ORAL HISTORY PROJECT

Lawrence M. Gartner, MD

Interviewed by Jeffrey P. Baker, MD, PhD

October 10, 2014

Valley Center, California

This project made possible by donations through the Friends of Children Fund, a philanthropic fund of the American Academy of Pediatrics.

2018 American Academy of Pediatrics Elk Grove Village, IL

Lawrence M. Gartner, MD Interviewed by Jeffrey P. Baker, MD, PhD

Preface i About the Interviewer ii Interview of Lawrence M. Gartner, MD 1 Index of Interview 97 Curriculum Vita, Lawrence M. Gartner, MD 100

i

PREFACE Oral history has its roots in the sharing of stories which has occurred throughout the centuries. It is a primary source of historical data, gathering information from living individuals via recorded interviews. Outstanding pediatricians and other leaders in child health care are being interviewed as part of the Oral History Project at the Pediatric History Center of the American Academy of Pediatrics. Under the direction of the Historical Archives Advisory Committee, its purpose is to record and preserve the recollections of those who have made important contributions to the advancement of the health care of children through the collection of spoken memories and personal narrations. This volume is the written record of one oral history interview. The reader is reminded that this is a verbatim transcript of spoken rather than written prose. It is intended to supplement other available sources of information about the individuals, organizations, institutions, and events that are discussed. The use of face-to-face interviews provides a unique opportunity to capture a firsthand, eyewitness account of events in an interactive session. Its importance lies less in the recitation of facts, names, and dates than in the interpretation of these by the speaker. Historical Archives Advisory Committee, 2017/2018 Jeffrey P. Baker, MD, FAAP, Chair Lawrence M. Gartner, MD, FAAP Jacqueline A. Noonan, MD, FAAP Tonse N. K. Raju, MD, FAAP Stanford T. Shulman, MD, FAAP James E. Strain, MD, FAAP

ii

ABOUT THE INTERVIEWER

Jeffrey P. Baker, MD, PhD Dr Jeffrey P. Baker is Professor of Pediatrics at Duke University School of Medicine. Aside from residency training at the University of Colorado Health Sciences Center in 1985-88, he has received both MD and PhD degrees from Duke University (1984 and 1992 respectively). His PhD, obtained in history of medicine in 1992, produced a dissertation on the history of premature infant care that later translated into his book, The Machine in the Nursery: Incubator Technology and the Origins of Newborn Intensive Care (Johns Hopkins University Press, 1996). He has served as a faculty at Duke University since 1992. Dr. Baker currently serves as director of the Trent Center for Bioethics, Humanities, and History of Medicine, in addition to having directed the Center’s History of Medicine Program since 2005. Along with Dr. Howard Pearson, he co-edited and helped write the 75th year anniversary history of the American Academy of Pediatrics, Dedicated to the Health of All Children. His research and writing in medical history has covered a range of topics including neonatal medicine, the rise of preventive pediatrics, vaccines, and most recently autism. He has known and admired Dr. Gartner since his days in graduate school, at which time Dr. Gartner kindly provided him a room in his house while researching the early history of neonatology in Chicago.

1

Interview of Lawrence Gartner

DR. BAKER: We are here today in Dr. Larry [Lawrence M.] Gartner’s study in his ranch in Valley Center, California. I’m Jeff [Jeffrey P.] Baker with the Historical Archives Advisory Committee of the [American] Academy of Pediatrics, and I want to first thank you, Dr. Gartner, for spending time with us. I also want to thank you for the time you’ve spent spearheading the Neonatology Oral History Project. Dr. Gartner sat on the other side of this interview table with 17 different people. DR. GARTNER: Seventeen. DR. BAKER: And, just speaking as a historian myself, that project is going to be such a wonderful resource for the future. I’m glad we finally have had a chance to sit down and to hear your story today, which is our task here. We have three major goals today. One is to learn about yourself, how you got to be where you are. We want to learn for future researchers your own clinical, scholarly, and other contributions to the field of pediatrics. And finally, as you know, because this is an oral history for neonatology, we want to hear your reflections about the evolution of neonatology of a specialty. We’re going to follow a format. It’s a format that you’ve played a role in developing, so we’ll go through a series of questions having to do with each of those broad goals, but I want to make clear that you at any point have the opportunity to wander off script and share something that you see as being important as well. Does that sound OK? DR. GARTNER: That sounds fine. DR. BAKER: I hope this will be a good experience overall and I’m looking forward to hearing your story. So, we’re going to start with your own story and at the beginning. I’d like to just hear about your own origins, a bit about your parents and childhood and early schooling. DR. GARTNER: Well, I was born in Brooklyn at Israel Zion Hospital, now Maimonides Hospital. Both of my parents were born in New York. I think my father was probably born in Manhattan. My mother was born in Brooklyn. Both grew up in New York City and went to City College [of New York]. My mother’s family came from an area near Minsk in what was then White Russia, now Belarus. It was a small town that I’ve never visited but have heard about because it’s where Chaim Weizmann came from, who was a remote cousin. My grandmother always had a picture in the dining room of herself with Chaim Weizmann, ice-skating. DR. BAKER: OK. (Laughs)

2

DR. GARTNER: My father’s family came from somewhere unknown in the Austria, Poland corridor. We don’t know exactly where, but both the families came here in the late 19th century, around the turn of the century, and both were fairly large families. My mother’s family was, particularly, a very large family. Nine Brimberg brothers came, each with their families, and one of them, in fact, had 22 children. DR. BAKER: Wow. DR. GARTNER: Two wives, but 22 children; 2 wives in sequence, not together. DR. BAKER: I wonder if that destined you for pediatrics. (Laughter) DR. GARTNER: And miraculously, I think all 22 survived into late adulthood, and now those are all gone. Actually, the child of the youngest of those 22 is also a neonatologist. DR. BAKER: Any other stories about the conditions or why the two families emigrated at that time? DR. GARTNER: Oh, I imagine for reasons of religious persecution and economic issues. I don’t know much about my father’s family. My mother’s family, they were mostly carpenters, lumbermen. When they came here my grandfather, my mother’s father, Max Brimberg, was a builder. He built a lot of houses in Brooklyn and, for a while, was very successful and then, at some point, lost a good deal of money during an economic depression. I think, he died fairly poor. I never met him, he died before I was born. The family all worked. Three of my mother’s brothers were auto mechanics, one a steel fabricator and one in the raincoat business. My mother herself went to City College, as did my father, and my mother worked for the Federal Reserve Bank in New York before I was born. After I was born, she stayed home and looked after my father and me. I’m an only child and grew up in a rather nice, middle-class area of Brooklyn in an apartment house and went to public schools. I went to James Madison High School, and I have many colleagues who graduated from James Madison High School. It was a very good high school. It was probably a good high school because I had a lot of good classmates. I always wanted to work in a laboratory. I was greatly influenced by Arrowsmith, the book. DR. BAKER: Oh, Sinclair Lewis. DR. GARTNER: Sinclair Lewis. What I always wanted to do was work at the Rockefeller Institute during summer vacations. I tried every year to

3

get a job at the Rockefeller. Just this past month I was talking to somebody who worked at the Rockefeller, and he said they never took young people during the summers. (Laughter) He said it was quite hopeless that I’d ever get anything there. DR. BAKER: Do you remember how old you were when you read that book? DR. GARTNER: Oh, probably in high school, probably 15, 16 years old. DR. BAKER: That’s a great story, isn’t it? A young doctor growing up, trying different paths, and ends up in research. DR. GARTNER: That’s right, and I always wanted to do laboratory work. Well, my first laboratory work was different. My father worked for a sugar refinery, molasses, and syrups company which had its office on Wall Street in New York and its factory, a big sugar refinery (Sucrest Sugar, Grandma’s Molasses, Nulomoline), in Brooklyn, in Red Hook. I got a job there, one summer when I was about 17, as a dishwasher in the laboratory and gradually learned to do sugar chemistry and routine analyses for the factory, and bacteriology. I did both of those, and would occasionally fill in when somebody was on vacation and that sort of thing. I actually worked there 5 summers, and I loved every minute of it. It was great fun. They were nice people, and the guys in the lab would always tell me, “Don’t go into chemistry. Don’t go into bacteriology. Go into medicine.” (Laughter) So I took their advice. DR. BAKER: There was a lot of camaraderie, it sounds like. DR. GARTNER: Yes, it was fun. They were nice people, and I remember them all very well. I decided -- just a side issue -- while I was there that I would make some rum. After all, we had millions of gallons of molasses and syrups, and I said, “Well, I’ll just make some rum.” So, I went downstairs where they had a very nice library in the building, and I found a book on making rum, and followed the directions, diluting the rum, adjusting the pH, adding the yeast. Everybody was very nervous about my making alcohol, because the federal revenue people would come regularly because the lab had a lot of ethyl alcohol that they used for testing purpose. And the fear was that they would find me making alcohol. This was long after Prohibition, but there are still a lot of restrictions about the manufacture of alcohol. But, they let me make my rum, probably because my father signed their pay checks. I made the rum in a big carboy, one of these big glass carboys. It was huge, and then I set up a still, and I distilled it. I got probably 2 or 3 liters of nice, clear alcohol. (Laughs) And then, I didn’t know what to do with it, and I wasn’t even sure it was rum. I thought rum would be dark-colored. Well, rum actually is clear. And the dark color is created by adding coloring to it.

4

DR. BAKER: It is clear. So what did you do with it? DR. GARTNER: Well, one of the other people in the lab, the bacteriologist, said that his fish had ich [Ichthyophthirius multifiliis], whatever ich is, and that alcohol was good for it. So, he took all the alcohol home. (Laughter) I hope he didn’t drink it. DR. BAKER: But we don’t know what happened. DR. GARTNER: No. DR. BAKER: So there were really 3 kinds of things that led you eventually to science and research: Arrowsmith, working in the factory, fermentation. You shared that interest with [Louis] Pasteur, I might add. DR. GARTNER: That’s true. (Laughter) I didn’t think of that, but you’re right. DR. BAKER: Any other influences from early life you’d like to share with us? DR. GARTNER: Well, a lot of encouragement from my parents, particularly my mother, who really wanted me to be a doctor. I don’t think there’s any question about that. The other influence, which was very important and probably the most important in going into pediatrics, was that I had a pediatrician in Brooklyn. He was the pediatrician for all my cousins, as well, Dr. Jacob Rosenblum. He had a busy practice, but he used to make house calls when I was sick. When I was 11 years old, I had rheumatic fever. Fortunately, without any cardiac involvement, but I had a lot of joint inflammation. He used to come to the house, and I would also go to his office. He was looked upon by the family as a bit of a demigod. (Laughs) He was very important and a very nice man, and I continued to go to him, actually, until I was maybe 21, 22, when he said that he thought I really ought to go to some other doctor. However, I continued to see him and to visit with him. I don’t know how often, but I know I did go there. After I graduated from medical school, toward the end of my pediatric residency, he offered me his practice. He said, “Would you like to take over my practice?” He had this very successful practice in Brooklyn on Rugby Road, and I had to tell him that, “I really want to do research and be an academic pediatrician.” He was a great influence on me. DR. BAKER: It’s nice to see how different streams came together for you.

5

DR. GARTNER: That’s right. DR. BAKER: You really had some pretty solid science dreams, but he’s really more of a classic clinician. DR. GARTNER: That’s right. I think he was the last of the American physicians who took some training in Germany, probably just before the Nazi era. So somewhere in the early 1930s or late 1920s. DR. BAKER: OK. Well, that was an interesting set of influences. DR. GARTNER: A nice, very nice man and a big influence. DR. BAKER: Maybe before we move on to talking about college and medical school, can you say a bit about your earlier education or education before medical school? DR. GARTNER: Well, I went to the public elementary school and junior high, then to James Madison High School, which was a very good school. The students there were really an outstanding group, many of whom have become academic leaders. There are apparently a very large number who became presidents of universities and two who became very famous as judges. One of them is [Ruth Bader] Ginsburg, who I went through high school with. She was in my class. We were not really friends, and I don’t remember her being a great scholar. She was a cheer leader. DR. BAKER: She picked up later on. DR. GARTNER: She did very well. (Laughter) DR. BAKER: She did fine. DR. GARTNER: And the other one is Judge Judy [Sheindlin], who was not in my class. She went there later. It was an interesting group of students with very high interests in education and scholarship and literature, art, a very interesting group of students. I think that had a big influence on my life and my own interests in literature and art and such. DR. BAKER: I was just thinking of that. It sounds like it was a group of students with a wide variety of interests. DR. GARTNER: Yes. DR. BAKER: It wasn’t particularly a focus on science or medicine.

6

DR. GARTNER: No. In fact, I had a group of friends, and every weekend we would go to Manhattan or somewhere in New York and go to museums, go to the theater. We went to Broadway shows probably once a month, maybe more often, for 90 cents, I think. You could sit in the second balcony and see all the great Broadway shows, so that was a big influence. Another group of friends and I made a telescope. We ground a reflective lens. We never got it finished, but we learned all about grinding lenses, and we actually ground the lens. And somewhere along the line I’ve lost the lens. I used to have it. It never was silvered. It had to be silvered to be usable, but it was finished otherwise. It was a 6-inch reflector. DR. BAKER: That was a substantial lens. DR. GARTNER: And it took us many, many hours of going around a barrel on which it sat in a specific way, and you had to move around to grind it properly into its parabolic form. I did a lot of interesting things as a kid, and my father was always very supportive. He would drive us to all the places that needed driving, although most of the time we took the subway. New York City was our playground, and we really took advantage of New York and went everywhere. I had an interesting childhood even though I had no siblings. DR. BAKER: Well, you sure did, it sounds like. Do you have any other stories you want to share about, before college? DR. GARTNER: Not that I can think of. They’ll come to me. DR. BAKER: Why don’t we move on to college at this point? DR. GARTNER: OK. Well, I applied to a number of Ivy League schools and did get accepted to all of them. Harvard, Columbia, Cornell were the 3 I applied to, and my parents were reluctant about my going out of the city and going to Boston. I guess my own inclination would have been to go to Harvard, but they said, “You know, Columbia [University] is just as good. Why don’t you go to Columbia?” So I did, and I did live there, in a dorm. It did have the advantage that I could bring my dirty clothes home on the subway a couple of times a month. (Laughs) DR. BAKER: Important. Not an advantage to be belittled. DR. GARTNER: Right. So I went to Columbia, and I was a pre-med, but at that time Columbia did not require you to have a major. In fact, nobody majored. And for pre-meds, that was a great advantage, because you could take a wide variety of courses as long as you took the requirements for medical school. So I took the chemistry and the biology courses and physics and so forth, but it left enough room to take a lot of other stuff including a

7

course in philosophy of aesthetics, which I really didn’t understand, with Irwin Edman, a great aesthetician. A funny story about this: I was a senior at the time I took this course. You had to write 4 papers, so I wrote my first paper, and he gave me a C. So, I went to him, and I asked him what I should have done, what was missing, and he said, “Mr. Gartner, you’re not a graduate student. What are you going to be doing?” I said, “Well, I’m going to medical school.” By then, I had been accepted, and he said, “Oh, OK.” And he took the paper, crossed out the C, and gave me a B. (Laughter) Well, this went on 4 times, and I never did find out what it was that I was supposed to learn. DR. BAKER: That was the extent of the feedback. DR. GARTNER: So, I’m afraid my knowledge of aesthetics is limited. But, anyway, Columbia was really a wonderful experience in general education. I think the experience was a very good one. In high school I was the editor-in-chief of the school newspaper. So, when I went to Columbia, I got involved with The Spectator, which was the student newspaper, and eventually became an editor in my senior year. And, in fact, I was the education editor, and I actually taught journalism, which I had done in high school when I was editor there. I taught, essentially, journalism writing to the freshmen who applied and wanted to be on the newspaper. That was great fun. DR. BAKER: I bet so. Are there any other particular courses or teachers in college that stand out to you? DR. GARTNER: There were a number of teachers who were really very good, particularly in what was called CC, Contemporary Civilization. Mr. [Arthur] Danto was one, who just recently died. We have a friend here in Valley Center who was a good friend of his and a retired professor. I’ve had a lot of good teachers. One of the most interesting, actually, and relevant to my own interests was one named Professor [James] McGregor, who taught evolution. He was well up in his 80s when he was still teaching. I took his course, which was quite popular, in evolution. He had been teaching this course continuously for more than 60 years, which meant that he started teaching not long after Darwin published. DR. BAKER: And he had seen the theory go through a lot of changes, a lot of developments in genetics. DR. GARTNER: Indeed. Absolutely. And he told us all these stories, and one of them was -- if you remember Piltdown Man, which turned out to be a fake? One of the things that Professor McGregor was most noted for is the heads he carved of the evolutionary humanoid figures. In the biology building attic, they had all these heads that he had made. Well, he had been

8

asked to make one of Piltdown Man, and he looked at what the bones looked like and what they had as evidence of this, and he said, “I started to make it but stopped because it was wrong.” He destroyed the model he had made. He said something didn’t fit right. DR. BAKER: He could tell. DR. GARTNER: From his experience, so he never made the head of Piltdown Man because he said there was something wrong with it. So, of course, it turned out he was right. (Laughs) DR. BAKER: He was right. This was before the hoax had been exposed. That’s very interesting. DR. GARTNER: But he was really quite fascinating. DR. BAKER: That speaks well for him as a scientist, though, because quite a few did get on board with that one. DR. GARTNER: Yes. Right. He was really sharp. Another interesting sort of sideline, I took a course in labor history, which was also very interesting. It was taught -- I can’t remember the name of the professor, but he had been the labor minister in the Kerensky government. DR. BAKER: Oh, in Russia during the brief interval after the czar fell, before the Soviet regime. DR. GARTNER: Before the Communist regime, right, and so he was very interesting, and it was an interesting course. DR. BAKER: That’s very unique, because I was trying to get a sense of where your interest in history developed, whether it went back a long way or whether college was a formative time for it. DR. GARTNER: Probably in college. I can’t remember any particular interest in history before that time. Anyway, those are really some of the nice memories I have. I had 3 roommates. I had a roommate in college for the first 3 years, David Russell Williams, a very good musician, a pianist and composer who went on to become head of the performance program at Eastman School of Music, and then he went to Memphis State University, now The University of Memphis, as chairman of the music department. He just died last year. He was a super person, interesting, very bright. I learned a lot about music from him. He would tell me about modern music and try to teach me something about it. We often went to concerts together, and I remember those very well. Once we went to a concert at the Museum of

9

Modern Art. It was a concert of new computer music, an early attempt at electronic music. Copland sat right behind me. DR. BAKER: Oh, Aaron Copland. DR. GARTNER: Aaron Copland sat right behind me, and throughout the entire presentation of the music he mumbled how terrible this was. (Laughter) He was really quite rude. DR. BAKER: I want to move on to medical school. DR. GARTNER: I applied to a fairly large number of medical schools, as one always did. For [Johns] Hopkins [University] I had an interview in New York at Goldwater [Memorial] Hospital early in my fourth year of college. Goldwater Hospital is now being torn down because that’s where the new Cornell Tech college is being built, on what I used to call Welfare Island, which is now Roosevelt Island. The Island had 3 hospitals, essentially chronic disease hospitals for the poor. One was very old and closed. The other 2 were newer and active at that time. DR. BAKER: OK. With a pretty long history, if I recall. DR. GARTNER: Oh, yes, it goes back a long way. It’s a fairly large island sitting in the middle of the East River. A great location. Anyway, so I went there for my interview, and the one who interviewed me was J. Murray Steele, who was a professor of medicine at NYU [New York University] and a Hopkins alumnus. I received an acceptance only a few weeks after the interview. This was long before I ever expected to hear anything from any medical school, so early on in my fourth year of college I knew where I was going. That was really where I wanted to go. And some of my desire to go to Hopkins was because of its reputation and its history. I am certainly glad that I went to Hopkins. My interest in history really gelled as a medical student. DR. BAKER: I could certainly see that. DR. GARTNER: I withdrew all my other applications. J. Murray Steele ran a large research laboratory at Goldwater Hospital, mainly on cirrhosis. There were 2 large wards in the hospital, probably a hundred patients with cirrhosis, mostly alcoholic cirrhosis. He did a lot of work on electrolyte balance, fluid and electrolytes, and had a very active laboratory. I now had a free summer after college graduation and before medical school, so I called up J. Murray Steele and asked him if I could have a summer job working in the lab, and he said, “Oh, sure.” He was a wonderful man.

10

DR. BAKER: Oh, just like that? DR. GARTNER: I worked there every summer, throughout medical school, because we had 4 months off. We ended in May, the end of May, and didn’t begin until the end of September, so we had 4 full months. It was the kind of research which I particularly liked and did later for my own research. Whole animal physiology. They had a lot of chronic dog preparations studying fluid and electrolytes and gut transfer. DR. BAKER: And with a focus on cirrhosis? DR. GARTNER: Yes. DR. BAKER: So, your interest in the liver begins to percolate at this point. DR. GARTNER: The liver may have begun there, although that’s not really where my major impetus in the liver came from. DR. BAKER: No? OK, I just shouldn’t rewrite your history. (Laughter) DR. GARTNER: It may have had an influence, but the Goldwater lab was a very interesting place with a lot of good people. I used to join medical rounds on the cirrhosis wards. After the first year, I was a medical student, so I had a little more knowledge about all of this. I really enjoyed it tremendously. It was a great, great experience. In fact, one of my old high school friends, who was a medical student at Harvard, also got a job there. One of the requirements at Hopkins was that you had to either have passed 3 years of both college French and German or take an exam in one or both at Hopkins. DR. BAKER: That was a requirement at Hopkins at that point? DR. GARTNER: That was a requirement at the time I was accepted. I could fulfill that requirement because I had German in college, and I had had French in high school. So, I was in the midst of taking a refresher course in French. Otherwise, I didn’t think I’d pass the exam, and I’m not a great language student. I was about halfway through the French course and struggling when I got a letter from Hopkins saying that only one language was now required. So, I dropped the French course. DR. BAKER: Let’s jump to Hopkins, and tell us what year it was that you arrived there with high expectations, presumably. I’d like to hear how the experience actually was.

11

DR. GARTNER: OK. Well, Hopkins was a great experience. I graduated from Columbia in 1954, which is known as the bicentennial year because it was the 200th anniversary of Columbia. I entered medical school in 1954 with great trepidation on the part of my parents because I was going to live in Baltimore where I had some cousins, but in a part of Baltimore that was not good. I shared an apartment with another first-year medical student who is still a close friend named Harry Beskind, who’s a psychoanalyst, psychiatrist. He and I rented an apartment on Broadway, a couple of blocks up from Hopkins medical school and the hospital buildings. At that time in Baltimore, that area was reasonably safe. It got a lot less safe a few years after I graduated. Now, it’s probably gotten a little bit better, but at that time we were told it was perfectly safe to walk anywhere in Baltimore if you put on your white coat. And medical students all wore white coats. They said, “You can go anywhere in Baltimore. Nobody will bother you.” And, in fact, we did that, and nobody bothered us. DR. BAKER: So that was true for all the medical students. You never heard of an incident happening. DR. GARTNER: Not at that time. Later, the white coat became a target, and it changed considerably. That was after I was there. So I was there for the 4 years, and then I also continued on for one more year as an intern at Harriet Lane [Home], Hopkins original children’s hospital. I had 5 years in Baltimore. And it was a wonderful experience. I just loved Hopkins. I still do. History had a big influence because the professors, when they gave their talks, talked about Hopkins history and the great names and the great people there, [William Stewart] Halsted, [Howard] Kelly, and [William] Osler. DR. BAKER: Yes, don’t leave him out. (Laughs) DR. GARTNER: All the great names, and it really was part of the teaching. There was the heparin sink, which was still there, where heparin was discovered. I’m sure it’s not there anymore. History was all around you, and, of course, the great painting of the Four Doctors [John Singer Sargent] in the Welch Library. DR. BAKER: So, history was really woven into the education. DR. GARTNER: It was then. I think it was of enormous importance in the education experience, because you knew where what you were learning came from. You knew who did it. It had a human touch to it. It wasn’t abstract, and I just found it fascinating. That really is where I began my interest in medical history. In fact, so much so that I recently have promised Hopkins, in my will, a fair-sized chunk of money to support a program for students to do work in history of medicine. We have started the support already. All first-year medical students have to do a research project, and

12

among the things they can select is history of medicine. There’s a big program in history of medicine at Hopkins. I set this up so that any first-year student who chooses a project in history of medicine who needs money for travel or for materials for their research project could apply and get funded. I thought that would encourage students to go into some work in history of medicine. DR. BAKER: That would be a wonderful idea. I know faculty there. They definitely do still have opportunities for students to do history. That’s wonderful. DR. GARTNER: Right. So, I’ve continued my commitment to history at Hopkins. DR. BAKER: You know, sometimes medical school, especially in the 1950s and 1960s and 1970s, became an experience of trying to just swallow an incredible number of facts and master them over a time period. This sounds like it was very different than your experience. DR. GARTNER: Hopkins was not that way. One of the things they did is they would never tell you what books to buy. That was a standard thing all through medical school. They said, “You go to the library, look at the books. You’ll buy a few books. You may not like them all, but you’ve got to do it yourself.” And I thought that was really good pedagogical technique because you became critical about the books as well. There was a great deal of freedom to do things in the hospital, in the laboratories. You could do research with faculty. I actually did some research in the department of psychiatry, peculiarly enough, but it was with someone who was doing work on endocrine effects on behavior in rats. I honestly don’t remember the specifics of his program, but he taught me how to do rat adrenalectomies, and I did that in his lab for a while. DR. BAKER: In which year? DR. GARTNER: This must have been first or second year. I can’t remember. DR. BAKER: First or second year? DR. GARTNER: Somewhere early on. It was more of this whole animal physiology, which I really continued throughout my career, so it had that influence. But you also were free to go to the emergency room. That was the entertainment on a Saturday night. You went to the Hopkins emergency room, and you could work there.

13

DR. BAKER: This is as a first- or second-year student before your clinical rotations? DR. GARTNER: Yes, Harry Beskind, my roommate, and I used to go to the emergency room very often. They would let us suture the lacerations, which came in in droves on a Saturday night. So, you just were in the environment. I had an interest in surgery, and I probably should have been a surgeon. I wasn’t a surgeon because I didn’t like the surgeons who were there. Then, I thought of being an obstetrician. That was the other interest in surgery, which I probably would have liked, but I also didn’t like some of the obstetric residents. Some of them were fine, but I decided that wasn’t what I wanted. I liked the pediatric faculty and the residents, so pediatrics it was. But, neonatology comes close to the surgical with a lot of hands-on technical stuff. When I was a child I had a wooden sign on my bedroom door: ‘Dr. Lawrence Gartner, Pediatrician.’ So, back to my roots. DR. BAKER: The field of pediatrics with procedures. DR. GARTNER: That’s right. That’s right. So that’s how I got involved in neonatology. But, anyway, Hopkins really had this wonderful freedom to do what you wanted, and there were very few exams. Exams were not a big thing. There were grades, but we never were told our grades. I don’t know what grades I or anyone else got. The only hint I have of grades in medical school was that I won a book award from Appleton-Century Crofts, and I could pick whatever book I wanted. I picked a dermatology book because it was very expensive, (laughs) and I thought I ought to have one. I still have it here. And when I won the award, I got a letter; it said, “This went to the student with high academic achievement.” DR. BAKER: But that’s how you found out. DR. GARTNER: That’s how I found out. DR. BAKER: Was there a sense of camaraderie among the students in that kind of setting or more competition? DR. GARTNER: There wasn’t a lot. There was some, but not a lot of either competition or camaraderie. I don’t remember that being a big thing. They had fraternities and such. That wasn’t my thing. I was probably way too serious. (Laughs) DR. BAKER: Can you comment on interactions with faculty, say, outside of the classroom? Were there many opportunities at that point? DR. GARTNER: No, not that I remember during medical school. During internship there was some, but not during medical school.

14

DR. BAKER: So, we might come back to that. DR. GARTNER: My advisor was McKusick, Victor McKusick, who actually became a good friend and was very good, very helpful, though none of my interests were shared with him. He was just my advisor. DR. BAKER: Would you like to comment any more about your clinical experiences on the wards there? DR. GARTNER: Yes, well, I mean, we had a fair amount of good clinical training; although some things were completely missing, like breastfeeding, which was never even mentioned. DR. BAKER: Oh, dear. We’ll come back to that, clearly. DR. GARTNER: (Laughter) I’ll come back to that in a moment because it really was very influential. The way I got interested in neonatology is sort of peculiar. The premature infant unit in the old Harriet Lane Home, have you ever been there? DR. BAKER: Never, no. DR. GARTNER: I mean, it’s gone now, but it was a 5-story, old brick building with big open wards. There was a preemie unit that had been carved out, obviously later, and it was always locked. And students did not rotate through the preemie unit and didn’t even go in there. That was not part of the pediatric rotation. So, I knew it was there, but never saw the inside. DR. BAKER: Because it was run by the nurses? Were the nurses doing primary work? DR. GARTNER: No, no, this was just not part of the rotation. DR. BAKER: It was not part of the student’s experience. OK. DR. GARTNER: So, one day I was walking down the hall past the locked door to the preemie unit, and one of the residents, stuck his head out of the door and said, “What’s your blood type?” (Laughter) And I said, “My blood type?” “Yes.” I said, “B-positive.” “Oh,” he said, “come on in.” DR. BAKER: I think I know where this is going. (laughs) DR. GARTNER: And he said, “Would you give some blood?” And I said, “Yes, I’ve been giving blood a lot anyway.” And he said, “Can I take 50

15

cc’s?” I said, “Yes, sure.” So, I put out my arm. He put a tourniquet on, drew my blood, and walked over to some preemie and injected the blood into the preemie. DR. BAKER: No kidding. DR. GARTNER: Yes. (Laughter) And he said, “Would you like to look around?” DR. BAKER: So, this is the ticket that got you into the preemie nursery for the first time. DR. GARTNER: That got me in the preemie nursery. “Do you want to look around?” I said, “Oh, yes.” DR. BAKER: What do you remember of how the place looked at that point? DR. GARTNER: Well, what I remember was that there was an office area with big glass windows behind the desk; on the other side were the incubators. And I honestly don’t remember what kind of incubators; they may have been the old Gordon Armstrongs, the tin rolling carts, but there must have been some early Air-Shields incubators, as well. They must have had some Air Shields because I remember it was easy to see the babies. What I do remember was that they had umbilical tape, long umbilical tape attached to the toes of a number of the babies. They took the tape from the baby’s toe out of the hole in the top. You know, there’s a hole for weighing. The tape went across the top of the door and were hung above the nurses station with labels naming which baby it was attached to at the other end. And when the babies had apnea and stopped breathing, you would pull the string and get them breathing again. DR. BAKER: You would pull the little tape. (Laughs) DR. GARTNER: I think it was Bob [Robert] Neerhout who was the resident who invented this idea, and we used to call it the ‘Neerhout Stimulator.’ That was my introduction to the nursery. I thought this was the most fascinating place in the whole building. I like the idea that there were a whole bunch of babies, all sort of the same, and there was something about it you could study. You could collect data. You could observe the whole thing. It was sort of an enclosed research environment, and that was really where I began my whole interest in newborns. That was a big influence.

16

The breastfeeding influence came later. As I said, nobody ever talked about breastfeeding. I mean, you never saw it, never heard anything about it, didn’t know anything about breastmilk. In fourth year we would do general pediatric clinic. One day, I had a patient who was new to the clinic. The baby must have been 4 or 5 months old. While I’m taking the history, the baby becomes fretful and crying, and the mother took the baby, lifted her blouse, and put the baby to the breast. I had never seen anyone breastfeed, and I talked to her a little bit about this. She had come from Germany relatively recently. She was not the typical patient that we saw. I just thought this was the most interesting thing, and the whole concept of it was amazing to me. So, I got interested in breastfeeding from that point on. I didn’t do very much until later, and I’ll get to how I got more involved in breastfeeding, but from that point on I just thought it was interesting. And I’ve always been more interested in normal physiology than disease, although I certainly did a lot of liver disease and bad disease stuff in neonates and older kids. My real interest, and certainly my research interest, is in understanding normal physiology, and this fit right in with that interest. At that time, I didn’t know how important or good breastfeeding was, except that it seemed like a normal, natural thing, and somehow it must be important. DR. BAKER: It sounds like this was not the normal way to feed a baby at this point in time. DR. GARTNER: At that time, no. DR. BAKER: And suddenly, seeing this one woman who was a recent immigrant, it just made you think harder, “What is normal? What are we doing here?” DR. GARTNER: That’s right. So that’s what happened there. During medical school, after my second year, I was married. It was an interesting story. After my first year of medical school when I came back for summer vacation back home, most of my friends had gone and weren’t around, or they may have been still in school because this was probably in late May. I lived in an apartment house and a neighbor across the hall who was a teacher of mathematics in high school, said to me, probably for the 10th or 12th time, “I have just the girl for you. Would you like her number?” And, of course, for many years I had said, “No, that’s OK, Bea. Sometime.” Well, this time she said it, and since I didn’t have any girl friends around anymore I said, “Yes, why don’t you give me her number?” (Laughter) So she did, and that was Carol’s number. And so, I called Carol up. I was supposed to meet her family. Her father was a dentist, and they lived in Brooklyn. Carol’s mother taught earth science in the same high school as

17

Bea, and that’s how they knew each other. That’s how she knew Carol. We were supposed to go out on a date, but Carol got sick with the flu or something. So, we had to cancel that, and then her family went out to Long Island. They had a summer place in Long Island, and they were out there. I called up and said, “Are you feeling better? Would you like to go out?” She was surprised because she thought, once they left Brooklyn, they’d never hear from me, but I was persistent. So, we went out on our first date. We went dancing at Guy Lombardo’s East Point House. It was a bandleader’s nightclub on Long Island. It was very nice, and they had great dance music, and we talked, and we danced, and that was it. And then, we started going out, and we were married the following summer in August, just after Carol graduated from Cornell [University]. Bea was right, this was just the girl for me. During the year before we got married I travelled by bus at night from Baltimore to Ithaca, New York several times, a harrowing experience at night. (Laughs) DR. BAKER: Harrowing in -- DR. GARTNER: It’s eerie in bus stations late at night in small towns and even in Harrisburg, Pennsylvania. (break in audio) DR. BAKER: OK, I’m resuming again. DR. GARTNER: Anyway, so I went up to Ithaca a few times, and Carol came to Baltimore once, and then we were married in August. After graduation from Cornell, Carol planned to go to graduate school. She had a Woodrow Wilson fellowship and she wanted to go to Hopkins and do her Master’s and PhD in English. The chairman of the English department interviewed her and said that she had all the credentials, but they weren’t taking any women that year because of the, quote, “high rate of attrition of women,” which, it turned out, was a complete lie. The high rate of attrition was actually men. And they wanted more men. (Laughs) We were living in Baltimore, of course, but Carol ended up going to Catholic University in Washington, DC, and did her Master’s, including thesis, in 9 months driving back and forth 3 or 4 days a week to Washington and wearing out our 1952 car. We had a Ford that someone in my father’s company had sold us, and it wasn’t very good. Anyway, at the end of that time, she had her Master’s degree, and now I was through my third year of medical school, and well into clinical work. During the first year of our marriage we lived in a very interesting house in Baltimore. It was not near the medical school, and I can’t remember how I used to go from there to the medical school. I think somebody used to pick

18

me up. I think Harry Beskind, who had a car, used to pick me up. And maybe I took the bus also. This place where we were living has some pediatric relevance. There was a couple who owned this house on Mount Royal Terrace. It was in a very nice area, and our apartment was on the third floor of their house. We had to walk through their house to get there. They had built the apartment for the woman’s mother who decided not to live there. It had a kitchen, a bathroom, a living room, a bedroom. It was quite nice, but it was in their house. Well, these were wonderful people who became good friends, and they introduced us to much of Baltimore and life in Baltimore. She was blind from retrolental fibroplasia. She was a preemie who had been given too much oxygen in New York. She grew up in the Bronx and had gone to the School for the Blind and ended up in Baltimore. This was 1956. She was a remarkable person who ran a television program in which she would interview people with various handicaps and show what they were doing and their success. She was very famous all over Baltimore. She had a seeing-eye dog named Prince, a collie; he was a beautiful dog. And Prince was very well known because he was on television with her. When she would go shopping in the big department stores like the May Company, people would follow along behind her, not because of her but because of Prince. If you remember, old department stores would have a big bank of elevators. DR. BAKER: Yes. DR. GARTNER: Prince always knew which elevator was coming next. (Laughter) He could hear them, so people would follow him and see which elevator he was going for. DR. BAKER: Interesting. DR. GARTNER: Anyway, it was a very interesting household; because of her fame and because she was a very interesting, very bright woman, she was involved with all of the politicians, the mayor and the governor and all kinds of people who came to the house. Because she was blind, they would come to the house, so there were people in the house all the time who were interesting and exciting. One day, we came back in the evening after something, a concert or something, and the house was all lit up, which was unusual. And we said, “Uh-oh, what’s going on?” We went in, and there was great sadness. The place was filled with people, and what had happened? Prince had been killed, and he was killed saving her life. They were standing on a corner, and a trailer truck came around the corner, cut the corner too close, and Prince pushed her back out of the way and was crushed by the truck. DR. BAKER: Oh, my goodness.

19

DR. GARTNER: So, there was much sadness. She was OK, but Prince was dead, and that was terrible. She subsequently got another dog while we were there, but it was not the same. It wasn’t Prince, so that was very sad. But they were quite wonderful people. DR. BAKER: A very remarkable person to have known. DR. GARTNER: Yes, it was very interesting. I got the apartment because she put up a sign at the hospital, “Wanting to Rent an Apartment,” and I saw it and called her up. We were there for a year. That was our first year of marriage, and then it got too difficult to live that far away, and we had to live at a rented apartment right near the hospital, which we did. DR. BAKER: Is that still in medical school? DR. GARTNER: That was my fourth year of medical school. And we lived there for 2 years because I stayed on and became an intern in pediatrics. So, we were there 2 years in that apartment and a total of 5 years in Baltimore at Hopkins. And the internship was a good one. I mean, there were harrowing times when I felt I didn’t know anything, and God knows what was going on, (laughs) but I got through it and probably would have stayed on except -- there was a lot of chaos in the department. Bob [Robert E.] Cooke, who was the chairman of pediatrics, was really a wonderful guy and used to have us out to his house on Gibson Island from time to time. He was really an interesting man and a nice man. He just wasn’t there, and the department was in a bit of chaos, and all of us felt unhappy about it. So, of the 12 interns, 6 left -- half left. DR. BAKER: That probably was not pleasant for the people remaining. DR. GARTNER: (Laughter) No, it was not good at all. I was actually being wooed by Einstein [Albert Einstein College of Medicine] when I made some inquiries. “Oh, yes, we’d love to have you,” so I ended up going to Einstein for my pediatric residency; that was 1959. Carol had been teaching; I guess she taught for a year. She was teaching high school English at Forest Park High School in Baltimore. And during that year she became pregnant. When word got to the chairman of the English department or the principal that she was pregnant, even though she wasn’t showing, they said she couldn’t stay. So, she had to stop teaching. But she got a job at Hopkins doing serum protein electrophoresis in the department of medicine. DR. BAKER: That was quite a change. DR. GARTNER: Oh, yes. She’d never done any lab work, but she did very well, and she actually enjoyed the work in the lab. She worked for a group of very good internist/immunologists who were very nice. She really

20

enjoyed it, and she did that until she gave birth. The only thing about what she was doing at that time that troubled me was that she was mouth-pipetting serum from patients who might very well have had hepatitis or who knows what. DR. BAKER: Oh, yes. DR. GARTNER: But she said she did it very well. She never got any in her mouth. DR. BAKER: She was very careful. DR. GARTNER: (Laughs) I said, “You really shouldn’t mouth-pipette serum.” Anyway, but she actually enjoyed that. So, Alex was born in April of 1959, and we left at the end of June when my internship was up and moved to the Bronx, to New York, to Einstein. DR. BAKER: OK, so this is just right after Alex is born then. DR. GARTNER: Yes, he was a couple of months old when we left Baltimore. I have always told him that he is a Hopkins baby, a special breed. DR. BAKER: Did Carol then spend some time at home? DR. GARTNER: Yes, she stayed at home at that point. Madeline was born exactly 2 years later. DR. BAKER: This might be a good juncture before we keep talking further about your career to talk about them. DR. GARTNER: Yes. Well, Alex, as I said, was born in 1959, and he was basically a good baby except for a lot of crying. That’s all I remember. My most vivid memory was, I guess both kids had a lot of strep throats or at least what was thought to be strep throats. Their pediatrician was the wonderful Lew [Lewis] Fraad. I don’t know whether you know the name. Lew Fraad was an amazing person and a great doctor and a wonderful teacher. The department at Jacobi Hospital, the city hospital, is now named after him. It is the Lewis Fraad Department of Pediatrics. One weekend day Alex, about a year old, had a fever and what looked like a red throat. I called Lew and he said, “Well, why don’t you give him a shot of penicillin,” and so I gave Alex a shot of penicillin. DR. BAKER: You gave it to him. DR. GARTNER: I gave it to him. (Laughter) I did it, and he cried, and he put his arms around me. And I said, “That’s the last time I’m ever giving

21

him an injection. Never again.” (Laughter) Anyway, but he was a good kid, and we had no problems. And then, Madeline was born 2 years later, and she was fine. From the day she came home, she slept through the night. She also had many strep throats. I remember giving her oral penicillin when she was older, but I didn’t give her shots. (Laughter) When we went back to New York, we first lived in the Bronx. Then, we bought a house in Yonkers, which was not a great place from an education perspective for the kids. So, we then moved to Larchmont, which had a much better school system. We had a little more money then, bought a nice house, and Carol was working by then. Carol didn’t work until Alex was about 3 or maybe 2. I can’t remember. And we had a babysitter take care of the kids during the day, and Carol started teaching. Oh, she first got her PhD. During that period of time, when the kids were young, she went to NYU [New York University] and got her PhD in English. DR. BAKER: At NYU? OK. DR. GARTNER: At NYU, and started out at first on a part-time basis. She went on Saturdays, and I would take the kids on Saturdays. And every Saturday, we had a New York City trip because we’d drop Carol off, and then we would go to a museum or the Statue of Liberty or some place of interest. I remember going to art shows, all kinds of things, so it was sort of a fun year. And then, Carol got a Danforth Fellowship, which was a fellowship specifically for women who had a hiatus in their career because of family, and it was perfect. They were very supportive. The woman who ran the program, who ultimately ended up at the University of Chicago, was really a great support. There were times when Carol said, “God, I don’t know if I can do all of this,” but she did. And this woman encouraged Carol through it, and it worked out well. Carol got her PhD in about 3 years and then started teaching. Anyway, so the kids grew up in a somewhat hectic household of things going and coming and all of this, but they did well, and the school in Larchmont was much better. They actually did fine. Alex went to Cornell [University] in the School of Industrial and Labor Relations, and the reason he went there was that he was active in the Boy Scouts. One of the Boy Scout troop leaders was president of the Amalgamated Clothing Workers of America and he was on the board of trustees of Cornell University representing the School of Industrial and Labor Relations, which is a state school. He asked Alex, “Are you interested in industrial and labor relations?” Alex didn’t know what it was, but he explained to him what it was. And Alex said, “Well, yes, I’d be interested.” He said, “OK, so apply.” Alex applied and he got in and actually did very well. He enjoyed Cornell and had a good time there. And that’s where Alex met his wife. Alex was interested in theater, although he’s not a good actor, but he was interested in theater. Judy [Dewey], his wife, was a graduate

22

student in acting. And they ended up in the same plays, and that’s how he met her. They were married, I guess, after a year or so. They got married in New York, in fact, at the NYU Chapel, which Carol had access to, and lived in New York. Judy was acting. She had a part in a soap opera. When Alex finished college, he thought he was interested in the labor side, labor unions, so he got a job with Actors’ Equity in their office, sort of an internship. He said that it was just chaos there; he didn’t like that at all. Then, he got a job with a company that imported films from Australia for cable distribution. Many cable television stations have nobody there. They just run huge reels of tapes all day long, which contain the movies, ads and anything else they are showing. Well, this company, Satori, made those up and distributed them, so he learned some of the business end of the movie industry in New York. He had a wonderful office location. Do you know the McGraw-Hill Building on 42nd Street? It’s this big green building. You’ve seen pictures of it with steps going back. It’s about a 40-story building built in the 1930s, a great landmark building. Their office was at the very top. They were up in the penthouse, and it had great views. He worked there for a few years while Judy was acting. She did very well in the soap opera until they had to write her character out because her soap opera husband decided to leave the program. So, they wrote them both out. (Laughter) She continued to audition; she’s a good actress. She’s a good comedienne, and she sings, and she dances; she’s really good. But she didn’t like auditioning, and she’s given up acting. In the meantime, Alex got more involved in the movie industry. Judy was doing a short movie in Greenwich Village at some small film studio there and got to talking to the woman who owned the studio who said that she was very interested in making full-length theater movies. Judy said something about how her husband was involved in movies. She wanted to meet him. So, Alex met with the owner, who turned out to be a very, very wealthy woman who was having her 70-something-foot yacht built in Norway. She had a lot of money. She wanted to make big movies, and she liked Alex, and she thought he could do it. Alex had never made movies, but she said he could make movies. How he learned how to do this I still don’t know, but he actually optioned -- I think it was 5 movie rights, books or scripts. He went to work in New York trying to figure out how you get the writers and the money for production and all this sort of thing, although she probably had the money. He realized after about a year or 2 years that this was going to be very difficult to do in New York because the writers and everybody else you need for a film are out in California. He said to the owner, “Well, I really have to go to California to do this.” She said, “OK, we’ll pay for it. You go out there

23

and continue to work for us and make the films.” So, he went out there, and eventually, one of the films was developed and eventually was made. And that film is Indecent Proposal. DR. BAKER: Oh, Robert Redford? DR. GARTNER: Robert Redford and Demi Moore. DR. BAKER: Yes. Oh, well, very good. That’s quite a remarkable story. DR. GARTNER: So, he’s the executive producer on Indecent Proposal, his first film. He sold the film to Paramount, so Paramount actually made the film, but he was involved with the production. And his major task -- and this is where his industrial and labor relations training came in -- was keeping Robert Redford on the set because Robert Redford was always upset about something. DR. BAKER: Oh, he was? (Laughter) DR. GARTNER: Anyway, the film got made, and I think Alex still gets some payments from it. That film has grossed in excess of $1 billion. DR. BAKER: Wow. DR. GARTNER: It still runs on television. DR. BAKER: It continues to run. DR. GARTNER: Anyway, and he has gone on to make a lot of films. He has been an independent producer. He was vice president of Fox 2000, and then was president of MGM film production. He left that and he now is a partner in an independent film producing company called Atlas Entertainment, and he makes movies. DR. BAKER: Wow. DR. GARTNER: Big movies. Some are good, and some aren’t good. (Laughs) DR. BAKER: A remarkable trajectory. There were some interesting turns. Can you tell us a bit about Madeline? DR. GARTNER: OK. Oh, let me just finish. Judy gave up being an actress; unfortunately, because I think she was good; but she has become a

24

writer of novels and has 2 published young-adult novels, which are very interesting. They deal a great deal with teenage drug, alcohol problems. They’re murder mysteries, and they’re very interesting books, so she has continued being a successful novelist. Madeline did very well in school and always got good grades and had a good time. She enjoyed herself in Larchmont, and decided that she wanted to go to Duke [University]. She got in and enjoyed it enormously as an English major pre-med student. She had a great education. She always said she wanted to be a pediatric geneticist. And I said, “That’s a good field. You should pursue it.” And she then went to Loyola University Stritch School of Medicine. She was also admitted to the University of Chicago School of Medicine, but decided that she really didn’t want to be where her father was chairman of pediatrics. DR. BAKER: Needed a little more space? (Laughs) DR. GARTNER: So, she went to Loyola, and Loyola was OK. Some parts were very good, and it was there that she decided that she really wanted to be a surgeon. DR. BAKER: That’s a pretty major change of direction, though, from genetics. DR. GARTNER: Yes, but, you see, I think she inherited the same desire that I had to do surgery, because all of my research used animal preparations, and I think she has the same inclination. She just likes doing things with her hands, even debriding burn wounds, which she liked, much to my dismay. DR. BAKER: Where did that carry her? DR. GARTNER: She then went to Brown University in Providence [Rhode Island], to Providence Hospital, for her internship and residency in surgery. She was there 2 years, and I guess in her second year she decided she wanted to do some research. There was a professor there who was doing wound healing molecular biology. She was working with him, and she applied for a research fellowship from the Society of University Surgeons, which awards only one fellowship each year, but for several years of research support. Much to my delight, she was awarded that year’s fellowship. The condition of the award, however, was that she had to stay with this professor, even if he moved to another institution. Obviously, the other professors, his colleagues, knew that there was a chance this guy was moving somewhere. She said, “OK,” not knowing where that would take her. By then, she had met her future husband, who was a surgical chief resident at the time, and they then were married. It turned out that this guy who she was working

25

with, her mentor [Michael D. Caldwell], was going to the University of Minnesota, so Madeline, of course, went with him. Mark [Ahrendt], her husband, comes from the Minneapolis area, Inver Grove Heights, and so this was going home. His family is there. And I remember his departing remarks as they drove off. He said to Madeline, “Remember, Madeline, it’s very cold in Minnesota.” (Laughter) DR. BAKER: She was forewarned. DR. GARTNER: Right. So, she went there. Well the University of Minnesota was the leading training hospital in general surgery. It was really a very good place. She went on to finish her residency and 5 years of research.; 9 years of training all together. Maybe it was 4 years of research. She published 20 papers. She gave a talk at every surgical research meeting throughout the time she was in training, and the surgeons at the University of Chicago, the wound healing people, used to say, “When your daughter is giving a paper, we are all there to hear her.” (Laughter) So, she did very well, and at the end of her training they offered her an assistant professorship in the surgery department, which she refused. I think she’s still a clinical assistant professor, but she refused the appointment. She said, “I can’t. I know what’s required of an academic surgeon,” she said, “and if I did all that I would have to do, I would not have a family. I would not be able to do anything else.” By then, she had 2 children, and she said, “No, I’m going to go into practice.” And she went in with a group practice of general surgeons and vascular surgeons, which she was with and became a partner. She left this group because she didn’t like the way they ran things, and joined an HMO, which was good in the beginning and then deteriorated. She then developed her own solo surgical practice doing only breast and endocrine surgery, mostly cancer, and is very happy. She loves it. She’s her own boss. She’s very busy. She likes what she does, and it runs her way, which is the way she wants it. She said to this initial group she was with, “Either you make me the managing partner and I’ll run the place, or I’m leaving,” and they wouldn’t make her the managing partner. She would have done very well. So, she has this practice, which she has had now for a number of years, lots of patients, does very well, lots of surgery, and likes it, but she’s ready to retire. In roughly another year or so, she will close her practice down and move out here. Her husband is a trauma surgeon at one of the big hospitals. And he’s ready to retire. He’s been ready to retire for 2 years now, so he’ll retire next June, and they’ve already bought their house out here near us in Valley Center, and they’re ready to move, which will be very nice. DR. BAKER: That’ll be very nice.

26

DR. GARTNER: I can’t wait until they’re out here. So that’s the children. The grandchildren, we have 4 grandchildren. DR. BAKER: If I can just comment, though, it’s so interesting that you have 2 children who have done very, very well and in quite different directions. DR. GARTNER: Oh, yes. DR. BAKER: That must say something about the family culture you established. DR. GARTNER: (Laughs) Well, we encouraged them to do what they wanted to do and what their real interests are, and that’s what they’ve done. DR. BAKER: Yes, very interesting. DR. GARTNER: When I said to Alex that Madeline was retiring -- after all, she’s 2 years younger than he is, he said, “I’m never retiring.” (Laughter) DR. BAKER: And do you want to mention your grandchildren? DR. GARTNER: Yes, my grandchildren. Each of the children has 2 children. They each have a boy and a girl. Alex’s 2 children are artists, and the genetics of that are clear. Judy’s father was an artist. Most of her siblings are in art and design and things of that sort. They’re an artistic family, and the children inherited this. They’re both very, very good artists. The older one, Samantha, does costume work for the movies and goes from movie to movie and does very well. Her specialty is aging and dyeing of fabric. (Laughs) DR. BAKER: Of fabric. OK. DR. GARTNER: Which is sort of funny. DR. BAKER: That is. DR. GARTNER: She also is an expert in making armor. So how do you make armor in the modern world? DR. BAKER: And why? DR. GARTNER: Well, because this was a movie that was a science fiction period piece in which everyone was armored. And how do you make the armor? Well, you do it at the computer, and you sent it off to the 3-

27

dimensional printer that then prints a full-sized set of armor. And I said, “How big is this printer?” She said, “Oh, it’s a very large room.” DR. BAKER: This is a 3-dimensional printer? DR. GARTNER: A 3-dimensional printer. DR. BAKER: Wow. DR. GARTNER: It’s all in plastic. She said the only problem is, when the actors and actresses wear it, it’s very warm under the lights, and they’re sweating, and that’s a problem. (Laughter) Anyway, and her brother, Oliver, who is 2 years younger, is a third-year student at the Rhode Island School of Design and interested in printmaking and etching. He has done very well there. [He has since graduated from RISD and is now a very successful art printer at the Gemini Studio in Los Angeles.] DR. BAKER: I saw some of his work earlier. I’ve seen both of their work. DR. GARTNER: Yes, they’re both very talented. So, they’re both doing well. Madeline has 2 children. The oldest one is Ben, who just graduated from Oberlin [College] as a psychology major. He is taking a few years to work, and is exploring what the world is like and what to do. He’s an avid reader, has worked at Barnes & Noble as a bookseller and now works in a roofing business office. He is exploring going to graduate school. Hannah, the youngest one, is a very, very bright, hardworking woman who now is 17 and in her senior year in high school. She has had nothing but straight As, and she does everything well. She plays tournament tennis for the high school. She plays the saxophone in the jazz ensemble, and in her spare time she does molecular biology at the University of Minnesota. She has done this for about a year and a half now and has her own project on something to do with cervical cancer and binding sites. [This research has recently been published and she is second author.] DR. BAKER: We would love to have her come join us at Duke next year. DR. GARTNER: Yes, well, that’s where she wants to go. (Laughter) She says at this point that she is going to be a pediatric surgeon. I have no doubt that she has all the talent to be a very good pediatric surgeon. She has remarkable hands and she understands what’s involved in becoming a pediatric surgeon. [She is now a pre-med chemistry major at Duke University and continuing to get As.]

28

DR. BAKER: In a number of the stories of your family, you actually can see the artistic and scientific strains of the family coming together. DR. GARTNER: That’s right. So, anyway, that’s the family. DR. BAKER: Well, thank you for sharing that with us. I think your career story can be told as a story that’s quite self-sustaining, but it’s clear that that part of your story is very important to you as well, so thank you for sharing that with us. DR. GARTNER: Yes, it is. DR. BAKER: I would like to return to your internship. This will take us up to residency, I assume. DR. GARTNER: Right. OK. DR. BAKER: This will take us back to New York. Do you feel ready to proceed on to that, or do you need a break? DR. GARTNER: Sure. No, no, no, I’m fine. DR. BAKER: OK. DR. GARTNER: I came to Einstein when it was 4 years old, and it was obviously a young medical school with a young, really exciting faculty in both pediatrics and medicine, which I got to know best, but other departments as well. And because it was small, there was a lot of intimacy. There was a lot of sharing among departments, and it was a great place. At that time, the clinical program was in the city hospital, Bronx Municipal Hospital. To the best of my knowledge at that time there was no physician billing. There were lots of patients, and probably very few people had insurance or paid anything. Whatever insurance there was, I’m sure it was collected somewhere; as a result, things were rather tight financially. One of the things I remember so distinctly was that, on the general pediatric floor, where we had 60 patients, 30 on each side, there were only 60 cloth diapers for the entire weekend. That was it. (Laughter) My image of those early days in Jacobi Hospital, Bronx Municipal Hospital Center, was of diapers hanging from the curtain bars after nurses, aides and parents washed them. (Laughs) DR. BAKER: Am I picturing an open ward? DR. GARTNER: Yes. Oh, yes. Well, there were 5 bedrooms, but they were down each hall and 6 beds in each room.

29

DR. BAKER: I’m trying to picture this. DR. GARTNER: The regular postpartum floor nursery, however, was a very interesting nursery which was designed with very good ideas in mind. The building was designed in the 1930s, and then the war came. The building was not built until after the war, so it was a fairly new building when I went there. The well baby nursery was designed with 4 separate nursery units, each of which held 12 babies. There was an entry area office, the nurse’s station, and then you went into the 12-bed room where the babies were, on each side of which were 2 6-bed mother rooms. DR. BAKER: Wow. DR. GARTNER: So, you had the nursery and then the 12 mothers, 6 on each side. DR. BAKER: Are the mothers’ rooms actually adjoining the nursery? DR. GARTNER: Yes, they had connecting doors into the nursery. But the mothers weren’t allowed in. The babies were brought to each mother for feeding in their own rolling basinet. DR. BAKER: This was still not a breastfeeding promotional. DR. GARTNER: No, no, no. (Laughs) This was designed for infection control. We had space for 48 postpartum babies and mothers on the floor. This was when mothers stayed probably 4 or 5 days, maybe 3 days later, so we didn’t really need 48 beds. And then, at each end, there were 2 separate units that were isolation units for babies and mothers. You would admit 12 babies and mothers into a unit, and then that unit was closed until those babies and mothers left. No new babies went in. They were cohorted for 12 babies, and then the units were cleaned and scrubbed, and no new babies went in until it was all cleaned up. And then, you went to the next 12 and 12 and 12, and you went down the hall. DR. BAKER: It’s kind of a rotational system. DR. GARTNER: Yes. There was always a unit in cleaning. DR. BAKER: Can you comment on what kinds of infections were common? DR. GARTNER: Staphylococcal infection was the real issue, and in older children there was a lot of staph [staphylococcal] pneumonia, which was a really serious infection of which a number of kids died. They would get these

30

big blebs in their lungs. We didn’t really have respirators of any value in those days. DR. BAKER: You’re talking now more about the pediatric patients, not the nursery. DR. GARTNER: Pediatric, not the nursery. DR. BAKER: In the nursery, there were staph infections. DR. GARTNER: Oh, yes. It was a big problem. We were scrubbing the babies with Phisohex [hexachlorophene]. I used to shower with Phisohex because some of us used to get infections. I remember having some boils. DR. BAKER: Why was there so much staph infection at that time? DR. GARTNER: I don’t know. DR. BAKER: When you look at infection precautions today -- DR. GARTNER: It’s gone. That’s right, and it’s very different. I don’t know why there was so much staph. It was obviously a very virulent strain. That is why I mentioned the staph pneumonia, because you don’t see that anymore. DR. BAKER: No. DR. GARTNER: I mean, diseases change, clearly, all the time, and I think it’s really interesting why that happens. But, anyway, that was the concept behind this nursery design. And the Phisohex was all part of this business of trying to prevent infection along with putting dye on the cord. The whole idea was to isolate a cohort and not have a continuous environment. And did it make any difference? I don’t think anybody ever really tested this. Another innovation way ahead of its time came from Lew Fraad, who said we had to examine all newborns on the mother’s bed. DR. BAKER: He did? DR. GARTNER: And that’s what we did. DR. BAKER: That’s forward thinking. DR. GARTNER: That really was, and so we did that. The preemie unit was on the floor with the general pediatric floor in its own wing between the two 30-bed pediatric units. The preemie nursery was set up in a similar fashion to the postpartum nursery in that there were 6 4-bedded rooms. I

31

guess we held about 24 babies in incubators and the unit was largely run by nurses. The interns and residents didn’t have a whole lot to do with what was going on, except to examine the babies, write notes and orders and give clyses. The doctors got orders from the nurses. The babies were largely cared for with oral feeding, tube feeding, and clysis. DR. BAKER: Can you describe that for people who have not heard of it? DR. GARTNER: Clysis is injecting fluid, basically saline, subcutaneously in the back over the chest in babies who weren’t getting enough fluid or at least were thought not to be getting enough fluid, and some probably were. There were antibiotics, and we did have a lot of infections, pneumonia, etc., and a lot of RDS [respiratory distress syndrome]. DR. BAKER: What would you do for RDS at that point? DR. GARTNER: Oxygen. By then, the oxygen was limited, and I think we were beginning to have oxygen monitors, so we knew what the oxygen concentrations were. DR. BAKER: Forty percent or -- DR. GARTNER: Right, we were limited to 40 percent. The machinery limited it automatically, but we would check it. And ventilators, we started playing with them. There weren’t any when I first got there, but a little bit later we began to use them. The preemie unit was run by a general pediatrician who was in practice, nice guy, but he was there only some of the time for rounds. It ended up that the chief resident ran the unit. At least, I did, because I was interested. DR. BAKER: Did the residents really rotate through it? DR. GARTNER: Yes. Oh, the residents did. Students did later. I can’t remember whether the students did earlier or not. DR. BAKER: Did the residents actually have a rotation there, or were they covering it while covering other -- DR. GARTNER: Oh, no, they ran it. There wasn’t anybody else. DR. BAKER: You made the comment about nurses before, and that’s why I wanted to ask. DR. GARTNER: No, it was just that the nurses told the docs what to do, (Laughter) because it was largely nursing care.

32

DR. BAKER: Yes, but there was an earlier period where the nurses really did do a lot of the primary care. DR. GARTNER: Oh, yes. DR. BAKER: So, we’re past that, and now the residents really have a very active role. DR. GARTNER: In this hospital, the residents ran everything. And the attendings would come when you asked them to come. Some would make occasional rounds. There wasn’t a whole lot of attending rounding on a regular basis. I came there in 1959, so I was the chief resident in 1961-2, and as chief resident I ran the whole service, which meant I rounded on every baby in the hospital, every day. And if I couldn’t do it or if it was a weekend, then another senior resident would do it. There were 60 babies upstairs plus the 20 to 24 preemies. And then, in the basement, we had a large, single-bedded, infectious disease isolation unit, which must have had another 30 beds, filled with a lot of bad infectious disease and a few chronic kids as well with them. DR. BAKER: Do you want to mention any of those infectious diseases, just what are those? DR. GARTNER: I’m trying to remember what we saw. I remember severe chicken pox cases. Measles, severe measles, probably some chronic bone stuff, osteomyelitis. Pneumonias. I can’t remember all of it. Anyway, the chief resident rounded essentially on over 100 kids a day, and you had to teach as well. So, often, I would know that there was a new admission or a particular kid there, and I would look up some stuff in advance and, essentially, give a talk or ask the residents things. It was a challenge, but very enjoyable. I had a ball that year, and it was good. When you needed an attending, we had some wonderful attendings like Abe [Abraham] Rudolph. Abe was wonderful; if you had a child with some cardiac problem or you thought it was a cardiac problem, you called Abe. He would be there immediately. Emile Scarpelli, was interested in pulmonology. And then, we had a very good pediatric neurologist, Larry Taft. There were a lot of good, very good attendings who were excellent teachers. DR. BAKER: But the residents really did run the service? DR. GARTNER: The residents ran the service. The residents decided on admissions from the emergency room or clinic and the floor resident admitted the patient. The resident didn’t call an attending unless he or she

33

did not know what to do or needed help beyond what the chief resident could do. The patient wasn’t admitted to an attending. They were admitted to the hospital, and you took care of them as the resident. The intern would work them up, and the resident would do his exam and everybody wrote notes. I think the care was actually pretty good for the period of time. There were a lot of things we didn’t have. In addition to not having diapers, we also did not have enough notepads. It was a city hospital, and at that time there was something like 12 or 15 city hospitals throughout New York. There still are a lot, and everybody had standard notepads, but we never had enough. We never had enough penicillin. Because we were a tertiary hospital, another city hospital like Morrisania [Hospital] would call up and say, “We have a patient we want to send you.” We would say, “OK, we’ll take the patient, but you have to send us 6 notepads and 12 bottles of penicillin. If you do that we’ll take the patient.” (Laughs) One of the residents, I don’t know how he did this, but he had a vast collection of drug samples. He must have hounded all of the detail men. There was a residents’ building where we all had rooms with beds and dressers. His dresser was filled with medicine. (Laughter) And whenever we needed a medicine that we did not have on the floor or in the pharmacy, we’d say to him, “Do you have this?” And he’d go over -- DR. BAKER: He has his own stash. DR. GARTNER: And we had a big emergency room. We saw 100,000 pediatric visits a year. And that was always a very exciting place and an interesting experience. It was a real learning experience. I think there are a lot of things we could have done better. I was at Einstein 21 years, and as things went on there were a lot of changes that took place and many improvements. Attendings became more involved. One of the things we did do a lot of was conferencing on patients. We’d sit down, we did it weekly in the preemie nursery, where you had the residents, students, the social workers, nurses. Everybody would sit in the room, and we’d present all the patients, and we’d talk about them and decide what we were going to do and how we were going to manage, and a lot of it had to do with, “Are we going to continue to support this child or are we going to let him go?” DR. BAKER: Were the parents involved? DR. GARTNER: No, not at that time. Not at those conferences. We had outstanding social workers and they knew the parents well. To some extent they represented the parents. There were often a lot of interesting things that came up. I remember one time we were talking about some child who clearly was going to end up handicapped, seriously handicapped. One of the

34

residents, a very good resident said he had a sister who was severely handicapped. And he talked about what it was like having a handicapped sibling. He talked about it in positive terms, not in negative terms. So, it was a very interesting discussion. As I said, we had wonderful social workers who really helped a great deal. Every preemie, before they could go home had to be cleared by a home visitor. The visiting nurse service went to the home that the child was going to. I think this was city or hospital rules. They couldn’t go home until the visiting nurse said it was OK, that there was a place for the baby, that it was safe, and that the house was clean and didn’t have vermin and rats and everything else. It was interesting. We often had a lot of kids hanging around waiting to go somewhere. At one time we had a holding unit on an unused adult medicine ward with 12 to 15 babies who were perfectly normal, full-term, healthy infants. Some resided there for weeks and months because there was no place to put them. I remember Carol and I taking one child, about 2 years old, for a trip to the Bronx Zoo. He had never been out of the hospital before that. DR. BAKER: No place to send them. DR. GARTNER: Well, I actually ended up doing some research on that unit. Because we had this healthy group of babies, many were newborns, we drew serum bilirubins on them daily for the first 2 weeks and established for the first time what normal bilirubin values were for healthy, full-term infants, during the first 2 weeks of life, which was published. For many years, it was the only data available. It was often quoted, and the graph reproduced. A lot of the problem about not being able to send babies home was due to maternal TB [tuberculosis]. If mothers had TB they couldn’t take the babies home until they had enough treatment and were cleared by then adult pulmonary service. I forget what the criteria even were for the mothers. We had a lot of TB mothers. DR. BAKER: It must have been hard to know the families very well at this point in time. You know, they’re not staying in the ward in the room with the child like they are today. DR. GARTNER: In the preemie unit, they came in often. The unit was supposed to be open for parent visiting 24 hours a day. But, there were occasions when I would come to the unit in the morning, and if I came in early enough, there would be a sign on the door into the nursery that said “No visitors tonight.” Some nurse had put up the sign, because they didn’t want to be bothered. I would have a scene over this with the nurses and it would stop for a while. Normally, the parents would come in, and they could stay in the room as long as they wanted. Admittedly, it wasn’t very

35

comfortable. It was 4 incubators in a small room, but they could sit there with their babies on metal folding chairs. They probably didn’t get to hold them very often or do much with them, which was unfortunate, but they were there, though not all. We had a lot of drug addiction. We had a lot of heroin addiction, and social workers would try to get these mothers into methadone or some other treatment program. They really worked hard. DR. BAKER: Wow. It’s such, in many ways, an utterly different world than the world a resident would work in today. DR. GARTNER: Oh, yes. The best part of it from a training perspective was that you were the doctor. And although there was an attending available, you were really running the case, and you had to keep on top of it. That was good training. I didn’t mention the reason I went to Einstein. The reason I ended up being interested in going to Einstein was that Harry Gordon, who was at Sinai [Hospital] in Baltimore and was on the faculty at Hopkins, was someone who I’d gotten to know quite well when I was an intern, or even as a medical student. And I went to him and told him I wanted to leave Baltimore and asked where would he suggest I go. He suggested I look at Einstein, which was a new place, so I did, and that’s how I ended up going there. What I didn’t know was that Henry Barnett was in the process of recruiting Harry Gordon to come to Einstein. And that’s why Harry knew so much about Einstein. DR. BAKER: I see. (Laughs) DR. GARTNER: So, I came to Einstein, and Harry Gordon arrived about 3 years later and joined the faculty at Einstein. And Harry, of course, ran the nursery, although I thought I did, and we occasionally had our differences. He became dean of the medical school after some years. He was very instrumental in getting the [Rose F.] Kennedy [Intellectual and Developmental Disabilities Research] Center at Einstein and played a big role in that. I think that was the major reason he was brought there, to be sure we got the Kennedy Center, which we did. DR. BAKER: Can you tell us a little bit about him as a person? DR. GARTNER: He was obviously very experienced and very bright and a good teacher. He really was dedicated to it. He had some fixed ideas about how to do things, which weren’t always the way either I or other people thought it ought to be done, but that was his way. But he was an important teacher, and we often met at his house for evening conferences. The

36

neonatology faculty would get together for a very specific reason, and that was to decide on how we were going to manage a particular disease or problem. We would collect all the literature and each of us would present some of the papers. We would then go through a process of evaluating what we thought was best. And at the end of the meeting, we would decide that this was how we were going to do things. DR. BAKER: So, you really developed a protocol. DR. GARTNER: We all did the same protocol, and we all did the same thing. I can’t remember whether we wrote out the protocols or whether we just did them. But we basically all practiced the same way, and we did it by essentially going through what the evidence was and deciding this is how we were going to do it. We weren’t going to have each attending doing a different thing. That wasn’t the case at the University of Chicago where I had a lot of independent souls, and I wasn’t running the nursery. I couldn’t get them to all agree on doing anything. There was a lot of variability, but at Einstein it was pretty uniform. We agreed on what we were going to do with the jaundiced babies, what we were going to do with the respirator babies, and so forth as we got into doing that kind of more intensive care. DR. BAKER: That’s not an easy thing to get done. DR. GARTNER: No. Now, the other thing that was very interesting that happened in the preemie unit when it was still a preemie unit -- I’m trying to think of what year. Maybe when I was assistant professor, probably mid-1960s. Sixty-five or thereabouts. Full-term infants who were sick, who had serious problems -- infants of diabetics who were hypoglycemic, full-term newborns with infections were cared for on the regular pediatric floor. We began to realize, as intensive care was developing and the concepts of specialized care evolved, that what we were doing on the floor was not adequate. So, we decided we would put those babies in the preemie unit, which up until then had only had preemies by weight and dates. DR. BAKER: The preemie unit was really a preemie unit. It wasn’t a special care unit. DR. GARTNER: It was a preemie-only unit, and the head nurse for the preemie unit, Mrs. Minott, was a first-rate nurse and a good friend. She ran a superb unit, and it was her unit. I remember we had an infant of a diabetic mother, my image is of a big baby, who was hypoglycemia. It may have had something more. We decided to put that baby into the preemie unit where we could watch it more closely, and I remember coming in with that baby. And Mrs.Minott was standing at the door saying, “No, no, no.” (Laughter) And we said, “Yes, yes, yes,” and we just walked in. She was furious.

37

DR. BAKER: She was not happy. DR. GARTNER: She was furious. She was very unhappy. And a very interesting thing is that she stayed on as head nurse for a little while, and then she resigned. And where she went as head nurse was to Goldwater Hospital, to the cirrhosis unit, because in the cirrhosis unit she could give the same kind of care that she was giving to the preemies, which was basically feeding and supportive. You know, good nursing, and that was what she did for the rest of her days. I visited with her after she left. There was a big turnover of nurses as we began to get into intensive care. But that’s how it began, at least at our place, and then we began to do what we could with ventilators and -- DR. BAKER: But really, before ventilators and the higher-powered means of taking care of a baby with RDS, these kinds of babies were coming in. Newborns with serious medical issues were starting to be admitted. DR. GARTNER: That’s right. DR. BAKER: So, where would I picture a baby being treated who has erythroblastosis? DR. GARTNER: In the preemie unit. It became neonatal intensive care, but most of those were preemies, of course, the serious ones. By then, the obstetricians were doing fetal evaluations, so they knew how the babies were proceeding, and they would deliver them early to avoid the most severe end result. DR. BAKER: So those babies were premature as well. DR. GARTNER: A lot were preemies. Some were very premature, which is not good, because their livers were not prepared for this onslaught of bilirubin and the anemia and all the rest of what went along with it. DR. BAKER: I didn’t realize that. Was that a practice? DR. GARTNER: That was a practice. DR. BAKER: A practice of delivering babies early. Did that develop in the 1950s, or earlier? DR. GARTNER: I’m trying to remember. I’m not sure. Maybe in the 1960s, early 1960s. DR. BAKER: OK. Interesting.

38

DR. GARTNER: But, you know, they began to monitor. They were doing amniocentesis, and they had a much better idea of what was happening and predicting the severity of erythroblastosis. And this was before we had RhoGAM, so we were still having large numbers of babies. We had a lot of them. Of course, Hopkins had a lot more because the system in Maryland was that all Rh-negative mothers who were sensitized, no matter where they were in the state of Maryland, had to go to Hopkins to deliver. DR. BAKER: OK, so you had every single one. DR. GARTNER: We had enormous numbers of erythroblastosis babies. In my internship I easily did 100 exchange transfusions myself. DR. BAKER: A hundred exchanges? DR. GARTNER: I mean, with my hands. Even as students we were doing exchange transfusions. Then, at Einstein, we continued. I still did large numbers of exchange transfusions. I used to race in at night from home to do them. Somebody would call up and say, “Hey, the baby’s bilirubin is 20. What are we going to do?” And I said, “Set up for the exchange. I’m coming.” And I’d race down the highway at 75 miles an hour. (Laughter) DR. BAKER: Wow. These are really interesting comments, because I think they give a sense of the kind of issues you were dealing with at Einstein in these years. We have slipped a bit into the future, and I want to kind of come back to your story again at this point. I’m thinking about the transition from residency into fellowship and research and how that happened. DR. GARTNER: Right. Well, what happened was that I came to Einstein for the first year of residency, and then before the second year they extended the requirement for years of residency from 2 to 3, including internship. And for some reason, there were excess people, and Henry Barnett said to me, “Would you like to take 6 months and do research?” And I said, “Yes.” He said, “What would you like to do?” And I said, “Well, I’d like to study jaundice in neonates.” And he said, “Well, there is someone in the department of medicine named Irwin Arias who is interested in bilirubin metabolism. Even though he’s in medicine, he has done some things on neonatal jaundice. Why don’t you see him?” So, I went over and visited with Win, who was a young faculty member in medicine and gastroenterology, and we hit it off. And he said, “Yes, come work with me,” for those 6 months. Well, those 6 months ended up being much more, in fact, a life time. I went back to being chief resident and then, after that, took my research fellowship with Win, in which I was doing bilirubin metabolism in the lab. I’ll talk about some of that later. I was running the nursery to a great extent. I can’t remember whether Harry was there or not at that point. And I also ran a liver disease service, which was fairly busy with kids with hepatitis and

39

metabolic diseases of various sorts including Zellweger [syndrome], which is an interesting story that I will tell. Don’t let me forget the Zellweger. DR. BAKER: I’ll make a note of it. DR. GARTNER: I learned to do liver biopsies when Win showed me one liver biopsy in a child. He had never done a child. He had done liver biopsies in adults, but I wanted to know how to do liver biopsies, so he showed me. I finally found a patient that was big enough that he thought he could show me, so he showed me once. From then on, I was on my own. DR. BAKER: You did them. DR. GARTNER: I did them. (Laughs) You know, it’s the old story, “Do one, show one, teach one.” Well, so I learned, and I subsequently did lots of liver biopsies and developed a wonderful relationship with pediatric pathology. I always had a close working relationship with pediatric pathologist, Jay Bernstein, over autopsies. We always made every effort to get autopsy approval and then I would bring the residents and fellows down to see the autopsy and the later review. When Jay left, Rachel Morecki came as our pediatric pathologist, and she had a special interest in liver disease. To this day, Rachel and I are very close friends. She lives here in California now, and some of my best times in medicine were sitting at a dual microscope with Rachel looking at a biopsy I had done, trying to figure out what disease the kid had. I remember we would pull out books, and we’d look at these. Many of these metabolic and viral cases were tough to figure out. She was a super, super pathologist, bright, great person, and we also did a lot of research together on hepatitis and biliary atresia. And the biliary atresia model is another interesting story, so I’ve got to remember that. So, I got involved in a lot of different things. DR. BAKER: There’s one thing I don’t want to skip over. At this point, you said you were interested in neonatal jaundice. DR. GARTNER: Yes. DR. BAKER: And I’m trying to sort out where that interest arose. You told me earlier it was not really the cirrhosis lab experience. So where did it come from? DR. GARTNER: OK. Carol is Rh-negative. So, when she was first pregnant, she went to an obstetrician at Hopkins, Eleanor Delfs, who was a very good obstetrician. Eleanor Delfs gave Carol some advice, which was that she should have an Rh-negative boy first. So, she said, “Make sure this one is an Rh-negative boy, because Rh-negative boys are OK. We don’t want any Rh-negative girls, and we don’t want an Rh-positive baby first because

40

you might get sensitized.” So, Carol had Alex, who is Rh-negative. And then, she said, “The next one, you have a girl, because you want a girl. So, you have a girl, and she needs to be Rh-positive, because you don’t want any Rh-negative girls.” So, Madeline is Rh-positive. And she said, “After that, you’re on your own.” (Laughter) She said, “But then, you have 2, and you may be sensitized, but you may not be.” So, you know, we don’t know. Of course, there wasn’t a third, so we never found out if Carol would have been sensitized, but that was her advice. That experience got me interested in the whole issue of jaundice in newborns, and I had done so many exchange transfusions, and somehow that whole gestalt of jaundice interested me. And I did a study during my intern year at Hopkins from computerized data in OB. We had this vast array of data that the obstetricians had of all these Rh-negative mothers who came in. Nicholas Eastman was the chairman, and he had kept scrupulously good computerized records, punch card computerized records, of all of these patients. So, I started doing some studies of the outcomes of exchange transfusions. I can’t remember exactly what that was, but I remember giving a paper at grand rounds at Hopkins about it. And that was really the first thing that I did in neonatal jaundice. I remember that one of the cases that I unearthed in doing this was an Rh-negative mother, baby, who came in with severe erythroblastosis, got to a bilirubin in excess of 50, and the medical records of this child went through age 9. So, I was able to see what happened to this child, which was nothing. DR. BAKER: Nothing? DR. GARTNER: This child was perfectly normal. DR. BAKER: So that must have intrigued you. DR. GARTNER: There are kids who get very high bilirubin levels who don’t get kernicterus. Now, they must be rare, but they don’t come to our attention because we never see them. Nowadays, there aren’t very many that get to that level. This kid was brought in from another hospital, and by the time she got to Hopkins the bilirubin was 50. She got an exchange transfusion, but it was already up to 50, so I always remember that. Anyway, this database was sort of the basis of my interest in looking into exchange transfusions. And then, you know, I continued to have this interest in jaundice, and working with Win really gave me the scientific basis, because then I learned all about the metabolic issues and how to do the research. By then, I had some experience in doing small rodent surgery; rats, guinea pigs, mice, and setting up preparations. I had done those adrenalectomies back in medical school. We did a lot of animal studies in Win’s lab looking at bilirubin transport and metabolism in a complex way.

41

We eventually applied this to a number of different animals including adult and newborn rhesus monkeys. DR. BAKER: So, every medical student today has to learn the bilirubin metabolism pathways. DR. GARTNER: Yes. DR. BAKER: And we still draw arrows and diagrams and show it all. DR. GARTNER: Yes, right. DR. BAKER: I guess I’d like to hear at this point, early-1960s, what was understood about bilirubin metabolism at this point. DR. GARTNER: Not nearly as much, and it was not taught in medical school, and I didn’t learn it in medical school. DR. BAKER: Did we even understand conjugated versus unconjugated bilirubin, or can you give me a sense of what is understood at this point? DR. GARTNER: Yes, I think we understood what it was chemically. I don’t think there was any real understanding of the intestinal component, the intestinal absorption and the metabolism of bilirubin subsequently. So, I think by then glucuronyl transferase and conjugation were understood. I don’t think it was understood in terms of what was happening in the newborn, however. In fact, I know it wasn’t, because the first real understanding of the relative contributions of uptake, conjugation and excretion came out of the stuff we did in the newborn monkeys. That was really the definitive study that identified for me -- and I think for most people -- the relative contribution of each. Win was particularly interested in the issues of hepatic uptake of bilirubin, and a lot of his work defined the limitations and what the mechanisms were of transfer of bilirubin from albumin to ligandin, which is the receiving protein in the liver, the membrane limitations and so forth, which are still not fully understood. But I don’t think there’s a great deal more known now than there was 30 years ago. I think there was a great period of understanding and research, and as far as I can tell what’s understood now is not very different than it was 25 or 30 years ago. DR. BAKER: Well, that’s humbling. So, would you say the 1960s and 1970s were a period where there was a huge increase-- DR. GARTNER: -- and some into the 1980s, but I think by 1980 it pretty well was understood. And I don’t think there’s a great deal more that’s known that contributes to this. Some of the intestinal stuff is a little clearer,

42

but not entirely. But the role of intestinal reabsorption in physiologic jaundice and then breast milk jaundice is an interesting phenomenon. There’s a story that goes with the movement into breast milk and breast milk jaundice that I have to tell. DR. BAKER: We’ll come back as we talk about your research. DR. GARTNER: Right. DR. BAKER: We’re still going to talk about this here, because I think it’s still part of your personal story, how you got interested in this and developed a career that will addresses this. So maybe at this point we can talk more just about the outline of your career as it now developed with fellowship and joining a faculty. DR. GARTNER: Well, I was originally what they called an “associate” when I was a fellow. At that time, it was possible, unlike now, to get a lot of grants for training. So, I had grants during my fellowship. They were usually institutional research, institutional training grants. I don’t know whether they’re available now or what’s being done, but they were readily available then, and that’s largely how we supported fellows. So, I went through that and then went on the faculty as instructor and then assistant professor and began to write my own grants, NIH [National Institutes of Health] grants. I got several of them. I can’t remember now exactly what, but the big one was the rhesus monkey bilirubin developmental program. That went on for a long time and was renewed several times. And I actually transferred it in 1980 to the University of Chicago and tried to continue it there, but I couldn’t do it and be chairman. It eventually died, but I brought a fellow with me, a PhD, Dave Moscioni, and, of course, Kwang-sun Lee, but Kwang and I were all too busy doing clinical and administrative work to give enough attention to the bilirubin studies. We did a few more studies on breastmilk jaundice and published more papers, but we could not keep it going. I was particularly interested in understanding what the factor is in human milk that promoted bilirubin reabsorption and what the mechanism is, but to this day we don’t know what it is about breast milk that causes the prolonged jaundice. DR. BAKER: I do want to really come back and talk more about this. I think at this point it would be useful just for the oral history for you just to outline the chief phases of your career, including how long you were in New York and then Chicago. And then just give us that overview. DR. GARTNER: OK. Well, after my period of fellowship, which was a little ambiguous, I continued to work in Win Arias’ lab for a few years, and was an assistant professor, and then I did get my own lab in the Kennedy Center. I’m trying to remember. I guess I waited until the Kennedy Center

43

was open, and then I had my own lab, so I no longer was with Win physically. I can’t remember what years that was, but I was probably still an assistant professor or maybe an associate professor. I had my own lab, and was running a laboratory. We had 2 or 3 technicians. One of them was with me for a long, long time, Donna, and a few others. And we had a woman who washed and cleaned up the lab, and we began to have fellows. The fellows were largely funded through institutional training grants, or sometimes they came with their own money. I didn’t think of having fellows initially. I was young. I wasn’t sure what I would do, but one came along because he was in the Public Health Service, and they had nothing for him to do for his second year of service. He decided he wanted to do some neonatology for that year. He was the first fellow. It just sort of happened without much planning. One of the other pediatric faculty members was contacted by somebody at the NIH asking, “Do you have a place for this guy?” He asked me and I said, “Yes, we’ll take him,” especially since he came with his own stipend. That first fellow was Bob [Robert] Chabon, father of the famous novelist, Michael Chabon, who was in our lab from time to time. I doubt that it had any influence on his writing. That was the beginning of fellowships, and it went well. So, we started saying, “OK, we have a fellowship program,” and we started taking fellows. I would have 2 or 3 at a time. Then, we began to really move along and do a lot more clinical research, not all bilirubin, but a lot of it was. It depended on the interests of the fellows. I continued on the faculty, and then, after 5 years or so as a tenured associate professor, went to full professor. At that point, I was director of the nursery. Harry Gordon had gone on to administration, and was no longer involved in the nursery, and I was running the newborn service and neonatal intensive care unit, and the liver disease program. We began to develop a number of programs. It was much more intensive care type of stuff, and bringing in a number of fellows was important. Lou [Louis] Gluck, was a good friend and became a big help. Two people were very important in this. One was Lou Gluck, who we invited down and who really gave a lot of good advice on what we should be doing. The other was Bill [William A.] Silverman. DR. BAKER: Let’s just pause. (break in audio) DR. BAKER: OK, we’re back. DR. GARTNER: OK. I was talking about Lou Gluck. I can’t remember exactly where or how I got connected with Lou, but he used to come down

44

from Yale where he had just begun the creation of his neonatal intensive care unit. I really think that Lou Gluck invented the concept of intensive care, not just for newborns and pediatrics but for adult medicine as well. DR. BAKER: Can you elaborate on that, because I think that’s a very important historical point. DR. GARTNER: I don’t have any data on this, and I’ve never looked at the dates, but I have sort of a gestalt feeling about this, that intensive care for adults really didn’t exist, or for older children. It didn’t exist until Lou created the concept of neonatal intensive care at Yale New Haven Hospital and that was the turning point in all of this. DR. BAKER: Interesting. That’s a project for a grad student. DR. GARTNER: Somebody will look at it. I think its influence on medicine is an interesting question. Lou came a number of times and just was a great support. In fact, when I was here in San Diego doing research in the zoo in 1967 or 1969, he and [Kurt] Benirschke, the perinatal pathologist, came together to look at San Diego. That was when they were thinking of coming here. I was doing research at the zoo, and they came, and I toured them through the zoo and the research facilities there. Lou was very important. The other person who was of enormous importance was Bill Silverman. Bill Silverman was really my guru. He was at Columbia [University College of Physicians and Surgeons], as director the preemie unit and later NICU at Columbia Babies Hospital. I never had any official role in his program. His wife, Ruth, was a nurse at Einstein in the genetics clinic. It was both, adult and pediatric genetics, and I got to know her because I had some liver patients who went through the genetics program. I got to know Bill through her. This must have been before Harry Gordon was there. I can’t remember exactly, but I felt the need to have some senior people who really knew more about this field than I did, so we used to invite Bill often. He used to come fairly regularly and make rounds with us in the nursery, which was wonderful. It was an incredible experience; a great, great teacher and a great human being. He became a very close friend and, really, my senior person. There was nobody at Einstein that I could have in that role. So, he fulfilled that role for the nursery and for me when it was mostly preemies, but I think we also began to move into the more intensive care. And he continued to play a role, and I would go to Columbia from time to time for various things. DR. BAKER: So, if Lou Gluck helped the idea of the intensive care nursery crystallize for you, what ideas crystallized in your head from your contact with Bill Silverman?

45

DR. GARTNER: His was more oriented to clinical research, generating a foundation for what we were doing and looking at it critically. I think that was really what he contributed. He had an interest in bilirubin metabolism, but it was really his orientation to the patient and to thinking about how we’re going to manage a patient. He had a lot of important ideas about the importance of the issues with management of heat and humidity for the preemies, sort of the general care of the preemie and the scientific basis for it. And I think that’s what he brought in, but he also brought in his vast knowledge of preemies and newborns. It was his thing. DR. BAKER: It also seemed like he was a great humanist -- DR. GARTNER: Oh, he was. DR. BAKER: -- and somebody who could even critique his own profession. DR. GARTNER: Oh, yes, and he did. Just his being in our unit fairly regularly gave us some credibility. He was THE neonatologist in New York, certainly, and he wrote the book, literally. Having him there gave us all some credential, which was important. It was part of the development of the unit, and we continued that involvement until he died. We even used to go up to see him and Ruth in the San Francisco area after they moved West. They lived in Greenbrae for many years and kept in touch. I invited him to Chicago a number of times. He was really my neonatal mentor. Win was my research and bilirubin mentor. The 2 of them were really my mentors. I think of Bill as my guru because I remember some wonderful times sitting with him up in Marin County at his house on the steps of the pool, in the water for hours talking. I can’t remember what we talked about, but we talked about research. We talked about philosophy. We talked about life. He was just a remarkable man. We did see him just before he died. He died voluntarily. He had renal failure. He had chronic renal disease, and he had renal failure, and he decided he did not want dialysis and quite consciously said goodbye. DR. BAKER: Yes, true to himself. DR. GARTNER: Yes. And I saw Lou as well in his final weeks. I did his oral history just before he died. I had been after him, through his son, David, to try to get him to do an oral history, but he was always too sick with pancreatic cancer to do it. And then, finally, he said, “OK,” and his son called me up and said, “He says he feels well enough if you can come right away.” I happened to be in San Diego at the condo, and I had my tape recorder, and I said, “OK, I’ll be there.” And I literally went up to Orange

46

County the next day and did his oral history in 2 hours. That’s all he could do, but in 2 hours I didn’t have to ask any questions. I did not even try to use the script. DR. BAKER: Yes. DR. GARTNER: He just talked steadily for 2 hours. He knew it was the last time he was going to tell his story. DR. BAKER: Are there any other highlights of your career at Einstein you want to mention before we say a little bit about Chicago? DR. GARTNER: I did not talk about Charlie [Charles] Cornelius, Corney as he was known. He was a veterinarian and biochemist who was at the vet school at Davis [University of California Davis]. Win and I met him at the opening of the Animal Medical Center in New York at a luncheon at the Waldorf Astoria. We had all given talks on bilirubin. At the lunch our deep friendships developed. A few years later, Corney came to Einstein to do a year’s sabbatical with Win and me. His wife, Bette, and his 4 children came, too. Bette and Carol became close friends, and now refer to each other as “sister.” For that whole year, the 3 of us were in the same lab in the basement of [Nathan B.] Van Etten Hospital (Bronx Municipal Hospital Center). Corney’s interest was in jaundice in sheep and monkeys. During that year, we not only had rats and guinea pigs in the animal quarters, but also sheep. Corney taught me how to do isolated liver perfusion studies. Either during that year or shortly after, Corney suggested that we 3 could go to the San Diego Zoo to do research there as Ellen B. Scripps fellows. He knew the director of the zoo and arranged it. We did that for one month stints for 3 summers, renting little houses at Mission Beach each time. The first summer Corney and I studied bilirubin transport and metabolism in the Caymen (South American alligator) and wrote a paper describing the anatomy and physiology of bile pigment (not bilirubin) in that species, which does not make bilirubin. That was a little evolutionary biology. The next year we did a study of comparative albumin binding in all species in the zoo. During that summer the Zoo offered to give us Mangabeys, old world monkeys, to study. So, we did our usual bilirubin transport studies on them. We did not find anything remarkable, but that stimulated me to consider doing the study of bilirubin metabolism in the newborn rhesus monkey, to try to fully understand the development of neonatal jaundice. The following summer, Corney and I studied 12 adult rhesus monkeys to establish the adult bilirubin transport and metabolism basis for later comparison with the newborns. By that summer, I had been funded by the NIH for this very expensive study, which went on for the next 8 or 9 years.

47

DR. GARTNER: I think I’ve really covered most of what I remember. I’m sure I forgot a lot, but I think those are really the important parts. One highlight I should mention that I didn't is the fellows I worked with, because some of them really did extremely well and were very important. The ones who were closest, and were very important, include Ilana Zarafu, who was a very fine clinical fellow. She was not terribly interested in research, but she went on to become the chief of neonatology at [Newark] Beth Israel [Medical Center] in Newark, which was a big inner-city unit, and eventually became medical director of a children’s rehabilitation chronic disease hospital in New Jersey. She contributed enormously to the healthcare of children in the state of New Jersey. She was wonderful and a very good friend. She, unfortunately, died very young; very sad. The other person is Kwang Lee, who was recommended to me by the chairman of pediatrics at Brooklyn Hospital where he had done his residency. He came from Korea where he was a medical student at Seoul National University to do his internship and residency in the US. The chairman of pediatrics at Brooklyn Hospital had been a resident at Jacobi Hospital. He called me up and said, “There’s this remarkable Korean fellow. I’ve never seen anything like it, and you need to take him as a fellow. He wants to be a neonatologist.” I interviewed him and said, “Oh, he is a remarkable man.” I took him on and he did his fellowship. We did a lot of bilirubin work together. This was in the mid-1970s, thereabouts, and then he stayed on, as junior faculty. In 1980, when the time came to move to Chicago when I took the chairmanship; I said, “I’m only going to Chicago if you’ll come with me to run the neonatal unit there,” because this was a big need there. He said he would come. He came at the same time I did, and started reorganizing and running the neonatal intensive care and the whole neonatology program, and he is still there getting ready to retire. He’s been chief of neonatology at The University of Chicago for 34 years, which may be a record, and has done an incredible job. He is a full professor and was recently given a named chair. He just runs a beautiful unit, great in every way, and is a wonderful person and a really close friend, as close to a brother as I have. (Laughter) DR. BAKER: Really? That’s right, the brother you didn’t have. Wow. DR. GARTNER: Even though I still think of him as a brother, he still considers me his teacher, and, therefore, I must go through every door ahead of him. It’s a Korean tradition. We have been to Korea a number of times and actually lived in Korea for 5 months, and he was very influential in that because you have to be introduced in Korea in order to have any acceptability. He’s considered a very important person in Korea even though he’s here.

48

DR. BAKER: OK. Well, that might be a segue to talk about how you happened to get to Chicago, and then we may take a break after that. DR. GARTNER: OK. Well, I got to Chicago. I was asked to interview for a chairmanship. I wasn’t really looking for chairmanships. I wasn’t looking to leave New York, but I got the invitation, and I always thought it might be nice to be a chairman. I knew some nice chairmen like Henry Barnett, and I thought being a chairman was sort of a next step that was natural. The reason I was on the list was because of Lou Gluck. Lou is a graduate of the University of Chicago medical school, and he was asked by the chairman of obstetrics and gynecology, who was chairing the search committee, to be their consultant, and he suggested me. DR. BAKER: It was that connection. DR. GARTNER: Lou was the connection, and therefore I was invited to try out. There were several other candidates, one from Washington, DC was actually a distant cousin of mine. I didn’t know he was a cousin, but he is. Anyway, the 2 of us were the finalists in this, and they ended up choosing me. I think the reason they chose me was that I was the neonatologist, and they felt the need to build the neonatology program, and the other person was a geneticist. I think they thought it was more important to build the neonatology, especially since the chair of the search committee was an obstetrician who very much wanted a good neonatal program. That all worked out well. The neonatology program at Chicago has been an enormous success. Half of all the net profit to the hospital comes from the neonatal intensive care program. It’s not unusual. That may be true at Duke as well, a big moneymaker. Kwang has really turned out to be a superb leader and has developed a super program. It’s a first-rate program and has been very successful. So that was my transition, and I went there as chairman intending to do innumerable things, only a small part of which ever got done, but I’ll talk about that. DR. BAKER: Well, I think that’s a major transition, so it’s maybe a logical time to take a break. We’ll come back to that. Thank you. DR. GARTNER: Good. OK. (break in audio) DR. BAKER: OK. Well, we’re returning after a break. And when we cut off before, we had just gotten you to Chicago. We talked about a couple of the relationships you had developed there, but we had just finished with that transition. I guess I’d like to hear more about your time as chairman at Chicago and what you look back at as important accomplishments.

49

DR. GARTNER: Well, living in Chicago was an interesting experience. It’s a great city in many ways, and the university was a quite remarkable experience because I had never been at a medical school that was physically part of the university. Hopkins medical was separate from the main university, and the same was true of Einstein, which was very separate from Yeshiva University. And here was the first time I was in a place which was a real university and a real college, and I felt that way. When we moved there, we bought a wonderful house in Hyde Park, just one block off campus, and I walked to work. And I said, “For the whole time that I’m going to be in Chicago, I’m going to walk through the quadrangle every day,” and I did. (Laughter) And one of the great joys was that on the block where our house was, the [Frederick C.] Robie House was located, which was one of Frank Lloyd Wright’s most famous houses. I walked past Robie House every day, and every day I walked past there I marveled at the beauty of that building. It’s now a museum. When I was there, it was part of the university, alumni house. We did have some departmental receptions there. It’s quite a lovely building inside as well as outside. Interestingly enough, that building came within probably 5 minutes of being destroyed and was saved by one of my neighbors on the block. He was a lawyer, a law school professor who, when walking past the building back in the 1960s, saw a crane with a big ball on it parked right next to Robie House. At that earlier time, it was owned by the Chicago Theological Seminary. He went up to the workmen in the truck and said, “What are you about to do?” And they said, “Oh, we’re going to tear down that old house.” And he said, “Oh, no, you’re not.” He identified himself and said, “You just don’t do anything. You just stay still for a little while. I’ll be right back.” He went to [Edward H.] Levi, who was president of the university at that time, and said, “They’re going to tear down Robie House,” and Levi didn’t even know that. DR. BAKER: Oh, God. DR. GARTNER: And they got on the phone, and they called [William] Zeckendorf, the builder in New York, and said, “We need some money, a couple of hundred thousand dollars to buy Robie House from the seminary and protect it from being torn down.” And Zeckendorf said, “Yes, you have the money. Buy it.” And he called up the seminary and said, “We’re buying the building. You’re not tearing it down.” They took the money, and the building was saved. The university owned it for 7 years. It now is part of a foundation for Frank Lloyd Wright, so it was saved, and it is a wonderful building. DR. BAKER: And you got to walk past it each day.

50

DR. GARTNER: Every day I walked past it. It was nice being able to walk to work. Carol had to drive to the 2 schools she was at. She was first associate dean at Northeastern Illinois University, which was north, and then she became dean of the College of Arts and Sciences at Purdue [University] Calumet in Hammond [Indiana], and there she had to drive south. I walked to work, so I had a lot of good warm clothes for the cold winters of Chicago, and it was fun living there. Being chairman was a mixed blessing. There were lots of nice things. It was a good department, a lot of nice people, a lot of good people, and we had a good children’s hospital. It was a nice building, and we had nice laboratories and really a lot of very good people like Peter Huttenlocher, a neurologist. I recruited some good people. Peter Whitington, who developed a very good liver transplant program in conjunction with the surgeons, who brought in a German surgeon, Christoph Broelsch, to do liver transplants. And one of the most exciting things we did was the development of the living donor liver transplant program, and that began at the University of Chicago. DR. BAKER: That began during your time. DR. GARTNER: In the pediatric department. It was an interesting experience. Chris and Peter called a meeting of the ethics committee and the dean and a number of other people in surgery and pediatrics to meet to discuss this. All they told us was that they were contemplating a living donor liver transplant program. We all went into the meeting saying, “Not on your life,” (Laughter) and we all exited from the meeting saying, “Yes, yes, you must do it.” They did a superb job of going through all of the issues including the safety of the donor and the independence of the donor, ethically, to make that decision. They did a wonderful job, and they presented the data on what the risks were of the donor giving a piece of liver. It was all done so well that from then on it really worked beautifully. It was a great program, and it has now become the standard of care. So that was one of the exciting events. What was tough was recruiting house staff. Recruiting faculty to the south side of Chicago was not an easy thing, and I think the people who came there, probably a little bit like myself, were a bit romantic about something, the romance of being at the University of Chicago: the name, the place, the fact that you were in the university. But that was part of the fun. We interacted with other departments outside the medical school. I had a research and discussion program with the Department of Chinese Language and Culture, an eminent department with great scholars. I got interested in traditional Chinese medicine from my Far East travels. Particularly Chinese pediatrics and neonatal medicine. The program was called “The Child in Ancient China.” We had a number of seminars, some with visiting scholars, that lasted a year or 2. I published a couple of papers as a result of that program.

51

A graduate student, Charles Stone, an American, who had learned Chinese in Taiwan, translated the ancient texts. He was a graduate of the University of Chicago undergraduate program, went to Taiwan, got another bachelor’s degree in Chinese, came back, and became a graduate student in Chinese studies. I had some money, and I paid him to do translations of ancient Chinese texts that dealt with breastfeeding and neonatal tetanus specifically. We discovered that the Chinese, back around 800 AD, knew how to prevent neonatal tetanus long before the West even understood what tetanus was. Well, the Chinese didn’t really fully understand, but they knew that it was transmitted to newborns by foreign materials that were in contact with the umbilical cord. Cutting the cord was the problem. They put that together and then were able to prevent tetanus by advising of not cutting that the cord. They wrapped it in linen, and then divided it having the mother bite through the linen through the cord, which I thought was an interesting technique. DR. BAKER: An interesting concept. (Laughs) DR. GARTNER: They also recognized hundreds of years earlier that adult tetanus and neonatal tetanus were the same disease. I thought that was quite a remarkable thing. The other study compared ancient Chinese and European writings on breastfeeding. This showed that the ancient Chinese had an understanding of breastfeeding management and advice that was in many ways comparable to our understanding today. The European writings were filled with bad guidance. DR. BAKER: But that line of work would not have happened had you not been able to collaborate with people in other departments. DR. GARTNER: And find a remarkable student who was willing to do this work and do the translations. The translations were very difficult. DR. BAKER: Sure. DR. GARTNER: At that time there was no translation dictionary of ancient Chinese characters for medical terms into English. But there was one that translated them into Japanese. Well, Charles knew enough Japanese that he could use the Japanese dictionary to get an English word, so that’s what he did. DR. BAKER: That’s a pretty unique connection. DR. GARTNER: He was very interesting. I always thought Charles would go on to be a professor of Chinese studies in a leading university after he got his PhD. He was married to a Chinese physician. I recently discovered Charles in Beijing, China. He had gone to law school in

52

Wisconsin and was now doing business law for a big international law firm. His knowledge of English, Chinese and Japanese was put to good use. DR. BAKER: Can you think of any other examples of interactions between the university and the department? DR. GARTNER: At one point the undergraduate dean said he wanted more of the undergraduates from the college to be interested in applying to medical school. He suggested that those of us in the medical school might want to offer some courses that would be of interest to the undergraduates. I had actually taught an undergraduate course in New York when I was at Einstein. Through our work in mental retardation, we had contacts with the Kennedy family. They were supporters of a small Catholic college in Westchester County and they wanted a course that would encourage the students to go into careers in mental retardation. Harry Gordon, then dean, asked me to develop the course which would be funded by the Kennedys, which I did. I used that course as a model for the University of Chicago course. From examining how various organs and their diseases or abnormalities could result in development of mental retardation or brain damage, I broadened the concept to examining fetal, neonatal, and later development of all of the major organ systems, brain, lung, heart, GI tract, endocrine system, immune system, and so forth. It expanded it into a course in human developmental biology. I recruited faculty from my department, including myself, and from other departments to give the lectures: the neurologists and the cardiologists and the pulmonologists and so forth. The course was a great success. We enrolled 100, 150 students each year. When I left, I turned it over to one of the other neonatologists, and he has kept it going ever since. I wanted to write a textbook based on the course, but I never did. I wanted him to write the book, but he hasn’t done it. That course was another example of how the medical school and the biology department were one. The medical school was actually a division of the biology department, and our appointments were joint. About half of the faculty in pediatrics taught undergraduate courses. DR. BAKER: That is very unique. DR. GARTNER: That aspect of academic life at Chicago was really very exciting. I really enjoyed that. But, of course, there were problems, the financial problems of getting support and being able to recruit good faculty. We never had a good genetics program in pediatrics. I tried recruiting, but I could never get enough underwriting from the dean’s office to really make it happen. I think that was a failure. We did a lot of interesting things, and it was an interesting experience leading a department. I think I did a decent job, probably as good as I could. I am the longest-term chairman of pediatrics at the University of Chicago. I was 13 years as chairman, and that’s far longer than any other chairman in the history of the department.

53

DR. BAKER: OK. (break in audio) DR. GARTNER: I don’t know where we broke off. DR. BAKER: Yes, we were just broken off. We were talking about interactions with the rest of the university, and I asked if there were any other, you know, particularly clinical programs that you were proud of. You mentioned the liver transplantation. DR. GARTNER: Yes, the liver transplant and some of the educational programs. I mentioned I brought Kwang Lee, and he really developed a very good neonatology program. One of the things that happened when I was moving there is that they were building a new general hospital, which included obstetrics, and I got the opportunity to design the neonatal intensive care unit. It was quite large. This was 1980, what I designed I thought was the state of the art. The concepts that I had were influenced by my experience in Jacobi Hospital. I wanted rooms that were limited to 6 babies to a room. Part of it was that we wanted to be able to have nurses watch a number of babies simultaneously, so we didn’t go to single rooms or smaller rooms. It was an economic issue. I can’t remember how big it was. It must have been 48 beds, or 36 beds? Maybe it was 36 beds initially, and it got expanded. One of the interesting things that the architects wanted were skylights over the intensive care nursery rooms. The NICU was on the second floor, and there was an open courtyard above it. I said “No. I do not want a skylight over the babies. The problems of maintaining heat and cool is going to be impossible; between sun and ambient temperatures and all.” I said, “I want a well-insulated roof over all the babies.” DR. BAKER: This was Chicago. (Laughs) DR. GARTNER: This was Chicago, and they agreed, and they took out the skylight idea. And it actually was a good unit. It was quite functional. The babies all were internal. There were no windows at all where the babies were, and the window areas were all offices and rooms for the nurses, lunchroom and so forth. I’ve had experience with babies being near windows and the problems of them getting too hot from sun, too cold from ambient temperature, and I didn’t want that. So, we internalized the entire nursery, intentionally, and that worked quite well. The Lou Gluck model of neonatal intensive care was to have one very large room for all of the infants. In ours, each 6-bed unit, although it was open, had a door that could close. So, if we had to, we could isolate the unit, and then we also had several

54

isolation rooms and procedure rooms. I thought it worked quite well. I didn’t think there were any great problems. Since that time, a new children’s hospital has been built, with a big neonatal unit. I think they now have 72 beds. It’s all single-room type, semi-open but essentially single-room areas that can be closed off for privacy. And obviously, parents can stay and be with the babies all the time and so forth, which I think is good. On the other hand, they have a vast runway. The amount of time devoted to walking for nurses and doctors in the unit must be enormous because it looks like it is a city block long. DR. BAKER: In the unit you designed, you were developing more insights by that point into breastfeeding, and we’ll come to them in a minute. DR. GARTNER: Yes. DR. BAKER: I’m wondering if any of that was incorporated into the unit, innovations to promote breastfeeding. DR. GARTNER: We did in the sense that we had a couple of rooms off of the nursery, where parents could sleep with their baby for a few days before they took them home. Part of that was to encourage them to do breastfeeding, but we didn’t do anything else physically in the NICU. On the regular nursery floor, the postpartum floor for obstetrics, we did have a breastfeeding room with pumps. The mothers didn’t need that since they were in their own rooms, but it was for the staff. So, doctors, nurses, anyone who worked in the area could come over and use the pumps and keep up their lactation. There was increasing use of breast milk in the nursery at that time, and there was some encouragement of mothers, not as much as I would have liked. I had one interesting administrative experience about breastfeeding. I went to the hospital CFO [Chief Financial Officer] and asked for funding to hire another lactation consultant, specifically for the neonatal intensive care unit so that we could increase the number of mothers who would provide breastmilk. I pointed out that one of the neonatologists had just published a paper showing that babies who got at least 50 percent of their feeding as human milk had a markedly reduced incidence of necrotizing enterocolitis. None of the babies who got at least 50 percent human milk needed surgery. Although some of them got symptomatic and had X-ray findings, they never progressed to perforation. DR. BAKER: OK, interesting. DR. GARTNER: I told the CFO this, but he said he couldn’t give me the money for the lactation consultant because it would reduce the net income of the hospital if they had less surgery. Oh, and he also told me that all 3 of his children were breastfed, so he was a big supporter of breastfeeding! But he

55

could not give me the money. Well, that was symptomatic of a lot of the attitude of the hospital administration. The dean’s office was OK. The hospital administration was a big pain. (Laughs) DR. BAKER: So, the job was a mixed blessing. DR. GARTNER: Yes, it was a very mixed blessing. And then, the job got much more complicated because at one point the chairman of pediatrics at Michael Reese [Hospital], Sam [Samuel] Gotoff, left to become chairman at Rush [Rush-Presbyterian-St. Luke’s Medical Center]. Michael Reese was an affiliated program; our house staff rotated there. And the decision was made that I would be chairman of both. DR. BAKER: Where were you at this time? DR. GARTNER: At the University of Chicago, so I also became chairman at Michael Reese. This was a decision made while I was out of the country, obviously for financial reasons. DR. BAKER: I thought I remembered you were physically in Korea at that point. DR. GARTNER: I was physically in Korea on sabbatical at the time they called up and said that was what was happening. Michael Reese was an interesting place. It had a big neonatal unit and good pediatrics, and it had some very good doctors. And I now had to go there for conferences and administrative meetings and occasional rounds and that sort of thing. So, I got involved in Michael Reese, which unfortunately doesn’t exist any longer as a hospital but at one time was the major site of the beginning of neonatology in this country. DR. BAKER: Absolutely. DR. GARTNER: I was very sad at the idea that it was not going to exist any longer. I was very concerned about where the [Julius] Hess paper and other materials would end up. Fortunately, the family gave all of his papers to the University of Chicago Library. There is even an hour-long 16 mm movie of Hess giving a lecture on care of the premature infant, done in 1943, during World War II. DR. BAKER: They did. That’s right. DR. GARTNER: So, all of that is there. The other concern I had when the building was going to be demolished or abandoned -- which it was -- was all of Hess’ bronze plaques. The hall walls were covered with his award plaques. I have no idea where all of that went when they took the building

56

down. I hope it wasn’t melted down. There was even a bronze plaque about [Evelyn] Lundeen. It was historically very important. DR. BAKER: Oh, gosh. That’s a sad story. DR. GARTNER: Anyway, I was no longer involved with Michael Reese at that point because it had separated from the University of Chicago and become affiliated with the University of Illinois. When that happened, we pulled out our house staff, much to the dismay of the president of Michael Reese who changed the affiliation without consulting with anyone at The University of Chicago until it was a done deal. He just broke off and expected me to leave the house staff there, and I said, “Not on your life.” They were gone the next day, and we made arrangements with Mercy Hospital, which was across the street from Michael Reese, to rotate our residents there. Mercy was not a great rotation, but it served for the moment to pay the salaries of all our residents for their month or 2 there. I made weekly rounds at Mercy in the hope of strengthening their program and supporting our residents. Our daughter, Madeline, as a Loyola medical student, took her pediatric rotation at Mercy, and told me it was not a good experience. Maybe that’s why she became a surgeon instead of a pediatrician. DR. BAKER: Correct me if I’m wrong, but as the 1990s are progressing you’re becoming more involved on the national level with promoting breastmilk, breastfeeding and the like. DR. GARTNER: Yes, right. DR. BAKER: And I know that’s going to come out of your research, which I want to get to in a minute. DR. GARTNER: Well, I’ll tell you the story. The reason I got so involved in the breastfeeding does go back to research, or starts with a clinical story. During the time when I was an early research fellow, between my residency and chief residency at Einstein, I was working in Win Arias’ lab. The house staff knew that I was interested in neonatal jaundice, and they would occasionally call me to see a patient who came in with jaundice. Well, they called me up one day, and I went to see this baby who was about 3, maybe 4 or 5 days old and had a bilirubin around 20, perfectly healthy, and I couldn't find anything wrong with him. And the only unique thing was that this mother was breastfeeding the baby, which was a real rarity at that time. The mother was Italian and had come relatively recently from Italy. I talked to her and said the baby looked fine, but would she give me some milk. So, she expressed some milk and I put it in a test tube. At that time, in the lab, Win was doing studies of serum to look for inhibitors of glucuronyl transferase, which Jerry [Jerold] Lucey had suggested was a mechanism of jaundice in

57

neonates. Don’t think that ever was proven, but Win was doing studies of inhibition of glucuronyl transferase, and I stuck the milk in the freezer in the same box with the serum specimens thinking that, well, maybe there was something in the milk, if not in the serum. DR. BAKER: In the milk. DR. GARTNER: So, it was sort of natural to think that. I actually wrote a note on this baby’s chart which I would love to recover now, saying that there wasn’t any obvious cause of this baby’s jaundice but maybe it was related to the breastfeeding, and that there might be something in the milk that was causing this baby to be more jaundiced. And the baby went home. Well, maybe a month or 2 later, after I’m now back being chief resident, Win Arias calls up and says, “What was the white stuff in the tube?” I said, “Why?” He said, “Well, it completely inhibited glucuronyl transferase.” (Laughter) And I said, “Well, it’s milk from a mother of a jaundiced baby,” and I told him the story. And he said, “Do you think we can get any more?” I said, “I don’t know. I’ll pull the chart.” So, I pulled the chart, and I looked up the address. There was no phone number, so I drove over to the address and knocked on the mother’s door. It was a basement apartment. She opened the door, and I said, “Are you still breastfeeding?” And she said, “No, I stopped,” and I said, “Oh, darn.” I said, “How’s the baby?” “Oh, the baby is fine.” She showed me the baby, and we talked a little bit, and I left. And I went back to Win, and I said, “No, no more milk from her.” So, we then sent out word to pediatricians who were connected with the hospital or who were in the area and said, “If you see any jaundiced babies who are breastfed please collect the milk for us and give us a little history.” And we started getting milk samples, and we started looking at this. Now, to this day, the substance in the milk that causes prolonged neonatal jaundice related to breastfeeding is unidentified -- it’s something in the milk. Also, we are still unsure whether the prolonged jaundice is due to the milk inhibiting glucuronyl transferase, which I think Win Arias still believes, but I’m not certain. I don’t believe that is the mechanism, but maybe I should, because there’s some recent data that suggests that might be the mechanism for some babies. Or, whether it’s the enhancement of intestinal bilirubin absorption, which is what I believe, based on our animal studies. Both may be true with some, with the inhibition being only for some people depending on what their genetic makeup is for the transferase enzyme. So, we don’t know, but that’s how I got interested in breastfeeding. So then, to go on to the breastfeeding issue, Win gave a paper at the internal medicine research meetings, and word got out that breastmilk caused jaundice. By then, we had some clinical reports. We then got a visit from a physician pediatrician who was connected with La Leche League saying they were very worried about this relationship of breastfeeding causing jaundice

58

and would I come and talk with them about it. And I said, “Sure.” I never refused an invitation to give a lecture, mainly because I loved lecturing. They organized a meeting. It was actually held at Northwestern [Memorial] Hospital, and I went and talked about it, showed them the data on the babies and talked about this phenomenon. I called it breastmilk jaundice. What I actually did, to get into the research, is whenever we identified a patient of our own who was breastfeeding -- and we were beginning to see a little more breastfeeding. The babies were staying 3 or 4 days, so we were beginning to see some higher bilirubins. So, I made a deal. It actually started with one mother. I said to her, “Well, the baby’s bilirubin is a little high, and you are breastfeeding.” I suggested that she stop so we could see if it was related to breastfeeding and then go back to breastfeeding, and she said, “No. she did not want to stop.” She said, “This is the right way to feed babies.” It was a black mother, and this was her fourth child, and she said, “No, this is the way you feed babies, and I'm not going to stop.” And I said, “Well, let’s make a deal then. You keep breastfeeding, and I’ll come to your house every day, and I’ll draw a heelstick bilirubin from the baby, and you collect milk.” And she said, “OK.” So that’s what she did. She diligently collected milk, and I went every day and did bilirubins on the baby. And indeed, what we showed was this prolonged jaundice. The bilirubin never got high enough to need rehospitalization or anything else, but we followed it, and that became the model. So now, I started doing more patients that way, and I would travel around the Bronx at some risk to my own safety, collecting milk and doing bilirubins on babies. DR. BAKER: Is this in your fellowship at this point? DR. GARTNER: Yes, it probably was fellowship time. DR. BAKER: OK, kind of early 1960s? I’m just trying to picture it. DR. GARTNER: Yes, early 1960s, and it went on for a few years. And we published these clinical reports with the analysis of the milk, and we thought that we had some evidence that it was inhibition of glucuronyl transferase. DR. BAKER: I think the study is fascinating because you’re having to study a phenomenon that’s no longer happening in the nursery. DR. GARTNER: That’s right. DR. BAKER: So, you were having to do home visits to track this. DR. GARTNER: That’s what I did. DR. BAKER: This is pretty unique to have done that. I think if we could have done that with colic maybe we’d understand it better.

59

DR. GARTNER: That’s right. Anyway, but the mothers were very cooperative about it, and it really worked. In addition, because I went to this La Leche League meeting, La Leche League started the annual Physicians Seminars. They would get 50 or 100 doctors each year to hear talks about breastmilk and breastfeeding and related issues. It was very successful and went on for probably 25 years. DR. BAKER: Did you learn from being at these seminars too? DR. GARTNER: That’s how I learned about breastfeeding, because I didn’t know anything about breastfeeding before that. But then I also became deeply involved in La Leche League, talking to the mothers and talking to lactation experts. I became knowledgeable about breastfeeding. That was really the beginning of my serious interest in breastfeeding, and it continued as we did the research. I became involved in a number of activities related to breastfeeding including at the American Academy of Pediatrics. The American Academy of Pediatrics had sent Linda Black, a general pediatrician, to a breastfeeding conference. She’s in your area somewhere, a neonatologist now. DR. BAKER: I’m not sure. DR. GARTNER: Anyway, she was sent by the Academy to a national policy meeting that was dealing with national breastfeeding policies. It had to do with job descriptions for people who were going to help in breastfeeding and other policy issues. She reported back to the AAP, and urged the Academy to endorse some of the meeting’s recommendations to support breastfeeding. The administration of the Academy was a little unsure of what to do about this. So, they asked me if I would put together a work group to discuss the report and other breastfeeding issues, which I did. And that work group included Ruth Lawrence, Audrey Naylor, Linda Black and about 4 or 5 other very knowledgeable people. Our first task was to write a new policy statement on breastfeeding for the Academy. DR. BAKER: And can you remind us when is this? What year is this? DR. GARTNER: Oh, let’s see. We published it in 1997 (Work Group on Breastfeeding and the Use of Human Milk. Pediatrics 1997; 100:1035.) So, it began probably in 1994 or 1995. We looked at the old policy statements that had been written some years before. They were pretty weak, and we said, “We’re going to write a good, strong statement,” which we did. And it was a struggle to get it approved by the [American Academy of Pediatrics] Board, but it eventually was approved and is the modern policy statement. There are now 2 or 3 updates of it.

60

DR. BAKER: OK. Why was it a struggle to get it approved by the Board? DR. GARTNER: There were some members of the Academy Board of Directors, including one president at the time, who had grave misgivings about it and didn’t believe what we said about breastfeeding. He actually asked for 50 reprints of the citations in the report having to do with the evidence, which he wanted to read. I don’t know whether he ever read them all. He continued to hold up the approval until the executive director said, “Look, you have to make a decision. You can’t just hold up things. They have to vote on it.” He finally yielded and said, “OK, let them vote.” I don’t know that he ever voted. He had some concerns, but even after I met with him, I don’t know what they were. He would never tell anyone. DR. BAKER: Not sure what they were. DR. GARTNER: It’s not uncommon to find people who don’t understand their own reluctance about breastfeeding. We’ve talked about this, and there’s a lot of speculation, but I don’t have any data that explains the negative attitude of some people toward breastfeeding. It has obviously become much less of an issue now, and the younger house staff who are getting training and experience relating to breastfeeding now come out of it with a positive attitude. DR. BAKER: Sure. DR. GARTNER: And it’s very different, but, anyway, that’s how I got involved, and that carried into the Academy. The recommendation from the Board was that we should create a section. So, I became the first chair of the new section, created the documents and the committees and all of the structure of what has now become, quite successfully, the Section on Breastfeeding of the Academy. They’ve continued to update the policy statements and we published a book on breastfeeding for physicians, the gold book [Breastfeeding Handbook for Physicians], and they have section meetings at each annual Academy meeting. It has been very successful. DR. BAKER: This is an interesting path that you followed. You’ve become a great advocate for breastfeeding, but your interests really started with papers that basically showed that there is a linkage between breastfeeding and jaundice, which was just not seen as a good thing at that time. DR. GARTNER: That’s right. That’s correct, and I had mixed feelings about what I was doing. Eventually, as we saw enough patients and saw the relationship as we followed up on the patients, we realized that it was much more complicated and that this phenomenon of what we called breastmilk

61

jaundice, was rarely if ever a cause of serious jaundice that would cause any problems. What it did, we realized, is extended the duration of physiologic jaundice. It was a prolongation of physiologic jaundice. Then, we came to realize there was another phenomenon, which actually had been recognized in adults, of starvation jaundice, which all mammals have. And every human, if starved for 24 hours, will have an increase in their bilirubin. They won’t get visible jaundice, but they have an increase in bilirubin, so it became clear that there was some relationship. And then, we realized that some breastfed babies weren’t getting adequate breast milk and were essentially hypocaloric. And when we did the big phototherapy study for the NICHD [National Institute of Child Health and Human Development], the big multicenter study, we actually had measurements of total intake and calories for all the premature babies in the study with and without phototherapy. And we had bilirubins on all the babies, because that’s what we were studying. So, we have a graph showing the relationship of caloric intake to the bilirubin level in one of the publications in the book. With or without phototherapy, inadequate daily caloric intake increases the serum bilirubin. It is more dramatic in preemies than it is in more mature babies. DR. BAKER: It’s the key thing. DR. GARTNER: So, there were 2 things going on, and sometimes you’d get both happening: inadequate calories, but the baby is breastfeeding. So, you can get both happening, but probably somewhere in the order of 60 percent, maybe 70 percent of all newborn babies have prolongation of physiologic jaundice compared with formula-fed babies, and the real question is whether that prolongation is beneficial. There is some data that bilirubin is an effective and clinically important antioxidant and that that is why it evolved as a by-product of heme degradation and why physiologic jaundice evolved, because it certainly evolved with evolution. DR. BAKER: Yes. DR. GARTNER: And newborns don’t make other antioxidants, so this may have been a way to take a waste product and make it into a beneficial product, which is why in mammals it may have moved from excreting biliverdin in reptiles to excreting bilirubin in mammals. DR. BAKER: Yes, this problem is interesting on a number of levels, but one of the levels is the level of evolutionary biology. DR. GARTNER: That’s right. DR. BAKER: If jaundice is purely a bad thing, why would it be more common in breastfeeding babies, which presumably evolution selected for? And

62

then, you have also done some interesting things. Your research at some point, I believe, led you to comparative studies in animals, did it not, with bilirubin? DR. GARTNER: Well, we did the studies in the monkeys. We haven’t looked at others, but we wanted a model to look at the phenomena of physiologic jaundice. All animals, even rats, have a little blip in their bilirubin in the newborn period. Monkeys have a higher level, almost as high as humans, but for a much shorter period of time. So instead of peaking on the third day, they peak at around 24 to 48 hours, and then it tapers off. We have never looked at the breastfeeding issue in the monkeys, but we have looked at physiologic jaundice. I’m sorry we didn’t, but we didn’t. That would have been very complicated because we would have had to keep the mothers, and it was expensive enough even just having the babies. DR. BAKER: It was a pretty big deal to do research with monkeys. DR. GARTNER: It was a big job, serious research, but we did look at the monkeys to get data on the mechanisms of physiologic jaundice, and from that monkey data we now really understand physiologic jaundice. DR. BAKER: All right. I’m sorry if I misinterpreted some of what you’re doing. I’m worried I may have injected confusion by asking my last questions. Perhaps you could just summarize your research record with breastfeeding jaundice, what were sort of the key steps in the evolution of your own thinking about breastfeeding jaundice or maybe, first, some key papers. DR. GARTNER: Well, I think the papers that influenced me most in this were the papers showing 2 things. One was the starvation jaundice data from adults and from animals as well. And, in fact, Charlie [Charles] Cornelius, the veterinarian who worked with us, had some papers on that in horses where they apparently get quite severe jaundice if they starve, and it’s all unconjugated hyperbilirubinemia. So, the starvation jaundice was one that I thought put into perspective this difference between the effects of breast milk with adequate caloric intake and the starvation, which could occur with or without breastfeeding. And that is certainly an important issue. The other were the papers of an investigator, Rudi Schmid, who wrote some very important papers looking at intestinal bilirubin absorption in adult animals, showing that there was in fact absorption of unconjugated bilirubin across the intestine and a return via the portal circulation. Those papers and that data, that idea, that concept fit in with this and led me to believe that it was the increase in intestinal absorption that resulted from the ingestion of human milk, and that we actually showed in animals.

63

Human milk did have that effect. It actually has that capacity not just for bilirubin, but it has that effect on a whole host of other components that are in the intestinal tract, which is probably part of the phenomenon of the efficiency of human milk to increase the retention of nutritional components. And it has been shown, for instance, for thyroid hormone. It has been shown for a number of other lipid-soluble components that they are reabsorbed, and the same thing happens in starvation, as you’d expect. But breast milk does it by some other mechanism. Now, what we’ve never gotten any information on is what is it in human milk that promoted this increase in intestinal absorption, not just of bilirubin but of other things. We don’t know. And, you know, I’ve tried to encourage people to do some research on this, and as far as I know nobody has done any. The issue of inhibition of glucuronyl transferase may be real, as I mentioned, so I wouldn’t totally discard that. It may be a real phenomenon in some babies. So, it was may be 2 things going on; but the common mechanism is intestinal absorption. DR. BAKER: OK. It sounds to me that your thinking evolved about this for a period of over 20, 30 years, really. Initially, you played a very key role in documenting that breastmilk is associated with higher levels of bilirubin. And then, over time, you play a role in distinguishing that phenomenon into 2 other sub-phenomena, if you will -- DR. GARTNER: Right. DR. BAKER: -- an early versus a late form. An early form which you reconceptualize along the lines of a starvation kind of jaundice. DR. GARTNER: That’s right. DR. BAKER: A baby is just not getting enough breast milk, and that’s the kind of jaundice that could get a baby into serious trouble. DR. GARTNER: Yes. Right. DR. BAKER: And then a late form. DR. GARTNER: Or if they have good breastfeeding with high absorption and have another phenomenon going on, such as genetically inadequate conjugation or hemolysis. DR. BAKER: Yes, anything else going on. DR. GARTNER: Any form of hemolysis. So, anything else pathologic that’s going on along with the breastfeeding can do it as well. And then, you get higher bilirubin levels.

64

DR. BAKER: And then, later on, you reconceptualized the late form as probably more likely to be involved in hepatic circulation, although Arias sounds like he has stayed more with the inhibitor. DR. GARTNER: Enterohepatic circulation, carrying the bilirubin back to the liver. Win still thinks inhibitors, and he may be right. It may be both. DR. BAKER: Yes, we’re not sure. The story is still unfolding. DR. GARTNER: That’s right, and we really need some more good studies. We tried doing some of this when I was in Chicago, but I just didn’t have the time to devote to the lab the way I would like to. And I’ve often thought that the thing I missed most when I was chairman and now, in retirement, is that I don’t have a laboratory to work in. I really liked working in a laboratory and just being able to do animal studies DR. BAKER: What did you love so much about the laboratory? I’ve heard you talk before about that. DR. GARTNER: Well, I love doing the surgical preparation of the animals. DR. BAKER: Yes. DR. GARTNER: And I actually was very good at it, and I even helped the gastroenterologists at Einstein get a big NIH training grant. The NIH team came for the site visit when I had started doing a bizarre piece of surgery in which I was inserting a bile duct catheter into a fetal guinea pig in utero. DR. BAKER: That sounds fairly formidable. DR. GARTNER: Well, it is. The technique I developed was that you kept the mother, the pregnant guinea pig, which is a fair-sized animal, in a large bowl of warm saline when you opened the uterus. So, the fetus would stay underwater. Otherwise, they would start breathing. These were near-term, so you would open the abdomen, suture the maternal skin to a board that had an opening in it, an oval opening with holes where you could put the suture through and pull the skin out. I didn’t have retractors, and I didn’t have any assistance, so I had to -- DR. BAKER: You didn’t have any assistance to do this? DR. GARTNER: No. No, I’m doing this all alone, so the mother guinea pig’s abdomen is open. Now, you expose the uterus, and you sew the uterus open, so you can get to the fetus, but you have to keep the fetus under the warm saline all the time. Otherwise, it’ll breathe.

65

DR. BAKER: Yes. DR. GARTNER: So now, I open the fetal abdomen, and I have to find the bile duct, which is not very large, although baby guinea pigs are pretty mature. DR. BAKER: About how big is a baby guinea pig? DR. GARTNER: Probably about so big, maybe 3 or 4 inches. They’re good-sized animals. And they’re very mature. And so, then, I find the bile duct, and my usual technique was to insert the fine catheter into the bile duct and then suture it in place and then suture the fetus back up, put the fetus back in the uterus, sew the uterus back up with the catheter now coming out, and sew the mother’s abdomen back together. And now we have the mother intact, the fetus intact, we hope still alive, and bile dripping out of the tube. DR. BAKER: Which you can now study. DR. GARTNER: Which we can now study. Well, I did this surgery several times without any success. The morning that the site visitors came I was doing another prep. I wasn’t involved in the site visit, but I was there in the lab, and I had set it up. And I had just finished all the suturing up, and the bile was flowing, and the site visitors came by, and they wanted to know what this was all about. And I told them, and they said they had never seen anything so remarkable. (Laughter) And they gave the grant. DR. BAKER: They gave the grant. DR. GARTNER: They got the grant because of that, maybe, maybe not. It was a pretty good program. It was a good gastroenterology department. Anyway, so I did a lot of crazy things, and I actually could never do it again. I tried a number of times afterward, and I was never successful. DR. BAKER: Well, that was the day for it to work, now, wasn’t it? (Laughs) DR. GARTNER: That was it. So, there was no further research using that technique. I just like working in a lab. I even like pipetting and doing chemical analyses. I mean, now it would be entirely different. Yes, I could still measure bilirubin, but you don’t measure bilirubin that way. You put it in a machine that measures it. It’s all automated. And, the molecular biology part is the important aspect of modern research-- DR. BAKER: How did you measure bilirubin?

66

DR. GARTNER: Chemically, with a chemical reaction. A van den Bergh reaction. DR. BAKER: I see. OK, the van den Bergh. I think a lot of us listening to this have never done that test. DR. GARTNER: My technician, Donna, she probably did a million bilirubin determinations, but yes, anyway, but I did many myself. DR. BAKER: And your interest in bilirubin went way beyond breastfeeding as well. DR. GARTNER: Oh, yes. DR. BAKER: And I wonder if we could talk about some of the other directions that you went at different points, biliary atresia or Zellweger. DR. GARTNER: Well, I looked at binding, bilirubin binding to albumin and looked at some phototherapy effects and optimal phototherapy intensities. Kwang Lee was particularly interested in that. He did some of that. DR. BAKER: Tell me why you were interested in measuring binding in free versus -- DR. GARTNER: Well, binding, of course, had to do with the fact that it was presumed that the free bilirubin is the one that gets into the brain. Of course, it’s kernicterus, and the question was whether we could measure the binding of bilirubin to albumin or the potential capacity that a baby had, and would that help us decide when to either use phototherapy or exchange transfusion, because we knew that there were babies who get kernicterus at low bilirubin levels. DR. BAKER: And there are stories of babies with very high bilirubin levels who didn’t get kernicterus. DR. GARTNER: And some high bilirubins would never get it, so we assumed that albumin binding was at least a big part of the mechanism. So, we looked at different binding methods, and we found one method, which we used ourselves, which was a fluorescent technique. It was an easy technique, which we thought bound to the same binding sites on albumin as bilirubin. But it was a fluorescent dye and therefore made it easy to measure. And we were interested in the evolution of that phenomenon of binding, so on our last summer at the San Diego Zoo, we wanted serum specimens from all the animals in the zoo and also all the ones at the Scripps [Institution of Oceanography] to look at the evolution of albumin binding. And quite

67

remarkably, they produced a sample from every species in the zoo, and from the Scripps also. And we measured the binding. Well, as you’d expect, lower animals have either no albumin -- for instance, sharks have no albumin -- and then you get increasing amounts as you go through evolution. It is still pretty low binding and fairly low albumin concentration until you get to the mammals which, of course, have more albumin, up to the primates. All primates have significantly more albumin and more binding, but it was still fairly low, except for the great apes. The great apes were the same as the humans in terms of their measured binding by this technique, but there was one primate, a very early primate, that had the same binding as the great apes and the humans, and that was the lemur. DR. BAKER: Lemur. DR. GARTNER: So, our hypothesis was that the lemur is in the lineage, evolutionary lineage, that led to the great apes and the humans. And knowing no evolutionary biology we never published this. I still have the data. I still think about it. I think the lemurs are unique, quite special primates. Our evolutionary concept is probably not valid because it is now believed that the lemurs evolved independently in Madagascar and are not precursors of the monkeys, great apes or humans. Their development of enhanced albumin binding is probably an example of parallel evolution. DR. BAKER: So, to understand that line of studies, you started by talking about measuring the capacity to bind bilirubin and albumin. But then, as you went into all these other species, they don’t all make bilirubin, right? DR. GARTNER: Well, the non-mammals don’t. DR. BAKER: The non-mammals don't. DR. GARTNER: No. DR. BAKER: So when you’re talking about their binding capacity -- DR. GARTNER: We were just looking at the albumin binding capacity. That’s all we were interested in. DR. BAKER: Thank you. OK. DR. GARTNER: And we were using this fluorescent dye, which was sort of a surrogate for doing -- DR. BAKER: As a surrogate for bilirubin binding, and you were finding that albumin binding capacity just started to rise among the mammals, and it shoots up in the great apes and lemurs. Interesting.

68

DR. GARTNER: But does albumin binding of bilirubin have anything to do with kernicterus? I don’t think so, even though everybody talks about it. We act as if it does. But, measuring binding for clinical management of jaundice in newborns by various methods seems to have gone by the wayside. Nobody is doing this for clinical decision-making, and that was our conclusion as well. Kwang published a paper showing that there was no correlation among the different binding methods. I don’t know what it means, and I think it’s been abandoned. We did do one other summer project. Charlie Cornelius by then had gone to the University of Florida in Gainesville as the first dean to create the school of veterinary medicine there. DR. BAKER: He was your collaborator in veterinary medicine. Yes. DR. GARTNER: My veterinary collaborator, and he suggested that we do a summer project in which we would use Marineland in Florida, in St. Augustine. He had some connections there, and I said, “OK, sure. Why not? We’ll spend a month in St. Augustine and we’ll do some studies.” So, we decided that we were going to see if we could produce kernicterus in sharks since they lack albumin. They had a lot of sharks there. They were happy to give us sharks. These were nurse sharks, which sound very benign. They are not benign. DR. BAKER: They’re not. (Laughter) DR. GARTNER: So, the first hint of their not being benign was when the handlers came, and they brought them in big plastic tanks. They were about 5 feet long, and in big plastic tanks with ketamine in the saltwater, so they were asleep. And we noticed that as soon as they brought the animals into the lab, the handlers ran off and disappeared, and we knew we were in trouble. DR. BAKER: (Laughter) That’s not good. DR. GARTNER: Well, the experiment was to infuse the sharks with bilirubin, and then we would sacrifice them and examine their brains to see if there was staining, a pretty simple thing. They have no albumin. They normally don’t have bilirubin, but if we infuse bilirubin it ought to get into the brain. Well, we don’t know anything about the blood–brain barrier either for sharks, but that was the experiment. We must have done about 6 or 8 sharks. We tied them to long 2x4 lumber with clothesline so that they can’t get loose. DR. BAKER: For obvious reasons.

69

DR. GARTNER: Sharks have to be in moving water all the time. They never stop moving because that’s how they put water through their gills. So, they have tanks in the marine lab that have flowing water all the time, to put the sharks in. As soon as we put them into the moving seawater tanks, the ketamine washed out, they woke up. But before we did that, we put in an arterial catheter. It’s very easy to get an arterial catheter into sharks because they have a dorsal artery. You go in near the tail with a Hubner needle, which is the angled needle and you put a catheter through the needle, pull out the Hubner, and you’ve got it. And you just sew it in, and you’ve got a good, firm, big catheter you can thread up the artery. And we pumped in lots of bilirubin. My assistant in this was daughter Madeline, who was then about 14. She was in a bikini, which was a good idea, because as soon as the animals woke up they were not happy. DR. BAKER: No. (Laughter) DR. GARTNER: Their fins were loose even though they couldn’t get loose, but there was water flying everywhere. And Madeline has a very detailed description of what this experiment was like. Anyway, we did it. We looked at the brains of all the animals. We even sent them off for pathology. Nothing, no evidence of any bilirubin getting in or any damage, and we don’t know why except they obviously have a blood–brain barrier that keeps it out, because we put in a lot of bilirubin, so it couldn’t possibly have been bound by anything else. Anyway, that was a failed experiment, but it was fun in St. Augustine. DR. BAKER: I wish we had caught that on video somehow. DR. GARTNER: Yes. Anyway, we ate a lot of shrimp. (Laughter) What else? DR. BAKER: As we’re talking about your research, we should talk about some of the projects that caught your interest for a while that ended up not being tied to your long-term work. You mentioned Zellweger. DR. GARTNER: Well, yes. Before we get to the Zellweger, let me tell you about something else. When I first started working in the lab after I finished my chief residency, I was interested in the issue of endocrine effects on bilirubin metabolism and transport and the question of whether hormones had any impact, thyroid hormone, corticosteroids, and so forth. So, we started a series of experiments looking at this, and I actually published some of it. I don’t remember it being particularly striking or useful, but I think we published one paper. Maybe that’s all. DR. BAKER: That’s the problem when you have a lot of publications. It’s hard to find one fast. (Laughs)

70

DR. GARTNER: I don’t know. I can’t remember. Anyway, I did some studies, and I probably presented some of it at meetings, and I thought I published something on it in which we looked at the effects of hormones, and they had some effect. I didn’t really find this particularly exciting, and nothing great turned out, and I sort of dropped it as the breastfeeding stuff got more interesting. Other issues having to do with the conjugation of bilirubin were much more interesting than that. But Win Arias tells me that that one publication started a whole series of studies of hormonal effects on liver function. But, I’ve never had any great interest in that area and never followed up on it. Now, the Zellweger syndrome is a much more important and a much more interesting story. A child was admitted, it may have been 2 months old or so, to the college hospital (Hospital of the Albert Einstein College of Medicine). We had 2 hospitals by then. This was the private hospital, and the child had jaundice, was clearly very sick, failing to thrive, looked awful, had some peculiar facies and funny hand positions. The thumb was in a funny position. I had never seen anything like this child, but it was a very characteristic face. So, I examined the child, admitted the child, ordered some labs, went back to my office and started looking through the files of syndromes and things that caused liver disease. The child clearly had some liver disease -- and came upon cerebrohepatorenal syndrome, also known as Zellweger’s Syndrome, and said, “Oh, that child looks just like a Zellweger.” So, I went back with the reprint in hand and held it next to the child. No question about it. “This must be a Zellweger,” and even the thumb positions and a whole bunch of other stuff, and they have cirrhosis, and they die. So, I decided to do a liver biopsy to see what the liver actually looked like in this child. On the case was a medical student who was an MD/PhD student doing research involving electron microscopy. I can’t remember whether it was on liver or not, and he said, “Gee, if you’re going to do a biopsy on the liver, could I have a little bit to do electron microscopy on?” And I said, “Of course.” So, I did the biopsy, gave him a little piece, and sent off the rest of it for pathology, which came back showing cirrhosis. The student came back to me about 2 or 3 weeks later with a bunch of EM studies, and said, “This is really bizarre.” “I don’t know what this is, but it looks very strange.” I looked at it and said, “Yes, it’s really strange looking, no question about it. I’m not even sure which organelles are what in this.” I said, “But I know who we go to. We go to Sidney Goldfischer,” who was a pathology professor and did a lot of liver pathology at Einstein. We went over to Sidney, and we threw down these photomicrographs on his desk. Sidney looks at them and says, “The botfly.” I said, “No, Sidney, this is a baby, not a botfly.” He says, “Yes, it’s a botfly,” and he goes to his file,

71

and he pulls out some pictures, and he says, “It’s the botfly.” I said, “Sidney, what are you talking about?” So, he explains that the botfly has large, dark, distorted mitochondria which looked like this baby’s mitochondria, indicating that oxygen was not getting to the mitochondria. Sidney kept looking at the photomicrographs and then said, “there are no peroxisomes.” “This child has no peroxisomes; they’re missing.” “This child has peroxisomal deficiency.” Peroxisomal absence or deficiency had never before been reported in any patient or animal. A new disorder! We did some more studies confirming the diagnosis. The child died, and within a short while 2 more cases of Zellweger’s syndrome came to our hospital, and now we knew what we were dealing with. We marshaled all of the experts in biochemistry, neurology and pathology, and we did biopsies on these 2 children and extensive workups. They both also died, so then we had autopsies, and we started doing more work-ups in conjunction with these investigators at Einstein. We published these cases and the laboratory studies in Science with Sidney Goldfischer as senior author, titled, “Peroxisomal and Mitochondrial Defects in the Cerebrohepatorenal Syndrome.” The student went on to become a professor of ophthalmology in New York and has more than 1,000 publications. DR. BAKER: Was the paper picked up on pretty quickly? DR. GARTNER: It was. Oh, yes. The paper was published in Science in 1973. It was hot. (Laughter) It was a real breakthrough. Research in peroxisomes and peroxisomal deficiency took off after that. Many more syndromes associated with peroxisomal deficiency and absence have since been reported. Every paper on peroxisomal deficiency cites the Goldfischer paper as the beginning. DR. BAKER: Wow. DR. GARTNER: Isabelle Rapin, who was a pediatric and adult neurologist, picked up on that and was very interested in the neurologic abnormalities. It led us to a whole series of studies of metabolic liver disease associated with brain disorders. We looked for a number of others, and did find a few other children with various syndromes in which they had both liver disease and some neurologic abnormalities. Bob [Robert] Terry, who was chairman of pathology, became very interested in these disorders, as well. He is a neuropathologist, and he’s out here in San Diego now at UCSD [University of California San Diego] continuing his research on Alzheimer’s disease. He’s still a good friend. He and I did a lot of work together at Einstein. None of the other children were nearly as dramatic as the peroxisomal deficiency and we did not make any great discoveries. The Zellweger discovery was encouraging, however. The hunt for new diseases is always great and especially enjoyable with wonderful colleagues.

72

DR. BAKER: Yes, that’s a remarkable story. DR. GARTNER: I gave a talk in England, in London, on the Zellweger syndrome discovery because I thought it was a good story and an important lesson. The important part of it is, when a student is with you, do everything you can do help the student. (Laughter) DR. BAKER: Especially when the student has access to an EM [electron microscope]. That’s fascinating. But it’s also a story of just getting the right people together. DR. GARTNER: That’s right. If Sidney didn’t know the botfly -- DR. BAKER: Yes, what is the botfly? I’m sorry. I didn’t understand that. DR. GARTNER: A botfly is a worm, a parasite, that lives in the intestines of horses. It’s oxygen-dependent, and it has a single trachea that goes down through its length. It has no organ of ventilation, so the oxygen seeps in, but it doesn’t get very far down this trachea. And as you go to the far end of the trachea, the peroxisomes disappear and the mitochondria become large and grotesque. He had never seen it in anything else, but that was the botfly story. DR. BAKER: I think at some point I’d like to turn and just ask you about how you developed the interest in pediatric history. Is this a good time to do that, or did you have any more laboratory or bench research stories you’d like to share? DR. GARTNER: No, I think we can go on to history. The history interest really came largely from my medical school experience at Hopkins. I just enjoyed the stories that accompanied the medical teaching. The idea of the oral history part, what we’re doing now, came about when we had the first training session for those who wanted to do oral histories that Susan Marshall organized at the AAP. The AAP had just started doing oral histories of Academy leaders. Janet Nolan was invited in to give a talk about oral histories and to teach us the principles and techniques of doing it. As she was talking, it occurred to me that it would be more useful to historians, if we used a more structured method for collecting oral histories. So, I suggested to the group that we explore this method and offered to do it with the founders of neonatology. We would ask everybody in neonatology that we interviewed the same questions, and therefore we’d get some uniformity in the data, and maybe we could reconstruct some of the early days of neonatology and how they evolved and what was important both in research and clinical. And neonatology was a young enough specialty that we could find almost all of the early people in the field. Of course, the real founder of

73

neonatology is Pierre Budin, but in the modern era it was Harry Gordon and others. Well, unfortunately, I did not get some of the earliest. I did not get to interview Harry Gordon. There were a couple of others who died early who we’re missing, but we got a large number of the next generation. And that’s how it came about. DR. BAKER: How many do you have at this point? DR. GARTNER: I think there are 17 altogether. You did one. I think somebody else may have done one or 2, so maybe I didn’t do 17. Maybe I’ve done 14 or 15, and about 10 of them, I think, were published already. I have them all here. But that has been my major activity in the history of neonatology. DR. BAKER: That’s an important project. DR. GARTNER: Yes, well, we got a lot of important neonatologists, and many of them are very interesting and revealing. Somebody, probably not me, ought to look through them. You can do it online now, so you could search, and see what each said about the management of a specific disease, such as respiratory distress syndrome. You could look at jaundice. You could look at other aspects and put together an impressionistic analysis of what was going on in the minds of those who were leading the pack. DR. BAKER: Yes, we have to find a medical or historian student to do this. DR. GARTNER: That’s right. DR. BAKER: It would be wonderful. Do you want to make any other comments about pediatric history beyond neonatology? You’ve written on Abraham Jacobi, for example. DR. GARTNER: Abraham Jacobi is sort of a favorite character. DR. BAKER: Why was he important to you? DR. GARTNER: Well, to me, personally, it relates to the fact that I worked at Jacobi Hospital, named after him, and it relates to the fact that Carol, my wife, became very interested in Mary Putnam Jacobi. And this came about from an article in The New York Times Magazine many years back that dealt with Town Hall and its creation in New York City. The name “Mary Putnam Jacobi” was mentioned in that article, and Carol said, “Gee, I wonder if she was related to Abraham Jacobi.” She looked it up, and, sure enough, found out that was his wife. She became very interested in Mary Putnam Jacobi and published several articles on her. One of them is in the

74

centennial book of the American Pediatric Society. The thrust of Carol’s article was that Abraham Jacobi was the founder of the American Pediatric Society. The first meeting was held at his house in Lake George [New York], and in that house, which is still there, there is a sign-in book, several pages of which are from that first APS meeting, which we have seen. Each of the people who attended that first APS meeting signed his book, and it’s still sitting there. DR. BAKER: And it’s still there? DR. GARTNER: It ought to be. I hope it isn’t anywhere else. DR. BAKER: I hope so. DR. GARTNER: Anyway, but he was a founder and Mary Putnam Jacobi, his wife, a pediatrician and neuropathologist, did not sign because she was not a member of the APS. The APS was only for male pediatricians. Carol’s article about Mary Putnam Jacobi was subtitled “A Famous Non-member.” DR. BAKER: A non-member of the American Pediatric Society. DR. GARTNER: She wrote some other papers on Mary, and she has been working on a biography of Mary Putnam Jacobi. She knows a lot about her. But what precipitated the book more than anything else was an interesting event that occurred in Chicago. We were at the medical school dean’s house for a reception, and the newly appointed provost was there. He came up to me and said, “I looked at your CV and saw that you worked at the hospital named for my wife’s great grandfather.” I said, “Your wife is the great grandchild of Mary Putnam and Abraham Jacobi?” He said, “Yes.” Well, I nearly fell over. Simultaneously, his wife went to Carol and said the same thing to her, and Carol said something about, “Yes, I’m very interested in her.” The wife of the provost said, “That dour old woman?” in very negative emotions. We now know a lot about the reason for that negative attitude. Abraham and Mary Jacobi did not have a good marriage by any means. They were, in a way, competitors, and there is an interesting example of this competition in one issue of the Annals of the Medical Society of the State of New York. They had monthly meetings and the proceedings were published verbatim in the journal. They discussed papers and science, and both Jacobis were there. She clearly knew a lot of science, particularly about infectious diseases, and stated her belief in the germ theory. Abraham Jacobi wasn’t so sure about the germ theory. He said some negative things about the germ theory, in the same report. That was only part of it. They also had other disagreements. Carol and I do a grand rounds together that deals with diphtheria and their

75

differing views. We’ve presented it 4 or 5 times now. It focuses the death of Ernst. Ernst was the older of their 2 children. DR. BAKER: He had diphtheria. DR. GARTNER: Yes. Ernst developed diphtheria and died, and that was not long after Abraham Jacobi had published his big book on diphtheria, which I have here. And that was a terrible loss to him because he looked upon Ernst as the inheritor of his empire and his career. The daughter, of course, was not looked upon by him the same way. So, the death was a terrible event for him. He accused his wife of Ernst death, alleging that it was the nurse maid that Mary had hired that brought the diphtheria into the house. I think that was the beginning of the end of their marriage, although they remained married their whole lives until she died. She died long before he did. The maid bringing diphtheria into the house was, of course, much less likely than the likelihood that Abraham, who took care of innumerable diphtheria patients and did tracheotomies on many of these children every day, was the one who was the source of the infection. Abraham subsequently wrote a paper, which was published, supporting his claim that household help are the source of diphtheria infections in the household and claiming, without evidence, that doctors are never the carriers of diphtheria. Where he got this crazy idea from I have no idea -- DR. BAKER: Wow. Wow. DR. GARTNER: He’s obviously defending himself and the relationship. After Ernst died he sent Mary out of New York with the daughter, who also had diphtheria but didn’t die. So that’s the subject of the grand rounds that Carol and I have given. I talk about diphtheria and the biology of it, and Carol talks about the letters from her to other members of the family relating to this terrible episode. After the revelation of the Provost’s wife being a Jacobi descendent and Carol’s interest in Mary, she connected us with her family. The surviving daughter [Marjorie] of Abraham and Mary Jacobi married and had 6 children. McAneny is their family name. Her husband was the deputy mayor of the city of New York and the publisher of The New York Times. He was an eminent figure in New York politics. Five of their 6 children were still alive in the 1980s, and we got to meet all of them and interview them. We have taped interviews with most of them, maybe not all; but we met all of them. We went to Jacobi Point in Lake George, which is where Abraham Jacobi had his house, which had burned down with the manuscript of his autobiography and all his papers in it. DR. BAKER: It burned down. Yes.

76

DR. GARTNER: He jumped out a window and escaped from the fire. Otherwise, he would have died. He never rewrote his autobiography. He had built another house for his daughter on the same large property, and that house is still there. It’s a big house with lots of bedrooms for the kids, but no kitchen or dining room. Why did it not have a kitchen? Because everybody had to eat with him in his house. (Laughter) And there’s actually a video that I have somewhere here of a 16mm. film of him supervising the 6 grandchildren having lunch on the porch of his house. The mother is not in sight. There’s another house on the property that’s down at the Lake. Several of the Jacobis were staying there while we were visiting. On the day we were there, one of the grandsons, I can’t remember which one now, told us that the day of Ernst’s death was the next day and that that was a terrible “black” day in the family because Abraham Jacobi became morose and very difficult. And what he would do that day is get in his canoe and paddle to an island in Lake George where Ernst had actually been born. They originally had a house on this little island. It seems bizarre to have a birth on an island, but he was born there. Abraham had erected a monument in memory of Ernst on the island near the water, and he would go there and spend the day on the island and then come back. The family remembers it as an awful day. And that day was the next day. And a canoe was there. We asked if we could take the canoe out and go to the island? “Tell us where the island is.” They did. So, Carol and I, with cameras in hand, canoed out on Lake George, found the island, found the monument, didn’t go onto the island because there were a lot of dogs, and I tried photographing it. I didn’t do very well with the photos, but that was our experience re-enacting the role of Abraham Jacobi. A couple of years later, the provost’s wife told us that her father had just died. He lived in Princeton, and I think he was a high school teacher. And they had just gone through his house, and found up in the attic a box of letters. The letters were all from Mary Putnam Jacobi, and they were to members of the family at various times, starting with her time at the Female Medical School in Philadelphia, or even earlier. She then went to Paris. She was the first woman admitted to medical school at the University of Paris and while she was in Paris the Franco-Prussian War broke out. She wrote to the family regularly. And they gave us the whole box to use. They lent it to us. DR. BAKER: Did they? DR. GARTNER: We xeroxed them on a very good Xerox machine because they’re very complicated, especially the ones from Europe. They’re written clearly and beautifully, but they’re written in one direction on onionskin and then turned 90 degrees and written the other way because

77

postage was expensive -- from Europe, and that’s how they kept the weight down. DR. BAKER: Do you still have these letters, or do you -- DR. GARTNER: We have the xeroxes. We returned the originals to them. DR. BAKER: You do? OK. DR. GARTNER: And the family has probably given them to some library, I hope. A lot of her writings are in the Radcliffe library, and almost every major historical library has at least one Mary Putnam Jacobi letter. She was a prolific writer. DR. BAKER: She was really quite a writer. Yes. DR. GARTNER: She wrote a large number of books. She was clearly the most important and most successful academic woman in medicine in the nineteenth century and early twentieth century. She died early of meningioma in 1906, which she self-diagnosed and wrote a paper on the disease while she was suffering from it. DR. BAKER: Wow. DR. GARTNER: And, you know, her fame is that she discovered the pathology of polio. She was a neuropathologist. In addition, her real fame for us as pediatricians is that the first hospital inpatient unit exclusively for children was at Mount Sinai [Hospital], as far as I know, at least in the US. She created and ran that unit. DR. BAKER: She created and ran that unit. DR. GARTNER: We’re not sure whether it was her idea or Abraham’s idea. He was medical director of Mount Sinai Hospital for 40-something years, but she ran the children’s unit. Her practice was, essentially, women’s and children’s medical care, as was true for women physicians at that time. She also wrote and published war reports from France during the Franco-Prussian war. DR. BAKER: She did. David McCullough uses them in his book on American doctors in France in the early 19th century. DR. GARTNER: Yes. Right. She was there.

78

DR. BAKER: She was such a prolific writer. Well, that’s wonderful, too, in some ways as a tangent, but I think it also is a nice example. Your involvement in history has been not trivial. DR. GARTNER: No. DR. BAKER: That’s a pretty significant involvement. I also like that story because it’s a case where I can really see the cross-fertilization of your work and Carol’s work together. DR. GARTNER: Yes, and, as I said, we’ve even given grand rounds together, which is fun. DR. BAKER: So, I’m glad you’ve had a happier relationship than the Jacobis had. DR. GARTNER: Yes. Yes. (Laughs) There is also a story. It may be true. Carol interviewed someone who said they had heard from some old relative that the Jacobis actually divided their house in half and put a wall down the middle. (Laughter) I don’t know whether that’s true or not. DR. BAKER: It may capture the truth even if it’s not true, I guess. DR. GARTNER: She, by the way, is from the Putnam family. She was the oldest child of George Palmer Putnam, the famous publisher, and grew up in this fabulous household where all the major authors of the world came through for dinner. So, her exposure to literature was considerable. I think she wrote some short stories and some other things and published them when she was a teenager. DR. BAKER: Wow. I wish I could hear your grand rounds. Another example of where Carol’s work and your work came together, I think, was in Korea, because Carol initiated that. DR. GARTNER: Yes. DR. BAKER: Can you talk a bit about that? DR. GARTNER: Yes. Well, Carol thought that we needed to live in an unusual, a different environment, to see the world by living somewhere different. A number of our friends who had been in the military had gone to France and Germany and other places and had lived there, and even one of them in Korea. So, she thought that she would like to apply for a Fulbright scholarship and see where they would offer it, and so she did. I was reluctant to go at all because I was chairman and life was complicated enough without going away on sabbatical. So, after saying, “No, I can’t do it. I can’t do it,” I

79

said, “Yes, I’ll go if we go for only 6 months.” If you apply for a full year, you get many more choices, but for 6 months it was offered only for Korea or Sweden. She really wanted to go to Korea. Kwang was a big influence on us, and Korea sounded like the place that would be the most exotic to go to, at least the most different, and probably more fun than Sweden. She was assigned to Chonnam National University. We were not assigned to Seoul. We were assigned to Gwangju, which is a smaller city in the southwest corner of South Korea. It’s the arts capital of Korea and the culinary capital, and a city of about a million people at that time, 1986. She was to teach English, American literature, and some writing for undergraduate students at this university, which was a national university, of which there are a number in Korea. When I knew we were going to Korea, I wrote to the chairman of the pediatric department at Chonnam National University that I wanted to come as a visiting professor because my wife was going to be there as a Fulbright professor. I didn’t expect any money or anything else. I was just going to come and offer to do some teaching or whatever, and I’d like to do some research while I was there on jaundice, because there was this issue of the Asian populations having more neonatal jaundice. I never got an answer. I wrote again, no answer. So finally, I talked to Kwang, and Kwang says, “Well, you can’t do it that way in Korea. You have to be introduced.” He’s a graduate of Seoul National [University]. He wrote his friends there. They contacted the people at Gwangju, Chonnam National University, and then I got an answer. “Oh, yes, we’d be delighted to have you.” (Laughs) DR. BAKER: Just being chairman of pediatrics at Chicago wasn’t enough. You needed an introduction. DR. GARTNER: Right. So, I left behind an acting chair, Jay Berkelhamer, and Arthur Kohrman was running our children’s chronic disease hospital, La Rabida [Children’s Hospital]. I went to Korea hoping all would be quiet at Chicago while I was gone. We got to Gwangju after a few days in Japan lecturing and visiting a former fellow. We were given an apartment in the faculty housing building on campus, which was actually quite nice, and the medical people were lovely and wonderful and did everything for us and were most welcoming. Some of them are still good friends, and we had a wonderful time. The chairman of the pediatric department became my agent. He booked me for lectures all over South Korea, so we would go off for 2 or 3 days. Carol came and sometimes he also came. Sometimes another faculty member came. We would be driven or fly or take the train or bus, and we’d go to all these different cities, and I would give lectures on jaundice. I don’t know what else I talked on, but other things. The payoff was that they would then tour us around the area, and we’d go to all the historic sites, of which there

80

are many, temples and all kinds of places. We had a ball, and they’d take us out to lunch and dinner. The way this always worked was that it was usually a younger person in the department that we were visiting who would tour us around, and they would always have a brown envelope, which was filled with cash which the president of the hospital or somebody in charge had given them. They would pay for everything, of course, and it always came out of this envelope, but it was always the brown envelope. (Laughter) DR. BAKER: It was always a brown envelope. DR. GARTNER: For her teaching at Chonnam, Carol got paid in cash in the brown envelope also. Originally, we were going to open a bank account, which turned out to be very complicated because you had to have a chop, you know, the stamp, to have a bank account at that time. So, I had a chop made, but first I needed a Korean name as well, so I was given a Korean name, which was close to what my name sounds like. It comes out in Korean as Lorenzu Gaduwan, which means “beautiful peach tree.” I thought that was rather nice. DR. BAKER: That’s very nice. DR. GARTNER: So, I would go into the hospital every day. The medical school hospital was in the middle of downtown, and the main university campus where we lived was north and on the edge of town, a big campus. It was a big hospital, an 1,100-bed hospital. So, somebody would come and pick me up every day, one of the faculty, and drive me to the hospital, and almost every day, 4 or 5 faculty had lunch with me in some interesting place in town. They would have rounds in the morning, in which they would present the cases in English, and then we would walk around the entire pediatric unit of 50 or 60 beds, and they would examine all of the children. And as I went around, I would point out to them that they had failed to wash their hands between patient A and patient B, and that wasn’t a good idea. And they pointed out to me that there was no hot water in the hospital. (Laughs) There was only cold water, and it was getting to be winter. And I suggested that they wash their hands at least in cold water. I don’t think they ever did. Next, we got to the newborn nursery with a small preemie/NICU, where we took our shoes off. The mothers and all newborn babies were separated, on different floors, but the mothers came down to sit on benches with their infants. The preemie unit had modern incubators made in Korea, and they had oxygen, and they had hot water. The nursery and the operating room were the only 2 places in the hospital that had electrically heated hot water. It wasn’t that the hospital wasn’t built to have hot water, but Korea has no fuel other than peat, so hot water would have to be heated with expensive imported oil. They minimized their imports as much as possible. It was a

81

time when they were struggling. It wasn’t like now where they have a lot of money, so they didn’t heat the water. That was the problem. But, anyway, the nursery did have heat and hot water. They were giving oxygen, and I asked them what the oxygen concentration was that they were giving this baby in a headbox. And they said, “Well, we don’t know.” I said, “Don’t you have an oxygen monitor?” And they said, “Oh, yes, we have one, but it wore out, and they won’t let us buy the refills, the cartridges, because they are imported.” And I said, “Well, that’s not good.” DR. BAKER: That’s not good. That’s definitely not good. DR. GARTNER: They were very good doctors, very good diagnosticians. And the woman who ran the nursery, the neonatologist, was wonderful -- Dr. Young-Yoon Choi-- a wonderful person. She’s still a good friend and incredible pediatrician/neonatologist. She was the only woman in the department. There was another woman pediatrician in town whose father had been the first chairman of the department, but she was connected with another hospital and had a private practice. She was German trained and very good. She had published quite a lot. She should have been the chairman of the department, but they wouldn’t make a woman chairman of the department. I don’t know that they have to this day. The woman who was the neonatologist was the first woman faculty member in this medical school. DR. BAKER: I want to shift from the specifics of your career to now thinking more broadly about neonatology and your role within neonatology. And I recognize there are some ambiguities in this question. I’d like to begin by asking when you began to think of yourself as a neonatologist. DR. GARTNER: Well, I had no formal training in terms of a fellowship in neonatology, since they didn’t exist, but I was involved with running the preemie unit when I came on faculty at Einstein. I can’t remember when I actually thought of myself as a neonatologist. I remember having discussions either with Bill Silverman or maybe Phil [Philip] Sunshine about what we were to be called. I think sometime in the early-1960s or mid-1960s I was thinking of myself as being a neonatologist and wondering what the field was. I think it was pretty clear that there was a group of people who had a very special interest in newborns. DR. BAKER: And were these generally doctors who worked in premature infant nurseries or not? DR. GARTNER: I think they mostly came out of working in premature infant nurseries. I think that’s the fountain out of which we all flowed.

82

DR. BAKER: And it seemed that your path to becoming a specialist in this was learning as you went along. You started working there. You were used to learning that way as a resident, to mastering this population of patients, and you kept on going with that as an attending. DR. GARTNER: Yes, right. And I had some people who were teachers like Bill Silverman, and there were some others, certainly Harry Gordon. But a lot of it was self-taught and just learning on the job. Certainly, the things we did early on in, say, ventilator care and CPAP and all of that were just jury-rigged ourselves. We’d go figure out how to do it. We’d read some article and say, “We could try that.” And then, we’d go up to the anesthesiology storehouse and pull out things. We’d find some old respirators that somebody had lying around, and we rigged something up. We had all kinds of issues with endotracheal tubes that caused terrible injury. We worried about traumatic effects of the ventilators due to excessive pressure, lots of issues. We tried not intubating babies and using masks that were fitted tightly to them so we could get positive pressure ventilation without intubating. It was pretty crude. DR. BAKER: How were you able to monitor what you were doing with these babies in terms of monitoring their oxygen? DR. GARTNER: We did have blood gasses, although we had to run them ourselves. We had a little lab in an old bathroom off the nursery that had the machine. DR. BAKER: So, you had to carry the sample down yourself? DR. GARTNER: Well, it was right there. It was in the nursery, but somebody had to run it. I don’t remember running it myself, so maybe the residents learned how to run it. But we didn’t have the kind of laboratory support that exists now. We didn’t have the kind of respiratory support that you have now, and we certainly didn’t have the machinery, at least early on, respirators that were reliable or good ones at all. We had Baby Birds, and we had all kinds of other not-so-good ones. Then, we did get some good ones, big boxes. They were pressure ventilators. They were pretty good, but I’m not sure we knew exactly what we were doing with them. But we did it. DR. BAKER: I’m picturing you as one of a number of doctors trying to work with premature babies in New York and other places around the United States at this point, and you’re all each trying to figure out different pieces of the puzzle. DR. GARTNER: That’s right.

83

DR. BAKER: You don’t have a book out there to tell you what to do. You’re having to figure it out on your own. DR. GARTNER: That’s right, and that’s what we were doing. And a lot of people were ventilating babies in one way or another. There were some people who did hand-ventilation and didn’t use machines because they, probably correctly, feared their negative effects, or they didn’t have the machines. But we tried all kinds of highly experimental, probably in some cases not even ethical, techniques. What we were doing was trying our best to save the babies. There was a learning curve in the beginning, when we started doing ventilation; all the babies died. DR. BAKER: Yes. DR. GARTNER: And then, all of a sudden, babies were surviving, and we never knew what it was that we had learned or the nurses learned. It was not clear even though we thought we knew what we were doing. We were aware of the procedures and the changes, but it was something that somebody learned almost subconsciously , nurses or doctors, that enabled us to get survivors. DR. BAKER: Are you making a comment about your own experience at Jacobi, or are you also making a comment -- DR. GARTNER: No, our own experience. I don’t know in detail what was going on elsewhere. Everybody was playing with ventilators. To a degree that was true of phototherapy. We were much more careful about the phototherapy. We weren’t sure about the safety of it. DR. BAKER: In what way were you not? DR. GARTNER: Well, the question was, one, how effective was it, and, number 2, was there any harm that would come of using phototherapy since who knew what it would do in preemies, small babies. That’s why we induced the NIH to run the big collaborative phototherapy trial to prove in an objective way that it worked and that it was safe, which I think we did quite well. That was a good study, but it was very expensive, and we did a lot of follow-up on those babies. Jerry Lucey probably felt it was a waste and we didn’t need to do the study. He was sure it was safe and effective. And he was right, but we wanted the proof. DR. BAKER: OK. I’ve also seen it argued that the interaction of CPAP [continuous positive airway pressure] -- you know, right around 1970, 1971, was sometimes seen as a turning point. The results with CPAP, you know, sort of generated a wave of optimism and excitement. Neonatology became noticed by Robert Wood Johnson [Foundation] and other places.

84

DR. GARTNER: Right. DR. BAKER: Does that resonate with your experience? DR. GARTNER: Yes, I think so. (Laughs) I think it was a breakthrough, but I think a lot of other things were happening at the same time because we also were clearly getting better ventilators and better control of the metabolism and blood gasses, controlling infection. A lot of things were happening so that it was becoming a more standardized practice. DR. BAKER: Right. DR. GARTNER: And I think that made a difference, whereas before we were all doing different things and we weren’t necessarily knowing what we were doing. DR. BAKER: And you’re getting a group of people now who are more standardized and maybe a more uniformly trained group of people by the 1970s. DR. GARTNER: Yes, I think it became more consistent. We started getting people who were coming out of fellowship who had gone through formal education in the field. There was now a literature. There was a bigger, growing literature we could rely on. DR. BAKER: Do you think nursing played a role in this, in the improved results? DR. GARTNER: Oh, there’s no question. Nurses were very important. I’m not sure what it was that they learned. I knew what they did, but I’m not sure what their educational experience was. DR. BAKER: OK. When does a real network of neonatologists begin to emerge? You’ve spoken of a local network in New York. DR. GARTNER: Yes. New York had a transport system. That was the first thing. New York City Department of Health Division of Maternity Service, under Dr. Jean Paktor’s direction, had a transport service in which city ambulances could be called to transport a preemie or sick newborn to a premature unit or NICU. There was a central call-in, and they would come and pick up the babies from whatever hospital or home had the baby and needed a preemie unit. They would call the receiving hospital first to find out if you had room, and then they would bring the baby if you had room. They brought them in the aluminum carry container, which had an oxygen tank and some hot water bottles to keep the babies warm. That was how they transported them. It was a pretty good system, and one thing that was

85

good about it is that they kept careful records of the weights of the babies, where they came from, their ages, and then the outcomes, and we all fed that data to the Department of Health. DR. BAKER: When was this happening, this transport system? It strikes me as a pretty important part of the story. DR. GARTNER: Yes, I think it was early on. I’m sure it’s been written up. I don’t remember, but it seemed to me that it was in existence certainly in the early 1960s. And it was really very well done, and also it led to meetings. We would gather groups of people interested in newborns, Peter Auld, Bill Silverman, and a number of other people in the city would meet together with Jean Paktor. So she, in a sense, pulled us together, and it was all around transport, but, nevertheless, it was an important role. DR. BAKER: Would this include the doctors who were doing the referrals as well? DR. GARTNER: Not that I remember. DR. BAKER: The reason I ask that is that Bill Silverman, in his writing, would talk about how an important factor was basically getting the babies sent to the tertiary center fast enough. In his experience some local hospitals would sort of keep a borderline premature baby hoping they would thrive. And then, only at the point where it looked like there was no hope, at that point they would refer, and it was very hard for you neonatologists to turn things around. Does that resonate with your experience? DR. GARTNER: Oh, yes. Oh, yes, that would happen, and, in fact, that happened in Chicago in the 1980s. Illinois, I always thought, had the best regional perinatal network by law, and it was enforceable. And actually, I had to enforce it a few times when a small, local hospital, didn’t send the baby or didn’t send the mother to us. They were supposed to send the high-risk mothers to us. Each tertiary hospital had a network of reasonably close regional hospitals or community hospitals who would feed into them. So, they would send the babies and some mothers to us. But more than that, each tertiary hospital was required to make a visit to every referring hospital in their network every month to review their statistics and their practices. An obstetrician and a neonatologist went out, to meet with the staff, nurses and doctors, reviewing all of their statistics and mortality and morbidity data, and make recommendations. And if it was thought that there were deficiencies, or they weren’t doing things right, they had to either change their policies or educate their staff. If we thought a hospital really was not doing the job, we could report it to the Illinois Department of Public Health, and they could pull their maternity license or threaten to, which meant they could no longer have any deliveries. That was a big threat because that’s

86

very important to the income of the hospitals. So, they listened to us. If we said, “You’re not doing it right,” they would turn it around. And if that’s still in effect, that system was very good. Also, the state required us to submit a summary data form on every baby admitted to our unit whether by transport or born in. Now, I don’t know what has happened with all of that data, but it exists. Incidentally, Chicago has vast amounts of data that nobody has ever looked at. There was a period back in the early 20th century, the turn of the century, where every newborn in Chicago had a visiting nurse visit, and there was a form filled out describing the house, the condition of the mother, the condition of the baby, etc. Anyway, Chicago has this data from all of these newborns over many years. It’s all stored away somewhere. The Chicago city librarian told me that it still exists somewhere in the many warehouses that are owned by the city, but the contents of these warehouses are not recorded anywhere, just stored. If one could locate these old records it would be interesting material to look at to see what was happening 100 years ago with newborn infant care. I think it was Dr. Herman Bundesen, the Chicago health commissioner who instituted this public health concept, though it may have preceded his tenure in office, which ran from the early 1920s until 1960. DR. BAKER: Every newborn was visited by a visiting home nurse. DR. GARTNER: Right, regardless of income. DR. BAKER: Yes, I don’t think that story has been told. DR. GARTNER: No. DR. BAKER: New York was doing that at a time, too, early in that period. DR. GARTNER: Yes. DR. BAKER: But it makes the point that the rise of neonatology is more than just simply a story of devices and machines. It’s a story of the rise of a technological system, of these things coming together in an organizational scheme involving people who are now trained. And then, even on the bigger level, it’s addressing social problems like how do you get these referring hospitals to get the babies to you quickly enough. All of these things started to fall into place in the 1970s. DR. GARTNER: Yes, I think that’s very true, and I think the amazing thing to me is that there has been a willingness to fund this enterprise. This is very expensive.

87

DR. BAKER: Well, comment on that. I’m picturing you doing this work in a hospital where none of the patients, I don’t think, are paying in the 1960s. (Laughs) DR. GARTNER: Well, it was a city hospital, and very few people were paying anything. If they had any insurance, they might, but by and large it was underwritten by the city, and not very well. It got a lot better as time went on. The whole [New York City] Health and Hospitals Corporation was reorganized and became a real corporate entity, which it is now, and it’s far better run and financially much more secure, but it’s still an expensive operation. And the fact is that society wants this; they clearly want to put that money in, and they want newborn care, so it’s obviously important. I think the neonatologists want it because, gee, that’s our job. But clearly the fact that there is money in it has encouraged hospitals to develop units and expand them and compete for them. Clearly, the economics are important, and I’m not sure anybody had looked at that very carefully. DR. BAKER: Right. So, all of these things come together. In the field of neonatology, I think we focus on your contributions especially in the areas of jaundice, and we talked about some of your role with respect to breastfeeding. Can you just say what you think are your most important contributions to neonatology as a field, not just research but just thinking about it more broadly? DR. GARTNER: Well, I think, overall, in the jaundice area just clarifying what neonatal jaundice was all about, and I think, having that sort of global understanding of what the issues are there was a significant contribution. The other one, I think, is what I’ve done, along with a number of other people, to really move breastfeeding from its low point in 1970 in the US. That really was quite an astronomical rise in commitment of people, hospitals, nurses, families to breastfeeding. We’re still not there by any means, and in some parts of the country we have very good initiation rates. No part of the country has long enough duration of breastfeeding. We would like to see every newborn breastfed for at least a year, 2, 3. So that’s really the big challenge. I think a lot of that came out of that initial AAP document, because that document came from the Academy, which is viewed as the spokesperson on children’s health. It got a lot of publicity, including a lot of opposition in some quarters, including the formula companies. Still, I think that that was the turnaround point in which things like media reporting on breastfeeding has changed dramatically. There was previously a lot of either negative or bland stuff. Now, by and large, the media sees breastfeeding as good, and it’s beginning to move to the point where it’s looked upon as the norm, which is how we want it to be seen. We want it to be the norm that everybody sees breastfeeding as the way to feed babies, and the formula, if needed, is fine but not as good. We really want to make it the normal, standard practice for the expectations of mothers, the expectations of fathers,

88

the expectations of all physicians. We aren’t there yet, but we’re moving in that direction. One of the recent, really important developments has been the Baby-friendly Hospital Initiative, which is essentially accrediting hospitals as meeting a high standard of breastfeeding support. This is a worldwide program. It came out of WHO [World Health Organization] and UNICEF, but it started here in San Diego. Dr. Audrey Naylor, of Wellstart International, a breastfeeding education organization, came up with the idea and got the WHO and UNICEF to move on it, and they did. They created the standards and materials for evaluation, and it’s something that’s going on all over the country, all over the world. In this country, until about 5 years ago, it was moving slowly, and there were just a few hospitals that were certified. But in the last couple of years, mainly through federal government and CDC [US Centers for Disease Control and Prevention] recognition of the importance of breastfeeding and the evidence of the benefit of it, good scientific evidence, they bought into it and feel that this is very important for the future health of the country. And they are really pushing for more hospitals to become Baby-friendly with better education in breastfeeding, better support for parents, and the Baby-friendly movement is really picking up in speed now. I have been on the board of Baby Friendly USA from the very beginning, from the initiation in San Diego in the mid-1990s, and I’m still very active on the board. I think that’s a big thing; we now have over 200 Baby-friendly hospitals in the US. Well, we still have a long way to go. There are several thousand maternity hospitals, and we’re now beginning to develop standards for certification of neonatal intensive care units as Baby-friendly. It started with the Scandinavian countries, which have been doing it, moving toward it and developing standards. And they’ve actually published a couple of papers on this along with the Canadians. We just initiated a work group in Baby Friendly USA, which I’m on, to develop the criteria for the certification of NICUs as Baby Friendly. It’s going to take us several years to develop it, roll it out, test it, until it becomes implemented. DR. BAKER: So, this is really where a lot of your energy today is going in retirement. DR. GARTNER: That’s where I’m spending time. Carol says I’m not retired. (Laughter) But that is where I spend a lot of time now. I no longer have any involvement with La Leche League. That’s changed a great deal. I don’t know what’s happened. It has sort of fallen apart. The local groups still exist, but the national organization and the international activities have disintegrated, as have the physician and nurse education efforts. I don’t know what happened. I resigned from it. The American Academy of Pediatrics has certainly picked up a good deal of work in breastfeeding education and promotion through the Section on Breastfeeding. And then, there’s the Academy of Breastfeeding Medicine. I was one of the founders.

89

They have become an important source of practice guidelines and standards both for practice and education in breastfeeding. This is a very good organization; I’m the chair of the ethics committee for them. So that’s an area I’ve moved into recently, ethics in breastfeeding, and I’ve been giving talks on that. I gave one in Paris last year and just gave one in Memphis. DR. BAKER: What ethical topics in particular have you been discussing? DR. GARTNER: Well, there are some specific issues in ethical issues, education of physicians, nurses, practices, people who are practicing as specialists in breastfeeding and what are they doing that’s ethically right or ethically wrong. There are some conflicts of interest that are quite major in the field, particularly physicians influenced by formula companies. Then there’s the whole issue of the formula companies and what they’re doing and the ethics of what they’re doing and not doing. They’re still fighting us. DR. BAKER: They’re still out there. They haven’t gone away. DR. GARTNER: Well, we’re winning. We’re getting more and more breastfeeding, but they still are selling formula. Of course, they also move it into older age groups, but -- DR. BAKER: Yes, they do. DR. GARTNER: I mean, I’d like them to start at age 5, but -- DR. BAKER: That would be good. I’d like you to reflect on the relationship between pediatrics and obstetrics in the development of neonatology. DR. GARTNER: Obviously, it’s a very important relationship. The neonatologists and the obstetricians, particularly the fetal medicine people, have to work together. Fortunately, at Chicago -- and that was true at Einstein as well -- we had a very good working relationship. The chairman of obstetrics at Einstein and I worked together very well on a lot of issues, not just preemie issues but other issues as well. We came up with this idea that maybe there should be a new residency that would be neonatology and obstetrics only, so you wouldn’t get the rest of pediatrics, and you wouldn’t get the gynecology. It would be purely obstetrics and neonatology; OB-NEO; would that work? The first thing people pointed out to us is, “What are these people going to do when they get too old and too tired to do perinatal medicine?” Obstetricians do gynecology, and neonatologists do general peds, or they do regular nursery. But doing neonatology is hard work, as is obstetrics, so they didn't think that would sell very well. They may be right.

90

Henry Barnett, actually, when I finished as chief resident, wanted me to take an OB residency. He wanted me to have dual training. DR. BAKER: Wow. DR. GARTNER: Well, I always thought that OB, would be an interesting thing to do, but at that stage of my career that wasn’t what I wanted to do, and I wanted to do research. I didn’t want to continue to be a trainee. So I said no. But Harold Schulman, the chairman of OB, and I had a lot of discussions about this integration and how we would put it together. We worked together very closely, and in Chicago it was the same thing. They had a wonderful OB department with a very good chairman, and superb head of fetal medicine. He’s a great guy, Atef Moawad. I just saw him a few months ago. We had a very close working relationship, not just with me but with all of neonatology. They would call us, let us know when they were expecting complicated cases. We would go to their conferences. They would come to our conferences. They were very supportive of breastfeeding and other things that we wanted to do in the OB unit, so it was a good relationship. DR. BAKER: There really is a sense that this line we draw between obstetrics and perinatology, neonatology, is really pretty artificial. DR. GARTNER: It is. DR. BAKER: And for neonatology to succeed, you really have to be at a place where there’s a very close collaborative relationship with obstetrics. DR. GARTNER: That’s right. A team approach works, and there’s probably a practical answer. Probably, even if you dual-trained everyone, my guess is that they would migrate into one or the other major role and I don’t think we’d end up with people doing both. DR. BAKER: Well, it is what we all try to strive for, but it’s hard. You know, everybody can tell stories of when it doesn’t work, too, which might be a good segue into another question. I’d just like to hear your comments about neonatology training today. You trained just by -- DR. GARTNER: I trained myself. DR. BAKER: (Laughter) So maybe you can comment about fellowship training in neonatology today and your thoughts about that. DR. GARTNER: Well, you know, I haven’t been involved in that area for a long time now, so I’m not sure exactly what’s happening today, although my impression is that it’s alive and well. There are a lot of people going into

91

neonatology fellowships. It’s the number-one subspecialty in pediatrics. Obviously, neonatal units are growing, and they need more and more people, so I think there are a lot of jobs. I think, for the most part, the people who are coming out of the training programs are clinicians, and they’re doing clinical work and some teaching. I don’t think very many are doing research. Some are. Some are taking it seriously. I suspect these days you almost have to do a PhD in order to be a serious investigator and get grants, so I think there is a subgroup of the trainees who will do some serious research and publish. Most of the other neonatologists will do clinical work, an occasional clinical paper. They’ll present at a meeting, and a lot of practice-related research. At least, I see a lot of this in the breastfeeding area, you know, clinical, practice things, what works, what doesn't work, which babies are doing better, which are doing worse, and some epidemiology of a sort. A lot of neonatologists are getting public health training or statistical training for that purpose, and that’s good, because they do turn out better studies and better papers. But I think the people who are going to do laboratory research these days probably have to have a PhD. You’ve got to know molecular biology, and you have to know very high levels, way beyond anything I ever did. (Laughs) DR. BAKER: It’s become a harder world to jump between the clinic and the laboratory. DR. GARTNER: Yes. It was easier then. I’m not sure you can quite do it now. Maybe you can, but I think getting funding is now difficult. I came through an era when funding was easy. That era is over, and it’s really tough to get funding. DR. BAKER: Yes, it’s a very tough thing, but you’ve seen just incredible progress in neonatology. DR. GARTNER: Oh, yes. DR. BAKER: A lot of it will be so obvious to many people hearing this. We won’t have time to go through it, but I’m just thinking even of the 32-weekers who were once quite a challenge, and now they come home; they’re off just on CPAP or on oxygen after a couple of days. DR. GARTNER: There is one thing that really troubles me about the field of neonatology, and that is that the prematurity rate in this country has skyrocketed. DR. BAKER: It’s gone up, hasn’t it? DR. GARTNER: Doubled.

92

DR. BAKER: That was not expected, was it? DR. GARTNER: No, not at all. We were sure it was going to go down. It was higher in the black population than it was in the white. It was very low in the Asian population. We thought there were some genetic issues there, but we really never got into it. And then, all of a sudden, it just started rising, and that shocked me and still does. And I guess some of it has to do with obstetric management and the fact that we have so many older women with induced pregnancies of various sorts and in vitro fertilization and multiple births, which obviously increases the prematurity rate. The great increase in C-section rates also troubles me and it may also be responsible for the increase in prematurity. But it really troubles me that prematurity has gone up so much. It obviously is why we have a growth of neonatal intensive care units. Most of the hospitals that I know of have C-section rates that are between 25 and 35 percent. DR. BAKER: Oh, yes. DR. GARTNER: And I think that’s pretty standard now. The obstetricians at the University of Chicago used to tell us that they thought that the real need for C-sections was 9 percent in their hands. Now, part of it was “their hands,” because of breech deliveries, for instance. If you know how to deliver a breech, you can deliver them from below. I remember the advice from Mo (Dr. Atef Moawad), who was our head of fetal medicine. He said, “If you don’t know how to deliver from below, you had better do a C-section.” And I would guess that’s part of it. DR. BAKER: Yes. It’s a harder thing to teach, some would say, than a C-section is. DR. GARTNER: That’s right. That’s right. And the finances are such that there’s an advantage in doing the C-section. DR. BAKER: Yes, and there’s a little bit of a legal incentive too. DR. GARTNER: Yes, there is that also. Now obstetrics residency is almost 100 percent women, and I don’t know what effect that’s going to have on the practice of obstetrics. It could be bad. It could be good. I don’t like to see anything that’s all one or the other. I like to see 50-50. One of the problems, I think, is that women often have a household and children to look after, and they may alter their practices with regard to deliveries to accommodate that need. So, we might end up with more induced labors, more C-sections, etc. I don’t know whether that’s driving it or not, but it occurs to me that it could have that impact.

93

DR. BAKER: Well, it’s quite a trend, and you’re right. It is a surprising trend. I can remember reading articles in the 1970s, and the great hope was that we would find ways that we can just prevent this, and a lot of ICN [intensive care nursery] care will go away.” DR. GARTNER: Oh, yes, that’s right. DR. BAKER: It has gone the other direction. On an analogous kind of subject, along with the great progress characterizing neonatology, they’re having some major errors along the way in management. DR. GARTNER: Yes. DR. BAKER: And as you kind of look back over your career, what things have stood out to you as some failings you wish had not happened. DR. GARTNER: You know, certainly drug treatments that were inappropriate, use of oxygen without effective monitoring or recognizing its impact. I think some of that is inevitable, and I’m sure there’s something we’re doing right now that isn’t going to turn out to be good. And as soon as you start with any new procedure, a new technique, or a new concept, you’re going to end up with some trouble. So, I’m not at all surprised that it happens. On the other hand, we need to minimize that as much as possible. I remember other kinds of errors in hospitals where the wrong drugs were given or the wrong doses. And I think a lot of that has been corrected with computerized techniques, locked delivery boxes, and that sort of thing; so technology has helped to minimize things. I think there’s better data collection. I think one of the things that is hoped for in the Obamacare [Affordable Care Act] and the move toward computerized records is to monitor what’s happening, which was impossible to do when you had paper records or poor data collection. And I think the thought is, certainly by the federal government, that if we had better data collection and analysis we’d be able to save money as well. So, I’m sure money is underlying this. DR. BAKER: And would you like to comment some about the role of parents in the nursery, in the ICN especially? DR. GARTNER: I think parents need to be deeply involved in the care of the premature or sick newborn. In the old days, they would be given a baby they had literally never held until maybe a day before the baby went home. They had certainly never participated in the feeding or care of the child, even to change a diaper, and that they were panicked and fearful and overly cautious is understandable. I think we’re evolving now into units in which the parents become much more involved in the care.

94

There’s a concept that actually came out of Estonia by an Estonian pediatrician, neonatologist, which he called “humane neonatal care,” and it’s an interesting story. His name is Adik Levin. Back in the days when he was doing neonatology and Estonia was still under the Soviet rule, they had very little money and very few resources. So, he started having the mothers stay in the unit, and they would be taught how to do much of the nursing care, whether it be gastric tube feeding, taking vital signs, washing the babies; everything short of some of the more highly technical stuff, and he had some nurses. He built a unit so that each baby was in a separate room. The mother was there all the time, which can be a problem regarding care of other children and the family, but that was the goal. There was a nurse on the floor who then could take care of maybe 10 or more babies. His data show that it was very effective and very safe. He has promoted this now for many years; he’s way ahead of his time. I think we’re moving a little bit in that direction. Units now have room for the mother to be there. They have separate rooms in the new children’s hospital NICU at the University of Chicago. Breastfeeding is moving in that direction, one of the concepts of the Baby-friendly Hospital Initiative is the development of kangaroo care in which the baby rests on the mother’s chest, skin-to-skin for extended periods of time. During kangaroo care, the preemies are physiologically much more stable. Their body temperature, their glucose, their fluid and electrolyte balance are all much better when they’re in kangaroo care than when they’re in the incubator. DR. BAKER: Right. Right. DR. GARTNER: And the physical involvement of the mother leads to breastfeeding. In general, it has a very positive effect, and that’s part of Baby Friendly. That’s a requirement, and it really works, and it works for breastfeeding as well. I think we’re slowly moving in the direction of parent involvement in a very real way. I remember years ago being very concerned about family relations of our patients’ parents and started meeting with the psychiatrists at Einstein. We had a number of meetings over the fact that there were a lot of marital and psychiatric problems in the parents of babies who were in the NICU. It was a stress on the family. We needed to identify the stress and deal with it. Somehow, we never came to any conclusion about what we could do, but they were interesting meetings. I think that still is a real issue that we need to deal with for families. NICU is a very stressful experience. And, if the baby turns out to be handicapped, it’s even worse. DR. BAKER: Yes. Of course, the stress doesn’t end for a lot of these families afterwards.

95

DR. GARTNER: It doesn’t end, although I remember a very poor black mother in the Bronx whose baby we had taken care of, and the baby ended up really badly damaged. I remember saying something to the mother about how difficult this must be, and she said, “No, Doctor.” She said, “This has given me a reason for living.” So maybe it’s not always bad for the parents, but I think it really is very difficult in many ways. Anyway, I think parents need to be much more deeply involved and given specific things they can do safely. The kangaroo care is one. Touching and feeding their babies is very important, and the touching and kissing of the babies is actually an important biologic phenomenon for protection of the baby, because then the mother who’s providing her breastmilk for the baby will provide antibodies. And it’s an accelerated process. It only takes a few days for that to happen, so it’s very important they share the environment. DR. BAKER: Well, I think this is a wonderful way to sort of bring closure to this day. These kinds of stories, I think, underline how in your life, in your career, you’ve seen powerful changes happen in neonatology. It’s a story that’s evolved tremendously over the last 50 years, but also in some ways, has moved back to an attitude that Pierre Budin -- who I know is also one of your heroes, the French obstetrician and the father of neonatology -- would have embraced in the early 1900s. DR. GARTNER: That’s right. DR. BAKER: He also grasped that you have to not just rescue the baby. You need to bring the mother along as well, bringing both together. DR. GARTNER: That’s right. DR. BAKER: It is interesting how neonatology, the specialty so associated with technology, has at the end of the century come around to rediscovering those insights. DR. GARTNER: That’s correct. DR. BAKER: We want to have some time separately to look at some of your artifacts, but I’d like to close by thanking you for this, for sharing your experience and sharing this day with us, and I’m just so glad we have this down on our permanent record. DR. GARTNER: Well, I have to thank you very much for doing it and for being my interrogatory person. (Laughs) DR. BAKER: It’s been a great honor.

96

DR. GARTNER: Thank you. DR. BAKER: Thank you very much.

END OF AUDIO FILE

97

Index

A Academy of Breastfeeding Medicine, 88 Ahrendt, Hannah, 27 Ahrendt, Mark, 25 Albert Einstein College of Medicine, 19, 20,

28, 33, 35, 36, 38, 44, 46, 49, 52, 56, 64, 70, 71, 81, 89, 94

American Academy of Pediatrics, 1, 59, 60, 72, 87, 88

American Academy of Pediatrics, Section on Breastfeeding, 60, 88

American Pediatric Society, 74 Arias, Irwin, 38, 39, 40, 41, 42, 43, 45, 46, 56,

57, 64, 70 Arrowsmith, 2

B Baby Friendly USA, 88 Baby-friendly Hospital Initiative, 88, 94 Baltimore, Maryland, 11, 17, 18, 19, 20, 35 Barnett, Henry, 35, 38, 48, 90 Benirschke, Kurt, 44 Berkelhamer, Jay, 79 Bernstein, Jay, 39 Beskind, Harry, 11, 13, 18 bilirubin, 34, 37, 38, 40, 41, 42, 43, 45, 46, 47,

56, 57, 58, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70

Black, Linda, 59 breastfeeding, 14, 16, 29, 51, 54, 56, 57, 59, 60,

61, 62, 63, 66, 70, 87, 88, 89, 90, 91, 94 Breastfeeding Handbook for Physicians, 60 Brimberg, Max, 2 Broelsch, Christoph, 50 Bronx Municipal Hospital, 28 Bronx, New York, 18, 20, 21, 34, 58, 95 Brooklyn, New York, 1, 2, 3, 4, 16, 17 Brown University, 24 Budin, Pierre, 73, 95 Bundesen, Herman, 86

C Caldwell, Michael D., 25 Catholic University (Washington, DC), 17 Chabon, Michael, 43 Chabon, Robert, 43 Choi, Young-Yoon, 81 Chonnam National University, 79 cirrhosis, 9, 10, 37, 39, 70 City College of New York, 1, 2 Columbia University, 6, 7, 11, 44

Cooke, Robert E., 19 Copland, Aaron, 9 Cornelius, Bette, 46 Cornelius, Charles, 46, 62, 68 Cornell University, 6, 9, 17, 21

D Danto, Arthur, 7 Delfs, Eleanor, 39 Dewey, Judy, 22, 23, 26 Donna (technician), 43, 66 Duke University, 24, 27

E Eastman, Nicholas, 8, 40 exchange transfusion, 38, 40, 66

F Forest Park High School (Baltimore), 19 Fraad, Lewis, 20, 30 Frederick C. Robie House, 49

G Gartner, Alex, 20, 21, 22, 23, 26, 40 Gartner, Ben, 27 Gartner, Carol, 16, 17, 19, 20, 21, 22, 34, 39,

40, 46, 50, 73, 74, 75, 76, 78, 79, 80, 88 Gartner, Madeline, 20, 21, 23, 24, 25, 26, 27,

40, 56, 69 Gartner, Oliver, 27 Gartner, Samantha, 26 Ginsburg, Ruth Bader, 5 Gluck, Louis, 43, 44, 45, 48, 53 Goldfischer, Sidney, 70, 71 Goldwater Memorial Hospital, 9, 10, 37 Gordon, Harry, 11, 13, 15, 18, 35, 38, 43, 44,

52, 73, 82 Gotoff, Samuel, 55 Gwangju, South Korea, 79

H Halsted, William Stewart, 11 Harriet Lane Home, 11, 14 Hess, Julius, 55 humane neonatal care, 94 Huttenlocher, Peter, 50

98

I Indecent Proposal, 23 Israel Zion Hospital, 1

J Jacobi Hospital, 20, 28, 47, 53, 73 Jacobi, Abraham, 73, 74, 75, 76 Jacobi, Ernst, 75, 76 Jacobi, Mary Putnam, 73, 74, 75, 76, 77 James Madison High School (Brooklyn), 2, 5 jaundice, 38, 39, 40, 42, 46, 56, 57, 60, 61, 62,

63, 68, 70, 73, 79, 87 Johns Hopkins University, 9, 10, 11, 12, 13, 17,

19, 20, 35, 38, 39, 40, 49, 72

K Kelly, Howard, 11 Kerensky, 8 Kohrman, Arthur, 79

L La Leche League, 57, 59, 88 Lake George, New York, 74, 75, 76 Larchmont, New York, 21, 24 Lawrence, Ruth, 59 Lee, Kwang-sun, 42, 47, 48, 53, 66 Levi, Edward H., 49 Levin, Adik, 94 Lewis, Sinclair, 2 Loyola University Stritch School of Medicine,

24, 56 Lucey, Jerold, 56, 83 Lundeen, Evelyn, 56

M Marineland (St. Augustine, FL), 68 Marshall, Susan, 72 McAneny, Marjorie Jacobi, 75 McGregor, James, 7 McKusick, Victor, 14 Michael Reese Hospital, 55, 56 Minott, Mrs., 36 Minsk, Russia, 1 Moawad, Atef, 90, 92 Moore, Demi, 23 Morecki, Rachel, 39 Moscioni, Dave, 42 Mount Sinai Hospital, 77

N Nathan B. Van Etten Hospital, 46 Naylor, Audrey, 59, 88 Neerhout, Robert, 15

neonatal intensive care unit, 44, 53, 54, 80, 84, 94

neonatology, 1, 13, 14, 36, 43, 47, 48, 53, 55, 72, 73, 81, 86, 87, 89, 90, 91, 93, 94, 95

New York City Health and Hospitals Corporation, 87

New York University, 9, 21, 22 Nolan, Janet, 72

O Osler, William, 11

P Paktor, Jean, 84, 85 Prince (service dog), 18, 19 Providence Hospital, 24 Putnam, George Palmer, 78

R Rapin, Isabelle, 71 Redford, Robert, 23 Rockefeller Institute, 2, 3 Rose F. Kennedy Intellectual and

Developmental Disabilities Research Center, 35, 42

Rosenblum, Jacob, 4 Rudolph, Abraham, 32

S San Diego Zoo, 44, 46, 66, 67 Scarpelli, Emile, 32 Schmid, Rudi, 62 Schulman, Harold, 90 Scripps Institution of Oceanography, 46, 66,

67 Sheindlin, (Judge) Judy, 5 Silverman, Ruth, 5, 44, 45 Silverman, William A., 43, 44, 45, 81, 82, 85 South Korea, 47, 55, 78, 79, 80 Steele, J. Murray, 9 Stone, Charles, 51 Sucrest Sugar, 3 Sunshine, Philip, 81

T Taft, Larry, 32 Terry, Robert, 71

U UNICEF, 88 University of Chicago, 21, 24, 25, 36, 42, 47,

48, 50, 52, 55, 56, 89, 90, 92, 94 University of Minnesota, 25, 27

99

US Centers for Disease Control and Prevention, 88

US National Institute of Child Helath and Human Development, 61

US National Institutes of Health, 42, 43, 46, 64, 83

W Weizmann, Chaim, 1 Welfare Island, 9 Whitington, Peter, 50 Williams, David Russell, 8

World Health Organization, 88 Wright, Frank Lloyd, 49

Y Yonkers, New York, 21

Z Zarafu, Ilana, 47 Zeckendorf, William, 49 Zellweger syndrome, 39, 66, 69, 70, 71, 72

CURRICULUM VITAE

Date prepared: January 1996

Name: LAWRENCE M. GARTNER, M.D.

Address: Office:

Place of Birth:

Family: Wife:

Children:

Education: 1947-1950 1950-1954 1954-1958

Department of Pediatrics The University of Chicago 5841 S. Maryland Avenue Chicago, Illinois_ 60637

Brooklyn, New York

Carol Blicker Gartner, Ph.D. Professor of English Purdue University Calumet

Alex David - born April 9-~ 1959 Madeline Hallie - born April 29, 1961

James Madison High School, Brooklyn, New York A.B. - Columbia University, New· York, New York M.D. - Johns Hopkins University School of Medicine, Baltimore, Md

Postdoctoral Training: 1958-1959 Pediatric Intern - Johns Hopkins Hospital(Harriet Lane),

Baltimore, Md 1959-196 l Pediatric Resident - Bronx Municipal Hospital Center, Albert

Einstein College of Medicine, Bronx, New York 1961-1962 Chief Resident in Pediatrics - Bronx Municipal Hospital

Center, Albert Einstein Col1ege of Medicine, Bronx, New York 1962-1964 Research Trainee - Departments of Pediatrics and Medicine,

100

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

1964-1965

1962 1975

Licensure and

1959 1961 1976 1980

Albert Einstein College of Medicine, Bronx New York (NIH Training Grant) Research Fellow - Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York (NIH Special Fellowship) Course in Medical Genetics - Bar Harbor, Maine Course in Light Scattering Techniques in Colloid Chemistry, Clarkson College

Certification:

New York State Medical License (inactive) American Board of Pediatrics Sub Board in Neonatal-Perinatal Medicine Illinois State Medical License

Academic Positions:

1961-1962 Assistant Instructor in Pediatrics, Albert Einstein College of Medicine

1962-1964 1964-1965 1965-1969

1967-1980

1967-1980

1969-1974

1972-1980

1974-1980 1980-present 1980-1993

1992 - present 1995 - present

Instructor in Pediatrics, Albert Einstein College of Medicine Associate in Pediatrics, Albert Einstein College of Medicine Assistant Professor of Pediatrics, Albert Einstein College of Medicine Director, Division ._of Neonatology, Albert Einstein College ofMedicine Director, Division of Pediatric Hepatology, Albert Einstein College of Medicine Associate Professor of Pediatrics, Albert Einstein College of Medicine Director, Clinical Research Unit of the Rose F. Kennedy Center for Research in Mental Retardation and Human Development, Albert Einstein College of Medicine Professor of Pediatrics, Albert Einstein College of Medicine Professor of Pediatrics, The University of Chicago Chairman, Department of Pediatrics, The University of Chicago Professor rn the College, The University of Chicago Professor of Obstetrics and Gynecology, The University of Chicago

Hospital Appointments:

1962-1969 Assistant Attending rn Pediatrics, Bronx Municipal Hospital Center

1962-1967

1967-1980

1967-1980

1967-1980 1969-1974

Assistant Director, Premature Center, Bronx Municipal Hospital Center Attending Pediatrician, Hospital of the Albert Einstein College of Medicine, Bronx, New York Director, Neonatal Intensive Care Unit, Hospital of the Albert Einstein College of Medicine Director, Premature Center, Bronx Municipal Hospital Center Associate Attending in Pediatrics, Bronx Municipal Hospital Center

101

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

1974-1980 1980-present

1980-1993

1980-present

1987-1990

1987-1989

1990-present 1990-present

Attending Pediatrician, Bronx Municipal Hospital Center Attending Pediatrician, Wyler Children's Hospital at The University of Chicago Medical Director, Wyler Children's Hospital at The University of Chicago Consulting Pediatrician, LaRabida Children's Hospital and Research Center, Chicago Attending Pediatrician, Michael Reese Hospital and Medical Center Chairman, Department of Pediatrics, Michael Reese Hospital, Chicago Consultant Pediatrician, Mercy Hospital and Medical Center Attending Pediatrician, Mercy Hospital and Medical Center

Other Professional Positions and Major Visiting Appointments:

1973-1980 Visiting Professor, Manhattanville College, Purchase, New York

9/86-12/86

1987-present

Visiting Professor of Pediatrics, Chonnam National University, Kwangju, Korea Permanent Moderator, Physician's Seminar, Annual Continuing Medical Education Program, La Leche League International

Awards and Honors:

1956

1958 1958

1958

1966 1967, 68, 70

1967-1975

1995

Appleton Century Crofts Book Award Recipient for Highest Academic Honors, Class of 1958, Johns Hopkins University School of Medicine Phi Beta Kappa, Johns Hopkins University School of Medicine Alpha Omega Alpha Medical Honor Society, Johns Hopkins University School of Medicine Mosby Book Award Recipient for Highest Academic Honors, Class of 1958, Johns Hopkins University School of Medicine Invited Guest Speaker, German Pediatric Society , Berlin Ellen B. Scripps Fellow - Institute for Comparative Biology, San Diego Zoo Career Development Awardee, National Institute for Child Health and Human Development Pediatrician of the Year Award, Illinois Chapter American Academy of Pediatrics

Professional Society and Committee Activities:

Academy of Breastfeeding Medicine, Founder and Member Board of Directors 1994-present

American Pediatric Society, (Council Member, 1983 -1990; Council Chairman 1989 -1990)

American Academy of Pediatrics, Illinois Chapter (Breastfeeding Coordinator 1992)

102

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

American Academy of Pediatrics (Member, Council on Pediatric Research, 1985-1992; Member, Pediatric Historical Archive Committee, 1992-present; Member, Sections of Perinatal Pediatrics and Epidemiology)

American Academy of Pediatrics: Breastfeeding Work Group, Chairman, 1994-presen t

American Association for the Advancement of Science American Association for the History of Medicine American Association for the Study of Liver Diseases American Medical Association ( 1986-1993) Association of Medical School Pediatric Department Chairmen, 1980-1993;

Member of the Council, 1983-1986 Chicago Maternal and Child Health Advisory Committee on Pediatric Health

Care, 1981 - 1986 Chicago Medical Society (1986-1993) Chicago Pediatric Society - (Executive Committee 1990-present; President-elect

1995) Gail I. Zuckerman Foundation for Research in Chronic Liver Disease of

Children; Medical Director Home for Destitute and Crippled Children (Wyler Children's Hospital Board) -

Member, Board of Directors 1980 -1989 Illinois Experimental Organ Transplantation Procedures Advisory Board, 1986-

1992 Illinois Medical Society (1986-1993) International Pediatric Research Foundation, Trustee, 1983 -1987 International Society for Research on Human Milk & Lactation (ISRHML),

Member, Executive Committee. 1995 -La Leche League International - Professional Advisory Board; Physician

Seminars Permanent Moderator; Member Development Committee La Rabida Children's Hospital and Research Center - Member Board of Trustees:

Ex Officio Voting 1980-1993; Elected Trustee 1993-present Milk Club, President 1994-1996 National Institute of Child Health and Human Development (NIH), 1983 -1986

Maternal and Child Health Research Committee; Chairman, 1986 - 1987. North American Society for Pediatric Gastroenterology (President, 1974 -1975) Perinatal Research Society Physicians' Breastfeeding Network of Illinois, Chair 1993-present Ronald McDonald House at Wyler Children's Hospital (The Family Place) Board

of Directors, 1986-1990; Honorary Board, 1990-present Society for Medical History of Chicago Society for Pediatric Epidemiologic Research, 1989-present Society for Pediatric Research - Senior Member

Editorial Boards:

Journal of Human Lactation, Editorial Board, 1985-present Breastfeeding Abstracts, Editorial Board, 1986-present Seminars in Perinatology, Guest Editor, Issue on Breastfeeding, 1994

Major Research Interests:

Bilirubin metabolism Neonatal jaundice

103

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

Human lactation and breastfeeding Jaundice in breastfed infant (breastmilk jaundice and breastfeeding jaundice) History of medical advice on breastfeeding Pediatric history

Principle Clinical and Hospital Service Responsibilities:

1963-1980 Attending Physician and Director, Neonatology Service, Hospital of Albert Einstein College of Medicine and Abraham Jacobi Hospital of Bronx Municipal Hospital Center

1965-1980 Attending Physician and Director, Pediatric Hepatology Service, Hospital of Albert Einstein College of Medicine and Abraham Jacobi Hospital of Bronx Municipal Hospital Center

1980-1993 Physician-in-Chief and Medical Director, Wyler Children's Hospital at The University of Chicago

1980-1983 Attending Physician, General Pediatric Service, Wyler Children's Hospital at The University of Chicago

1980-1986 Attending Physician, Pediatric Gastroenterology/Hepatology Service, Wyler Children's Hospital at The University of

Chicago 1987-present Attending Physician, Postpartum Nursery, Chicago Lying-In

Hospital/Wyler Children's Hospital at The University of Chicago 1980-present Attending Physician, Section of Neonatology, Wyler Children's

Hospital at The University of Chicago 1991-present Attending Pediatrician and Consultant in General Pediatrics,

Mercy Hospital 1994-presen t Co-Director, General Care Nursery, Chicago Lying-In Hospital,

The University of Chicago

Educational Proi:ram Development:

1968-1980 First year medical student elective, Introduction to the Newborn Infant, Albert Einstein College of Medicine 1968-1980Fourth year medical student elective, Neonatal Intensive

Care, Albert Einstein College of Medicine 1973-1980 Undergraduate Course, Biologic Basis for Mental Retardation,

A Course in Human Organ Development, Manhattanville College, Purchase, NY

1985-present Continuing Medical Education for Pediatricians, Family Practice Physicians and Obstetricians, Physician's Seminars, Annual Course for La Leche League International and American Academy of Pediatrics

1989-present Undergraduate Course, Human Developmental Biology, The University of Chicago

1992-present Pediatric Residents, Attendings and Nurses, Breastfeeding

Selected

1966 1972

R ounds, Postpartum Unit and Nurseries, Chicago Lying-In Hospital and Wyler Children's Hospital at The University of Chicago

Invited Lectures:

Breastmilk Jaundice. German Pediatric Society. Berlin The Physiology of Physiologic Hyperbilirubinemia of the Newborn. 3rd International Conference on Experimental Medicine and Surgery in Primates, Lyon, France

104

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

1972

1974

1977

1980

1981

I 981-present

1985-present

1986

1988

1989

1989 1990

1991

1991 1993

1993

1993

1993

1993

1994

1994

Mitochondrial and Peroxisomal Defect in the Cerebro-Hepato-Renal Syndrome. Great Ormand Street Children's Hospital, London, England Bilirubin Binding, Free Fatty Acids and a New Concept for the Pathogenesis of Kernicterus. International Symposium on Bilirubin Metabolism in Newborn. Jerusalem, Israel Breastfeeding and Jaundice. Symposium on Human Lactation. Department of health, Education and Welfare Cholestatic Syndromes in the Newborn. American Association for Study of Liver Disease History of Premature Infant Care. Society for Medical History of Chicago, Morris Fishbein Memorial Lecture, Chicago

Twice annually. Hepatitis in Pregnancy: Implications for the Newborn. Continuing Medical Education Course for Obstetrician/Gynecologists. National Center for Advanced Medical Education, Chicago

Annually. Bilirubin Metabolism in the Newborn. Continuing Medical Education Course for Neonatologists. National Center for Advanced Medical Education, Chicago Jaundice in the Breastfed Newborn. Korean Pediatric Society. Seoul, Korea The Epidemiology of Neonatal Jaundice. Developmental Consequences of Neonatal Hyperbilirubinemia, European Society for Pediatric Research, Oslo, Norway . Jaundice in the Breastfed Newborn. Korean Perinatal Society, Seoul, Korea History of Premature Infant Care. Milwaukee Children's Hospital The Doctor/Patient Relationship in Pediatrics. Symposium on Doctor/-Patient Relations, The University of Chicago Patterns of Neonatal Jaundice in Asian Children. Kernicterus Symposium VIII, New Orleans History of Premature Infant Care. St. Louis Children's Hospital Two Thousand Years of Medical Advice on Breastfeeding: Comparison of China and Europe. Society for Medical History of Chicago Current Concepts of Neonatal Jaundice - Biology and Management. Philips University Medical School, Children's Hospital, Marburg, Germany Current Concepts of Neonatal Jaundice - Biology and Management. Free University of Berlin, KA VH Children's Hospital, Berlin, Germany Two Thousand Years of Medical Advice on Breastfeeding: Comparison of China and Europe. Breastfeeding Symposium, Debrecen, Hungary Jaundice in the Breastfed Newborn. Wellstart International. San Diego, California. For French language African training program. Jaundice in the Newborn and Related Issues. Henry Ford Hospital, Detroit, Michigan Medical Values: Breastfeeding Then and Now. 1994 Illinois Symposium on Human Lactation. Illinois Department of Public Health Southern Illinois University, Springfield, Illinois and Rush University, Chicago, Illinois.

105

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

1994

1994

1994

1995

1995

1995

1995

1995

1995

1995

1995

[995

1995

1995

1995

1995

1995

1996

1996

Jaundice in the Breastfed Newborn. Wellstart International. San Diego, California. For Spanish language Latin American training program. Visiting Professor, Danciger Post-Graduate Pediatric Conference, Children's Mercy Hospital, Kansas City, MO. Schorer-Pakula Lecture Greater Kansas City Pediatric Society, "2,000 Years of Medical Advice on Breastfeeding - China and the West." Recent Advances in Bilirubin Metabolism. Society of Neonatology, Tainan, Taipei, R.O.C. Medical Advantages of Breastfeeding. Taichung Veterans General Hospital, Taichung, Taiwan, Breastfeeding: Role of the Physician. Taichung Veterans General Hospital, Taichung, Taiwan, Two Thousand Years of Medical Advice on Breastfeeding: Comparison of China and the West. Symposium on Breastfeeding. National Taiwan University Medical School, Taipei, Taiwan, R.O.C. Keynote Address: Role of the Physician in Breastfeeding, Southern Illinois Breastfeeding Taskforce Annual Meeting, Carbondale, IL Two Thousand Years of Medical Advice on Breastfeeding. Southern Illinois Breastfeeding Taskforce Annual Meeting, Carbondale, IL The Death of Ernst: Shoemakers' Children. (With Carol B. Gartner, Ph.D.) Society for the History of Medicine of Chicago Infant Formula Manufacturers and Breastfeeding Connection. Birth Conference, Johns Hopkins University School of Medicine, Baltimore, Maryland Breastfeeding: Benefits and Problems. Visiting Professor, Eastern Virginia Medical School, Norfolk Virginia Jaundice and the Breastfed Infant. Visiting Professor, Eastern Virginia Medical School, Norfolk Virginia The Management of Hyperbilirubinemia in the Term Infant. Pediatric Grand Rounds; The Children's Hospital of San Diego, San Diego, California Viral Transmission Through Breastmilk. La Leche League Inter-national Conference. Chicago, IL The Benefits of Breastfeeding. Pediatric Grand Rounds. The University of California, San Diego Bilirubin Metabolism. Course in Neonatal/Perinatal Medicine. National Center for Continuing Medical Education, Chicago, IL Gartner, LM and Gartner CB. Shoemakers' Children: Diphtheria and the Doctors Jacobi. Annual History of Pediatrics Lecture Series, Children's Mercy Hospital and University of Missouri School of Medicine, Kansas City, Missouri Gartner, LM: Neonatal tetanus: What Did the Chinese Know Two Thousand Years Ago? Annual History of Pediatrics Lecture Series, Children's Mercy Hospital and University of Missouri School of Medicine, Kansas City, Missouri

Grand Rounds and lectures in Chicago area and at The University of Chicago are too numerous to list and have been omitted.

106

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

BIBLIOGRAPHY

Original Communications in Reviewed ,Journals:

1. Gartner, L.M. and Arias, I.M.in Rat and Guinea Pig Liver.

Developmental Pattern of Glucuronide Formation American J. Physiol 205: 662, 1963.

2. Arias, I.M., Gartner, L.M. Furman, M. and Wolfson, S. The Effect of SeveralDrugs and Chemicals on Heptic Glucuronide Formation in Newborn Rats. Proc of the Soc for Exp Biol and Med 112: 1037, 1963.

3. Arias, I.M., Gartner, L.M., Seifter, S. and Furman, M. Prolonged NeonatalUnconjugated Hyperbilirubinemia Associated with Breast Feeding and aSteroid, Pregnane-3 (ex), 20(B)-diol, in Maternal Milk that Inhibits GlucuronideFormation In Vitro. J Clin Invest 43: 2037, 1964.

4. Gartner, L.M. and Arias, I.M. Production of Unconjugated Hyperbili-rubinemia in Full-term Newborn Infants Following Administration of Pregnane-3(cx), 20(B)-diol. Nature 203: 1292, 1964.

5. Gartner, L.M. and Bernstein, J. Kernicterus and Prematurity. Journal of the Jewish Memorial Hospital, Wallerstein Festschrift, 10:124, 1965.

6. Gartner, L.M. and Arias, I.M. Studies of Prolonged Neonatal Jaundice m the Breastfed Infant. J Peds 68:54, 1966.

7. Bernstein, L.H., Ben Ezzer, J., Gartner, L.M. and Arias, I.M. HepaticIntracellular Distribution of Tritium-labeled Unconjugated and ConjugatedBilirubin in Normal and Gunn Rats. J Clin Invest 45: 1194, 1966.

8. Schmidt, M., Gartner, L.M. and Arias, I.M. Studies of Hepatic ExcretoryFunction: III. The Effect of Hypopituitarism on the Hepatic Excretion ofSulfobromophthalein Sodium in Man. Gastroent 52:998-1002, 1967.

9. Arias, I.M., Gartner, L.M. and DeLeon, A. Effect of Phenobarbital on Hyperbili­rubinemia on Glcuronyl Transferase Deficient Rats. J Lab Clin Med 70: 273-278,1967.

10. Rosenfeld, R.D., Arias, I.M., Gartner, L.M., Gallagher, T.F. and Hellman, L.Pregnane-3(),20(8)-diol: An Unusual Urinary Metabolite Associated with Neonatal Jaundice. J Clin Endocrin Metab 27: 1705, 1967.

I 1. Gartner, L.M. Hormonelle Beziehungen Zwischen Mutter und Kind mit besonderer Beruck-sichtigung der Frauenmilch. Monatsschrift fur Kinderheilkunde 115: 151-154, 1967.

I 2. Gartner, L.M. and Arias, I.M. The Transfer of Bilirubin from Blood to Bile m the Neonatal Guinea Pig. Ped Res 3:171-180, 1969.

13. Arias, I.M., Gartner, L.M., Cohen, M.I., Ben Ezzer, J. and Levi, J. Chronic

107

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

Nonhemolytic Unconjugated Hyperbilirubinemia with Hepatic Glucuronyl Transferase Deficiency: Clinical, Biochemical, Pharmacologic Evidence for Heterogeneity. Amer J Med 47:395-409, 1969.

14. Cohen, M.I., Gartner, L.M., Blumenfeld, 0. and Arias, I.M. Gamma GlutamylTrans-peptidase: Measurement and Development in Guinea Pig SmallIntestine. Ped Res 3:5- I 0, 1969.

15. Gartner, L.M., Snyder, R.N., Chabon, R.A. and Bernstein, J. Kernicterus: High Incidence in Prematures with Low Serum Bilirubin Concentrations. Pediatrics 45: 906-917, 1970.

16. Gartner, L.M., Lane, D. and Cornelius, C. Hepatic Bilirubin Transport by Liverin Adult Macaca Mulatta. Amer J Physiol 220:1528-1535, 1971.

17. Cohen, M.I., and Gartner, L.M. Management of Biliary Atresia.

The Use of Medium Chain Triglyceride m the J of Peds 79:379-384, 1971.

18. Arias, I.M. and Gartner, L.M. Jaundice in Breast-Fed Neonates. JAMA 218:321,1971.

19. Gartner, L.M.: Genetically Determined Unconjugated Hyperbilirubinemia,Birth Defects, Original Article Series: VIII:122-125, 1972.

20. Gartner, L.M. and Arias, I.M. Hormonal Control of Heptic Bilirubin Transport and Conjugation. Amer J Physiol 222: 1091-1099, 1972.

21. Dahms, B., Krausse, A., Gartner, L.M., Klain, D., Soodalter, J. and Auld, P. BreastFeeding and Bilirubin During the First Four Days of Life. J Peds 83: 1049-1054,1973.

22. Novogroder, M., Mackuanying, N., Eidelman, A. and Gartner, L.M.Nasopharyngeal Ventilation in RDS. A simple and Efficient Method ofDelivering Continuous Positive Airway Pressure. J Peds 82: 1059-1062, 1973

23. Javitt, N., Morrissey, K., Siegel, E., Goldberg, H., Gartner, L.M., Hollander, M.and Kok, E. Cholestatic Syndromes in Infancy: Diagnostic Value of Serum BileAcid Pattern and Cholestyramine Administration. Ped Res 7: 119-125, 1973.

24. Gartner, L.M. and Arias, I.M. Temporary Discontinuation of Breastfeeding m Infants with Jaundice. JAMA 225: 532-533, 1973.

25. Goldfischer, S., Moore, C.L., Johnson, A.B., Ritch, R.H., Rapin, I. and Gartner,L.M. Peroxisomal and Mitochondrial Defects in the Cerebro-Hepato-RenalSyndrome. Science 82:62-64, 1973.

26. Kandall, S. and Gartner, L.M. Late Presentation of Drug Withdrawal Symptoms in Newborns. Am J Dis Child 127:58-61, 1974.

27. Kandall, S., Johnson, A. and Gartner, L.M. Solitary Neonatal Hepatic Abscess. J

108

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

Peds 85:567-569, 1974.

28. Lee, K. S., Gartner, L.M. and Zarafu, I. Fluorescent Dye Method forDetermination of the Bilirubin Binding Capacity of Serum Albumin. J Peds 86:280-285, 1975.

29. Vaisman, S.L., Lee, K.S. and Gartner, L.M. Diminished Enhancement of HepaticUDP Glucuronyl Transferase (Bilirubin) by Phenobarbital during Pregnancyin the Rat. Biol of the Neonate 28:287-296, 1976.

30. Lee, K.S., Tseng, P.I. Eidelman, A., Kandall, S. and Gartner, L.M. Deter-minantsof the Neonatal Mortality Rate. Amer J Dis Child 130:842-845, 1976.

31. Kandall, S., Albin, S., Lowinson, J., Berle, B., Eidelman, A and Gartner, L.M.Differential Effects of Maternal Heroin and Methadone Use on Birth Weight.Pediatrics 58:681-685, 1976.

32. Vaisman, S.L., Lee, K.S. and Gartner, L.M. Various Bilirubin Conjugates inPregnant and Non-pregnant Rats with and without Phenobarbital Treatment.Ped Res 10:111-113, 1976.

33. Rubinstein, A., Eidelman, A.I., Melamed, J., Gartner, L.M., Kandall, S.R. andSchulman, H. Neonatal Immunologic Consequences of Maternal Promethazine Therapy. J Peds 89:136, 1976.

34. Lee, K.S., Eidelman, A.I., Tseng, P.I., Kandall, S.R. and Gartner, L.M.Respiratory Distress Syndrome of Newborn and Complications of Pregnancy.Pediatrics 58:675-680, 1976.

35. Vaisman, S.L., Lee, K.S., and Gartner, L.M. The Effect of Promethazine-HCI on Bilirubin Metabolism in the Rat. Ped Res 10:788-791, 1976.

36. Vaisman, S.L., Lee,K.S., and Gartner,L.M. Xylose, Glucose and Glucuronic AcidConjugation of Bilirubin in the Newborn Rat. Ped Res 10:976-971, 1976.

37. Gartner,L.M., Lee, K.S., Vaisman, S.L., Lane, D. and Zarafu, I. Development ofBilirubin Transport and Metabolism in the Newborn Rhesus Monkey: TheFunctional Basis of Physiologic Jaundice of the Newborn. J Peds 90:513-531,1977

38. Lee, K.S. and Gartner, L.M. Spectrophotometric Characteristics of Bilirubin. Ped Res 10:782-788., 1976.

39. Primack, W.A., Gartner, L.M., McGurk, H.E. and Spitzer, A. HypernatremiaAssociated with Cholestyramine Therapy. J Peds 89: 161, 1976.

40. Kandall, S.R., Albin, S., Gartner, L.M., Lee, K.S., Eidelman, A. and Lowinson, J.The Narocotic-Dependent Mother: Fetal and Neonatal Consequences. EarlyHuman Development, 12: 159-169, 1977.

109

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

41. Doyle, P.E., Gartner, L.M., Lee, K.S., Daum, C. and Eidelman, A.I. ExchangeTransfusion and Hypernatremia: Possible Role in Intracranial Hemorrahage in Very-Low-Birth-Weight (VLBW) Infants. J Peds 92:848, 1978.

42. Pearlman, M.A., Gartner, L.M., Lee, K.S., Marecki, R. and Horoupian, D.S. TheAssociation of Kernicterus with. Bacterial Infection in the Newborn.Pediatrics 65:26-29, 1980.

43. Lee, K.S., Gartner, L.M. and Vaisman, S.L. Measurement of Bilirubin-Albumin Binding. I. Comparative Analysis of Four Methods and Four Human Serum Albumin Preparations. Ped Res 12:301-307, 1978.

44. Kahn, M., Lee, K.S. and Gartner, L.M. Chart for Fluid Intake rn Neonates. JPeds 92:296, 1978.

45. Pearlman, M.A., Gartner, L.M., Lee, K.S., Marecki, R. and Horoupian, D.S.Absence of Kernicterus in Low-Birth-Weigth Infants from 1971 through 1976:Comparison with Findings in 1966 and 1967. Pediatrics 62:460-464, 1978.

46. Cashore, W.J., Gartner, L.M., Oh, W. and Stern, L. Clinical Application ofNeonatal Bilirubin Binding Determinations: Current Status. J Peds 93:827-833, 1978.

47. Lee, K.S., Paneth, N., Gartner, L.M. The Very Low-Birth-Weight Rate:Principal Predictor of Neonatal Mortality in Industrialized Populations. J Peds 97:759-764, 1980.

48. Lee, K.S., Paneth, N., Gartner, L.M. and Pearlman, M., Gruss, L. Neonatal Mortality: Analysis of the Recent Improvement in the United States. Amer J Pub Health 70:15-21, 1980.

49. Wolkoff, A.W., Chowdhury, J.R., Gartner, L.M., Rose, A.L., Biempica, L., Giblin,D.R., Fink, D. and Arias, I.M. Crigler-Najjar Syndrome (Type I) in an AdultMale. Gastroenterology 76:840-848, 1979.

50. Hammerman, C., Eidelman, A.I. and Gartner, L.M. Hypocalcemia and the Patent Ductus Arteriosus. J. Pediatrics 94:961-963, 1979.

51. Japko, L., Skolnick, L., Marecki, R. and Gartner, L.M. Saccular Aneurysm of the Ductus Arteriosus. NY State J Med 1980; 80(13):1970-1.

52. Bangaru, B., Marecki, R., Gaiser, J.H., Gartner, L.M. and Horwitz, S.Comparative Studies of Biliary Atresia in the Human Newborn and Reovirus­Induced Cholangitis in Weanling Mice. Lab Invest 43:456-462, 1980.

53. Hammerman, C., Eidelman, A.I., Lee, K.S. and Gartner, L.M. Comparative Measurements of Phototherapy: A Practical Guide. Pediatrics 67:368-372, 1981.

54. Lipper, E., Lee, K.S., Gartner, L.M. and Grelling, B. Determinants of Neuro-behavioral Outcome in Low-Birth-Weight Infants. Pediatrics 67:502-505, 1981.

110

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

55. Paneth, N., Lee, K.S., Gartner, L.M. and Pearlman, M. Influence of Race onNeonatal Mortality. J Peds 99:505, 1981.

56. Lee, K.S., Gartner, L.M., Paneth, N. and Tyler, L. Recent Trends in NeonatalMortality: The Canadian Experience. Canadian Med Assoc J 126:373-376, 1982.

57. Moscioni, A.D. and Gartner, L.M.: Thyroid Hormone and Hepatic UDP-Glucronosyl Transferase Activity: Contrary Effects in Rat and Mouse. Res Com in Chem Path and Pharm 39:445-462 1983.

58. Gartner, L.M., Lee, K.S. and Moscioni, A.D. Effect of Milk Feeding on Intestinal Bilirubin Absorption in the Rat. J Peds 103:464-471, 1983.

59. Gartner, L.M. Hospital Policies, Breastfeeding, and Neonatal Jaundice. Breastfeeding Abstracts 2: 13-14, 1983.

60. Gartner, L.M., Lee, K.S., Keenan, W.J., White, Jr. N. B., Phil, M., Bryla, D.A.Effect of Phototherapy on Albumin Binding of Bilirubin. Pediatrics 75:401-406, 1985.

61. Lipsitz, P.J., Gartner, L.M., Bryla, D.A. Neonatal and Infant Mortality rnRelation to Phototherapy. Pediatrics 75 :422-426, 1985.

62. Lee, K.S., Chen, T., Gartner, L.M. Neonatal Mortality: Surveillance of Quality ofcare. World Pediatrics Child Care 2:5-18, 1985.

63. VanThiel, D.H., Gartner, L.M., Newman, S.L., Lindahl, J.A., Stoner, E., New, M.I.,and Starzl, T.E. Resolution of Clinical Features of Tyrosinemia Following Orthotopic Liver Transplantation for Hepatoma. J of Hepatology 3:42-48, 1986.

64. Whitington, P.F., Moscioni, A.D., Gartner, L.M. The Effect of Tin -Protoporpyrin IX on Bilirubin Production and Excretion in the Rat. Ped Res 21:487-491, 1987.

65. Lee, K. S., Ferguson, R.M., Corpuz, M.S. and Gartner, L.M.

Incidence of Low Birth-weight at Term: A population Study.158:84-89, 1988.

Maternal Age and Am J Ob/Gyn

66. Lee, K.S., Corpuz, M., Woo, D. and Gartner, L.M. Teenage Pregnancy: Trend andImpact on Low Birth-weight, Maternal and Neonatal Mortality Rates of theUnited States, Am J Pub Health, 1987.

67. Scheidt, P.C., Bryla, D.A., Nelson, K.B., Hirtz, D.G., Hoffman, H.J., Gartner, L.M.Phototherapy for Neonatal Hyperbilirubinemia: Six-year Follow-up on theNational Institute of Child Health and Human Development Clinical Trial.Pediatrics 85 :455-463, 1990.

68. Scheidt, P.C., Graubard, M.A., Nelson, K.B., Hirtz, D.G., Hoffman, H.J., Gartner,L.M., Bryla, D.A. Intelligence at Six Years in Relation to Neonatal Bilurubin.

111

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

Pediatrics 87:797-805, 1991

69. Gartner, L.M. and Stone, C. Two Thousand Years of Medical Advice onBreastfeeding. Seminars in Perinatology 18:532-536, 1994

Published Proceedings of Meetings:

l . Arias, I.M., Gartner, L.M., Furman, M. and Wolfson, S. The Effect of SeveralDrugs on Hepatic Glucuronide Formation in Newborn Rats and Humans. Annals of the New York Academy of Sciences III:274, 1963.

2. Arias, I.M. and Gartner, L.M.: Further Studies of the Mechanism of ProlongedNeonatal Jaundice Associated with Breast Feeding. Proc. 2nd Int. Congress on Steroid Metabolism, Milan., 1966. Excerpta Media International Congress Series 132:570-575, 1966.

3. Gartner, L.M. The Hormonal Regulation of Hepatic Bilirubin Excretion. Bilirubin Metabolism ed. by Ian D. Bouchier and Barbara Billing. Blackwell Scientific Publication, Oxford, 1967: 175-188.

4. Gartner, L.M. and Arias, I.M. Pharmacologic and Genetic Determinants of Disordered Bilirubin Transport and Metablolism in the Liver. Ann NY Acad Sciences 151:833-841, 1968.

5. Gartner, L.M. and Lane, D. The Physiology of Physiologic Hyperbili-rubinemia of the Newborn. Medical Primatology 1972, Part I: 237-247(Karger,Basel, 1972).

6. Gartner, L.M. and Lee, K.S. Bilirubin Binding, Free Fatty Acids and a NewConcept for the Pathogenesis of Kernicterus. Presented at the InternationalSymposium on Bilirubin Metabolism in the Newborn, Jerusalem, Israel, April1974. Bilirubin Metabolism in the Newborn (II) Defects: Original ArticleSeries XII, 2, 264-274, 1976.

7. Gartner, L.M., Zarafu, I., Lee, K. and Eidelman, A. The Prophylactic Use ofPhototherapy in Low Birth Weight Infants: Experience with a Controlled Clinical Trial Pilot Study. Presented at the Conference on Phototherapy, Washington, D.C.1974. In Brown AK, Showacre J, eds. Phototherapy for Neonatal Hyperbili-rubinemia: Long-Term Implications. D.H.E.W., Pub. #NIH 76-1075.

8. Gartner, L.M. The Functional Basis of Physiologic Jaundice of the Newborn.In Goresky CA, Fisher MM, eds. Jaundice 2:257-266, Plenum Press, N. Y. 1975.

9. Gartner, L.M. Breast Feeding and Jaundice. In Waltzky LR, ed. Symposium on Human Lactation. U. S. Dept. of Health, Education and Welfare (DHEW) Pub No. (HSA) 79-5107), 1979: 95-102.

10. Lee, K.S. and Gartner, L.M. Jaundice in the Breast-Fed Infant: New Conceptsof Pathogenesis. International Congress Series No. 518. Human Milk. Its

112

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

Biological and Social Value. Selected papers from the International Symposium on Breast Feeding Tel Aviv, 1980.

Books and Journal Issues:

I. Gartner, L.M., Editor. Human Developmental Organ Biology. A Textbook. (InPreparat ion)

2 . Gartner, L.M., Guest Editor. Breastfeeding. Seminars m Perinatology, December 1994 Issue (In Press)

Book Chapters and Review Articles:

I. Gartner, L.M. and Arias, I.M. The Liver in Barnett HL, ed. Pediatrics 14thedition, Appleton Century Crofts, NY. 1968: 1490-1518.

2. Gartner, L.M. and Arias, I.M. Formation Transport, Metabolism and Excretion of Bilirubin. In Physiology for Physicians. N.E.J.M. 280: 1339-1345, 1969.

3. Gartner, L.M. and Hollander, M. Disorders of the Liver and BilirubinMetabolism in Assali NS, Fetal and Neonatal Disorders, Vol 3, Pathophysiologyof Gestation. Academic Press, NY, 1972.

4. Gartner, L.M. and Arias, I.M. The Liver in Barnett HL, ed. Pediatrics 15th

edition, Appleton Century Crofts, NY. 1972:1663-1694.

5. Gartner, L.M. and Arias, I.M. The Liver in Barnett HL, ed. Pediatrics 16thedition, Appleton Century Crofts, NY. 1976: 1063-1106.

6. Vaisman, S.L. and Gartner, L.M. Pharmacological Treatment of Neonatal Hyperbili-rubinemia. Clinics in Perinatology 2:37-59, 1975.

7. Kandall, S., Saldana, L. and Gartner, L.M. Hemolytic Disease of the Newborn.In Conn HF ed. Current Therapy 27th Edition, 1975:246-251.

8. Gartner, L.M., Marecki, R. and Lee, K.S. Jaundice and Liver Disease in theNewborn, in Behrman RE, ed. Neonatology 2nd Edition, CV Mosby, 1976.

9. Lee, K.S. and Gartner, L.M. Bilirubin Binding by Plasma Proteins: A CriticalEvaluation of Methods and Clinical Implications. Scarpelli EM, Cosmi EJ, eds.Reviews in Perinatal Medicine, Vol. II, Raven Press NY, 1978.

10. Lee, K.S., Gartner, L.M., Eidelman, A.M. and Ezhuthachan, S. Unconjugated Hyper-bilirubinemia in Very-Low-Birth Weight Infants. Clinics in Perinatology 42:305-320, 1977.

11. Ezhuthachan, S. and Gartner, L.M. Physiology of Bilirubin Metabolism. In Lifshitz F ed. Clinical Disorders in Pediatric Gastroenterology and Nutrition. Marcel Dekker, 1979.

113

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

12. Gartner, L.M. Report on Frequency and Impact of Pediatric Liver Diseases. In Report to Congress of the United States of the National Commission on Digestive Diseases, Vol. IV - Reports of the Workgroups, Part 4: Epidemiology and Impact. U. S. Department of Health, Education and Welfare, Public Health Service, National Institutes of Health, Publication No. (NIH) 79-1887, 1979:531-541.

13. Gartner, L.M. Disorders of Bilirubin Metabolism. In Nathan DG, Oski FA, Eds.Hematology of Infancy and Childhood, WB Saunders, 1981:86-118.

14. Raker, K. and Gartner, L.M. The Infant of the Diabetic Mother. In DiabetesMellitus, Rifkin H, Raskin P, eds. 1981: 179-184.

1 5. Gartner, L.M. and Arias, I.M. The Liver. In Rudolph AM, ed. Pediatrics 17th Edition, Appleton Century Crofts NY, 1981: 995-1033.

16. Gartner, L.M. Breast Milk Jaundice. In Levine R, Maisels MJ, eds. RossConference on Hyperbilirubinemia in the Newborn, Ross, Columbus, 0.1983:75-91.

17. Gartner, L.M. Chapter: Neonatal Jaundice: A Selected Retrospective. In Smith G, ed. Historical Review and Recent Advances in Neonatal and Perinatal Medicine. Mead Johnson, Evansville, In. 1983:87-97.

18. Gartner, L.M., Lee, K.S. and Morecki, R. Jaundice and Liver Disease. InFanaroff AA, Martin R, Behrman's Neonatal-Perinatal Medicine: diseases ofthe Fetus and Infant. 3rd Edition. CV Mosby, St. Louis, MO., 1983:753-784.

19. Lee, K.S. and Gartner, L.M.rubinemia in the Newborn.

Management of Unconjugated Hyperbili­Seminars in Liver Disease 3:52-64, 1983.

20. Gartner, L. M. Cholestasis of the Newborn (Obstructive Jaundice). Peds In Review 5: L 63-172, L 983.

2 l . Lee, K.S. and Gartner, L.M. What Mortality Statistics Tell Us About Perinatal Care. Contemporary Ob stet Gynec March 1985: 111-132, 1985.

22. Chilcote, R.R. and Gartner, L.M. Hemolytic Diseases of the Neonate. In GellisSS, Kagan BM, Current Pediatric Therapy, 12th Edition, WB Saunders, 1986:727-732.

23. Lee, K.S. and Gartner, L.M. Fetal Bilirubin Metabolism and Neonatal Jaundice.Ostrow ID, ed. Bile Pigments and Jaundice: Molecular Metabolic and MedicalAspects. Marcel Dekker, NY, 15:373-394, 1986.

24. Gartner, L.M., Auerbach, K.G. Jaundice and Breastfeeding. Mothering 41:77-81, 1986.

25. Gartner, L.M. and Whitington, P.F. Disorders of Bilirubin Metabolism. InNathan DG, Oski FA eds. Hematology of Infancy and Childhood, 3rd Edition. WB

114

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

Saunders 1987:74-103.

26. Auerbach, K.G., Gartner, L.M. Breastfeeding and Human Milk: Their Association with Jaundice in the Neonate. Clinics in Perinatology 14:89-107, 1987.

27. Gartner, L.M., Auerbach, K.G.: Breastmilk and Breastfeeding Jaundice.Advances in Pediatrics 34:249-274, 1987.

28. Whitington, P.F. and Gartner, L.M. Disorders of Bilirubin Metabolism. InNathan DG, Oski, FA eds. Hematology of Infancy and Childhood, 4th Edition. WBSaunders, 1993: 74-ll 4.

29. Gartner, L.M., Lee, K.S. and Morecki, R. Jaundice and Liver Disease Part I. InFanaroff AA, Martin R, Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 4th Edition. CV Mosby, St. Louis, MO., 1991: 1075-1104.

30. Gartner, L.M. Commentary: Management of the Jaundiced Well-Baby. Pediatrics, 89:826- 827, 1992.

3 l . Collins, J.C., Morecki, R., McPhillips, J., Gartner, L.M. Colchicine treatment of paediatric chronic cholestatic liver disease, Paediatric Cholestasis 32:305-308, 1992.

32. Gartner, L.M., Gartner, C. The care of Premature Infants: Historical Perspective, Neonatal Intensive Care, NIH Publication #92-2786, 1992.

32. Gartner, L.M. Letter: Overtreatment of Neonates? A Personal Retrospective. Pediatrics 91:169-70, 1993.

34. Gartner, L.M., Alonso, E.M. Physiologic Jaundice of the Newborn: Animal Models of Perinatal Development. In Cornelius C, ed. Advances in Veterinary Science and Comparative Medicine. Academic Press, 37:61-86 1993

35. Gartner, L.M. Neonatal Jaundice. Pediatrics In Review 15:422-432, 1994

36. Gartner, L.M.: Jaundice and the Breastfed Newborn. Colorado Breastfeeding Update, Vol 2: No. 2; pages 1-2, 1994.

37. Gartner, L.M. and Stone, C.: Two Thousand Years of Medical Advice onBreastfeeding: Comparison of Chinese and Western Texts. Seminars in Perinatology 18: 532-535, 1994

38. Gartner, L.M.: On the Question of the Relationship Between Breastfeeding andJaundice in the First 5 Days of Life. Seminars in Perinatology 18:502-509, I 994

39. Gartner, L.M.: Introduction: Breastfeeding and the Hospital. Seminars in

Perinatology 18:475, 1994

40. Gartner, L.M., Catz, C.S. and Yaffe, S.J.: Neonatal Bilirubin Workshop.

115

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

Pediatrics 94:537-540, 1994

41. Gartner, L.M.: Moderator, Breastfeeding - Current Thoughts. American Academy of Pediatric UPDATE. Continuing Education Tape, 1995.

Editorials, Letters, Book Reviews and Miscellaneous Publications:

I. Eidelman, A.I., Rubinstein, A., Melamed, J., Schulman, H. and Gartner, L.M.More on the Effect of Maternal Promethazine (P-HCI) on NeonatalImmunologic Functions. A reply. Pediatrics 90:332, 1977.

2. Lee, K.S, Eidelman, A.I., Kandall, S.R. and Gartner, L.M. Letter to the Editor:Quality of Care vs Neonatal Mortality Rate. J Peds 89:161, 1976.

3. Gartner, L.M. and Gartner, C.B.: Book Review of Breast Feeding - A Guide forthe Medical Profession by Ruth A. Lawrence, M. D., Am J Dis Child 135:88-89, 198 l.

4. Paneth, N., Lee, K.S., Gartner, L.M., Pearlman, M., Hein, H. and Anderson, J.Analysis of Neonatal Mortality. Letter to the Editor, J Peds 99:503, 1981.

5. Gartner, L.M.: Editorial - Breastfeeding: Korea. Breastfeeding Abstracts, 1987.

6. Gartner, L.M. and Lee, K.S.: Kernicterus. Editorial Comment-Bronze Baby Syndrome, J Peds 88: 465-466, 1976.

7. Gartner, L.M.: BFHI an BFHI: The Baby Friendly Hospital in the U.S., ColoradoBreastfeeding Update, A Newsletter for Health Care professionals, Vol 3: No. 3,1995.

Abstracts: (*Presented )

* 1. Arias, I.M., Gartner, L.M., Seifter, S. and Furman, M. Neonatal UnconjuatedHyperbilirubinemia Associated with Breast Feeding and a Factor in Milk that Inhibits Glucuronide Formation In Vitro. Presented at the Soc. for Clin. Invest. Atlantic City, N. J., 1963. J Clin Invest 42:912, 1963.

*2. Gartner, L.M. and Arias, I.M. Production of Unconjuated Hyperbilirubinemia in Full-Term Newborn Infants Following Administration of Pregnane-3(), 20(8)-diol. Presented at the Amer. Ped. Soc., Seattle, Wash., June 18, 1964. J Peds 65: 1045-146, 1964.

* 3. Gartner, L.M., Shanske, A. and Arias, I.M. Effect of Human Albumin and pHon Hepatic Uptake of Sulfobromophthalein (BSP) rn the Dogfish (Squalus Acanthas) Fed Proc 25:2, 1966.

4. Gartner, L.M., Arias, I.M.: Pituitary Regulation of Bilirubin Excretion by the Liver. J Clin Invest 45:1011, 1966.

116

CURRICULUM VITAE LA WREN CE M. GARTNER, M.D.

* 5. Gartner, L.M., Gluck, J. and Arias, I.M. Hormonal Regulation of Bilirubin Excretion by Rat Liver. Soc for Ped Res 1967.

6. Gartner, L.M. and Lane, D. and Zarafu, I.Bilirubin in Human Cord and Adult Sera.

Protein Binding Capacity for Soc for Ped Res 1970.

*7. Gartner, L.M. and Lane, D Hepatic Metabolism of Bilirubin during Physiologic Jaundice in the Newborn Rhesus Monkey. Soc for Ped Res 1971.

* 8. Goldifscher, S., Moore, C.L., Johnson, A.B., Ritch, R.H., Rapin, I. and Gartner,L.M. An Absence of Peroxisomes Associated with Mitchodrial Dysfunction m the Cerebro-Hepato-Renal Syndrome. 4th International Histochemical Congress, Kyoto, Japan, 1972. Histochemical Pathology and Cytochemistry 1972:31-32.

9. Goldfischer, S., Moore, C.L., Johnson, A.B., Ritch, R.H., Rapin I. and Gartner,L.M. Peroxisomal and Mitochondrial Defects in the Cerebro-Hepato-Renal Syndrome. Gastroenterology 64:883, 1973.

* l 0. Lee, K.S., Gartner, L.M. Transport of Bilirubin m Plasma by Free Fatty Acids (FFA). Soc for Ped Res. Ped Res 7:338, 1973.

11. Vaisman, S. and Gartner, L. M. Diminished Stimulation of Hepatic Glucuronyl Transferase by Phenobarbital in the Pregnant Rat, American Association for the Study of Liver Diseases, Gastroenterology 65:574, 1973.

* 12. Lee,K.S. and Gartner,L.M. Plasma Bilirubin Transport and Free Fatty Acids (FFA). American Association for the Study of Liver Diseases. Gastroenterology 65: 557, 1973.

13. Lee,K.S. and Gartner,L.M. Fluorescent Dye Method For Determination of Bilirubin Binding Capacity of Serum Albumin. Soc for Ped Res. Ped Res 8:404, 1974.

14. Vaisman, S. and Gartner, L.M. Diminished Response of Hepatic Glucuronyl-Transferase to Phenobarbital During Pregnancy. Soc for Ped Res. Ped Res 8:366, 1974.

* 1 5. Lee, K.S. and Gartner, L.M. Albumin Binding of Bilirubin - Comparison ofMethods. Soc for Ped Res. Ped Res 10:427, 1976.

16 Lee, K.S., Eidelman, A., Tseng, P.I., Kandall, S.R. and Gartner, L.M. of Respiratory Distress Syndrome and Complications of Pregnancy. Soc. Ped Res 10:463, 1976.

Incidence Amer Ped

17. Gartner, L.M. and Lee, K.S. Enteric Bilirubin Absorption and Physiologic Jaundice of the Newborn. Gastroenterology, 71:907, 1976.

* 18. Bangaru, B., Gartner, L.M., Morecki, R., Udem, S., Goldfischer, S. and

117

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

Horwitz, M. Reovirus Murine Model for Biliary Atresia. American Association for the Study of Liver Disease. Gastroenterology, 1977.

* 19. Shanske, A., Brenholz, P., Nitowsky, H., Gartner, L.M., Sobel, E. and Shutta, E. Costovertebral Dysplasia: A Clinical and Genetic Analysis. American Society of Human Genetics, San Diego, California, 1977.

*20. ' Morecki, R., Bangarau, B.S., Gartner, L.M. and Goldfischer, S. "DuctalRemnants" in Biliary Atresia and Murine Viral-Induced Biliary Injury, Ped Pathology Club, Atlanta, Ga. 1977.

21. Primack, W., Gartner, L.M., McGurk, H.E. and Spitzer, A.Hypernatrmia Associated with Cholestyramine Therapy.Research. Ped Res 11:520, 1977.

Hyperchloremia and Society for Pediatric

22. Bangaru, B.S., Gartner, L.M., and Lee, K.S. Seasonal Incidence of Idiopathic Neonatal Hepatitis (NH) and Biliary Atresia (BA). American Association for the Study of Liver Disease. Gastroenterology, 73:1211,1977.

*23. Pearlman, M. A., Gartner, L.M., Lee, K.S., Morecki, R. and Horoupian, D.S. The Association of Kernicterus with Bacterial Sepsis. Society for Pediatric Research, Ped. Res. 12:532, 1978.

*24. Lee, K.S., Paneth, N., Pearlman, M.A. and Gartner, L.M. An Approach to the Evaluation of Neonatal Mortality Rates (NMR). Society for Pediatric Research, Ped Res 12:532, 1978.

25. Lipper, E., Lee, K.S. and Gartner, L.M.Predictor of Neurobehavioral Outcome.Res. 12:373, 1978.

Head Circumference at Birth as a Society for Pediatric Research. Ped.

26. Pearlman M.A., Hobbs,J.F. and Gartner,L.M. Continuous Nasgastric Infusion (CNGI): A Safe and Effective Way to Feed the VLBW Infant. Society for Pediatric Research. Ped Res 12:439,1978.

27. Pearlman, M.A., Gartner, L.M., Lee, K.S., Morecki, R. and Horoupian, D.S.Absence of Kernicterus in Low-Birth-Weight Infants 1971-1976: Comparison with 1966-1967. Society for Pediatric Research. Ped Res 12: 531, 1978.

*28. Gartner, L.M. and Lee, K.S. Effect of Starvation and Milk Feeding on Intestinal Bilirubin Absorption. American Association for the Study of Liver Diseases. Gastroenterology, 77: Al3,1979.

29. Hammerman, C., Eidelman, A.I., Lee, K.S., and Gartner, L.M. Standardization ofPhototherapy Irradiance. Society for Peditric Research. Ped Res 14:467,1980.

30. Perl, H., Capriglione, A.M., Lee, K.S., and Gartner, L.M. Determinants ofNeonatal Morbidity in Full-Term AGA Infants. Society for PediatricResearch. Ped Res 14:493, 1980.

118

CURRICULUM VITAE LAWRENCE M. GARTNER, M.D.

*31. Gartner, L.M. and Lee, K.S. Intestinal Bilirubin Absorption. 14:498, 1980.

Effect of Starvation and Milk Feeding on Society. for Pediatric Research. Ped Res

32. Ebara, H., Kuo, C.Y., Lee, K.S. and Gartner, L.M. Sociodemographic Change andRecent Improvement in Low Birth-Weight-Rate in the United States. Societyfor Pediatric Research. Ped Res 16:149A. 1982.

*33. Perl, H., Nijjar, A., Ebara, H., Lee, K.S. and Gartner, L.M. Bilirubin Toxicity without CNS Staining. Society for Pediatric Research. Ped Res 16:303A, 1982.

*34. Roberson, D.A., Lee, K.S. and Gartner, L.M. Regional Variation in Bilirubin Absorption within the Small Intestine. Society for Pediatric Research. Ped Res 15:305A, 1982.

35. Lee, K.S., Atakent, Y.S. and Gartner, L.M. Regional Variation in BirthweightDistribution in the United States. Society for Pediatric Research. Ped Res16: 150A,1982.

36. Moscioni, A.D., Gartner, L.M. Chowdhury, N.R., and Chowdhury, J.R.Enterohepatic Circulation of Bilirubin. American Association for Study of Liver Disease. Gastro-enterology 84:1386, 1983.

37. Ebara, H., Lee, K.S., Aoki, K., Mishima, H., Takeucji, T., and Gartner, L.M.Influence of Fetal Death Statistics on Neonatal Mortality Rate. Society for Pediatric Research. Ped Res 17:177a, 1983.

38. Sinha, R., Lee, K.S. and Gartner, L.M.: Economic Cycles, Reproductive Patternsand Perinatal Mortality. Society for Pediatric Research. Ped Resl8:187A,1983.

39. Lee, K.S., Corpuz, M., Woo, D. and Gartner, L.M. Teenage Pregnancy: ImpactOn Very Low Birth-weight Rates (VLBWR) and Neonatal Mortality Rates(NMR) in the United States. Society for Pediatric Research. Ped Res, Vol 21: p399A, #1352, 1987.

*40. Ebara, H., Takeuchi, T., Gartner, L.M. Relative Importance of Perinatal Care and Health Intervention in Japan. American Public Health Association, 1987.

*41. Gartner, L.M. Rhesus Monkey.

Enterohepatic Circulation of Bilirubin in the Newborn International Perinatal Collegium, 1991.

*42. Gartner, L.M., Stone, C.: Two Thousand Years of Medical Advice on Breast-feeding. International Perinatal Collegium, 1993.

*43. Gartner, L.M., Stone C.: Tetanus of the Newborn: Two Thousand Years of History in China and Europe. International Perinatal Collegium, 1995

119