Institutional Memory

Vol. 3 No. 4 (2019) 443–447 Cardiovascular Innovations and Applications ISSN 2009-8618 DOI 10.15212/CVIA.2017.0017

COMMENTARY

C. Richard Conti, MD, MACC

I recently read an editorial by Chris O’Connor in it is today. E.g. Osler, Halsted, Kelly, Welsh, Thayer, JACC heart failure on the topic of institutional Rich, Ross and many more. memory [1]. This stimulated me to think about the current state of institutional memory vs that which we perceived in days gone by. In my case, Second Year I am referring to the institutional memory of Johns During my second year at Hopkins, several indi- Hopkins School of Medicine (where I went to med- viduals stood out for me. One of them was Abu ical school) and comparing it to the institutional Pollock, professor of pathology. memory at the University of Florida, College of As medical students, we were assigned to autop- Medicine, (where I have been for the past 43 years.) sies, which in those days were much more common What follows are some of my memories of my time than they are today. This is partially related (not at Hopkins. totally) to the fact that all the imaging we do today As a medical student, my first contact with gives us a fairly clear idea of what was wrong with a Hopkins faculty person was Professor Allan the patient who died. Grafflin. Grafflin was a meticulous individual who Another faculty person who stood out was Gilbert insisted that we know something about the histori- Mudge, who was professor and chairman of phar- cal aspects of medicine. This was the start of my macology. He later left Hopkins and went on to learning who the leaders were in medicine, and I become Dean of the medical school at Dartmouth. am forever grateful to him for starting my jour- A third person who stood out was a resident in ney. Unfortunately, most medical students today medicine. The resident physician was Dr. Eugene rarely learn of the history of medicine, and who Braunwald, who assigned us a patient who was hard is responsible for the state of medicine that they of hearing. Can you imagine two young medical know today. students trying to get a history from someone whose I don’t think many graduates of UF COM, will hearing was impaired. That was my first meeting have a recollection of COM faculty at the begin- with Dr. Eugene Braunwald and I have never for- ning of the COM. As a current faculty member of gotten that meeting. the Department of Medicine, I see no prominent portraits, memorializing the early faculty and it is highly unlikely that current medical students and house staff have any knowledge of persons that Third Year helped build the medical school. At Hopkins it was My third year was a very memorable year in that I a different story. We were constantly reminded of was very fortunate to be at Hopkins at a time when the Prominent Physicians that made Hopkins what there were faculty members who had huge interna- tional reputations; for example, Nicholson Eastman was head of OB/Gyn, Richard Telinde, and head of Correspondence: C. Richard Conti, MD, MACC, Gyn, A.M. Harvey, head of medicine, and Johnny University of Florida Medical School, Gainesville, FL, USA, Eager Howard in endocrinology. Others of note E-mail: [email protected] included Philip Tumulty in general medicine,

Samuel Asper in endocrinology, Lockhard Conley the 40’s. Hopkins was in a southern town (below as head of hematology, Tom Hendricks head of the Mason Dixon line) and many of the faculty were gastroenterology, Richard Ross head of cardiology, opposed to having a black man in such a prestig- and several prominent cardiac surgeons including ious position with Dr. Blalock. Vivien performed Alfred Blalock, Henry Bahnson, David Sabiston, the first subclavian, pulmonary artery anastomosis and Frank Spencer. A future honorary M.D. (Vivien in a dog. Thomas was with Blalock in the operating Thomas) was also a teacher of mine, during my dog room, along with other prominent young surgeons surgery experience as a third year medical student. (Cooley and Longmire) when the first “Blue Baby” During our medicine experience, we were operations was performed. Later in life, Vivien was assigned to Baltimore City Hospital, Mason Lord awarded an Honorary Doctorate of Medicine from was Chief Medical Resident. The unique thing Hopkins (the only one ever given up to that time). about Mason Lord is that even as a medical resi- When I left Hopkins in 1974, the Blalock Clinical dent, he would wear a flower in his lapel. This was Science building had three paintings displayed. One a signature of this physician that persisted until the was Alfred Blalock, the other was Vivien Thomas time of his death. and the third painting was the dog on whom Vivien During a surgical rotation, I had contact with a performed the Blalock-Taussig Shunt. I must say physician in the general surgery clinic by the name that the TV movie “Something the Lord Made” is of Ned Brockenbrough. Ned subsequently described quite accurate and consistent with what I remember the Brockenbrough-Braunwald-Morrow sign seen of the Vivien Thomas story. in hypertrophic cardiomyopathy, then called idi- opathic hypertrophic subaortic stenosis. The OB program was run by Professor Nicholson Senior Year Eastman, a prominent obstetrician who edited the During my senior year, my first clinical exposure book, “William’s Obstetrics”. I still have “William’s was in medicine at Hopkins. My first attending Obstetrics, 11th Edition” in my library at home. physician was John Eager Howard, and my second In pediatrics, we were taught by the new Professor attending physician was Ward B. Allan, also a well- of Pediatrics Dr. Robert Cook. As I remember viv- known faculty person whose expertise was related idly, he wore what we then called “sweat socks” as to diseases of the chest. My experience with these if he was playing tennis or other sports while lec- two individuals, convinced me that I wanted to train turing to the students. I also remember Cook using in internal medicine. On the medical wards the stu- the word “prodigious” many times during his lec- dent history, because of its completeness, was the tures. At the time, I never figured out what the word official history put in the patient’s medical record. meant. I have since learned that as an adjective it I remember the interns were John Mulholland means extraordinary or huge. and Tony Werner. Jack Mulholland subsequently Another important memory relates to my future became Chief Resident several years later and health. In 1958, Professor John Bordley asked for eventually became Chief of Medicine at Union a volunteer to demonstrate the ear nose and throat Memorial Hospital replacing John Eager Howard. examination. I was the volunteer, and when Bordley looked in my mouth, he said, “You have some leu- koplakia on inside of your cheeks.” and it may be a House Staff that Influenced me as a precancerous lesion. He then asked me if I smoked Senior Medical Student cigarettes. I answered yes and his comment woke me up to the problems of smoking, so I immediately quit. Mike Criley and O’Neal Humphries clearly had some influence on my eventual selection of cardiology, and they subsequently became my teachers Dog Surgery and Vivien Thomas in cardiology during my cardiology fellowship, and later as colleagues on the Hopkins faculty. Our instructor was Vivien Thomas. Vivien was a Mike Criley was an outstanding photographer black man, who endured much abuse at Hopkins in and also outstanding in the cardiac catheterization C.R. Conti, Institutional Memory 445 laboratory. Most of what I know about congenital lived near the hospital, (that is no longer the case) heart disease comes from Mike Criley and pediat- and I basically was home for dinner every night, but ric cardiologists, Catherine Neill and Richard Roe I was also back in the hospital every night. During and occasionally from Helen Taussig. Mike also my house staff training there were not as many combined his photographic interests and his angio- diagnostic and therapeutic tools as we have now, so graphic interests and began the study of the physi- we probably spent more time with the patient than ologic basis of heart sounds and murmurs. what is done in current medical house staff expe- O’Neal Humphries, in contrast, was an expert in riences. It is interesting, as I look at a picture of pacemakers and general clinical cardiology. O’Neal the house staff, during my internship year, it turns eventually moved from Hopkins to the University out that three of us, Dean Mason, Robert Frye, and of South Carolina in Columbia, South Carolina I later became Presidents of the American College where he became Chair of Medicine and eventually of Cardiology. Dean of that Medical School. Mike Criley eventually moved from Hopkins and took over as Chief of Cardiology at Harbor General Hospital in Torrance, James Jude California, an affiliate of UCLA. During that internship year, James Jude, who was the Chief Surgical Resident on the Halsted Surgical Osler Internship 1960 Service initiated the CPR program and cardiac resuscitation using AC defibrillation. Jim Jude My internship class consisted of eighteen individu- eventually left Hopkins after being there for many als. I loved the job. We had to take responsibility years and traveled to Miami where he became Chief (ownership) of our patients. This task was some- of Cardiac Surgery for several years thereafter. what attenuated by the fact that all of us lived very close to the hospital and could walk there within 10 or 12 min, but we still had to get up and go to hospi- Fellowship in Cardiovascular tal. All of us took this responsibility very seriously. Medicine In August, 1960 my intern associate was Roger Palmer, who graduated first in his class from the After finishing my medical residency at Hopkins, University of Florida, the first graduating class at I began my Cardiology fellowship training in July that university. Roger also had a very good under- 1965. My first assignment was to work in the sur- standing of physiology and pharmacology (much gical dog lab with David Goldfarb, a surgical resi- more than most of us). Roger returned to Florida, dent. David was working in the surgical animal lab where he worked with Thomas Marin, the inventor using diastolic augmentation as the main therapy for of Diamox. While at Florida, Roger was one of the acute myocardial infarction. As far as I can recol- first to report that the use of beta blockers dimin- lect, we never used the device in patients with acute ished aortic dissection in patients with that problem. myocardial infarction. But this preliminary work Those observations are still consistent with current eventually led to the development of the intra-aortic treatment of descending thoracic and abdominal balloon that accomplished the same goal, but more aneurysms. efficiently. The individual who developed a proto- This internship was no walk in the park, but it type balloon, at least at Hopkins, was Greg Brown, probably was the most accelerated learning experi- who was an MD, PhD medical student. ence of my entire life. During internship, time off Following that 3 month experience, I spent the began after rounds on Saturday morning, one of us next 20 months working off and on in the cardiac could have the afternoon and evening off and the catheterization laboratory. The major imaging done same was true on Sunday morning for the other in those days was done in the cardiac catheteriza- intern. tion laboratory. At any rate, the internship was something that Most of the coronary angiography was done as a I really enjoyed and will treasure forever. We all research tool at Hopkins, and many of the patients 446 C.R. Conti, Institutional Memory were admitted to a research ward known as Osler underwent emergency lumbar disc surgery, and she Five. Thus, investigation of coronary artery disease will never forget him. patients were done on a research protocol, since revascularization with surgery or percutaneous Samuel Asper: Sam was an endocrinologist, intervention did not exist. As a result of our early who became president of the American college of experience with coronary angiography, Gottlieb Medicine. I received my FACP during his tenure Christian (Bud) Friesinger, published a landmark as president. Sam became Dean of the American paper on the natural history of patients based on University of Beirut. He also was temporary their coronary angiographic findings. Department of Medicine chair when Dr. A.M. Harvery had his heart attack.

Coronary Artery Bypass Graft Victor McKusick: 1951–52 Chair of Medicine, Coronary artery bypass grafting did not begin at Osler Professor, Father of Human genetics. Hopkins until 1969, after René G. Favaloro initi- Richard S. Ross: 50’s Chief of Cardiology and ated this procedure at the Cleveland Clinic on May Professor, later Dean and Vice President of Hopkins 9th 1967. I had the pleasure of meeting Dr. Favoloro Medicine. at the American Heart Association annual conference in Dallas (as a young faculty cardiologist, I Leighton E. Cluff: Professor and chief ID, Hopkins, rode a bus to the meeting venue with him) and later Professor and Chair of Medicine UF-President in Buenos Aires, as a slightly older cardiologist as Robert Wood Johnson Foundation. well as an invited faculty, at a conference in his honor. Before his death, I received an autographed Henry Wagner: Professor of Medicine and Chair copy of his book “the Challenging Dream of Heart of Nuclear Medicine Hopkins. Surgery, from the Pampas to Cleveland”, this book was written in 1992. He died on July 29th 2000. Frank Iber: 1959–60 Professor and chief of Hepatology Hopkins.

Cardiac Transplantation at Hopkins Joseph Johnson: 1960–61, Professor and chief ID UF, Chair of Medicine, Beauman Gray, Dean U The first cardiac transplant at Hopkins (99th in the Michigan. world) was a patient of mine and was transplanted by Harvey Bender and Vincent Gott. The patient Charles C J Carpenter: 1961–62, Professor and survived the operation but died 4 weeks later, prob- Chair of Medicine, Case Western Reserve. ably of acute rejection since the immunology of rejection had not yet been figured out. Gottlieb Christian Friesinger: 1962–63, Professor and Chief of Cardiology, Vanderbilt. Chief Medical Residents at Hopkins John Mullholland: 1965–66, Professor and Chair Phillip Tumulty: Sometime during in my senior of Medicine, Union Memorial Hospital succeeding year, I got to know Dr. Phillip Tumulty, who was John Eager Howard. thought of by the medical students, house staff, and faculty as an outstanding internist/clinician. Phil C. Richard Conti: 1967–68, Professor and Chief Tumulty was my wife Ruth’s physician after she of Cardiology, UF, President American College of C.R. Conti, Institutional Memory 447

Cardiology, Editor in chief Clinical Cardiology, John Eager Howard: Endocrinologist and inven- ACCEL and CVIA. tor of the Howard Test.

Others, trained by AM Harvey who Conclusion were not Chief Residents but were members of his medical staff: Perhaps the difference in the recognition of our colleagues at each school of medicine, by students Richard Johns: 1950’s – Professor at Hopkins and and house staff, is related to the duration of the Chair of Biomedical engineering. existence of the Schools, e.g. Hopkins existed for Lockhard Conley: Professor of medicine and chief >100 years and changed the teaching and practice of hematology. of medicine, and UF COM existed since 1956. However, I do not think that is the only reason for Thomas Hendrix: Professor and chief of the difference. It may also be related to the time Gastroenterology. each faculty member spent at the particular insti- tution, e.g. many faculty stayed at Hopkins for Albert Owens: Professor and chief of Oncology. their entire career., e.g. Halsted. Harvey, Tumulty, Conley, Hendricks, Johns, Owens, Howard, Ross, Gordon Walker: Professor and Chief of Nephrology. Wagner, Walker. That may change in the future as the UF COM ages, but it may not, since both Mason Lord: Private practitioner and former places have changed (possibly related to new Chief Resident at BCH during my third year at diagnostic tests and new treatments) in the past Hopkins. few years. Only time will tell.

Reference

1. O’Connor CM. Does Institutional memory matter? JACC Heart Fail 2017;5(8).