Watts, James: Oral History, January 25, 1979

From GWUEncyc

Faculty

Oral History Committee
George Washington University Medical Center

Dr. James Winston Watts, M.D.
Interviewer: Thomas M. Peery

January 25, 1979

Dr. Peery: Jim, to get the record started, suppose you tell us something about your family, your ancestors, your home and your boyhood in Lynchburg.

Dr. Watts: Tom, my family as far as we can determine, originated from a Scotch/Irish minister who came here in the latter part of the nineteenth century. I don't know much about the people in between, but my grandfather was born in Bedford County and then he moved to Lynchburg, Virginia. He was in the Civil War, served under General Turner Ashby, became a colonel, and after the war, he and his brother owned a hardware store. My father, Thomas Ashby Watts, was named for General Ashby. My father was a banker first and then later Secretary Treasurer of the Lynchburg Perpetual Building and Loan Company in Lynchburg.

When I filled out my first application to go to VMI I knew Father went down to his office regularly, but I did not know exactly what his business was. I said "Father, what do you do? I've got to put into this little slot what your occupation is". He says, "I am a capitalist." I said "Father, what is a capitalist?" He said, "A man who lives off his capital." I used that in every application I filled out. Mother's father was a physician, a family physician, but he died in his thirties of tuberculosis.

We lived in Lynchburg, Virginia. Lynchburg is on the James River. It was a city of 30,000 people and at one time during World War I. Father told me it was the second richest city per capita in the United States. This wasn't based on industry in Lynchburg because there weren't many industries. The largest were Craddock Terry Shoe Company, Lynchburg Foundry, Glamorgan and a few tobacco companies. The wealth was based on investments that Lynchburg people made in West Virginia and Kentucky coal. My home was on Washington Street. It was a big, old, red brick house which is now known as the Babcock-Watts house. Now the neighborhood is being renovated and restored. Babcock was a United States congressman and built the house. Julia Meem Harrison, whom I later married, lived on the same street in Lynchburg about one block away. We thought Lynchburg had everything that any city could have with the possible exception of Broadway, where there was the theater.

Since I’ve been on the oral history committee, it’s made me think back and realize that the people who had the greatest influence on me were Father and Mother. I went to public schools, to primary and grammar school, and to high school, but I don’t remember being influenced by a particular teacher. I thought they were good but as individuals, I don't remember much about them. Mother ran the home and as Lord Bryon said, “A man is the head of the house, but the woman is the boss.” and Mother certainly was the boss. Father didn’t like to discipline us, he turned over the entire running of the home to Mother. If we got into any trouble Mother came to our rescue. There were three sons, James, Ashby and Hubert. I was named for my grandfather, Ashby was named for our Father and Hubert was named for my Father's brother. It may tell you something about us; our first son was named for me, our second son was named for Julia's father, Randolph Harrison. Our grandchildren are named James Winston Watts IV, Randolph Harrison Watts, Jr., Julia Harrison Watts, and Ann Randolph Watts. We must have some pride in the family and like something about the families. I would like to tell you something about my wife's family. She's descended from Pocahontas and John Rolfe. Benjamin Harrison was signer of the Declaration of Independence. She had two Harrison presidents in the family. Her father was a distinguished lawyer and was counsel representing Virginia in the Virginia/West Virginia debt case. Virginia was suing West Virginia when West Virginia seceded from Virginia. Virginia sued to make West Virginia pay its share for roads built when they were a small state. The case was in litigation twenty years, and Mr. Harrison won the case.

Now, I must mention Dr. George M. Preston who was our family physician. Dr. Preston was a general practitioner who also did surgery and gynecology. We had the greatest confidence in Dr. Preston. One thing impressed me rather early. Mother would get worn out from time to time and feel so badly that she had to stay in bed. That naturally upset Father, so he’d call Dr. Preston. We could hear Dr. Preston’s car approaching the house a block before it got there. I think you’ll remember in those days when a car was in low gear it made a grinding sound. Dr. Preston drove in low gear because he didn’t learn to drive until he was an older man. When he was driving, if he passed a lady, he’d take off his hat to her. As a result he had several minor accidents, so he always drove in low gear when he was in the city. When he went on a trip, he shifted to high gear. But we could hear Dr. Preston’s car driving up to the house; then he’d walk up the flight of wrought iron stairs and ring the bell. Father would let him in. Mother had been telling father how badly she felt, but then when Dr. Preston got up to her room he’d say, “Mrs. Watts, how do you feel?” and Mother would say, “Why I feel fine”. Father never, never did understand that.

Father often felt badly. He’d had tuberculosis at one time and he had rheumatic heart disease. When I examined Father I could hear murmurs over every heart valve. Father didn't like to go to church, he always said he felt too badly to go to church. He said he felt too badly to go to funerals. I recall one time Father said, “Fan”, (he called my mother Fan). Her maiden name was Fannie Crenshaw Cheatwood. “Fan, I wish you'd go to that funeral in Lexington, my cousin Captain Steel died.” Mother said, “Ash, I'm sick and tired of going to your family’s funerals.” He said, “Fan, I just feel entirely too badly to go to that funeral.” And so mother said, “Well, what will you give me to go to that funeral?” Father said, “I'll give you one hundred dollars.” Mother said, “I'll go.” I'd heard this conversation so when Mother said “James, will you drive me to Lexington funeral?” And I said “Mother, what will you give me?”, she said “Ten dollars.” I said “I'll go.”

To get back to Dr. Preston. Dr. Preston to me was a very remarkable man. He left me his surgical instruments and he left me a library which dated from 1870 up until about 1931 or 1940. It was he, who aroused my interest in Neurosurgery. When I came home from medical school, I used to make rounds with him to see his patients and watch him operate. He was Chief of Staff at the Memorial Hospital in Lynchburg. He was very meticulous, never liked to get his hands dirty, he wore rubber gloves when he’d change a surgical dressing, wore rubber gloves when he'd pass a stomach tube. He said, “You should never let your hands get dirty.” I think that made me pretty fussy about some things too in later life. I'll tell you more about Dr. Preston later.

Dr. Peery: Jim, that family story of yours, the history that you’ve accounted, showing a deep love of family and pride in family, is a great thing to get on the record. It certainly contributed, I’m sure, to a stable life on your part and on Julia’s. I wonder, did you always live in that big house in Lynchburg or did your family move about a bit, I think this is another factor in stability.

Dr. Watts: Tom, we lived in the same house until father’s death in 1937 and then mother moved to an apartment on Rivermont Avenue that was a newer part of town. I would like to tell you one more thing about our home. Mother loved young people. When I came home on furlough from VMI, I usually brought one or two of my roommates and we had some of the girls we were courting from out of town stay in our home. Mother loved to make matches. When a couple began to look serious, one that Mother had been encouraging all along, but then as it began to get serious, she’d remind them that the first match she’d made, the husband committed suicide.

Dr. Peery: That’s sounds to me like a wonderful start for a professional career. Jim, did you ever have a job as a boy at home or in high school or college?

Dr. Watts: Tom, I never had a job. Father was satisfied if I made good grades in school and he was very dissatisfied if I didn’t, and he had real good ways of showing it. When I was in college and wanted to borrow the family car, when I had girls up to the dances, if I was doing well in school, he allowed me to have it. If I didn’t do well in school he’d say “James, I think you are running around too much, you are not studying”, and I didn’t get the car. He never would give me an allowance. I said, “Why, Father?” He said, “Well, I gave your mother an allowance and she just spends it, and then when that runs out she overdraws her account at the bank”. He never would give me an allowance, I had to ask him each time I wanted some money, and I’d ask him usually at the time of the dances.

Dr. Peery: Well, again, that sounds like a good way to bring up a child. I bet you asked for the money just as often as you needed it then. Now to go on from there, Jim, and get into your college years, what influenced you to go to VMI rather than say, the University of Virginia, or to one of the other colleges which were fairly numerous in that section of Virginia?

Dr. Watts: Tom, the influences that are brought to bear on us seem to me rather subtle. Father used to tell me about his brother, Hubert who graduated at VMI. I knew Uncle Hubert because his wife died rather young and he used to come over to Sunday dinner with us. Everything that father said about Uncle Hubert made him sound like a very fine man, a man with a lot of spirit. Uncle Hubert graduated at VMI. Father told me a story about a duel Uncle Hubert had when he was a cadet. A big cadet was hazing or harrassing a smaller cadet and Hubert said, “Stop picking on that little boy”. The other replied, “I suppose you are big enough to do something about it”. Hubert allowed he was. As a result, there was a duel. Nobody was killed or anything like that. He told me about another incident somebody picking on Uncle Hubert. Uncle Hubert picked up a pine knot, knocked him in the head and knocked him out. Now that kind of appealed to me. I suppose in growing up we feel insecure or sensitive and there was a saying around Lynchburg that VMI will make a man out of you. And that kind of appealed to me too.

Dr. Peery: Just for the sake of the record, if there is anybody so ignorant that he doesn't know what VMI stands for it is, of course, the Virginia Military Institute. Did the military life appeal to you specifically, Jim?

Dr. Watts: Tom, I suppose if you told somebody that the military appealed to you, that you enjoyed it, they'd think you're a nut. Getting up for reveille at 6:15 a.m., drilling in the hot sun and drilling in the bitter cold weather. There was something rather satisfying about it. We often think about the past and talk about the good old days and we seem to take pride in some of the adversities, and some of the obstacles that we’ve overcome. I’d like to tell you just a little bit about barracks life. I went to VMI in 1920, which was just two years after World War I. You approach barracks through the Washington and Lee University campus. Washington and Lee campus is a beautiful campus with colonial buildings, great white pillars, shade trees, grass; you come upon the parade ground and there you see the VMI barracks, and it is rather stark in appearance. It’s built in a quadrangle and inside there are what you call stoops or porches. Stairs go to the fourth stoop in each of the four corners of barracks. On each floor in each of the four corners was a cold water spigot and a basin; there was no running water in our rooms except a small section of new barracks for first classmen. We had a wash basin, a two gallon bucket; we filled that at the cold water spigot and then we had a second two gallon bucket which served as a slop-jar. We shaved in cold water; a good many times I found ice frozen on the pail of water, I had to break the ice to wash my face. I don’t see how you could say you really enjoyed that but there is a certain pride in having gone through that kind of discipline. Now, we did have warm water to take a shower in the “sinks”, that was in the basement, so when you wanted to go to the toilet or take a shower and your room was on the fourth floor, you had to get properly dressed in uniform and walk down four flights of stairs.

Dr. Peery: That reminds me of the days at George Washington Medical School on H Street prior to moving to the new building. The toilets were on the first floor, except for the ladies toilets which were on the fourth floor. The freshman students in anatomy on the fifth floor had to go back and forth from the first floor. During examination there was always quite a rush there. You spoke of having a bucket of water as a slop-jar. Now is that the same as having a chamber pot in your bedroom?

Dr. Watts: It’s a combination of a chamber pot and then it was used after you washed your hands and face or shaved you’d just dump the dirty water in this slop-jar, and then when it got full you’d take it out to this basin in the corner of the barracks and empty it, and at the same time you'd fill up your clean two gallon bucket.

Dr. Peery: I trust the barracks were centrally heated.

Dr. Watts: Yes, the barracks were centrally heated. We were required to keep the door wide open at night and we had french windows which occupied the greater part of the wall opposite the door and we had to have those open. I think we were talking the other day, you asked me whether I’d ever had snow on my bed. Several times I’d awaken with snow on my blankets in the morning.

Dr. Peery: Well it sounds to me that life at VMI was somewhat different from present day college life as I heard it from my daughters and as I hear it from even younger friends now. Jim, do you recall any specific happenings during your college years that you want to tell us about, maybe they made some special impression upon you or maybe it was something that just to show that there was some vigor in the old fellow, anything of this sort that you want to get on the record?

Dr. Watts: Tom, there are several things that made a great impression on me. In May of 1922 I was a third classman, that is a sophomore. Tattoo had sounded, that meant that there was release from quarters and we could leave our rooms and wander about the stoops; you could hear the men talking on the stoops, hear the footsteps on the stoops, people were running around to see their friends. It was a balmy night, there had been tension in the air for a couple of weeks because one of our self-assigned tasks had not been completed. Then there was a sound of a thud in the courtyard. The sentry in the courtyard said “Bombs are falling.” Within a matter of seconds there was another and another and another, I don’t know how many, but within about a minute you could see about a dozen fuses of about a dozen bombs smoking. Then what seemed like a long time the bombs began to explode, one after another and the concussive effect was tremendous, it blew out hundreds and hundreds of windows, there were fragments of bombs flying around, and the wire and some would get stuck in the walls and go through the windows. Of course, as soon as the sentry in the courtyard and sentry on the first stoop heard these things and announced that the bombs were exploding, everybody scattered and dove for his rooms and within a few minutes the class of 1924 had completed its task and thrown its 24 bombs.

Dr. Peery: You mean the bombs were thrown by the students? I thought something was falling from the sky.

Dr. Watts: At a recent reunion, the Commanding General at Fort Meade, a VMI graduate, recalled that during World War II a newspaper article came out and it said soon bombs would be falling in Britain, bombs would be falling on Berlin and bombs would be falling in the courtyard at VMI. There was a tradition that each class throw the number bombs, for example the class of ‘24 would throw 24 bombs, the class of ‘16 threw 16 bombs and this went on until around 1941 when one of the cadets was injured and lost his eye.

Dr. Peery: In a given year, all four classes wouldn't throw bombs, would they?

Dr. Watts: The bombs were always thrown by the third classmen and these bombs were made in a special way. They put three pounds of black powder in a Prince Albert pipe tobacco can, and then the can was wrapped with black tape, then with wire, then with black tape, then with wire until it got to be about the size of a man's head. The fuse was planted in there at the proper place and it was measured so that it took three minutes to go off, that gave everybody a chance to get into his room and get out of the way. It didn’t seem quite fair, but whoever was on guard duty was thrown off guard, got a neglect of duty for not preventing the bombs from being thrown.

Dr. Peery: What class served as guards and sentrys? Were they all classes or were there sophomores out there too?

Dr. Watts: Yes, all classes. Sometimes there were rats (new cadets), other times there might be third, second or even first classmen.

Dr. Peery: Did all the members of the senior class get involved in this?

Dr. Watts: No. Men who threw the bombs were the Certified Thirteen; they were referred to as the “CT's,” they were third classmen (sophomores) and as I think back on it and to use a term that’s used now, they were the "good old boys." They were appointed by the “CT's” of the previous class. It was a great honor. To get back to my story, it was at 9:30 and that's when the bombs were thrown; by taps, taps was at 10:00, by taps everything was quiet and all the cadets in their rooms except a few. I found myself in the guard room with three of my classmates. We'd been reported by the officer in charge, who claimed that he’d seen bombs thrown from our rooms. It happened to be my turn to serve as “orderly” of my room that week. The orderly is responsible for any breach of regulations if the culprit cannot be identified. So we were marched over to the superintendent's house at midnight by two guards with fixed bayonets. We would refuse to answer all questions.

Dr. Peery: Jim, now let's turn to medical school. How was medical school different from VMI?

Dr. Watts: Quite different from studying most of the things that we studied in military school. Neuroanatomy to me, was particularly difficult as it was taught in my school. Was that the case with you? You know I wonder how I got through medical school. Neuroanatomy was taught by Dr. Speidel, incidentally, Dr. Speidel is still living in Charlottesville. Our first quiz had ten questions—it seems to me all of our examinations were quizzes of ten questions—and he asked, gave us a list of pathways and asked us to state whether they were efferent or afferent. I must not have been paying attention then ‘cause I didn’t know what efferent and afferent was, so I got 50 on that one. I think neuroanatomy is difficult.

Dr. Peery: Jim, I don’t see why we should have any trouble with efferent and afferent. If you just take the name and write spinal cord the thing that comes first is where it comes from and the thing that comes second is where it goes to, so that would be efferent since its going toward the thalamus and that would be going centrally and it would be afferent.

Dr. Watts: Tom, you may have understood all those things when you were in school. It took me a while to catch on to these different terms and methods. When I did though, I think I learned but I didn’t get it in the beginning.

Dr. Peery: Then you did all right from the fact that you were Alpha Omega Alpha and so on. Let me tell you one of the episodes from my class in anatomy, if you don't mind the interruption. We had one chap in my class who was worse than any of the rest of us and he just couldn’t seem to learn. One day the professor thought he’d ask a very easy question. He said, “MacMillan, what is the location of the sixth intercostal space?” And, of course, the interspaces are numbered after the ribs and he thought that would be just a dead winner, easy question for Mac. And somebody sitting beside MacMillan said, “The tenth, the tenth rib”. And Mike said, “Below the tenth rib, Dr. Phillips.” And, of course that didn’t do very well.

Dr. Watts: We’d heard that the second year was much more difficult than the first, chiefly because we had Harry T. Marshall who was Professor of Pathology and very strict and demanding man. Actually Dr. Marshall had a conviction that nobody could take part in athletics in medical school. And we had a man a few classes ahead of us who was a star football player, and Marshall never would pass him, he never did pass him. He went to Harvard to summer school and made a good grade, and finally the faculty had to step in and pass him over Marshall’s objections. Marshall made it very difficult for us. I don’t know where Dr. Marshall was from, it just seemed to us that he’d always been there. I thought pharmacology was difficult. We were supposed to memorize the dosages and uses of some 500 drugs, which was an impossible thing.

The Professor of Bacteriology did something that made a tremendous impression on me that I’m sure influenced me in some of my attitudes and was a real simple experiment. He brought us into a lecture room and there was a platform and a podium and he put agar plates on the seats on the first row and the fifth row and the eighth row and had a student get up and talk in a normal voice. At the next session, I guess it was a couple of days later, there was no growth on any of the agar plates. He had another student, maybe the same one, get up and talk in a loud voice. There were colonies on the agar plates on the first row. Then he got someone to cough and brought those plates back and there were colonies on the agar plates on all three rows. And I came to the conclusion then that when people are coughing and sneezing, that’s when they spread infection, and I never would let anybody into my operating room who had a cold. I’ve had fights with operating room supervisors about that, I’ve thrown assistants out, nurses out, antagonized the operating room supervisors but I simply wouldn’t permit it.

In the third year we were in the outpatient department. The students were assigned to the outpatient department and the fourth year we were assigned .to the wards. It seemed to me that even at that time that that was the wrong way to do it, because you had much more supervision on the wards, so much more time than you did in the outpatient. But anyway, that's the way we did it. It seems to me that the fourth year was a repetition of the third year. In most cases, heads of departments at University of Virginia did the teaching on the wards. Dr. Steven Watts taught fourth year students, Dr. Goodwin taught fourth year students, Dr. Bigger, who later went to Medical College of Virginia as chairman, taught us. It wasn’t handed down to the instructors. Dr. Flippin, who was Dean and Professor of Medicine, was active in teaching students and holding clinics. We felt that we got the top people in school teaching us.

Dr. Peery: Jim, do you recall any particular patients or any particular clinics that made a special impression on you in the last two years?

Dr. Watts: I was a student intern during my fourth year from Thanksgiving until graduation, and I was assigned to Pediatrics and enjoyed that very much. I was impressed by Dr. Steven Watts at lectures, he made everything rather simple. He liked abdominal surgery, and almost everything that he taught seemed to follow what I often think of as the Mayo Clinic method. Everything has four symptoms and four signs and he made it very easy to take notes and by the time I got to be a fourth year student I was pretty good, I made A+ on five subjects that year. Internal Medicine was a little too big for me, there was too much to know in medicine; surgery is much simpler, I think.

Dr. Peery: What would you say were the major differences between medicine as it was taught at the University of Virginia in 1924-28, while you were a student there, and medicine as it was taught at GW Medical School when you came here in 1935?

Dr. Watts: Our knowledge of what went on at GW was fairly limited to neurology and neurosurgery, except for the clinical pathologic conferences. I used to attend some clinical pathological conferences at GW and thought they were really very fine, the students enjoyed them. Dr. Bloedorn used to hold some of those conferences, I think, and Dr. Choisser was present. I can't remember CPC's in Charlottesville. I remember Dr. Flippin’s medical clinics and they were well attended and interesting and informative. Steven Watts taught in lectures and in ward rounds and he had an attitude that I liked. He didn’t say this in say one round, but he was always satisfied with what he did in the sense “I operated on this man and he recovered,” or “I operated on this man and he didn’t really improve and I gave him the best chance he had,” “Unfortunately, I operated on this woman and she died, but if I hadn’t, she’d have died anyway.”

Dr. Peery: In your medical school days, Jim, do you recall any competition for grades or was it just sort of you did the best you could?

Dr. Watts: There was tremendous competition for grades, particularly those in the upper third of the class. Half a dozen men were trying very hard to be number one in the class. If you were number ten, you were trying to be number one. You knew what everybody was making and you were trying to beat him. But those of us who were competing with each other in that way were the best of friends. They were all friends, the people who were close together in the class and the people I see at reunions, most of them happened to be in the upper third of the class.

Dr. Peery: Jim, was there any cheating at Charlottesville in those days?

Dr. Watts: We lost one man in our class. There were two brothers in our class and one man was caught cheating and was dismissed in his third year. It’s the only incidence that I know of. Now, we had the honor system at the University of Virginia and we could (for example, the instructor or professor would be in the room part of the time but he wouldn’t be in the room all the time) we could just get up and go to the toilet without saying anything to anybody. We took a precaution, I don’t think anybody told us, but two of us wouldn’t go out together, just one person would go out to the toilet at the same time. I thought the honor system was really superb.

Dr. Peery: As I remember, there was also a rather strict dress code. What did the student’s think of that?

Dr. Watts: It was strict in the sense of a tradition. I don’t know whether you’ve thought about it, but I think tradition is stronger than law. For example, all of the students wore dark suits. They all wore ties, they didn’t even wear sports coats. I remember one time, I must have been in a hurry, I went to class, and when I got to class I found out I didn’t have a tie on, and I put my handkerchief around my neck and just told people I had a sore throat, I was so embarrassed by not having a tie on.

Dr. Peery: Was that dress code throughout the University or just in the medical school?

Dr. Watts: That was throughout the University. We called the undergraduates “college boys.” The college boys were dressed better than we could, because we had to go to the anatomy lab and the cadavers were not refrigerated at that time, so the odor of the cadavers got into our clothes. Of course, we wore lab coats to anatomy. We wore black dinner jackets, we wore what is often referred to as a “Boiled Shirt,” that is a stiff tuxedo front and bat wing collars and everybody wore exactly the same thing. At dances, oh yes. But to the classes, everybody wore dark suits.

Dr. Peery: I personally think that really adds something to the educational environment but it’s a very good thing. Jim, did you take National Board, Part One while you were at Charlottesville and was this a common practice at that time in Charlottesville?

Dr. Watts: Yes, I did in 1926 or 1921. Dean Flippin asked seven or eight of us if we’d be willing to take the National Board. University of Virginia students had not taken it before and when he asked us to do it, we went ahead and did it and we passed it. He selected those in the upper third of the class and it was a rather interesting experience. I don’t remember Part Two as well, I thank we must have taken that in Charlottesville too. I don't have a distinct recollection of Part Two, I do remember Part Three. I decided to wait until it was given in Boston. It was going to be given in Chicago and I didn’t like to go to one of those places I didn’t know anything about, so I took it in Boston and I remember that very well. We actually did an operation on a cadaver for hernia as a part of our examination. I was pretty cockey at that time, for in closing the incision, they just gave us some silk sutures and the examiner said “What suture material would you use?” And I said, “Black silk, sir”, I always said “sir”. He said “I mean, if you were doing this on a patient?” I said “Black silk, sir”. “Thought you’d use cat gut, wouldn’t you?” I said, “No sir”. You see that was a Halsted technique and Dr. Goetsch, my chief had been at Hopkins with Halsted and used the Halsted technique so we closed with black silk. Taking the exam in medicine, I recall, the examiner said “Dr. Watts, where are you from?” I said “Virginia, sir”. And he said “Oh, well tell me about malaria”. I said “I’ll be glad to tell you about malaria, sir, but we don't have any in Virginia”. He said “Well, tell me about syphilis, I guess you have that down there, don’t you?”

Dr. Peery: Getting back to the National Board, Jim, I remember you were very active in the examination in Part Three at GW for many years. Would you compare the National Board Examinations when you took them in Virginia and when they were given later, your experience with them later?

Dr. Watts: Tom, I did not take Part Three in Virginia; I took it in Boston. My role in the National Boards in Washington, I should say, that Dr. Bloedorn was Chief Examiner and then I was the Secretary. At that time, we gave thirteen different examinations and it fell to me to chose the examiner in each subject. I did it in consultation with Dr. Bloedorn. We had a good many George Washington and Georgetown men, I suppose almost all of them were from our faculties. Most of it was done at the D.C. General Hospital. Actually, I took very little part in examining students. My work was primarily administrative. What I did was to record the results and send them in to the headquarters in Philadelphia. This lasted over a period of years. I don’t think I’m making very good comparison or contrast between the examinations at the two different periods. One thing happened that amused me a little bit. After sending in the grades one year, to Philadelphia, which was the head office, I got a letter saying “You’re failing too many students.” Another year I got a letter saying “You’re passing too many students.” So, I wrote Dr. Elwood, or his successor, and I said, “Please tell me exactly what percentage you want failed and I’ll see what we can do about it.” I never heard anymore from him.

Dr. Peery: Jim, Charlottesville in those days was a small town, not even the city that it is today. How did you, what you did think of life in Charlottesville, would you have liked that as a future life for yourself?

Dr. Watts: Tom, I thought it was an ideal place to live. The University is a perfectly beautiful place to begin with.You may know the Rotunda and a number of buildings were designed by Thomas Jefferson. The Farmington Country Club was designed by Thomas Jefferson and there were homes around for which he was the architect. His influence prevaded the whole community, and still does and he is known as Mr. Jefferson and is always referred to as “Mr. Jefferson.” I think on his tombstone he had three things: Founder of the University of Virginia, Signer of the Bill of Rights, Writer of the Declaration of Independence; he didn’t mention being President of the United States. But it’s a delightful place and actually I tried to get a position in Charlottesville. Every year I’d go back and I’d meet Dean Flippin when he was Dean, and later on when Dr. Jordon became Dean, I’d go back and try to keep up my contacts. They had no neurosurgeon there, but I would have enjoyed living in Charlottesville.

Dr. Peery: How did they get enough patients to teach all of the medical students in such a small town as Charlottesville?

Dr. Watts: They came from all over Virginia and West Virginia and the hospital was always full, no problem about patients. Of course, many of them were what we would call “Staff Patients,” they were just under the care of the physicians on the staff.

Dr. Peery: There were both private and the staff patients then. Jim, I wish you would tell me something about your classmates. Did all of them plan to take internships after graduation? The state laws, in those days, were different than they are now, I’m sure. Do you remember what portion were planning to go into private practice?

Dr. Watts I’m confident that all of them took an internship. I really don’t have any figures on it, except for those who are surviving now, but I think about a third went into general practice, and then it was scattered over the various specialties. It’s interesting the way one member of the faculty aroused the interest of some of us. We had a Dr. J. Edwin Wood, who was a cardiologist, and Wood and several other members of the staff had been residents with Dr. Paul White at the Massachusetts General, so some of our men went to Massachusetts General and spent some time with Paul White. Others naturally, went into surgery and other specialties.

Dr. Peery: Did most of the members of your class go into private practice, solo practice, or were there some of them that went into academic medicine, as it is commonly known?

Dr. Watts: Those were the days, I think, of solo practice, and I think many of them went into solo practice. But we had, for example, about four of the men who were in the upper part of our class who went to the Virginia Mason Clinic in Seattle. One became Chief of Surgery and Chief of Staff; one became Chief of Orthopedics, one became Chief of Medicine. Those men are also on the faculty of the medical school in Seattle.

Dr. Peery: That sounds sort of like a transplant of the University of Virginia to the northwest. I think we can all quickly see that a good many people at Charlottesville were transplants from John Hopkins, isn’t that correct?

Dr. Watts: Yes, I don't know where all of them came from, but Hopkins did have a tremendous influence, because Steven Watts spent seven years in residency in Hopkins and came down as Chairman of the Department in 1918 and he did General Surgery, which in those days, for a while meant Urology and Orthopedics and Gynecology, and he might have done a few heads too. I know the man who succeeded him did some cranial work.

Dr. Peery: Jim, how did you go about seeking an internship? What sort of guidance did you get from the faculty and just how did you do it, did you take a trip to visit them, and so on?

Dr. Watts: We didn’t have any faculty advisors, if that’s what you mean. We usually talked to the men in the class ahead of us and then if we wanted some help, we would go to the Dean and the Dean was always available or we would go to, I’ll mention for example, J. Edwin Wood, the cardiologist. Some people admired him very much and sought his advice. Dr. Preston, our family physician, aroused my interest in neurosurgery and it came about like so many things do. You know somebody that knows somebody and one of our neighbors on Washington Street was Henry Christian. Dr. Henry Christian was Chairman of the Department of Medicine at Harvard and Chief at the Peter Bent Brigham Hospital. Steven Watts went to Randolph Macon College in Ashland near Richmond with Henry Christian and Dr. Preston was a cousin of Henry Christian. Dr. Preston asked me if I'd ever thought of going into Neurosurgery and I said “I hadn’t thought about it, but it sounded interesting”. There was a story told that when Dr. Adson was asked by Dr. Mayo to start a neurosurgical service in Rochester at the Mayo Clinic, he said that he did not know whether there was a need for another neurosurgeon because there were already four neurosurgeons in the United States!

Dr. Watts: Dr. Harvey Cushing, who is the best known neurosurgeon in the world was Chief of Surgery and Neurosurgery at the Peter Bent Brigham Hospital. He was also Professor of Surgery at Harvard. Dr. Preston said that he could get me an appointment as a clinical clerk between my third and fourth years at the Brigham on Dr. Christian’s service, so I went to Boston and went on Dr. Christian’s service. I stayed on there about ten days, but what I really wanted to know was what Dr. Cushing was doing, so I got permission to transfer to Surgery. I transferred to General Surgery, I spent another ten days on General Surgery, and I guess by that time I thought I knew enough.

Dr. Peery: Now, you're talking about the period between your third and fourth year, that you were a student, that you were there as a student clerk.

Dr. Watts: Yes, I was a student, a student clerk and then I spoke to Dr. Cushing’s resident surgeon, Dr. Hugh Cairns (who later was knighted for his work at Oxford and became Sir Hugh Cairns) and I told him I wanted to assist Dr. Cushing and he said “All right, be in the operating room at nine o’clock tomorrow morning.” While we were scrubbing he said “How much experience have you had in surgery?” and I said rather proudly, “Ten days, sir” and he said, “And you want to assist Dr. Cushing?” I said, “I certainly do.” And he didn’t know whether to take the risk of throwing me out and getting somebody who had been on longer and risk Dr. Cushing’s ire at not finding his two assistants gowned and gloved when he came in. So he let me stay. And so then I was Dr. Cushing’s second assistant. The intern passed instruments, there was one nurse, she had the table set up, she made cotton patties and threaded needles, but the intern passed the instruments and a student was second assistant. So I assisted Dr. Cushing in about ten craniotomies.

Dr. Peery: Jim, as second assistant, would you stand on the same side as Dr. Cushing?

Dr. Watts: Tom, you’re thinking about an abdominal operation or a chest operation. With operations on the head, the surgeon stands at the head of the table in the middle and first assistant stands at his right and the second assistant stands at his left. Actually, it may seem a simple thing to you, part of the time I was pulling the needles through, these rounded needles and that requires a skill. I came into a little criticism about that, these were very fine needles and you were liable to break them, personally I didn’t break any. While I was there General Wood was operated on by Dr. Cushing. I didn't learn until later that General Wood had been a doctor, I don’t know whether you knew that or not. I think he went to Harvard, went to the Boston City Hospital and he got fired, as a matter of fact. Because when he saw something to be done he did it, when it might have required a more experienced person. He simply did certain procedures and maybe some small operations.

Anyway, he got fired and joined the Army and he became Chief of Staff and also, Governor General of the Phillipines. He had a recurrent meningioma. The operation was done under local anesthesia in those days. To me, the most interesting part of it was the conversation between Dr. Cushing and General Wood, because each one of them got rather impatient with the other. But Cushing had the advantage. One comment that may be worthwhile, Dr. Cushing was prepared for a transfusion of one pint of blood for the meningioma (currently a surgeon requests the laboratory to have 5 to 8 one pint units available in a brain tumor of this type). The blood was given by one of my classmates who was there, Calvin Burton of Roanoke, who was a clinical clerk. And during the night when General Wood developed post-op bleeding, they couldn't find any more blood so they had to find Cal Burton and take another pint out of him. He felt rather puny for several days. Dr. Cushing was a real disciplinarian and there was a sense of history, there was always a sense that history was being made. He had distinguished visitors from all over the world visiting his clinic. There was a board in the operating room, and just as a brain tumor operation was completed, the number of the operation was recorded. When I was there it must have been up around 1800, 18th hundred brain tumor, but just as he would finish an operation the number was changed in a very dramatic way. One of our physicians in Washington, Walter Boyd, you remember Walter Boyd, Obstetrician and Gynecologist. But if you look at Fulton’s biography of Cushing, many of the pictures of the two thousandth brain tumor operation were photographed by Walter Boyd. The whole thing was recorded, everything was recorded, you knew that you were taking part in history, it was rather exciting. Book of the Classifications of Classification of Gliomas of the Brain was by Percival Bailey and Harvey Cushing. I met a lot of people, most of the men went into academic neurosurgery. The House Officer who passed the instruments was Cobb Pilcher who went to Vanderbilt as Professor. The senior intern was Bill German, who went to Yale as Professor of Neurosurgery. Most all of them went somewhere as Chiefs or Heads of Departments.

Dr. Peery: Jim, those are obviously very impressive years, I’m sure you were quite impressionable and obviously retained much of what you saw and heard as important memories that shaped your career.

This is to pick up on the interview with Dr. James Watts on Saturday morning, January 26, 1919.

Dr. Peery: Jim, yesterday we finished your comments on your years at medical school in Charlottesville and now we ought to take up your graduate training. When you started in your internship, I wish you would tell us something about the experiences of the first few weeks, perhaps the routine of the day and something about the things that made the most impression on you.

Dr. Watts: I arrived at Massachusetts General Hospital on July 1, 1928. I failed to get the appointment I applied for in the medical service at the Peter Bent Brigham Hospital and immediately began to look around for another job. Several things turned up, one at the University of Virginia, another desirable appointment at the Virginia Mason Clinic that I referred to before, which was staffed largely by University of Virginia graduates. For some reason I still wanted to go to Boston and I found that one of my classmates had a six month appointment at the MGH in Neurology. That sounds a little odd, but at that time, in Boston, at least in the Harvard teaching hospitals, instead of having all interns start on July 1, they were staggered. One group came on July 1, another group around October 1 and another group around February. Neurology was rather young, neurosurgery was very young and the appointments then were given for six months and they would pick out interns whose appointments didn’t begin until spring. One of my friends and I went to Dean Flippin and he was able to arrange for an exchange. I got a six month appointment in Boston and my friend got his appointment at the Mason clinic. So I went on in neurology without serving a medical internship. As I said, I arrived on the morning of July 1 and that the resident in neurology, Dr. Biddle, introduced me to the nurse, took me around to see the patients, turned over his room to me, which was a nice private room with a private bath and then by noon he’d left, and I was acting resident in neurology. I didn’t know much neurology because we didn’t have a neurologist at University of Virginia. The Professor of Medicine taught us some neurology. That night, the resident of neurosurgery signed out on me, I had to see a patient suspected of meningitis and I did my first spinal tap and verified the diagnosis. Dr. H. Solomon was my first visiting man. Neurology had an attending neurologist come in on a two month rotation. Dr. Solomon was a very fine neurologist, he later became Director of the Boston Psychopathic Hospital because men were doing psychiatry and neurology at the time. He was one of the most effective men I had as an attending. He arrived promptly, he reviewed every new case with me, he made working diagnoses, in contrast to some of the later ones who insisted on waiting until they got the spinal fluid exam, the pneumoencephalogram and X-rays, and so on. Then he told me what he thought should be done to work up the patient. We had, at that time, two wards, a men’s and a women’s ward of twelve beds each and a conference room and an examining room in between. I think we averaged about three admissions a day. That meant that I was looking after the majority of the twenty to twenty-two patients and working on three patients a day. I usually worked from about eight until midnight and since I was interested in neurosurgery, I was allowed to be second assistant in the operating room. I mean that my working hours were from about 8 a.m. till about midnight, in addition to that, anything that came up in the night, I did that too. We think about those days as being great days for discipline. The neurosurgical resident was Diller Ryan and I had no idea how Diller Ryan got into neurosurgery. One day we were operating, and in the middle of a craniotomy Ryan walked out of the operating room and I asked Dr. Hodgdon where he’d gone. He said he didn’t know. After the craniotomy was over I said “Dr. Ryan, why did you leave the operating room?” He said “It was too hot in there for me.” Ryan later went into psychiatry. Toward the end of the month, I told Dr. Solomon that I was working too hard, that I enjoyed what I was doing, but I wasn’t doing justice to the patients and I would like some help. He said, “Well, tomorrow morning Dr. Ayer will visit the service.” (Dr. James B. Ayer was the Chief of Neurology and Professor of Neurology at Harvard. Dr. Ayer looked like the country squire, smoked a pipe, wore tweeds, congenial man and I’m sure he had heard something about his new House Officer and he was prepared. I said, “Dr. Ayer, I’m really enjoying what I’m doing but I’m working too hard, I’m not doing justice to the patients and I need some help.” He said, “Dr. Watts, what would you like?” “Sir, I’d like to have another intern, or I’d like a resident, or I’d like a secretary. Last year you had a resident in neurology and two interns from the medical service and now all you’ve got is one, just me.” He said, “Dr. Watts, my secretary will be down tomorrow morning, she’ll be down early though, take your dictation, so it will save you some time writing up the histories longhand, she'll bring back the written reports the next day, and you can keep her until I can get someone for you, I’ll try to get a resident for you in September.” So he got Charles Kimberly; Charles Kimberly was an older man about thirty, who had some experience in psychiatry and neurology, he knew some of the attending men and it must have been a comfort to my Chief. It certainly was to me.

Then on August 1, Henry Viets came on as an attending neurologist. He was a bachelor, he was what I thought a fine clinical neurologist, he was pompous, egocentric, but very able. In about a week something happened that might have changed my career. By that time Ryan had left, Ryan left on August 1 so that left me as acting resident in neurology and neurological surgery, responsible to all of the patients, and being first assistant in the operating, so I was kept very busy. Viets came in, I reported to him about the patients, he looked at the records, I hadn't written up the reports, I had been up till one o’clock in the morning and he said to me, “Doesn’t look like you’ve done anything since I was here yesterday,” his tone of voice infuriated me, I can’t remember being angrier and I looked him in the eyes, I clenched my teeth, I clenched my hands, my fingernails dug into my hands and the thought came into my mind “I’d like to hit that S.O.B between the eyes and get the hell out of here.” I didn’t say anything, he didn't say anything, but the following morning when he came in he said “Dr. Watts, would you be my guest at the Harvard Club tonight?” We went to the Harvard Club, it was wonderful, luxurious, Viets was charming. He could be difficult, though.

Dr. Peery: I remember Dr. Viets name, as I recall you had him down as a guest on one of your post graduate programs.

Dr. Watts: Viets and I wrote four papers together. We were the first in this country to describe what proved to be an independent disease, aseptic-lymphocitic meningitis which later was proven to be choriomeningitis. It might be of interest to George Washington people that Dr. Walter Bloedorn described two cases of aseptic meningitis and Dr. Paul Dickens described two cases of aseptic meningitis, that was 1932. Armstrong and Dickens, Armstrong was at the National Institute of Health, it was with Dickens’ cases and Armstrong's techniques that a virus was isolated for choriomeningitis, was called choriomeningitis because not only was the inflammation of the meninges but the chorio plexus was inflamed. This was an interesting condition when the patients were admitted, they'd look like tuberculus meningitis, had stiff neck, headache, nausea, vomiting and fever. But there was a difference, the sugar and clorides were not decreased and all of our patients recovered. We considered it an independent disease. We later found out that Walgren, from Gottenberg, Sweden had described something similar to that. We attracted national attention, a report in the New England Journal and the AMA and so I started out in I thought, a rather exciting way.

Dr. Peery: I guess that would be exciting. I remember cases of that disease, it really did look like tuberculus meningitis, the spinal fluid looked like it too, except for the chemical changes, I mean the cells were just like it. Sounds to me like you had exceptional responsibilities at MGH. Did you have time to attend conferences and rounds, or were you so busy in your own work, that you didn't have time for that?

Dr. Watts: I had time for conferences and rounds; they were a part of my duties. Because, as I told you, every morning at nine o’clock the attending man was there to go around, and we reviewed all the patients, particularly the new patients but we saw every patient, every day, together. Then we had a conference once a week which was attended by three or four of the neurologists and one of the neurosurgeons.

Dr. Peery: Did you also see a patient in consultation then, Jim?

Dr. Watts: I did not see any patients in consultation on other wards, that is, on the medical or surgical services, I take that back. When you ask me that it makes me think. The Massachusetts Eye and Ear Hospital adjoined the Massachusetts General by a long corridor and I recall now that I used to see many patients at the Eye and Ear with meningitis. It was called otitis meningitis, secondary to middle ear and mastoid infections, one of the interesting things about that was the meningitis almost never developed in acute cases, it was the chronic cases with mastoid infections that developed meningitis. I became very good on prognosis, not on treatment, but very good on prognosis and I got a lot of credit for that, I could tell when we found bacteria in the spinal fluid, I could predict within a day or two when the patient was going to die.

Dr. Peery: You never had any problems with prognosis about whether the patient was going to live or die, just when they were going to die. I remember those days too, mastoiditis was a serious illness and without the antibiotics to treat them, prior to surgery, it was really a bad thing. Thrombo-phlebitis was a frequent complication in those cases, I might add.

Dr. Watts: I’d read about patients with tuberculus meningitis recovering, but never saw anybody and I don't think any of the men on the staff claimed to have seen one recover. It was a bad disease. I would like to tell you about one incident, this was early in August, because the resident of neurosurgery had left, and I was alone and one of the patients that had been operated on for a brain tumor died, and I called up the admitting office and reported (let’s call him) John Doe has just died; and this man at the end of the wire said, “Dr. Watts, was he on the danger list?” I said, “No, he wasn't on the danger list, but he’s dead now.” He said, “Doctor, would you hang up the telephone and call me back and tell me John Doe is on the danger list?” I said, “Sure.” He said, “The time is now 8:15.” So I recorded that on the record, and he said, “Now, will you hang up and call me back and say John Doe, is dead?” I said, “Sure.” So I called him back and he said “Thank you, the time is now 8:20.” And everything was O.K. Nobody died without being on the danger list. I thought that was rather amusing until I came down to GW where things were rather informal. One night I got a call from the intern saying the patient had died. I asked the time of death. The intern said “I don’t know what time he died, the nurse was making rounds about 4:00 and found him dead in bed and I came around about 4:30 and I pronounced him dead”. I found that people like to know exactly what time a relative died and as well as possible, the circumstances. Sometime later at M.G.B. I got a call from the assistant administrator and he said, “Doctor, did you fill out this death certificate?” I said, “Yes, sir.” He said, “You put down the cause of death was brain operation?” I said, “Yes, sir, he was living when we took him to the operating room and soon after that he was dead.” He said “And you put down there the secondary cause as brain tumor?” I said, “Yes, sir.” He said Good God, don't ever do that again!” I said, “What would you like me to say?” He said, “Would you be willing to make out this certificate again?” I said, “Certainly”. He said, “Well, put down cause of death - brain tumor.” I said, “What about secondary causes, contributing causes?” He said, “Put postoperative shock.” So I did.

Dr. Peery: Well, we can laugh at that but you know that is exactly the way those death certificates are meant to be filled out and so many doctors are never instructed in how death certificates are to be filled out. You have a case where a patient comes in with certain symptoms that clearly suggest that there is something seriously wrong, whatever diagnosis is arrived at is the cause of death. Your appointment at the Billings Hospital, University of Chicago, must have been an exceptionally fine experience in neuropathology, wasn’t it Jim?

Dr. Watts: I learned a lot about primarily tumor pathology from Dr. Percival Bailey. Dr. De Roy Grinker was a good neuropathologist and he was interested more in the inflammatory and degenerative diseases.

Dr. Peery: Jim, did you do any scientific writings while you were at Billings in Chicago?

Dr. Watts: I wrote two papers, one on torula infection and I had some beautiful illustrations in color, but before I get to the second one I'd like to tell you something about Dr. Bailey. Dr. Bailey was considered a brilliant man, he was rather brusque, he wore his hair in a crewcut. I’d heard him talk at neurological meetings where classification of brain tumors was a great subject in those days and he was highly critical of Globus who was a New York neuropathologist at the time. But what I wanted to tell you about was, I had gotten into the habit of taking a nap in the early afternoon when I was at V.M.I. If I didn’t lie down to take a nap, I took a nap in class. During my first week at Billings after lunch, I went back to my room, and I usually undressed and got in bed and took a nap. Dr. Bailey called up and said “Watts, are you ready to make ward rounds?” I said, “Sir, just as soon as I get dressed, Dr. Bailey, I was taking a nap.” So he didn’t say anything then and the next day he called me up after lunch and he said, “Watts, are you ready to make ward rounds?” I said, “Just as soon as I get dressed, Dr. Bailey, I'll be down.” Then he said, “Watts, what the hell time would it suit you to make ward rounds with me?” I said “Sir, it would suit me better after the outpatient department”, and then he growled, “Well then, we’ll make them after the outpatient department.” He appeared to be gruff, but he was really a considerate man of the people that he was associated with. I learned a lot from Dr. Bailey. When I'd go around the country to medical conventions, people would say “Can Bailey operate?”, because they knew him for his reputation as a neuropathologist. I thought he was a beautiful technician. He was highly critical of Dr. Cushing, he didn't think Dr. Cushing treated him very well, as a matter of fact, Cushing didn't pay any attention to Dr. Bailey socially except when somebody came over from France and he needed Dr. Bailey as an interpreter. Dr. Bailey left Dr. Cushing once for about a year and went to France where he did important scientific work, yes, he mastered the language. I can recall several occasions when Dr. Bailey got into an awkward situation in an operation, he’d wonder outloud “I wonder what the Chief would do in a case like this?” So he had respect for him, but he often downgraded him.

Tom, just to finish off that question, we had a good many patients with acromegaly when I was in Chicago. I guess it was about this time it was reported that gonad stimulating hormone was found in the urine of pregnant women. So it was suggested that I try to determine whether there was any of this gonad stimulating hormone in the urine of acromegalics. For those who may not be familiar as you are, acromegaly is due to an eosinophilic adenoma of the pituitary gland. I read the papers and consulted with members of the staff and the way it was to be done was to inject rats at a certain age, and so we ordered some very expensive pregnant white rats from the Wistar Institute in Philadelphia. I decided to stay on a couple of months longer just to finish up this experiment and I didn’t know when I could go home on vacation until the baby rats were born. I couldn’t plan my vacation because I had to be back to start injections on the twenty first day after birth. Then I called up Julia because I’d been corresponding with Julia; as a matter of fact when I was at Long Island College I sent her orchids to Paris where she was staying with her family. She told me later that made quite an impression on her. Well, I called her up and said I wanted a date and told her when I was coming home and she said that she had a date and I said “Break it, I’m coming home, I’ve got to come home because I’ve got some rats, I’ve got to inject these rats, I have to come when it can fit in with the rat schedule”. So, she was good enough to break the date, and I went home and Mother brought Julia to the station to meet me. You see, I got a lot of help from Mother and I can say I’ve never seen Julia look more beautiful and more stylish and it happened that just before I got off the train, a case of rats were taken off. I don’t know how that happened, Mother and Julia thought I’d brought the rats home with me. Well, anyway I didn’t bring the rats home.

By that time I was thinking I really did want to get married and I believe Mother and Father thought it was a good thing for me to have someone in Europe with me. I don't think that they didn’t trust me but they thought it would be safer if I had a wife with me instead of meeting some of these foreign girls. Anyway, I talked to Julia about getting married and she wasn't in any hurry, she was having a real good time. Then I had to make financial arrangements with Father, because Father was supporting me during my graduate work. I did earn a salary in Chicago, so I didn’t really need any supporting there. But when abroad I needed his assistance and Father agreed to pay my expenses in Europe because I was going on a fellowship. Father felt very strongly about being fair with the boys, he wasn’t going to pay Julia’s way so he loaned me the money to take Julia. Father was, as I told you, he was in the savings and loan business, so he charged me 6%. Julia thought that was kind of queer, but she realized later when we had sons that if you do something to one son, you probably want to give it to the other and you don’t want to give one an advantage over the other. Anyway, Julia claims that after I’d been in Lynchburg about a week we passed on Main Street, she was on one side and I was on the other side of the street. She says I yelled at her and said, “Julia, you don’t have to make up your mind now, but I’ve arranged with Father to go to Europe and take you.” Anyway, I proposed to Julia and asked for her hand, got her agreement to be married. I recall that before the engagement was announced Julia called me up in Chicago, because I guess we didn't know each other too well, asked me if the wedding was still on and I said, “of course”. The announcement appeared in the Lynchburg, Richmond, Baltimore and New York papers. Both of our families were prominent in Lynchburg, but what made our engagement of national interest was that there were two Harrison Presidents of the United States. I stayed in Chicago and finished my experiments, which proved there was no gonad stimulating hormone in the urine of the acromegalics. After our wedding we went to Breslau, Germany where Professor Otfried Foerster had his clinic.

Dr. Peery: Jim, I bet that Watts/Harrison wedding in Lynchburg was about the biggest wedding that had been there for some time. Tell us something about it, especially how you managed, I remember that was during Prohibition.

Dr. Watts: Tom, I take nearly everything “seriously” and so instead of doing like some couples do and go away for a weekend or take a day off to get married I came home a month before the wedding and went to parties for about a month before we were married. We sent out about a thousand invitations and we had eight bridesmaids and eight groomsmen. The wedding was at nine o’clock at night in the St. Paul’s Church in white tie and tails. Julia’s parents had been members for many years, Julia attended and I joined St. Paul’s when I was at Virginia Military Institute (V.M.I). We had a big wedding but the reception was small, this was in Julia’s home. Just a few friends invited. But speaking of Prohibition, I know you’ve heard of this, but we actually drank champagne from Julia’s slipper and it was really rather a gay party but the Harrison's didn't serve any hard liquor. But I had a V.M.I. classmate who lived across the street, Charlie Burroughs and Charlie said, “I’ve got five gallons of corn liquor over here and if anybody wants some, they can just come over and get what they want.” And so, a good many of the groomsmen went over and got some corn liquor and one of them was my brother Hubert. We had to put Hubert to bed before we went to the station that night on the way to New York, but it was an exciting time. It seems so many exciting things have happened to me.

Dr. Peery: Jim, let me let you know that you’re aren’t the only one that had a big wedding. I had a big wedding too with white tie and tails, I've forgotten how many groomsmen and bridesmaids we had but it seems to me we had about six or so and a big party afterwards, big reception. Let’s get philosophical a second, let me ask you a philosophical question. Do you think the fact that weddings have been simplified and may be taken somewhat less seriously over the years since the time when you and I got married, don't mean to each other, but when we each married to our brides, do you think the fact that weddings have taken more lightly now have anything to do with the divorce rate?

Dr. Watts: Tom, when we talk like this, I’m afraid that if anybody does listen to these tapes, they are going to say that a couple of old men are talking. Of course, they would be right about that. I think things have gotten to be too casual, dress is casual. As I told you, at the University of Virginia we wore dark suits, not even sport coats, always wore ties. When we went to the dances we wore dinner jackets, when we got married, they were planned, there were a great many ceremonies and having a ceremony like you and I had before the company of several hundred people in a church and with all those witnesses you promise for better or for worse, it sounds pretty serious. Some people seem to think that the younger people may be altogether brighter than we were, but frankly, I doubt it. They do know more, they have more information than we had but I think they are more casual in their attitudes and certainly more casual toward marriage.

Dr. Peery: (We start again on this interview on Monday morning, January 29). Jim, it seems to me that we’re ready to go to Germany now, is that right? I’m sure that is right. Your year was planned there, did you plan it more as a honeymoon or as a period of study and research?

Dr. Watts: Tom, this was planned first as a year of study in pathology and research. I met Professor Foerster when he was lecturing in this country and I knew about some of his work on cortical localization, particularly. Dr. Bailey told me what I needed was more neuropathology but I thought I needed some neurophysiology. As a matter of fact, I corresponded with Professor John Fulton at Yale where there was a lot going on that was of interest to clinicians. When I finally made the decision and I began to think I was going to be away about a year then I began to think that it might be good idea to get married. My Mother and Father felt like I was going a long ways away and they didn't oppose it, they rather encouraged it.

Dr. Peery: I guess that kind of helped you make up your mind to get married instead of putting it off a few more years, didn’t it? Well, Jim, we think of your going to Europe and to Germany but is it correct that Breslau, where you went, was no longer in Germany since the remapping of Central Europe after World War I; just where is Breslau?

Dr. Watts: When Julia and I went to Breslau, it was in the Prussian portion of Germany and was one of the biggest cities in Germany. It had around 600,000 inhabitants. After World War II, it became a part of Poland, it was completely overrun and I’m told it was almost completely destroyed during World War II. The information I have about it is vague but the name of the place has changed and now has a Polish name. At that time it had a great university, and I suppose when I think about a university at least as far as training is concerned, I’m thinking about the medical school and hospitals. Foerster was the best known neurosurgeon in Europe at that time. Before I got to Breslau, Penfield, McLean and Bucy from the States had studied with Foerster. Paul Bucy preceded me at the University of Chicago and was taking a sabbatical leave with Foerster when I was at Billings Hospital.

Dr. Peery: Did it work out that the experience that you got there was as much as you expected or hoped for?

Dr. Watts: I’d say yes. By this time, you asked me once earlier, you asked me something about my teachers, my teachers in college and teachers in medical school. Now I was beginning to study not just the books, but studying what the individual professor was doing. I was beginning to study him and find out what made him do what he does and how he did it. Each one of the men that I was associated with was nationally known and often internationally known. I was trying to find out what made them stand out from the crowd, made them better than other people, or at least better known. Professor Foerster had a clinic at the Wenzel Hanke Krakenhaus. It had a hundred beds, an operating room and an office. They were all indigent patients. His private patients were in nursing homes, as at that time the hospitals in England. Hospitals were primarily for the charity patients and the nursing homes were where the more affluent people were. He had about fifty beds for male and fifty beds for female, huge ward, I’d say there were at least forty to forty-five patients on each.ward and a few cubicles up near the nurses station for the critically ill patients. He had an assistant, Ludwig Gutman, who ran the clinical service and was first assistant at operations. He had a neuropathologist who was well known throughout Germany named Oscar Gagel and a neurophysiologist, Altenberger. Each one of these men knew more about his aspect of the nervous system than the professor. But Professor Foerster had an enormous sum of knowledge, he studied in Paris at one time, he traveled extensively and he was able to devise procedures, operative procedures based on sound physiologic principles. Maybe he would not like to have it put just this way, but when I watched him I thought that every operation he did, every operation he did was really a clinical experiment. When he operated on the head as he did in many cases, he did them all under local anesthesia, he mapped out the brain. You and I probably think that we can identify the sylvian fissure and the central subcus. He did much of his neuropathology, he described the brains, but he claimed he really couldn’t be sure without stimulating the brain, so he stimulated the brain, every case the brain was exposed, marked out the motor and the premotor area and put little markers on the spots and photographed them. When he operated on the spine, he did have a lot of patients with neuritis and neuralgia, and a good many spinal cord tumors, he would stimulate the posterior roots and this would produce a flush along the course of the intercostal nerves and when the patient would scream, he would be quite irritable about it and he just said “You’re interfering with my work, keep quiet.” Then he would cut two posterior roots and clip the roots and so he could identify the level. As a result, his maps of the distribution of the roots were the most accurate in the world, at that time.

Dr. Peery: Is the distribution of the roots quite constant in different individuals or is there some variation?

Dr. Watts: There’s some variation, but I think that clinically one can determine the root within one or at most two nerve roots. I think sometimes it’s difficult to tell fifth lumbar from the fourth lumbar, or the fifth lumbar from first sacral sometimes. In the cervical region, there may be a little difference, difficulty determining whether it’s the at the level of the fifth or the sixth cervical disk.

Dr. Peery: It sounds that your experience at Breslau did add significantly to your medical knowledge and not just more of the same. Did you get some writing done during this year you were in Europe?

Dr. Watts: I did write one paper with O. Gagel on Zur Pathogenese der Raynaudschen Gangran of gangrene, that was rather interesting. We found degenerative changes in the lateral horn cells of the spinal cord, I don’t know how many people paid attention to it but Gagel told me that the lateral horn had to do with the autonomic function. We published it in German and I thought that looked rather good to publish a paper in German. I tried to persuade Professor Foerster to allow me to do a study on spinal cord tumors. I wasn’t sure whether he simply didn’t want to do it or didn’t think I could handle it, but he gave me the material so very slowly, that we never got around to it. I would like to tell you one thing about his methods of teaching. When I was there Harold Wolfe was in Breslau. I don’t know whether you remember Dr. Wolfe but he was at Cornell and he did some very fine work on pain and differentiated between perception of pain and the reaction to pain. Wolfe was there for two months while I was, and about three nights a week, after I’d been working all day, Professor Foerster would call up and say “Meet me at the Nord Hotel.” We’d go down to the Nord Hotel and it would be Harold Wolfe, Ludwig Gutman, sometimes Gagle, sometimes another visitor. We would drink beer and talk until midnight and I was tremendously impressed with his memory first, and then his knowledge of neurology and neurophysiology and pathology. I thought that when I went to Germany it was going to be easy. I had heard that German professors got started late in the day but I was mistaken. Foerster got up at 5:30 a.m, got started working on his scientific papers until he had breakfast, and came to the hospital around nine o’clock. I thought that maybe weekends would be different, but he worked seven days a week, and even Christmas Day. When he worked he demanded that I be present.

Dr. Peery: He attracted more American students than he did German, or European, is that correct?

Dr. Watts: I believe that is correct. I don’t remember seeing many Germans as visitors. I think Dr. Penfield was one of the most distinguished and I believe Wilder Penfield, you may remember, the Rockefeller Institute gave money for the Montreal Neurological Institute, Dr. Penfield was the Director. I think Dr. Penfield's work was an extension and refinement of what Professor Foerster was doing on localization of brain function at that time, that is, Dr. Penfield refined the operative procedures, he extended the work and got into the temporal lobe, learned something about the functions of the temporal lobe, hallucinations and so on.

One of the things about being away, I think, is that one can look at himself more objectively, I don't know why it's easier when you're across the waters or it might be when some foreign country, say a foreign country and a foreign language and then you can look back on things in the States. It was, to me, a well worthwhile year.

Dr. Peery: I remember the Dr. Wolfe that you spoke of at Cornell now. As I recall, he was one of the leaders in the movement to blame systemic illness on psychic disturbances, the psychosomatic situation, is that correct, or have I got that mixed up?

Dr. Watts: I think you're right about that. I was interested in the pain aspects. One thing, I remember a slide that Dr. Wolfe threw on the screen when he was talking about a patient that had had a lot of trouble with his back. I believe he had had a lamenectomy. While he was doing electromiograms on the patient, as the patient was being interviewed, they were talking about what I guess psychiatrists call a neutral subject, talking about baseball or something like that. The tracing was going along in a rather regular fashion and as soon as Wolfe asked him about his wife, with whom he didn't get along very well, the peaks and valleys became high and more irregular and he began to complain of pain in his back. There's no doubt in my mind, that tension aggravates certain physical conditions. He found it was true with the back but also with stomach.

Dr. Peery: Would you tell us too, Jim, something about the traveling you did in Europe during this year you were at Germany?

Dr. Watts: Tom, when we left Breslau, we visited a number of the German cities. I thought there was a big contrast between Prussia, where Breslau was located, and Bavaria where Nuremberg and Rotenberg are located. I believe Dresden is in another province of Germany. But the Bavarians were much pleasanter, nicer people to deal with. We enjoyed Nuremberg and I know that we mentioned this before - Rotenberg. I was fascinated by Rotenberg, it was just, as you remember, a small walled town, you could walk all over the city, probably in a morning. One of the great tourist attractions was the clock in the town hall, where - at noon each day - these little figures in Tyrolian costumes would come out and while the music was playing, they'd raise their mugs of beer to their lips and empty them.

Dr. Peery: Do you remember the story that clock was meant to be telling?

Dr. Watts: No, I don’t remember that. We often walked around places on our own rather than with guides and I don't remember hearing about that.

Dr. Peery:Well, Ellen and I were in Europe in 1970 and one of the features of our trip was, we had rented a car, a drive taking about five days from Munich along what was called the “Romantic Roads,” it led to Rotenberg which was the featured place, but there were several other spots I can't recall at the moment. At Rotenberg, as you say that is a walled city, quite old, high on a hill and looking out on the valleys below, we stayed at a little reconstructed hotel there. As I remember, it was the hotel Isenhote. It had, instead of a sign giving the name of the place, it had hanging out in front, an iron helmet. Isenhote apparently means the iron hat or something like that. Anyway, our room there was an enormous room with beautifully colored wallpaper and matching drapes, and Eleanor was very much taken with it. The food was good too, which I enjoyed. Yes, I meant to get to the story on that clock in the town square. The clock was in a steeple on the top of a tall building, I think it was the Rathaus (town hall) or something of that sort. They had a sign down below suggesting that all tourists should climb up into the steeple. We thought that sounded like a good way to see more of the countryside, so we got in line and went up these very steep stairs which ended in a ladder. We got to the top of the ladder and with just one more round of ladder to go to get out on the top around the steeple, they started taking up money. There hadn’t been any sign about how much it was going to cost; we were a little taken back by that but we figured we had to pay, so we payed and went up on the top and there was a narrow walkway around the steeple. The steeple was shaking in the wind, the wind was blowing very hard, it was really some concern to us because more people were going up than were coming down. The first thing you know, it was crowded up there. I could just see people sliding off of the top of that place. Nothing like that happened, but to come back to the story of what the mannequins that were moving about with the clock at the time of day meant. Apparently it was either history or legend that in a very early time in the town of Rotenberg history they had a leader of some note who resisted an invasion by enemy from the east, they were barbarians, as I understand it. In some way, the deal was made between the barbarian chief and the mayor of the city, that if he would drink this whole jug of beer, I don’t know how large it was but it must have been enormous, without swallowing, just gulp it down and leave his gullet open and let it run, if he could do that, they would leave his city without further damage. He drank the enormous mug of beer and fell over dead immediately afterwards, but the barbarians let the city survive. I judge, Jim that you and Julia were fairly fluent in German?

Dr. Watts: Tom, that was a wonderful story and after hearing you tell it, I do remember it. Now, to answer your question. No, we weren’t. I’d never studied German before I went over there, Julia had studied a little German. Professor Foerster spoke excellent English and he liked to practice his English and the younger men, Gutman and Gagle, particularly liked to practice their English on me. And so, our conversation would be, Germans were talking in English, and I was talking in German. I learned to read, I learned enough to read directions to stain microscopic sections with the various special dyes and things like that. I could read a little in the newspapers, but we weren't very fluent in German. I do remember another story about Rotenberg, I heard this obviously later. During World War II, Americans were sending flying fortresses over Europe. I happened to visit in Wurtenberg and saw a path that our flying fortresses had made through the city. It was just about four blocks wide, there wasn't a single building standing in the path of the bomber, The Americans gave the town two hours to decide whether they wanted to declare it an “open city” and surrender, or whether they would refuse. The people refused. Almost nobody was killed, they had a chance to leave town, but there is just a path of utter destruction.

The story I heard about Rotenberg was that it happened to be in the path of the American bombers, so it seemed a good thing to wipe out. But a young American Air Force Captain who had visited Rotenberg as a student, persuaded the commanding officer to leave it intact, since it was not a military target.

When you went over in 1970, you were affluent. When we went in 1931 and 1932, we were anything but affluent. We had our tour arranged, had the names of second class hotels and we rarely paid, say more than five dollars a night for the hotel for both of us. We made a kind of a game about it. Once got a hotel room about three dollars, we bargained with the people. Actually, when we were travelling, we were travelling on about ten dollars a day by train. Maybe the train and the hotel cost about ten dollars. One other thing that might be of general interest, when we visited Munich, Nuremberg, Dresden, it was as sightseers. When we visited Berlin, I visited what had been the KaiserWilheim Institute, but after the war they changed the name to the Max-Planck Institute. I was trying to think of their names. Professor Cecile and Oscar Volk were there and they were the scientists who mapped the cortex. One of their maps of the cortex of the brain was very well known. At that time in addition to the Volks, Bilshowsky was there. Dr. Bailey often used a stain he developed to study brain tumors. So when I went to the Max Planck Institute in the suburbs of Berlin, I walked up to the door, I should say the gate keeper, they always had a guard there and I simply said “I’m Dr. Watts from Chicago, I’d like to see Professor Volk, or I’d like to see Professor Bilshowsky, I’d probably hesitate to do that now, but then I was pretty confident that that would get me in, and it always did. Well, I asked for Bilshowsky first; and the first thing that he said to me was “Did you ask for Professor Volk first?” I said, “No, Dr. Bailey used to talk about you and I thought I'd like to see you first”. “Oh”, he said, “You must call on Professor Volk,” so he phoned and by the time I called I was told he was going to Berlin and I could not see him. I had offended him by not asking to see him first, but I saw his wife, Professor Cecile Volk. One of the things that she showed me was Lenin’s brain. Professor Foerster had been called in consultation to see Lenin in Russia and when Lenin died, he brought Lenin’s brain back to Germany for study, because they had scientists and scientific methods there that weren't available in Russia at the time. They showed me the specimen of Lenin's brain with some pride these beautiful, well stained neurons stained with nissel stain, and then they showed me the brain of a man who had murdered another individual for one mark, which is a quarter. The murderer’s brain had shriveled up little neurons and they made quite a point with that. After the World War II, I read in the papers that the Russians had demanded that Lenin's brain and all those slides be returned to Russia.

Dr. Peery: Was there anything especially noteworthy about Lenin’s brain, size or anything of that sort?

Dr. Watts: I think it was just a normal brain, but the Volks did just perfectly beautiful sections. They had whole brain sections, and I don’t think anything is better than the nissel stain when it is done well. I thought before I went to Germany that you had to have all the gold and silver stains but when you are accustomed to the nissel stains as Spielmeyer did them, (Gagle had studied under Spielmeyer), they could tell almost as much. That is as far as clinical diagnosis was concerned.

Dr. Peery: Well, Jim, I certainly enjoyed our trip to Germany. We are back home now in the United States and we’ll carry on with your studies at Yale. When was it you went to Yale and how long were you there and tell us something about your instructors there?

Dr. Watts: I was at Yale in 1932 and 1933. That was one year, that is from July to July. Most academic years, or at least appointment years seem to be from July to July. As I told you, I’d communicated with Professor Fulton when I was on Dr. Bailey’s service because I. wanted to know more about brain function, not about pathology alone and Fulton’s work was attracting a lot of attention at that time. Much of the work had been done before, but with the refined techniques, he expected to improve our knowledge of the brain. Each one of the chiefs that I studied with, some of them were very agreeable men and some weren't so agreeable, but all of them were distinguished men and outstanding figures. Fulton had taken his PhD at oxford where he studied under Sir Charles Sherrington and a Fellow at Magdalene College in England. Then he fell under Dr. Cushing's influence. He knew he wanted to run a physiology department but Dr. Cushing persuaded him to go to medical school to get a better idea about man. So he went to Harvard and that didn’t take too much of his time. So while he was at Harvard as a medical student, he was a Fellow on Dr. Cushing’s service and also wrote a book on the Selected Historical Aspects of Physiology Fulton was in his early thirties when I arrived at Yale, he was a Sterling professor and he was Chairman of the Department and already he was attracting people from all over the United States and some from foreign countries. He established a primate laboratory and he had laboratory chimpanzees and orangatans and various kinds of monkeys. A short time after coming down from George Washington, I had gotten an invitation for him to address the Smith-Reed-Russell Society. I remember one remark he made. He said, “The difference between Jim Watts and me is I have to pay five hundred dollars for a chimpanzee to operate on and he charges people five hundred dollars to operate on them.” The thing that impressed me about Fulton more than any single thing, was that he could carry on a dozen or more projects at the same time. I must have learned, must have been Benjamin Franklin, that if you want to do something well, you do it yourself. Another was if you want to do something well you do one thing at a time. Fulton could do a dozen or twenty things well at the same time. I wondered how this happened until I watched him. When he would talk to me, for example about the hypothalmus, that occupied his entire attention; nothing came in to interrupt his train of thought. When he was writing a letter, if I walked into his office and he was writing a letter, while he was writing a letter you could see that he was entirely occupied mentally with the person he was writing to. I sometimes felt closer to him in his letters than I did when I was talking to him. He could get one of the members of the staff started on a project and then he could leave it, and maybe come in once a week or talk to you and he just got a tremendous amount done.

Dr. Peery: I remember Dr. Fulton when you brought him to GW for that Smith-Reed-Russell and I think you also had him there with you on your post-graduate program on psychosurgery. Jim, what did you accomplish there in the way of research, papers that you wrote with Dr. Fulton at that time?

Dr. Watts: I did two papers with Dr. Fulton, one was in connection with the relation between diencephalon and peptic ulcer. It was either 1930 or 31 that Dr. Cushing made a report called “Peptic Ulcer and the Interbrain.” A number of his patients who died following a craniotomy developed, I guess what might be called, terminal ulcers, but they had bleeding from the stomach and some of them had acute ulcers and occured mostly after operations on the diencephalon or tumors in the posterior fossa. He attributed this to the lesions in that portion of the brain. Dr. Fulton was interested in that, I had some skill as a neurosurgeon, which gave me really a big advantage at Yale because I was trained in neurosurgical techniques and had done a lot on man, so I knew the surgical techniques. So we began to make lesions in the diencephalon, going through corpus callosum. We wrote a paper on that subject and were able to produce discreet ulcers both in the stomach and the esophagus.

In the course of that I discovered several cases of intersusception. Also learned nobody in the labortory really knew too much about the gastrointestinal tract. It isn't all smooth and clean like you see it in the pictures, and the monkeys' intestines seem to have more variation than the human, although I haven't opened too many human intestines. But when I expressed an interest in studying the intestine of every autopsy, I was welcomed. And so every time an animal was sacrificed, the intestines were turned over to me and so I had to go through those doggone intestines, and if you think the smell of the human intestine is bad, I believe the monkey is worse because a lot of them are fed onions and all kinds of things, awful smell. Anyway, I discovered three monkeys who had intersusception with intestinal obstruction who had had the premotor areas removed on both sides, that is, area 6. Then Paul Bucy, I told you I followed Bucy to Breslau, Buoy followed me to Yale and Bucy was studying ipsilateral representation of the premotor area of the cortex. He would stimulate it over a long period of time. These were acute experiments, and then when I had occasion to open the intestines, I found numerous acute interrsusceptions. Then I was able to do it myself in animals that had been treated or experimented on for other purposes. But I would get the animal before it would be sacrificed, stimulate the premotor area and I could produce intersusceptions under my own eyes. And so, that became quite exciting and that led to a paper entitled “Intersusception-Relation of the Cerebral Cortex to the Intestinal Motility.” One of the things I was rather pleased about, it attracted national attention, I might say, but more than that, it gave rise to further work at Yale for maybe ten years on the relation of the cortex to kidney function and kidney size and bladder function and things like that. I looked over the list in preparation for this interview, I wrote or was co-author in eight publications that year. So I was really in high gear.

Dr. Peery: That certainly sounds very worthwhile. Jim, how did you produce the destructive lesions in the brain, was it a mechanical matter or electrical or what?

Dr. Watts: That was electrical, with electrocautery.

Dr. Peery: Did you ever (know) of Grant Rasmussen? He and I shared a small apartment in Charleston, South Carolina for two years and learned how to drink some of that clear corn liquor together. Grant developed a very clever way of providing an electrical stimulus. He drew out glass tubing inside hypodermic needles and the glass served to insulate the needle wall from a wire that he would then put inside the glass tubing and by having the wire come out right to the tip of the needle he was able to get an electrical current to damage the nervous system. He used this device to place tracks in the brain and as I remember, did place some lesions I think in the auditory system, place several tracks in the brain and had a very clever way to route serial sections on continuous tape of cellophane so that you could look at every single section by just rolling a roller along under your microscope.

Dr. Watts: I'm sure I've net Grant Rasmussen. I knew the Neuroanatomist who may have been his father and then I knew the neurosurgeon who was at the Montreal Neurological Institute and became the Chief of Neurosurgery there. Tom, you have asked me about my basic training in neurology and neurological surgery. But I felt that I needed more experience operating and you couldn't run around like I did and expect to walk into a job where the chief was going to make you first assistant over people who had already been residents and then turn over operative cases when a resident surgeon had been waiting around for three or four years to do that work. So it was difficult to find the kind of position I wanted. I knew that when I completed my training I wanted to get a position in a university hospital where I would be the chief (or have an opportunity to become chief); have an opportunity to teach and do some type of research. Fortunately for me, Dr. Charles H. Frazier, who was Professor and Chairman of the Department of Surgery and Chief of Neurosurgery at the University of Pennsylvania needed another resident and was interested in my background in physiology; he made me a Fellow and Instructor in Surgery. So I had that position from 1933 to 1935. Now the programs are organized, you have to have the basic sciences, you have to have some children’s work, the whole setup is different. I do think it might be a good idea . . . for example Paul Bucy did it, he was at the University of Chicago but he was able to get leave to go to Breslau. I, for example, sent one of my residents to the University of Vienna for a year. But those things are a little hard to arrange. It’s good to look around to see what other people are doing, but you wouldn’t be able to do what I did, no. I wouldn’t have missed it though.

Dr. Peery: Well at the time you were taking your training, I’m certain this was the best way to have done it. I guess the American Board of Neurological Surgery has had an enormous impact on training programs in that specialty.

Dr. Watts: It has, the American Board was founded in 1940 and it makes certain demands on you (the candidate) and the character of the examinations means that you’ve got to know some neuropathology and neurophysiology, neuroanatomy and neuroradiology, things like that, so the programs have to be arranged for that.

Dr. Peery: Jim, I’ve known a lot a physicians who graduated from medical school about the time you did but in my experience there have been very few who spent as long in training for their specialty as you did, you spent a total of seven years, I believe. Among your colleagues and friends, was that unusual?

Dr. Watts: That was unusual. The only one that I can think of was one of my classmates at V.M.I., Crenshaw Briggs, who came to Washington, operated on me a couple of times. Briggs went to John Hopkins School of Medicine and then spent seven years in internship and residency training. It wasn't too unusual at Hopkins because, I think I told you that my cousin, Steven Watts, who was Professor at the University of Virginia spent seven years. So Hopkins is one of the only places that I know that required that kind of thing. A good many of my classmates, for example, the group at the Virginia Mason Clinics, started out as interns, then they became residents and, then became assistants and so on. As younger members of the staff, they first were under the supervision of the senior staff and for a long time under the influence of the senior staff. At the Virginia Mason Clinic they received excellent training.

Dr. Peery: Jim, that completes all the questions I have now about your training, preparation for your career and now let’s get on to the rest of it. Which is really the more important part as far as this oral history is concerned. What circumstances led you to decide to come to Washington for practice? What did you do to make a decision as to where you wanted to go?

Dr. Watts: Tom, I was interested in several places. One was the University of Virginia, I think one always has an affection for his own school. I talked to the Dean after graduation but almost every year they weren’t ready to put anyone in at the University of Virginia. I might have had a chance at Massachusetts General. Dr. Mixter told me that Tracy Putnam, you may remember Tracy Putnam was a fine neurologist and neurosurgeon who later became Director of the New York Neurological Institute, but he said “Dr. Putnam has been talking about coming over here, if he doesn’t come, you can.” Well, Dr. Putnam did go to the Massachusetts General before going to New York.

I think I’d spent enough time in the North and wanted to go South, in thinking about it, I thought I’d like to go to Washington or Atlanta or New Orleans, those places appealed to me. During this period of training I published thirty articles so I was getting around a lot, I was going to meetings everywhere. That’s one thing my chief would always let me off for, to go to a meeting, especially if I was giving a paper. Then I met Walter Freeman in Atlantic City. I’d heard him speak several times, and he is a colorful man, as you know. I’d seen him on the boardwalk with a sombrero and a cane and he was wearing a beard before people wore beards. When he spoke, instead of reading from his notes, he gave an oration and he attracted a lot of attention. I noticed on the little synopsis that he was from Washington, D.C. and then I inquired about him and found out that he’d been a medical student at the University of Pennsylvania and intern at the Hospital of the University of Pennsylvania. He knew Dr. Frazier, he knew Dr. Spiller, Dr. Grant, so I arranged to meet Dr. Freeman and Dr. Freeman was interested in me because he knew the people that I'd trained with, especially the Philadelphia. But he knew the others too because he was a great man for meetings. So then we began to talk about it and he invited me down to give a lecture and I gave a lecture at the combined meeting of the Section in Neurology and Psychiatry of the Medical Society of the District of Columbia and he gave a party for Julia and me. We met a lot a people who were interesting.

I also talked to Dr. Frazier. I may have given you the impression that I couldn’t talk to Dr. Frazier about anything, I’m sure I did. When anything was going wrong with patients it kind of upset him, but I could talk to him about my training and he thought that Washington would be a very good place to go. He knew Harry Kerr and he knew that no one was doing neurosurgery full time in Washington. At that time, Washington was best known for its opthalmologists. Wilmer had come back from Baltimore and Burke and the groups around them and they were attracting patients from out of town. Dr. Frazier thought it would be a good idea and gave me an excellent recommendation. Oh yes, William Thornwall Davis, and he was giving post graduate courses long before they were given in the rest of the University and he was attracting people from all over the country to his post graduate courses. It just seemed to me that this might be a real good place to practice. I was ready to go out on my own. I did want a University appointment. And I wanted a place where I was either the chief or had a good chance to be the chief, I don’t know whether you looked at it that way or not. I’d gotten tired of assisting other people and I thought I’d like a position of responsibility.

Dr. Peery: What members of the faculty at GW did you talk to when you came here for interview, Jim, maybe talked to Walter Freeman, but did you talk to anyone else in the medical school or university about the possibility of a position here? Also, what was your impression of them?

Dr. Watts: Tom, when I’ve been so detailed and specific about some of these other things that have led up to coming to Washington the interviews here left very little impression on me. I met Dean McKinley and I had lunch with President Marvin at the Metropolitan Club and we just talked. I’m not quite sure how it was with you or how it was in your department later on but actually getting the appointment depended almost entirely on the chairman of the department. The other was just a kind of a ritual. It may not have been as much of a ritual for you, because you were being paid, but I was getting three hundred dollars a year. As a matter of fact, after I’d been here maybe thirty- four years and had been Chairman for fifteen years, the University doubled my salary, I was getting six hundred dollars a year. The Dean almost always accepted my recommendations for appointments and promotions. He never pressured me into appointing an individual I did not think suitable.

Dr. Peery: That was my experience too. Democracy did not run rampant in the halls of the medical school at that time like it has more recently. Well, obviously you accepted a position here, Jim, and came here then in 1935 to set up your practice. What do you recall about the University Hospital when you joined the staff in 1935?

Dr. Watts: May I go back for just a moment to say when I came to Washington, Walter Freeman gave us a party and I knew something about the Department. There were just three men in the Department, Walter Freemen, Herbert Schoenfeld, who was an associate in neurosurgery and H.D. Shapiro, who was an associate in neurology and then I met Tony Schneider; Antoine Schneider, who was Professor of Neurology at Georgetown and he and Freeman had offices together. They asked me to join them in their office and I thought that was a real friendly thing to do. Also I met John Shugrue who was Professor of Neurosurgery at Georgetown and also Chief at Emergency Hospital.

My impression of George Washington University Hospital was, that if I hadn’t been told that was a hospital or medical school, I just would have walked past it and wouldn't have noticed it. You remember that it was a hundred bed hospital at that time and when you entered it, you walked into a lobby, there was a bench that would seat four people that had been given by the Women's Board I understood. To the left there was an office with two people in it, and that was a combination of information desk and admitting office. There were a half dozen rooms for patients on the first floor, and around the corner beyond the admitting office was an X-ray department and rooms for an outpatient department. The library may have been, I'm not sure whether the library was on the first floor or the second floor. There was a striking contrast with the Massachusetts General Hospital, University of Pennsylvania Hospital., University of Chicago and Yale University School of Medicine.

Dr. Peery: I know, Jim, the library was in the old medical school and it was up on like a shelf at the back of hall B - it made the hall B not a full amphitheater like hall A was and that's where it was, the library was a very small unit.

Dr. Watts: Yes, I remember, I remember now. That was in the medical school. The medical school was a building of about comparable size, I think in same vintage. There wasn’t anything very impressive about the George Washington University Hospital. I was particularly incensed about the X-ray Department. We had a radiologist who came in about two hours a day, I think his name was Elwood. But we had a very good technician. I ran the machine when we did myelograms, the technician and I would do pneumoencephlograms together. But there were wires hanging down from the ceiling, I never knew what they were for but they came pretty close to my head and a number of times, when my head would get too close to one, there would be sparks of electricity that would make my hair stand up. One time I irritated the Dean, Dean Bloedorn. I was angry about something that had happened and I walked into Dr. Bloedorn’s office and said, “Dr. Bloedorn, there isn’t but one thing to do with that X-ray machine, give it to the Smithsonian Institute.” He didn't think it was funny. There was one obstetrical floor, Dr. Howard Kane was the Professor. I know that he delivered our first son, Winston. I liked him very much. Then we had on the fourth floor, two twenty bed wards, one male and one female. The operating rooms were interesting. There were two operating rooms, one with an amphitheater and there was a great mirror above the operating table; it must have extended almost the length of the operating table. There must have been two mirrors because one was at a diagonal so that people in the amphitheater could see what was going on. I was trying to visualize that mirror and you reminded me that it was at a 45 degree angle so that people in the amphitheater could look down into the abdomen or at the head. Around the top of the amphitheater was a series of windows and you could see the sun shining through those windows and it always seems to me that when the sun was shining I could see millions of particles of what looked like dust in the operating room, but it couldn't have been because our infection rate was just as good as it was anywhere else. We rarely got an infection.

Dr. Peery: Do you remember how patients were rolled up to the operating room?

Dr. Watts: There was a ramp leading from the patient area on the third floor up to the operating room, and it seemed to me that when there was a heavy patient on the cart, an orderly had to get a running start, and I was always afraid that somebody was going to fall off of the ramp onto the floor. The ramp wasn’t, you might say, a built-in thing, it was arranged so that it could be raised up when not in use; nurses could walk from the patient area to the surgical supplies. Makes me think of something Brian Blades said later when we moved to our marble palace on Washington Circle in 1948. It was at one meeting and he was asked what he thought could be done with that operating suite. He said that if we renovated it, it could be used for animal work.

Dr. Peery: That operating room certainly had many deficiencies, but, as one who occasionally sat in the amphitheater waiting for a frozen section, I must say the view of the operative field in that mirror was certainly exceptional. The amphitheaters that I’d sat in before had no such mirror and even if you used binoculars you couldn’t get the angle that you could in that mirror and you couldn’t really see what was going on, but that was really superb and it was a good mirror too, that was another thing, and it was wall mounted.

Dr. Watts: Now I agree with you that was exceptional, because we don't use amphitheaters anymore. I think it’s a shame, as a matter of fact.

Dr. Peery: Jim, what was the general medical picture in the city of Washington in 1935 when you came here, who were the medical leaders, how did they compare with those in the cities where you had trained?

Dr. Watts: Tom, it was my impression that Washington was not a medical center at that time. I do know that the opthalmologists were well known. People used to come from out of town to see opthalmologists. I mentioned first Dr. Wilmer because Wilmer Institute at John Hopkins is named for him and he was the first Director. Dr. Burke was well known, Dr. Willian Thornwall Davis was ahead of him time, I think in giving post graduate courses and he attracted physician students from all over the country and he ran a good show, I thought.

Dr. Peery: Yes, I remember that very well. He put on practice sessions for the doctors in his course and they did cataract operations on rabbits. It was a very elaborately organized program and one, which as you say, did attract a great deal of attention.

Dr. Watts: I didn't know about some of the important people until I got here. But I thought one of the really distinguished physicians was Dr. William A. White who was superintendent at St. Elizabeth’s. I thought he’d created a great hospital and the treatment of the patients was good. Another man was Charles Stanley White. Charles Stanley White was certainly a distinguished surgeon and well known throughout the community. At the Emergency Hospital there was Dr. James Mitchell who had trained at John Hopkins and was well known. Harry Kerr, H.H. Kerr, who was chief at Garfield, was known beyond Washington. He belonged to the Society of Neurological Surgeons and nearly all of the surgeons knew Dr. Kerr. He divided his time between brain surgery and general surgery but I think general surgery was his first love. One of the men who made great contributions was Joseph Wall, Joseph Wall was at Children’s Hospital and again, in those days, Dr. Wall simply decided what should be done and did it. And he was right so often that there wasn’t much to complain about. I think that Dr. Wall along with Dr. Hazen wrote the Medical Practice Act of the District of Columbia, which we've been operating under, there may be a few changes in progress now, but we’ve been operating under that pact which they drew up. I don’t think I met Dr. Bloedorn when I came down first, but it wasn’t long before I found out he was a real power, when you think that he was Chairman of the Department of Medicine, he was Dean of the Medical School he was Medical Director of the Hospital. He and Paul Dickens, I think had more members of the Congress and the Cabinet not only than almost anybody else, but probably than almost everybody put together as patients. They knew, Dr. Bloedorn had offices with Admiral Grayson who was President Wilson’s physician, Yes, that was before he was with Dr. Dickens, but he got in on the inside track. Most people went to Baltimore for neurosurgery at that time. It was a little bit disturbing in the beginning when I’d see a patient and make a diagnosis, then he'd go on off to Baltimore to be operated on by Dr. Dandy.

Dr. Peery: Well I don’t believe the neurological surgeons were spread widely over the country. I remember my medical school, Charleston, South Carolina, we had no neurological surgeon, there was a man there who took care of the trauma cases but he was a general surgeon. I don’t believe there were, you said there wasn’t one at the University of Virginia, for example and was there one in Richmond?

Dr. Watts: Dr. Claude Coleman was in Richmond. I thought about Richmond (as a place to practice). I liked Richmond. I used to court a girl from Richmond and I’d been to Richmond many times, but since Dr. Coleman was in Richmond, there wasn’t room for another neurosurgeon.

Dr. Peery: Jim, Dr. Earl McKinley was the Dean of the Medical School at that time, as I recall in 1935 and was active until his death in 1938. He came from the Rockefeller Institute in New York City. There was a feeling, I think, that he might develop the Medical School in a great way particularly as far as research is concerned, do you remember anything about this?

Dr. Watts: Tom, I knew that he came from the Rockefeller Institute, I don’t know about the research, but one thing he was responsible for was the big change. Many of the physicians were on the faculty at George Washington and Georgetown, and some of them were also on the faculty at Howard. It is my understanding that Dean McKinley demanded that the members of the faculty make the choice. They couldn’t stay on the faculty of more than one medical school. And that caused a number of people to be upset, but Dean McKinley certainly had a good point. It’s hard to have any allegiance if you have allegiances to too many places.

Dr. Peery: Jim, how were you introduced to the physicians in the Washington area? Where was your office and tell us more about that?

Dr. Watts: I told you that I gave a lecture at the Medical Society of D.C. in 1934. Walter and Marjorie Freeman gave a party for Julia and me. Antoine and Colette Schneider were present. Schneider shared offices with Freeman.

Wallace Yater was at the party along with Millicent and John Shugrue, the first man to limit himself to the practice of neurosurgery in Washington, was there. Shugrue was trained at the Mayo Clinic. I have mentioned Dr. Shapiro, Dr. Matthew White Peery, a distinguished internist and his wife Fanny. Herbert Schoenfeld was doing the neurosurgery at George Washington and on the George Washington division at Gallinger Hospital. Herb took me along, introduced me to the appropriate people at George Washington, Garfield, Children's and the Gallinger Hospital and recommended me for priviliges and then he transferred to the Department of General Surgery. I think he enjoyed working with Walter Freeman and yet I think he recognized that it was going, to require more time than he was able to put in, but I thought he was most gracious the way he handled the situation. He was one of the nicest men I ever met. He was associated with Harry Kerr at the time and I would like to say something about Harry Kerr. Harry Kerr went to Europe with Harvey Cushing. Dr. Cushing was the consultant in Neurological Surgery for the American Expeditionary Forces and he took Kerr along as his assistant. After World War I, Dr. Kerr edited the section on head injuries for World War I and it was a significant help to surgeons in future wars. That was in the Surgeon General’s office, so I suppose it was a combination of history as well as medical report. One of the most important reports on neurosurgery that came out of World War I was by Henderson from London, who studied Dr. Cushing’s cases. Cushing had been very meticulous. All the other surgeons were rushing through everything, you know, trying to operate on all of the head injuries as they were brought in from the battle field. Dr. Cushing, before he did anything, he’d get the patient’s name and I.D. number and names of all his relatives and after the operation was over he would sit down and dictate a detailed operative note and make a sketch of the operative findings. He aroused some antagonism about that, but actually more was learned from his cases than from all the rest of them together.

Dr. Peery: Well, now I know where you got it from. That was certainly your reputation at George Washington Hospital, that your records were meticulously done with great care and that you could make something out of this for the record and for future research. In the case of most of the surgeons that was not the case.

Dr. Watts: Tom, you are very kind in saying that, I do have a kind of compulsion to do things. I’m sure you’ve learned that, I know that you didn’t expect to make this many tapes on me, but I’ve started and you can't figure out a graceful way to stop it. I mentioned, I told you before I’d been invited by Walter Freeman and Tony Schneider, who was Professor of Neurology at Georgetown, to join them in an office and so we selected an office on, well actually, we selected the Rochambeau. I don’t know whether you know the Rochambeau, but it was on Connecticut Avenue, no, just below the Army and Navy Club, between I and H, and then the Federal Trade Commission took it over, I’d had bookshelves made for that but then they took it over we couldn’t do anything about it and so we got an office at the LaSalle Apartments on Connecticut and L, that’s a twelve story building and a penthouse was available at the time. It was a beautiful thing. The living room was two stories high had and had a spiral staircase going up to the second floor. What would be called the living room, we used as a waiting room. Actually it was fifty/sixty feet long, two stories high and Walter took the dining room for his office on what would be the first floor of the penthouse and used the kitchen for an examining room. Tony Schneider and I took the upstairs. There were two bedrooms up there and a place for an examining room. We had secretaries, we started out with a couple and then got up to about four and they were arranged around the foot of the staircase. Looked pretty good. The patients walked up the stairs to my office, there was never a real problem about it, you see, disc surgery hadn't come in at that time. Disc surgery was put on the map by Mixter and Barr at Massachusetts General. This was 1935, so it took a while before it was accepted; most of our work was dealing with the head. We thought we'd give a big party to let everybody know that we were in town and we had about two hundred doctors and their wives. It was really a fine party. People are doing that more now, we must have been among the early ones to do that type of professional entertaining.

Dr. Peery: Jim, what were your impressions of Walter Freeman in 1935; tell us about him as a teacher and as a physician with his patients?

Dr. Watts: Tom, I thought that Walter Freeman was a great teacher and I don’t think there is any question about it and he stimulated students. I would like to say that neurology became a department in 1932. Prior to that time it had been in the department of medicine and I believe that pediatrics and psychiatry also became departments at the same time. Lectures had been given in neurology, but they were lectures and not clinical demonstrations. Walter had been Director of Laboratories at St. Elizabeth's Hospital and he did some teaching up there and he found out that students loved seeing patients. So, in 1935, neurology was taught in three years of medical school. We had two big things going, one was the Saturday clinic which was held in Hall A of the medical school. Walter, as you know, was not only a very knowledgeable man, I thought that he was, I don’t use the word brilliant or genius very often, but he bordered on both of them. He was good and he was a great showman. One of the things that he did that the students liked so much, the students would present the case, Walter would review it or I would review it and then, for example, if the patient had had a stroke or had Parkinson's disease, Walter would walk up to the board with a piece of chalk in each hand and draw perfectly beautiful sections of the brain. He would put in the basal gangalia, internal capsule or whatever had to be done and the students were just fascinated with the way he did it. I’m afraid I didn’t make quite clear, he would draw with both hands simultaneously and the pictures of the brain that came out of it looked like they were line drawings in the textbook. They thought that was wonderful and then he’d sketch in the lesion, and that kind of thing made a great impression on the students. Another thing he would do, and I never saw him get into trouble with it but it wouldn't be a thing to recommend. A patient would come in who would need a spinal fluid examination and Walter would say that “If I do the spinal tap down in the lumbar region, you’re liable to get a headache, but I will just insert the needle in the cisternal region and there is no headache associated with that.” Now, the usual way of doing a cisternal puncture, I’ve done many of them at the Massachusetts General, because then we used to do what we called a combined lumbar and cisternal puncture and measure the pressure in each area and if there is a significant difference it might indicate an obstruction somewhere in the spinal canal. To repeat, the usual way of doing it is to insert the needle cautiously, touch the posterior rim of the foramen magnum, and then tilt the point downward and cautiously insert it into the cistern. Walter would simply have the patient stride a chair, cross his arms over the back of the chair, rest his head on his arm, wipe off the skin of the neck with a little alcohol and push the needle directly into the cisterna magnum, take out the stilet of the needle and out would come the fluid. I never saw him get into any trouble, but the students liked that kind of thing.

Dr. Peery: I’m sure the students did like it. I came along a few years later but the clinic was still in operation and it was Saturday afternoon after the CPC which started about one o’clock and it’s a little hard to expect students to hang around on a Saturday afternoon, but that had a full attendance and there were students in there not only from the senior class but junior class and the thing that amazed me and impressed me was many of the young men would bring their dates with them.

Dr. Watts: Tom, Walter said that those were days of the Depression “it was cheaper than going to the movies.” I’d say we averaged about 30 to 35 but I’ve seen 70 to 75 students there and they did bring their dates. We made something of a show of it. I remember one time, Jonathan Williams, who you probably remember, a neurosurgeon who was a resident at the time, and Jonathan Williams saw somebody out on the street who claimed he could eat glass. So, he brought him into the clinic and we had this man eat glass. Broke a Coca-Cola bottle and just swallowed the glass, so we put on a few extra’s for the patients. Walter could talk about anything in the most objective manner. As you remember, Dr. William A. White was Professor of Psychiatry at G.W. and superintendent at St. Elizabeth’s, but there were no psychiatrists at George Washington. So, we handled the psychiatric patients as well as the neurology/neursurgery patients. I don’t mean the really wild ones but the neurotics and so on. Walter could talk about people’s sex life, I never have gotten used to talking about anybody’s sex life, even when I'm in the room alone, but Walter could do it for a whole class and it seemed quite natural, going into all these, not details like we have now in pornography, but all the details about sex life, and the patients would tell him about this for a whole class. Another thing, he was a great man for exercise, he was backpacking and skiing up until his seventies. He didn’t care much for psychoanalysis. He thought there was a lot of ritual and not much substance. But I remember a young woman came into our clinic one day and she had some sort of psychoneurosis, you might call it psychesthenia or something like that. After he listened to her story, that she was too tired to walk up the grocery store, or the drugstore which was a block, a block and a half away, Walter says “I want you to get up tomorrow morning, throw up the windows (this was in February) take a cold shower, and then go down walk around Hains Point, come back by the K Street Market, then go on home after that.” I walked out with her and she said, “Is he crazy, or does he mean it?” I said, “I don’t know whether he is crazy or not, but he does mean it”. She came back a couple of weeks later with wonder in her eyes and she said, “It worked.” She felt good, she could walk now, she had gotten back her strength. Walter was very demanding in what he wanted patients to do. He could say, in his practice, people would call up urgent, say something was very urgent, he said, “I’ll see you next week.” The patient would reply, “I can’t possibly wait until next week.” He said, “OK, meet me at the office tomorrow morning at seven o’clock”, then they would usually wait until next week. There is one other thing that I would like to mention, that was probably one of the best things we did from the student point of view. Walter inaugurated a conference, we always called it the Friday Conference in Neurology at the Gallinger Municipal Hospital. It started either in 1934, it might have started in 1933, but it was attended by the Georgetown and the George Washington staffs. It proved to be a wonderful meeting place for all of us, it was a great teaching session. The cases were presented by the residents and then there was a discussion afterwards and the nearest thing that I can compare it to is the sessions that you probably see on television from time to time, “Agronsky and Company,” where Agronsky will pose a question and all five of the men will start talking at the same time. Will, and Seidey, Rowan and Fitzpatrick, all of them talking at the same time and then he has to quiet them down so that you can hear what’s going on. We did that kind of thing, it was a kind of organized bedlam, but we got to know each other, instead of being divided and never seeing the Georgetown people we saw them every Friday and that had a lot to do with the friendly relations between George Washington and Georgetown and good relationships that still exist among the neurologists and the neurosurgeon's in the Washington Metropolitan area.

Dr. Peery: Well I certainly agree with you on everything positive you said about Walter Freeman. I got to know him pretty well too. You remember that he was not only a brilliant neurologist and psychiatrist and not only was he very important in the organization of the American Board of Psychiatry and Neurology but he was a Neuropathologist of considerable note. I remember when we used to have a regular weekly brain cutting section that he would preside over it. We would remove the brains at the time of an autopsy, or on some occasion