Remarks in honor of Clark Darwin West, MD,

in appreciation of his inspirational service to the Children's Hospital Medical Center, Cincinnati, Ohio

I was a resident at Children's Hospital Medical Center, Cincinnati, from 1957 to 1960, and spent the next 3 years as a postdoctoral fellow with Clark West. So many aspects of my time as a house officer and in the years of further training with Clark typify the unique characteristics of the Cincinnati experience. I am honored to have the privilege of making these remarks in honor of Clark's retirement. It gives me the distinct pleasure of acknowledging how much the years in Cincinnati have meant to me personally and

professionally. I will never forget my first meeting with Clark. Fluid and

electrolyte management was a complete mystery to most of us, but Clark's simple, practical system is so workable that I can still quote the volumes and fluids for correction nearly 30 years later, even though I have not written a hydration

order since I left Cincinnati in 1963. Naturally, all situa- tions did not go according to plan, and on occasion we needed to have additional input from Clark. I remember our discussion of a patient on the occasion of our first one-on- one meeting. I asked a question, and Clark said "I don't know." I was absolutely shocked. Again, you have to remember that in those days, when all facult~r were equated with deity, they were never wrong and they always knew the answer. Clark said "I don't know" as a matter of factly as if he were telling me the time of day. I had never heard a faculty member (and seldom another student, for that mat- ter) say "I don't know." Over the years, in remembering this episode, I have come to realize that one of the most remarkable aspects of this admission was his ability to ad- mit his ignorance of a subject without making any excuses, without conveying any sense of guilt, and without trying to shade the statement in any way. Not "I don't know because I didn't have time to read such and such." Not "I don't know, but it's not an important point, anyway"--just "I don't know," straight and simple. What he was saying then--and it took me only 20 or so years to fully appreciate

it--was that (1) he wasn't superhuman, (2) an admission of ignorance does not diminish your place in the sun, and (3)

you are no less of a physician or a person because you have admitted that you don't know everything.

I also remember the day that I elected to stay in Cincin- nati with Clark. Earlier in my residency, I had decided that metabolic disease was the wave of the future and had been accepted for a postdoctoral position at another institution. I remember speaking to the program director on the phone and saying that I would come and would send a letter of confirmation within a day. That same afternoon, Clark asked if I would be interested in staying on in Cincinnati and working with him. He explained that I should understand

that he was changing fields, and that might have some im- pact on my decision. He announced that he was moving into immunology and no longer would be conducting research in fluid and electrolyte physiology. He rightly surmised that 1 probably did not quite know what immunology was, because it was then a relatively new discipline. He proceeded to ex- plain: "You know that article by Doug Heiner about the di- agnosis of histoplasmosis, with that picture of the little cir- cles and the dark lines between them?" He was referring to Oucbterlony diffusion arcs, of course. I said yes. He contin- ued, "Well, that's immunology." Well, with that sales pitch, how could I do otherwise than stay? I sent off a letter ex- pressing my regrets and started with Clark here in Cincin- nati.

Clark had developed his interest in immunology because

he wanted tO know more about an alpha-2 protein that was elevated in certain renal problems and about a complement protein called beta-lc. In the process of following some of our patients with more chronic renal disease, Clark saw that they had a persistent absence of beta-lc. Extensive charac- terization of their abnormality and clinical course led to the original description of hypocomplementemic nephritis. As Clark plunged deeper and deeper into the metabolism of complement, he eventually became a complementologist, and the majority of his research contributions since the mid- 1960s have related to this system. It was about this time that I left Cincinnati to pursue immunology in a slightly

S l 1 5

S 1 1 6 Hong The Journal of Pediatrics May 1990

different way from studying arcs developing between cir- cles, and Clark surged ahead to become a foremost comple-

mentologist. Clark had worked out a method for protein quantitation,

and this was the first known method of easily measuring IgG, then known as 7S gamma globulin, in mass units. The technique was also used to quantitate IgA and IgM (called beta-2A and beta-2M). This allowed him to be the first to describe selective IgA deficiency. Although many years later I devoted a lot of energy to studying and characteriz- ing patients with this disorder, all the essential features of

the syndrome were recorded in that original article in the

Journal of Clinical Investigation Each of us, as fellows in Clark's program, carried away

many special memories of a very special time. Over the years, a number of Clark's observations have served as im- portant guidelines for me in my academic career. I remem- ber when he told me, while mildly criticizing one of our more arrogant colleagues, "With knowledge comes humility." That comment fit in so well with his overall demeanor. Clark is truly a humble guy because he knows so much. And ev- ery time my not-so-latent arrogance comes to the fore or I 'm

tempted to be a little cocky, I hear that phrase and I am truly

embarrassed that I am trying to cover up for my lack of knowledge by bad behavior.

Robert Good once said to me: "Most people in academia think that their papers are their most important contribu-

tion. But one year after you've written a paper, no one will remember that you're the author. Five years later, they will have forgotten the journal. Ten years after the publication, no one will even remember the title. If you want to leave something behind that will last long after you've gone, leave students." This is certainly true. Those of us in the teaching profession leave much more to the world through our stu- dents than through our writings. In Clark's case, each of his students has shared a remarkable legacy. That legacy rep- resents the ideal standards for which we all must strive. He taught by action, by speech, and by behavior. For this, I thank you, Clark Darwin West. For this, we all thank you.

Richard Hong, MD Professor of Pediatrics University of Wisconsin

Madison, WI 53792