Rochester Academy of Medicine
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Rochester Academy of Medicine
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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 common around 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 your senses 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 occasional case 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—or Foundation—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—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, I 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 the full-time people—I think we only had five full-time people—and 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's body_ 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 faculty members. 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 at Strong. 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 he could 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; was that 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 was located 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 saving, "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 other characteristics 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 someone—a secretary or a cleaning person or someone—who 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 bag—shopping bag—full 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. |