The Origins of the Mount Sinai Endocrinology Division
Speech Given by Dr. J. Lester Gabrilove on his 80th Birthday Celebration of September 24th, 1997.
A distant relative of mine by marriage, Mark Twain, remarked, "Whenever I am introduced, I am embarrassed. They always say too little." On the occasion of presenting a Jacobi medallion to Arthur Fishberg, one of my great mentors, I said some very nice things, all of them very true. Arthur thanked me and said "Lester, even if you exaggerated, do you know anyone who doesn't like flattery?" And Walter, thank you for not embarrassing me.
I wish to thank all of the speakers, and, particularly, Terry Davies, who conceived the idea of a Festchrift and dinner and the assemblage of such superb speakers. What a wonderful idea!
When Alice Levine started to work with me on benign prostatic hyperplasia, it was readily apparent that she was a rising star. Kal Post has made Mount Sinai a Mecca for pituitary surgery. Mount Sinai and Mecca, a felicitous solution. I am thankful that both Andrea Dunaif and George Chrousos were able to bring us the details of their superb investigations: Andrea's slow unraveling of the polycystic ovary syndrome, a mystery since its original description over 60 years ago, and George Chrousos masterfully leading us through the physiology of the hypothalamic-hypophysis-adreno- cortical axis and its possible endocrine regulation. You can easily understand why both Dunaif and Chrousos were awarded the Rhone-Poulenc Rorer Clinical Investigator Awards of the Endocrine Society in 1996 and 1997. I also want to acknowledge Drs. Donald Bergman and Rhoda Cobin who, as trustees and secretary, represent the American Association of Clinical Endocrinologists and the American College of Endocrinology.
Now I would like to tell you something about the early days of Endocrinology in Medicine here. I came to Mount Sinai in July of 1940, a long time ago, at the age of 22. Danny Burdick, who is here with us, and I elected the three-year internship which included a year of Bacteriology and Pathology. In the latter part of my internship, the residency program was initiated, and in July, 1943, I started my residency in Medicine.
One of the common disorders we encountered was Graves' disease. Patients with this illness were treated with Lugol's solution, and then one morning after preparation with paraldehyde or chloral hydrate, the thyroid was "surgically" stolen. In 1943, early in my medical residency, an exciting paper by Astwood appeared on the treatment of Graves' disease with thiouracil, that you heard about just a little while ago. With the permission of my attendings, I obtained the drug and embarked on a Mount Sinai study enlisting the help of Morley Kert, my fellow resident on the other medical service. Early on, we encountered leukopenia, which can, of course, be seen in association with Graves' disease, but again with the approval of our attendings, we continued the drug. In 1944, Kert and I reported on some of the complications of treatment with thiouracil. We did encounter an instance of agranulocytosis and noted it to be sudden in onset and unpredictable. Fortunately, with this complication, the patient usually ultimately recovers. Now as you know, Janice's isolation of GCSF has permitted us far more satisfactory treatment of this complication. After we acquired what we thought to be a significant series, confirming Astwood's work, we wrote it up. Dr. Baehr, who was Chief of the Medical Service, thought that the paper should include a member of the attending staff, and so the paper appeared in 1946 by Gabrilove, Kert and Soffer. I had previously had no significant contact with Dr. Soffer.
During the middle of my residency, Emanuel Libman offered me a Dazian Foundation Fellowship to study whatever field I wanted. Since I was at that time interested in salt and water metabolism, I elected to go to Yale to work in John P. Peters's laboratory. Dr. Peters was the co-author with Donald D. VanSlyke of the celebrated text, Peters and VanSlyke's Clinical Chemistry. You may not know it, but it was the greatest book at the time. In 1945, while at Yale, in addition to salt and water problems, I was exposed to Diabetes and Endocrinology. Incidentally, I worked on one of the first flame photometers studying electrolyte excretion in diabetes mellitus. Don Seldin, who was a resident at Yale at the time, succeeded me in my laboratory. That was an extraordinary time in Endocrinology at Yale with studies going on protein bound iodine by Salter, by Man & Peters and their groups, and on the adrenal by C.N.H. Long, Abraham White, Alfred Wilheimi, and Frank Engel, the latter a former Mount Sinai house officer whose brother, Lewis, had brought deoxycorticosterone to the United States, the story of which I have told elsewhere. Long and Wilheimi were to become Presidents of the Endocrine Society.
My previous exposure to Endocrinology had been with Dr. Elaine P. Ralli at the New York University College of Medicine as a student. At Sinai, there was no formal endocrinology service, although several of the staff had been investigating various endocrine disorders. Arthur Sohval and Fred King had studied creatine excretion in Graves' disease; Sol Silver and B.S. Oppenheimer reported on adrenal cortical carcinoma and Cushing's syndrome. Rabin had described chromaffin cell tumor of the suprarenal gland, and Beer, King, and Prinzmetal had reported on the demonstration of a pressor substance (Adrenalin), in blood preoperatively during a hypertensive crisis in pheochromocytoma. Louis Soffer, who had worked with Harrop at Hopkins, was confirming Thorn's work on the use of deoxycorticosterone in Addison's disease, as well as studying the physiology of the adrenal with Lesnick and Sorkin. In 1946, he published a monograph on the adrenal. On my return to Sinai in 1946, I was the recipient of a Blumenthal Fellowship for three years, which helped support me while I established a private practice. Dr. Baehr appointed me liaison between Diabetes (Dr. Herbert Pollock), which had a clinic, and Endocrinology(Dr. Louis Soffer), which existed practically in name only. The appointment put me in the crossfire between the two (Pollack and Soffer). The Diabetes Clinic had been started in 1917 by Arthur Bookman and then in succession had been headed by George Baehr, Herman Lande, and Herbert Pollock. Pollock resigned in 1951 and was succeeded by Henry Dolger.
Endocrinology, at least at Mount Sinai, in the 1930's and early 1940's was mostly gynecologic endocrinology, established by one of the fathers of American Endocrinology, Dr. Robert T. Frank, who, in fact, gave a Harvey lecture in 1930 on "The Female Sex Hormone." Among the later endocrine gynecologists were Udall Salmon, Samuel Geist, and Joseph Gaines. As I indicated, Endocrinology existed mostly only in name in Medicine. It occupied a small bench in the Chemistry Laboratory headed by Dr. Harry Sobotka and was located in the old Laboratory Building. It was there that I started my investigations with the help of an extraordinary technician, Mildred Jacobs. I have been fortunate to have had extraordinary technicians including Erlinda Concepcion. Meanwhile, Soffer and I started an Endocrine Clinic with Joe Gaines providing the gynecologic expertise.
In 1947 or 1948, Soffer invited me to co-author the Textbook of Endocrinology with him which he had just started. Henry Dolger was asked to supply the Diabetes section and Arthur Sohval the section on the gonads. I worked part of every day and evening researching and writing a rough draft. One or two times a week I would meet with Soffer and we would polish up the text. I edited the chapters by Dolger and by Sohval and in 1951, Diseases of the Endocrine Glands appeared. I was then 34 years of age. During this period, we also found time to give an invited lecture on "The Virilizing Syndrome in Man" at the prestigious Laurentian Hormone Conference.
In 1946 or 1947, I noted a report from Montefiore by Seidlin on the treatment of thyroid cancer with I-131. In reviewing the literature, I found that Hamilton, Soley, and Hertz had been using I-131 for the treatment of Graves' disease. I went to see Seidlin, I do not recall who, if anyone accompanied me, but I returned all excited and eager to start its use. However, Dr. Baehr decided to assign its use to Dr. Solomon Silver and to help him, Dr. Sergei Feitelberg, who had a small physics lab on the 3rd or 4th floor of the old Administration Building. I started some experimental animal work using I-131, but found the atmosphere in the Physics Laboratory very stifling, as did most of the young people such as Norman Simon, Steve Yohalem, and Paul Kaunitz. The Silver group continued the study of the use of radioactive iodine in the treatment of thyroid disease, started a thyroid clinic, and initiated a course on the use of radioactive isotopes together with Edith Quimby. This excellent course, with a textbook by Silver, Feitelberg, and Quimby, was taken by Radiology and Endocrinology fellows and physicians, including myself, from throughout the Metropolitan area, a prerequisite for licensing as a user of radioactive materials.
The official designation of an Endocrine Division came in 1952, when Dr. Alexander Gutman reorganized the Department of Medicine along medical school lines. The Fellowship Program was started at about the time the lab moved to the Atran Building in 1950. Norman Boas and Arthur Ludwig had worked in the Endocrine Lab in 1948-1950, but the first Endocrine Fellows were William Dorrance, brother of Sam Dorrance, a former house officer, who subsequently worked with George Thorn at Johns Hopkins on further studies with deoxycorticosterone and had been killed in World War II, and Irwin Weiner from Gynecology.
Investigatively, in the late 1940's, some of this you have heard before from Walter, Armour had isolated ACTH, and we utilized the drug to shrink thymic tumors associated with myasthenia gravis. This was based on the work of Dougherty and White, who had shown the marked shrinkage of lymphatic and thymic tissue following the administration of corticoids. This was the first therapeutic use of ACTH and antedated the Nobel Prize winning work of Hench and Kendall on the use of cortisone in rheumatoid arthritis. In 1949, Soffer and I were invited to the first Armour conference on ACTH to present our work, and I came back with the idea that ACTH might be effective in blocking the Shwartzman phenomenon which we subsequently demonstrated. Dr. Shwartzman was a bacteriologist here and described the Shwartzman phenomenon. It was unfortunate that we did not realize the full immunologic and anti-inflammatory significance of these studies.
Incidentally, in 1938, while taking an elective in Pathology at Beth Israel Hospital, as a 4th year student, I reported on a carcinoid in the stomach tissue of an ovarian dermoid. If only that dermoid had manifested the carcinoid syndrome or at least Cushing's disease!
In the mid-to-late 1950's, Dr. Perrin Long, Chairman of Medicine at Downstate, appointed Soffer as Clinical Professor of Medicine and myself as Assistant Clinical Professor. Long had known Soffer from the days when they had both been at Hopkins. Long approached me and asked me if I would be willing to offer an elective in Endocrinology to students at Downstate. I readily agreed, and among our earlier students were Dan Present, Mark Chapman, Ruth Abramson, and Charles Gerson, all of whom on graduation came as house officers to Mount Sinai and are presently on our Faculty.
In short, in the course of about 10 years, the late 1940's and early 1950's marked the start of the Endocrine Division, the Endocrine Clinic, the publication of Diseases of the Endocrine Glands, the earliest use of ACTH therapeutically, the start of the Fellowship Program, and an elective program in Endocrinology and the introduction of I-131 in the treatment of thyroid disease at Mount Sinai Hospital. History has a way of placing things into the proper perspective, and the further and more recent growth of the Endocrine Division remains to be told at a later date.