Dr. John Phillips: the Unknown Physician

Dn John Phillips: the unknown physician

CHARLES Q. MCCLELLAND, MD

N A SUNNY, WARM shortly after 9 PM, the father was May afternoon, a notified of the death of this sen- boy lies in the front ior friend and colleague, a distin- hall of his suburban guished internist. The father O thought so highly of him that he Cleveland home avidly scanning the newly arrived evening news- had hung his photograph in his paper. Vivid headlines and pho- study. tographs highlight the story of The date was May 15, 1929. an explosion and fire at a major The site of the disaster was the Cleveland medical center. He Cleveland Clinic. The boy's fa- views never-to-be-forgotten im- ther was Joseph E. McClelland, ages of fire engines with nar- MD, and the senior colleague who rowly angled rescue ladders died was John Phillips, MD, one reaching into high-arched first-, of the four founders of the Cleve- second-, and third-story win- land Clinic. The boy was me. dows, firemen removing victims via ladders and safety nets, and WHO WAS JOHN PHILLIPS ? hospital staff and patients re- ceiving first aid on the adjacent Sadly, details relating to the lawn and hospital roof. life and professional career of this remarkable physi- At about 5:30 PM the boy greets his exhausted cian are almost unknown to present members of the father, who has a story to tell. A physician at another Cleveland Clinic medical staff. I would like to rem- institution, he and many others had rushed to the edy this serious oversight in Cleveland's medical scene of the disaster to give first aid. He had worked history. closely throughout that day with a most respected Unfortunately, while we have ample records of senior colleague and mentor who had been in the Dr. Phillips' public life, the private man remains area of the explosion and fire in the morning, and elusive. One reason may be that his colleagues did who had made his exit by jumping out of a third-floor not know him very well. Of the four founders of the window into the firemen's rescue net. That evening, Cleveland Clinic, three, Drs. Crile, Bunts, and Lower, were surgeons. They had been raised in northern Ohio and went to medical school in From the Department of Pediatrics, Case Western Reserve Cleveland, and they had practiced together for dec- University. Cleveland. ades. Dr. Phillips was an internist and a naturalized Address reprint requests to C.Q.M., 24560 Duffield Road, Beach wood, OH 44122 American citizen of Canadian birth.

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Another reason may be that Dr. Phillips did not by faculty and peers as highly intelligent, skilled, possess a flamboyant personality. The image that and responsible.7 emerges at this distance of years is that of a solid, In 1906 he was appointed to the internal medi- serious worker. At his death, Dr. Crile said he was "a cine faculty of Western Reserve University, and to man of few words and careful thinking; a serious- the position of Assistant Visiting Physician at Lake- minded, learned, and great physician. He had never side Hospital.11 At the time, Western Reserve Uni- known an interest, a diversion, a hobby outside of versity was recognized as one of the three finest his profession.'" medical schools in North America. Indeed, Flexner had chosen it as his model in curriculum, faculty, 12 EARLY YEARS and resources. In addition to his bedside teaching and inpatient On February 19, 1878, a son, John, was born to care responsibilities, Phillips also served as physician Robert and Jane McCullough Phillips in the Village in charge of the medical dispensary, and as assistant of Wainleet, adjacent to Welland, Ontario. The visiting physician on the children's ward. great-grandson of immigrants from Ulster in North- Phillips became the mentor for many bright, ern Ireland, he was reared in a farming community. promising young physicians. He worked hard, and His background instilled in him a work ethic that expected his residents to do the same. He main- lasted all his life. After attending public schools, he tained warm friendships with colleagues of all ages graduated from the Model High School and planned and ranks, from fourth-year medical students to the a career in teaching. world-famous. Charles Thwing, president of West- Phillips spent 3 years as a grade-school teacher ern Reserve University from 1908 to 1921, wrote: before matriculating at the Faculty of Medicine of "His students came to him to talk about their prob- the University of Toronto in 1898.2 In part, his lems-and medical students have problems more nu- decision to become a physician came from his close merous and deeper than most."13 relationship with his older sister, a registered nurse Like many physicians trained in internal medi- who cared for diabetic patients. cine in that period, Phillips had great interest and Although the curriculum was of 5 years' duration, skill in pediatrics.14 Dr. Edward Cushing became his only a high-school degree was required for admis- mentor, encouraging him to pursue this interest and sion to the University of Toronto, which was typical to publish his findings. In the 10 years before the of Canadian and many US medical schools at that onset of World War I and his military service, Phil- time.3 Abraham Flexner, praised it in his classic text lips published 30 scientific papers, 13 of which ad- The Flexner Report on Medical Education in The dressed pediatric subjects.15 Compared with the best United States and Canada.4 Phillips excelled in both of then-current textbooks such as Osier's Principles basic sciences and in clinical clerkships. As an and Practice of Medicine and L. Emmitt Holt's Dis- "honors" graduate, he was awarded the silver medal eases of Infancy and Childhood, Phillips' papers were by the medical faculty in 1903.5,6 as good, and often better.16"19 Writing may not have come easily to him. Thwing LAKESIDE HOSPITAL wrote: "His mind was not facile, its operations were not swift... But the matter was compact, the sugges- Phillips won a highly competitive 3-year resi- tions germane, the inductions inevitable, the lessons dency in internal medicine at Lakeside Hospital in apt, timely, pregnant with great meanings."13 Cleveland.7 This 200-bed hospital had opened in 1895, less than 10 years previously. Based on the MARRIAGE AND FAMILY Johns Hopkins Hospital model, it had already received national recognition for its excellent clinical On September 13, 1907, Phillips married Corde- and laboratory facilities.8 Phillips served on a medi- lia Sudderth, of a family that had lived in North cal service which was chaired by Dr. Charles Hoover Carolina since before the American Revolution. and which included Drs. John Lowman, Hunter She was a graduate of Oberlin College and the Nurs- Powell, Henry Upson, and Edward F. Cushing.9'10 ing School of Lakeside Hospital.20 Their only child, Photographs made during his residency show Phil- John Edward Phillips, was born the following year. lips as short, stocky, and robust. He was recognized He was to graduate from Hawken School and Yale

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University, and, following naval service in World Cleveland Academy of Medicine, one of the young- War II, he remained in Cleveland as a business est presidents in its history.25 executive.21 In these years he also provided critical leadership Dr. Phillips shared the competitive struggles of in the construction of the Dudley P. Allen Memorial many academic physicians, balancing the demands Medical Library. He was solely responsible for plan- of time for patient care, teaching, and writing ning and procuring the financial support for the against those of his family. Although his profession Cushing Reading Room, which honors three gen- was medicine, his avocation was fishing. Vacation erations of Cleveland's most distinguished medical expeditions to the family fishing camp on Lake Ti- family, including its youngest member, Dr. Harvey magami in Ontario became an annual tradition, giv- Cushing. Indeed, Phillips' ties with many of Cleve- ing him time to enjoy his family.22 land's elite families was responsible for the overall support of the new library.26 THE CLEVELAND CLINIC In 1923 he was elected to the prestigious board of regents of the American College of Physicians. He In 1919, Phillips, a newly naturalized US citizen, served on this board until his death. In 1927 he returned from his duties in the US Army Medical chaired its annual clinical session, which was held at Corps to join Drs. Crile, Bunts, and Lower in the the Cleveland Clinic. This decade also saw the or- planning and organization of the Cleveland Clinic. ganization of a number of medical subspecialties As pending chief of medicine, he resigned his full- such as the American Heart Association, the time faculty appointment at Western Reserve School American Gastroenterological Association, and the of Medicine and Lakeside Hospital.23 However, he American Association for Study of Internal Secre- did continue to teach a highly popular course on tions. Phillips joined them all, and all invited him to medical therapeutics for fourth-year medical stu- present scientific papers.27 Yet, until his death, Phil- dents at Western Reserve University.24 This provided lips remained a generalist. His increasing interna- him an ongoing relationship with medical students tional reputation was based on his enormous skill as that was unavailable at the Cleveland Clinic. a diagnostician. At the time of his death, Phillips Dr. Perry McCullagh, who became chairman of had the largest consultant internal medicine prac- 28 the department of endocrinology at the Cleveland tice in North America. Clinic, remembers: "In spite of his appearance of But he still made house calls, and he was a com- calmness, there was considerable tension. For exam- passionate physician. According to Thwing, no pa- ple, when he was dictating, no one dared to inter- tient was a "case" to Phillips; each was a friend. He rupt. At the end of a busy day his friendliness shone recalled an episode when Phillips appeared tired and through clearly. He liked very often to sit down depressed. The reason: "I have had to tell three somewhere with his younger staff and fellows. For mothers this afternoon that their little children can the first time in the day, so far as I know, he would never be normal. Their minds will never be more now light a cigarette. For half an hour he would than half a mind."13 relax and chat of matters of current interest or medi- Phillips published an additional 30 papers in the cal topics. He spent almost all his weekends visiting 1920s on a wide range of subjects in internal medi- patients at their homes or in consultation in Cleve- cine, including cardiovascular disease (angina pec- land or in neighboring cities."23 toris, myocardial infarction, hypertension, endocarditis), endocrine disorders (thyroid disease, INTERNATIONAL CONSULTANT goiter), and gastrointestinal disorders (gall bladder AND MEDICAL LEADER disease, carcinoma of the colon).15 He was invited to write chapters in internationally prominent text- In its first decade, the Cleveland Clinic grew books such as the Oxford Monographs on Diagnosis dramatically, due in part to the emerging interna- and Treatment, Volume 8, and Cecil's Textbook of tional reputations of the founders and their active Medicine.17 participation in local, regional, and national medi- Reading these articles gives a glimpse of what it cal organizations. Having served previously as chair- was like to practice medicine in that era. Of subacute man of the Ohio State Section on Internal Medi- bacterial endocarditis, Phillips wrote that the prog- cine, in 1922 Phillips was elected president of the nosis "is discouraging, recovery occurring in only

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from one to two percent of the cases. In my own pipe leaking on electrical wiring may have caused series of cases, there has been only one recovery."29 the fire. Incomplete combustion of the old nitrocel- On hypertension: "Since we do not know the lulose films generated toxic fumes, which spread causes of high blood pressure, our efforts to prevent from the basement to the other floors via heating its development are apt to be more or less unsatisfac- ducts. At about 11 AM, an explosion blew out the tory . . . For the advanced stages of hypertension skylight of the three-story atrium; fire and deadly gas regular hours of rest are important. The patient swiftly followed. Phillips and others were forced to should lie down for an hour after lunch and should leave the building by jumping from windows into spend at least eight hours in bed at night. In severe firemen's nets placed on Euclid Avenue and East 93 cases at least one day a week should be spent in bed. Street. Patients, employees, nurses, and physicians Frequent vacations of from two to four weeks should received emergency treatment on adjacent streets be taken. A vacation in mid-winter and one in and lawns and on the roof of the unaffected Clinic mid-summer with a week at Easter and Thanksgiv- Hospital Building, directly south of the Clinic ing spent in the country or on the water together Building.32'33 with week-ends free from work and spent in the Many Cleveland doctors who had no professional pursuit of some hobby, will relieve the patient from relationship to the Cleveland Clinic rushed in to an injurious mental strain."30 help.32 My father found Dr. Phillips on the hospital On smoking and angina: "Tobacco and alcohol roof, directing the first aid efforts. should be used with the greatest moderation. The By the late afternoon, Phillips appeared exhausted patient should not smoke more than two mild cigars and was cyanotic. Shortly thereafter, he returned to a day. What physician has not seen improvement his residence at the nearby Wade Park Manor. Early after the prohibition of smoking in patients with in the evening, Drs. Bunts and Crile were told that angina who have been accustomed to smoking 8 or his condition was worsening. They immediately 10 heavy cigars a day?"30 came to his home and began vigorous treatment with On exercise: "It is extremely important to warn blood transfusion and oxygen. To no avail. Shortly patients of sedentary habits against over exercise after 9 PM, recognizing the lethality of his acute after the age of fifty. It has often seemed to me that pulmonary illness, Phillips requested a final medica- more men are injured than benefitted by exercise tion and asked his physicians to withdraw and com- after the age of fifty because of their tendency to fort his wife. John Phillips died alone.34 over-do. Often they do not realize that they cannot Overall, 124 people died, including five physi- do the things that they could do when they were cians. As a result of the inquiry that followed, na- thirty."31 tional standards were adopted establishing safety re- quirements for the manufacture and storage of CLEVELAND CLINIC DISASTER radiographic film.33 AND DR. PHILLIPS' DEATH The tragic loss of such a distinguished physician and community leader had a profound effect on Early Wednesday morning, May 15,1929, Phillips Cleveland's intellectual and professional life. made his usual inpatient hospital rounds with inter- Thwing commented: "As a result of his death, and nal medicine department staff and residents. Among the death of many others, the methodology to pre- his priorities that day were the completion of plans to vent such future disasters resulted. In his death, as in host 25 old friends and colleagues travelling the fol- his life, Phillips was a savior of men."13 In 1929, as a lowing day from Toronto to attend a scientific meet- memorial to the late Dr. John Phillips, the Ameri- ing at the Cleveland Clinic. Sometime after 9:00 can College of Physicians donated the Phillips AM, he went to the third floor of the adjacent Clinic Medal to be awarded to outstanding members for Building facing Euclid Avenue and East 93 Street for achievement in internal medicine.6 scheduled morning office appointments. Although the precise time of onset has never AFTERWORD been documented, sometime that morning a fire began in a basement area of the Clinic Building Years passed, and the boy who sat on the floor where old radiographic films were stored. Two safety reading the newspaper became a physician like his doors had been blocked from closing, and a steam father. I didn't think very much about the picture of

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Dr. Phillips in my father's study until I met Dr. able physician, and of Dr. Phillips' enormous contri- Stanley Hoerr, distinguished former chief of surgery butions to the founding and early success of the at the Cleveland Clinic. I came to know Stan well Cleveland Clinic. when we shared a decade on the Board of Trustees of Most importantly however, before his death, Dr. the Cleveland Medical Library Association, and Hoerr encouraged me to review the many archival when I succeeded him as its president. He knew of resources in Cleveland and to prepare a manuscript my father's close relationship with Dr. Phillips. Stan defining Phillips' still largely unknown and unac- reminded me of how few of the present-day Cleve- knowledged contributions to this distinguished insti- land Clinic staff had any knowledge of this remark- tution and to Cleveland's illustrious medical history.

REFERENCES Poor Children: 1908-1968—Dr. John Phillips & Dr. William I. Staples. Handerson History of Medicine Society of Cleveland, December 10, 1991. 1. Crile GW. George Crile. An autobiography. Philadelphia, J.B. 17. Brainerd AM. The visiting nurse in outing work. Visiting Nurse Lippincott, 1947:435. Quarterly 1909; 1:5-6. 2. John Phillips Family Papers, MSS. No. 4197; Western Reserve 18. McClelland CQ. An annotated bibliography of Dr. John Phillips' Historical Society. Folders 28 and 29. pediatric publications, 1908-1921. Archives, Cleveland Medical 3. Ms. Lagring Ulanday, Records Archivist, University Archives, Library Association, 1991. University of Toronto: Personal Communication. 19. McClelland CQ. John Phillips' contributions to pediatric litera- 4. Flexner A. On medical education in the United States and Can- ture. Archives, Cleveland Medical Library Association, 1991. ada. New York: Carnegie Foundation For The Advancement of 20. John Phillips Family Papers, MSS. No 4197, Western Reserve Teaching, 1910:108,323. Historical Society, Folder 30. 5. Mr. Alan Bakes, Faculty of Medicine Archivist, University of 21. John Phillips Family Papers, MSS. No 4197, Western Reserve Toronto. Personal Communication. Historical Society, Folders 2 and 3. 6. John Phillips Papers; Archives: The Cleveland Medical Library 22. John Phillips Family Papers, MSS. No 4197, Western Reserve Association, Box #3. Historical Society, Folder 22. 7. University Hospitals (Lakeside Hospital) Archives, and 1905 23. Van Ommen RA. Internal Medicine at The Cleveland Clinic. House Officer Photographs. In: Brown KL, editor. Medicine in Cleveland and Cuyahoga 8. Gottlieb M. The Lives of University Hospitals of Cleveland. County 1810-1976. Cleveland: Academy of Medicine of Cleve- Cleveland: Wilson Street Press, 1991:71,74,83. land, 1977:132-133. 9. Waite FC. Western Reserve University Centennial History of 24. Dr. John Phillips Papers; Archives, The Cleveland Medical Li- The School of Medicine. Cleveland: Western Reserve University brary Association, Box 1. Press, 1946:374-375. 25. John Phillips Family Papers, MSS. No 4197, Western Reserve 10. Inkley SR. The Department of Medicine of Lakeside Hospital. Historical Society, Container 1, Folder 22. In: Brown KL, editor. Medicine In Cleveland and Cuyahoga 26. Archives, Cleveland Medical Library Association; Box 1, Endow- County 1810-1976. Cleveland: Academy of Medicine of Cleve- ment Funds, Folder 11, January 19, 1925. land, 1977:143. 27. John Phillips Papers. The Cleveland Clinic Archives. 11. Case Western Reserve University Archives. #24 F-D Faculty Ar- 28. George W. Crile Family Papers; MSS. No 2806, Western Reserve chives. Box 2, pages 33, 34, 49, 76, 84, 117. Historical Society, Container 37, Folder 9. 12. Flexner A. On medical education in the United States and 29. Phillips J. Subacute bacterial endocarditis. Memphis Med J Canada. New York: Carnegie Foundation for the Advancement of 1928;5:117-128. Teaching, 1910:90,125. 30. Phillips J. General discussion of prognosis and treatment of arte- 13. Thwing CF. Friends of men. New York, Macmillan, 1933:323. rial hypertension. Ohio State Med J 1925; 21:637-640. , 14. Veeder BS. Pediatric profiles-a pediatric meeting in 1910. St. 31. Phillips J. Angina pectoris. South Med J 1926; 19:95-100. Louis: CV Mosby, 1957:258-264. 32. The Cleveland News, May 15, 1929:1-3. 15. McClelland CQ. A complete bibliography of Dr. John Phillips - 33. George W. Crile Family Papers; MSS. No 2806, Western Reserve 1906 to 1929. Archives, Cleveland Medical Library Association, Historical Society, Container 37, Folder 1. 1991. 34. George W. Crile Family Papers; MSS. No 2806, Western Reserve 16. McClelland CQ. Innovative Health Services to Cleveland's Historical Society, Container 40.

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