Review Highlights and excerpts

o understand a medical school in current times, you need to know something about where it came from--the story of its champions, its glories, its soaring victories, and, perhaps more instructive, its difficulties and disputes. A new book from Scholars Press, The Quest for Excellence, approaches the history of the Department of Medicine at Emory from just such an expansive viewpoint. Written by cardiologist J. Willis Hurst, who served as chairman of Emory's Department of Medicine for 30 years, the book chronicles the events of more than 150 years, presenting the department's history in the larger context of its connections to the medical school and the university. In its early days, Emory needed many things, certainly money. But perhaps most of all it needed love and tending. This book tells of that love and tending, by the school's early benefactors and by many great faculty, including former Department of Medicine chairs Eugene Stead and Paul Beeson. Hurst chose to include "quest" in his title because, he writes, "the more progress we make, the more we understand that the job is never done. I would not dare say that excellence was achieved in the Department of Medicine during the years discussed in this book. I can say that the quest for excellence was intense, determined, and persistent." Hurst served as chair from 1957 to 1986. When he began, there were only 14 faculty members in the entire Department of Medicine. There was no chair of either Surgery or Gynecology-Obstetrics and only a part-time chair in Pediatrics. The departments of Psychiatry and Pathology were in dire straits. He was charged not only with building his department but also with helping rebuild all the clinical departments. At 36, Hurst was too young to be scared of the challenge. Although he had no idea what was ahead, he knew he was sunk without help. He turned to Eugene Stead, the first full-time chair of the department, who told him the most important authority of the chair was the ability to make appointments. Hurst immediately began recruiting. Soon after, the department began to sponsor postgraduate courses (in electrolytes, hematology, cardiac arrhythmias, and liver disease, to name a few). These courses were first given in the Anatomy and Physiology Building on the Emory campus and then in the auditorium at Grady Hospital, after it was finished. Visiting faculty from across the nation and abroad came to give the lectures. "Dean Arthur Richardson credited the postgraduate courses as the major reason alumni regained their respect for Emory following the ruckus of 1956," Hurst writes. The first four chapters of Hurst's book shed light on the events leading to this infamous dispute, with chapter 5 chronicling the 30-year span of Hurst's chairmanship. The book's beginning pages describe the medical school's origins in antecedent schools centered at or near Grady, at a time when there were no medical facilities on the Emory campus. By the 1940s, some activities had shifted to Emory, and a lively debate had begun over whether the medical school should be located at Emory or at Grady. A 1946 planning committee chaired by Eugene Stead (interim dean at that time) reversed the recommendation of a previous planning committee in a report concluding that future development of the medical school should be focused on campus. Meanwhile, formation in 1949 of the Emory campus Private Diagnostic Clinic (the forerunner of The Emory Clinic) added to the mix of growing tensions, with many physicians, both on campus and in town, dismayed at the idea of an organized faculty clinical practice. (By this time, Stead had left Emory to chair medicine at Duke, and Paul Beeson, who himself would eventually leave to chair medicine at Yale, was head of the department here.) When Eugene Ferris became the Department of Medicine's third full-time chair in 1952, he was well aware of the recommendations in the 1946 planning report. He had also played a role in the decision to petition University President Goodrich White for creation of The Emory Clinic. Subsequent actions on his part, however, indicate that somewhere along the line he had a change of heart on both issues. He began to align himself with a faction who thought the medical school should be centered at Grady and who expressed deep reservations about administrative policy to develop a faculty clinical practice. His disenchantment growing year by year, Ferris finally went public with his opinions, joined by two other chairs, in Surgery and Gynecology-Obstetrics. "It got to where they and the administrators couldn't talk anymore," says Hurst, who had joined the faculty in 1950. By 1956, Dean Arthur Richardson felt compelled to relieve the three chairs of their positions. Hurst had been away from Emory in 1954 for a year of naval duty. "When I got back here," he says, "no one was speaking to anyone. The controversy had created a turmoil involving the medical school, Grady, practicing physicians--the whole town." "There can be no doubt that the commotion hurt the University to a degree which is indeterminable," Emory officials reported in the Emory Alumnus in March 1957. "But it is equally true that the trouble has given the faculty in medicine a unity and a oneness of purpose it had not previously known." This, then, was the climate Hurst entered in his early days as chairman. He went about rebuilding the department "like a bulldog with his teeth set on his aspirations for the Department of Medicine," remembers colleague Robert Schlant. "He'd get on causes and support them 24 hours a day. New people were coming in, and new ideas. He was a champion of high-quality teaching...." Teaching was a cornerstone of Hurst's 48-year career at Emory from the beginning. During his chairmanship, he resisted committee members who snubbed good teachers when it came time to grant tenure. He shook his head in disbelief at the comment by one faculty member that pretty soon all he would have would be a department of good teachers. When Hurst stepped down as chairman in 1986, the Department of Medicine had 147 faculty members. It had attained national prominence, particularly in clinical care and teaching, and had begun to increase its research efforts. Additionally, the department had spawned three new departments--Community and Preventive Medicine, Neurology, and Dermatology--and had supplied the new chair of Rehabilitation Medicine. Meanwhile, Hurst has remained a treasured faculty member over the past 12 years. He still teaches eight sessions per week and devotes half a day each day to writing. --RM and KS

J. Willis Hurst, 1956 Back in 1957, when this postgraduate course on liver disease was being taught, Emory's no-smoking policy was considerably more liberal than it is today. Displayed as part of an exhibit labeled "The Human Approach" at the New York World's Fair, this photo was taken at the request of the Communicable Disease Center (now Centers for Disease Control and Prevention) to illustrate the advantages of immunization. It features Hugh Wood, dean of the medical school from 1946 to 1956. J. Edgar Paullin was the department's first volunteer (unpaid) chair. A physician at Piedmont Hospital (from where most of Emory's early volunteer faculty came), he established long-standing close relations between Emory and that facility. Paul Beeson was the second full-time chair of the department. His office was in the basement of the old Grady Hospital. "Anytime it rained," he wrote, "the place flooded and the rug all but floated out the door!"

he following are highlights and excerpts from The Quest for Excellence.

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The following is from a report submitted by university president Goodrich White [also president during the subsequent medical ruckus] to the Board of Trustees on November 10, 1944: The most urgent and the greatest financial needs of the University are for funds for the support of the...School of Medicine. The minimum goal we should set for ourselves is $10,000,000. It should be approached as rapidly as possible. There is no probability of providing for increased enrollment.... But we must commit ourselves to a program of development such as I have presented above; and such a program will cost money. Endowment of $1,000,000 might wisely be sought for each of four or five of the major departments. But I cannot urge too strongly that at least half of the suggested $10,000,000 should be unallocated departmentally, thus to be available for the support of the program as a whole.... General endowment for the School of Medicine is our most vital need if we are to discharge the responsibility that is inescapably ours and make our contribution to the meeting of the needs of this metropolitan area and the region of which it is the capital.

here were three dining rooms in the new hospital: one for white people, one for "professional" black people, and one for the "nonprofessional" black people. There was segregation not only according to race but also according to occupation.... Grady administrators believed it would not be wise to spend the public's money to air-condition Grady Memorial Hospital when no private hospital in Atlanta was air-conditioned. Some years later, at great expense, Grady was air-conditioned, when it was pointed out that the physicians had to close the windows on the side of the hospital near the new noisy expressway in order to talk to patients, or to listen to their hearts and lungs with a stethoscope. Closing the windows to perform these acts made the heat unbearable. Therefore, it was concluded that it was medically necessary to air-condition the hospital.

n 1958, soon after we moved into the new Grady Memorial Hospital, I received a phone call in my office in the Glenn Memorial Building. At that time we were still understaffed with secretaries. I answered the phone. The nice woman on the line said, "We are out of toilet paper in the renal laboratory." I obtained a roll of toilet tissue from the toilet near my office and walked across the street to the renal laboratory. I asked, "Who needed the toilet paper?" A lesson was taught: I was willing to do anything to maintain a happy group of faculty members, technicians, and secretaries.

hen I was a house officer in the forties, I made $25 a month during my internship. House officers of that era were relieved that they no longer had to pay tuition. I had no work schedule because World War II was raging, and the University Hospital in Augusta, Georgia, was understaffed. Because of this, we worked almost continuously. We wore "whites." As a medical resident I was in charge of the clinical laboratory at night and matched blood for all of the hospital services. I also performed the agglutinations needed to diagnose certain infectious diseases. Although marriage was frowned upon, I was married. I was permitted to live in a shack near the furnace of the hospital because it was no farther away from the hospital wards than the house officer quarters. It did cost me $8.00 a month. Vacations were rare.... By 1997, the stipend for interns had increased to $33,000 per year. A one-month vacation was granted, and the interns worked every sixth night.

In a section titled "The Fleas Come with the Dog," the author shares perspective about various difficulties, including the Darsee affair, and personal challenges, including the following: I discovered that I had cancer of the colon.... Surgery [performed by Dick Amerson] went well.... One year later, on routine follow-up examination, the CAT scan showed what was interpreted to be metastatic lesions in the liver. Later, however, in consultation with friends at the Mayo Clinic, I was given a clean bill of health. Prior to traveling to the Mayo Clinic I had told a group of the faculty good-bye and believed my days were numbered. When the diagnosis was reversed, ...I called home and announced, "I am fine. Don't appoint a search committee!"

his is the last Annual Report I will submit. I have been chairman of the Department of Medicine since February 1957.... During my tenure as chairman, we moved into the new Grady Hospital and the new Veterans Administration Hospital, began to officially organize Crawford W. Long Hospital, and developed the Emory University Clinic. The house staff program was unified.... Our patient care program and teaching programs are very strong. In fact, they have gained national recognition. The weakness is inadequate funding for the department as a whole. Too many faculty members earn their salary by patient care services. This limits the amount of time for scholarly work and research. I have always wanted a research-oriented department, and I am proud of the research that has been done. More could have been done if we had adequate research space and financial support for the faculty. I am extremely pleased that Dr. Juha Kokko has accepted the chairmanship of the department beginning in September, 1986.* *Editor's Note: Dr. Kokko resigned the chairmanship this past April, and a search committee has been appointed. He will continue to serve as chair until July 1999 or until a new chair is appointed. He had always planned to return to his first love, research, when he accepted the chairmanship, and he will continue on at Emory as an associate dean for clinical research.