This House of Noble Deeds: The Mount Sinai Hospital, 1852-2002

12 Division of Rheumatology

12 Division of Rheumatology THE TERM “RHEUMA,” which literally means “flowing,” was used by Hippocrates to describe an excess of watery humor thought to flow from the brain. Ancient Greek physicians used “rheuma” interchangeably with “catarrhos” to describe a variety of illnesses, including joint problems. In 1642, Guillaume de Baillou (Ballonius), a French physician , coined the word “rheumatism” to distinguish noxious humors that affected joints from those that caused catarrh (hay fever, colds, and the like): “The whole body becomes painful, the face in some becomes red, the pain rages especially about the joints, so that indeed neither the foot nor the hand, nor the finger can be moved . . . without pain and outcry . . . . Although the arthritis is in a certain part, this rheumatism itself is in the entire body.”1 Today, rheumatic disease covers a wide gamut of illness, the common denominator being pain and inflammation involving muscles and joints. The specialty of rheumatology did not exist in the early years of the twentieth century. There was little knowledge or interest in diseases of the muscles and joints on the part of the general medical community. At Mount Sinai, however, musculoskeletal problems (i.e., arthritis) were treated on the Medical Service; trauma, bone tumors, and infections were within the province of the surgeons. When Mount Sinai’s first orthopaedic outpatient clinic was established in 1909, Philip Nathan, known for his work with arthritic patients, was placed in charge. He would become the first Chief of the orthopaedic inpatient service one year later.2 Arthritis was the poor relation of medical research. The situation began to change in the 1920s, first in Europe; in 1934, the American Rheumatism Association was established and held its first formal meeting. Several years later, at Mount Sinai, Maurice Wolf, a European refugee physician, was placed in charge of an outpatient arthritis clinic. In the past fifty years, the field has burgeoned, spurred on by the Omnibus Medical Research Act of 1950, which established the National In122 stitute of Arthritis and Metabolic Diseases (NIAMD) in the Public Health Service. All of this notwithstanding, Mount Sinai’s physicians were making seminal contributions to the understanding of the illnesses that constitute the field of rheumatology long before the term became fashionable. As a consequence, the current Division of Rheumatology is heir to an illustrious history in the subspecialty. In 1924, Emanuel Libman and Benjamin Sacks provided the first description of the characteristic heart lesions that can occur in patients with lupus erythematosus.3 A decade later, George Baehr recognized the exacerbating effects of sun exposure and “wire loop” kidney lesions in patients with lupus.4 Gregory Shwartzman devoted his career at Mount Sinai to the study of the pathogenesis of tissue lesions induced by endotoxin and immune complexes.5 In 1942, the term “diffuse collagen disease” was introduced by Paul Klemperer, Mount Sinai’s Chief of Pathology, as a critical unifying element in scleroderma, lupus, and related disorders.6 The pathologists Jacob Churg and Lotte Strauss provided the first description of allergic granulomatosis, now generally known as the Churg-Strauss syndrome.7 Also in the early 1950s, one of the first gout clinics in the United States was established at The Mount Sinai Hospital by Alexander B. Gutman, then Chief of Medicine, and his long-time associate Tsai-Fan Yu, Emeritus Professor. The clinical effectiveness of probenecid in lowering the serum urate and diminishing the size of gouty tophi was established at Mount Sinai.8 The effectiveness of colchicine taken daily as prophylaxis against recurrent attacks of acute gout was documented by Yu and Gutman in a landmark report in 1961,9 and this finding was subsequently corroborated by Yu in follow-up studies that extended for more than thirty subsequent years. A defining moment for the specialty occurred in 1956 when Charles Plotz and Jacques Singer, working in the serology laboratory, developed and standardized the latex fixation test for the diagnosis of rheumatoid arthritis.10 Plotz, who had been on the faculty of Columbia University’s College of Physicians and Surgeons, followed Gutman to Mount Sinai when Gutman was recruited as the Chief of Medicine. Plotz was named head of a section of rheumatology and was working in the laboratory on tests for rheumatoid factor. Singer came from Israel to become a fellow in the laboratory. The original papers on the technique became Citation Classics; the ease and applicability of the latex technique advanced studies in immunology to a profound degree. DIVISION OF RHEUMATOLOGY 123...