910
PRESENTATION OF THE ACADEMY MEDAL TO SAUL KRUGMAN, M.D.* JOSEPH DANCIS, M.D. Professor and Chairman Department of Pediatrics New York University School of Medicine New York, New York
ITis a pleasure and a privilege to have the opportunity to talk to you about Dr. Saul Krugman, recipient of the Academy Medal for 1978, a distinguished award to a. distinguished physician. Dr. Krugman has been selected for distinction many times previously. He is recipient of the Haven Emerson Award, the James D. Bruce Memorial Award of the American College of Physicians, the John M. Russell Award of the Markle Foundation, the Charles H. Hood Foundation's Child Health Award, the Grulee Award of the American Academy of Pediatrics, and the Bristol Award, and has been elected to the National Academy of Sciences. As a member of select committees, he has contributed to the fashioning of national policy. These assignments include the World Health Organization Expert Advisory Panel on Virus Diseases, National Advisory Council of the National Institute of Allergy and Infectious Diseases, chairman of the Committee on Viral Hepatitis of the National Research Council, chairman of the Panel on Review of Viral and Rickettsial Vaccines of the Food and Drug Administration, and many others. Let us review some of the steps that led to his preeminent position in medicine. Dr. Krugman returned to New York after World War II, having enjoyed for a few years the exotic beauties of the South Pacific. Released from the Army, he was offered the privilege of serving as externe on pediatrics at Bellevue Hospital, a position with no visible responsibilities or opportunities and a commensurate salary. I had arrived a few months earlier and had been given the last legitimate opening on the house staff. It would have taken the imagination of a Horatio Algier to suspect that this pleasant supernumerary to our staff would, in time, follow the eminent *Presented at the Stated Meeting of the New York Academy of Medicine held April 13, 1978.
Bull. N.Y. Acad. Med.
ACADEMY MEDAL
ACADEMY MEDAL
911 911
L. E. Holt, Jr., as chairman of the department and a renowned leader in pediatrics. Dr. Robert Ward, assistant to Dr. Holt, soon found that he shared scientific interests with the new externe. Harmonious, collaborative efforts between the two forged strong personal bonds that lasted through the years. They were joint authors of a book on infectious diseases which has become the authoritative text in the field, and together they embarked on a study of hepatitis at the Willowbrook State School. A few years later Dr. Ward accepted the chair of pediatrics in Los Angeles. At the time he left he made Dr. Krugman an extremely attractive offer to join him, but Krugman refused sunshine and security in the West because he considered the work at Willowbrook too important. I can remember with what amazement I received this information, faced as I was at the time with similar problems of survival and an uncertain future. Willowbrook State School in the late 1950s was not an unusual representative of institutions set up for the care of the mentally-retarded child. It was too large, overcrowded and understaffed, situated in an isolated part of the city, largely deserted by society, and ignored by the medical profession. The conditions were ideal for the rapid dissemination of infectious diseases, with newcomers frequently succumbing to endemic diseases or serving as the focus of new outbreaks. The arrival of Dr. Krugman and Dr. Ward with a staff from New York University was welcomed by the administration, the medical staff, and the parents of these unfortunate children. Here were capable, energetic doctors and nurses, interested in their problems and anxious to help. Federal funds had been obtained so that a special ward could be established, staffed, and equipped within the Willowbrook State School. The subjects were to receive the best of medical care while being meticulously observed. The first notable impact was made with measles. Measles had been a common invader of Willowbrook, attacking each time a new group of susceptibles had accumulated, inflicting significant morbidity and mortality. Dr. Krugman seized the opportunity to test within Willowbrook a newly available measles vaccine, and demonstrated its effectiveness in carefully designed clinical trials. The Willowbrook children were the first to benefit from these studies. A preventive program was promptly introduced and there has not been a case of measles in Willowbrook since 1962. A grateful group of parents of the children recognized this contribution, among others, in an award in 1967 which states "In recognition of Vol. 54, No. 10, November 1978
912 912
J. DANCIS J.
DANCIS
SAUL KRUGMAN, M.D.
Bull. N.Y. Acad. Med.
ACADEMY MEDAL ACADEMY MEDAL
913
913~~~~~~~~~~~~
his distinguished, pioneering, humanitarian research in the prevention of infectious diseases and their resultant complications in children everywhere, born and unborn." Hepatitis was a major endemic problem at Willowbrook. Virtually all inmates and most attendants became infected during their sojourns. The challenge of this disease soon commanded the major part of Dr. Krugman's attention. Depending primarily on his superb clinical skills, he succeeded in describing over a period of 10 or so years the main features of hepatitis. He demonstrated convincingly that there were actually two types of hepatitis at Willowbrook, clinically and immunologically differentiable. Recovery from one infection did not protect against the other, which explained what had appeared to be second attacks of hepatitis, and pooled gamma globulin protected against one but not the other. Our understanding of epidemiology was extended by the demonstration that subclinical infections and the oral-fecal route of spread were common to both. The culmination of this exciting series of revelations was the demonstration that one infection, now known as hepatitis B, caused an intense viremia and that heating the serum destroyed its infectivity but not its antigenicity. The direction to take in seeking a potent vaccine had been clearly indicated. Many of the details of hepatitis have now been filled in by others, generally working from the vantage point of the laboratory investigator. Again and again these investigators have turned to Dr. Krugman to test their hypotheses or techniques against the invaluable samples of potent sera collected over the years and kept frozen against such a need. By comparing laboratory results with the data-filled notebooks of clinical observations on these same patients, unusually rapid progress has been possible. Dr. Krugman's efforts have not been limited to Willowbrook. His field studies have taken him far afield. Nor has his research been confined to hepatitis and measles. His contributions to the control of rubella are equally well known. But one must look beyond his research to understand why he is one of the best known pediatricians of our day. As chairman of pediatrics at New York University for 15 years, large numbers of medical students and residents looked to him for guidance and inspiration. As a popular lecturer and a spirited panelist, he has extended his influence as an educator far beyond the university. Through his book he has become the ultimate authority on infectious diseases for pediatricians everywhere. Now 67 years old, retired from the chairmanship for three years and 9.5 Vol. 54, No. 10, November 1978
914
914
J. DANCIS
months (the reasons for this precision are personal), one might presume that Dr. Krugman had reached that stage of life when he would be satisfied with taking pride in his children, boasting of his grandchildren, and taking long vacations with his devoted wife, Sylvia. That is not quite true. Dr. Krugman is busier than ever, keeping his textbook on infectious diseases current, planning a field test in Greece of a newly developed vaccine against hepatitis B, willingly responding to innumerable requests for lectures, serving as a valued consultant in Washington, D.C., in Atlanta at the Center for Disease Control, and in the medical capitals of the world. A generous, tireless, gifted physician, loyal to his friends, his colleagues, and his patients, he is eminently worthy of the honor bestowed on him tonight.
Bull. N.Y. Acad. Med.
PRESENTATION OF THE ACADEMY MEDAL TO SAUL KRUGMAN, M.D.* JOSEPH DANCIS, M.D. Professor and Chairman Department of Pediatrics New York University School of Medicine New York, New York
ITis a pleasure and a privilege to have the opportunity to talk to you about Dr. Saul Krugman, recipient of the Academy Medal for 1978, a distinguished award to a. distinguished physician. Dr. Krugman has been selected for distinction many times previously. He is recipient of the Haven Emerson Award, the James D. Bruce Memorial Award of the American College of Physicians, the John M. Russell Award of the Markle Foundation, the Charles H. Hood Foundation's Child Health Award, the Grulee Award of the American Academy of Pediatrics, and the Bristol Award, and has been elected to the National Academy of Sciences. As a member of select committees, he has contributed to the fashioning of national policy. These assignments include the World Health Organization Expert Advisory Panel on Virus Diseases, National Advisory Council of the National Institute of Allergy and Infectious Diseases, chairman of the Committee on Viral Hepatitis of the National Research Council, chairman of the Panel on Review of Viral and Rickettsial Vaccines of the Food and Drug Administration, and many others. Let us review some of the steps that led to his preeminent position in medicine. Dr. Krugman returned to New York after World War II, having enjoyed for a few years the exotic beauties of the South Pacific. Released from the Army, he was offered the privilege of serving as externe on pediatrics at Bellevue Hospital, a position with no visible responsibilities or opportunities and a commensurate salary. I had arrived a few months earlier and had been given the last legitimate opening on the house staff. It would have taken the imagination of a Horatio Algier to suspect that this pleasant supernumerary to our staff would, in time, follow the eminent *Presented at the Stated Meeting of the New York Academy of Medicine held April 13, 1978.
Bull. N.Y. Acad. Med.
ACADEMY MEDAL
ACADEMY MEDAL
911 911
L. E. Holt, Jr., as chairman of the department and a renowned leader in pediatrics. Dr. Robert Ward, assistant to Dr. Holt, soon found that he shared scientific interests with the new externe. Harmonious, collaborative efforts between the two forged strong personal bonds that lasted through the years. They were joint authors of a book on infectious diseases which has become the authoritative text in the field, and together they embarked on a study of hepatitis at the Willowbrook State School. A few years later Dr. Ward accepted the chair of pediatrics in Los Angeles. At the time he left he made Dr. Krugman an extremely attractive offer to join him, but Krugman refused sunshine and security in the West because he considered the work at Willowbrook too important. I can remember with what amazement I received this information, faced as I was at the time with similar problems of survival and an uncertain future. Willowbrook State School in the late 1950s was not an unusual representative of institutions set up for the care of the mentally-retarded child. It was too large, overcrowded and understaffed, situated in an isolated part of the city, largely deserted by society, and ignored by the medical profession. The conditions were ideal for the rapid dissemination of infectious diseases, with newcomers frequently succumbing to endemic diseases or serving as the focus of new outbreaks. The arrival of Dr. Krugman and Dr. Ward with a staff from New York University was welcomed by the administration, the medical staff, and the parents of these unfortunate children. Here were capable, energetic doctors and nurses, interested in their problems and anxious to help. Federal funds had been obtained so that a special ward could be established, staffed, and equipped within the Willowbrook State School. The subjects were to receive the best of medical care while being meticulously observed. The first notable impact was made with measles. Measles had been a common invader of Willowbrook, attacking each time a new group of susceptibles had accumulated, inflicting significant morbidity and mortality. Dr. Krugman seized the opportunity to test within Willowbrook a newly available measles vaccine, and demonstrated its effectiveness in carefully designed clinical trials. The Willowbrook children were the first to benefit from these studies. A preventive program was promptly introduced and there has not been a case of measles in Willowbrook since 1962. A grateful group of parents of the children recognized this contribution, among others, in an award in 1967 which states "In recognition of Vol. 54, No. 10, November 1978
912 912
J. DANCIS J.
DANCIS
SAUL KRUGMAN, M.D.
Bull. N.Y. Acad. Med.
ACADEMY MEDAL ACADEMY MEDAL
913
913~~~~~~~~~~~~
his distinguished, pioneering, humanitarian research in the prevention of infectious diseases and their resultant complications in children everywhere, born and unborn." Hepatitis was a major endemic problem at Willowbrook. Virtually all inmates and most attendants became infected during their sojourns. The challenge of this disease soon commanded the major part of Dr. Krugman's attention. Depending primarily on his superb clinical skills, he succeeded in describing over a period of 10 or so years the main features of hepatitis. He demonstrated convincingly that there were actually two types of hepatitis at Willowbrook, clinically and immunologically differentiable. Recovery from one infection did not protect against the other, which explained what had appeared to be second attacks of hepatitis, and pooled gamma globulin protected against one but not the other. Our understanding of epidemiology was extended by the demonstration that subclinical infections and the oral-fecal route of spread were common to both. The culmination of this exciting series of revelations was the demonstration that one infection, now known as hepatitis B, caused an intense viremia and that heating the serum destroyed its infectivity but not its antigenicity. The direction to take in seeking a potent vaccine had been clearly indicated. Many of the details of hepatitis have now been filled in by others, generally working from the vantage point of the laboratory investigator. Again and again these investigators have turned to Dr. Krugman to test their hypotheses or techniques against the invaluable samples of potent sera collected over the years and kept frozen against such a need. By comparing laboratory results with the data-filled notebooks of clinical observations on these same patients, unusually rapid progress has been possible. Dr. Krugman's efforts have not been limited to Willowbrook. His field studies have taken him far afield. Nor has his research been confined to hepatitis and measles. His contributions to the control of rubella are equally well known. But one must look beyond his research to understand why he is one of the best known pediatricians of our day. As chairman of pediatrics at New York University for 15 years, large numbers of medical students and residents looked to him for guidance and inspiration. As a popular lecturer and a spirited panelist, he has extended his influence as an educator far beyond the university. Through his book he has become the ultimate authority on infectious diseases for pediatricians everywhere. Now 67 years old, retired from the chairmanship for three years and 9.5 Vol. 54, No. 10, November 1978
914
914
J. DANCIS
months (the reasons for this precision are personal), one might presume that Dr. Krugman had reached that stage of life when he would be satisfied with taking pride in his children, boasting of his grandchildren, and taking long vacations with his devoted wife, Sylvia. That is not quite true. Dr. Krugman is busier than ever, keeping his textbook on infectious diseases current, planning a field test in Greece of a newly developed vaccine against hepatitis B, willingly responding to innumerable requests for lectures, serving as a valued consultant in Washington, D.C., in Atlanta at the Center for Disease Control, and in the medical capitals of the world. A generous, tireless, gifted physician, loyal to his friends, his colleagues, and his patients, he is eminently worthy of the honor bestowed on him tonight.
Bull. N.Y. Acad. Med.
