The Genealogy Of Mass General

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By 1908 the self-criticism that eventually led to David Edsall’s appointment was under way. The senior medical staff realized that they must either reorganize so as to incorporate a strong program of research or else settle into a kind of quaint obscurity as the hospital remembered for the promotion of a discovery—ether anesthesia—made before the Civil War. The General might even lose its preeminence in Boston, for another hospital, the Peter Bent Brigham, was in the planning stages. The Brigham was to be built adjacent to Harvard Medical School and, like Johns Hopkins, it openly intended to recruit the best people it could from hospitals elsewhere in the country. Thus, in a letter to their trustees, the majority of Mass General’s “visiting physicians,” as the hospital’s doctors were called, advocated changing the system of appointments so as to bring in a full-time chief with a mandate to organize and advance clinical research. Within a year, David Edsall, from New Jersey by way of Philadelphia, was identified as the man they wanted.

When Edsall finally came, in 1912, the hospital was ready for him. He was able to work rapidly, and with remarkably little resistance, to make the changes he thought necessary. In part he simply opened the hospital to outsiders; graduates of medical schools other than Harvard were granted internships. In the meantime Edsall began to identify the most promising young men already at the hospital and to send them away for training in laboratories in Europe or elsewhere in America. Paul Dudley White, for example, was sent to England to study cardiology; he returned with a prototype of the electrocardiograph in his luggage (and many years later would serve as President Eisenhower’s cardiologist). When Mass General opened its luxury building for private patients (the Phillips House) in 1917, every room was equipped with its own electrocardiograph. In the same era, George R. Minot was sent to Europe to study blood. Two decades later he would share the Nobel Prize for his contribution to the treatment of pernicious anemia. Others of that generation went to study at Johns Hopkins, Rockefeller, or other institutions.

In 1913 J. Howard Means was dispatched to Copenhagen, where he studied the body’s conversion of oxygen to carbon dioxide with August Krogh, who was to receive a Nobel Prize seven years later for his work on the body’s handling of these vital gases. Means returned to Mass General and was put in charge of a machine designed to measure gas exchange. Located in a “small triangular room” that Edsall had managed to liberate for the purpose, this tiny laboratory became the hospital’s center for research on metabolism. By 1918 the metabolism laboratory had been assigned more spacious quarters, and Means had turned his attention primarily to diseases of the thyroid, which has a profound effect on metabolic rate. Studying metabolism in patients proved to be exceedingly complicated; the investigator required very accurate information about diet and often needed to obtain frequent samples of blood or body fluids. To do this, a special ward was opened in 1925 for patients undergoing metabolic studies. Named Ward 4, it became famous as a center for work on a variety of topics that required close monitoring of patients’ physiology.

 

The first patient in Ward 4 suffered from lead poisoning and was studied by Joseph Aub, one of the hospital’s first Jewish physicians, who was accepted as an intern immediately after Edsall’s arrival. Edsall had long been interested in occupational diseases, and he stimulated Aub’s interest in lead poisoning. Thus Aub used Ward 4 to explore the way in which the body’s handling of lead was related to its handling of calcium. One student of Aub’s, Fuller Albright, took up an investigation of bone disease and from there made fundamental contributions to the understanding of hormones and vitamins as well as to kidney research. Although Albright’s career was abruptly terminated nearly thirty years ago, when an experimental operation to relieve his Parkinson’s disease left him totally incapacitated, his name is still among the best known in American medicine. As Albright began studying bone, his contemporary Walter C. Bauer turned to the study of joints and arthritis. This work led to research on related inflammatory diseases and then to more basic studies of immunology, as it became apparent that rheumatoid arthritis and a group of related conditions appeared to result from a disordered immune response.

THUS, EACH OF THE research programs seeded by Edsall in the few years before World War I took hold and then branched into new ones as scientific problems revealed new complexities. At the outset the research tasks were defined mainly as practical and clinical ones; Edsall’s interest in industrial health, a major concern of the period, was reflected in his protégés’ work on lead poisoning. But as time went on, the work tended to be reoriented toward more “basic” problems, such as the body’s handling of calcium—knowledge that was needed to explain the reaction to toxic metals. By the middle of this century, many of the hospital’s laboratories were devoted to fundamental study of biochemistry, with little immediate relevance to patient care.