UNIVERSITY OF WISCONSIN-MADISON ARCHIVES
ORAL HISTORY PROJECT

Interview #643
SEGAR, WILLIAM E.

SEGAR, William E. (1923- )
Professor of Pediatrics
At UW: 1970-1989

Interviewed: 2003	
Length: 2 hours, 1 minute
Interviewer: Ann Peckham

Childhood; Medical education; Residency in Indianapolis; Appointment to Indiana University School of Medicine; Research; Appointment to UW in 1970; Chairmanship of pediatrics department, 1974 to 1985; Consolidation of neonatal intensive care facilities; Faculty in pediatrics; Move to the new hospital; Residents; Shortage of primary care patients; Establishment of mentor program; Teaching; Payment system for pediatrics department.

First Interview Session (October 31, 2003): Tapes 1-2

Tape 1/Side 1

00:00:27	William Segar was born in Indianapolis in 1923.  His father was the first pediatrician in the state of Indiana. 

00:01:18	WS dropped out of high school in order to begin his college pre-med courses.  When World War II began, he joined the army Enlisted Reserve Corps.  However, he failed the physical exam and instead went through medical school as a civilian.

00:02:34	Only about 90 students graduated from his medical school class.  Those who did not successfully complete their first year were called to active duty in WWII.  After graduating, WS took an internship at Indiana University.  

00:03:41	After his internship, WS joined a residency program at the University of Illinois.  During this time he met Harry Waisman and Julius Richmond, the future Surgeon General of the United States.

00:05:18	WS continued his residency in Indianapolis.  He explains how residency training programs in the 1950s were different from residency training programs today.  He relates three anecdotes that illustrate these differences.

00:15:06	During his residency in Indianapolis, WS was sent to Yale University for two years to work with Daniel Darrow so he could learn to perform fluid therapy on babies.

00:17:09	The Korean War started after WS's time at Yale.  He served most of his time at the metabolic research unit at Walter Reed Army Medical Center in Washington, D.C.  This is where he learned how to conduct artificial kidney dialysis.

00:21:11	WS joined the faculty at the Indiana University School of Medicine, where he worked from 1955 to 1967.  There, with co-author Malcolm Holliday, he published a groundbreaking paper on pediatric fluid therapy.

00:23:41	He tells a story about performing exchange transfusion on three babies suffering from boric acid toxicity.  He discovered that peritoneal dialysis was highly successful in removing boric acid.  The article he wrote following the experience was published in the New England Journal of Medicine.

00:28:27	WS talks about his work on a study measuring anti-diuretic hormone (ADH) in the blood. 

00:30:25	End of side.

Tape 1/Side 2

00:30:26	WS continues talking about the ADH measurement study.  He discovered that both the total hydration of the patient and the distribution of the blood within the vascular system influence the amount of ADH in the blood.  This discovery led to a number of clinical applications.

00:34:01	Before he left Indiana University, WS served on a committee to review the medical school curriculum.  After determining that first-and second-year classes were inadequate, three members of the clinical faculty, including WS, decided to teach basic sciences courses.

00:36:01	In 1967, WS decided to go to the Mayo Clinic to help develop the curriculum for their medical school.  He continued his work on ADH with John Zehr.

00:37:50	The curriculum at the Mayo Clinic was centered on growth, and most of the courses were taught by clinicians.

00:41:07	WS decided to come to the University of Wisconsin in 1970 in order to work with Charles Lobeck.  As chair of the department from 1974 to 1985, WS attempted to resolve the lack of primary care patients by hiring Catherine DeAngelis.

00:43:49	Eventually, WS decided to add pediatricians from the Madison community to the faculty.  The move to the new hospital building also added to the patient base, since the new building was easily accessible.

00:45:19	WS mentions programs that were added to ambulatory pediatrics, including adolescent medicine, outpatient eating disorders, and sports medicine.

00:50:43	In about 1966 or 1967, a neonatal intensive care unit was set up at St. Mary’s Hospital.  The obstetrical department hired Perry Henderson to set up a program for high-risk mothers at Madison General Hospital.1  More and more high-risk babies were delivered at Madison General Hospital, and the hospital developed its own high-risk neonatal unit.  It became difficult for the university’s four neonatologists to move back and forth between the two hospitals.

00:55:00	Robert Cooke and Charles Lobeck decided to consolidate the two neonatal units.  The university wanted the neonatal unit to be housed at Madison General Hospital, since St. Mary’s Hospital did not allow obstetricians to perform certain procedures on mothers.  In 1976, the university neonatal service was moved to Madison General Hospital, and St. Mary’s developed its own neonatal service.

00:56:42	WS makes a correction concerning his earlier statements.  He notes that Madison still has two neonatal units, located several blocks apart.

00:57:54	WS begins to discuss the faculty members who were brought into the department in the 1970s.  He talks about Philip Farrell, who developed a program in pediatric pulmonary medicine, with an emphasis on cystic fibrosis.

00:59:24	WS describes the background of Gerard Odell.

01:00:26	End of side.  End of tape.

Tape 2/Side 1

01:00:38	WS continues to describe how he recruited Gerard Odell, a world famous pediatrician, to UW.

01:01:43	Other important additions to the department were Russell and Joan Chesney. Russell Chesney helped trained some notable physicians, including Aaron Friedman, who joined the department in the mid 1970s, and who is now chair of the department. Joan Chesney eventually took over the department of infectious diseases.

01:03:11	Around 1976 or 1977, two Madison pediatricians simultaneously saw young women suffering from a rash and acute renal failure.  This condition was subsequently diagnosed as toxic shock syndrome. Jeff Davis, a member of the state department of communicable diseases, and Joan Chesney discovered that toxic shock condition was caused by the contamination of tampons by a strain of staphylococci. Joan Chesney was also an outstanding teacher.

01:05:29	The Chesneys left UW in 1985 to join the University of California, Davis.  They are now both at the University of Tennessee.

01:06:10	End of session.

Second Interview Session (November 3, 2003): Tape 2

01:06:30	WS discusses several other distinguished members of the department.  Philip Farrell succeeded WS as chair of the department, and subsequently became dean of the UW School of Medicine.

01:07:14	WS mentions Aaron Friedman and Norman Fost.  Fost has become a widely respected authority in the field of medical ethics.

01:08:51	WS talks about the connections between the pediatrics department and the Waisman Center.  Communication with physicians at the Waisman Center was difficult during Rick Heber’s tenure as head of the center, but improved once Terrence Dolan succeeded Heber.

01:10:58	The pediatrics department had an association with several hospitals on the east coast of Nicaragua.  WS accompanied Charles Lobeck on some of his trips to Nicaragua, where they developed a program to help the Mesquite Indians learn to take care of their medical needs.  WS taught nurses how to treat babies with severe diarrhea.  The program was unfortunately disrupted by the Nicaraguan revolution.

01:13:16	WS mentions several other members of the pediatrics department, including Paul Sondel and Michael MacDonald.  During WS’s years as chair, he tried to develop a strong academic program and research program in pediatrics.  The department was successful in obtaining $5 million of grant funding, and it was ranked eighth in the country in terms of grant money from the National Institutes of Health.

01:17:16	WS talks about the move to the new hospital in the late 1970s.  The department was not given as much space as it had been promised, and shortly after the move, it outgrew its space.

01:18:28	The module for clinical use was poorly designed.  WS says that after a fire destroyed the interior of the module, it was redesigned.  Several other departments, particularly oncology, gave up some of their research space to pediatrics.

01:20:00	During WS’s years as chair, the department successfully recruited excellent residents.  The department normally had about thirty residents.  In 1976, the residents had clinical responsibilities at Madison General Hospital (now Meriter Hospital) and St. Mary’s Hospital.  Following the removal of the neonatal intensive care unit from St. Mary’s Hospital, the residents worked only at Madison General Hospital and at the university hospital.

01:23:29	When the new outpatient unit was built in the university hospital, the department built facilities for pediatric ophthalmology.

01:25:08	The residents spent most of their time in general pediatrics.  One of the problems the department faced when WS became chair in 1974 was a shortage of patients in the general pediatric clinic.  After Catherine DeAngelis was hired to oversee the general pediatric outpatient clinic, the number of annual pediatric visits roughly doubled.  However, this increase was still insufficient because it did not provide enough training opportunities to the residents.  The department then hired Peter Karofsky, a practicing pediatrician in Madison, who brought a number of his private patients to the university hospital.

01:27:29	Residents also care for the newborns at Madison General Hospital.

01:28:40	When WS stepped down as chair in 1985, he was not yet ready to retire, but was too far removed from research to reestablish his research program.  He begins to discuss the mentor program he established.

01:29:51	End of side.

Tape 2/Side 2

01:29:57	WS had two sons in medical school at the time who often complained about how irrelevant their courses in the basic sciences seemed to them.  He realized that medical students might benefit from hearing from a clinician on why the basic sciences were important to medicine.

01:30:54	Dean of the Medical School Arnold Brown was happy to let WS establish a mentor program.  After sitting through most of the first- and second-year medical school lectures, WS became convinced that instructors were focusing excessive attention on preparing students to pass the National Boards Exams, which meant that students were memorizing details rather than learning to solve problems or investigating topics of interest to them.

01:33:55	WS established excellent relationships with the medical students, and remains in contact with many of them.  He is pleased that the medical school agreed to continue the program after his departure.  Robert Schilling succeeded WS as mentor, and Frank Larson succeeded Schilling.

01:36:05	As a mentor, WS assumed heavier teaching responsibility in nephrology and renal pathology.  He talks about the independent study program, a program that allowed students to attend medical school part-time.  Some students in this program were women with small children, and others were students who were simultaneously working on a PhD.

01:38:00	WS became disenchanted with multiple choice examinations and instead used written exams.  He assigned only one of two grades to students, A or B.  Students who did not receive a B were asked to repeat the exam.

01:39:51	WS decided to experiment with group testing.  Students studied for a test in groups of three.  When they were ready, one of their names would be chosen at random, and that student would take the test for all three of them.  WS explains that this method of testing students was very successful.

01:42:22	WS also visited students working at other locations around the state.  He learned that students at the Marshfield clinic received an excellent education because faculty in internal medicine there were not financially penalized for spending time with students.  In contrast, clinical faculty members at the university hospital whose income depended on their research productivity or their clinical productivity had no incentive to spend a considerable amount of time with medical students.

01:44:32	End of side.  End of tape.

Third Interview Session (December 1, 2003): Tape 3

Tape 3/Side 1

01:44:48	WS discusses the way the pediatric department paid its members.  Either Nathan Smith or Charles Lobeck established a program whereby department members earned a guaranteed base salary that was paid using money from both the medical school and the department.  If the department generated extra practice income, half of this “secondary net income” was given to a research fund, and the remainder was distributed equally between all members of the department as a bonus.  A few years before WS became chair, the department did not earn enough money to pay its portion of the guaranteed base salary, and it had to take out a bank loan.

01:47:33	The department voted on how to use money in the research fund, which in some years amounted to several hundred thousand dollars.  WS explains that this way of paying department members allowed some salary equalization between those who spent most of their time seeing patients and those who spent most of their time conducting research.  During WS’s eleven years as chair, only one person complained about this payment system.

01:49:53	WS explains that the department’s payment system allowed it to recruit new people, since it made research funding available to them until they were able to find outside sources of funding.  He mentions several people in the department who became successful researchers.  WS points out that the money in the research fund came out of the pockets of all the other members of the department.

01:54:50	WS clarifies that every department donated a fixed percentage of its practice income back to the dean of the medical school.  He talks about why the department’s payment system would not be accepted today.

02:01:06	End of side.  End of tape.

END