 
sounds bad. 

Hughes: They're all in-house people? 

Gerbode: In-house people, but one or two outsiders. Every hospital has one 
of these committees now. 



263 



Hughes: All of those committees are following the NIH guidelines? 
Gerbode: More or less. The NIH guidelines influence their decisions. 

Hughes: But the way you just phrased it, it made me think that there is a 
bit of leeway in interpretation. From hospital to hospital there 
might be slight variations? 

Gerbode: Yes, some hospitals are extremely strict, and others are lenient. 
It depends on their committee. However, it gives the doctor a 
very good basis for trying or doing something, if the committee has 
approved it. 

Hughes: What is the reputation of Presbyterian on that scale? 

Gerbode: They're very reasonable about it. We have a lot of research going, 
so that the problems do come up fairly frequently, and they have 
to be fairly knowledgeable and intelligent about it. 

Hughes: You mentioned the surgeon from the South who will remain nameless 

and his rather unusual ideas. How did he get away with that in light 
of human use committees? 

Gerbode: I once had a patient of his in whom one of his valves failed. I 

had to operate upon this patient in the middle of the night and put 
another valve in. I called [the surgeon] up and told him about it. 
I said, "You'd better be prepared, because this fellow I think may 
want to sue you." He said, "Well, he'll just have to stand in line." 

Hughes: Well, that's a different attitude! 



Research vs. Patient Benefit 



Hughes: From talking to you all these sessions, I know that research is 
very dear to your heart , and I believe that taking care of your 
patients is as well. At times those two aspects are in conflict. 
I mean, the research oriented person is trying to break through to 
new information. The physician is looking after his patients to the 
best of his ability. Have you ever had problems in reconciling 
those two? 






264 



Gerbode: No, I don't think so. If you're on a frontier, as we were in the 
very beginning, you simply would sit down with the family and 
discuss the whole thing. Here are the possibilities. You can do 
this or that or the other thing, or do nothing. There are very 
good statistics on virtually every disease at the present time, 
so that you can say the life expectancy under certain circumstances 
with this disease is this. And it might be this, if we try to do 
something. I never thought 1 was really experimenting on patients. 
I was always applying something which I thought was ready to be 
applied to human beings, because it might be better than what was 
available. 

Hughes: Did you ever operate with the idea of providing a technique which 
would benefit patients in general but perhaps not the specific 
patient that you were operating upon? 

Gerbode: Well, I suppose so. I'd have difficulty finding the exact operation 
where this might apply. The whole question of developing our 
monitoring system, using the computer, that was new when we started 
it, and we obviously were testing and experimenting on patients 
every minute. But there wasn't any risk involved. We were simply 
measuring something. We found out which things we could measure 
the best, and which would give us the best information for a patient 
or his disease. 

Hughes: In those early days with the monitoring system, were you backing 

up the computer monitoring with the old methods of doing the testing 
to check the computer methods out? 

Gerbode: Yes, we did that. But you know, there were so many exciting things 
about it, to be able to sit there or have the nurse sit there and 
read off these data on the patients and make a decision. Previously 
they had to go through a chart full of papers and scribbled notes 
to make the decision. The nurse would put lab reports which were 
stuck on little bits of paper in the chart somewhere, and you'd 
have to go through the chart to find them. After we developed this 
[computer monitoring] technique, the laboratory put them right in 
the patient's computer record, so the nurse pushed a button and 
there it all was right in front of her. Furthermore, at the end of 
everyday there was a printout of all that data, which was then put 
in the patient's chart. 

Hughes: Does every hospital use computerized monitoring now? 

Gerbode: Oh no. it's expensive, and it's more applicable to hospitals that 
are doing rather complicated work. 



265 



The Doctor-Patient Relationship 



Hughes: Patient relationships. You spoke of having to keep a certain 

distance from patients, although you didn't put it quite that way. 
I was wondering what type of relationship you sought to establish? 

Gerbode: I always tried to seek a relationship in which the patient's 

family or the patient, or both, would understand what I was trying 
to do. 

Hughes: As simple as that. 

Gerbode: Yes. I would always try to tell them that other doctors would 
be helping, so that they wouldn't see somebody working on the 
patient and not understand why he was there. 

Hughes: Did you ever find it difficult not to become personally involved? 
I'm thinking particularly of the early surgery on children. 

Gerbode: No. The children's parents were virtually all very receptive to 
explanation and the desire to do what was right for the child to 
make the child better. I think that certainly you have to develop 
an attitude in which patients [and] the relatives trust you. I 
think mostly they thought I was alwr.ys honest , not given to false 
hoods. 



Patient Referral 



Hughes: You spoke of having problems in the early days concerning patient 
referral, and that your practice had been pretty much taken over 
by the people that didn't go off to war. But after that, when you 
began to make your name in surgery, was it by virtue of your name 
that you received most of your patient referrals? 

Gerbode: No, I think we got a lot of patients because we demonstrated that 
we could treat them successfully. One reason that I could treat 
them so successfully at that time and was ahead of a great many 
people was because I'd had so many years in the experimental 
laboratory, where I'd been trying out techniques repeatedly on 
animals. People who are against animal experimentation just don't 
know what's going on in the world. 



266 



Medical Uncertainty 



Hughes: Medicine, and of course I include in that surgery, is by scientific 
standards a very uncertain field. There are so many aspects to 
medicine that can't be properly measured. In the case of surgery, 
one often doesn't know exactly what one is going to find when the 
initial incision is made. How did you cope with this uncertainty? 

Gerbode: I guess it's a matter of your training. Surgery is an art as well 
as a science. You can apply your knowledge in basic training to 
any situation when it is presented to you, and you try to solve 
the problem based on your knowledge and your ability. Oh, there are 
always surprises. But you cope with the surprises with the training 
and the equipment and the knowledge you have. And if it's very 
unusual, you publish it so that other people will be aware that 
this [problem] might occur. 

Hughes: A book on organ transplantation by an historian of medicine and a 
sociologist of medicine describes transplant surgeons as having 
"the courage to fail."* The point is that in order to push a field 
ahead, you have to be willing to have some setbacks. Would you 
characterize yourself in that way? 

Gerbode: I think yes, because the whole field of open heart surgery was 

very tenuous in the beginning. The first time you looked inside a 
living heart was quite different from looking at it in the autopsy 
room or in a pickled state in the laboratory. So you had to learn 
all these things, and [there were] many surprises. You had to cope 
with these surprises based on your ability and your knowledge. 

Hughes: Were the surprises functional as well as anatomical? 

Gerbode: Oh yes. Many times you'd operate on a heart and not know for 
sure what exactly you were going to find. 



New Diagnostic Techniques in Cardiology 



Hughes: I was wondering when radioactive imaging came into relatively common 
use and what kind of impact it made on diagnosis? 



*Renee C. Fox and Judith P. Swazey, The Courage to Fail: A Social 



View of Organ Transplants and Dialysis, Chicago: 
Chicago Press, 2nd ed. , 1978. 



University of 



267 



Gerbode: It's just really being applied now. It's relatively new, and it 
certainly is another tool to show how various parts of the heart 
function. It's very useful in determining how much damage has 
occurred from a myocardial infarction, a so-called heart attack. 
You can also use imaging to determine how well the heart is 
contracting and performing. There are a whole host of tests that 
are coming up which are going to revolutionize [diagnosis]. 
Nuclear magnetic resonance, for example, is going to make certain 
diagnoses much more accurate. 

Hughes: Because you can visualize exactly what's going on. 

Gerbode: Particularly inside the skull. You can find out all kinds of things 
about the brain with NMR that you can't find out so well with other 
techniques, and you don't have to inject anything. 

Hughes: So there's no risk. 

Gerbode: No risk at all. 

Hughes: But with radioisotope imaging 

Gerbode: There is a little risk, but it's not very much. You have to inject 

something . 



Hughes: Is it technetium that's mainly used? 

Gerbode: Technetium is one. 

Hughes: Now, those techniques would be handled by a cardiologist? 

Gerbode: Yes, that's all cardiology. The surgeons don't get involved with 
this, except they can ask for a test [to] be done. 

Hughes: Would you be required to read the test? 

Gerbode: Not necessarily. But a good surgeon will read the test, because 

[he] can decide better whether [he] can cope with it surgically if 
[he's] seen how the organ is performing. 

Hughes: As you may know, the Anger scintillation camera was developed at U.C. 
Berkeley by Hal Anger. Did you ever use one or have any contact 
with one? 

Gerbode: They have used them in cardiology here. I didn't have any particular 
use for them myself. 



268 



Teaching 



Hughes: Has teaching been an important part of your career? 

Gerbode: I like to teach. When I was full-time faculty in the medical 

school, I really enjoyed teaching. I enjoyed lecturing. I enjoyed 
bedside teaching, the Oslerian method of teaching. I guess I've 
done my share of it. But I think the best thing I did in teaching 
was to train these young surgeons to do heart surgery. As I 
mentioned before, I had eighty-six fellows in my program over the 
years, and sixty-three of them currently are very active in heart 
surgery in their 'countries [of origin] or in this country. 

Hughes : That ' s quite a record . What would you say is your most important 
contribution to surgery? 

Gerbode: I think training these young men. 



269 



VIII PHILANTHROPY, FAMILY AND RECREATION 

[Interview 11: October 3, 1983 ]## 

/ 

The Wallace Alexander Gerbode Foundation 



Gerbode: My oldest son, Wallace Alexander, was a sophomore at Stanford when 
he was killed in an automobile accident near Stanford. This was a 
very sad and shocking event in our lives. In thinking about it 
afterwards, we thought that we might establish a foundation in his 
name. This then would give us an opportunity to do things in the 
community and at the same time honor him. So we established the 
foundation on that basis. The foundation was made to benefit 
projects in the Bay Area and in Hawaii. So ever since then we've 
made contributions to the Nature Conservancy, civil rights, 
minorities, music and drama organizations; never to fellowships or 
scholarships, and very little for bricks and mortar. The idea was 
to start programs in the community which couldn't be started or funded 
initially from civic funds, to get them going, and if they had 
survival strength, then the community would pick them up. We've 
started a great many things in the Bay Area and in Hawaii which 
have been taken up by the communities or by other larger agencies. 
I could furnish you with a long list of them, but you could get 
them from the [foundation] office if you'd like. 

We made a modest contribution to the foundation to start it, 
and since then we've added money to it and invested the money, so 
that what was rather modest in the beginning now has become a fairly 
important foundation in San Francisco. 



270 



Hughes: When you say "we," you mean your wife and you. 

Gerbode: Yes, and various members of the family. Actually my wife and I 
made the major contributions to it. The children haven't really 
made contributions to it to any large extent. We have a foundation 
board, upon which one of my sons and one of my daughters sit, and 
we discuss requests for funds on a quarterly basis. 

We have an office which is run by a full-time administrator 
[Thomas C. Lay ton] and a secretary. Whenever you start giving away 
money, of course, you have numerous requests for the money, and so 
this requires someone to sort these things out. Many of the requests 
are not in our field of interest, and therefore they're disqualified 
on that basis. 

Hughes: In reading the 1982 annual report, the list of interests of the 

foundation fell into the categories of art, education, environment, 
and urban affairs. 

Gerbode: Yes, that's pretty much it. 
Hughes: Why those fields particularly? 

Gerbode: Because those were the things that we were interested in as citizens 
in the community. I suppose it's just an extension of what we were 
interested in. Having the foundation gave us an opportunity to do 
it on a different level. 

Hughes: I recognized all of the names on the board of directors [Frank L.A. 
Gerbode, Frank Albert Gerbode, Maryanna Gerbode Shaw] , except for 
Charles [M.] Stockholm. 

Gerbode: Charles Stockholm is a vice president of Crocker Bank, an old friend. 
I've known him ever since he was a small boy. His father built our 
house on Divisadero Street. His father was a very successful 
contractor, and his grandfather was, too. In fact, his grandfather 
built many of the houses in Pacific Heights. 

Hughes: And you asked him to join the board because of his 

Gerbode: Well, because he's a businessman and a banker. There is money 

involved and businesses involved, so he can get a lot of information 
for us through his bank that we couldn't get as individuals. 

Hughes: Can you give me an idea of what the review procedure is for an 
application? 



271 



Gerbode: The applications are sent to the office, and they're reviewed by 

the office staff. If they fall in our sphere of interest, then they 
are considered at a board meeting, which occurs three or four 
times a year. An agenda is made up; all the materials sent in to 
recommend the grant are included in the agenda but are reviewed 
by the board well in advance of the meeting. 

Hughes: Is it the responsibility of the person or the organization applying 
to supply all the necessary information? 

Gerbode: Yes. 

Hughes: Is there sufficient information in the application itself to make 
a decision? 

Gerbode: If there isn't enough [information], we'll ask for it. For example, 
sometimes they don't send a budget; they don't say how they want to 
spend their money, so then we request a budget and a description of 
how they're going to spend their money. The grants are for one 
year, sometimes two or three years, depending on what is involved in 
the program. 

We also occasionally will make a grant which is actually a loan 
to get something going. People can't borrow money to get things 
started, so once in a while we'll grant an agency or an organization 
enough money to get them going, hoping that they will be able to 
generate enough finance to pay us back. This happens once in a 
while. Frequently they can't repay the grant. 

Hughes: Would the application be made for a loan? 

Gerbode: They don't call it a loan, but they'll say they hope to retain 

enough earnings to repay part of this money or something like that. 
So it is really a loan. 

Hughes: How do you make the choice amongst the applications? 

Gerbode: We have a certain amount of money we can spend. We have a budget 
for the year. We look over every application critically, both as 
to the objective of the application and the budget that they've 
submitted. Occasionally we will give them what they request, but 
more often we'll say that we can't give you all you request; we'll 
give you a certain amount. If we gave what everybody wanted, there 
wouldn't be enough money to go around. So we'll give them 50 or 20 
percent or 100 percent, depending on the merits of the application. 



272 



Gerbode: The other thing that happens very often is that they apply to 

several other foundations at the same time, and if they are all 
granted what is requested, then they have more money than they need. 
So it's up to our administration to find out from other foundations 
how much they intend to give to a particular venture. 

Hughes: Is there considerable cooperation among foundations? 

Gerbode: Yes. The foundation directors know each other very well, and 
they're very knowledgeable about things in the community that 
require private funding, and they discuss [them]. We encourage 
this. [The foundation directors] belong to several organizations 
where they meet and discuss voluntary efforts like this. 

In the Hawaiian Islands we've played a different role occasionally, 
because the Hawaiian agencies are not as aggressive in looking up 
things to do with their money. In the past they were apt to give the 
money according to their legal requirements. In other words, you're 
supposed to give 5 percent annually of the value of your portfolio 
or your assets, and very often they [would] pick out the ordinary 
things, like Boy Scouts and time-honored things, just to satisfy 
the requirements. We've tried in the Islands to pick out [organizations] 
which require help, and by giving [them] money, we've encouraged the 
Hawaiian foundations to help, too, and they've done it. This is 
true not only on Oahu, but it's true on Maul and Kauai, Somebody on 
the outside has to make a little contribution to cause attention 
and popularity. 

Hughes: Do you remember what some of the first awards were in the early 
days? 

Gerbode: I think probably some of the first awards were Planned Parenthood 

and things like the Nature Conservancy. We were very active in the 
various agencies that are trying to stop development of areas that 
might be better [used by] the public at large. 

Hughes: In San Francisco specifically? 

Gerbode: Well, Marin County. For example there's a big valley over there 

which was going to be developed into a whole bunch of condominiums 
by an oil company. The Nature Conservancy and the people of Marin 
County were against this. They wanted it to be a public park. So 
the Nature Conservancy got together a number of people and what 
happened was that we bought this piece of land from the oil company 
at the same price they had paid for it and then gave it to [the] 
Nature Conservancy , who then gave it to the government . It ' s now 
a public park. 



273 



Hughes: This is the piece at the Marin headlands, called the Gerbode 
Preserve? 

Gerbode: Yes. 

Hughes: The Nature Conservancy seems to be a particular love of yours, at 
least if dollars speak 

Gerbode: It goes way back to when they first began to do this sort of thing. 
We were among the first to get interested in the techniques of 
converting private land to public use on a fair and equitable 
basis. The people working in this area are very fine people. They 
have the best interests of the public at large at heart, and I think 
they've done a very good job. 

Hughes: Would you say that the foundation has changed emphasis since it was 
founded? 

Gerbode: It's broadened its field quite a good deal. We've gotten into 
supporting various activities at Stanford and the University of 
California. For example, in the law school at Stanford there are 
several projects which couldn't be funded out of university funds, 
but could be funded privately, and we've helped them do that. Those 
are projects which involve activities in the community by students 
or professors. 

Hughes: Is this broadening the result of having more money to spend, or 
is it a change in philosophy? 

Gerbode: No. Usually what happens is that an organization like this is in 
everybody's focus, so everybody that wants money for any project 
will try to get it from a foundation. And some of the things that 
are requested are really worth supporting. That's how it comes 
about . 

Hughes: So the change in emphasis really is external the fact that you have 
a broader range of applications rather than being due to an 
intrinsic change in the board itself. 

Gerbode: Yes. There are more applications all the time. Particularly now 
since so many government projects have been cut back and there's 
less money available for new projects on a city, state, or federal 
level, so that there is much more demand on private foundations. 

Hughes: Mr. Layton made what I thought was a very interesting comment. He 

said something to the effect that he believed the foundation was more 
liberal in outlook than the board of directors itself. 



274 



Gerbode: You mean to say that what he's trying to do is more liberal than 
what 

Hughes: No, he wasn't referring to himself. He was trying to say that the 
foundation itself takes on a character that is somewhat independent 
of each individual member of the board of directors, that there is 
a foundation identity which is above and beyond that of the 
individuals making up the board. 

Gerbode: That may be true. It may be wishful thinking on his part, too. 

Actually , every grant is discussed at some length by all the board 
and voted on. 

Hughes: I can see that you would perhaps be induced to move in certain 
directions by the very nature of the types of grants that 
organizations request. 

Gerbode: Oh, there's no question that applications make things visible that 
we wouldn't otherwise see. We obviously can't be aware of every 
organization that is starting something. For example, I never heard 
of the Pickle Family Circus before they put in an application. 
When we got the application and began to look into it, it turned 
out to be quite a good thing to support. We probably were largely 
responsible for getting it started. I don't know whether that 
could be considered a liberal thing, but we certainly made it more 
visible. 

Hughes: I would think that the coloration would become most obvious in the 
category of urban affairs. 

Gerbode: Well, there are several instances where the people on Kauai wanted 

to do something or stop something, but they couldn't do it very well 
because they were not very knowledgeable about how to go about it. 
For example, right now there's a very embarrassing situation for a 
group of developers who decided that they could put up a hotel and 
a large collection of condominiums on a certain acreage near Lihue 
without getting all the proper permits. They thought because they 
had so much money and had bought the land that they could just go 
ahead and do it. Well, the people didn't like this on Kauai. So 
they formed a citizens' group to object to it, and it was actually 
brought to the courts. One court ruled that their development was 
legitimate, and another court ruled that it was not legitimate. 
The citizens were doing this without very much legal help, so we 
gave them enough money so that they could at least discuss it on a 
proper intellectual and legal basis. We're not trying to influence 
their decision 



275 



Hughes: No, but to give them the tools. 

Gerbode: Give them the tools to make an intelligent decision. So actually 
this whole project is stopped. There's a half -built hotel and 
some condominiums that were finished and sold and some people 
living in them; quite a few others are half-built. It's a mess. 
But the fact remains that they should not have gone ahead without 
getting the proper building permits and permission. They thought 
it was such a sleepy little island they could get away without going 
through all the formalities. Well, the people finally woke up. 

We try not to get involved in politics, because that's a very 
difficult thing. But some of the things border on politics, because 
a lot of things that happen in a community are based on political 
activity. 

Hughes: Would the politics of an issue keep you away from it? 

Gerbode: Not necessarily. I think the issue itself is what we would consider. 
Whether it was involved with politics would be of secondary 
consideration. But sometimes organizations ask for money when we 
feel they could do it themselves. For example, the legal profession 
in the Bay Area has occasionally asked for substantial funds to 
start things like a legal aid society or pay for lawyers to defend 
people who don't have money. We've helped some of these things, 
but actually it's my belief that the lawyers don't give enough 
money to charitable events. They're very parsimonious when it comes 
to contributions. It seems to me that they ought to be doing more 
of it: themselves, rather than going out for other organizations. 
I don't know of any doctors that have gone around passing the hat 
for various things they do like that. 

Hughes: Once you award a grant, how much leeway does the organization 
receiving the grant have in the way the money is spent? 

Gerbode: They're supposed to follow the outline which they've submitted for 
the grant. I think that our executive director would watch these 
developments, and if they are obviously doing something entirely 
different, he'd say something about it. 

Hughes: How does he watch? 

Gerbode: We call up and drop in on them once in a while. Not like a big 
brother looking over their shoulder, but more because we're 
interested in what their project is supposed to be doing. 

Hughes: It's an informal follow-up? 



276 



Gerbode: It's an informal follow-up. 
Hughes: Do you ever solicit applications? 

Gerbode: I wouldn't say that we never solicit applications. Occasionally we 
will see something that needs a little boost and we'll suggest 
that we might review an application. That's been done particularly 
in the Hawaiian Islands, not so much locally in San Francisco. 

Hughes: I know there are geographical limits to the foundation. 

Gerbode: We're constantly being asked to give money for national things. 

For example, we've had quite a few requests on a national level for 
money to legalize abortions, but we try to avoid getting involved 
in national things, because there are too many of them and it's 
very hard to monitor them. If we ship money off to New York, we 
would never see it again. We can do a much better job by supporting 
things in the Bay Area and in Hawaii, because we are familiar with 
the cities and what else is going on. 

Hughes: Does the fact that you were asked on a national level to support 
abortion mean that the foundation has quite a name for its work 
with Planned Parenthood? 

Gerbode: They know that we have supported Planned Parenthood from the very 

beginning. Mrs. Gerbode was on the first board of Planned Parenthood 
in San Francisco, when they had a little place out in the Sunset 
District and it was very unpopular to even be associated with such 
a "bad" thing. But we've always been in favor of the right of 
women to have a child or not to have a child. 

Hughes: Was that when the foundation was first founded? 

Gerbode: Oh, even before the foundation we made contributions to Planned 
Parenthood. Obviously we're not a Catholic family. But I know 
some Catholics who are very much in favor of Planned Parenthood. 

Hughes: They're the sensible ones. 

Gerbode: I think they'll probably go to heaven anyway! Maybe even quicker! 

Hughes: Can you give me a rough estimate of how many applications you 
receive in a year? 

Gerbode: You'd better ask Tom Lay ton. Every meeting we have, which is 

quarterly, we'll review perhaps twenty new applications, but we will 
also have turned down twenty or thirty automatically. 



277 



Hughes: The rejection is simply on the basis of the interests of the 
foundation? 

Gerbode: No, rejection is sometimes based on the fact that we know another 
agency is going to take care of them. 

Hughes: I didn't phrase that question very well. I was meaning, before 
the application even gets to the board of directors, the staff 
would reject some applications? 

Gerbode: Oh yes. We reject perhaps twenty three or four times a year; maybe 
fifty or sixty are rejected by the staff. We always have a list 
of the rejections that are made by the staff, and occasionally 
we'll ask for a review of one of those rejected applications, if 
we think that maybe it should be given further consideration by the 
board. It doesn't happen very often. 

Hughes: Do you ever require an organization to match funds? 
Gerbode: Yes, that's quite common. 
Hughes: Have you always done that? 

Gerbode: It happens automatically. When the people submit an application, 
they say, we have ten thousand dollars; we need twenty. That's 
matching funds. 

Hughes: I know Tom Layton is director, and I spoke to a woman assistant. 
Is there anybody else on the staff? 

Gerbode: No, that's all. We have people come in and do clerical work 

occasionally. But [the foundation] is really run by Tom Layton and 
the secretary. 

Hughes: In 1969 Congress passed the Tax Reform Act, which established 

tighter regulations on all nonprofit organizations. Did that cause 
any particular change? 

Gerbode: Not really. The only thing it affected is the Island properties 

we have at Diamond Head. Before that 1969 tax law was put through 
we could occasionally go down and use those houses ourselves, but 
that law pretty much forbids personal use by the board of any 
foundation property. We can go down there for the purposes of 
looking over the property but we can't go there and entertain. 

Hughes: Tell me a bit more about that property. 



278 



Gerbode: There are two houses on the Diamond Head property. The first 

house was built by my mother- and father-in-law, Mary and Wallace 
Alexander. He was president of Alexander and Baldwin. They spent 
about half the time there and half in Piedmont.* They bought the 
land from Jay Gould of New York, a rather famous man, and they 
built a house which was designed by a cousin, Will Dickey. He's 
the architect who designed the Claremont Hotel. The Claremont 
Hotel in Berkeley is an entirely different structure. He is 
credited in the Hawaiian Islands with incorporating Oriental style 
in the construction of the roofs and the general appearance of the 
houses and buildings. So they are rather unique. They're well known. 
They've been illustrated quite often in various architectural 
magazines. The house was built out of coral and lava rock, so the 
walls are very nice looking and obviously very permanent. 

There was some adjoining property owned by a man by the name 
of Mr. Atherton Richards, and my mother- and father-in-law bought 
the land from him a few years after my wife and I were married. 
Then we built a house which complemented the one that they had on 
this other piece of property right next door. Now the lawns and 
the acreage and everything are contiguous. 

If 

Gerbode: We rented our house a good deal of the time, because obviously we 

couldn't use it fully. I was busy being a doctor,* or being trained 
to be a doctor. One of the renters left a cigarette burning in the 
bedroom while he was looking over his income tax papers. He had 
failed to submit income tax returns for a couple of years , although 
he was a wealthy man. I think he was trying to sort out the papers 
so that he'd have answers for the IRS, and he either left a cigarette 
near them or something like that happened. So the house virtually 
burned down. But we had it fully insured, so we rebuilt it pretty 
much the way it was before. 

Hughes: When was this? 

Gerbode: Middle or late sixties. When my mother- and father-in-law and 

Mrs. Gerbode died, we put both houses into our family foundation. 
Since then we've rented the houses through the family foundation. 

Hughes: The grants by the foundation for 1982 range from under a thousand 
dollars to the one hundred thousand dollars that was awarded to 
the Nature Conservancy. Would you say that this is a fairly typical 
range? 



*The preceding two sentences were moved from the session on 7/20/83. 



279 



Gerbode: 



Hughes: 



Gerbode: 



Hughes : 
Gerbode: 
Hughes: 
Gerbode: 

Hughes: 
Gerbode: 

Hughes: 
Gerbode: 



I'd say the average grant is from one to thirty thousand dollars. 
There aren't very many one thousand dollar grants, though. 

Obviously the foundation's policy is to fund a number of organizations 
in a modest way rather than to give large sums to a very few 
organizations. 

I think that's true. Our general policy is to get things started, 
as I mentioned to you before, which we think would have enough 
value to be carried by the community, by other organizations. Pickle 
Family Circus, for example, carries itself now. There are several 
dance groups, too, that we started they are mostly connected with 
various countries and they are on their own now, too. There's a 
Holocaust memorial being developed now [by the Palace of the Legion 
of Honor] to remind people of the number of Jews that were killed 
during the war. We've supported that because we think it's a good 
thing to have people see what it was all about. Many people don't 
think any Jews were killed at all, or there weren't any concentration 
camps. A lot of Germans think that, too. 

You certainly know better than that. 

Yes. 

What would you say is the image of the Gerbode Foundation? 

I think probably the image is one of an organization that is 
interested in community affairs in the Bay Area. 

There wouldn't be a political coloration? I'm thinking on the 
scale of conservative to liberal. 

I think we're right in the middle somewhere. For example, we 
supported the building of the [Louise M. Davies] symphony hall. 
You might consider that conservative, yet it takes care of a lot of 
liberal people, too. 



Well, things have changed, 
nature-related activities. 



In the old days it was unusual to fund 



That's true. I think that people are generally more conscious of 
preserving green areas. We'd been very interested in this in 
San Francisco long before the foundation was founded, in being sure 
that where there was a possibility of making a park, that we could 
help get the park made. This is a form of nature conservancy, 
preserving green areas in the community. 



280 



Hughes: In the annual report, religious activities are specified as an 
area which are not funded. Was this a conscious exclusion? 

Gerbode: I don't know how to answer that question. We have not been very 

interested in religious activities in the community. I don't know 
whether that was conscious or unconscious. 

Hughes: So it's just a lack of interest, not fear of being accused of 
supporting one religion against the other. 



Religion 



Gerbode: Not really. [My wife's] family, way back in New England, were 
Congregationalists. It's a very simple form of a Protestant 
religion. Their churches and their programs are simple. The 
Hawaiian mission children's church, the Kuaihau Church, was built 
by missionaries, and their programs are very simple and very humane. 
That's the sort of religion, I think, that they practiced. My 
mother- and father-in-law went every Sunday in Piedmont to a very 
small Protestant church, and they supported that church's activities. 
My wife and I would go occasionally, but not very much. 

Hughes: And that was a Congregationalism church? 

Gerbode: I guess they called it a joint Protestant church, encompassing 
various Protestant religions. 

Hughes: What about your side of the family? 

Gerbode: My father was a Catholic, but my mother wasn't and I wasn't either. 
When I took a look at the Catholic religion, I decided I couldn't 
really be a Catholic without being dishonest. 

Hughes: What were the grounds ? 

Gerbode: Well, if you follow the rules of being a Catholic, the rules are 
so strict that I'd be going to confession twice a week. 

Hughes: Or maybe more often. 

Gerbode: Or maybe more often. I don't really believe that when St. Peter 

said, "Upon this rock I founded my church," he meant only the Catholic 
church. That's the basis for the Catholic church saying that there's 
only one church. But I have a lot of doubts about various forms of 
religion anyway. 



281 



Hughes: Was this a disappointment to your father when you didn't follow ? 

Gerbode: No, he didn't care. 

Hughes: He wasn't a strong Catholic influence? 

Gerbode: No. 

Hughes: Does that date back to the German background? 

Gerbode: Saxon. I think his family were quite strong Catholics, and they 
wanted him to be a priest. 

Hughes: That would be interesting in a mining town. 

Gerbode: But if he had been a priest, then I wouldn't be here! 

Martha Alexander Gerbode 



Hughes: Shall we talk about your wife? I know that she was active in the 
foundation, but I would really like to go further back and hear a 
little bit about her upbringing. 

Gerbode: She was an only child. She was the daughter of Wallace and Mary 

Alexander. She was born in Piedmont and raised there. She went to 
private school there, and then subsequently went to Mt. Vernon 
Seminary in Washington, which was sort of like a junior college for 
girls. Then she went to Stanford after that and graduated from 
Stanford.* 

I think that you could characterize my wife as being a liberal. 
She was more liberal than conservative. Although she was a Republican, 
she very frequently voted for candidates who weren't Republicans. 
She had always been interested in the underdog. She was very apt 
to take an unpopular stance if she felt that it was justified. 

Hughes: Did her family background warrant this orientation? 

Gerbode: Her mother and father were very conservative people. On the other 
hand, they did support community [activities] on a broad basis. 

Hughes: Even liberal community activities? 



*This paragraph was moved from the interview on 7/20/83. 



282 



Gerbode: Once in a while, but not so much. She was much more liberal than 
they. She would periodically rise up and do something unusual. 
For example, when Lamar Hunt was talking about taking over Alcatraz 
and making it into a gambling resort, she took a very strong stand 
against it and publicly denounced the whole idea, and even told 
the mayor that she'd be willing to raise money to buy it for 
San Francisco. The mayor thought this was quite funny in a way. 
He said, "Well, I wouldn't mind if she bought it. If she wants to 
buy it, that's fine with me." Something like that. But actually 
the community did react against Hunt's offer. 

Hughes: What were her grounds for disapproval? 

Gerbode: She thought it'd be much better as a national park, which is what 

it turned out to be. I think people go over there by the thousands 
to look at the jails and see how we took care of the criminals and 
where Al Capone was interred. That's been a jail, you know, long 
before modern times. It was a jail in the 1800s. 

Hughes: Under the Spanish. 
Gerbode: Yes. 

She also took up Planned Parenthood, as I mentioned to you 
before, when it was unpopular, and actually was under the rug. 
Anyone who discussed Planned Parenthood was considered to be a bit 
wild. 

Hughes: How did she come to be that way? 

Gerbode: [laughs] I don't know. I suppose maybe she was compensating for 
the fact that she was financially secure, maybe a little conscious 
of this and not wanting to show it too much. 

Hughes: Do you think Stanford had any influence? 

Gerbode: I don't really think so. She was a good student at Stanford, but 
she didn't join any liberal causes down there. 

Hughes: When did her real community involvement start? 

Gerbode: I guess [after] we were married and began to live in San Francisco. 
Then she began to look around and find things to do as a wife and 
as a citizen, and she found that many of the so-called liberal 
causes were more interesting than just giving money to the Boy Scouts 
and the YMCA. 




Martha Alexander Gerbode 



283 



Hughes: You said that her parents had given money to community efforts in 
the past; did that make it almost certain that she would become 
involved with charity work? 

Gerbode: I don't know. I think probably it certainly put the basis of 
giving into her behavior. 

Hughes: I don't know enough about the founding families of Hawaii* to know 
whether philanthropy is 

Gerbode: Philanthropy has always been a characteristic of then. But I think 
in the last twenty or thirty years, philanthropy has in general 
been much more inclined to give to the museums, cultural [activities] 
like that , and to some of the schools , rather than to reach out and 
get programs going. That's where we've tried to do a little 
stimulating. 

Hughes: I know there are a tremendous number of foundations in San Francisco; 
do you think it could be characterized as a city that is very strongly 
supported by private foundations? 

Gerbode: There are some very wealthy families in San Francisco that have 

always been interested in philanthropy. The Jewish families, the 
Haas and the Stern families , have always been very active in 
philanthropy. I use those two names, but there arc many branches 
of the family which have been very interested in good deeds in the 
community for a long, long time. 

Hughes: So you think that set the ball rolling, so to speak. 

Gerbode: It's helped enormously to do that. I'm sure that the same thing is 
true in other big cities. In Los Angeles, for example, there are 
a group of people who have been in family foundations for a long 
time and have done a lot of good the Chandler family, for example, 
the publishing family in Los Angeles , has done a tremendous amount 
of good in the community through its foundations and personal 
giving. 

Hughes: Can you tell me a little more about your wife's day-to-day 
activities? 

Gerbode: She was on quite a few boards in the community. She was on the 

board of Planned Parenthood, [the] YWCA, and several other organiza 
tions. She was very interested in the original San Francisco 



*The Alexanders are one of the white missionary families who came 
to the Hawaiian Islands to convert the natives to Christianity. 



284 



Gerbode: Planning and Urban Redevelopment Board, which had to do with 

planning in the community as a whole. I think she was on the board 
of Nature Conservancy. So she spent a lot of time in meetings 
with these organizations. Obviously if she was going to a meeting, 
she would have an influence on the decision making. She enjoyed 
doing that very much. 

Hughes: Over the years I would think she would have come to be known as an 
expert in certain areas. 

Gerbode: I don't know about being an expert. I think she was certainly known 
for her stance in all these organizations. 

Hughes: Because of this reputation, were there many demands for her 
participation? 

Gerbode: Oh yes. Demands for money, too. 

It's curious, in all these years we never got much involved 
with any religious activity in the community. You'd think that 
churches would be after us a good deal. Well, there was one church 
in our neighborhood, an Episcopal church. We thought it would be 
nice to join the church and get involved with some of their programs. 
So we went to church a few Sundays, and began to get interested, 
and the next thing we knew, we were approached to give a vast sum 
of money to the church to rebuild it and to do a lot of other things. 
So we told them that isn't why we were there. We were there because 
we felt a little religion might do us good. But we didn't want to 
get the religion by giving them a lot of money. 

Hughes: Did they lay off? 

Gerbode: They laid off, and then they weren't interested in us after that. 

Hughes: I understand that your wife was a major force in saving Diamond Head. 
Was that beyond the purview of the foundation? 

Gerbode: Yes. This was entirely on the basis of being a citizen. We had 
the Diamond Head properties. There was a Chinese businessman who 
had made pots of money during the war, and he wanted to buy up the 
property along Diamond Head toward Kahala and build a lot of high- 
rise buildings and condominiums. Financially it would have been 
tremendous for him if he had gotten away with it, and there were 
certain people in the community who were in favor of it. The 
argument always is, well, if you put these things up, you'll get 
that much more back in taxes. 









285 



Gerbode: But [Martha] and another elderly woman by the name of Mrs. [Alice 
Spaulding] Bowen, who lived on Diamond Head Road, or nearby, 
fought this thing out. One thing that Martha did was to buy the 
Fagan property, which is a big piece of land down the road, rather 
than let the Chinese fellow get it. This was like playing monopoly. 
If you get certain pieces in a certain area, then you can stop a 
development. By buying this piece of property, she stopped a lot 
of the thought of converting all that land into highrises and 
condominiums. [The two women] organized a campaign which all the 
other people who had property along Diamond Head got interested in. 
They realized that their views were going to be cut off and that 
their neighborhood would change entirely. Even the transportation 
down that little road would have been impossible with a lot of big 
buildings. It's just a small, two-way road. To make it a super 
highway would be very, very difficult. It could be done, but not 
without losing an awful lot of good land to do it. 

Hughes: We've talked about your wife from the standpoint of her community 
activities. Can you give me a better idea of what she was like as 
an individual? 

Gerbode: She was a very compassionate individual. She felt very strongly 

about right and wrong, and she would take strong stands on issues. 
In general, she was suspicious of successful business people and 
backers. 



Gerbode: Some of the people she'd gone to school with in childhood thought 
that she was much too liberal. So socially we didn't see those 
people very often. 

Hughes: Did she ever run into other problems because of her liberal stands? 

Gerbode: No, I don't think so. I think in the community she was not very 
impressed with being a society person, and in our home we never 
pursued very much of a social life in that sense. We had our friends 
in the community who were important people, but were not essentially 
society people. 

Hughes: How did your viewpoint coincide with hers? 

Gerbode: I was always too busy in my profession to worry too much about it 
one way or the other. When you're working ten, twelve, fourteen 
hours a day putting something together, you're not very concerned 
about things like that. 



286 



Hughes: I was thinking more in the political sense of her liberal causes. 
Do you think you in general went along with her viewpoints? 

Gerbode: Yes, I would go along with most of them, but sometimes I wouldn't 
go along with them at all. 

Hughes: And you said so. 

Gerbode: Sure. 

Hughes: And she went right on. 

Gerbode: Usually. 

Hughes: We will at a later date have Maryanna speak for herself,* but I 
was wondering if you could say something about her role in the 
foundation. 

Gerbode: First of all, she's a very intelligent young woman, and she is 
very much like her mother. She is given to thinking liberally 
about things. She also has a very strong will, as her mother did, 
too. She's been very interested in the foundation, in its activities, 
and she reviews all the applications very carefully and writes an 
independent opinion about them. 

Hughes: The other board members do not do this? 

Gerbode: Yes, they do it. They all review the programs. But I think she's 

perhaps a little more serious about it than the rest of us. She has 
more time also to look into some of the things that are suggested. 

Hughes: So she would do more than just read the application. 

Gerbode: She might even go take a look or call up somebody or have Tom 

Layton do it. She'll say, "Tom, why don't you investigate this part 
of it. I'd like to know a little bit more about it." 

Hughes: Do you think that her opinion influences your eventual decision? 
Gerbode: If her reasons are valid, then she influences me. 

Hughes: I'm glad you listen to a woman. [laughter] I understand, again from 
talking to Tom Layton, that he and Maryanna spend quite a bit of 
time together working on foundation business. 



*The transcript of an interview recorded on November 4, 1983 with 
Maryanna Gerbode Shaw is on deposit in The Bancroft Library. 



Gerbode; 



Hughes: 
Gerbode: 
Hughes : 

Gerbode: 



Hughes: 
Gerbode : 

Hughes : 

Gerbode: 

Hughes: 

Gerbode: 

Hughes: 

Gerbode: 



287 



He's very apt to call her more often than me. He'll call me about 
certain aspects of foundation activities, but on certain decision- 
making things, he'll call her and get an opinion. We actually 
have kind of a working rule that he and one other foundation board 
member can make an independent decision before a board meeting for 



grants of a small amount of money, 
apt to call her than to call me. 



On those small ones he's more 



Did she work very closely with your wife? 

No. 

Do you think that Maryanna has taken over your wife's role in the 
community? 

I think she has with regard to the foundation. With regard to 
other activities in the community, she's been more interested in 
the business aspects of the family. She's on the board of the 
company that's been associated with the family. And she goes to 
Hawaii once a month to board meetings. She follows [what is] 
happening quite carefully. I think she wants to be, and has become, 
a knowledgeable businesswoman. 

What is the family company? 

Alexander and B.aldwin. It was founded by her great-grandfather and 
some other members of the family. 

Is that still very much oriented towards the Islands? 

Yes, it's mainly an Island company. 

Was your wife not particularly interested in the company? 

Not as intimately as Maryanna. 

What, again, is Maryanna 's background as a college major? 

She went to Stanford and graduated in anthropology. She went to 
Hamlin School first for two years, and then we sent her to Milton 
Academy in Milton, Vermont, for the last two years. She was the 
first girl ever accepted from the West [at] Milton. It was really 
quite a thing for them to accept somebody from way out in the wilds 
in San Francisco. 



Hughes: I'm sure she did well for the reputation of the West. 









288 



Gerbode: She did well enough to get into Stanford. 

Hughes: The other children are not particularly interested in the foundation? 

Gerbode: My oldest son [Frank Albert Gerbode] is, but he will get interested 
just before the meeting. He'll read all the material, and then he 
gives an opinion about it. The others haven't been asked to get 
into the foundation activities. I think they're interested in the 
activities, but they have their own interests. [John] Philip, my 
youngest son, is in Vermont, so it's very difficult for him to do 
anything locally. My youngest daughter, Penelope Ann, is busy 
taking care of her own family. She is interested in the Nature 
Conservancy and the Oceanic Foundation. She has her own activities 
along these lines. 

Hughes: Would you say that the board of directors pretty much sees eye to 
eye when it comes to a decision about whether to award a grant or 
not? 

Gerbode: We disagree once in a while, but I think that [if there is dissension], 
even on the part of one board member, we're apt not to approve the 
grant. Although sometimes several of us will be in favor of [an 
application] , and one will cast a dissenting vote. Of course the 
[majority] vote carries. 

Hughes.: Can you make any generalization about what the usual reason for a 
rejection would be? 

Gerbode: There are various reasons. One very good reason is that they're 

already sufficiently funded or that they have enough possibility of 
being funded without our help. Sometimes the request is for something 
which is not exactly in our sphere of interest. 



Family Life* 



Hughes: 
Gerbode: 



Was it difficult with two very busy people to keep the home fires 
burning, so to speak? 

I think it was a little hard on the children in some respects. We 
didn't spend as much time with them as we should have, although we 
always had our vacations together. But the chances of having me 
come home and read to the children were pretty slim. However, I 



*More information on family life is contained in the interview 
with Maryanna Gerbode Shaw. 



289 



Gerbode: don't think the children suffered very much from it. Maybe 

Philip, the youngest son, might have felt a little bit left out 
because of our activities. 

Hughes: Because you were busier ? 

Gerbode: Yes, busier than perhaps he thought we should be. But he's 

forgiven us now, and he's very much of a family man at the present 
time. We usually took the children to the Hawaiian Islands and 
spent a month or six weeks with them [during summer vacation]. 
That was always very good from the family point of view. 

[While the children were growing up] , we had a black lady by 
the name of Eloise Washington who was one of the most sterling 
characters I've ever known. She managed the whole household by 
herself, with occasional cleaning people. Mrs. Gerbode never went 
shopping and never ordered anything. Eloise did everything, made 
up the menus and ordered the food and watched the children. 

Hughes: Was she there for most of their growing up? 

Gerbode: Yes, she was. She was with us for thirty-five years. 

We've had a series of people since then, and none of them were 
really very significant as far as the family is concerned. A very 
fine Chinese woman, Lau Chun, takes care of me now. She's excellent. 
She's a good cook. She can't read English, and she can hardly 
speak English, but I manage with a kind of pidgin English to convey 
my wishes. The nice thing about a Chinese woman like that is that 
she doesn't have anything else to do. 

Hughes: Maybe it's the time to say something about your love of flowers. I 
know you have a greenhouse. How old is this love? 

Gerbode: I think I've always been interested in a garden of some kind. My 
problem is that I don't spend as much time in it as I should. I'm 
very apt to get things going and they'll do very well. Then I'll 
switch to some other part of gardening and the first one suffers 
from neglect. 

Right now I'm in a position of having to convert a summer 
garden to a winter garden. I was working on this in my mind's eye 
over the weekend. I like planting vegetables. 



290 



The Chit Chat Club 



Hughes: Shall we talk a bit about the Chit Chat Club? 

Gerbode: I guess I got interested in the Chit Chat Club because of a 

professor of anthropology at Stanford by the name of Harold Fisher. 
He was a Ph.D. He was a very good friend of mine, and also even 
before that of my wife. She met him in her classes at Stanford, 
and he became a kind of a family friend. He was a member of the 
Chit Chat Club. Incidentally, it's over a hundred years old. It 
may be the oldest men's club in California. If it isn't the oldest, 
it's pretty close to being the oldest. So he invited me to go to 
some meetings, and then finally they asked me to become a member, 
which I then did. 

Hughes: Is that by election? 

Gerbode: They look you over for a couple of times, and then send a little 
note around, "Dr. So-and-So has been proposed for membership. Do 
you agree or disagree?" It's done very informally. 

Hughes: Is there any attention paid to what your career is? 



Gerbode: Not really. The membership has been rather heavily weighted toward 
lawyers and judges, with some professors, throughout the years 
since I've been a member, which is I guess about twenty years now. 

Hughes: It was founded in 1874. Do you know what the original purpose of 
the club was? 

Gerbode: I think just to get together and talk. That's why they call it 

Chit Chat. It was [modelled after] a similar club in London. In 
fact, Samuel Jonson belonged to a little club like that. They 
used to meet in a restaurant in the City of London. The 
restaurant's still there, incidentally. 

The Bohemian Club started the same way. It started as a small 
club that met once a week in an apartment in what is now the 
financial district. They were writers and doctors and engineers. 
There were just a handful of them. But they started getting 
interested in music and the arts. They went on and became what is 
presently now a very large club, while the Chit Chat Club has always 
been small. It's always been maybe fifteen or twenty members. We 
never wanted to be big. We wanted to sit around one dining table 
conveniently, and we wanted to have it small so that everybody at a 
meeting could have something to say. 



291 



Hughes: What is the format of a meeting? 

Gerbode: The format has been the same forever. We meet for cocktails at 
six o'clock, and for many years this was at the University Club. 
Now we meet in a special room at the [Grace] Cathedral. We meet 
around a big table and have a cocktail or two, and then precisely 
at six thirty we go down to the dining room [and] sit around a 
U-shaped table. There is a permanent secretary and a speaker at 
every meeting. The chairman of the meeting is the speaker of the 
previous meeting. We sit around this table, and we have a dinner, 
usually selected by the secretary, with good wines, which usually 
takes about forty minutes. And then there's the speaker. The 
subject that he's going to talk about is announced by letter a 
couple of weeks before the meeting, so that you have a general idea 
of what he's going to talk about. But the trick of the matter is 
that they usually couch the name of the talk in euphemistic terms 
so you can't be quite sure, so that some smart aleck won't arrive 
and know more about the subject than the speaker. Usually there 
is one smart aleck who knows more about it anyway. 

Hughes: But it's not the intention for the members to do a lot of research 
before the meeting. 

Gerbode: No, it isn't. If one of the members guesses what it's about and 
he's interested in that subject, he's apt to do a little reading 
on it. 

Hughes: That implies that there is a time for question and answers. 

Gerbode: Yes. Usually [the talk is] read from a manuscript, and it usually 
takes about half an hour. 

Hughes: That's a fairly formal presentation? 

Gerbode: Yes, it is. Then the chairman, who is the previous speaker, will 
ask people around the table to comment on the talk. 

Hughes: Does the Chit Chat Club do any publishing? 

Gerbode: All the talks are turned over to the Stanford Library. 

Hughes: Why Stanford? 

Gerbode: I suppose because way back several members were Stanford faculty. 

Hughes: The topics of the talks are left entirely up to the speaker? 



292 



Gerbode: Entirely up to the person. He tries not to speak about something 
that's been discussed previously. 

Hughes: These are scholarly presentations? 
Gerbode: Yes. They're not humorous. 

Hughes: Just to give an idea of the sort of talks that occur, I wrote down 
the titles of the six of yours that I found. The first was "The 
Crisis at the University of California." That was given in 
January, 1965, right in the middle of the Free Speech Movement. 

Gerbode: I had given talks before that. 
Hughes: You don't have copies. 

Gerbode: There's a very good one on the French Impressionist painters, and 
I don't know what happened to that manuscript. 

Hughes: Nineteen sixty-five was the first one. Then they came rather fast 
and furious. You gave another in 1967 called "Animals and Man," 
which was about research on the social relationships of animals. 
Then "Medical Manpower in Our Changing Times," which was in May, 
1970, about the shortage of doctors in this country and some 
possible solutions. "Traveling Behind the Iron Curtain" in 1972. 
"The Barking Dog" in 1973". And then "In Pursuit of Aphrodite,." which 
didn't have a date on it. 

Gerbode: I've forgotten the date. 
Hughes: How did you choose these topics? 

Gerbode: [laughs] I don't know. I'm constantly thinking what I'm going to 
have to do the next time. It's like painting that picture for the 
Christmas card.* It's on my mind all the time. 

Hughes: Is it done on a rotation basis? 
Gerbode: Yes. 

Hughes: How long do you expect to spend on the preparation of a Chit Chat 
talk? 

Gerbode: Oh, I have to spend a lot of time, because I'm not very smart. 



*After he took up painting, Dr. Gerbode each year sent a reproduction 
of one of his paintings as a Christmas card. 



293 



Hughes: Oh, come! [laughter] 

I was very impressed with the bibliography for the Sir Francis 
Drake paper, which went on for pages. Did you really look at all 
that? 



Gerbode: Yes, I did. I really researched him. I really think that people 
don't realize what an important person he was in the formation of 
the British empire. 

Hughes: Do you have any opinion on the famous Drake plate which resides 
in The Bancroft Library at Berkeley? 

Gerbode: I remember when it was found, and [that] Mr. Alan Chickering, the 
lawyer, was excited about it. He's the one that got it into the 
Bancroft Library and made a big thing about it. I have no idea 
about whether it's really authentic or not. If it's not authentic, 
somebody did a powerfully good job in faking it. 

Hughes: What about notable members of the Chit Chat Club? 

Gerbode: Joel Hildebrand was one of the famous ones. He was a long-time 

and very interesting member. He finally had to give up because of 
old age; he couldn't get back and forth across the bay. Professor 
Robinson of Stanford, a famous historian, was a long-time member. 
He finally gave up. A very famous astronomer I can't remember 
his name just now was a member for a long time. One of the judges 
is Ben Duniway, who is quite a liberal superior court judge, also 
a trustee of Stanford University. He's been a member for a long, 
long time. There's a Judge Searles, who's a well-known judge 
currently. There was Langley Porter, a pediatrician, for whom the 
Langley Porter [Institute] is named. He was a real giant in the 
community. One of the good things about him was that he liked me. 

Hughes: Was that unusual? 

Gerbode: Well, he took a personal interest in me, which, as a young man, 
was very flattering. I don't know why. I never asked him. He 
invited me to his house to meet other friends of his. 

Hughes: Did he have any particular interest in the field of cardiovascular 
surgery? 

Gerbode: No. 

Hughes: Did that friendship have any bearing on your subsequent career? 



294 



Gerbode: No, I don't think so. It was something I was flattered to have. 
Hughes: What was he like as an individual? 

Gerbode: He was a big man. He was vigorous in his attitudes and his 

approaches to life. He always made good decisions. He was highly 
respected as a physician and had an enormous practice. He managed 
a lot of things at the same time. For that reason he was a man 
of considerable stature. 

Hughes: You mean much more than medicine? 

Gerbode: Yes. He was very interested in the community, which is unusual for 
a very busy practitioner. A similar man was Chauncy Leake, who was 
active in Chit Chat. 

A very well-known anthropologist by the name of Harold Fisher, 
who was a very prominent professor from Stanford , [was also a 
member]. Currently there are three judges and three lawyers. One 
cleric , Dean Julian Bartlett , who is the dean emeritus of Grace 
Cathedral, is a member. He comes to the meetings quite regularly. 

Hughes: What are the numbers involved? 

Gerbode: There are usually about twelve to fifteen members present. I think 
the total membership is about twenty. 

Hughes: Does the group tend to be fairly critical? 

Gerbode: They can be very critical. If they know something about the field 
and the man has made some erroneous statements, they'll point [them] 
out to him. 

Hughes: So the question and answer period can be quite lively. 

Gerbode: Yes. It's more of a discussion period. 

[Interview 12: October 23, 1983 ]//# 
Hughes: Shall we talk about your children. 



The Home on Divisadero Street 



Gerbode: Yes. After I'd been in Germany for a year just before the war with 
Professor Borst in Munich, we came back and I had an appointment 
as an assistant resident on the surgical service at Stanford in 



295 



Gerbode: San Francisco. We had children coming and we decided since we 
were going to have a modestly large family, we'd better get a 
house to accommodate them. So we looked at lots of property and 
houses and decided the best thing to do would be to get some 
property and build a house somewhere near the good schools , which 
is Pacific Heights in San Francisco. We actually had our eyes 
on Grant School, which was a good public school with a long history 
on Pacific Avenue. 

Meanwhile we had rented a house on Green Street. We finally 
found this lot on the corner of Divisadero and Broadway. The real 
estate people wanted an outrageous amount of money for it. The 
contractor, Mr. Sophus Stockholm, was a good friend of mine and 
also a very good friend of the Pope family who owned the property. 
So he went to the Pope family directly and said, "Look, there's 
this young doctor who would like to build a house on that corner. 
How much would you really take for it straight from him?" So they 
gave us an extremely good price on the lot. It was a hundred feet 
each way , on the corner , with a nice wall around it , which we 
decided to keep. 

We also had a very good friend by the name of Bill Wurster who 
was a famous architect in San Francisco. We liked his sort of 
modern style of building. It wasn't modernistic. It was modern 
Georgian style. So among all of us, we designed this house. When 
the plans were complete, we discovered that it was going to cost 
me about five dollars and sixty-five cents a square foot. I went 
to Bill and I said, "Bill, I can't afford this." He said, "Frank, 
it's all relative. Go borrow the money." [laughter] He's never 
said a truer thing in his life. I couldn't build that house for 
eighty dollars a square foot now. 

So we borrowed the money and went ahead with building it. It 
was finished within a year. Sophus Stockholm, a very good friend, 
did a meticulous job in building it. I had a few arguments with 
Bill Wurster about certain parts of it, because he was a very 
determined, somewhat stubborn man. But I won all the arguments. I 
had other arguments with him later about a house for my sister and 
a house in Sugar Bowl. But I finally won all the arguments. 

So the house was finished. It was a big house for an assistant 
resident in surgery to owr . 

Hughes: What year was the house built? 
Gerbode: It was 1938. 



296 



Hughes: 
Gerbode: 



How could you have been sure that you'd stay in San Francisco? 



Hughes : 
Gerbode : 



Hughes : 
Gerbode: 



I just decided I'd be here, 
five times later. 



I made that decision about four or 



It [is] a lovely house. We didn't have enough furniture to 
complete it. Meanwhile, my father, who was a contractor, had hurt 
his back badly in a fall from a scaffold and couldn't be a 
contractor any longer. But he could work maybe two or three hours 
a day. So he bought a lot of tools and equipment and started 
making furniture at home just for fun. 

They were in Piedmont? 

Yes. They had a little house over there, and he had a shop in the 
basement. So he decided to make us some furniture. He made the 
dining room table and some beds for the children and a few other 
odds and ends. It took him a long time to do it, because he could 
only work a couple of hours a day. He was about seventy-eight or 
eighty years of age. So it gave him something to do and he enjoyed 
it. 

Had he ever done anything like that before? 

He was trained in fine cabinetwork and construction, because that's 
what he did when he was a contractor. He would not only build a 
house, but he designed all the cabinetwork inside as well. 

So we got some furniture from him, and we bought some. We 
had some pieces which we'd inherited through the family, and put 
together a reasonably well furnished house. 

The house is on a corner lot on Divisadero and Broadway, and 
the lot falls off rather steeply down Broadway. That means that if 
you build the house level with Divisadero Street, the back of the 
house goes down about sixteen or more feet. So that meant that by 
doing a little excavating in the front , we could have a full 
basement which would be built on rock. Part of it turned out to be 
a playroom for the children. I was very interested in doing 
photography as a hobby at that time, so I made a photograph 
developing room. I did a lot of developing pictures and printing 
down there. The children's playroom and the photography room 
became an apartment during the war. Donovan and the Secret Service 
took it over for the Navy. [Bob Haynie and Herbert Little] were 
down there during the war as our guests, designing programs which 
would frustrate the Japanese on the air. 



297 



Hughes: How did that connection come about? 

Gerbode: I guess they wanted to have a place in a neighborhood where they 

wouldn't be obvious. It was easier to bury themselves in somebody's 
house than it was downtown in an apartment or an office. So I 
think they remained anonymous there during the war. 

It proved to be a very fine house to raise children. The 
block is flat in front, so the children could play on the broad 
sidewalk. I had figured this all out in advance as well. We 
made a play-yard for them in the back where they could have a 
jungle gym and a few things like that. 



Children 



Wallace Alexander Gerbode 



Gerbode: We initially put all the children into Grant School, but the oldest 
son, Alec, never had any homework. I asked Alec, "Why don't you 
have any homework?" He said, "I do it all in just a few minutes 
at school , and then the teacher assigns me little chores to do 
around the classroom like cleaning the erasers and running errands." 
So I went around and found the homeroom teacher at the school and 
said, "I have a son here who is in your class by the name of Alec 
Gerbode. I was just wondering how you think he's getting along." 
She said, "Now which one is he?" 

So I said [to myself] , that means that she doesn't really know 
the students in the class. So we pulled him out and put him in a 
new little private school on McAllister Street called Town School, 
which was just being started. There weren't many children in it, 
but the instruction was quite good. Then he stayed when Town 
School moved to a new location on Jackson Street. We helped them a 
bit financially to get moved over there, helping to buy the property 
from some nuns. 

Then instead of sending Maryanna to Grant School, we put her in 
the Hamlin School, and subsequently Penny and Maryanna 's daughter, 
Sarah, went there, too. Philip and Sarge went to Town School. It 
was all in the neighborhood, [so] they could walk to school, which 
is a great thing. 



298 



Susan Gerbode 



Gerbode: We lost a daughter, Susan. Just when I was getting ready to go 

overseas during the war, Susan was born, and she died a couple of 
days after birth. We don't know why. I've always felt that maybe 
she had too much medication or somebody didn't pay attention to 
her. She may have aspirated some mucus. 

Hughes: Did she seem healthy when she was born? 

Gerbode: Yes, she seemed quite healthy. The pediatrician thought she was 
perfectly all right. That was pretty hard for my wife, to lose a 
little girl and then have me leave shortly thereafter in the army. 

Hughes: Do you want to say something about what the children are doing now? 



Wallace Alexander Gerbode (Continued) 



Gerbode: Alec, the oldest boy, went to Exeter. My good friend Paul Bissinger, 
who lived on the corner of Divisadero and Pacific, had a son, Paul, 
Jr., and Alec and Paul, Jr. were very good friends. The two 
families decided to send our boys East to school. The both got into 
Exeter. Alec did very well at Exeter. In addition to having a 
good academic record , he was on the swimming team and set some new 
records in the school in swimming. He was a tall, very handsome 
young man. He looked very much like Maryanna's oldest son, who's 
also named Alec. 

In any event, Alec then went to Stanford. When he got there he 
got into some advanced classes because of what Exeter provided. He 
went through his first year quite easily. Then after the summer 
vacation he went back to Stanford as a sophomore and was at an 
evening party, and driving home there was a head-on collision and 
he was killed. 



Maryanna Gerbode Shaw 



Gerbode: Maryanna had gone to Hamlin School for two years in high school and 
then decided that she'd like to get out of Hamlin, since she'd been 
there all through grammar school and high school. So we looked 
around and decided that we'd send her East too. The most difficult 







THE GERBODE CHILDREN 



LEFT: Left to right, 
Wallace Alexander Gerbode, 
Frank Albert Gerbode, III, 
Maryanna Gerbode, 
ca. 1940. 



BELOW: Left to right, 
Frank Albert Gerbode, III, 
Maryanna Gerbode Shaw, 
Penelope Ann Gerbode Jay, 
John Philip Gerbode, 
1985. 




299 



Gerbode: school to get into in the East for a girl was Milton Academy in 

Milton, Mass. They'd never taken anybody from California. I guess 
it was too far away from New England. But in any event, we took 
her back there and she was interviewed. The school here wrote 
very good recommendations, so they accepted her in the junior high 
school class, the first time it ever happened. She felt very 
alone there for a while, because the Eastern girls stick together. 
Many of them had known each other forever, and they are inclined to 
be a little bit impressed by their Eastern connections and so forth, 
But she is a very friendly person, and she soon made her way with 
the staff and with the teachers and managed a few friends among 
these Eastern girls. She knows more about it than I. I'm only 
telling you what I gather in speaking with her about it. Eventually 
she decided she would go to Stanford. She applied and got into 
Stanford as a freshman. When she was there she wondered what to 
take and decided that anthropology might be a good thing. 

We also were very good friends with Fee Keesing , who is a 
professor of anthropology at Stanford. She liked him and liked 
what he was doing. He was an expert on Polynesia, and that, I guess, 
intrigued her a little, too, because of her [Hawaiian] Island 
connections. So she went through Stanford and finally graduated in 
anthropology. 

During her senior year she met Joe Shaw, who was a premedical 
student, and they were married. Then he went through medical school 
at Stanford, and then went East for training, went through a full 
residency in orthopedic surgery. They had three children. 

Hughes: The children must be close in age. 

Gerbode: Yes, they are a couple of years apart and fortunately got along very 
well together, and she gets along very well with them. We had 
bought this old house on Pacific near Steiner, the oldest house 
in Pacific Heights, built in 1852. They were about to demolish it 
and put up some townhouses on the lot. So we heard about it and 
bought it, and finally had it classified as an historic building. 
We rebuilt it, modernized the inside of it. For example, there 
was a dirt basement , and we wanted to cover it over with cement , so 
we had to dig it out and level it underneath the house. 

[telephone interruption] 

Gerbode: As we started redoing the house we found the old gas light shades, 

which are made out of very pretty old glass. We saved most of those 
and were able to put those into a fixture in each room, which was 
then electrified. That worked out very well. And in the basement, 
in addition to finding some other things, we found some broken pieces 



300 



Gerbode: of marble. We put them all together, and it turned out to be a 
marble fireplace which somebody had taken out and broken up and 
stuck in the basement. So we put all these pieces together and 
made a very handsome fireplace in the living room, which was 
probably exactly the way it was in the old days. 

In any event, we had a lot of fun with that house. Then we 
gave it to Maryanna when she moved out from the East , when she was 
married to Joe Shaw. She has lived there ever since. In fact, 
she's redone it a couple of times since then herself, but retained 
all the fine personality of a really beautiful Victorian-type house. 

Hughes: Is it decorated in that fashion as well? 
Gerbode: Well, it's modern and Victorian. 

Hughes: Do you want to say more about Maryanna? You've spoken about her 
work with the [Gerbode] Foundation. 

Gerbode: Maryanna, in the process of raising these children, got involved 
with various things in San Francisco, very much like her mother. 

In more recent years she's gone on the board of Alexander and 
Baldwin, which is a firm with which the family has had something 
to do for over a hundred years. She's the first woman to be on 
that -board in a hundred and fifty years of its existence, and she's 
doing a very good job there. 

In addition to that she's gone on the board of the University 
of the Pacific as a trustee, which she likes very much as well. 

Hughes: How do these things occur? 

Gerbode: These things occur because somebody spots you and they have a place 
and they want you to fill in that spot. 

Hughes: So she had shown herself already to be a capable young woman. 
Gerbode: That's right. And people like her. 



Frank Albert Gerbode III 



Gerbode: My son Sarge, who is Frank Gerbode III, was admitted after Town 

School to both Andover and Exeter and went back to the East Coast 
to see which one he wanted to go to. Exeter has a very proud 



301 



Gerbode: headmaster who thinks that Exeter is the end of the world in 

preparatory schools and believes that anyone who's been admitted 
to Exeter has been admitted to heaven, more or less. [laughter] 
So Sarge first went to Andover and looked it over, and then he went 
to Exeter and looked it over, and then he went to see the head 
master. The headmaster said, "Aren't you happy that you were 
finally selected like your brother to go to Exeter?" He said, 
"Well, I came here to tell you that I've decided to go to Andover." 
[laughter] I think the headmaster fell through the floor. But 
anyway, at least he had the courage and the decency to go tell the 
headmaster what his decision was. So he went to Andover and did 
very well. 

He also got into Stanford and got advanced standing in several 
courses, English I think, for one. He went through Stanford and 
graduated. He's always been interested in philosophy, so he said, 
"I'd like to go to England and try to get a Ph.D. in philosophy." 
So he was admitted to Cambridge, which is unusual as well, and was 
about two-thirds of the way through the year when he wrote me a 
letter saying that he'd decided that he didn't want to get a Ph.D. 
in philosophy, that he thought he'd get an M.D. degree, because he 
thought he could do more with an M.D. degree, which is certainly 
true. So he finished his year at Cambridge, came back, and then 
had to take some premedical subjects, which he did at the University 
of California and Stanford. Then he applied to several medical 
schools. He got into all of them, including Harvard. Some of my 
friends at Harvard were delighted that he was admitted, and they 
thought of course he'd go there. But again, he wrote and told them 
he didn't want to go to Harvard and decided to go to Yale, because 
Yale didn't have any examinations. You took the national board 
examinations, rather than taking course examinations. 

Hughes: All the way through? 

Gerbode: Pretty much all the way through. So he graduated from Yale Medical 
School. Then he took a full residency in psychiatry, both at Yale 
and at Stanford. He now practices a form of psychiatry. He's a 
very intelligent young man, almost middle-aged now, I guess, isn't 
he? He was married to the daughter of a professor at Stanford, 
Rodney Beard. Julie is extremely bright, Phi Beta Kappa at Stanford. 
They were married when he went to England. I was not terribly happy 
with that marriage, because I thought zhe two of them were too much 
alike. I guess they decided that, too, because eventually they got 
divorced. He had two sons, Collin and Ian, by Julie, and they're 
now teenagers. Then about three years ago he met a girl from South 
Africa by the name of Gail. They were married in my house, and they 
have a daughter, Sharon. Gail is a very charming young lady, and 
the daughter is very charming, too. 



302 



Hughes: Do they live down the peninsula? 

Gerbode: They have a beautiful country style house in Woodside. 

The Adoption 



Gerbode: 



Hughes : 
Gerbode: 



Hughes : 
Gerbode: 



Then [there is] Penny, the youngest daughter, the adopted daughter, 
and her brother, Philip, who's adopted as well. 

After Alec was killed in that accident, Mrs. Gerbode was 
shaken very badly, as I was, too. We decided that it might be 
better for everybody concerned if we adopted some children. At that 
point we could afford to do it. So we heard about two English 
children who were abandoned by their mother and father and were 
living with their grandmother. We investigated the situation. They 
seemed like nice children. 

How old were they? 

They were three and four, more or less. So we went through the 
rather complicated process of adopting them. We had to go to 
England to get some papers signed by the father. I think the mother 
had disappeared. The father didn't want the children, so that 
turned out very well. It was a little difficult to bring the 
children up to standards academically, because they had not been 
trained very much. We found out that there was a very famous nanny 
around by the name of Miss Elsie Jeeves. Jeevie, as we called her, 
said that she would come and live with us and help to raise the 
children, so she did. Jeevie had raised four or five well-known 
children in Pacific Heights previously. She's a well-known character. 
At that point she was about seventy years old, but very strong. 
She used to take long walks like a Scotch mistress. She was very 
good, very strict with the children. They learned to respect her, 
which is very important, even though she was really hard on them. 

Was there quite a period of adjustment? 

It was very hard on Mrs. Gerbode. They were completely undisciplined 
and had really never learned good study habits or anything. It 
was really difficult to get them brought around. But Jeevie helped 
a lot. The Town School took Philip, and Hamlin's took Penny. 



303 



John Philip Gerbode 



Gerbode: After Philip finished Town School, we sent him to Cambridge School 
in Weston, Mass. He did reasonably well academically there , enough 
to get into Middlebury College in Vermont. He got to know some 
sons of prominent Eastern families who were filled with their own 
way of solving the problems of the world, one of which was to buy 
some farmland and put underprivileged people and ex-convicts on it, 
and have them learn how to do farming and become good citizens 
through work and having responsibilities. But unfortunately this 
proved to be a complete failure, because they didn't do what they 
were supposed to do. [Problems arose] in various ways. I don't 
know in which ways. But at least the idea didn't turn out very well. 
Philip meanwhile got to like the seasons and Vermont and decided 
he wanted to stay there. He had not graduated from Middlebury. 

Hughes: Had he worked with this organization? 

Gerbode: Yes. Two or three had enough money to do this. Meanwhile, he had 
been to art school in San Francisco and also Boston, but he was 
apparently not getting along well enough to be satisfied with it. 

Meanwhile we'd given him some money and he bought a small farm 
with a small barn and a few cows and decided to learn how to be 
a dairy farmer. He did all this himself. He milked the cows with 
one other boy and arranged the contracts with the people who 
bought the milk. When I visited him, he smelled like a cow. He 
had two piles of clothes, one that had been through the washing 
machine; the other which hadn't. He'd take off the dirty ones, put 
them on the floor, and take some from the other stack and put them 
on. But I guess this was his way of getting into the act seriously. 

When*"my wife died, we'd had some money put aside for all the 
children. So this was divided up evenly among the four children. 
Philip then got enough money to spread out a bit, and he decided 



304 



Gerbode; 



Hughes : 
Gerbode: 

Hughes : 
Gerbode: 



he'd go into it more seriously, and began to buy property in Vermont. 
He finally built a big, very modern barn and a house and sold some 
property, bought some more property and some thoroughbred cows. 
Now he has nearly two thousand acres of Vermont land , and he milks 
about two hundred and thirty cows a day, all done very scientifically. 



Is he still doing it himself? 

He runs it, but he has good people to work for him now. 
loves it. 

How many head? 



He really 



Well, he has about two hundred thirty milking cows, and he must have 
another fifty or sixty out in the pasture. He has a sale every 
once in a while if he gets too many cows. Since they're all 
registered and thoroughbred, he can advertise them nationally. He 
has good records on all of them, so he can say that in this line of 
cows the production has been so-and-so. He once had a national sale 
and got quite a bit of money back [from] a brochure sent out to 
breeders everywhere. 

I don't know whether we should record this, but he's always had 
someone living with him, but he never wanted to get married. Now 
he has a very nice young lady living with him, and they have a baby, 
and that makes it a little more serious.* I have nine grandchildren 
now. 

I've always gotten along very well with Philip. He's gregarious, 
very open and cheerful. Sometimes he doesn't tell me things that 
I think he should. For example, he decided to go into stockcar 
racing. He had enough money left over from his farm to buy a 
couple of racing cars and to race them on weekends. Usually he 
[races] for some company or other combine. Of course he knew that 
this would upset me, so he didn't tell me about it until he'd just 
about decided to give it up. But now he has built another racer 
and will do ten races this winter. 



Property on Kauai** 

Gerbode: About twenty-five years ago we began to worry, since we had so 

many roots in the Hawaiian Islands, that we should have some land for 
the grandchildren. We were afraid that the Diamond Head properties 



1984, less than a week 
**This section was moved from the interview on 6/20/83. 



*Philip was married in Vermont on December 1, 
before his father died. 




Papaa, Kauai 



Frank Gerbode 1984 




Papaa Bay, Kauai 



Frank G<?rbode 1980 




Kahala, Oahu 



Frank Cerbode 




305 



Gerbode: would eventually become something else. We can't get there any 
more, because in a family foundation, the family can't use the 
property. About twenty-five years ago, my wife and I started 
buying property on Kauai. We have a farm over there now, which 
I've maintained. I'm gradually buying the whole little valley. I 
own almost all of it already. 

Hughes: What do you farm? 

Gerbode: I put cattle on it, and citrus fruit, too. It's not a money-making 
thing, but it eventually will break even. Then it will be something 
that the grandchildren will have. 

Hughes: Does somebody maintain it? 

Gerbode: Yes, I have a caretaker. 

Hughes: How much time do you spend there? 

Gerbode: I go over about every two months. I like it very much. 

Hughes: Is it an old house? 

Gerbode: No. We first built a prefab house, an extremely simple one, having 
made a good site for it, overlooking a bay. Then as time went on, 
I wanted to make it a bit bigger. The kitchen was like a little 
closet. Since I always ended up doing the cooking, I wanted to have 
a bigger kitchen, but my wife didn't want to have anything too 
pretentious. So I waited until a year and a half after she died, 
and then I enlarged the house, built a bigger living room, and made 
a decent kitchen. Since then, we've built another bedroom. This 
last year, I rebuilt the whole house again, because it was filled 
with dry rot. I was afraid it was going to start falling down. 
So now it's brand new but the same [design] as it was. 



Hobbies 



Hughes: Shall we talk about hobbies? 

Gerbode: Yes. I have enough hobbies to keep me going, and periodically 
there's competition between hobbies and work. In the past work 
has always won out. 

Hughes: How long have the hobbies been in your life? 



306 



Tennis 



Gerbode: Tennis was a hobby; I liked tennis a lot when I was in college. But 
I was working so hard, I really didn't have time to play it the way 
I wanted to play it. I took some lessons from a very good pro and 
played in some minor tournaments. [It] became a pastime more than 
anything else, until about six years ago when I hurt my arm on 
my boat, so I couldn't play tennis anymore. The biceps muscle is 
all bunched up. I tore it loose. 



Carpentry 



Gerbode: I've always liked working in a shop, repairing furniture or making 
things once in a while. 

Hughes: Do you have a shop? 

Gerbode: Yes, there are a whole bunch of unfinished projects there. I'm 
inclined to try to repair things. 



Photography 



Hughes: You mentioned photography. 

Gerbode: I did photography very seriously. When I was in Germany I bought a 
Leica camera and took some lessons from a very fine photographer 
and had a little darkroom in that house which we rented in Germany, 
and did a lot of developing myself. Then when we built the house 
in San Francisco, I had a darkroom where I could continue it. I 
did hundreds and hundreds of pictures. Where they all are now, I 
don't know. 

Hughes: Did you ever enter competitions? 

Gerbode: No, but I won a prize once without knowing I was going to win it. 

We were skiing in Sun Valley, Idaho. One of the things to do there 
is to climb up to the top of the tallest mountain nearby. It took 
all day to climb up there with skins. We went into a little cabin 
with a wood stove and enough food to last for a couple of days. 
The eggs froze in the cabin that night, it was so cold up there. 




In front of the 
Gerbode house at 
Sugar Bowl in the 
Sierra. 




Fishing with friend, 
Thomas Plant. 



307 



Gerbode: Anyway, there was a ski instructor by the name of Florian who 

was our guide to get us up there. Florian the next day after we 
got there did some jumping. He was doing turn-overs in the air 
and a lot of other acrobatics. So I took a lot of pictures of him 
doing it. We finally skied down from the top of this mountain after 
a couple of days, and I took the film into the photography shop in 
Sun Valley, and the man who ran it said, "Why don't you enter the 
photography contest? These pictures are good enough." I said, 
"Fine, you make some prints and put them in it." We left a couple 
of days later, and then I got a letter from the man saying, "You 
have won the first prize in the photography contest." So I wrote 
back and said, "What did I win?" He said, "You won a dancing 
lesson with Arthur Murray." [laughter] 

Hughes: You have given up photography. Why is that? 

Gerbode: Well, I've never stopped taking pictures, but I gave up developing 
them. 



Painting 



Gerbode: After I'd gotten into open-heart surgery it was then about 1953 
I got to know Hector Escabosa quite well. He was then manager of 
I. Magnin's. He and I got along very well. Our wives were very 
compatible, and he for some reason liked me, although my work was 
certainly as far removed from his as you could imagine. He'd been 
trained as an artist and had started with the Magnin Company in 
Seattle as a window decorator. Then finally he went all the way up 
the ladder and became the manager of I. Magnin. He was a very 
lovable, very nice, warm-hearted person and a good painter. So he 
kept telling me when I'd see him here and there, "Frank, have you 
thought about taking up painting?" I said, "Well, I've thought about 
it." He said, "I think you could paint." So this went on for a 
year or so. Finally he called me up one day and he said, "Frank, 
what are you doing for lunch today?" I said, "Nothing." He said, 
"All right, I'm going to meet you at Jack's Restaurant. We're going 
to have lunch. Then we're going to buy you some paints." 

So we had a martini lunch and a nice trne and walked up to 
Flax's, which was about four blocks away, and bought a bunch of 
paints and canvases, and that Sunday we went to his lovely apartment 
on Jackson Street it's a penthouse apartment, a beautiful place 
to paint and started painting. 

Hughes: He had a real studio? 



308 



Gerbode: He had a place where you could sleep and cook, but it was a real 

studio with a beautiful view of the bay. The first thing I painted 
was some dying anthuriums. The painting is now in Hawaii. It's 
not a bad painting. 

So we painted together about once a week. Our wives would 
come over and give us cocktails once in a while, and then we'd 
have a meal together. I didn't really take myself seriously. I 
just was having a good time. 

The four of us once went to Hawaii together on a vacation this 
was when we first bought the farm on Kauai and did some paintings 
of the farm as it was then. He did some, and I did some. We were 
invited to go to Jack Waterhouse's farm at Kipukai for a few days. 
So we took our paints and stayed at Jack's place for about three 
or four days. He had a Japanese cook who cooked all our meals. 
She would come in and say, "Supper ready; you come now?" We would 
say, "Well, just a minute," and sometimes we would be an hour later, 
we were so engrossed in what we were doing. I did twelve paintings 
down there, some of which I discarded or gave away, but there are 
two or three that I kept from that vacation. 

Hughes: Were they mostly oils? 

Gerbode: They were all oils then. More recently I switched to acrylics. 

We were both members of the Bohemian Club , so I began to put a 
painting into the spring exhibit of the Bohemian Club and also into 
the so-called Ice House Show up at the Grove. Then I guess about 
twelve years ago I decided to do a Christmas card every year. I 
haven't done this year's yet, and here it is almost November. 

I've enjoyed the painting, although I don't take myself 
seriously. My philosophy is that a painter should paint what gives 
him pleasure, and if you get to want what somebody else wants, 
then you're worried about that and are not so happy. 



Sailing 



Gerbode: I've gotten a few other hobbies since then. So about twelve years 
ago I decided . I'd been looking at that bay out there all my 
life and had hardly been on it. I decided that wasn't right. If I 
was living by this bay and I liked the water, then I should get a 
boat. So I did some research on it. One day I was in New York during 





A Farm 



Hrjnk Cerbode 




Aiguille tie Blailirrp Ohamorux 




Frarw Gerbode ; 983 




309 



Gerbode: the New York Boat Show, so I went over to the Boat Show, which is 
one of the biggest in the country. I saw a boat which seemed to 
fit what I wanted. So I put a deposit on it and I asked a friend 
who goes by the name of Commodore Warwick Tompkins, who is one of 
the most famous sailors around the bay, if when he was in the East 
he'd look at it and see if it would be suitable for San Francisco. 
He did, so then I bought it, and he got it rigged for me. I 
decided the best way to learn how to sail it would be to race it 
and go on as crew. Commodore Tompkins got a very good crew together. 
I took the most menial job on the boat each time, but at least I 
learned how to sail it. 

Hughes: You didn't know any of these people beforehand? 

Gerbode: I knew Tompkins slightly, but the others not at all. 

Hughes: Was he part of the crew? 

Gerbode: He was the captain. 

ti 

Gerbode: He's got a tremendous ego. If you do something slightly wrong, he'll 
just* blast you openly on the boat. I finally told him, "I can't 
sail with you anymore, Commodore, because you give me an inferiority 
complex," which is what he always tried to do. Even experienced 
sailors would [get] this treatment. We won a lot of prizes. I've 
got a few things at home. This was the boat, that one in the middle 
there. [points to photograph] It's a thirty-three-foot sloop. 

Hughes: It's a beauty. 

Gerbode: It was a very solid boat, not a very powerful racing boat, but with 
a good crew and good sails and knowledge of how to sail in the bay, 
we managed to win quite a few races. But it was always a chore. You 
get the team lined up, and then one member might call up and say, 
"My wife's got a backache, I can't come." Then you don't have 
somebody for a key position for the race, and you have to try to 
find somebody else. It takes time, and it's always a worry. I 
always had to bring the food down for the whole crew and arrange 
to have everything fixed that got broken during the race and get 
the boat cleaned up. So I finally gave up racing. I also decided 
that I wanted to get a larger boat. 

[telephone interruption] 

Gerbode: I talked to my friends here and in the East who were serious 

sailors, and they said one of the best commercially made boats is 
the Swan line. They're made in Finland. So I began to get 



310 



Gerbode: literature on it and discovered that the boat I would want is a 
forty-one-foot boat, and I finally order one. I sold my Luders 
to Tom Plant, and I bought the new Swan, a forty-one. It came out 
on the top of a Finnish freighter, and it was very dirty and had 
been improperly mounted on the deck so the company had to spend a 
lot of money to get it cleaned up. It was over there in dry dock 
for over a month, while they cleaned it all up and fixed all the 
little things that were damaged on the trip. 

I sailed that Swan forty-one for about five years. Everybody 
who's got a boat wants one smaller or bigger. I was staying with Tom 
Plant up in the San Juan Islands, where he has a beautiful house. 
We were there one night having dinner , and along came a Swan about 
the same size as mine and anchored right in front of the house. So 
we got in a little power boat and went out to find out who owned 
this Swan. It proved to be a dentist here in town. He invited us 
aboard. He'd sailed all the way up there with his wife and newborn 
baby and I think one other crewman. It was quite apparent that 
this boat, which was forty-four feet long, was much more capacrious 
and much more suitable for long cruising than my forty-one. So I 
thought, well, maybe I'll get one like that. So when I came back 
I talked to the Swan people here, and they said, "Well, we have 
a forty-four in Annapolis. We brought it over to have it shown at 
the Annapolis boat show, and we were thinking of bringing it out 
here to show at the boat show in Newport. We'll give you a very good 
price if you'll let us show it down south during the fall boat show." 
I said, "That's fine." The boat was at the Newport boat show as 
the queen of the show. They got it all dolled up. People had to 
sign in advance to go see it. 

It's a bigger boat so it takes more physical labor to 
sail it. But we've had a lot of fun on it. I can sail it with one 
other good sailor. But I usually like to have two people with me in 
case there's an accident of some kind, because you at least have 
two people left to do everything. It's very strong and beautifully 
built. I've got four people who have been on the boat a lot. So 
I usually get one or two of them to come along, because they know 
what to do. I don't really have to do much myself, except steer it. 



A Brush with McCarthyism 

Hughes: Would you care to tell the story of your wife and the problem with 
the Communist affiliation? 




Relaxing after the trans-Pacific race, Papaa, Kauai, 1981. 

Photograph courtesy of Dr. Ellen Ki-llebrew 




Sailing on San Francisco Bay, early 1980s 



311 



Gerbode: My father-in-law was a founder, with Ray Lyman Wilbur, of the 

Japan Society, which later became the Institute of Pacific Relations. 
He was very active with Wilbur, in improving our connections with 
Japan. There were a great many Japanese coming into the country at 
that time, and he felt that Japan was close to us. [He was also 
interested in Japan] because of [his connections with] the Hawaiian 
Islands, where there were a great many Japanese coming over as 
laborers. So Mr. Alexander was very keen on keeping good relations 
with Japan. 

The Institute of Pacific Relations got to be a little bigger 
than just a small, local organization. They opened an office in 
New York, mainly for fund raising. They put the office in charge of 
a man, Mr. Carter, who later became very friendly with the Russians. 
I guess through him the FBI began to think that maybe it was a 
Communist front organization. 

Hughes: When was this? 

Gerbode: This must have been '38, '39, somewhere in there. My wife and I 

didn't have much to do with it. We gave a small contribution. Once 
in a while we'd go to something that was organized for the Japanese, 
usually in association with diplomats who were sent over. Mr. 
Alexander. made contributions every year because he was a founder. 

Then we began to [hear] that it was being considered kind of 
a Communist front organization because of this fellow in New York. 
Once you get your name down in the FBI with anything like this, 
you've had it. Some of the people connected with the organization 
and some of the neighbors were at a party in Pacific Heights. Somehow 
the FBI spotted that party as being where the people in the red cell , 
so to speak, were going to be together. They catalogued everybody 
that went into that place. 

Hughes: Unbeknownst to you at the time. 

Gerbode: I was away overseas in the war. They got my wife's name, and also 

that her father was a founder of the Institute of Pacific Relations, 
a principal backer and therefore suspect. Meanwhile she had been 
sponsoring liberal causes in town. Nothing Communistic, but liberal 
causes, such things as the Planned Parenthood organization. 

Hughes: [laughs] A well-known red front organization. 

Gerbode: Right. She would take public stands on the liberal side once in 
a while. This was considered not very good by the FBI at that 
point, because McCarthy ism had started. Then anyone who'd had any 
connection with anything that was even slightly liberal was investigated. 



312 



Gerbode: When I got out of the war I was asked to become a consultant for 
the Veterans' Administration Hospital [in San Francisco]. All of 
a sudden the appointment was held up and I was investigated by the 
FBI. The appointment was not granted because of these [associations 
with the Institute of Pacific Relations], So I had to hire legal 
counsel. I got Dick Guggenheim, a friend, and Paul Bissinger, my 
neighbor, and Joe Moore, my friend, all good solid Republicans 
and about as straight as you could imagine, to testify. We had to 
have a hearing downtown in front of the FBI and the Veterans' 
people. It was a very sordid business. The sad part to me was 
that I thought I had a good war record. I'd been overseas and 
gotten six battle stars and a unit citation and a promotion. I 
thought that was pretty good, enough to warrant being a consultant 
for the Veterans'. When you sit down in front of these FBI fellows, 
they look at you as though you were a criminal. They can't tell 
you anything. They can't sympathize with you. They just stare at 
you and ask more questions. It really is the most disgusting, 
disheartening thing that you can possibly imagine. 

Finally that appointment went through, and then I was asked to 
become a consultant to I've forgotten which position it was in 
Washington. It might have been as a member of the National 
Research Council. That was held up for a long time. Finally the 
Assistant Secretary for Medical Affairs, Frank Berry, who had been 
our surgical consultant in Europe, came to my rescue. He was my 
friend in Washington. Once when I was visiting him in New York 
at another committee meeting, I said, "Well, what's happened to 
that position they asked me to [take]?" He said, "The same old 
business concerning the IPR." 

Hughes: So even though you got the Veterans' Administration appointment 
Gerbode: They had to go through the whole damn thing again. 
Hughes: it was not taken off your record. 

Gerbode: Nothing is erased from your record. It is impossible to get your 

record out of the FBI. I could say you're a Communist, tell an FBI 
person and cook up some fictitious [story]. It'll go into your 
record, and it'll stay there forever. 

So I guess Frank Berry [told] them that I was a good, law- 
abiding citizen, he'd been with me all during the war, I had a good 
track record, and everything was absolutely clean. I guess he got 
it straightened out in Washington, because later on I've been on 
four or five other commissions back there, and that stuff has never 
come to the surface again. But I'll tell you, it's a very sickening 



313 



Gerbode: thing. I never told my wife during all these investigations why 
the FBI was investigating me. She knew something was going on, 
that I was going down there, but I never told her a thing about 
the party she went to. 

Hughes: Because it would upset her. 

Gerbode: I didn't think she had done anything wrong, and so why bother her 
with it. 



314 



IX TRIPS 

[Interview 13: April 12, 1984 ]## 

Russia 

Hughes: Would you tell me how your trips to Russia came about? 

Gerbode: The first trip I made was to a joint meeting of the International 
Cardiovascular and International Surgical Associations in Moscow. 
It was a scientific meeting with quite a few participants from 
other countries in addition to Russia. The Russians actually put on 
a very good meeting. They had everything well organized and they 
had large meeting halls. The equipment they had to record and to 
hear the various talks was beautifully operated. 

I would say that the Russians did not produce very much that 
was original or new. Most of their papers were statistical, and 
some of them were even not very good statistically. However, I 
think the people who went rather felt that it was a worthwhile 
meeting. This lasted about five days altogether. We had a very 
good understanding for Russian medicine and Russian surgery as a 
consequence of that meeting. 

Later on President Nixon went to Russia where he was asked to 
work on a collaborative program with the Russians in science. This 
was a time when he was doing very well with the Russians, and they 
agreed to have a collaborative program, more or less across the 
board, in science. So when he came back they set up committees in 
various categories. For example, they had a committee on arterio 
sclerosis, and one on emergency surgery. Another was on congenital 
heart disease. They had people in this country and in Russia assigned 
to these various committees, and they were supposed to have joint 
meetings, have scientific presentations, and discuss the problems 
relative to these various categories. 



315 



Gerbode: I was appointed chairman of the committee on the surgical aspects 

of congenital heart disease. There was a committee in Russia under 
a Professor Boris Burokovsky of the Bukalev Institute in Moscow, 
which is the biggest institute relative to heart surgery in Russia. 
I appointed a committee in this country of about five or six members, 
and Burokovsky appointed a similar committee in Russia which was 
supposed to work up scientific data for presentations. 

Our committee then went to Moscow and met with Burokovsky at 
the Bukalev Institute and discussed what the themes should be in 
congenital heart disease. In other words, we didn't think that we 
should encompass ; all the various aspects of congenital heart 
disease because that would be too much, so we chose a couple of 
themes which might be identified as subjects that could be discussed 
bilaterally between the two countries. We set up a time for the 
first meeting. This was set for a year and a half or so after 
this initial more or less business meeting. 

Everything was documented carefully by Russian secretaries, and 
in due time this was all approved with the official sanction of the 
government. Then we decided on a date. We then went back to Moscow 
and had a joint meeting in one of their big halls, and the 
presentations were more or less on the subject matter which we had 
chosen to be important. There were an equal number of papers from 
the Americans and from the Russians. These papers were all 
presented in an abbreviated book. form, and th^s was distributed in 
due time to all the members of the committees- 

Hughes: Did you find that the congenital problems were similar in Russia 
and the United States? 

Gerbode: I really think the congenital problems are almost the same worldwide. 
Hughes: So it was really obvious which ones needed attention? 

Gerbode: Yes, and the terminology connected with each one was pretty well 
known between the countries. I think you'll find the same 
incidence of congenital heart disease in most countries. Some 
countries, perhaps Alaska, among the Eskimos, might have more than 
some of the other countries, but I'm not even sure of that. 

The subject matter was quite pertinent and worthy of discussion, 
and I think the presentations were generally quite good. However, 
I think the American presentations were, if I may say so, much more 
advanced and new than the Russians'. The Russians, I thought 
generally speaking, were playing catch up, if you can use that term. 



316 



Gerbode: Obviously they were behind in technology in developing methods of 
treating congenital heart disease and therefore their results 
were not quite as good. 

However, the participants got along fairly well. The social 
programs arranged by the Russians for the Americans were quite good. 
They took us to a number of dinners and luncheons and that sort of 
thing. Lots of drink. Lots of vodka. And lots of toasts. 

Hughes: When you say that they are behind in medical technology, does that 
imply that they're not keeping up with the world literature? 

Gerbode: Well, they, for example, had to make their own heart-lung machine, 
which was not very good, being a copy of an American heart-lung 
machine. Their respirators were mostly not Russian respirators; 
they were copies of Western respirators. One was made in East 
Germany. Some were made locally in Russia, but were not very 
satisfactory. Their intensive care unit, where the seriously ill 
patients were taken care of , was about ten years behind our level 
of competence. They had decided some years before we went there 
that monitoring of patients requiring intensive care was important, 
so they had bought a very big console from Italy to monitor various 
parameters in these sick people, but they could never make it 
work. It was sitting there like a white elephant in their intensive 
care unit, which means that then they were obliged to measure very 
simple things with rather out-of-date methods. 

Hughes: Why do they put up with inferior technology? 

Gerbode: I don't think their industries were advanced enough to do it. For 
example, just the matter of tubing. They didn't have enough tubing 
to use disposable plastic tubing for every case. So then they used 
rubber tubing, which they then cleaned and sterilized and reused, 
which is a very primitive way of doing it, because you can't really 
clean rubber tubing once you use it and people get febrile reactions 
and other things from it. There's one thing in its favor and that 
is it ' s cheap if you use it over and over again , but cheap at the 
expense of the patient. 

They had made a ball valve, for example, which was a copy of 
our Starr-Edwards ball valve, not very satisfactory. 

Hughes: What is to prevent them from buying a heart-lung machine, for 
example, from the West? 

Gerbode: Well, they started doing that; they finally bought a monitoring 

system from Hewlett-Packard. It was a long time being delivered, 
and they kept writing letters to me and telephoning to see if I 



317 



Gerbode: could get the delivery time speeded up a bit. Hewlett-Packard 

kept telling me that it was being made for them by an Eastern 
factory of Hewlett-Packard. Eventually they got it, and I think 
it's working all right. 

Hughes: But that is an option for the Russians. 

Gerbode: It was an option, yes, but it wasn't in the very beginning. In 

the very beginning I think they rather felt they could do all these 
things themselves, but then they couldn't. The same thing is 
happening with the Chinese. The Chinese don't have the money, 
which is one big difference, but they know what they should have 
and they try to make it. They've done a fair job of copying Western 
devices. 

Hughes: Are you saying that the Russians do have the money? 

Gerbode: Oh, they certainly have enough to put a person into space. That's 
millions of dollars. 

Hughes: But it's a question of whether the government would allow that kind 
of money to be used for [medicine] . 

Gerbode: It's a matter of priority, sure. I'm sure if they felt that medicine 
and medical devices were a high priority they could do a lot better 
than they're doing. 

Hughes: How much do they rely on developments in the rest of the world? 

Gerbode: I would say that the answer to that is how much original work comes 
out of Russia very little. I think the best thing they ever did in 
recent times was to develop stapling machines to make intestinal 
anastomoses. It didn't take very long for American companies to 
meet that challenge and produce their own instruments, which are 
quite good, maybe even better than the Russians, I don't know. But 
that was one thing the Russians did originally which was innovative 
and quite good. 

Hughes: Can you explain why there is so little innovation in a country the 
size of Russia? 

Gerbode: Oh, I think it's just a matter of the emphasis being placed on the 
people that have ability. If you follow people's real ability, you 
can make things for space, or automobiles, or whatever. Priority 
is established from above. 



318 



Hughes: You said that you got an understanding for Russian medicine and 
surgery. Was that because you were actually taken around to 
different hospitals? 

Gerbode: Yes. They had meetings and presentations in hospitals, and they 
produced their best figures and their best case reports. They 
tried very hard to put their best foot forward. One of the 
principal problems of the Russians is they never admit that they're 
not first-class in any category. If they did, they'd probably have 
their heads cut off as individuals. If you ask them if they've 
ever done a certain thing, they'll say, "Oh yes, we've done that. 
We did it years ago," or "We've done that a thousand times." They 
cannot say they never did it. And it isn't that they don't want to 
as individuals; it's because they don't dare say what is really 
true, which means that present Russians cannot be intellectually 
honest. That's the biggest deficiency I think our people have found 
with them, that they are not intellectually honest. And they can't 
afford to be as individuals. It's sad. 

The Chinese, on the other hand, are mainly very intellectually 
honest. If they haven't done it, they'll tell you, or if they've 
done it twice, they'll tell you. They try very hard to make their 
own instruments when they can't buy them. And they'll apologize for 
having tried and not having done a very great job, but they made 
their best effort. 

Hughes: Did you get a feeling about how successful the Russian medical 
system is in caring for an average patient? 

Gerbode: It's pretty hard to find out about that, because you don't have any real 
figures on it. From what I could gather, they're doing very well 
with emergency services. Their ambulance services in the big cities 
I think are quite good from what I could gather, and getting people 
quickly to the right hospital with emergency ailments. 

Hughes: Is their system of training and qualification similar to ours? 

Gerbode: Much, I think, depends on whether somebody under whom you're working 
likes you and whether you're a good member of the party. 

Hughes: So politics does play a 

Gerbode: Politics is terribly important. Nobody coming up this ladder will 
ever say anything bad about anything in the system, even their own 
unit. They can't afford to. So self-criticism in the sense that we 
know it in this country or in England, let's say, just can't exist, 
and it can't exist because it's not practical. 



319 



Hughes: I know in China there's a subcategory, if you can call it that, of 
the barefoot physician; is there anything comparable in Russia? 

Gerbode: No, I don't think so. They sort of categorize the female doctors in 
this category. But I saw some very good female doctors when I was 
there. One of the best heart surgeons they have is a female. 

Hughes: Are women more highly represented in the system than they are in 
this country? 

Gerbode: It's very hard to find a female surgeon at all in this country. But 
they do accept them there, because it's a matter of work, and if they 
can do the work, they let them do it. 

Hughes: Why were you appointed chairman of the committee on congenital 
anomalies? 

Gerbode: I don't know. You never know where these things originate. Maybe 
it was because I had done so many open heart cases early on in 
congenital heart disease. I've written a certain number of papers. 

Hughes: What was the national umbrella under which this committee fell? 

Gerbode: It was something like National Cooperative Effort or Association 
with Russi.i in Scientific Matters. 

Hughes: It was an entity unto itself. 

Gerbode: Yes, it had a budget established by Congress and run by a committee 
in Washington. 

Hughes: It met only one time? 

Gerbode: No. I was going to say that the next meeting was held in Washington 
at NIH. We again prepared papers. We selected some more Americans 
who hadn't been to Russia before but who had important things to 
describe or talk about, and they presented their papers, and the 
Russians tried to do the same. But actually, by the second meeting 
it was quite apparent that they were having difficulty finding 
really good things to talk about , whereas we had some pretty good 
stellar performers to talk about their work. Anyway, it was very 
amicable, and we had nice luncheons and dinners in Washington for 
about three days and decided that the next meeting again would be 
in Russia. 



320 



Gerbode: So we all went back again. At that point I decided that I would 
rather not be chairman of the committee any longer , because I had 
other things to do, and I felt that I'd made my major accomplishment 
by getting it going. So I turned the chairmanship over to Henry 
Bahnson, who is professor of surgery at the University of Pittsburgh. 

Hughes: Was that your decision to pick him? 

Gerbode: Yes, they accepted my recommendation and Henry was made chairman of 
the committee. I participated in the committee for one year after 
that. 

Hughes: What responsibilities does the chairman have? 

Gerbode: The chairman has to get people to present their best work from this 
country and to get them to go to Russia or present the material in 
Washington . 

Hughes: [The chairman] actually chooses the individuals? 

Gerbode: Yes, I think I originally picked out ten people. Then the second 

time around we used some of the old ones and some new ones , and then 
Bahnson had to pick the -ones for the next go-around. 

Hughes: Where was the money coming from for these trips? 

Gerbode: It all came out of an allocation from Congress, a budget developed 
for the effort. We have a budget like that with the Chinese at the 
present time, too. 

Hughes: But nothing with Russia anymore? 

Gerbode: I think the committee is still operating, but I'm not sure when the 
next meeting is going to be. 

Hughes: So it is an ongoing thing. 

Gerbode: To a certain extent it's ongoing. When you talk to the chairmen of 
other committees, the overall result has been that the Russians 
probably got a lot of information from us, and we got practically 
nothing from them. It wasn't that they were holding anything back; 
it was just because they didn't have too much to offer that was 
really first-class. The people involved are very likable. 

Burokovsky is a very likable, stout man. His daughter was in 
terrible trouble from a simple operation. I think it was something 
like an ovariectomy. The anesthetic was not very good so she had 



321 



Gerbode: cardiac arrest, and then she got pulmonary complications of 

resuscitation. There were several long distance calls, of which I 
got one: "Should we do this or do that for her?" Finally we 
settled on sending a young fellow from Boston to go over and help 
out the situation. I'm merely saying that this is an example of 
their realizing at high level that something special was needed, but 
they were not able to do it locally. 

Hughes: Do they read the world literature? 

Gerbode: Yes, they have all the literature. There's no question about that. 

Hughes: Does the average physician speak or read English? 

Gerbode: No. Most of the people in the big centers speak and read enough 
English to get by. But it doesn't go very far in depth. 

Hughes: But enough so that they can read the English literature? 

Gerbode: Yes. There were a few of the Russians whom we met who were fairly 
outspoken about the system. I don't wish to mention their names 
because somebody may read about them and they might get in trouble. 

Hughes: What sort of things were they saying? 

Gerbode: They were having trouble getting proper equipment, proper things 

for their patients. One of the professors had a daughter, and she 
got to like an English correspondent. I don't know if anything was 
present more than like, but they got to the point .of wanting to 
correspond , and all of a sudden the letters were terminated by the 
postal service. 

Hughes: Would you say that the Russian physician has a similar position in 
society that the American does? 

Gerbode: No, I wouldn't think so. I think the people in society who are in 
the driver's seat are the members of the Communist party who have 
official appointments. Burokovsky, who was the professor of the 
biggest heart unit in all of Russia, lived in a small apartment with 
two bedrooms, very meagre furnishings, a rickety old elevator. 

Hughes: Was he on a salary? 

Gerbode: Oh sure. 

Hughes: There is nothing approaching private medicine? 



322 



Gerbode: Oh no, nothing at all. I suppose somebody who's a farmer or something 
like that might bring in a goose or something and give it to the 
professor. [laughs] 

I've been on the list to help with Russian committees in 
medicine who come to San Francisco, because I've been identified 
with these committees I've been on. They very often call me when 
one of these delegations comes here, and I give them a cocktail 
party or supper or something. 

I'll tell you something that probably shouldn't be in the record, 
but one of the last delegations which came through last year was a 
group of specialists, and the chief of pathology for all of Moscow 
was in the delegation. The delegation otherwise was led by a 
professor of surgery in Moscow who's a terribly nice fellow, very 
polite, has good manners, and gets along very well with the Americans. 
I like him very much. Anyway, the group came here. I had some 
hors d'oeuvres and a buffet supper lined up for them. The hor d'oeuvres 
vanished in about two seconds. Then I noticed that the professor of 
pathology, head of all the pathologists in Moscow, had disappeared, 
and I looked around and I couldn't see him. So I finally came to 
the library, and he was sitting on a stool in front of the fireplace, 
smoking and blowing the smoke up the chimney because somebody told 
him I didn't like people to smoke in my house. [laughter] And he 
did the same thing after the buffet supper was finished. 

Well, there's another great difference between the Chinese and 
the Russians. The Chinese are born with good manners. They know what 
to say and what to do and how to act naturally. The Russians never 
do. You have a feeling that everything they do and say is more or 
less drilled into them, and you're never quite sure what they really 
think or believe. The Chinese are just the opposite. What they say 
is usually quite honest and very straightforward. 

Hughes: Do you think this is anything to do with the political situation? 

Gerbode: I think they're born that way. I don't know how you get that 

developed into a gene. There's a big difference in dealing with 
people. 

Hughes: It sounds as though you couldn't have a very intimate conversation 
with a Russian. 

Gerbode: Oh, never. Particularly if they don't have good manners and they're 
not intellectually honest, then you can't ever have a really decent 
conversation, because sooner or later you make a remark about something 
over which there's a slight controversy, and then they will always 



323 



Gerbode: avoid any personal statement about it, and they'll say only what 

is generally accepted. Otherwise you deal entirely with platitudes 
the weather, the country, simple things that everybody will accept 
as being reasonable discussions. You don't discuss sex or crime or 
alcoholism or robberies. 

Hughes: Or politics. 

Gerbode: Or politics above all. Oh, they're interested in our country. They 
ask you questions about our country, but they would never have an 
opinion themselves. 



China 



Hughes: 
Gerbode: 



Gerbode; 



Tell me the circumstances of the two visits to China. 

Professor Y. K. Wu is a charming man whom I met before the revolution 
when I was a resident in surgery at Stanford. He liked me. He came 
over from the Rockefeller Institute in Peking to have a tour of the 
country and to work with Evarts Graham in St. Louis for a while. 
Afterwards he went back to Peking and became the first trained 
thoracic surgeon in all of China, did the first big operations, and 
became a leader in the field as chief of, I guess, thoracic surgery 
at Peking Union Medical College. Then the Chinese revolution came 
along, and since he was an intellectual and since they terminated 
all teaching in China, he was shipped off to the country to be an 
ordinary dirt farmer. He had a little house in Peking I think he 
had two children and his wife the government simply took half of it 
away and gave it to somebody else. So his family had to share the 
house with an unknown family, while he was off being a farmer in the 
country. Luckily, he wasn't killed. A lot of the intellectuals were 
killed by the Chinese at that time. 



In any event, after the revolution was over, he was reinstated. 



## 



It's not the old Peking Union Medical College; they never restored 
that to what it was before, because that was completely American in 
conception and financing by the Rockefeller family and the Rockefeller 
Foundation. 



Hughes: Was that pride that they didn't reinstate it? 



324 



Gerbode: I suppose so. In any event, it's now called the Capital Hospital 

and has its own budget from the Chinese government. Y. K. Wu began 
to develop his former friendships in this country and got enough 
money to travel around and meet some of the people he had known 
when he was in the old teaching university there, and began to 
develop a program of cardiac surgery, as well as pulmonary surgery. 
He arranged to have some of his young people sent around to clinics 
here and there in this country for training, to be brought back 
and then put into good hospitals in China. His program is still 
going, but unfortunately now our government has stopped us from 
giving any foreign doctors any clinical responsibility, and there's 
virtually no money from them either. 

Hughes: Who was responsible for instituting that policy? 
Gerbode: That's a policy of the United States government. 
Hughes: Dating from when? 

Gerbode: About three years ago [1981]. So this terminated all the foreign 

fellowships. I had all my foreign fellowships terminated then, too. 

Hughes: Was that fear of competition? 

Gerbode: I think mainly it was because so many people came from underprivileged 
third world countries and wouldn't go home. South America is a 
prime example where hundreds of men came up here after they finished 
their medical school, went into training programs, and then just 
didn't want to go home anymore. 

Hughes: Did the AMA have a role in this? 

Gerbode: The AMA took a position, I think, of believing that the programs 

should be curtailed. So anyway, it was very difficult to have the 
Chinese come over here, and it's still difficult, except if they 
come over and simply are observers. If somebody can pay for them, 
they can come if the chief will let them come, and they'll observe. 
For example , last year six Chinese from a whole team in Peking were 
sent over and they observed for a year at the Pacific Medical 
Center. But that's very difficult, too, because if you can't 
really let them do things or be responsible for patient care, all 
they can do is watch and guess what's right. But it's not the full 
way to train anybody. 

Hughes: Obviously this policy hurts the rest of the world; but doesn't it 
also have repercussions for this country? 



325 



Gerbode: Well, it does certainly the world has been saturated with graduates 
of our training programs. Now there are so few of them here. Many 
of them, I think, are going to England, where it's become 
difficult too, or Germany, where it's also very difficult. It's 
now much harder for a foreign graduate to get into any kind of a 
training program outside of his own country. 

Hughes: What would a young Chinese with ambitions in surgery do? 

Gerbode: About the only thing he can do is get a traveling fellowship, either 
from somebody in this country or through our China committee. There 
is a committee set up in Washington with federal funds, a cooperative 
committee very much similar to the Russian one, where people are 
selected to come if they have a place to go back to and if the 
Chinese will pay for part of their experience in this country and 
if somebody will accept them. But when they get here, all they 
can do is observe, go to rounds and watch operations. 

Hughes: Would their preference in general be to come to this country, rather 
than Britain, for example? 

Gerbode: Yes, I think so. We're still the predominant country, although 
there are quite a few going to England and some to Germany and 
Scandinavia, too. 

Hughes: Did you get any impression of how much influence traditional 
Chinese medicine still has on everyday practice? 

Gerbode: Well, that's a very curious thing, if you're talking about acupuncture 
and herb medicine. 

Hughes: Yes. 

Gerbode: All the villages have a traditional Chinese medicine department, and 
it looks like some of the stores we have downtown in Chinatown 
with all these herbs and bottles around. A traditional Chinese 
doctor will write out a prescription of herbs for a given patient. 
They mix it up just like we mix up a prescription in our drugstore, 
and the patient drops by to take it. 

Now, why do they retain these things, particularly acupuncture? 
You go into the hospital and they have a section devoted to taking 
care of patients with acupuncture. Which operations do they do 
under acupuncture? Once in a while they can get a patient 
psychologically prepared to, let us say, have an atrial septal defect 
or something relatively simply done with acupuncture, but that 
patient has been verbally trained to accept acupuncture, and also he's 



326 



Gerbode: under a fair amount of intravenous medication, like morphine or 

demerol. So it is well known among cardiac surgeons, for example, 
that you can do lots of operations with intravenous demerol and 
oxygen. In fact, I wrote a paper on it once. I did about two 
hundred cases that way. 

Hughes: With the patient ostensibly conscious? 

Gerbode: Well, he's half conscious, but he can't feel anything because the 
intravenous demerol knocks out his pain centers. 

Hughes: And do the Chinese use demerol? 

Gerbode: You never know how much, but they do use intravenous medication. So 
if you ask one of the higher authorities in any one of these big 
clinics, they'll say, "Well, about the only time we use acupuncture 
these days is for head and neck surgery." For some reason it works 
a little better to use it for operation above the clavicle. I don't 
know for sure what the reasons for that are, but that's what is true. 
Also, the other thing that's true is they always had an anesthesiologist 
on standby. 

Now, the other reason for maintaining traditional Chinese 
medicine is that the Chinese politicians believe that it's still very 
good treatment, and probably some of it is. 

Hughes: It's probably politically expedient, too. 

Gerbode: That's the whole point. They don't dare say that Western medicine 
is better. So in every one of these big centers they have a 
section on traditional Chinese medicine supported by a federal 
budget, and also they send people to this country as missionaries 
of traditional Chinese medicine who are trying to convince the outer 
world that it's still good. I've had some come to me in my house. 
I had one of them give a lecture here once. Not very convincing, but 
at least on record when he went back home he could say he gave 
lectures on it here, there and elsewhere. 

I'm probably talking it down a little bit more than I should, 
but the Western-trained people who've been here and in England, 
Germany, and Scandinavia, don't use it except maybe occasionally for 
political reasons. Now, in the country I guess it's a way of 
giving [patients] what almost amounts to a placebo, by giving them 
some herbs to make them be sure that they're being taken care of 
until the point that they have a tumor, then obviously they'll 
take care of it another way. 



327 



Hughes: Is there a formal system of education for the traditional medicine? 

Gerbode: I think so. They have courses. 

Hughes: But it's not a four-year medical school. 

Gerbode: No, I think it's mainly courses within their normal curriculum. 

Hughes: There were two trips to China? 

Gerbode: The first trip was organized by Y. K. Wu. He had one American, one 
Frenchman, one Swiss, one Englishman, and one Romanian. Y. K. had 
enough political power to say, "I would like to have these people 
come over and talk on various aspects of medicine." He asked me to 
talk on a certain part of cardiac surgery, and he asked the other 
ones to discuss something that they'd been particularly interested 
in. Our main meeting was in a relatively small town, Hanchan, and 
this was the first meeting of the Chinese Medical Association in 
fifteen years. 

Hughes: Why was that? 

Gerbode: Well, because of the revolution. They asked me to give the opening 
introduction, the good words, which I managed to put together 
properly. But to look at the mass of about two thousand physicians, 
all in the same gray coats, in this big hall, was really something, 
and to know that this was the first time they'd had a formal meeting 
in fifteen years. They housed them in various buildings all around 
the town and fed them in big halls. 

We put on a program of emergency surgery, cardiac surgery, and 
coronary surgery. 

Hughes: Did you have the feeling that you were telling them things that they 
hadn't heard before? 

Gerbode: Yes. I'm sure they hadn't been able to read the literature on all 
these subjects. 

Hughes: What about their ties to Russian medicine? 

Gerbode: That had terminated abruptly a year before, although in some of the 
hotels they still had, for example, "restaurant" listed in English, 
and then before that on the same strip was "restaurant" written in 
Russian, so you knew that they had been around most places. But by 
the time we got there no one hardly even mentioned the word Russian. 



328 



Gerbode: They took very good care of us. We stayed in an old hotel which 

had been built by the French many years before. It was quite old- 
fashioned. We had hot water. They brought us tea to the room in 
the morning. We had rather standard meals in a big hall. Coffee 
was very difficult to get in any quantity or quality. 

For the first meeting to Russia, for example, my English 
friend, whose name I won't mention, said, "Frank, you know, the 
Russians have finally learned how to make coffee out of grounds." 
Which is a typical English remark. In Russia they'd serve you an 
egg or a piece of bread or toast or something, and then after you'd 
finished all of that they'd bring in this terrible coffee. 

Hughes: Do you care to say anything more about the China trip? 

Gerbode: Yes, I would like to say that the first trip impressed me with how 
friendly and honest they were. We never locked anything. The 
regional Communist officials, the men who are really in charge of 
the Communist party, came to a dinner party. They were very 
friendly. It was difficult to communicate with them because they 
couldn't speak English, but they had interpreters there. Everything 
we said on the stage at those meetings was translated right away. 
They put on a Chinese opera for us. They took us to the theater 
where acrobatics were being put on, which was fantastic. 

I took a long train trip from Shanghai to Peking, which is 
really something. I had to share a compartment with Y. K. Wu. It 
was really kind of an uncomfortable trip. The sanitation facilities 
on those trains were just like the Russian or the old French. Nobody 
seemed to clean them up. 

Anyway, we got to Peking and we were put in a very nice, modern 
hotel in Peking, which was filled with business people Americans, 
English, Europeans. They took us to the famous Peking Duck Restaurant 
for a big feast and to a symphony concert in a great hall. I think 
that hall held something like six thousand people. Then we went to 
the Great Wall in private cars. They just treated us very beautifully. 
The meals were interesting. Breakfast was certainly much better than 
the Russian breakfast. They had coffee and tea and beer at every 
meal. Pretty good beer. 

Hughes: Breakfast? 

Gerbode: Yes. They had eggs and cereal and rice for breakfast. What you 
miss in all these countries, Russia as well as China, is fresh 
green vegetables. And the only things we really got in China were 
green beans, but no lettuce. Once in a while some tomatoes or 



329 



Gerbode: cucumbers. Cucumbers seemed to be generally [available] in Russia 
and China, mainly Russia I guess the cucumber lasts a long time, 
and you can ship it around and nothing much happens to it. And 
they're easy to grow. 

They took us to Canton, where we saw the great trade building 
where all their Chinese goods are on display for foreign buyers. 
Rugs and silks and even tractors and automobiles. They're about 
twenty years older than our vintage , but they looked reasonable 
well made. 

Hughes: And a lot of foreigners looking at them? 

Gerbode: Yes. Well, they're really there to buy, I guess, silks and rugs 
and things like that. This rug [in my library] came from Peking, 
for example, not from the Canton trade fair, but from the so-called 
Friendship Store, which is where foreigners can buy things. 

After being in Peking for several days, we visited a number of 
hospitals and talked with the staff and discussed their equipment and 
what they were doing. They were all terribly friendly. They hang 
on to their friendships. I keep getting letters and postcards from 
them even now. 

Hughes: Did you give rounds? 

Gerbode: Yes. 

Hughes: So the purpose really was to get information from you. 

Gerbode: Yes, but also to exchange ideas. What actually happened was that 

Uncle Sam paid for our transportation to China and the Chinese paid 
for everything else. We didn't spend any money at all except if we 
wanted to buy something in the Friendship Store. That was my first 
trip. 

Then a year and a half went by, and the China Scientific 
Cooperation Committee that isn't the exact title was developed in 
Washington. This was to develop mutual understanding between the 
two countries, very much like the Russian idea was, except it 
seemed to me it was built on individuals rather than groups of 
people representing specialties. 

So they asked me if I would go over again, and I said, "Yes, 
under what circumstances?" They finally told me they'd like to have 
me go to at least one medical school and give some lectures. And 
would I go to Shanghai? I said all right. 



330 



Garbode: So I went over as an individual, gave lectures for three weeks in 
a medical school in Shanghai, had rounds with their patients, 
watched them operate, and discussed their operations. 

Hughes: Was this on contemporary problems in heart surgery? 

Gerbode: It was all heart surgery. They documented every word I said, and 

they copied all my lantern slides. They worked me from eight o'clock 
in the morning till twelve noon, and then I went to the hotel for 
lunch. They picked me up at one-thirty again, went back till four. 

Hughes: How did you find the state of cardiovascular surgery? 

Gerbode: Well, actually I could see that technically they were very able. 

Their machines weren't perfect. They made them themselves, copying 
our machines of maybe ten years before. The way they handled their 
blood was a little old fashioned and probably made some patients sick. 
There's no plastic industry in China, so they again used rubber 
tubing, which they washed and reused. That produces a lot of problems. 

Hughes: Did that influence the length of operations that they'd be willing 
to tackle? 

Gerbode: It made people sick; that's the main thing. 
Hughes: But they had to do it anyway. 

Gerbode: Yes. This main hospital was really something. It was an old 

building, built about 1850. Cement floors, which were worn down from 
thousands and thousands of people walking over them. The walls had 
once been covered with some kind of plastic which was peeling off. 
Everybody in the whole hospital, including staff, were fed the same 
meals. The patients are all served with a bowl and a soup plate. It 
was usually rice and a little meat broth of some kind, very little 
vegetable of any kind. These things were hauled around the hospital 
on great carts, getting kind of cold before they were delivered. 
In the place where the doctors ate it seemed to me the meal was 
almost the same. 

The elevator was used for hauling the meals, the patients, the 
staff, and everybody. An old rickety elevator which looked as though 
it were going to break down any minute. Not very big. 

Hughes: Does this imply that there isn't money in China for medicine? 

Gerbode: They just don't have enough money to do what they want to do yet. 
They're trying. I guess what they're doing mainly now is putting 
their money into industries that will bring them some currency, like 



331 



Gerbode: oil. They're developing a big coal-mining project, which the 

Bechtel Corporation is helping them with, of taking the coal out 
of the mines and putting it in water pipes. They pulverize the 
coal, put it in a suspension, ship it somewhere in a big pipe where 
it's dried out, made into bricks, and sold to the people. That's 
a cheaper way of doing it than putting it on a railroad train. 

My daughter Maryanna decided she wanted to come over and join 
me, so she got a visa from the Chinese consulate for herself and for 
her daughter Sarah in about five minutes, and all of a sudden they 
appeared. 

Hughes: Unbeknownst to you. 

Gerbode: I had a suspicion they were coming, but I didn't know exactly when. 
But they got through the customs by themselves, and one morning they 
just appeared at the hotel. Sarah jogged every morning. The first 
morning she was out at five-thirty, and she came back at seven. We 
were having a little breakfast. She said, "Papa, there are people 
all over the place jogging and brushing their teeth and everything, 
old people and everybody." She couldn't understand how they were 
all out there early in the morning jogging and doing all these 
things. For some reason the Chinese like to brush their teeth out 
in the street early in the morning. She was a little afraid at 
first, but she found out she could jog among them and get back to 
the hotel. 

They were there for ten days and had a grand time, and was I glad 
to see them, too! You know, there are a lot of little things. For 
example, in all the hotel rooms they put hot water for tea every 
morning in a thermos bottle. These thermoses are standard. They 
must make millions of them because they're all the same all over 
the country. So you can either have tea, or coffee if you've got 
the coffee to make it out of. I brought some instant coffee along 
with me. And the meals are about the same. You have lots of 
chicken and rice, gravy, and once in a while some beans or cucumbers. 
In the hotels people order maybe four or five things, and there's 
all this tremendous waste, because they don't eat it all. I don't 
know what happens to the extra , but I suppose a lot of it ' s thrown 
away. And the inevitable beer at any meal; you can get all the beer 
you want. 

ii 

Gerbode: The brandy is terribly strong and not very palatable. But in Peking, 
of course, there are many things to see. Outside of the Great Wall 
you can go to these gorgeous museums and all these [building] which 



332 



Gerbode: were built for the emperors thousands of years ago. And I must 

say, you have to admire the craftsmanship. It's beautiful. Their 
engravings and paintings are magnificent. So finally that was 
over and we left by plane for Hong Kong. 



Saudi Arabia 



Hughes: Would you like to tell me about the recent spring trip to Saudi 
Arabia? 

Gerbode: Again, you don't know how one's name gets in the hat in any of these 
things. But anyway, they have two great hospitals in Saudi Arabia 
for specialized surgery. One is in Jedda, which is on the coast, 
and one is in Riyadh, which is about five hundred miles away, to the 
northeast. Jedda is the great port of Saudi Arabia. Their port 
facilities are great. Riyadh is the capital. In any event, I was 
asked aboug six months ago if I'd be willing to go to an inter 
national symposium there to be put on by a group of men chosen from 
all over the world, one or two from each country, to celebrate the 
thousandth open-heart case they'd done at this hospital in Jedda. 
They have beautiful equipment and a nice modern hospital. 

The organizer of the symposium was a man who , I guess , had some 
training in this country. He spoke perfect English, had an absolutely 
gorgeous wife, as many of the young Arabian and Bedouin women are. 
When they get to be about thirty years old , they begin to get fat 
and rounded. But when they're young, they're gorgeous. 

In any event, the meeting was held in a big central auditorium, 
and we were all brought over with all expenses paid. First-class 
going and coming. We stayed in an American-style hotel, a Hyatt 
Regency, if you can believe it. There's also an Intercontinental 
Hotel there, all built by the Saudis with the participation of 
various countries, principally the U.S. The country is dominated 
mainly by American or English architects and builders. However, 
there are other countries which sometimes contribute some architecture 
or building skills. 

In any event , there were about ten surgeons in our group : three 
from this country, one from Taiwan, one from China, one from 
Switzerland, two from England, one from Scandinavia and one from 
Canada. We formed a kind of a clinical faculty, and they had already 
decided what we were to talk about, having been warned six months 



333 



Gerbode: before. Actually, what they had selected for topics was really 
what they had read each man had contributed to the science of 
cardiovascular surgery. 

Hughes: Whom do you think had made these decisions? 

Gerbode: The surgical director of the hospital. The invitation came from the 
minister of health. I mean, that's where the money came from. I 
don't know how much the minister of health had to do with planning 
it, but he was there every day. He's a rather huge man, very jocular. 

Hughes: A physician? 

Gerbode: Yes, I think he was a physician. Somewhere he'd picked up a Ph.D., 
too. His last name was something like Jaboom. 

The wives were all invited, too, and expenses paid for the wives 
as well. All first class. It probably cost nine thousand dollars 
per couple to bring us there. Anyway, we were met at the airport. 
My daughter Maryanna and I came in from London. Earlier they had 
some question about whether they should pay for Maryanna since she 
wasn't a wife. But I simply said, "I'm going to bring her, so if 
you don't want to pay for her, then .that's your problem." But they 
paid for her. Very few women go out in the daytime. But they do go 
out at night, usually in couples. Maryanna went around almost 
everywhere, except in sacred places, with two other ladies who were 
part of the delegation. 

Hughes: What sort of feeling did you get about Arabian medicine? 

Gerbode: Pretty hard to tell, although their figures are quite good. The 
mortality rates that they discussed were very acceptable. 

Hughes: What about their equipment? 

Gerbode: Equipment is first class. 

Hughes: Because they have the money. 

Gerbode: They have the money and they can buy anything they want. 

Hughes: Probably very little of it is indigenous. 

Gerbode: Practically nothing is indigenous except manpower. 

Hughes: And yet the people at the head in the past have all been foreigners, 
British or American. Is that still true? 



334 



Gerbode: Yes. For example, in Riyadh their most famous hospital is a 

specialized hospital for special services, which means brain surgery, 
chest surgery, malignancy, heart surgery, kidney transplants. Any 
thing like that goes to this hospital if they can get in. It's 
only two hundred and fifty beds. The hospital was designed by an 
English architect. He didn't pay his subcontractors, went back to 
England, was arrested, and presently, I think, is in jail. He 
designed a hospital with virtually one long corridor, about a 
quarter of a mile long, with rooms on each side. 

Hughes: What was the concept there? 

Gerbode: You'd have to ask him; I don't know why. It'd take about half an 

hour to walk from one end to the other. But the rooms are fantastic. 
The operating rooms are the best you can imagine. Their xray 
department, instead of having one body scanner, they have two; and 
the lab where they do all the lab tests , instead of being designed 
for two hundred and fifty beds, it's designed for a thousand beds. 
Any kind of test you want on blood or urine can be done there , and 
they have all these automatic instruments for testing blood. 

Hughes: Are they training their own people? 

Gerbode: Yes, they're trying to train the Saudis, but they don't seem to be 
learning very fast. 

Hughes: Why is that? 
Gerbode: I don't know why. 

The king, of course, determines everything in the end. There 
are little stores all over the downtown. He'll give the fellow 
an interest-free loan to set up a little store. Then the fellow 
gets people to run the business, usually a Lebanese. Then when it 
gets going, he kind of retires from the scene. He just comes in and 
checks on it once in a while. It's kind of demeaning for him to 
stand there all day long and run the business. So as a consequence, 
they're not really learning. 

Hughes: The same is true in medicine? 

Gerbode: 1 think it is. One of the English doctors in the hospital in Riyadh 
said, "Well, we make rounds at seven o'clock and make all the 
decisions; at eight o'clock the Saudis arrive, and the decisions are 
already made." 



335 



Gerbode: In the heart program, they have two teams. They have American 

teams from Houston, which go there in groups of three or four and 
stay about three months each time. They're paid very well by the 
Saudis. Then the same day at the same time they have a Saudi 
team doing heart cases, maybe with an American or an English 
surgeon helping. 

Hughes: Is there any difference in the cases? 

Gerbode: I think they try to give the foreign team the hardest cases. 

Hughes: Surely there must be some system of training? 

Gerbode: Not all, but most, of the residents are Saudis. 

Hughes: So they would be assisting the American team from Houston? 

Gerbode: Yes. Opportunities for learning are there, all right. 

Hughes: Is the main reason for the Houston team being there to do the cases, 
or is it to pass on its knowledge? 

Gerbode: It's supposed to be demonstrating and training. 
Hughes: Then why keep the teams so separate? 

Gerbode: Well, I guess they feel they can train the residents better by 
showing what an American team does. 

Hughes: Do you think the Arab team had received training in the United 
States? 

Gerbode: Some members have been here. But now it's hard for them to get real 
training because of this law that's been passed forbidding foreign 
M.D.s to participate in clinical training. 



Australia 



Hughes: Shall we go on to Australia? 

Gerbode: The Aurtralian trip was a meeting of the Pan-Pacific Surgical 

Society, which was started in Honolulu in the early 1920s. It has 
a meeting every other year, and all the meetings until this one have 
been in Honolulu. They've brought people from all over the Pacific 



336 



Gerbode: 



Hughes : 
Gerbode; 

Hughes: 
Gerbode: 



Hughes: 

Gerbode: 

Hughes: 

Gerbode: 

Hughes: 
Gerbode: 



basin as members and attendants at the meetings, and they also 
encourage people from the mainland United States and even from 
Europe to come. Hawaii is such a nice place to go, particularly 
in the winter. So the attendance has always been very good, and 
the meetings have always been very successful. 

This time the Australians and New Zealanders, who have quite 
a large membership in the society, persuaded them to have the 
meeting in Sydney. It was quite a successful meeting. They had a 
little over a thousand people signed up for it. 



Even though people are escaping 
medical or surgical meeting? 



local winters, it is a serious 



Oh yes. The subject matter is always really quite good. It may 
not be brand new on the scene, [but] it's contemporary and first 
class. 

Do they tend to be leading figures in that particular field? 

Yes, they're usually first-class people. The other thing they have 
which is quite good, is very open discussions. If you get a lot of 
big leaguers there who are discussing a given subject in which they 
are knowledgeable, it's very interesting. They'll really talk 
straight about it. 

One thing they didn't do this time, which they do in Honolulu, 
is have breakfast meetings at seven o'clock in the morning where 
they have very frank discussions of the subject matter. 

So there's an assigned topic for the breakfast. 
Yes. 

I know you gave the introductory talk, "Turning Points in Cardio 
vascular Surgery," that opened the meeting. Do you know how that 
came about? 

It came about because one of my trainees was in charge of the 
planning committee , and I guess he wanted to do something nice for 
the old man. 

[laughs] That was all there was to it? 

I had enough friends around, I guess, so they accepted the idea. 
John Wright is the man who did this. He's one of the most successful 
cardiac surgeons in Australia. A very, very nice guy. While I was 
there I saw five men who'd trained in my department. 



337 



Hughes: All doing well? 

Gerbode: All doing very well. 

Hughes: Anything more that you can think of on the subject of trips? 

Gerbode: I could say something about Australian medicine in general. They're 
going through a terrible upheaval because the ministry of health 
and the politics of the country is so radical, so socialized, that 
they are really trying to squeeze into the English type of national 
health insurance, doing it in various slithery ways which are too 
apparent to the doctors , and the doctors are rising up and 
complaining at every turn of the road. In fact, in one or two 
towns they've actually had a strike rather than adopt the measures 
proposed by the minister of health. The minister of health came 
and talked to the group. He sounded either like an out-and-out 
Communist or a dictator. 

Hughes: Is it very much along the lines of the National Health Service in 
Britain? 

Gerbode: Yes, it is. But the Australian doctors don't want it, and they're 
fighting it. The same thing is happening, actually, in Canada. 

Hughes: Will it come to be, do you think, in both places? 

Gerbode: Well, it's coming to be it's a matter of degree, I guess, how much 
they can shove down the doctors' throats. I may sound like too 
much of a rightist on this subject to you, but actually the things 
they say about the medical profession, bad as it may be in spots, 
are really quite awful . 

Hughes: Such as what? 

Gerbode: Well, they try to point doctors out as only being interested in 
making money and not caring about the patients, fees being too 
high, and all that. I think they are too high in some respects, but 
you don't have to change the whole system because some people are 
not being nice. They're really having some battles down there. 



338 



X FURTHER COMMENTS ON MEDICAL /SURGICAL TOPICS 
[Interview 14: April 23, 1984] If 

NIH Support of the Multidisciplinary Team in Cardiovascular Surgery 

Hughes: The National Heart Institute awarded its first grants in 1949. In 
1959 when Stanford pulled out and Presbyterian Hospital and the 
Institutes of Medical Sciences came into being, NIH granted your 
heart institute $400,000 a year for about ten years. Had you 
received NIH money before that? 

Gerbode: I think we had soiae before 1959, but we didn't get a big grant until 
they decided to move the medical school to Palo Alto. I believe part 
of NIH's feeling in the background was that they wanted to retain 
some sort of an educational research facility on the campus of the 
old medical school, because after all, historically it was the 
first medical school in the West and had trained many physicians and 
made many contributions in research. Since many of the faculty 
decided not to move to Palo Alto, I think NIH basically was rather 
anxious to keep it going. 

Furthermore, we had a very vigorous research and development 
program in cardiovascular surgery. They recognized this and were 
happy, I guess, to fund it. In any event, when I prepared the first 
application, the committee came out and surveyed me about it and 
said, "You should apply for everything you will require." I put in 
an application for over a million dollars a year! In the end they 
gave us a little over $400,000 a year, which really vas the basic 
reason we were able to put together a first-rate cardiovascular group 
and institute on the old medical school's cafnpus. This went on 
every year. We had, of course, to tell what we were doing, and NIH 
had to [base the new grant] on what our progress reports amounted to. 
It wasn't just a handout. We had to prove ourselves every year, 
which I think we did quite well. 



339 



Hughes: What sort of things were they looking at? 

Gerbode: Publications, improvements, development, contributions to the field, 
training. 

Hughes: Do you think the fellows program had a large impact? 

Gerbode: The fellows program made a difference, because they obviously felt 
that I could train people, and so they gave me a training program. 
They gave me a very small amount, about $5,000 per year per trainee, 
which was enough money in those days. I had a fellow paid for by 
NIH for at least five years, and I had many other fellows during 
that same time. I raised money privately to support them. These 
fellows are now scattered all over the world and very happy 
apparently to have been here. 

Hughes: Was over $400,000 an unusually large grant at that time? 

Gerbode: It probably was in the upper 10 percent of the big grants in the 

country, but people like Mike DeBakey were getting equal amounts of 
money, and I guess there were other centers in the country that NIH 
felt had the possibility of developing something unusual. I imagine 
that the University of Minnesota would always emerge as being one of 
the early groups to get large grant money, because it was doing such 
a good job and had been doing it for quite a while. 

Hughes: Government intervention in medicine and the sciences is largely a 
postwar phenomenon. Do you think that NIH can be credited to a 
certain extent with the fact that cardiovascular surgery when it 
began to take off was largely an American phenomenon? 

Gerbode: Well, it's certainly true that without NIH help, we wouldn't have 
gone nearly as far as we did in the beginning, or since then. The 
American Heart Association helped a good deal, but it doesn't have 
the amount of money NIH has. 

For example, I got Mr. Bramson, who was our engineer for many 
years, to come to our group in the early '50s. He didn't know 
anything at all about blood or the physiology of the circulation, 
but he was a fantastically intelligent man and a very fine engineer. 
So we put in an application to the American Heart Association to 
have him appointed as an established investigator, and for some 
reason they made him the first engineer in this category in the 
country. No one before had ever gotten one of these grants from 
the American Heart Association without being an M.D. I can assure 
you that their money was extremely well invested, because throughout 
the years Bram made a lot of very good contributions in the field of 
cardiovascular surgery. 



340 



Hughes: Was that the beginning of the teamwork concept in cardiovascular 
surgery? 

Gerbode: Yes, that was the first time, really, that people realized that to 
push this field forward, you couldn't depend entirely on M.D.s; you 
had to have Ph.D.s and others who could back up the whole program. 
So we brought Ph.D.s to the bedside, so to speak, and said, "Here's 
the problem with measuring this or that, and how would you solve it?" 
We had a number of people like Bram who worked with us at the 
bedside on clinical problems , and they helped us a great deal to 
solve them, and established the principle of a team working on the 
clinical problems of sick people. It's amazing how quickly they 
could understand the physiology of a clinical problem and offer 
suggestions. 

This is particularly true later on when we got the monitoring 
people in to work with us. They were all Ph.D.s and not very 
knowledgeable about the physiology of sickness, but they could see 
what we wanted to find out, and they applied their methods to 
solving the problems, and were fantastic in how quickly they under 
stood and came forward with suggestions and solutions. 

Hughes: IBM was the corporation that was first involved with computerized 
monitoring [at Presbyterian] . Was that the first time they had 
collaborated with medical people? 

Gerbode: No. They had worked with the Mayo Clinic before that, but they 
wanted to go into a more serious large-scale program, and they 
looked over the country to decide where they'd put their money. And 
for some reason they came to us. I think one of the reasons was 
that we were small and had a small group who could work well. We 
had many patients, and there weren't any other things that would 
interfere with the research program. We could do it pretty much on 
our own, and they liked that. They had looked at Texas and various 
other places before they came to us. 

Hughes: This was early "60s? 

Gerbode: Yes. 

Hughes: Did other centers have people like Bram? 

Gerbode: The other centers began to have people like Bram. 

Hughes: So it wasn't by then unusual to have a bioengineer on the team. 



341 



Gerbode: Oh no. By that time whole schools of biomedical engineering were 
developing, and one of the biggest ones was in Chicago. They were 
turning out biomedical engineers who were Ph.D.s really faster, I 
think, than they could be absorbed. 

Hughes: Do you think the heart-lung machine was the original impetus? 

Gerbode: Part of that was the development of the heart-lung machine; there's 
no question about that. 



The Artificial Heart Program 



Hughes: In 1964 the National Heart Institute drew up a crash program for the 
construction of an artificial heart with an energy source to be 
completely implanted within the patient's chest. The first artificial 
heart was to be implanted on Valentine's Day, 1970, and as we know, 
this goal was not reached. Do you know anything about this program? 

Gerbode: I think the artificial heart program really was pushed forward 

faster than anything else by the fact that -Christiaan Barnard put 
in a heart in Cape Town, South Africa. This was kind of embarrassing 
for this country to have a South African do this when we had spent 
so much money on this sort of thing. So they quickly looked over the 
whole field and decided they'd better get an artificial heart program 
going, too. 

Hughes: Now who is they? 

Gerbode: I guess the advisors of NIH. Then there was a group under Kolff in 
Salt Lake who had already developed the artificial kidney, and they 
were a very busy, active research group and were doing excellent 
work. It was natural for them to take on an artificial heart 
program, since they had developed an artificial kidney. So they got 
some of the first grants, but there were other grants given to 
various centers in the country, including our center under Dr. Hill. 

I remember being on an artificial heart program committee at 
NIH. We made certain recommendations to NIH about the development 
of an artificial heart program. As far as I can remember, NIH didn't 
follow any of our recommendations, but they developed an artificial 
heart program anyway. They just didn't do it the way we suggested 
doing it. But they did a good job. 

Hughes: I gather that you thought that such a program was feasible? 



342 



Gerbode: We suggested it was feasible, and we suggested more or less how to 
do it. One of the things we suggested was that business should 
collaborate with universities or laboratories in developing an 
artificial heart. We in fact suggested certain business firms to 
work on this, because it's a big engineering problem. 

Hughes: And did NIH take up that aspect? 

Gerbode: Yes. 

Hughes: Do you remember where they did things differently? 

Gerbode: No, I can't remember where they put their emphasis. 

Hughes: The Houston group received most of money? 

Gerbode: The Houston group got some of the money but not any more than anybody 
else. I think probably more money went into Salt Lake, the 
University of Utah, than almost any other place. 

Hughes: And did that boil down to track record? 

Gerbode: Well, they funded them because they had a -laboratory going employing 
techniques and research people on this other problem [the artificial 
kidney]. 



Targeted Medical Research 



Hughes: What do you think about very specifically targeted research such as 
this? 

Gerbode: Well, another big question that came up at the same time as the 

artificial heart program [was] whether or not NIH should put their 
money into targeted research. It's interesting that you should 
ask the question, because before that decision was made, people 
would consider research something that would just come along out 
of the minds of research people. But then when you look at various 
problems in research, or in medicine, it's very easy to think of 
applying targeted research to certain basic problems. Well, for 
one thing they decided arteriosclerosis was very important and they 
shoi-ld have targeted research that would develop methods of under 
standing and preventing arteriosclerosis. That's targeted research; 
they put a lot of money into arteriosclerosis research. 



343 



Gerbode: Another way of getting targeted research is to have a prominent 

senator or president or vice-president get a disease, and all of a 
sudden there's targeted research developed around that particular 
disease. 

Hughes: Do you have any idea whether in the long run this is a profitable 
way of spending money? 

Gerbode: I guess the term "profitable" means whether in terms of spending money 
there's a bigger yield for the money spent in doing it that way. 
I can't answer that question. Right now, for example, there's a 
great deal of thought about work in immunology, and things like 
interferon and other methods of controlling the rejection phenomenon 
are very important. Whether they want to call it targeted research 
or not, they're putting an awful lot of money into it because it's 
terribly important. Scientists as a whole realize it is important, 
so they're spending a lot of time on it. 

Hughes: It seems to me that the fact that government in most countries now 

(at least most governments in the Western world) plays a larger role 
in research than it ever has done in the past changes the whole tune 
of things, because you now get people making decisions about what a 
scientific effort should be, when in the past that has been largely 
left up to the individual. Basic research led to applications which 
the individual himself may never have foreseen. 

Gerbode: It's a very complicated process, because each individual's application 
for money goes through a peer group that analyzes his proposal and 
what he wants to do. That peer group has a tremendous amount of 
influence over whether or not it gets funded. I would say on the 
whole the peer group approval of an individual research worker's 
proposal is a very good way to do it. On the other hand, it does 
subject his ideas to a committee for committee approval, which 
sometimes is not very good. However, there's no question that in 
this country we've made many more contributions with our particular 
system of giving money for research than any other country. But I 
must say that there is excellent research product in other countries 
with a completely different system, mainly due to the fact that 
individuals by their ability can produce things which sometimes are 
better than the committee activity. 

Hughes: On the other hand, research has gotten to be such an expensive 
proposition, particularly in the medical sciences, that it's no 
longer the individual scientist working alone in his .lab that really 
can hope to make many contributions, so the individual is almost 
forced to become a part of the group in order to produce. 



344 



Gerbode: Yes, and this influences the peer group evaluation of a proposal. 

One of the first things they look at is whether or not the laboratory 
is adequate to do what the man wants to do and whether he has enough 
help to do it. 



The Transventricular Mitral Valve Dilator 



Hughes: We talked a little bit about the transventricular mitral valve 

dilator, although I don't think we called it that, and I was wondering 
if you'd tell me a little bit more about how you came to devise it. 

Gerbode: We were using finger fracture methods of fracturing the mitral valve, 
and occasionally using an instrument to cut the valve. We very 
quickly found that cutting the valve was not very satisfactory 
because you couldn't cut it blindly through the atrium or through 
the ventricle with an instrument without sometimes cutting the wrong 
place, and therefore making a tight valve an incompetent valve. 
This was found out early on by Cutler and Beck when mitral valve 
surgery started becoming a reality. 

Once you felt these valves and fractured them with your finger, 
you realized that the commissures were giving away and opening up 
rather than some other place on the valve. Both commissures would 
usually open because they were stuck together less securely than 
the rest of the valve. So various people devised these valvotomies. 
One very good one was under Andrew Logan in Edinburgh, who developed 
one which was used a lot in Europe, mainly in the United Kingdom. 

My concept was a little different in that I controlled the 
amount of fracture of the valve gradually with a special little 
screw attachment which would let you open it slowly. You could feel 
the valve at the same time, so that you wouldn't tear the tissues 
apart too quickly. This became quite an acceptable valvotomy 
instrument in this country. 

Hughes: But not abroad? 

Gerbode: Yes, it was used abroad, too. Finally the Pilling Company had the 
instrument made in Germany. They felt that the Germans could make 
it more cheaply and better than they could in this country. 



345 



The First Open Heart Surgery Team on the West Coa st 



Hughes: I thought you should say a little more about the fact that your 
team was the first open heart surgical team on the West Coast. 

Gerbode: I guess this came about because we were so busy trying to put 

together a heart-lung machine, and we really had quite a few patients 
around the place, mainly because of our very fine pediatric 
cardiology outpatient clinic. This was under the direction of Dr. 
Ann Purdy, who was Dr. Holman's wife. She had a lot of patients 
with congenital heart disease. Then we knew that there were plenty 
of patients that needed care. 

So we devised a number of heart-lung machines, with Dr. Osborn 
being in charge of the early ones. Later on Mr. Bramson came into 
the picture and designed several. We had various emissaries from 
the University of California who were in charge of thoracic and 
cardiovascular surgery there come over and take a look at what we 
were doing, and were a little dubious that we could do it, I think. 
However, in time they realized we could do it. 

Some of our early efforts in repairing congenital defects of 
the heart were not successful, mainly because the machines we were 
using weren't entirely good. They were the best we could design 
at the time. However, teamwork is very important, and we very soon 
realized that if we made a mistake or didn't work out something the 
way it should be worked out, that we should make the improvement 
right away before the next case. And this is what we did. So 
eventually it became rather successful. This was the first open 
heart surgical team, I guess, on the West Coast. Actually it was a 
little bit ahead of the Houston group, who came along six months or 
a year later. 

Hughes: Would you like to say something about the membership of that team? 

Gerbode: The membership was really based on Mr. Bramson, Jack Osborn, and 
my fellows, who were all very anxious to get things going. They 
realized that this was something that had a big future, so they 
worked very hard in the laboratory and also clinically to push the 
field forward. 

Hughes: How much of the operating were the fellows doing? 

Gerbode: They always assisted me, and I would let them do the parts of the 

operations that I felt that they could do safely. Some of them were 
better than others. Some of them were so good they could do the 
whole thing. Others would do parts of the operation. Eventually, 
when they went back home, they did everything, and very well. 



346 



Hughes: What were the main types of operations that you were doing in those 
early days? 

Gerbode: Pulmonary valvotomy was one of the early cases, because that was 
something you'd get in and out in a hurry. 

Hughes: Now this was with the heart-lung machine? 

Gerbode: Yes. We did some pulmonary valvotomies without the heart-lung 

machines, blind ones; they weren't very satisfactory. In fact, we 
had Mr. Russell Brock come over from London as a guest professor., 
and he did a number of blind pulmonary valvotomies without the 
heart-lung machine, but we in the end had to do them over again 
because they were not very adequate. They were adequate for a time 
but not adequate for the long haul. 

Hughes: Was the main problem not being able to see? 

Gerbode: Yes, and not having time. It takes time to do these things right. 

So then we went from pulmonary valvotomies to atrial-septum defects 
that's the hole on the right side of the heart. They were easier to 
do, and the results were very satisfactory. So we did a group of 
atrial-septal defects. 

The main thing, of course, in those days was to do operations 
which would give the pediatricians and the cardiologists confidence 
in what you were trying to do. So you couldn't have very many 
complications and fatalities; otherwise they'd turn off the spigot, 
entirely. But we were able to select the cases that in the early days 
gave us good results with very low mortality and morbidity rates. 
Then as confidence grew among the referring physicians, we took on 
more complicated cases. We had a lot of tetralogies, blue babies, 
to do because we had done a lot of Blalock procedures on them before 
a palliative operation so they were more or less our patients because 
we had operated upon them before. So as soon as the machines got 
good enough, we began to operate upon tetralogy patients for 
complete repair, and we were lucky because we found the mortality 
rate was pretty low and the success rate was really quite good. 

Hughes: What was the success rate mainly due to? 

Gerbode: I think probably just the fact that we were operating everyday, and 
everyday we learned something and we applied what we learned. 

Hughes: Do you think you were putting more care into the selection of patients 
than other teams? 



347 



Gerbode: No, we were just ahead of them. 

## 

Gerbode: Later on as the work progressed, we found that there were a lot 
of surprises, as we got into more complicated cases. But then we 
had more time so that we could sort out the problems and end up 
with a satisfactory result. 

Hughes: Time because the heart-lung machine was improved by then? 
Gerbode: Yes. The heart-lung machine was improving all the time, too. 

Hughes: Was there much change in the diagnostic procedures within that 
period of ten years or so? 

Gerbode: Yes, cardiac catheterization and angiocardiography were becoming more 
accurate, and the cardiologists and roentgenologists were much more 
accurate in making a diagnosis, which was important. 

Hughes: Was that a matter more of people than the instrumentation? 

Gerbode: I think it was a matter of experience. We had a very fine angio- 
cardiographic machine, one of the first on the West Coast. It was 
great for about three years, and then another one came out which 
was much better. The field was moving ahead so rapidly that you 
had to expect that these big companies coming into the picture would 
see the advantage of having something better, and they were working 
very hard all the time, too, to improve things. 

Hughes: Were these techniques now accepted parts of a residency program, so 

that a resident in cardiology would automatically learn catheterization? 

Gerbode: Yes, residents in cardiology they were fellows, really originally 
learned how to do cardiac catheterization under guidance from the 
senior people, and the residents in roentgenography would learn how 
to interpret the angiocardiographic procedures. It's very easy for 
a roentgenologist to inject the dye, but the hard part is interpreting 
what the dye shows them inside the heart. So this was all part of 
the learning process. Every patient who was studied this way, was 
studied by the senior people as well as the junior people. And the 
surgeon would always look over all the studies, too, with the roentgen 
ologist. Sometimes they wouldn't agree, but most often they all 
agreed that the anatomy was such-and-such and proceeded accordingly. 



348 



Endocardial Cushion Defects 



Hughes: The subject of endocardial cushion defects. You're known for 
devising surgical procedures. Can you explain ? 

Gerbode: As we were doing more and more atrial septum defects, we began to 
encounter patients who had not only an atrial septal defect , but 
other abnormalities of the valves on that side of the heart. So as 
we became technically more able, we began to repair some of the 
more complicated forms of atrial septal defect with the valve 
abnormalities, and I suppose we were lucky in being able to sort out 
some of these complex anomalies and correct them. 

Luckily, we also had a fairly generous supply of these patients, 
so that we were able to learn rather fast. There's nothing more 
spectacular than to correct an atrial septal defect with valve 
abnormalities and the endocardial cushion defect. The result is so 
spectacular. You take a child who has severe heart failure and 
really make a normal child out of him. 

Hughes: Between the beginning and the end of the operation; is it that 
clear? 

Gerbode: Well, from the beginning of the operation till he recovers from the 
operation. One spectacular, case was a young woman with a severe 
endocardial cushion defect and heart failure. I was able to sort 
this out and correct it. She had two valves involved and two holes 
in her heart, one in the ventricle and one in the atrium. Two 
valves that were split. Well, I was able to patch up that heart, 
and she walked out of the hospital ten days later, and subsequently 
got married and was a very strong housewife. Then she got pregnant; 
her first-born male child had the same defect that she had. She 
was an awfully good mother. This child was in heart failure almost 
from the very beginning. I did a palliative operation to cut down 
on the flow of blood to the child's lungs to hold him for a while, 
because I didn't think I should operate for complete repair when he 
was so young. These days they're doing these operations in a younger 
age group. However, the palliative operation held him for about 
three or four years, and then he began to not do very well even 
with the palliative operation. So I did a complete repair, and he 
had exactly the same combination of defects that the mother had. I 
was able to correct them the same way as I had done in the mother. 
Every Christmastime I get a picture of this boy and a little note from 
the mother telling me how well he's doing. 



349 



The Membrane Oxygenator 



Hughes: We talked about the membrane oxygenator, but you didn't bring it 
up to the final stages with the Harvey Company. 

Gerbode: I first met Mr. Bramson at a cocktail party in Paris being given 

by some local friends who happened to be there, and they invited Bram 
to come along because he was an engineer with them. They were 
just about terminating his work with them, which had to do, 
curiously, with the left-over wood from the lumber industry. 

[phone interruption] 

Gerbode: Bram said he was not going to be busy with Mr. Heller after a certain 
time, and I said, "Well, would you like to work on a membrane 
oxygenator?" "Well," he said, "I don't know what it's all about, 
but I'll be happy to work on something like that with your group if 
you think it's very important." I said, "It's going to be very 
important . " 

So Bram came on as a consultant. We got him approved by the 
American Heart Association, as I mentioned previously, and he 
started working on a membrane oxygenator in our research group , 
without having done anything before with blood or biology in his 
whole life. 

Hughes: How far along were you with the oxyg;enator when Bram came in? 

Gerbode: We weren't anywhere at all with the membrane oxygenator when I got 
him. We had some other prototype oxygenators. 

So Bram came aboard in our little research group , and we very 
quickly realized that developing a membrane oxygenator that would 
be clinically useful was going to take a lot more than just a few 
weeks or months. So Bram then devised another type of disk 
oxygenator which was useful to keep things going. It was a disk 
type of oxygenator, which I used in about three hundred cases, I 
guess, while we were trying to develop a membrane oxygenator. 
Meanwhile, he was doing work with Mr. William Tyson, another 
engineer, and Cutter Laboratories in Berkeley, developing a prototype 
membrane oxygenator while we were using his disk type of oxygenator. 
Finally, after a couple of years, we developed a prototype membrane 
oxygenator, which was clinically very good. The only problem with 
it was that it had to be put together by hand every time. 

Hughes: When was this? 



350 



Gerbode: 



Hughes: 
Gerbode: 



Hughes : 
Gerbode: 



Hughes: 
Gerbode: 



Hughes: 
Gerbode: 



In the early '60s. Bram got some girls to help him at Cutter 
Laboratories. They put the oxygenator together manually each day. 
Then the whole problem of sterilizing it had to be developed, but 
they worked it all out. We developed a prototype membrane 
oxygenator after a number of years, and then I started using it 
clinically. I used it in about three hundred cases. 

Can you remember when you first started to use it? 

No, I can't remember. It had to be put together manually by Bram 
and the nice girls at Cutter Laboratories, and then it had to be 
sterilized. It was just not very practical. However, it was the 
first membrane oxygenator in the world to be used clinically in a 
large group of patients. 

How did you come to realize that the membrane was the thing? 

Well, see, the disk oxygenator was developed on the principle of 
exposing blood to oxygen in an open chamber. Even though people 
use this method in a way , it is pretty well shown that when you 
expose blood directly to oxygen or any other gas, it's not very 
good for the blood various things happen whereas the membrane 
oxygenator depends upon oxygen and C02 diffusing through a membrane, 
so blood is not directly exposed to any gases. 

Had you found these things out in your own lab , or was this common 
knowledge? 

No, various other people had begun to find this out as well. 

Various Ph.D.s and people working in our laboratory found out 
various ways of making a membrane oxygenator more satisfactory, and 
we even developed patents on the way blood went through it. We 
finally sold our ideas to the Harvey Company, a subsidiary of Bard, 
and they spent about five years on it to develop a commercial 
product that could be sold easily, a disposable one. Having done 
all that, they changed their mind and decided to put all their money 
into another type of membrane oxygenator built by Dow Chemical 
Company . 

Do you know their thinking? 

I think probably it's that they'd make more money with the Dow 
Chemical one and it's more feasible commercially to make it. So the 
present situation is, our membrane oxygenator is sitting down in 
Santa Ana in a laboratory with everything ready to go clinically, and 
they've shifted gears now and are putting all their production into 
the Dow Chemical one. It's kind of a sad ending to the whole story. 



351 



Hughes: Why did you choose the Harvey Company in the beginning? 

Gerbode: They were very interested in developing a membrane oxygenator, and 
we had the patents and the concepts. 

Hughes: We talked a little about choosing patients for new types of operations, 
and you mentioned in connection with the mitral valvotomies that 
in the beginning you were interested in choosing good risk patients, 
mainly to keep the supply of patients coming. I was wondering in 
general, though, if you had a policy about operating on poor risk 
patients. 

Gerbode: In general, the cardiologists and this is not only true in our 
institute but throughout the world would only offer patients to 
the surgeon in the beginning if the patients were really desperate. 
This was a hard hurdle to overcome. We gradually got around it, I 
guess, by having good results with the patients we did do, and 
bringing some pretty desperate cases through. But as I mentioned 
before, one of the ways of getting around the skeptical cardiologists 
was to have the patients that were referred come directly on the 
surgical ward , and I skillfully arranged to do that as much as 
possible. Then I would pick the cardiologist who was most surgically 
minded to see the patient and bypass the skeptical ones. Then 
eventually the skeptical ones had to come on the bandwagon, too. 

Hughes: What do you think was the deciding point when a patient wasn't a 
very good risk? I'm thinking on one hand of the consideration of 
what you might be able to do for the patient, and on the other hand 
what the outcome of the operation might have on the statistics of 
a new procedure. 

Gerbode: Of course, everything changed as soon as we got the heart-lung 
machine and started doing a lot of open mitral operations. We 
then. could see the valve, and then later on got artificial valves 
which could be used to replace the diseased valve, and that made 
the picture quite different. Now there are very few cardiologists 
who would not allow the surgeon to try to repair a diseased valve 
in a very sick patient, because the results are overwhelmingly so 
much better with surgery than they are with medicine. 

Hughes: In the beginning when this procedure was still very experimental, 
there must have been a lot of gray areas where you weren't really 
sure that you could benefit the patient or, for that matter, the 
future of the procedure. 



352 



Gerbode: Yes, it was a very complex situation, and I guess in the long run 
it depended on what the surgeon's mortality rate was in those days 
and how his patients did afterwards. If the mortality rate 
consistently wasn't so great, and generally speaking the patients 
were better, then more patients would come for operations. 

Hughes: As simple as that. 



Counseling Patients 



Hughes : 
Gerbode: 

Hughes: 
Gerbode: 



I know you are against smoking, 
the anti-smoking campaign? 



Have you ever played any role in 



Hughes: 



I support any anti-smoking organization that comes along and asks 
me for support, because I think it's terribly important. 

What about counseling patients? 

Well, I used almost to refuse to operate upon patients who were still 
heavy smokers. I wouldn't actually turn them down, but I'd make it 
very difficult for them to have the operation without quitting, 
because it makes a lot of difference. Bad mitral patients who are 
heavy smokers Have a much harder time getting through the operation. 
The respirator has to be used for a longer period of time, and they 
require a lot more care. So I would point this out to them and 
tell them, "If you want to get through this operation more easily, 
you'd better stop smoking for a month or so so your lungs get a 
chance to improve a little anyway." To get some of the women who 
were smokers to stop, I'd use various tricks. One thing I used to 
tell the women who were smokers and had serious heart disease , "You 
don't mind smelling like a man, do you?" And the woman would say, 
"I don't smell like a man." I said, "You certainly do, and if you 
want people to like you, you shouldn't want to smell like a man." 
Sometimes vanity would overcome her desire to smoke, and she'd 
change. [laughter] 

What about other aspects of heart disease, such as diet and drinking 
and tension? Were those things that you'd talk to your patients 
about as well? 



353 



Aortocoronary Bypass Operations 



Gerbode: Obesity is one of the things that we had trouble with in some 
patients. But actually arteriosclerosis came into prominence 
because of coronary disease, and so when AC bypass (aortocoronary 
bypass) techniques were developed, it was quite apparent that 
arteriosclerosis was a very important part of heart disease. I 
elected not to do this operation because I found it kind of a 
monotonous procedure. So I turned it over to my associates. It 
has two aspects that are very good. One is that most of the 
patients are relieved of their anginal pain, and the surgeons 
are better off financially because it pays very well. 

Hughes: Why is that? 

Gerbode: The fees in the beginning were set pretty high because the procedure 
was new. 

Hughes: Why is that particular procedure more monotonous than others. 

Gerbode: It's just taking a vein out of the leg and sewing it onto the 

heart. It's not inside the heart. There's no physiology connected 
with it. It's just mechanical, transferring the vein to the outside 
of the heart. 



Keeping Patients Alive at Any Cost 



Hughes: Dwight Harken, another cardiac surgeon, has written in reference to 
Barnard's all-out efforts to keep Louis Washkanski, his first 
heart transplant patient, alive despite pneumonia and heart failure 
and all kinds of things, that Barnard was obligated to do anything 
he could to save his patient. What is your philosophy about keeping 
patients alive at any cost? 

Gerbode: I guess I've always felt that if I could do something that would 

make the patient who was desperately ill more comfortable and perhaps 
prolong his life a bit, it was my duty to do it. There are situations 
where we are keeping people alive when we know that there's no 
possibility of making their life better, and it's a terrible drain 
financially and emotionally on the family. In those situations I 
agree with what has been recently stated as a position that we 
should let the patient decide whether he wants to be kept alive any 
longer or not. Some people have said if they got a cancer or something 
that was not curable, they didn't want to be kept alive, and I think 
we should believe in what they say. 



354 



Hughes: The government doesn't seem to be moving in that direction. 
Gerbode: I don't think the government's influencing this so terribly much. 
Hughes: I'm thinking of the Baby Doe case.* 

Gerbode: Well, there, you see, the government has taken a position because 
there is treatment available, and therefore it feels [the hospital] 
should apply the treatment. But there are certain congenital 
abnormalities in children [in which] I think palliative procedures 
should not be applied. It only prolongs the agony; really it's 
not very good. 

Hughes: I understand that the United States has a much more liberal attitude 
toward medical intervention than Britain, for example. 

Gerbode: I don't have any figures on this, but I think that probably we keep 
trying harder and longer in some of these situations than other 
countries do. 

Hughes: Do you think that might change with the great emphasis on keeping 
medical costs down? 

Gerbode: [chuckles] I suppose we might get to the point where the government 
or insurance companies would say, "We're not going to pay for 
treatment in this kind of a patient." 



Heart Transplantation Programs 



Hughes: Blue Shield of California has recently decided to cover heart and 
heart-lung transplants for its 1.3 million policyholders in 
California as long as procedures are performed at Stanford University 
Medical Center. 

Gerbode: I was at the meeting where this was decided, and voted in favor of 
it as a consultant. 

Hughes: Can you tell me why? 



*The Baby Doe case, which occurred in 1984, concerned a baby born 
with severe congenital anomalies. Against the parents' wishes, the 
government required the hospital to use extraordinary measures to 
keep the baby alive. 



355 



Gerbode: They have the best record, and I think to keep the confidence in 
the procedure at the proper level, those who can do the job very 
well should be permitted to do it with compensation. 

Hughes: So it really does boil down to a matter of statistics? 

Gerbode: Yes. Eventually, as other units demonstrate that they can do the 
procedure with a very low mortality rate, then I think Blue Shield 
will pay for them. 

Hughes: Why was Blue Shield prompted to make this policy decision? 

Gerbode: I guess because some of these families have Blue Shield insurance, 
and unless they have the insurance money to help pay for the bill, 
it is too hard on them financially. 

Hughes: Why would an insurance company take on this potentially tremendous 
expense? 

Gerbode: It's not such a big thing, because there aren't hearts available 

in volume to make it very much of a burden on the insurance company. 
Patients have to be carefully selected. [They have to be] in a 
certain age group with a certain type of disease. That eliminates 
a great many people right away. Then you have to find a donor that 
will be satisfactory for that particular recipient. That immediately 
cuts down the number. It's not like mitral stenosis or a patent 
ductus or something like that. There are all these limiting 
factors that cut down on the volume [of heart transplant cases]. 

Hughes: Was it just sheerly numbers of policyholders that wanted this coverage 
that caused Blue Shield to consider covering heart-lung transplants? 

Gerbode: I suppose the number of families that have Blue Shield insurance, 
even if there weren't very many of them, who wanted to have their 
insurance apply to this procedure, would influence that decision. 
But also Stanford probably applied for permission to have Blue 
Shield pay for it. I don't think anybody else applied. 

Hughes: Isn't there a danger that this will hold back other [heart transplant] 
programs, including the one at the Pacific Medical Center? 

Gerbode: I think it will. It will certainly limit the ones who are trying 
to get in without too much ability and background. 

#1 

Gerbode: However, in time other units will develop their techniques to the 
point where their results will be equally good [as Stanford's] and 
then they'll want to be paid as well. 



356 



Hughes: I can see that an insurance company stepping in at an early stage 
in the procedure could very much influence which centers succeed 
and which don't, at least for the immediate future. 

Gerbode: Yes, that's true. 

Hughes: Was any of this considered when the Pacific Medical Center decided 
to start a transplant program? 

Gerbode: It was always considered, because the trustees, of which I was 
one, had to vote in favor of doing it even though we might lose 
money . 

Hughes: Why did you make that decision? 

Gerbode: Because we think it's something that's in our realm of capability. 

Hughes: And that would override the financial considerations? 

Gerbode: Yes, I think so. I think some institutions can afford to do this 
and some can't. 

Hughes: Did you know that the Blue Shield business was coming up when you 
made the decision to have the program here? 

Gerbode: No. 

Hughes: Do you think your decision would have been different if you had 
known? 

Gerbode: I don't think so. Blue Shield knew that we had a successful case 
and were going to continue to do cases. I was on the advisory 
committee I think we all felt that eventually other units would 
have enough experience so that they would be paid as well. 

Hughes: Given the fact that there aren't very many patients in this area 
needing that kind of operation, why do you need [heart transplant] 
units at different centers? 

Gerbode: [pause] You don't need very many, but you need more than one. 
Hughes: Is that just the spirit of competition? 

Gerbode: I think it's better to have more than one; competition enters into 
it. I think if two units are trying to do a certain procedure, 
they're certainly going to keep their techniques sharp. 



357 



Etiology 



Hughes: Medicine has been called a practical art rather than an applied 
science, because in general its primary aim is to cure disease. 
In many cases there is little concern to understand the mechanism 
of cure or even the cause of the disease. Do you agree that 
medicine really has this orientation? 

Gerbode: No, I don't agree with that at all. I think the physician and the 
surgeon are very interested in what causes the disease and to 
understand the mechanism of what caused it. 

Hughes: Is that intellectual curiosity? 

Gerbode: No, it's not intellectual curiosity. I think it's being intelligent. 
We can't understand all the mechanisms that produce the congential 
heart lesion in a baby, but we've made a great many inroads into 
understanding how it happens. For example, German measles in the 
mother has been found out through the medical profession to be a 
cause of congenital heart disease in babies. Doctors are curious 
to know why certain types of severe influenza in the first trimester 
would be a cause of congenital defects. We don't understand the 
actual intrauterine event that causes this thing, but some people are 
veiy curious about it. We're very curious to know why mitral valve 
disease has occurred, and we find that it's due mainly to rheumatic 
fever, and that rheumatic fever is caused by a streptococcus. We 
teach families to give their children antibiotics when they have 
streptococcal infections. I don't think I fully understand your 
question. 

Hughes: You answered it more or less. 

Gerbode: I think also doctors are very good about suggesting abortions in 
women who have had German measles or some severe illness in the 
first trimester. That's due to the understanding that the incidence 
of having a child with a congenital abnormality is much higher 
than in a woman without this sort of medical background. We're a 
lot more interested in cause [and prevention] than we are in getting 
that child for a corrective operation. 

Hughes: What you were doing in the dog lab wat very directly tied in with 
what you were hoping to do in the operating room, but do you think 
that's pretty much true across the board in all the areas of 
research at HRI? Is the ultimate aim patient application, or is 
that link sometimes not quite so direct? 



358 



Gerbode: I think the ultimate aim is to understand disease better and prevent 
it or cure it. There's another whole moral aspect of this thing 
that worried me in the beginning, of being able to operate upon all 
these children with congenital heart disease, particularly the blue 
babies with severe congenital abnormalities. I worried for a little 
while, not very long, whether it was right to keep those children in 
circulation, because the incidence of congenital heart disease in 
those children who marry and have babies is higher. But then I said 
to myself, "I'm being God if I do that. I can't take that attitude. 
If there is a good treatment available we should use it." 



Setting and Controlling Medical and Surgical Fees* 
[Interview 15: May 15, 1984 ]## 

Hughes: I was wondering how you establish fees for operations. 

Gerbode: Fees are established by custom and also by a schedule which is 

called the California Relative Value Scale. Each operation has a 
certain number of units connected with it. A big operation would 
have more units than a smaller operation. Then you apply the basic 
fee for one unit to that and multiply it by the number assigned to 
that particular procedure. However, it's been customary in California 
for heart surgeons not necessarily to obey that mode of charging 
patients. Some of them, unfortunately, have been charging rather 
large fees which I think has been very bad for the speciality as a 
whole. 

The relative value scale in California was adopted by various 
specialities, and then later was used by insurance companies and 
units in other states as a basic groundwork for charging for the work 
done. I helped put together the first relative value scale for 
cardiovascular and vascular work in this state with a committee for 
which I was chairman. 

Hughes: What sort of criteria were you using to establish the fees? 

Gerbode: Well, we just decided if, for example, an appendectomy was worth this 
number of units, a cardiovascular procedure would be maybe twice as 
complicated and you would use twice the number of units. 



*See the session recorded on 6/21/84, pp. 429-430. 



359 



Hughes: What is a unit based on? 

Gerbode: A unit is based on what surgeons have been charging over a short 
period of time before the unit was established. 

Hughes: So it's a matter of time and the difficulty of the operation? 

Gerbode: Yes. 

Hughes: Anything else? 

Gerbode: I guess the rarity and difficulty of a procedure has something to do 
with it. If there has been a complication, this adds something to 
it as well. It's been working in this form more or less for quite 
a while and I think that some of the insurance companies simply 
call a procedure by a given name and they pay just that amount for 
the procedure to be done. 

Hughes: When you say quite a while, do you mean after World War II? 
Gerbode: Oh yes. This is all in the last ten or fifteen years. 
Hughes: How were fees determined before then? 

Gerbode: I guess surgeons just charged whatever they felt their contemporaries 
were charging in the same field. 

Hughes: So the same operation in different parts of the country could be 
quite a different price? 

Gerbode: Yes, that's true. They would charge more on the East Coast than 
on the West Coast, for example. 

Hughes: Why don't heart surgeons hold to these conventions? 

Gerbode: In general, they stick pretty close to the convention, but there 

are a few who take advantage of the situation and charge a lot more. 

Hughes: Not necessarily those who are prominent in the field? 

Gerbode: These are all good surgeons, but they just have a different attitude 
about how much they should charge. 

Hughes: Do you find that patients nowadays are shopping around much more? 

Gerbode: Yes. They are much more knowledgeable about fees too, and they're 
more apt to ask in advance what the fee is going to be , which is 
very good. I always told patients the bracket within which the 
charge would fall and would be sure to stay within that bracket. 



360 



Hughes: Are you talking just about the surgery or about the preop and 
postop care as well? 

Gerbode: Well, if we were going to operate upon a patient, we wouldn't charge 
anything for the preoperative visits nor for the postoperative 
visits for a year. It's all a one-packaged deal. That's not true 
for the cardiologists, however. They charge for everything. 

Hughes: The anesthesiologist, of course, would be another fee, wouldn't it? 

Gerbode: Yes, anesthesiologists earn more money in the United States than any 
other group of physicians. 

Hughes: Why do you think that is? 
Gerbode: I don't know why, but it's true. 
Hughes: Anything else about establishing fees? 

Gerbode: The whole business of payment for operations with Medicare is very 
shortly going to undergo a great revolution. I think what's going 
to happen is that the medical profession will be told that it's 
only going to get a certain amount per operation. 

Hughes: Regardless where it's done? 

Gerbode: Regardless; the idea being that the easy operations would sort of 
smooth over the tough ones and even it up more or less. If the 
hospital hires surgeons as they are trying very desperately to do 
in Australia it's still against the law here then they'll begin 
to set the fees for the surgeons they've hired. 

One administrator in Australia felt that if the hospital hired 
a surgeon, that he should charge no more than forty-five dollars an 
hour for his surgery. 

Hughes: Regardless. 

Gerbode: Regardless. Now, if you can imagine what uproar this occasioned 

in Australia I don't think they have a chance of it getting through- 
but that's the thinking of the administrators. 

Hughes: How would an average fee be determined in this country? 

Gerbode: Well, to begin with, you use that relative value scale and then 

surgeons have been charging a certain fee for certain operations for 
quite a while, so they could average those out. The pay for an 



361 



Gerbode: AC [aortocoronary] bypass, for example, would be determined by 

how much was being charged by the average surgeon for an AC bypass 
operation. 

Hughes: Do you think that will ultimately affect the distribution of surgeons 
in this country? 

Gerbode: If you're asking what effect control of fees, perhaps through 

hospitals, will have, it'll cut down on the number of hospitals and 
doctors that are doing that work. Most cardiac surgeons are not 
overwhelmed with cases. Some are, but most of them aren't. So 
that means we have a relative surplus of cardiac surgeons. That 
means that this [control of fees] opens the door for competition, 
and eventually that's going to occur. 

Hughes: Do you think that will be fought by the AMA and other medical 
organizations? 

Gerbode: Well, it depends on how they do it. I think the business of 

hospitals hiring doctors to do the work is going to be fought very 
strenuously. 

Hughes: Because of the fee-setting policy? 

Gerbode: Yes, and also you would get administrators running the doctors, which 
is not what they like very much. 

Hughes: I imagine this will be one of the things that you'll be discussing 
at the National Academy of Medical Specialities.* 

Gerbode: Oh, I think that'll be one of the things under consideration all 
right. Only I think fees in general will be considered, too, and 
how to establish a fee. 

Hughes: How well is this voluntary moratorium on fee increases working? 

Gerbode: I think it's working all right. 

Hughes: Do you think it could be kept on a voluntary basis? 

Gerbode: I think as long as it's working all right, it should be. What so 

often happens with voluntary things is that some people begin to break 
the voluntary rules and then it becomes a free-for-all again. 



*The Academy, formed of prominent representatives of the medical 
specialities, was established by Congress in 1984 to advise the 
federal government on current medical problems. Dr. Gerbode accepted 
the co-chairmanship of the section on medicine in March 1984. He died 
before the first formal meeting of the Academy in 1985. 



362 



Artificial Heart Valves 



Hughes : 



Gerbode ; 



Hughes : 
Gerbode: 
Hughes: 
Gerbode: 



Hughes : 



Gerbode: 



Hughes: 
Gerbode: 
Hughes : 

Gerbode: 



I was reading some correspondance written in 1973 with Viking Bj6rk 
about the use of artificial heart valves and he was wondering if you 
were using his disk valve. You wrote back saying something to the 
effect that you had been using the Edwards and Cutter valves. I 
was wondering why you selected certain valves over others. 

I hadn't seen very many patients with Viking's disk valve. But 
I had seen a fair number of patients with the first Cutter valve, not 
the cloth-covered one which proved to be a disaster. We very early 
took on tissue valves made out of the pig's aortic valve and treated 
with glutaraldehyde. 

You mean in preference to the artificial valve? 
Yes. 

Why? 

Well, because the incidence of thromboembolic complications was 
virtually zero with tissue valves, whereas it was still appreciable 
with mechanical valves. Patients on mechanical valves had to have 
cumadin, a blood thinning drug, and this in itself can produce 
complications. I remember having seen two patients come in after 
having a mechanical valve installed and being placed on cumadin 
and dying of brain hemorrhage. 

You said in this same letter that you preferred not to use any anti 
coagulants. 

Now we've seen that the complication rate for tissue valves is lower 
than it has been for mechanical valves. But the tissue valves are 
now showing a certain amount of failure after five to ten years. 
So you have to weigh that against the disadvantages [of the mechanical 
valves] . 

You mean they simply wear out? 
Yes, or get calcified. 

Is the greater frequency of embolism with the artificial valve just 
because it is an artificial substance? 

Yes, it's a metallic substance and it 's more foreign than a tissue 
valve, you might say. 



363 



Hughes: Were you unusual in not using anticoagulants with artificial valves? 

Gerbode: No, but if we used the mechanical valve, we had to use anticoagulants 
because it proved to be statistically better to do so even though 
there are problems with giving patients cumadin. The problems with 
not using cumadin are greater. There are a certain number of 
patients who bleed with cumadin, too. They [may] get massive 
hemorrhage in their gut or if they get a bad bruise somewhere it is 
apt to grow into a big hematoma. 

Hughes: You've never had to use anticoagulants with the pig valves? 

Gerbode: Well, some people felt they had to use anticoagulants in the mitral 
area because there was a small instance of thromboembolism. But 
some people still didn't use anticoagulants even though there was a 
small incidence of thromboembolic complications. 

Hughes: Why should there be more incidence at the mitral valve? 

Gerbode: Because the flow of blood is slower and not as vigorous. There is 
more chance of little thrombi forming on the rim of the valve. 

Hughes: Bjork said in this correspondance that he always used cumadin 
because that was what was commonly used in Sweden. 

Gerbode: He used cumadin from the very beginning, and so did Starr with his 
valve, and so did the so-called Sacramento valve people, and later 
on others who developed mechanical valves used anticoagulants, too. 

Hughes: Well, when you used the Starr valve, would you use anticoagulants 
as well? 

Gerbode: Yes. We've put a lot of Starr valves in and we used anticoagulants 
in all of them. 

Hughes: Which did you think was the best? 

Gerbode: I thought the Starr valve was the best when we first started, because 
I really didn't know too much about Viking's valve. But now, having 
looked back at the whole thing, I think Viking's valve has a slight 
advantage over the others. 

Hughes: Which is what? 

Gerbode: Well, there are fewer complications with the mechanical aspects 

of the valve, and I think it just works better for a longer period 
of time. 



364 



Hughes: Was it widely used in this country? 
Gerbode: Oh yes! Thousands have been put in. 

Hughes: You said in this letter that you hadn't used it very much, but it 
would be the valve of preference in children with a very narrow 
aortic root. 

Gerbode: Yes, that's true. 
Hughes: Why would that be? 

Gerbode: The orifice size for the ring which you have to use to hold the 
valve is bigger than some of the others. 

Hughes: You said just a minute ago that the cloth-covered Cutter valve was 
a disaster. Why? 

Gerbode: Well, Dr. [Nina] Braunwald, who had suggested this from a rather 
limited number of dog experiments, thought that fewer thromboses 
occurred when the ring was covered with cloth. She thought the 
tissue would grow into it and make it more like natural tissue. But 
actually what happened was that it "just formed a great nidus for 
clots. So everybody finally gave up on that, and I'm afraid that 
Nina Braumwald's reputation has suffered quite a good deal as a 
consequence. 

Hughes: Was she a local person? 

Gerbode: No, she was in Boston. Her husband is professor of medicine at 
Harvard. She was a heart surgeon trained at the United States 
Public Health Hospital in Bethesda. 

Hughes: Isn't she one of the few women to go into heart surgery? 

Gerbode: Very few women. 

Hughes: Why do you think that is? 

Gerbode: It's a tough life (both laugh). I saw a couple of them in Russia 

who were doing very well. Some of the Russian female heart surgeons 
are pretty good. 

Hughes: You mean technically good. Were they accepted by their male 
colleagues? 

Gerbode: Yes, because they're tough. 



365 



Extrapolation from Animal Research to Operations on Humans 



Hughes: I was reading an article written in 1969 by Francis Moore and he 

said that it's impossible to reproduce chronic valvular disease or 
congenital heart disease in a dog. 

Gerbode: Well, I think it's impossible to make it identical with what occurs 
in nature. 

Hughes: So it's the fact that it's experimentally produced. It's not that 
the dog is not susceptible. 

Gerbode: It's technically too difficult to do it and have it exactly like 
it is in the human. 

Hughes: I would think this would make a difference when you made the great 
leap from the dog lab into the operating room. Were surgeons in 
general pretty well aware that what they had been doing and seeing 
in the dog might not be replicated in the human? 

Gerbode: Generally speaking, when a surgeon first looks into a beating human 

heart and contemplates an open heart operation on that heart, I think 
he really can be very confused with the appearance of it. Most of 
our knowledge about hearts and how they look and what went wrong 
are based on pickled specimens. They're kind of shrunken and hard, 
whereas the living heart is soft and pliable and quite different 
looking. 

Hughes: Yet you, who have done so much work in the dog lab, wouldn't have 
had that problem. The living beating dog heart doesn't look that . 
different from the human. 

Gerbode: No, it looks like a human heart. Well, we did experiments on the 
dog simulating what we thought would be necessary. Sometimes we 
put in an artificial valve, for example. You just take out a 
normal valve and put an artificial one in, or create an atrial 
septal defect and then repair it. 

Hughes: Did you find that in most cases what you had done with the dog held 
very true for what you found in the human? 

Gerbode: Oh yes. 



366 



Consent Forms 



Hughes : 
Gerbode: 

Hughes: 
Gerbode: 
Hughes : 
Gerbode: 



Hughes: 
Gerbode: 

Hughes: 

Gerbode: 
Hughes: 
Gerbode: 
Hughes: 

Gerbode: 



Do you remember if patient consent forms were always 

In the beginning we had no consent forms especially designed for 
heart surgery. 

Were there consent forms of some kind? 

Yes, there were. There was always an operative consent form. 

This is going way back to the thirties. 

Way back, yes. But later on when surgeons began to be sued very 
freely and easily, we wrote another consent form in which we said 
more or less. "My surgeon has explained all the possible complications 
and reasons for failure of the operation and I understand the risk 
very thoroughly and we don't hold him responsible." The words were 
changed depending on who wrote it. 

What was the previous form like? 

The previous form was a simple statement saying I hereby approve my 
surgeon to perform an appendectomy or whatever it was. 

In both of those cases it sounds to me as though the aim is really 
to protect the surgeon and the institution rather than the patient. 
Is that not true? 

I don't see how a form like that can protect the patient during an 
operation. 

A form obviously can't prevent an operation from causing some harm, 
but it could give the patient legal recourse. 



That's after the harm has been done, 
very much during the operation. 



It wouldn't protect the patient 



It seems to me that the emphasis has shifted somewhat so that now 
there is an effort to look after the patient's rights as well as 
the physician's. 

I always had a conference with the patient and his or her spouse. 
I had both of them sign the consent form so that they would both 
acknowledge that I'd explained the operation rather thoroughly to 
them. 



367 



Hughes: Was there ever any problem with signing those consent forms? 

Gerbode: Once or twice somebody wouldn't want to sign it for a while and 
we'd simply hold up the operation till they made up their mind. 

Hughes: When did lawsuits really pick up? 
Gerbode: Just about ten years ago [1974]. 



Correcting Septal Defects 



Hughes: You were correcting ventricular septal defects successfully in 1956. 
Could you describe what you did in those days? 

Gerbode: When you get involved with doing congenital heart cases, among the 
very first ones you get are ventricular septal defects. We adopted 
our method of closing ventricular defects based on what little 
experience there was elsewhere and what we thought would be the 
best way to do it. 

Hughes: Could you describe it? 

Gerbode: Most of them could not be closed directly with a suture for various 
reasons, so we used patches of dacron cloth. We cut a little circle 
out, about the size of the defect, and sewed it in. 

Hughes: Were other people using that technique? 

Gerbode: They were using that same technique too, or trying others. But 

most of them quickly realized that they would have to patch the hole 
rather than just try to close it. There are various ways of 
entering the right ventricle to expose the defect. Mark Bainbridge, 
working in our laboratory, decided that a transverse incision in the 
right ventricle was tolerated better than a verticle incision to 
expose the VSD. Mark is now chief of cardiovascular surgery at 
Saint Thomas' Hospital in London. 

Hughes: Why would that be? 

Gerbode: Because it's more in the direction of the fibers rather than cutting 
across the fibers. I think a lot of people have adopted that 
incision. It also preserves more coronary vessels. 

Hughes: Is that what was referred to as the Gerbode technique? 



368 



Gerbode: Yes. [laughter] 

Hughes: I read about a hook that you apparently devised in connection with 
these operations. 

Gerbode: Before we had an open heart team and a heart-lung machine we had 

a lot of atrial-septal defects to close. There were various blind 
techniques being used for closing the atrial-septal defect. One of 
them was a Sondergaard technique. Sondergaard is a Scandinavian 
surgeon who put a circular suture around the defect, guiding its 
insertion from the outside with his finger, and then he'd tie it, 
pull it together. That would close it. It was like tying the top 
of a purse. That worked in many cases but sometimes the suture would 
loosen after a while and the hole would open again. 

Bob Gross devised a method of making a well, putting a sort 
of funnel on top of the heart with the blood still in the heart 
because blood would only go up to a certain level in the well. He 
could sew through the well and close the defect. I tried it a couple 
of times but I didn't really like it very much. They tried it at 
the Mayo Clinic too. 

I devised a hook; guiding the hook with my left hand I grasped 
the medial edge of the defect, pulled it over to the outside and 
when it was pulled over and held that way I'd put a suture through 
the outside and engage it. I did about thirty ASDs that way. I 
think most of them stayed closed. It's not a very good way. It's 
so blind you know. 

Hughes: Yes, and having to work fast too, I'd imagine. 

Gerbode: Not terribly fast, no. The main thing is not to upset the heart too 
much; take your time and not upset the heart. 

Hughes: In his correspondence with Bjork, he mentioned forcing Crafoord 

to try this technique which would have been the mid-1950s. Why was 
Crafoord resistant? 



Gerbode: I guess maybe he was still influenced by Sondergaard. 



369 



Early Open Heart Operations 



Hughes : 



Gerbode: 



Hughes: 
Gerbode : 
Hughes: 
Gerbode: 

Hughes: 
Gerbode: 

Hughes: 
Gerbode: 



Here's a letter which you wrote to Bjork in April 1960. I'll read 
one paragraph: "We are very busy using the combination of 
hypothermia in extracorporeal circulation with our new lung. And 
since August we have done approximately one hundred cases with it 
and have for comparison another one hundred cases done during the 
previous six months using milder hypothermia and the Stanford version 
of the Melrose lung. The last one hundred with the new equipment 
seemed to have much less reaction to the operation. One the whole, 
the combination of the two as we are now employing it seems to give 
us much more versatility and command of the situation. This is 
particularly true in the more complicated lesions. For example, 
of the nine consecutive very cyanotic tetralogies we have done 
recently, we have lost only one and the other eight are apparently 
completely cured." 



Was this an unusual study for those days? 
with two hundred cases all told. 



You were dealing 



I think we were all running in the same direction using slightly 
different techniques. I decided that we'd use hypothermia with the 
heart-lung machine because you didn't have to use the machine as 
much, which was better, and you could make a heart drier with more 
safety, and it. just seemed to work better. 

The machine, at that point, was still pretty primitive, wasn't it? 

Yes, it was. 

What was the Stanford version of the Melrose lung? 

Melrose came over here from England and brought his machine with him. 
He changed it a bit after he got it here. We tried it on a series 
of patients, tut it was not a very satisfactory machine. 

It's that slight modification that he made while he was here that 
is called the Stanford version? 

I've forgotten the details of that now. I don't quite remember what 
he did about that. But it was too much like a washing machine. It 
damaged the blood far too much. 

So you went back to your disk oxygenator. 
Yes. 



370 



Hughes: Why did you say that the combination of hypothermia and extracorporeal 
circulation gave you more versatility and command of the situation? 

Gerbode: First of all, you don't have to pump as much blood. The less that 
blood goes through that machine, the less trauma there is to it. 
You could work under lower blood pressure and this is easier too. 
The patient can tolerate that lower blood pressure much better if 
there's hypothermia with it. 

Hughes: How were you determining the level of hypothermia? 

Gerbode: We just arbitrarily decided that it would be a certain level which 
was about 32, about 5 lower than normal.* I guess we found if we 
went much lower that, we'd get in more trouble from the hypothermia 
and if we went higher than that, it wasn't much use. 



Postoperative Problems After Open Heart Surgery 



Hughes: Do you remember what the main problems in those days were post- 
operatively? This was 1960. 

Gerbode: I think the main problems were associated with postoperative pulmonary 
problems, and they had to do with trauma to the blood as it went 
through the machines. We weren't using blood filtration in those 
days and so there was a lot of debris that went through the machine 
and got into the patient's lungs and that produced, they call it, 
the pump-lung syndrome . 

A lot of people didn't realize what the pump-lung syndrome was 
until we began to study the blood after it went through the heart- 
lung machine. We found platelet debris and little bits of thrombi 
and sometimes a little bit of the tubing. Tiny bits of the tubing 
would break off from pumping with it, and they would all go to the 
lungs and plug up the capillaries of the lungs. 

Hughes: So it was more lung problems than heart problems. 

Gerbode: Yes. But then there were central nervous system problems too 

because some of that blood went to the brain and produced little capillarj 
thromboses. A few patients would have central nervous system events 



*In a letter to Bjork, written in 1960, Dr. Gerbode said that he 
was using hypothermia to the level of 18 centigrade. 



371 



Gerbode: which would be kind of frightening. Practically all recovered from 
them, but I think that there was probably a little more brain damage 
than we were able to measure. 

I suppose the main postoperative problems were failure to 
recover as quickly as you expected the patient to. But the main 
thing, neurological problems. The ones who did revive right away 
seemed a little bit slow in recovering and some didn't recover. 
The mortality rate wasn't very high; I'm talking about isolated 
cases here and there which did not revive as quickly as we expected. 
It took us quite a while to realize that this wasn't due to 
hypothermia itself; it was due to the fact that oxygenators weren't 
really taking care of the damage to the blood properly. We studied 
this a bit later and found out that blood filtration was the best 
preventative of serological manifestations after open heart surgery. 



An Aortic Valve Prosthesis* 

Hughes: There was another letter written in 1962 on an aortic valve 

prosthesis which apparently you were developing with Franz-Josef 
Segger. He was training with you at that point. Was that an idea 
that he came to you with? 

Gerbode: No, that valve which we were developing with Franz Segger was one 
which came out of our own laboratory. We didn't know what to use 
at that time, of course, so we investigated all the prosthetic 
material that was available and finally decided on one which seemed 
to be the most feasible. Franz Segger and I, with the help of a 
dentist actually , developed a stent on which we could build an 
artificial prosthesis out of synthetic material. Unfortunately it 
was made out of material which was mostly silicon and this functioned 
only for a relatively short period of time. It was the best thing 
we had at the time, however, but it wasn't good enough. 

Hughes: How did it compare to other aortic valves? 
Gerbode: Well, there weren't any, really. 
Hughes: I saw a reference to a 'Muller. ' 



*The following discussion of medical and surgical typics was moved 
from the session recorded on 5/3/84. 



372 



Gerbode: Oh yes. Muller valves and also a McGoon valve were developed out 

of cloth and made into bicuspid valves. I put one of those in once. 
This was something that would correct the insufficiency and the 
stenosis, but unfortunately these cloth valves fell apart very 
quickly. 

Hughes: Was your valve ever used on a wide scale? 

Gerbode: No, it wasn't. We watched it very carefully and when a couple of 
them failed because of fracture of the cusps, we stopped using 
them immediately. 

Hughes: Was the design quite different than that of the other valves? 

Gerbode: Yes. Our valve was based on the same anatomy, the same appearance, 

of a normal [aortic] valve. Their valves were bicuspid valves, 

which were two flaps of cloth which opened and closed. Mechanically 
they worked all right for a short period of time. 

Hughes: Why did they think of changing nature's design? The aortic valve is 
not a bicuspid valve, is it? 

Gerbode: No, it's a tricuspid valve. It's easier to make a bicuspid valve. 
Hughes: And that was the reason. 
Gerbode: Yes. 

Hughes: In 1962 Bjork wrote to you from Uppsala saying that he was very 
impressed with your ability to put in an aortic valve in twenty 
minutes. He said that it took him an hour. I was wondering why 
there was that great difference in time. 

Gerbode: I don't know. 
Hughes: He was slow. 

Gerbode: I wouldn't say that. Maybe I was fast and maybe he was slow, but 
I don't know. 

Hughes: That would make a difference though in 1962, wouldn't it? I'm 

thinking of the oxygenator and the problems that were still happening. 



Gerbode: Yes. 



373 



The Early Membrane Oxygenator 



Hughes: In January 1967, you wrote to Clarence Crafoord at the Karolinska 
that Hallikainen Instruments of Richmond was producing a fully 
engineered membrane heart-lung machine. I was surprised at this 
because I didn't realize that you were marketing the membrane at 
that stage. 

Gerbode: We weren't marketing it, but they had developed it and so they 
ware willing to make a few for others to try. 

Hughes: So it was really a prototype? 

Gerbode: Yes. 

Hughes: What became of it? 

Gerbode: I used it in about three hundred patients, but the problem was that 
it was too difficult to service between operations. Patients did 
very well on it, but there's a certain point where if things work 
easily or don't work easily, you have to decide whether to use them 
or not. 

Hughes: It was not only the disk oxygenator that was sent over to Cutter 
[Laboratories] to be cleaned? 

Gerbode: The membrane had to be sent over, [cleaned], and assembled by Cutter, 
which was also very difficult, and a nurse had to be over there who 
could put these various layers in the membrane together , and usually 
Bram went over to supervise. This was too complicated. 

Hughes: Were there other membranes at that time used right here in the 
Bay Area? 

Gerbode: There weren't any really in use at that time. We had the first 
membrane which was used clinically on a broad scale. 

Hughes: Were you using the disk at the same time? 

Gerbode: No, I don't think so. When we switched, we used just the membrane. 

Hughes: When you found that this wasn't feasible, you went back to the disk? 

Gerbode: When we found the membrane was too complicated to run routinely in 
cases, the bubble-oxygenators came into being. 

Hughes: The chronology then was disk, membrane, bubble. 



374 



Hughes: Later you joined the Harvey Corporation. Why the change? 

Gerbode: We had done a lot of research on the membrane oxygenator and 

developed a method of getting maximum oxygenation and CC>2 transfer 
of the blood. This was incorporated in a new design for a membrane 
oxygenator. We realized that we couldn't produce this on a large 
scale, so we asked the Harvey Company to come in and take over the 
development of a production model. It looked very feasible to them, 
so we gave them the patents which we had and let them go ahead with 
it. After about five years of work in their laboratories to 
produce a commercially viable product, they decided to adopt the 
Dow Chemical membrane oxygenator probably because they felt they 
could make more money with it. 

Hughes: Can you summarize the differences between the membrane oxygenator 
at the stage it was being worked on by the Hallikainen Company and 
Harvey? 

Gerbode: It had to be put into a package which could be disposable after each 
operation. The Hallikainen was used once and [then] it had to be 
taken apart and cleaned and put together by an expert. All hand 
work. The one which Harvey finally developed was one which could 
be put together quickly and commercially in a way which was 
feasible as far as general use was concerned. Unfortunately, I 
think they found the Dow Chemical one would be cheaper to market 
than ours. Now they are selling the Dow Chemical one. These 
big companies keep looking for something which will make them more 
money right away. 

Hughes: Do you think that boils down to ease of manufacture? 

Gerbode: Ease of manufacture, ease of assembling, ease of operation. The 
minor differences in physiology of each one are erased by all the 
mechanical aspects of putting it together. 

Hughes: The changes that occurred between your early membrane and the later 
ones were somewhat in terms of ability to clean them. Wasn't that 
a big factor? Did that boil down to different materials that were 
available over time? 

Gerbode: Yes, it did in a way, because originally we weren't using the same 

membranes which we used in the end. In the end microporous membranes 
came into being and almost all the companies that were involved in 
this business switched to them because the oxygen and CC^ transfer 
through those membranes is so much better than anything we had before. 
Our oxygenator behaved beautifully with these microporous membranes. 



375 



Hughes: Were those membranes developed specifically with this use in mind? 

Gerbode: No, they're used in industry a lot. This development came out of 

industry. There are a lot of other uses for microporous membranes. 



The Bubble Oxygenator 



Hughes: I have a letter here that you wrote to Hans Borst in 1957 and in it 
you referred to the Lillehei system. Do you want me to read it? 

Gerbode: Yes. 

Hughes: "I have your letter of April 10, 1957 and was interested in your 

remarks about the Lillehei system. We have, of course, experimented 
with this device for about a year and a half now and have found it 
to be far from what we would like for human use although I know it 
has been used successfully in many cases. We have our own combination 
of Gibbon pumps, which the Gartner-Kay model also uses, but we have 
disposable membrane lungs made of plastic. This gets away from 
pyrogens and problems with cleaning screens, etc. Our extracorporeal 
program is booked solid until June. It is curious that for a while 
we wondered whether there would be much demand here for this kind 
of work, for the demand far exceeds our ability to meet it at the 
moment and 1 worry that my research program may get submerged by 
the clinical work. But that is a matter of interpretation, for a 
great deal of clinical work can be done on a rather large volume of 
cases which is now going through my service. 

"We have also built a small new laboratory for extracorporeal 
experiments and I have an excellent staff of associates including 
Jack Osborn and a number of others. I believe that Dennis Melrose 
is coming from England to work with us on problems of physiology 
and extracorporeal circulation. But I doubt if he would be 
interested in doing any surgery." 

What was this Lillehei system that you referred to? 
Gerbode: It was using the bubble oxygenator. 

Hughes: Which at that point you were realizing had drawbacks? 
Gerbode: Certain limitations, yes. 



376 



Hughes: Was that obvious pretty quickly because in 1957 they hadn't been 
around for a long time. 

Gerbode: No, it wasn't obvious right away, but it was pretty soon. 

Hughes: This was the reason that the bubble oxygenator, you felt, was 
inadequate for patient use? 

Gerbode: Well, it had limitations. 

Hughes: Which meant that you didn't use it. 

Gerbode: Not in the beginning, but later on we did use it. 

Hughes: After it had been improved somewhat? 

Gerbode: Yes, it had been improved quite a bit. 

Hughes: What about problems with bubbles or micro-bubbles? 

Gerbode: And there were bubbles too. This is true of using bubble oxygenator s. 
Though to a much lesser extent , even the disk oxygenator produced 
bubbles which got through the filtration and other systems. 

Hughes: But the bubble oxygenator was worse? 
Gerbode: It was the worst and it still is. 

Hughes: Why did you doubt that there would be much demand for the extracorporeal 
program? 

Gerbode: You never know what cardiologists will do and realizing how difficult 
it was in the beginning to start closed heart surgery, I didn't 
know whether they'd accept open heart surgery or not. So I guess it 
wasn't until the results were good that they realized that this 
was the best way to take care of these patients. 

Hughes: So there really was doubt amongst cardiologists in the beginning 
that open heart surgery was an acceptable technique? 

Gerbode: I don't know whether it was doubt. I think it was just hesitancy. 
Hughes: Turning over their patients to 
Gerbode: ...these terrible surgeons! 

Hughes: Do you think your research program did get submerged by the clinical 
work at this time? 



377 



Gerbode: No, I kept the laboratory going all the time. 

Hughes: When you speak of the advantages of clinical work, you mean from 
the standpoint of accumulating cases and statistics? 

Gerbode: Yes, and studying what really happened. 

Hughes: How did you manage your day, assuming that you had a fairly heavy 
case load. Were there certain times which you set aside to work 
in the dog lab? 

Gerbode: On certain days I went over to the dog lab. 
Hughes: You didn't schedule cases on those days? 
Gerbode: That's right. 



Early Extracorporeal Research 



Hughes: Do you remember when the extracorporeal work with Jack Osborn began 
in earnest? 

Gerbode: Jack came with me in the early 1950s and we started working then. 

Jack came with some experience with hypothermia in New York, not so 
much with heart-lung machines. I told him early on that I thought 
we ought to get on with a heart-lung machine. We looked at various 
ones which were already on an experimental basis. One of these, the 
disk oxygenator, had actually been worked on at the Karolinska by 
Crafoord. 

Hughes: When was this? 

Gerbode: The early fifties. At the same time John Callaghan came from Canada 
and worked with me in the laboratory. We tried various other kinds 
of oxygenator s. We used plastic bags filled with oxygen and mixed 
blood with a sort of a bubble oxygenator in a plastic bag. We used 
this experimentally, a terribly cumbersome way of trying to do it. 
We did a couple of patients with this method and that wasn't very 
good either. This was really before the idea of bubbling oxygen 
through a column of blood proved to be feasible. 

Hughes: Are you saying that Osborn came to you with the idea of working on 
hypothermia rather than the heart-lung machine. 



378 



Gerbode: He came with the reputation of working on some basic things in 
hypothermia. 

Hughes: Where had he done his previous work? 

Gerbode: At New York Hospital. We really didn't exploit his previous work 
in hypothermia at that time. We got started trying to develop a 
heart-lung machine. 

Hughes: Was it easy to talk him into working on the heart-lung machine? 

Gerbode: Oh yes. 

Hughes: It took a number of years to combine those two processes, didn't it? 

Gerbode: It did. 

Hughes: In retrospect, it seems obvious. 

Gerbode: I guess, what happened mostly was that we could see the need after 
a while, and we realized that something was necessary to supply the 
need, and hypothermia would not really supply the need a great 
adjunct to the picture, but not an answer to the whole picture. 

Hughes: The use of hypothermia with the oxygenator took surprisingly long. 
That didn't occur right from the beginning, yet the two techniques 
were going on side-by-side for almost a decade. 

Gerbode: We realized that the hypothermia would help almost anything relative 
to a heart operation. But we also realized it would overcome some 
of the inadequacies of an oxygenator system. 

Hughes: Were there certain operations that you were doing with closed heart 
procedures? 

Gerbode: Yes. We were doing closed heart procedures all the time. 

Hughes: After the heart-lung was available, were you picking and choosing 
your operation procedure? 

Gerbode: There were certain cases we could do with closed heart techniques 

quite safely and quite easily. The ones that we thought we could do 
this way, we did. 

Hughes: A letter from Hans Borst [written early in 1958] has an interesting 
passage: "As you know, Professor [Rudolph] Zenker has been in the 
States. He had hoped very much to see you in San Francisco but 



379 



Hughes: contracted grippe in Los Angeles. His impression of the United 
States was most interesting for me, as you can imagine. He was 
very much impressed. However, the basic differences between 
American and German medicine seem so remarkable that there doesn't 
really exist a possibility to modify the present system. The 
differences, he felt, are due to the fact that in the U.S. there 
is a shortage of doctors and there is private initiative in 
medicine. I am sure that is a very important sociological difference, 
but I believe the real discrepancy is due to the different mental 
attitudes in the U.S. .this overcritical Anglo-Saxon overtone, and 
here [in Germany] , this curious mixture of hollow dogmatism and 
genius. " 

Gerbode: He's a smart guy, Hans. 

Hughes: It's a very interesting summary. You spent some time in Germany. 
Would you agree with his assessment? 

Gerbode: Now it's much better, of course. The systems are very much more 
alike. 



380 



XI PACIFIC MEDICAL CENTER AND ITS PREDECESSORS 



The Institutes of Medical Sciences and the Old Presbyterian 
Hospital 



Hughes: You said earlier that John Osborn, Henry Newman, Arthur Selzer, 

Fred Merrill and Mrs. Harley Stevens were the original founders of 
the Institute of Medical Sciences. I know of Osborn, but why were 
the others involved and who were they? 

Gerbode: Well, Arthur Selzer was our cardiologist and he was very interested 
in experimental work at the time because there wasn't very much 
clinical work. So I asked him to join the group to form the 
institutes. Mrs. Stevens is a very good friend of mine and very 
interested in the research that I've always done. She has always 
been very supportive and so she came along for that reason. 

Hughes: Was she putting money into it as well? 

Gerbode: She put some money into it. She has sense, too. Jack Osborn of 
course came with me to develop and run the heart-lung machine , so 
it was natural for him to come along. 

Hughes: He was already here at Stanford Hospital? 

Gerbode: Yes. 

Hughes: What about Fred Merrill? 

Gerbode: Fred Merrill was on the board of trustees of the hospital and so I 
put him on [the board of the institutes] because he was a good 
representative businessman. 

Hughes: Did the six of you really establish the policy and get the whole 
thing going? 

Gerbode: Yes. 



381 



Gerbode: When Stanford pulled out, we had no organization to work through. 

I took a look at the chiefs of service and decided that none of them 
were interested in research, and it would be impossible to get them 
to agree on anything relative to research, so I just gave up on that. 
In fact, when we started thinking about building the research 
building and wanted to take some of the money which a very nice lady 
had left us, and asked for something like $150,000, there was a 
great uproar. They said, "We need a hospital more than a research 
building. We've got to put that money into a hospital. We couldn't 
even buy a dressing room for $150,000!" 

Hughes: So how did you handle that? 

Gerbode: We just went ahead and did it anyway. 

Hughes: Eventually the hospital was built. Was that very shortly thereafter? 

Gerbode: That's another story when we got that hospital built. 

Hughes: I've forgotten how much longer that took. 

Gerbode: It took seven or eight years or more, I guess. There were all kinds 
of plans designed by various experts to convert the old Stanford 
Hospital and the rest of those buildings into a modern hospital. It 
was just wasted time and money to do that and the only ones who 
profited by it were the planners. 

II 

Hughes: You talked earlier about the vigor of the program in heart surgery 
carrying along the hospital for a number of years. 

Gerbode: I think there was a time, when we burst into the field of heart 
surgery and started doing a lot of cases , when we were the only 
really ongoing unit in the whole hospital. 

Hughes: What happened to the patients that had been coming to Stanford 
Hospital? 

Gerbode: I think some of them didn't stay with us because they were told by 
the Stanford administration that the hospital was going to close. 
Some of them even believed that. They felt that with some of the 
faculty moving to Palo Alto , that the faculty who were staying 
weren't good enough for them. A lot of little things like that. 

Many times I heard people say when a patient was referred, "Where 
are you going to operate on this patient?" I said, "In the old 
Stanford Hospital." They would say, "We thought that was closed." 
This was deliberately conceived by one of the trustees of the university. 
Absolutely deliberate. 



382 



Hughes: Was it motivated by their fear of competition? 

Gerbode: Yes. Stanford didn't think they could make it too easily. They 
even wanted to close the out-patient clinic. Stanford said, "We 
have no money to pay a deficit for an out-patient clinic." So since 
they raised the question of the deficit, Henry Gibbons and I got 
fifty doctors to promise one thousand dollars apiece to pay for any 
deficit in the out-patient clinic. Of course, there wasn't any 
deficit and so we didn't have to pay anything. 

Hughes: Were you pretty confident of that? 

Gerbode: Oh sure. You see, it's a natural place for a clinic. It's near 

the underprivileged people and hundreds of those patients have been 
coming there for generations, and many of them walked to the clinic. 
The ones who had to come from farther away could all get there on 
general transportation. There were lots of doctors who were not 
going to go to Palo Alto and they were willing to stay there and 
take care of those indigent patients. 

Hughes: Did you have trouble filling in the gaps in the staff in those early 
days? 

Gerbode: No, there was a good distribution always. 
Hughes: But you had to take on new people, didn't you? 

Gerbode: We did, but some of the younger people didn't go down [to Stanford] 
with the chiefs, so then they became chiefs up here. It was 
delightful for them. 

Hughes: Tell me about the other institutes that were founded in these early 
days? 

Gerbode: The other one that came along very strongly was the eye institute 

[the Smith-Kettlewell Institute of Visual Sciences] under Dr. Jampolsky. 
There was a time when we thought that maybe some of the other eye 
doctors would not go to Palo Alto and would stay and help to 
develop the eye institute. That old Stanford Medical School had a 
terrific reputation in ophthalmology, going back for two generations. 
It was started by two Swiss ophthalmologists, [Adolf] Barkan and 
[Dorman] Pischel, who liked teaching and took their responsibilities 
of being professors very seriously. They had children and their 
children became doctors and carried on in the profession. They 
carried on with lots of clinic activity and continued to he modern. 
So we've always had a big eye center there. 



383 



Hughes: And Jampolsky was part of that? 

Gerbode: He was part of it. He grew up under Barkan and so did Cleasby. 

A whole bunch of the ophthalmologists stayed around and some of them 
developed practices downtown; some of them developed practices in 
other hospitals, but most of them continued to teach in the old 
Stanford Hospital. 

Hughes: Where did the money come from for the eye institute? 

Gerbode: Originally there wasn't much money, but they got federal research 
grants, and then there was a fellow by the name of Clement Smith 
who was both a patient of Dr. Jampolsky and mine. He had very poor 
vision and very poor circulation. I was taking care of his poor 
circulation and Jampolsky was taking care of his poor vision. He had 
no relatives. He made an awful lot of money in the offshore insurance 
business after the war. He liked us. I think Dr. Jampolsky worked 
on him harder for donations that I did, although I put my nickel's 
worth in whenever I could. One day when his health was really failing 
I knew him through the Bohemian Club he called me up and said, "Frank, 
I'd like to have you come down and talk to me. I'm going to die before 
long." So I went down. He said, "I'm going to give Jampolsky one 
million dollars for his eye work and I'm going to give you one 
million dollars.'* I said, "What do you -want me to use the money for?" 
He said, "Whatever you want." Well, I found it would be much better 
to have that million dollars go into the institutes as a whole to help 
the broad base of all the various research workers. So we put it 
into what was then called the Institutes of Medical Sciences. 



The Institutes 



Gerbode: Then Jampolsky founded his own private institute and kept the money 

in it. Later on he did the same thing with a woman named [Catherine] 
Kettlewell who was a patient of his. Mrs. Kettlewell gave all her 
money to Jampolsky 's eye institute. 

Hughes: The eye institute is separate from the Institutes of Medical Sciences? 

Gerbode: They have two foundations as I understand it. They use all their money 
for cheir eye work. Because of Smith and Kettlewell, they got enough 
money to build their own building. 

Hughes: So they're more independent than the rest of the institutes? 

Gerbode: Yes, they're independent, but they have to use MRI as an umbrella 
because they have a certain number of federal grants and they need 
to have the institute to back them. 



384 



Hughes: Is that the only real reason that they keep the affiliation? 

Gerbode: I think so because they don't really cross-fertilize much in their 
research. 

Hughes: Is that somewhat because of the nature of their research? 

Gerbode: I suppose eye research is more or less separate from general research, 
but there are areas where they could overlap. I think they have 
collaborated a bit with some of the other people over there, But 
generally speaking, they don't. 

Hughes: Do they have more manpower than the other institutes? 

Gerbode: Well, I don't know about the total manpower compared to that of the 
total MRI. MRI has a lot of manpower because of all the other 
grants we've gotten. The eye institute is able to fund quite a few 
extra people out of their endowment funds. 

Hughes: What about other institutes? 

Gerbode: Then the neurological institute [the Institute of Neurological 

Sciences] came along. Knox Finley was doing research on the long- 
term effects on the brain of certain infectious diseases of the 
brain. He had this contract to study these patients over a long 
period of time. 

Hughes: Dating back to the very beginning in 1959 when this all got off 
the ground? 

Gerbode: Yes, but later on that work ran out of gas, you might say. I got 

interested in the long-term effects of open heart surgery on patients 
with congenital heart disease, so I got Knox's group to study these 
children, psychologically and neurologically , before and after 
heart operations. That work went on for quite a while. 

Hughes: Using your money? 

Gerbode: Using our money; it came out of my grants. 

Hughes: So that pulled them along for a while. 

Gerbode: Yes. 

Hughes: What about the other institutes? 



385 



Gerbode: The other big group that came over was from the U.S. Public 

Health Hospital [in San Francisco]. They were studying coronary 
disease and high blood pressure. For one reason of another, they 
decided that they ought to get out of the U.S. Public Health 
Hospital. We encouraged them to come over to IMS and gave them 
space and set them up. They transferred all their funds over, 
which were considerable, to study hypertension and heart disease on 
a group of patients. 

Hughes: They became a part of your [Heart Research] Institute. 

Gerbode: Yes, they did. Later on they decided, since they had so much money, 
that they ought to be by themselves. So they asked to get out of 
my institute and become a member of a new institute which they 
called The Institute of Behavioral Medicine, So they now have 
their own separate institute. 

Hughes: Did that involve a battle? 

Gerbode: No, I didn't fight. I didn't want to have anybody around that was 
unhappy. The reason they dropped out was because they felt they 
could run their own money better than having to go through my 
institute. 

Hughes: It was coming directly from the Public Health Service? 

Gerbode: Yes. 

Hughes: Was the Institute of Behavioral Sciences already extant? 

Gerbode: Yes, it was. It was part of my Heart Research Institute. They 
reached certain conclusions from their research, and then they 
went into another big research program on alcoholism and its causes 
which they now run with the University of California in Berkeley. 
So they're coasting along in that alcoholism funding right now. 

About three years ago Dr. Osborn, who had been with me from 
the very beginning, decided that he could get more research grants 
if he got an institute of biomedical engineering. So he split off 
with a couple of grants and set up the Institute of Biomedical 
Engineering [Sciences]. 

Hughes: Was that with your approval? 

Gerbode: Again, I didn't fight it. It makes sense to have an institute of 
biomedical engineering if they can get somewhere with it. As it 
happened, once they split off, they had practically no funding. 
I think they have only one grant right now. So what Osborn thought 
was going to be great stuff turned out to be not so great. 



386 



Hughes: Do you think it would have been better if he had stuck with you? 
Gerbode: I don't know. 

Hughes: Is there anything else to say about the early days of the 
institutes? 

Gerbode: I would say that in general the hospital staff they were mostly 

people left over from the old Stanford days viewed a continuation 
of this research effort with a somewhat jaundiced eye. They couldn't 
understand why I was so interested in maintaining a research program 
when the hospital was falling apart and so were a lot of the programs. 
My point was that the hospital would never amount to anything without 
a research program. So I think there are still people who don't 
quite understand how a research program in a hospital can possibly 
make the hospital any better. But that's a matter of philosophy and 
belief. 

Hughes: I know that UCSF, at least since the war, has had a research 

program. Was there any other hospital complex in the Bay Area with 
a research program? 

Gerbode: Mount Zion always had a little research going. Nothing very much. 
Children's Hospital has some research funds and they had a unit 
built for research in their new hospital a number of years ago. 
They may have one research program over there now, but it's not 
very much. 

Hughes: Do you link the fact that at Presbyterian the great advances in 

heart surgery on the West Coast were occurring with the fact that 
you had a serious research program? 

Gerbode: We could never have developed the heart-lung unit without a big 

research program. In fact, NIH decided that on its own and gave me 
what amounted to about $400,000 a year for about ten years for 
developing an open heart program, monitoring, training young 
people and nurses, improving the technique and safety of heart 
surgery. I think the research really helped enormously. 

Hughes. It was more common on the East Coast, was it not, to have research 
associated with a hospital complex? 

Gerbode: It was always common in the university hospitals. It was not so 

common in the private hospitals. But the reason we might have been 
different, you see, is the fact that this had always been a medical 
school. So we have the same sort of aura as when there was a 
medical school here. 



387 



Hughes: You had, at least in the early days, people who had been teaching, 
including youself. 

Gerbode: Yes. 



The Old Stanford Hospital and the Presbyterian Church//// 
[Interview 16: May 22, 1984] 



Hughes: Dr. Gerbode, in January 1960, the Presbyterian church announced that 
it would take over ownership and operation of the San Francisco 
Stanford Hospital. Fred Merrill, president of the board of 
governors of the hospital, said that "the church's decision to take 
over the hospital represented a solution to the difficult problem 
that has confronted the board of governors for the past six years." 
Do you know what problem he was talking about? 

Gerbode: I suppose he was talking about which organization would sponsor the 
hospital. Very few hospitals are free standing without a sponsor. 
Since we'd had Stanford Medical School as our sponsor at the old 
Stanford Hospital, we were quite used to having quite a respectable 
organization behind us. There are other hospitals in the country 
which are sponsored by the Presbyterian church. Tnere's one in 
New York, a very famous one [Columbia Presbyterian Hospital], and 
there's a new one in southern California, and [others] are scattered 
here and there. I suppose the church feels, too, that it gains kudos 
by having something other than just a church. So that's why they do 
it. But they are Scottish Presbyterians and they are pretty good at 
collecting money , but not very good at spending it , which was what 
we found out . 

After we got connected with them, everyone thought, well, the 
Presbyterian church is going to pour thousands of dollars into the 
place. But actually they made a token contribution and that was it 
and they have never made much of a contribution since then. 

Hughes: What took up the slack then? 

Gerbode: We had to raise it and we had to make it out of earnings from the 
hospital. A great many of the special units in the hospital were 
paid for out of research funds or special funds we got from various 
agencies. For example, the whole heart center intensive care unit 
was paid for largely by NIH funds and IBM. The first angiocardiography 
machine was paid for by a Mr. Newton Bissinger who was treated so well 






338 



Gerbode: in the hospital, he felt he should do something about the hospital. 
This came as quite a big life-saver because that year Stanford 
decided it would take the angiocardiography unit out and re-install 
it in Palo Alto, which was all right since the next year there were 
big advances and we got a more modern unit. 

Hughes: The agreement between Stanford and the Presbyterian church included 
the gift of the [old Stanford] hospital and adjacent properties to 
the Presbyterian church of San Francisco, the development and 
maintenance of a graduate medical center by the Presbyterians, and 
also full financial responsibility for the administration of the 
hospital and its properties. Why was Stanford willing to make a 
gift of the hospital and its properties? 

Gerbode: It didn't want responsibility any longer for San Francisco. 
Hughes: Why wouldn't money have changed hands? 

Gerbode: Well, we didn't have any money, first of all, and Stanford really 

didn't want to have anything to do with San Francisco. I went down 
and talked to Wally Sterling [the president of Stanford], several 
times to try to get him at least to maintain a postgraduate unit up 
here loosely affiliated with Stanford. He wouldn't have anything to 
do with it. In fact, the president of the [Stanford] board, who 
was Dave Packard, [at] several meetings we held in the auditorium 
of the Fireman's Fund Insurance Company, whenever a question came up 
about maintaining an out-patient clinic or maintaining anything 
like that in San Francisco, Dave Packard, the president of the 
[Stanford] board, would say, "No, you can't do that." When I raised 
the question of teaching up here, carrying on some kind of graduate 
teaching program, "No, you can't have any teaching up here. 

Hughes: Why? 

Gerbode: Because they were afraid of competition. They were going to close 
the out-patient clinics because, first of ell, they wanted the 
patients to go to Palo Alto and secondly, they thought it would cost 
them money to keep them open. So when this suggestion was made by 
Dave Packard, I organized a committee with Henry Gibbons and we got 
fifty doctors to guarantee one thousand dollars apiece to pay any 
deficit incurred by out-patient clinics so we could keep them open. 
Well, this kind of shamed the trustees into letting us keep them 
open. With that in front of them, they didn't really have any 
reason not to keep them open. 

Hughes: The out-patient clinics had been doing fine, hadn't they? 



339 



Gerbode: Oh yes. They wanted those patients to move down to Palo Alto. 
Indigent patients don't move that far. They come from the area 
[around Presbyterian Hospital] and many had been coming to the old 
Stanford clinics for generations. We were very happy to keep them 
because we were accustomed to them and they were accustomed to us. 
We had a clinical staff who could take care of them because most of 
the clinical staff wasn't going to move to Palo Alto anyway. 

Hughes: Did you lose some of the wealthier patients to Stanford? 

Gerbode: I suppose we did because the old Stanford Hospital was in terrible 
shape physically. Many of the referring doctors thought that the 
hospital was going to close when Stanford moved to Palo Alto. In 
fact, they were surprised when they would occasionally refer a 
patient up here, when we said we were going to take care of them. 
They said, well, we didn't even think your hospital was open. This 
is exactly what Stanford wanted to be circulated. Anyway, instead 
of closing, we started making plans for a new hospital. 

Hughes: You were confident all along that you could raise the money? 

Gerbode: Oh yes, we were confident that we could do it. I don't know whether 
you want to hear. the story of how that came about or not. 

Hughes: Go ahead. 

Gerbode: Fred Merrill was hoping some organization would come along and help 

us by being a sort of financial godmother /god father for a new hospital 
and he was flirting with quite a few people including a group of 
nuns at Saint Joseph's Hospital because Saint Joseph's Hospital was 
going to close anyway, they thought. He said they had lots of money. 
When they got to the point of what they would do and what they 
wanted, they really weren't going to give very much money to the 
place nuns being very careful businesswomen. Secondly, they wanted 
to control the board of trustees. 

Hughes: You mean putting a majority of their own 

Gerbode: A majority of nuns on the board. Well, that plus the fact that they 
weren't going to put up very much money in anyway. Then we were 
without any sort of godfather or godmother for the place and we were 
in limbo. 



390 



Proposal for a Medical School 



Gerbode: I was up at the [Bohemian] Grove one summer and I started talking 
to the president of the University of the Pacific, Bob Burns. 
He was a very, very nice man and one of the best 
presidents they ever had. I said, Bob, you could almost start a 
medical school [at Presbyterian] like the one you did in Sacramento 
at the law school. This appealed to him because he was in a kind 
of an expansionist frame of mind. He said, how can we do this? I 
said, well, let's go over and talk to Fred Merrill. We went over 
and talked to Fred Merrill and Bob said, we can start by sponsoring 
the hospital and maybe programs within the hospital. I said, you 
might even start some graduate training programs. This appealed to 
him a great deal. So he agreed to make our hospital a University of 
the Pacific affiliate. 

Hughes: Do you remember when that was? 

Gerbode: It was maybe four or five years after Stanford left.* That started 
it really because Bob Burns was a ball of fire and he really took 
hold of the idea. Then we started worrying about how we could 
build the hospital. We had a fellow by the name of Ed Westgate on 
the board of trustees who was the head of a committee to get a 
bank loan. He got together a consortium of banks which we considered 
might be willing to loan us some money to build a hospital. Of 
course, Bob Burns was always in the background sponsoring this 
concept. At the meeting at this consortium of banks which was 
scheduled on a certain day , he got a call from the Bank of America 
I think Clausen was the president then. He told Westgage, "Ed, don't 
worry about a consortium. We'll take the whole thing." Westgate 
was really responsible for maneuvering this. So then we had a bank 
which would loan us some money to build the hospital. This spurred 
Bob Burns on even further. This was the last of the Hill-Burton 
funds to build hospitals, so we got a Hill-Burton grant [application] 
together and Bob was working on Sacramento to get them to sponsor 
the hospital. He got them to recommend that we get the Hill-Burton 
funds for the hospital. We got quite a large sum of money. 

Bob kept hanging on to this idea that maybe there would be a 
good opportunity for a medical school and we had a committee that 
developed a curriculum for a new type of medical school and got a 



*Robert E. Burns, president of the University of the Pacific in 
Stockton, became president of the hospital board of trustees in 1967. 
At that time, the corporate name of Presbyterian Hospital and Medical 
Center of San Francisco was changed to Pacific Medical Center, Inc. 



391 



Gerbode: 



Hughes: 
Gerbode: 



Hughes: 
Gerbode: 
Hughes : 



grant to do this. Bruce Spivey was in charge of those funds. He 
is now the president of the center. The [medical school idea] 
looked like a realistic thing for quite a while. Then various 
statistics came out to show that we were turning out too many 
doctors. When that became apparent, then people realized that it 
was a mistake to try to have a medical school when we were over 
producing [doctors] already. So that idea died. 

For a while there was even a thought that the state should have 
another medical school. There was a survey which showed that the 
San Francisco Bay Area could tolerate another medical school. It 
was logical to have it in the old Stanford Medical School location 
because physically it's a place for a medical center. The people 
who put it there in the first place were pretty smart. That whole 
idea died, but the concept of working together with the University 
of the Pacific continued for quite a few years. Stan McCaffrey 
came on as president of the board of trustees when Bob Burns died. 
Their financial officer came on too and stayed on it for several 
years until there really wasn't much of a program going between the 
university and San Francisco, so they dropped out of the picture. 

Meanwhile, or even before all this happened, some of the people 
who used to be old faculty members persuaded the [University of the 
Pacific] Dental School to move from the Mission District to our 
neighborhood. That was another great advance for the [medical] 
center concept. They got money from the government and from their 
own alumni. They had a tremendous response from their alumni and 
built a very fine dental school. 



Is it right near the center? 



It's in the same area. And there were collaborative programs, 
example, we did some research with them. Some of our research 
people went over there from MRI to work with them and they liked 
being near us even though we were not a medical school. We use 
their faculty and dental clinic and some of their faculty consult 
on our patients' dental problems, and they like that. They also 
collaborated in developing the library. 

Are they strong competitors with the dental school at UCSF? 
Oh yes. 

We're going back to 1960 when the changes came about. When the 
Presbyterians took over, did the composition of the board of 
trustees change at the same time? 



For 



392 



Gerbode: Yes, it changed a bit. There's been a gradual change of the board 
of trustees. It's hard to say that at any one point there was a 
great change. I've been on the board now for over twenty years and 
I know a great many of the battles we had. I always held to the 
view that we could run a first class hospital and that once we put 
it up that it would be financially solvent. It certainly has been. 

Hughes: You mean there were members of the board of trustees who doubted 
that? 

Gerbode: There are always people around who doubt or are scared of any 
big venture. 

Hughes: So they wanted to take the conservative route? 
Gerbode: Yes. 

Hughes: Were they resisting the idea of a full-blown medical school, as 
well? 

Gerbode: Yes, they were. They probably were correct at resisting me. That's 
the other thing that happened to Bob Burns. He realized, after he 
went into it a little more thoroughly, how much it was going to cost. 
It s^ very expensive to run a medical school. But the thing that 
changed too was that the national subsidy for medical schools went 
down quite a good deal after they discovered they had enough medical 
schools. So that source of funds diminished a good deal, and, 
rightfully, people had to pull in their horns a bit. Even the big 
schools had to retract many programs. Some of the big schools 
had been getting as much as twenty million dollars in research grants 
and subsidies before these surveys showed that we had enough doctors 
already and were probably spending too much on medical schools. 
This was a big blow for some of the big schools to lose that amount 
of support. 

In Washington there was a great deal of sentiment in favor 
of maintaining something in San Francisco. They realized there 
were a lot of clinical teachers and some research people who'd been 
with the school for a long time, and they were rather anxious to 
keep us going. This helped us a lot at MRI. 

Hughes: The fact that you were sitting on a lot of those committees in 
Washington should 've helped. 

Gerbode: That didn't hurt. That's right. 



393 



Hughes: You mentioned the fact that the Presbyterian church was operating 
Columbia Presbyterian Medical Center which has a long and 
prestigious career. Was there any conscious emulation? 

Gerbode: I think it was rather nominal. I'm not quite sure how much the 
Presbyterian church put into the medical center in New York. I 
have a notion they gave it the name and a little religious blessing 
and that was it. 

Hughes: There's been no particular association between 
Gerbode: Between the other Presbyterian hospitals? No. 

Hughes: Are you saying, just to summarize, that the Presbyterian church 

really had very little part in the financial aspects of getting the 
medical center in San Francisco going? 

Gerbode: They probably helped a little bit in fund raising, but not very 
substantially. 

Hughes: Do you think their association helped you fund raise? 
Gerbode: I think the name helped, not an awful lot, but some. 

Hughes: Soon after the hospital was taken over by the Presbyterian church, 
four buildings were demolished to make way for new hospital 
facilities and a professional office building. Do you remember which 
buildings were built first? The hospital didn't come along for 
some years after that. 

Gerbode: We didn't have to demolish anything to start the new hospital. 

Hughes: I know one of the first buildings that was built after the break 
with Stanford was an office building. 

Gerbode: No, that's not true. The first thing that was built after the 

break with Stanford was a research building [for the Institutes of 
Medical Sciences]. There were funds available in the government 
for research facilities. Since we had such a good record and had 
quite a few research people whom I had held together , we had a 
pretty good reason for continuing a research facility and research 
effort. We applied for funds for a research building and the board 
of the center approved of it. In fact, they allocated about 
175,000 of their precious dollars for this. The building cost close 
to $800,000. It's now worth about three or four million. 

Hughes: Are you talking about the present building for MRI? 



394 



Gerbode: Yes. We originally contracted it for three stories, but we had 
the foundation built for five stories. So we built the three 
stories and no sooner were we finished then we realized we had 
enough resources to build a couple of more stories. So we raised 
a bit more money and applied for more money from the government, 
and they gave us some more money to build the two other stories. 

We had the old Stern Building, too, where Stanford had had 
quite a big research effort, and we put some of our people there. 
Most of the people who had been doing research in the Stern 
Building had gone to Palo Alto. 

Hughes: That means you were recruiting new research staff? 

Gerbode: To a certain extent new research people came in, but we just had 
places to put the ones that stayed. 

Hughes: John [R.] Little was chosen as the first president of the board 
of trustees. 

Gerbode: Yes, he was. He was the one who really got excited about the church 
getting involved with us. He was very much of a far-seeing fellow. 
He dreamt of a big center there. He was in the hospital during part 
of that time recovering from a not very major illness. I used to 
drop in to see him and he said, "1 think this would be the greatest 
place for a big medical center." 

Hughes: What was his background? 

Gerbode: He represented the Presbyterian church.* He was very influential 
in getting the Presbyterians to come into the picture. 

Hughes: Was he on the board before the Presbyterians took over? 

Gerbode: No, I don't think so. I think he came at the same time as we got 
serious with the Presbyterians. I'd have to look that up. 

Hughes: Did much of the old board continue after the Presbyterians 
took over? 

Gerbode: Yes, quite a few of the board continued on. There were some 

stalwarts who weathered the whole change quite a good deal. Mrs. 
Fred Early and Jack Hume were ones that stayed with the board of 
trustees during these critical times. Fred Merrill stayed on. 
I was put on the board around that same time too. 



*Little was chairman of the negotiating committee of the Presbytery 
of San Francisco. 



395 



Hughes: Is board membership strictly a board decision? 
Gerbode: Yes, it is. This is a self-perpetuating board. 
Hughes: What were the backgrounds of board members? 

Gerbode: We had some bankers and lawyers and one or two doctors, not very 
many doctors. 

Free Hospital Beds 



Hughes: I read about ten to fifteen so-called free beds at Presbyterian. 
Is this something the church instituted? 

Gerbode: No, I don't think the church really contributed any money for free 
beds. I think that was probably a requirement to get the Hill- 
Burton funds. 

Hughes: Do you know how patients were selected? 

Gerbode: They were indigent patients. 

Hughes: But there were probably more than fifteen at any given time. 

Gerbode: Yes, that's right. I don't know. They weren't all lined up and 
pointed out. But I think what happened was that the fifteen beds 
were filled, and then when one was empty, the next indigent patient 
was put in there. 

Hughes: In 1967 the Presbyterian Medical Center became the Pacific Medical 
Center, Incorporated. Why was the church's name dropped. 

Gerbode: We kept the church's name by calling it Presbyterian Hospital. I 
was the one who was very strongly in favor of that because we'd 
spent a lot of time telling people that we had a hospital with that 
name. It was a good name. They decided it would be called 
Presbyterian Hospital of Pacific Medical Center. I think since 
then there's been rather a tendency just to call the whole place 
Pacific Medical Center, including the hospital. MRI is part of 
Pacific Medical Center, too, as is the dental school. 

Hughes: Why drop 'Presbyterian' from the whole complex? 



396 



Gerbode: I think they thought that Pacific Medical Center sounded a little 
more global. It encompassed the whole Pacific Coast, more so than 
the church's name. 

Hughes: What significance did the "incorporated 1 have? 

Gerbode: Whenever you change a name you have to change the incorporation. 

Hughes: So it was Presbyterian Medical Center, Incorporated? 

Gerbode: Yes. 

Hughes: At the same time the name change was occurring, Robert Burns was 
elected president of the board of trustees and the board was 
reconstituted. Do you remember why Burns was elected? 

Gerbode: He was elected because at that time we thought that it would allow 
Bob to get a medical school in some form started. Unfortunately, 
after two or three years, Bob had the idea that everything MRI, 
the dental school and the hospital should all be under one board. 
He wanted to be president of that board. Some of the research 
people didn't think that was a very good idea, and it wasn't, really. 
You could influence any one of these individual organizations quite 
a good deal without having them all on one board. A single board 
might try to govern research too much. 



Gerbode: The curious thing is that the board members really never thought 

about medical research and weren't really doing anything for medical 
research. They just wanted to have control. 

So much needs doing when you get involved with research that 
you have really to get interested in it and participate in the 
programs somehow. You can't just sit back and be in control without 
exercising some influence on the type of research and perhaps 
getting people to come and do research with you. After a while that 
idea [of a single board] died a slow death. Meanwhile, Burns 
himself got a serious illness, so he couldn't really keep up with 
these things. The concept of a medical school also died down 
because of the factors I mentioned before. 

There have been several efforts to put MRI and the hospital 
in one corporation. I think this is kind of a national preoccupation, 
you might say. All the time we see corporations incorporating 
other corporations presumably for the betterment of one or the other. 
You might call it the amalgamation era. Sometimes I think people 
think just by amalgamating that things will get better. But I 



397 



Gerbode: don't think that really is what makes it get better. I think you 
have to be concerned with programs and people internally rather 
than with control. 

Hughes: Is that idea of amalgamating still in the wind? 

Gerbode: It comes up every year. 

Hughes: Do other medical institutions operate that way? 

Gerbode: Well, medical schools don't operate that way any more. I guess 

some medical schools do incorporate other institutes or ancillary 
[units] in their medical school's overall structure. Generally 
speaking, there aren't too many of these things happening now. 



Mergers with Other Hospitals 



Hughes: In 1969 Callison Memorial Hospital, which was an 83-bed facility 

near downtown San Francisco, merged with the Pacific Medical Center. 
Why did this come about? 

Gerbode: This came about because to get Hill-Burton funds we had to 

eliminate beds in other hospitals or eliminate hospitals. For 
example, Saint Mary's Hospital got hold of the hospital on Van Ness 
Avenue and changed that into a convalescent home in order to get 
credit on Hill-Burton for the money to help them build their 
hospital. We got Callison and this helped us get the Hill-Burton 
funds. We had to take the Callison doctors in and this was quite a 
little job in some places because some of those Callison doctors 
were not considered quite so good by our staff. 

Hughes: Were they from different specialties? 

Gerbode: Well, there weren't very many specialists. There weren't very many 
board-certified men over there a lot of GPs and a lot of GPs that 
were doing surgery, obstetrics and other things, even orthopedics. 

Hughes: What happened to the hospital itself? 

Gerbode: It's still going. I think it's a convalescent hospital now. 

Hughes: But it's not associated with PMC? 

Gerbode: No. 






398 



Hughes: You did, as well, at some point take over a convalescent hospital. 

Gerbode: Yes, we took over the one out on Geary Street, Garden Hospital 

Jerd Sullivan Rehabilitation Center. That still runs as an extended 
care hospital. 

Hughes: And do you tend to send patients there? 

Gerbode: Yes, we do. It works quite well. 

Hughes: Was that taken on for the Hill-Burton money? 

Gerbode: I think so, in a way. 

Hughes: In 1972 PMC became the official leasee of Brookwood Hospital in 
Santa Rosa. 

Gerbode: There has been a tendency for quite a while for tertiary hospitals 
in cities to help peripheral hospitals maintain programs of 
different kinds by sending staff for educational reasons and 
collaborating on teaching programs. I think with Brookwood Hospital, 
we took over their accounting practices and taught them how to use 
accounting in the same way that we do in San Francisco. 

Hughes: What would be the advantage to PMC? 

Gerbode: Well, you see, being a tertiary hospital, you need to have a supply 

of tertiary patients. Brookwood is a good primary hospital. It's 

only when they get into complicated medicine, that they have to have 
some other hospital to send them to. 

Hughes: So PMC is the one. 
Gerbode: Yes. 



The New Presbyterian Hospital 



Hughes: In April, 1973 the new Presbyterian Hospital, costing $22,500,000, 
opened. Do you think we've discussed adequately how the hospital 
was financed? 

Gerbode: I think I have yes mainly a bank loan and the staff raised over 
one million dollars. 

Hughes: You mean from their own pockets? 



399 



Gerbode: Yes, from their own pockets. 

Hughes: Did you have a major part in planning this? 

Gerbode: I was in charge of the staff fund raising program. 

Hughes: What about the actual design of the hospital? 

Gerbode: We had many, many, many meetings about that. 

Hughes: The whole board? 

Gerbode: No, various people on the board. I was asked to collaborate a lot 
on the surgical part and really designed the intensive care unit 
areas. We were very interested in having an open heart program. 
To have a good open heart program, you have to have things put 
together in a certain way. The architects were very happy to have 
somebody talk to them. 

Hughes: Were the architects used to building medical facilities? 

Gerbode: Yes they were, but they were very anxious to please and to do what 
we wanted. And, luckily, some of us could read plans and knew what 
we wanted. 

Hughes: Computerized monitoring of patients was going very well by then. 

I would think that that would have had considerable bearing on the 
design of Presbyterian Hospital. 

Gerbode: It did. We had started that in the old hospital in very cramped 

space. When it was apparent that we could do it and that we were going 
to have a rather busy open heart surgery program, IBM came along 
and said they would help us. Therefore, we could sit down with the 
architects and design space and accommodations that would do it 
correctly. We knew what we were talking about. 

Hughes: Were you involved with the fund raising? 

Gerbode: You never stop being involved with fund raising, unfortunately. We 
got a lot of money out of research grants. Jack Osborn and others 
of us put in grants [to] take care of certain aspects of the 
intensive care unit. 

Hughes: Was IBM donating its time? 

Gerbode: IBM donated about one million dollars worth of time and materials. 



400 



Hughes: 
Gerbode: 



Including the computers themselves? 
Components of the computers themselves, yes. 



The Heart Research Institute Fellowship Program* 
[Interview 17: June 13, 1984]//// 



Hughes: Would you pick out a few of your cardiovascular fellows and tell me 
a little bit about what they did subsequent to their training with 
you. 

Gerbode: I'd rather first talk about why we established a fellowship program. 
[telephone interruption] 

Gerbode: Particularly when Stanford decided to move to Palo Alto, and even 
before that, it was very difficult to get competent help in the 
operating room. The residents in general surgery were mostly 
preoccupied with general surgical procedures and there was no resident 
in thoracic and cardiovascular surgery. There were a number of 
people who'd heard that we had a good experimental laboratory and 
they wrote to me and asked if they could come over and work in the 
laboratory and assist with operations. 



Frank Rundle 



Gerbode: The first of these was Frank Rundle who came to me from St. 

Bartholomew's Hospital where he was assistant director of the 
surgical professorial unit. He came because he wanted to do some 
experimental work in vascular surgery. Although he had an appointment 
at the Massachusetts General Hospital to do this, they wouldn't give 
him any time in the laboratory and were generally not very friendly 
with him. That's why he finally came with me. He had plenty of 
opportunity to work in the laboratory and assist me with the vascular 
experiments we were conducting at that time getting ready for 
extracorporeal circulation. 



*See the discussion recorded on 11/14/84, pp. 484-485. 



401 



Hughes: And this was after your year at St. Bart's.* 

Gerbode: This is before the year at St. Bart's. We worked together and did 
quite a few experiments and wrote some papers on major vessel 
surgery. Then he finally went back to St. Bartholomew's. 

He talked to me a little when he was here about coming over 
and working at the professorial unit. I said I'd like to do that 
sometime if it was all right. This was, I guess, about 1947 or 
1948. A few months after he got back to London, a letter came from 
Sir James Patterson-Ross who was a professor of surgery there. He 
asked me if I'd like to come over for a year and work with their 
unit and get some experimental surgery going. 

Hughes: Do you think the invitation was instigated by Rundle? 

Gerbode: I think Rundle told him about me and probably convinced Sir James 
that I was probably a likely person to come over. 

Before I got there, however, he had another young man there by 
the name of Gerard Taylor who was working in their unit. I brought 
Jerry over to work with us, too, and we worked together in the 
experimental laboratory and wrote some papers. Jerry went back to 
London as well. Then I went over in 1949 and established the first 
experimental surgery connected with St. Bartholomew's at the Royal 
Veterinary College. 

This was a great experience. It was freezing cold in the 
winter, no heat in the building, so I wore long underwear everyday 
when I went there to do our experiments. 

The next year, having come back [to the U.S.], I began to 
look around for other candidates who might like to work in the 
laboratory and help with cardiovascular operations. After that, 
there was a whole stream of fellows that came over. I shall start 
with some of the early ones. Some I would interview when I went to 
meetings in Europe. If they looked like they might have promise, I 
would invite them to come over. I also had at the same time a 
training program with the National Institutes of Health. They were 
beginning to realize that they needed to have more cardiovascular 
surgeons in the country, so they gave me a program which permitted 
me to have up to thr=e men at one time paid for by Uncle Sam, working 
in the laboratory and in the operating room. This was a great, great 
help to the program. This got me out of the problem of having to 



*Dr. Gerbode was an associate in surgery at St. Bartholomew's 
Hospital, London, 1949-1950. 



402 



Gerbode: use general surgical residents and interns, and this gave me my 

own assistants, really. I didn't have to get the money to pay for 
them from any other source, which was a great help too. 

Hughes: And these people could be foreigners? 

Gerbode: At that time there was no problem with having foreign graduates 

working in the laboratory. [The problem] didn't start till about 
1979. 



John Callaghan 



Gerbode: One of the earliest fellows was John Callaghan. John Callaghan 

had been working with Bigelow on hypothermia. He was one of the men 
who really started hypothermia with Bigelow in Canada and also had 
been invited to go to England to work with Sir Russell Brock. Brock 
was getting interested in using hypothermia in open heart surgery. 
Actually, when John got there, Brock paid very little attention to 
him. Although he was using hypothermia, he hardly asked John anything 
about it and made him feel rather useless. After tolerating this 
for a while he decided he'd better get out and go somewhere else, 
and that ' s how he came with me . 

John is a hard-working, very intelligent, fine person. We worked 
together on some of the early attempts at making a heart-lung machine 
before anybody else around here had thought of it. We tried a 
variety of things which were cumbersome and not very good. We did 
do a few patients, but the results were quite unsatisfactory. 

Hughes: Was this a prototype of the disk oxygenator? 
Gerbode: It's before the disk oxygenator. 
Hughes: What did the apparatus look like? 

Gerbode: Well, we actually were oxygenating the blood in plastic bags and 

then putting the blood from plastic bags into a transfusion outfit 
which went into arteries. It was a very crude, simplistic approach 
to the problem. John, having worked with me for a while and helped 
with some of the other procedures, went back to Canada where he got 
a position at Edmonton on the faculty and finally became a professor 
and probably the leading cardiovascular surgeon in western Canada. 

Hughes: He dropped his interest in hypothermia? 



403 



Gerbode: Well, he kept up hypothermia to a certain extent, but as soon as 
a heart-lung machine became available in any feasible form, he 
used it quite often with hypothermia. John has been a very good 
friend of mine all these many years, and I see him at high-level 
meetings here and there. He's been made a member of organizations 
like the American Surgical Society and has done extremely well. 

Hughes: When these fellows came, was it simply a matter of your deciding 
that they were adequate? 

Gerbode: Yes, I decided and then I would just simply tell the faculty that 

they were coming over to work with me. It was easy for them to say 
yes because it didn't cost them any money. 

Hughes: The NIH stipend was open-ended? 

Gerbode: It was open-ended. I didn't have to submit any names to them 

either. Shortly after that, we had a whole bunch of fellows who 
started coming and particularly, later on, when we got to using a 
sort of a disk oxygenator. 



Dennis Melrose 



Gerbode: We brought Dennis Melrose over from London. Dennis had invented an 
oxygenator which worked like a washing machine. It thrashed the 
blood around and it was very traumatic and not at all satisfactory. 
But we didn't know all that when we brought him over with his machine. 

Hughes: What did it look like? 

Gerbode: Well, it had a big cylinder in which the blood went through over 
baffles and then it moved as well and shook the blood so it would 
be exposed to the oxygen. By that time, we were doing some open 
heart cases and I used it on a series of tetralogies of Fallot, 
blue babies, and also used another one as a sort of a trial 
experiment to see which one would be the best. Actually, the other 
one turned out to be better. 

Hughes: Was that the one that was developed at Stanford? 

Gerbode: Yes, the one that was developed at our place. So Dennis went 

back to England and he actually abandoned that oxygenator very soon 
after he got back and started working on a membrane oxygenator and 
doing some other experimental work. He's since retired from the 



404 



Gerbode: faculty of the London Postgraduate Medical School and is now, I 
think, a consultant on a limited basis to Hammersmith Hospital. 
Dennis was a very good person to come at that time because he was 
very interested in the progress of surgery and had suggested using 
potassium arrest to stop the heart so it could be operated upon 
quietly. This was adopted quickly in various parts of the world. 
Unfortunately, it not only stopped the heart, but it also eventually 
began to produce fibrosis in the myocardium. This was not a very 
good thing to happen, so it was finally abandoned. However, later 
as everyone knows, potassium came back again with the use of cold 
cardiac arrest to stop the heart but in much reduced concentrations 
so it wasn't injurious. 

Hughes: How could you stop the heart if you didn't use potassium? 

Gerbode: We didn't stop it in the beginning. We just cross-clamped the aorta. 
That made the heart ischemic and it slowly quieted down and would , 
of course, stop eventually. So we'd leave that clamp on only for 
about three or four minutes so the heart wouldn't be permanently 
damaged. Then we'd take the clamp off again and perfuse the heart 
until it recovered and then we'd clamp it again and start working 
some more. 



Mark Bainbridge 



Gerbode: In any event, there were some really outstanding people who started 
coming from England. One of the first was Mark Bainbridge. He'd 
been working with a heart team in England. He did some very fine 
experimental work with me and helped with the operations in the 
operating room. By that time we had really quite a large volume of 
open heart cases to do. 

Hughes: When was this? 

Gerbode: This was, I guess, '54 or '55. Anyway, Mark finally went back to 
England and there established a heart team at St. Thomas' Hospital 
under John Kinmonth. Mark is one of the very best in Europe at the 
present time. Mark divorced his nice wife by mutual agreement and 
now is remarried to a lovely woman who travels with him everywhere. 
He has a son who is a godson of mine and a couple of daughters who 
are all doing well. 



405 



Gutmund Semb 



Gerbode: Around that same time, Gutmund Semb came over. I had interviewed 
him in Germany at a German Surgical Society meeting. Gutmund 's 
father was Karl Semb who had started thoracic surgery in Norway. 
He was the dean of thoracic surgery in Oslo. At this time he was 
a very sick man and was hospitalized. But Gutmund wanted to come 
over and have a year or so with me. He was one of the most 
outstanding fellows I ever had. We used to call him the surgeon 
with three hands because he always seemed to do a third more than 
anybody else in the operating room. Also characteristic of him, 
without being told what to do, he'd go through all our patients in 
the hospital it might be twenty-five or more either to be 
operated upon or already operated upon. He'd see them all at seven 
in the morning and he'd know all about their medications and what 
their wounds were like, and he'd report to me in the operating room. 

Gutmund finally went back to Norway and worked his way through 
various hospitals until he finally was given the same chair that 
his father had in the university in the big municipal hospital where 
he is now. He has a lovely wife named Greta who is a great skier 
and outdoor swoman. He has lovely children. His youngest son caught 
his first fish down here at the dock where my boat is. Gutmund 
has been a great friend. I see him at various meetings. Actually, 
he's coming here with his wife in October [1984] to the meeting [in 
San Francisco] of the American College of Surgeons. 

I can't really give you an abbreviation of all the fellows who 
were there. There were eighty-six of them. 

Hughes: Did most of them operate and do research in the dog lab? 

Gerbode: Most of them did a combination of assisting at operations and doing 

work in the laboratory when they weren't in the operating room. They 
all had a project to do in the laboratory. 

Hughes: Did they all fit in nicely with your team? 

Gerbode: From the point of view of personality and disposition, every one of 
them fitted in beautifully. 

Hughes: Did you have some sort of personal connection with all these people 
before they came? 

Gerbode: No, I didn't. Some of them just wrote to me or their professors 

wrote and asked me if I would take them. That was one of the common 
ways of doing it. 



406 



The Evarts Graham Fellowship 



Gerbode: 



Hughes: 
Gerbode: 

Hughes: 
Gerbode: 



Hughes: 
Gerbode: 



Hughes : 



Gerbode: 



Hughes: 
Gerbode: 



Another way was the Evarts Graham Fellowship. He was a very famous 
chest surgeon in the United States who did the first pulmonary 
resection for cancer of the lung. He was honored by the American 
Association for Thoracic Surgery by the association giving a Graham 
traveling fellowship every year to somebody outside the country. 
These fellows could go wherever they wanted once they got the 
fellowship, and three of them elected to come with me. They were 
very fine people and they were assured of a good job when they got 
back to England and I was very happy to have them. 

Did you ever have American fellows? 

Yes, 1 had American fellows too, and every one of the American 
fellows has done well. 

I read somewhere that you had trained more cardiovascular surgeons 
than anybody else. I don't know if it was in the country or in the 
world? Do you think that's true? 

I don't know- whether we added them all up. But 1 guess maybe that 
wouldn't be true now, because there are so many big units that are 
just filled with trainees of different kinds. But at that time I 
guess I had one of the few training programs [in cardiovascular 
surgery] in the world. 

Where else would there have been training programs? 

Oh, in Houston, the Mayo Clinic, New York. The Mayo Clinic had 
quite a few fellows. I don't know if they really were concentrating 



on training cardiovascular surgeons, 
the general surgical program there. 



I think they fitted in with 



Were these other programs emphasizing the research aspects as well 
as the surgery? 

No, most of them were not. I think the unique thing about my program 
was that I really expected them all to do some experimental work in 
the laboratory, and most of them liked that. They wanted to do some 
experimental work and to write some papers. 

Had they not been used to doing that wherever they originated? 

Most of them had never done any experimental surgery before. So 
this was really quite good for them. 



407 



Torkel Aberg 



Gerbode: I could really talk about a great many of them. [Torkel Aberg] 

came from Stockholm as a fellow and he had never even been trained 
in general surgery. He didn't know how to tie a knot. But we 
put him in all the operations and had him assist and do little 
parts of the operation and pretty soon he was as good as any of the 
general surgical trainees. By the time he finished, after a year 
and a half, he was an excellent cardiothoracic surgeon. He now is 
probably going to be a professor of surgery at a university in 
Sweden. 

Hughes: Why did you decide to take a person who hadn't surgical training? 

Gerbode: I didn't know that he was lacking in general surgical training. 

He had such good recommendations because he was very studious and 
very intelligent, so I took him on that basis. But I was delighted 
that he came because he turned out to be really a first-class person 
and he's one of the finest cardiac surgeons in all of Sweden at the 
present time. I'm very proud of him. 

Hughes: Is there anything more you care to say about the Fellows Training 
Program? 

Gerbode: All I can say is that I looked over the lot a number of years ago 
and I found that sixty-three out of the eighty-six were either in 
very active programs as cardiothoracic surgeons or they were heads 
of departments or assistant heads of departments. Only two of 
them, out of the whole lot, sort of went by the board and became 
what you might call 'journeymen' thoracic surgeons. They were not 
failures, but they weren't doing a lot of cardiac work. 

Hughes: Is it true to say that the fellows program in a way was a substitute 
for a residency program? 

Gerbode: Yes, it was. You see, when Stanford moved to Palo Alto the whole 
residency program stopped and there wasn't any way of getting 
residents. It was even very difficult to get general surgical 
residents. So [the fellows program] meant that I had men that 
were absolutely devoted to me or to my unit full time. 1 was way 
ahead of everybody else. 



408 



The Accomplishments of the Medical Research Institute 



Hughes: We talked about MRI, but I don't believe we talked in summary about 
its accomplishments. 

Gerbode: Initially MRI was called the Institutes of Medical Sciences. At 
that time, I had one of the biggest grants in the [Presbyterian 
Medical] Center, an NIH grant, which gave me about $450,000 a year 
to work on experimental things and to create safety factors and new 
knowledge about extracorporeal circulation. They maintained this 
grant to me and my unit, which included Jack Osborn and Mr. Bramson 
and a number of PhDs, for about ten years. 

Hughes: The grant was specifically to develop extracorporeal circulation? 

Gerbode: Yes, it was [awarded] to make extracorporeal circulation, open 

heart surgery, safer. Out of that grant, of course, we developed 
the on-line monitoring for seriously ill patients and the use of 
the computer to follow sick people. This all came out of that 
original grant, really, because we had the people and some of the 
equipment and the desire to study these things. Jack Osborn was 
in charge of the postoperative studies. The grant really went on 
until open heart surgery became pretty safe. 

Hughes: Then what did you do about funding? 

Gerbode: Then we had to cut back on the number of people we were supporting 
on the research funds. But we managed to keep going by applying 
for separate funds for specific programs. 

Hughes: When did that NIH grant stop? 

Gerbode: Oh, I can't remember the exact date. It must have been about ten 
years ago, I guess. 

Hughes: Do you want to say anything in specific about the accomplishments 
of the institutes? 

Gerbode: I guess outside of developing open heart surgery at our place, we 
published a great many papers on techniques that would refine 
open heart surgery and make it safer. We developed a membrane 
oxygenator and wrote some papers on that. We talked a lot about 
the biology of postoperative care and wrote papers about that which 
were all results of our research at MRI. The eye department 
[the Smith-Kettlewell Institute of Visual Sciences] got to be very 
prominent under Jampolsky. They had a lot of individual research 



409 



Gerbode: programs connected with strabismus and blindness and a great 

many things connected with the eye, some of which I don't even 
understand. 

The neurological institute [the Institute of Neurological 
Sciences] under Finley did quite a bit of work on the long-term 
results of inflammation of the brain. He followed patients for a 
long time and published long-term results of these various illnesses 
in childhood. We never did much research in MRI in general surgery. 
The cardiologists, originally, were quite active at MRI, but as 
their clinical load got greater it was much more interesting for 
them to take care of sick cardiac patients than it was to do pure 
research. [whispers] Besides there's more money in it. 

Hughes: The reason for not much interest in general surgery was because 
the cardiovascular unit was so strong? 

Gerbode: That and also because, I guess, there weren't any people around who 
could identify problems in general surgery that would be interesting 
enough to fund. 

Hughes: Did you have general surgeons on the staff? 
Gerbode: Oh yes. 

A 

Hughes: Anything more to say about MRI or HRI? 

Gerbode: I guess, really, to find out what the accomplishments were, you'd 
have to look over the publications. Every year MRI would turn out 
maybe fifteen or twenty publications that were accepted in the 
national journals. More recently, I guess, my unit has done more 
work in immunology under Charles Glaser, who is a member of my unit. 
He's done quite a bit of work on enzymes, particularly those with 
pulmonary function. 

fi 

Gerbode: The rejection phenomenon is probably the biggest roadblock to 

advances in transplanting tissues. It wasn't until recently that 
any drugs influenced it very much. But now they have some drugs 
that influence the rejection phenomenon quite a good deal, which 
has made cardiac transplantation a lot more feasible and more 
successful. Immunology gets involved with cancer. The production 
of interferon is another example of what immunology research has 
developed. I think that this is probably going to make a big 
difference in the future discoveries in immunology. It will make 
a big difference in how we treat cancer in the future. 



410 



Hughes: How much was this decision [to emphasize immunology at HRI] based 
on the availability of money for immunological research? 

Gerbode: It's mainly based on the availability of the people who can and are 
willing to do the research. If they're good they can get the money. 
[HRI] provides them with laboratories and equipment of various kinds 
and gives an umbrella which protects their work and gives them 
social security and other things which people have to have for their 
own protection these days. 

Hughes: Does this emphasis on inmunology relate at all to the decision of 
Presbyterian to do heart transplants? 

Gerbode: Yes, the fact that some drugs came along that made it easier to 

control the rejection phenomenon made it easier for them to make the 
decision. The other reason they made the decision was that we 
have a very good renal transplant unit. If you get kidneys for 
transplantation, the same person who gives the kidney has a heart. 
If the family are willing to give the heart , providing it ' s a younger 
person, that heart should be used for cardiac transplantation. So 
they realized that they had the source of hearts and we have a big 
cardiac unit, so we had the source of patients too. 

Hughes: Does the research in immunology have any direct link with the 
transplantation program? 

Gerbode: It doesn't, really, but every discovery in immunology and the control 
of the rejection phenomenon has a direct practical connection with 
what is being done or wants to be done in surgery. Surgeons can 
transplant almost any organ except the brain and the central nervous 
system. They haven't done it because they know the organ would die 
in three weeks or sooner from rejection. Anything that will stop 
that rejection is something that preserves the future of those 
particular operations. 

Hughes: Stanford University in Palo Alto, of course, is one of the pioneers 
in heart transplantation. Wasn't Stanford seen as a strong 
competitor when Presbyterian decided to set up its own transplant 
program? 

Gerbode: First of all, Stanford didn't have a kidney transplant program. For 
some reason they didn't want one. I think they want one aow. We 
didn't have a cardiac transplantation program until last year (1983). 
Meanwhile, Stanford has done over 200 transplants. So we're very 
much latecomers in the whole field. 



411 



Hughes: I would think that there would have been fear that in a relatively 
small radius that two heart transplantation programs would not be 
viable? 

Gerbode: Norm Shumway [at Stanford] likes us very much and he'd be the one 
that might be concerned about it. But I think he's got as much 
work as he can take. 

Hughes: And that was a consideration when you were starting up the program 
here? 

Gerbode: I think so. That plus the fact that we probably had a fairly good 
source of hearts and kidneys. 

Hughes: There is patient demand, then, for transplantation? 

Gerbode: Oh yes! The problem is that there aren't enough hearts to go 
around. 

Hughes: From how large a radius are organs pulled for Presbyterian? 

Gerbode: They're pulled from all over northern California. They bring in 
kidneys or hearts by air. The techniques of preserving the organ 
till it gets to the hospital are much better now than they were 
even two years ago so the organ is still alive when it gets here 
even though it's been taken out of the body. 

Hughes: I believe Stanford is the only heart transplant unit I don't know 
if it's in the country or on the West Coast that has Blue Shield 
coverage. 

Gerbode: Stanford is the only one on the West Coast. 

Hughes: That makes it very difficult for the average patient to come to 
Presbyterian. 

Gerbode: All patients don't have Blue Shield. Even the ones who have heart 
problems and go to Stanford, the percentage who has Blue Shield is 
not very great. Most of the patients, for that reason, have to raise 
money anyway . 

Hughes: How much does heart transplantation cost? 

Gerbode: Oh, you get various figures. I think about $50,000. It's very 
expensive. 



412 



XII MISCELLANY* 



Honors 



The Second Henry Ford International Symposium on Cardiac Surgery 

Hughes: We've talked a bit, but not completely, about various honors you have 
received. I wanted to talk about the Second Henry Ford International 
Symposium on Cardiac Surgery which was held in 1975. I believe that 
over 700 specialists attended, physicians and engineers as well 
as surgeons. They came from all over the world. What was the purpose 
of this symposium? 

Gerbode: It was simply to bring everybody up to date on the current practice 
and level of excellence in cardiac surgery. 

Hughes: Whose idea was that? 

Gerbode: I guess it was the [cardiovascular surgery] department at Henry 
Ford Hospital. 

Hughes: Which is in Detroit? 

Gerbode: Yes. 

Hughes: Do they have a strong program in cardiac surgery? 

Gerbode: They have a strong program there, too, yes. 



*Most of the topics in this chapter, as well as some in the immediately 
preceding and following chapters, were generated by a selective reading 
of Dr. Gerbode 's correspondence and surgical records dating from the 
mid 1940s to the early 1980s. 



413 



Hughes: 
Gerbode: 



Hughes: 

Gerbode: 

Hughes: 

Gerbode: 



Was it a particularly significant symposium? 

Very much so because they spent a lot of money publishing it and 
all the speeches were carefully recorded and edited and put in two 
volumes, I think, and were available at all the libraries. It 
was a very successful meeting. 

How was it funded? 



Henry Ford Hospital. 

I believe you were honored as a cardiac pioneer, 
what accomplishments were singled out? 



Do you remember 



Well, I guess I've been called a pioneer several times. I don't 
specifically remember being called one there. I guess there were 
pioneers present at that conference: Clarence Crafoord, Viking 
Bjork, and Robert Gross. These are all men who were definitely 
pioneers, much more so than I. 



Shiley's Celebration- of the 40th Anniversary of Cardiac Surgery 



Gerbode: Shiley, [a company manufacturing medical equipment], selected [eleven 
cardiovascular surgeons] in the world who were considered pioneers 
in the sense that they really moved things along in a hurry. 

Hughes: How did they come to that decision? 

Gerbode: I guess by reading all the publications. They had a group of 

research people and they came up with these people and I was one. 
They did this, I believe, at one of the college [American College of 
Surgeons] meetings in San Francisco [in 1980 to celebrate the 40th 
anniversary of cardiac surgery]. They honored these people by 
putting out a book on them and telling what they did. Each one 
got an oil painting of himself as a present. Nobody in my family 
except Penny wanted it , so she ' s got it . 

Hughes: Why did Shiley decide to do this? 

Gerbode: Well, these things are all done for advertising really. Shiley makes 
valves and a lot of other things. It was really an advertising 
stunt from their point of view. 



Hughes: An expensive one. 



414 



Gerbode: Very expensive because they had about seven or eight hundred people 
for dinner when they made these presentations at the Fairmont Hotel, 
no less. 



The Michael E. DeBakey Award 



Hughes: Then in 1982 you received the Michael E. DeBakey Award. Do you know 
anything about the history of this award? 

Gerbode: A group of people who were trained with Dr. DeBakey decided they 
would form a society in his honor. They call it the Michael E. 
DeBakey International Cardiovascular Surgery Society. 

Hughes: This is very recent? 

Gerbode: I don't know when it was founded. I guess about ten years ago. 

Subsequent to that, they decided occasionally to make somebody an 
honoree of the society. Somebody put up a lot of money and had a 
bronze statue made of Dr. DeBakey which I think is in front of the 
Methodist Hospital or somewhere down in Houston. Then they decided 
that they would have small facsimile copies made of this statue.. 
They would present this to each one of the honorees. I got one when 
I was there and it weighed a lot. I had to carry it all the way back 
from Buenos Aires. 

Alton Ochsher, who was a famous general and thoracic surgeon, 
was the first honoree and the second was Charles DuBost from 
Paris, and I was the third. Since then there haven't been any, but 
there'll be a meeting in Monaco in September 1984 at which point a 
very fine fellow who is a very fine surgical teacher and surgeon 
will be honored. 

Hughes: What are the criteria for making these choices? 

Gerbode: I guess maintaining high standards in cardiovascular surgery and 
making contributions to the field. 

Hughes: Do you, as an awardee, automatically become a member of the society? 

Gerbode: Yes, an honorary member. 

Hughes: Does this society do anything other than make these awards? 



415 



Gerbode: It has a scientific meeting every other year. This year the meeting 
is going to be in Monaco and there'll be scientific papers presented 
and the person who gets the award has to give a major address. 

Hughes: What did you speak on? 

Gerbode: Something like important considerations in extracorporeal 

circulation. They've already decided that in two years they will 
go to Australia and have the meeting. 

Hughes: It's obviously a society that meets all around the world. 

Gerbode: Yes. 

Hughes: Do you have any idea who proposed you for the award? 

Gerbode: They have a committee, and I know who are on the committee and who 
is the chairman of the committee. But, the committee may have 
gotten suggestions from outside of the organization. I don't know. 
Incidentally, they have a very fine stipend that goes with it, too. 
I don't know whether you need to put that in there, but it's $10,000, 
and all expenses paid, and you don't have to pay income tax on it. 
It's an honorarium and you don't have to pay income tax on 
honorariums. 



Communication Among Surgeons 



Hughes: How do you keep abreast in cardiovascular surgery? 

Gerbode: We know all the important people because we've all grown up together, 
been to the same meetings, and talked and read about the same 
subjects. We are actually in communication [all the] time. So if 
something comes along that you're curious about, that somebody is 
doing in Pittsburgh or New York or somewhere, you know the person 
involved and what you usually do is talk to them on the telephone. 

Hughes: Now that the field is larger is that still possible? 

Gerbode: Very possible. The individuals who are running the big shows, making 
contributions, are very often still the ones in charge of their 
departments even though they have younger men coming along doing a 
lot of the work. Still they are responsible for the work that comes 
out of their units. 



416 



Hughes: When you were trying a new procedure for the first time, did you 
usually get to know about it by word of mouth rather than reading 
about it in a journal? 

Gerbode: It was a combination of hearing about it and reading about it and 
sometimes using something that you had developed in the laboratory. 

Hughes: Did you still feel it necessary to keep up with the literature? 
Gerbode: Oh yes! In fact, I still do. 

Hughes: Considering that you were at the forefront of cardiovascular 

surgery, the literature, I would think, would have lagged behind. 

Gerbode: Well, in the very beginning, there were so few people doing it and 
so few people writing about it, you could read all about it in one 
afternoon. But now every journal is filled with something in the 
cardiovascular field. There are so many young people working on 
the experimental and clinical aspects of it and writing papers that 
you can hardly keep up with the flood of publications. 



The Bohemian Club 



Hughes: You also belong to a lot of. social clubs. Are any of these related 
to your career in surgery? 

Gerbode: You mean the clubs I belong to here in town? No. 

Hughes: So there was no cross-fertilization between your social 

Gerbode: No, nothing connected with them at all. 

Hughes: I'm thinking particularly of the Bohemian Club. 

Gerbode: I was made a member of the Bohemian Club when I was still in medical 
school. In the medical profession I wasn't contributing anything 
yet. 

Hughes: Are there medical camps? 

Gerbode: There are some camps that have a few more doctors than others. But 
I think [the professions] are generally scattered. Our camp has a 
lot of lawyers and judges. We've had three judges and about four 
or five lawyers. 



417 



Hughes: Why do you people become members of a specific camp? 

Gerbode: Because they have friends and they're invited to join them. Some 
of the camps have big-time politicians. One camp, for example, is 
the bastion of the Republican party. 

Hughes: Who proposed you? 

Gerbode: I was proposed by a couple of men who knew me in Piedmont who were 

members. It was a little rare for a young person to become a member 
of the Bohemian Club. There were only three or four younger members 
than I when I went in. 

Hughes: Why did you decide to become a member? 

Gerbode: Well, I thought it was a very interesting group of people and what 

they were doing was very unusual: writing their own plays and music 
and putting on plays. It was a group which was obviously interested 
in good fellowship. 

Hughes: Did you ever participate in their plays? 
Gerbode: Oh yes! 
Hughes: Everybody does? 

Gerbode: Not everybody, but I participated several times and I was once the 
assistant stage manager for a big production. 



The Tuberculosis Hospital in San Luis Obispo 



Hughes: Okay, another topic. The tuberculosis hospital in San Luis Obispo. 

Gerbode: Well, I decided that if I was going to be a cardiothoracic surgeon, 
I'd really have to have more experience in thoracic surgery. We 
didn't have a large enough volume of ordinary chest cases going through 
the university service here at [San Francisco] Stanford [Hospital]. 
So a couple of the people in charge of the San Luis Obispo General 
Hospital asked me if I would come down and operate upon some of the 
people who had tuberculosis. 

Hughes: How did they know to ask you? 



418 



Gerbode: Well, I was at a university hospital and I was a young thoracic 

surgeon. I said sure, I'll be glad to come down. I decided that 
by doing a lot of patients who had tuberculosis that I'd get to know 
more about the field, and also it'd be very good for my record. 
About twice a month I'd get on an airplane at six in the morning 
and go to San Luis Obispo. They'd meet me at the airport, then 
take me to the hospital, and they'd have the first case all ready 
to go. I would have gone over the case beforehand through the mail 
or on the telephone, so I knew what was wrong and what had to be 
done. So then I'd operate, say, until three or four in the 
afternoon doing two or three cases, and then if the patient seemed 
to be getting along all right postoperatively, I'd catch the 4:30 
or 5:00 p.m. plane home. 

Hughes: If not? 

Gerbode: If not, then I'd spend the night there. 

Hughes: The local surgeons weren't specialized enough to 

Gerbode: There were two local surgeons who weren't chest surgeons, but were 
good [general] surgeons who were anxious to help and participate 
in this. It was very interesting; when I first started there were 
a couple of families who'd been in that hospital, serially, for 
several generations. They obviously got the disease in their homes and 
then they went to the hospital. There was one whole family. I 
think it was called the Ayala family. In any event, I think there 
were three or four members in the hospital at the time and a 
couple of them had died and one or two, I guess, had at least been 
arrested, if not cured. But hardly anyone had gone down there to 
do lung resections or thoracoplasties or some of the more advanced 
methods. That was called "advanced," at that time. 

This was rather major surgery big cases. By the time I 
finished there, which was a year later, I had just about emptied 
out all the potentially surgical cases and about half the hospital. 
There were nurses down there who had been on civil service for so 
long that they really almost ran their environment. By the time we 
finished down there, we cleaned out so many patients that they 
didn't need so many of these civil service people, which made them 
kind of unhappy. 

Hughes: You mentioned thoracoplasties. 

Gerbode: That's a matter of taking out ribs so that the chest wall would 

collapse in that area and make the lung collapse where the tuberculosis 
was. When it collapses, it puts that area of the lung to rest and 
it also lets it heal. 



419 



Hughes: It usually worked out that way? 

Gerbode: Yes. Now they're more apt to go in and resect that part of the lung. 

Hughes: But you weren't doing that then? 

Gerbode: We were just starting to do them. 

Hughes: Why were you just starting? 

Gerbode: Because there hadn't been anyone there before who'd been doing 
any of this major surgery on the TB patients. 

Hughes: But resections were commonly done elsewhere? 

Gerbode: They were just beginning to be done. 

Hughes: What would have been more difficult about a resection? 

Gerbode: Well, opening a chest and removing part of the lung is technically 
a little more difficult than doing a thoracoplasty. 

Hughes: There was no problem with anesthesia? 

Gerbode: Well, they had one fellow down there who was a pretty good 
anesthesiologist and he learned as we went along. 

Hughes: Whose idea was this to have you operate? Did the local surgeons 
decide they needed some help? 

Gerbode: There were two local surgeons who decided that they weren't really 
getting along as well as they should be. And then a certain amount 
of money was allocated for the care of these patients and the 
people in charge of the budget were tired of paying out money to 
keep [certain patients] on as boarders forever. Even they realized 
that there were other ways of taking care of patients than just 
boarding them forever. 

Hughes: I believe you were doing these cases between 1950 and 1953 and 
you already at that time, if I remember correctly, were very 
interested in cardiovascular surgery. You didn't feel that this 
sort of work was taking you away frDm your real interest? 

Gerbode: No, it was just something that I as a cardiothoracic surgeon felt 
that I had not done enough of. I thought I'd better go do some of 
it so I really had some actual experience. 



420 



Hughes: Did it help at all with the cardiovascular surgery? 
Gerbode: Oh yes, I think it did help. 
Hughes: Why did you stop? 

Gerbode: I stopped mainly because we'd cured nearly all the patients. We 

didn't kill any of them, and we mostly got them out of the hospital, 

Hughes: I noticed a lot of Spanish surnames. Is that just because there 
are a lot of Spanish surnames in the area? 

Gerbode: Yes, there are a lot of Spanish people down in that part of the 
country. 

Hughes: So there was no particular predilection of the Mexicans for TB? 

Gerbode: No, except some of the families, of course, just pass the TB down 
in their families forever. 



Early Surgical Lists 

[Interview 18: June 21, 1984 ]## 



Hughes: I was going through your correspondence and I came upon a surgery 
list dated January 1946 through December 1947. There was a very 
wide range of types of operations. I was wondering if you were, 
at this point, already beginning to think about specializing in 
cardiovascular surgery? 

Gerbode: Yes. The trouble is, of course, you had to encourage people to 
refer cases like this to you because many people didn't realize 
these procedures could be done. So they had to be educated. 

Hughes: Did you come home from the war with the idea of specializing in 
cardiovascular surgery? 

Gerbode: I came home realizing that vascular and thoracic surgery were going 
to be the future. Cardiovascular was certainly in the wings and 
we all knew it. 

Hughes: Was there something that happened during the war that made you 
reach that conclusion? 



421 



Gerbode: Thoracic surgery became a reality during the war. One of my friends 
was a very good general surgeon at the Mass. General Hospital in 
Boston. He came back from the war and he found everything was 
transthoracic. He said, my problem now is how to do a breast 
operation transthoracicly just to be in tune with the times. [they 
both laugh] 

Hughes: Was Stanford particularly trying to attract cardiovascular cases? 
Gerbode: Not particularly. 
Hughes: Holman wasn't 

Gerbode: He did attract a certain number of them, but his wife was the one 
who really provided many of the cardiovascular cases because she 
was a very successful and dedicated pediatrician. So she had a 
lot of patients in her practice and as things developed, she would 
cautiously release a few once in a while. 

Hughes: I notice that there are six Blalock operations and that in each case 
you assisted Holman. The same was also true of patent ductus 
ligations. Did you have trouble convincing Holman to let you 
operate on your own? 

Gerbode: No, he wanted to do them because it was the beginning edge of things 
and the professor always likes to be the one to start things going. 
I was very happy to assist him and I learned quite a bit by 
assisting him. 

Hughes: Did you eventually get to the stage with him where you were doing 
the procedures yourself? 

Gerbode: Oh yes! In fact, his wife began to send the cases to me, which 
was wonderful. 

Hughes: There's another list of thoracic operations, dated 1950. There's 
again quite a range and I'll read only the cardiovascular 
operations. There were sixteen ligations for patent ductus, five 
Blalock, six coarctations of aorta, two pericardiectomies, one 
transposition of great vessels, one Brock procedure for pulmonic 
stenosis, one pericardiotomy for removal of bullet, one cardiotomy 
for removal of bullet, and one finger fracture of mitral valve 
for mitral stenosis. 

Was it unusual at that time to have an operating list with this 
many cardiovascular cases? 



422 



Gerbode: It was certainly unusual in San Francisco because we were 
dominating the scene in northern California at that time. 

That removal of the bullet was an interesting one. This was 
a duck hunter who was up in the [Sacramento] valley sitting in 
his blind and a young man started shooting a '22 nearby. They 
shouted at him, telling him to stop shooting, there were people 
around. Well, he didn't and one of the bullets went into this man's 
chest, went through his heart. They got him to the hospital; he bled 
a little bit, but he didn't have to have an operation to stop the 
bleeding. I think they gave him a transfusion. Then they took an 
xray and there was the bullet. So they sent him down to me and I 
did some studies on him and found the bullet within the base of 
the aorta just outside the heart. That was kind of scary because 
it might have gone anywhere in the body from there. So we operated 
upon him. I opened up his aorta and there it was. We just plucked 
it out and closed up the aorta and he was fine. 

Hughes: It wasn't embedded in the wall of the aorta? 

Gerbode: No, it was just lying there. It went all the way through the heart 
and lodged in the base of the aorta. 

Hughes: Were you thinking of yourself as a cardiovascular surgeon by 1950? 
Gerbode: Well, I guess I was beginning to think of myself that way. 
Hughes: How much encouragement was Holma.i giving you in this line? 

Gerbode: Holman was never a person that would encourage you to do anything 
much. You'd have to tell him what you wanted to do and then start 
doing it. Then if the results were satisfactory, he wouldn't 
prevent you but he wouldn't really sit down and say, now I think 
you ought to do this or that. 

Hughes: Was that just his conservative nature? 
Gerbode: Yes. 

Hughes: So it wasn't particularly that he was interested in keeping the 
power in his own hands? 

Gerbode: Well, he was looking toward retirement at that time. He had to 
leave Stanford University Hospital at 65 because this was a rule. 
So his wife created an environment for him at Children's Hospital 
and then she encouraged me to go over there and help him to do cases 



423 



Gerbode: which she sent to him. I already had established a unit at 

Children's Hospital by seeing that they bought the right equipment 
and more or less outlining what the program should be. So it was 
easier for him to step in and start doing it. 

I did a few cases over there myself, but I never really wanted 
to develop another cardiovascular unit over there because it was 
enough doing one at the old Stanford Hospital. 

Hughes: How far did Holman get? 

Gerbode: He did only a few cases, coarctations, not intracardiac cases. 
Only a few Blalocks and ductuses and things like that. 

Hughes: Was that because the pump wasn't developed? 
Gerbode: He didn't have a heart-lung machine. 

Hughes: Do you think he would have been confident enough to go ahead with 
that at his age? 

Gerbode: I don't think so. 

Hughes: So, in 1950, according to this list anyway, these were all closed 
heart operations. 

Gerbode: Yes. There was one mitral patient, wasn't there? 

Hughes: Yes, there was at the end. 

Gerbode: That's a closed operation too, though. 

Hughes: Finger fracture. So that very well could have been a closed 

operation. Was that the common method for doing mitral valves 
at that time? 

Gerbode: We started by doing finger fractures. Later on I used an instrument, 
which I developed, to fracture the valve through the ventricle. 

Hughes: That was the valvulotome? 
Gerbode: Yes. 



424 



A Letter to John Kinmouth, January 1957 



Hughes: I have a letter that you wrote to John Kinmouth in January 1957. 
I'll read just a bit of it: "As to the Ivalon sponge, I can say 
that I find a great falling off of enthusiasm for it here as well. 
I have only used it in a few cases and have now switched to teflon 
for the abdominal aorta and iliacs. Time will tell whether this 
will prove to be better. My oldest homograft cases are now six 
years and they are doing extremely well and I still like them the 
best." 

What is this sponge? 

Gerbode: Well, this is the Ivalon sponge which people had offered as a means 
for closing holes in the heart and actually making some grafts out 
of it. But it was not very good material. It was the only thing 
we had at the time. I used it in a few cases, but I was never very 
satisfied with it. 

Hughes: And teflon came along later? 

Gerbode: Teflon came along later and that was, of course, knitted fabric 
and you could do more with it. 

Hughes: Why did you like the homografts the best? 

Gerbode: One reason is that I had developed an arterial bank at the Irwin 

Memorial Blood Bank and we had developed a method of freeze-drying 
them and they fitted very well. 

Hughes: Another letter to Kinmouth, this one written in October, 1958. You 
wrote of being able to convince a good many people at the American 
College of Surgeons meeting that the median sternotomy was an 
excellent incision for intracardiac surgery. Why? 

Gerbode: Well, it's easy to do and it gives beautiful exposure and it doesn't 
cause as much postoperative pain. 

Hughes: Why were people doing it the other way? 

Gerbode: Well, they were using a transverse incision which is much more 

complicated to close and there are many more postoperative complica 
tions. So I just thought the median sternotomy was better. I think 
most people use it now throughout the world, not exclusively, but 
for most cases. 

Hughes: Why did they start with the transverse incision? 



425 



Gerbode: Oh, I guess they thought this would give you better exposure to 
the heart and many of them had not had any experience with the 
median sternotomy. We had, because we used it in pericardiectomies. 
We did a lot of pericardiectomies and this was a wonderful 
incision for that. Although there were other people [who thought 
otherwise]. For example, [Edward] Churchill's group in Boston [at 
Massachusetts General Hospital] believed in a left thoracotomy for 
a pericardiectomy. But we didn't think we could free up the 
veins entering the heart as well with that incision as we could 
with a median sternotomy. 

Hughes: Were you the first to promote the median sternotomy? 

Gerbode: I think some people thought about it at the same time. I know that 
Ormand [C.] Julian had thought about it and started using it at 
about that time, too. 



A Letter from John Kinmouth, January 1959 



Hughes: In January of 1959 Kinmouth wrote to you thanking you for getting 
perfusion going as a practical proposition at St. Thomas'. I was 
wondering what exactly you did. 

Gerbode: Well, I was a guest professor there at St. Thomas', just when they 
were getting their program cranked up. 

M 

Gerbode: They were a very conservative group, I must say. John Kinmouth was 

an extremely conservative surgeon and it wasn't until Mark Bainbridge 
came along, one of our former fellows, and took charge of the program, 
that it really got going. 

Hughes: Was this just the surgical tradition in Britain? 

Gerbode: No, most of the teaching hospitals in Britain were inclined to be 

rather conservative about new things. John himself was particularly 
conservative. 

Hughes: Did you introduce one of your oxygenators? 

Gerbode: Yes, we sent one of the oxygenators over to them, and they used it 
for a while. Later on they switched to bubble oxygenators, as most 
people did. 



426 

Hughes: Did they use the Melrose heart-lung machine as well? 
Gerbode: No, they used our disk oxygenator. 

A Letter to John Kinmouth, April 1959 



Hughes: You wrote to Kinmouth in April 1959: "We have been using polybrene 
routinely and there's no question in my mind of its being superior 
to protamine. I have still not decompressed the left side of the 
heart and 1 really question whether you will do it either once you 
feel completely at home with these patients. I have not been 
stopping the heart with potassium for interventricular septal 
defects as often as I used to, and this helps of course in not 
having a flacid heart to start off with after the repair." 

What is polybrene? 

Gerbode: Polybrene is a chemical which neutralized heparin after the operation 
was over. I'm not sure that we continued to use it afterwards, I 
think we went back to protamine. 

Hughes: Do you remember why? 

Gerbode: I can't remember why. But we also gave up using potassium arrest 
by itself because I began to worry about it being injurious to the 
heart itself. It wasn't until many years later that they combined 
cold arrest with potassium with hypothermia, but with a much smaller 
concentration of potassium so that it wasn't injurious to the heart 
itself. 

Hughes: So it was a question of high concentrations being toxic? 

Gerbode: Yes. 

Hughes: Was this observation and trial and error? 

Gerbode: Yes, pretty much so; 

Hughes: How was the heart stopped with potassium? 

Gerbode: You cross-clamped the aorta and injected the material into the base 
of the aorta and then it got into the coronaries because the 
coronaries are right there. 



427 



Hughes: Was that something that was developed in this country? 

Gerbode: No, Melrose developed it in England. He brought it over to us when 
he was with us as a fellow. 

Hughes: What does the term 'decompression of the left side of the heart' 
mean? Remember that sentence in the letter? 

Gerbode: That means putting a catheter into the left ventricle to be sure 
that there wouldn't be any strain on it when you were coming off 
bypass. But we didn't follow that system very much. It didn't 
prove to be very efficacious. 

Hughes: It just wasn't necessary to do that? 
Gerbode: It wasn't necessary to do that. 



A Case Report from Letterman General Hospital, February 1960 



Hughes: Here's a case report from Letterman General Hospital dated February 
8, 1960. I thought I'd read it because I think it's an interesting 
account of how closed heart mitral commissurotomies were performed: 
"A purse-string suture was placed in the left atrium and an index 
finger of the right hand inserted into the atrium where it became 
very obvious that a half centimeter opening of the mitral valve 
existed. All efforts to open this valve by pressure on the index 
finger were to no avail. At this point, the purse-string suture 
was then placed in the apex of the heart overlying the left 
ventricle and a stab wound into the ventricle made, following which 
a dilating valvulotome was introduced into the left ventricle and 
guided up into the stenotic mitral valve where, after several efforts, 
the valve was finally fractured. The valvulotome was then withdrawn 
and the purse-string suture in the ventricle drawn taunt, following 
which several interrupted sutures were placed in the ventricle 
which adequately maintained hemostasis. After the fracture of the 
valve it was felt that a significant regurgitation was occurring 
from the left ventricle back into the left atrium and the valve 
orifice appeared to have been widely opened. The right index finger 
was then withdrawn from the left atrium, following which the purse- 
string suture was tied and this also maintained absolute hemostasis." 

Gerbode: Did I dictate that? 



428 



Hughes: I think you did. It has your name at the top. There's a bit 

more too. "The chest was then closed with interrupted black silk 
sutures in layers after having placed a posterior intercostal 
catheter in the eighth interspace in the posterior axillary line. 
The patient was then returned to the recovery room in only fair 
condition. This was not a septic case." This case was performed 
in February 1960. Why do you suppose you didn't use the pump? 

Gerbode: The army hospital at that time didn't have a heart-lung machine. 
Hughes: They didn't consider transferring these cases to Presbyterian? 

Gerbode: Well, this case sounds as though it would be one for closed mitral 
valvotomy, and so they kept it there. 

Hughes: What that a good decision? 

Gerbode: This patient had mitral insufficiency and maybe had to be 
reoperated upon later. 



A Letter to Viking Bj'drk, May 1960 



Hughes: In May 1960, you wrote to Bjork that you had performed sixteen 

consecutive cyanotic tetralogies with two hospital deaths. Was this 
a good record? 

Gerbcde: I think it was very good. 



The Look Magazine Article 



Hughes: I saw an article in Look magazine in 1963 which was written about 

you and the cardiovascular team at Presbyterian. It mentioned that 
team members volunteered to give back part of their annual income 
to help cover expenses. Was this an unusual occurrence? 

Gerbode: I think I was the only one that did it. [both laugh] We got a lot 

of publicity from it, but I don't think the cardiologists contributed 
anything. 

Hughes: Was this something that was done elsewhere? 
Gerbode: No. 





Above : 

On a visit of the Surgeon 
General to Presbyterian 
Medical Center's Cardiopulmonary 
Unit, 1966. Dr. John Osborn, 
far right; Dr. Frank Gerbode, 
third from right. 



Left: 

Mogens L. "Bram" Bramson, 
IMS engineer who designed the 
Bramson membrane oxygenator, 
and Dr. John Osborn, Director 
of the Presbyterian 
Cardiopulmonary Unit, test out 
the promising life-saving device, 





Four photographs that 
appeared in LOOK Magazine 
showing Frank Gerbode, 
John Osborn, and 
colleagues during an 
operation which employed 
the Bramson membrane 
oxygenator, ca. 1963. 



Photographs this page 
and next copyrighted 
by Cowles Mazagines and 
Broadcasting s Inc. 
publishers of LOOK 
Magazine. 



429 



Hughes: Why didn't you raise surgical fees to make ends meet? 

Gerbode: Well, I think it's best not to have your fees any more than the 
going rate. 

Hughes: Even when you're doing experimental 
Gerbode: Pioneering work? 
Hughes: Yes. 

Gerbode: There were several cardiovascular surgeons in the state who 

considered their work pioneering and so they tripled their fees. 
But in the end, we haven't heard very much of them. 

Hughes: Was there some restraint from the Crippled Children's Service as 
well? 

Gerbode: Crippled Children would only pay the set rate. The insurance 

companies paid more than the set rate but only about 80 or 90 percent 
of the fee you charged. But we had set fees and we stuck to them. 

Hughes: How were they established? 

Gerbode: The fees were established by the California Medical Association 

Committee on Fees. They had a schedule in which I participated in 
forming. It was adopted by many states, particularly other western 
states. 

Hughes: Do you remember the criteria you used to establish the fees? 

Gerbode: The criteria we used were difficulty of the operation and whether 
it was unusual or not. 

Hughes: Was time a factor as well? 

Gerbode: No. We called it a relative value scale and it's still used, I 

think, by a lot of organizations. Insurance companies adopted it. 

Hughes: Fees, if left to their own devices, would vary quite a bit from 
metropolitan to rural areas. When you were establishing these 
fees, were you more or less taking what you supposed to be the 
average? 

Gerbode: Yes. We established a fee which we thought was average in the area 
in which we were working, in this case, California. 



430 



Hughes: How did surgeons respond to the fee schedule? 

Gerbode: Well, they responded pretty well and, I think, used it generally, 
but there were always a few surgeons who would use it as a spring 
board for increasing their fees. 

Hughes: Was there any control over that? 

Gerbode: The insurance company wouldn't always pay this larger fee. 

Hughes: Does the fact that you were asking members of your team to make 

donations mean that there were quite a few expenses that were not 
covered by NIH or some other grant? 

Gerbode: Well, we always had to buy instruments or new equipment for the 
intensive care unit or something new for the heart-lung machine. 
There wasn't any budget for [those items]. The hospital didn't pay 
for anything, so you either had to buy it yourself or get together 
to buy it. Our intensive care unit originally was paid for out of 
research grants and IBM and personal contributions. Later on when 
the unit got to be active and established, the hospital began to pay 
for replacements. 

Hughes: When do you think that was? 

Gerbode: I think they replaced some of the electronics just five years ago. 

Hughes: Is this true of how other units operate? 

Gerbode: No, I think most units submit a budget to the hospital and wait for 
the hospital to pay. 

Hughes: Why was Presbyterian so recalcitrant? 

Gerbode: Because we were a very poor hospital at that time. There wasn't 
any money around. We were in the old hospital and we were really 
struggling. 

Hughes: You're speaking of the years just after the break from Stanford 
in 1959? 

Gerbode: Yes. 



431 



A Letter from John Kinmouth, September 1960 



Hughes: Another letter from Kinmouth. This one's dated September 1960. 

Another quote: "I was most grateful for your letter which arrived 
yesterday morning just in time to give me some hopeful technical 
tips about an acquired aortic stenosis and incompetence which we 
were doing that day. Your maneuver of supporting the left ventricle 
manually to prevent it distending after coming off perfusion is a 
very good idea. The patient which we did turned out to have a 
valve which it was possible to sculpture back into something that 
was almost like normal, certainly functionally. She was a young 
woman and the enormously thickened valve had not become calcified. 
I spent forty minutes on it with two periods of five to ten minutes 
perfusion of the coronary arteries. Whether this is really necessary 
or not it is difficult to say. But the heart started to beat again 
during the perfusion of the coronaries. I think it was quite 
definitely a useful maneuver just before taking off the aortic cross- 
clamp. We also used the cold saline in the pericardium as you 
suggested. We have got some more of these acquired aortic valve 
lesions to do. I'm sure a lot of them are going to be very much more 
difficult and I wish we could get a good artificial valve. I hope 
you and Bramson are getting on well with your plans." 

What was the rationale for perfusing the coronary arteries? 
Gerbode: Well, to keep the muscle alive! 

Hughes: That's basic. [interviewer laughs] What artificial valves would 
have been available 

Gerbode: Well, we were working on an artificial valve at the time, made out 
of polyethylene. I used it in a few cases, but it actually fell 
apart after two or three years, so I stopped using it. It was 
functionally like a normal valve. 

[interruption] 

Hughes: It's interesting how these things are very much tied in with 
technological progress, aren't they? 

Gerbode: Oh yes. If it hadn't been for the plastic industry in the 

United States, we'd be far behind. We have developed the best 
plastic industry in the whole world: tubing for the instruments, 
tubing for the heart-lung machines, the best material for a 
membrane oxygenator and for artificial prostheses. We led the 
world in this. 



432 



Hughes: Why the United States? 

Gerbode: Because we had the engineering know-how to do it and also industry 
realized that if they could do it well, they could make money. 
They made fortunes out of it. 

Hughes: You were obviously working on an aortic valve, from the tone of 
that letter. Was that the one that turned out to be not very 
successful? 

Gerbode: Yes. 

Hughes: What was the problem with aortic valves at that time? Was it the 
material they were made from? 

Gerbode: Yes, the material we made the valve out of looked as though it 
would last forever and it functioned perfectly. But it cracked 
after a while and then became incompetent. 

Hughes: You didn't know that from animal studies? 
Gerbode: No, we couldn't tell until we tried it. 



Fritz Linder and the University of Heidelberg 



Hughes: There's a thick folder of correspondence with Fritz Linder, a 

cardiovascular surgeon at the University of Heidelberg. Did you 
have a part in getting his cardiovascular team going? 

Gerbode: I was invited to the [Free] University in West Berlin [in I960], 

We didn't do any open heart surgery there, but we did other closed 
heart surgery procedures. But when I went to Heidelberg [in 1964], 
they were just beginning to experiment with a heart-lung machine, 
and so I did a few cases with them and criticized some of the things 
they were doing. I think they changed some of the methodology 
afterwards. I helped them also with their postoperative care 
because they didn't really appreciate the value of a volume 
respirator postoperatively. They had one, but the anesthesiologist 
wasn't using it. He didn't really realize it was there. So we 
took it out of storage and began to use it and they liked it finally. 

Hughes: How could he have overlooked it? 



433 



Gerbode: Very easily. The fashion was to use a pressure respirator and 
unless you are curious and begin to think about it a bit, you 
wouldn't use the volume respirator. But the Swedes had demonstrated 
several years before that it was much the best. So you'd have to 
know what had been going on in Sweden and then take it seriously. 

Hughes: That was the Engstrom respirator? 

Gerbode: Yes. 

Hughes: Did it take much know-how? 

Gerbode: Not particularly. You had to take a little time, sit down and 

figure out how to work it, but any good anesthesiologist could do 
that. 

Hughes: Did the team at Heidelberg ever use one of the oxygenators that 
you were developing? 

Gerbode: No. 

Hughes: Did European surgical teams tend to buy European products? 

Gerbode: No, actaally I think they bought American products, except the 

people in Sweden and Denmark. They were quite advanced in heart- 
lung machines and they bought their own. They were quite good. 



A Contract to Retrain Female Physicians 

Hughes: In 1966, you and Dr. Selzer had a contract to retrain female 
physicians. How did that contract evolve? 

Gerbode: Female physicians? 

Hughes: Yes, I saw a reference in a letter. You don't remember? 

Gerbode: I guess I did if I had a contract. 

Hughes: It didn't say with whom. I don't know mors about it than that. 



434 



A Contract to Develop a Computer System to Identify Vacant 
Hospital Beds 



Hughes : 



Gerbode: 
Hughes: 

Gerbode: 

Hughes: 

Gerbode: 

Hughes: 

Gerbode: 



In 1967 the Public Health Service contracted with the Institutes of 
Medical Sciences to develop and test a computer system designed 
to identify vacant hospital beds. Do you remember this? The idea 
was to identify the beds in the community and to predict their 
future availability. 

I guess we did that too. I guess it was a statistical analysis 
which we all participated in. 

Well, I believe that it was tested first at Presbyterian and I was 
wondering if it spread elsewhere. 

I can't remember. 

This was an offshoot of the computerized monitoring of patients? 

Yes. 

Perhaps it was something that IBM was 

I don't think IBM helped in that. 



A Grant for a Training Program in Cardiovascular Surgery 



Hughes: In June 1968, the National Advisory Heart Council made a site visit 
to review your application for a training program in cardiovascular 
surgery. One of the reviewers reported this was in a letter from 
Langley, who was connected with the Heart Research Institute? 

Gerbode: Lee Langley, yes. 

Hughes: He quoted one of the reviewers in the following words: "The 

program director [Dr. Gerbode] is renowned. The facilities are 
almost luxurious. There's affluent support for research. There 
is really a most inadequate training program that is not attracting 
U.S. surgeons." Why was the training program considered inadequate? 

Gerbode: Because we had no residency program at that time and so we didn't 
have a source of American doctors. That's why I brought over 
European surgeons who were very adequate and very intelligent and 



435 



Gerbode: very well-trained. [The National Advisory Heart Council] accepted 
my application. The three surgeons [who were supported each year 
as fellows] went on for about six or seven years, I guess. 



More on the Possibility of a Medical School at Presbyterian 
Medical Center 



Hughes: In 1968 you were interested in establishing a medical school at 

Presbyterian Medical Center. You argued that the Bay Area needed 
another medical school, that the location of Presbyterian was ideal 
and that much of the old staff of Stanford Medical School was 
still on the staff of Presbyterian Hospital and willing to teach. 
You also mentioned that the new hospital was in the process of 
being built and that there was a dental school and also a research 
institute in the complex. Why, with all these advantages, wasn't 
a medical school established? 

Gerbode: I got the president of the University of the Pacific interested. 

He at this time or just before had established the McGeorge School 
of Law in Sacramento with very little money. With my encouragement, 
I think he thought, we might be able to do it in medicine. We 
got a grant to study a new curriculum for a medical school and 
Bruce Spivey, who is now the president of the [Pacific Medical] 
Center, was in charge of developing a curriculum for a new type of 
medical school, and he developed a very good one. But as time 
went on, everybody began to realize that we had more doctors in 
California than we needed. We also realized that to start this 
school , it would have cost a good deal more money than we could 
picture. The federal government also at that time decided not to 
put any more money into new medical schools. The state did too, so 
without any federal or state support, it would be impossible to do 
it. 

Hughes: That was quite a turnabout. 

Gerbode: Well, actually there wasn't a great groundswell for a new medical 
school. There were a few starry-eyed people around who wanted to 
do it. There were various surveys that occurred at that time, too, 
or just before this, which said that the Bay Area really could 
tolerate another medical school other than the University of 
California, since there were many teaching places and many people 
could serve as faculty and there was also a long tradition [of medical 
education] in San Francisco. So this all died down, because of 
lack of money, and the fact that they began to show statistically 
that we already had enough doctors in California. 



436 



Hughes: That part of it is a bit strange, because I read something written 
that same year, 1968, saying that it was felt that three thousand 
more medical graduates were needed every year. 

Gerbode: Well, it was made up very quickly by another thing that happened. 

We imported doctors from all over the United States and some people 
figured out that Harvard and Columbia and all these other medical 
schools were turning out doctors for us in California and so it 
didn't cost us [ Calif ornians] all those educational fees. They were 
turning out doctors [elsewhere] and all they had to do was come out 
and pass the [California State Medical Board] examination and get 
to work. So we had a great many, and still do have a great many, 
doctors whose education was paid for by other universities, who then 
moved to California. Furthermore, we had a great influx of foreign 
doctors around that time who came in before the laws were strict 
and took internships or something in a hospital, then stayed on and 
practiced. 

Hughes: So that made up the deficit. 
Gerbode: Yes. 



Arthur Selzer, Ian Carr and Pediatric Cardiology 



Hughes: A letter from Arthur Selzer who was a cardiologist at Presbyterian. 
The letter was written to Ian Carr, a pediatric cardiologist. He 
was writing about setting up a pediatric cardiology section in the 
cardiology unit. Do you remember any of this? 

Gerbode: Yes, of course. 

Hughes: Selzer promises Carr full use of the cath[eterization] lab, the 
initial use of his cardiology trainees, and flexible scheduling 
of cases by the unit and the section. He promises all pediatric 
cardiology cases to Carr. Did the unit and the section actually 
end up working harmoniously in this way? 

Gerbode: Yes, Ian Carr came out and there was a little problem with Bob 
Popper, who was the existing pediatric cardiologist. But they 
worked that out so that they shared the work between them. Ian Carr 
tried to have cardiology conferences in various centers around 
northern California where we had already established contact. But 



437 



Gerbode: for some reason it never worked out too well. He was an extremely 
competent, intelligent pediatric cardiologist, but maybe the fact 
that he was English was against him. Doctors are funny. 

Hughes: He was considered a foreigner? 

Gerbode: Yes. Maybe his way of talking wasn't exactly western enough. He 

wasn't getting anywhere, so after a number of years he got an offer 
to be a cardiologist with a Chico medical group. He was up there 
for a few years and did excellent work, but I think he wasn't 
accepted by the Chico doctors, maybe for the same reason: he spoke 
English rather than western American. 

Hughes: Then he went to Chicago. 

Gerbode: The Cook County Hospital was where he was first. There you have 
a built-in practice in a unit paid for by the city and there's no 
private competition. 



A Letter to Hans Borst, September 1971 



Hughes: A question about computerized monitoring. In September, 1971, you 
wrote to your friend, Hans Borst, that you were not interested in 
automated computerized treatment programs. Why? 

Gerbode: Well, this is what is called closing the loop. 

H 

Gerbode: For example, Franny Moore in Boston and also John Kirklin [had 

computer programs where,] if you measured certain parameters, put 
them in the computer, the computer would then automatically give a 
transfusion or give fluid or whatever without the nurse telling it 
what to do. This was not my idea of how to use a computer. I 
thought, and also Jack Osborn felt, that closing the loop, so to 
speak, was not the way to do it. Our idea was to furnish the nurses 
and the doctors with very accurate information [from the computer] 
and have them make the decisions about whether to give medication 
or transfusions or whatnot. Certainly, we could have closed the 
loop, hut you'd have the same number of people sitting there watching 
to see that the loop was being closed properly, and so you might 
as well have that person making the decisions on how to use the 
information. I liken this whole business to flying an airplane 
with the use of instruments rather than the seat of your pants. 



438 



Hughes: What did other hospitals do? 

Gerbode: They finally didn't close the loop very much. They wrote a few 
papers and then they quit. 

Hughes: What you said in this letter is pretty much what you just said: 
Your interests were in obtaining accurate physiological data on 
seriously ill patients and correlating these data to establish 
relationships (which I guess would take a human being) . 

Gerbode: Yes. 



Operating Room Donors at the New Presbyterian Hospital 



Hughes: 

Gerbode: 
Hughes : 

Gerbode: 



Hughes: 
Gerbode: 

Hughes: 

Gerbode: 
Hughes: 



In January 1974, you were still trying to raise funds for operating 
rooms in the new Presbyterian Hospital. Six operating rooms had 
already been donated by people such as Kresge. 



You know, Kresge stores? 

Yes, Waterhouse, Taylor, Merrill and so on. 
donations? 



Who arranged these 



Waterhouse is our family. I had one room named after an aunt, 
[Martha A.] Waterhouse, and I got the family to contribute money 
enough to honor her. Then Taylor was the wife of a patient I had 
operated on. He died some time later of something else and she 
inherited an awful lot of money from his estate. So I asked her to 
give an operating room and part of a viewing room to the hospital, 
which she did. 

You would write a letter to these people? 

I talked to them about it. Mrs. Taylor finally died of a wasting 
disease, which was very unfortunate. So all the money she inherited 
from Mr. Taylor went to her children, not by him however. 

The Gerbode family gave $75,000 for an amphitheater and viewing 
room. Do you remember who else gave money? 

We all participated in it. We just passed the hat around. 
Who was Dr. Truman Brophy? 



439 



Gerbode: Truman Brophy was a resident surgeon following me on the old 

Stanford service in 1936 or '37. He always remained a good friend 
of mine. He had a congenital abnormality of the colon and had 
several operations which were not very successful, so he retired 
from surgery and moved to Mexico. 

Hughes: He also gave money for these operating rooms. 

Gerbode: I don't know. Did he give some money? 

Hughes: I think so. It was mentioned in that same letter. 

Gerbode: Yes, I always hoped he would give us more than he did. [both laugh] 

A Letter from Hans Borst, January 1955 



Hughes: A letter from Hans Borst in January 1955 mentions that you were 

already having trouble with Stanford four years before the actual 
break came. Do you remember what exactly was going on as early as 
1955? 

Gerbode: Actually, Stanford was very naughty about this whole business. They 
really wanted to have the hospital pulled up completely. They 
wanted us to bury it and forget about it. 

Hughes: They were already planning their hospital in Palo Alto? 

Gerbode: Yes, sure they were and I think I mentioned this before they 
wanted to close the out-patient clinic [in San Francisco], 



Grants to Establish Cardiovascular Centers 



Hughes: In 1966 you wrote of applying for a grant for a specialized cardio 
vascular center. What exactly was the center? 

Gerbode: Well, I think this was a big NIH grant which I had applied for. 

They were establishing centers NIH-supported centers where training, 
teaching and research would go on, all supported in a center of 
excellence and paid partially by the government. I got one and it 
went on for about ten years. 



440 



Hughes: So the committee making the decision would be looking at these 
three areas to see how strong the institution was? 

Gerbode: Yes. 

Hughes: Do you remember which other cardiovascular centers were funded at 
that time? 

Gerbode: I think they had about ten in the country. Mike DeBakey always had 
one. 

Hughes: There was probably some attempt to spread them out geographically. 
Gerbode: Yes, that's right. 



Heart Clinics in Alaska 
[Interview 19: July 17, 1984 ]## 



Hughes: You began to hold heart clinics once a year in Alaska beginning in 
1958. How did this come about? 

Gerbode: Well, we found ourselves operating upon virtually all the 

congenital heart cases on the Pacific Coast including Oregon and 
northern California and Nevada. Then the group in Alaska realized 
they had a lot of congenital heart cases up there among the 
Indians and Eskimos. So they began to send them down to us and 
these were all paid for by the California State Crippled Children 
Services which was then reimbursed by the Alaska Crippled Children 
Services. This went on for a couple of years and these children 
would arrive with their mother and a nurse and sometimes other 
members of the family. They had to be housed and taken care of in 
San Francisco while the children were being studied and operated 
upon. Expenses included airfare for everybody. 

After a while, I totalled it all up and it was kind of 
ridiculous to spend all this money to bring a child all the way down 
from Alaska. So I proposed to the Alaska Crippled Children's 
Services, instead of bringing them all down, that I would bring a 
group to Anchorage, Alaska to study the children and find out 
which ones would require an operation and which ones would require 
study. The trip was sponsored by the Alaska Heart Association and 
the Alaska State Crippled Children's Services. 



441 



Gerbode: I had the opportunity to choose the people to go up there. In the 
group was Herb Abrams, a roentgenologist , who is now professor of 
roentgenology at Harvard, Herb Hultgren, who is now with Stanford 
Veteran's Hospital doing cardiology, Saul Robinson, who is a 
pediatric cardiologist, and myself. 

So we went up there and were housed in the old hotel in 
Anchorage. They brought all these children and Eskimos and 
virtually everybody who had heart problems in Alaska into the 
public health hospital in Anchorage where they had it set up so 
we could see patients rather quickly and make a decision about 
whether they needed an operation or whatever. We saw an average 
of over two hundred patients over a two day period and decided that 
some of them really needed an operation soon, some were not operable, 
and some needed study. Then the question was where to send them, 
and the obvious place would have been to send them to Seattle but 
they weren't quite ready to take these cases in Seattle at that 
time. So we brought some of them down to me in San Francisco later, 
but after a while the California Crippled Children Services decided 
they did not want to process these children any longer which meant 
that they wouldn't handle the paperwork connected with bringing 
them down here. So that left the Alaska Crippled Children's Service 
in rather a bad situation. 

There was one man up there who had very good connections with 
the Mayo Clinic and he simply arranged to have them all sent to the 
Mayo Clinic. The Mayo Clinic said they would process the Crippled 
Children's paperwork. So that ended that. However, we went up 
there three years in a row and we not only had clinics in Anchorage, 
we had a clinic in Fairbanks and one in Sitka. I can't say too 
much about the public health nurses in that whole area because they 
would go up, sometimes with dogs, and get these babies and small 
children out of huts and igloos and bring them down to the clinic. 
They were very strong, husky women, very dedicated and they did a 
terrific job. We not only saw all the Crippled Children's patients, 
but we saw a lot of adults, too, who thought they had heart 
problems, and some of them did. So doctors' wives and everybody 
came to our clinic. We didn't charge anybody anything. It was a 
free clinic. 

Hughes: Why did Crippled Children's Services decide to get out of it? 

Gerbode: They got out of it because they didn't want to go through the 

hassle of processing the paperwork. It was rather a blow to the 
whole program. I guess they were also worried about the expense 
of bringing them down. 



442 



Gerbode: But quite apart from that, everybody was extremely kind to us up 
there. The local doctors organized expeditions in the late 
afternoon and on the weekend to fish or take a look around. I 
became quite an expert fisherman in that part of the world. On 
one expedition we caught so many large trout and grayling, I 
couldn't carry them. I had a sash cord along and I simply rafted 
them down the river after me. We couldn't leave the fish on the 
shore because the animals would come and eat them. 

Hughes: Then you froze them? 

Gerbode: We brought them into Anchorage and they froze them and flew them 
down later to us here in San Francisco. 

We saw lots of wild animals when we were there. There was one 
stream that we went back to twice, and the second time around, the 
same moose was there with his family nearby, looking at us. The 
bear tracks were apparent all around us but we didn't see any of 
the bears. At other times we had to chase bears away from the 
stream. We simply flew the airplane up and down until the bears 
ran away. The same eagle's nest was in the trees high above the 
second and third time around. It was absolutely gorgeous country. 
I can tell you it's the most "beautiful part of America that I've 
ever seen. People go to Switzerland to see the Her de Glas. They 
think it's great to see this glacier there, but you can see one of 
those every fifteen miles in certain parts of Alaska. 

Hughes: Were the types of surgical problems similar to what you were seeing 
in the Bay Area? 

Gerbode: Yes, they were all the same. There were tetralogies and patent 

ductus and mitral and aortic valve problems. We were able, I guess 
because we had such a knowledgeable crew, to make a good clinical 
diagnosis in almost every case. 

Hughes: What was the training of the Alaskan physicians? 

Gerbode: There were one or two cardiologists up there, but they hadn't had 

the experience of looking at a lot of possibly operable heart cases. 
So we were able to help them quite a good deal. 

Hughes: Did they liave all the modern techniques? 

Gerbode: They had no catheterization laboratory. They talked about having 

one and I think later they did have one. They had xrays and that's 
about all. They had no angiocardiography to make a diagnosis. I'll 
tell you, it was a very worthwhile experience. 



443 



Hughes: I believe you did some teaching in connection with these clinics. 

Gerbode: We had lectures in addition to seeing [patients in] the clinic. We 
usually were in the clinic most of the morning, and then in the 
afternoon and sometimes at night, we'd give lectures. 

Hughes: To people who were connected with the hospital? 

Gerbode: Yes, all the local doctors including the public health doctors. 

Hughes: Did Seattle eventually get 

Gerbode: No, Seattle never really got up to the level required to take 

these patients. Maybe a few of them filtered down there, but most 
of them went to the Mayo Clinic. 

Hughes: The very early sixties, it shifted to the Mayo? 
Gerbode: Yes. 

Hughes: When Alaskan patients were mainly coming to Stanford, was that a boon 
in a way? Did you need heart cases? 

Gerbode: We didn't need them, but we could take care of them. We had enough 
space to manage the nun.ber of cases they sent. It was very 
interesting to see these children come down from igloos and 
little villages way up near the Arctic Circle to a big city with 
their nurse or with their mother. We organized a little tour group 
for activities. They were taken to the zoo, Golden Gate Park, 
Fisherman's Wharf and so forth. After one of these expeditions, 
about four o'clock in the afternoon, they said to a little girl, 
"What would you like to see next?" She said, "I want to go back to the 
hospital." [both laugh] The food was good and she was safe there. 

Hughes: It sounds as though the local physicians were very pleased to have 
you there. 

Gerbode: They were very pleased to have us and we didn't interfere with 
their practice. We told most of them what we thought should be 
done and we left it up to them to do something about it or not. 
In some instances, I think they simply didn't do anything with the 
patients. They took care of them medically, and that was it. 

Hughes: Postoperatively , the patient would be turned back to the referring 
doctor? 



444 



Gerbode: If they came down here, we'd always send them back to the referring 
doctor. 

Hughes: And that worked. 
Gerbode: It worked very well. 



Surgical Films 



Hughes: There was a reference in these papers I was going through to a film 
called, "Transverse ventriculotomy for tetralogy of Fallot," which 
you showed, I believe, in connection with one of these clinics. 

Gerbode: Well, this was some experimental work that Keith Cohen and I did 
in the laboratory. To view a stenotic lesion or a hole in the 
heart, you have a choice of either making an incision in the right 
ventricle either vertically or transversely, or trying to see the 
abnormal condition through the atrium. The atrium is not satisfactory 
except in very specialized cases. So we did some experiments which 
. showed that a vertical ventriculotomy in the right ventricle cut 
through coronary arteries and also weakened the right ventricle so 
it didn't contract as well as it would if we made a transverse 
incision parallel to the blood supply to the right ventricle. I 
think this led a lot of people to use the transverse incision in the 
right ventricle. Some people haven't ever used it, but that's 
characteristic of heart surgeons. They decide what they want to 
do, regardless, sometimes. [both laugh] 

Hughes: Do you remember when that was? 
Gerbode: It was in the early sixties. 
Hughes: Was it your practice to make films? 

Gerbode: I made a lot of films. I still have a lot of films and nobody looks 
at them anymore of course. 

Hughes: Were these prepared for meetings? 

Gerbode: Meetings and local lectures. They were very expensive to make too. 
Historically, I think they'd be quite interesting to somebody. 



445 



Hughes: 
Gerbode: 



How many do you suppose there are? 

Oh, I guess there are about five very good ones. 



Malpractice 



Hughes: Would you like to move on to malpractice? 

Gerbode: Well, that's a very disagreeable subject, but I guess we ought to 
talk about it. 

Hughes: I have some fairly innocuous questions to start out with. 

You had quite a large folder on malpractice and I found a 
pamphlet which is called, "Malpractice and the Physician," which 
was printed in 1951 by the Committee on Medico-legal Problems of 
the AMA. It was later also published in the Journal of the 
American Medical Association. I gather that the report was made 
in response to a striking rise in malpractice claims. I remind 
you, this is 1951, long before I thought malpractice was a real 
problem. It characterizes malpractice as "a contagious disease of 
the social body." The report stressed the importance of a good 
doctor-patient relationship in avoiding malpractice claims. Did 
any of your education, either as a medical student or later, prepare 
you for malpractice? 

Gerbode: As far as I know it was never mentioned either in medical school 
or in my postdoctoral training. It increased remarkably a little 
bit later than 1951 because of the contingency fee. We, in this 
country, allow a contingency fee to the lawyers, something which 
is illegal in England and Canada. The contingency fee means that 
the lawyer agrees to take for himself 40 or 50 percent of whatever 
the award is, which is a tremendous opportunity for him to get 
wealthy in a hurry. 

Hughes: Now, this isn't just in the field of medicine is it? 

Gerbode: It was medicine to begin with. Now a strange thing is happening 
and the lawyers are suing each other. Also, they're suing a lot 
for devices. For example, if a valve fails, they'll sue for a 
million dollars or if some other instrument didn't work the way 
it was supposed to, they'll sue about that. 

Hughes: They sue the instrument maker? 



446 



Gerbode: Yes, sometimes the doctor too for having used it. And they also 
are suing the doctor for a lot of other things which they never 
thought of before. For example, if you don't tell the patient all 
the possible complications of a serious nature that might occur 
with an operation, if that complication arises and you didn't 
tell him about it and make a record of it, he will sue you saying 
well, I didn't know it was so risky; I didn't know that was a 
possibility. One of the local heart surgeons in San Francisco 
was sued for a million dollars and lost the suit because he didn't 
mention that paralysis might occur with a certain kind of operation. 

Hughes: This AMA committee report went on to make the point that the 

majority of all malpractice claims are found in "unwise comments 
or criticisms of physicians with regard to treatment given to 
patients by other physicians." 

Gerbode: That's right. It's a very dangerous thing for a patient to be told 
by another physician that the first physician really didn't know 
what he was doing or made a mistake. That's an open invitation to 
sue the first physician. 

Hughes: Did you ever have any problem along those lines? 

Gerbode: I didn't have anything happen that way as far as I know, but I've 
been sued three times. No surgeon who's doing a lot of serious 
work, either cardiac or otherwise, escapes being sued. No one's 
ever won an award against me. 



The Salgo Case, 1957 



Gerbode: The first case, which was the famous Salgo case,* we lost in the 
first round and the award was for $212,000, as I recall. The 
malpractice attorney, Fitzgerald Ames, was walking around the town 
hardly believing that he'd won $212,000. Of course, these days, 
that's nothing. But this was the first time he'd ever won a big 
case, so he was completely mesmerized by this amount of money 
because he of course was going to get 40 percent of it. However, 
the appellate court reversed that decision and threw the case out 
completely. 



*Salgo v. Leland Stanford, Jr., University Board of Trustees. The 
term 'informed consent' was used for the first time in this case. 



447 



Hughes: If you don't mind, why don't you backtrack because that's a very 
interesting case which was published verbatim in the Journal of 
the American Medical Association. 



Gerbode: Yes, it was an historic case because it involved the activities 

of a resident in a hospital following orders requested by a staff 
member. Well, this patient came to me with very serious peripheral 
vascular disease to find out whether he would benefit by an 
operation. We did a test which is called an aortogram. It entails 
putting a needle in through the back now we can put it through a 
tube up an artery and injecting dye to show the extent of the 
circulation. I requested the test be done by the xray department 
and the actual test was conducted by the xray department and by a 
resident. 

Hughes: Was that common practice? 

Gerbode: Yes, it was common practice. The resident may have been a fellow 
at that time; he was certainly an advanced resident or a fellow. 
He performed the test perfectly as far as we could find out. But 
Salgo, the patient, developed a paralysis afterwards. So the 
assumption was that the needle was put in the wrong place; the dye 
was injected next to the spinal cord which caused the paralysis. 
Well, we had many people look at the films and decided that the 
needle was in the right place; the dye was injected in the aorta 
and not around the spinal cord. However, the malpractice lawyer 
made a great thing of this and assumed that the physicians were 
all in collusion. Even the judge, whom I met in the hall during the 
case, remarked to me, "I kept thinking about my daughter getting a 
spinal anesthetic for [having a] baby and what might have happened 
to her," which shows you how much brains this fellow had. Actually, 
this judge was a political appointee, a kind of a payoff for some 
good he did to somebody else, and he was a very stupid man which was 
pointed out by the appellate court later. 

In any event, Salgo remained paralyzed and his family tried 
to get tons of money out of everybody. When the case was finally 
thrown out, I think I offered to help him financially, but I was 
advised not to do this while the case was still pending because it 
would be an admission of guilt. 

Hughes: Your lawyer advised you not to? 
Gerbode: Yes. 



448 



Hughes: There was another aspect to the case too, I believe. The suit made 
three charges. The first was that you should have performed the 
aortogram yourself , and you answered that by saying that it was 
common practice for a trained resident to do the aortogram. 

Gerbode: Yes, that was accepted practice. 

Hughes: Another charge was that the manufacturer's recommended dosage of 
the contrast fluid, which was urokan, was exceeded. 

Gerbode: I don't believe that's true. I think he gave the regular standard 
dose which we had been using [previously]. 

The other thing that was an issue was res ipsa loquitur, the 
fact speaks for itself. In other words, the fact that something 
unusual happened meant that something unusual was done, and the 
fact that it happened meant that there was guilt somewhere. 

Hughes: There was negligence. 

Gerbode: So that was one issue and this was something that was beginning to 
become a very big issue in the medico-legal aspect of California. 
When this case was reversed, the whole issue of res ipsa loquitur 
was pushed back quite a good deal. It has gradually crept in 
again since then. 

The other issue was if a doctor ordered a test which was done 
by a resident, was he responsible for it if something bad happened. 
This, of course, affects the whole residency program everywhere in 
the United States. The custom is that residents and fellows do 
these diagnostic tests all the time. It's the only way you can 
run a big service. This is where the University of California came 
into the picture because they realized the implications [of the 
case for] residency training. So they were very much on our side 
and put up money to support my case. 

Hughes: How did it stand after the case? People that aren't very well 
trained have to be supervised, do they not? 

Gerbode: They have to be supervised. The issue is not quite closed yet. 
It's certainly possible legally now for a physician to ask a 
resident or a Jellow to do a test and if something very bad happens, 
then the whole issue is of course raised. But the fact that 
something happened just because it was a resident or a fellow 
doesn't mean that there's guilt associated with it. 



449 



Hughes: You wouldn't have a house officer doing an aortogram would you? 
Gerbode: Yes, we certainly would. 
Hughes: How are those things worked out? 

Gerbode: You see, every physician on a staff knows the ability of a houseman. 
If he thinks the houseman is capable and has the ability to do 
something, it's very possible he'll ask him to do it. 

Hughes: In a court of law that would stand up if you could prove that the 
man did have the ability? 

Gerbode: Yes. I was having dinner in an Italian restaurant and Fitzgerald Ames, 
the lawyer, was running for judgeship in San Francisco. He came 
through the restaurant asking people to vote for him, passing out 
cards. He came up to me and I gave him a glassy stare and he 
quickly turned in the opposite direction. [both laugh] 



Hughes: The third charge was that you had failed to warn the patient of 
the risk of the procedure, namely, the aortogram. 

Gerbode: Well, this particular complication in doing the aortogram was so 
extremely rfire it never occurred to me that it would even happen. 
What probably happened was that some of the dye got into the 
collateral circulation to the [spinal] cord and, because he had such 
terrible arteriosclerosis, produced a thrombosis in one or two 
arteries that were supplying the cord. Well, I've never seen this 
accident since then; I never saw it before, and never read about 
it. So it wasn't anything I would have warned somebody against. 

Hughes: Why was the case originally decided against you? Was it because 
the judge applied this doctrine of res ipsa loquitur? 

Gerbode: That's one reason. The other reason was that they just didn't 

believe all the expert testimony. They just assumed that because 
something bad happened that somebody did something wrong. 

Hughes: Why did the California District Court of Appeals reverse the 
decision? 

Gerbode: They said that no one had proved that we had done anything wrong. 

Hughes: You appealed it. 

Gerbode: Actually the law office appealed it. 



450 



Hughes: Then the California Supreme Court made the decision final by 
refusing to review the decision of the appellate court. 

Gerbode: Yes. 

Hughes: The prosecuting lawyer had referred it to the supreme court? 

Gerbode: So it was thrown out. 

Hughes: What was the reaction of the medical profession to this case? 

Gerbode: Oh, they were scared about the [original] decision because that 

meant that if a house officer, a resident or a fellow did anything 
that was ordered by a physician, and if any little thing went 
wrong, that the doctor and the hospital would be sued. 

Hughes: Was the medical profession aware that this trial was going on, or 
was it only afterwards when it was published? 

Gerbode: No, they were aware of it going on. Very much so. 
Hughes: What about the legal profession? 

Gerbode: Oh, I think they were watching it because of the doctrine of 

res ipsa loquitur which they wanted to promote as much as they 
could because it meant more business for them. 

Hughes: Just to summarize, the questions that were raised in this case 
were, of course, the doctrine of res ipsa loquitur and the 
responsibility of the senior man for the man not quite so senior. 
Then also there was the question, are you necessarily experimenting 
whenever you exceed the manufacturer's suggested dosage? Was that 
actually an issue in the Salgo case? 

Gerbode: I don't remember it being an issue, but the way you'd solve that 

would be to find out what the custom was in other places where they 
were doing angiograms or in our own place. 

Hughes: Were there any hospital or medical procedures that you changed as 
a result of the case? 

Gerbode: No, we continued to do everything about the same way. 



451 



Consent Forms 



Hughes: The consent forms ? 

Gerbode: In more recent times, however, all these consent forms came into 
being. We had to be very careful to explain everything to the 
patient or his relatives beforehand and to make a note of it in 
a chart. 

Hughes: You mean after this case. 

Gerbode: It wasn't until a number of years later that this came into being, 
not so much because of my case, although I guess it had something 
to do with it, but because of other cases where something unfortunate 
happened and the doctor hadn't warned [the patient and his family] 
about this being a possibility. There was one such case here in 
San Francisco where a surgeon did not tell the family that paralysis 
might occur in correcting a coarctation of the aorta and he was 
sued for a million dollars and lost. 

Hughes: There is an article in this same folder by a surgeon by the name 

of Adelstein it's called, "What Price Malpractice* Insurance. " He 
actually included some consent forms which are very, very specific; 
the particular operation is designated and the 'possible risks 
resulting from that operation. Were your consent forms this 
detailed? 

Gerbode: I don't think we had consent forms when I was sued on this Salgo 

case. I think all we did was sit down with the family and describe 
what we were going to do and why the test was necessary. But later 
on consent forms became very much a matter of practice and were 
required. We either had to have a consent form or make it quite 
clear in the record that you had explained everything to the patient 
or his relatives about what might happen. 

Hughes: And you did do that even before you had the consent forms? 

Gerbode: I did it, but I didn't have anything signed or anything written 
down about it. 

Hughes: This is fairly early, this sample consent sheet. It was published 
in the Los Angeles County Medical Association Bulletin in 1957. 

I came across a letter from W.G. Bigelow who is a prominent 
cardiovascular surgeon in Toronto. He wrote to you in February 
1960 with some legal questions relating directly, I think, to the 
Salgo case although he doesn't say so. "You will recall our discussion 



452 



Hughes: regarding the unfortunate legal problem you had as a result of an 
aortogram and at that time you told me the key to the trial was 
whether or not this man had the dangers of the investigative 
procedure explained to him. Following my discussion with you, we 
had a special consent form drawn up in which the patient signs 
to the effect that he has had the dangers explained to him." That 
was fairly early; that was February 1960. 

Then Bigelow goes on to say: "Have you any general observations 
on the matter of legal responsibility in some of the more complicated 
cardiovascular investigative procedures such as left heart catheteri- 
zation, aortagrams, etc.?" Can you reconstruct what you would have 
answered? 

Gerbode: Didn't I write him? 

Hughes: It wasn't in the folder with this letter. 

Then he asks: "Do you think the courts are likely to hold the 
surgeon responsible if he delegates this to a responsible senior 
resident, for example, who has the status of a staff man who does 
not legally require supervision? Or is this the responsibility 
of the hospital who employs him?" All that had been fairly definitely 
answered by the reversal of the Salgo case, hadn't it? 

Gerbode: Yes. Another thing we incorporated in the consent form later was 

a statement that I had explained to the patient that I might assign 
parts or all of the procedure to somebody else. As a matter of 
fact, according to the consent form, I could turn the whole case 
over to somebody else. If something bad happened, they'd have to 
show that the fellow was totally incompetent. 



The Captain of the Ship Doctrine 



Hughes: Bigelow' s last question is: "Do you think that in an open heart 

procedure the authority must be delegated to the anesthetist as one 
group and the individual running the pump as another to such a degree 
that they should be held responsible? Or do you think that the 
ultimate responsibility for all these individuals is the surgeon's?" 

Gerbode: I don't recall patients having sued the men running the pump unless 
some obvious thing happened to the extracorporeal circulation, like 
bubbles getting into the circulation. Anesthesiologists are 
frequently sued. 



453 



Hughes: 
Gerbode: 

Hughes : 
Gerbode: 

Hughes: 
Gerbode: 



Hughes: 
Gerbode: 

Hughes: 



Gerbode: 



Even back then? 

Yes. Even now, I think anesthesiologists get charged more for 
malpractice insurance than [other types of medical specialists]. 

When did that change come, because in the very early days the 
surgeon was responsible for the actions of the anesthesiologist. 

Yes. Now they usually sue everybody, but it may start with the 
anesthesiologist . 

Do you remember having talks with your heart team about malpractice? 

Oh yes, we discussed these cases and discussed the rising incidence 
of malpractice cases all over the country, much more in California 
and New York than anywhere else. We became known in California as 
being a malpractice prone state, and some doctors just wouldn't 
practice here for that reason. 

Why California and New York? 

Well, there's so many kookie people in California. [both laugh] 

So our medical insurance was more expensive here than it was in, say, 

Nevada or Arizona. 

It used to be that the so-called captain of the ship doctrine 
applied to surgical practice. The surgeon was responsible for all 
those assisting him until he left the operating room. This doctrine 
has changed recently because of the increasing specialization of 
the operating team. Courts now require that a definite relationship 
exist between the surgeon and others before the captain of the ship 
doctrine can be applied. Do any of these changes affect the 
surgeon's responsibility in terms of the actions of the cardio 
vascular team? 

No, I think people are still inclined to hold the surgeon responsible 
for anything bad that's happened unless it's an obvious thing that 
was done by another member of the team, like failure to keep the 
heart-lung machine running or having the anesthesiologist give too 
much or not enough anesthetic or giving something intravenously 
which he shouldn't have given. These things happen once in a while. 
In any suit they usually sue everybody. They sue the doctor in 
charge of the operation, the anesthesiologist in that case, and the 
hospital. In a teaching institution they sue the university as well. 
It doesn't cost any more to sue for a billion dollars than it does 
for ten cents. 



454 



The University of California and the Salgo Case 



Hughes: When was the Salgo case? Nineteen fifty-four, wasn't it? How 
did the University of California get involved? 

Gerbode: I think somebody simply told the University of California that 

this was an extremely important case [having implications for] their 
residency programs. 

Hughes: You said they put up money. 

Gerbode: The regents put some money into the pool to help pay for legal 

defense for the case. They weren't part of the suit, but they were 
certainly part of the effort to win the suit. 

Hughes: Who was your lawyer? 

Gerbode: The lawyer was a fellow named Smith who was hired by Hazard and 
Company who are malpractice lawyers for the California Medical 
Association. 



Expert Witnesses 



Hughes: 



Gerbode: 



Hughes: 
Gerbode: 

Hughes: 



In the trial of most malpractice cases, the evidence of a doctor's 
negligence must be established by the testimony of another physician- 
the so-called 'exert witness'. Were there expert witnesses in your 
malpractice cases? 

There are physicians who say they're expert witnesses. Of course, 
the jury doesn't know what an expert witness is supposed to know. 
They're so stupid. So there are physicians who can be hired by a 
malpractice lawyer to take any stance he asks them to take. They 
fly under false colors all the time. 

This is now-a-days? 

Even now. The medical profession usually calls in very good expert 
witnesses. The juries always think that they're in collusion with 
the guy that's being sued, so it's a difficult thing to handle. 

In the Salgo case, was that your lawyer's responsibility to choose 
the expert witnesses? 



455 



Gerbode: Yes, he got good expert witnesses. 
Hughes: Didn't he ask your advice? 

Gerbode: Yes. We had conferences: What do you think about asking so-and-so 
to testify and I'd say yes or no. 

Hughes: How does the expert witness decide whether there was negligence or 
not? 

Gerbode: Well, what [the lawyers] would do is show all the material to the 
expert witness and then ask him if he'd like to testify. In other 
words, they get an opinion about what he thinks about the case before 
he's ever asked to testify. 

Hughes: Do physicians like this role? 

Gerbode: They don't like it, but they do it usually because they may be in 
the position next time [of being sued] , so they might as well be 
a good boy and help. 

Hughes: In October 1962, Charles Hufnagel, a prominent cardiovascular 

surgeon at Georgetown University Hospital wrote to ask you to be 
an expert witness in a malpractice suit in which Melvin Belli was 
the prosecutor. You replied that you were frequently out of town 
and hence it would be better to ask one of your associates. I 
think you referred him to [William] Kirth to be an expert witness. 
Was that the real reason or was it because you really didn't like 
being an expert witness? 

Gerbode: I never have liked being an expert witness and I have been a few 

times. I can't remember what the problem was at that time. I do 

travel a lot and I may have wanted to go to an international meeting 
at that time. What was the year? 

Hughes: October 1962. 

Gerbode: I can't remember but I know that Bill Kirth did act as expert 
witness once in a while. 



456 



Pre- and Postoperative Consultations 



Hughes: Since you were in the vanguard of cardiovascular surgery, many 

of the operations you were performing were comparatively new. How 
did you walk the line in regard to giving the patient a full 
explanation of a new procedure and the risk of alarming him 
unnecessarily? 

Gerbode: I always took a lot of time to explain these things to the patient. 
Very often it was the family because there were so many children 
being operated upon. We'd have diagrams showing what the lesions 
was, and then I'd show them what I intended to do. If it was a new 
procedure, one that hadn't been done very often, I'd tell them so. 
But I also had one big advantage, and that was I knew the risk of 
the child retaining the abnormality. I knew what the life expectancy 
was. The expectation was that if I corrected it, they would have 
a normal life expectancy. So that's a pretty strong argument. I 
could tell them what the mortality rate was also. Sometimes I 
didn't know, but I could guess at it. 

Hughes: Medicine is not an exact science. When an operation or a procedure 
did go wrong, how did you handle the situation with respect to the 
patient and/or the family? 

Gerbode: Well, if we lost a patient in the operating room or immediately 

thereafter, I would simply say that I thought the reason was whatever 
I thought it was. I always had the family stay in the hospital 
during the operation. I always talked to them right after the 
operation and told them the prognosis, what we found, what we did, 
and what might happen. 

Hughes: Was there always an autopsy? 

Gerbode: I would always ask for an autopsy. 

Hughes: Was that usually granted? 

Gerbode: I would say it was granted more than half the time. 

Hughes: So you were trying to learn from your mistake, if there had been 
a mistake? 

Gerbode: Yes. 



457 



Malpractice Insurance in California 



Hughes: You mentioned the high cost of malpractice insurance in California. 
Do you think there have been effects on the practice of medicine 
and surgery in this state other than keeping certain people away 
from practicing here? 

Gerbode: YesJ I think it's increased the cost of medicine because the 
average physician or surgeon will order tests which would be 
otherwise unnecessary because he wants to be sure he'll be covered. 
He'll order more xrays and tests than often required. He does all 
these things to protect himself from the lawyers and from the 
patients who are litigiously-minded. 

Hughes: Is there any solution other than eliminating the contingency fee? 

Gerbode: That's the biggest thing. If we had no contingency fee, a great 
many lawyers just wouldn't take cases. 

Hughes: Do you have anything more to say about malpractice? 
Gerbode: No. 



The California Medical Association and Medical Liability 



Hughes: In 1971 the California Medical Association published a pamphlet 

called "Professional Liability." The list of commandments on how 
to avoid malpractice claims had grown to twenty-eight. The previous 
pamphlet put out in 1956 had listed twenty-three commandments. 
Some of the commandments, such as avoiding criticism of the work of 
other doctors and the need for keeping "ideal" medical records, were 
repeated in 1971. The report recommends that a physician sensing 
dissatisfaction in a patient or his family should always ask for a 
consultation. Such consultations, according to the pamphlet, 
afford great protection against a suit. You've already said that 
you put this into practice; you discussed the case fully with the 
patient. 

One thing the report says: "All injections and medications 
should be given under the doctor's supervision." I was wondering, 
given the severity of many cardiovascular operations, was it always 
possible for you to supervise medications especially in emergency 



458 



Gerbode: It certainly was not! 

Hughes: Why would a booklet put out by the California Medical Association 
make such a blanket recommendation? 

Gerbode: I don't know who wrote it. But it's impossible to have every 
intravenous injection, for example, supervised by a physician. 
Nurses do a lot of them. 

Hughes: There's one of these fourteen so-called commandments which I'll 
read to you. "In a treatment of a patient, there must be no 
experimentation without the explicit and informed consent of the 
patient, and then only when there is sufficient reason to believe 
that such experimentation offers greater potential for benefit to 
the patient than currently acceptable modes of treatment." 

In the late 1930s and later in the postwar years when you were 
establishing yourself as a surgeon, do you think the surgical team 
was ever tempted to perform operations that might not have been 
specifically to the good of the individual patient but had a good 
chance of advancing the whole field of cardiovascular surgery? 

Gerbode: No, I don't think so. That's really saying that doctors would use 
the patient for experimental purposes, and I don't think we ever 
did that. We did operations which were certainly experimental, but 
we explained to the family that, let's say, this particular device 
had never been used before, that the background for using it was 
pretty good and what we thought the reasonable success rate might 
be. 



459 



XIII FURTHER COMMENTS ON EARLIER TOPICS 
[Interview 20: October 3, 1984 ]## 

Recent Problems at the Medical Research Institute 



Hughes: Dr. Gerbode, several years ago, in the early 1980s, there was a 

political upset at MRI, the Medical Research Institute. Could you 
tell me about that? 

Gerbode: We have two basic points of view which are more or less opposite to 
each other. One is that some of the people in the institute feel 
that we should have a strong scientific director. Another group 
feels that we don't need to have any strong scientific direction, 
that the institute directors and the scientists themselves can 
determine their direction. My view has been. ... [tape interference] 
I believe the better attitude would be to have somebody on standby 
to offer advice, counsel, when requested, and to keep an eye out 
for research people who would like to move into our group. Having 
decided that we might want a particular group or an individual or 
a laboratory, then, it takes money and a certain amount of logistic 
arrangement to get the person moved into the organization. 

Hughes: Would you hope the scientific director had a medical degree? 

Gerbode: I think he'd be better off if he had a medical degree although a 

Ph.D. could do the job too. These days, the combination of a Ph.D. 
and M.D. is very desirable, although not essential. I think of the 
two an M.D. has more breadth than a Ph.D., so I would favor that. 

When we had this big discussion a few years ago, the people 
who were in favor of not having a strong scientific director won. 
They got more votes and therefore, they appointed Mr. [James] Ludwig 
who is known in the community for fund raising for the ballet and 



460 



Gerbode: for the zoological society. He was selected because he was an 

affable, pleasant person. I told him that I didn't think he was 
the proper person for the job because he didn't know anything about 
research. As time went on he also claimed that he was not hired to 
raise money, that he was not a fund raiser. Well, he had raised 
money for the ballet and for the zoological society, so he did have 
experience along those lines. In addition to those things, he 
also was very active in running the downtown garage. [tape 
interference] 

The SKIVS [Smith-Kettlewell Institute of Visual Sciences] people 
under Dr. Jampolsky are the ones who don't want to have strong 
leadership in MRI as a whole. They are always anxious to.... [tape 
interference] SKIVS should pay an overhead rate [for membership 
in MRI] even though the money comes out of their endowment funds. 
They should pay the going rate which currently is about 72 percent. 
We don't know that they do that, nor do we know what they spend 
their money on. It makes it sort of an abnormal situation. 

Hughes: Is that legal for an element in an institution to retain secrecy 
in that way? 

Gerbode: Yes, it is. They have to file a report in Sacramento stating what 
they've done with their money, and we could get that report if we 
wanted to, but we might be accused of snooping if we did. It's 
available because it's a public institution. Presently we have a 
long-range planning committee appointed under Sidney Unobsky , who 
is a wonderful guy, and Bill Creson, who is also a very intelligent 
and active person. They have been working for about a year on a 
plan which could be used for long-range planning at MRI. 

Hughes: How were they chosen? 

Gerbode: Mr. Ludwig had something to do with appointing them, before he was 
asked to resign. But I think the institute directors really 
determined who would be most desirable on the job. 

Hughes: Why were those particular men chosen? 

Gerbode: Because they are very interested in MRI and they are very intelligent 
and willing to look at all aspects of it and render an unbiased 
opinion about what should be done. 

Hughes: What are their backgrounds? 

Gerbode: Mr. Unobsky is a very successful private investor. Mr. Bill Creson 

is the chairman of Crown Zellerbach Corporation, which is an enormous 
company. 



461 



Hughes: Because of their backgrounds, I would assume then that they're 

looking at the institute mainly from the standpoint of efficiency 
and financial organization. 

Gerbode: They're looking at it from the point of view of what we should be 
emphasizing within the institute. In other words, should we bring 
in other research groups to broaden the base of research? They're 
also looking at the role of what we call the science council as 
to whether or not it should have jurisdiction over certain aspects 
of administration which it has assumed in recent years. It's 
questionable whether it should be exercising any authority in those 
fields at all. Also they're looking at what sort of top leadership 
we should employ. In other words, do we want a strong scientific 
man at the head of MRI with organizational ability and interest and 
knowledge, or do we want just a bookkeeper kind of a person? 

Hughes: What sort of criteria would they use in making such a decision? 

Gerbode: I guess it really has to do with their final decisions about long- 
range planning. 

Hughes: Is that decision very much tied in with what the federal government 
is funding? 

Gerbode: Yes, it is because 80 percent or more of our money comes from the 
government. We have to compete for it. Certainly there's no use. 
trying to do research which is not adequately funded anywhere. You 
can't do that. 

Another big question which is up for review is whether or not 
the institute should remain entirely separate from the hospital. 
We originally put [the institute] together in such a way that the 
hospital would not influence the type of research or the people 
doing the research and would not be responsible for policy in spending 
[research] money. There are some people, I believe, who feel that 
maybe the research should be under the overall administration of 
the hospital.* My view is that the trustees of the hospital and 
certainly the chiefs of service in the hospital are not particularly 
knowledgeable about research. In fact, the present chiefs of 
service really don't do any research and rather feel that it's not 
a necessity in a private hospital complex like ours. 



*What Dr. Gerbode refers to as the board of trustees of the hospital 
is actually the board of trustees of Pacific Medical Center. 



462 



Hughes: That's always been the feeling at the hospital group, has it not? 

Gerbode: There has always been that feeling. From the very beginning, they 
resented very much our spending one hundred and fifty thousand 
dollars to support partially construction of the research building 
[MRI] which is now worth about three million dollars. 

Hughes: There are, of course, in this country many institutions that have 
this combination of a hospital plus a research institute. Do you 
think that in general there is a tension between the two? 

Gerbode: Usually where they're together in one complex it's in a university 
setting, a medical school setting. There are some private 
hospitals that do have research programs run by the staff of the 
hospital, but generally speaking the clinical staff in any private 
hospital is not particularly interested in research. They're 
interested in practice, more practice. 

Now we're building a whole new office building in the [Pacific 
Medical] Center for a hundred doctors, and none of those doctors in 
that building who occupy space there have been selected because 
they're particularly interested in their particular specialities. 

Hughes: Is that because the hospital board has been in charge of selection? 

Gerbode: No, the [hospital] staff selects the doctors, and they're more or 
less in favor of having successful practitioners, and it should be 
that way too. It's an extra dividend if somebody comes in and 
likes to do a little research on the side. That's great. But 
it's hard to find people like that. They would much rather have a 
big private practice. Money is a very important factor in life. 
No question about it. [both laugh] 



Possible Affiliation of Pacific Medical Center and Children's 
Hospital 



Hughes: I know you've spoken about the Pacific Medical Center possibly 

affiliating with Children's Hospital. Is this part of the scheme 
that's being work on? 

Gerbode: It's being discussed very seriously now. We have a joint committee 

of Children's and PMC which has been meeting almost on a weekly basis 
trying to work on the guidelines of how an amalgamation of the two 
hospitals might be beneficial for both. Some of the issues that are 



463 



Gerbode: bothering the committee now are who will be selected to be the 
chief officers of the two combined hospitals. People are very 
jealous of their perogatives, so they wouldn't want to have this 
person or that outfit be the chief executive officer or the 
president. 

There is also the more sticky problem of duplication of services. 
Currently, Children's Hospital wants to start cardiac surgery and 
cardiac catheterization. This would be in direct competition with 
PMC which has a big cardiac service going already. We want to start 
a cancer therapy program with irradiation. Children's Hospital has 
one already, and they don't like the idea of our having one too. 

Hughes: Is that the purpose of the linear accelerator that's going in at 
PMC? 

Gerbode: If we did it, we would have to get a linear accelerator. So these 
are very sticky questions which will have to be solved in the next 
few months. 

Hughes: Does Children's have any appreciable research going on? 

Gerbode: They have funds for research and they have a small research 

laboratory. As far as I know, they only have one serious research 
worker over there and she's in immunology. I tried to have her 
come with us, but they offered her more money and more space, so 
she went over there. I haven't heard how she's doing. There are 
some other clinical people who have quite a bit of research money 
tucked away here and there, but as far as I know they don't really 
do much with it. 

Hughes: So the amalgamation with Children's wouldn't particularly affect 
MRI. 

Gerbode: Actually, it would be beneficial for MRI to have whatever Children's 
Hospital research efforts might be to work through MRI or in 
connection with MRI make that a joint effort. But that hasn't 
even been discussed yet, so I don't know what will happen. 



Recent Problems [Continued) 



Hughes: Is there a time limit placed on the survey of MRI? 

Gerbode: No, there's no time limit, but they're getting pretty near the end. 



464 



Hughes: How has the institute been doing with interim administrators? 

Gerbode: Well, we run right now with a business office. We have one vice 
president in administration, [Mary Woolley] , but she's not very 
knowledgeable about research. She's knowledgeable about seeing 
that everybody obeys the rules which have been established by the 
board or by the science council. She's not the kind of person who 
can think of what we should be doing in research the day after 
tomorrow. There are some people who feel that she's enough and that 
the place can be run by what amounts to a hotel concept. 

Hughes: What do you mean by a "hotel concept"? 

Gerbode: [MRI would] charge people for working there, which it does now, and 
have everybody pay their bills and let them determine on their own 
what kind of research they're going to do. 

Hughes: That doesn't make a very cohesive institution. 

Gerbode: It isn't very good. The hospital runs very well now because they 
have a president in charge of the whole thing who is extremely 
knowledgeable, very talented at handling people. I'm talking about 
Bruce Spivey. Under his presidency, they made a lot of major 
advances and constructive improvements. We could do the same at 
MRI if we got the right person. I don't know what's going to happen. 

Hughes: Because the scientific vacuum at the top at the moment, do the 

science council and the institute directors assume more importance? 

Gerbode: The institute directors do to a certain extent, but actually the 

science council has been running things more than it should be. It 
assumed control of space; it assumed control of appointments and a 
lot of other internal political things, which I think it should not be 
doing. I personally think the science council should be looking at 
the science in the place and saying, we need more of this kind of 
science, or we need to get some people in doing this kind of work 
to complement what we're doing already, and we should go out and 
find them and get them to move in with us. That's what you do when 
you're building up a faculty in a medical school. 

Hughes: Does the science council have the power to change the direction of 
an institute's research? 

Gerbode: It probably doesn't. It has the power to assign space. It should 
make constructive criticisms of the kind of research which is being 
done in the various institutes. But it doesn't do that. It will 
exercise a political position now and then. 



465 



Hughes: I know you modeled MRI (or the Institutes of Medical Sciences as 

it was in those days) more or less after the Rockefeller Institute. 
Did it have something comparable to the science council? 

Gerbode: Yes, it has a science group; I have forgotten what it's called. 
But they've always had a scientific director at the top. 

Hughes: A strong one. 

Gerbode: A strong person who is science-oriented. The infrastructure was 
very simple and the bylaws and the rules and regulations were on 
a few pages in very simple words. I tried to keep it that way in 
our place too, but it's gotten more complicated than I think it 
needs to be right now. 

Hughes: The Rockefeller has always had a very strong director at the 

hospital and another individual who is a very strong director of 
the institute. 

Gerbode: That's right. They've always had somebody at the top who is 

extremely knowledgeable about research and helping a person get on 
with his research and complementing his research by getting other 
people to work with him. 

Hughes: Getting back to the situation at MRI, can you remember what the 
arguments were for having a nonscientif z director? 

Gerbode: [chuckles] Yes, the argument was that the institute directors 

know pretty much what they want to do with their research and they 
should be left alone to do it on their own. I think the rest of 
the arguments are kind of weak, and I think they have to deal with 
apprehension on the part of at least one institute that it didn't 
want to have anybody too strong around who might say something about 
the way it runs its show and maybe also something about the amount 
of money it has and how it's used. 

Hughes: I can understand that viewpoint coming from SKIVS. But there must 
have been people in the other institutes that were going along 
with this viewpoint in order for it to pass. How could they see 
that as an advantage? 

Gerbode: They caved in because of political pressure. The other strong 

institute over there is the Institute of Behavioral Medicine. They 
had money for hypertension research for quite a few years. Now they 
have a lot of money for alcohol research, and therefore they are 
quite solid financially. It's run by Ph.D.s in psychology and 



466 



Gerbode: they really don't have too much interest in what anybody else is 
doing. It's too bad because they're strong financially. A lot 
of money is put into alcohol research. 

Hughes: At the moment. 

Gerbode: Well, it's a five-year grant. 

Hughes: What about after five years? 

Gerbode: They've usually renewed them. They did with hypertension. That 
went on for ten or fifteen years. 

Hughes: Do you want to finish the story by telling what happened to Ludwig? 

Gerbode: The trustees were not very happy with Ludwig 's performance as 

president of MRI. Over a year ago they told him they thought he 
ought to do more fund raising, and he said he wasn't hired to do 
fund raising. They also felt that he wasn't really spending the 
time on developing MRI. He was spending too much time on the 
ballet, the zoological society, and that downtown garage, and doing 
it all out of the office in MRI. He had a telephone and everything 
there and the secretaries. That meant that he was probably giving 
us about one quarter time. 

Hughes: What was the contract? 

Gerbode: The contract was at least 50 percent of his time . The board of 
directors told him a year ago that it wished that his performance 
would be more along the lines which it had hoped, but he didn't 
change anything at all. So after a year it went back to him and 
said, things haven't changed very much and we think maybe we ought 
to get some new blood in. 

Hughes: This is the institute board? 

Gerbode: The executive committee of the board made the determination. I've 
always been suspected of being politically behind any big thing like 
this because of being the founder and prominent in .MRI's 
development. But I didn't enter into this picture one bit. The 
trustees did that themselves, and I'm glad they did. Unfortunately, 
there were several women on the board whom Ludwig had brought in, 
and therefore they were more or less personally obligated to him. 
When he resigned, they resigned too. That's all right. 

Hughes: How many people resigned? 
Gerbode: Two. 



467 



Hughes: Have those places since been filled? 
Gerbode: One has been filled; one will be filled. 
Hughes: How is that done? 

Gerbode: It's done by a trustee making a recommendation to a nominating 

committee. The nominating committee looks over the nomination to 

see if the nomination is in compliance with what is expected of 

that position. If it is, then they will suggest it to the executive 
committee. 

i 

Hughes: Is one of the main criteria expertise in financial matters? 

Gerbode: No, I think getting along with people and seeing that the image of 
the institution is kept good in the eyes of the community. Very 
often it requires organizational ability. If they want to have 
a fund raising dance or something, they have to have some ladies 
in order to do that, and the various institutes [do] too. For 
example, the arthritis group under Bill Kuzell has a lot of 
strength in the community because arthritis is a very prevalent 
disease. When they had a party for the arthritis institute [the 
Kuzell Institute for Arthritis Research],' it was very successful. 
Certain ladies raised a lot of money. 

One of the new institute directors is Gail Schlesinger. She's 
married to Mr. Schlesinger who used to be my across the street 
neighbor. She's a very, very capable administrative person. She's 
very active in the group which is sponsoring research among 
college scientists. She'll do a lot, I'm sure. 

Two of the people who resigned were on the Children's Hospital 
board, and that, in their minds, posed a conflict of interests 
because Children's Hospital has to raise 40 million dollars. That's 
about as much as a person can do, to have one big interest like that. 
As soon as there was a little bit of a problem at the top, they 
quickly used that as an excuse to get out which is all right. 

Hughes: You talked earlier about the competition between the cardiac programs 
and the cancer therapy programs at both hospitals. How are things 
like that resolved? 

Gerbode: That's going to be a very tough one because the doctors involved 

won't like it. I've said all along that although they can discuss 
amalgamation at a very high level among the trustees, when it actually 
comes down to deciding that a given specialty should be given 
preference in one hospital rather than the other, this involves the 
doctors right away, and they don't like it. 



468 



Hughes: How are such decisions made in the first place? 

Gerbode: Some of these things now are determined by a state committee. 

For example, to start a new open heart surgery unit in San Francisco, 
they have to get a certificate of need. They have to establish 
that there is a need for another heart unit. Unless they get it, 
they can't do it. I don't think anyone has really raised that 
question yet with Children's Hospital. But with us, you see, we 
simply started doing [open heart surgery]. I developed a team and 
did a lot of experimental work and finally got Crippled Children's 
[Service] to designate us as being somebody they'd pay to do their 
cases. So we were in business. Nobody else was doing it. 



Heart Transplantation 



Hughes: When Presbyterian decided to do heart transplants did that require 
state approval? 

Gerbode: No, it required approval of the trustees. They are not being paid 
by insurance carriers for this work yet. [A few sentences of 
repetitious material were omitted here.] 

If 

Gerbode: Tissue typing of kidneys is broadcast through a computer network. 
There is a latent period of a certain number of hours for kidneys 
to be moved by air from one place to the other and used. [The 
system is] working very well and eventually the same thing will be 
true with hearts. It's already in operation to a certain extent, 
but it will become even more organized in the future. 

Hughes: Do all units doing heart transplants subscribe to that computer 
program? 

Gerbode: In northern California, there are only two programs doing heart 
transplants. 

Hughes: Don't the hearts come from all over? 

Gerbode: They're made available mostly in California and Nevada, I would say. 
There are kidney transplant units in almost every state, so [kidneys] 
tend to stay in that same state or general geographic area. 

Hughes: It would seem, from the stories that one hears of heart patients 
waiting for very long periods for a heart, that it would be well 
to extend the system to the nation. 



469 



Gerbode: Yes, but it's very costly. It costs a minimum of $75,000 to do 
a heart transplant. If complications arise, it may even be 
$100,000. 

Hughes: I mean the retrieval system, locating hearts. 

Gerbode: Along the Atlantic seaboard, where they have three or four very 
active heart transplant programs, there's fiendish competition 
for the hearts. They almost fight over them. I can see where that 
might eventually occur here too. 

Hughes: Isn't that in the end determined by the tissue typing? 

Gerbode: That is a determinant, but I think the relatives of the donor heart 
have a lot to say about where the heart's going to go. But they 
are usually so upset by the fact the patient has died, they don't 
really want to enter into the question of where the heart will go. 

Hughes: Do you think the Bay Area, because it has a terribly high ratio of 
doctors to patients, might be on the vanguard of the changes that 
are occurring in American medicine? 

Gerbode: I think we're pretty much up at the front of things in many areas 
no question about it. Some of the traditional areas in the East 
are not quite so outstanding as they used to be. The Mayo Clinic, 
for example, used to have a very dominant role in the Middle 
West. It's still very dominant from the point of view of general 
service, but people don't necessarily just go there anymore. They 
go to Cleveland and Detroit and Topeka, Kansas and a lot of other 
places rather than to the Mayo Clinic, because insurance covers 
them wherever they go, and they'd rather be closer to home, and the 
doctors are good. But a lot of people still go to the Mayo Clinic 
because they think that the place is so big and great that mistakes 
won't be made and they can always say that they've been to the Mayo 
Clinic for a decision, for whatever that's worth. People are still 
going to Lourdes. 

Hughes: Well, is there any more to be said about MRI or anything else? 
Gerbode: I think that's about as much as we need to say right now. 



470 

Family Background and Early Education//// 
[Interview 21: November 14, 1984] 



Hughes: There are things that you left out about your parents, when we 

talked before, and I was wondering if you could tell me a little 
bit about their education, occupations and personalities. 

Gerbode: Well, my father was trained in Saxony to be a contractor and he 

came over [to the U.S.] with his foster father who was his uncle. He 
came to Placerville because the first Frank Gerbode had established 
a gold mine outside of Placerville. My father very quickly got into 
the business of building small factory towns and the various things 
necessary for gold mining and also for tree farming. He built 
several saw mills, for example, for the people up there who were 
cutting down trees for lumber and I think he was quite successful 
at it. Of course, I was still a child and I don't remember any part 
of that. They decided to move to Sacramento when I was three years 
old. So my awakening that I can remember [chuckles] occurred some 
time later. I can remember the first day my father took me to 
school. I know he got me all dressed up. He even bought me a hat 
to wear [laughs]. Why, I don't know. 

Hughes: Was it the local 

Gerbode: It was the local elementary school in Sacramento. It was a 

beautiful old red brick school. I can even remember my worry about 
whether I should ever learn how to tell time because this was very 
quickly brought into the picture in school and I should have learned 
how to tell time before that, but I hadn't. 

Hughes: Did you start at kindergarten? 

Gerbode: Yes. 

Hughes: Why did your parents decide to move from Placerville to Sacramento? 

Gerbode: I think [my father] saw that he had built everything that he'd like 
to build up there. He built several small towns and mills and 
things like that, and he covered the ground pretty well. I guess 
he figured he might as well get out. So he moved to Sacramento 
where he started doing the same thing on a smaller scale contracting 
to build houses or business places. I guess he was reasonably good 
at it. Whatever ht did he did to absolute perfection; I know that. 



471 



Gerbode: As time went on I went through elementary school and started going 
to high school in Sacramento. Meanwhile my sister, who was quite 
a bit older than I, had decided she wanted to be a businesswoman. 
So she took business courses and learned how to be a very efficient 
businesswoman and learned all about the paper business. Zellerbach 
Paper Company and Blake, Moffitt and Town both wanted her to take 
over their fine paper business. She worked for Zellerbach for a 
while but finally Blake, Moffitt and Town gave her a better arrange 
ment, so she worked with them. This was also an inducement for my 
mother and father to move to Sacramento because my sister and my 
mother and father were very close and very compatible. 

Meanwhile my brother (Did I tell you about that before?). 
Hughes: About the drowning? 
Gerbode: About drowning. 
Hughes: Yes. 

Gerbode: And my older sister about her dying? 
Hughes: Yes.* 

Gerbode: This actually brought the family closer together because these were 
two very shocking things to happen. I think maybe it was partially 
responsible for my mother and father hanging onto my sister and me 
a little. 

I would characterize my father as being a very strict, honest 
hard-working man. He did a great many things as a contractor. He 
did it himself. He did all the calculating, bidding and planning 
himself, working late at night. He'd rather do it himself than to 
hire somebody to do it. 

Hughes: Did he have people working for him? 

Gerbode: Yes, when he started building something, he'd get a crew together. 

Hughes: And it was always the same crew? 

Gerbode: No, he'd hire different people. 

Hughes: Did he speak English with an accent? 



*See p. 2. 



472 



Gerbode: No, he didn't. He spoke very good English. 
Hughes: And you spoke English in your family? 

Gerbode: Yes. My mother spoke very good English too. It was a very closely 
knit family life. My mother was not the kind of a person to go 
chatting around the neighborhood with friends. She kept pretty 
close to home. As a matter of fact there was a kind of tradition 
in the family that you never discussed family affairs with anybody 
[outside the family]. I find that some of the members of my family 
are the same. They just don't like to wash their linen in anybody 
else's yard. I guess I'm the same way. If I'm in trouble I try to 
work it out myself. 

My mother was an extremely loving person. She was very 
affectionate and very attached to her family. I think her children 
and her husband were the most important things in her life. She 
always wanted to know where I was as a small boy, what time I was 
going to be home and so forth and so on. She always dressed me 
immaculately. Sometimes it was a little embarrassing to be always 
shiny and bright when some of the other kids weren't so shiny and 
bright, but I had no choice. This was the way I was told I should 
be. 

I guess in grammar school I was a little bit on the shy side, 
although I did join the Boys Scouts and went on scouting expeditions. 
I never got to be an Eagle Scout because after I became a first-class 
scout I tired of the whole program and didn't want to do it anymore. 
Besides I got malaria on one of these trips and almost died. We 
were camping out near the Sacramento River. Obviously, I was bitten 
by an Anopheles mosquito and got malaria and, I think, almost died. 
I can still remember the hallucinations I had during the high fever 
episodes. 

Hughes: How old were you? 

Gerbode: I guess I was ten or eleven. 

Hughes: What was the treatment? 

Gerbode: It was symptomatic treatment. I know we didn't have any of the 
drugs that are currently being used. If they gave me anything I 
can't remember what it was. 

Hughes: Did you spend much time with your father? 



473 



Gerbode: Yes, I did. He taught me how to fish and to hunt. We'd go off 
in the mountains together. It used to be very aggravating to me 
that he could always walk farther and longer and steeper 
than I could. [both laugh] He was a very slow walker, but very 
deliberate. I had a very hard time keeping up with him even as a 
young man. 

Hughes: Did he carry on those activities once they moved to Piedmont? 

Gerbode: Yes, we decided we'd rebuild the old miner's cabin in the mountains 
when I was seventeen years old. We camped out for several weeks 
while we rebuilt that log cabin. It was very, very hard work. 

Hughes: Were you using material from the property? 

Gerbode: We chopped down the trees right from the same place and we had to 
"snake" them down to the site. We floated some of them down a 
little creek which was along the side of the cabin, and then, we 
had to pull them out. "Green logs are awfully heavy. 

Hughes: Just the two of you? 

Gerbode: Yes. So we had to figure out ways of putting ropes around them and 
putting them up on some sawhorses so they could be trimmed to fit 
properly between the other logs. But we did it all and the place 
still stands. 

Hughes: Did you use the cabin after that? 

Gerbode: Yes, we used it for a while. But the one who used it more than 

anybody was Philip, my younger son. He loved it and he used to go 
up there whenever he could with some friends and camp out, hike 
around there. We had it pretty well outfitted with a good wood 
stove, kerosene lights, and a good fireplace which my father and I 
rebuilt during that same period. 

Hughes: There was no electricity? 

Gerbode: No, you were just way off in the middle of the forest