The History of the Department of Internal Medicine at Saint Louis University

Introduction

The Department of Internal Medicine at Saint Louis University School of Medicine celebrated its centennial during 2011, marking 100 years since Charles Hugh Neilson was appointed as the inaugural director of the Department of Medicine. Early on, the department was actively involved in teaching and research, and played a pivotal role in the managing the outbreaks of St. Louis Encephalitis in 1933 and 1937. In the middle years, faculty in the department established the first cardiac catheterization laboratory in the Midwest, while more recently its research has focused on vaccine development and liver disease, among other areas. This article summarizes the people, buildings, and events that have taken place in and around the Department of Internal Medicine at Saint Louis University in its first 100 years of existence.

Background

In the past 100 years, the Department of Internal Medicine at Saint Louis University has grown substantially and created and maintained a record of academic excellence.

Since 1911, the department has had 10 chairmen, one of them (Ralph Kinsella Sr., MD) for nearly 30 years (See Table 1). Each of them has added their own perspective to the department and its growth. The early chairmen (Kinsella and Broun) were both outstanding researchers and academicians, who published extensively and established the department on a solid footing. Those leading the department in the 1950s, 60s, and 70s consolidated it and established subspecialty divisions. During the latter part of the 1980s the department went through a cycle of rapid growth under Dr. Fitch, who recruited a series of young, vigorous division directors who in turn, recruited young faculty members (See Figure 1). The department grew very substantially during the 1990s and is poised to go through another growth cycle again.

Table 1.

Chairmen of the Department of Internal Medicine

Chairman	Years
Charles Hugh Neilson	1911–1924
Ralph A. Kinsella	1924–1953
Philip Tumulty	1953–1954
Goronwy Broun	1954–1958
Rene Wegria	1958–1963
Thomas Frawley	1963–1973
Raymond G. Slavin (interim)	1974
Stephen M Ayres	1975–1985
Coy D. Fitch	1985–2000
D. Douglas Miller	2000–2006
Adrian M. Di Bisceglie	2006-present

Figure 1.

Coy D. Fitch M.D., MACP, Chairman of the Department of Internal Medicine between 1985 and 2000, Governor of the Missouri Chapter of the American College of Physicians 1995 to 1999. Of note, both Drs. Kinsella and Frawley, two previous chairmen, had previously served as acting governors of the same organization.

Source: (http://www.acponline.org/about_acp/chapters/mo/governors.htm)

The first subspecialty division to be established was actually the section of Chest Diseases under Paul Murphy, MD, in 1946. This division is now named the Division of Pulmonary, Critical Care and Sleep Medicine. Although the records are a little vague about the origins of some divisions, it appears the next was the Division of Cardiology in 1948 under Eugene Lee Shrader, MD. One of Dr Shrader’s recruits was J.F. Gerard Mudd, MD, who was a medical resident for whom Shrader arranged a year of training in cardiac physiology and catheterization under Richard Bing, MD, at Johns Hopkins. Dr. Mudd returned to establish the first cardiac catheterization laboratory west of the Mississipi in 1951. This laboratory was a necessity for Hopkins trained C. Rollins Hanlon, MD, to initiate a cardiac surgery program for adults and children. Mudd’s efforts contributed to the excellence of clinical care and research in cardiology at Saint Louis University which has persisted for more than a half century now and included the first heart transplant in the region. One of the last divisions to be created was Geriatric Medicine under John Morley, MD. The foundations of this division were laid in a program begun in 1976 with a large grant awarded to the VA and was led by Bernard Davis, MD. Dr. Morley came from Los Angeles in 1989 and created a program that has achieved international recognition for excellence in research into neuroscience and gerontology as well as clinical care of the elderly.

Jack Zuckner, MD, established the Division of Rheumatology in 1954 and passed its leadership on to Terry Moore, MD, who remains at the helm now after 28 years. Raymond Slavin, MD, founded the Division of Allergy and Immunology in 1965 and remained director of that division for 43 years until it was recently combined with the Division of Infectious Diseases into the Division of Infectious Diseases, Allergy and Immunology.

Buildings

In 1911, the School of Medicine occupied buildings that were constructed in the 1890s as part of the Marion-Sims-Beaumont College of Medicine. This college was acquired by Saint Louis University in 1903 and resumed medical education at the University which had ceased in 1855. One hundred years ago, clinical instruction was primarily taught at Rebekah Hospital and the Saint Louis University Dispensary, located on the first floor of the medical building. Associated hospitals included: St. Louis City Hospital, St. Louis Sanitarium, St. Mary’s Infirmary, St. John’s Hospital, Mt. St. Rose Hospital, St. Ann’s Lying-in Infirmary, St. Ann’s Foundling Asylum, Alexian Brother’s Hospital, Alexian Brother’s Free Dispensary, Obstetric Clinic, St. John’s Clinical Dispensary and the Obstetric Dispensary.

Today, most of the clinical education for medical students and residents is provided at Saint Louis University Hospital. The original hospital, Firmin Desloge, opened in 1933 (See Figure 2). Now called Firmin Desloge Towers, it is part of a complex that has been added to over the years, the most significant addition being the Bordley Tower in 1988. Saint Louis University Hospital was originally operated jointly by the Sisters of St. Mary and the University, but in 1959 administration of the hospital shifted completely to Saint Louis University. Although sold to the Tenet Corporation in 1998, Saint Louis University Hospital remains the primary teaching facility of the School of Medicine and is staffed exclusively by physicians of Saint Louis University. Interestingly, associated hospitals now include: the St. Louis VA Medical Center, Cardinal Glennon Children’s Hospital and St. Mary’s Health Center. St. Louis City Hospital played a major role in the education of students and residents but closed in 1985. After being threatened with demolition for 15 years, it was placed on the National Register of Historic Places in 2001 and finally transformed into a modern apartment complex in 2006.

Figure 2.

Firmin Desloge Hospital at its opening in 1933. This building remains part of the current Saint Louis University Hospital.

For most of the twentieth century, the main medical school building was Schwitalla Hall, sections of which were constructed in 1921, 1927, and 1948 (See Figure 3). Additions to that building include Doisy Hall, the Caroline Building, and the Margaret McCormick Doisy Learning Resource Center. Modern research laboratories for the School of Medicine and many investigators in the Department of Internal Medicine are housed in the Doisy Research Center, opened in 2007.

Figure 3.

Schwitalla Hall, showing the sections completed in 1921 and 1927 and named after a long-term Dean of Saint Louis University School of Medicine, remains the face of the school and a place where teaching, research and administration continue. The building is shaped like an E. The middle wing was constructed in 1921, the main building along Grand and the north wing along Caroline in 1927, and the south wing in 1948.

Medical Care

Of course, much progress has been made in providing medical care, a great deal of it in managing infectious diseases more effectively through vaccines and antimicrobials. The average life expectancy around 1909–1911 was 51.5 years while most recently it is approximately 77.9 years.¹

Over the years, Saint Louis University has played a major role in investigating and managing outbreaks of infectious diseases. One of the first was the outbreaks of St. Louis Encephalitis that occurred in 1933 and 1937. Researchers at Saint Louis University were involved in identifying the viral agent responsible for this deadly disease (915 cases were reported, with 219 deaths, mortality rate 24%).² Drs. Kinsella and Broun collected clinical data on cases admitted to Saint Louis University Hospital and reported their findings as the first detailed clinical descriptions of St. Louis Encephalitis.³ The first cases were reported from the St. Louis Isolation Hospital.⁴ The executive committee of that hospital consisted of Dr. Helmuth H. Kramolowsky and Dr. E. Lee Shrader. The “head” physician was Charles H. Neilson, MD and the consultant physician was Ralph A. Kinsella, MD. Dr Broun coauthored an article in Science magazine pinpointing mosquitoes as the insect vector for the virus responsible for this form of encephalitis.⁵ Dr Kinsella chaired the Committee on Scientific Publications of the Metropolitan Health Council of St. Louis.

In the early part of the last century, syphilis was one of the greatest public health scourges and it was estimated that one in ten Americans was infected (source: Lantern slide published by the U.S. Public Health Service, date unknown). Treatments for syphilis were not adequate until the discovery of penicillin some time later. By comparison, recent estimates from the Centers for Disease Control and Prevention (CDC) are that there were 13,997 cases in the US in 2009, approximately 4.6 per 100,000 of the population. Missouri ranks twenty-first out of twenty-third in the nation in new reported cases of syphilis with 173 (approximately 2.9 per 100,000 of the population).⁶ One of the greatest scourges in recent times is infection with human immunodeficiency virus (HIV), also a sexually transmitted disease. CDC estimates in 2009 are that more than 1 million persons are living with HIV infection, and that there were approximately 48,100 new cases of HIV infection and 14,110/33,979 deaths due to HIV/AIDS.⁷ Researchers at Saint Louis University were heavily involved in the hunt for a vaccine against HIV – unfortunately, the prospects for this seem to have dimmed somewhat in recent years.

Accomplishments

Faculty in the Saint Louis University Department of Internal Medicine have continued to make contributions to science and medicine, carrying on a tradition established by Drs. Kinsella, Broun and Mudd. Many of these have been in the area of vaccines and vaccine development. Robert Belshe, MD, was appointed as Director of the Division of Infectious Diseases in 1989, under Dr. Fitch as chairman. He brought with him to Saint Louis University a Vaccine and Treatment Evaluation Unit (VTEU) which has been continuously funded by the National Institutes of Health since 1982. Since 1989, approximately 80 VTEU funded studies have been conducted. The VTEU remains at the forefront of research in fighting and preventing infectious diseases and is one of only eight NIH-funded vaccine centers. The VTEU was instrumental in developing an intranasal influenza vaccine⁸ and has also conducted pioneering studies of vaccines against herpes, smallpox and hepatitis C.

Dr. Morley’s research into aging and neuroscience led to a key invention which may well have promise as a treatment for Alzheimer’s disease.⁹ This devastating condition is related to the accumulation of beta-amyloid protein in the brain. Morley’s research team established a mouse model of Alzheimer’s disease (aged SAMP8 mice) and then developed a strategy to decrease the production of beta-amyloid precursor protein (APP) using antisense RNA. This antisense RNA approach is moving to clinical trials in humans and may not just control the symptoms of Alzheimer’s (as most current medicines do) but rather may actually prevent or even reverse the disease.

When Dr. Bruce Bacon joined the Division of Gastroenterology and Hepatology in 1990, he was already recognized as an authority in the inherited condition of hemochromatosis. This disease is inherited as an autosomal recessive condition, but because the gene frequency is quite high in the United States, it is the most common inherited metabolic condition. During the 1990s there was an international race going on to discover the gene responsible for hemochromatosis. Leaders in the field from Australia, Canada and France were outdone by researchers at Saint Louis University, led clinically by Bacon, with the discovery of the HFE gene in 1996.¹⁰ Further funded work at Saint Louis University has delineated the functions of the HFE gene and its protein product and led to a clearer understanding of the pathogenesis of this common inherited condition.

The Division of Nephrology, directed by Kevin Martin, MD, since 1989, is the first academic center to start a comprehensive interventional nephrology program in 2000.^9–11 This program provides diagnostic angiography for problems with dialysis catheters and shunts. Since that time, the division has provided training in interventional nephrology for many university programs across the country and is credited with establishing the subspecialty of interventional nephrology.

Bacon and Di Bisceglie have established a liver center at Saint Louis University which is world-renowned. In addition to his pioneering research leading to the discovery of hemochromatosis, Bacon is an active clinician treating large numbers of patients with chronic liver diseases, including viral hepatitis and others. Di Bisceglie was already an established researcher in the field of viral hepatitis before coming to Saint Louis University. Together with Bacon, he has been involved in many of the pivotal clinical trials that have brought new therapies to the market for patients with chronic hepatitis B and hepatitis C.^12,13

Summary and Conclusions

The Department of Internal Medicine at Saint Louis University has a long and proud tradition of excellence in patient care, research and education that goes back for 100 years, but also appears to remain strong for the future. The department has played a key role in several medical discoveries and innovations over the last 100 years and continues to make an impact on those in its community.

Biography

Adrian M. Di Bisceglie, MD, MSMA member since 2010, is Chairman of the Department of Internal Medicine, and practices in the Division of Gastroenterology and Hepatology, Saint Louis University Liver Center. Connie Manning, MA, and Assako Holyoke, MD, work in the Medical Center Library at the Saint Louis University School of Medicine.

Contact: dibiscam@slu.edu