“IN THE DAYS OF THE GIANTS”
A BRIEF PERSPECTIVE ON THE RELATIONSHIP BETWEEN JACOBI MEDICAL CENTER AND THE ALBERT EINSTEIN COLLEGE OF MEDICINE
Michael Touger, M.D. Department of Emergency Medicine/Jacobi Medical Center
Associate Clinical Professor of Emergency Medicine/Albert Einstein College of Medicine
The story of Jacobi Medical Center and its affiliated medical school begins decades before their opening in 1955. During the Great Depression and the second World War, little hospital construction was completed in New York City. By 1948 a post-war population boom created a crisis of hospital overcrowding. This was compounded by an uncontrolled tuberculosis epidemic. Streptomycin had been discovered in the 1940s but no effective combined drug chemotherapy treatment for TB existed; victims lingered in sanitariums or hospital TB wards, and the public was increasingly afraid of entering municipal hospitals for fear of contagion.
Then Mayor O’Dwyer authorized five new hospitals, the largest two to be built first in the underserved borough of the Bronx. With considerable controversy this was financed by an unprecedented nickel (5 cent) rise in the cost of a subway token. A vacant 64 acre site on Pelham Parkway was chosen where the largest racetrack in the U.S, the Morris Park Racecourse, had operated until 1904. Until its decline this was the largest and finest racetrack in the U.S. with stalls for over 1000 horses.The first hospital to be built was a 500 bed TB hospital that was named after a prominent Bronx doctor, Nathan Van Etten. It was constructed with open air decks to maximize TB patients exposure to sun and fresh air. Van Etten Hospital was located at the southernmost tip of the property to keep it as far away from the larger general medical hospital at the opposite northern end. This facility was named for Abraham Jacobi, who has been called the father of American Pediatrics. Jacobi had been a revolutionary in Germany, a friend of Karl Marx, and came to this country as a political refugee. He became the 1st U.S. academic professor of Pediatrics, founded the first section of Pediatrics in the American Medical Association and later served as AMA president. Although he died years before JMC opened, his daughter attended the opening dedication ceremonies and expressed deep pleasure that he was remembered in this way.
The two hospital site, named Bronx Municipal Hospital Center, also offered other advantages. By the early 1950s the country was in the midst of the cold war and the city fathers were fearful of an atomic bomb attack. These new hospitals were on the periphery of the city and would be expected to survive an atomic blast centered on Manhattan. They were near rail, water and highway evacuation routes. Jacobi was built with enormous basements and sub-basements reinforced with thick concrete walls designed to serve as mass fallout shelters. Fortunately these were never used for that purpose.
By coincidence at the same time a small Jewish university, Yeshiva, petitioned the New York State Board of Regents for permission to open the first new NY State medical school in 50 years. Motivated by rampant anti-semitism in the established medical schools, especially in the Ivy League, Yeshiva’s new school would offer a refuge from anti-Jewish quotas and barriers to career advancement.
By today’s standards, that discrimination was appalling. One of the founding professors came to Einstein from Yale, where he had sat on the medical school admissions committee. The Yale admissions committee in those years was given two stacks of applications. One pile was marked with an “H” on the upper left corner. The “H” stood for hebrew. They were permitted to accept only a few from that pile of applications, no matter how tall it got. The bulk of the acceptances were drawn from the other pile of applications, the ones without an “H”.
Bertrand Bell recalls that when he showed up for his interview at Columbia, the dean demanded to know where he had gotten his name. When he said his father had changed the family name from Bilotsky that ended the interview.
When the new school’s founders led by President Belkin first approached Albert Einstein, the most famous scientist in the world, for permission to use his name, he was at first reluctant. In 1951 Einstein replied in a letter that he strongly supported the new school because Yeshiva promised full equality for all people regardless of “creed or race”. That document, far ahead of its time, remains on display on the campus of the Albert Einstein College of Medicine.
In 1954 Yeshiva and New York City signed an affiliation agreement between Jacobi Medical Center (BMHC) and the new Albert Einstein College of Medicine. From the beginning both institutions shared a common mission. All but one of the founding academic chairs at Einstein were based at Jacobi, and it was the primary teaching and research site for the school.
Progress came slowly but eventually did arrive. The first class at the medical school in 1955 included 3 women out of 53 students; the next year 5 women joined a class of 90 including 1 African-American. Many more women and people of color would enter in the coming years as more qualified applicants appeared, liberated by the changing times. To its credit, Einstein established the first program to recruit and retain African-American medical students.
By 1955 the anti-communist hysteria of Joseph McCarthy was in full swing. Many faculty came to Einstein and Jacobi because of their progressive politics. One example was the pioneer cell biologist Alex Novikoff, best known for characterizing the Golgi body and the lysosome. Novikoff had been fired by Brooklyn College and the Vermont School of Medicine because he had been a member of the Communist Party in the 1930s. He found a refuge and was permitted to continue a productive career in the Bronx. These progressive minded scientists and doctors influenced the culture at Einstein, with a focus on primary care, ambulatory care and preventative medicine.
Eleanor Roosevelt adopted the Jacobi Department of Pediatrics and was a frequent visitor to the Peds TB ward. She refused to wear a mask insisting it would frighten the children. At the time of her later death from miliary tuberculosis there was unconfirmed speculation that she contracted her disease at Jacobi.
It is difficult to name all the illustrious founding faculty. The neurosurgeon Leo Davidoff, protege of Cushing, was the first chair of Surgery. Alfred Gilman became the first chair of Pharmacology. Irving London founded the department of Medicine, and mentored Helen M. Ranney, who pioneered the treatment of sickle cell disease and went on to become the first female chair of Medicine in a university department at the University of Californa at San Diego. Henry Barnett, Louis Fraad, Stanley Levenson, Milford Fulop and many others made seminal advances in their fields. Discoveries in the treatment of congenital heart disease, neonatal jaundice, Tay-Sacks disease, pediatric renal tubular acidosis, Wilson’s disease, acid-base disorders, artificial skin, CO2 laser therapy and hyperalimentation for burn patients all originated in the Bronx. The diminutive anesthesiologist Gertie Marx developed the spinal needle named after her that is still the standard used for obstetric anesthesia.
The first successful U.S coronary artery bypass was performed at Jacobi Medical Center in 1961. The 38 year old patient received an thoracic artery to right coronary artery bypass and survived one year.
By the time the Van Etten Hospital opened in 1954 isoniazid and ethambutol, antibiotics effective against tuberculosis when used together, had been discovered. This multi-drug strategy rapidly made TB victims non-contagious. Tuberculosis had become a curable disease and when it opened less than half of Van Etten’s inpatient beds were needed for TB patients. M. Henry Williams soon created the first TB home care program at Van Etten Hospital. By 1970 the TB ward needed only 70 beds and Van Etten had been converted into a general care hospital specializing in the treatment of other pulmonary diseases.
The modern era has produced its own challenges and both Jacobi and Einstein have met them. When the AIDS epidemic struck, many fearful New York City doctors shunned infected patients. Jacobi and Einstein met the challenge and doctors like Carol Harris provided compassionate care during the terrible early years of the epidemic. Jacobi opened the first Pediatric AIDS day-care center in the U.S.
Under Bertrand Bell’s leadership Jacobi conducted early federally funded clinical research studying care of the critically injured trauma patient. This led to the establishment of New York City’s first paramedic training program, it’s first residency program in Emergency Medicine and it’s first Pediatric Emergency Medicine fellowship program. Bell later led the famous Bell Commission that reformed resident education in the U.S.
With the passing of time the relationship between these 2 great institutions has changed. Weiler Hospital proved to be too small to serve as the university hospital for the medical school and Montefiore eventually assumed that role. Sadly, in 1995 Yeshiva ended the affiliation contract with Jacobi, weakening a 40 year relationship.
Nonetheless Jacobi and Einstein still stand side by side. Predictions made in 1995 that Jacobi would cease to exist proved wrong. Jacobi remains a vibrant center for patient care and clinical research. It excels in areas like emergency and trauma care, and HIV prevention and treatment. Led by Paul Gennis the Jacobi faculty developed an independent doctors’ group, NYMA, that pioneered a successful physician role in hospital administration. Recently Jacobi provided 5 acres including the Van Etten building under a long term lease arrangement that permitted the building of the new Price Research Center For Translational Research. Jacobi has a new, state of the art facility.
Jacobi offers the college unique opportunities for medical education. I believe that Jacobi’s and Einstein’s joint history argues strongly for continued close collaboration. Together, Einstein and Jacobi should plan for the healthcare challenges the future will bring.
(Much of the historical material used in writing this brief commentary is drawn from an unpublished manuscript written in 1974 by a Jacobi administrator named Paul Aronson. I also interviewed Drs. Melvin Zelefsky, Ruth Freeman and Bertrand Bell, who were witnesses to the birth of both institutions.)