Leighton E. Cluff, MD, MACP, an internationally known educator, investigator and administrator, died April 14, 2004 in Gainesville, FL following a fall. He was 80 years old.
Lee was a native of Salt Lake City, Utah and received his baccalaureate degree from the University of Utah in 1944 with a major in biology. He then enrolled as a medical student at George Washington University School of Medicine in Washington, D.C. While he was a first-year medical student, the school began a transition from a three year accelerated wartime curriculum back to a four year curriculum, resulting in an opportunity for Lee to spend six months of his second year in a student fellowship in pathology at Gallinger Municipal Hospital (later D.C. General Hospital). Lee considered this experience pivotal in his career. He participated in a number of autopsies which became the basis of three published papers. One of the autopsies was on a patient with disseminated tuberculosis and polyarteritis nodosum and this case triggered Lee's initial interest in the role of immunologic or hypersensitivity reactions in the pathogenesis of tuberculosis. Another case leading to publication involved the distribution of thorotrast used in diagnostic radiology. Many of the autopsied cases had tuberculosis and it was perhaps no great surprise that he and a fellow student were found to have converted their tuberculin tests to positive at the conclusion of the fellowship (considered an occupational hazard of medical students at that time). In Lee's case, active disease was found and he was admitted to the Trudeau Sanitarium at Saranac Lake, NY. In the next bed was Bernard Davis, who had contracted tuberculosis while working at the Rockefeller Institute in New York. (Dr. Davis was later to become a distinguished professor of medicine and immunology at Harvard.) While at Trudeau, Lee continued his medical studies, completed work on a third paper and also read Cushing's Life of William Osler. Following Dr. Osler's recommendations for medical student reading, he expanded his reading to include classics such as Elliott's Middlemarch.
Returning to medical school at George Washington after a year's hiatus, Lee received his MD degree in 1949. Among major influences in medical school were visiting lectures given by Dr. Helen Taussig from Johns Hopkins and Dr. Arnold Rich also from Hopkins. Dr. Rich was a leading authority on tuberculosis and Lee had read his book on The Pathogenesis of Tuberculosis while at Trudeau. Dr. Rich would later become a friend and mentor. Key faculty influences at George Washington were the newly appointed chairman of medicine, Dr. Thomas McPherson Brown, and Drs. Harry Dowling and Mark Lepper. Lee was also greatly impressed by an excellent physician, Dr. Benjamin Manchester in caring for the patient. Between the third and fourth years of medical school Lee returned to Trudeau as an extern where he continued his interests in studying pulmonary diseases. His first patient assignment that summer was a medical student from Johns Hopkins, Ed Andrews, with whom Lee later collaborated in research at Hopkins, and who later became Chairman of Pathology and then Dean at the University of Vermont.
Lee's excellent academic performance in medical school led to acceptance of his first choice for internship: the Osler Medical Service at Johns Hopkins where Dr. A. McGehee Harvey was Chairman of Medicine and Dr. Robert Austrian was chief resident. Dr. Austrian's interest in infectious diseases was influential and also led to Lee's acquaintance and later close friendship with Dr. Colin MacLeod, Chair of Microbiology at New York University. Other house officers in 1949–50 included David Rogers, Jerome Barondess and Evan Calkins. After internship at Hopkins, Lee moved to Duke University as an assistant resident in the department chaired by Dr. Eugene Stead. Also going to Duke from Hopkins as an assistant resident was Ivan Bennett. At Duke, Lee and Ivan shared a common interest in infectious diseases and worked together in the laboratory of Dr. Samuel Martin, Chief of Infectious Diseases, beginning a series of studies on bacterial endotoxins and leukocytic pyrogens, which they would continue later at Hopkins. After a productive year at Duke, Lee accepted a residency position back at Hopkins where Victor McKusick was now Osler chief resident. During that year, Lee also worked with Dr. Manfred Mayer in immunochemistry. He was also able to spend a week in St. Louis at Washington University with Dr. Barry Wood learning the “rabbit ear chamber” technique used for studies of changes in blood flow and leukocyte and platelet function. Dr. Wood later returned to Hopkins as well. While completing the year of assistant residency, Lee's research activities led to a publication in the Journal of Experimental Medicine. Subsequently he went to the Rockefeller Institute in New York for a two-year research fellowship with Dr. Maclyn McCarty, continuing his studies on endotoxins and pyrogens and getting to know Drs. Rene Dubos, Lewis Thomas and Henry Kunkel.
In 1954, Lee returned to Johns Hopkins as Chief Resident on the Osler Service with Dr. A. M. Harvey. The Osler Resident was a junior faculty position with major teaching, clinical and administrative responsibilities, and typically led to a full-time faculty position. Following his year as the Osler Resident, Lee spent the next eleven years on the Hopkins faculty, rising to the rank of full professor in 1964. He initially worked with Ivan Bennett to develop the infectious Diseases Division and after Ivan moved over to the Department of Pathology as Chairman, succeeding Arnold Rich, Lee became Chief of the ID Division, and continued to expand the research and clinical activities of the division. At various times the division included Robert Petersdorf, Edward Hook, Robert Wagner, Philip Norman, Paul Hoeprich, Robert Fekety, Joseph Johnson, Richard Reynolds, Charles Carpenter, and James Allen. During this period Lee continued his extensive research leading to a number of publications in infectious diseases. He was nominated by the medical school and was awarded a prestigious Markle Scholarship in Academic Medicine.
While at Hopkins, Lee was co-editor of the 17th (new) edition of the Osler Textbook of Medicine. He also volunteered as an officer in the U.S. Public Health Service, assigned to Ft. Detrick, MD and was able to continue his activities at Hopkins while serving as a consultant at Ft. Detrick in the Biological Warfare Program. He carried out a series of investigations on laboratory and occupationally acquired infections, adverse effects of intensive immunization and the psychological determinants of delayed convalescence from acute and chronic infections. At Hopkins he did extensive studies on the pathogenesis, epidemiology and clinical manifestations of staphylococcal infections as well as infections in the newborn nursery, studies on fever and endotoxins and the pathogenesis of fatal pneumococcal infections. Following this he began a series of studies, which would continue over the next fifteen years on drug utilization and the epidemiology of adverse drug reactions. Several dozen research fellows were recruited by Lee during this period, many of whom went on to distinguished academic careers.
With Dr. Fred Bang of the Hopkins School of Hygiene and Public Health, Lee developed and served as Co-director of a Hopkins research and training program in India. The program was established at the Institute of Tropical Medicine in Calcutta and was funded through the NIH. Lee recruited Dr. Charles Carpenter to lead a research effort on the metabolic abnormalities in cholera, leading to the development of the first intravenous and oral preparations specifically tailored to correct the fluid and electrolyte derangements in cholera.
In 1966 Lee accepted the position of Chairman of Medicine at the recently opened medical school at the University of Florida in Gainesville, where a number of former friends and colleagues were helping to build the new institution. He was persuaded that changing circumstances required new settings for medical education and he saw in the new institution the opportunity for developing expanded clinical training programs for students and residents in surrounding rural areas. Lee's first faculty recruit as Chief of Infectious Diseases at Florida was Dr. Joseph Johnson, who came with him from Hopkins. Shortly thereafter he recruited a former research fellow now in private practice, Dr. Richard Reynolds, to direct community and ambulatory programs and to oversee development of a rural education program. The resulting program was the first developed by a college of medicine to serve rural citizens without readily available medical care and was developed in three locations. The prototype program was established in Mayo, Florida where students and residents received a real life experience in a community medical practice. Inevitably, this popular University of Florida program came to be known as the “Mayo Clinic.”
Lee's ten years at the University of Florida as Chairman of Medicine was an exciting period of growth and development. The Department of Medicine faculty increased five-fold, and the residency and research programs grew and became progressively competitive.
Soon after Lee's arrival in Florida the new Veterans Administration hospital opened across from the University medical center and Lee worked closely with the new director, Malcolm Randall, to develop a strong association between the two institutions with joint faculty and trainee appointments. This close relationship came to be regarded as a national model of affiliation between a medical school and a VA hospital.
During this period, Lee's national and international reputation grew and he became a consultant to a number of groups including the National Institutes of Health, the National Research Council, the Food and Drug Administration, the Department of Health, Education and Welfare, the Department of Defense, the Department of State and the World Health Organization. He was a founding member of the Infectious Diseases Society of America and later served as its President. He established a faculty exchange program with the University of Edinburgh and with the University of the West Indies in Jamaica. He also served as a delegate to the U.S.-Japan Cooperative Science Commission. He served as chairman of the Advisory Council of the National Institutes of Allergy and Infectious Diseases, and on behalf of the International Center on Research and Training, he visited program sites abroad.
Continuing studies begun at Johns Hopkins on drug utilization and adverse drug reactions he developed study methods and led research initiatives, becoming an internationally recognized authority in the fields of pharmaco-epidemiology and drug surveillance programs.
During his tenure at the University of Florida he had been invited to consider a number of positions as dean or vice president of health affairs in other institutions but declined them having determined to complete at least ten years developing the Department of Medicine at Florida. Finally in 1976 at the end of a decade in Gainesville, he was recruited by his former colleague David Rogers to join him at the Robert Wood Johnson Foundation in Princeton as Executive Vice President.
Lee spent a total of fifteen years at the Johnson Foundation, succeeding Dave Rogers as President for the last five years. While at the Foundation he had major responsibility for the evolution and strengthening of the “flagship” RWJ Clinical Scholars Program. He had a major role in the development of a number of initiatives including the SUPPORT Study (the use of life sustaining technology in intensive care units and the impact of “living wills” and family wishes); Interfaith (Faith in Action); the Minority Faculty Development Program; the Substance Abuse Program (Fighting Back); Hospital Nursing to Improve Patient Care; Chronic Diseases Program; and the Rural Practice Program among many others.
Retiring from the Foundation in 1990, Lee accepted a position back at the University of Florida as VA Distinguished Physician at the Gainesville VA Medical Center. Returning to Gainesville Lee and his wife Beth re-established contacts with many former friends and colleagues. In addition to his activities over the next five years at the VA, Lee was active in a number of assignments for the University and for the state of Florida. He was appointed by the Governor of Florida to chair a work group on health care reform and several recommendations from this group were adopted by the state legislature. Other activities included chairing the board of the American Social Health Association for two years and serving on the board for eight years. He served on the board of directors of Hospice of North Central Florida. He was active in the University Center for Performing Arts, making a substantial endowment to the Center and chairing its Advisory Board. He was also able to pursue his long-term interests in tennis, golf and fly-fishing. He enjoyed the annual meetings of the “Noble Order of the Flea,” an organization he had founded shortly after he had become chairman of medicine at Florida. The “Fleas” include current and former chief residents and chairs of medicine at Florida plus elected honorary members. He continued to be active up until the time of his death following a fall resulting in intra-cranial trauma.
Over his career, Lee authored or co-authored more than two hundred papers and was author or editor of ten books. He was the recipient of a number of honors and awards, including honorary degrees from six universities and was recognized as a distinguished alumnus by four institutions. He was widely recognized as an inspiring leader, a stimulating Socratic teacher, a caring physician, an innovative investigator and a gifted administrator. He is survived by his wife of sixty years, Beth, their two daughters, sons-in-law and two grandchildren.