Leonard Rowntree and the Birth of the Mayo Clinic Research Tradition
2005; Elsevier BV; Volume: 80; Issue: 7 Linguagem: Inglês
10.4065/80.7.920
ISSN1942-5546
Autores Tópico(s)History of Medical Practice
ResumoLeonard Rowntree (Figure) is perhaps the individual most responsible for establishing a research tradition at the Mayo Clinic. Despite this fact, Rowntree remains a relatively little-known figure in the history of North American medicine. Leonard Rowntree was born in London, Ontario, in 1883. He entered Western Ontario Medical School in 1901, interned at Victoria Hospital in 1905, and entered into general practice in New Jersey in 1906. In 1907, the young general practitioner traveled to Philadelphia, Pa, to hear William Osler, the most prominent physician in the English-speaking world, lecture at the College of Pharmacy. Rowntree recalls half a century later, “I was thrilled, and at [the lecture's] close had the opportunity to meet [Osler] personally.” That same night, Rowntree wrote Osler a letter, telling him that he had decided to give up general practice and become an academic physician. Rowntree had so much confidence in Osler after hearing and meeting him that he wrote to Osler, “Whatever you advise, I will do my best to carry out.” In 1958, looking back on this important juncture in his life, Rowntree saw himself as being “immersed in [general practice] to the point where I had no time left for study,” exemplifying his career-long concern for preserving time for research as well as for patient care. (Indeed, it may safely be said that to Rowntree, research became more important than patient care as the years progressed.) Osler promptly stated in a return letter that Rowntree should study at Johns Hopkins for at least 6 years. Rowntree went to Johns Hopkins that same year and because he carried Osler's letter, was accepted there.1Rowntree LG Amid Masters of Twentieth Century Medicine. Charles C Thomas, Springfield, Ill1958Google Scholar Rowntree became an assistant to Dr John J. Abel, the famous pharmacologist. Just as Osler was always Rowntree's clinical “guiding star,” Abel became for him the embodiment of the researcher. Rowntree's work with Abel was both fundamental and far-reaching. Together, they introduced the phthalein compounds to the medical world. In 1910, Rowntree and Dr John T. Geraghty were the first to describe the use of these chemicals for the determination of renal function.2Geraghty JT Rowntree LG The phenolsulphonephthalein test for estimating renal function.JAMA. 1911; 57: 811-816Crossref Scopus (4) Google Scholar, 3Rowntree LG Geraghty JT An experimental and clinical study of the functional activity of the kidneys by means of phenolsulphonephthalein.J Pharmacol Exp Ther. 1910; 1: 579-661Google Scholar, 4Rowntree LG Geraghty JT The phthalein test.Arch Intern Med. 1912; 9: 284-338Crossref Scopus (6) Google Scholar This “Rowntree test” was a clinical standard for the next 30 years. Abel and Rowntree also developed the first artificial kidney in animal research, reporting their success with the apparatus in 1913.5Abel JJ Rowntree LG Turner BB On the removal of diffusible substances from the circulating blood by means of dialysis.Trans Assoc Am Phys. 1913; 28: 51-54Google Scholar That same year, Rowntree presented an article with Dr Norman Keith (who later became a member of Rowntree's group at the Mayo Clinic) about a vital red dye method for determining blood and plasma volumes. This test also remained a standard for decades.6Keith NM Rowntree LG Geraghty JT A method for the determination of plasma and blood volume.Arch Intern Med. 1915; 16: 547-576Crossref Scopus (33) Google Scholar Finally, Abel and Rowntree devised the first successful method of plasmapheresis in dogs.7Abel JJ Rowntree LG Turner BB Plasma removal with return of corpuscles.J Pharmacol Exp Ther. 1914; 5: 625-641Google Scholar In 1914, after spending 6 years in the laboratory, Rowntree became active in teaching clinical medicine as an associate professor under Theodore Janeway, Chief of Medicine at Johns Hopkins. In 1915, Rowntree accepted an offer to become Chairman of Medicine at the University of Minnesota, but World War I cut short his work there. He entered the US Army in 1918, where he became interested in aviation medicine, studying aviation accidents and the effects of altitude on health. Rowntree also helped develop a school for flight surgeons. After returning from the war, Rowntree declined numerous offers in order to accept William J. Mayo's invitation to work at the Mayo Clinic. On his arrival in Rochester, Minn, in 1920, Rowntree was made Head of Section and Professor of Medicine of the Mayo Foundation. By this time, Rowntree and W. J. Mayo knew each other well, Mayo having already saved Rowntree's life by performing surgery on him for a perforated ulcer in 1918. In January 1922, Rowntree was given the title of Chief of the Department of Medicine, the Mayo Foundation.8Physicians of the Mayo Clinic and Mayo Foundation. WB Saunders Co, Philadelphia, Pa1927Google Scholar At this point, Rowntree recruited men to Rochester who would later be known as the “Rowntree Group”: “I contacted immediately Dr. Norman Keith of Toronto, Dr. Samuel Amberg of Chicago, and Dr. Reginald Fitz of Boston, all of whom had been collaborators with me at Hopkins, and Dr. Henry Helmholtz, the pediatrician. … Later were added Dr. George Brown from Miles City, Montana, and Dr. Walter Alvarez from San Francisco. Dr. Russell Wilder, already on the clinic staff, was also brought into the fold.”1Rowntree LG Amid Masters of Twentieth Century Medicine. Charles C Thomas, Springfield, Ill1958Google Scholar This group soon was augmented by Drs Stanley McVicar, Albert M. Snell, and Jay Bargen in gastroenterology; Dr Carl Greene in laboratory medicine; Dr Philip Hench in rheumatology; and Dr Bayard Horton in allergies. Great things were expected of the Mayo Clinic after Rowntree made his appearance. Dr Russell Wilder believed that Rowntree's arrival at the clinic was the reason for William Osler's statement, made in 1919, that the Mayo's were wise men to make the clinic as important in medicine as it was in surgery.9Wilder RM Recollections and reflections on diabetes, other metabolic diseases and nutrition in the Mayo Clinic and affiliated hospitals, 1919-1950. Mayo Clinic Libraries, Rochester, Minn1954Google Scholar Rowntree's group formed a new section within the clinic, bringing the total number of medical sections to 8. Dr Henry Plummer, who retained the title of Chief of Medicine of the Mayo Clinic, headed the other 7 sections. Thus, during this period, the clinic had not 1, but 2 chiefs of medicine.10Graner JL A History of the Department of Internal Medicine at the Mayo Clinic. Mayo Foundation for Medical Education and Research, Rochester, Minn2002Google Scholar In addition to his clinic responsibilities, Rowntree supervised 6 hospital services, all concentrating on research as well as patient care. “Each section of our department became productive almost immediately…. Almost overnight, everyone in the Clinic seemed to become interested in clinical investigation, and the output of publications shortly became enormous.”1Rowntree LG Amid Masters of Twentieth Century Medicine. Charles C Thomas, Springfield, Ill1958Google Scholar Rowntree's research output was remarkable. During his 12 years at the clinic, he published more than 100 articles, primarily in the fields of endocrine disease, water metabolism, and hepatology, as well as 2 important monographs, The Volume of the Blood and Plasma, written with G. E. Brown and G. M. Roth,11Rowntree LG Brown GE Roth GM The Volume of the Blood and Plasma. WB Saunders Co, Philadelphia, Pa1929Google Scholar and A Clinical Study of Addison's Disease, written with A. M. Snell.12Rowntree LG Snell AM A Clinical Study of Addison's Disease. WB Saunders Co, Philadelphia, Pa1931Google Scholar Rowntree's work on adrenal gland diseases was especially noteworthy, and he was probably the first physician to use adrenal gland extracts effectively in the treatment of Addison disease.13Medvei VC A History of Endocrinology. MTP Press Ltd, Lancaster, Mich1982Crossref Google Scholar Rowntree also pursued studies in roentgenography, outlining veins and the renal system with use of sodium iodide solutions14Osborne ED Sutherland CG Scholl AJ Rowntree LG Roentgenography of urinary tract during excretion of sodium iodid.JAMA. 1923; 80: 368-373Crossref Scopus (99) Google Scholar; this work was extremely important in the history of radiology. Rowntree's article on the visualization of the renal system has been republished by the Journal of the American Medical Association in its Landmark Article series.15Osborne ED Sutherland CG Scholl Jr, AJ Rowntree LG Landmark article Feb 10, 1923: roentgenography of urinary tract during excretion of sodium iodid.JAMA. 1983; 250: 2848-2853Crossref PubMed Scopus (11) Google Scholar Reflecting W. J. Mayo's convictions, the rule at the Mayo Clinic well into the second half of the 20th century was that the medical staff function as generalists first, regardless of their subspecialty interests. While they initially saw “all comers” in terms of patients, the various members of the Rowntree group (all with strong research interests) soon tended to narrow their investigative and therapeutic efforts. Wilder concentrated on diabetes; Keith on nephrology; Bargen, McVicar, and Snell on gastrointestinal diseases; and Brown on peripheral vascular diseases. Brown and Keith shared an interest in hypertension, with Brown focused on its early stages and Keith more interested in advanced hypertension and kidney diseases. Snell began to focus on liver and adrenal gland disease. Hench's main interest remained arthritis. With the divergence of their various interests, the Rowntree group began to disperse. With time, the individual members affiliated more with other medical sections within the clinic, substantially enriching those sections and providing them with a much stronger research orientation. The result, at least in terms of the members’ research interests, led to the formation of new subspecialty groups. Importantly, all of Rowntree's associates made noteworthy contributions to the medical knowledge of their day. Hench went on to win the Nobel Prize. They attracted the next generation of more research-minded clinicians to the Mayo Clinic and established the clinic in the minds of physicians throughout the world as a research institution. In the words of Nelson Barker,16Barker N. The history of the medical vascular section of the Mayo Clinic as recorded by Dr. Nelson Barker. Rochester, Minn: Mayo Historical Unit.Google Scholar “Perhaps Leonard Rowntree's greatest contribution was the fact that he stimulated in his associates, first assistants and fellows a strong and lasting interest in clinical investigation and research.” Waltman Walters,17Walters W Reminiscences of a Mayo Clinic Surgeon (1920 to 1960). Mayo Clinic Libraries, Rochester, Minn1960Google Scholar whose research career also was aided by Rowntree, recalled, “The greatest stimulus to research … in my opinion, was that brought to the Clinic by Leonard Rowntree.” Russell Wilder9Wilder RM Recollections and reflections on diabetes, other metabolic diseases and nutrition in the Mayo Clinic and affiliated hospitals, 1919-1950. Mayo Clinic Libraries, Rochester, Minn1954Google Scholar explained, “At the Mayo Clinic the clinical investigations of the twenties, the thirties and the forties, in arthritis, gastroenterology, diseases of the liver, nephritis, hypertension, diseases of the arteries and veins, diabetes, hyperinsulinism, hyperparathyroidism, Addison's disease and nutrition, must almost all be credited to the clinical investigators of the Rowntree group. …” Unlike his colleagues, Rowntree never became assimilated into the Mayo Clinic's structure and routine. Over the years, he spent less and less time caring for patients and instead devoted his energies to clinical investigation and the supervision of projects carried out by his fellows. Rowntree also spent much time in the late 1920s attending various national meetings and serving on committees. Apparently, Rowntree saw patients in the diagnostic sections of the clinic only by special request, and his hospital service was taken over gradually by Dr Snell.16Barker N. The history of the medical vascular section of the Mayo Clinic as recorded by Dr. Nelson Barker. Rochester, Minn: Mayo Historical Unit.Google Scholar The final breakup of the Rowntree organization occurred in June 1930, with the closing of his research laboratories. Rowntree left the clinic in 1932. Although the Depression undoubtedly played a role in this shutdown, strong personal factors also were involved. The new academic lifestyle that Rowntree brought to the clinic simply did not suit many of the older staff, causing tension and resentment among some of them.18Alvarez W Incurable Physician. Prentice-Hall Inc, Englewood Cliffs, NJ1963Google Scholar One of the clinic's physicians of the period saw Rowntree as leaving “under a cloud of disappointment and dissatisfaction.”19Weir JF. Memoirs. Rochester, Minn: Mayo Historical Unit.Google Scholar Russell Wilder considered Henry Plummer a major influence in the termination of the Rowntree organization. Plummer had “expressed concern, lest Rowntree's department, growing at St. Mary's Hospital, which he called a clinic within the Clinic, become a rival of the Clinic.”9Wilder RM Recollections and reflections on diabetes, other metabolic diseases and nutrition in the Mayo Clinic and affiliated hospitals, 1919-1950. Mayo Clinic Libraries, Rochester, Minn1954Google Scholar Another element contributing to the Rowntree family leaving Rochester may have been increasingly strained relations between his family and W. J. Mayo.20Rowntree K. The Journal of Katherine Rowntree [provided to the author by the Rowntree family]; 1960.Google Scholar Rowntree, writing a quarter of a century later, explained that when he left the Mayo Clinic in 1932, W. J. Mayo was somewhat upset with him1Rowntree LG Amid Masters of Twentieth Century Medicine. Charles C Thomas, Springfield, Ill1958Google Scholar: “I explained to him that I had no criticism of the Clinic, but sought other opportunities in life and a different environment, but he was not completely mollified.” Was W. J. Mayo upset simply because Rowntree wanted to leave? A letter written in September 1930 by Rowntree to Dr William Welch, his former advisor at Johns Hopkins, provides a clue as to why W. J. Mayo may have changed his attitude toward Rowntree21Rowntree LG Letter to William H. Welch. Alan Mason Chesney Medical Archives. Johns Hopkins Medical Institutions, Baltimore, MdSeptember 17, 1930Google Scholar: Since writing you in January much has happened that makes me eager to leave Rochester. The new titles and increased salary were accompanied by a demand that I must sign a ‘declaration of intention’ or make a public statement that I would never leave the Mayo Clinic. This I refused to do and in consequence Doctor Mayo's attitude towards me has changed considerably. Research opportunity in medicine has been cut down materially…I fear that unless I acquiesce in this demand the great opportunity here is past. We know nothing about this so-called declaration of intention or about how often it was used at the Mayo Clinic. Rowntree left the clinic in 1932 to continue his illustrious career in medicine as director of the Philadelphia Institute for Medical Research.1Rowntree LG Amid Masters of Twentieth Century Medicine. Charles C Thomas, Springfield, Ill1958Google Scholar The Mayo Clinic, primarily due to the impetus provided by Leonard Rowntree and his group, has remained one of North America's premier medical research centers.
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