History of the pulmonary specialty in the U.S. is largely borne out of the history of tuberculosis (or previously termed “consumption, pthisis, contagion, white plague, or king’s evil”).
Interestingly, Chevalier Jackson (JMC class of 1886, lived 1865-1958) was one of the foremost figures responsible for developing esophagoscopy and laryngobronchoscopy. In his Philadelphia bronchoscope clinic he trained numerous students and physicians in his techniques. During the 1920s, Jackson also began a crusade to spread knowledge of preventive measures to protect children from inhaling foreign objects. He also campaigned for passing a federal law to control hazardous substances available to children. This led to the passage of the Caustic Act of 1927, which required labels on all poisonous substances (skull & cross bones label). Jackson’s career at Thomas Jefferson University ended with his mandatory retirement in 1930 at the age of 65.
Another notable contributor is John H. Gibbon, who opened a new era in the history of cardiac surgery by developing the first heart-lung machine and performing the first successful surgery with it on May 6, 1953. A fifth generation physician, John H. Gibbon was born in Philadelphia in 1903. Gibbon received his MD from Jefferson Medical College in 1927 and completed his internship at Pennsylvania Hospital in 1929. It was during his research fellowship at Harvard in the early 1930s that Gibbon initially conceived the idea of an apparatus that could temporarily assume the functions of a patient's heart and lungs. While always known for the heart-lung machine, Gibbon made several other clinical contributions. Editor of the Annals of Surgery and author of Surgery of the Chest, Gibbon was active in and received awards and recognition from numerous medical societies in the U.S. and abroad. In addition, Gibbon held the position of Samuel D. Gross Professor and Chairman of the Department of Surgery at Thomas Jefferson University from 1946-1967. Gibbon retired from the University in 1967 and died on February 5, 1973. In 1990, Jefferson paid Gibbon a posthumous honor by renaming the new Thomas Jefferson University Hospital the Gibbon Building, located at 10th and Chestnut.
Prior to Dr. Gibbon becoming the Samuel D. Gross, Professor of Surgery, there were two surgical services at Thomas Jefferson University: one was headed by Dr. Thomas Shallow, and the other headed by Dr. Gibbon. The Shallow service was general surgery alone, but the Gibbon service included thoracic as well as general surgery. Graduates of the Gibbon service had received training in thoracic surgery, including TB and lung cancer. Most continued in careers that emphasized the thoracic component of their practice, apart from general surgery. As the field of cardiac surgery advanced, future graduates became involved in cardiac surgery, while many such as Dr. Herb Cohn embraced the non-cardiac components of thoracic surgery. Dr. George Willauer was a significant mentor on the field of TB surgery while Dr. Gibbon did much more lung cancer surgery after the first successful open heart case, and turned over the development of cardiac surgery to his associates John Templeton and Rudy Camishion. John Templeton performed non-cardiac thoracic surgery until he became so busy in cardiac that he concentrated on that exclusively.
Besides Dr. Herbert Cohn, the current Anthony E. Narducci Professor, Vice Chairman for Quality, Department of Surgery, others involved in non-cardiac thoracic surgery were John McKeown, Charles Fineberg and Benjamin Bacharach. The pulmonary conferences continued after the closing of the Barton Memorial Hospital at Broad and Fitzwater, when the Pulmonary Division was moved to the main campus. These included case presentations of both medical and surgical interest. Notables from the medical pulmonary division were Harold Israel, Pete Theodos, Jack Kirschner, Jim Fish, Jonathan Gottlieb, Krishna Mohan and John Cohn. In recent years, active participants include Gregory C. Kane, Sandra Weibel, Bharat Awsare, Sal Mangione as well as the very recent recruits.
In 1913 the Department of the Diseases of the Chest was established at 236-38 Pine Street with Elmer H. Funk (JMC 1908) as Medical Director. The facility, identified as “Little Jeff” was organized as a hospital with medical, nursing and social service personnel to provide care for patients with active tuberculosis. A major mandate was to provide teaching in physical and clinical diagnosis as well as managing and treating tuberculosis. This institution reflected the activities of Lawrence F. Flick (JMC 1879) who founded the 1st State Society for Prevention of Tuberculosis in 1892. In 1895, the Free Hospital for Poor Consumptives, in 1901 the White Haven Sanatorium and in 1903 the Henry Phipps Institute came into being. Dr. Flick was described as the “White Knight fighting the White Plague” by his colleagues and was an early proponent of the contagiousness of tuberculosis.
In 1927 Burgess L. Gordon (JMC 1919) was appointed to the Directorship of the Department of the Diseases of the Chest and was succeeded in 1951 by Martin J. Sokoloff (JMC 1920) who concurrently was an Attending Physician at White Haven Sanatorium and the Chief of the Division of Tuberculosis Control of the Philadelphia Department of Health.
In 1946, White Haven Sanatorium merged with Jefferson Medical College while concurrently, the Barton Memorial Division of Jefferson Medical College Hospital opened at Broad and Fitzwater Streets for the treatment of tuberculosis. In 1956, the Department of the Diseases of the Chest became the Barton Memorial Division of the Department of Medicine.
The Anthracite Health and Welfare Fund funded a pulmonary physiology laboratory under the directorship of Hurley L. Motley, MD. The effects of bronchodilator aerosol therapy on “Miner’s Asthma” were an early example of clinical investigation. In 1953, Richard T. Cathcart, MD, became the Director of the Pulmonary Physiology Laboratory and in 1962 succeeded Dr. Michael J. Sokoloff as the Director of the Barton Division of Diseases of the Chest.
G. William Atkinson (’70 PG) became the Director of the Pulmonary Laboratory in 1970 and Director of the Barton Division in 1974. During his tenure a Respiratory Intensive Care Unit was established in 1977. James Wilson became the Chief of the Barton Memorial Division in 1983 but his tenure was shortened by his sudden demise. Subsequently, the division was directed by acting co-chiefs, J. Denise Moylan (PGA ’78) and Edward Schulman (JMC ’75) from 1983-85.
In 1985, James E. Fish, MD, became the Chief of the Division of Pulmonary and Critical Care Medicine. During his directorship the training program expanded greatly with an increased number of fellowship positions and the development of numerous basic research protocols. This was a period where in the division became recognized for asthma translational research, Asthma Clinical Research Networks and extramural NIH-level funded laboratories. The successful group included Drs. Fish, Stephen Peters, Shaver, Penn, Zangrilli and others who conducted investigational bronchoscopy research studies in patients with asthma. Dr. Fish departed Thomas Jefferson University in 2002 (after a brief period where he was the Acting Chair of the Department of Medicine). Stephen Peters, MD, served briefly as Acting Director 2002-03 and Frank T. Leone, MD (PGA’97) from 2003-05. The “old guard” of the Fish era all departed largely to go to Wake Forest.
In 2005, Paul E. Marik, MD, was recruited from the University of Pittsburgh by the new Chair of Medicine, Art Feldman, to largely develop medical critical care at Thomas Jefferson University Hospital. He, as an intensivist with a prolific CV, was the Director of the Division of Pulmonary and Critical Care Medicine until 2008.
Gregory C. Kane, MD (JMC ’90), a highly respected clinician educator (Director of the Residency Program for over 15 years) assumed the position of Acting Director until the appointment of Dr. Mani Kavuru in 2010. Dr. Kavuru joined the University in September 2010, after a tenure as Division Director for four years at East Carolina University in NC. Dr. Kavuru is a clinician scientist who trained at the Cleveland Clinic and was on faculty there for 14 years (1991-2005). He established a reputation in several lung disorders including asthma, sarcoidosis and pulmonary alveolar proteinosis. He has an extensive track record of grant funding, clinical trials and publications.
The position of directorship of the Division of Pulmonary and Critical Care Medicine reflects the evolution of the subspecialty of pulmonary medicine from the treatment of tuberculosis described as “phthisiology” to the current broad-based specialty that encompasses pulmonary physiology, critical care medicine, interventional & procedural medicine, immunology and the diagnosis and management of allergy and sleep disorders. During the initial 50 years, the focus was not only managing tuberculosis but also the public health aspects and controlling this disease. During the post World War II period, there was an increased interest in occupational respiratory disorders, asbestosis and anthraco-silicosis, emphysema and lung cancer. Concurrently, the development of spirometry and arterial blood gas analysis in the pulmonary physiology laboratory led to increased applications. Invasive diagnostic procedures, including flexible fiberoptic bronchoscopy, percutaneous needle aspiration of the pleura and lung biopsy were incorporated in the practice of pulmonary medicine. This was rapidly followed by the development of acute and chronic ventilatory support and respiratory care units that progressed to identifying critical care medicine as an integral component of pulmonary practice. Today, both clinical and basic science investigations have led to new management techniques and previously undiagnosed respiratory disorders.
A Tribute to Harold L. Israel
Harold L. Israel, MD
Professor Emeritus of Medicine
November 16, 1909 - November 22, 1996
Harold Louis Israel, Philadelphia's first true chest physician and an internationally renowned specialist in sarcoidosis, died on November 22, 1996 at his home. He was 87.
The cause was colon cancer, according to his family.
For six decades, from the 50's to September 1996, he served as the most prominent consultant in the Philadelphia area on enigmatic diseases of the chest. He had been on the faculty at Thomas Jefferson University since 1959. After working as a clinical professor for 13 years, he was appointed full professor in 1972 and held the rank of Emeritus Professor of Medicine since 1980. Upon his retirement in September 1996, he received the Dean's Medal in recognition for his superior contribution to resident education, clinical care and innovative research.
Although his first publications focused on tuberculosis, which he co-authored with such TB experts as Heterington and Long at Phipps Institute, his knowledge of pulmonary medicine was far broader. In addition to tuberculosis, he became internationally recognized as an expert in sarcoidosis, a poorly understood lung disease. Not only did he contribute to unraveling the etiology of this disease process, but he also suggested an intelligent approach to its medical management.
Dr. Israel graduated from Amherst College in 1930 and from Jefferson Medical College in 1934. From 1934 to 1936, he served as a resident at Philadelphia General Hospital where he won an award for his paper on understanding the epidemiology of TB by studying the conversion rates and patterns of distribution among nursing students at the hospital. From 1936 to 1942, he trained and worked as an associate at the Phipps Institute which had been set up by a Philadelphia philanthropist to find a cure for tuberculosis by gathering scientists and doctors from all over the world. While working at Phipps, he obtained a Master's degree in Public Health from the University of Pennsylvania. From 1942 to 1945, he was a general internist in the U.S. Army, stationed in England and New Mexico. He began in private practice after the war, but also was the Assistant Director of Tuberculosis Control for the City of Philadelphia from 1947 to 1951. Before joining the University faculty, he was Chief of Pulmonary Medicine at PGH from 1951 to 1959. In 1976, Dr. Israel became one of a few Americans who have been honored for his work in pulmonary medicine by being inducted into the Royal Thoracic Society of Great Britain.
In 1938, he married Dorothy Harris Israel, a teacher and principal at the College in Rose Valley, a private progressive College in suburban Philadelphia. She was tragically killed in the 1974 bombing of a TWA flight over Corfu. With his second wife, Frances Tebet Greenspan, an editor and writer, he participated in the cultural life of Philadelphia until her death. He is survived by his children, Stephen Israel of Baltimore, Maryland; Daniel Israel of Cave Creek, Arizona; Dr. Edith Israel of Boulder, Colorado; and Emily Raphael Greenfield of Brooklyn, New York, stepsons Dr. Peter Greenspan of Newton, Massachusetts, Dr. Ralph Greenspan of New York City and 10 grandchildren.
Elmer H. Funk (JMC '08) -1913-26
Burgess L. Gordon (JMC '19) – 1927-51
Martin J. Sokoloff (JMC'20) – 1951-62
Richard T. Cathcart – 1962-74
G. William Atkinson (PGA'70) – 1974-82
James Wilson – 1983
J. Denise Moylan (PGA'78) and Edward Schulman (JMC'75) – 1983-85 (Acting Co-Directors)
James E. Fish – 1985-2002
Stephen P. Peters – 2002-03 (Acting Director)
Frank T. Leone – 2003-05 (PGA'97) (Acting Director)
Paul E. Marik – 2005-2008
Gregory C. Kane - 2008-2010 (JMC'90) (Acting Director)
Mani Kavuru – 2010-2016
Michael Baram - 2016 - (Acting Director)