Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 94

From the Editor

Facts and ideas from anywhere

DEVELOPMENT OF INTERNAL
MEDICINE
In 2003, Dr. H. Lawrence
Wilsey gave me the book Grand
Rounds: One Hundred Years of Internal Medicine edited by Russell
C. Maulitz and Diana E. Long (1).
The book was published in 1988
and includes chapters on general
internal medicine and many of its
William C. Roberts, MD.
subspecialties (infectious diseases,
gastroenterology, rheumatology,
nephrology, and cardiology). This book would appeal to any
internist. The chapter that intrigued me the most was entitled
“The Inner History of Internal Medicine” by Paul Beeson and
Russell C. Maulitz. Paul Beeson is a favorite of mine, and
maybe that is one reason I enjoyed so much his 40-page chapter. Beeson has many similarities to William Osler. Both were
Canadians, both were chairmen of departments of medicine at
prominent institutions (Osler: University of Pennsylvania and
Johns Hopkins University; Beeson: Emory University and Yale
University), both were Regius professors at Oxford University,
United Kingdom, and both had biographies of them written
by a neurosurgeon.
Beeson and Maulitz asked initially “What is internal medicine? And who is the internist?” The terms have been misunderstood by many in the public. American internists trace their
ancestry back to the tiny Royal College elites granted monopoly
rights by royal warrant beginning in the 16th century. The
American College of Physicians professes a filial relationship
with the Royal College of Physicians of London (now of England), empowered by Henry VIII in 1518. From there, Beeson
and Maulitz developed the internist’s world from the scientific,
clinical, personal, and professional perspectives.
The process of demarcating new medical specialties first
in Germany and soon after in the other industrial nations was
fueled by two powerful engines: new technology (primarily
diagnostic but also therapeutic) and an increased professional
competition. Specialized fields like ophthalmology and otolaryngology found professional niches. Slightly later, old fields
like surgery gained in professional power as they created their
edifices on foundations of science.
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The designation “internal medicine” seems to have originated around 1880 in Germany with the use of the modifyi ng word
innere. The term was employed to indicate a field of practice in
which concepts were based on an emerging understanding of
physiology, biochemistry, bacteriology, and pathology and in
which surgical methods were not employed. The expression was
intended to connote special knowledge and training rather than
dogma, empty hypotheses, and mere observation of outward
manifestations of disease. At that time, North America took
most of its medical cues from Germany. Over a few decades,
thousands of physicians and medical students flocked to the
laboratories of polyclinics of Strasbourg, Berlin, and Vienna.
Consequently, the expression “internal medicine” reflecting
German institutional arrangements was adopted quickly in
America. William Osler, incidentally, disputed its status as an
incipient specialty but favored the good old name “physician”
in contradiction to general practitioners, surgeons, and obstetricians and gynecologists. Osler tended to deemphasize the
“specialized” aspect of the field and chose to stress its role as a
gateway to other more limited specialties—domains of scientific
knowledge or technical expertise now conventionally thought of
as subspecialties. Most American internists preferred the phrase
“internists” to Osler’s “physician.”
The chapter goes on to describe contributions made by
American physicians and important events in the specialty: the
development of the Association of American Physicians, the
publication of the first edition of Osler’s textbook, Principles
and Practice of Medicine (1892), the founding of the Johns Hopkins Medical School (1893), the Flexner report on American
medical education (1910), the development of the Rockefeller
Institution, the making of clinical investigation scientific, the
development of the full-time system, the explosion of medical
research just before and after World War II, the changes in
patient mix seen by internists over the decades, the changes in
therapeutics in internal medicine, and the development of the
various subspecialties in internal medicine.
KIDNEY TRANSPLANTS
According to Gary S. Becker and Julio J. Elias, writing in
The Wall Street Journal, in 2012, 95,000 American men, women,
and children were on the waiting list for a new kidney, the
most commonly transplanted organ (2). Yet, only about 16,500
Proc (Bayl Univ Med Cent) 2014;27(2):168–178