School of Tropical and Preventive Medicine - History

School of Tropical and Preventive Medicine - History

From LLU website

http://www.llu.edu/centennial/1940.html

Centennial timeline: 1940s 1948 - April 1 - School of Tropical and Preventive Medicine opens.



http://www.llu.edu/news/scope/scope_story.php?id=478&date=

The emergence of research: Historical insights from the emergence of research at Loma Linda University By Barry L. Taylor, PhD

The emergence of research: Historical insights from the emergence of research at Loma Linda University
By Barry L. Taylor, PhD

The train station at the base of “The Hill Beautiful” was the first view of Loma Linda for many passengers that got off there.

After the Santa Fe railroad reached Los Angeles in 1887, many new settlers from the East and Midwest came in search of a better lifestyle, health, and riches. A group of businessmen and physicians established a health resort on the hill at Loma Linda with the goal that it would be one of the finest health resorts among the many developing in Southern California.¹

The resort struggled and then failed and was offered for sale at a discounted price of $110,000. Ellen G. White, a founder of the Seventh-day Adventist Church, had seen in a dream a very attractive property on a hill that she envisioned as a health center for the Adventist Church. She was in touch with a minister, John A. Burden, and asked him to look out for such a property in Southern California. It was Pastor Burden who found the Loma Linda property that was for sale, and later Ellen G. White said that this was the property she had seen in her dream.

When the price of the 76-acre Loma Linda property dropped to $40,000, Pastor Burden received conflicting advice. Without spending time to consult Church leaders, Ellen G. White advised, “Secure the property by all means, so that it can be held and then obtain all the money you can and make sufficient payments to hold the place. This is the very property we ought to have. Do not delay; for it is just what is needed. … We will do our utmost to help you raise the money.” However, Church leaders meeting in Washington, D.C., sent Pastor Burden a wire saying, “Developments here warrant advising do not make deposit on sanitarium.”¹

Pastor Burden accepted the advice of Ellen G. White and personally borrowed $1,000 for the deposit that secured the property, knowing that $4,000 was due to be paid one month later, and a

Loma Linda’s first nursing class admires the newly-arrived Richard Edward Abbott.

nother $5,000 after two months. No one knew where that money would come from; but when the payments came due, the Church received unexpected donations that were just sufficient for the payments. Clearly God was leading.

The pre-research era: 1905–1922

To understand the history of research at Loma Linda University you must recognize this historical context. The Adventist Church sought to establish a major health center and a heath-related educational institution without the necessary resources. They were inspired by faith that God was leading, but it was a constant struggle and the survival of the institution was often in doubt. On top of that, the Seventh-day Adventist denomination was organized only 40 years before purchasing the Loma Linda property. The Church was on fire with a mission to save the world—a mission that included a strong emphasis on training medical missionaries to serve the evangelistic goals of the Church. Research was not considered relevant to this. The faculty had little background in traditional academic research that was characteristic of major historic universities.

The School of Nursing was the first educational program, followed in 1909 by a charter from the state of California for the College of Medical Evangelists. This established a school of medicine, but no research. The new medical school received a class C rating from the American Medical Association accrediting body in 1915, which made the students’ diplomas of little value. This was upgraded to a class B rating in 1917, still with heavy criticism of the qualifications of the faculty.^1,3

The era of freedom to do research: 1922–1951

I

Elder John A. Burden was one of the few that believed, as Ellen White did, that Loma Linda would one day become a successful educational institution.

n this research era, medical missionary training was still the main activity, but accrediting agencies began to mandate that the fledgling medical school make plans to include research as a component of the CME academic program. As a result, individual faculty members who were passionate about research, and able to do it with minimal resources, were given the freedom to add research to their busy schedules. Some faculty members made notable research contributions.

Newton G. Evans, MD, president of the College of Medical Evangelists from 1914 to 1927, was a graduate of Cornell University School of Medicine, and he and others recognized the importance of sending Adventist young people for training in major universities. As the quality of the faculty improved, CME received the much desired class A rating in 1922. But in the letter from the Council on Medical Education and Hospitals, research was identified as an area for improvement. “You are undoubtedly already fully familiar with the fact that improvements can be made with great advantage in the following particulars: … the making of adequate provision whereby medical research can be carried on.”

Between 1930 and 1940, pressure to improve research continued to come from accreditation requirements. Fred Zapffe, MD, of the American Medical Colleges criticized CME for the lack of credible research programs: “It is the function of every medical school to teach and to do research, and I may add, to care for the sick in its hospitals. A teacher who has not been bitten by the research bug is not a real teacher. He merely passes on what he has read, which is not real education at all. Such teaching is being discouraged and even condemned more and more.”

Pressure also came from a group of alumni w

Newton G. Evans, MD, president of College of Medical Evangelists from 1914–1927, was also known for his
research in pathology.

ho formed the Harveian society to advocate for reform at CME. Percy T. Magan, MD, dean of the School of Medicine, summarized attitudes to research in a letter to A.G. Daniells, a church leader, by stating, “I have never felt that I could conscientiously and fairly, in view of the interest of the school, take a position that we would do no research work, but in a way I have looked upon this much the same … as I have looked upon accrediting with these worldly organizations. I have felt that it would undoubtedly be necessary to try to do a little along this line in order to keep the peace and keep our school from getting into trouble with the men who are at the helm of things medical in the United States. Nevertheless, in my soul I have had very little regard and fondness for this thing.”

With research tolerated by most and encouraged by a few, some individual faculty achieved distinction in their research during the 1940s and 1950s. They were mostly on the Los Angeles campus where students received clinical training for the MD degree. An additional boost to research was the access of CME clinical faculty to the broader world of medicine at the Los Angeles County Hospital, where they had contact with physicians from other medical schools.

Philip J. Vogel, MD, a neurosurgeon, developed a technique to sever the connections between the cerebral hemispheres to aid patients with intractable seizures. By following the patients, Dr. Vogel’s collaborator Joseph Bogen, MD, and Roger Sperry, PhD, at the California Institute of Technology, began human right-and-left-brain research.

Cyril B. Courville, MD, a prominent neuropathologist and textbook author at CME, was nationally recognized for his research on concussions and head injury. This research is still

Roger W. Barnes, MD, a urologist, pioneered endoscopic surgery and published regularly, including a well-used textbook.

cited today. His collection of weapons associated with head injury is now housed in the Courville museum in the department of pathology.

Roger W. Barnes, MD, a urologist, pioneered endoscopic surgery and published regularly, including a well-used textbook. Dr. Barnes never retired and did not take sick leave for more than 55 years. Of the more than 200 published scientific articles, 25 were submitted after the age of 75.

H. James Hara, MD, an ENT physician, pioneered bronchoscopy. He was of Japanese-American decent and was confined during World War II.

Ellsworth E. Wareham, MD, pioneered the use of the heart-lung machine in Southern California and, with C. Joan Coggin, MD, MPH, began the Loma Linda University Overseas Heart Surgery Team.

Other research physicians included Alonzo J. Neufeld, MD, in orthopaedic surgery, and Milton G. Crane, MD, and John J. Harris, MD, in the endocrinology of hypertension. Vernon L. Nickel, MD, pioneered orthopaedic rehabilitation medicine at Rancho Los Amigos Hospital. Newton G. Evans, MD, president of CME from 1914–1927, later established a good reputation for his pathology research. Dr. Neufeld established the CME Alumni Research Foundation, in part, from royalties from the Neufeld nail used to pin hips.

Era of externally mandated research: 1952–1961

In this era, medical missionary training was still the main activity, but the patience of the accrediting bodies ran out and CME was unexpectedly placed under a mandate to demonstrate administrative support for research. The leadership team at CME responded positively and actively recruited faculty with research training.

At the dawn of the 1950s the Loma Linda campus of CME was known as “the farm.” There was little researc

C. Joan Coggin, MD, MPH, and Ellsworth E. Wareham, MD (right), began the Loma Linda University Overseas Heart Surgery Team. Here, they are congratulated by U.S. Vice President Lyndon B. Johnson.

h on this campus. Raymond A. Mortensen, PhD, persevered on metabolic studies in animals. Raymond E. Ryckman, PhD, remembers when he, Bruce W. Halstead, MD, and Harold N. Mozar, MD, approached administrators on the topic of research. After their discussion, it was clear that research was not a priority.⁴

Two important events in Loma Linda’s research history would soon change that.

The first event was the formation of a School of Tropical and Preventive Medicine (STPM) in the old South Laboratory. After World War II, there was a great deal of interest in tropical medicine, and it was expected that U.S. medical schools would quickly develop expertise in this area. Dr. Mozar had directed an Army School of Topical Medicine in New Guinea, and Walter E. Macpherson, MD, then-dean of the School of Medicine, invited him to develop a School of Tropical and Preventive Medicine at CME. An upstart medical student, Bruce W. Halstead, was to be the associate director, and to continue what became his lifelong study of poisonous fish. Research and scholarly publications were prominent in the mission of the new school.²

Dr. Halstead became an internationally recognized expert in marine toxicology and his three-volume treatise on poison-ous and venomous marine animals is still the definitive work in this field today. The STPM hired well and built a strong research team. Dr. Ryckman, a medical entomologist trained at University of California, Berkeley, joined the team and obtained contracts with the Army to study various vectors. He became the foremost authority on Triatoma, the “kissing bug” that is the vector for Chagas disease. This work is still highly important to public health in Central and South America, and as a result, the Communicable Dise

Raymond E. Ryckman, PhD (left), became the foremost authority on Triatoma. This work is still highly important to public health in Central and South America.

ase Center of the United States Public Health Service republished Dr. Ryckman’s dissertation and an annotated bibliography of 23,000 references in Spanish, French, Portuguese, and English only a few years ago. This research was supported in part by funding from the World Health Organization.

Edward D. Wagner, PhD, a medical parasitologist, was also hired and studied snails and their role in Schistosomiasis. George A. Nelson, PhD, by improving the protocol of a Japanese scientist, was the first person to crystallize large amounts of tetrodotoxin, thereby bringing classified research to Loma Linda. Dr. Nelson supplied the crystals to Robert Woodward, PhD, a Harvard chemist, who determined tetrodotoxin’s structure, and later received the Nobel Prize in 1965.

U.D. Register, PhD, in biochemistry, was the first to prove scientifically the nutritional adequacy of the vegetarian diet, leading the American Dietetic Association to stop listing the vegetarian diet as nutritionally deficient in amino acids.

The STPM made two more important contributions. It hired Milton Murray as a public relations officer and fundraiser, launching his illustrious career. They also were the first researchers at Loma Linda to obtain National Institutes of Health (NIH) funding, although the formal peer review process that we associate with NIH was not yet in place. Mervyn G. Hardinge, MD, PhD, DrPH, appears to have been the first recipient of an NIH award under the peer review process. The STPM also developed productive links to naval and army research funding offices.

The second event that stimulated research on the Loma Linda campus was another unfavorable accreditation report in 1952. The Council on Medical Education was dissatisfied with the attempts to upgrade the teaching of anat

U.D. Register, PhD, led the American Dietetic Association to stop listing vegetarian diets as nutritionally deficient in amino acids.

omy, physiology, and pharmacology, and it mandated that CME look outside the Adventist Church and hire experienced chairs for these departments. As a result, CME hired Otto F. Kampmeier, MD, PhD, in anatomy; Charles M. Gruber, MD, PhD, in pharmacology; and J. Earl Thomas, MD, in physiology. Dr. Thomas later joined the Adventist Church. These new chairs immediately improved the teaching of basic sciences and also worked hard to foster research. They received strong support from Harold Shryock, MD, who embraced research after the 1952 accreditation report.

The new chairs worked cooperatively with CME to recruit well-trained Adventist basic scientists and then mentored them in both research and teaching. Drs. Kampmeier and Gruber were instrumental in starting the first PhD program. Early well-known recruits included Dr. Hardinge, who had received a DrPH at Harvard for his research on vegetarian nutrition, and was then sent to get a PhD in pharmacology at Stanford. He subsequently took over as chair of pharmacology, where he led out in securing external research grant funding.

Later he founded the School of Public Health with a strong emphasis on research. The growing research emphasis in the basic sciences in the 1950s and 1960s attracted many new faculty with research interests, including Ian M. Fraser, PhD, and Leonard R. Bullas, PhD (both from Australia); R. Bruce Wilcox, PhD; Allen Strother, PhD; Joe Willey, PhD; and Brian S. Bull, MD.

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