Dr. Robert Grayson, MD, American Academy of Pediatrics, April 20, 2004
This most wonderful interview can be downloaded as a PDF file at www.aap.org/en-us/about-the-aap/Pediatric-History-Center/Documents/Sanders.pdf
Interviewed by Robert Grayson, MD, April 20, 2004, Murfreesboro, Tennessee
This interview was supported by donations from the following institutions and individuals:
Phyllis F. Agran, MD, MPH, FAAP
Marilyn J. Bull, MD, FAAP and Scott
Dennis R. Durbin, MD, FAAP
H. Garry Gardner, MD, FAAP
Georgetown Pediatric Center, PA
(Georgetown, South Carolina)
Gary A. Smith, MD, DrPH, FAAP
Deborah D. Stewart
William P. Tully, MD, FAAP and
Susan Tully, MD, FAAP
Robert S. Vinetz, MD, FAAP
Flaura K. Winston, MD, PhD, FAAP
ORAL HISTORY PROJECT
Robert Grayson, MD
April 20, 2004
This interview was supported by donations from the
following institutions and individuals:
Phyllis F. Agran, MD, MPH, FAAP
Marilyn J. Bull, MD, FAAP and Scott
Dennis R. Durbin, MD, FAAP
H. Garry Gardner, MD, FAAP
Georgetown Pediatric Center, PA
(Georgetown, South Carolina)
Gary A. Smith, MD, DrPH, FAAP
Deborah D. Stewart
William P. Tully, MD, FAAP and
Susan Tully, MD, FAAP
Robert S. Vinetz, MD, FAAP
Flaura K. Winston, MD, PhD, FAAP
©2004 American Academy of Pediatrics
Elk Grove Village, IL
Robert S. Sanders, MD
Interviewed by Robert Grayson, MD
Interview of Robert S. Sanders, MD
DR. GRAYSON: This is Bob Grayson. I’m here in Murfreesboro, TN sitting on the porch with Dr. Bob Sanders. Here to talk with Bob, to investigate and learn how he got into the thing for which he is so well-known, namely the car seat legislation here in Tennessee. This was the first state that mandated car seats and baby restraints for children. We want to find out about his career, where he started and how he got into pediatrics and all.
We’ll be interviewing Bob here. This is for the archives at the [American Academy of Pediatrics]. Bob will go down along with many other people in pediatrics who have made significant contributions. As you hear this tape and as
the transcriber hears this tape, you will hear Bob answering some questions that I ask and allowing him to discuss them. I will just be the questioner and allow Dr. Sanders, Bob Sanders, to do the explaining. And you will hear in the background as part of this, Pat [Patricia] Sanders, his wife, who has been really part of this whole enterprise, this entire initiative for car seat and seat belt and many other things that you will hear about in Bob’s career.
So let’s start, Bob. I’m going to ask a little bit about “how come?” Let’s start with where you’re from. I understand we’re on a farm and you can tell us about this right now.
DR. SANDERS: Well, Bob, first I want to thank you and the Academy for calling on me in this fashion. It’s quite an honor and I hope you can understand me. We are on the front porch, as you mentioned, of this old farmhouse where my mother was born and we have been here now some 40 years. I was born and raised in a town about 40 miles south of here, in Tullahoma, Tennessee. It’s a town smaller than Murfreesboro. I guess the population there was probably four or five thousand when I was born. Murfreesboro has always been bigger. We were talking about this last night, weren’t we Pat?
MRS. SANDERS: It could be 50,000; it could be more because they extended the city limits.
DR. GRAYSON: When were you born, Bob? What year?
DR. SANDERS: 1927, October 24 of 1927. We like to think about October 24 as the birthday of the United Nations, too. United Nations Day is on October 24.
DR. GRAYSON: It’s an important day for both of you.
DR. SANDERS: [laughs] Yes. So I grew up in Tullahoma. I had no idea about ever moving back here because my mother had . . .
MRS. SANDERS: Two sisters and two brothers who lived here . . .
DR. SANDERS: All their lives.
MRS. SANDERS: Until they died. They farmed it. Bob loved this place, he kept telling me. He would come in the summers with his mother to visit and stay quite a while. Your brother and you and your three cousins from
Texas would come.
DR. SANDERS: We had some Texas cousins.
MRS. SANDERS: He’d look at it romantically, like, “Oh, isn’t this fun?” But when we moved here 40 some years ago it was quite a job. The farm was about 370 acres in size.
DR. GRAYSON: Well, your family lived down in this other town you mentioned, and this was your grandmother?
MRS. SANDERS: He didn’t know his grandparents. They’d already died.
DR. GRAYSON: Oh, I see, this was your mother’s family’s farm.
DR. SANDERS: Yes, it was the Smith house and this was, we understand, part of a land grant program from the Revolutionary War. This particular property, this house and this property ended up in the hands of my grandfather whom I never knew, Robert Andrew Smith. He built this house. His wife was Florence Elizabeth McLean.
MRS. SANDERS: That’s your namesake.
DR. SANDERS: Yes, so I grew up in Tullahoma and we would visit down here in the summer when the Texas cousins would come. One of my cousins was a boy, Johnny, and we had the best time running around on these dirt paths. We were always, always barefoot in those days, climbing around on haystacks.
MRS. SANDERS: And big rocks. We have a lot of limestone rocks here.
DR. SANDERS: I guess there must be five or six acres of limestone.
DR. GRAYSON: It was a working farm at that time?
DR. SANDERS: Oh, yes, yes. I can remember in the 1930s much of the work was done by mules. They had families that lived on the place and they would work those mules in the fields. Then I think shortly after the war, after World War II, my uncle bought a tractor, Allis Chalmers.
MRS. SANDERS: International Harvester is still here; he bought it in 1948 or something.
DR. SANDERS: Something like that. International Harvester it is.
MRS. SANDERS: We call it the “Big M.”
DR. SANDERS: “Big M” and that’s what a lot of people called this tractor. The big M they called it.
DR. GRAYSON: Where did you go to school, Bob? Elementary and high school?
DR. SANDERS: Elementary in Tullahoma and through the 10th grade and when I reached the 11th year we were still in the middle of the war—1944. I went out to Castle Heights Military Academy in Lebanon. I’m not sure I would have gone there had not the war been going on.
MRS. SANDERS: His parents encouraged him, right?
DR. SANDERS: Yes, I think so.
MRS. SANDERS: Just knowing he’d have to go into the military.
DR. SANDERS: It did give me a little of a leg up, I think, in knowing how to carry a rifle and so forth.
MRS. SANDERS: . . .and shine shoes.
DR. SANDERS: And shine shoes and a good bit of discipline and respect.
MRS. SANDERS: Well, it was also a good little prep school. Learned how to write themes and stories.
DR. SANDERS: It was a good school academically too.
DR. GRAYSON: Was it a residential school or did you live at home?
DR. SANDERS: It was residential. I lived in a dormitory there in Lebanon, TN, which is about 30 miles north of Murfreesboro. We had uniforms and had to put a tie on everyday and keep your shoes shined. We’d have inspections. I thought it was quite strong academically. What I learned there and what skill I maybe developed in writing themes, for example, carried me on through to entering Vanderbilt [University]. It was a good foundation I thought. I thought the math and English were quite good.
MRS. SANDERS: And he got to do athletics. He got to be captain of the football team. He had been in football at Tullahoma. He loved football; he really does love football still. Loved playing it, and without glasses. He could
DR. GRAYSON: Then you went to Vanderbilt undergraduate from the prep school.
MRS. SANDERS: After the Army.
DR. SANDERS: In 1946 when I graduated there [Castle Heights], I enlisted with another friend of mine, Lester Freeman, was at that time living in Port Orange, Florida. He had some kinfolks there. He had grown up in
Tullahoma too. We were fast friends. So he graduated from Columbia [Military Academy], an archrival of Castle Heights as you can imagine. I remember coming off the field at Columbia where we lost 13-6 in a critical
game. Had we won that game we would have been the Midsouth Conference champions. We did not win the game, and it was very sad for us. I can remember, though, walking off the field and suddenly someone is walking
with me, his arm on my shoulder, and it was Lester Freeman. We had been friends way before that in scouting.
Anyway, he moved here again. We called and talked to each other on the phone and resolved that we didn’t want to get drafted anyhow. This was during a so-called draft holiday about that time.
MRS. SANDERS: Even though the war was over?
DR. SANDERS: Even though the war was over, right. I don’t know whether I’d have been drafted or not, but I surely would have been drafted a few years after that in the Korean War. That would have been my war. I’m sure glad that we enlisted. You could enlist for 18 months then and it would help you with the GI Bill too.
So we decided just to enlist and ended up in the Army engineer training. I later got the opportunity to go to surveying school at Ft. Belvoir in Virginia. That was a three-month school. So that’s what I became in the Army; I was just a surveyor in an engineering outfit.
DR. GRAYSON: How long were you in service?
DR. SANDERS: Eighteen months. So Lester and I both were able to stay in that position and made some other friends along the way there too that we’ve kept in touch with and met with . . .
MRS. SANDERS: Still do.
DR. SANDERS: Still do. The two of us and these two other fellows.
MRS. SANDERS: The four musketeers.
DR. GRAYSON: You were fortunate that you only had 18 months. When I was in the service two years was what you needed not to be called back at the time of the Korean War. If you had only 23 months and 2 days, if you didn’t have
a full two years, you were called back. I was in the service for two years, from 1944 to 1946, but I stayed for two full years and I wasn’t called back. A lot of the other doctors couldn’t wait to get out after the war was over and they were discharging them. Then they got caught in the Korean War. So I was just interested to hear that you did not get caught by that.
DR. SANDERS: I did not.
MRS. SANDERS: He was at Vanderbilt undergraduate at that time.
DR. GRAYSON: After army service, where then?
DR. SANDERS: Then I came on home and I worked for about six months in my dad’s lumber yard there driving the truck and trying to get back into shape. So I worked for Dad until the following September. I got out in February and the following September entered Vanderbilt in the premed program. The time at Castle Heights, I think, as it turns out, was so strong academically and athletically. For example, we didn’t have a gym at Tullahoma. We were remodeling the gym so I never played basketball. So I went out for those things, went out for football. I played a little football in Tullahoma, it was a football town, and so I went out and played football at Castle Heights.
MRS. SANDERS: One thing that happened at Castle Heights that preceded his going there was Sam Carney’s going there. Sam Carney is a pediatrician who died last year, but he helped lobby and had crucial influence on getting the governor to sign the seat belt bill. He was a year ahead of Bob, Sam Carney was, and it’s funny how their paths went the same way into Vanderbilt and then pediatrics. They’d been in the rattlesnake patrol together in Boy Scouts, way back.
DR. GRAYSON: This is what legislation and advocacy is all about: who are your friends and whom can you get to help you when the chips are down. So after you got out of service then you went to Vanderbilt undergraduate.
DR. SANDERS: Yes.
MRS. SANDERS: Three years.
DR. SANDERS: And so after three years if you had the grades you could apply for school as a senior absentia.
MRS. SANDERS: And guess what one big benefit was? The GI Bill.
DR. SANDERS: That was beautiful.
DR. GRAYSON: This was a question I was not going to ask but you’ve answered it for me. How, after the war, somebody coming from a rural area was able to afford college. Schools then were expensive. How does one get through? The GI bill helped me through my residency.
MRS. SANDERS: Yes, I don’t think he had it at Castle Heights.
DR. GRAYSON: My last two years at medical school also we were enlisted in the service in the Army Specialized Training Program. So we stayed in school but we were getting some stipend as a private and that was how they solved the problem.
MRS. SANDERS: I think they also paid his first year medical school, so he got four years. So that’s why you did the senior year in absentia. Is that correct?
DR. SANDERS: That’s good.
DR. GRAYSON: What was your major at Vanderbilt, Bob?
DR. SANDERS: It was chemistry.
DR. GRAYSON: Mine too.
DR. SANDERS: I think. I am sure on the charts that I was not an A-1 prospect.
DR. GRAYSON: Well, they picked the right guy. I won’t ask why. I think they choose well.
MRS. SANDERS: Well, it was difficult to get in to Vanderbilt.
DR. GRAYSON: After the war it was very difficult.
MRS. SANDERS: I don’t know about that. But he said it was difficult to get into the medical school.
DR. GRAYSON: That’s what I meant.
MRS. SANDERS: Oh, OK. Well, and his brother was a big help on that and he didn’t know it until later.
DR. GRAYSON: OK, well, let me stop us here for just a minute.
DR. GRAYSON: We’ll go back and start again. Bob, you were telling us about your application for Vanderbilt University medical school and very briefly mentioned how people helped you to get into school because it was very difficult at that time.
DR. SANDERS: Well, you mentioned the GI Bill helped finance it, but the process of getting in was rather difficult. My brother Bill, who died this past September at 81 of cancer of the prostate, stepped in on it. He got three
respectable and leading citizens; I guess you could say, to write a letter to the admissions committee. One among few that was very influential and very well respected in Tullahoma. I’m aware that this is often done and maybe
doesn’t have much effect. But they wrote the admissions committee chairman and I’ll assume he must have copied and circulated those letters from those three individuals in Tullahoma. The local minister, Reverend
Marcus Triplett and Clifton Lewis. The third man was “Daddy Ricks,” an official with the Methodist Church.
MRS. SANDERS: The Methodist minister?
DR. SANDERS: Yes, in Tullahoma. And then the scoutmaster at that time was Clifton Lewis. I think I mentioned my scouting work a moment ago. It was a good workup and I got my Eagle Scout. The Boy Scout program, that is wonderful. If you can hang in there a few years with it, it is really a broadening, responsible program and I had a lot of respect for some of those leaders, junior leaders, older teenagers who stayed with the program, counselors that helped me along the way there to the Eagle. I stayed with the scouting program a little while after that, but I haven’t been a part of the Boy Scout program since then until my son, Robert, came along and worked his way up. It is work to do it, and he got an Eagle Scout award.
MRS. SANDERS: And your brother’s son had done that. It was sort of in the family.
DR. SANDERS: Yes. Robert’s [Sanders] award ceremony was in this front yard here.
MRS. SANDERS: Court of honor.
DR. SANDERS: That was really nice to have several kinfolks coming out. We had some chairs and had refreshments afterwards.
MRS. SANDERS: The funeral home man was a big Boy Scout enthusiast and he supplied a couple of tents in case it rained.
DR. GRAYSON: Well, this shows how important contacts are, whether it be getting into medical school or getting a piece of legislation through your legislature or whether it’s helping in the community in many other activities.
Contacts are important. I think that is the message you are making here.
DR. SANDERS: The funeral home people helped a lot, because from 1983 to 1999 I was the county medical examiner, so you have a lot to do with funeral homes, death certificates.
MRS. SANDERS: They are friendly people.
DR. GRAYSON: We’ll be talking about that part of your career in a little bit. We’re not quite there yet. So you got into medical school and it was a four-year program at that time.
DR. SANDERS: It was. Yes.
DR. GRAYSON: Was there a lot of pediatrics at Vanderbilt then as part of the program?
DR. SANDERS: I don’t know if it had more pediatrics there than any other school, but what we did have in pediatrics was an intense time on the wards and the residents were quite helpful then. It was so fascinating to see these people do a spine tap on a six-month-old baby.
MRS. SANDERS: You saw that as a student?
DR. SANDERS: No, but later.
MRS. SANDERS: There was somebody very influential in that pediatric department as well.
DR. SANDERS: The chief of pediatrics was a very well known, nationally well-known pediatrician. Amos Christie. Amos Christie and his coworkers, I think, are known for their work in delineating a lot of kids that had calcification in the lungs. They did not have tuberculosis but had histoplasmosis, which is everywhere in this area. I have a skin test that is about the size of a silver dollar or more to histo, whereas hardly anything tuberculin.
DR. GRAYSON: So Amos Christie was head of pediatrics at that time. And I’m sure he was a great teacher. I’d gotten to know Amos Christie too, indirectly through my years at Duke [University]. He was a very close friend of Dean Davison, Wilburt [C.] Davison at Duke. Amos would come over to Duke and the dean would come over here. So I did have an opportunity to meet him when I was in my formative period too. He was very impressive as a teacher. Good clinician.
MRS. SANDERS: Yes, and Bob, I don’t know if you were going to mention this. The way he would teach on rounds, he acted like he didn’t know a thing and make statements and the others would think, “What in the world is the matter with him? He doesn’t know . . .” And he was trying to pull it out of them. And he was skillful and he could be very serious when he was at work, but you get him at a party—whole different guy and just very fun-loving. I wanted to say too, the contacts. Bob met somebody and was on the cadaver with somebody—you want to tell him who that was?
DR. SANDERS: My anatomy partner was Danny Dolan and also in that foursome was a young man named Jack Rice, who in 1954 married Pat’s only sister.
MRS. SANDERS: And he was in the wedding and I was in the wedding. So that’s when we met, 50 years ago.
DR. GRAYSON: That is interesting. We got to know our anatomy partners a lot more then than they do now. I have a granddaughter who is in medical school now and her entire anatomy program was six weeks or eight weeks in the first year. You and I spent a year in anatomy and we got to know one another very well.
DR. SANDERS: Yes, indeed.
DR. GRAYSON: Anyway, you were in Vanderbilt and graduated Vanderbilt and went into an internship. Was that a pediatric internship right from the start?
DR. SANDERS: It was. I had always liked kids but I didn’t hardly know what to do. My advisor was John Shapiro who was a pathology professor, chief of that department. I went to see him about it and he was a great help in talking about enjoying children. I said I thought I was interested in a pediatric experience, but I was thinking about going into general practice, even, back in Tullahoma in those days. He said, “Would you like to go here?” And I said, “Oh, well that would be wonderful if that could be arranged.” “Well, come on, we’ll go down the hall to talk to Amos.” We got up and walked down to see Amos Christie and we sat down and talked a while and that was my internship. I mean that’s the way it happened.
DR. GRAYSON: That was the start. So it was a pediatric appointment. So you got into pediatrics right from the start.
DR. SANDERS: Dr. Christie, I think he was noted for helping his residents to go elsewhere. So after my internship he had great affection for and had worked with pediatricians in California. He was from Washington but went to school in San Francisco and so
MRS. SANDERS: His wife was from San Francisco.
DR. SANDERS: Yes. So he called Bill [William] Deamer of the University of California, San Francisco medical school—I don’t remember sitting there while he did it, but he called and set it up that I go out there for my first year of residency, assistant resident they called them in those days.
This followed my internship at Vanderbilt, which was very good training. As you remember, the intern year is loaded with responsibility and all sorts of things. Everything, the details, is so critical. I learned how to do procedures
that we wouldn’t have dreamed a few years earlier.
MRS. SANDERS: Dr. Deamer was a big influence regarding allergies. He got brainwashed about that. Dr. Deamer himself was allergic and carried around adrenalin and what was the other one?
DR. SANDERS: Benadryl®.
MRS. SANDERS: Benadryl®, in his pocket in case he ate crab that was maybe disguised. He’d go to cocktail parties and have that stuff right there, because he’d had episodes.
DR. GRAYSON: University of California, San Francisco was a very excellent program at that time. One of their people came to Miami about the same time I did. What was his name—Bill [William H.] Tooley? Does that name mean anything to you?
DR. SANDERS: Yes. He was a neonatologist.
MRS. SANDERS: He came to see Millie [Mildred] Stahlman and she had us over for supper and he was there. It was for him.
DR. GRAYSON: Well, Tooley came to Miami as a pediatric neonatologist, I guess. It was intensive care, cardiology, neonatology—they were all sort of mixed together at that time.
DR. SANDERS: Yes, yes.
DR. GRAYSON: But I do remember that he came from San Francisco and I was just wondering if you knew him out there—about that time.
DR. SANDERS: He was departing and I didn’t have any direct work with you because he was on his way to you, I think, about that time. I’d met him over a year before that at Millie Stahlman’s. Mildred Stahlman was a big influence on a lot of us coming through. She was, I think, quite well known in the neonatal area.
MRS. SANDERS: The first doctor to put a baby on a respirator.
DR. GRAYSON: Yes, Millie Stahlman. Duke, [Johns] Hopkins [University], and Vanderbilt were a trio at that time. Everybody seemed to come from Hopkins. I don’t know whether Amos Christie trained at Hopkins or not, but
Dean Davison did and he brought all the Hopkins people and they were very closely related. They weren’t competitive; they were friends.
MRS. SANDERS: He was with Red Cross, wasn’t he? Up there in Baltimore. Something like that. But a lot of the Hopkins doctors came down and sort of built up the Vanderbilt medical school in the 1920s.
DR. GRAYSON: What happened is Vanderbilt and Duke, both sponsored by well-endowed individuals, were new medical schools. They were young medical schools and they went elsewhere in the early days to get the best possible people.
Mr. Duke and Mr. Vanderbilt, both for the same reason, wanted to get a good medical school going quickly and they went to the trough, if you will.
MRS. SANDERS: They got a bunch down.
DR. GRAYSON: I knew Millie Stahlman, too, because I was interested in neonatology. Anyway, I don’t mean to digress and I want to hear from you and not from me. Then you went to UC San Francisco and had your first year of so-called residency there.
DR. SANDERS: Yes.
DR. GRAYSON: Then came back to Vanderbilt.
DR. SANDERS: I came back to Vanderbilt and finished out another couple of years there.
MRS. SANDERS: Well you came back as chief resident for one year, right?
DR. SANDERS: Yes, I came back as chief resident in 1956, 1957, something like that.
MRS. SANDERS: 1957 to 1958 was the chief residency year because you went to Sweden right after that. Tell him how many interns and how many residents you had—how many on the house staff. Pitiful.
DR. SANDERS: Well, I think we had six interns when I was there as an intern.
MRS. SANDERS: When you were chief resident.
DR. SANDERS: No, the next year, before I went to San Francisco and came back as chief resident.
DR. GRAYSON: We were talking about your residency days at Vanderbilt under Amos Christie. Tell us a little bit more what it was like at that time to be a pediatric resident.
DR. SANDERS: It may be a surprise to some listeners on this oral history, that as chief resident I thought I had done my share of getting called out at night. I had, as an intern in San Francisco and as a resident. I remember the chief residents before me, many were married, but they weren’t on the wards at night. They sort of were preparing presentations for patients the next day, but at home or something. They rarely came back to the hospital in the middle of the night. So I elected to do that, too. I don’t know, but I would think that maybe some of the people on the intern and assistant resident there were not too happy that I was not right there with them but I thought that I should be doing other things in the middle of the night. Sleeping for one thing. And then preparing for the next day
presentation if we had rounds of some sort, especially the grand rounds once a week.
It was a good experience; I felt that was a chance to, among other things, see how I was at teaching and working closely with residents and the interns and then teaching the junior med students who were on the ward when they
would come have pediatrics in those days. They spent their pediatric time mainly on the wards. I would usually once-a-week pick a case and I would talk about it to those students. I enjoyed that if I had time to be prepared;
that was a nice experience. And there was a good bit of respect, I think, for the chief resident. I mean, it was something I’d always hold dear, that Dr. Christie so selected me.
The next thing that Dr. Christie did that was such a wonderful favor to me was to ship me out again after my residency. For some years, I think in the early 1950s, Arvid Wallgren from Karolinska [Institute] program in
Stockholm came over and was the school [Abraham] Flexner lecturer. He gave, I guess, a half dozen lectures about pediatric medicine in Stockholm and in Sweden and what they had done to cut down on tuberculosis in that
people. Mainly it was to inoculate babies with BCG [bacille CalmetteGuérin] vaccine in the nursery. They tried to go nationwide with it too.
A friendship developed between Dr. Christie and Dr. Wallgren for some years before I came along. They would send a resident from Sweden, someone who usually knew English much better than we knew Swedish, but they could fit right in on the ward, well-trained pediatricians. Millie Stahlman was one that was on a fellowship to Stockholm, an exchange fellowship. We had a little bit of difficulty, I think, for some of them with the Tennessee brogue, the way some people would speak. So I had the chance to go over there, to spend a year over there with Johnny [John] Lind. He was the current chairman at Karolinska Hospital there. Actually he was the chairman of the pediatric program there. This Johnny Lind, that’s a person that I would list as being very influential and very interesting. He was so
very charming and had lots of ideas. He knew how to express himself and could think of things to do, especially regarding complications of a baby with initiating respiration in the early days of life. So that was one of his big
interests, newborn respiratory physiology. That’s how I got to know Millie Stahlman quite well through the years.
MRS. SANDERS: That’s what you wrote me back in a letter, a handwritten letter, from Sweden. I was still in college and he wrote, “I’m doing newborn physiology.” That’s all I knew.
DR. GRAYSON: That was really new in those days.
MRS. SANDERS: To call it newborn physiology?
DR. GRAYSON: Yes, absolutely.
MRS. SANDERS: But that’s Johnny Lind.
DR. GRAYSON: How long were you in Sweden, Bob?
DR. SANDERS: It was about 14 months as it turned out. I arrived there in September of 1958 and came home in October, 14 months later.
DR. GRAYSON: Did you learn Swedish while you were there?
DR. SANDERS: Well, I was determined to try to and I did go to night school twice a week at one of the local public schools there, at Borg School. I had my little textbook. I was there; I was single at the time and I wanted to be sure that I was not going to be considered an ugly American. By that I mean, so many Americans in my experience make unfavorable comparisons with either the food or the customs or this or that in the country they are visiting. I would imagine that’s not too much appreciated by natives and I was determined I was going to try to fit in there and not be an ugly American. Yet I could open my mouth or even try to speak Swedish and most of the other parties were anxious to speak English with me and would answer in English. So that was not a big complication. What I did at school there, I learned to speak very simple Swedish. I could get along with a child for example.
At rounds in the hospital there, it was hard enough just the straight stuff, but the medical! For me to understand what could be going on with an x-ray or this or that, and the discussion being purely in Swedish, was difficult for me.
Now I think when there were other guests at these rounds, I mean other non-Swedish speaking folks there; they would have rounds in English. That was always very considerate. The word got around that I was going to school to
learn Swedish and then if I was in the audience they would look and they’d see me but then they’d just go ahead and keep speaking Swedish, which was an indirect compliment.
DR. GRAYSON: I’m interested in asking you about the Swedish medical system there. Did they have national health at that time? Was it universal national health and what your feeling about it was? I’m constantly thinking of
what we can do in this country to improve our medical system and I wonder if there was any influence, anything you brought back from Sweden about their medical system that could be copied or at least we could learn from?
DR. SANDERS: Well we could certainly learn from them, I think. I was very, very impressed with their national health program. This was in the 1950s now, late 1950s. It seemed so timely and so well supervised or well performed. Some of the physicians would complain a little bit about not making quite enough money doing that. But what I was so impressed with was the fact that anybody, anywhere in the country, had access to good medical care, I thought.
I went out a few times with some of my Swedish colleagues to the clinics that they would have out in the country, away from the city, away from the hospital. I think as a part of their understanding that they got their medical
school expenses all paid by the government, part of that requires that these graduates spend some time in various and sundry areas out in the field so that all these small hospitals or clinics out in the country were staffed often
by recent graduates or Swedish physicians who were required to be there.
Essentially that was the understanding. I don’t think they complained about running the clinic in certain areas away from the madding crowd. I thought that was very commendable.
DR. GRAYSON: It is so important for us Americans to understand that there are other systems of medicine that provide good care, provide good training, that we are not doing as well as they, I think. Shirley, my wife, and I went to Sweden and Norway much later, as adults and having been in practice; I have better comparisons. But I did talk with people there and my feeling was that they had adequate care, very good care, and everybody got care, which was the important thing. There were no arguments as we’re having in this country about the 15 million uninsured kids.
There comes a time when we have to look at other countries and to learn from them in this kind of a thing. That’s why I’m stressing your year and a half in Sweden because I think this is a wonderful opportunity to learn about public health. When I say public health I mean the health for the public, not as public health the way we talk about it. I wish more of us could have traveled and I wish more of us could have learned from other places.
You mentioned Amos Christie sent you all out; Dean Davison, my mentor, also sent people. He particularly sent them to England because when he was at Hopkins, as a young physician, maybe even as a resident, the great British
physician, [William] Osler, was teaching at Hopkins and then went back to Canada to practice. Dean Davison was very much influenced by him as a British physician and his teaching method and all. A lot of my older colleagues needed to get out as soon as we could, but many of the younger ones were sent over to England or London and spent a year over there in their hospitals and it was a very, very important learning experience. This is why I’m stressing my talking about it as well as yours, that I think in medicine we could learn a great deal from our
MRS. SANDERS: Dr. Christie had that vision. He got the picture in everything. He mentioned to Bob about going into world health before he did other things.
DR. GRAYSON: I don’t think the younger physicians today are getting this feeling of the global aspect of medicine. It is global; every little part of the world is a globe unto itself.
MRS. SANDERS: I think Dr. Christie is the one that instigated your teaching the course down here; is that correct?
DR. SANDERS: Yes.
MRS. SANDERS: When you were at the health department here and working, after practice. Dr. Christie got involved with students after he retired, in the [Vanderbilt Appalachian] Student Health Coalition. They have him in a book that’s been written about him, the way it was. He’s on a motorcycle with these students all behind him who went that summer to take care of people where there was no physician in Tennessee. The mountainous area of Tennessee, up there in East Tennessee and Appalachia. They called them “Dr. Christie’s Commies.” They joked about it.
DR. GRAYSON: So I think what you are saying is that pediatricians have a different feeling for medicine. What I’m trying to present in this history that you are telling us is your experience in Sweden relates to this.
So we were talking about your time in Sweden and then you got back and if I remember from your biography you also went to Chapel Hill. Tell us about that.
DR. SANDERS: Yes, I came back from Sweden appreciating not only their fine brand of medicine as I perceived it but with an understanding of what I thought probably even was more important, which was enjoying and understanding their society or their way of thinking about the world. It was more global, I think, than many of us as we grew up or even now as adults. I just appreciated them, the country of gentle people, reserved people. I
thought they were remarkable. As far as learning from one country, there are so many countries now that do have national health. Does not most of Europe have national health? Mexico, I think?
MRS. SANDERS: Industrialized nations.
DR. GRAYSON: We’re the last to even think of it.
MRS. SANDERS: I wanted to say something about Dr. Christie too, because he did encourage him to go to Sweden with that contact with Dr. Wallgren and then he helped him on along deciding things after that. He just
was incredible and he took such a personal interest. It had to do with racism.
Vanderbilt Hospital was segregated. Dr. Christie is THE one that integrated the pediatric ward one night in July—hot, hot, hot, hot, hot! Who was not being cooled? The black children. So he just put them all together and it
never changed after that.
DR. GRAYSON: Good for him.
MRS. SANDERS: Good for him. Just one step right after another. He was doing things, going over to the chancellor to try to get money to pay his faculty. I mean, he just was always looking for avenues to help whoever, whether it was Bob or Bob [Robert E.] Merrill, right?
DR. GRAYSON: I don’t have to ask you twice—Amos Christie was a great influence, right?
DR. SANDERS: Yes, yes.
DR. GRAYSON: You’ve indicated, and rightly so. These are the folks that, I think, made American pediatrics. One of my heroes was Isaac Abt in Chicago. Again, he was the first president of the American Academy of Pediatrics and I tell this because I think these are important too. I had a rotating internship at Mount Sinai [Hospital] in New York and pediatrics was very low on the totem pole at that time. Sinai was a big surgical hospital. Great surgeons, they did things that were remarkable.
Bela Schick of the Schick test was on the staff of Mt. Sinai Hospital at that time. He was an old man then and he was fighting to have the Schick test done in schools so that they could reduce diphtheria. The thing that impressed me most and why I went into pediatrics, in part, was he would make rounds. This was a time in pediatrics when parents were not encouraged to come to the hospital to be with their kids. The nurses felt they were in the way; the doctors felt they were in the way. The kids were brought into the pediatric unit and maybe on Sunday the parents could come and visit with them. But Bela Schick did not feel that way and he would walk around the ward and he would pick up these kids and walk with them and hold them and talk with them. And I said, “If anybody as famous
as this could be this way about kids there must be something in pediatrics.” And that’s why I went into pediatrics. Just a little thing like that. And Amos Christie obviously was the same kind of a thing.
MRS. SANDERS: Well, another thing Dr. Christie said to Bob, “Your patients are more salvageable.” We were telling this to his nephew who is an internist, whose son is maybe thinking about pediatrics. He’s a freshman med student.
DR. GRAYSON: OK, we were talking about why you went to North Carolina. Was that Dr. Christie’s suggestion too?
DR. SANDERS: Well, when I came back from Stockholm I was in charge of the clinic at Vanderbilt for a year. I was talking to Dr. Christie about further training for me or some sort of fellowship or what else was I interested in. I said infectious diseases and virology. I always thought that was a very interesting sub-specialty. So we talked to Dr. Cheatham, Bill [William J.] Cheatham.
MRS. SANDERS: That was back into pathology, around the corner on the third floor.
DR. SANDERS: I talked to Bill Cheatham about spending x months of the year trailing him, or maybe some projects over there.
MRS. SANDERS: With Katherine Anderson Goodpasture. She was laboratory assistant and later married Ernest Goodpasture who had done a lot of research at Vanderbilt.
DR. SANDERS: Yes. We always thought Ernest Goodpasture should have gotten the Nobel Prize in medicine because he was the one that developed the method of culturing vaccines in chick embryos.
MRS. SANDERS: He and Katherine worked with a lot of chicken embryos and did a lot of inoculations and etc.
DR. SANDERS: So it was decided I would have a year then a second year with Floyd Denny in Chapel Hill. Who was my boss there?
MRS. SANDERS: You had about two years with Katherine, until 1962, and then we married in June of 1962 and moved to Chapel Hill a few weeks later. You worked there with Wally [Wallace A] Clyde and Floyd Denny.
DR. SANDERS: So I worked there for a year in the lab and my project was inoculating parainfluenza-3 and looking at it from the hematological response and what happens physically to the little critters. So we inoculated these guinea pigs, had controls, and then on certain days those that were inoculated got sick. We followed them ten days to two weeks. Sacrificed them and then looked at the respiratory tract and the serial sections and we could fluoresce out parainfluenza-3 on this. I had a working colleague who was experienced, Wally Clyde, and he was a wonderful patient fellow. So we got some good slides and we followed a number of these animals with serial studies for a certain antibody response and presence of parainfluenza-3 (P3). I learned how to do that in those days.
DR. GRAYSON: This might be a good place to stop.
DR. GRAYSON: This is tape 2. We’ll continue with Bob Sanders and the story of his days in medicine and what he did. We have just finished, as I said on the last tape, his work with Floyd Denny in Chapel Hill. And now his considering
going on into practice.
DR. SANDERS: We got this call from my aunt, my mother’s sister, Selene Smith North, called Teenie by all of us. Teenie T E E N I E is what we called her. Teenie, with her family, lived in Dallas, Texas. When my other
aunt, who was living here alone, had a fall and was hospitalized with a broken hip, she had surgery and had it repaired here. But Teenie came to Tennessee to look into how things were going with Missie, who was the aunt
who had been living here alone. She never married, and had this broken hip. She called and said that she felt like the farm should be auctioned off unless some kinsman would want to buy the place. Her suggestion to us was, “If
you would like to do this, Bob, why don’t you consider coming back to Tennessee and live on the place for a while? Help Missie with her affairs and watch how it went with the sheep. If you maybe spend a year or two or three
and afterwards you could have it appraised by independent appraisers or you get somebody and we’ll get somebody and if you like you can buy the place. Then it would be all yours to do what you like with it. Otherwise I
think most of us would feel like it should be auctioned off. I don’t know how you feel about that but a lot of us feel like it would be nice if the farm could be kept in the family. It has meant so much to so many.” So I talked to Pat
about that with my mother who was still living in Tullahoma at the time. She had mixed feelings about it, don’t you think, Pat?
MRS. SANDERS: Your mom?
DR. SANDERS: Yes. She remembered the days of struggling on the farm, didn’t get enough rain for this or that.
MRS. SANDERS: Farming was a hard life and she had no electricity here, no running water when she grew up. She lived here 30 years, till 1920, and electricity didn’t come until 1936, with Franklin Delano Roosevelt’s Rural
Electrification Administration, and he remembers when it came. He remembers when it was not here. But I think she thought, you know, this place is kind of ‘shacky.’ It is a patchwork house, like a patchwork quilt. But we were willing to do it and so she was very supportive of whatever we wanted to do.
DR. SANDERS: Then we thought if we came we wouldn’t depend on the farm for revenue to necessarily support us. We didn’t think that would happen. But we would like to keep it as a working farm. It would be very nice if we could make some money with selling lambs every spring and shearing wool and selling it. But that’s the only source of income the farm could provide. There were some acres that were being rented out to other neighboring farmers, usually to grow a crop of corn and they would pay you so much or x percent of what they got for the corn.
MRS. SANDERS: They didn’t live here but they rented it out that way.
DR. SANDERS: Yes. So for three years then, we peeked in on the sheep and on the lambing. And tried to take care of Aunt Missie. When we moved here, she had been moved to a nursing home near Murfreesboro. We found office space; I think it was $200 a month?
MRS. SANDERS: $250 a month for a six and a half year lease. Even when he stopped after three years of practice he had to still pay that rent.
DR. SANDERS: Sure. I was stuck with that. So we moved in and established a practice. We had approached the Murfreesboro Medical Clinic here where they had two pediatricians and talked to them. I think one of the pediatricians—two fine fellows, really—one I think said they would be happy to have me as a third in the group because they anticipated that it was going to grow in times to come.
DR. GRAYSON: What year was this, Bob?
DR. SANDERS: This was in…
MRS. SANDERS: 1963 was when we moved here, October of 1963. He approached the clinic then, I think.
DR. SANDERS: So, as it turned out, with that hesitation on the part of one of the partners about adding me, we decided it might be better to go ahead rather than wait for them to decide for several months or whatever. We decided we would hang out a shingle and try it solo for a while. So we did that and I had a little office right downtown there. Nice office with two examining rooms and a lab and a waiting room. We shared that building
with a urologist. The building still stands. What’s the business there now?
MRS. SANDERS: Well, the Episcopal Church owns it now. They use it as office. It’s a very substantial building and it’s been a dentist’s office. We leased it from this dentist who’d moved somewhere else.
DR. SANDERS: So everything was rather slow there for a while. We rarely would have 20 patients a day; I mean really rarely. Many of our patients early were newborns of old friends, cousins or whatever. They would bring their newborns, so that was really good, that well baby care that everybody knows in pediatrics. That is the bread and butter issue of somebody going into practice. But I didn’t have very many of those in this town.
MRS. SANDERS: On one hand you could count your newborns.
DR. SANDERS: The obstetricians or the general practitioners who delivered babies carried on with these young children, took care of their well-baby history, immunizations and some of their childhood illnesses early, so
they were baby doctors or you could call it that, a general practice kind of exercise. But these were nice fellows with a practice like that.
MRS. SANDERS: Are you talking about Dr. Kennedy, Lois Kennedy?
DR. SANDERS: Lois Kennedy was a wonderful woman when she was an obstetrician, but she took care of the babies after they were born. They stayed with her for shots, so I did have a few babies from a few obstetrics and
gynecology people that were very supportive. They would call me in to be the pediatrician for certain families. That was very nice.
MRS. SANDERS: But you could count them on one hand each year that you had them.
DR. SANDERS: Yes, I think so. And I would also be on call with the other two pediatricians, on call with the emergency room after hours. So we divided that up; we’d each have essentially four months out of the year.
There was almost no night that would go by that I didn’t get a phone call from the emergency room. This was usually right after the late movie was over.
MRS. SANDERS: Or the 10 o’clock news. Once the news came on at 10 then the phone would start ringing because they’d gone to the emergency room.
DR. GRAYSON: You were living on the farm here? Going down this road that I just came up on at night to get into town? Quite a ride into town, to see these children in the emergency room.
MRS. SANDERS: Oh, yes.
DR. SANDERS: That’s right. A good twenty miles roundtrip.
MRS. SANDERS: Put a drip in. I don’t know how long he would stay. He’d come home and the nurse would call and say, “The drip came out,” so he’d go back in there. It got old.
DR. SANDERS: That was just those that we would admit. We didn’t admit too many, but we did if they were quite sick.
MRS. SANDERS: Now they would be Medicaid. He didn’t make any money then because they were NOT able to pay.
DR. SANDERS: We were a little concerned with the finances that were not rolling in to the office.
MRS. SANDERS: Because you had to keep paying that lease.
DR. SANDERS: Oh yes and had a very nice woman as a secretary.
MRS. SANDERS: Patti Buckingham?
DR. SANDERS: Patti Buckingham came along.
MRS. SANDERS: This was her first job after raising children. She went back to work and was a whiz-bang typist and everything. She was bright; she was incredible.
DR. GRAYSON: This was the kind of girl I had. The kind of person who could do everything for you in the office. Handle your phone, handle the patients, keep the books. That was when I started.
MRS. SANDERS: And stay as long as you needed. And have a lot of laughs.
DR. SANDERS: A very pleasant woman, yes. Enjoyed her a lot. And, I think salary for her—I don’t know how we had come upon that amount of money, but I think it was $200 a month.
MRS. SANDERS: $225 and then it went to $400. It was pushing it to do $400 a month.
DR. SANDERS: We finally got to that; that was about the time . . .
MRS. SANDERS: Course no benefits. She got them with her husband who worked with American Airlines probably. Those days were different from now. I mean you have the emergency room now, emergency room doctors.
DR. GRAYSON: So how long did you manage that, Bob, under those really trying conditions? I thought I had a hard time and I see what you did. I called you a rural physician and it’s true. This was a rural community and when I
consider driving into town this way and having to come back and forth at night—it’s bad enough to do it during the day. I can understand how it must have been very, very hard.
MRS. SANDERS: And there were a lot of poor people in this county.
DR. GRAYSON: And you had to take care of them. I mean you went and you saw them whether they were poor or rich.
MRS. SANDERS: Oh, yes.
DR. GRAYSON: So what prompted you to make the change? How did that happen to become director of public health for Rutherford County?
DR. SANDERS: Well, I was approached by the Tennessee State Department of Public Health.
MRS. SANDERS: Because of Marion Young.
DR. SANDERS: Yes.
MRS. SANDERS: A friend of ours from Crossville, Tennessee, where I’d grown up. Marion Young, a physician who had been in practice there, went into public health in Chattanooga and became the director of the Hamilton County Health Department in Chattanooga. He kept talking to Bob. He’d sit out here in the yard when they’d come through and say, “You really ought to think about going into public health.” And he mentioned it to Dr. Farris and he said, “Would you at least talk to Bill Farris?” Isn’t that right? And that’s when he began talking, thinking.
DR. SANDERS: And it was so appealing to think that this was, for me, a substantial salary. No overhead anymore and no weekend calls, no ER [emergency room]. And how you could get your sleep at night.
MRS. SANDERS: Well, at that point we had two children. Well, no because we just had Robert, but he was not even getting to be a part of that much.
DR. SANDERS: And I was sorry about that of course. I was missing out on a lot and think Pat could use some help and . . .
MRS. SANDERS: Every weekend was like Christmas.
DR. SANDERS: So I don’t know how many months it took us to make up our minds on that, but . . .
MRS. SANDERS: Well, by March of 1966 you started thinking very seriously. In June of 1966 you sent out a letter. You saw the handwriting on the wall and saw how much money you had made and you were, what was it, $3,000 in the black, so you thought, “Well, if I work twice as hard I might make $6000.”
DR. GRAYSON: Well, it’s not about working hard. You have to have the patients come in. It’s not as if you can go out and buy and sell something and make money that way. It all depends upon what happened for you.
MRS. SANDERS: I mean we just joked about it.
DR. GRAYSON: So that you made that decision then. At that time was there already a director of the Health Department and you were second to him.
DR. SANDERS: Yes. This was the idea. There was Dr. [Robert Dewey] Hollowell, who was about to retire, we had understood. He was in his 70s then.
MRS. SANDERS: He kept saying he was going to retire and two or three years went by.
DR. SANDERS: So what they did was to create a position so that I would cover headquarters here, mail and all of that would be here in Murfreesboro at the Rutherford County Health Department. But my job would be on the
road to go to three adjacent counties. So I would spend two or three days in Lebanon in Wilson and a day in DeKalb County and a day in Smith County or Carthage.
DR. GRAYSON: Were these in driving distance each day or did you have to stay over on some of these?
DR. SANDERS: Nothing was beyond an hour away.
MRS. SANDERS: Carthage was longer than an hour. They had wonderful health department nurses. It was very pleasant and he didn’t mind the drive.
DR. GRAYSON: Were they under the jurisdiction of the Rutherford County Health Department?
MRS. SANDERS: State. They had their own county health departments. One was the Model Cities, under [President Lyndon Baines] Johnson.
DR. SANDERS: During that time, when Johnson instituted the Model Cities program and it enabled us to get a new health department building, in DeKalb County. Center Hill [Lake] is there. Smithville is the county seat.
MRS. SANDERS: And that was where one of the congressmen was from. So it was sort of done there because of Joe L. Evins, the congressman from that district.
DR. SANDERS: So that was therefore an accomplishment. They had been meeting upstairs in some other public building, which was quite awkward for some mothers who might be carrying a small baby up steps or
something. So I think having that new building was helpful.
DR. GRAYSON: Was this mainly administrative, Bob, or were you actually doing clinical work at the same time?
DR. SANDERS: I was doing both of those things. But the administrative, they had sort of run on their own all these years. Some physician from the state health department would be sent out periodically. Dr. Farris himself was in charge of local health programs for physicians at least. He would go out sometimes so he knew of the need and where. That’s how that started out and stayed that way for two and a half years, I guess.
Then Dr. Hollowell retired and I came on board as the health officer here in 1969. Went into public health in 1966 and then Dr. Hollowell retired in 1969. Then I came on board in August of 1969.
MRS. SANDERS: You came here full time in August of 1969. But he still once in a while went to the other counties. You were still going to the counties until almost your retirement, to one of them.
DR. SANDERS: I kept making that trip.
MRS. SANDERS: And about that same time, 1969, Eugene Fowinkle became commissioner, isn’t that right? Or a little bit after that? And Eugene Fowinkle was commissioner [of public health] when this whole thing went through the legislature about the Child Passenger Protection Act. I don’t think he was commissioner in 1969, but he at least was in Memphis at that health department there?
DR. GRAYSON: State commissioner you mean?
MRS. SANDERS: He became state commissioner after that, right after that. He’s a jewel. He’s a wonderful man.
DR. GRAYSON: The department of health programs at that time were, I guess, what we all know as department of health: infectious disease, child health
MRS. SANDERS: Well baby care
DR. GRAYSON: Nurses did home visits and things of that sort.
MRS. SANDERS: But this one had environmental, sanitation, checking swimming pools, even at the nudist colony. We have two nudist colonies here. And other places. And rabies control, dog, animal. I mean, it’s a whopping amount of stuff that they were doing. Soils for developers, try to keep them from dynamiting everything where they shouldn’t be, to put in septic tanks. Isn’t that correct?
DR. GRAYSON: Environmental as well as health.
MRS. SANDERS: That’s right.
DR. SANDERS: Yes.
MRS. SANDERS: Now they’re separate.
DR. GRAYSON: And you were district health director for how many years before you finally retired.
DR. SANDERS: This was 1966 till 1991.
DR. GRAYSON: Did you create any innovative changes in the health department that you would like to tell us about? Of course, this is the time now we’re beginning to get into your role in safety. At the same time, if I remember
correctly, you were on the Accident Prevention Committee of Tennessee Pediatric Society [Tennessee Chapter of the American Academy of Pediatrics].
DR. SANDERS: Yes. George Lovejoy was state chapter chairman at the time and I think he wanted to make me a little bit more active on the state chapter level so he appointed me, designated me, or dropped in my lap the chairmanship of the Accident Prevention Committee.
DR. GRAYSON: George Lovejoy was in public health, too, was he not? Down in Memphis?
DR. SANDERS: Yes, yes.
DR. GRAYSON: I knew him at that time. I visited him in Memphis and stayed with him. I can remember so well; he took me over to the river and pointed out the bridge to me. It was the first time I’d been in Memphis and the
only time I’ve been in Memphis. So I did know him when he was chapter chair, we were sharing things and I came up to visit him.
DR. SANDERS: Oh, he’s a wonderful person, a fine fellow. So he asked me to do that and I didn’t exactly know what was going on. I had several members on that committee; I guess it must have been six members. But it
was not very active. The only program that I knew that that committee was doing by that time was to join the state PTA group in a program of artwork, having sixth and eighth graders competing.
MRS. SANDERS: A poster contest.
DR. SANDERS: Safety poster contest. They asked if the pediatricians would help with judging posters. So for the next three years I would go down the day they judged these things and they would get word to the family so that the governor would give the awards on a certain future date. So they asked me to be there for that too. So that’s the way I first met Governor Ray Blanton. Then the next thing to do was in this particular program, there would be three winners in this. They got bicycles from Murray Bicycle from somewhere in middle Tennessee, where Murray bicycles were made. So those were rolled into the hall outside the governor’s office. He would come out and be a part of presenting the bicycles to these kids and they were thrilled about that.
We did that two or three years and then one of our pediatricians, I can’t think of his name, said, “You know, bicycles are dangerous and I think we ought to not give them a bicycle but give them a savings bond.” We couldn’t
object to that too much. Bicycles are trouble to get in there, a lot more dramatic to present that to the child. So we switched over and went to just direct money rather than the bicycle. I think we did that yearly until, I don’t
remember how long. I think we did that two or three years.
MRS. SANDERS: That was part of the Accident Prevention Committee of the Tennessee Pediatric Society.
DR. GRAYSON: Where did the idea of child restraint need come from? Did the pediatricians talk to you about it? Or was it from the health department or the automotive. . . .
DR. SANDERS: Well, the state of Tennessee in its wisdom had a Tennessee State Health Planning Council and they formed an accident prevention committee to come up with something that would alert the public on ways that children are hurt on the road, especially in automobiles because they had enough data to know how many children had been killed on the road each year. This committee was formed and the chairman of this committee, to whom much praise should be given, Ed Casey, was a colleague who had worked for years in public health, in accident prevention, mainly agricultural dangers.
MRS. SANDERS: Environmental? Was he in solid waste?
DR. SANDERS: No, not at that time. He had been in accident prevention then and he would go out to farms and give presentations about the danger of falling from the silo or the danger of getting your hand caught in the corn picker and these kinds of things. So Ed Casey, I don’t know whether he was alone in this, but I think he and Mike Ellis, who was the governor’s highway safety representative at the time, and two others on the committee asked me if I’d be on that committee since I was a pediatrician and since I had this position in accident prevention with the state chapter of the pediatric group. I said, “Yes.”
I don’t think I got to the meeting where they came up with the idea of making it mandatory for children to utilize these little car seats. Ed’s point was that in the 1960s, 30 or 40 states tried to enact seat belt laws and they all
failed. Then he knew that in 1977, 15 countries abroad had seat belt laws for adults. These included Australia, New Zealand, several provinces in Canada and most of Western Europe.
MRS. SANDERS: But not for children, not for babies.
DR. SANDERS: We had a slide made of that and in any presentation we would remind the audience.
DR. SANDERS: So I asked Ed Casey what motivated him to have this idea for these young children and he said something like, “Religious-wise it is the right thing to do, to care for young children that can not care for
themselves.” For me, at least, I respected that. Ed and Mike Ellis, they got together with somebody from NHTSA [National Highway Traffic Safety Administration] and drew up a six-page bill.
So a bill was drawn up, this was in fall of 1975. This was a long bill. We didn’t know anything about lobbying, how you did it or who approached whom or what did you need to give them as far as literature or whatever.
What we decided then was we would try to work on a state law. I thought it was a good idea. It seemed it was timely and it would indeed save lives if the studies by Bob [Robert J.] Scherz in Tacoma, Washington were accurate. He had an article; I think that was in 1976. [Scherz RJ. Restraint systems for the prevention of injury to children in automobile accidents. He had surveyed for a year or two. . .
MRS. SANDERS: Had a five-year study, I thought.
DR. SANDERS: If you think that, I think it’s probably right. A long time study of children being killed in automobiles and automobile crashes. This was just after the car seats had come out. And he documented that, I believe the figures are there and I’m not real sure about them, in the crash cases about 90% of those cases that had a car seat survived. The death numbers were thus reduced. And the state of how serious the injuries were was cut way down if they were properly packaged in the car seat. So we had that information.
DR. GRAYSON: Did you meet with Bob Scherz personally?
DR. SANDERS: No, I never met him. I talked to him on the phone. I think we have since met, I don’t really recall where…
MRS. SANDERS: He came in May of 1978 to the first Child Passenger Safety Conference when Seymour Charles came; Bob Scherz came.
DR. SANDERS: OK. I’m sure glad you remember that.
MRS. SANDERS: He was part of the program. See, after it passed there was this money for education in the Transportation Center, directed by Kenneth Heathington over at UT [University of Tennessee] Knoxville, where
the whole headquarters were. They paid his way.
DR. SANDERS: Well, we had our work cut out for us though, about who would be a sponsor and how do you find a sponsor? Then what do you do? We thought we could get the local representative here; John Bragg might go
for it. These two pediatricians at Murfreesboro Medical Clinic, Charlie [Charles W.] Lewis and Jim [R. James] Garrison and I made the appointment with John. We went to see him and gave him a copy of an article that was in Pediatrics in September of 1975 by Seymour Charles and Annemarie Shelness. I gave a copy to the members of that committee because none had seen it.
DR. GRAYSON: Was it Charles Seymour or Seymour Charles?
DR. SANDERS: It was Seymour Charles. He was a pediatrician from New Jersey. He had been for a number of years, I understand, butting his head against the wall to energize the Academy to speak about all of the crashes and he and Annemarie had this article in 1975. That article was a stunner to me and I think to other pediatricians across this country.
MRS. SANDERS: And you and Bruce Dan wrote an article [Sanders RS, Dan B. Bless the seats and the children: The physician and the legislative process. JAMA. 1984;252(18):2613-4].
DR. SANDERS: This is in JAMA. This article was sort of a guest editorial there.
MRS. SANDERS: Bruce Dan is not a pediatrician, but he was a student who came down and took Bob’s course and he was in on the early lobbying of this legislation in the second year, 1977, when it passed. He would get medical students or anybody off the street and put them in white coats and take them to the committee meetings.
DR. SANDERS: Well, not quite.
MRS. SANDERS: Put them in the front.
DR. GRAYSON: Well, that’s it. That’s where they’re seen.
MRS. SANDERS: Yes, he wanted them to be seen.
DR. SANDERS: He did get medical students, nurses, nursing students to come to fill up some of the committee rooms and then I would try to get some doctors there too to sit on the front row and eyeball . . .
MRS. SANDERS: Especially the Calendar and Rules Committee where it could be killed.
DR. GRAYSON: This is they way it is done. To those who hear this years from now, realize that these are the techniques that are so important to impress legislators who have many things on their minds. That doctors are interested in health and that we’re willing to go to a legislative session and sit there to let them know that we’re behind legislation. Go ahead Bob. I had to add that as a supplement. This was our experience in Florida, the same thing.
MRS. SANDERS: They were thrilled, like Curtis Person, the senator who seconded the motion, remember? He believed doctors should be listened to and he also thought this is not a self-serving bill.
DR. SANDERS: Yes and that was clear in every letter that we wrote and any of our conversations. I did talk to a number of legislators before the committee meetings and especially during the committee meetings if we could
get to those. It was understood that this whole issue was not self-serving, but for the safety of kids. I would say it was not self-serving for the doctors or even the car seat manufacturer themselves. We didn’t get into that but we
wanted to be sure that we were not making money on this thing. I was accused time after time about how much was I making from these car seat manufacturers so that was surprising to me.
DR. GRAYSON: The first time around was 1976? This was the bill first drawn up in the fall of 1975?
MRS. SANDERS: Failed in 1976.
DR. GRAYSON: By many votes? Was it close?
DR. SANDERS: It was passed in 1976 by both transportation committees and then from there it goes on to the Calendar and Rules Committee, which oversees whether this particular bill has merit enough to be presented to the floor of the House or the floor of the Senate. So that year it was the Calendar and Rules Committee that killed it. There had been a good bit of discussion in the papers about it, letters, and I don’t know really remember who was against it. There were a few legislators . . .
MRS. SANDERS: Roscoe Pickering was against it and Roscoe Pickering was the one, a year later, who wanted the “child crusher” amendment. He didn’t call it the “child crusher” amendment.
DR. SANDERS: But we did.
MRS. SANDERS: But we did and he really did resent it. In 1981, we went back and got that out.
DR. GRAYSON: In 1975, your first attempt, were the newspapers supportive? Were they for or against it in general?
DR. SANDERS: Well, the Tennessee Medical Association lined up Douglas Henry and Ed Blank to become the sponsors.
MRS. SANDERS: But he asked you about the newspapers. The Tennessean endorsed it, but not the Banner, not the Nashville Banner. The Nashville Tennessean endorsed it, but Bob was pretty much alone and didn’t appeal to a lot of other pediatricians at that point. One guy told him he looked like a lobbyist for banking and insurance. He’d gone to college with him and said, “Don’t give up; come back, but get more support. You can’t do it with just the endorsement of one newspaper.” So that’s when he said, “Broaden your base and get some grassroots support, other organizations.”
DR. GRAYSON: So in 1977 when it did pass, tell us how you improved the advocacy and whom you got to do it, Bob. This is so important to us.
DR. SANDERS: Even that first year, 1976, when it did fail, we did get an endorsement from the major newspaper in middle Tennessee at the time, still is, the Nashville Tennessean. We wondered to whom could we speak there. So, as it turned out, we didn’t know it then but the chief editorial writer there, Lloyd Armour, and Ed Casey’s father knew each other somewhere along the way. So I think Ed called him, I don’t think I called him. Somehow I think Ed mentioned this relationship that Lloyd Armour had with his own father. Some kinsman back from west Tennessee somewhere asked if we could come by and talk to Lloyd Armour about this and he said, “Of course.”
So we went by and we had some literature. We had the article by Seymour Charles and Annemarie Shelness. I had it all; I had copied the thing, along with a car seat and some other literature and took that into his office. We talked to him a little while and he said, “I think we can go with this, but what I’ll need from you, we need a bunch of letters to come in right now.” I volunteered and said, “We’ll try to get some to you.” So they endorsed the bill and editorialized for it in 1976 when it was first introduced. That’s when it got by both committees, both the transportation committees of the House and Senate, but it was killed in the Calendar and Rules Committee.
DR. GRAYSON: But you brought it up again the next year.
DR. SANDERS: But we learned. What we realized is that you are going to need some help by getting grassroots people to speak up. The way to do that is Pat and Bob walking up and down the hall, knocking on doors with a
car seat in our hands. So the members of the Accident Prevention Committee, those guys were wonderful.
MRS. SANDERS: You mean the Tennessee Pediatric Society?
DR. SANDERS: Yes. We did have a legislative committee and so on. I contacted them, told them where we were and what we needed to do and what was happening. I think we sent out home numbers and office phone numbers for legislators who were on a specific committee that we were going for. We had about six or eight members of our committee. Just for the record here, this is a little bit I wrote. I don’t know if it is OK, if I read this thing into the recorder?
DR. GRAYSON: Sure.
DR. SANDERS: This is the way we remembered the law’s 25th anniversary.
MRS. SANDERS: “This April is the 25th anniversary” and this was written April of 2002, so April of 2002 is the 25th anniversary of the passage. Is that what you want?
DR. SANDERS: Yes.
MRS. SANDERS: “From 1977 to 2002. And it was the first such law in the nation or even the world. Some 15 countries earlier enacted seat belt laws only for adults. This Tennessee law required parents to properly package children under age four in federally approved car seats.” What else did you want read?
DR. GRAYSON: Does it have the names of any of the other pediatricians at that time? That would be interesting.
MRS. SANDERS: Yes, because we’ve mentioned Ed Casey already. “Endorsed by Tennessee pediatricians, medical, nursing, and safety organizations, the bill nevertheless failed in 1976 but passage in 1977 was due to a grassroots effort and especially to two groups. State legislators: Representatives John Bragg, Robb Robinson, Mike Murphy, and Senators Douglas Henry and the late Ed Blank. Nashville pediatricians: Doctors Sam Carney, Eric Chazen, David Thombs, and the late Ed Caldwell, Amos Christie, and Robert Quinn.” Those are the physicians that helped. Only
one not a pediatrician is Bob Quinn.
DR. SANDERS: Well, we mentioned in the next paragraph the role that Lloyd Armour played. HE’s dead now.
DR. GRAYSON: Well, that’s good. It’s nice to have their names mentioned as participants in a permanent record in the Academy.
DR. SANDERS: I want to mention two of these individuals that were on my committee. One of them, Sam Carney, who died this past year, grew up in Tullahoma and I got him to be on this committee. He was a political animal. He really enjoyed politics, national or state. He was in a general pediatric practice, solo. He worked with children.
MRS. SANDERS: He was a big help.
DR. GRAYSON: His name again?
DR. SANDERS: Sam W. Carney.
MRS. SANDERS: When the bill needed to be signed by the governor, there was some balking on the part of the governor. Sam had a friend who was an attorney for the governor, George Barrett. They got the governor to
sign it because they got the governor’s daughter to talk to the governor. Sam took care of the daughter’s children. The grandchildren to the governor were Sam’s patients.
DR. GRAYSON: This is when you call your chips in.
DR. SANDERS: That’s right.
MRS. SANDERS: It was a tense day or two, whatever it was.
DR. GRAYSON: You do it while the iron is hot. This is interesting Bob, because this is the whole process that we have tried and tried to get grassroots people. It is very hard, as you know. I don’t have to tell you. So that was 1977, the bill passed and it was the first state, if I understand correctly, for child car seat restraint under four years of age. Have you any idea what the next couple of states might have been?
MRS. SANDERS: Rhode Island.
DR. SANDERS: In 1980 Rhode Island passed their law.
MRS. SANDERS: And then by 1985 all states had passed similar laws. As we said earlier, Al [Albert] Gore, Jr., wanted some incentive grants to go to these states to do it. He had Bob come up, when Al was our congressman,
and had a highway patrolman go with him and went before a congressional committee and on the Congressional Record about making this incentive grant stuff happen.
DR. GRAYSON: Now let me ask some questions, because this is important for the Academy to know. Number one, was the Accident Prevention Committee of the Academy of any help to you? Were they interested in this at this very early date? Who might have been on that?
MRS. SANDERS: Thomas Reichelderfer.
DR. SANDERS: He was chairman of the national accident prevention committee for the AAP. I called him about it and he wrote a nice letter endorsing it. He then called or wrote inviting me up to one of their committee meetings.
MRS. SANDERS: Yes, it was like October or November of 1977, after it had passed, because he wanted to get these other states hopping, you know.
DR. SANDERS: I think I went up there before the law passed also.
Maybe the year before and took with me this wonderful movie called, Where Have All the People Gone? It was made by the American Safety Belt Council. Something like that. It opens up with a football stadium and it becomes
empty. The stadium represents 50,000 people, the number killed annually on the U.S. highways. This song, Where have all the people gone? sung by Pete Seeger, I think. Then the next sort of scene goes to kangaroos, nature’s first
DR. GRAYSON: To hear Pat so much involved in this, it was really a team effort. I’m sure that you were a tremendous help during this period, Pat, to move it along with women or the auxiliary members. It takes that kind of a coalition to do it.
MRS. SANDERS: Bob was determined to go back that second year. I saw his determination and I thought, “He really does need some help.” I did not help that first year; I didn’t know what was going on much. We called it from that point on “the subject.”
DR. GRAYSON: I know that in Florida, I was very much involved at this time. I was chapter chairman in Florida from 1969 to 1976 and this is when all of this was going on and the Academy got involved. I think this is why after 1980 it
spread so quickly. I think the Academy got behind it as well as the automotive safety group and it just spread like wildfire, because it was such a good cause. It really was important. You could see when you’ve got something good. How quickly it does move along. Now one of the other questions I wanted to ask was, I forget what you call it, but holding babies, newborns especially, in mother’s lap and the difficulty you had in trying to prevent that amendment being added to the bill.
MRS. SANDERS: They called it the “Babes in Arms” amendment because it was all right to hold the baby in the mother’s arms or in the arms of an older person, is that correct? So then we called it later the “child crusher”
amendment and after a certain number were killed we went back. They had been crushed in the arms of another passenger against the windshield.
DR. SANDERS: Twelve, I think, in three years
MRS. SANDERS: We told the legislature this is happening. One of them was three miles down the road here. John Bragg sponsored improving it and getting the amendment out. We had Douglas Henry and John Bragg and
Robb Robinson working very hard.
DR. GRAYSON: What year was the amendment to prohibit holding babies in mother’s arms? Was that both front seat and back?
MRS. SANDERS: That was repealed in 1981.
DR. GRAYSON: Oh, the original said that could be done, that babies could be held in the lap of an adult in the front passenger seat.
MRS. SANDERS: The original bill in 1977 had it in it. Annemarie Shelness was so grief-stricken she couldn’t get over it that we allowed that amendment. But it was a compromise and John Bragg understood all of this. In passing legislation you have to have a compromise.
DR. GRAYSON: Wait for a while and then move it up again when the thing has been accepted. It was the same way with seat belts. They didn’t want seat belts at the beginning either, early on I mean. Not children, but adults. They felt this was another gadget, something that wasn’t necessary. It was the same with airbags. There was a lot of opposition to airbags too. Tennessee and you and your friends here, your colleagues, were the ones that started a whole lot of things happening for child safety. This is part of the reason we want this all here. May I sort of summarize for you and see if I am wrong? To get things passed in the average legislature you need grassroots support, number one. You need media support, number two. And you need to be persistent. If you don’t succeed once; try, try again. Lastly, pediatricians can help through their patients. Is that correct? Didn’t you find that here too?
DR. SANDERS: Yes. Any chance you had to have the parents of children you were seeing speak out on your behalf is helpful. Of course in public health I was seeing all age groups, rather than just children. But what seemed to work on that was to have Eric Chazen chair the legislative committee.
DR. GRAYSON: There was another problem that you mentioned in some of the articles that you wrote and sent me. It was that the cost of a car seat was prohibitive to some families. How did you get around that?
MRS. SANDERS: That was sort of brought up. It was brought up in the Calendar and Rules Committee too. Then Tommy Burnett gave this eloquent three-minute talk about it and said, “You know, compare that to the emergency room, what it costs to go through all of that. A $75 visit there.” They just really socked into him. They got into the economics. He said, “You can’t afford not to have a car seat, even if you were indigent.” So that’s why the loaner program came about later, to get them to the people who couldn’t afford them.
DR. GRAYSON: In Florida, if I recall this, the hospital newborn nurseries also had car seats available. If a parent didn’t have one they couldn’t go home with their baby and so a loaner program was established. You could give a person taking a baby home, the newborn, a car seat either to buy or to return when they had one of their own. Any precedent for that here?
DR. SANDERS: No. We approached the administrative people at the hospital and they were not too keen on it. Not this particular hospital. Some hospitals across the country did this.
DR. GRAYSON: It is something you couldn’t mandate by law but you could get that by education perhaps. And the benefits that could come from it.
MRS. SANDERS: Yes, but Borgess Hospital up in Kalamazoo, Michigan had a loaner program and educational program. It was developed by Jana Hletko; her husband is Paul Hletko, who is a pediatrician now in
Georgetown, South Carolina.
DR. SANDERS: There was great interest in other parts of the country, I think, in what had happened here and how to spread the word on it. The [University of] North Carolina Highway Safety Research Center in Chapel Hill were . . .
MRS. SANDERS: B. J. Campbell, his comment, remember?
DR. SANDERS: No, I don’t. What did he say?
MRS. SANDERS: He thought this was the most significant legislation that had ever passed for safety. Something like that. He was talking about significant it was.
DR. SANDERS: Well that was a very fine comment from B. J. Campbell. So we met with them. I had some correspondence with them, some conversation with them, this North Carolina group. What they wanted to do,
and did do, was to talk to NHTSA and have a program funded that would allow some people in their organization there to hold some national and regional programs. The Carolina group would talk about how to properly
use the car seats, what is out there, what’s available. They were real well up on the use of car seats and how would you use them and this and that. They were looking for somebody I guess to talk to the state legislature and asked if
I would go with them to some of these regional meetings. I had the slides I showed at that time, didn’t I?
MRS. SANDERS: Yes, you had slides like the industrialized world that had seat belt legislation. All these countries, you know. You didn’t throw out the comment you got about Russia, did you? Guy from Oak Ridge or
somewhere said, “Well if Russia is for it, I’m agin it!”
DR. SANDERS: That’s bad.
MRS. SANDERS: Cold war days, you know.
DR. SANDERS: And I don’t know whether I thought it before I ever said it to the group because this was in front of the state chapter or something that we were talking about this. I said to him, “If Russia had a way to make bread out of air or cure cancer, would we turn away from that or not consider it since it was a Russian idea?” He didn’t say much after that. The Carolina people, though, asked if I could go along and I did. As Pat remembers, I had a few slides. I had about a 20 or 30 minute talk to the groups; usually they were well attended. This was with NHTSA, which is
National Highway Traffic Safety Administration.
DR. GRAYSON: There was a woman who was in charge of NHTSA who was a very excellent person; I am trying to remember now. I think she was the one who went with [Ralph] Nader.
MRS. SANDERS: Oh, yes, Joan Claybrook. She is a humdinger. She is wonderful!
DR. GRAYSON: She’s good. I’ve contacted her on occasion.
MRS. SANDERS: Wonderful woman. She headed up NHTSA
DR. GRAYSON: So when Joan Claybrook worked at NHTSA you were able to work with them.
DR. SANDERS: I can remember that there were meetings that—where were some of these meetings?
MRS. SANDERS: Well, you would come back with t-shirts. Seattle you came back with dogs and cats dripping wet because it rains dogs and cats in Seattle. And you went to Houston or somewhere in Texas and you went to
Raleigh, North Carolina and talked to the legislature. In Atlanta I went with you to one of these things.
DR. SANDERS: And that’s where Jim [James] Nichols heard my spiel and I think he put in the word to utilize me anyway the Carolina people could at the upcoming meeting.
DR. GRAYSON: National television was important. I think you presented the concept on several programs. Morning news, evening news, that sort of thing.
MRS. SANDERS: ABC Good Morning America and then Walter Cronkite sent someone down here for the evening news because a horrible crash happened in middle Tennessee, Fayetteville, and the only one that survived was in a car seat. The mother and brother were killed and somebody else, an aunt or somebody. So the father is left holding this child, the only one that survived. Then he announced how many days the hostages had been held in Iran. That was 1980. It was pretty dramatic.
He talked about the program that the Department of Safety in Tennessee was doing with, “Don’t punish parents, protect children.” Ticket them by giving them a ticket and a car seat. Then they bring back the car seat and the ticket gets erased if they bought their own and show proof of purchase. That was one program that really helped.
DR. GRAYSON: Great.
DR. SANDERS: The commissioner of safety, Gene Roberts, said that that one program was enough to make a major change. How did he describe that? It was the best public service that the Tennessee Department of Safety had ever had.
DR. GRAYSON: It was important; it was good; it was not self-serving. All the things you’ve already said, Bob. People want good things. I have a great deal of confidence in people, parents, their judgment and all. I may have some
questions about some of the folks who make the laws but I think people want good laws and I think people want good things for their kids. I think that is one of the functions of a pediatrician is to constantly remind people what’s good for them. There are many other examples of that too. I saw in some of the materials that you have sent the Academy that you were involved, as director of public health, in other things that were educational. You were very strong on sex education, for instance, which has always been a difficult thing to get across to people.
MRS. SANDERS: Well, there was a lot of venereal disease [VD] and he showed how many, Half a Million Teenagers, was that the name of the movie?
DR. SANDERS: A Quarter Million Teenagers.
MRS. SANDERS: Excuse me, A Quarter Million Teenagers, is a movie about VD. He showed that in some of the schools in this county only.
DR. SANDERS: And Wilson County.
DR. GRAYSON: This is a hard thing to get across because there is so much opposition unfortunately.
MRS. SANDERS: I think we had three students who could not attend because their parents had said, “No”. That was pretty good out of a huge population.
DR. GRAYSON: No, that’s not bad at all. That was another one of your initiatives that you were interested in, am I correct, Bob?
DR. SANDERS: That’s right. The young man who was VD investigator for this area had this movie. He had gone to some schools in the past, but this time we decided we’d try to do that again. I’d not been a part of it before. So we first thought that there would be some objection by the public, some parent might not wish to have their children so exposed. So we had these permission slips. When the program was announced it was stated that if the parent did not wish their child to attend this program please sign down here. So of those that were sent out, ever child took them home, there were 6,000 that went out, I think only six came back.
DR. GRAYSON: That is remarkable.
DR. SANDERS: So we went to all the junior and senior high schools in this county and a few in Wilson County. We left it up to the principals and teachers how they wanted the film to be shown, what kind of atmosphere. So some of the schools wanted it to be shown to boys all alone or the girls all alone. The more sensible, I think, schools allowed both boys and girls to see it at the same time. We tried to oblige them any way they wished.
MRS. SANDERS: You did it for seventh through twelfth grade.
DR. SANDERS: Yes, all the junior high schools and the senior high schools. There were 6,000 students as I told you.
DR. GRAYSON: Has the program continued?
DR. SANDERS: I don’t think so. I’m not aware that anybody has tried it again.
DR. GRAYSON: So this was a Bob Sanders program and Bob was no longer available to do it. This is the trouble. One of the good things that I have learned is when something good catches on the system in the Academy now is to enlist the individual chapters and spread the news that way and then pass it down to local pediatric societies so that a good thing can get moving real rapidly.
I noticed something else that you were interested in connected with safety was environmental issues like lawnmowers and things of that sort, dangerous things. I think you mentioned that at one time. The committee got involved with agricultural machines and all, not necessarily you personally but part of the accident prevention movement. How about smoking, were you involved at all as a public health officer in trying to limit smoking in kids? Did you get into that at all?
DR. SANDERS: The only way I got into it I think was anytime I had a chance to be in front of a group of youngsters I mentioned the hazards of smoking.
MRS. SANDERS: Talked about guns almost more than cigarettes. Because the deaths from the guns were just enormous every year compared to Paris, France or whatever. We would go together and talk about different
things to the government class.
DR. SANDERS: That was Pat and I. Mainly Pat was the one who was invited because she was on the board of Common Cause and it was about campaign finance reform.
DR. GRAYSON: Common Cause is a wonderful organization.
MRS. SANDERS: Yes, so I would hand out the brochures for Common Cause and our friend, Steve Cates who was the teacher would have us come every semester and after Bob retired he got to go with me and that was a plus
because then he could go into the legislation for the car seats and smoking. But guns—that was where it got explosive! These guys would say, “I keep my gun locked up,” or “I keep it right behind me because I don’t want my
nephews to get it when they’re in the house.”
DR. GRAYSON: Those are the ones the kids get a hold of too.
DR. SANDERS: Yes.
MRS. SANDERS: Children killing children. Of course, as medical examiner he had death certificates he had signed with a four-year-old who had killed a grandmother.
DR. GRAYSON: I almost forgot that. I had a note of it. Tell me about the medical examiner thing. This was in addition to being health director, am I correct?
MRS. SANDERS: Overlapped.
DR. SANDERS: That came about in 1983. The county executive came to me and sort of backed me into a corner in the office there, made a plea that the current medical examiner had been ill and was ready to retire. His name
was Matt Murfree.
MRS. SANDERS: He was a descendant of the person the city is named for. Dr. E. C. Tolbert was president of the medical society.
DR. SANDERS: He encouraged me and pleaded with me. I don’t think any physicians wanted to take that job.
MRS. SANDERS: They were paying $25 a body and one doctor said, “I wouldn’t answer the phone for $25.” So then they upped it to $50, didn’t they?
DR. SANDERS: Yes. And finally up to $75.
DR. GRAYSON: You know, you’re trying to avoid night call, but the medical examiner unfortunately gets called quite often.
MRS. SANDERS: Oh, yes, you’d come home and you’d have 40 messages on the machine. Car crashes, gun deaths, every suicide, every homicide.
DR. GRAYSON: Guns are such a major part of that job. Did you have to do the pathology too?
DR. SANDERS: No, not that part of it.
MRS. SANDERS: We sent them all to Nashville.
DR. SANDERS: If they needed an autopsy, I’d be the one to call the chief medical examiner of the state, call the pathologist in Nashville who had a practice there. We would call him, fill out whatever papers he needed and
ship the body off to do an autopsy.
DR. GRAYSON: As medical examiner did you get calls for court testimony?
DR. SANDERS: Only once.
MRS. SANDERS: It was a murder case and it was hilarious.
DR. GRAYSON: Pat is laughing, but you watch television and the medical examiner is the one that gets cross-examined in court.
MRS. SANDERS: The thing that saved his life is these wonderful paramedics. He didn’t have to go out on the highway to see the bodies or go to the homes where the murders took place and see the bodies. He had had this mild heart attack in 1987, so after that they just said, “We’ll do the paperwork; we’ll call you.” It was mostly paperwork and phoning, lots of paperwork and lots of phoning.
DR. SANDERS: But this was a unique approach to trying to solve the medical examiner being on the spot to see bodies or this or that. You could be there and I did that some but after I had had my mild coronary the chief
coroner, Mike Nunley, came to me and said, “You know our people are willing, if it’s OK with you, to represent you on site with a body here or an accident victim here. So that you don’t have to get up and go to the highway and see where these people are if you would trust us to describe the situation.” I thought this was super because every county has a coroner system to assist the medical examiner and so as it turned out all of the emergency medical services personnel drove ambulances and would go to all of the scenes of these tragedies. So they would, indeed, write the case up and I would sign it unless there was some reason for me to go as it turned out.
Because these people were well trained and before they were doing it they had yet another civilian person, untrained.
DR. GRAYSON: How long did that last, Bob? How long were you medical examiner?
DR. SANDERS: I was medical examiner from 1983 to about 1999 when I retired.
DR. GRAYSON: Really, that’s 16 years. My gosh, that’s another career that Dr. Sanders has been involved with. I’m going to stop this for a few minutes.
DR. GRAYSON: This is Bob Grayson again. Bob Sanders was involved with another very interesting environmental problem in his county here. I will let him tell you about it because I thought it was fascinating to hear again how
advocates work. Tell us, Bob, about that situation.
DR. SANDERS: Well, a day or two after I was hospitalized with a coronary back in 1987, television talked about that Tennessee was one of the candidates for the government to build a linear accelerator, superconducting
MRS. SANDERS: What happened was our son came in the house one day and he’d found a stake up here. I’d seen an article in the paper. So we went to see our congressman in 1987 to find out what was going on. It was a hearing. The Department of Energy wanted to look at all these different states where they were possibly wanting to build this thing. Big tunnel underneath the ground. You’d have all these protons hitting each other, lots of unknowns. Finally the Farm Bureau came around and thought there were too many unknowns and they were behind us in saying this is not a good idea for around here where you have so many people and all of this lime dust and everything. It was really designed for the desert and called the “desertron,” right?
DR. SANDERS: Something like that.
MRS. SANDERS: But anyway we went straight to our congressman’s office and sure enough we were in the map and we were going to be involved and what all. SO we found out New York State didn’t want it and we wondered why not, what are the reasons? What’s wrong? Cornell University did want it, it looked like, but the people up in Rochester and Ontario area of upper New York, they were fighting it. They got 25,000 signatures within a matter of three weeks.
Bob Ragland, a friend of ours, called and said, “I know this guy that lives up there and he and I go to car shows and he knows the people who are the ringleaders.” So we got them to come down and we got 200 people to come to
Riverdale High School and have a press conference. We called every radio station, TV, and newspaper and had them all right there on a Saturday afternoon, April 30th of 1988 and the two guys from New York to talk at the microphone in the auditorium. We spread the word and that began our SSC fact-finding mission. We wanted to find out, “Well, why don’t you want it?”
Why New York didn’t want it, etc. What’s going to be wrong with it environmentally? I heard the groundwater thing. Our present governor, Phil Bredesen, we had him come down. He was not our governor then, he was just working for the person who was the governor then, which was Ned Ray McWherter. The families began to realize the groundwater was going to be affected. Whether it’s nuclei or whatever were going to be in there and all of this environmental mess.
DR. GRAYSON: The energy department was . . .
MRS. SANDERS: They took New York off the list, but they did not take Tennessee off. I talked a lot to someone up in Illinois, which is near where the American Academy is, and the morning it was decided was Nov. 10 of 1988. I just picked up the phone at seven o’clock, after it rang, and she said, “Deep in the heart of Texas.” So Texas got it, and unfortunately those lovely people were thrown off their land and then it stopped dead in its tracks after they made a mess out there. It went to Waxahachie.
DR. GRAYSON: That was another time when organizing people for a cause pays dividends.
MRS. SANDERS: Well, we had had experience with the Child Passenger Protection Act, so this looked like a breeze. But it wasn’t. It was real time consuming. I got three stress-related illnesses with that. I got an abscessed tooth, muscle spasms in my back, and I can’t remember what the third thing was, but anyway. It was a little bit more stressful, wasn’t it?
DR. GRAYSON: Bob, we’ve covered a lot of ground. We’ve been very interested in what you have to say. Let me just ask you now whether you have any ideas, comments about what the Academy can do in general? We are talking
about the American Academy of Pediatrics, who are much more interested in what is going on around the country now than they ever were. For a long while I after I joined, their interest was very provincial, if you will, and they’ve become much more global. Do you see any problems that the Academy should address as we go along, as you have matured, if I can use that word? Aged is not the right word. And that you feel need to be looked at? This is a look into the future, and it will be interesting to see if sometime in the future you guessed right. Pat, you had . . .
MRS. SANDERS: Experienced is a good word besides age or maturity. The American Academy did make a stand about this children killing children with the guns. You managed to talk to the newspaper and get on the front page about guns. You got some heated phone calls and letters to the editors, “Why is Dr. Seat Belt going to do that? They are taking our guns away from us!” That is a really hot subject.
DR. GRAYSON: Yes, they are so wealthy and they are lobbying.
MRS. SANDERS: But I think the American Academy needs to keep putting the facts out: Four-year-olds killing grandmothers, six-year-olds… and vice versa. And just counter that NRA [National Rifle Association] with it. Michael Moore has got lots of facts for them, you know.
DR. GRAYSON: That’s one of the big issues, absolutely.
MRS. SANDERS: Did you see Bowling for Columbine?
DR. GRAYSON: Yes.
MRS. SANDERS: He went to the bank and he got his free gun for opening a checking account. A lot of people think that’s incredible. It really happened; it really happened.
DR. GRAYSON: Unbelievable.
MRS. SANDERS: It’s a gun culture here.
DR. GRAYSON: The other question I would like to ask again for your view, because this is very interesting. Your viewpoint can be from an academician, you have a lot of time in what you were doing in the 1960s; a pediatrician; or a public health officer. About the medical system, the access to care in our country and its problems; do you have any ideas or suggestions that we ought to think about in the future?
DR. SANDERS: Well, we talked earlier about the 14 months in Sweden and how impressed I was with that system. I do think that what our nation needs to do is look at what other countries do and what does national health mean in those countries. Because it seems to me that we have a number of families and a number of people here who don’t have access to good care, so I would think we have a lot to learn from all these other countries and should study them. Then it seems to me that if a case could be made that this country could afford the national health program just like these other countries have, I think that would be number one, having a national health program. Some sort of program where our tax dollars pay for it, I suspect. I don’t know where else it would come from. In Sweden, for example, they complained about their taxes, but their educational program is such that students can go on to college, if they make the grade, can sometimes go on to med school, at no cost to the family.
MRS. SANDERS: And architectural school. All sorts of things.
DR. SANDERS: I think we need to nail down the information that we can get from all these other countries with national health. How are they funded? Is it satisfactory? How can we improve?
DR. GRAYSON: Is there anything you’d like to add, Bob? In general, more about health? As your guest, I certainly appreciate the time you’ve given us. I’m sure it’s been difficult for you, but I’m amazed how well you remember things way back thirty years ago. I think that the Academy is very fortunate to have this as a record. But I think even more important the Academy and kids are fortunate to have you as an advocate for one of the things that’s really been a lifesaver.
Speaking for the Academy, for myself particularly, I thank you. Any other final words that you would like to say?
DR. SANDERS: Well, I think it is apparent here but I would like to remind our listeners that I don’t think we would have a law were it not for Pat Sanders. Pat was a co-worker at every step and was a charming kind of lobbyist, if I may say so. But she worked hard on this, just as I. She was tolerant about all these papers that would end up on the dining room table for years.
MRS. SANDERS: It became a habit, no matter what our project is now. I did want to say this. I appreciate your comment there.
The “Speak Up for Children” logo that the American Academy developed really made an impact on Bob, because that was what he was doing was speaking up for children. He became Dr. Seat Belt, yes, but he became Dr.
Lightning Rod and became a lightning rod on so many of these things like the guns and smoking.
He is the person who wanted to be liked. Just like when he was chief resident in the pediatric department at Vanderbilt, he wanted to have it happy.
Everybody do their part and not fuss, not argue and everybody liked him. You were the class president in high school or junior high, I can’t remember.
People loved Bob Sanders. I’ve run into people who he hasn’t seen in 50-something years and I mean they love him. And he liked that. Then when he gets this job down here and is supposed to go find a place to put the garbage,
he gets shouted at and fussed at and he is a lightning rod on finding the place for the garbage to go to, to this sanitary landfill. That was the beginning of his unpopularity and got the only life-threatening letter of his life. “Stay out of the Matthews landfill thing if you want to live and do good.” And that was when he was Mr. Unpopularity with a lot of people. People would come up and say, “You’re on my list.” He didn’t like that.
DR. GRAYSON: Whenever you are on a good cause there are people who have other interests for whatever reason, and most of them usually are financial.
MRS. SANDERS: But I think he surprised himself in taking up some controversial things. Don’t you think you surprised yourself?
DR. SANDERS: Yes, I guess so.
MRS. SANDERS: In taking up things that were going to be controversial. Because for many years you didn’t have to do that. You didn’t have to do that in biology really. You just worked hard; you were diligent. But to get
out there and put your neck out and take the heat that comes. Like some of these wonderful people that run for Congress. We have a wonderful Congressman. He doesn’t initiate a whole lot of things and he gets on safe
issues, because I don’t think he wants to be fussed at either; but he does sometimes.
DR. GRAYSON: You’re apt to get into conflicts with people who don’t see it that way, but one has to push as you did for the car seat issue. So anyway, I think you are a great team. It’s been a long day, but a very good one and I’m so happy I came over. We’ll push the button now and say good night.
DR. SANDERS: Let me say that I don’t know if we thanked you enough, and the Academy, for honoring us so. We are just very much obliged to feel so honored to be a part of this bit of history.
MRS. SANDERS: Yes, and its important and you’ve poured a lot of time into it and energy and we appreciate your work.
DR. GRAYSON: All the same, we do it because we love kids and because we want to help kids in general. I think that is true for all of us sitting here. And I think most pediatricians want that too. I feel sorry now for the pediatricians who are overburdened with paperwork, overburdened with office routine, overburdened with all the problems of malpractice insurance and all, that they can’t give the time which they would like to give to help causes, pro-bono. It makes it very difficult. One of the reasons for these archives is to say that there were better days and we hope there will be better days to come when pediatricians could be what they really want to be. So I thank you all.