Paul D. White: At the Center and Beginning of Everything

One way of looking at the origins and evolution of formal CVD Epidemiology is within “spheres of influence,” with Framingham, Minnesota-Boston (Keys-White), and the London School of Hygiene as the centers of three spheres. Paul White and Ancel Keys are responsible for the international sphere and to a major degree for its expansion and diffusion. White was essential to the realization of the ideas and vision of the two American spheres.

Beyond cardiology, where he was the international doyen, Paul White’s passion and identity were in medical history, in medicine as international diplomacy, and in physical activity for health. He was a serious scholar of history, illustrated in the sweep of the presentation on “The Coronaries Through the Ages” that he gave at the seminal Minnesota Symposium on Arteriosclerosis in 1955 (White 1955), and in his work translating Lancisi’s 1728 book, De Subitaneis Mortibus (On Sudden Death) (Lancisi).

In the latter, White was amazed at the thoroughness of Lancini’s autopsy reports but disappointed that none suggested coronary occlusion as the cause of sudden death.

In the Minnesota Symposium, we can read White’s insights about his own and others’ understanding of coronary manifestations in the early days of U.S. cardiology: “In none of these experiences (i.e. 1914 with Thomas Lewis in London, in the AEF in Europe 1917-19, or at the Massachusetts General Hospital until 1921) . . .was I more than faintly aware of the existence of angina pectoris and certainly I did not recognize coronary thrombosis.” He went on to say: “ Samuel Levine (the finest clinical cardiologist in Boston) has told me that at the time he prepared his paper on infarction of the heart in 1918, he was unaware of Herrick’s important contribution six years earlier!” (White 1955).

White’s correspondence with colleagues of the International Society of Cardiology in the 1950s and 60s, now housed mainly in Harvard’s Countway Library, displays the intensity of energy that he devoted to bringing the international community together. He did not separate care for the sick from research into cultural disease differences, or these, in turn, from humaneness and peaceful political intercourse. They all flowed together in a natural unity and with an embracing spirit seen rarely among either medical or political leaders.

Paul White spent countless hours writing letters, encouraging compromise and seeking agreement, volunteering intervention or support to diminish political and attitudinal obstructions to evidence or to professional camaraderie. Weeks he spent each year traveling in his quest to understand geopathology and to open colleagues’ minds to the interplay of culture and heredity that causes heart disease. Tens of thousands of dollars from his own pocket he sent quietly to an investigator here, a practitioner there, a student anywhere so they might attend a conference and hear or present a new message.

Paul White’s use of medicine as diplomacy (he visited the Soviet Union in the early 60s and Beijing in 1971, before Kissinger!), was as moving and salubrious as were the grand tours of America’s great diplomat, jazz trumpeter Louis Armstrong, during the same frigid epoch in international relations. “PDW’s” political message of peace and international cooperation is writ in his dramatic clarity of style and penmanship. Note the hopeful vision, from a draft of a talk he presented in Leningrad in 1964, of “an improvement of international friendship by medical means, which can be an important step on the path to international peace” (Paul White Archive, Countway Library, Harvard University). This is quintessential PDW.

Witness also White’s humanity and directness among the volumes of letters to colleagues about medical-political issues dear to his heart, in this note to Ancel Keys:
“I am taking the liberty of sending you a helpful check, I hope, from my own Coronary Research Fund at the Massachusetts General Hospital, still extant though dwindling, to help your Council with the expenses of the seminar in Pioppi in September.”

And these excerpts from letters to others:

“Eventually we hope that we’ll simply turn our functions over to a committee of the ISC; then they’ll have to cooperate with themselves.”

“In the last number of the WHO Chronicle I found the summary, quite complete . . of the WHO program in cardiovascular diseases, undoubtedly prepared by Fejfar. Do you recall the date of the occasion years ago when you and I went to Geneva to upbraid the WHO for doing nothing in cardiovascular diseases? . . . Our protest may have been the needed stimulus.”

Again, moving and shaking, across politics, we see his persistent handiwork:

“I think it would be fine to invite some observers from the “red” countries during the work of the 5-year follow-up in Finland next fall. If you need any help about inviting the Russians or Poles or Czechs and so on, let me know.”

“I am sure you remember that it was in 1954 in Washington at the Second World Congress, four years before Brussels, that the view was first expressed that the International Society of Cardiology should do more than organize periodic congresses. . . At that time the only activity which was envisioned as reasonably practical between congresses was the epidemiological team-research type of activity.” [The idea of Ten-day teaching seminars came in 1962 at Mexico City.]

“I hesitate to recommend Lamm’s extradition. I think he may be more useful in the world if he stays on the job in Hungary despite his desire to leave. This reminds me somewhat of our old problem with trainees coming to the USA and wanting to stay.”

High-level politicking and perpetual fund-raising was PDW’s constant obligation and fate. In a 1963 letter to the ISC Research Committee he advises:

“As often happens I have been awakened a bit early by thoughts which have come belatedly but which may be useful for you to pass on to the Committee or indeed to the entire group. One is this, namely that it may well be helpful very soon, because of the current state of the world, to arrange to have represented on either the Committee itself or on one of the new subgroups or on one of the teams working in the field, or perhaps on all three, of at least one African and at least one Chinese–they can of course be nationals of any country in the world (except Taiwan in the case of the Chinese), but of course they must be able scientifically, honorable, and personable too–there are, I am sure, plenty available if looked for.”

In a May 1963 letter to Ancel Keys he reports on big-time fund-raising for international cardiology: “You will be pleased to know that yesterday afternoon and evening we had a most successful first meeting of the Lay Committee of the International Cardiology Foundation at the Harmonie Club in New York under the chairmanship of Albert Baer.

It was very informal and there was enthusiastic response among the 45 or 50 leading businessmen and others who were there, who incidentally included Howard Rusk and George Wakerlin who will be useful allies. They spoke strongly on our behalf.”

And the next year, on the fly for the American Heart Association, he wrote:

“I keep advertizing our International Cardiology Foundation all over the country–in the last two weeks the annual heart drives have taken me to Chicago, Racine, Dallas, Vancouver, and New Orleans. We started off in Boston with a luncheon late in January and I’ve been in the air ever since. P.D.W.”

Even as he retires from the board of the ICF, he formally invites the elite world of cardiology to join and get involved. Who could turn down this engraved invitation:

July 30, 1970

Dr. Paul Dudley White, retiring President of the International Cardiology Foundation and Albert M. Baer, retiring Chariman of the International Lay Committee invite you and your wife to a Reception on Monday, September 7, 1970 at The Dorchester Hotel, London, from 5:30 P.M. to 8:00 P.M.

 

( Paul White Archive, Countway Library, Harvard University)

Anecdotes abound about Paul White’s commitment to the fitness regimen he advocated–walking, bicycling, taking the stairs instead of the elevator. Classic photographs can be found of PDW, in galoshes and umbrella, striding to work along the Charles River, or gracefully posed, he and his lovely wife Ina, on their bicycles. But this story best characterizes his earnestly living the active life he encouraged, in the midst of urban chaos:

One afternoon, White, who would have been about 80 at the time, left the New York offices of the American Heart Association after a meeting with Campbell Moses, its Medical Director, en route to the airport to take the Boston shuttle home. A short time later Moses received an unusual call from the New York City Police. It seemed the cops had, according to Cam, “picked up a guy riding a bicycle across the 59th St. Bridge.”

The officer told Moses, “He seems like a nice old man; knows where he’s going. He’s got tickets for an airplane at LaGuardia. And it’s a folding bicycle he’s got.”

Clearly, White did know where he was going, and he must have identified himself and suggested that Moses would vouch for him. Neverthless, the police apparently decided the “nice old man” would be better off in a squad car. “They picked him up and escorted him to the airport” (Moses-Blackburn interview 2002). (Henry Blackburn)

 

This photograph exemplifies the simplicity and open heart of a man immersed otherwise in the deepest matters of his time. Here PDW instructs, encourages, or just kibbitzes as the 8-year old daughter of a colleague attempts to skip stones in the Bay of Naples in 1964.