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A history of the Ohio State University Department of Surgery
The American Journal of Surgery 186 (2003) 208 –210
Special article
A history of the Ohio State University Department of Surgery Robert M. Zollinger, Sr., M.D.*, E. Christopher Ellison, M.D. Department of Surgery, Ohio State University, 327 Means Hall, 1654 Upham Dr., Columbus, OH 43210-1250, USA Manuscript received April 30, 2003
Abstract Doctor Robert M. Zollinger wrote this piece prior to his death in 1992. He recounts the history of the Ohio State University Department of Surgery from the evolution of the Ohio State University College of Medicine to the years of the department’s reorganization and growth after World War II. © 2003 Excerpta Medica, Inc. All rights reserved. Keywords: Ohio State University; Zollinger; Zollinger-Ellison syndrome
Early years Today’s Ohio State University College of Medicine and Public Health, of which the Department of Surgery is a part, evolved from a succession of institutions established during the 19th century. In January 1847, the trustees and members of the faculty of the medical college of Willoughby University, in Willoughby, Ohio, moved to Columbus to establish a new school, which was called Willoughby Medical College of Columbus. Housed in a large, frame building in downtown Columbus, the college contained an amphitheater accommodating 150 students and a small room for the teaching of anatomy. During the college’s first year, 160 students attended, of whom 32 graduated and six received honorary degrees. Late in the same year, Lyne Starling, the uncle of Dr. Starling Loving of Columbus, Ohio, donated land in the center of the city and $35,000 to construct a new college hospital, which was called Starling Medical College. Two thirds of the building was assigned to St. Francis Hospital, which was operated by the Sisters of the Poor of St. Francis. During the almost 60 years of its existence, from 1847 to 1902, the college graduated 2,500 students. In 1875, Dr. John Hamilton, professor of surgery, and Dr. Starling Loving, professor of medicine, disagreed on the filling of a vacant faculty position at Starling Medical College. As a result, Dr. Hamilton resigned and was instrumental in establishing a new school, which was called Columbus * Corresponding author. Tel.: ⫹1-614-293-8701; fax: ⫹1-614-293-4063. E-mail address: [email protected]
Medical College. About 500 students were graduated from Columbus Medical College before differences were resolved, at the time of Dr. Hamilton’s death in 1892, and the faculty merged with that of Starling Medical College. In 1892, another medical school was established at Protestant Hospital, in a building erected on land donated by The Ohio State University. The school was named Ohio Medical University, and from 1892 to 1907, about 1,200 graduates received degrees there. On March 13, 1907, at a meeting of the Ohio Legislature, all properties of the Starling Medical College and the Ohio Medical University were transferred to a new corporation that established the Starling-Ohio Medical College. The new corporation included medical, dental, and pharmacy departments. Teaching took place at Protestant Hospital and St. Francis Hospital. On January 10, 1914, the trustees of the Starling-Ohio Medical College gave to the state of Ohio all its properties to found the College of Medicine of the Ohio State University, which was established on the south side of the campus. The first chief of the Department of Surgery was Dr. William Means, who served from 1914 to 1916. He was followed by Dr. Verne Dodd, who was acting head from 1917 to 1922, and Dr. Charles Hamilton, who was head from 1922 to 1926. Doctor Dodd became head of the department again in 1927. By 1933 there were two parallel but separate departments of surgery. Clinical surgery was directed by Dr. Dodd, who was noted for bedside teaching and who initiated plans for residency programs in specialties. Research surgery was directed by Dr. George Curtis, who was known for his research in thyroid and chest surgery and
0002-9610/03/$ – see front matter © 2003 Excerpta Medica, Inc. All rights reserved. doi:10.1016/S0002-9610(03)00225-3
R.M. Zollinger / The American Journal of Surgery 186 (2003) 208 –210
iodine metabolism. Doctor Dodd served as head of the department until 1947. Postwar reorganization In 1946 Dr. Robert Zollinger was appointed professor of surgery at Ohio State, with the understanding that he would assume leadership of the department after Dr. Dodd retired. Doctor Dodd gave Dr. Zollinger a free hand to begin recruiting personnel and developing the existing surgical specialties. The surgical service was small, and the residency program in surgery had been markedly curtailed during World War II. Under Dr. Curtis, the Department of Surgical Research made its own appointments, and its productivity in research became nationally recognized. After his appointment as chairman of the Department of Surgery in 1947, Dr. Zollinger reorganized the general surgical service along the lines developed by Dr. Harvey Cushing and Dr. Elliot Cutler, with whom Dr. Zollinger had worked as a resident and faculty member before World War II. The training program in general surgery was established as a five-year program, in keeping with the Halstead concept. A straight surgical internship was established, and a research program involving the house staff was incorporated into the program. The Department of Surgery was indebted to Dean Walter Krill of the College of Veterinary Medicine, who permitted the department to develop a small dog lab in a space formerly used for raising chickens. Somehow the space was made into a functioning research laboratory, and Dr. Clark Case was the first resident to spend a year in research. The Society of University Surgeons (SUS) met in Columbus in 1947, the year that Dr. Zollinger served as the society’s president. The residents working in the laboratory were unfailingly productive, making presentations to the SUS and other national surgical societies, and undoubtedly this experience inspired some to follow an academic career. One of the first faculty members recruited by Dr. Zollinger was Dr. Edwin Ellison, who had finished his surgical training in 1946. Doctor Ellison went on to become a major influence in the development of the academic department. The Department of Surgery could not have grown so rapidly without him. In 1948, in response to the need for more extensive medical facilities, construction of a new University Hospital building began. The first patient was admitted in 1951. Seven additions were built, and in 1976 the complex was named the James A. Rhodes University Hospital. In 1983 the Board of Trustees renamed the original building, the first six additions, and a portion of the seventh Charles Austin Doan Hall. Clinical research, especially related to nutrition, became the major thrust of the Department of Surgery. In 1949 members of the department developed interest in the pancreas. Because of the reputations of Dr. Doan and Dr. Bruce Wiseman in hematology, the surgical service was involved
209
with more than the usual number of splenectomies for various hematologic disorders. Both the Division of Pediatric Surgery, under Dr. H. William Clatworthy, and the Division of Urology, under Dr. William Taylor, were established in 1950. Separate services were established in orthopedic surgery, neurosurgery, and plastic surgery. Research Surgery was incorporated into the department as the Division of Thoracic Surgery, under Dr. Karl Klassen. The number of medical students rose to 150. The department gained international recognition. Doctor Clatworthy, a protege of Dr. Robert Gross of Boston, soon developed one of the outstanding training programs in the country. He became internationally known for his contributions, including mesocaval shunt for portal hypertension, which he presented to the Central Surgical Society in 1953. Doctor Curtis Artz, one of the first to complete a residency under Dr. Zollinger, became director of the United States Army Institute of Surgical Research in Texas and then chairman of the Department of Surgery at the University of South Carolina. Doctor Daniel Elliott had the background and the desire to perform original experimental work, even as a resident. His contributions to surgery of the pancreas were outstanding. After a period as clinical professor of surgery at the University of Pittsburgh, he was appointed chairman of the Department of Surgery at Wright State University School of Medicine, where he remained until his retirement in 1989. Doctor Artz, Dr. Elliott, and Dr. Ellison were elected to the American Surgical Association.
Zollinger-Ellison syndrome By 1954 sufficient time had elapsed to evaluate at least 100 patients who had radical gastric resection, suggested by Dr. Owen Wangensteen, for the control of gastric hypersecretion associated with ulcer resistant to medical therapy. Doctor Zollinger and Dr. Ellison reported on 100 or more gastric patients evaluated five years after operation, emphasizing the effects of extensive gastric resection on postoperative nutrition. Doctor Ellison had a patient with recurrent ulceration of the jejunum, which was resected several times. She continued to have excessive acidity, despite two gastric resections, and died after a total gastrectomy. Doctor Zollinger also had a patient who had two perforations of the jejunum and uncontrollable ulcer symptoms. She was found to be secreting 300 mEq of gastric acid during a 12-hour period. She underwent truncal vagotomy and proximal gastrectomy, but despite irradiation to the small gastric remnant, she continued to secrete volumes of gastric acid. Doctor Hilger Jenkins of Chicago suggested she might have an insulinoma. A total gastrectomy was performed. Several lymph nodes and a piece of the tail of the pancreas resected during the
210
R.M. Zollinger / The American Journal of Surgery 186 (2003) 208 –210
Fig. 1. Dr. Zollinger (front row, far left), Dr. William Pace (front row, far right), and other Department of Surgery staff pose on the steps of Starling-Loving Hall at Ohio State University in 1968.
procedure demonstrated tumor in the lymph nodes and a small pancreatic adenoma. Though pathologists differed, all agreed it was not an insulinoma. A syndrome was proposed implicating a pancreatic tumor producing a potent gastric secretagogue. Since all medication available at that time failed to control the hypersecretion, a total gastrectomy was advised as a lifesaving procedure. In 1960 Professors R.A. Gregory and Hilda Tracy of the University of Liverpool, England identified the secretagogue hormone as gastrin. Gradually other cases were documented throughout the world. The clinical syndrome continues to be called the Zollinger-Ellison syndrome, as suggested by Dr. Ben Eiseman of the University of Colorado. These tumors are now referred to as gastrinomas. Doctor Zollinger insisted that all presentations from the department be “packaged well,” which meant carefully prepared slides and editing of the article. Medical illustrator Fred Shepard and his staff provided the department with slides and illustrations that were recognized and appreciated as the “gold standard” of surgical presentations. In 1961 Dr. Zollinger, Dr. William Pace (Fig. 1), and George Kuenzle, chief of the School of Journalism, developed a paperback guide on making medical slides. Despite emphasis on scientific activity, patient care was equally emphasized. Residents called Dr. Zollinger every night at 9 o’clock with a report on postoperative and critically ill patients, including a long checklist of important physiologic parameters. The department developed and maintained an enviable reputation for clinical excellence. Over the years, the department was awarded numerous grants from the National Institutes of Health and other extra-
mural granting agencies. One of the first involved early recognition of colon cancer. Doctor Harvey Knoernshield, later of the University of California, and Dr. A.B. Cameron, later of Harvard, were recipients of these fellowships. Polyps of the colon were tagged and later observed in an effort to evaluate the rate of growth and the potential for malignancy. In 1967 Dr. Ronald Tompkins, Professor D.G. Cornwell, and others published a paper on the role of phospholipids in the formation of human gallstones. Doctor Tompkins continued these studies at the UCLA Department of Surgery, as well as studies concerned with identification of the hormone associated with diarrheagenic endocrine tumors of the pancreas. Doctor Edward Passaro made many original observations on gastrinoma at the Veterans Administration Hospital in Los Angeles. His observations contributed to better procedures for the diagnosis, localization, and treatment of the gastrinoma. The department hosted visiting surgeons from abroad. Doctor J. E. Murat of France was a productive investigator during the time he was in the laboratory. Doctor Colin Howe of England spent a year working in association with Dr. Elliott. In 1974, after 28 years in the department, Dr. Zollinger retired. He remained active as professor emeritus of surgery until his death in 1992. Acknowledgments Photograph from the collections of the Medical Heritage Center, Prior Health Sciences Library, Ohio State University, Columbus, Ohio.
Special article
A history of the Ohio State University Department of Surgery Robert M. Zollinger, Sr., M.D.*, E. Christopher Ellison, M.D. Department of Surgery, Ohio State University, 327 Means Hall, 1654 Upham Dr., Columbus, OH 43210-1250, USA Manuscript received April 30, 2003
Abstract Doctor Robert M. Zollinger wrote this piece prior to his death in 1992. He recounts the history of the Ohio State University Department of Surgery from the evolution of the Ohio State University College of Medicine to the years of the department’s reorganization and growth after World War II. © 2003 Excerpta Medica, Inc. All rights reserved. Keywords: Ohio State University; Zollinger; Zollinger-Ellison syndrome
Early years Today’s Ohio State University College of Medicine and Public Health, of which the Department of Surgery is a part, evolved from a succession of institutions established during the 19th century. In January 1847, the trustees and members of the faculty of the medical college of Willoughby University, in Willoughby, Ohio, moved to Columbus to establish a new school, which was called Willoughby Medical College of Columbus. Housed in a large, frame building in downtown Columbus, the college contained an amphitheater accommodating 150 students and a small room for the teaching of anatomy. During the college’s first year, 160 students attended, of whom 32 graduated and six received honorary degrees. Late in the same year, Lyne Starling, the uncle of Dr. Starling Loving of Columbus, Ohio, donated land in the center of the city and $35,000 to construct a new college hospital, which was called Starling Medical College. Two thirds of the building was assigned to St. Francis Hospital, which was operated by the Sisters of the Poor of St. Francis. During the almost 60 years of its existence, from 1847 to 1902, the college graduated 2,500 students. In 1875, Dr. John Hamilton, professor of surgery, and Dr. Starling Loving, professor of medicine, disagreed on the filling of a vacant faculty position at Starling Medical College. As a result, Dr. Hamilton resigned and was instrumental in establishing a new school, which was called Columbus * Corresponding author. Tel.: ⫹1-614-293-8701; fax: ⫹1-614-293-4063. E-mail address: [email protected]
Medical College. About 500 students were graduated from Columbus Medical College before differences were resolved, at the time of Dr. Hamilton’s death in 1892, and the faculty merged with that of Starling Medical College. In 1892, another medical school was established at Protestant Hospital, in a building erected on land donated by The Ohio State University. The school was named Ohio Medical University, and from 1892 to 1907, about 1,200 graduates received degrees there. On March 13, 1907, at a meeting of the Ohio Legislature, all properties of the Starling Medical College and the Ohio Medical University were transferred to a new corporation that established the Starling-Ohio Medical College. The new corporation included medical, dental, and pharmacy departments. Teaching took place at Protestant Hospital and St. Francis Hospital. On January 10, 1914, the trustees of the Starling-Ohio Medical College gave to the state of Ohio all its properties to found the College of Medicine of the Ohio State University, which was established on the south side of the campus. The first chief of the Department of Surgery was Dr. William Means, who served from 1914 to 1916. He was followed by Dr. Verne Dodd, who was acting head from 1917 to 1922, and Dr. Charles Hamilton, who was head from 1922 to 1926. Doctor Dodd became head of the department again in 1927. By 1933 there were two parallel but separate departments of surgery. Clinical surgery was directed by Dr. Dodd, who was noted for bedside teaching and who initiated plans for residency programs in specialties. Research surgery was directed by Dr. George Curtis, who was known for his research in thyroid and chest surgery and
0002-9610/03/$ – see front matter © 2003 Excerpta Medica, Inc. All rights reserved. doi:10.1016/S0002-9610(03)00225-3
R.M. Zollinger / The American Journal of Surgery 186 (2003) 208 –210
iodine metabolism. Doctor Dodd served as head of the department until 1947. Postwar reorganization In 1946 Dr. Robert Zollinger was appointed professor of surgery at Ohio State, with the understanding that he would assume leadership of the department after Dr. Dodd retired. Doctor Dodd gave Dr. Zollinger a free hand to begin recruiting personnel and developing the existing surgical specialties. The surgical service was small, and the residency program in surgery had been markedly curtailed during World War II. Under Dr. Curtis, the Department of Surgical Research made its own appointments, and its productivity in research became nationally recognized. After his appointment as chairman of the Department of Surgery in 1947, Dr. Zollinger reorganized the general surgical service along the lines developed by Dr. Harvey Cushing and Dr. Elliot Cutler, with whom Dr. Zollinger had worked as a resident and faculty member before World War II. The training program in general surgery was established as a five-year program, in keeping with the Halstead concept. A straight surgical internship was established, and a research program involving the house staff was incorporated into the program. The Department of Surgery was indebted to Dean Walter Krill of the College of Veterinary Medicine, who permitted the department to develop a small dog lab in a space formerly used for raising chickens. Somehow the space was made into a functioning research laboratory, and Dr. Clark Case was the first resident to spend a year in research. The Society of University Surgeons (SUS) met in Columbus in 1947, the year that Dr. Zollinger served as the society’s president. The residents working in the laboratory were unfailingly productive, making presentations to the SUS and other national surgical societies, and undoubtedly this experience inspired some to follow an academic career. One of the first faculty members recruited by Dr. Zollinger was Dr. Edwin Ellison, who had finished his surgical training in 1946. Doctor Ellison went on to become a major influence in the development of the academic department. The Department of Surgery could not have grown so rapidly without him. In 1948, in response to the need for more extensive medical facilities, construction of a new University Hospital building began. The first patient was admitted in 1951. Seven additions were built, and in 1976 the complex was named the James A. Rhodes University Hospital. In 1983 the Board of Trustees renamed the original building, the first six additions, and a portion of the seventh Charles Austin Doan Hall. Clinical research, especially related to nutrition, became the major thrust of the Department of Surgery. In 1949 members of the department developed interest in the pancreas. Because of the reputations of Dr. Doan and Dr. Bruce Wiseman in hematology, the surgical service was involved
209
with more than the usual number of splenectomies for various hematologic disorders. Both the Division of Pediatric Surgery, under Dr. H. William Clatworthy, and the Division of Urology, under Dr. William Taylor, were established in 1950. Separate services were established in orthopedic surgery, neurosurgery, and plastic surgery. Research Surgery was incorporated into the department as the Division of Thoracic Surgery, under Dr. Karl Klassen. The number of medical students rose to 150. The department gained international recognition. Doctor Clatworthy, a protege of Dr. Robert Gross of Boston, soon developed one of the outstanding training programs in the country. He became internationally known for his contributions, including mesocaval shunt for portal hypertension, which he presented to the Central Surgical Society in 1953. Doctor Curtis Artz, one of the first to complete a residency under Dr. Zollinger, became director of the United States Army Institute of Surgical Research in Texas and then chairman of the Department of Surgery at the University of South Carolina. Doctor Daniel Elliott had the background and the desire to perform original experimental work, even as a resident. His contributions to surgery of the pancreas were outstanding. After a period as clinical professor of surgery at the University of Pittsburgh, he was appointed chairman of the Department of Surgery at Wright State University School of Medicine, where he remained until his retirement in 1989. Doctor Artz, Dr. Elliott, and Dr. Ellison were elected to the American Surgical Association.
Zollinger-Ellison syndrome By 1954 sufficient time had elapsed to evaluate at least 100 patients who had radical gastric resection, suggested by Dr. Owen Wangensteen, for the control of gastric hypersecretion associated with ulcer resistant to medical therapy. Doctor Zollinger and Dr. Ellison reported on 100 or more gastric patients evaluated five years after operation, emphasizing the effects of extensive gastric resection on postoperative nutrition. Doctor Ellison had a patient with recurrent ulceration of the jejunum, which was resected several times. She continued to have excessive acidity, despite two gastric resections, and died after a total gastrectomy. Doctor Zollinger also had a patient who had two perforations of the jejunum and uncontrollable ulcer symptoms. She was found to be secreting 300 mEq of gastric acid during a 12-hour period. She underwent truncal vagotomy and proximal gastrectomy, but despite irradiation to the small gastric remnant, she continued to secrete volumes of gastric acid. Doctor Hilger Jenkins of Chicago suggested she might have an insulinoma. A total gastrectomy was performed. Several lymph nodes and a piece of the tail of the pancreas resected during the
210
R.M. Zollinger / The American Journal of Surgery 186 (2003) 208 –210
Fig. 1. Dr. Zollinger (front row, far left), Dr. William Pace (front row, far right), and other Department of Surgery staff pose on the steps of Starling-Loving Hall at Ohio State University in 1968.
procedure demonstrated tumor in the lymph nodes and a small pancreatic adenoma. Though pathologists differed, all agreed it was not an insulinoma. A syndrome was proposed implicating a pancreatic tumor producing a potent gastric secretagogue. Since all medication available at that time failed to control the hypersecretion, a total gastrectomy was advised as a lifesaving procedure. In 1960 Professors R.A. Gregory and Hilda Tracy of the University of Liverpool, England identified the secretagogue hormone as gastrin. Gradually other cases were documented throughout the world. The clinical syndrome continues to be called the Zollinger-Ellison syndrome, as suggested by Dr. Ben Eiseman of the University of Colorado. These tumors are now referred to as gastrinomas. Doctor Zollinger insisted that all presentations from the department be “packaged well,” which meant carefully prepared slides and editing of the article. Medical illustrator Fred Shepard and his staff provided the department with slides and illustrations that were recognized and appreciated as the “gold standard” of surgical presentations. In 1961 Dr. Zollinger, Dr. William Pace (Fig. 1), and George Kuenzle, chief of the School of Journalism, developed a paperback guide on making medical slides. Despite emphasis on scientific activity, patient care was equally emphasized. Residents called Dr. Zollinger every night at 9 o’clock with a report on postoperative and critically ill patients, including a long checklist of important physiologic parameters. The department developed and maintained an enviable reputation for clinical excellence. Over the years, the department was awarded numerous grants from the National Institutes of Health and other extra-
mural granting agencies. One of the first involved early recognition of colon cancer. Doctor Harvey Knoernshield, later of the University of California, and Dr. A.B. Cameron, later of Harvard, were recipients of these fellowships. Polyps of the colon were tagged and later observed in an effort to evaluate the rate of growth and the potential for malignancy. In 1967 Dr. Ronald Tompkins, Professor D.G. Cornwell, and others published a paper on the role of phospholipids in the formation of human gallstones. Doctor Tompkins continued these studies at the UCLA Department of Surgery, as well as studies concerned with identification of the hormone associated with diarrheagenic endocrine tumors of the pancreas. Doctor Edward Passaro made many original observations on gastrinoma at the Veterans Administration Hospital in Los Angeles. His observations contributed to better procedures for the diagnosis, localization, and treatment of the gastrinoma. The department hosted visiting surgeons from abroad. Doctor J. E. Murat of France was a productive investigator during the time he was in the laboratory. Doctor Colin Howe of England spent a year working in association with Dr. Elliott. In 1974, after 28 years in the department, Dr. Zollinger retired. He remained active as professor emeritus of surgery until his death in 1992. Acknowledgments Photograph from the collections of the Medical Heritage Center, Prior Health Sciences Library, Ohio State University, Columbus, Ohio.