Two first-hand and delightful accounts of the beginning of rheumatology at Washington University School of Medicine and Barnes Hospital are presented below. Note that at the outset the division had two branches; the research/academic side with a focus on immunology, as outlined by C. Kirk Osterland, and the practice/clinical side as discussed by Bob Karsh. Some of the most distinguished rheumatologists of the next generation had their first exposure or were young faculty members in this division, which was originally set up as part of the Department of Preventive Medicine.
In addition to Kirk Osterland, who left in 1972 to become Chairman of the Department of Rheumatology, Clinical Immunology, and Allergy at McGill University Faculty of Medicine, Eng Tan and Bevra Hahn, who went on to become longstanding rheumatology chiefs at Scripps Clinic in LaJolla, Ca., and at UCLA, respectively, were part of this group. All three of these remarkable individuals have been nationally and internationally recognized for their contributions to rheumatology. In addition, Gary Fathman, Chief of Rheumatology at Stanford, and Luis Espinosa, Chief of Rheumatology at the University of South Florida and then University of Louisiana (New Orleans) had their formative years here and then went on to exceptionally outstanding academic careers.
Edited accounts of C. Kirk Osterland and Bob Karsh
Research and academics beginning in the 1960s by Kirk Osterland, MD
“After finishing extra training years at the Rockefeller and then going to the Institut Pasteur, I was recruited to Washington University by Richard Krause who was my immediate chief. I was to establish and develop a Rheumatology Division. The Department of Medicine in those days was quite unusual. We were located in an area some distance from the bulk of the Department; the area being called a Department of Medicine and Preventive Medicine.
The Department of Medicine divisions were very strong and competitive, vying for the best trainees. We received some grants and got started. Krause busied himself with his work on Streptococci, some immunology and miscellaneous items. He was a strong organizer and he believed (as did I) that he should have been head of all Infectious Diseases – a hot area in those days. I was left largely on my own. There were some clinical Rheumatologists at Barnes-Jewish Hospital and they were very helpful and cooperative, but without any interest or skill in research. Bob Karsh was quite outstanding as a teacher and he was very well read, giving him lots of ideas. We were good friends. Dave Lieberman, Bob Owen, Bernie Hulburt and Paul Hageman (an outstanding gentleman and statesman of the Department of Medicine) made up the rest.
It was greatly strengthened when Eng Tan joined the division. About the same time Julian Fleischman joined us. Julian was a PhD coming from a series of Nobel laboratories. He did his own Immunochemistry and was very much involved with the Microbiology Department. As things turned out, Eng was offered the job of Chief of Rheumatology at Colorado. He pursued a distinguished career there and at Scripps. Krause got itchy feet, wanting more, with administration – first at NIH, later Emory (Dean) later back to NIH!! By this time (late 1960s) the division had good financial support and a training grant. Chick Spilberg came from NYU, and Bevra Hahn joined me finishing off her training and then joining the staff (she also was to have a very strong career at UCLA).
Gary Fathman got his start with me spending a year plus in my lab. As we got him into medical school (he was a renegade, but needless to say, his career has been distinguished). Joe Davie started a PhD with Krause, but spent his last 2 plus years with me in medicine. He was a pathologist and he obviously became a superstar of Washington University (Chairman of Microbiology and Immunology). I received a very attractive offer to run a Department at McGill and took over there in 1972. This was done with reluctance as I was a Professor by then and because I loved Washington University and my colleagues there.”
Clinical beginnings – “A pleonasmic peirastic apercu on Washington University Rheumatology” by Robert Karsh, MD
I finished as chief resident in medicine at Jewish Hospital in 1957, after one year of residency and two years as an Air Force internist. That left one more year of training to satisfy internal medicine boards. Internal medicine is my first love, but St. Louis boasted so many fine internists that I needed a gimmick. So I asked Carl Moore what the community lacked and he said a rheumatologist. “Get me a good job and I will be a rheumatologist.” The good job was at Mayo’s with Phil Hench, the cortisone Nobel laureate.
After one year of training, I returned to find that my serendipity was empyrean. Carl Vernon Moore put me on Barnes staff at once and rewarded me with consultant perks at City and Homer Phillips Hospitals. Mind you, this was a time when anyone could label himself a rheumatologist, since there were no boards and no training at WUSM or Barnes Hospital. My earliest memory of a chief was Kirk Osterland who served well until he moved to Montreal, being a Canadian. Petie and I visited him and Jane and confirmed his success there in an antique house built of ancient ship rafters. These were also the days of Eng Tan and Bevra Hahn who went on to greater things out west.”
Leadership from 1976
After Kirk Osterland left in 1972, the division had no formal head but Bevra Hahn more than held things together and began to establish her reputation relative to the immunologic basis and treatment of SLE. John Atkinson, after a three-year stint at the NIH and two-year postdoctoral fellowship with Charles Parker in the Division of Allergy here at WUSM, was appointed divisional director in 1976. Within a year, Ben Schwartz), having just completed a two-year postdoctoral fellowship at the NIH, arrived to direct rheumatology at Jewish Hospital. They combined forces and then co-directed divisional activities until Ben departed for Monsanto in 1991 before founding the Camden Group in 1999.
In 1992, John Atkinson became Chairman of the Department of Medicine and Louis Simchowitz became Interim division chief. In 1995, Wayne Yokoyama was recruited from Mount Sinai School of Medicine to be the division chief. Wayne did a spectacular job of rebuilding including recruiting Rick Brasington to direct clinical activities. In 2007, Wayne stepped down to become Director of MSTP. John Atkinson, who rejoined the division served as interim director and director until 2017. Deborah Lenschow took over as interim director in 2017 until Christine Pham assumed the director position in 2018.
The VA connection
There has been a “subdivision” at the John Cochran VA Medical Center since the early 1970s. It was initially directed by Isaias Spilberg who made contributions to our understanding of gout and related crystal deposition diseases. Seth Eisen became director at the VA in 1993. He developed a national reputation through his Vietnam twin study registry and ability to tap into the VA database so he could ask questions about the treatment of rheumatoid arthritis. Amy Joseph has headed this program since Seth Eisen left in 2006 to become the Director of Health Services Research and Development at Veterans Health Administration in Washington, D.C.
Collaboration with Pediatric Rheumatology
Since the late 1960s, the division has had a productive relationship with the Department of Pediatrics. For over two decades, the adult service provided inpatient consultative care and Owen Kantor directed the JRA clinic at Shriner’s Children’s Hospital. Although the clinics and consult services are now distinct, we continue to run a combined educational program. The weekly Rheumatology Grand Rounds and Translational Research Conference are conjoint activities.
A goal of the division is to provide outstanding rheumatology consultants for the greater St. Louis community. In our region, there are currently 25 rheumatologists who underwent their clinical training in our division. Also, an equal number practice throughout the United States. Several have formed successful enterprises including medically related companies. Further, David McLain founded in 1983 and continues to direct the Congress on Clinical Rheumatology, formerly Rheumatology on the Beach, in Destin, FL.
Wayne Yokoyama was elected to the National Academy of Sciences in 2007 and the American Academy of Arts and Sciences in 2009. John Atkinson was elected to Institute of Medicine of the National Academy of Sciences in 1996 and received the 2018 American College of Rheumatology Presidential Gold Medal, the highest honor bestowed by the ACR. Five members of the division, John Atkinson, Andrew Chan, V. Michael Holers, Benjamin Schwartz and Wayne Yokoyama have been Howard Hughes Medical Institute Investigators. There are four endowed chairs in the division, including the Samuel B. Grant (Atkinson), Sam J. Levin and Audrey Loew Levin (Yokoyama), Alan A and Edith L Wolff (Hsieh), Guy and Ella Mae Magness (Pham) chairs. Over the years, several members of the division have been named Best/Top Doctors, including John Atkinson, Richard Brasington, Leslie Kahl, Benjamin Schwartz, Deborah Parks, Reema Syed. John Atkinson, Ben Schwartz, and Richard Brasington were named Masters of the American College of Rheumatology in 2008, 2009, and 2018, respectively. Richard Brasington also received the ACR Distinguished Program Directors’ Award in 2015.