Emanuel M. Papper, M.D., Ph.D.






JUNE 1 st – JUNE 21 st , 1986

The occasion for this trip is a combination of events, some of it holiday and some of it working engagements. The main working events are my participation in the celebration of the 600th Anniversary of the founding of the University of Heidelberg in Germany, the workshop on the "State of Consciousness " in Cardiff in Wales, and finally the “Meeting of the European Academy of Anesthesiology”, in Barcelona .

Pat and I decided to travel in our usual and very comfortable way because of the large number of American tourists who had cancelled their plans to Europe this summer. The reasons for the cancellations were varied, but in the main they consisted of a unwillingness and fear - quite legitimate - to face the possibilities of terrorism in Europe from the PLO, Syria and Libya. There was also a reluctance on the part of many Americans to spend their U.S. dollars in Europe again for two reasons both quite legitimate. The dollar is relatively weak with respect to foreign currencies and it is an expensive way to take a trip to Europe. Secondly, there are others that feel very resentful of some of our NATO European Allies who failed to support the Reagan Administration in its efforts to “punish” the Libyans for the terrorist activities by the bombardment of their capital in the late Spring. There are of course others who are concerned about the influence of radiation from the tragic events in the Soviet Union with the melt down of the atomic energy plant in Chernobyl. For all these reasons Europe seemed to be empty of Americans this summer and it is reflected in approximately 80° downturn in reservations by Americans for various places in Europe. For those Americans like us who intended to go to Europe despite these other very legitimate considerations there was some opportunity to overcome the effects of the weak dollar because of the various promotional fares and rates of hotels and other events in Europe.

We took off by Concorde from Miami with British Airways on Sunday morning the first of June. There was one stop in Washington and there were a good many travel agents taking the leg between Miami and Washington - normally closed to pick-up traffic, but seemed to be okay for a "promotional activity". There were relatively few passengers on board the Concorde, but not different in our experience from previous Concorde flights. The flight was very pleasant to Washington where re-fueling and loading of Washington passengers for London took place. The flight from Washington to London was three hours and thirty-two minutes - all of it comfortable with a pleasant meal and just about enough time to read the Sunday newspapers pretty thoroughly! We arrived in London at 10:00 P.M. London time and were in the Londonderry Hotel in London in the Mayfair district by 11:00 P.M. local time. We had a very long and pleasant night's sleep and the next morning started our journey to Germany.

We flew with Lufthansa from London Heathrow to Bonn - Cologne, where Horst Stoeckel met us at the airport. Since we were well rested we simply left our luggage in the hotel in Bonn and then went up with him to have dinner with the Stoeckel Family in their lovely home just outside of Bonn. The weather was not great - a harbinger of things to come for the week, but we had a marvelous dinner and very much good talk in Bonn . It is a great delight to be with the Stoeckels. They are so close to us and such good friends we simply had a marvelous visit. Their daughter Nicole, now sixteen, is a very charming young woman and is planning to go to school in Ascot in England for a year this autumn. Her English has vastly improved and obviously much more so than my German has!

On the third of June, which was Karen Stoeckel's birthday, we all drove to Dusseldorf for a very pleasant lunch, shopping and a visit to a marvelous provincial museum in Dusseldorf, which had a very strong collection of German expressionists paintings. It was a most interesting hour and one-half that we spent at the museum. Our shopping trip was somewhat curtailed because of the rain and we did go back to Bonn for a rest, which Pat and I needed, despite the way in which we traveled. The circadial rhythm is still disturbed even if you treat it gently. Our jet lag was, therefore, not outlandishly uncomfortable, but we had to sleep a bit more at different hours then we had thought would be necessary. On that evening of June 3rd, we went to Cologne, to one of the outstanding French restaurants in Germany to celebrate Karen's birthday at dinner, which I thought was excellent, but the Stoeckels seem to be somewhat less impressed then we were. Then back to Bonn for a rest and sleep.

On Wednesday, the fourth of June we went to Baden-Baden, by way of Ider­obersheim, which is one of the remarkable mining places in Germany for semi­-precious stones. The industry has long since languished and practically disappeared, but we saw how the miners dug their materials out of the earth and how they processed and polished them. The main thing of interest in that town was the museum devoted to various kinds of both precious and semi-precious jewels. Among other interesting things is the largest topaz that is polished in the world. I was particularly taken with the pearl exhibition which showed marvelous natural pearls as well as cultured ones.

From Iderobersheim, we drove on to Baden-Baden and went to the Brenner's Park Hotel where we had been before. In fact, Pat's parents had been there before the war and after the war. It is one of the great hotels of the world and a place right in the center of an important spa. The climate is marvelous. It is in the Black Forest. It has wonderful international shops, beautiful and excellent restaurants, wonderful places to hike and walk, all the facilities of a well established European type spa and of course the always present casino for gambling, but on a very sedate level and very much like it is done in Monte Carlo. We went from there to a beautiful restaurant for dinner, about a twenty minute ride outside of Baden-Baden called Burg Winkett. The dinner was somewhat more German and a little less French, but excellent indeed. As we looked out from the top of the mountain where the restaurant was we could see the Rhine River and further on in the distance as the sun was setting the French frontier, which at this point is pretty near Germany. After dinner we went back to the Brenner's Park Hotel for a fairly early and a good night's rest.

On Thursday morning the fifth of June we walked around Baden-Baden and looked at the shops. The Stoeckels did a bit of shopping and I did none, and Pat also a little. We then drove out of Baden-Baden to another very lovely and much less known spa about an hour's drive into the mountainous area of the Black Forest, a place called Baden-Heernalb. This town was the sight of a middle aged monastery and there was also a nunnery nearby. The rooms of the monastery still exist. The headquarters, if that is the correct word, for the chief Monastery is now called The Post Hotel and has been there since the seventeenth century. It has an excellent restaurant which the Stoeckels have known for many years and we had a very fine lunch again of asparagus constituents. We made our way onto Heidelberg and checked into the Europaischerhof Hotel in ample time, where we were placed in what looks like the largest suite of this old and stately hotel. ­It has much old world charm and all the comforts of modern living.

We had our first official banquet in connection with the Heidelberg meeting where the various Chairmen and speakers and their spouses attended at the Heidelberg castle. It was preceded by a warm welcoming address by the Pro­rektor - a position roughly equivalent to Vice-President of a University - who spoke movingly and passionately about the six-hundred years of history of the University of Heidelberg. His welcome took place in the old hall as it is called here, and there are elements of this building that go back to the 14th century, but much of it was re-built from time to time, and the largest part of it is approximately 150 years old. His presentation was preceded by a short string quartet playing a single movement of one of Mozart's compositions and it was very charming in that all of the performers were students and they were very good.

The dinner at the Castle brought together many old friends and I also met a few new ones, and all together we had a very happy time, but certainly not a particularly good meal. There was also some music at the Castle of a hunting nature with young men in costumes of the 18th century, playing 18th century horn instruments. During and after the dinner there were a great many speeches and Otto Just made some very nice comments indeed to a number of us and made particular reference to me and to our attendance at this happy occasion. I think we were the only Americans present that night, and that too was noticed because so few Americans tourists are in Germany, at least at this time.

The next morning, Friday the sixth of June, the Scientific Meetings opened, and Ted Mayrhofer and I were co-Chairmen of the first Scientific Session. Teddy was helpful to me in putting together a short comment in German, and I elected to conduct the meeting entirely in German and this was obviously very much appreciated by all of the audience including the power structure of the University of Heidelberg. They were very kind about my German and said that it was very easy to understand and that my accent was (except for the sound of R) almost perfect. Very flattering comments indeed, and I don't take them too seriously, but they were nice to have been heard. As a matter of fact the impression deepened with various people through the meeting that I had always spoken German well, and simply either refused to speak it over the years or was too "shy" to do so. These kinds of rumors are always amusing but the fact is that I did work hard to learn some German for this purpose.

The major lecture which was written about the influence of the German speaking University on American medicine and science from 1870-1914 was extremely well received and praised highly by Otto Just. It will be published in one of the two major German journals devoted to anesthesiology, and I look forward to seeing what it will look like in print. I received much help for this purpose from both Horst Stoeckel and Sylvia Baier and am deeply grateful to them for being of so much help.

After the scientific sessions we went to lunch in a charming place called Schwetzingen - a town not far from Heidelberg where we had lunch in one of the two hotel restaurants, again of asparagus because this is the major asparagus season in Germany, and the white asparagus are absolutely delicious. We returned a bit late from lunch and I took a short rest before the evening activities, which consisted of another banquet, this time at the Castle in Schwetzingen, and we had the Hayden London Symphony played by a Chamber Symphony Orchestra - a group of students and extremely well done. There was dancing of all sorts, American influenced in part, and also the Viennese waltzes. We had a good time but unfortunately with transportation and all other problems we didn't get to bed until 2 in the morning.

On Saturday the seventh of June all went along peacefully and quietly. I looked at some of the exhibits, took in a bit of the meetings and had lunch with some new and old German friends at a very lovely restaurant in the Hotel Europaischerhof. As I now dictate we are completely up to date, and Pat and I hope to have a bit of a rest before we go to the countryside for another nice local dinner.

Tomorrow the eighth of June, we go on to London and this will end the visit to Germany. It is difficult to summarize in a diary, but we have had some considerable discussions about the volatility, as Europeans fear of American foreign policy, and the unpleasant and even fearful aspects of the impact of the air raid upon Lybia. The American President has very little status at this point, at least among the people to whom we have talked in Europe, but of course they don't vote for him or for his policies. In my opinion there is an unfortunate possibility of a deepening growth of misunderstanding between Europeans and Americans over many issues, not the least of which concerns that continued fear that American foreign policy may provoke and precipitate World War III which they take seriously and worry about a great deal.

On Saturday the seventh of June the rain continued and the projected walk that Horst Stoeckel and I had to take on what is called the "Philosopher's Road" just wasn't possible. It would have been a delightful walk to have taken, where we would have further discussed the issues that he seems to feel are important to reconsider. He makes, for example, the point that it, in the long run, will do much harm to keep on reminding the world, and of course particularly the German people, about the Holocaust. It is his view that this constant reminder can only lead to a further feeling of finger pointing and an irate canon of a feeling of guilt on the part of Germans of this generation that feel that they have had nothing to do with the terrorists and the problems of the Hitler regime. I don't share his view although I certainly understand it. I think the reason for keeping the memory of the Holocaust alive is crucial and has more to do with the need to remind the world that this kind of barbarism can occur and did in fact in the middle of the twentieth century, so that it could occur anywhere else at any time. For Jews it is particularly important because ­they are a small isolated minority wherever they are and another Holocaust, whether it be in Israel itself or in Arab countries or for that matter even in the United States, seems to those who are sensitized to the problems of irrational barbarism, when the world goes amuck with its problems of politics, economics and the threat of nuclear war, is just too much to be a real possibility. Pat and I were fairly tired and the rainy afternoon was a good opportunity to take a rest and a reasonable nap, which we did.

In the evening we drove out to a suburb of Heidelberg, in a town called Rauenberg, which had a delightful inn and a wonderful restaurant based on the local cooking of that area. At the dinner were the Stoeckels with their daughter Nicole, the Schulte am Esch, and of course the Tammistos. Schulte am Esch came to the chair - that is - he came to the chair in Homburg as the first of Horst Stoeckels students to achieve a Chairmanship in Anesthesiology in Germany. He is a native of Westphalia and she of Vienna. They are very nice people and devoted to the Stoeckels. They have come to the decision to learn English too late to be fluent, but they are working hard on it and have done well. For his work in international medical things it is important to become competent in at least English and to probably a much lesser degree in French.

We had a private dining room in a charming restaurant. Most of the people had the "spargel" menu, which is the thing so many people do at this time of year, when the asparagus which is white and is the English word for spargel is prolific and it exists for approximately six weeks. The traditional dishes are spargel and some form of hollandaise sauce or melted butter and usually buttressed with pancakes and various forms of cold ham. There are many other ways to deal with the asparagus menu, but perhaps this is the most typical. We had a wonderful local wine. There was very much happiness and rejoicing on all our parts, even though it was "the last supper" for us in Germany and of course in Heidelberg . Many toasts were made, much demonstration of really close and good feeling on all our parts. These people have become very important in our lives and very close friends indeed. We had our usual "schnappsel", the local fermented fruit product of that particular area in Central Germany . It was very good and we all had a wonderful time. We went back to the hotel in Heidelberg and had a night cap of similar schnapps. Hoerst Stoeckel had given each of the families a remembrance bottle of the local brandy or schnapps and we will take it home with us.

On Sunday the eighth of June we were driven to the Frankfurt Airport by a driver and car hired by Professor Otto Just. We were accompanied by one of his junior staff members, Dr. Bach, who is a very nice person - a native of Heidelberg , and also a young man very fluent in English. The ride to the airport was fast and uneventful and we flew to London via British Airways to Heathrow again with a very lightly populated airplane, a small number of Americans on the aircraft, and when we touched down at the airport in London as before, there was a very easy passage through immigration with hardly any people and an easy pick-up of baggage and a return to the Londonderry Hotel. The hotel is not full and although very pleasant indeed it is, I think, suffering economic disadvantage from the lack of American tourists in Europe . Before we left for Germany and spent the night here, Pat had picked room 705 which she liked very much and this was available to us. It has a beautiful view over Hyde Park , and is air conditioned, quiet and very pleasant indeed.

We dined that evening with Diana and Michael Zatouroff at the Piccadilly Hotel. It is an old hotel newly renovated and put into excellent condition for a tourist season which simply did not materialize. Dining in London on Sunday night is a tough problem, and not even all the hotel restaurants are opened, but we had our usual very pleasant and amusing evening with them. We reviewed all the things that had happened to both of us since our last get together, some six or eight months ago, and were brought up to date on all their doings. He has become very active in the College of Physicians Funding drive and had invited us to dine with them on Wednesday, the eleventh of June at which time the Queen will dedicate the new precinct, as it is called, consisting of the headquarters of the College of Physicians, and a number of buildings of the best Regency style completely renovated and refurbished, but the exterior facade left pretty much the way it was in the time of the Prince Regent who became George IV later. We obviously couldn't attend that dinner since we must be in Cardiff, but Michael showed us the precinct area and was very enthusiastic about the party which was going to be held that Wednesday. Diana Zatouroff has been taking up a new hobby related to horses in a sport called "driving". The sport consists of wearing a certain very specific kind of uniform and driving what appears to be the equivalent of a marathon course for a single horse and for a specially constructed carriage. A groom attends the whole bit. They seem all excited about it and have invited us to either watch or even for Pat to sit besides Diana and to take one of the races in. Michael was his usual very joyous, intelligent and extroverted self and so the evening was a great success. The meal was pleasant and very expensive for me the host!

On Monday, the ninth of June, Pat and I slept a bit later and then we went shopping together on Sloane Street at Valentino's Shop as recommended by Barbara Schiff. Valentino of course is the well known Italian clothes shop for women and to a lesser extent for men. We have been shopping together for Pat's birthday at Valentino's in Paris and in New York. She bought some very pretty things and nice clothes in Valentino's in London and I hope she will not find that the prices are not considerably lower in Milan which is entirely possible. We then met Sally Rosen at Fortnum and Mason Fountain Restaurant for lunch and were indeed very happy to see her as we always are. She gave us a brief overview of what will happen at the Cardiff Meeting, and a few other things about the children, family and just a very pleasant up-date. Then she and Pat did some shopping together at the Bond Street area and I looked at some of the sights that I like to see on Bond and Regent Streets and Piccadilly.

We met at the hotel for a brief rest before going out to dinner with Sally's elder sister, who is fourteen years older than she. She had been recently widowed and married again a very interesting person who is retired as Chairmen of the Hansom Investment Trust, which is a big business in London. His name is Kenneth Osborne and her name now is his and her first name is Rifka. This is the ancient Hebrew name for Rebecca and it has always been a curiosity to me that she has used this ancient name, which is not all that common for women of either her or any other generation in the Western countries to continue to use. They are obviously very happily married and they have a very beautiful flat in Portnam Square, in a fashionable part of London.

Michael and Sally met us at their flat and all six of us went out to a restaurant in the Greek area near Soho. The restaurant is called the White Tower, and is apparently old enough that Sally's and Rifka's parents have both dined there. In some ways it reminds me a bit of the relationship of Pat's family to Gatti in Miami Beach. The analogy is not at all perfect but similar enough to be of interest. The meal was an excellent one - said to be Greek in its ethnic origins - but obviously quite modified by British influences and continental influences as is Gatti's Italian cooking by American and more specifically the Miami Beach version of American cuisine. It was a most interesting evening in many respects and we had a really good time.

On Tuesday morning the tenth of June, we got up a bit earlier than we had in the last two days having rested somewhat better after going to bed earlier, and we went to Jermyn Street where I indulged in one of the long time fantasies that I have always had, or it seems like always. This was the notion of having "made to measure" shirts made for me at Turnbull and Asser Shop for men. The shop has been in existence for more than three hundred years and it has been patronized by many members of the Royal Family. Its most recent patron is Charles, the Prince of Wales, who has all of his shirts made there. Needless to say they are quite expensive, but one shot at it might get all of this out of my system, or, perhaps on the other hand, I will have very unusually good looking and good shirts.

Pat then went to a hairdresser on Albermarle Street and during that interval I had the measurements made for the shirts and then went for a walk to look at some of the shops and also the branch of the British Museum that is called the Museum of Mankind, very near the hairdressers. I looked at some of the selected pieces from their African primitive art collection and also their Northeastern American Collections, which are among the best in the world. We met on Albermarle Street after these events, and Pat and I went to look at the Marlborough Gallery on Albermarle Street. They had a very interesting collection of Kokoschka drawings, prints and watercolors. Pat very much liked one of them, and perhaps we will put in a bid on it.

The shirt story is not complete either since I neglected to mention the fact that they make the fast shirt in about six weeks from the time the measurements were made. It is then worn by me and laundered and if there are any dissatisfactions about it they are corrected, and if all is well they go on to make the eight or so shirts which I have ordered. A very long and complicated process and quite different from the speed of Hong Kong, and perhaps therein will lie the higher quality of the British shirts compared to all others. To return to the story, we then had lunch at a place we had been to before called the Granary, a kind of blending of cafeteria service plus health foods, plus a rather "in" place where the young people who in this country would be called "yuppies" tend to congregate. Their food however is good, although expensive and was well worth having lunch there.

From there we went to the Barbican Center and saw the absolutely smashing Cecil Beaton Show, which showed all of his important works including designs for plays including, of course, the famous “My Fair Lady” and “Gigi” designs, as well has his marvelous photographs. He was the photographer for the rich, well born, and able and in the arts and nobility and otherwise “Important" people. To my way of thinking, the whole show was worthwhile to see these two things. One of them was the marvelous photographs of Marlene Dietrich and the absolutely glorious designs of the dresses for Ascot for “My Fair Lady”. After spending some two hours at the show, we took a taxi to Walton Street to look at world famous shops, which on the whole were I think a bit disappointing. There was however, a shop selling Greek icons, especially of the Byzantine, and they were marvelous to look at. I very much enjoyed looking at these serious religious emblems and always think I want to own one, and then change my mind after looking at them.

After this we had a modified tea, and then some rest and dinner at Alexander and Diana Hood's beautiful house in Chelsea. Their eldest son Henry was there and is a young lawyer, very handsome and almost exactly looks like his mother and a very nice young man indeed. In addition, Mary-Lou de Zulueta was there for dinner. Her husband Sir Phillip de Zulueta succeeded Alexander Hood on the Board of Abbott, and this is how I know him. Of course Alexander and Diana have become good friends of ours over time, and we had a most interesting discussion again of catching up again on family, friends and mutual interests. Alexander is a member of The Commission of the House of Lords, in which he serves to investigate the use of nuclear energy for the United Kingdom and is very strongly in favor of it despite all of the recent commotion of the Soviet Union. After very much good talk, we came back to the Hotel and then to sleep. Tomorrow we are on our way to Cardiff for the next of the meetings that we are to attend in Wales. On Sunday the eighth of June, we went to Paddington Station to take the train to Cardiff. It was a very pleasant train ride through the English countryside heading straight west through Devon, Cornwall and over the Severn River to Wales. Michael Rosen met us at the railroad station in Cardiff, and we drove to their home where of course we had such a good time seeing both Sally and Michael once again. We had a very wonderful light lunch of a Scottish salmon and some cheeses and fruit.

We then went to see Mandy and Nicky (the Rosens daughter who is a doctor and her husband who is a specialist in cattle breeding) in their new home. We also saw the grandchildren, including of course the elder one James who is four and one half years old, having just returned from his school in a very proper uniform and a tie. His younger brother Andrew, a newborn, was sitting in his highchair. The two children were having "tea", which consisted in the case of James of lasagna and a bottle in the case of Andrew! We had a very pleasant visit with the children and then returned back to the Rosens house to get ready for the evening dinner, which was held in a very pleasant restaurant in Cardiff. We saw all of the people who are going to be present at the workshop and their spouses and met some people we of course did not know before, including among many others a very bright young barrister (British lawyer who works in the courtroom) who is also trained as an anesthetist. Bill and Betty Mushin were there and it was a great pleasure to see them looking so well and to renew friendships once again. They had just returned from a brief vacation in Spain and looked appropriately suntanned and healthy. (Dinner Sunday night the eighth of June in restaurant in Cardiff.) We went to sleep late since the dinner ran rather slowly and on and on. It was very pleasant however. The food was excellent and the company most agreeable. We were at a table for four with Ho Stoeckel and Michael Powers. After a pleasant dinner we went back to the Rosens and had a good night's sleep although it was much too short.

On Thursday the twelfth of June the workshop of “The State of Consciousness" began at eight-thirty in the morning. The members of the workshop were anesthesiologists, psychologists, neurophysiologists and one or two other people who had joint interests, such as the members of the legal profession. The first day was devoted largely to the various forms of EEG evaluation of the depth of anesthesia and there was little attempt to bring to closure, with the exception of a preliminary report from Dr. Robert Dutton from Sacramento in California, who had some evidence that he could evaluate the state of consciousness and correlate it with the EEG. The others were descriptions of the relationship of EEG to various other parameters, including blood concentrations of anesthetic agents. The discussions were of considerable interest, but did not really bear on the primary purpose of the workshop.

After a long day's discussion and including a return to the Rosen's house for lunch both on Thursday and Friday, which was quite a feat to do by Sally Rosen, we went to a place out in the country called The Walnut Tree, somewhat north of Cardiff, I think a little bit east. The restaurant was Italian, the food was simple, but very good and we had a very pleasant social occasion. On the way up on the bus I talked to Gareth Jones, who is a professor of Anaesthetics at the University of Leeds where he has just begun his new duties. He has had considerable research experience both at Northwick Park and at the Cardiovascular Research Institute when it was directed by Julius Comroe.

On Friday the thirteenth of June the discussion went toward the correlation of other observations, like esophageal movements and the relationship of frontalis muscle behavior to the state of consciousness. Brian Kay of Manchester stated outright that the frontalis muscle contractions could be directly correlated with consciousness and unconsciousness, but nobody at the workshop seemed to put much credibility in this statement or its evidence. There was then considerable discussion about the medical and legal aspects of patients being awake and grossly uncomfortable or having pain, or both, with the British anesthetists not being aware that these patients were actually conscious although paralyzed and automatically ventilated. Len Hargrove, who serves on the Medical Defense Union of Great Britain and is also a consultant anesthetist at the Westminister Hospital, presented some evidence that the lawsuits and claims for this kind of experience were rising and that something needed to be done about it. There were many suggestions of how to avoid patients becoming conscious unexpectedly, and they all consisted of essentially deepening of the general anesthesia, with a favorite approach being the use of small amounts of volatile anesthetic agents, although there was some serious positioning claim for total I.V. anesthesia.

In the course of these discussions, that auditory stimulation by the spoken word was perceived in some layer of unconsciousness long after other forms of consciousness had disappeared, there was speculation on whether good auditory stimuli, like favorable and relaxing messages, should be tried for patients submitted to general anesthesia, but no firm conclusion came of it. I think the audience was sympathetic to my feeling that the study of the state of consciousness, in many ways, is the study of life itself, and an important biological problem for people in anesthesia to undertake. However, there was little planning of movement in this particular direction by any of the people who were there. Michael Rosen thinks there will be a book published of these proceedings and with his skillful editorial management I am sure it will occur and it will be a worthwhile one, and I do hope to add increased written reinforcement of the idea that the state of consciousness and unconsciousness deserves very serious study at the cellular level and particularly with molecular biological strategies. Michael Vickers led a discussion of the consensus conclusions and they were essentially what I have just described.

We had a very nice walk, Michael Rosen and I did, and saw some of the beautiful rhododendrons and azaleas in a park just outside of Cardiff and then we rested a bit and joined the Rosens' guests for dinner at their house. There was a couple named Michael and Susan Freeman and another couple named Bill and Lilly Pollock, all of whom were very nice and very interesting. The two Pollocks came as children to Cardiff with their families, one from Vienna and one from Czechoslovakia ahead of the Germans before the war, and Susan Freedman came as a child from Vienna. Michael Freeman was born in Cardiff. There seem to be many German, Jewish and Austrian Jewish refugees in the Cardiff area and it was suggested to us that some of the reason may be that there was great unemployment in Southern Wales just before World War II, and therefore there was an opportunity for new businesses and enterprises to be established and available labor of change. Bill Pollock, for instance, is one of the largest manufacturers of wrist watch straps in the world, and in the case of Michael and Susan Freeman, her family was in a business that dealt with mica -- a business rendered obsolete by the development of plastic materials. However, she is in the waste disposal business and, of all places each, and also both of them, are actively involved in investments in the stock market in the U. K .

After a pleasant night's sleep and a mid-morning brunch with the Rosens at their house, Pat and I took off for London Heathrow Airport by taxi which Michael Rosen had arranged, and some two hours later we arrived at the airport in ample time to get our flight to Milan. We were met at the airport on Saturday the fourteenth of June, late afternoon by Carlo and Giuliana Morpurgo, relatively new, but good friends from Italy. They are highly educated and very friendly, wonderful people. Like so many people of education in Europe they are multilingual and very good at all the languages they speak including of course English. We drove out together to their country home in Lake Orta. It was a very pleasant drive toward the Swiss frontier and a bit west of Milan toward the Alps. In early evening we had a very pleasant local dinner at a restaurant in Novaro.

Carlo spent all of his summers and vacations from the time he was a small boy in this area and Giuliana also knows the country well, having spent weekends and summer holidays while the family were growing up for the last thirty years. It is an extraordinarily beautiful place on the lovely lake and many old and charming houses to look at. There are remnants of buildings that go as far back as the beginnings of Christianity, i.e. 4th Century A. D., and some other remarkable things. We saw a Franciscan Monastery on the top of one of the hills of the back of a town called Pella just across the lake from the town of Orta . We went to a museum and looked at the collection of an extraordinary Italian artist called Calderara, who was splendid indeed and watched his paintings demonstrate his evolution from pretty orthodox post-impressionism to minimalist technique. It was a very pleasant experience there. We had a simple local fried fish lunch at an old restaurant in Pella and then continued our sightseeing throughout this particular area. In the evening we went across a part of the lake to an island and had an extraordinary local dinner at a restaurant on the island. Everybody knows the Morpurgos well and it was a very pleasant experience. On Sunday the fifteenth of June we are about to go to sleep probably as early as we have done in these two weeks. It is reasonably cold as it was in Germany and associated also with rain. Tomorrow we will be on our way back to Milan and more dictation will occur at that time.

On Monday morning, June sixteenth in Lake Orta, Carlo Morpurgo felt that we had not seen one of the really remarkable things of that area. It was raining on and off and fairly hard most of the time that morning and we decided, or rather he decided, to go over to the island in the middle of the lake in his small metallic boat with a engine on the rear of it. We got into the boat, rain and all with raincoats and rain gear, and Pat sat in the middle of the boat holding an umbrella over her head as the rain came down with continuous and persistent clatter. We did finally get to the island and went to see the Church of San Giulio, which had been there for a great long time. Its first parts were built by the Pilgrim and spreader of the new word of Christianity, St. Julius himself, who came to the island and started a church in the 4th Century A. D., shortly after it became the official religion of the Roman Empire. We saw some of the original columns, which date back to the 4 th Century, and some marvelous black sculptures depicting the four apostles, in essentially the style that was some where in the region of the 9th Century when Otto the first, Holy Roman Emperor, declared that this part of Italy would be a free "city". The Frescos also date back to various periods, which span the time between the 4th Century and as recently as the 19th Century, where additions were continually made to the church. Carlo Morpurgo is incredibly knowledgeable about these matters. We then went back with this small engine driven boat with the same arrangement of raincoats tightly buttoned up and Pat holding an umbrella over her head and more persistent rain pelting on us as we went.

When we got back to the house in Orta we loaded their car with their baggage and ours and drove to Milan via Lake Maggiore, part of which is in Italy and part in Switzerland. It was a pleasant enough drive although it began to get fairly warm as we approached the city. We went to their house where we had a very pleasant lunch, quite late in fact, and then went on to check into the Hotel Galileo, a very pleasant small new hotel which is in downtown Milan and very much less expensive than the elegant ones, although by no means inexpensive. I don't know exactly what the price will be, but it will be in the neighborhood of $185 - $200 per night for a suite, which is not large, but comfortable.

That evening on Monday the sixteenth, we went to the famous opera house, La Scala, to hear “Peleas and Melisande”, by Debussy on the occasion of the centennial celebration of Debussy's death and also the last series of performances to be conducted by the distinguished conductor and music director of La Scala, maestro Claudio Abbado, who was at his best. The various singers were unfamiliar to me with the exception of Melisande, who was sung by Frederica Von Stade, who despite the name is a distinguished American soprano. We had a very light sandwich dinner quite late, somewhere near midnight and then went to sleep.

On Tuesday morning the seventeenth of June, Pat met Giuliana Morpurgo for shopping which apparently was a "great success" in terms of the quality of the very high fashion area which exists in Milan and also considerable reduction in prices, possibly because of the dearth of foreign visitors, especially Americans. During this time I went to see the Leonardo da Vinci painting of “The Last Supper”, which is once again being restored. It is a most moving painting, although one can no longer be sure of what was Leonardo's and what is the restorer's. During the time we were on our way to the Church we passed through the main part of the Church of Santa-Maria Della Grazie, which houses the Leonardo, and there were a very large number of people attending a tragic funeral of what must have been a young and small child. Carlo and I encountered Ralph and Barbara Millard looking at “The Last Supper”, as Pat had met them in one of the shopping areas the day before.

Carlo and I then walked through much of the central part of Milan looking at the old Roman ruins and the exterior of the Church of Saint Ambrozio, who brought the essentials of Christianity in the 4th Century to this part of Milan, and then continued to their apartment where we expected to have lunch. We received a telephone call from Pat and Giuliana to come to the Gucci shop where there was a great sale of men's shoes of some 40% off and a considerably lower price then one could buy in Miami or New York. Carlo and I each got some shoes and I think that the ladies did also, but I am not sure. We then went to lunch at a nearby place where the Morpurgo children often go and had a very pleasant pizza. We then walked to the famous Duomo, one of the great and large gothic cathedrals of Europe. It did begin as a 4th Century church, also when Christianity became the official religion of the Roman Empire. We saw the elements of the old church under the cathedral and then leisurely walked through the basilica, looked at the stained glass, the columns, and on the exterior the marvelous flying buttresses.

After this I went to rest a bit, met Pat and then we went back to the Morpurgo's for some drinks in which a few of the Italian anesthesiologists came to meet us. It was a small reception, partly in our honor. The reception for us at their home was a pleasant one and a few of the prominent people in anesthesiology in Milan came to meet us. Only one of them, however, was really competent in English and our Italian is not up to any discussion level. It was pleasant and essentially just that. We then had a light supper at their home and came back to the hotel a little earlier than usual for what we hoped will be a good night's sleep.

On Wednesday the eighteenth of June, Pat and I were met by both Morpurgos in Giuliana's Citroen car. It was most interesting to see this strange gear shaft on this car and Carlo confessed that he couldn't drive it very readily, and I suppose it would take some kind of genius or a Frenchman to manage this car with any routine safety. The car did not look like it had been totally unscathed in its lifetime in Milan. We went to the Brera Museum, or really an academy, which is one of the treasures of the city. Giuliana dropped us off to get them ready for their automobile trip to Barcelona where we shall see them again. They are going with a couple from Turin, named Bianchetti that I know pretty well. Bianchetti is the head of one of the large hospital's department of anesthesiology in Turin. Bianchetti and the Morpurgos are very close friends.

Carlo Morpurgo took us into the Brera Academy and immediately after the entrance there was an exhibition of permanent acquisitions by this distinguished museum of 20th Century modern Italian art. It was represented by such distinguished artists' paintings that have become priceless as Morandi, Carra and similar greats of major distinction. Their work was outstanding in its beauty and Pat enjoyed, particularly since she was more familiar with these names and their paintings than I was. There was one painting by Carra that I had seen and photographed before of a young woman with no features and an elliptical shaped head holding a tennis racquet and tennis ball. From the modern part of the museum we went in to see the great treasures of their permanent collection. Among the major artists represented were Raphael, Rubens, Van Dyke, Canaletto and Giuardi. One of the paintings that particularly struck me however, was a painting of Christ just after removal from the cross by Mantegna. It was an absolutely magnificent picture in every possible respect. We also looked at some Carpaccios and Caravaggios. It was a most interesting hour and one-half or so.

After having looked at the collections we left our hotel and toured by way of the La Scala and another and possibly final view of the Duomo, the major cathedral of Milan. We had a small sandwich lunch, which apparently was quite common to do in Milan, and then went to our hotel for a bit of rest since it was very hot today, and we encountered the usual problems of shops and most other activities closed from approximately 12:00 or 1:00 - either 3:00 or 3:30 p.m. for lunch hour, which is very common throughout this part of the world still. After the shops and other things became open I walked with Pat down to the Monte Napaleone, which is the major shopping street, something like the Fifth Avenue of New York there, and the street is equivalent in Milan.

I had an appointment with a distinguished bookseller, Dr. Carlo Alberto Chiesa, whose entire building at Number 11 Via Bigli is devoted to bibliographic research material and marvelous books of his specialty, which comes of Italian works of the 14th, 15th and 16th Centuries. Some of the books are hand done and others are in the early times of printing. He also has marvelous maps and manuscripts of various kinds which he was kind enough to show me. He is a large, very friendly outgoing man whose scholarship has brought him into close contact with other dealers in all parts of the world as well as major collectors. He gave me the names of booksellers in London and New York that might have books and materials having to do with medical science and particularly anesthesiology, as well as others who are specialists in the area of the British Romantic period of literature.

He was very familiar with Jack Pincus and his collection in Los Angeles , and also with a Dr. Norman in San Francisco. He is a good friend of Franklin Murphy who was the Chairman of the Board and Chief Executive Officer of the Los Angeles Times - Mirror enterprises, and prior to that was the Chancellor of the University of California at Los Angeles, and prior to that was the Dean of The School of Medicine. He is an extraordinary physician who has made his way in both medical and the business worlds and both in the BIG way. Presently in his retirement from all the various careers, he is head of the National Gallery of Art and the Kress Foundation as well. He comes to Milan about once a year, or sometimes more often and has become a friend and presumably also a client and customer of Carlo Chiesa, Milan 's distinguished bookseller in this particular period. It is obviously a most interesting world and I had a marvelous hour and one-half or so with Dr. Chiesa, who was kind enough also to give me a copy of a small booklet he had published of a letter from Petrarch to a monk who was his "agent" for gathering books and manuscripts. The letter was written in the 14th Century before the time of printing so everything had to be hand written and is particularly desirable. The booklet is written in the original Latin of Petrarch, and Italian translation as well as English translation by a colleague of Carlo Chiesa's. It deals entirely with the passion for the search of knowledge and for books and makes very dear the interest of the bibliophile as well as the one who satisfies his craving for books for knowledge, i.e. the distinguished bookseller.

After that very wonderful experience I walked back via the Monte Napaleone to the hotel and identified the Santa Lucia restaurant just back at the hotel where Carlo Morpurgo had recommended that we should have dinner tonight and hopefully we will. As this is being dictated Pat has not yet returned from her shopping tour, and presumably will be along any minute. Milan and Orta have been exciting experiences thanks of course to the Morpurgos and to the many treasures this beautiful city holds. In our last evening in Milan on Wednesday the eighteenth, Pat and I went to a very nice restaurant and very well known among opera buffs called the Santa Lucia restaurant which is really quite near the hotel. In fact, it is between the hotel and the La Scala Opera House. The restaurant is elegant and yet simple, and it has many photographs of distinguished opera stars and conductors of opera on its walls. It is in a way analogous to the "21 Club" in New York, except for the total emphasis on vocal music at the Santa Lucia restaurant. Pat and I had a very nice salad and we then ordered two pastas - one a pizza, and the other a very nice form of spaghetti. The cooking in this restaurant is on the order of that of Italy in the Naples area, and these dishes were characteristic of that type of cuisine. We had also a very pleasant local wine from not too far from Milan and it was a very nice dinner indeed.

On Thursday, the ninth of June, we flew via Iberia Airlines to Barcelona with an on scheduled flight and nothing but the nicest people both as passengers and as crew. The Boeing airplane of the 727 series was completely full, much to my surprise, and I think to the surprise of the crew as well. The ride went from Milan almost straight west across the Riviera and in places over the Mediterranean Sea, landing at Barcelona on schedule with no problems. Our ride into the city was comfortable and quick in a taxi. The taxi as it turned out later was quite inexpensive for so large and important a city in Spain. On arrival at the Hotel Ritz, we met Sally Rosen and Karen Stoeckel having a drink. We then took off to register. The people couldn't have been nicer in the registration area, and for that matter in all of the management of the meeting, but they were as ineffective in doing what needed to be done promptly as they were pleasant. One cannot get upset with people who are so nice, but they certainly are a far cry from the efficiency and effectiveness of the Germans and the British.

That night the Rosens and we had a very pleasant dinner at one of the restaurants whose Catalan name I can neither pronounce nor spell. It was a fish restaurant and the food was outstandingly good. The local wine from the north of Spain was very pleasant indeed, and we had a very nice time. Since everybody in Spain eats extremely late - dinner beginning usually between 10:00 and 11:00 o'clock somewhere - nobody gets to sleep until the early hours of the morning. They do seem to start their work somewhere between 7:30 and 9:00, depending on their occupations, but they close for lunch for two hours from 12:00 to 2:00 and they stay closed for what I have been told is a rest or a sleeping rest called a siesta for another two hours. In effect nothing happens between 12:00 and 4:00 in this part of Spain.

The scientific meeting on Friday the 20th of June was a very good one in its beginnings in that Olof Norlander organized a very effective international panel on Jet Ventilation and its other effects on various systems. Among the speakers was Jean-Jacques Rouby, who is a good friend of Brian Craythorne's and it was a joy to see him once again. He is from Paris and the hospital where Professor Wars is the Chairman. His work was extremely good and for that matter so were all of the panelists. We had a modest light lunch in the cafeteria adjoining the meeting which was held at the Faculty of Biology and then went back for the meeting of "free papers" during the afternoon. A very excellent paper was presented by Peter Lauwen of Bonn on the quantitative aspects of absorption of local anesthetic agents from the standpoint of producing their toxicity.

There is an election campaign going on in Spain, and it is therefore difficult to get any of the officials to participate in events here in Barcelona, and one hears various aspects of fireworks all the time during the campaigning. In some ways it looks as though everything has been suspended for the very active business of the various people campaigning for the Cortes, which is Spain 's parliament. The outcome of the election will determine the next Prime Minister. If taxi drivers are to be relied upon (which is highly dubious) the opposition party should gain great strength in this coming election.

Tonight we go to an official reception - to the extent that any officials are willing to receive us - and then the Rosens, Stoeckels, Morpurgos and we go out to another elegant restaurant for dinner. Before that takes place I will have a nap and I hope to find sometime during tomorrow to revisit the wonderful Picasso Museum, which houses his own collection, works that he began as a child and continued through his youth. There is also a marvelous exhibition of Miro which I hope to be able to have time to take in without short cutting too much of the meeting.

On Saturday the 21st of June (the longest day of the summer) the meeting began to be more sparsely attended than before, which was a surprise to me. Cedric Prys-Roberts put on a symposium of the function of calcium channel blockers and their interaction with anesthetic agents that was simply superb. As usual information transfer in this lecture form is difficult for me, but it does mean I shall be reading in this area more than before, because there are important aspects of the use of calcium channel blockers or calcium entry blockers as they are sometimes called, and how anesthetic agents interact with them. There is some fluidity in the knowledge about this subject, but clearly with so many patients on these drugs who come to operation, and who simultaneously have beta adrenergic blocking agents, the problems can be most difficult and lead to unexpected unfortunate outcomes if more knowledge in this area isn't possessed to begin with and isn't widely distributed as an ultimate goal. The rest of the meeting was a collection of "free papers" which were not of enormous interest.

In the afternoon Michael Rosen had a meeting that he had to attend, but Pat and I and the Stoeckels went to the Miro Foundation Exhibition, and were delighted to find that there was also a temporary exhibition of Max Ernst paintings in that museum. The Miro paintings and sculptures were spectacular and the Ernst ones were difficult, certainly very disturbing and one would immediately understand that this kind of artist was persona non grata to the Hitler regime. Many of his paintings were consequently sold either to private collectors or auctions at very low prices. In this fashion many of his best paintings came into private hands and also to Swiss museums who bought them very inexpensively considering their value as a production of a major artist of our times.

After the museum viewing we looked at some of the waterfront in Barcelona. It is the place where Christopher Columbus received both the approval and the financial support of their Catholic Majesties Ferdinand and Isabella, who are often praised for the support of Columbus and his "discovery of the new world". Actually they were motivated by a rather high index of greed since he promised them the riches of Indies and not any major geographical expedition.

Fourteen-ninety-two was also the date when the Spanish version of the church's Inquisition was so virulent that heretics and especially Jews and Moslems were expelled from Spanish-held territories. It does seem that the teaching of history in any society, ours included, is somewhat over simplified, and therefore perhaps falsified, whether deliberately or otherwise is not the point. It was a very mixed year for Spain and for the world, the year that we shall be celebrating soon in this country.

At night the farewell banquet was held in the Palace which was built by Alfonso the XIII, the last King of Spain of the Bourbon line prior to the establishment of the Republic. All of this occurred between the two world wars and just prior to the onset of World War II the Germans and the Italians used Spain as a testing ground with the Soviet Union for the development of their new weapons and their strategies for large scale fighting, which turned out to be World War II. The Germans took them very seriously and developed their best offensive weapons and strategies in support of General Franco, the Falangist leader (the head of the Fascist Party of Spain), and were therefore ready for the field activities of World War II. The Italians and the Russians seemed to have learned much less than the Germans from this experience. Anyway the Palace is a very elegant one, especially its grounds. The house is inadequately furnished except for many paintings of the Bourbon Monarchs ending of Bonn.


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