History of the Department of Medicine

For the past ninety years, the Department of Medicine has had a rich heritage which is extremely important, not only to the University and the State of Indiana, but also to the academic medical scene in the entire country and indeed in the world. The individuals and events depicted in the following narrative are very brief synopses of the total history of the department. We have attempted to compile milestones, breakthroughs, and major organizations programs; we fully realize none of these would have been possible without the daily endeavors of our faculty and staff, both present and past.

From very humble beginnings, the School was established on the Bloomington campus in 1903. Dr Allison Maxwell was made the first dean in 1909. From 1911 to 1932, Dr. Charles P. Emerson was the first chairman of the department and was also Dean of the School. He was a graduate of Johns Hopkins University School of Medicine and did his internship there under Sir William Osler who encouraged him to spend several years studying in Europe. Many of the current buildings were dedicated during his time frame - Long Hospital (now named Emerson Hall), Riley Hospital, Coleman Hospital, Ball Residence. Dr. Emerson knew that in certain illnesses a change of occupation with the accompanying social readjustment was a necessary part of therapy, and of work on medical social service was begun in the School. Two major programs were initiated at Indianapolis City Hospital (now Wishard Memorial Hospital):

  1. Near the end of World Was I, a heart program was established (the Krannert Institute of Cardiology is an outgrowth of this early program
  2. The Lilly Laboratory for Clinical Research was established in 1926.

There were very few full-time faculty in the department; clinical teaching and patient care was the part-time responsibility of the town internists, pediatricians, and surgeon; no "true" clinical research or clinical research laboratories exited on campus. Dr. Emerson's private practice was located in the Hume-Mansur Building downtown. In 1923 he was President of the Association of American Medical Colleges. He became nationally known as an internist and author of many important books, the best known probably being his Textbook of Medicine.

 

In 1918 there were four medicine residents, one of whom was Dr. James O. Ritchey. He became chairman of the department in 1932. Under his leadership the department developed an important regional role in teaching medical students and in training most of the internist who would go on to practice internal medicine in Indiana. The Clinical Building was erected and the Laboratory Science Building (now Fesler Hall) was received from the State Board of Health. Dr. Ritchey also was in private practice downtown and was not paid by the University for his service as chairman. Dr. Glenn W. Irwin, Jr., joined the full-time faculty in 1950. Dr. Robert J. Rohn joined the faculty in that same year on a half-time basis to head the establishment of a hematology research laboratory, serving both the adult and pediatric populations of the Center; the other half was spent with private patients here as well as St. Vincent and Methodist Hospitals. In 1953 Dr. Charles Fisch became the founding director of the Krannert Institute of Cardiology, known then as the Robert M Moore Heart Clinic established by Mr. And Mrs. Herman C. Krannert. Drs. George Lukemeyer and Robert Failey traveled to Boston in 1953 to view an artificial kidney at Peter Bent Brigham Hospital built by John Merrill Laboratory. One was purchased for use here and, under the direction of Dr. Lukemeyer and assisted by Dr. Hunter Soper, the first patient began hemodialysis treatment in the summer of 1954.

When Dr. Ritchey retired in 1956, a search was held for a full-time chairman. During this interim Dr. Glenn W. Irwin, Jr., was appointed acting chairman and served in this capacity until 1958. The chosen candidate was Dr. William M. M. Kirby who served from April to June 1957. He was from the University of Washington in Seattle and was hired by Dean John D. Van Nuys at a salary of $22,000 annually and with an operational budget of $141,800. It is reported that he became frustrated and disappointed in attempting to implement his programs due to the slowness of administrative channels. Dean Van Nuys later wrote him an apology for the lack of funding he had anticipated but didn't receive from the General Assembly - $12,000. However, Dr. Kirby did accomplish the assigning of Dr. Roy H. Behnke to the Veterans Hospital as chief of the medicine service, thus beginning the combined program between VA and University Hospitals concerning the instruction of house staff and students.

Dr. John B. Hickam was recruited from Duke University to head the department in 1958. Under his leadership the department grew dramatically and began to excel in academic areas as well as in teaching. On a School-wide note, classes were moved from Emerson Hall to the new Medical Sciences Building (subsequently named for Dean Van Nuys) and the entire medical school program was brought together at the Medical Center campus; remodeling of the old medical school building was completed and renamed Emerson Hall; Phase I of University Hospital was occupied; the Indiana Statewide Medical Education System was instituted by incorporating first-and, later, second-year students on eight campus location. Dr. Hickam had a major impact on developing the latter before his untimely death in 1970.

In addition to establishing a centralized department, he was very instrumental in fostering not only the research activities, but also by introducing the General Practice Preceptorship, revising the medical school's curriculum, and by integrating residencies at the VA, City and University Hospitals. In his tenure, the department grew from less than 10 full-time faculty members to about 70. Grant funding was almost non-existent in 1958; by 1970 the department's grants totaled approximately $2.3 million.

 

The divisions were not formally established as they are currently, but he recruited the following: Dr. Philip A. Christiansen in 1958 began the first training program in gastroenterology in the state and was also the first division to be organized across the three hospitals; Dr. William P. Deiss, Jr., headed the endocrinology division in that same year and was succeeded by Dr. C. Conrad Johnston, Jr., in 1968; in 1961 Dr. Charles Fisch became director of the cardiology division; and in 1967, Dr. Arthur C. White was recruited to start infectious diseases and Stuart A. Kleit began the nephrology division. Dr. Hickam brought with him from Duke University in 1958 a U.S. Public Health Service Research Fellow, Dr. Joseph C. Ross, who later became Director of the Pulmonary Disease Division and Pulmonary Laboratory.

At the time of his death in 1970, Dr. Hickam had the primary responsibility for developing the new education and service affiliation between the School of Medicine and Marion County General Hospital. Plans had also been formed to move the chairman's office from Emerson Hall to Marion County General Hospital, but this was never finalized.

Dr. Walter J. Daly was chairman from 1970 until he became Dean of the School in 1983. Shortly after becoming chairman, he appointed Dr. David R. Challoner as Assistant Chairman to administer the house staff program. Dr. Joseph J. Mamlin, who had joined the faculty in 1968, became Chief of Medicine at Wishard Memorial Hospital (the called Marion County General Hospital) in 1971. Research continued to grow: a Specialized Center for Research (SCOR) in Hypertension was established by Dr. James T. Higgins in 1971 — the first of four established by the NIH; the Rheumatology Division was formed in 1975 under Dr. Kenneth D. Brandt; the Diabetes Research and Training Center was funded in 1977, one of five such centers in the nation; and Dr. Ronald Hoffman succeeded Dr. Rohn as Director of the Hematology/Oncology Division and a major expansion began. One of the most notable research projects in this decade occurred in 1976 when Dr. Lawrence H. Einhorn presented the findings of his research on testicular cancer. The first patient was treated with these new techniques in 1974. The "Einhorn Regimen" is now the standard protocol for the treatment of testicular cancer in this country and beyond with a 95% cure rate in a here-to-fore uniformly fatal disease.

The department's practice plan, University Medical Diagnostic Associates, was incorporated in 1971. Interestingly enough, this evolved from an executive physical program set up by Dr. Hickam for Sam Regenstrief's Design and Manufacturing Corporation (D & M). Under Dr. Daly's leadership the faculty had grown from approximately 70 full-time faculty to 130, the house staff and fellows from 95 to 140, and research funding grew to approximately $8.1 million. During Dr. Daly's term Dr. Philip J. Snodgress succeeded Dr. Behnke as Chief of Medicine at the Veterans Hospital 1983 and Dr. Richard E. Brashear was named to replace Dr. Joseph C. Ross as head of Pulmonary Division.

It is difficult to discern when discrete divisions started because there is no sharp delineation in time. There were appointed directors of each division since Dr. Hickam's time, but no separate chiefs in each of the three hospitals. As the number of faculty and staff increased, it seemed logical to begin de-centralization of many functions from the chairman's office to the divisions and to meet regularly to discuss areas of concern. Dr. Daly accelerated this process.

 

When Dr. Daly became Dean in 1983, Dr. August M. Watanabe became chairman. The department continued to grow and excel with new research and service. The Bone Marrow Transplant Unit was established in 1984; a cardiac transplantation program was established with the Department of Surgery and the Alcohol research Center was funded, both in 1986; the Walther Oncology Center was established a year later, as well as the Specialized Center of Research in Osteoarthritis; the liver transplantation program was begun with the Department of Surgery in 1988. Grant formed: Clinical Pharmacology in 1986 under Dr. D. Craig Brater; and Biostatistics formally became a separate division in 1988 (Dr. Siu L. Hui had joined the faculty in 1981). There were a number of changes in the divisions chiefs: Dr. Lawrence Lumeng followed Dr. Christiansen in the Gastroenterology Division in 1984; in 1988 Dr. T. Dwight McKinney succeeded Dr. Kleit in the Nephrology Division, Dr. Robert B. Jones replaced Dr. White in Infectious Diseases, and Dr. William J. Martin II became director of the Pulmonary Division; Dr. Charles Fisch retired as Director of Cardiology in 1990 and was followed by Dr. David R. Hathway.

Two major health-care entities were incorporated into the School in order to sustain a referral base needed for teaching and research: University Health Care, Inc in 1986 with a focus on primary care and Indiana University Health-Care Associates, Inc. in 1987 for managed care. The department underwent a major review and reconstruction in 1986 with the establishment of a finance area and its first Chief Operating Officer, Charles F. Fox, Jr. At the same time Dr. Watanabe organized Associate Chairs for Post Graduate Medical Education, Undergraduate Medical Education, and Clinical Affairs.

 

An agreement between the IU Department of Medicine and Moi University in Eldoret, Kenya was signed in 1990 to establish teaching programs and elective rotations for students and house staff. When Dr. Watanabe accepted a position at Eli Lilly and Company in May of 1990, the faculty had grown to approximately 200 and the resident and fellows to about the same.

Dr. D. Craig Brater has been the current chairman since 1990. Since that time there have been substantial changes in the junior core curriculum as well as the house staff program. The department continued to grow with $24.8 million in research grants in 1992. A joint venture with the Indiana Regional Cancer Center at Community Hospitals of Indianapolis to establish an autologous bone marrow transplant unit began in 1991. In that same year, a lung transplant program was developed. Outreach clinics were established both by University Health Care and by Wishard Memorial Hospital to better deliver primary health care to the community. In 1992 the University Hospital adult Ambulatory Care Center was opened. Seed funding was also secured for a Cancer Research Building and for a Cancer Treatment Building and to build a nursing home (chronic care facility) as part of Wishard Memorial Hospital. At this point in time, we have trained approximately 75% of the internists practicing in Indiana.

The department has grown exponentially since its inception. Its success at a truly international level represents the cumulative efforts of a faculty dedicated to the tripartite mission of the Department. We are justifiably proud of those who preceded us and left a challenge for the future.

 


During its more than 100 year history, the Department of Medicine has excelled

under the leadership of the following individuals:

 

Charles Emerson, M.D., the first chairman, trained at Johns Hopkins University under Sir William Osler. During his term in office (1911-1932), Emerson Hall, Long Hospital, Riley Hospital, and Coleman Hospital were constructed. Clinical teaching and patient care were the part-time responsibility of the town internists, pediatricians, and surgeons. Indianapolis City Hospital (the predecessor of Marion County General Hospital, later renamed Wishard Memorial Hospital) was the home of the predecessor of the Krannert Institute of Cardiology, as well as the Lilly Laboratory for Clinical Research.

 

James O. Ritchey, M.D. served as a resident at the Indianapolis City Hospital in 1918 during the influenza pandemic. He served as chair from 1932-1956. The Clinical Building was erected and the Laboratory Science Building (now Fesler Hall) was added to the School. During Ritchey's tenure, Drs. Glenn W. Irwin, Jr. (Endocrinology) and Robert J. Rohn (Hematology) joined the faculty, Dr. Charles Fisch became the founding director of the Krannert Institute of Cardiology, and Dr. George Lukemeyer introduced hemodialysis to the campus.

 

John B. Hickam, M.D. was recruited from Duke University to head the department from 1958 until his death in 1970. Medical school classes were moved from Emerson Hall to the new Medical Sciences Building, and phase I of University Hospital was completed during his tenure. The department grew from fewer than 10 full-time faculty members to about 70; the residency programs at the VA, University, and Marion County General Hospital were consolidated. Dr. Hickam created specialty divisions led by Dr. Philip A. Christiansen (Gastroenterology), Dr. Conrad Johnston, Jr. (Endocrinology), Dr. Arthur C. White (Infectious Diseases), Dr. Stuart A. Kleit (Nephrology), and Dr. Joseph C. Ross (Pulmonary Diseases). Grant funding was almost non-existent in 1958; by 1970 the department's grants totaled approximately $2.3 million, and the Regenstrief Institute for Health Care was established.

 

Walter J. Daly, M.D. succeeded Dr. Hickam, serving from 1970-1983. Important leadership positions were taken by Dr. Joseph J. Mamlin (General Internal Medicine), Dr. Kenneth Brandt (Rheumatology), Dr. Philip J. Snodgrass (Chief of Medicine/Veterans Hospital), Dr. Richard E. Brashear (Pulmonary), and Dr. Ronald Hoffman (Hematology/Oncology). The Diabetes Research and Training Center was funded in 1977. Under Dr. Daly's leadership the faculty grew from 70 full-time faculty to 130, the house staff and fellows from 95 to 140, UMDA was created, and research funding grew to approximately $8.1 million.

 

August M. Watanabe, M.D. served as chairman from 1983-1990. The bone marrow and liver transplant programs were initiated; the Alcohol Research Center, the Specialized Center of Research in Osteoarthritis, and the Sexually Transmitted Diseases Center were funded. The Medical Research and Library Building was completed in 1989. New leaders in the department included Dr. D. Craig Brater (Clinical Pharmacology), Dr. Siu Hui (Biostatistics), Dr. Lawrence Lumeng (Gastroenterology), Dr. T. Dwight McKinney (Nephrology), Dr. Robert B. Jones (Infectious Diseases), Dr. William J. Martin II (Pulmonary), and Dr. David R. Hathaway (Cardiology). University Health Care, Inc, the predecessor of IUMG-PC was created. Our research funding reached $25 million.

 

D. Craig Brater, M.D. was selected as chair in 1990, serving until 2000. New leaders were appointed in many divisions: Dr. Bruce Molitoris (Nephrology), Dr. Douglas Zipes (Cardiology), Dr. Stan Spinola (Infectious Diseases), Dr. Ted Gabig (Hematology/ Oncology), Dr. Alain Baron (Endocrinology), Dr. Barry Katz (Biostatistics), Dr. William Tierney (General Internal Medicine), and Dr. George Sarosi (Chief of Medicine/Veterans Hospital). IUMG-PC built its system of health centers through out Central Indiana, and IUMG-Specialty Care centralized contract negotiations and information technology among the clinical departments in the school. The School received National Cancer Institute Clinical Cancer Center designation. The Indiana Center for Vascular Biology and Medicine was established. Clarian Health Partners consolidated the management of the Riley, Methodist, and University Hospitals. Research funding grew dramatically, from $25 to $39 million, and the NIH ranking of the department reached the mid teens.