The anxious passage from childhood choice ("I want to be doctor") through the ordeals of academe and residency has commanded more than its share of literature. This has been augmented in recent years by the orgy of television voyeurism seeking, unsuccessfully alas, to sate the seemingly insatiable public hunger for "material" about physicians.

I can recount some personal experiences, which significantly influenced my professional consciousness, yet have not, I'm quite sure, found record in any book or TV production.

"Now a lot of people come here with slips from their precinct captain or their ward committeeman or even their congressman." Speaking is the Medical Director of the fabulous Cook County Hospital; his audience, the one hundred competitively selected interns of the 1947 class. "These slips say the bearer is a worthy citizen and you should admit them to the hospital. Now you and I know they don't need those slips. But they think they do. So there's no use you tearing up those slips or criticizing the precinct captain. Just tell the patient you will take good care of them:"

Thus were we oriented to the crucial role County Hospital played as a service expression for the political machine: with 3400 beds, over 100,000 admissions (20,000 deliveries), the hospital was an enormous center, entry to which, its users believed absolutely, required a note from the local pot (to whom, of course, a political debt was then owed to be paid on voting days).

The Medical Director, a political bureaucrat himself, was giving the new team an instruction, reinforced throughout residency: the Organization's interest was to assure that its minions assumed the Hospital's services were a benefit or reward for political fidelity.

Regularly, patients who required no hospital care (often unwanted elderly relatives) were admitted after a visit or phone call to the Warden's Office. "Admit, per Warden" was an override familiar to the Emergency Room doctors. No one ever challenged this regular abuse of terribly over-strained resources. Physicians in training who would fight for their sick patients as a tigress for her cubs were totally compliant, learning early on "to render unto Caesar" even if Caesar subverted the hospital's mission.

From the beginning, I was a critic of organized medicine, the conservative American Medical Association. My attending physicians at County admonished me to join up, rather than criticize from the outside.

So I joined. I dutifully attended my local Branch of the Chicago Medical Society (CMS) the first month out of my residency. I remember the speaker talked about Crohn's Disease; there were eight people present. And in the social hour following I was warmly greeted by an elderly doctor, who informed me he was the Branch President and invited me to be the slated candidate for Secretary at the upcoming election.

"Why should I do that?" I queried. "Well, after serving as Secretary we will elect you President and you will then also serve on the CMS Council, where the action is!" "That's interesting. But why, may I ask, me? You never met me before and already you have me running for office." "We have;' he said, "a lot of colored in this Branch and we want to keep the officers white."

That unembellished racism I was not expecting and it posed an obvious moral dilemma. I chose to accept his shameful offer and, of course, when I ran for President it was with a black colleague for Secretary. The color bar in the CMS Council was ended the next year, never to be re-established. It should be noted that the American Medical Association insisted it was a federation of state societies and, until 1957, "did not condone" but gave full recognition to the state associations in the south which formally barred non-white physicians from membership. In Illinois, the informal limitations on black doctors' election to leadership, a gentleman's agreement, worked quite well.

In the mid-1950's there were other efforts addressing institutional racism in medicine. A group with a cumbersome but precise title arose locally: The Committee to End Discrimination in Chicago Medical Institutions (CEDCMI). We were concerned that exclusion of black physicians from medical staffs, other than Provident Hospital, was a way to exclude blacks as patients. We knew that of the 300 black physicians (150 of whom were certified by Speciality Boards), only 24 had appointments on "predominantly white hospital" staffs.

We shared the common knowledge that blacks were not welcome at most private hospitals. The hospital spokesmen and the Chicago Hospital Council angrily denied systematic exclusion. "Indeed;' they said, "we don't even keep any records of a patient's race;' as if this was further exculpation.

The CEDCMI was stymied. Without data, we could not overcome the hospitals' repeated public utterance denying difference of accesss by race. Then we got a bright idea! By state law, birth and death are reported by race. Could we get the City Department of Health to give us the birth and death statistics by hospital? The commisssioner of Health (and simultaneously the President of the Board of Health) was colorful Dr. Herman Bundesen, a medical maverick. Until Dr. Spock, Bundesen s baby book was the nation's most popular. He had proven his courage in more than one battle with organized medicine (which had expelled him from the Society) and with the political machine, which generally left him alone.

Nevertheless, he knew the great effect his data might have on the medical establishment. He paused for a few seconds, though to us it seemed interminable, and curtly said yes. We would have the racial breakdown of births and deaths.

A very few minutes later (it was the pre-computer era of machine sorted cards), we had our numbers. It told an unequivocal story of exclusion, total or nearly so in most of Chicago's hospitals-even those located in black neighborhoods.

Upon publicizing the finding, we never had to prove racial segregation again. At that point the hospitals thrashed about to explain the pattern, most often blaming their medical staffs, who pass on physician credentials, conveniently concealing the reality: the medical staff understood-and often concurred in-the hospital's wishes to keep out blacks and, again, acquiesced.

Remarkably, in 1955 and 1957 the Chicago City Council, based on the strong evidence of exclusion and, of course, pressed by rising impatience of Chicago's "minority" citizens, passed ordinances which outlaw discrimination both in hospital admissions and medical staff appointments.

The outcome, harbinger of national civil rights laws, illustrated to me what can be done with tenacity in proving your case, coupled with versatility of tactics. It worked, to be sure, when a top official was won over to the importance of our petition and, finally, we were able to inform the public.