Rochester Academy of Medicine
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Rochester Academy of Medicine
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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 with—a 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 was—sort 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 along—sulfa 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 (end of side 1 of tape) ... 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. |