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Interviewee: Dr. George Corner
Interviewer: Dr. Gordon Meade
Date: October 14. 1978
Dr. Meade: I am Dr. Gordon Meade, a graduate of the School of Medicine in the class of 1935, and currently I am Executive Secretary of the Alumni Association. I have the privilege this morning of talking with Dr. George Washington Corner, who was the first Professor of Anatomy of the School of Medicine. This interview will be part of a series that we are making on behalf of the Medical Alumni Association under the inspiration and guidance of Dr. Edward Atwater. Dr. Corner, your association with this school goes back a good many years, but I think before we talk specifically about that, I would like to bring out a little of the background of your life, illustrate how it fits in with...the early parts of your life fit in with what you have done in the succeeding years. I understand, that for example in just about two months, you're going to celebrate your 89th birthday.
Dr. Corner: That's so.
Dr. Meade: On the 12th of December. That's something of a milestone. I'm sure, in that you arc the fourth George Washington Corner, or is it the third?
Dr. Corner: The third.
Dr. Meade: But there is a fourth.
Dr. Corner: Yes.
Dr. Meade: And that was your son?
Dr. Corner: Yes.
Dr. Meade: That is quite a long record of the survival of a specific name, isn't it? And your grandfather, who was also George Washington Corner, he was the first one, was he not?
Dr. Corner: Yes.
Dr. Meade: He was the... one of the founding trustees of the Johns Hopkins Hospital. Dr. Corner: Right.
Dr. Meade: So that your association with Hopkins and the eminent school institution there goes back a long way.
Dr. Corner: Right.
Dr. Meade: Well, like so many men who have gone into medicine, it seems to me that your career has followed a similar path, in that as a boy you were one who liked to tinker. You built things, and then when you got into your teens, you became interested in biology, photographing birds' nests and working with a veterinary surgeon. What was it about the experience with the veterinary surgeon that really fired your interest in biology?
Dr. Corner: Well, it happened that he had some books, series of volumes of reports of the U.S. Department of Agriculture on his shelf, and one summer day when I had nothing else to do and was sitting, lying in a hammock, I took one of these books outdoors and opened it for casual reading, and came on a paper which immediately fascinated me. It was the story of the discovery of the transmission of Texas cattle fever by tics, written by... the name's gone right out of my head.
Dr. Meade: Theobald Smith.
Dr. Corner: Theobald Smith. And this was the first piece of biological research that I had ever read. I had biology, first year of biology behind me at the college, and it was perfectly fascinating, and I felt right then and there that I'd like to do that kind of work or something of that type.
Dr. Meade: Was the fascination because of the precision and the logic of it?
Dr. Corner: Yes, and the interesting manipulations and all the biological background.
Dr. Meade: Then I understand later on there came to be another association between yourself and Theobald Smith, not in a direct contact way, but there was another way in which you came in contact with him, wasn't there?
Dr. Corner: Well, many, many years later. Dr. Meade: Many years later.
Dr. Corner: Many years later when I was writing the history of the Rockefeller Institute, I was in the building in which he had done his work there. I was in New York. He did his work chiefly at Princeton; but the building was named after him.
Dr. Meade: You also had contact with the great J.B. Watson, the behavioristic psychologist. I understand.
Dr. Corner: He was a young man, he had been called to Johns Hopkins from an instructorship at the University of Chicago at the age of 33, and I was in the first class he taught. He began by insulting us. He said that he had been told that Johns Hopkins undergraduates were a rowdy lot and he didn't want to take time from his graduate students to beat psychology into our heads but he'd do the best he could. Whereupon, he began a series of brilliant lectures...
Dr. Meade: His name is of interest to me because as all my friends know, I'm an ardent bird watcher and I think one of his early pieces of work on which he did establish his career was on the behavior of terns.
Dr. Corner: Yes, I remember that. Dr. Meade: Down in Florida, I think. Dr. Corner: Yes.
Dr. Meade: Well, after you graduated then, from Hopkins, you were invited to stay on as a candidate in zoology, but I understand you decided against that.
Dr. Corner: I decided against it partly because the eminent Professor of Biology at Hopkins, Herbert Spencer Jennings, did not take an interest in undergraduates. And I had been one of the top students in biology and never had a chance even to talk with him. One of his younger colleagues wanted me to join them as a Ph.D. candidate. I thought if the head professor under whom I would probably work didn't even know of my existence, it wasn't a very good bet.
Dr. Meade: So, what did you do?
Dr. Corner: So then I went across town and enrolled in the Johns Hopkins Medical School. In those days there were no fancy tricks about it. One just went in and said I'd like to study here. And if you presented a good college record you were in.
Dr. Meade: Uh urn. And you were about the youngest student in the class.
Dr. Corner: I was the youngest by but two. The youngest of all was Edgar (Erskin Huhm) who became a major general in the Medical Corps of the Army.
Dr. Meade: And while you were there, I think there was the genesis really, of your lifelong interest in the history of medicine, because you undertook... was it a term paper? A theme paper on the vascular structure of the pancreas.
Dr. Corner: I asked Professor Mall to let me do some research with him, and he and I had been on a project involving the embryology of the pancreas. And as I worked on the modem theme of the embryology of that organ, I got interested in the early history and in the medical school library, there was a case of old books bound in handsome leather bindings that Sir William Osier had bought when he was a Professor of Medicine from an old dispensary in England. And on the shelves there were the Latin classics of the period in which the first work on the pancreas was done.
Dr. Meade: The fact that you went to boys' Latin school in Baltimore was no hindrance to you then, was it?
Dr. Corner: I had been a pupil of the master teacher of Latin, Edgar Lucas White, who made little boys like Latin. He didn't make a real Latinist of me, but at least I wasn't afraid of the language.
Dr. Meade: And then when you got to Hopkins you found that there was a very flourishing medical history club and you joined into its activities.
Dr. Corner: Yes, the oldest medical history club in the country, it's still in existence. In my student days this was regularly attended by the senior professors. Osier had left for England four years before. but Professor Halstead and Howard Kelly, other top men of the great faculty, came regularly to the medical history club, and this was quite an inspiration to the youngsters.
Dr. Meade: So the atmosphere was there for you to gender a long interest on your part in that. Then the... and I understand that you spent a summer with Sir Wilfred Granfell, in fact spent two summers with him, and along with your tinkering... perhaps I should not say tinkering, your invention. one of the things you did as a fourth-year student was to devise an improved apparatus or I should say, "an" apparatus for the administration of ether.
Dr. Corner: That's right. We were doing tonsillectomies in great numbers in those days and even as far away as Battle Harbor, Labrador, there were tonsillectomies to be done, and the first summer I was there I was anesthetist on quite a number of operations and I got tired of being interrupted... of having to interrupt the surgeon every so often to put the ether mask over the patient's face, take him away from his job, so that I had seen in Baltimore a newfangled apparatus for delivering ether vapor into the neighborhood of the larynx through a tongue depressor with a tube on it.
Dr. Meade: Uh, uh.
Dr. Corner: And so before I went back to Battle Harbor the second summer, I got a little... we had no electricity there to run a heater to vaporize the ether, so I had to put in... build a thing around the can which stood in a basin of hot water. And the ether dropped into that through one of these mechanical oral cups with an adjustable screw. It was all very crude. I think it cost about $3.00 for the materials and to get a mechanic to solder it.
Dr. Meade: I take it, it was never patented or gained you a fortune? Dr. Corner: No, that's right, but it was used with great success.
Dr. Meade: Good, good. Then you, at the end of your fourth year, you had to choose between becoming an assistant in Anatomy which had been offered to you or whether you would take an internship in Gynecology.
Dr. Corner: That's right.
Dr. Meade: Can you tell me something about how you made your choice and what choice you made?
Dr. Corner: Yes. I wanted to try both. I wanted to see which I liked better. Dr. Meade: You were greedy!
Dr. Corner: I was greedy! The students in the next class thought I was over-greedy. because this cost them one internship and the Medical School very kindly permitted me to postpone my internship for one year. And I took the year with Mall. This was... I was helped very much in this from the political standpoint by Thomas Cullen, who was #2 man in the Department of
Gynecology, Howard Kelly's right hand man. He was broadminded enough to see the point and he persuaded Howard Kelly to allow this. The Dean, (which was/Woodreese) Williams, was good-natured about it, so I had what I wanted both ways.
Dr. Meade: Back of this, I think, lay your conviction that the future of gynecology really lay in doing basic research on the embryology and the physiology of the reproductive system.
Dr. Corner: Yes, I saw this when I was intern. These great men, Kelly and Cullen, were superb surgeons. Kelly was the most adroit surgeon I ever saw, anywhere, before or later. And they knew the pathology, but they were balefully ignorant of the physiology of reproduction... we didn't know then at what time ovulation occurs in the menstrual cycle, and it was as crude as that.
Dr. Meade: Uh urn. I think in reading one of your writings, that you even saw a fine surgeon who removed a normal corpus luteum, thinking it was a tumor.
Dr. Corner: Yes, he thought it was a tumor. And I ... after my internship I was back visiting the hospital and spent an hour or two in the Operating Room watching my former associates. I had persuaded him to let me have this tumor and drove back home, and had it sectioned, and found it was a normal corpus luteum.
Dr. Meade: I suspect you knew more then about these matters than the professors did. Dr. Corner: I believe I did.
Dr. Meade: I'm sure you did. So that your choice then was to go into the anatomy laboratory for a year and then go back to your internship in gynecology, and during that year, you began to work with, was it swine?
Dr. Corner: During the year I was with Mall as assistant in Anatomy, yes it was a slaughterhouse only three blocks from Johns Hopkins Medical School and this provided unlimited amounts of material. Mall was beginning his great collection of human embryos and he was interested in dating the earliest human embryos. This was all very vague... we didn't know the time of ovulation. He felt that by making a serial study of the corpus luteum which you sometimes get with normal relation to the menstrual cycle that we could date the embryos from the corpus luteum, and I could get both embryos and ovaries at the slaughterhouse, and so I studied all this on the pig, on the sow that way.
Dr. Meade: So you worked with the sows out there. Dr. Corner: ...on the sows out there.
Dr. Meade: Then you did go on into an internship that you... I think you were even more convinced then that there was this great need to determine what the physiology of reproduction really is.
Dr. Corner: Right, right, yes.
Dr. Meade:... and also menstruation. And along about this time you began to have some personal doubts, did you not, about your own temperament as to being a physician who would deal with patients?
Dr. Corner: Yes, largely because operative surgery, particularly in the pelvis, requires immediate judgments. When you have the patient open you can't afford to wait a week to see what you think about it, you have to do something then and there. And I don't operate that way very well. My best opinion about a question is two or three days after I start to think about it. This, then... I found I was not very much interested, not critically interested, in the human aspects. I don't want to paint myself as a mere cold young scientist.
Dr. Meade: Well, none of us look at you in that way. We never felt that way about you, but... Dr. Corner: But it was more fun to work on a problem than on a patient.
Dr. Meade: And then, along about that time you had a chance to leave Baltimore and go somewhere else.
Dr. Corner: Yes. Herbert (McLean Evans) was the brightest and most apt-minded member of the Anatomy Department under Mall and while I was intern, he was called back to his native state of California to be Professor of Anatomy at Berkeley, and asked me to go with him. I was...he was the youngest full professor on the University of California faculty, I believe, and I think I was the youngest....
Dr. Meade: You were the youngest Assistant Professor.
Dr. Corner: Evans offered me an instructorship and I went to Mall about this, and Mall, he really wanted me to stay with him, was nice about it, but pretty cool, and he said that an institution on the Pacific Coast ought to give an assistant professorship to anybody who could get an instructorship in Baltimore. So I told Herbert Evans this and Evans wrote out to Berkeley and got me an assistant professorship, so I began...
Dr. Meade: So, you did move out there and then it was there that you first met Stafford Warren who later was here as a Professor of Radiology.
Dr. Corner: Yes, he was a very good medical student and truly Californian in his easy friendship. We became lifelong friends while he was a first-year student.
Dr. Meade: We who were students here in these early days of the school remember him very well, and all the clutter in his hall of all his bits of apparatus that he built with his assistants. And then along in 1915 I believe you were married and a couple of years later you had a call to come back to your hometown of Baltimore.
Dr. Corner: Yes, Mall had died and Lewis Weed who was only two years my senior was surprisingly made Professor of Anatomy, and he had to reorganize the department and I was called back as Associate Professor at Johns Hopkins.
Dr. Meade: You say surprisingly, you use this term because he was not really an anatomist, or why?
Dr. Corner: Well, no, because he was relatively young.
Dr. Meade: I see. I see.
Dr. Corner: And then, yes... well I'd be getting in too deep if I tried to think this out. Dr. Meade: Well, yes, certainly, I understand...
Dr. Corner: He simply wasn't the type of man you'd expect to become a Professor of Anatomy.
Dr. Meade: And then going back to Baltimore which I'm sure is something that pleased you, as your home area. You went on to continue to work with sows but you soon began to feel that you ought to work with a species that was nearer to the human.
Dr. Corner: Right, because we had to have an animal that had a menstrual cycle, which only the apes and higher order of monkeys have. So, Weed was very generous and built with the department funds a little monkey outdoor cage. I went to the Philadelphia zoo to learn how to keep...they were breeding Rhesus monkeys then. And they taught me how to keep them
outdoors. We built a monkey shack on the veranda of one of the adjacent buildings to the anatomy laboratory, and I installed a dozen female Rhesus monkeys and went to work.
Dr. Meade: Well, now we have a pretty clear picture of how your career proceeded up to that point and now we're coming up close to the Rochester era.
Dr. Corner: Right, yes.
Dr. Meade: Can you tell us what were the circumstances that surrounded your "call" to Rochester, sounds almost ministerial to say call, but...
Dr. Corner: Well, that's what it was. Well, I was in Baltimore_ had been in Baltimore four years as Associate Professor, when the news got around that a great medical school was to be started in Rochester with the help of funds from George Eastman and the General Education Board, and Weed tipped me off to the fact that I was on Whipple's list. He'd done an inquiry about rising young anatomists, and I was on Whipple's list, and I had known Whipple in Berkeley.
Dr. Meade: You'd known him in Berkeley?
Dr. Corner: ...when I was in Berkeley and he was in San Francisco. and I had actually given him a little help in finding young men for his new system of medical student fellowships.
Dr. Meade: Oh_ he started that there?
Dr. Corner: He started that there. It was highly successful and I found for him in the first-year classes at Berkeley his first two fellows. Elmer Belton and Hyatt B. Smith. Belton later became one of the leading urologists in California. Hyatt Smith wound up at Columbia University as Professor of Pathology.
Dr. Meade: Well. you had had contact with George Whipple even before that.
Dr. Corner: Even before that, I'd been his pupil in pathology at Johns Hopkins when he was a resident pathologist and assistant, associate, in pathology. So. he knew me and I think I was first on his list and one day Dr. Rush Rhees. President of the University of Rochester and Mr. George Eastman turned up on what you'd call a site visit these days, Rush Rhees had come along to see what a good medical school was like, and brought him to Johns Hopkins and I was rather pointedly brought up and introduced to the two gentleman. So. I knew then that something was going to happen...
Dr. Meade: Oh_ you had to interview at that time.
Dr. Corner: No interview... just introduced to them. A few weeks later I received an invitation to have dinner with Dr. Whipple and Dr. Rush Rhees at the Belvedere Hotel in Baltimore, and this... my wife and I knew this meant business. So she saw to it that I was dressed in my best suit, and she even blacked my shoes, which she'd never let me tell anybody else that before. She wanted me to look as perfectly neat and clean as possible.
Dr. Meade: ...as possible.
Dr. Corner: So, we had a hotel dinner and adjourned to Dr. Rhees' hotel room and spent the evening talking about what was doing at Rochester, and what a fine opportunity it would be for a young anatomist, and I was then and there offered the post of professor.
Dr. Meade: What persuaded you to accept?
Dr. Corner: Well, I tried to play a little bit hard to get and said I would give a decision after I visited Rochester, so 1 came up to Rochester and spent a day or two.
Dr. Meade: I hope it was a good day and not a typical winter day.
Dr. Corner: You know, I forget the weather, I was so interested in what was going on. One of the amusing things that I remember is, Dr. Rhees' surprise when I asked if Rochester had a nice big slaughterhouse. I had to explain to him what I meant. So he promptly took down the phone and called the Rochester Packing Company and asked if they could provide a supply of pigs'
ovaries, and whether they would be cooperative, and was able to tell me that that hurdle was over.
Dr. Meade: No problem. Dr. Corner: No problem.
Dr. Meade: No problem there.
Dr. Corner: Well, I was very much impressed. Dr. Rhees was a very impressive man, kindly and generous and obviously a man of force and in short, I could see he would be a good leader. And I could see. I knew George Whipple would be.
Dr. Meade: Well, Dr. Rhees as you say, was a small man in stature, as I remember. He was a quiet man.
Dr. Corner: Right.
Dr. Meade: But at the same time, had great vision and force.
Dr. Corner: And knowing that he was having a medical school to deal with, he had done a lot of homework. He obviously had taught himself from reading the background. from talks with Flexner I'm sure. the background of all the problems of medical education in his day, and it was a pleasure to talk with him.
Dr. Meade: I think most of our people who will be listening to this tape and know the story of the Flexner Report and how it came to be that a school was decided upon here in Rochester, and how Mr. Eastman would be asked if he would contribute and he offered $1 million_ and Flexner said, "we've got you down for six."
Dr. Corner: Well, there was some sort of... something going on there.
Dr. Meade: Something like that! Now, who were the other department heads that came to form this new faculty and what would your characterization of them be as men and professional people?
Dr. Corner: This might take the rest of the hour... I was the first appointed... the first to accept an appointment after Whipple. The next was Walter Bloor whom Whipple had know in Berkeley, a Canadian from the region of Toronto, a professor of biochemistry. A quiet man, limited I think largely in his interest to biochemistry, but he was the #1 man in the country. I think, on the biochemistry of lipids and fats and similar substances. Very, very faithful, became a very faithful associate of Whipple's as a kind of Assistant Dean, informally the Assistant Dean at first. Now I forget the order in which the others came. I know Bayne-Jones who had been a friend of mine at Hopkins Medical School. He graduated a year later in Medicine, and everyone knows of his great rise to various posts high in medical education and in government medicine. He was the diplomat of the faculty. When there were problems, interpersonal problems to be solved Whipple would often ask BJ to take a hand.
Dr. Meade: Oh, I'm interested in that because I'm sure there were problems, as there always are among a group of people.
Dr. Corner: Relatively few, but there were problems. Once for example, Bill McCann, a Professor of Medicine hinted, or more than hinted that Dr. Murlin, a Professor of Vital Economics whom we had taken over from the college faculty here, hinted that Murlin's granting Ph.D's on somewhat less than full qualifications. I think this was hardly a fair charge, but McCann made it. And this led to quite a feud for a few weeks between the two men, and Whipple asked Bayne-Jones to do something about that, and he got the two men around to his house one evening, filled them full of cocktails and talked it all over and made peace.
Dr. Meade: Well, I had never heard that particular incident, but then there was John Morton.
Dr. Corner: John Morton had been my classmate in Baltimore. I think it's worth telling a little incident about his choice. Dr. Rhees sat in with us...as the faculty grew beginning with the first group of Whipple, Bloor and myself, Dr. Rhees sat with us to talk over the qualifications of each successive appointment to the head positions. And when we came to discuss the Chair of
Surgery, and Morton's name came up. Dr. Rhees had already known of Morton's availability and he had seen Morton. And he said that he had found Morton so shy and retiring. that he'd doubt if he could succeed in the post as demanding of personal prestige as the Chair of Surgery. Well, so Dr. Rhees...1 saw him play football... in those days medical students could play football with the undergraduates, and he weighed 140 lbs. and he had some college experience at Amherst, he was a right end on the Johns Hopkins football team. And they took the risk of playing against the
Carlisle Indians, when Jim Thorpe, the nation's greatest athlete, weighing 40 lbs. more than Morton, was opposite him in the line.
Dr. Meade: They were opposed to each other?
Dr. Corner: They were opposed to each other. Well, the first time the ball came around their end, Morton plunged into Jim Thorpe and got bowled over, and John told me that when they picked themselves up, Thorpe said, "Doc, I wouldn't try that again, you might get hurt."
Dr. Meade: Well, that's a wonderfully....
Dr. Corner: Well, I'll tell this story, and then McCann has to tell his story. He had been to Woodshole on the collecting team that was sent out to get in boats with nets to get specimens for the biologists. And Morton was the captain of the collecting team. And McCann said whenever there was a difficult job, somebody had to go overboard in very cold water or hide under. or crawl
under the rocks to get a specimen, Morton was the first man in. And Dr. Rhees said, "Gentleman; you've convinced me."
Dr. Meade: Good. Then there was Dr. Clausen.
Dr. Corner: Sam Clausen and Karl Wilson, came from Baltimore. Dr. Meade: Wallace Fenn.
Dr. Corner: And Wallace Fenn.
Dr. Meade: So, in a way there was almost a transplantation of part of Hopkins to Rochester, wasn't there?
Dr. Corner: Well, Dr. John Ableman of Baltimore said to me, "You boys are just opening a Hopkins Country Club up there in Rochester." But as a matter of fact, out of the ten of us. counting Faxon, the hospital Director, I think there were five with strong Hopkins connections. Faxon and Fenn came from Harvard, McCann from Cornell Medical School...
Dr. Meade: What was the relation.... Dr. Corner: ...and then Hopkins...
Dr. Meade: What was the relation between Dr. Whipple as Dean with the faculty? He'd know many of them as students or colleagues, but of course he was in quite a different position as Dean.
Dr. Corner: Yes...
Dr. Meade: Was it an easy relationship? Were you given your own way to go or was there a firm guiding hand always there'?
Dr. Corner: Both of what... both are right. He was older than any of us, except Bloor. He had experience of having been Dean at Berkeley. He was the kind of person that thinks out in advance everything he proposes and he was very secure in his opinions, and he was naturally our leader. He kept a firm hand for a few years, a very firm hand on the finances. He had to see all our requisitions, even for small purchases and checked them over. He even sometimes forbid the purchase of an expensive apparatus that he thought we didn't need. On the other hand, with regard to our teaching, he was completely liberal. We had no instructions and no strength about what we should teach and how we should teach it. And once or twice I had occasion to try something radical. For example I went to him to say when we opened the histology course, I would like to teach histology as a branch of biology useful for medicine, but not necessarily a handmaiden to pathology and internal medicine. I said, "If you let me do this, my students will learn about (end of side #1 on tape)
...diseased human organ." Well, Whipple said, "You forget all this. You teach it from the theoretical standpoint. Teach them about histology and we'll make the applications." Another time, I wanted to try experimenting with having no final examination. Just grade the people on what we had seen of them during several months of work. This was a little bit radical. It didn't work very well, but George said, "It's your business to teach and handle the class any way you want to." He was completely liberal. And with regard to student... questions of student behavior and discipline, he was equally liberal. He wanted us to treat the students as grown men and
women, and when disciplinary things aroseundefinedvery uncommon, fortunatelyundefinedhe dealt with these people as adults. So he was very, very conservative, he was very, very conservative in business administration. And completely liberal in educational policies. You couldn't call him either a liberal or conservative. He was just a sensible man.
Dr. Meade: Will you talk something about the faculty that came in relation to Dr. Whipple? Let's go back to your interests and... at what stage had your investigations of reproductive physiology reached when you came to Rochester and how did you go on from there? That may be a long time, too...
Dr. Corner: Yes, I could talk a week about this. Well, I had gone on from the corpus lutcum of the sow to the whole reproductive cycle of the sow. This couldn't all be done in the slaughterhouse like the one in Baltimore, but in Berkeley I had great cooperation from a little slaughterhouse where I could watch the sows in the pens for several days before they were taken up to be turned into sausages and bacon. So I sat on the fence of the slaughterhouse with a long pole with a white rag on the end dipped in white paint. And when I saw a sow that was in heat. I'd reach...I didn't want to get down among these milling sows in the muddy yard... I would reach over with my long pole and rub some white paint on the back of the sow's hair and renew this every day. I had to go to the slaughterhouse every day, so that four or five days later when she was killed; I knew I had a corpus luteum of four or five days' age and ova that were probably by this time degenerating, and I found the pig's ova going down the oviduct and found traces of degeneration in the uterus and got a good description of the first part of the sow's cycle. When I got back to Baltimore four years later, after that... four years after I went to Berkeley, I was able to follow the rest of the cycle by making use of a war-time institution piggery farm down the
(Pawtukskill) from Baltimore where they kept sows, fed sows, up for the market, feeding them on city garbage. It was an economical measure. The operator of this farm turned out to be friendly to science, and he let me... he gave me help and facilities for following 30 sows through the cycle. Johns Hopkins University bought the sows for me, from the piggery, took them up to Baltimore, to home and slaughterhouse and sold them for enough to pay the cost of the journey and members of the anatomy staff joined me in a busy day as sows were slaughtered one after another one morning and I worked with my colleagues all day pickling the ovaries and so on. In this way, I got the whole cycle of the sow, and then I began with the Rhesus monkey which was a much more difficult story. And by the time I was called to Rochester, I had pretty well established the time of ovulation in relation to menstruation...
Dr. Meade: In the monkey...
Dr. Corner: ...in the monkey. And this had been... the better gynecologists, particularly in Germany, were getting a hint of what the human cycle was like, but this was I think the first confirmation of the fact that these higher primates ovulate in the middle of the cycle between two menstrual periods. Menstruation was not equivalent to estrus, in the heat in the sows or other domestic animals. It was a different and separate phenomenon. This is what I think I obtained credit for establishing from actual observation of the ovaries and the ova and all that. I couldn't finish it, didn't have time to finish it. I worked on the monkeys there four years and published what I found. When I came to Rochester the monkey colony was part of the deal. So I went on here, and during the first years I was here, I pretty well completed the morphological study of the primate cycle as shown by the monkey. And as I got that pretty well in hand, we had progesterone, I could begin to make experimental studies on relation of the ovary and hormones to the cycle.
Dr. Meade: Now for those who are not familiar with the term, what was progesterone?
Dr. Corner: Progesterone was a hormone made by the corpus luteum in the cycle of all mammals. The small ovarian follicles, some of the small ovarian follicles begin to develop.
Once in each cycle, to make a somewhat oversimplified the statement. In the human, usually one follicle ripens and sheds its egg into the oviduct. In the sow there is ten or more at one time. When the follicle is emptied it is converted into an organ of internal secretion by the growth of its lining, it fills up the emptied cavity, and makes in the human ovary a small mass brightly colored yellow, hence the name, corpus luteum, made up of large cells and capillary blood vessels and nothing else, no ducts. It's an organ of internal secretion.
Dr. Meade: So, you were after the active principle. Dr. Corner: I was after the active principle. Dr. Meade: And how did you go about that?
Dr. Corner: Well, I had to have help because I was not much of a chemist. I had passed my chemistry in medical school but I wasn't a good chemist. I knew the biology of 13 years of working with the sow's cycle, and then several years of working with the monkey's cycle. Looking back on it, I think I was very rash to choose as my biochemical colleague a first-year medical student named Willard Myron Allen. He was in the second class admitted to the school. Whipple had started this fellowship system here by which a medical student might drop out into the department of his choice and spend a year helping to teach the next class and doing research with some member of the staff. So, I offered Bill Allen, knowing that he had started chemistry at Hobart College, and that he had led Bloor's class in biochemistry, and that he had led my class in histology, and was a very calm and steady-headed young man. I asked him if he would take the fellowship and work with me for a year, and we began to work right away and Bill never made a mistake. His contribution was perfect, and...
Dr. Meade: It was Willard then who did the actual chemical isolation.
Dr. Corner: He led the chemical isolation with me as pupil and assistant and.... Dr. Meade: I doubt he was your pupil...
Dr. Corner: Pupil in biochemistry, then, right? Whereas, I picked out the choice corpora lutea and steered the general mechanics of the working of the operation. I did the surgery, although removing the ovaries is part of the test and so-called Corner-Allen test.
Dr. Meade: Was there a specific point where Willard came to you and said, "Here, this is it."
Dr. Corner: Yes, after about more than two years of work in which he had done the advanced biochemistry, he did come into my office one morning with a test tube with a few cc of clear solvent in it and a little flocculent mass of white crystals, and said, "This is it."
Dr. Meade: This is it...
Dr. Corner: I said, "What is it?" He said, `"It's a steroid." I said. "What's a steroid?" "Well. you look in (Conan's) book," he said, "and you'll find out what a steroid is."
Dr. Meade: Did you name it Progestin?
Dr. Corner: I named it Progestin first... Dr. Meade: Progestin...
Dr. Corner: ...that which is in favor of gestation because the corpus luteum is necessary for the implantation of the embryos. Later, four different groups of biochemistsundefinedtwo in this country and two in Germanyundefinedwere working at the same time on the final structure, on the (kamma kamophormiaundefinedcould this be something like "chemo... chemoformia"undefinedpertaining to chemical form?undefinedcan't find anything close to this word but sounds like that exactly and whatever this word is has something to do with a form/structure), and we all got the result about the same
time, and I don't think it would be easy to give specific credit. One of them was Adolf (Huttenought) who after had got the Nobel Prize for chemical work in another field. And it was he who emphasized the fact that this hormone has oxygen... two oxygen molecules in a double bond... two oxygen atoms and that it is therefore a sterone, and he suggested that we change the name to Progesterone.
Dr. Meade: I think your relationship with Willard Allen is a very convincing example of the relationship that existed here in Rochester, and we hope to a large degree still exists, of the close relationship between students and faculty. But I think that one of your great satisfactions has been your relationship with students and young scientists like Willard whom we all admire and know, and this informal, close relationship here was rather a sort of a hallmark of the school, was it not?
Dr. Corner: Indeed it was.
Dr. Meade: How did it come about?
Dr. Corner: Well, it came about because we were few in numbers to begin with. We were all young, we were working in a place far removed from a lot of social temptations. We were together a great deal. And we, I must say, we had a pretty good group of professors, and we certainly had a star group of students. It was just kind of a natural companionship. I asked one of the candidates...I was on the Admissions Committee and I would ask, "Why do you want to study medicine at Rochester?" One said, "Well, I hear the professors play softball with the students." I thought that was a pretty good reason for coming to medical school.
Dr. Meade: Well, that I'm sure is true because there used to be the ball games out here where this present building is, or just beyond it.
Dr. Corner: Yes, just beyond it.
Dr. Meade: Dr. Whipple, of course, had a great interest in baseball, because he had actually played professional ball at one time, and I think he told us at one time, at one point in his career he had to make a choice between going into biology or becoming a professional baseball player. I'm sure no matter what he did he would have been a great success.
Dr. Corner: Right.
Dr. Meade: So, that in addition to this warm relationship, there was also... were there not also special opportunities for research and study for the students here?
Dr. Corner: Oh yes, the schedule... we let out the schedule to guarantee two free afternoons a week. And this was definitely intended to let the students work on research problems or special studies of any kind. And then the opportunities were given to work on a special problem. After we got started and one or two of my students had actually published research papers, I put up a showcase in the histology laboratory where we put up reprints so they could see what their predecessors had been doing. And this grew from year to year until the time I left we had a dozen or so reprints there of published papers in good journals done by our students.
Dr. Meade: You're speaking of the two free afternoons. I know that a few years ago I obtained from students who were here during Dr. Whipple's deanship...to ask them of recollections, and one of them told me that when he came to school, after he'd been admitted, Dr. Whipple asked him where he was going to live. And he said he hadn't decided yet where it was going to be, and Dr. Whipple said, "Well, what you should do is to get a room over on the other side of the river and that'll give you some exercise going back and forth. He said many times when he came across that Elmwood Avenue bridge in the winter, he wondered how good that advice was because he nearly froze. But I know that Dr. Whipple was very, very firm in his conviction that students should have the opportunity to have some time off, get away from here and forget their studies for awhile, and to have some exercise. Actually, I imagine that we were about the first and only medical school to have a gymnasium built with the school.
Dr. Corner: Well, it was built a few years after it was built. After Mr. Eastman died. Dr. Meade: I see.
Dr. Corner: Or shortly before. Anyway, Mr. Eastman had made a small extra endowment, as I remember it, had given a special endowment, I don't think it was too big. between the big one they made first and that which he left by bequest. Anyway, there was enough money to do something of importance for the school, and Whipple polled the senior professors what should we do with this money, and I may be exaggerating a little bit, but practically speaking each of us asked for some special thing as his #1 choice. But everybody put down a gymnasium as a second choice, and that was done and the gymnasium was built.
Dr. Meade: That still is a feature here with the students.
Dr. Corner: Well, in the long Rochester winter it was a godsend.
Dr. Meade: And talking about the students, did you have any part in the choosing of students accepted, or how was it done?
Dr. Corner: Well, I was made a member of the Admissions Committee at once. Whipple acted as the chairman, and the committee for several years consisted of Whipple, Bloor, McCann and myself. Three preclinical and one clinical man. Applications were received on the usual forms and they stacked up in Bloor's office, and he took the responsibility for checking them over, making preliminary check and sorting. And once a week each year for several months the four of us met in Whipple's office and sat on his famous stools and went over the... he put on his half glasses, and we went over them. We, of course... we all felt...the first criterion was good marks in biology and hopefully good marks in chemistry. Other qualifications interested... one of us or another, according to our own tastes. I sometimes think maybe each of us was looking for people like ourselves who could be the best... Whipple was obviously and frankly interested in athletes. He said anybody who could be captain of a college athletic team had qualifications that would
help make him a success in medicine. He was interested in Californians, too. So, it was a common joke around here that the captain of the California football team could be admitted ...
Dr. Meade: Practically assured admission...
Dr. Corner: ....practically assured admission. This is a slight exaggeration but during the interviews, which each of the four conducted with the incoming students, I've heard many stories of how some boy by accident or perhaps by intuitive intelligence got Whipple talking about fishing or hunting, and got into the medical school probably on the basis of that.
Dr. Meade: That is quite true and when I collected letters a few years ago from students and their recollections of their interviews, so many of them speak about Dr. Whipple's interest in their... whether they fished or hunted. And there are some very interesting stories. One chap who is now a member of the faculty came and he expected to see a rather austere individual who would be awesome and he went in, and sat there with Dr. Whipple, and Dr. Whipple had on his lab coat and this gentleman... chap didn't say anything, Dr. Whipple didn't say anything, and after awhile, Dr. Whipple said, "Mr. Saward, Ernie Saward, what do you do best?" Ernie said, "I wracked my brain to find out what it was, and I blurted out, all I could think of was that the best thing I do is kill woodchucks." Well, this amused Dr. Whipple very much, and they spent the half hour discussing how the best methods were to kill woodchucks, and Ernest went out of here feeling he's failed completely, but the next day he got a notice that he was admitted. When you came to Rochester, too, you continued your interest in the history of medicine and you had a good deal to do with the forming of a medical history society here, did you not?
Dr. Corner: Yes, when I told Dr. Rhees I was interested in the history of medicine, early in my connection to the school, he encouraged me very much, thought this was a good idea to develop some interest in it. So, I organized a highly informal medical history club along the lines of the one in Baltimore at Johns Hopkins which is the oldest medical history club in the country. Quite informal. We didn't have any named officers. I took the chair at the beginning and later somebody else did. I recruited the papers. I made a special effort to get the hospital residents to take part, because I thought, correctly I believe, that the resident is respected by the students ordinarily, as much as or sometimes even more than the professors. The students are even closer to them. You can't get a resident to spend weeks and months in research, but I'd persuade the residents to talk about some particular case that turned up that reflected the long story of medical history or to present a review of a new book in his own field, and this worked pretty well. And another trick I had was to invite people from the community who had some parallel interest paralleling medicine... Arthur Parker, the head of the zoo...
Dr. Meade: Oh yes.
Dr. Corner: ...gave us a beautiful paper on the medicine of the local Indians. Dr. Meade: He was a Seneca himself.
Dr. Corner: He was a Seneca Indian and he had been through the medicine bundle ceremony as a young man. This was right out of the horse's mouth. Mr. Edward (Bosch) came out and told us about the part he'd had in developing the first rotary microtome. So we had a number of local people. In short, I tried to make it very widespread and very informal, no pressure, and it
worked very well.
Dr. Meade: Well, does that mean, too, that you were involved in bringing together the books in the history of medicine library.
Dr. Corner: Yes. I was made chairman of the library committee, first off. And Bayne-Jones and Wilson who were my colleagues, were also rather bookish people, and the three of us worked quite hard on collecting books in medical history. And you know the story of Dr. Mulligan's gifts?
Dr. Meade: No, I don't.
Dr. Corner: Well, after we had been running three or four years, Dr. Edward Mulligan, the local... king of the local surgeons, a man of great influence in the city... I was taking him home from a meeting at the country club one winter night, and on the way home. Dr. Mulligan said. "I hope you're getting the translations of all the great medical classics." He said, "I got into medical school from high school and I can't read ancient languages." Well, I had to explain to the good man that the great medical classics have mostly been translated into English. I said, "I know you're very much interested in the career of the great French 16th Century surgeon. Ambroise Pare." I said. "Pare was translated into English, his complete works, but these books are antiques now," and I mentioned a large sum... "I think it might cost us $100 to get one." And I said, "The budget for the library is generous but limited, and we have to get books for practical use first." This was all of that conversation, but at Christmas that yearundefinedthis was a little before. I got a letter from Dr. Mulligan... I got a call from Dr. Rhees, saying Dr. Mulligan had sent him a check for $5000 to be expended by Dr. Corner for books on the history of medicine.
Dr. Meade: That's the way it all started.
Dr. Corner: That's the way it started. Then the next year he did it again, and he did it the third year, and I heard that he was going to make it a total of $20.000 by the 4th gift, but he died before that could be implemented. But we had $15,000 which my colleagues and I spent. according to Dr. Mulligan's wish, we got together as many translations of the great early works as could be found. And altogether... we tried to get together a representative example of the development of medicine as shown by literature.
Dr. Meade: Well, Dr. Corner, you've contributed yourself to the history of medicine by the things that you have written about the institutions, about the prominent medical people and people who were not so well known. Let me ask you first... how did you come to write the book, George Hoyt Whipple and His Friends?
Dr. Corner: Well, I was invited to do that by the alumni. Dr. Meade: I see.
Dr. Corner: This was a commission, so to speak. They had secured a gift, what was it... $6,000, or something like that from Eli Lilly and Co. It was more than sufficient to pay my expenses. This was on my part a labor of love. I didn't receive any direct compensation, but I was given a generous budget to come up here several times and to do some...
Dr. Meade: That was after you had left here?
Dr. Corner: Oh yes, I had gone back to Baltimore by that time.
Dr. Meade: And then, I know you have been interested in writing recently a book about Dr. Kane.
Dr. Corner: Yes, I got interested in Dr. Kane because my grandfather, G.W. Corner #1, was almost an exact contemporary of Dr. Kane, born in about the same year and my grandfather was interested in shipping...he was a shipping merchant, and interested in travel, and he bought a copy of Dr. Kane's beautiful book, the greatest classic of Arctic exploration we have I think.
Dr. Meade: Dr. Kane was an Arctic explorer, then. Dr. Corner: Arctic explorer, a young... Dr. Meade: Was he also a physician?
Dr. Corner: A Philadelphia doctor, graduated from the University of Pennsylvania, and he just had a wild zest for foreign travel and exploration, and so my grandfather had the first volume of the two volumes of his first beautiful book, on his shelves, and as a little boy on Sundays, we were good Methodists, we couldn't romp and play noisily, but we could look over picture books. So I knew about Dr. Kane before I could read.
Dr. Meade: I see.
Dr. Corner: Well, when I grew up I was surprised to find that he was a member of my own profession and had lived in the next city to ours, and my other grandfather had actually sold him supplies for his Arctic expedition, and I set out to write his biography. I gathered notes and reminiscences and references for 20 years or so, and finally began quite recently to write his life.
Dr. Meade: Eventually, you left Rochester... Dr. Corner: Yes.
Dr. Meade:... to our regret and loss, but how did that happen?
Dr. Corner: Well, the Department of Embryology at the Carnegie Institute in Washington, had been founded some years before by Franklin Mall with whom I did my first research, the Professor of Anatomy at Johns Hopkins. After his death, he was succeeded as Director by George (Streeter), a very good medical-trained embryologist, and this institution became the
41 center for the study of human embryology in the world. When (Streeter) retired I was offered the post of Director. I was happy here and was expecting to stay on. It was a terrible, terrible burden of choice for me. I went through agony. So did my wife. My wife thought it would put me on a larger scale in the world of scientific institutions. I don't know whether it would or not, but this is a good deal bigger place now than it was then, and if I'd stayed
on... Whipple said that if I would stay he would vacate the deanship for me. I don't think this has ever been recorded before. But I didn't want to be Dean, and who would want to be Dean with Whipple staving on, watching?
Dr. Meade: Especially Dean nowadays when there are so many problems.
Dr. Corner: That's right. So I was so upset over this, that after visiting Baltimore again secretly, we didn't tell my relatives there that I was coming to look over to see what Baltimore was like, and after consultation with my wife and a few choice close friends, I finally wrote two
lettersundefinedone accepting and one declining the invitation to Baltimore, and put them on my desk and waited until the next day, grabbed one and ran out and mailed it. And for months... for years, I continued to have regrets for leaving Rochester, and as you can see, still enjoy coming back and often wondering what... I don't think it would have grown to the size it has if I had been Dean.
Dr. Meade: And then you had a career there at the Carnegie Institute for 17 years... Dr. Corner: For 17 years...
Dr. Meade:... and following that you moved onto another position.
Dr. Corner: Yes. I was invited to the Rockefeller Institute as historian. Ted (Bronk), the
president asked me to come, and bring along a colleague for laboratory work, so I was able to
continue research through the aid of a younger man, Dr. (Berley), but I spent most of my
five years there compiling the history of the Rockefeller Institute which they published very handsomely.
Dr. Meade: And following that, you wrote the history of the University of Pennsylvania School of Medicine.
Dr. Corner: Yes, after I finished up at the Rockefeller, when I got the book done. the job was over, and I wondered what I would do next, and then Henry (Moh) of the (Guggenheimer) Foundation, who was President of the Philosophical Society, asked me to come there as the Executive Officer.
Dr. Meade: So, how many years were you there at the American Philosophical Society?
Dr. Corner: Well, I went there in 1960, I'm still there. I was Executive Officer for more than 17 years. I retired from the Executive Office last year and am now staying on as Editor of the Society's publications.
Dr. Meade: Well, now, we've had a view of your whole career, and a very fruitful career it's been, of great benefit to many people and to science. We are coming to the end of our time in this interview. I should say that for purposes of record, the date today is the 14th of October, 1978. And you now will be going back to, after a pleasant stay here in Rochester doing some research, what... to sum this up, this research you've been doing here this past few days is connected with your next endeavor, and that will be what?
Dr. Corner: That will be an autobiography, which my Philadelphia friends have been teasing me about for several years. I finally gave in and started it, and I've actually written the first half in rough draft and have come up to the time when I came to Rochester. So. I thought I'd like to come up and look over the old catalog. By the way, I drafted the first catalog, with some revisions by Dr. Rhees and by Dr. Whipple. Look over the old catalog and refresh my memory about the dates of arrival of my associates and assistants.
Dr. Meade: Well, we look forward, Dr. Corner, to reading that autobiography, before too long.
Dr. Corner: Well, if I succeed in finishing it, then you should have it in a couple of years if all goes well.
Dr. Meade: We've... I've certainly enjoyed this interview and I'm sure those who see it later on will, and I thank you indeed for being with us.
Dr. Corner: It's been a great pleasure. Dr. Meade: Thank you.
Interviewee: George L. Engel, Professor of Medicine and Psychiatry
Interviewer: James Bartlett, Medicine Director/Senior Associate Dean at the Medical School for the Miner Library
Date: December, 1987
Bartlett: Actually, George, this is the second video tape that you've made. There was an earlier one for the AOA series on Leaders in American Medicine where you. with Sandy Meyerwitz reviewed a good deal of your scientific and clinical career. Today. we want to focus on you and your time here in Rochester as a faculty member of the medical school. It was in 1946, I believe, after graduating some years before that from the Hopkins Medical School and going to Sinai for your house officership and then to the Brigham for work there with Soma Weiss and others. and on to Cincinnati to the Department of Psychiatry and Medicine there. that put you in a position in '46 to come on to Rochester. I wonder what you found here by coming in as a new faculty member to this medicine school that was then 20 years old. and what kind of faculty, what kinds of students and what kind of an atmosphere was there?
Engel: Well, when I came here in 1946, I came with a very conditional frame of mind. John Romano had just been appointed the founding chairman of the Department of Psychiatry. I was an internist. had been in the Department of Medicine in Cincinnati. He and I had. in Cincinnati. been working towards developing what would be called psychosomatic teaching at that time within the Department of Medicine, which was my primary affiliation and the question was. was Cincinnati or Rochester to be the place where I would continue to do that. I made a visit here. met with Dr. Whipple and Dr. McCann and others. and very quickly got the feeling that Rochester was going to be the place to come. Why? It was quite an experience to come here in 1946. It was a small school. 20 years old: that seemed like an old school to me then_ but then I was only 10 or 12 years older than the school. But. there was a certain ambiance and a certain characteristic and certain flavor which I think had been established by Whipple from the beginning and by the people he brought with him. which I quickly sensed would be extremely conducive to developing something which was different and innovative. Remember. there had not ever been this kind of teaching program developed anywhere. We had already seen problems in trying to do this in Cincinnati. and my first meeting with McCann who parenthetically was the person who got the money for the endowment of the Department of Psychiatry and the money for the building of Wing R. in itself a testimony to a kind of openness and interest in the school as compared to parochial interest in one's on department. And I think that was the essence of what I sensed right from the beginning. that the people I spoke with seemed to have a sense of commitment and dedication to the school as a whole, and even more importantly to the education of medical students. Medical students in most medical schools hav e never enjoyed first priority among faculty. The proposal I made to McCann was one that 1 don't know that he necessarily grasped with full significance. I don't know how one could It was something brand new. but in essence what he said. not in so many words. but came through loud and clear. "We're open to new things here. go ahead. I'll support you in anything you want to do. and if you fall on your face. that's your problem. not mine ' Coming as I did as an internist with evolving and developing psychological and psypsychiatric interests. I found myself right from the start in two departments and administrative issue there. McCann with a twinkle in his eye. had told John Romano. "We're very happy to have Engel here_ but of course. you're going to pay for him, and you're going to give him space After all. who had gotten the money for Psychiatry? I didn't even give that a second thought_ what my primary appointment would be. and it ended up my primary appointment has been in psychiatry.. but my main commitment has been in areas elsewhere_ And one of the things that very quickly emerged well within the first year. was that this was a school which was small The Department of Psychiatry was brand new. and there were just John Romano. and myself. and a couple of residents beginning. one or two people who had
been here; and in the Department of Medicine, I think I was the fifth full-time member of the Department. It was that small in those days. It was immediately post-war. And everybody knew each other. Everybody ate in the same dining room, and by everybody I mean students and nurses and nursing students, and facultyundefinedsenior and junior. There was none of the elitism that I had grown accustomed to at Harvard and Hopkins and other places where there were separate dining rooms for Chiefs of Staff and that sort of thing. I've described it many times as a school with very permeable interdepartmental barriers, and for what I was interested to do, to work across disciplines and around disciplines, and through disciplines, this was absolutely incredible. I quickly found that with my white coat I could go anywhere in the hospital or anywhere in the medical school without anyone asking me, you know, "What are you doing over here?" One got to know people quickly. One discovered interest in new people coming in. very welcoming. And then I became quickly aware of the place of students in this school. I think it was George Corner, he used the term the other end of the log.' I didn't grasp what that meant until I had been here for a while, but I had not been in anyplace, including Hopkins, which was supposed to be noted for that in which there was such an intimacy between student and faculty. And in which faculty really did spend a good part of their time thinking about and wondering about how to work with students. Very impressive people in that regard. Whipple used to have and run the monthly medical meetings, and we all came regardless of what the programs were, whether they were in our area or not. John Romano often used the term `citizenship' of the school. And at first, I thought that was something peculiar to John because he used it in Cincinnati, too, but it wasn't quite as meaningful in Cincinnati as it was here. By and large, people did have that attitude about the school and about what they were doing.
Bartlett: What about the students, George? What kind of students did you find here?
Engel: Uh, well, over the years I've come to feel that most people who get into medical school are pretty good students. My Hopkins elitism and Harvard elitism from the little time I spent there as a student and as a fellow, it didn't last very long. Most people who get into medical school are pretty good, and have gotten better, I think. It was a period of immediately after the war in which students coming in were largely... many of them were veterans, quite a few of them were married and had families. They had had their lives interrupted, but they also had lived more. Graves, of Graves' disease, 150 years agoundefinedmore than that, 1730undefinedhad written... I'm sorry, 1830s, had written and strongly recommended that before people come to medical school they should live a bit, because you can't really know what it is that your patients experience if you haven't shared. So, that was a very exciting time in terms of the students' interests and what we were interested to bring, and John Romano had the wisdom to decide right from the beginning that we should teach only the class that entered with us, which was the class of 1950. And then the next year, take on two classes. We didn't have the faculty to do any more than that, and whether he expected it would work out as it did or not, I really don't know, but it was a brilliant notion because within a year, the students who were not having experience in psychiatry and experience with usundefinedmy colleagues and myself, a group that quickly formed in Medicine, were howling that they were missing out on something, and we set up electives and so on.
Bartlett: What was your first teaching?
Engel: My first teaching was with house staff. Coming as I did, and with a primary appointment in Psychiatry, it became very critical for me to establish my identify in Medicine. I was a well established teacher as an internist in Cincinnati, and also at the Brigham. and so I volunteered to attend beginning in July a few weeks after I got here, and...
Bartlett: Did people realize you were an internist?
Engel: No, they didn't realize I was an internist and there were amusing episodes that occurred where I would be praised for knowing so much internal medicine for a psychiatrist. A memorable incident where I made the first antimorphic diagnosis of a perforated interventricular septum, and we were going down to view the autopsy, someone joined the group and the house officer who was very pleased they were attending and had done so well, mentioned to this man, "You know, Dr. Engel made this diagnosis of perforated interventricular septum." Thinking that I was a psychiatrist, he scowled, frowned a bit, and said, "How did you do it? Did you put air in the ventricles?" He thought the only ventricles I would know were up here. And Whipple looked over his glasses when someone said. "You know, Dr. Engel made this diagnosis..." "You mean the new psychiatrist?" But that eventually clarified in time.
Bartlett: So you started out teaching with the house staff in Medicine?
Engel: We started out teaching with the house staff. I didn't do any student teaching the first year. John Romano took the first class in Psychiatry and I got busy with our fellows. We had come with money from the Rockefeller Foundation and the Commonwealth Foundation, which had originally been awarded to Cincinnati, but which we brought with us to begin a program. And I began with a number of people who, most of whom were coming out of service, Peter Hamburger, and Dick McKay, and John (Herra, Herron) and others.
Bartlett: Fellows in what, George?
Engel: They were internists and the objective was to develop their skills in what we would now call the psychosocial... I think then we would call it psychosomatic...psychosocial aspects of medicine. And you have to remember that I had just gotten into this myself. I had been in Cincinnati for four years, but it had only been in maybe the last two years at Cincinnati that I began to interest myself. So, I was very much of a beginner. John Romano's taking a flyer on me and giving me kinds of responsibilities for teaching that were actually well beyond what I was prepared for, in fact, constituted a remarkable source of stimulation and education for me.
Bartlett: But you and John had been together for all the years...how many years m Cincinnati? Engel: Well, we had been four years in Cincinnati, and before that...
Bartlett: ...and before that at the Brigham...
Engel: ...so he and I had been together for five years...
Bartlett: ... so it was a flyer on five years of observation...
Engel: ... yeah... but my interest in Psychiatry and even in that of psychological was very slow in developing. I talked about that on the other tape and don't want to repeat here.
Bartlett: Yes, I remember after your stand as Acting Chairman of Psychiatry when John was on sabbatical, as I recall the house staff gave you a residency certificate for finally completing your residency in psychiatry by chairing the department.
Engel: Yes, that was 1959/1960 and I was Acting Chairman for the year. John was abroad and on the very first meeting with the residents, they brought a patient and asked my judgment. It turned out to be a schizophrenic patient. I had to say "I know very little about schizophrenia."
They were shocked. "How come I was acting as Chairman?" Fortunately, the Department of Psychiatry had very excellent people, and I had no concern about matters not being taken care of. But they gave me a certificate at the end.
Bartlett: So. the fellowship program...the capacity to establish it came with you from Cincinnati, and you really went right into that.
Engel: Yeah, the fellowship program was the first thing we did and we just began working, the fellows and I, on the medical service. We established an outpatient clinic, which we called the Special Medical Clinic, which actually became the precursor of the psychiatric outpatient clinic, although in those days we were seeing more patients with what would now be referred to as psychosomatic kinds of problems, and in the early days of the fellowship program, the internists coming in did not yet have any clear model with whom to identify, and about half of them moved over into psychiatry. There was a good deal of uncertainty about roles at that point. and the psychiatrists as the program began to evolve would press our fellows as to "why didn't you do the real thing?" and the internists would press them and say, "why are you fooling around with this stuff?" And it was about five years, I think, before what we referred to as a liaison identity' formed, that people began to recognize that it was possible to stay in medicine. I think Bill Greene was one of the first people to emerge in this role and continue to be an active and vigorous teacher and investigator in the Department of Medicine. We started with students in the second year, that would be 1947, the fall of '47. John asked me to take over the second-year course. And that was really a challenge. As I said before, it involved my undertaking teaching in areas with which I had no real knowledge or familiarity. I hurried to learn as much as I could. But it was a wonderful group of students, and don't know whether they knew how ignorant I was, but we got along very well. Even how anxious I was. I remember any number of classes I would come into wondering exactly how I was going to handle this, interviewing a psychotic patient when I had had very little experience. But it turns out by and large the patient usually made the exercise in any event, and I began distributing notes, write notes for myself and began to distribute the notes to the students, and that eventually became my book. Psychological Development in Health and Disease, which went through 17 versions.
Bartlett: That sort of grew out of the syllabus of the second-year group.
Engel: That grew out of the syllabus and it was 17 years before I finally decided it was ready to be published as a book. It didn't appear until 1962, I think it was. '62? Well.... and in the third year we began our teaching on the medical service with once-a-week, two-hour rounds in the regular medical schedule during the students' 12-week assignment. That was always very exciting. I continued to round with the residents in the summer and kept a very busy schedule in those days. The first...well, until 1961, I did the second-year course all by myself. And until 1950, I did the third-year rounding all by myself, so I had the second-year course once or twice a week through the year and then I rounded with every group on Medicine four times a week, four groups at any one time. Bill Greene was the first of the fellows who stayed on as a faculty member. He came through the residency in Medicine and joined us as a fellow in 1948, became a faculty member in 1950, so by 1950 Bill and I were sharing it, and then after that the group grew very rapidly. Frans (Reichsman), Art (Shmallie), and a total of more than 130-40 people went through that training program over the years. So, it was a very active clinical program but I think an important element of it was that, in one way or another, most of us were involved in the teaching. Because we were involved in clinical research, that means we were actually working with patients. We managed to interdigitate and to incorporate a good deal of the research aspect right into the teaching. Simple enough, I was working with patients with ulcerative colitis at that point in particular, and Bill Greene with leukemia and so on. Patients
whom we saw on teaching exercises second year or third year readily became part of the material. And we were so involved in our evolving new understanding and new insights and new discoveries in these aspects, I think there was an element of intellectual excitement which was communicated to the students.
Bartlett: George, you talked about that in terms of teaching the medical students and of the work in two departmentsundefinedMedicine and Psychiatry, and also the low departmental barriers here. How did you find it with other departments? Did the focus go on and extend some into other departments, or was this mainly a medical/psychiatric....
Engel: Yeah. let me say a little bit more about Psychiatry. At this point it became very important to me to learn more about Psychiatry, which I started as soon as I got here, seeing the handwriting on the wall, so that in addition to what I was doing with our fellows, and then with our students, I also took to attend as best I could on Psychiatry. and learn as much as I could and then to supervise residents in Psychiatry with psychiatric patients. That's how I gained some familiarity with clinical psychiatry, although I never really undertook the care of psychiatric patients. I mean, in all the years I admitted a total of three patients to Wing R and two of them were a mistake. They shouldn't have been admitted to Wing R. It was in the very early days. An example of the permeability of the barriers is our study of the child Monica and Frans (Reichsman) sitting in the dining room, that wonderful dining room that doesn't exist anymore. and a pediatric nurse, Miss Murphy, who I think is still here, says to him. "We have a very interesting child with a gastric fistula who seems to be very depressed and upset, wouldn't you people like to see her?" See, that came from a nurse at the lunch table and Frans went up and did see her, and realized that this was an ideal object for study in our just-beginning study of behavior in gastric secretions. And to make a long story short, I went to see the child with him on her next admission which was a few months later. We recognized the unique opportunity here... we were all set to go ahead and it required only saying a word to the Chairman of Pediatrics, and at the moment I can't remember whether that... it was still Clausen, I think... '53 or '54.
Bartlett: I think Bradford had just come in because...
Engel: Yeah, I think Bradford had just come, 1 think you're right. But Bradford, just with a wave of his hand, said, "Sure, go ahead." And there we were, on the pediatric service, and it ended up actually that we studied intensively three children. Here. neither one of us had ever worked with children, other than a month or two in my rotating internship, but that didn't deter anybody, and then I got involved with gastroenterology, of course, in my area with ulcerative colitis and I got involved with surgery.
Bartlett: Now, did Monica ever get involved in medical student teaching?
Engel: Monica got tremendously involved in medical student teaching. She was so exciting to us, that we made films of her in the very beginning so that... we had not anticipated that we would continue to work with this youngster for any length of time, and actually it turns out we are still working with her. this is now 30 years later and she became an integral part and in fact, the major vehicle for the teaching of child development. As part of my teaching philosophy, that the patient is our teacher, that the well-studied patient no matter what the issues are with the patient, demonstrates, provides information, demonstrates data from which one can develop principles and develop generalizations. So it didn't really bother me that anyone could say that Monica was as unrepresentative of an average child as could be. I could also say, "Well, where else do you have the opportunity to take one child beginning early in infancy and follow her year by year?" And the students got very involved in this, actually the year that Frans (Reichsman)
left to go to Downstate, which was 1964, the students of that class included Monica in their yearbook. And beginning in about 1955, there was no school student play which did not include Monica. She became an integral part of the teaching. So we would spend many, many hours just going over with the students the films and the tape recordings, occasionally have Monica come in as she got older, learning about observation of children, that's how I learned it, was watching Monica. And then we got other children, one of the house officers had a baby and so we wanted to have more information, more material, from which students could learn how to observe babies, and he and his wife made home movies and we edited that and used that. to show the first 15 months. There was such a... I'm merely still talking in many ways about the ambiance of the school...
Bartlett: Yes, how you got involved in pediatrics and spread out from beyond just medicine and psychiatry.
Engel: We got into surgery, not in... many of these areas we didn't ever get into formally but if I wanted to... I did pursue my patients wherever they went, so many of my ulcerative colitis patients ended up on surgery, so there I was on surgery seeing my patients. Some of them I took care of medically, some of them I took care of psychotherapeutically. I did get psychoanalytic training during this early phase, more to develop the skills and a perspective about this than to become an analyst as a practice, although I did that for about 20 years. With students and with fellows, what it really comes down to is that any patient is of interest.
(side 1 of tape ends here)
the development of which was influenced by the atmosphere that already existed. but in addition I think by what we were doing, that the teachers should be working in areas in which they were not necessarily most expert. We wanted to encourage internists to work on the surgical service and so on and so on, so that students would have instruction in that which is common to medicine irrespective of discipline. Some faculty were uneasy with this, but it worked.
Bartlett: As I recall, even before that the medical psychiatric group was very active in the teaching of physical diagnosis... both physical diagnosis and history-taking, which were the old precursors in the traditional end of the second year that were eventually consolidated into the general clerkship in the beginning of the third year.
Engel: Yes. Physical diagnosis was taught in the end of the second year two or three afternoons a week and while physical diagnosis had been...physical examination had been an important area of instruction, in most medical schools, probably in all medical schools in the early days, certainly it was when I was a student... a tremendous amount of time was spent learning how to percuss properly and so on. Very little attention had ever been paid to the interviewing of the patient and those aspects of the personal contact with the patient. The teaching of physical diagnosis, as it was called, meant "taking a history," which you were supposed to somehow or other know how to do out of your hip pocket...
Bartlett: ....or follow an outline slavishly...
Engel:... or follow an outline... .was something that it was difficult to get people to do. Most teachers found it somewhat tedious and boring and it didn't have the excitement of being the attending on the floor, etc. So, we had the good fortune of coming into a sort of vacuum situation. We wanted to teach interviewing and I recruited all of the people in our group and set them on this, and I can't remember whether Ralph Jacox was in charge of that at that point. I
think someone before him had it, but he soon took it over. But in any event, he welcomed the addition of attention to teaching interview and we rewrote the format for the writing up of the history. It used to be OB had their form and Medicine had its form and Surgery had its form, and the student had this peculiar notion that there was something called the medical history and the surgical history and so on. So our group rewrote that, and as time went on over several years, we moved into a vacuum, so that by the mid '50s or late '50s we were in position to play a very considerable role in this teaching and to bring about I think a very considerable reform and again, the ambiance in the organization and the structure of the school, enough of this got generated so on the committee of six, I was not a member of the committee of six, and I wasn't a member of the committee that had to do with the general clerkship, but had gotten enough into the ambiance and the atmosphere that some of these people had been students here and some had been house officers and some had just worked with us in one way or another, but the work didn't go on in camera. Lots of people sought me out to talk about this and so on. So when the general clerkship emerged, it had already emerged out of experiences that we had had.
Bartlett: Even if there was a vacuum in the examination of the patient, in filling it, you must have experienced an occasional resistance once in awhile.
Engel: Yes, there's never been a period in spite of all the things that I have said in which there was not resistance. And the resistance came from a number of sources. Once source of resistance was what I refer to as the irreducible number of people that will exist anywhere and even under the best of circumstances...
Bartlett: ...even in Rochester...
Engel: ... .even in Rochester, who like people who are tone deaf or color blind, etc., simply do not have whatever it takes, and I'm being very vague, to grasp and sense and organize psychological and social material. And I would say very strongly that this is not a criticism. That's just a statement of fact. And those people are not necessarily opposed. They may be obstacles. They are not necessarily even obstacles. I can think of one person in another school who was able to say, "I just don't grasp what this is about, but inside I have the feeling that it's got to be important, so go ahead and do it." That was Ludwig (Eichner), at Downstate. He was the professor of medicine. So, there was the kind of resistance that came from that source. Then there was the resistance that came indirectly from people for whom this was threatening. There is no question that when you begin to work with psychological and social data, it is threatening to some people, and there is also no question that when you begin to do something new, it is threatening, regardless. That's human. And the third source of resistance, which I think has gradually increased over the years by the nature of the beast, the many people who join our faculty from other schools where this atmosphere has not existed, for whom this is strange and different and who make sort of apriori misinterpretations, namely they tend to think of all of us as psychiatrists, which then also becomes a convenient way of making us aliens.
Bartlett: Alicnists, eh?
Engel: Yeah, alienists. Uh, and there were times when the resistance got quite intense, and I remember on one occasion, I could hardly forget it, when Larry Young became Chairman, and the first meeting of the full-time staff, and it was at that point that several very respected members of the Department of Medicine spoke up and said, "Is this psychosomatic stuff really necessary during the clerkship?" Larry spoke up and said as long as he is Chairman, this he felt was an integral part of the education of a student and the house officer. And there it rested. It does say something I think very significant, namely, the leadershipundefinedin whose-ever hands leadership isundefined
whether we like it or not is a very powerful factor in directions; that when a department Chairman takes that position, barriers come down. And McCann took that position and I was never convinced that McCann really understood what we were doing, but to me the mark of a scholar and of an open person is the ability to do that in areas with which they are unfamiliar. It takes courage.
Bartlett: Yes, it's an interesting kind of leadership, isn't it?
Bartlett: Because it goes beyond one's own capacities.
Bartlett: George, in speaking of the general clerkship, a book came out of that also, that you and Bill Morgan wrote, that probably a great many of our students read, and the rest of us, too. Clinical Examination of the Patient, was that title?
Engel: Clinical Approach to the Patient.
Bartlett: Clinical Approach to the Patient... would you... how did that develop?
Engel: Well, that evolved again like my other book, out of the syllabi that we had prepared over a number of years, and it gradually expanded and it existed in mimeographed form or photocopied form that we handed out to the students and then at some point it just seemed logical to put it into book form. It was actually the first text in that area which gave any attention, strangely enough, to the patient.
Bartlett: Yes, the texts before that used to be called physical diagnosis and had a lot of pretty or unpretty pictures of various normal and distorted things about patients, and very little about the approach.
Engel: Yeah, it's interestingly parenthetically, Evelyn, my wife, who was trained as a medical illustrator at Hopkins did the illustrations, and when we were doing the illustrations, she of course was supplied with textbooks of anatomy and so on, and Bill and I somewhere along the line, and Evelyn, got into great conflict because we kept saying these pictures are wrong, and she would say, "Yes, but I've gone to the other textbooks of physical diagnosis and so on, and I've checked them out." And do you know that in the pictures in most textbooks of physical diagnosis of that period showing the regional location of the viscera and also hernia and the genitals, were taken from cadavers, and are incorrect? The liver is way too low. We say the liver has to be above the costal margin. She'd say. "Well, look here. Here's the best recognized text and look where the liver is."
Bartlett: I remember Evelyn not only drew the pictures but you were the model for some of them, including the hernias.
Engel: I was the model...
Bartlett: She could be the only appropriate artist.
Engel: Some students modeled. Bill Morgan appears in some of those. You will recognize him.
Bartlett: What about the curriculum? We've talked about students and faculty and the organization of the medical school here. What have you seen about the curriculum over the years that you've been here? And also you've looked at the organization of curricula in teaching around the country in many medical schools. Would you talk about that here?
Engel: Well, rather than get involved in details of curriculum, because that's a word that stirs up a particular context, I'll pick up on your last remark. I've visited about 75 medical schools now in this country and Canada and abroad, Britain and Australia mainly, and if there is a distinguishing feature about Rochester from all other medical schools. it is that in one way or another, the educational programundefinedI use that term rather than curriculumundefinedthe educational program has evolved in such as way that students at Rochester are more oriented, and everything is relativeundefinedwhen I say more oriented, I'm saying more oriented than students at other schools towards the patient. Rochester students and Rochester graduates are more likely to see themselves working with patients not just with disease, the nature of our curriculum as it has evolved, as it evolves for the student from the first to the fourth year incorporates a great deal more opportunity for the student in a paced, orderly and systematic fashion to begin to learn about human beings in the context of health care, illness, etc., and it is done in such a way that is natural. In moving, for example... if you look at time allotments in other schools you'll see that the amount of time that is devoted to these areas of patient is in most schools miniscule. Even the time devoted to psychiatry is very limited. I've often said that if... and many of these courses are open to a great deal of criticism by students, and I've often said that if pathology, for example, was given as little time to deal with its subject matter as psychiatry and what I call the people sciences, whatever names they use, as those courses are given to deal with, all that's involved in human behavior and illness, etc., pathology would be damned as a terrible course. You know, this is a growth process for students, so often the educational organization of a school is heavily biased towards content. That's a reflection of the nature of the beast. that much of what students learn in the first two years does involve concepts, should involve. but doesn't as often as it should, general principles and so on. But the fact is, that the physician is not going to become, with rare exceptionsundefineda biochemist or an anatomist or a physiologistundefinedand especially since the laboratories have gone out as part of student experience, and science has become more complex from a technological point of view, students are all too much placed in a situation in which they deal with content, with substance, and don't really have much ground to be involved in process and experience. You are also suggesting that students grow during medical school and that the educational experience should work hand-in-hand to facilitate the growth of the student to become a physician.
Engel: Yeah... that you have to... that when you are learning to become a physician, you are learning a role. You are learning to become someone and to do something. That's not happening when you are learning biochemistry and anatomy. etc. You have to do it. That's not what's happening. So in the evolution of the teaching of the psychosocial aspects of medicine, which broadly refers to everything human, behavioral, social, all those aspects of medicine, for the student to a much less greater extent requires content. The content you're learning as you go along, but unless the student also learns how to elicit the information upon which that content is based, how to interview, how to relate, what's involved in interacting with another person, whether it be the patient or family or visitor or whatnot, and do this in an orderly systematic fashion and to come to recognize that this area is just as accessible to the scientific method as any other area. By scientific method I mean systematic, careful observation, checking for reliability, using methods which are reproducible and so on and so on, and so on. Much that's taught in other schools leaves no impact. As a matter of fact, it's really not much more than the average person can pick up in lay publications. You know, there's all kinds of articles about
psychological and social things in the public press these days. What has evolved in our program, in the University of Rochester program, and has sort of gotten built into it as a way of approach, is that from the first to the second, to the third and to the fourth, the student more and more becomes a participant, more and more is beginning to use that which is going to be his or her way of life, and our graduates leave the school...they don't know this is happening while they are here. It's only after they get out. And I have innumerable feedback from...
Bartlett: You've surveyed students as well as visited a great many, and many have kept in contact with you spontaneously.
Engel: Yeah, I did a survey of the class of I think it was 1968/'69/'70. Or maybe '69/'70/'71 a year or so after they were out, and I sent out a very simple, open-ended type of questionnaire. I just asked in which ways did you feel yourself better prepared than your peers as an intern from other medical schools. In which ways did you feel yourself less well prepared? How long did it take you to catch up in the areas you felt less well prepared? How long did it take them to catch up in the areas in which you felt less well prepared? And the upshot of that was that 90%--and
we got something like a 75% yield on the questionnaire... and 90% of our respondents, who were free to write as much as they wanted to, responded to this question by saying that they felt more comfortable, more competent, more capable in all the areas, and I'm using that broadly, that had to do with dealing with patients as human beings. And where they didn't feel as competent, scattered among the graduates, some said, "Well, I didn't know as much dermatology as someone else, or I didn't know how to do certain procedures." But whatever those were, by and large, the students, the graduates reported that they caught up within months or certainly by the end of the year, whereas with respect to their peers catching up, uniformly it came back that they never caught up. And several of them wrote eloquently saying that nothing happened in the house officership which would facilitate their catching up, and in essence that if you haven't got this built in, in the course of your undergraduate education, the chances are it's not... it may not ever come.
Bartlett: We're working more nowadays with residents, most of whom are coming from other schools, in the Associated Hospitals Program and in the General Medicine Unit and so on, and this is quite evident that after all, the people who elect to do this are people who are genuinely interested as the people who've applied for fellowships. But it's a long haul for many of them, and I've had a number of residents just this fall, a number of residents or fellows who made this kind of statement: "When I just begin to see, yeah, I'm finishing my residency or four years out or five years out, and now I discover that I don't have at my fingertips the kinds of skills to work with people that I need, and I'm angry." One man said that. "I'm furious. This all was neglected." Such ordinary, simple, day-to-day circumstances of how do you behave when you walk into a patient's room and there are visitors there? Do you follow a rote, and say, "Will you please leave?" And so on and so on. All of these are what I call microdecisions, behavioral decisions, for which there is available a body of information which allows you to say that one thing works better than another or that if A, B, and C comes out, you make decision 1, and if C, D, E comes out you make decision 2, that there are no...
Bartlett: George, you've been a teacher here for awhile, a good deal longer than anyplace else in your career. What's it been like personally? What have been the satisfactions, the frustrations, the changes that have gone on?
Engel: Well, I've had innumerable opportunities to leave... Bartlett: I know. And you've stayed.
Engel: And I've stayed, and that in itself says a lot there, and now that I've retired from the directorship, and am phasing out my activities, people still say, "Why are you staying in Rochester?" Well, it's been an absolutely marvelous place to be, and I know people are likely to say that about many institutions, but I know that it would have been impossible for me to do what I did here in many schools of this country. Notably, the name schools, the big schools. There's no way I do think that anybody could accomplish this kind of... have this kind of experience that I've had which has been exciting and generative and creative and lots of gratifying feedback, and the opportunity to innovate: no way that one could do that in schools like Harvard or (BNS) and so on and so on, because they are so weighted by tradition and so structured in independent, almost independent units that hardly relate to each other. I've grown with the school. The school now is what? 60 years old?
Engel: Almost 60 years old, and so I've been here 2/3 of the school's life, and that makes a difference. I have to say that it gets more difficult as the school gets bigger, but at least so far. and I hope it continues, those in leadership have had the wisdom not to let happen here some of the things which have plagued other schools, such as not allowing there to develop the kind of independent operations and fiefdoms and power centers. We have our share, but they nowhere compare. People around here who grumble about how things are in Rochester, I very quickly find out that they've not been anywhere else. They don't know how difficult it can be in other places where there are power structures and so on. We have a large enough sprinkling of our own graduates which I think serve a very important moderating effect.
Bartlett: Yes, most people speak of the desirability of bringing together people from all over. You've spoken several times of the desirability of having a core of Rochester people.
Engel: I think that is a historical anomaly, perhaps. I think it is a historical anomaly because Rochester unfortunately still is the main center for this kind of development, and it's lonely. I would hope that it's not going to be much longer before these kinds of changes begin to take place elsewhere, and that will no longer be an issue. I see this still as a somewhat delicate plant in the recent couple of years, the recent five or six years, within the educational planning. I think we saw what happened when we had someone who was thoroughly versed in the basic philosophy of the school and then someone who came from outside, and now someone again, who the first person as I said was not a graduate of Rochester, but had been in the program for awhile... and now we have someone who is a graduate of the school who has... those two people have the sense of what certain, almost intangible strengths are here, which are very difficult for an outsider to grasp, unless they've really worked at it.
Engel: I might say too, I don't want to leave the impression, simply because someone comes from the outside, they are incapable. That's far from true, and I'm very gratified you know, that the last... we've only had four deans, but the three deans who came, all came from the outside, all came with no knowledge or familiarity about this, and the second and third who have finished their tenure, not only left with a very strong and positive supporting view, one even joined our group, Don Anderson, and the present dean, you wouldn't find him saying the kinds of things he says if he were at some other school.
Bartlett: Yes. George, you've been emeritus several years now and you've been an important part of this focus of (recitative) soil, but how are things going to continue? I know there's going to be a professorship, is there not?
Engel: There is going to be a professorship, and I have very encouraging news about where the... how the fundraising for that is coming along.
Bartlett: So there'll be an Engel professorship, and what role can that play in preserving this?
Engel: Well, I think it plays a very important role, not because it has my name attached to it, because it is the first acknowledgment, first of all the unit which now is headed by Robert Ader who is an experimental psychologist, and whom we brought here 25 years ago. It's the first acknowledgment by the university, that discipline now called Behavioral and Psychosocial Medicine is meaningful, is significant, it's a new discipline, just as Immunology once was a new discipline and biochemistry once was a new discipline. And for our university and for a medical student to publicly acknowledge that, I think is a very important occurrence. I've often said that what we need is some kind of public acknowledgment whether it be by a foundation or by whatnot, that this is an important area of education and training, and if they were to establish the so-and-so foundation scholarships in psychosocial medicine or whatever, whatever they are called, for funding to develop chairs, that's a social support, and there's no question that things don't move without social and society support. So I think this is a very important development. I hope it will become a reality soon.
Bartlett: Well....that's it.
Interviewee: Charles B. F. Gibbs, M.D.
Interviewer: James Stewart. M.D.
Dr. Stewart: I'd like to introduce myself. I'm Jim Stewart, an internist in Rochester since 1951, a mere child compared to our distinguished guest of the morning, Dr. Charles Gibbs, who has been in practice, or in Rochester, since 1921. Charles, you were a native New Yorker from upstate near Watertown, and graduated from Syracuse undergraduate and medical school, interned in Brooklyn Hospital, and came to Rochester in 1921.
Dr. Gibbs: That's right.
Dr. Stewart: I understand you were really associated with the university before the medical school existed. Could you tell us about your arrangement?
Dr. Gibbs: When you start practice. you start at zero. and I was fortunate to meet Dr. Arthur Stokes, who was then working with Dr. Murlin in the Department of Vital Economics, on the top floor of the Eastman Building on University Avenue, part of the university.
Dr. Stewart: Were you part-time then or was this your full-time ?
Dr. Gibbs: No. I was doing part...well, to get into that. Dr. Stokes developed tuberculosis and had to leave, and recommended me to Dr. Murlin, and through that increment of income, it became very fortunate that I should work starting very soon after I came to Rochester with Dr. Murlin doing experimental work with dogs. Dr. Murlin had been working in diabetes research since about 1916, so he had a story of quite a bit of background to this. We were doing experimental work with dogs. depancreatizing the dogs. making them diabetic, and seeking the hormone which Dr. Murlin felt existed to replace the loss of the pancreas. And so helped to control diabetes.
Dr. Stewart: How close were you to finding insulin when Banding and Best published their work?
Dr. Gibbs: Well. that's another very long story because Dr. Murlin was hot on the trail of this hormone and we tried to obtain it from the pancreas but just the motion of the pancreas itself produces insulin but also trypsin, which is a very potent destruction... enzyme which destroys protein, so injections of this material would not only perhaps lower blood pressure but would destroy the muscle into which it was injected. So Dr. Murlin had the rather happy idea of perfusing the pancreas, by that I mean injecting the pancreas with a saline solution through the artery and retrieving it through the vein, taking that perfusate as it's called and concentrating it by removing the fluid by vacuum distillation and then using that without the trypsin, and this turned out to be quite successful, and we were able to keep dog #32 alive for something like five or six weeks.
Dr. Stewart: Were you working full-time with Dr. Murlin?
Dr. Gibbs: No, I was doing part-time.
Dr. Stewart: How much time were you spending on that? I was spending about 4-6 hours a day with Dr. Murlin in the laboratory doing respiratory quotients which I disliked heartily, but also working with the animals, which was most pleasurable and most fascinating.
Dr. Stewart: You were doing some clinical practice at the same time then?
Dr. Gibbs: Doing practice at the time, and I used to bore Dr. Murlin exceedingly by telling him all the exciting things that were happening in the practice of medicine and the unusual cases that I saw, and I'm sure he was very kind and very understanding, but I think....
Dr. Stewart: When you set up in practice in '21, where was your office and were you independent, or were you associated with someone?
Dr. Gibbs: No, I came unknown and I'd been in Rochester a day before, and we found a real estate agent, and bought a house on Plymouth Avenue South. At that time, the railroad... streetcar tracks were running down either side of the road. And from there we gradually progressed.
Dr. Stewart: Where was your office in those days'?
Dr. Gibbs: In the house. on the second floor.
Dr. Stewart: Now, what was your means of getting around? Did you have a car in those days?
Dr. Gibbs: My uncle had given me a car he had driven for four or five years. which was an old Ford Model T with a... it had a battery on top. Well, the battery didn't work, the starter didn't work, so I sold that and cranked it... so we got around to the Model T at that time. And the snows at that time were much like they are today. It wasn't easy.
Dr. Stewart: What staffs... what hospital staffs were you associated with in your early days?
Dr. Gibbs: Well, we very soon associated with the Rochester General Hospital and then I had an appointment at Saint Mary's, with the Endocrine Service, which didn't work out very well, but the General Hospital staff service was most important. That was the leading hospital in Rochester in those days, as I recall. That was really a wonderful place. It had a home-like atmosphere and the men there were particularly interesting and helpful.
Dr. Stewart: Who were the outstanding practitioners of that day, as you would recall them?
Dr. Gibbs: Well, one would certainly think of Dr. Mulligan as most outstanding, and it was he who developed the Sunday noon conference which became quite a noteworthy affair. One can think of your father, for example, who worked with Dr. Mulligan, Dr. Audley Stewart. and Dr. Alva Miller, who was very kind to me and very helpful in consultative work. Dr. John Booth and... quite a number of interesting people, Dr. Albert Kaiser I can't overlook, because Dr. Kaiser was so kind to me at the very beginning. One appreciates these early touches where people refer a case, or ask you to see somebody in their absence or on vacation, and they were a very warm, comfortable, homey, ethical group which I thoroughly enjoyed and still do.
Dr. Stewart: The Sunday morning conference, was this later to become the Friday noon conference, teaching conference, that I knew in my early days'?
Dr. Gibbs: Yes, that was an awkward time on Sunday noon, 12 o'clock, and the wives complained, and nobody got to church. so that was finally changed to the Friday noon conference.
Dr. Stewart: Yes, I was very sorry to see that Friday noon conference drop, fall victim to the many required departmental conferences. It was one you could meet so many of your friends in other branches of medicine. It was an excellent teaching session.
Dr. Gibbs: There was a good to and fro, back and forth, and the discussions were sometimes very energetic.
Dr. Stewart: Now, tell us a little more about what it was like to practice in the '20s in Rochester.
Dr. Gibbs: Well, people are the same. Diseases were pretty much the same. More infectious diseases, perhaps. Calls at that time were about $3.00 a call, and office calls were $2.00 or $3.00 or if more work were done, $5.00, and perhaps first examinations might be $15.00, or if you were real bold, perhaps $20.00, so that money at that time was worth more.
Dr. Stewart: In the '20s, and then came the '30s, and what happened then?
Dr. Gibbs: Well, things got a little bit slippery at that time.
Dr. Stewart: Did you ever get paid in chickens and produce?
Dr. Gibbs: No, people were very kind, and had some donations but no, I can't say we had a bag of potatoes at the back door.
Dr. Stewart: I recall being at home, and my father having a family that came up with chickens or at Canandaigua Lake, a truckload of produce, which was always very welcome, of course.
Dr. Gibbs: Yes, well...
Dr. Stewart: What about the treatment of diseases in those days? Ifs hard for anyone practicing now, with all of our weapons to really appreciate the limited number of specific treatments. What were some of the drugs that you really had in the '20s?
Dr. Gibbs: Well, of course, we began to have mercury and salvarsan for syphilis and that brings to mind Dr. Goler and his infectious disease hospital, where he attempted to segregate people with infectious diseases. He was also...one can't speak about Dr. Goler without a good deal of reminiscence because he was hot on the trail of infected milk, infected water, and did so much. In fact, I've always thought of Dr. Goler with his clearing of the water and the milk and everything he could clean up, did more for the general health of the community than all the doctors' pills. He used to have a little sign... he was a very critical person, which I think we enjoyed because good criticism is welcomed. He used to have a sign in the front of the Health Bureau, in which he'd put letters of various things, and one quote that I couldn't help but remember was, "Mediocrity is excellence to the mediocre." But, that sort of stung you as you went by, to raise your standards and get out of that trough. He did so much.
Dr. Stewart: Dr. Goler) was one of the key people in the founding of the Medical Center here. At what point did you get involved with the Medical School as it was being formed with Dr. Whipple? When did you meet him?
Dr. Gibbs: Well, I think around 1927. Of course, I came over via the Department of Vital Economics with Dr. Murlin, so I was sort of in at the back door when this started. so they couldn't do much else but let me come in the front door. That I did appreciate. One of the reasons I came to Rochester actually, was because I had known there was a development ahead for the new medical school here.
Dr. Stewart: So that appeared to you...
Dr. Gibbs: That was...that was one of the purposes.
Dr. Stewart: What sort of a man was Dr. Whipple in those days? What do you remember about him?
Dr. Gibbs: I always enjoyed Dr. Whipple. We could always sit down and talk fishing, and that was a way to start. And then you could get into other subjects with Dr. Whipple, and I always enjoyed him just as long as I had contact with him.
Dr. Stewart: A remarkable man, certainly.
Dr. Gibbs: He did so much for so many. One of the things that stands out, was his pathological conference which he had out in the pathological area... .which we had benches with iron rails and hard seats, and uncomfortable positions, but that's all forgotten when you began to see the display of pathological material, and his questioning and evoking of high degree of interest in whatever he touched. He had a skill in making you stimulated by the things that he displayed and the discussions that went on and the possibilities that it evoked.
Dr. Stewart: Yes, I had the privilege of working for six months in pathology when I got back from the Army, and his demonstration of the pathology of the day was certainly an excellent teaching session.
Dr. Gibbs: He would do it so simply that you'd think, well, this is not very difficult, and yet you'd get down into greater and greater depths, and pretty soon you'd find that the questions weren't all answered yet.
Dr. Stewart: I thought that Dr. Bohrod at the General Hospital, his introduction of the Kodachrome teaching slide in pathology was one of the major contributions to education. Do you remember those slides?
Dr. Gibbs: Right, they were such beautiful slides, and his ability to take pathological specimens and blow them up on the screen so that you could see, almost see the glomeruli in the kidney.
Dr. Stewart: It was always interesting to me the sort of rivalry there between the teaching methods. Dr. Whipple never did accept, I think, the Kodachrome slide as being any way better, or in fact far inferior he thought, to the live material. This brings up a question about the early rivalries between the Strong Memorial Hospital as it evolved, and the Rochester General Hospital staff. Can you comment on that?
Dr. Gibbs: Yes, I think they were stimulating, as a matter of fact. Because each was trying to do its thing to the best advantage, not necessarily seeking to outdo, but seeking at least equal or if possible get a little lead, and those were warm days and the talk of the town and gown was very rife. The criticism, of course, with the new thing coming, that Strong attracted... it was brilliant, it was sparkling, it attracted, it was often said that people on the top level came to the Strong, and the maids and servants were taken care of by the rest of us. Well, being in both places. I think I as able to see some of that, but by and large, I don't think that was a great factor, and gradually it became more and more necessary that each one had not only a dependence on the other, a relationship with the other, but also a help... each one could help the other. Most of the men on the staff at the Rochester General became Assistant Associate Professors of Medicine or in Surgery at the Strong, which helped to integrate. Then the Strong was able to. by dint of its deeper research efforts, contribute to the general interest in medicine, and the staff conferences up here began to be attended by many of the men from the General, so that there was an interplay with medical forces, so the town and gown became gradually gown in the town, and I'm sure after quite a good deal of resistance on the parts of a few, but many people like Dr. Kaiser and your father, and a number of others, could see that the Strong was here to stay, and the thing to do was work with it, and work in conjunction with its efforts to integrate into the community, and so to closely relate the two bodies, both of which has strengths and ambition and purpose and were working.
Dr. Stewart: Was there any major difference in the type of patients admitted to the two institutions in those days?
Dr. Gibbs: Well, I brought patients to both hospitals and I think that it was a decision on the part of the patient. Some patients with the attractiveness of a new hospital wanted to come to the Strong, and that was fine. And other people, that sort of liked the homey_ atmosphere of the General, and that was fine, too. I think that I worked the same in either place. And felt at home in each place, so I don't think I'm a good... I'm not a "contextual" person.
Dr. Stewart: Well, whereas in '51 when I went into practice, there still was occasionally the statement you heard, "Don't go to Strong, they experiment on you." That was one of the popular noises of the day. Was that considered... was that thought widespread in the '30s?
Dr. Gibbs: Oh, I think so. I think that research work was going on at Strong and everybody knew about that and we worked on animals, and knew about that. So. I think there was a certain reluctance on the part of some people to enter into that kind of an atmosphere. but the atmosphere of the research doesn't get into the atmosphere of the hospital setting, and I think that most people appreciate that research work is necessary if you're going to learn something, and felt rather warm toward the effort rather than backing away from it.
Dr. Stewart: Clinical research nowadays certainly requires a very careful understanding of the patient that he or she is participating in clinical research. Was there any grounds in the early days where patients were used...participating in research projects without their knowledge?
Dr. Gibbs: Well, I suppose so, but I think I'm not aware of any distinct detail of that. I'm sure that we used a group with placebo and a group with the other trying to find out whether a particular drug was effective or not. That was well understood and that was part of the process of determining efficacy of drugs.
Dr. Stewart: Right.
Dr. Gibbs: But I think that it's become much more apparent that people have to know what's going on and I'm sure we've come to a very strong stand on that.
Dr. Stewart: The homey atmosphere at the General Hospital was still apparent in the '50s when I joined the staff there. There was a warmth among the people working there. a very great loyalty. I think that was characteristic of that institution, which a newer institution could not cultivate immediately certainly.
Dr. Gibbs: It takes time to develop atmosphere and people like Dr. Harry Clough and Dr. Harry Green, oh, made things work. Dr. Clough with his early electrocardiography, and all helped to raise the standards of effort there.
Dr. Stewart: Right. Your practice evolved along in general, in internal medicine but you always had a particular interest in diabetes and endocrinology. I recall working in the diabetic clinic here as a member of the house staff. I believe you were the senior attending at this point in the clinic here. Your interest in diabetes continued after your research. What phases did you see that disease go through?
Dr. Gibbs: Well, we were... when we finished medicine there were two things I was never going to be interested in... was urology and diabetes. But you know how fate takes you by the ear and leads you around, so that I found myself working in diabetes and of course, you can't work in diabetes without becoming highly attracted to it because of all the things it gets intoundefinedpathology, physiology, endocrinology, controlled diet, chemistryundefinedit encompasses the whole realm of one's physical status and naturally with having worked with diabetes, I was able to have diabetic patients so that we really were much interested in controlling diabetes in young people and older people and so on. Of course, the very early days with diabetes were so difficult. Diets at that time were very low in carbohydrate, very high in protein and fat. Now we know that makes things a little worse. We used to use alcohol for a substitute calorie. Some people liked that. The gradual change in diet, trying to find out the proper ratio between carbohydrate and protein and fat. Of course, restriction in diet and keeping people thin was about the only thing we could do at that time. And acidosis was common.
Dr. Stewart: And very frustrating, I'm sure. It's difficult to see.
Dr. Gibbs: Bicarbonate and fluids, and sometimes people survived and often they didn't. The average life of a youngster at that time was only about 2.2 years, which was terrible.
Dr. Stewart: When did you first give insulin to a patient?
Dr. Gibbs: I think in 1922. To go back to Dr. Murlin for just a moment, that was the time when the group in Toronto with Banding and Best were able to salt out the proteins of the pancreas and obtain insulin in a commercially usable form, and thereby obtained the credit for the development of insulin. Also to go back just a moment... Dr. Murlin in some of his experimental work, found that when we gave our extract, that there was a little rise in the blood sugar before the subsequent fall due to insulin, and he thought there must be another hormone in the pancreas which produced a rise in blood sugar or mobilized sugar in the blood, and he gave the name of Glucagon to this.
Dr. Stewart: Dr. Murlin originated that...?
Dr. Gibbs: Dr. Murlin originated the idea and named the substance, which now we use and see commonly used, and find it increasingly valuable in our understanding in the control of sugar. To Dr. Murlin belongs the credit of the idea and the name.
Dr. Stewart: Hmm, I hadn't realized that. What... who is the oldest patient still in your practice, going back... do you have any going back to the '20s or '30s in their diabetic management'?
Dr. Gibbs: Yes, I have some 40...40-odd-year diabetics who are still able... I remember one woman in the clinic who was in her '70s who had had diabetes for about 45 years. which along in the 1930s and '40s was quite a phenomenal thing, because she'd escaped from the early days by having a mild diabetes, but after about 40-odd years of diabetes, we were able to show that she had very little change in her (high grounds/eye grounds), had good kidney function, didn't have any difficulty with the arteries in her legs, had had no heart trouble and smoked about a pound of Prince Albert in a pipe each month, so we presented her at conference and gave her a pound of tobacco to carry her for the next month, and were quite thrilled with the fact that she had conquered as much of her diabetes as that.
Dr. Stewart: Don't know if that was the grace of God, or the Prince Albert, or the skills of Dr. Gibbs?
Dr. Gibbs: Wasn't my skill, I'm sure of that! But, she had evidenced her continuity before I saw her.
Dr. Stewart: What other memories of the practice in the '20s and '30s have you about the management of disease processes in those days?
Dr. Gibbs: Well, it was difficult because we had no antibiotics, we had no sulfonamides, of course, and as I had said before, I think Dr. Goler did much more than all the rest of us put together, but we did the best we could with what we had, and there were analgesics and pain relievers and interestingly enough, aspirin was brought out originally, or hoped to be an antibiotic, and then it turned out not to be, but the analgesic which is used by the ton now.
Dr. Stewart: Were there any other specifics in those days? In those days you had morphine for pain, and of course, the opiates, but it's so hard for us to comprehend the lack...
Dr. Gibbs: The lack...
Dr. Stewart: ...the lack of things. What about IV fluids in the '20s and '30s?
Dr. Gibbs: Well, we were just getting into it, and I once wrote a paper which was turned down by the Academy because it wasn't quite that good... just beginning to get into the matter of fluid balance and electrolytes along about 1940, but think of it... people used to. I'm sure. die dry, and that's an awful thing because they couldn't take water by mouth. We did use needles under the skin and suffused fluids under the skin. We did that quite commonly, and that was being done, oh, in the '20s and then we got a little more into intravenous fluids, but didn't until around 1940. at the time of the war that we appreciated the value of fluid balance, and necessity of electrolyte balance.
Dr. Stewart: We used to give it by rectal drip, too, as I recall at times.
Dr. Gibbs: Yes, nasogastric tube.
Dr. Stewart: Did you have to mix up those IV fluids yourself, or were they available from some central location?
Dr. Gibbs: They became available.
Dr. Stewart: Seems to me I remember Henry Keutmann describing how as a member of the house staff or early staff here he used to go to the chemistry lab and mix up his own saline and intravenous glucose solutions.
Dr. Gibbs: That sounds like Henry. He would do it.
Dr. Stewart: So strange to us today.
Dr. Gibbs: Now they pour in from the back door in great cartons...
Dr. Stewart: It's hard to get the plastic catheters out of veins once they are in around... today everybody's on an IV it seems. Any other memories in those days in terms of disease processes?
Dr. Gibbs: Well, we saw typhoid fever. I had a chap who had camped on the rim of the Grand Canyon and came back with malaria, there was typhoid fever... there was quite a lot of tuberculosis, there was a scourge at that time, and of course, Iola was a very prominent institution. We thought that they did such excellent work. That was long before any real drug therapy was effective. That was the fresh air and...
Dr. Stewart: A year, or two, or three or four or five years in the sanitarium in those days.
Dr. Gibbs: Easily, and quite a good many recovered. Undulant fever became quite a scourge. Out in Fairport there was a man who had cattle who died with undulant fever, and we had patients with undulant fever, and we used to test quite commonly for that and some of the low grade, unexplained fevers turned out to be brucellosis or undulant fever. And that was an interesting period. But it was a radical treatment of taking care of the brucella-infected cows that finally wiped it out. And there again, public health stands as a real contributor to the welfare by getting rid of the source.
Dr. Stewart: Do you recall the introduction of the specific treatments with sulfonamide? Were you...?
Dr. Gibbs: Yes, what a boon that turned out to be, and what we thought we could to with that. It was going to conquer everything. And it did conquer quite a good many things.
Dr. Stewart: What treatments were used for infection experimentally prior to that? It seems to me mercurochrome or at least some of the antiseptics were tried.
Dr. Gibbs: Well, we had surface antiseptics but things that you could take internally for the effect on bacteria invasion, we got rid of a lot of throat paintings and whatnot after awhile. Those were really sort of superficial ways of relieving rather than curing. There were some intravenous or at least parenteral or oral antibiotics attempts before sulfa came in successfully... .
(END OF SIDE 1 OF TAPE #1)
Dr. Stewart: It's hard again to think back before the days that vitamins were known. I believe many of the vitamins were described in the '30s, were they not?
Dr. Gibbs: Yes, and I was highly interested in that too, because my daughters' stepfather-in-law, Glen King, had the isolation of vitamin C to his credit.
Dr. Stewart: Really?
Dr. Gibbs: And that was a time when there was... through him I learned a great deal about vitamin possibilities and he was highly interested in nutrition and was sent by the government to places like Guatemala to investigate the difficulties, lack of protein, lack of minerals and whatnot. were hurting the population, but the problem of vitamins became very high and one of the conferences at Atlantic City was devoted almost entirely to what was known about the vitamin sources and complexities that occurred and the lack of them. Pellagra was not unknown with its lack of thiamine, so that gradually we became much more aware of these subtle vitamin sources which mean so much to one's bodily health.
Dr. Stewart: Reflecting back on the practice in the '20s and '30s, what percentage of your time did you give to say, house calls, and what percentage of time to office was ....?
Dr. Gibbs: I think about half and half As office practice grew and you had less time to go running around town with house calls. Everybody made house calls then. It's becoming a lost art, but it was common at that time.
Dr. Stewart: As I recall, my father used to make house calls in the morning and hospital rounds, never started in the office until after lunch. House call lists were very long. sometimes eight and ten a day.
Dr. Gibbs: Yes, that was the story. And they were scattered around town so that transportation was an item.
Dr. Stewart: Well, the house call still to me is a very valuable way of assessing a person. You learn so much more about the person in the setting of the family and what books he reads and all the rest. It tells you about that patient as a person, in a few minutes in the home. It's a shame that they're not more a part of our practice. Do you still make house calls on occasion?
Dr. Gibbs: People who can't get to the office and who are... if it's easier for me to go and see them than it is to drag out and get to the office, I go and see them.
Dr. Stewart: I know you used to see my mother, so I know that's true.
Dr. Gibbs: And I enjoyed that. But it's, after all, I can't stand it to be in the office... I couldn't stand it to be there all day. I think it's difficult, but you get out and see what's going on around, especially as you say, to see people in their own habitat and how they live. it means quite a lot to understanding the person.
Dr. Stewart: Your office was moved eventually from South Plymouth, and v_ ou've been on Goodman Street a good many years.
Dr. Gibbs: I think that was Dr. Ingersoll, who was another notable... Mr. Kelber built this building I think in 1928, so I moved over there at that time. So I've enjoyed that building ever since.
Dr. Stewart: Dr. Ingersoll was an ear, nose and throat man, and used to take out tonsils in his own private office hospital, or private...
Dr. Gibbs: That's right he had a hospital in the building on South Goodman Street.
Dr. Stewart: He got into some trouble with the rules and regulations on that, did he not?
Dr. Gibbs: I think so.
Dr. Stewart: Forced to give it up?
Dr. Gibbs: I never heard very much about it, except that he stopped doing it.
Dr. Stewart: I think it was the desire to have it under the hospital roof, as I recall.
Dr. Gibbs: Yes, yes. For emergency's sake, it was desirable, too, like all laws, they are made because there are difficulties and deficits and so somebody makes a law.
Dr. Stewart: He was one of the pioneers I'm sure in this area of ENT.
Dr. Gibbs: ...and a very engaging and brilliant fellow. I enjoyed Dr. Ingersoll so much. And Dr. Nash who was with him.
Dr. Stewart: My tonsils fell to Dr. Ingersoll's knife back in the old General Hospital.
Dr. Gibbs: Oh. yes.
Dr. Stewart: Who are some of the other men, I say men because there were probably very few women physicians back in the '20s and '30s. Were there any?
Dr. Gibbs: Yes, yes, I think there were three or four in town. Dr. Craig Potter's mother was a notable gynecologist, for example. And there were some others. I think there were three or four others.
Dr. Stewart: So women did make their mark in medicine early on in the century.
Dr. Gibbs: Yes, yes, of course, Dr. Blackwell, who was the first woman physician. a graduate of Syracuse, that was back in '47, wasn't it, somewhere there? At any rate, think now, how many there are.
Dr. Stewart: Can you recall any other stories about one of the more colorful characters of our early days? You mentioned Dr. Mulligan. He was certainly colorful, among other adjectives. I guess one might apply. A very fine surgeon. I do not remember him personally, but I know him through my father's and mother's stories about him.
Dr. Gibbs: Well. he was a very interesting person, gruff and austere, but really a very kind person, I think was kind to people fundamentally. He made house calls, but all he carried in his pocket was a little vial of morphine and if people were sick enough to really need medicine. a little morphine would help to allay. He didn't carry a bag, and I think he had a stethoscope in his pocket but I'm not sure of that, but he always had this little vial of morphine if things were really that bad. But just his presence and his ability to calm people's fears and anxieties and postpone the time from the immediate to the future when things would improve was his great asset. He was a good surgeon, too, as I'm sure your father could have testified.
Dr. Stewart: He really, he was such a man of commanding presence, there's no question he inspired confidence.
Dr. Gibbs: There was no questioning it.
Dr. Stewart: He was also a knuckle-rapping surgeon in the Operating Room as you undoubtedly know.
Dr. Gibbs: Uhuh.
Dr. Stewart: He also had a very great interest in medical history to which interest our medical school library is indebted. His photograph...his portrait stands there at the entrance to our historical section of our library.
Dr. Gibbs: Of course, another good surgeon we had at the time for those many years was Dr. Howard Prince, and one has to admire the way he handled people in also rather a gruff fashion, but with great skill. Altogether I've always felt that I was so fortunate in having such an admirable group of physicians in town with skill and with good ethics. And then to come to Strong and to find this group, many of whom came from placesundefinedJohns Hopkins. Harvard, and so on. and there was a new color to the life of medicine, and we became so very fond of people like Dr. Corner, and Dr. Bloor I must mention because he was one of the finest. sweetest persons I ever did know, and Dr. Fenn, Dr. Adolph who is still here, and Dr. McCann, and Dr. Clausen was an admirable person. You're thinking, I'm sure of some others. Dr. John Morton, whom I was always devoted to. And Dr. Herm Pearse. Really such an admirable group of people who really worked so well together and with Dr. Whipple, and Dr. Whipple I think kept a rather loose rein, and gave people quite a good deal of autonomy in their own departments.
Dr. Stewart: That's not entirely the picture as I recall hearing it, that he may have given some loose reins. but he also had a fairly tight rein on...
Dr. Gibbs: Well, that may be...
Dr. Stewart: ....on decision-making in the early days.
Dr. Gibbs: Well, decision-making early, but I think later he loosened up a little.
Dr. Stewart: Well he certainly gave commanding leadership here. I was very grateful for my association with him in my later days in the six months I spent in pathology. Dr. McCann, of course, was head of the Department of Medicine here for must have been about 30 years... I can't recall just when he... stopped in the '50s sometime. What are your memories about Dr. McCann?
Dr. Gibbs: Well, I enjoyed Dr. McCann, too, and he was certainly very kind to me. We were able to develop a diabetic clinic here and at the General. And privileges and opportunities to do things and I was still working a little with Dr. Bloor and with Dr. Murlin, so during that time he was very understanding about the other obligations that I did have. Enjoyed him as a teacher. One of the very simple things that he said one time that I recall was apt and namely, that the heart receives a certain amount of blood and discharges a certain amount of blood. And unless those two are exactly equal, either the blood is backed up and fluid is stored in various places or the heart is not doing its best duty so that these very simple things that he was apt in speaking about, would go sort of unnoticed that I enjoyed him for. And you add a lot of other interesting angles, and I think running a Department of Medicine with the gradually increasing demands and the research grants and whatnot, is far from a simple thing.
Dr. Stewart: He developed... he certainly had a talent for appointing people all around him with great skill and giving them their head. He never felt he had to dominate the department. I was impressed with this when I was a medical resident, and he often said that he didn't have to know all the facts but he had to have around him people who did.
Dr. Gibbs: I always liked that idea anyway.
Dr. Stewart: And he was very much of a gentleman.
Dr. Gibbs: Yes.
Dr. Stewart: Thinking back to the early days, the '20s and '30s, in your association with the two hospitals and the nursing staffs and the care of the patient, what is your memory of the General and the Strong in that regard? The nursing care given'?
Dr. Gibbs: Well, you may have other ideas, but I couldn't see very much difference. I think nurses were dedicated to work and doctors were dedicated to their business, get along very well with problems that arise and I felt equally at home in both the General and the Strong as far as care of people were concerned. I didn't seem to have any real struggle or conflict. What was your experience?
Dr. Stewart: I agree. I thought the nursing was excellent in both institutions. The attitude of the nursing staff always amazed me at the General Hospital. I was brought up in medical institutions where nurses were respectful but not... when I walked on the wards in General Hospital in 1951, the nurses practically stood at attention. I was not used to that. that treatment. and it rather surprised me. It was a little different here and that was one of the differences, not necessarily in quality of care but in attitudes towards physicians. Do you recall that'?
Dr. Gibbs: Yes, I think so.
Dr. Stewart: In addition to the hospitals we also have in Rochester the Academy of Medicine which was formed even before your day, in 1900, as the, I guess, the developer of the library for continuing medical education.
Dr. Gibbs: Yes.
Dr. Stewart: There was no central location where doctors could come and look up journals, so they formed that in 1900. In the 1920s, before the Medical School library was developed, do you recallundefinedwas the Academy of Medicine library used considerably?
Dr. Gibbs: Well, I think so, because that was about the only source we had for special journals and various books. At that time it was down on Chestnut Street, had a very nice house there on Chestnut Street. But that was pretty valuable property, and it was salable and then the house on Prince Street was purchased and we were there for about 10 or 12 years. until Dr. Kaiser's idea that something better and larger and more acceptable would be possible, and that led to his
contact with the (Lyons/Lions) family, and finally the giving of the (Lyons/Lions) home on East Avenue to the Academy, which was such a wonderful thing. At that time. you remember. we had a fundraising and raised enough money so that half of it could be used to build the auditorium as an addition to the house and makes the fine institution there that we now have.. of which we are all so proud.
Dr. Stewart: Right. For the record, I'd say it was my father was the physician to the
(Lyon/Lion) children, and when Mrs. (Lyon) died, they were wondering what to do with the house. and my father suggested to them that the Academy of Medicine was looking for new headquarters.
Dr. Gibbs: Oh. wasn't that wonderful.
Dr. Stewart: So, it was out of that suggestion that I think they contacted Dr. Kaiser...
Dr. Gibbs: I see.
Dr. Stewart: ...and the building was eventually given. The Academy in its early days had rather strict membership requirements. It was an august body that demanded scholarship and presentation of a paper before the group to be eligible for membership. I'm not certain whether this pattern continued very long after it was first founded. In the '20s, were you... do you recall whether this was still required?
Dr. Gibbs: I think not or I probably wouldn't have been in it. But I think it was not at that time. But that function and the opportunity to present papers moved on to the Rochester Pathological Society, and I remember giving a paper there, and one could write and express ideas. The Pathological Society was really great fun as well as an opportunity to review some pathological subject or bring pathological specimens and show them, and then afterward the treat was, Mr. (Magg's/Megg's big dish of....
Dr. Stewart: ....ice cream...
Dr. Gibbs: Oh, but...the... it's hard for me to think of all the lovely... shrimp, there were big rounded platters of these... and after the talk we would go out and have a wonderful discussion with each other. To go back to the Academy for just a minute... one of the great fields in which the Academy has been very constructive has been the integrating of the doctors, again town and gown. The Strong has always been contributory to the Academy, has had members, has had presence, has had influence in the Academy, and I'm sure it was partly through that sort of a contact that the people found that the doctors at Strong weren't something strange and mysterious but were human beings like everybody else. So I think it's a great integrating force between the two hospitals, although through the other hospitals in the community. It was a time you'd see people you'd never see any other time.
Dr. Stewart: I think also the interest of Don Anderson when he took over the deanship in mending fences with the community and with the Medical Society was an important contribution. In reading about, I think in George Corner's. George Whipple and His Friends, that marvelous book about our institution, and Dr. Whipple... it impressed me that Dr. Whipple when he came here said he would not come if he had to be very active in the community committees downtown. and he stuck with that through his many years here. Dr. Anderson came with different feelings about the importance of relating to the community... does that jog your memory?
Dr. Gibbs: Yes, I think so. I think that's right.
Dr. Stewart: Speaking of other hospitals in Rochester, when did The Genesee Hospital... that was a homeopathic hospital in its early years. When did that shift into the mainstream?
Dr. Gibbs: Well, during my time. The transition was gradual. Homeopaths began to use a little more allopathic medications and so the thing was not a sudden change from homeopathy to the other. but rather of a transition.
Dr. Stewart: It was still a homeopathic hospital in the '20s
Dr. Gibbs: Oh. yes, yes.
Dr. Stewart: Of course, in those days, homeopathy was probably less harmful than some of the... it'd be before the '20s, but when organized medicine was purging and puking, homeopathy's treatment was probably the less harmful, and...
Dr. Gibbs: Well, not only that, but I think they really taught us the use of hygiene, water for fevers instead of depriving people, sanitation. I defend them strongly because my three unclesundefinedmy mother's three brothersundefinedwere all three homeopaths.
Dr. Stewart: I didn't realize their involvement in sort of public health measures as well. Was that part of their tradition?
Dr. Gibbs: Yes, strongly. In other words, back to nature is a homeopathic idea. Mithridates, _you know, was the first homeopath who took a little of each of the known poisons every day so that nobody could really poison him. So he developed a system of antibody resistance to the known poisons of his day. So he was the first homeopath. Tiny portions...
Dr. Stewart: Some of the other hospitals that grew up in Rochester. I think I have vague recollections about them evolving around personalities. I think the Park Avenue Hospital was a product of Dr. Barber, is that right?
Dr. Gibbs: Yes. Dr. Barber.
Dr. Stewart: He left the homeopathic hospital under some... for some reason. What do you remember about him?
Dr. Gibbs: Very little, except he was a very engaging person and for a person to go ahead and develop a hospital is quite a trick. And he did it and ran it, and I always enjoyed Dr. Barber. I never knew him too closely, but there it is and still going. Now the Park Ridge, and it just shows how a ferment of an idea can take hold and develop.
Dr. Stewart: Maybe you can tell me also about a Dr. Lee. When I was resident in charge of the Outpatient Department here we used to go around and visit nursing homes and various places with the students and house staff on Saturday morning to see where our patients came from, and one of the places we went to was called Dr. Lee's private hospital down on Lake Avenue. And that was the first Pd ever heard of him. What was his history?
Dr. Gibbs: Well, that was ...I'm not too clear about all the details, but those things wax and wane, and he waxed for a time, and then he waned and the thing passed on. But he had quite a strong following and his hospital was Pm sure run on a very modest medical basis. but it prospered for quite a number of years. I can't give you many details because I don't think I was ever in the hospital.
Dr. Stewart: Right. That's one hospital that I think has gone by the way. Were there any other hospitals that sprang up in Rochester and disappeared during your memories?
Dr. Gibbs: No, I think it was a favorable move to move the General up to the north side of the city. The north side really needed a hospital, and now with the Northside General and Park Ridge. the north side is much better.
Dr. Stewart: I guess there was a fair development of the Beach Avenue Facility for Children's Diseases. What was that?
Dr. Gibbs: Well, the Infant Summer Hospital. Those were notable institutions who took care of a good many children.
Dr. Stewart: Was that... I just have vague memories of hearing of this. This was for rheumatic heart disease, or infectious diseases, or what?
Dr. Gibbs: Yes, for crippled children particularly. Well, I'm sure that could have a good historical review, because it served a very useful purpose.
Dr. Stewart: Well there are a number of hospitals that rise and fall with the changing disease pattern. When I was in medical school, the Good Samaritan Hospital in Boston. a three- or four-story building full of children with rheumatic heart disease, now no longer needed. And our Iola no longer needed, fortunately.
Dr. Gibbs: Yes, think of what has happened to tuberculosis. But that also brings up an interesting question of what should be done in hospitals with some of this expensive equipment and each hospital doesn't have to have all the expensive equipment like this. scan that produces information about the various levels of the body but it costs a great dealundefinedwhat is it, around $350 or so'?
Dr. Stewart: $350,000 for the equipment, or $500,000 for the equipment...
Dr. Gibbs: Oh, boy, yes...
Dr. Stewart: ...and going up fast I presume with the newer generations.
Dr. Gibbs: That's right. But not every hospital needs every one of these technical assets. And so that's another reason for better integration of the hospitals and I'm sure that a lot of that is being discussed at the present time, and who should have what. It hurts anybody to give anything up, and this struggle as to who should have the maternity division is an example of how difficult it is to get, to stop anything that is going. Like a law, it's hard to get rid of it once you get it on the books.
Dr. Stewart: Well, there's a great pride, even though we have a remarkable example of cooperation among the hospitals and most of them with university affiliation. There's still immense pride in each of our Rochester hospitals. And I think that is a very real factor in wanting the latest equipment in each institution.
Dr. Gibbs: You spoke of the affiliation, which I don't think we mentioned but which I think is such an admirable idea. Because it means better understanding between the various hospital groups and hospital Boards and Pm sure that that is a developing thing and could be extended into hospital purchases and hospitalundefinedas we were just speakingundefinedof various expensive equipment and organizing patterns of abuse. So I think that's a very forward motion and hopefully will cut down on some of the extenuating costs of things at the present time.
Dr. Stewart: How do you feel about the coming, or what's arrived and seems to be increasing constantly in our practice, and that is the government regulations and eventual extension of control into more and more areas of our practice? Are you feeling the constrictions thereof?
Dr. Gibbs: You notice it in your writing hand where you sign all the things that you have to sign in duplicate and triplicate. Of course, this is bordered by... again, like any law, there is some reason for it. and of course, these triplicate forms we have to make out for drugs that are reserved. one goes to Albany, one goes to the pharmacist and one stays in your drawer in the desk.
Dr. Stewart: It's one of the greatest wastes of money, in my opinion, it seems that really is an unproductive program.
Dr. Gibbs: I know, it seems absurd. Well, I think to answer that, the paperwork and the paperwork in the government has become such a notable load that everybody is rebelling.
Dr. Stewart: Dr. Gibbs, I think we're running out of time. I think we've covered a number of subjects over your perspective of medical practice, that would make about 57 years this summer.
Dr. Gibbs: Don't mention it!
Dr. Stewart: That's a remarkable perspective from the days of pre-insulin, pre-vitamin, pre-specific antibiotics, pre-IVs, pre-blood banks, we didn't mention that. But. it's...you've watched medicine evolve in a fascinating way. I've been privileged to watch it in the last 27 years myself. and it's a constant struggle to keep up with some of these evolving, exciting developments.
Dr. Gibbs: It surely is. It's a wonderful period in which to live, despite the wars. and difficulties that have been present. But I don't know of any other period in history that would have been any more exciting than this particular period. And certainly in medicine no more rewarding than to have lived in this period of this degree of technical and chemical advance. Interesting enough. the chemical part of the advance is now turning back to nature, and getting back to looking at some of the things in plants, and of course it's been so well known that we've had the opium and the cocaine and the quinine and digitalis, but there must be many more things in nature that nature has been trying to tell us over the years that we haven't known about.
Dr. Stewart: And I've known you've been vitally interested in biology and in botany, and have left your mark on Highland Avenue, in your lovely old home there where you planted a very great variety of trees.
Dr. Gibbs: We had a little digitalis growing there too. (END OF SIDE 2 OF TAPE #1)
(BEGINNING OF SIDE 1 OF TAPE #2)
Dr. Stewart: ...I think an outstanding level of medical care to which youve created a fine leadership and example.
Dr. Gibbs: Thank you, Jim, I think it's highly overrated but I've enjoyed it.
Dr. Stewart: Thanks. Charles.
Interviewee: Dr. Nolan Kaltreider, Professor Emeritus of Medicine
Interviewer: Dr. Pricilla Cummings
Date: May, 1979
Dr. Cummings: It is a very great pleasure today to talk to one of my favorite people, Dr. Nolan
Kaltreider, who is now Professor Emeritus of Medicine. Kalt. when did you come to Rochester?
Dr. Kaltreider: I arrived in Rochester on July the 1st, 1931. Dr. Cummings: How did you happen
to pick Rochester?
Dr. Kaltreider: Well. I went to medical school at Johns Hopkins and I did a fair amount of
investigative work in the Department of Physiology.
Dr. Cummings: In what field?
Dr. Kaltreider: In heat production in smooth muscle. And I met Dave Rioch. who recently came
from Rochester, and I heard about Rochester, so I ran right out and saw Dave, and he thought I'd be very much interested in coming to Rochester. He said it was a very good internship. and he thought the main thing was the house officers had a lot of responsibility. much more than they had at Hopkins. He said that McCann is a good chap. but....
Dr. Cummings: And McCann was who?
Dr. Kaltreider: McCann was Chairman of the Department. professor in Medicine. And he also said that he's always riding a pony. He explains everything on this point or that point. and goes from one to the other.
Dr. Cummings: I see. And did you like Dr. McCann when you got here?
Dr. Kaltreider: Well. I...Hopkins you know, is a rather cold and formal school as far as students go. When I arrived here I found it a very friendly atmosphere and I was over in X3 assigned to Psychiatry when I arrived as an intern, and about the second day, a young fella came along and sat down next to me, and said, "Kaltreider, how's it going?" That was Dr. McCann, And ever since that, until the time of his death, why, we were very good friends.
Dr. Cummings: Oh, well that's very nice. You mentioned that a lot of the treatments were quite different in the early day, even on x-ray, where it was barred, was it not, at that time?
Dr. Kaltreider: That's right.
Dr. Cummings: There were some things that you were interested in that were quite commonaround Rochester. One was rheumatic fever. Do you remember how things were in those days?
Dr. Kaltreider: Oh yes, we had many cases of rheumatic fever, particularly mitral stenosis.
Dr. Cummings: Now, what's that, because everybody you're talking to is not a doctor.
Dr. Kaltreider: Well, it's scarring of one valve on the left side of the heart and.. .
Dr. Cummings: And it comes from what?
Dr. Kaltreider: It comes from streptococcal infections. At Hopkins, we didn't see very much rheumatic fever, being a warmer climate. We saw mainly syphilis and in syphilitic heart disease, it was the aortic valve, the main valve leading to the heart to the aorta that was involved. and there we saw or heard aortic insufficiency and the so-called Austin-Flint murmur...
Dr. Cummings: Now, don't get too technical!
Dr. Kaltreider: ...which sounds like... which is similar to the one that you hear when the mitral valve is involved. But when we came to Rochester, it was the other way around. We had mitral stenosis, scarring of that valve, and because of increased pressure in the heart, why. .. the pulmonary valve would become insufficient, and you would have the so-called Graham Steell.
Dr. Cummings: And why don't we have much of that now?
Dr. Kaltreider: Well, I think since we've had Penicillin we have prevented, or taken care of, streptococcal infections and we no longer see rheumatic heart disease or nephritis.
Dr. Cummings: You told me that you were interested in the rheumatic valvular disease because Jack Goldstein could hear something other people didn't, at that time.
Dr. Kaltreider: Oh, yes...
Dr. Cummings: And Jack was resident. was he?
Dr. Kaltreider: Jack Goldstein was resident in Medicine in 1931 and 1932. As you know, he's a very enthusiastic gent and he claims he always heard something in early diastole in mitral stenosis. Now, since then, they have said that this noise heard...
Dr. Cummings: Little noise that Jack was hearing?
Dr. Kaltreider: heard... that he heard, was the opening snap. But in those days. nobody
appreciated that. But Jack would go around trying to get everybody to hear this extra sound, which was not the third heart sound and was not the splitting of the second heart sound, but something that was different that he heard early in diastole, and only turned out to be the opening snap.
Dr. Cummings: I see... so Jack was ahead of his day.
Dr. Kaltreider: He was, and one day he stepped on the professor's toes, I think, by saying to the professor. "Do you want to listen to this heart?" And he did. Dr. McCann says. "I don't hear anything unusual about this heart." And Jack says, "Don't you hear that sound early in diastole?" And the professor said, "I guess we'll go on and see the next case."
Dr. Cummings: Speaking of Dr. McCann, you were interested always in the Monday morning clinics. You said something to me about trying to avoid Dr. McCann, so that...
Dr. Kaltreider: In the '30s we had the main medical clinic given to the third and fourth year on Mondays, 12-1. Dr. McCann was not a chap to think about the year in advance, in other words, we didn't have any schedules. So, we had... we all worked Saturday mornings. sometimes Saturday afternoon. Dr. McCann would usually come along Saturday morning and many times he came into my laboratory and he would say, "Well, there's a very interesting patient over in Y3. I think it's just up your alley and why don't you give a clinic on the patient on Monday?" Well, you had to say yes, and that spoiled the weekend, because until you saw the patient, worked up the clinic, and the literature, the weekend was shot. So, we always tried to avoid him Saturday morning.
Dr. Cummings: Dr. McCann probably was well aware of that, too, wasn't he?
Dr. Kaltreider: Oh, I'm sure. I'm sure.
Dr. Cummings: Now, you had the doubtful distinction, as you said, of being the first married intern at Strong Memorial Hospital, and at that time, everyone lived in the staff house, did they not?
Dr. Kaltreider: That's correct.
Dr. Cummings: And the staff house was a residence hall connected to Strong Memorial Hospital. Perhaps you can tell us something about the room arrangements.
Dr. Kaltreider: Well, the interns live in small rooms_ and Dr. Faxon who was the first Director of the hospital and was here when the hospital was built, insisted that the telephone be over near the door, as far away from the bed as possible. We were all on call at nighttime, so that he felt that if you had a call at nighttime, you should be awakened. and well awake by the time you answered the phone. So we had to get out of bed, walk across the cold floor, and answer the telephone. You became assistant resident, and resident, you had a telephone by your bedside.
Dr. Cummings: By that time you were supposed to be able to wake up at night and have yoursenses with you, is that right?
Dr. Kaltreider: Immediately.
Dr. Cummings: You mentioned a few minutes ago, working on Saturdays. What was Saturdays famous for in those days, that you had to work then?
Dr. Kaltreider: Well. as a house officer, Saturday afternoon was a great day. That was the L Clinic, or syphilitic clinic, and it was held in L1, and all the medical staff when to L clinic.
Dr. Cummings: You mean, you had a lot of syphilitic patients then.
Dr. Kaltreider: Yes, almost everybody that came in the front door of the OPD was considered to have syphilis until proven otherwise.
Dr. Cummings: On Saturdays?
Dr. Kaltreider: On Saturdays. All the house officers attended the clinic, except for one who was on call in the Emergency, and one in the house. John Laidlaw was the head of the clinic.
Dr. Cummings: He was my husband, incidentally.
Dr. Kaltreider: He was a syphilologist and one week you were assigned to giving intravenouses... intravenous arsenic... arsphenamine, neo-arsphenamine, and we had to be very careful because arsphenamine is very caustic. It gets outside of the vein and produces necrosis...
Dr. Cummings: And necrosis is what?
Dr. Kaltreider: Killing of the tissue. And we had to be very careful, because these people required eight or twelve injections every week.
Dr. Cummings: That's why you were so busy all the time with the clinic? They had to keep coming back.
Dr. Kaltreider: Oh yes, coming back for a year or two. When they didn't get arsphenamine or arsenic preparations, they got bismuth in their buttocks, and alternate weekends or alternate Saturdays, why, you were assigned to giving bismuth in the buttocks all afternoon long. We had a few complications from the infection, from the injections. With bismuth we had an occasionalcase of nephrosis, and with arsphenamine...
Dr. Cummings: And nephrosis is?
Dr. Kaltreider: ...is a... well, it's a type of... it's an involvement of the kidney, where the kidney loses a lot of protein, and the individual becomes very swollen, or edematous. The other complication was what we thought was arsenical poisoning, involving the liver, but it may well have been one of the ("varices") of hepatitis. The other complication was exfoliative dermatitis, which is a very...
Dr. Cummings: ...breaking out of the skin.
Dr. Kaltreider: ...breaking out of the skin, very prolonged illness and we had no definite treatment for it.
Dr. Cummings: And now all we do is give people a few Penicillin shots, and the whole thing is over, rather than having a long, ongoing treatment over years.
Dr. Kaltreider: That's right, that's right.
Dr. Cummings: Well, after being on the house staff, or maybe while on the house staff you did some research with Dr. Hurtado. Want to tell us a little about that?
Dr. Kaltreider: Yes, when I came here, Dr. McCann knew I was interested in research, because I had spent two summers at (Woodshole) at the marine biological laboratory.
Dr. Cummings: Down on the Cape.
Dr. Kaltreider: Down on the Cape. And I also spent partially my last year at medical school at the University of Pennsylvania at the Biophysics Institute undefined or Foundation undefined there. So, during my second year, Dr. McCann suggested that I might find it interesting to work with Alberto Hurtado who was here on a fellowship from Lima, Peru, and he was interested in high altitude, and in the physiology of the function of the lung.
Dr. Cummings: I remember those tremendous-size drums that used to be in that room there. What were they for?
Dr. Kaltreider: Well, they were spirometers, they collected the gas and we analyzed them. We did all our own analysis, because you know, Dr. McCann was opposed to having technical help. He always felt that you should do your own analysis, even as interns. If we had a diabetic, we, at nighttime, would do our own blood sugars and our own carbon dioxide combining powers because he felt that you couldn't make a good judgment as to the value of these tests unless you did them yourself.
Dr. Cummings: I hope they were as accurate as he thought. So, in the laboratory, what did you work on with Dr. Hurtado?
Dr. Kaltreider: We were mainly interested in pulmonary emphysema, which was fairly common at that time, but we did not see the severe cases that we have at the present time.
Dr. Cummings: Why?
Dr. Kaltreider: Because most of the individuals died before... of pneumonia or respiratory infection before their disease became severe. We did see a lot of patients with bronchiectasis, which is rather rare these days.
Dr. Cummings: And bronchiectasis is what?
Dr. Kaltreider: Bronchiectasis is destruction of the bronchial tree by infection.
Dr. Cummings: And those are...the bronchi are the small tubes in the lungs'?
Dr. Kaltreider: That's correct, and I think the reason we saw so much at that time. for several reasons, they used a lot of mustard gas during the first World War, and we were seeing individuals about 10 years, 15 years later, and that would result in chronic infection and bronchiectasis in the lung. And then as you know, we had a very severe epidemic of influenza in 1918-19, and that also resulted in bronchiectasis, and third great factor, I think, was whooping cough. Children developed whooping cough, pneumonitis and bronchiectasis.
Dr. Cummings: Isn't it wonderful that those things aren't around that way anymore?
Dr. Kaltreider: We take care of them now with antibiotics. Dr. Cummings: Yes.
Dr. Kaltreider: The other problem we were interested in was pulmonary fibrosis undefined silicosis. At that time there were about 150 cases in the Rochester area and industry consulted Dr. McCann on this problem to see about really rating disability. And Mr. (Miner) who was president of the (Faltner) Company at the time, passed the hat and our chest laboratory was really supported by industry in the Rochester area.
Dr. Cummings: That was certainly the beginning of a lot of industry-supported research. was it not?
Dr. Kaltreider: That's correct.
Dr. Cummings: So, you worked around here and stayed around, and worked in the research laboratory and finally got to be on the permanent faculty in the teaching capacity. And you always enjoyed it, didn't you?
Dr. Kaltreider: Yes, I did. I became an instructor in 1934 and sort of went up the academic ladder slowly, assistant professor and in 1946 I decided that perhaps it looked a little greener outside of the university than the inside. and in 1946 went out into practice in the city.
Dr. Cummings: And how was it to change that way? Actually, you stayed on the consulting staff though, didn't you?
Dr. Kaltreider: Yes, I was part-time.
Dr. Cummings: So you kind of kept your hand in...
Dr. Kaltreider: That's right... did a lot of teaching and it wasn't really too much difference.
Dr. Cummings: I know your patients all love you because you gave me a lot of them when I first started to practice, a thing for which I've been very grateful.
Dr. Kaltreider: Well, they're in good hands.
Dr. Cummings: Well, thanks. But I personally always enjoyed your teaching, and had lots of it, because during the war, many of the men went off to war, to play their part_ whatever it was and you and Larry Kohn, Dr. Kohn stayed here so that during that time I was personally on the house staff. As we rotated from floor to floor in the Department of Medicine, we kept having you and Dr. Kohn as teachers, a thing for which I've been very grateful. I always remember one thing you said, and that was to always examine your patient. And every time I look at somebody and think, just saw them last week, I think Kalt said, `Always examine your patient." so I do.
Dr. Kaltreider: That's important.
Dr. Cummings: It really was put to me that way, and I've followed it out.
Dr. Kaltreider: Well, we had... our faculty was markedly reduced during the war. and thefull-time people undefined I think we only had five full-time peopleundefinedand we taught about nine months of the year.
Dr. Cummings: That's right. How many people are there now, by comparison, would you estimate?
Dr. Kaltreider: It must be several hundred. Dr. Cummings: I think so, uh uh.
Dr, Kaltreider: And then, of course, we graduated a class every nine months so that we had a new class every nine months.
Dr. Cummings: Yes, uh uh. Early on, how were things run around here? There was an advisory board and it was made up of whom?
Dr. Kaltreider: Yes, in the '30s the Advisory Board was small... Dr. Cummings: And they ran this place?
Dr. Kaltreider: They ran this place, much smaller than the one that Bob Joynt talks about now, that have to meet in the Coliseum because there are so many members.
Dr. Cummings: Oh, so who was on the old one?
Dr. Kaltreider: In the old days, it was Dr. Corner, Bloor. Bayne-Jones. Fenn, Murlin, and then the
clinical side was Clausen and Wilson, Morton, McCann, and the hospital administrator or
director. Dr. Faxon, and the Dean, Dr. Whipple. I think that's ten members on the Advisory
Board. Now, I always thought of them as being rather autocratic. I noticed that Dr. Corner refers
to them as gentle autocrats. I thought that they were gentle sometimes, in the fact that they were
wise most of the time but not always. Of course, they were quite autocratic. There was no input
or participation of the faculty in making decisions. These decisions were all made by the advisory
board. We had nothing to say about them. And of course we felt that most of the time they did
very well, but naturally made some mistakes.
Dr. Cummings: What kind of mistakes do you recall?
Dr. Kaltreider: Well, there were a lot of minor ones which we griped about every week or so, but there were several major ones that I think are important. First of all, I thought that they should have tried to keep Dr. George Berry here.
Dr. Cummings: And Dr. Berry was Professor of Bacteriology and what... .
Dr. Kaltreider: And Associate Dean, and he was in charge of the students in the military during the war, and many of us were hoping that he would stay on as Dean.
Dr. Cummings: To replace Dr. Whipple when he retired, you mean?
Dr. Kaltreider: That's right, that's right. Instead of that, Dr. Berry went on to Harvard as you know. as Dean. The other mistake, major mistake I thought they made was that Dr. McCann and Dr. MacLean, Dr. Whipple, turned down the government, of the Veterans Administration, when they suggested that they build a Veterans Administration hospital here.
Dr. Cummings: They wanted to build it in connection with the Medical Center?
Dr. Kaltreider: That's right, just like they did in Albany and Syracuse and Buffalo. We're the only medical school upstate that does not have a veterans hospital, and I think that we could use it at the present time for patients...
Dr. Cummings: For instruction of students you mean?
Dr. Kaltreider: ....for instruction of students and also for the surgical faculty, experienced in surgery, that would be brought here from Canandaigua and Bath, and various other hospitals in the community.
Dr. Cummings: Did they build the one in Canandaigua as a substitute for the one they didn't do in Rochester?
Dr. Kaltreider: No, I think that the Canandaigua Hospital, which is a psychiatric hospital is much older than the one we would have here.
Dr. Cummings: Oh, I wasn't aware of that. I'm sorry...
Dr. Kaltreider: One other thing that we were very much upset about was that Dr. Bassett. Samuel Bassett, who was Associate Professor of Medicine, leaving and going to the West Coast.
Dr. Cummings: And what did he do here?
Dr. Kaltreider: He did mainly research and teaching... saw very few patients, but during the '30s and the '40s I think he helped more young people in research than anybody else in the Department of Medicine.
Dr. Cummings: And he was in charge of the Metabolism Ward? Dr. Kaltreider: He was.
Dr. Cummings: Which checks out all kinds of body functions chemically? Dr. Kaltreider: That's right, that's right.
Dr. Cummings: Is that a fair statement?
Dr. Kaltreider: Balance studies, he knew what was going into the body and knew what was coming out, and what was being burnt by the body.
Dr. Cummings: I see. And he went to California and carried on out there.
Dr. Kaltreider: Yes. That reminds me, back in 1945, we had a great day in the Department of Medicine. Jake Holler was assistant resident, C3. And the other...
Dr. Cummings: And C3 is a medical floor?
Dr. Kaltreider: Medical floor of women...
Dr. Cummings: ...women patients.
Dr. Kaltreider: That's right. and he had a diabetic who became... developed muscular weakness,respiratory paralysis, so they had to put her in the (Janka) respirator. And Jake went over to
Sam Bassett, and he says, "Dr. Bassett, we're flushing out all the potassium in this woman'sbody_ and I'm sure it's...."
Dr. Cummings: You flushed it out by giving fluids in the veins...
Dr. Kaltreider: ...intravenous, that's right. And Sam, as always, went right over, got some serum, and then did a very complicated and prolonged procedure, chemical procedure, to find out how much potassium this woman had in her serum. And sure enough, the potassium was low, they gave her potassium, the paralysis cleared, and I think this was one of the first times that it was noted that potassium was noted in the body. Now since then, potassium is done almost every day on almost every patient.
Dr. Cummings: Yes, I'm sure that's true and Jake Holler really made a good discovery in that night's work with Dr. Bassett.
Dr. Kaltreider: He certainly did.
Dr. Cummings: You mentioned that Dr. McCann in keeping his medical staff fulfilled as to personnel, hardly took people from outside universities but rather from his own teaching group.
Dr. Kaltreider: Yes, that's correct, when the school opened he had four or five full-time facultymembers. Shortly after the school was opened, Dr. Hannon; who was interested in metabolism, the same field that Dr. Bassett was interested in. left and went to China. Did a lot of work on osteomalacia, and Dr. Lyman, who was a neuropsychiatrist, left and went to Russia to work with Pavlov. Dr. McCann brought in two people from that time, Dr. John S. Lawrence, who became Associate Professor of Medicine. and was a hematologist, and...
Dr. Cummings: ...and that's blood work.
Dr. Kaltreider: Blood work. And Dr. Garvey came from Michigan, as you well know. as neurologist. Now, following that time, during throughout Dr. McCann's complete tenure as Chairman, no other faculty members were brought in from the outside. They all came from the so-called farm system, that is through the residency program. And I think it is of interest to name some of these people on his faculty during the '30s and the '40s. I think it was a rather superb faculty. Now, first of all there was Sam Bassett, and Henry Keutmann. Pat (Stavin), Ralph Jacox, Larry Young, Scott (Swisher). (Zan Tru), Bill Valentine. Arthur (Bauman), Chris Waterhouse, Jack Jaenike, Frank Lovejoy, Paul Yu and probably many others. And I really think this is a very excellent faculty. Also included is a fellow by the name of Kaltreider.
Dr. Cummings: That is lovely! Now, in all that time everyone worked hard, I'm sure, but also we all had a lot of fun, don't you think so?
Dr. Kaltreider: Oh yes.
Dr. Cummings: How about telling us something about medical history meetings, which came on Thursday evenings?
Dr. Kaltreider: Well, we all lived in the staff house during our residency. my residency anyhow...
Dr. Cummings: Mine, too.
Dr. Kaltreider: ...and you had a lot of young people in there, they are bound to occasionally have a party or two. And from 1931 to 1946 we had many informal parties.
Dr. Cummings: And they were called medical history meetings, and paged over the loud system... the sound system.
Dr. Kaltreider: That's right. They occurred on Thursday, and most of the time we'd have to call the dining room and tell them that we'd be a little late for dinner, and sometimes we were as much as an hour or two late, and sometimes we didn't even get there.
Dr. Cummings: What were you doing at the history meeting? Like drinking?
Dr. Kaltreider: Well, we had highballs. And we always had enough alcohol around.
Dr. Cummings: How'd you get the alcohol in the Prohibition days?
Dr. Kaltreider: Well, when I came here we had Prohibition, and we were also in the depths of the Depression. Nobody had any money. But there was a lot of ethyl alcohol in the various laboratories. There was ethyl alcohol...
Dr. Cummings: Ethyl alcohol is the kind you can drink.
Dr. Kaltreider: Drink... pure, they did not put any contaminants in it. Dr. Corner had a lot of it in Anatomy, Dr. Bloor had a lot of it in Biochemistry, and Dr. Bayne-Jones had large quantities in Bacteriology. So, usually after L Clinic, one of the house officers, usually the intern, was assigned to get some alcohol, and he would add some (side 1 of tape ends here)
Dr. Kaltreider: ....that's right. It was tax-free, and in those days, everything was open. None of the doors were locked...
Dr. Cummings: In the Medical Center.
Dr. Kaltreider: In the Medical Center. And nobody stole anything. Well, this chap who would pick up the alcohol Saturday afternoon, would add gin drops or pink solution which we called pink lady. And they would allow this to age from about 4 o'clock in the afternoon until 8 o'clock at nighttime, and then we would start imbibing it.
Dr. Cummings: Well, that was much more reasonable than it is now, certainly. We also had a lot of parties at your house. And first let me ask you about your family. Your wife's name is Ann, and you were married how long ago?
Dr. Kaltreider: Well, September the 21st. 1979, it will be 50 years.
Dr. Cummings: Isn't that wonderful. I certainly take my hat off to you because so many people don't stick by their original loves.
Dr. Kaltreider: That's right. Well, Ann is a...she helped me through medical school. We were married between my second and third year in medical school. And she worked as a social worker with the Family Welfare, the Family Society in Baltimore for two years, and then when we came here, she worked with the Family Society here. She was a rather smart girl. I met her in high school. She was number one in her class. I was a bit below that. She was also number one in college, so I guess it's the old saying, as Larry Kohn used to say, if you can't beat 'em, join them," so I joined.
Dr. Cummings: I think that's great. But nowadays, it's so a rather a common thing to have a medical student's wife to help him through medical school, and then he sees greener pastures and leaves her. and so I'm thankful that did not happen to you. So...
Dr. Kaltreider: I was very fortunate.
Dr. Cummings: Yes. So you have three children... Dr. Kaltreider: That's right.
Dr. Cummings: And their names are'?
Dr. Kaltreider: The oldest one is Nancy, who received her degree, her Ph.D. in history at Berkeley, and she now teaches part-time at Penn State University, and she is married to... her husband is Professor of Physical Chemistry there: they have two children. A girl and a boy. Our son is Benfer, who is Associate Professor of Medicine at the University of California Medical School in San Francisco, and he is head of the Pulmonary Disease Unit at the Veterans Hospital there. He's interested in the immunology of the lung. He is married to a psychiatrist. Ben is about my size. When he went to Harvard, in Gross Anatomy was a small girl across the way who had difficulty turning over her cadaver. He helped turn over her cadaver and after that he started dating her, and they are now married. have two children and she is a psychiatrist teaching at the University of California.
Dr. Cummings: You never know where you're going to meet people, do you?
Dr. Kaltreider: You certainly don't. And our younger daughter, Pamela, was married, she has two children. And she teaches remedial reading in the Oakland school system in California.
Dr. Cummings: The fact that I've known you for a long time is certainly evidenced from one party we had at your house, and we had many, in which you had Pam as the centerpiece on the table. and she was a little bit of baby.
Dr. Kaltreider: Well, for many years we had the....Paul Garvey and I had the house staff at our house for an all-out party, to celebrate. And a little later Gordon (Khuri/Curry) joined us. and a little after that Bill (Coleman/Kohlman). We always had a fair amount of liquid refreshments and lots of food, because Dr. Garvey always insisted that as long as you ate you could not get in any trouble with alcohol. These parties all ran about, along the same line, and invariably about the middle of the party, Dr. Garvey would turn up his cuffs, pull up his coat collar, push his hair down over the front of his head, and we would then sing the Skater's Waltz and Paul, somebody would dust the ice, and Paul would gracefully glide across the ice, performing the figure-eight. A little bit later he would come out with his umbrella and do his so-called tightrope walk. All very amusing.
Dr. Cummings: All of us sang Climb Up Sunshine Mountain, too, didn't we? Dr. Kaltreider: Yes, we all did that and... Dr. Cummings: ...and had a parade.
Dr. Kaltreider: Yes, we almost always had a parade to one of Susan's marches, my older daughter does the same thing.
Dr. Cummings: Oh, I think it's great that it's carried on, because certainly it was fun.
Dr. Kaltreider: That's right.
Dr. Cummings: We also had parties in the staff house and as you said before it was partly because we lived there and partly because we had no money to go anywhere else. I recall one year that because our parties were perhaps not as gentle as they might be, the university would not allow us to have any ornaments on our Christmas tree, because they said all we would do was break them, which was probably true. So, this particular year, they let us... or they decorated our big Christmas tree in the staff house lounge only with soap chips. This really burned us up. and we decided that New Year's Eve we would burn the Christmas tree. Now you go on...
Dr. Kaltreider: Well, I was on the faculty at that time, I was supposed to behave myself. I invited our neighbor, Lucille and Ernest Pavier, along... I said, "How about going over to the staff house to the New Year's party?"
Dr. Cummings: And who is Mr. Pavier?
Dr. Kaltreider: Mr. Pavier is now 91 years old. Dr. Cummings: Is he really?
Dr. Kaltreider: He is emeritus member of the Board of Trustees of the University, and in those days, he carried all the insurance for the university. So, we came along, we had a wonderful time.
And somebody got the idea that we should burn the tree, and that we could burn it by pushing it
into the fireplace.
Dr. Cummings: That was your idea, I thought... nobody else would have had that kind of an idea!
Dr. Kaltreider: And we felt that we could push it in faster than it would burn coming out but we
forgot about the trunk, and the trunk would not burn, so the flames came out, and many things caught on fire, burning. And we had lots of smoke, partly because of the burning soap.
Dr. Cummings: Yes...
Dr. Kaltreider: Which I hadn't thought of before. Mr. Pavier went to the telephone and called the operator and said, "We're having trouble over here, call out the fire engines."
Dr. Cummings: Call out what? Dr. Kaltreider: The engines. Dr. Cummings: Fire engines'?
Dr. Kaltreider: That's right. And he said, "I'm Mr. Pavier, a member of the Board of Trustees." And she said. "We need somebody in authority before we can do that." So by that time some of the surgical team came along, and extinguished the thing. But the next morning, the sofa and several other things were still smoldering.
Dr. Cummings: I remember that very well. There was quite a lot of pandemonium about that thing, was there not? The first thing someone did was turn out the lights, which made it dark and smoky and really quite an occasion.
Dr. Kaltreider: That's right.
Dr. Cummings: Did you ever get called on the carpet for any of that, or anybody?
Dr. Kaltreider: No...
Dr. Cummings: How come?
Dr. Kaltreider: The resident was a little upset about it because he had to report to Dr. MacLlean the next day. But when he went in to see (Passel), (Passel) said, "Well, that's fine. That staff lounge really needed to be redecorated, and I was wondering whether we were going to get the money." So he said, "We'll just put in a claim to Mr. Pavier." And Mr Pavier's insurance company paid for it.
Dr. Cummings: Well, that was just one of the things that happened around in the staff house and I think we all look back on those as very happy days. They were while we were growing up, they were all while we were learning lots of things and everything was sort of a stimulation. And it was fun, and hard work, and great all around, I thought.
Dr. Kaltreider: Yes, we worked hard but we had a good time. And...
Dr. Cummings: Yes.
Dr. Kaltreider: In those days, of course, we did not have a night float. We were on call...
Dr. Cummings: Now, what's a night float?
Dr. Kaltreider: At the present time they have a house officer on call at nighttime. and they sleep during the daytime.
Dr. Cummings: And he's called a float, why?
Dr. Kaltreider: Because he goes from one floor to the other, he floats from one floor to the other, all over the hospital.
Dr. Cummings: Taking the night calls.
Dr. Kaltreider: Taking the night calls. When we were house officers, we were on call 24 hours of the day, unless we signed out for a few hours at nighttime, and went to a movie.
Dr. Cummings: And how were the people kept track of? I remember a very nice man, named Mr. Darrow, who was on the switchboard in the municipal hospital.
Dr. Kaltreider: I remember Darrow. He was not the municipal, he was at the main switchboard atStrong.
Dr. Cummings: Oh, was he?
Dr. Kaltreider: And the switchboard in those days was just off the lounge, the main lounge...
Dr. Cummings: At the Strong Memorial?
Dr. Kaltreider: At the Strong Memorial. And at nighttime they would open the doors so that hecould see anybody coming in the front door. Now, Mr. Darrow was a friend of all house officers. He knew all the house officers by name, he knew all their characteristics, he knew all their bad habits, and he knew all their good habits. And when I was resident, if I wanted to know where one of my interns... I was looking for an intern, I would call Darrow, and Darrow would say, "I think he's in room so-and-so, and there may be a couple of other people in there_ and they may be having a highball or two." He not only knew where they were, but he also knew who was sleeping with whom.
Dr. Cummings: Well, at least that made everybody available, when he was due to be called for some emergency, didn't it?
Dr. Kaltreider: Absolutely, yes.
Dr. Cummings: And it was a great spirit around here in those days. A friendly spirit, everyone knew everyone, and everyone I think cooperated with everyone else, trying to do the best he could for medicine and for all the patients and everything else. Why don't you tell us a little about...
Dr. Kaltreider: Yes, I think that's true and I think that Dr. McCann had a lot to do with that, because he was always talking about esprit de corps, and he would always have a party for his house officers and he would come to the history meetings and at times he would relax. I'd like to go on and say a few other words about Dr. McCann. Dr. Corner referred to him as a gadfly.
Now a gadfly is a horsefly that bites cattle. I think the reason he referred to him in this sense; wasthat at times Dr. McCann's criticism could be quite biting.
Dr. Cummings: What did he criticize? What do you mean?
Dr. Kaltreider: Well, he was... when I was in the chest laboratory, the chest laboratory waslocated on E3 which is now the McCann room. And on a number of occasions, Dr. McCann would come from the Advisory Board, and on the way to his office would stop in the chest lab and with hair bristling, would try to let off steam because things happened at the Advisory Board that he did not approve of or the others members did not support him. I remember his saying, "This so-and-so doesn't have the backbone of a jellyfish." He said, "I'm going to get so-and-so eventually." But he was very... he had very definite ideas and he thought that some of the members of the Advisory Board would let him down from time to time.
Dr. Cummings: You mentioned that he would then at least talk things over with you, so you really felt kind of a part of everything, didn't you?
Dr. Kaltreider: Oh, yes, he came in and let his hair down so to speak and let some of us at least on the inside of things, as to what was going on because otherwise we wouldn't know what was going on as far as the school was concerned. When I left the hospital as full-time, in 1962, I thought the pendulum had swung quite a great deal over, in that I thought there was too much faculty input and participation, participation of the faculty, so that the process of making decisions became rather unwieldy. It took a long time, had to go through a number of committees before a decision could be made, and I also felt that a lot of our time was wasted in this process. and I hoped that the pendulum would swing back a bit towards the autocratic side. I thought we had too much democracy.
Dr. Cummings: I certainly think that's true. So often a person now is not allowed to make a decision, but it has to go through a committee, and the committee's too big to make a unanimous decision and very often nothing happens. Whereas before, a question. an opinion was asked of a person and they could make a judgment and whatever they said, went. Well, it's just a different time, Kalt.
Dr. Kaltreider: That's right. I thought very highly of Dr. McCann. He had a few othercharacteristics I'd like to talk about just for a moment. He was never interested in small problems. He only wanted to hear about big problems. And if his faculty came in, and he felt that he was being needled by little problems, he would soon disappear for two or three days...
Dr. Cummings: Oh...
Dr. Kaltreider: ...and I was a good friend of his secretary's, so I knew what happened. He would go down to his farm, get out his tractor, and start cutting grass. Another characteristic is. if you went and had a conference with him, you didn't want to stay too long because he would get bored very easily. And one indication was that he would sit in his office and would look directly at you while he was interested. As soon as he felt there was enough said, he would start looking out the window. And when he looked out the window, it was time to go.
Dr. Cummings: Well, it was nice you got to know him that well, so that you knew when he was cutting grass he was letting off his stress.
Dr. Kaltreider: That's right.
Dr. Cummings: And when he was bored, he looked out the window. That's marvelous.
Dr. Kaltreider: He always had what we called light-haired boys.
Dr. Cummings: Oh?
Dr. Kaltreider: Chuck Boller was one of his favorite light-haired boys. Adi Bastian, you remember?
Dr. Cummings: Yes.
Dr. Kaltreider: ...was also one of his boys.
Dr. Cummings: And by white-haired boys you mean favorites?
Dr. Kaltreider: Favorite, that's right. I was sort of at the halfway house, I think. Sometimes up here, sometimes down here. Now, in contrast, Jack Goldstein was not his white-haired boy. He had great respect for Jack, for his knowledge, and his ability, but Jack in his enthusiasm would step on his toes occasionally, inadvertently, of course.
Dr. Cummings: And what was the difference with what happened with the white-haired boys and those who weren't?
Dr. Kaltreider: Well, the white-haired boys were always going into the professor's office.
Dr. Cummings: To talk over things.
Dr. Kaltreider: To talk over things, that's right.
Dr. Cummings: Well, it's interesting what's happened to some of these people, isn't it? Dr. Boller went over to the Genesee to be Chief of Medicine, and that was actually a university appointment, because the Medical Center has gradually taken over the teaching for all the hospitals in Rochester.
Dr. Kaltreider: That's right. He was the first Chief of Medicine under the Department of Medicine here at the university.
Dr. Cummings: Uh, um. What do you think about the eating arrangements? Once, or early on, at least, we had a... we, who were on the house staff, had a corner of the dining room where we could eat together and talk together and then there became so much equality that everyone had to
eat together. To me, this was a degradation of everything, because you could no longer sit at a table and talk over your patients because there would be someoneundefineda secretary or a cleaning person or someoneundefinedwho wouldn't understand, or might misinterpret what you were saying.
Dr. Kaltreider: Or even a member of the family might be next to you. Well, I think we lost a lot by not having a separate dining room for the staff, and of course you remember in the old days we not only had a separate space to eat, but we also were served.
Dr. Cummings: That's right. I remember we had a box of our own napkins.
Dr. Kaltreider: I think now in the new hospital, of course, the cafeteria is tremendous, and you can never find anybody, and you can't find your friends. I think that the thing I like about the new hospital best of all, the one thing, is the johns. We now have enough johns. In the old hospital we had one john for 150 people.
Dr. Cummings: Oh, did somebody work that out?
Dr. Kaltreider: And I was always concerned as to what would happen if at lunch we had some bad food and had an epidemic of acute gastroenteritis? Now, I. .. and I remember working in the chest clinic, in the chest laboratory on E3 and if I were in a hurry, I may have, probably had to look up four or five johns before I found one available. Now, you can walk around the corner and find a john almost anywhere, and I think this is one of the great things that's happened with the new hospital. It was worth the investment!
Dr. Cummings: Well, everyone likes something for some reason. Do you get lost in the new hospital?
Dr. Kaltreider: I certainly do.
Dr. Cummings: I do, too. Every day I get disoriented.
Dr. Kaltreider: And, I also feel that when I go into one of the sections that I am isolated from the rest of the hospital. I imagine the house officers feel the same. I don't see all my surgical friends anymore, or my GYN and OBS friends, whom I used to see regularly every time you came into the hospital.
Dr. Cummings: Well, I think we covered a lot of medical territory over the eating because we could eat together and you didn't have to write someone a letter about a case. You could meet them, you knew they were going to be there some time, and you could talk to them.
Dr. Kaltreider: Curbstone consultations. Dr. Cummings: Right.
Dr. Kaltreider: You could see our surgical confreres, or our GYN confrere and have a curbside consultation and solve many problems right at the lunch table.
Dr. Cummings: Well, none of us could know everything and it was very pleasant to me and I don't think derogatory to you to ask someone something you didn't know, and this is gone now. And it really is to me a sad thing. I like that. because I don't know a lot. And I know it.
Dr. Kaltreider: That was one of my favorite statements: I don't know. I said it many times. Even in the old days when there wasn't very much knowledge and we weren't at the molecular level.
Dr. Cummings: Yes. When you first came did you have to make up your own intravenous solutions?
Dr. Kaltreider: Yes, when I was an intern we often made our own solutions and we gave them subcutaneously rather than intravenously.
Dr. Cummings: Why?
Dr. Kaltreider: Well. everybody was afraid of infections. We didn't have antibiotics, so that most of the floors were giving it into the lateral aspect of the thigh. And of course, it didn't absorb very rapidly and they would have large lumps there. We had to do all our laboratory work. all the blood counts, stools, urines.
Dr. Cummings: Bacteriology?
Dr. Kaltreider: And the intern was assigned to bacteriology for a period of six weeks. I came here, an intern from Hopkins, and hadn't thought about bacteriology since I was a second-year student. And I was placed in the bacteriological laboratory, and we were supposed to make throat
cultures, stool cultures, all the sputa, take the blood cultures, for pneumonias we would have to inject the sputum into the peritoneal cavity of a mouse and then type them, because we had antiserum for only a few of the types of Pneumococci. I got most of my help from a young lady who was a bacteriologist for the Health Bureau. She worked just across from the lab and that was Priscilla Cummings, and I would go in there with a plate, and say, `What's this?" and Priscilla would say, "Why, that looks like typhoid." And I said, "Well, the thing to do now is put it on the sugars and see whether we get acid and gas or both." I remember one day, Priscilla, coming into your laboratory, and you had a great big bagundefinedshopping bagundefinedfull of house dust, and I said, "What are you doing?" You said, "I'm making an extract of house dust."
Dr. Cummings: That was because somebody might be allergic to their own house dust.
Dr. Kaltreider: That's right, and the patient was... it was suggested to the patient to take the vacuum cleaner and dump it into the bag. Well, on this particular occasion, you said, "I'm going to extract everything but this." And I looked at it, and it was a rubberized contraceptive device. And I said, "Priscilla. You have to extract that because perhaps the woman... that's just the thing the woman's allergic to!" But I don't think you did.
Dr. Cummings: We used to find a lot of things to laugh about in those days. And it was good. was it not?
Dr. Kaltreider: It was good for us.
Dr. Cummings: That's how we all became acquainted, because as you said, I tried to help you with the bacteriology. You've always helped me with medicine and that's the way we carried on.
Dr. Kaltreider: I certainly wasn't a very good bacteriologist. I tried to stay away from it.
Dr. Cummings: Well, I always enjoyed it and even on the house staff during the war. Dr.
Lawrence used to pay me $50 a month to straighten out the laboratory on Sundays. That was one little source of income that I had.
Dr. Kaltreider: The other thing was, you know, we did our... we matched blood, crossmatched, and you wonder why we get into more difficulty.
Dr. Cummings: That was for transfusions.
Dr. Kaltreider: Transfusions. Now there's so many subtypes and so many different reactions and we had really very few reactions from blood transfusions. Of course there weren't nearly as many. .. as much blood used as there is now.
Dr. Cummings: Kalt, I think we've had a great time reminiscing about the good old days, and I think our time is about up, and I want to say to you once more, that I am very grateful to you for all you've done for me over the years, and I'm very pleased to have been able to have this interview with you.
Dr. Kaltreider: Thank you very much. I'm pleased to be on the other end.
Interviewee: Dr. Robert McCormack, Emeritus Professor and Chairman of Plastic Surgery
Interviewer: Dr. Elethea Caldwell
Dr. Caldwell: It's my pleasure this afternoon to talk with Dr. Robert McCormack, Emeritus Professor and Chairman of Plastic Surgery. Dr. McCormack has had a long and distinguished career in Rochester. New York, coming to Rochester in 1944 as a surgical intern. graduated from Swarthmore College in 1940, the University of Chicago Medical School in 1943. His training was done here in Rochester, interrupted by two years with the United States Army at William Beaumont Hospital in El Paso, Texas, where he was with the Hand Service. and was Chief of the Hand Service in 1947. He returned to Rochester in 1947 for his plastic surgical residency from 1947 to 1949. He then went to spend a year in Milwaukee in private practice of plastic surgery, and returned to Rochester in 1950 as Chairman of the Division of Plastic Surgery. He has been here ever since that time, has seen many changes and will share those. I hope, with us this afternoon. His curriculum vitae is long and very distinguished. Important to me is the fact that he has served as president of three national societies of plastic surgery: The American Society for Surgery of the Hand, American Association of Plastic Surgery, and the American Burn Association. He has also been awarded many honors. He was awarded the Award of Merit of our Rochester Academy of Medicine. He was a distinguished alumnus of the University of Chicago, he received the Gold Medal Award of the University of Rochester, and was named Clinician of the Year of the American Association of Plastic Surgeons in 1975. Also very special in Dr. McCormack's list of awards is being awarded the Sports Illustrated Silver All-American in 1967 in football. He refers to Swarthmore as a small girls' school in Philadelphia. I would not agree with that, but that award means a lot to him and it certainly means a lot to me. Dr. McCormack?
Dr. McCormack: Well, thank you Lee, it's a pleasure to have this interview with you and have an informal chat about some of the times and at the University of Rochester over a long period of time. I came here in 1944, and it's now February 1986. And, so that makes my time here over 60 years and... I beg your pardon, my time here about 42 years, and as the school has been opened for approximately 61 years, it means that I've been here essentially 2/3 of the time that the University of Rochester. School of Medicine and Dentistry, Strong Memorial Hospital have been in existence. There obviously have been many changes that we can talk about. I came here in the war years. The resident staff was small. I counted the other day in some old publications, it was about 55 people. And now the resident staff of Strong Memorial Hospital is about 550. so you get some idea of the tremendous growth in numbers of people that are being trained. The medical school has increased to approximately 100 students in a class, number of more graduate students, more nursing students. Just everything has enlarged. And I think it's kind of interesting to follow that during one's career and how these various changes have influenced one's own career and integrated into the community and the practice of plastic surgery as one of the surgical specialties here at Rochester. Dr. John J. Morton was the original professor of surgery, was a professor... everyone called him Professor when I came here and he retired in 1953. During those early years, it was a pleasure to operate with him. He was very informal, a relatively small man. with small hands. He wore what was called a #7 cadet-size glove which has especially short fingers, and my hands were small and short-fingered also, so I always got the second set of #7 cadet gloves which was quite a pleasure. Dr. Morton would talk softly to himself at the table and say. "Well. I think it should be in this area. The books say it should be...". and then of course. he was in exactly the right place all the time, and carefully dissecting out whatever the pMalllem. So, it was... he was one of the pioneers in general surgery in this country, and I think all of us who have been through the Department of Surgery during his era were influenced greatly by his personality, his integrity, his honesty, and his imprint on the University of Rochester of course is immeasurable. Dr. Morton in those days had a small but key faculty. Dr. Herman Pearse; Dr. Merle Scott, and Dr. Earle Mahoney. The faculty, of course, during the war years was depleted, and they were all very busy and doing a lot of general surgery in the broadest sense of the word throughout that period. Immediately after the war as so many former residents and interns had been away, the University of Rochester and Strong had an informal policy that they would take everybody back as a resident if at all possible if they wanted to come back. So, probably at no time did we have more people around as far as various positions in the department. Certain affiliated positions were created of... oh, they went to Bradford, Pennsylvania for three months, for example. They went to Canandaigua for several months. They rotated several people on surgical pathology, and so that era immediately after the war was an era of rapid expansion in numbers of house staff, the GI Bill of Rights had come through so there was financial help for residents from extramural sources for the first time and the housing project left over from the war _years, nicknamed "Splinter Village" was across the street next to Helen Wood Hall for many of the young residents, many of us lived with our start of the baby boom era, many young children around and so on. And it was an interesting and full time. Dr. Morton continued to be Chairman of the Department until 1953 and that was the same year that Dr. Whipple, the original Dean and our founding father of this institution as we all know, also retired as Dean. It's been kind of interesting that during my time here of seeing five Deans of the Medical School... Medical Center... and also five Chairmen of the Departments. The first. of course. was Dr. Whipple, then Dr. Anderson from... started in 1953 and then in the mid '60s Dr. Orbison was appointed, first as acting Dean and later as the permanent Dean. Dr. Young in approximately 1980, Dr. Frank Young of Microbiology, and this past year, 1985 Dr. Robert Joynt. a neurologist, was appointed Dean. So, they have been very active years working with these various heads of the center during eras of expansion and so on, and that's been a pleasure to have contact with all of these five Deans. Similarly, in the Department of Surgery, we've spoken about Dr. Morton. He was followed by an interim period of several years when Dr. Herm Pearse, head of the administrative duties and Dr. Merle Scott was appointed after that interim period as Chairman in 1955, when Dr. Donald Anderson was Dean. Dr. Scott had been here many years as sort of the second person in the Department of General Surgery coming from Cleveland and he headed the Department through a very short time but a time of rather great changes in many things from 1955 to 1960. It was at that time for instance that the faculty compensation plan which defined more definitely the full-time faculty and the so-called part-time or clinical faculty. And the full-time faculty compensation plan came into being in 1956 after much discussion by the Advisory Board and the various departments, and it was during Merle Scott's term as Chairman of the Department of Surgery that this came in. After Merle Scott left, Dr. Anderson appointed, to the surprise I think it's fair to say. of many people in American surgery, a British citizen as Chairman of Department of Surgery. It was rarely done in the United States, although it was relatively common to have a British surgeon as a Chairman of a department in Canada or Australia. This is, of course, Dr. Charles Rob. There is kind of an interesting sidelight along that story that I haven't voiced many times in the past. I was attending an international Congress of Plastic Surgery in London, England, in July of 1959, and I got a special delivery airmail letter from Donald Anderson, asking me if I would interview, contact and set up an interview, with Dr. Charles Rob, since I was in London. The meeting was at the Royal College of Surgeons Auditorium, right in the heart of London. So, I turned to some of my British friends who knew Charles Rob. I didn't know him at the time and I contacted several friends that of course knew of him, one of whom had gone to medical school with him during part of his clinical phase at St. Thomas Hospital in London, and I also took the time to go the library of the Royal College of Surgeons, and figured, well, before I meet this man I better find out a little bit about him. And, so I looked him up in the directory of the Royal College of Surgeons and found out that he went to Cambridge and had trained at St. Thomas and so on and so on, had a distinguished war record as a one-time physician to some of the paratroops that went into Yugoslavia, and many other basic facts about Dr. Rob. As many of you who know him, he did a similar thing when he got the note from Dr. Anderson that I was going to contact him. He had looked me up in some directory, so when we first met at St. Mary's Hospital in London, over lunch one noon hour, the opening conversation, of course, was, "Well. have you been back to Cambridge recently?" And he said, Have you been at Swarthmore recently?" And it was obvious that we knew a little bit of background on either side and I think a certain amount of respect for each other started right then, and actually continued during the entire 17 years that he was here. That was an interesting era in the department as far as general surgery was concerned. Vascular... Dr. Rob, of course, was a pioneer in vascular surgery, having done some of the very early carotid endarterectomies and other procedures, was widely known
for his writings in those areas, and vascular surgery partly due to previous influences of Dr. Merle Scott, Dr. Mahoney, and now with Dr. Rob here, vascular surgery grew rather rapidly, and to this day remained... I think it's fair to say... remains an important part of the surgical residency. This brings up I think also another point of the post-war period along vascular surgery being a subspecialty area, an area of interest of general surgery, many of the other specialties had grown dramatically after the war. We have to reflect a little bit that the American Boards of Surgery, Orthopedic Surgery Urology and so on, all came into being primarily in the 1930s as far as any major impact. And residencies were just beginning in the late 30s in the specialty areas just prior to WWII. For instance, in our field of plastic surgery, we were the first... we were a subsidiary board of general surgery in 1937 when the American Board of Plastic Surgery was founded, but we only identified separate training programs a year later in 1938 and at that time there were only four in the country. There were two in New York, one at King County, one at Presbyterian, there was one at University of Pennsylvania Hospital in Philadelphia, and there was one at the Mayo Clinic. And those were the early, earliest programs in plastic surgery. Well. soon others developed, of course, but it gives you some hint as to how small some of the specialties were, particularly in an official sense of training programs, and training by apprentice, by preceptor was still a very common way of attaining surgical training in those pre-war days. Well, during the war, of course, because of the large, particularly because of the large number of casualties in all services, identifiable Army services were developed in all the fields. There was a tremendous amount of orthopedics, for example, practically every Army general hospital and at the height of the war there were 60 of them in this country, had huge, large numbers of patients and numerous wards of orthopedics as well as general surgery and other specialties, but when this group of physicians, surgeons, came back from the war, they had had rather specific training in say, orthopedics, and they had to make some career choices. A typical example here in Rochester were Philip Winslow and Norman Egel, who had gone through the general surgical residency at Strong prior to their entrance into the Army, had had... in those days the orthopedic resident was a six-month rotation in the latter years of the general surgical program. Well, they had had a fair amount of orthopedics. And when the Army realized that they had had some background in orthopedics, they ended up doing a lot of orthopedics in overseas, and when they came back to Rochester after the war, they were Board qualified according to the standards at that time in both general surgery and orthopedics, and they had to make a decision. Well, they made a decision to become orthopedic surgeons, even though they could have just as well become general surgeons and they opened their office together and later built one of the first medical buildings near Strong Memorialundefinedthe one at the corner of Elmwood and Mt. Hope, the 797 building, one of the first external medical office buildings near Strong. Well, those were the kind of decisions that many people made and it illustrated how people got into specialties, got interested in them and in my own case, I had had three months' rotation as an assistant resident. During the war years some people will remember the internship was nine months, assistant residency...they had what they called a 9-9-9 program. And you could be... everybody got a nine-month internship and got deferred from service. After that, many people went into service directly, a few were chosen to stay on for another nine months of training, practically no one was chosen for the third nine months unless you had some physical disability. The manpower situation was that tight. So, during my second nine months, I rotated on plastic surgery and on orthopedics, actually at the same time. Those days we operated on Saturday, and I would scrub Monday, Wednesday and Friday on orthopedics, and on Tuesday, Thursday, Saturday on plastic surgery. Well, it was time-consuming and busy, but it gave me at least some beginning exposure to these two fields, and so when I went into the Army with a thousand other doctors, after basic training they looked at your card, and they said "Oh, you've had a little orthopedics and plastic." And in those days, not many people had had that combination. So they sent me down to the service command out of Dallas. Texas, primarily because I'd had that. And down there they said, "Well, we have this big hospital out in El Paso, William Beaumont General Hospital, and they have a big orthopedic service, and they have a big plastic service, and they also have a hand service." Well, I had never heard of a hand service in those days, so I got on a train and took a 24-hour train ride out to El Paso from Dallas, which is a long ways, and typically, shall I say, of the U.S. Army, they said, "Oh, we don't need anybody on surgery today. We have plenty of surgeons. We need somebody on medicine." So, they put me on internal medicine, more specifically the subspecialty of gastroenterology. So, having had surgical training up to that date it was an interesting experience. The most interesting, which again I haven't told many people around here, but was...this was fairly late in the war, that I arrived there, and then after the atom bomb and VJ day and all. many, many patients flooded back from overseas so the hospitals were very, very busy. At the height of it, we had 6000 patients at William Beaumont Hospital, and we were next door to Biggs Air Base. Biggs Airfield, and to Fort Bliss, Texas, which was a big anti-aircraft. Well, we had a whole ward of hepatitis, 45 people to a ward and in those days we kept them at bedrest for six weeks and more or less symptomatic treatment. Well, the first bed was occupied by a gentleman who was rather interesting, talked very intelligently about numerous subjects and people would come in to see him all the time, civilians, some rather higher-ranking officers. This was right after Labor Day in 1945, and we would make our roundsundefinedthese were big open wards, and our GIs, this was an enlisted man's ward, were primarily reading their comic books and listening to their what has now become country and Western music, as this was the southwest, of course, and most of the patients were in general from the southwest, and this gentleman in the first bed would be reading the handbook of chemistry and physics. So, we got to know him fairly well. He spoke English. He had a slight accent, and he began to talk about rockets. And he started talking about how much propulsion you would have to do, to do this or that, and as a matter of fact he drew me a sketch which for some reason or another I've lost, of a three-stage rocket that would ultimately have enough propulsion to get to the moon and return with a third stage, which is, as you may recall, how they did it. Well, as you might guess by now this gentleman was Wernher Von Braun. So I often tease that my contribution to the space program was taking care of Wernher Von Braun's hepatitis as a surgical assistant resident out of Strong Memorial Hospital. We did get to know him quite well. I only saw him once after that. Many years later he talked at the American College of Surgeons in Chicago at a huge meeting as the invited speaker, and after that I was able to go up and at least say hello to him, but of course there were so many people around we couldn't really reminisce. He has now passed away, as you may know. He died of carcinoma of the colon, I believe, when he was about 64 years of age. He was 34 at the time I knew him. And that was the beginning of what they called in those days, the guided missile battalion at Fort Bliss, and they set up the early rocket shoots from White Sands proving ground which was 40 miles to the north. What had happened as you might guess, both the Russians and the Americans wanted these rocket scientists very badly and there was quite a race to get them to various parts of Europe as it was being separated. Von Braun realized this and he made a point to go to Bavaria because he knew it was occupied by the Americans, and he made a point I think frankly to be captured by the Americans. And he subsequently became an American citizen, and although he was never in charge of a space flight, he was in charge of the rockets themselves, and in charge of the Redstone arsenal in Huntsville, Alabama, where he spent most of his career after leaving the White Sands proving ground area. But it was an interesting time. They had captured 150 B2 rockets and brought them to America, and of course the Americans didn't know how to run them, so they brought over 400 Germans to start our rocket program and it was right after the war, and many of our soldiers had been in Europe and injured and been prisoners and whatnot, and they gave part of the hospital grounds that included a swimming pool, and made over some hospital wards into apartments for these people. They created a bit of a feeling as you might guess, with being so close to the end of the war, but it was a start, and in those days the security of a rocket launch was rather meager, particularly if you were in uniform, and a friend of mine and I, another doctor... we used to go up... they used to shoot one off every Thursday. So we used to go up on Thursday afternoon and watch one of the rockets go off, and various things happened. Some would just go '/4 of a mile and land in the desert, and one, one time, went over El Paso and landed in Mexico. And of course, it didn't get on the evening news right away and it was kept rather quiet. But fortunately they had no serious problems, and no fatalities. But it was an interesting sidelight of having been a surgical trainee here at Rochester and ending up in El Paso in medicine, and then have contact with Wernher Von Braun. Well, I think, when I came back the residencies were beginning to be established here in the various specialties, so we had the beginning of residencies in orthopedics, urology... we had had one on otolaryngology for some time and in ophthalmology, but they were growing and they were becoming competitive for positions in these training programs. Neurosurgery residency was started and so on. For instance, in our field, Warren George was really the first trainee of Forrest Young. He came back from the war a little sooner having gone in sooner and he trained more by the fellowship or preceptorship method. I was, I think, the first formal resident who was in a white uniform and paid by the hospital a magnificent fee of $38 a month, and things like that. It was an era of growing interest in the specialties and the organization of the specialties and the training programs. There was a lot of talk about how much training in general surgery you should have before you go into a specialty as there still is...and I think it was the beginning of the formalized impact of specialties on our national picture, now through the residency programs and the American Board examinations. This is then reflected in the American College of Surgeons and the figures roughly run even to this day that about half the people who are in the American College of Surgeons represent the specialties if you count obstetrics and gynecology as one of the broad specialties. A lot of people in that area are members of the College of Surgeons. So this has been an important growth. It wasn't always very rapid. I think ifs fair to say Dr. Morton's era who grew up as broad general surgeons, they were not particularly interested in seeing a narrow area grow quickly and rapidly and in large volume, and felt that as do many people to this day in surgery that fragmentation is not the best way to care for some surgical problems, and this can be debated of course, long and hard, as to how much specialty contributes to care. Obviously the only justification for a specialty is improved care....(end of side #1 of tape)
... division into too many parts as we all know. You may lose sight of the whole and certainly at this school, a leader in the field of a total concept of the patient, the psychosocial, psychomatic side of medicine. Things that have been stressed very strongly here at Rochester, particularly since WWII with the growth of the Department of Psychiatry and Dr. Romano and Dr. Engels' influence. These are all very important contributions, and Rochester has become known as a place that looks at the total patient. I don't think we ever got caught up in being superfragmented or building such high walls that we couldn't see the other side. One of the pleasant things I think, about Strong and the University of Rochester over the years, in addition to our relatively small size, is that we've always had quite informal and easy communication between areas of interest, even between the basic sciences and the clinical sciences, and between the various specialties within surgery, within medicine. Many things that are now departments in the school were merely areas of interest within the department. For instance, in medicine, radiology when I came here in 1944 was part of the Department of Medicine, and Neurology was a one-man part of the Department of Medicine, Dr. Garvey. And so it went, in the Department of Medicine various sections developed, units in Cardiology and Nephrology, Infectious Disease and so on, but because they didn't have a special American Board in each one of those areas, although that has changed somewhat more recently with subsidiary boards of one form or another. The specialization came a little later I think in medicine, and to this day isn't quite as separate perhaps as surgery, because they don't have separate examining boards, many of them take a basic period of two or three years of internal medicine before they go into one of these areas of interest and similarly in pediatrics they do that. So medicine and pediatrics have specialized in a somewhat similar fashion. Surgery has specialized with a little more definitive identification, calling them divisions of orthopedics, divisions of urology and so on, as have many medical schools, most medical schools. Because each of them have a separate examining board, a separate residency review committee, a separate identifiable residency that you applied for as a separate thing and so on. But now of course, many of those areas in medicine are separate departments and similarly in surgery we've had a significant development of separate departments out of what was the entire Department of Surgery in the '40s and '50s and in the early days of this institution. Orthopedics became a separate department in 1975 and Dr. Mac Evarts was one of our graduates. had been at the Cleveland Clinic and came back, and brought Dr. Del-lawn and Dr. Burton with him, and rather rapidly built a large, strong and importantundefinedimportant in teaching, important in graduate education, important to the communityundefineda rather large department, rather quickly out of what used to be with Dr. Plato Schwartz, a relatively small division with Dr. Schwartz, Dr. Zuck and others, and a good bit of the clinical part-time faculty taking on quite a bit of the teaching load in those days. Well, similarly it's happened in urology. Recently urology became a separate department. Dr. W.W. Scott, who was the original Chairman of Urology, left a considerable amount of monies to the institution and a development of the Department of Urology with Dr.
(Kockitt) as the Chairman as a result. Ophthalmology became a separate department seven or eight years ago. And under Dr. Metz' leadership has grown a lot, had a lot of investigation going on, have excellent clinical facilities on the floor of the new ambulatory wing, what we still call the new hospital that opened in 1975. So all of these represent on both the medical side and on the surgical side... reflect the development of specialties in the national and international picture. The picture is quite similar all over the world with some variations in just how it's done depending on the country, but I think the early years with Dr. Morton and Dr. McCann were not particularly anxious to see formal separation, formal training programs in specialty areas, so the budgets were rather minimal. In the early days people will recall the specialty heads of the divisions were all part-time. They received a very small salary from the University of Rochester. I think $1000 a year as I recall from what Dr. Forrest Young told me, and but... in those days with Dr. Young, Dr. Schwartz, Dr. W.W. Scott, Dr. Clyde (Healey), Dr. John Gilmer, they were part-time, they had practices with... most of them had offices outside of the building, although Dr. Schwartz and Dr. Forrest Young had their offices in the building. They, in those days, we did not have a formal compensation plan, and the specialties developed essentially around those men.
Now, in fairness to Dr. Morton, he encouraged them to have areas of special interest and he is the one who told them to go work with so and so, become good in it, because I think we need, say a urologist at Rochester. Forrest Young told me that it was suggested to him after he finished his training in 1934, having come here as an intern from Stanford in 1930, Dr. Morton himself knew he was interested in reconstructive surgery in the rather broad sense of the word, and he suggested to Dr. Young that he go to Washington University of St. Louis, which is where Dr. Blair was running a well-organized and rather famous plastic surgical service at a teaching hospital at Barnes, Dr. Barrett Brown, Dr. McDowell, and Dr. Byers, it was a strong group in the '30s and throughout the war years, and then into the '50s, Barrett Brown was essentially in charge of all of the plastic surgery during the war years, organized numerous centers and services and then later on in the Veterans Administration, so Dr. Young went to St. Louis at the suggestion of
Dr. Morton and was there for around roughly six months and then came back here to Rochester and started as the plastic surgeon to Strong Memorial Hospital. And he was essentially in the very early days, Dr. Merle Scott for instance did the cleft lips and palates, but when Dr. Young got that additional training in those days, when he came back from St. Louis, he was doing the lips and palates and that was sort of the start of the plastic surgical service. There is a State of New York children's program financially to help low income families, where they have a congenital anomaly or an acquired anomaly that something can be done about, and so about to this day, as you know Lee, about a third of the work on the plastic surgical service involves children and much of it through what we nickname state aid, state medical rehabilitation program. Well, that's the way Dr. Young started and some of his earliest papers, he has one paper on surgery and gynecology and obstetrics back in the '30s, the late '30s on cleft lip and palate and it's a very good paper. And so, he did a wide variety of procedures. His early writings, he was one of the first people to write about immediate excision of full-thickness burns and skin grafting and it's so long ago now, that these older papers all get lost to... you know. we tease that if you quote a paper over 10 years ago, it's ancient history in medical terms, so he wrote about ear reconstruction, he wrote about cartilage grafts, putting them into (vitalian molds) in the subcutaneous tissue into the abdomen and making a new ear out of these little diced pieces of cartilage that grew together with fibrous tissue and then bringing it up to the ear. He wrote about many, many things, that he was really ahead of his time, and then when I was here from '47 to '49 and then the year in Milwaukee, the university called me in Milwaukee one day and said. Dr. Pearse called me and he said, "Would you come back and cover the plastic surgery service? Dr. Young is going to take a sabbatical." He was a California native and I don't think ever really got used to the winters here in Rochester, and he said, "He's going to take a sabbatical in California and think about what his future plans are going to be. If he does not come back, you might be considered, along with others, for the position. Salary: Zero." Those were the conditions I came back on from Milwaukee, which, if we made similar offers today, I'm afraid it would be rather ludicrous. But I had missed the contact with students and residents in Milwaukee, we were pretty much in straight private practice, in a nice community but I had missed the teaching side of it and the contact with young trainees, so I did come back in September of 1950, and have been here ever since as you know. So, well, I've been rambling on here. .. what... any particular questions you'd like me to...
Dr. Caldwell: Well, obviously being focused a little bit on plastic surgery, one thing that you have done among many other things was to serve as Vice-Chairman of the Department of Surgery from 1968 until 1983 and perhaps you would like to make some comments about the interface and interdigitation of plastic surgery or the other specialties and general surgery during that particular era.
Dr. McCormack: Well, it was an interesting era. Dr. Rob had come in 1960 and Dr. Duthie was here at the time in orthopedics. And Dr. Duthie was well trained and eager, ambitious for his specialty and I think many of us in the specialties at the time felt that we perhaps weren't allowed to expand fast enough. Dr. McDonald was here in urology, Dr. Snell in ophthalmology, and so on. And there were obviously limitations, financial and otherwise that you could only have so many residents in a given field, no matter how the individual felt about his own field, but I think some of us felt that the expansion was rather slow as far as trainees, as far as operating room space, as far as numbers of beds and you remember this was in the old hospital, and everyone was feeling the pinch for beds and expansion was difficult. We went so far as a matter of fact and again, I don't think this is widely remembered, those of us who were head of the specialties, got together and got up a proposal in writing to create a Department of Surgical Specialties, as we felt that departmental status would be important to the specialties, and it would be unique amongst medical schools. I still think it was a pretty good idea. It ws proposed to the Advisory Board, which as you know in that time, was the ruling body of the medical school, our Advisory Board consisting of the Chairman of the various departments and the Director of the Hospital and so on, and the Advisory Board voted negative on the proposal, so we never did establish a Department of Surgical Specialties, but the thought was behind it and then shortly, reasonably shortly after that, within eight or ten years, the Department of Orthopedics was formed. the Department of Ophthalmology, and some of those facts that I talked about before, so the expansion actually did take place with these people represented on the Advisory Board and with, well, partly in reaction I think to the problem, Dr. Orbison appointed an external committee to review the Department of Surgery, and it consisted of an anesthesiologist from Boston, an orthopedist from I believe it was either Dallas or Columbus, Ohio, and a general surgeon from Johns Hopkins. And these three people came, interviewed everybody in the department including all the specialties and essentially told their side of whatever their problems were and so on, and I don't know what their report to the Advisory Board and the President of the university said, but at any rate, some changes did occur, one of which was appointment of a Vice-Chairman of the Department of Surgery as a Dean's appointment with a seat on the Advisory Board. And I was appointed to that position and actually, and I think it was more or less, although it was never spelled out that way... you act as a citizen of the school on the Advisory Board, you don't act in only a parochial interest of your own department or area of research interest, and so on. I was appointed more or less to be the representative shall we say, of the surgical specialties, and that's what I tried to do in the broadest sense of the word as well as being a good citizen of the school. and it was interesting, it was time-consuming, of course, but it was an interesting phase in my career and I tried to contribute to the work of the Advisory Board. And I was actually on that for 13 years I believe, '68 until '80 or '81. Well, now there's a Chairman of Orthopedics that sits on the Advisory Board, the Chairman of Ophthalmology, the Chairman of Urology, obviously that's not needed anymore. And there's a lot of representation of specialty areas. So, it's within the administrative organization of the medical school particularly for a rather large department, I think it was a reasonable thing to do, because again these surgical specialties represented roughly 50% of the beds that were occupied in the hospital, 50% of the ambulatory care that was going in the clinics and the private areas, so it was a lot more than just general surgery in the Department of Surgery, so that... but now with these new departments, the new hospital having more identifiable areas, which of course again people have pros and cons about that. Instead of having the old floors that were mixed-B2, C2, X2, X1 and so on that we all rememberundefinedwe now have two orthopedic floors, we have a neurosurgical floor, we have a burn and plastic floor, and we have several general surgical floors, some of which are primarily cardiovascular and as well, of course, a surgical intensive care area. So, it's a different physical organization, the new hospital, and that has identified these specialty areas even more.
Dr. Caldwell: In this present day and age of serious consideration of our national budget, you've been a citizen of the university community for a long period of time. You've also been a citizen of the community of Rochester, New York, where I think if my facts are straight we experienced as an experimental prototype one of the first communities to participate in a 3`d party payment system via Blue Cross Blue Shield, and if you would just give us a few words about how that impacted perhaps on the school and on the community and was it divisive, or was it unifying?
Dr. McCormack: Well, the Blue Cross came first, and Blue Shield came after WWII, and people like Ed and Sam Stabins were leaders in getting this... Harry Kingsley, were all leaders in getting this accepted by the surgeons particularly and the other physicians in all areas in the community. I think in the early '50s, I don't recall exactly, I believe it was 1952 or so, essentially the Industrial Management Council, which of course, was Kodak, Xerox, Bausch and Lomb, and all the industrial representatives, essentially strongly indicated that they wanted a service-type plan in contrast to an indemnity type of service plan, whereas a service type means that up to a certain income, which is supposed to be'/4 of the people in the community, up to that income level, whatever fee the plan pays to the surgeon say, that's the fee and he will accept it, and there's no extra billing, and that kind of thing. Well, this is rather, still is rather new in the entire country to get a community of physicians and surgeons to accept this concept of a service contract. In contrast with an indemnity contract where they pay, or perhaps you pay the first 20% and then they pay 80% up to a certain amount and so on and so on... there are many different ways health insurance is written, but this service-type contract came in in the '50s and was very strong for a long, long time with essentially 100% participation. Well, of course, in those days there were also some penalties if you didn't participate, you would only get 10% of the fee, which now has been changed by various legal actions I guess, and if you are a nonparticipating physician but lived in the community, there was no question you were penalized. So there were some incentives economically to join. I think on the whole it has worked very well. All areas, all specialties worked hard on the fee schedule, there was give and take of everybody to develop a reasonable fee schedule and it worked pretty well for 25 years or so. Well. then the cost of medicine, the cost of all kinds of things, concerning operating rooms, equipment, nurses, everything went up, the cost of hospital beds. And I think it's fair to say in the last five to ten years, that concept has almost been priced out of existence. A separate private insurance company just cannot do that and foot the entire surgical or medical bill for the community, the in-hospital medical bill, ambulatory bill, etc. It's.. . so we've now gone to other mechanisms as we all know, with prepaid plans, HMOs, that have some kind of a control on them as far as the fees, but there's usually an element of extra billing somehow for a larger segment of the population. They don't try to... you know, they used to brag here with our local Blue Shield, that the doctors accepted 90+% as their total fee, even though the range of the ceiling income for eligibility for the fees was supposed to be set at 75% of the community, but it's true that 90+% of the doctors accepted those fees in full. Well, that went on for a long time, but now it's become economically almost impossible to do that. Some groups have dropped out of that concept by choice and there's more and more fine print, exceptions, so I think we're in a different era now where a single insurance company just cannot balance the budget and pay the entire fees for health care for an entire community. Even the government probably cannot do that. And Ontario, for instance, in Canada, is finding this out.
Dr. Caldwell: Well, we certainly have enjoyed your sharing your history, your personal insights and recollections attic past 42 years here in Rochester. We hope that the growth of the university, the community, will be as good in the next 42 years as it has been in the last 42 years. Dr. McCormack has been a physician, surgeon, teacher, and role model to many. He is a role model without parallel and he is a leader without replacement.
Interviewee: Dr. Burtis Breese, Emeritus Clinical Professor of Pediatrics
Interviewer: William Hall, University of Rochester
Date: October, 1984
Dr. Hall: I first met Dr. Breese about 18 years ago when I was courting his daughter and now some three grandchildren later and many, many conversations, lots of trips, interesting experiences, I think I know him reasonably well both as a father-in-law, as a friend and as someone who has had a very distinguished career in clinical pediatrics in Rochester, and in a sense was here at the beginning of the creation of this medical school and has been quite instrumental in its attaining and preserving its national-international reputation. We're going to try to have an opportunity over the next few minutes to explore some of the aspects of Dr. Breese's life, where he came from, what he did here at Rochester, and if we're lucky maybe a few words as to what he would like us to glean from his own experiences over the years, so I guess welcome!
Dr. Breese: Thank you!
Dr. Hall: And you can start anywhere you like, but I guess maybe at the beginning wouldn't be a bad place to start.
Dr. Breese: Well, usually you start at the beginning. There are times when you start at the end, you end up at the beginning... thank you. I am asked to start my, uh... where I came from. I originally came from Cincinnati, Ohio. My father was a professor at the university there. He was a psychologist and head of the Department of Psychology at the University of Cincinnati. He sent me off to my educational career with some misgivings, I guess. I think he put it most succinctly when he said, "For what I have spent on that boy's education, I could have put him in a first-class institution for the rest of his life." So, with that start we'll go ahead. The... I went actually to Princeton as an undergraduate. From there I went to Harvard Medical School, and from there to Johns Hopkins as an intern, and from there to Cornell at the New York Hospital, and from there I came to Rochester. I'd been told that Rochester was a sort of a lovely country spot, and once I arrived there I would have no further problems. They didn't tell me one damn thing about the climate, however, and when I got through the first winter with 20̊ below 0, at one point, I was about ready to turn around and give up Rochester. Now, from... I got in here as an assistant resident. First I was at Hopkins for a year in medicine. I've gone over that before: I won't repeat it. Then I went to, when I got here, I was an assistant resident in pediatrics. And Dr. Sam Clausen was head of the department there, and the group was pretty small compared to what it used to be.
Dr. Hall: About what year was that?
Dr. Breese: It was about 1935. I guess, in there. Dr. Hall: And Dr. Clausen was professor then?
Dr. Breese: He was professor, yes. And, he had a staff of... Dr. William Bradford was his second in command, and he had a third man, Fred Gachet who came from Alabama, and was a great student of glomerulonephritis. Fred was...he didn't have an awful lot of sense of humor, and I don't suppose that that held him back very much. Maybe he never got very far. But anyway, Fred Gachet was... I'm going ahead of my story, I believe. I think before I get into Fred Gachet I should go back and talk a little about Sam Clausen who was a professor. He was a very kindly
individual, had a lot of knowledge, had been brought up as a chemist under Marriott. In St. Louis, Marriott was probably one of the outstanding pediatricians of the time, and Sam came from Marriott's group in St. Louis, to Rochester and brought along with him Dr. William Bradford who has been here for many, many years and who died just last year. Brad... Brad was quite a character. He loved to tell a story, and he did quite well at it, especially if it had anything to do with baseball. It was questionable in his mind as to whether he would do better in baseball or better in medicine, and medicine won out. I don't know what would have happened had he gone on into his other love which was baseball. In any case, Brad had carved out a reputation for himself in the field of pertussis, or whooping cough. He was one of the first people to be able to culture whooping cough. He had developed a method of culturing the germ on cough plates and he developed an almost international reputation as an expert in the field of pertussis, and beside being such a wonderfully winning personality.. Fred Gachet as I said, didn't certainly have the charm that Brad had, and I remember very well, Fred was sort of a stern kind of guy brought out from the depths of Alabama, and brought here to Rochester; where he undertook teaching of pediatrics. He was meticulous about trying to get things done as far as detail was concerned. I remember one time after I had gotten into practice, I had Fred Gachet cover for me. And Fred... I left him about noon, got back at 6:00 and Fred was still going over a patient that I had left him withundefineda simple respiratory infection. But Fred's...the greatest even I remember, was one time Fred asked me to come over for dinner, and his wife asked this. And I came over to their rather cramped apartment, they had one child, and Fred asked... we sat down to dinner, and after dinner....of course, there were no drinks. Fred was not much of a drinker. And after dinner, he had coffee. And Mrs. Gachet poured the coffee out from this old-fashioned coffee-pot, and as she poured it, out from the stem came the unmistakable parts of a rectal thermometer. Fred looked up, rather his wife looked up, and she said, "Fred! I often wondered where that thermometer went!" Well, that's enough for Fred Gachet at the time. Another character with whom the Pediatric Department could not have operated was Augusta McCoord. Augusta McCoord was a maiden lady of uncertain age but with the most ridiculous sense of dressing. She used to wear, I remember full well, a sailor suit with, uh, what do they call these things on the lapels and the Augusta, let me go back to Augusta again. She could get the most remarkable results with the tiniest amount of blood from any one of the patients. She ran the chemistry laboratory and without her the department would have completely collapsed. But she used to come to grand rounds, and she knew absolutely nothing about medicine, but she'd ask these rather ridiculous questions that had no bearing whatever on the particular medical problem that we were talking about. But anyway, Augusta added a certain flair to the grand rounds that occurred in pediatrics and she pipetted in the most unconventional way, using her thumb on the pipette and not normal finger movement that is appreciated by most real chemists, but there were very few that could equal her in the results that she had. Augusta made some very good contributions to the knowledge of chemistry and pediatric chemistry, and eventually the department conferred on her a Ph.D. in chemistry, and although she'd had relatively little training, no one really deserved a Ph.D. more than Augusta. Then there was another character at that time in Rochester, Stafford Warren. Stafford Warren was a long, lanky radiologist with more ideas than a dog has fleas. But Staff had a difficulty in staying with any particular course. Once he got started on something, and he had these brilliant ideas, but he just didn't want to complete them, so it was hard to hold him on course. But he did develop a hot-box for, among other things. for the treatment of central nervous syphilis which was a terrible problem in those days. I had seen this same procedure used of applying high fever, up to 107 or 108̊F. to patients with syphilis and having them vastly improve by the procedure. However, they did this as I mentioned by giving them artificial malaria. Staff decided he could do it much better, and he built this box, and put the patients in that and got the temperature up to 108̊ or 107, whatever it wasundefinedsort of a risky business but he got away with it and really, it helped a good many of these dangerously ill patients. Among the other characters that were around at that time, I should be a little more respectful, I suppose,
rather than just calling them characters, because among them was first and foremost, Dr. Whipple, who had the great respect of everyone that knew him, and whom as I'm sure you all know, won the Nobel Prize for his work associated with anemia, with led to perfection of a method of treating pernicious anemia. Along with him, came with Dr. Whipple was Dr. William McCann. And McCann was a youthful-looking, unassuming person with great knowledge, and a perfectly superb clinician. But he didn't look old enough to be a professor, and my wife tells me that at one time he was walking down the hall and one of the nurses mistaking him for an orderly, asked him to pick up a bedpan and deliver it to where bedpans are delivered. And, Dr. McCann without batting an eye, did just that. Also among the people that were here at that time, was Dr. Murlin. Dr. Murlin had done some very basic work on the pancreas, and on the development of insulin for the treatment of diabetes. Then there was in the School of Nursing a perfectly lovely-looking, little mite of a girl, Clare Dennison. She had a good sense of humor but she had to hide it. because she had to protect all her students from the lascivious intent of the interns and house officers.
Dr. Hall: Some things haven't changed at all over the years.
Dr. Breese: I suppose so. Then at the top of the administrative group was a fellow by the name of Faxon. Faxon was an absolutely superb administrator and he did this hospital a great deal of good in settling the course that it was to take subsequently in administration.
Dr. Hall: You know, all these people now are just... we know them mainly because there are rooms in the hospital and the medical school now. The Whipple auditorium and the McCann room and the Murlin room and the Dennison room, and the Faxon room. I guess you knew all these people personally.
Dr. Breese: Well. I knew...
Dr. Hall: ...or at a distance anyway.
Dr. Breese: Yes, at a distance. As a house officer...I was here for two years as a house officer and assistant resident, and finally resident in pediatrics. The Department of Pediatrics as far as house staff consisted of resident and assistant resident, and two interns. After I finished the residency I went into practice in Rochester and it was a nice town to work in. The salary wasn't exactly remarkable. I got $44 a month and room and board to support my wife and family. There wasn't any family, so that wasn't bad. But the amounts that were paid residents weren't very great. Finally it got up to $88 a month as a full resident. Having finished up here in 1935 I guess it was, I went out into practice and tried to carry on a little bit of investigative work, some of it with... one of the things we worked on, since Dr. Clausen was interested in vitamins and was pretty much of an expert in it, we did a little work on vitamin A. One of the things was a study of the vitamin A, was trying to get it into the circulation from its body stores. And one of the best methods of doing this was with alcohol. At least that was the case in animals, and we of course had to try it out in people, and of course the people that had to undertake that were people like the resident, the visiting man, and even Dr. Nolan Kaltreider took part in it. I remember we had one lovely time in which we started with, had to keep track of the vitamin A... I don't mean vitamin A, I mean the amount of alcohol, that we consumed. See what that would do to the blood, vitamin A. And it did increase it. I don't. ...it's true that Dr. Kaltreider and I weren't in very good shape to appreciate the magnitude of that discovery, but at least we did do some investigative work there. Finally, after I'd been out and got interested very much in scarlet fever and hemolytic strep which was a pervasive organism in those early days, and I worked on that for the rest of my life more or less, as far as my clinical and professional life was concerned.
Dr. Hall: I guess that your entry into the Navy in WWII had a lot to do with that.
Dr. Breese: Well, in WWII, I got into the Navy, and the overriding problem... I got into an epidemiology outfit, and the overriding problem in the Navy, at least in this country, was strep infection. They had thousands of cases of Streptococcal infection that occurred and a very high percentage of them developed rheumatic fever, a disease that was crippling to the heart as you all know, but which has subsequently almost disappeared. We don't know why, but that's been the case. But with all the strep infections that we get in a group of a thousand men, into a camp. and within three weeks 800 or 900 of these men would come down with a strep infection, and they'll lose about 3% of them, would develop rheumatic fever. So there were thousands of them, and this occurred all through the war years that I was in the service. When I got out in practice, it seemed that strep infections should have been a problem there, and actually they were at that time, although subsequently they died off as far as frequency was concerned during the war years and shortly thereafter up to the 1950s, strep infection was a very common ailment.
Dr. Hall: I wonder during the war, you were there when the first antibiotic therapy came alongundefinedsulfa drugs. These days when we talk with medical students and house officers, it's commonplace if someone has an infection, just give them an antibiotic and no one thinks twice about it.. But there must have been kind of a sense of excitement when you suddenly had the magic bullets that really worked all of a sudden.
Dr. Breese: You're certainly correct. I remember vividly one child that was the son of an obstetrical friend of mine, and Peter developed a fulminating case of erysipelas, which in those days was frequently a fatal disease, caused a spreading rash, and often a septicemia. There was nothing to do about it, you just had to wait it out and occasionally the patient... more than occasionally, the patient succumbed. But Peter developed this rash and we had just gotten some, one of the early sulfa drugs, and with great hesitancy I gave some
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... morning he was practically clear. It was absolutely a magic bullet, and was not just coincidental as subsequently occurred. Later on the sulfonamides during the war, especially in the Navy camps, the sulfonamides no longer... lost their ability to kill the organism, and they had to be...they were supplanted by penicillin which to this day still remains the chief drug in treatment of strep infection.
Dr. Hall: Well, I guess, as I understand from our previous conversations, once the Streptococcus became resistant to sulfa, you still had the problem of the epidemics, is that right? And whole camps would have to close down.
Dr. Breese: Oh yes, once it developed... in this one camp, the amount of streptococcal infection just mounted up almost in a straight line and increasing the amount of sulfa did nothing. It was obvious, especially in retrospect, that the organism had become resistant to the drug, an occurrence which now is commonplace, but in those days, the thought that the organism would develop a resistance to the drug, didn't seem a very likely event. Now, we know that this is one of the great problems in chemistry.
Dr. Hall: Well, you must have then had to do something about the epidemiology of the disease and how it was spread around the camp.
Dr. Breese: Oh, we did all sorts of things trying to study the spread of the disease within the camps, as to how it was transmitted. Other people were working with it at the same time, because the problems in the big Navy camps of which there were four major ones and a lot of smaller ones, the problem of containing these epidemics was really major. And eventually the way it cleared up, we cleared them up, was to close some of these camps. and keep these people from infecting one another. I think maybe that's going far enough with our discussion.
Dr. Hall: OK, I know that the Navy Department thought enough of your work that there was a famous poster that we used to see around, that had a picture of you, talking about stomping on the Streptococcus. Do you remember that?
Dr. Breese: Yes.
Dr. Hall: We may be able to find that a little bit later. Well, then after the war you came back to Rochester and I think one of the... many of the interesting things about your career here is the way that you are able to combine research, clinical research, into your practice. and I think that would be worth sharing with everyone.
Dr. Breese: Well, yes as a matter of fact, that's probably as far as I'm concerned, the one contribution that I would like to be remembered for, was the fact that I found that you could combine the practice of pediatrics and research in a reasonably commendable manner that allowed us to treat Streptococcal disease much more efficiently.
Dr. Hall: Did you start up in this clinical research right away as soon as the practice opened up. or how did it...?
Dr. Breese: Oh no, of course, like everything else it started small scale and finally we got some money from some of the drug houses and we also got some from the U.S. Public Health Service and over the years, my associates and I, particularly Frank Disney, developed an ongoing program of streptococcal disease followup and treatment. It's still going on, and has produced some pretty interesting results as far as treatment is concerned.
Dr. Hall: You know, these days if somebody is going to get started in research. I guess the first thing they do is get a grant from the NIH, set up a laboratory for several hundred thousand dollars, hire technicians and all the rest. What did you do about lab equipment. space and all that sort of thing? You must have had to be pretty inventive.
Dr. Breese: Well, we did some of it in my own office, quite a bit as a matter of fact. I started out making blood plates, pouring the plates in the office, and finally I got so that we could buy the blood plates and this was the cornerstone of the followup and we cultured thousands of patients. From observation of these thousands of patients, we found out certain drugs were effective, like Penicillin. Certain drugs lost their effectiveness like the tetracyclines, which were originally quite valuable, but they later became ineffectual because the organism became resistant to them.
Dr. Hall: I guess there was a whole series of antibiotics there that resistance developed. I thought one of the more interesting things in addition to the antibiotic studies was that you got to the point where after seeing thousands and thousands and thousands of these infections. you were pretty good at predicting if a child presented with a sore throat whether it was going to turn out to be strep or not. I think, what... you used to have a score system, or a kind of a card game about that?
Dr. Breese: Oh, we developed... yes, found out that a certain group of symptoms would characterize a clinical streptococcal infection, and so we made up a score card. a 13-point score card for the diagnosis of streptococcal infection. And it worked out pretty well. If you had a score of such and such, I don't remember right now exactly what the scores were, but the chances were overwhelmingly good that they would have a strep. Whereas if they fell below it. the chances were pretty good that you didn't have a strep. And it was important because you didn't want to treat non-streptococcal infections with Penicillin and they were by and large viral things they wouldn't be helped by.
Dr. Hall: How did you get all your patients and their families to agree to all these studies? There are dozens of studies over the years.
Dr. Breese: Well, the patients realized that actually this was to their advantage, that if we could... they were sick and tired of these infections and if maybe we could by watching them with the results of our studies. observations on how the drugs affected them, could come to conclusion about effectiveness of a certain program, this was to their advantage, and we had relatively little problem with getting patients to follow through on that. They were most cooperative and of course, we didn't get into anything that we thought that the chances of having a very adverse effect was at all likely.
Dr. Hall: I think, that as usual, you are probably being overly modest. I think that some of the study design that you brought forward was very much ahead of its time. The idea of precisely identifying a population, using controls and clinical trials, and even trying to work out some algorithms for decision analysis...these are things that are now being talked about as very, very up-to-date ideas in the forefront of medical research and you've had 30 years of this I think under your belt already. I think that's one of the things that's absolutely remarkable. at the same time I think still building up what was really and still is the premier pediatric practice in the community. I know from my own experience meeting you at an airport, or going shopping with you, all those great big men with beards have come up to you and say, "Dr. Breese, do you remember me?" I think you always handle that pretty well, because I know the last time you saw those people. they were probably this tall, and in diapers, but, so I think a lot of the success in the research had to do with your ability to instill a lot of confidence in patients. Well, then. a few years ago. you decided to retire and write a book? Want to tell us about that?
Dr. Breese: Well, that book, for years I've been working on that, and finally to my wife's great delight, I got it to a publisher, and it isn't a great book, and it didn't sell very many copies. Certainly it hasn't made me very wealthy, which is unfortunate because I would have given it all to charity, and...
Dr. Hall: Maybe the university...
Dr. Breese: ...yes, probably the university, but the book was reasonably well received, and for somebody who is in practice rather than full-time work, it was somewhat of a milestone to be able to write a book on relating to what were often academic pursuits.
Dr. Hall: Well, I don't know, I guess this will come as a surprise to you, but preparing for our little interview, I went to the Science Citation Index, which is the official document that looks at how often a piece of work is cited, and your book already has been cited several hundred times per year since it's been out. So, I think other people are using it, and believing in it...
Dr. Breese: Well. I....
Dr. Hall: ...even if they don't buy it. They're finding it... it's in enough libraries that they're using it.
Dr. Breese: Well, that's good. Enough really, I think my total royalties in the last half-year was $38.00.
Dr. Hall: $38.00... well that's pretty good. That's about what you made during your first month as an intern at the old Strong Memorial.
Dr. Breese: That's right, and more than I made in the first two years as a... well, first year, in practice.
Dr. Hall: Uh, uh. Well, I guess it's hard to cover all these years in a half-hour, so do you have any observations about the field of pediatrics overall, over all these years?
Dr. Breese: Yes, I think...I've never been sorry that I got into pediatrics. They were a group of kids and their families that the future of the work depends on these children, and to do something for them, even though it's miniscule, is very rewarding. And you got to know the families and you got to know the children, some of them you got to know the children in particular who as soon as they saw you ran and hid under the bed, but by and large, they became friends and almost associates, in the health care of their children, and this is a very rewarding experience. And I think that that still exists today. I don't... don't think that pediatrics is down the river by any matter of means, and I think that maybe there are too many of them now. Of course, there are too many doctors now, according to what I've been reading, and I suppose that will develop into more balance between demand and requirement.
Dr. Hall: Well, is there anything else you want to record for posterity in terms of your career, what any lessons you've learned? They say you can't repeat all the mistakes yourself in life...
Dr. Breese: Well, it's a good thing! To repeat all the mistakes I've made... there were a number of times when you did things that... subsequent years or even almost immediately showed that you'd rather not have done. I don't know whether I have contributed over the years on balance much to civilization, I don't think it's very much. but it was I hope a little on the side of... favorable side, rather than reverse. Bill, I think that's about all I can....
Dr. Hall: OK, well I think, that although I'm a certainly biased individual in this whole situation. I think it's safe to say that you certainly have made your mark in pediatrics, in your contributions to the community and we're very much in your debt. I think you should know that.
Dr. Breese: Well, thank you very much, sir. I'm sure you're prejudiced. Dr. Hall: I think probably so.