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Department of Pathology History


Conversations with Robert Heptinstall

Robert H. Heptinstall
Director of Pathology
1969 - 1988

October 28, 2007  |  December 9, 2007  |  January 20, 2008
Hruban: Today is October 28, 2007, I am Ralph Hruban and I am joined by Ed McCarthy and Dr. Robert Heptinstall for a Sunday afternoon. So Heppy what we thought we would do is start at the beginning and move forward chronologically.
Heptinstall: Before we do that, let us decide what we are trying to accomplish. One of the few sensible things I learned in the Army was in the Officer's Field Handbook and it told you how to conduct an exercise, or a battle if you like. And the very first question asked (it is a question that is very seldom asked at Johns Hopkins committee meetings or of any other meetings you go to) was what are the aims and objects of the exercise.
Hruban: What we are trying to do is to capture a time in Hopkins' history, and in particular the characters in Hopkins' history and since you've obviously been associated with Hopkins and the department for a long time and quite a character, we thought we would try to capture both and document both and what we hope to do is to...
Heptinstall: But you see this rather conflicts with what you had on your email. On your email you wanted to know something about my history, my evolution. What has that got to do with this window framework.
Hruban: Because you did not arrive out of the blue at Hopkins. I think clearly who have a wonderful history that frames who you are. So we will start at the beginning. And I think the main thing we can do is to feel free to edit it. If someone says something that they regret later, we'll just cut it out. Nothing is written in stone. So you were born in Cumberland, England?
Heptinstall: I was born in England, yes; in Cumberland yes.
Hruban: What year?
Heptinstall: 1920.
Hruban: So if you can start with that, who your parents were and all that and move forward.
Heptinstall: I grew up in Cumberland. I had two very nice parents. I went to a local school.
Hruban: Was your father a physician?
Heptinstall: No, my father was in the bakery business.
Hruban: And you had a sister?
Heptinstall: I had a sister. A sister brighter than I was. She was a school teacher. The school I went to was a rather unique one - it was a coeducational school. Both day boys and boarders. I was a day boy naturally because I lived there. It was a very good school.
McCarthy: Does it still exist?
Heptinstall: No, it doesn/t exist anymore. Its foundation was not a very large one and it went out of business about 15 years ago.
Hruban: And then at one point you knew you wanted to go into medicine, you had an inkling for science, at what point was that?
Heptinstall: When I was at school, I specialized in chemistry, physics, and mathematics. I wanted to do medicine and of course, when I applied for med school in 1938 the war clouds were looming so I applied to two schools where we heard that they were going to shorten the course if a war came along, Oxford, Cambridge had made no such provisions so I applied to London University and Edinburgh. I was accepted at London first so I naturally went there.
Hruban: Why did you want a shorter course?
Heptinstall: Because it was obvious the war was coming and I wished to graduate as quickly as possible. I wasn't going to be branded as a stay-at-home, would you?
Hruban: And so that's the Charing Cross Hospital Medical School?
Heptinstall: London University has many different medical schools: Guys, London, St. Thomas's, Bart's, St. Mary's, Charing Cross is about the smallest of the London hospitals. Its students did their preclinical work at King's College in London.
Hruban: Do you remember any of your teachers - your professors from Charing Cross?
Heptinstall: I remember the ones I want to remember, some of them particularly well. No doubt in the many teaching classes you and I have shared you've heard me mention a man named Gordon Holmes. Gordon Holmes was the world's premier clinical neurologist. As an aside, Hopkins tried to get Holmes back in the 1920's. His signature is in the department visitor's book. Probably it has disappeared now. I don't know. Holmes was invited to come here, but he was not at all flattering about Baltimore.
Hruban: He's the one with the needle.
Heptinstall: I told the students many tales of Gordon Holmes. He was an absolutely brilliant teacher, but we were all terrified of him.
Hruban: Did you have a nephrologist professor?
Heptinstall: There was no such thing as nephrology in those days. Nephrology didn't come along as a specialty until the 1950's.
Hruban: What about in surgery?
Heptinstall: I interned in Surgery. I interned under one of the best surgeons in London named Norman Lake. Lake was a wonderful man. He was not just a very good surgeon; he was a highly intelligent man who knew something about everything. He took part in a very popular program on B.B.C. radio during the war called The Brains Trust in which they would have four very bright people who would be asked questions on a variety of topics. Lake was a member of The Brains Trust and his knowledge was so extensive that he could hold his own with these very bright people. He was a wonderful surgeon too.
Hruban: so you were in London during the bombing and in school?
Heptinstall: I wasn't in London during the bombing of 1940-41. What happened at the beginning of the war when it finally came in September 1939, was that they decided to evacuate the medical students from the London medical schools and teaching hospitals. They kept a skeleton number who were in their final clinical years in London to do fire watching duties and work in the emergency room and in the half dozen wards that were kept open. But all the London teaching hospitals had what they called a sector which was the area draining the particular London hospital, and in each sector they had the sector hospital which was where most of the patients were sent. I didn't particularly enjoy the sector hospital. It was rather like a country club. It was on the verge of the Ashridge Golf Course which was one of the best courses in England. There was just a general laid back atmosphere there.
Hruban: Even during the war?
Heptinstall: Yes. They wanted students at Charing Cross in London to do fire watching duties and other things, and I went there after several months at Ashridge and saw a tremendous amount of material. We were allowed to do a great many things that medical students weren't usually allowed to do and I became very friendly with a surgeon from the Urology hospital around the corner, St. Peter's, and he let me help with many procedures. I got a very solid grounding in surgery and that's why I interned in surgery and always intended to be a surgeon. But to get back to your original question about the bombing of 1940-1941. At that time I was still at King's College where Charing Cross students went to do their pre-clinical work. So I was doing anatomy, physiology, pharmacology - that was all in Glasgow where we had been evacuated. I think they got rather fed up with us in Glasgow and in the summer of 1940 we went to Birmingham University in the Midlands. So I was in Birmingham the nights of the big air raids on Birmingham. But they didn't go on night after night. I think there were three or four big raids on Birmingham. I did experience air raids in London later in the war including the V-1 bombs in 1944.
Hruban: Did you have a good pathology professor during that time?
Heptinstall: Charlie Vines. Charlie was the author of one of the standard English textbooks. Charlie was a very good teacher but a very acid sort of fellow. Very sarcastic always taking the piss out of people. On the whole we were taught pathology well.
Hruban: Then your motivation to go into surgery was essentially the hands on experience you received?
Heptinstall: Yes, because of all the practical experience that I had had and I wanted to continue with that. And then when I was in the Army, I decided that I didn't really want to do surgery.
McCarthy: How did you come to get into the Army?
Heptinstall: I was drafted as were all physically fit people.
McCarthy: During what year was that?
Heptinstall: I went into the Army about the Spring of 1944. I graduated in about the middle of 1943 and we were allowed to do a six month internship and then when I finished that I was drafted into the Army. We learned how to salute and all that rubbish and about regulations and learned how to make latrines. And then we probably had the best teaching I've ever had in my life. The RAMC (Royal Army Medical Corps) put on an absolutely wonderful course in tropical medical which lasted two weeks. I had never had such good teaching and this was by officers from the RAMC. They had a wonderful collection of specimens because the RAMC had a long history of service overseas. All those famous people like Leishman and Ross were somehow connected with the Army and all their material and all their specimens were filtered back to London and we had all this wonderful teaching material.
Hruban: So you must have known at that time that you were going to go to the Far East for your military service?
Heptinstall: No, there was tropical medicine to be practiced in the Middle East, West and East Africa and numerous other places. But I was put on a boat after I'd done the course in tropical medicine and sent to India.
Hruban: What did you do when you arrived in India?
McCarthy And what year was that?
Heptinstall: Summer of 1944. First thing I did the first night I was in India was to eat eight eggs because eggs were very severely rationed in England. I had two boiled eggs, two scrambled eggs, two fried eggs and two poached eggs.
McCarthy: Where in India?
Heptinstall: I was first sent to a place near Poona, Center of British imperialism, where the Army was strongly represented. I was sent to a depot a few miles from Poona, but I wasn't there very long. I was put on a train and sent over to Calcutta and from Calcutta we went by boat and various conveyances into Burma. In Burma I went first of all to a field ambulance, a mobile hospital. And then after a time in the field ambulance there was a vacancy in one of the rifle battalions and I went as the battalion medical officer to an infantry unit. I stayed in Burma until approximately March of 1945, when as we shall see, my unit was sent back to India.
Hruban: So the war was still going on at that time?
Heptinstall: Of course it was. Why otherwise would we have been there? Yes the war was still going on. Then we came out of Burma. Before I went out to India, I had used every device I knew in how to avoid being sent to the Far East. I wanted to go to France because the second front was just being opened up at that time while we were doing our basic military training. So I applied for airborne troops, I applied for the Commandos, I told all sorts of terrible lies that I spoke fluent French and German which would be absolutely wasted in the Far East, but in spite of that, they sent me out there. Well, my unit pulled out of Burma and went back to India to a place near Madras in the south of India and we went there to rest and refit and then we were to go over to the coast to train in combined operations because the next item on the agenda after Burma was the invasion of Malaya. While we were there, I got a telegram one day telling me to report to headquarters Force 136 in Kandy in Ceylon. I had no idea what Force 136 was. So I went to see my C.O., charming man called Tony Read. He said, oh gosh, Heppy, you've really let yourself in for it. Those are the people who parachute into Japanese occupied territory. I know all that because my brother's in it. And he was. I met his brother and he was an equally charming fellow. This is where the Army wasn't so stupid, they had got my records. They had seen while in the U.K. that I had volunteered to jump out of airplanes. So I went to Ceylon and was sent to a training camp where we were taught how to survive in the jungle and other things from like using plastic explosives to unarmed combat, etc. Then I was sent up to a place called Jessore in India for parachute training and then came back to Ceylon to be allocated to a team to be dropped into enemy-held territory. I was in the Siamese section, but before I was put into a team, Harry Truman sensibly dropped the atomic bomb. At that stage all operations were cancelled and it was decided to drop doctors into the prisoner of war camps where conditions were dreadful. I parachuted into a camp in the Kra isthmus in Siam where I stayed for about two months or so until all the occupants had been evacuated.
Hruban: The prisoners were British soldiers?
Heptinstall: The prisoners were from many different countries; most of them were British. But the camp that I dropped into was a camp of Malay coolies who had been taken up to Siam to build yet another railway. The Japanese were obsessed with building railways, and this camp held about 3,000 Malays in various stages of breakdown. It was the most appalling sight. They had been terribly neglected and very cruelly treated.
Hruban: What were the illnesses they faced?
Heptinstall: Beriberi, malaria, dysentery and all forms of malnutrition. Those were the main things. I found that the situation was altogether too much for me to handle as I was the only medical officer. So I sent a signal back that I needed help. In response they parachuted in several young medical officers from an Indian Airborne unit and gradually we sorted things out. The Japanese had the medicine and the means to treat them all, but did nothing. The Japanese general in charge of the area, I got to know him very well because I had to deal with him on many issues. I remember very clearly he was called General Hamada.
Hruban: Where was the flag pole incident?
Heptinstall: The flagpole incident happened when I was in Siam in this awful camp. It was a storm in a teacup and best forgotten. After we had cleaned up the mess in the camp, with the survivors evacuated to Malaya, I was sent to Singapore where I went to see a charming man, I think his name was Colonel Thompson who was in charge of postings. He said "what would you like to do"? I replied "go where there is something interesting going on." He said there are some interesting things going on in the Dutch East Indies where the Indonesian rebellion against the Dutch had just begun. The British has been given the task of taking over the Dutch East Indies from the Japanese but encountered opposed landings. It was one of the few places in the Far East where the Japanese didn’t observe the terms of the surrender and many of their weapons got into Indonesian hands. At least that is what was believed at the time. Regardless, the British and Indians had a lot of casualties and there was a full-scale rebellion going on. I told Colonel Thompson I should like to go there and was sent there as a medical officer to an artillery unit. I was in Java for the best part of a year during which Dutch troops gradually replaced the British, and Indians, and were able to leave. After Java I went back to Singapore (September 1946) and was given a posting as medical officer to Changi Jail which was a huge prison that housed Japanese war criminals. My job was to supervise the Japanese doctors looking after their own awful people. I had an uneventful time there and left for England in January 1947 to be demobilized.
Hruban: When you were in India at one point, you told me a story where you took some new troops out to teach them about the jungle and tell us about the rock that moved.
Heptinstall: it was in the spring of 1945 at a camp near Madras. We had just got a batch of new young officers from England who had just come into the Army. It was decided that in preparation for going into Burma that they should get some experience of the jungle. There was a very nice smallish area of jungle close to where we were so the second in command of the unit, John Robinson, and I, went out to do a reconnaissance of this local jungle area to establish water holes so that the new officers could survive for a few days and fend for themselves. We soon found that there were a lot of snakes (cobras) around. We reached a place where our primitive map showed a water hole. We saw the water from a distance with a very dark slope adjacent to it. As we approached, this dark area started melting away and revealed a rocky slope bereft of any form of life. I don't know what these snakes were doing; resting I suppose but they disappeared by the time we got there. On the basis that we had not been attacked by any snakes, we decided to let the young men go ahead. All emerged quite healthy after several days and that was the story of the disappearing rock.
Hruban: So you are now on the boat back to England in 1947?
Heptinstall: January 1947. So I get back to England and it's the bitterest winter Britain had had in about 100 years. There was snow everywhere. My parents lived in the Lake District in Cumberland and I naturally I went to stay with them because this was home. I decided I was going to take a two-month vacation before I went to London to explore any postgraduate training. I had a wonderful time up in Cumberland. The Labor government was in power then; Churchill had been thrown out in 1945, and Labor were screwing up on the fuel supply. There was very little coal. You see, people in England heated their houses with coal in those days. We had a cottage on the coast about 20 miles away from where my parents lived. My father decided to close the house down and move to the cottage to conserve coal. Up to this time I had seen very little of my parents and I was with them in this little cottage for about six or seven weeks. We played dominos and cards every night. (There was no TV in those days and only radio to amuse us.) Father and I used to plow our way though the snow to the local pub to purchase our sustenance. And then I decided it was time that I went and started making some arrangements for my future. I went up to London to Charing Cross Hospital and I found that Charlie Vines, the Professor of Pathology, was now the Dean. I interviewed with Vines and I told him that I no longer wanted to continue with my original plans to do surgery, but that I'd like to take up pathology. I thought that this would please him. "Well, before I take you on in pathology," he said "you've got to do some more training in internal medicine and you've got to get your MRCP. That's the higher qualification that internists have in England. So I asked him why should I want to have an MRCP and go through all this training if I was going to be a pathologist? He told me that the pathologists of tomorrow would have to give advice to clinicians as to what tests should be done and what these tests mean. And in order for you to understand these matters you've got to have a thorough training in medicine. I thought to myself, what bloody nonsense. No mention of doing research or anything, all just routine clinical practice. So I told Charlie that I really was very sorry he couldn't take me, but I was unprepared to take training in internal medicine as he suggested. I realized I had now burnt my boats with my old medical school but fortunately I met a friend at a pub that night or the night after, a fellow called Ken Turk who told me that he had had a similar experience and how he had dealt with it. We had been students and interns together at Charing Cross. Ken had also decided to take up pathology and following a similar rebuff to mine went to see a man called Sir Philip Panton who was working for the government, Ministry of Health I think. Panton was interested in getting people into pathology, having been a distinguished pathologist himself. He had found a trainee position in pathology for Ken at The Royal Free Hospital, one of the London teaching hospitals. Ken gave me Panton's address and telephone number, and I called him the very next day. He agreed to see me at his office in Whitehall and I liked him immensely. He laughed at the story of Charlie Vines and said that was typical Charlie. He asked me one or two questions and then picked up the telephone. I had no idea who he was speaking to, but he kept asking me questions coming from the other end of the phone. Are you married? I said "no" and he relayed the information to the person. He said "do you have any money?" I said "yes, I have some money. I have a government grant in the princely sum of ₤650 a year" - which was quite a lot in those days (about $3,000 in American currency). He asked various other questions, talked to the voice at the other end and then put the phone down. He said "you have half an hour to get to St. Mary's Hospital in Paddington where Sir Alexander Fleming is waiting to interview you. So it was Fleming that he had been talking to on the phone. I went to St. Mary's and I interviewed with Flem and he took me on straight away.
Hruban: Tell us what the interview was like?
Heptinstall: It was very short. Flem was a man of very few words. He puffed on his cigarette - he smoked an enormous amount and I told him I wanted some training in bacteriology as it was called in those days and immunology. I told him I eventually wanted to do tissue pathology; in England it was called Morbid Anatomy. So he took me on and I started working in his department just doing routine things. We weren't doing any research. I stayed there six months and then I went across the road to the Morbid Anatomy Department. It was run by a charming man called Wilfred Newcomb. I trained with "The Newks" for over 2 years and really learned everything there was to learn about tissue pathology. I did a fantastic number of autopsies, surgical pathology, cytopathology and hematology. At the end of my training I got a junior staff appointment. There was no research of any consequence going on in the department, but I was very fortunate to have met the Professor of Medicine, George Pickering, and he asked me if I would like to do a project with him which I did. Incidentally he introduced me at a later time to experimental methods. He was interested in the treatment of hypertension and he had a lot of kidneys that had been removed from patients who were thought to have unilateral chronic pyelonephritis. At that time of course, effective antihypertensive drugs had not appeared. I did a couple of papers with Pickering, one of which was a very controversial one showing that malignant hypertension could be reversed if you could reduce the pressure below a certain critical level you could stop the nasty changes going on in the blood vessels and glomeruli.
Hruban: Was that in humans or in animal models?
Heptinstall: These were in human beings. We wrote a paper with a surgeon called Dickson Wright, who had done most of the surgery, entitled The Reversibility of Malignant Hypertension. It appeared in the Lancet at the end of the year in November 1952. Ann and I lived out in the country in a place called Beaconsfield which was about 25 miles out of London. I used to travel up to London by train every day. George Pickering lived at a place called Chalfont St. Peter or Chalfont St. Giles (I can't remember which of the two) which was only about three or four miles from Beaconsfield. I was out in the garden one Saturday morning, I think I was digging up the tubers of the dahlias to wrap them up in paper and store them until the spring next year. Suddenly my wife called out through the French windows, "Pickering is on the phone and he sounds very, very angry." So I got to the phone which was really crackling; you could feel the rage at the other end. What had happened was that our article had appeared on Friday the day before and was accompanied by an editorial centered on our paper. This editorial cut our paper up. I had already read it on the Friday evening and realized the explosion it would evoke. Pickering asked what was I doing? I said I was gardening. He replied, "put your gardening off and get over here." So I got in my car, drove to his house and there he was writing at his kitchen table. He was a most fluent writer and could have been the editor of The Times quite easily. He said, "some mischief making bastard has pulled us to pieces," or words to that effect, "but here is the reply." He asked me to read it and wanted to know whether he was right on certain technicalities. I read it and found it to be an absolutely masterly rebuttal of the editorial. We both knew that it was Clifford Wilson who had written this.
Hruban: So it wasn't a signed editorial?
Heptinstall: Oh no, Lancet editorials were always anonymous and for all I know they may still be. We knew it was Clifford Wilson because he ran the rival school of hypertension in London. He was at The London Hospital while Pickering was at St. Mary's. One of the criticisms in the editorial, if I remember correctly was a conflict between our findings in man and those in the rat. Pickering ended the letter by saying, "After all, when human conditions are being discussed the evidence from man is entitled to at least a little consideration" or words like that. This has often been quoted and sometimes attributed to me. I should like to make it abundantly clear that the author of this was George Pickering and not I.

To follow with our chronology, in 1954 I applied for a Medical Research Council Fellowship to study in the United States. The Medical Research Council used to give six fellowships every year. Four of them were funded by the Rockefeller Foundation and two by the Eli Lilly Company in Indianapolis. The Eli Lilly ones were rather better - they paid you a few more hundred dollars a year and included a trip to Indianapolis. The amount was $3,900 for a year. I applied for one of the six fellowships and there was heavy competition for them. I had a very frightening interview. The committee was made up of the big men in British medicine and they were very intimidating. Anyhow, they decided to give me one of the fellowships and fortunately it was an Eli Lilly.
McCarthy What year did you arrive at Hopkins?
Heptinstall: September of 1954. I came over on the Queen Mary and then by train from New York. I got a taxi at Baltimore station which brought me to the front door by the dome. I remember very clearly standing there in the bright sunshine. Ann and I had decided that she and the three children would stay at home for a couple of months and I would come over here first and save a bit of money. It obviously was going to be difficult supporting five of us on a small salary because you were not allowed to export a single penny from England because of the strict currency regulations. Rich very kindly arranged for me to live in the residency free of charge so we were able to save quite a bit of money. In those days the residents lived in what is now the administration building – Billings Building. That is where I picked up athlete's foot that I never got rid of. The bloody showers on the 3rd floor. My next door neighbor was Jerry Spear who was a resident in pathology. Jerry as you know was a wonderful violinist and he used to play his violin for me most evenings. It was wonderful. Ann and the children came over from England a couple of months later and we went to live in a rented furnished house.
Hruban: What was your impression when you first arrived at Hopkins?
Heptinstall: That it was bloody hot, especially for September. That everyone was kind and helpful to me. That Hopkins was a bustling place with many activities, and that pathology had a high standing. Rich was in Europe when I arrived but I made friends with a young man called Fred Germuth who was Associate Professor of Pathology and doing excellent research in the immunopathology of glomerular disease. I spent the whole of my fellowship working with Fred. I did of course do some studies on blocking antibody in the Arthus phenomenon with Rich, who taught me a great deal on how to approach a scientific problem. Apart from my research I taught the second year medical students and helped the housestaff as much as I could.
Hruban: Were they competitive with what you had in England? The thought level was competitive with what you had in England?
Heptinstall: I was tremendously impressed with Rich. He was of the same mental caliber as George Pickering. Rich had a wonderful mind and seemed to me to be the outstanding man at Hopkins.
Hruban: Can you give an example of Rich?
Heptinstall: In contrast to most present day heads of Pathology Departments, Rich had a thorough knowledge and understanding of human pathology. This, coupled with his imagination, amazing visual acuity and ability to devise ways for solving problems made him what he was. Who, but Rich, would have noticed that in certain patients with what in his day was called lipoid nephrosis showed a selective sclerosis of the juxta medullary glomeruli, an observation that laid the foundation for our recognition of the entity focal segmental glomerulosclerosis as well as opening up studies on the differences in the circulation between the superficial and deep glomeruli. Notice too, that these groundbreaking observations were made on autopsy material and required no external funding. He was also a master at experimental studies such as his work on tuberculosis, serum sickness, polyarteritis and glomerulonephritis. After several weeks, Ann and the three children joined me and we spent the rest of my fellowship in a small house in Parkville. As my year came up, Rich asked if I could stay on a little longer. Ann was absolutely terrified. She thought that he was trying to get me to stay here permanently. I don't think he was, I just think he wanted me to finish what I set out to do. So we stayed on until December instead of going home in September. We went home just before Christmas 1955. That was my first experience in Baltimore. Because I had an Eli Lilly fellowship, I was allowed to go at their expense to their home base in Indianapolis. Unfortunately, I could not afford to take Ann and the family on the trip. I had a very good time at Lilly and made some good contacts there.

Oh, Something I didn't mention when we were talking about St. Mary's days. After Pickering asked me to do the work on the nephrectomies and hypertension. I told him that I wanted to learn something about experimental methods, but that there was little chance of doing anything in the pathology department. So he said that he had a young South African coming over to work with him for a year (a young man called Bronte-Stewart from Capetown) and that it might be a good thing if Bronte and I would work together on the project that he was proposing. The project was to test whether high blood pressure accentuated atherosclerosis in an experimental model. The model chosen was cholesterol-induced atherosclerosis in the rabbit. So Bronte arrived - charming young man - and after Pickering had shown us how to put silver clips on rabbits' renal arteries to produce hypertension, take blood pressure readings on rabbits, etc., we embarked on the project. We showed very conclusively that hypertension did accentuate atherosclerosis in the rabbit model. I recount this to show that I had some experience in working with experimental atherosclerosis.

So when I went to Eli Lilly and found they were interested in atherosclerosis and had produced a new compound called sitosterol which interfered with the absorption of cholesterol. They arranged for a large amount of sitosterol to be sent to me when I got back to England. I did various studies on it. My visit to Lilly also gave me a jumping off point to visit other parts of the United States. George Pickering had very kindly given me several letters of introduction to distinguished Americans and I next went to Cleveland to visit Harry Goldblatt. I had a delightful day with Harry and he took me home to dinner and asked me to spend a longer time with him at some time in the future. I was unable to do that until 1959 when I was visiting the United States from England. I spent several weeks with him and had a wonderful time. I also met Irvine Page in Cleveland and John Gofman at Berkeley. I also visited Stanford when I was on the West Coast. I went to Chicago and met Bob Kark who was pioneering the percutaneous renal biopsy, and Conrad Pirani. Then I got back to Baltimore where we had a summer vacation in Ocean City before I resumed my work at Hopkins. We went back to England at the end of 1955 and started working again at St. Mary's in January 1956.
Hruban: So at that time, what was your impression of the Untied States?
Heptinstall: Very favorable on the whole, but with certain reservations. 1954-55 was the time when Joe McCarthy was conducting his awful vendetta against anyone whose politics were to the left. I wasn't impressed with that. I was rather shocked to the find that almost anyone could buy and own a gun. I saw other things that surprised me - that there wasn't a national health service and that many people were medically uninsured. Finally, and most importantly, black people didn't have the same rights as whites. On the whole, my impressions were favorable.
Hruban: Any your impressions of the science? Were they better funded than in England?
Heptinstall: Oh yes. In England in order to get research funds of any substance you had to be a big name or under the umbrella of one. It was difficult to get started and this must have discouraged many people from embarking on a research career. It is of interest that when I did my Fellowship Fred Germuth was the only person who had a research grant in the entire pathology department. Rich used to scorn research grants. He felt you must not become dependent on the federal government. He hated anything to do with the federal government.
McCarthy Did you know his daughter, Adrienne, at all?
Heptinstall: I didn't know her. I knew Cynthia. Cynthia was his younger daughter. Adrienne had left home by the time I had got there, but I corresponded with Adrienne after I gave a talk on her father on the occasion of his 100th birthday. I had nice letters from her.
Hruban: Had she reconciled with her father by that time?
Heptinstall: I don't know.
Hruban: In 1955 did you go to journal club? Rich's journal clubs were famous?
Heptinstall: Yes. Rich's journal clubs used to be held at his house, if I remember correctly, every Tuesday evening and they were wonderful affairs. He would conduct the professional part, which took some two hours, and when that was over, Mrs. Rich used to serve soft drinks and the musical part would begin. Mrs. Rich was a terribly good pianist. Rich played the viola, Jerry Spear played the violin and there were one or two others who used to contribute. It was a wonderful evening, educational and entertaining.
Hruban: Back in 1955 when Rich was Chair, did you have a sense of him as a leader?
Heptinstall: He led by example, showing the way by his teaching, research and profound knowledge of pathology. To me, and to many others, he was the intellectual giant of his era in the entire Hopkins medical school. His basic philosophy was not to cram people with facts, but to get them to think. In this he succeeded brilliantly. Generations of Hopkins students still remember his influence on their careers. This is all the more so with those residents who trained in Rich's department. However, there is always a downside to fame and there were certain members in the department who regarded him as a god and never questioned any of his views. The exception to this was Fred Germuth who thereby gained Rich's respect. Fred was very bright and did pioneer work on the role of immune complexes in the production of glomerulonephritis. Fred was an associate professor when I worked with him and he had set his heart on succeeding Rich. In a better world it should have happened, but they decided to appoint Ivan Bennett, which in retrospect was a very good appointment because Ivan knew his way around the NIH and set the department on a modern footing. Fred left the department in 1958 but continued his research in a number of different places, although never achieving his full potential.

So I went back to St. Mary's and continued my experimental work on kidney infections, atherosclerosis and hypertension. I used this wonderful drug of Eli Lilly, sitosterol, and found that I could almost completely prevent cholesterol-induced atherosclerosis in the rabbit. I stayed at St. Mary's for the next few years doing research, service work and teaching. I applied for several chairs of pathology. In England, as you know, you have to apply for chairs. You don't get invited to them. Unfortunately I did not get one. Fortunately I received various feelers from America including an invitation from Stanley Hartroft at Washington University in St. Louis, offering me a position as a Visiting Professor of Pathology. So I came over to interview with Stanley in 1959. I used the occasion of a symposium. I had been invited to a symposium on urinary tract infections in Detroit at the Henry Ford Hospital. I got a lot done on that trip. Before the trip I had been asked whether I would be interested in the foundation chair of pathology at the newly formed medical school of the University of Kentucky in Lexington. I went to the symposium in Detroit and used that as a jumping off ground for various other enterprises. I then went to Kentucky and was treated very well and liked all the newly appointed heads of department, but I knew nothing about the politics of American pathology and funding agencies and obviously, if you are going to take over as chairman of a new department you ought to know your way around. I began to think it best to work with Hartroft so that I could learn the ropes before going on to a chair in the United States. I then next went to Duke University where Wiley Forbus was retiring from their chair of pathology. I went to Duke and had very good interviews. I loved Duke but had the same reservations as I had at Kentucky. Duke was very sensible in seeing my shortcomings and sent me a letter to that affect. They very wisely appointed Dr. Tom Kinney (a wise and experienced old hand). He did a splendid job over the ensuing years and I got to know him well. I often thought in later years how nice it would have been to have gone to Duke, just as I thought how nice it would have been to have gone to McGill in Montreal where I was considered for the Strathcona chair of pathology in either 1957 of 1958.

To continue with my trip I went to St. Louis to see Stanley Hartroft. I spent several days with him and agreed that I would accept his invitation and would join his faculty in July of 1960.

The last event on my trip was to accept Harry Goldblatt's longstanding invitation to work with him for 6 to 8 weeks. He was then running the pathology department at the Sinai Hospital in Cleveland, but still running a productive research lab. We had a wonderful time together and he taught me countless experimental procedures and his general philosophy of hypertension. I literally lived with the pioneer of experimental hypertension and profited enormously. He was one of my scientific fathers and we became lifelong friends.
Hruban: What kind of person was he?
Heptinstall: Wonderful! Harry Goldblatt was every bit as bright as Rich, but a much more retiring sort of man. He was American but went to medical school at McGill in Montreal. Because he had been a medical student at McGill, he qualified for what was called a Beit fellowship. Beit was a partner of Cecil Rhodes (who endowed the Rhodes scholarships) in South Africa; he made a great deal of money in gold and diamonds. And like Rhodes, set up trusts to educate young people. Beit fellowships were open to people who had been to British Commonwealth Universities to go and study in England. So Harry, even though he was American, qualified for a Beit and went and spent two years at the Lister Institute in London, working on what was then called the anti- rachitic factor which later became known as Vitamin D. Harry did what he considered the most distinguished work of his career on this topic. His two years at the Lister being up, he went to work with Bayliss - a great physiologist working at University College in London for six months. So he then went to work with Bayliss who taught him techniques and tricks with dogs and different laboratory animals. When he finished with Bayliss, he went to spend a year with Erdheim who was the greatest pathologist in Vienna at that time.
McCarthy Did you ever meet him?
Heptinstall: No. He was before my time - a whole generation. He told Harry that there wasn't much he could teach him in the time available, but at least he could teach him to speak and write German. To that end, Erdheim suggested that Harry write a monograph of all the work he had done on the anti-rachitic factor and rickets in general in German. It appeared in the Ergebnisse der Pathologie back in 1931. It is a classic work and Harry told me an amusing story about it. Apparently Harry was at a dinner and sitting next to Fuller Albright, the great sage of Boston. Albright said, "You know Goldblatt, I have just read a superb monograph written in German by a man with the same name as you on rickets and the anti-rachitic factor!" Harry just smiled and said, "It was I." How lucky I was to have met such men as Newcomb, Pickering, Joekes, Rich, Germuth and Goldblatt who did so much for my education.
Hruban: Let's go back because we still haven't talked about your work with Marc Joekes.
Heptinstall: By the time I got back to England in January 1956 and started working again at St. Mary's, Joe (as he was always called) had just done a handful of biopsies. He had got Ken Porter who was a little bit junior to me to look at these biopsies. Ken had gone shortly after to work at the Brigham in Boston. So Joe asked me if I would like to take over the pathology on this biopsy service, which I did. Joe and I continued our association until I left for the United States in 1960. He was a most charismatic man with a profound knowledge of the kidney and a wonderful sense of humor and fun. We got on together splendidly.
Hruban: Where was the first kidney biopsy in humans?
Heptinstall: It is not really known who did the first kidney biopsy. Using it in a systematic way it was either a man named Nils Alwall in Sweden or a pair, Pol Iverson and Klaus Brun in Copenhagen. The story goes that Alwall tried a few, but when one of his patients developed a nasty hemorrhage he abandoned them. Iverson and Brun did very large numbers and they usually get the credit for being the first to put the percutaneous needle biopsy on the map. Word of this technique gradually spread and two people at the VA Hospital in Washington, DC - one was an old Hopkins pathologist: John Howe. Alvin Parrish and John Howe did the first biopsies in the United States. They were soon overshadowed by a group from the University of Illinois headed by a South African named Bob Kark. Bob Kark was primarily a liver man. He had done a lot of liver biopsies and immediately saw the potential of the renal biopsy. In short order he got together a team made up of Bob Muehrcke who did the actual biopsies, Victor Pollack, a young South African who handled the clinical side, and Conrad Pirani from the pathology department who interpreted the biopsies. Between them they did an incredible amount of work and showed the enormous potential of the renal biopsy. This group really put the renal biopsy on the map. Kark sent Bob Muehrcke to spread the gospel to England; this was while I was over with Rich. Bob Muehrcke went to St. Mary's and gave a demonstration to Joe and taught him how to do a renal biopsy. So that was how Joe came into it and in short order became adept at doing biopsies. He and I did very large numbers. We wrote quite a lot of papers on various renal conditions.
Hruban: I'm still curious about your impressions of Hopkins back in the 50's. What about people outside of the department - who did you meet?
Heptinstall: I got to know a lot of people mainly in the Department of Medicine and Surgery. On a regular basis I used to go to Medical Grand Rounds and the meetings of the Hopkins Medical Society. I saw people like Lock Conley who was head of the Hematology Division for whom I developed a tremendous admiration. Ivan Bennett, head of Infectious Diseases, was a very impressive person. Mac Harvey, who was head of Medicine was very bright although somewhat retiring. He used to do the CPC's with Rich. There was an absolutely wonderful chief resident in medicine that year who impressed me a great deal - a man by the name of Lee Cluff. I used to go on the rounds he did with the Osler housestaff. Lee became the head of medicine at the University of Florida and I think he took over from Dave Rogers as head of the Johnson Foundation at a later time. Lee was a brilliant teacher and he really brought one up to date on internal medicine. There were also some good young people like Dudley Jackson and Henry Wagner. Others didn't really impress me as much. Although St. Mary's was much smaller on a proportional basis, Pickering's medical unit could match the Hopkins internists. The big difference was the number of conferences and opportunities for discussing and disseminating knowledge. Academic surgery was more advanced at Hopkins, but I did not have time enough to go to their conferences.
Hruban: The path department must have been very small, right?
Heptinstall: The pathology department was smallish, but it did a lot of work. In those days they used to do 850 to 900 autopsies a year. It didn't do as many surgicals as now and of course it did not do gyn pathology because Woodruff from the gyn department used to do it. There was a tremendous amount of teaching with this relatively small staff. People worked very hard and everyone including the housestaff was involved, but they loved teaching because Rich set the example. There were few senior people of whom Ella Oppenheimer stood out. She was the main bulwark of the department and gave years of service. City Hospital pathologists also taught of whom Abou Pollack was the most effective. The housestaff, with a few exceptions, were very good. The chief resident, who shall remain nameless, was a dummy, but Ed Andrews was excellent and eventually became President of the University of Vermont. Jim Shaka was excellent and became a great friend. Sumner Wood was already showing great promise in research, and Jerry Spear and Jack Yardley went on to have successful careers in pathology. There were plenty of conferences and the intellectual environment was good. On the whole it was a very happy and cohesive department.


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