A conversation between Peter Puchner and John K. Lattimer


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INTRODUCTION

Dr. John K. Lattimer was one of the pioneers in the medical management of tuberculosis and a founder of the field of paediatric urology. I asked Peter Puchner, who is a long-standing faculty member in the department of urology at Columbia Presbyterian, to interview Dr. Lattimer to talk to him about his career. Dr. Lattimer is not only a leader in urology, past president of the AUA and SIU and past Chairman of the distinguished department of urology at Columbia Presbyterian, but is also a noted historian. Dr. Lattimer is an expert on both the Lincoln and Kennedy assassinations and an avid collector historical memorabilia. Dr. Puchner was an excellent interviewer for this conversation because of his long relationship with Dr. Lattimer.

By E. Darracott Vaughan, Jr

INTERVIEW

Well you’ve had a great 90 th birthday celebration – you have probably had one of the longest careers in the history of urology, and you have been the leader of virtually every local, national or international urological organization. I would like to talk with you about your unique career.

I was in training from 1938 to 1942 and then went into the military for 3 years, staying on as a medical officer at the Nuremberg trials.

Can you tell us a little about your early life? Where you grew up? Early influences? What helped you make a career in medicine and urology?

One of my grandfathers was a doctor in Michigan and he took great pleasure in taking me along in his big old Buick. We would go roaring off to emergency calls and I would go with him. I spent my summers out there with him.

And this was in Michigan?

Yes, and it was an introduction to medicine, but I quickly realized that you had to become a specialist if you wanted to get anywhere, so urology attracted me when I went to medical school at Columbia with Dr. Squier. Dr. Squier had two enormous automobiles. One was a big pearl grey Rolls Royce, with a chauffeur and a footman. The next day, he arrived in a long Isotta Franchini. It was the longest car ever made. It had a purple and silver colour scheme. He would come up to the 10th floor, where a nurse brought everyone to attention, and he would conduct grand rounds, on every patient.

You grew up in New York?

Ah, yes. I had been born in Michigan, my dad was a farm boy who managed to become the chief of the ‘long-lines’ department of AT&T. He was brought to New York, so I came with him at the age of 3 years. I went through New York Public Schools and then Columbia College, where I worked out with their track team.

Was there anybody, either in grade school or high school or at Columbia College that influenced you to decide to go into medicine?

Yes! My grandfather was the main influence, and of course, his daughter, my mother, was all for it. I did it as a course of least resistance.

How did you happen to choose coming to Columbia Presbyterian Medical Center for training in urology?

I don’t remember that there was any particular thing other than going through school and watching Dr. Squier do his lightning fast operations. One of the things that happened on Dr. Squier’s watch was that the Hindenburg burned. Then Dr. Squier developed a little eye trouble and he missed a bladder tumour, so he decided to retire. He did this after he had appointed me as a resident and I never got to work with him.

Then you became Chairman in what year?

In 1955–1980 (25 years).

What did you consider to be probably your most important contribution at that time? Looking back at it.

Well, I had become involved with kidney tuberculosis, and during the war, just as Dr. Waxman came up with streptomycin as the first medicine effective against tuberculosis. At that time, I had just come out of the army and the tuberculosis programme with streptomycin was assigned to Archie Dean, who was then the Chief of Memorial Hospital. He arranged for me to be in charge of a tuberculosis project at the new Kingsbridge Veteran’s Hospital, up here in the Bronx, as the home base for the kidney TB part of the study and that’s how I got involved in it. I had got to meet all the TB doctors from all over the country. They found that the Germans had a second effective medicine against TB called PAS, that we didn’t know about. When we combined it with streptomycin, it cured about half of our patients. Then Isoniazid came along in 1954, and wiped the disease out. I would say that my major personal contribution was to run that whole nationwide VA programme on renal TB and have it work.

When did you develop your interest in paediatric urology?

After I got out of the army, one of the accomplishments of Dr. Squier had been to get the entire 10th floor of the Babies Hospital with 40 beds for paediatric urology and at that time, the paediatric surgeons dominated the field. They were very aggressive. Our material had been accumulating on Dr. Squier’s huge paediatric urology service and had never been assessed. So I went to work to see what it all showed and came up with the fact that we had 100 exstrophy cases operated upon, at The Squier Clinic. As it turned out, I was the president of the New York Section of the AUA at that time, and so I sent letters of invitation to every urologist in the country.

You’ve had a long, long career and seen a tremendous amount of change in urology and what we’ve done as a speciality. If you look over the many years you have been an urologist, can you identify one or two things that stand out in your mind as being the most important segment or contribution to the speciality?

Well I suspect that the infection field, the drug susceptibility studies were unknown up until about 1946. This testing was probably the most effective one thing against UTIs. I would think that is probably the most important single discovery. Initially nobody else cared anything about it. In another area a big advantage that we had was our Dr. Melicow, who was interested in genitourinary pathology, when nobody else was. He first described carcinoma in situ of the bladder.

Over the last years, the focus of urology has changed from infectious disease and BPH and now it seems to be focused almost exclusively on cancer. If you looked at that, what do you think has been the greatest contribution as far as how we deal today with today’s problems?

Well, cancer of the prostate, of course, is by far the most frequent. It has had a lot of attention and I think now we are getting off into the high science, which we have not had up to now, and the articles that you read now are hard to understand, because they are so complex and so interesting. As of yet, I am not sure that we’ve seen an end product that really will cure the problem.

You have had an award from the French Government. You’ve had countless other awards and recognition; which would you consider most meaningful?

Well, the fact that I was the president of the AUA, and we began to produce a lot of this work and show it at the international society meetings, the leadership came to me one day and said did I want to consider being president of the International Society of Urology? So I became the president of the SIU for 6 years, and at the same time I was president of the AUA, and as a consequence I came in contact with other leaders all over the world. I would think that was the high point of my career, being able to demonstrate all of the things we have been talking about to them, including the Russians.

Besides being a great physician, a good investigator, administrator, organizer, you’ve also had a lot of other interests for which you are very well known. Mostly, your interest in history – when did you start this interest?

I guess it started when I read about Lincoln’s assassination. It seemed to me to be perfectly straightforward. Then to my surprise a Canadian misquoted me. He said I had claimed that one of the doctors had killed him by sticking his finger in the bullet hole, which is wrong. I had to gather evidence and do experiments to support my theory. Well, then of course, Kennedy was shot, again with a head wound. Kennedy was hit in the back of the head but there was a theory that there was a second bullet from the front. Through the anatomy department I was able to get fresh skulls, and with wire sutures and brains and a plastic bag we were able to reproduce the shooting over and over. We used the same rifle, ammunition and path of the bullet with the same angles and proved the ‘single bullet theory’ was correct, but the movie-makers love to claim JFK was shot from the front, nevertheless.

You’ve also been a great provider of education. If you asked me to mentor to young physicians in training, particularly medical students, about choosing a career, why would you tell them to choose urology?

I have an inclination towards manual dexterity. I think dexterity is a must in our field, and curiosity about new things, like endoscopic techniques that are now being applied.

In conclusion, if you had a word of advice for the young urologists today, in going into practice and going into the future, what would you tell them?

I would say that they have to try all the areas in urology that they are offered and see which ones fit their particular capabilities, and see which ones to pursue. It is wonderful to see all the new techniques that are being offered, with enthusiastic advocates who are anxious to have us follow them. That is how progress will occur.

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