A Century of Healthcare and Medical Education from the Viewpoint of a Clinical Chemist
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A Century of Healthcare and Medical Education from the Viewpoint of a Clinical Chemist By Raymond E. Vanderlinde, PhD Diplomate of the American Board of Clinical Chemistry Emeritus Professor of Pathology and Laboratory Medicine (Division of Clinical Chemistry) and Emeritus Professor of Clinical Biochemistry Hahnemann University School of Medicine (1991) Drexel University School of Medicine (as of 2002) © 2007 by Raymond E. Vanderlinde Catonsville, Maryland Published by the AACC History Division with permission of Dr. Ray Vanderlinde, with minimal editing. 1850 K Street, NW, Suite 625 Washington, DC 20006 Dedication This book is dedicated to Wilfred Wiedy “Weste” Westerfeld, Weste set very high standards and the only one I knowingly PhD, Rhodes Scholar at Oxford University (1938–1940), Harvard failed to achieve was learning to smoke a pipe while doing Medical School Faculty (1940–1945), Chairman and Professor of chemical procedures. As Dr. Westerfeld’s first graduate student Biochemistry at Syracuse University College of Medicine at Syracuse University Medical College, I was the only gradu- (1945–1950), Chairman and Professor of Biochemistry at SUNY ate student to receive his degree in four years and five summers Upstate Medical Center (1950–1979) (successor to SU College of and from Syracuse University. My training prepared me Medicine); Acting Dean SUNY Upstate Medical Center exceedingly well for both a career in academic Biochemistry (1955–1960). and in hospital Clinical Chemistry. Since I was the first of at Weste received his PhD at age 23 under Edward A. Doisey least four of his graduate students who became clinical Sr., PhD, who was Chairman and Professor of Biochemistry at chemists, he was proud of my achievements and leadership in St. Louis University Medical School. Later, Dr. Doisey the field. My accomplishments were due to his excellent train- received the Nobel Prize for the identification of the structure ing and instilling motivation in his students and his challenge of vitamin K, the vitamin necessary for blood to clot. of “becoming the best you can be.” ii Contents Preface iv Acknowledgements v Introduction vi 1 A Century of One Family’s Healthcare 1 2 Highlights in the History of Medicine 8 3 Pharmacy, Dentistry, Nursing, and Hospital Development 25 4 Drug Discovery 31 5 Medical Education in the United States 40 6 Faculty of the University of Maryland from 1950 to 1957 47 7 Chemistry and Medicine 54 8 Public Health 69 9 Changing Medical Education 85 10 Selected Topics 96 11 Health Economics and the Future of Healthcare 109 12 Quality of Healthcare and Bioethics 116 iii Preface Every hospital or institution participating in clinical research On June 5, 2003, Eric M. Meslin, PhD, Professor and involving new experimental drugs, medical devices, or retro- Director of the Indiana University Center for Bioethics, deli- spective reviews of patient data is required by the Food and vered a talk to the St. Agnes Hospital medical staff and invited Drug Administration (FDA) to have an ethics review group, guests of the 2nd annual Raymond J. Donovan, MD, Memorial called an Institutional Review Board (IRB), approve all such Lecture on Ethics in Clinical Research. During the question proposals. An IRB consists of a group of physicians and nurses and answer period after Dr. Meslin’s lecture, I replied to a ques- and appropriate people from the community who must approve tion involving transplants in Maryland. My comments spon- every proposed clinical research study. Annual review of studies sored so much interest on the part of Dr. Meslin that he rushed in progress is required. Because of my experience in Laboratory back to me, requested a brief summary of my over 40-year pro- Medicine (formerly Clinical Pathology) and no professional ties fessional background and insisted that I had to write a book on to St. Agnes Health Care, I have served as an outside volunteer the highlights of the past century of healthcare and medical on the St. Agnes Hospital IRB since June 2002. education. Raymond E. Vanderlinde, PhD, at age 80 in 2004. iv Acknowledgements I wish to thank Anthony F. Hammond, MD, FACS, for taking My wife, Ruth Hansen Vanderlinde, MLS, worked with me the time to review the first draft of this autobiographical manu- throughout the writing of the book, making many comments script in May 2004. His many constructive suggestions resulted and recommendations that were extremely useful. Her proof- in a complete reorganization and the addition of new content reading was a dedicated and consistent endeavor. I greatly between June 2004 and December 2006, making it much more appreciate her very extensive efforts, but as the author, I must logical and complete as a history of healthcare and medical take ultimate responsibility for any errors. education in America. Dr. Hammond, whom I taught as a medi- I owe a debt of gratitude to the information staff of the cal student (University of Maryland, 1957), took the time from local Catonsville Public Library who have very patiently and his busy life as an ENT specialist to review the revised draft for frequently sought out information for me. In addition, the staff content and medical errors, for which I am much indebted. In of the St. Agnes Hospital Health Science Library, the librarians his words: “The section on clinical chemistry greatly impressed of the Chemical Heritage Foundation in Philadelphia, and me and it crystallized for me the marriage between clinical Thomas Flynn, MLS, Director of the New York State chemistry and medicine in advancements in healthcare. Department of Health Library, have assisted me on numerous Clinical chemistry seemed to have been a half-step ahead of occasions. medicine in this progression.” v Introduction Roman statesman Marcus Tullius Cicero said, “History indeed Emeritus Professor of Clinical Biochemistry as an honorary is the witness of the times, the light of truth.” degree from MCP-Hahnemann University in Philadelphia in My mother kept detailed records of her health and that of my 1991, which has since become Drexel University School of father and their four children from 1912 through 1981, which Medicine. I describe in the first chapter. I started my graduate studies at the After review of my book, Dr. Anthony Hammond stated to Syracuse University College of Medicine in 1946. In August me that he never realized how much modern day medicine is 1950, I received the first PhD in Biochemistry and Physiology founded on clinical chemistry. The goals of this book are to with the goal of teaching either Biochemistry or Physiology describe the role of clinical chemistry as the foundation of (body function) at a medical school. In addition to seven years modern medicine, the advances in vaccines, therapeutics, and (1950–1957) on the faculty of the University of Maryland School antibiotics, the role of clinical chemistry in medicine during the of Medicine in Baltimore, my 40-year professional career last half century, and the major changes in the curriculum of includes serving on the staff of five other medical schools, direc- undergraduate and graduate medical education instituted over tion of two university hospital clinical chemistry laboratories, the past five years. Since all medical terminology is defined, it and 12 years in public health where we licensed the hospital and should be of interest not only to clinical chemists and physi- independent clinical laboratories in the State of New York. cians but as an orientation manual for first-year medical stu- I received the titles of Emeritus Professor of Pathology and dents and as an informative booklet for premedical students and Laboratory Medicine (Division of Clinical Chemistry) and their parents and for the lay public at large. vi Chapter 1 A Century of One Family’s Healthcare In the early 1700’s, disease and sickness such as smallpox and Until Louis Pasteur developed his germ theory in 1878, typhus were so rife in the filthy holds of some ships coming to most people believed that illness was due to deadly miasma America that statistics from 1711 indicate only one out of three arising from stagnant water and swamps. However, even when immigrants survived the crossing, and typhus became known as filth, polluted water, and poor sanitation accompanied disease, “ship fever” (1). Nevertheless, New York State, settled by the people failed to recognize the role of mosquitoes, flies, and Dutch beginning in 1624 at New Amsterdam (New York City) insects in carrying disease. As a matter of fact, in the 1700s and and Fort Orange (Albany, New York), grew from a population of 1800s, people thought most diseases were the responsibility of just over 4,000 in 1650 to almost 163,000 in 1770 (2). A similar the individual and solely the result of lifestyle (3). situation prevailed in the middle-Atlantic states, with the popula- In 1900, 11.8% of deaths were due to pneumonia and tions of Pennsylvania and northern Maryland enhanced greatly influenza; 11.3% to tuberculosis; 8.3% to diarrhea, enteritis, by the leader of the Quakers, William Penn, who offered religious and ulceration of the intestines; 8.3% to heart disease; 6.2% freedom to all immigrants. Between 1737 and 1746, over 15,000 to stroke; 5.2% to kidney diseases; 4.2% to accidents; 3.7% to Germans landed on some 67 ships at the port of Philadelphia. cancer; 2.9% to senility; and 2.3% to diphtheria (4). Thus, the Similar large numbers of German immigrants came to Maryland, 10 leading causes of death in 1900 accounted for only 64.2% along with many Catholics, who had come as early as 1634 under of all deaths in 1900, which indicates the difficulties in data Leonard Calvert, seeking religious freedom and life in the New collection before the development of public health systems.