Mount Sinai Journal of Medicine

506 Pages·2000·43.6 MB·English

by  Mount Sinai Hospital (New York, N.Y.)

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OGNT JOURNAL
SINAI
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F MEDICINE
Si
/OLGME 67 NUMBER JANUARY 2000
1
THEME
ISSUE
GASTROENTEROLOGY AND HEPATOLOGY
AT THE MOUNT SINAI HOSPITAL 1852-2000
Parti
Jeremy Hugh Baron and Henry D. Janowitz, guest editors
CONTENTS
Introduction J.H. Baron and Henry D. Janowitz 2
—
1 The Mount Sinai Hospital A Brief History J.H. Baron 3
2 Gastroenterology and Hepatology as Subspecialties J.H. Baron 6
3 Morris Manges and Edmund Aronson J.H. Baron 9
4 Burrill B. Crohn (1884-1983) Henry D. Janowitz 12
5 AsherWinkelstein (1893-1972) Henry D. Janowitz 14
6 Franklin Hollander (1899-1966) J.H. Baron and Henry D. Janowitz 16
—
7 Gastroenterology and Hepatology The Diagnostic Data J.H. Baron 18
8 The Esophagus Ellen L. Wolf 25
9 Gastric Secretion J.H. Baron 32
continuedinside
SAINT BARNABAS Veterans
HEALTHCARESYSTEM
Affairs
TLJ
C* '^'le MountSinaiJournal ofMedicine is published by tine Mount Sinai Medical Center of New York and has the
1 following affiliates: Veterans Affairs Medical Center, Bronx, MY; Elnnhurst Hospital Center, Queens, NY;
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JOURNAL OF
MEDICINE
Editor-in-Chief Administrative Assistant
Sherman Kupfer, M.D. Ron Stein
Associate Editors Assistant Editor for Housestaff
Harriet S. Gilbert, M.D. Meredith F. Lash-Dardia, M.D.
Leslie A. Kuhn, M.D.
Kenneth V. Lieberman, M.D. Assistant Production Assistant
Julius Wolf, M.D. Mel Meyer
Assistant Editors
Scott H. Barnett, M.D. James H. Godbold, Ph.D. Lynda R. Mandell, M.D., Ph.D. Allan E. Rubenstein, M.D.
David H. Bechhofer, Ph.D. Richard S. Haber, M.D. Steven Markowitz, M.D. David B. Sachar, M.D.
Constantin A. Bona, M.D., Ph.D. Moam Harpaz, M.D. ArthurMaron, M.D.. M.P.A. Henry Sacks, M.D.
EdwardJ. Bottone. Ph.D. Tomas Heimann, M.D. Bernard Mehl, D.P.S. Ira Sanders. M.D.
James L. Breen. M.D. RobertV.P. Hutter, M.D. Myron Miller, M.D. Martin H. Savitz, M.D.
Donald Brief, M.D. FredM. Jacobs, M.D., J.D. Richard Panush, M.D. Clyde B. Schechter, M.D.
Daniel Buchbinder, D.M.D. M.D. Sheldon Jacobson, M.D. Barbara E. C. Paris, M.D. StuartC. Sealfon, M.D.
Lewis Burrows, M.D. Barry W. Jaffin. M.D. JeromeG. Porush, M.D. Michael Serby, M.D.
Christopher P, Cardozo, M,D. Joseph L. Kannry, M.D. Edward Raab, M.D. Phyllis Shaw, Ph.D.
Mark R. Chassin. M.D.. M.P.H., M.P.P. Suzanne Carter Kramer, M. Sc. Georges R. Ramalanjaona, M.D.. D.Sc. Alex Stagnaro-Green, M.D.
William H. Constad, M.D. Mark G. Lebwohl, M.D. ElliotJ. Rayfield, M.D. Barry D. Stimmel, M.D.
Joseph S, Eisenman. Ph,D. Philip S. Ledereich, M.D. Allan Reed, M.D. Nelson M. Stone, M.D.
Richard A. Frieden. M.D. Zvi Lefkowitz, M.D. Joshua Rosenblatt. M.D. Max Sung, M.D.
Frederick Friedman, M.D. Dana M. Lewis, M.L.S. Clive Rosendorff, M.D., Ph.D. JulesA. Titelbaum, M.D.
Steven Fruchtman, M.D. Tariq K. Malik, M.D., M.P.H. Fred Rosner, M.D. Richard P. Wedeen, M.D.
James M. Gladstone, M.D.
Editorial Board
Barry S. Coller, M.D. Charles K. McSherry, M.D. Arthur H. Rubenstein, M.B.B.Ch. Alvin S. Teirstein, M.D.
Barry Freedman, M.B.A. Jack G. Rablnowitz, M.D. Alan L. Schiller, M.D. Rosalyn S. Yalow, Ph.D.
Panayotis G. Katsoyannis, Ph.D. John W. Rowe, M.D.
TheMountSinaiJournalofMedicine (ISSN No. 0027-2507; GSPS 284-860) is published 6 times a year in January, March, May, Septembe
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THE
MOUNT SIMM JOGRNAL
Volume 67
Number
OF MEDICINE 1
January 2000
CONTENTS
continued
10 Acid Secretion after Gastric Operations J.H. Baron 37
11 The Gastric IVIucosal Barrier J. Lawrence Werther 41
12 Gastrointestinal Hormones Eugene Straus 54
13 Peptic Ulcer J.H. Baron 58
14 Treatments of Peptic Ulcer J.H. Baron 63
15 The Pancreas J.H. Baron 68
16 The History of Liver Disease atThe Mount Sinai Hospital
Fenton Schaffner 76
17 Alcohol and the Liver: Metabolism of Alcohol and Its Role in Hepatic and
Extrahepatic Diseases Charles S. Lieber 84
Information for Authors
i
Required Form for Authors C3
Introduction
JeremyHugh Baron. D.M..F.R.C.P., F.R.C.S.,
ANDHenryD. Janowitz, M.D.
This publication began as two independent ini- forces to co-edit this history of gastroenterology
tiatives. After Dr. Janowitz became Chief of and hepatology in time for the millennium in
Gastroenterology at The Mount Sinai Hospital in 2000 or the sesquicentenary of The Mount Sinai
1958. he made inflammatory bowel diseases the Hospital in 2002. We produced a list of topics,
main interest of the division. He had long wrote some chapters, and invited colleagues to
intended to write the history of this topic after he contribute their expertise. We express here our
retired as chief. Dr. Baron was a fellow in this gratitude to all of them and to our secretaries,
division in 1961 - 1962, and after he retired (in Sharon Nieman and Octavia Paul, for decipher-
1996) from his national health and university ser- ing the illegible scripts; Janine Kail, for the med-
vice in London, he decided to devote his energies ical records data; and Al Lyons, Richard Steele,
to the history of gastroenterology and to spend and Barbara Niss, the Mount Sinai archivists, for
his winters in New York. Therefore, we joined their skilled assistance.
2 ©TheMountSinaiJournalofMedicinbVol.67No. 1 January2()0()
1
The Mount Sinai Hospital
A
Brief History
Jeremy Hugh Baron, D.M., F.R.C.P.. F.R.C.S.
Abstract
In 1852, The Jews Hospital was founded for the increasing number ofJews in New York. It opened in 1855 with 45
bedsonWest28th Street; 92% ofthepatients were indigent. In 1864, thehospital fomially becamenonsectarian and, in
1866, changed its name toThe Mount Sinai Hospital. The medical staffwas primarily Jewish, because until relatively
recently, it was difficult forJewish doctors toobtain postgraduate training or specialist posts at major New York hospi-
tals. As the Jewish population moved uptown, so didThe Mount Sinai Hospital: in 1870 to 66th Street, and in 1904 to
100th Street, with 456 beds, growing with new buildings and services to the current 1 100 beds. 50,000 discharges,
400,000inpatientdaysand300,(XX)outpatientvisitseachyear.
Services increasingly became specialized, and then subspecialized. Key innovations includedthe choiceofinterns
by competitive examination (1872), an advisory Medical Board (1872), the Nurse Training School (1881), the library
(1883), the Alumni Association (1896), a professional medical hospital administrator (1903), research laboratories
(1904), clinicopathological conferences (1905), the Social Services Department (1906), postgraduate teaching programs
(1923), full-timechiefsofclinical services(1944), thededicationoftheMount Sinai School ofMedicine(1968),andthe
merger in 1998 into the Mount Sinai-New York University Medical Center. Key Words: Mount Sinai Hospital New
York,history
This chapter highlights some of the main Avenues, ground was broken in 1853, and The
events of the first hundred years of Mount Sinai Jews Hospital was opened May 17, 1855 with 45
(1-13). In the 1850s, the increasing population beds (2). The hospital's services were intended
of New York City, frequently subject to over- primarily for the indigent, and of the 216 patients
crowding, poverty and disease, signaled the need admitted in 1855- 1856 only 16 could pay (3).
for new hospitals to complement the older volun- In the 1852 Articles ofAssociation, the hospi-
tary ones (New York Hospital, 1771; Lincoln, tal was established for "medical and surgical aid
1839; St. Vincent's, 1849) and the older munici- to persons of the Jewish persuasion" (1 ) but from
pal institutions (Bellevue, City). The increasing the beginning accident cases were admitted from
number of Jews in New York (16,000) led the all ethnic groups. In 1862, the Jews Hospital
Hebrew Benevolent Society in 1850 to plan a admitted soldiers from the Civil War. The follow-
Jewish hospital. In 1852, they and the Young ing year, those injured during the Draft Riots
Men's Hebrew Association, the German Hebrew were admitted (4). In 1864, a formal nonsectarian
Benevolent Society, and the Assistance and policy was adopted, but this policy was not
Education Society formed Articles ofAssociation widely recognized (5). To emphasize this change
(1). Land was bought on the south side of then- in policy, the hospital was renamed, in 1866, The
rural West 28^^ Street between 7^^ and 8^^ Mount Sinai Hospital (5). Nevertheless, this
change did little to diminish the anti-Semitism
prevalent at the time.
In the 19th century and much of the 20th,
From the Dr. Henry D. Janowitz Division ofGastroenterology, Jews were not readily accepted into medical
MountSinai SchoolofMedicine,NewYork,NY.
Address correspondence to Dr. J.H. Baron, Division of schools (14). Moreover, it was more difficult for
Gastroenterology, Box 1069, Mount Sinai School of Medicine, them to obtain postgraduate training and even
OneEast l(X)th Street,NewYork,NY l(X)29-6574. more difficult to become specialists at a univer-
©ThkMountSinaiJournalofMedicineVol.67No. I January2000
4 THE MOUNTSINAI JOURNALOFMEDICINE January2000
sity hospital. Some medical schools did not take of time to contribute materially to the advance-
any Jews, while some ofthe better schools, su&ch as ment of neurological science. . . . Incidentally I
the College of Physicians and Surgeons ("P S") stressed the importance of the doctor looking
Medical School at Columbia University, had a neat, being scrupulously clean, using good
quota ofonly 10% Jewish students (14, 15). When English, and articulating distinctly."
Crohn qualified at P & S in 1906, he came to The In 1903, Mount Sinai appointed Dr. S.S.
Mount Sinai Hospital as an intern (16). When Goldwater as the first professional medical hospital
Janowitz qualified at P & S in 1939, second in his administrator in the U.S. (1). Dr. Goldwater main-
class, he was given a message that he should not tained that health was not a privilege but a right,
expect an internship at Columbia, but should con- and he fought throughout his long career in New
tact Dr. George Baehr at Mount Sinai, as should York to ensure that its citizens should be warm,
his friend (third in the class), whose "accent was well fed and sheltered. Under Dr. Goldwater's
too thick for the Harkness Pavilion" (16). administration. The Mount Sinai Hospital's Social
Some social exclusions were blatant. When Service Department was opened in 1906.
Crohn attended to a patient vacationing in a hotel The development of a medical school in The
in Maine, he could not spend the night there, and Mount Sinai Hospital took almost one hundred
when he went to an executive board meeting of years. In 1873 the Board was asked, but consid-
the AGA in Pittsburgh, he found that he alone was ered it not expedient then, to start a medical
lodged in a hotel because he could not stay with school. In 1908, when the decision was made to
the other board members at the Fort Duquesne take medical students from Bellevue and
Club (17, 18). When Winkelstein went to meet- Columbia, the titles of clinical professor of medi-
AGA
ings ofthe in the 1920s, he could not stay in cine and clinical surgery were awarded to senior
the main conference hotel (19). In 1962, I visited hospital staff. Clinical pathological conferences
Dr. Morton Grossman's department in Los were held occasionally from 1905 and regularly
Angeles and one day was invited to have lunch from 1919. Formal postgraduate teaching pro-
with Stuart Tuttle at his country club. Dr. grams began in 1923.
Grossman learned where I had visited and Research, too, flourished at Mount Sinai.
remarked that I had been entertained where Dr. When the Pathology Department was formally
Tuttle could never have taken him (20). instituted in 1906, the 15 staff members were all
As the Jewish population of New York pro- engaged not only in routine clinical testing but in
gressively moved uptown. The Mount Sinai "active research work in higher problems of
. . .
Hospital followed. In 1870, it relocated to modern medicine" (12). The philanthropist
Lexington Avenue between 66'^ and 67^^ Streets Adolph Lewisohn (a Mount Sinai Hospital trustee
(6), and then again in 1904 to Fifth Avenue at from 1898 to 1938) insisted that a first-rate hospi-
lOO'h Street (11). At the time of this second tal must be a first-rate research center; he there-
move. Mount Sinai had 456 beds. In 1855, the fore financed both with capital and revenue the
beds were divided into Medicine and Surgery. By laboratories built in 1904 and 1916. By 1923,
1875, when a separate outpatient dispensary was there were 22 professional laboratory staff mem-
opened, gynecology and pediatrics cases were bers. The laboratory directors became full-time
treated separately. From 1872. interns were cho- salaried employees in 1926, Klemperer for mor-
sen by a competitive examination and served two bid anatomy, Shwartzman for bacteriology and
years (8). The Association of the Alumni of The Heidelberger for chemical pathology. But there
Mount Sinai Hospital was created in 1896. The were also 60 volunteer researchers-clinicians who
Mount Sinai Training School for Nurses was maintained an active clinical practice, seeing
incorporated in 1881 (8). The medical library patients, but who also devoted more than 20
opened in 1883. The first medical adult sub-spe- hours per work to research (22, 23). They were
cialist, a dermatologist, was appointed in 1890, motivated by being associated with progress in
and a pathologist (Henry Heineman) and a neu- scientific medicine, which was thought to lead to
rologist (Bernard Sachs) in 1893 (10). a higher level of clinical care. They also knew
Sachs (21) enunciated the ethos of a Mount the Mount Sinai policy of promoting clinicians
Sinai Hospital specialty service: "The chiefaims with a scientific background. Thus, over its first
. . .
should be the considerate treatment of the patient, hundred years. The Mount Sinai Hospital evolved
making use of the most recent methods, the train- from a small community hospital into a major
ing of an adequate House Staff, and, above all, medical center which was recognized internation-
the development of a group of able associates and ally for its excellence in clinical care, research
assistants who would be certain in the course and postgraduate teaching.
. . .