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GrandRounds

Spring 2011

Saint Louis University School of Medicine

Internal Medicine Celebrates Centennial

Match Day

New Advocate for Faculty Development

exceence 100
Years of

Known at different times as Medicine, or as Experimental Medicine and Therapeutics, the Department of Internal Medicine started with a dozen physicians who were jacksof-all-trades and grew into a department with nearly 130 full-time medical specialists in 10 divisions cardiology; endocrinology; gastroenterology and hepatology; general internal medicine; geriatrics; hematology and medical oncology; infectious diseases, allergy and immunology; nephrology; pulmonary, critical care and sleep medicine; and rheumatology. As part of the departments year-long centennial celebration, a different division is featured every month with daily health tips on St. Louis radio station KEZK-FM

102.5; the divisions are sponsoring health literacy programs through the St. Louis County Library and news of special department events and stories are carried on digital display boards throughout the Medical Center and on the SLUCare website. A special exhibit of archival materials is on display outside the Medical Center Library. Were very proud of our heritage as the oldest university west of the Mississippi and the part our department of internal medicine plays in increasing the prestige of the University, said Adrian Di Bisceglie, M.D., chair of the department of internal medicine and holder of the Badeeh A. and Christine V. Bander Chair in Internal Medicine. You can follow the departments rise to national and international prominence by tracing its timeline.

Department of Internal Medicine Celebrates a Century of Compassionate Care


In 1911, there were no antibiotics.

1900s

Deep Roots: The Kinsella Legacy

No immunizations against childhood diseases. No blood pressure medications. No effective treatments for heart disease, cancer or ulcers. Roentgenographs (x-rays) were coming into use but were considered more of a novelty than a diagnostic tool.

1903 SLU acquires the Marion-Sims-Beaumont College of Medicine, resuming medical education the University had ceased in 1855. 1910s

Laurence J. Kinsella, M.D. (85) Neurologist | SSM St. Clare


Following a fruitful career investigating streptococcal infection and endocarditis at the Rockefeller Institute, my grandfather, Dr. Ralph A. Kinsella Sr., returned to St. Louis in 1919 to establish a research institute at Jewish Hospital. He returned to SLU in 1924 as professor of experimental medicine and the physician-in-chief of the newly constructed St. Marys Hospital. Together with his friend and collaborator, Dr. Goronwy Broun, he would go on to publish seminal works in inflammatory arthritis, bacterial endocarditis, and St. Louis Encephalitis. Ralph produced a slew of Kinsella physicians Ralph Jr. (endocrinologist and chief of staff at City Hospital), Edward (gastroenterologist at St. Marys) and Peter (pulmonologist at St. Marys). A generation of nurses at St. Marys would help young trainees distinguish the Drs. Kinsella as Endoscopy Ed and Pulmonary Pete. Ralph Jr. and Peter married physicians as well: Margaret Boyle, M.D., and Maria Stack, M.D., respectively. The current generation of Kinsella physicians includes Margaret (Maggie), a rheumatologist in Bellingham, Wash.; Laurence, an adjunct professor in neurology at SLU and a neurologist at SSM St. Clare; and Charles, a pulmonary/critical care specialist in Indianapolis. And already, the fourth generation has begun. Christopher Ralph Jr., M.D. (Eds grandson and my nephew) will be a surgical resident at SLU in July. In addition to all of these physicians, we cant forget the many nurses in the Kinsella family including Jane Ann, Kathy and Maria. I think Ralph would want todays physicians to recall what a privilege it is to practice medicine, to remain vigilant to variations in disease presentation and to remain ardent students of the science of medicine.

1911 Charles Hugh Neilson, M.D., is appointed director of the department of medicine. 1918 The first wave of an influenza pandemic hits the nation, killing more than 20 million people more than had been killed in WWI. 1919 Ralph A. Kinsella Sr., M.D. (11), joins the School of Medicine as a professor in the department of medicine. He receives a federal grant to study infectious diseases. To help investigate the influenza pandemic, he recruits recent School of Medicine graduate Goronwy O. Broun Sr., M.D. (18), whose sister died from the virus. Together they discover the factors responsible for hemorrhaging in severe cases. The department has 26 part-time faculty members.

In 1911, medical education was digesting the Flexner Report,


which called for improved admission and graduation standards, and full-time professors. Medical educators and private practitioners were beginning to set aside their hostility and recognize each others legitimacy.

And in 1911, Saint Louis Universitys School of Medicine established what would become one of its largest departments, the Department of Internal Medicine.

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1920s 1924 Kinsella, also known as Big Red, is appointed director of the department of medicine and physician-in-chief of the University Hospitals, which consists of St. Marys Hospital, St. Marys Infirmary and Mt. St. Rose Hospital. Associated hospitals include Alexian Brothers, St. Anthonys and St. Johns.
Kinsella

1933-38 Brouns research into encephalitis brings national attention to the department. Broun was the first to isolate the viral agent responsible for St. Louis Encephalitis. 1933 Firmin Desloge Hospital is opened, supplanting St. Marys Infirmary as the chief teaching center of the medical school. The hospital was owned jointly by the Sisters of St. Mary and the University until 1959. The Graduate Board authorizes the conferring of the degree of master in internal medicine, in place of the previously conferred degree, master of science in internal medicine. 1936 The American Board of Internal Medicine convenes for the first time, and the first internists are certified. Neilson is the first from SLUs School of Medicine to be certified.

1950s

Ralph A. Kinsella Sr., M.D. (11), was the first to demonstrate that

salicylates, such as aspirin, have anti-inflammatory effects. He also made a major contribution to the understanding of the pathogenesis of infective endocarditis.

1951 J. F. Gerard Mudd, M.D. (45), establishes the Cardiac Catheterization Lab. 1952 Mary Frances Nawrocki, M.D., is the first woman to graduate from the School of Medicine. 1954 Broun becomes chairman of the department of internal medicine. The John Cochran Veterans Administration Medical Center opens and becomes an important part of the departments clinical, teaching and research activities. The relationship continues today. 1958 Broun retires and is succeeded by Rene Wegria, M.D. as chairman. chairman 1960s 1961 Broun emerges from retirement to become dean of the School of Medicine. 1964 Thomas F. Frawley, M.D., succeeds Wegria. 1965 The division of allergy is created with the hiring of Raymond Slavin, M.D. (56).
WEgria Ayres

J. F. Gerard Mudd, M.D. (45), established the first major cardiac catheterization laboratory in St. Louis in 1951, thus beginning landmark clinical research that continues today. George E. Thoma, M.D. (47), professor emeritus in the division of nuclear
medicine and vice president for the medical campus (1973-86), was a pioneer in the use of radio-isotopes in diagnosis and was the first editor of the Journal of Nuclear Medicine.

Broun, who left the school to work with some of the most famous virologists of the time, returns to the University and becomes the first full-time faculty member in the department. 1925 The department of medicine is renamed the department of internal medicine and has 40 faculty members. 1927 Rev. Alphonse Schwitalla, S.J., is appointed dean of the School of Medicine, and Neilson is appointed associate dean the following year. 1930s 1930 The University formally establishes graduate fellowships in internal medicine, which marks the beginning of formalized training in internal medicine at SLU. These positions were filled by men who had completed their medical degrees and had at least one year of approved internship. The two-year program provided physicians with the opportunity for intensive development both in the fundamental and the clinical sciences, fitting him more adequately for his future work as a physician. 1931 Broun is promoted to professor of internal medicine. The department has 48 faculty members. 1932 Graduate fellowships are designated to honor the Broun memory of persons intimately associated with the development of the school. Honorees in internal medicine include the William Banks Rogers, the Mother Seraphia, the Don R. Joseph and the William Beaumont Graduate Fellowships in Internal Medicine.

in memory of a father

John C. Soucy Jr., M.D. (61) Internist | Private Practice


My father, John C. Soucy Sr., M.D., was one of the first four residents to graduate from the internal medicines accredited residency program in 1932. He often told me stories of the legendary diagnostic skills of his director and teacher, Dr. Ralph Kinsella.He said Dr. Kinsella could walk into the room of a complex and challenging patient and smell the diagnosis.The residents under Dr. Kinsella were well trained and masters of physical diagnosis.My father practiced internal medicine for more than 40 years in East St. Louis, Ill. He often made house calls in exchange for parts of a chicken, eggs, produce or other commodities.He became well known as a diagnostician and often was consulted in the most challenging cases. From my memory and the testimonies of patients, he made many life-saving diagnoses of atypical presentations of diseases such as tularemia, typhoid, Rocky Mountain spotted fever, subdural hematomas, pancreatitis, severe hypoglycemia with coma and other entities.Remember, there were no CT scans, MRIs, guided needle biopsies or other high tech resources. And, clinical laboratory diagnostic testing was in its infancy and considered archaic by todays standards.

John Morley, M.D., and James Flood, Ph.D., were the first to establish a mouse model of Alzheimers disease, which has allowed them to develop revolutionary therapies that appear to reverse the memory deficits in these animals by blocking production of beta-amyloid. Morley and his team also are leading studies on hormone replacement therapy to treat and/or prevent some of the problems of aging. One of their most significant findings showed that testosterone therapy could improve memory and strength in elderly men. The division of infectious diseases has received federal funding as
a Vaccine Treatment and Evaluation Unit for two decades. One of eight NIAID-funded vaccine research centers, the division is studying the safety and efficacy of several vaccines including potential vaccines against various strains of flu and TB.

Bruce R. Bacon, M.D., played a critical role in the discovery of the gene

responsible for hemochromatosis. He and his team also are pioneering combination drug therapies for patients with chronic hepatitis C.

Frawley

1940s 1940 Faculty increases to 66 members. Broun becomes director of laboratories. 1946 After WWII, the hospital board increases the number of residencies to meet the demands of returning medical officers. Residencies in internal medicine increased from three to nine.

James R. Drake Professor | Division of General Internal Medicine | 35 years


When I arrived at SLU in 1976 I was one of only three physicians in the primary care section, later to become general internal medicine. The Doctors Office Building was nearly new with color-coded modules. The old colored tiles still are visible in the back halls. I shared an office with Dr. Broun Sr., one of three generations of Brouns to be in the department during my time.Dr. William Dunnwas my immediate boss. We were a hospital unit in terms of finances but had academic appointments in the department. Often there were conflicting priorities between the hospital (Mr. Richard Stensrud) and the department (Dr. Stephen Ayers), which would leave us caught in the middle. It wasnt until 1987 when Dr. Coy Fitch took us into the department as the division of general medicine that we felt fully a part of the department.Dr. Robert Heaney was brought from City Hospital to be the first division director.Today the division of general internal medicine has 13 physicians at the University Hospital. Over the years I have had the privilege of attending while my current colleagues Drs. Heaney, Olsen, Walden, Maxwell, Porter, Rice, Buckhold and Chako were students and/or residents in training. By the way, Im probably the only person currently at the University who actually ever met Dr. Charles Hugh Neilson. He was the grandfather of a close friend Ive known since childhood.

1966 The internal medicine residency program is accredited by the Accreditation Council on Graduate Medical Education. 1970s 1975 Stephen M. Ayres, M.D., is appointed chairman of the department. 1977 The department establishes the division of endocrinology. 1980s 1981 The combined internal medicine and pediatrics residency training program is established.

1949 Neilson retires. The same year, Melvin A. Casberg, M.D., succeeds Schwitalla as dean of the school. Three women are admitted to the school.

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a little comic relief


2000's

Stewart Albert, M.D. Professor | Division of Endocrinology | 33 years


Dr. Coy Fitch established the division of endocrinology in 1977. I arrived a year later, Dr. Alan Silverberg in 1979 and Dr. Marla Bernbaum in 1983. During the 30 plus years, the peripatetic division has wandered its offices within the medical center complex by moving eight times. One permanency, however, has been a goal emanating from the endocrinology division directors: residents and fellows should be internists first. As Dr. Harold Rifkin, past president of the American Diabetes Association said, to know diabetes, you must know internal medicine. We have had outstanding researchers and educators as directors Drs. Coy Fitch, Arshag Mooradian, John Morley. More critically, these outstanding clinicians have set the standard for medical care regarding both evidence-based medicine and the art of treating always. This seriousness, though, must be tempered and, as in all great works, there must be comic relief. The divisions physicians, fellows and staff star in an annual play that is a parody of medicine, health care and politics. Fortunately, the politicians keep us well stocked with material. The plays have ranged from Star Trek, Trek, Sherlock Sherlock Holmes, Holmes, Hamlet, Hamlet, Inherit Inherit the Wind the Wind and culminated and culminated (when (when there there was sufficient was sufficientor talent talent bravado) or bravado) with a fractured with a fractured musical musical versionversion of The of Wizard The Wizard of Oz. We of hope Oz. the We inevitable hope the inevitable bonding bonding will keep us will in keep touch uswith in touch our graduates. with our graduates.

In graditude in

2000 D. Douglas Miller, M.D. (Bus 99) , is named chairman of the department. 2001 Saint Louis University Liver Center is established. It becomes the largMILLer est liver center in Missouri in terms of research funding, patient visits, clinical trials and hepatologists. It has the most active Hepatitis C practice in the United States. 2006 World renowned hepatologist Adrian M. Di Bisceglie, M.D., is appointed acting chairman of the department. In 2009 Di Bisceglie is named chair and inaugural holder of the Badeeh A. and Christine V. Bander Chair in Internal Medicine.

1985 Coy Fitch, M.D., is appointed acting chairman of the department of internal medicine. In 1988 he is named chairman. 1985 St. Louis City Hospital closes.

35 years

Terry Moore, M.D. (72) Professor | Director of the Division of Rheumatology |


I have enjoyed my time at SLU immensely and would like to express gratitude to the people who have helped me along the way. This includes: 1)Dr. Stephen Ayres, the former department chairman, who recruited me back here and gave me the time to pursue my research and achieve NIH funding; 2) Dr. Jack Zuckner, my longtime mentor and first director of rheumatology who guided me in my early days on the faculty; 3) Dr. Raymond Slavin, who has been a colleague and provided guidance throughout the years; 4) Dr. Adrian Di Bisceglie, our present chairman who again provided support for our division. Also, I would like to express my gratitude to Ms. Margery Fort and Elizabeth and Chris Dorr who have provided funding over the last seven years for our research through their Campbell-Avery and Dorr Family Trust Funds, as well as thanks to John Fischer and the Lupus and Juvenile Arthritis Group of St. Louis for helping in our fundraising.

a past proud

A Bright Future - A Word From the Chairman Adrian M. Di Bisceglie, M.D.


When I interview candidates for faculty positions I tell them our story. It goes something like this. Saint Louis Universitys School of Medicine is the oldest medical school west of the Mississippi, and the department of internal medicine is 100 years old. I have been here for 17 of those years. When I arrived in 1994, I gathered the University as a whole was experiencing something of a revival under University President Lawrence Biondi, S.J. Since becoming president in 1987, Fr. Biondi has committed vast University resources to academics, student scholarships, financial aid, faculty recruitment, state-of-the-art technology and campus improvement projects. Thanks to his leadership, SLU has grown from a mostly commuter school that drew primarily only local students into a major national university that attracts students from all 50 states and nearly 80 countries. And Fr. Biondi has transformed a campus that nearly 25 years ago was a collection of unrelated buildings interrupted by busy city streets into a lush urban oasis lauded for its beauty. At the same time, the department of internal medicine was undergoing a revival of its own under the leadership of Dr. Coy Fitch. Beginning in 1988, he recruited a series of young, vigorous division directors who in turn, recruited young, energetic faculty. The department grew substantially during the 1990s and reached a plateau where it has been for the last five years. Then, I tell those faculty candidates that I believe the department is poised for another cycle of growth. The reasons for this are new leadership in the form of a new dean, Philip O. Alderson, M.D., and my appointment as chair of the department. SLU has committed to making a very substantial investment in the department, and it is my hope that, using these resources, we will be able to again recruit another series of young, vigorous division directors, and they will recruit new clinicians, researchers and teachers. In fact we have named three such vigorous division directors in the last few months (see Vital Signs). At this turning point, it is important to reflect on our history and see how far we have come before we look ahead to the tasks and opportunities that lie ahead.

1987 The University Hospital is expanded with the building of Bordley Tower. The division of general internal medicine is established and plays an instrumental role in developing the comprehensive, affordable University Health Plan for students and families. 1988 The division of geriatric medicine is created, and internationally known gerontological researcher, clinician and educator, John E. Morley, M.D., is appointed director. 1989 Fitch recruits Robert Belshe, M.D. (infectious diseases) and, a year later, Bruce R. Bacon, M.D. (gastroenterology and hepatology) as division directors, thus beginning significant education, research and clinical expansions in their specialties. 1990s 1996 Patricia Monteleone, M.D., (61) is named first woman dean of the School of Medicine. 1998 Saint Louis University Hospital is sold to Tenet Healthcare Corp.
Monteleone

remembering the 1980 heat wave

Raymond G. Slavin, M.D., (56) Professor | Director of Allergy and Clinical Immunology | 46 years
Washington University had left City Hospital that summer, and SLU remained. In July, the city experienced 17 consecutive days of temperatures above 100 degrees. The ER was the only area with air conditioning. Many patients experienced heat stroke in the hospital! A heat stroke room set up next to the ER was filled with patients immersed in ice. More then 700 patients were admitted with heat stroke, and 150 people died in St. Louis during that heat wave. Ten days into the scorching heat, Scott Air Force Base sent over a desert team with jet engines to run compressors that generated cold air to be piped into the wards. It was quite a sight to see an enormous tent housing the jet engines in front of the hospital. There were no private rooms only large wards with beds on the periphery. On each ward another row of beds was set up in the middle of the room. I can remember going down to City Hospital to see consults and lecture and feeling exactly like I was in a sauna. All faculty members participated, but particularly yeoman services were rendered by Drs. Bob Heaney, Bill Mootz and Don Kennedy. Everyone who was at City Hospital during that period, including medical students, was invited to a party at Dr. Steve Ayres home, who then was chairman of the department. We were given a blue pin with 1980 emblazoned on it. Several weeks later at medicine grand rounds at the LRC, Dr. Ayres asked all of the people from City Hospital to stand amidst thunderous applause.

2008 The University opens the new Edward A. Doisy Research Center. The department has grown to: 128 full-time faculty 275 part-time faculty 103 residents 75 fellows Faculty members serve as attending physicians at Saint Louis University Hospital, the Veterans Administration Medical Center, SSM St. Marys Health Center and Des Peres Hospital. The department generated more than $15.5 million in externally funded research in 2010.

In honor of Dr. Coy Fitch, the physician who helped lead SLUs department of internal
medicine to prominence, the Fitch family has established the Drs. Coy D. and Rachel F. Fitch Endowed Lectureship Fund. Gifts to this fund can be made using the envelope which appears in this magazine.

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Di Di Bisceglie Bicseglie